Health Care Now
The cooks, custodians, and maintenance workers at the Old Rochester School system in Massachusetts are facing an impossible healthcare situation. You can help by signing their change.org petition asking their employer to do the right thing and raising awareness about the need for single-payer healthcare reform.
Here’s what happened: the Old Rochester School Committee is proposing to shift 50% of healthcare premium costs onto new workers. For cooks who start earning $13,300 a year, buying a family plan would cost 80% of their income, leaving them earning $2 an hour! Going uninsured could result in a large fine (over $1,000) from the individual mandate already in place in Massachusetts.
Please support these courageous workers who have called for a Medicare-for-All system, which would prevent millions of workers across the country from finding themselves in a similar situation when the individual mandate is implemented in all fifty states next year.
Here is their letter asking for your support:
We are cooks and custodial and maintenance workers at the Old Rochester Regional (ORR) School district in Massachusetts, where the School Committee is proposing to make new hires pay 50% of health care premiums. For cooks who start out at $13,300 a year, it would cost 80% of their paycheck to buy health insurance for their families, leaving them earning $2 an hour – not enough for food, rent, and other basic necessities.
Choosing to go uninsured is not an option for workers like us. We live in Massachusetts where everyone is required to purchase health insurance or face a fine of over $1,000 a year – an “individual mandate” that will apply to everyone in the country next year. Making matters worse, most workers who are offered a health plan by their employers are banned from receiving subsidized health care from the state, which means many of us will not see any help from health reform.
Pushing 50% of premiums onto school employees at ORR is not just immoral, it puts our families in an impossible situation: we can pay almost all of our wages towards a health plan, or go uninsured and face a fine that we also cannot afford.
Health care should be a right for everyone. Every other country in the developed world protects this right at half the cost through a medicare-for-all, or “single payer” type health care system. Until we win that, please support the families of workers at ORR by asking the School Committee to provide affordable health insurance and care for all school district employees.
TIAA-CREF, the nation’s largest retirement fund, covering academic (including medical) and religious organizations, has an option for those who want to invest their money in “socially responsible” companies. It’s called CREF-Social Choice.
While CREF-Social Choice does not invest in the tobacco, gambling, or liquor industries, the fund has chosen to invest in for-profit health insurance companies such as Aetna, Wellpoint, Coventry, Cigna, and Humana.
For-profit health insurers profit from denying care to patients, causing premature death and financial ruin to countless Americans. They also profit from rising health care costs, which are undermining every other industry and our prospects for economic recovery.
Investing in such corporations is not “socially responsible,” and we are demanding that TIAA-CREF no longer include health insurance companies in the CREF-Social Choice portfolio.
If you are a TIAA-CREF shareholder you can help by writing a letter to TIAA-CREF’s Corporate Secretary supporting the shareholder resolution to divest from for-profit health insurers. A sample letter, along with the address to send the letter to, can be downloaded here. The text of the shareholder resolution is available here.
If you are a concerned resident or patient who has dealt with our broken health insurance system you can help by signing this online petition to TIAA-CREF.
You can read a summary by Sandra Fox of the divestment campaign’s efforts to date on HCN’s website, and if you would like to get more involved in the campaign, please email us at firstname.lastname@example.org!
ST. JOHNS COUNTY, Fla. — This prosperous community is the picture of the good and ever longer life — just what policymakers have in mind when they say that raising the eligibility age for Social Security and Medicare is a fair way to rein in the nation’s troublesome debt.
The county’s plentiful and well-tended golf courses teem with youthful-looking retirees. The same is true on the county’s 41 miles of Atlantic Ocean beaches, abundant tennis courts and extensive network of biking and hiking trails.
The healthy lifestyles pay off. Women here can expect to live to be nearly 83, four years longer than they did just two decades earlier, according to research at the University of Washington. Male life expectancy is more than 78 years, six years longer than two decades ago.
But in neighboring Putnam County, life is neither as idyllic nor as long.
Incomes and housing values are about half what they are in St. Johns. And life expectancy in Putnam has barely budged since 1989, rising less than a year for women to just over 78. Meanwhile, it has crept up by a year and a half for men, who can expect to live to be just over 71, seven years less than the men living a few miles away in St. Johns.
The widening gap in life expectancy between these two adjacent Florida counties reflects perhaps the starkest outcome of the nation’s growing economic inequality: Even as the nation’s life expectancy has marched steadily upward, reaching 78.5 years in 2009, a growing body of research shows that those gains are going mostly to those at the upper end of the income ladder.
The tightening economic connection to longevity has profound implications for the simmering debate about trimming the nation’s entitlement programs. Citing rising life expectancy, influential voices including the Simpson-Bowles deficit reduction commission, the Business Roundtable and lawmakers on both sides of the aisle have argued that it makes sense to raise the eligibility age for Social Security and Medicare.
But raising the eligibility ages — currently 65 for Medicare and moving toward 67 for full Social Security benefits — would mean fewer benefits for lower-income workers, who typically die younger than those who make more.
“People who are shorter-lived tend to make less, which means that if you raise the retirement age, low-income populations would be subsidizing the lives of higher-income people,” said Maya Rockeymoore, president and chief executive of Global Policy Solutions, a public policy consultancy. “Whenever I hear a policymaker say people are living longer as a justification for raising the retirement age, I immediately think they don’t understand the research or, worse, they are willfully ignoring what the data say.”
A Social Security Administration study several years ago found that the life expectancy of male workers retiring at 65 had risen six years in the top half of the income distribution but only 1.3 years in the bottom half over the previous three decades.
In 1980, life expectancy at birth was 2.8 years longer for the highest socioeconomic group defined in a research study than the lowest, according to a report by the Congressional Budget Office. By 2000, the gap had grown to 4.5 years.
Health Care for All PA, a statewide non-profit organization today released an economic impact study. The results prove that a single-payer health care plan will save families, businesses and tax payers $17 billion annually while at the same time providing comprehensive health care to all.
This study was done by University of Massachusetts – Amherst professor of economics Gerald Friedman, Ph.D. It compares the cost of the current for-profit health insurance model in Pennsylvania whereby provider choice is limited and health services are rationed by health insurance companies to that of a consumer-driven health care system which lets people have the freedom to choose their own doctors, hospitals and health care providers.
Some of the important advantages of a single-payer system are:
- Comprehensive coverage for every resident of Pennsylvania, including dental, vision and mental health services;
- Eliminates the need for hospitals to absorb the cost of care for the uninsured;
- Reduces bureaucracy for private physicians resulting in reduced administrative costs and improved compensation for private physicians;
- Reduces or eliminates health insurance over-costs for small business, allowing for more job creation, greater reinvestment of profits, and reduced workers’ compensation costs.
- Radically reduces the total cost of health care to levels more consistent with costs in the rest of the industrialized world.
Steven Brill's article in Time Magazine about the cost of private health care is likely to make most of his readers very angry. Angry about the prices we pay, about the lives that are devastated, and about the fact that we're one of the few developed countries without adequate health care for its citizens.
Economists have told us that the profit motive of privatization comes with an "invisible hand" that automatically corrects inequities in the market. It hasn't worked that way for health care. The personal stories recounted below, and some additional facts to complement them, make it clear that an essential human need has been turned into a product that benefits a few people at the expense of many others.
$15,000 for Blood Tests
Brill's article begins with the story of a 42-year-old Ohio man named Sean Recchi, who traveled to MD Anderson Cancer Center in Houston for treatment of non-Hodgkin's lymphoma. He and his wife Stephanie had paid $469 a month, or about 20% of their income, for insurance that covered $2,000 per day of hospital costs. His financial troubles started when MD Anderson told him, "We don't take that kind of discount insurance."
But he had to go to the hospital. His wife recalled that he was "sweating and shaking with chills and pains. He had a large mass in his chest that was..growing. He was panicked."
Stephanie asked her mother to write a check for $48,900.
Sean waited for 90 minutes while the hospital confirmed that the check had cleared. He was also required to advance MD Anderson $7,500 from his credit card. The total cost for the initial treatment and chemotherapy was $83,900, including a $15,000 charge for lab tests for which a Medicare patient would have paid a few hundred dollars, $283 for an x-ray that Medicare categorizes as a $20 charge, and $1.50 for a generic version of a Tylenol pill.
Hospital Boss $1,845,000 — Medicare Boss $170,000
MD Anderson provided this statement in its defense: "The issues related to health care finance are complex…[our] billing and collection practices are similar to those of other major hospitals and academic medical centers." The company made $531 million in profits in 2010, on total revenues of about $2 billion. That 26% profit margin was, in the author's words, "an astounding result for such a service-intensive enterprise."
It's true. A PayUpNow.org analysis of Medical Services providers showed that from 2008 to 2010, Humana had a profit margin of about 5%, United Health Group just under 7%, and WellPoint about 8%.
Last year's salary for Ronald DePinho, the president of MD Anderson, was $1,845,000. That's over twice the compensation paid to the president of the University of Texas medical complex that includes MD Anderson. It's about ten times the compensation of the federal Medicare Administrator in 2010.
Privatization Has Failed Us: The Deadly Facts
Our private health care system has indeed failed us. We have by far the most expensive system in the developed world. The cost of common surgeries is anywhere from three to ten times higher in the U.S. than in Great Britain, Canada, France, or Germany.
Everyone has their hand in the money pot: insurance companies, pharmaceutical firms, physicians, hospitals, equipment suppliers, the AMA. Steven Brill notes that the medical industry has spent $5.36 billion on lobbying in the past 15 years, compared to $1.53 billion spent by the defense/aerospace industry and $1.3 billion spent by oil and gas interests.
As reported by the Census Department, 50 million Americans can't afford the price of health insurance. According to a study by the American Journal of Public Health, nearly 45,000 annual deaths are associated with lack of health insurance. A 2001 survey revealed that, because of cost, forty-two percent of sick Americans skipped doctor's visits and/or medication purchases. Even careseekers with insurance can end up uncovered, as in California, where a survey found that one out of four claims were denied by private insurers, even when treatment was recommended by the patient's physician. The after-effects can be disastrous. A 2007 study at the Harvard Medical School found that 62 percent of US bankruptcies were a result of medical expenses.
Meanwhile, the evidence for incompetence in the private sector is overwhelming. Data from the Congressional Budget Office (CBO) and the Center for Medicare and Medicaid Services (CMS) shows that since 1997 private insurance costs have risen much faster than Medicare costs. According to the Council for Affordable Health Insurance, medical administrative costs as a percentage of claims are about three times higher for private insurance than for Medicare. A study by researchers at Harvard Medical School and Public Citizen found that health care bureaucracy last year cost the United States $399.4 billion. The U.S. Institute of Medicine reports that the for-profit system wastes $750 billion a year on waste, fraud, and inefficiency. As a percent of GDP, we spend almost twice the OECD average.
Private Health Care Has Shortened Our Lives
When we look beyond industry malfeasance to the effects on human life, we find that Americans are paying the ultimate price. We now have a shorter life expectancy than almost all other developed countries. A National Research Council study placed the United States LAST among 17 high-income countries.
It wasn't always this way. Since 1960 there has been a close parallel between worsening life expectancy and increased health care costs as a percentage of GDP. Most disturbing is our growing infant mortality rate relative to other countries. A UNICEF study places the U.S. 22nd out of 24 OECD countries in "children's health and well-being."
In startling contrast, Americans covered by Medicare INCREASED their life expectancy by 3.5 years from the 1960s to the turn of the century.
Another Horror Story
Janice S., a 64-year-old woman in Connecticut, was rushed to the hospital in what turned out to be heartburn. She was charged $995 for the ambulance ride, $3,000 for the doctors, and $17,000 for the hospital – $21,000 for a three-hour precautionary checkup.
Part of the hospital bill was a special stress test, employing radioactive dye and a CT scan, which cost $7,997.54, about six times more than the hospital's regular stress test. Medicare would have paid the hospital $554 for the special test.
For many of the lab tests, Janice was charged about ten to fifteen times more than the Congress-supervised Medicare rate. The hospital's own filings to the Department of Health and Human Services showed that lab tests in 2010 brought in $293 million from patients, while costing the hospital just $28 million.
When confronted with the details, a hospital spokesperson said, "Those are not our real rates..It's a list we use internally in certain cases, but most people never pay those prices."
Emilia Gilbert was 62 when she fell at home and bloodied her face, spent six hours (most of it waiting) at the at the Bridgeport, CT Hospital emergency room, and received a bill for over $9,000. She even got charged for bandages and tubing, which are supposed to be part of the $900 emergency room charge. The hospital sued her for the money.
Steve H. went to Mercy Hospital in Oklahoma City for back treatment. He had $45,181 remaining on the $60,000 annual payout limit from his union's health insurance plan. For basic medical and surgical supplies he was billed about $8,000, including charges for a surgical gown, a blanket warmer and a marking pen. The most significant cost was the Medtronic stimulator that was implanted in his back, which cost the hospital $19,000, but cost Steve almost $50,000. His total bill at the institution run by the Sisters of Mercy ended up at nearly $87,000.
Steven D. (a pseudonym) was diagnosed with lung cancer in January 2011. When he died eleven months later, his wife Alice was left with a bill for over $900,000.
Many of the patients, or their family members, interviewed by Mr. Brill took advantage of a growing industry called medical billing advocacy, by which outlandish bill totals can be negotiated downward. The initial hospital bill is apparently an attempt by the hospital to get all they can from a patient. Steven D's $900,000 bill for cancer treatment was dramatically reduced, to about $170,000, but Alice was forced to literally sell the family farm to pay off most of her debt.
Human Need as a Product For Sale
An underlying theme through the Brill article was the vulnerability of patient's spouses or other relatives, who were not in the appropriate state of mind to challenge, or even consider, the excessive costs of treatment. As the wife of a terminally ill patient stated, "Are you kidding? I'm dealing with a husband who had just been told he has Stage IV cancer. That's all I can focus on…You think I looked at the items on the bills? I just looked at the total."
By treating the essential human need of health care as a product, the hospitals and doctors and drug companies and insurance companies and equipment suppliers are lured toward a pot of money, with little regard for the effects of their profit-making on average Americans.
The solution, of course, is Medicare for all. If, that is, the invisible hand of the market ever reaches out to average Americans.
Despite insights, Time magazine’s cover story falls short on remedy
In his recent Time magazine article, Steven Brill paints a vivid and rather depressing picture of the perverse malfunctioning of our health care system – overpriced and technology-addicted – and he acknowledges some of the advantages of Medicare.
Sadly, however, he shies away from an endorsement of the obvious solution: an improved Medicare for all, i.e. single-payer national health insurance.
I’ll come back to that a little later. However, let me first say that Brill masterfully illuminates much of what’s wrong with U.S. health care.
Take, for example, the “chargemaster” list: an archival, bizarrely hyper-inflated price list in each hospital based on some long-lost secret formulas and automatically inflated over time.
As a physician and health policy researcher, I’ve long known about the massive charges offered to non-contract payers (read: individuals not covered by a public or private insurer), charges that are completely meaningless for costing studies because they’re almost never paid in full and don’t represent the real resources used to provide care. However, what Brill lays out brilliantly (pun intended) is the following:
- Some very poor (lower-middle income) people actually do pay the sky-high chargemaster rates.
- There is a cottage industry (growing, I’m sure, if nothing else due to this article) to help those hapless souls negotiate steep discounts on these ridiculous bills.
- Hospital administrators either refuse to discuss the chargemaster list or offer up the most heinous, transparently nonsensical justifications for using it.
- Perhaps worst of all, the CEOs of large not-for-profit providers are paid literally millions of dollars (OK, not tens of millions like big for-profit companies, but still …), thereby introducing into a supposedly public-good-oriented setting the compensation (and marketing) tone of for-profit industry.
- When these not-for-profits list their “charity” care they value it at the price levels in the chargemaster, even though the cost to produce those services is less than 10 percent of the chargemaster price.
In these and other instances, Brill performs an outstanding public service. However, he regrettably stops short (or his editors stopped him short) of explaining why a single-payer health care system is the only effective remedy for the mess we find ourselves in today. This despite the fact that much of what he says would lead you directly to that conclusion.
He goes so far as to quote others, including John Gunn, Sloan-Kettering’s chief operating officer, who says, “If you could figure out a way to pay doctors better and separately fund research … adequately, I could see where a single-payer approach would be the most logical solution. … It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.”
Yet Brill characterizes single payer, the most logical solution, as “unrealistic” and fraught with the danger of government overreach and intrusion, summarily dismissing it. Need we mention insurance-company overreach and intrusion in the doctor-patient relationship? Need we note the freedom of Medicare beneficiaries to choose their own doctor and hospital, something that would also characterize a single-payer system?
Incidentally, Brill sharply undervalues the government role in paying for health care. He says that the federal government pays $800 billion per year out of our $2.8 trillion health bill, with the remainder mainly picked up by private insurers and individuals.
The $800 billion federal spending on Medicare and the federal portion of Medicaid is right. However, when you add in other federal programs, the state portion of Medicaid, other state and local programs, health insurance for government employees, and tax subsidies, the total government contribution is over 60 percent of total health spending, and rising. Our government already spends enough to pay for universal single payer!
Single-payer health reform is clearly the answer. We need to create the meme and the momentum and the aura of inevitability to do the right thing — despite the opposition of individuals and organizations with massive vested financial interests in the private health industry. They can be overcome.
Think Lincoln and the 13th amendment. As he said (or at least Daniel Day-Lewis said in the movie), regarding prospects of passing the amendment out of Congress, despite doom-saying by his advisers — “I like our chances” (slight smile).
I like our chances on single payer because it’s now so obvious how irremediably broken our system is, and the house of cards will eventually fall. It’s all about perseverance and timing.
James G. Kahn, M.D., M.P.H., is a professor at the Philip R. Lee Institute for Health Policy Studies, Global Health Services, and the Department of Epidemiology and Biostatistics, all at the University of California, San Francisco. He is also past president of the California chapter of Physicians for a National Health Program.
Your company already knows whether you have been taking your meds, getting your teeth cleaned and going for regular medical checkups. Now some employers or their insurance companies are tracking what staffers eat, where they shop and how much weight they are putting on—and taking action to keep them in line.
The goal, say employers, is to lower health-care and insurance costs while also helping workers. Last month, 1,600 employees at four U.S. workplaces, including the City of Houston, strapped on armbands that track exercise habits, calories burned and vital signs, part of a diabetes-prevention program run by insurer Cigna. Some diabetic AT&T employees also use mobile monitors; in September, AT&T also started selling to employers its blood-pressure cuffs and other devices to track wearers 24/7.
But companies also have started scrutinizing employees’ other behavior more discreetly. Blue Cross and Blue Shield of North Carolina recently began buying spending data on more than 3 million people in its employer group plans. If someone, say, purchases plus-size clothing, the health plan could flag him for potential obesity—and then call or send mailings offering weight-loss solutions.
Marketing firms have sold this data to retailers and credit-card companies for years, and health plans have recently discovered they can use it to augment claims data. “Everybody is using these databases to sell you stuff,” says Daryl Wansink, director of health economics for the Blue Cross unit. “We happen to be trying to sell you something that can get you healthier.”
Some critics worry that the methods cross the line between protective and invasive—and could lead to job discrimination. “It’s a slippery-slope deal,” says Dr. Deborah Peel, founder of Patient Privacy Rights, which advocates for medical-data confidentiality. She worries employers could conceivably make other conclusions about people who load up the cart with butter and sugar.
Analytics firms and health insurers say they obey medical-privacy regulations, and employers never see the staff’s personal health profiles but only an aggregate picture of their health needs and expected costs. And if the targeted approach feels too intrusive, employees can ask to be placed on the wellness program’s do-not-call list.
For their part, companies say tracking employees’ medical data saves money because they use it to make people healthier—and sometimes reward them in other ways, too.
Johnson & Johnson, for example, pays employees $500 to submit their biometrics and other health information; J&J then offers eligible employees an additional $250 if they get pregnancy counseling, enroll in a disease-management program or get their colonoscopy on time. The “tailored and targeted messages” paired with the monetary incentives are a “great way to bring people to participate in the program,” says Dr. Fikry Isaac, the company’s vice president of global health services.
With companies under more pressure than ever to reduce health-care spending, the so-called advanced analytics industry provides an opportunity to zero in on errant employees and alter their behavior. “As an employer, I want you on that medication that you need to be on,” says Julie Stone, a Towers Watson TW +0.09% benefits consultant.
A growing number of US companies are now urging their employees to slim down, exercise more, reduce their cholesterol and blood pressure levels, or quit smoking—all socially desirable goals. But if these workers fail to cooperate with the new corporate “wellness” regime and adopt a healthier lifestyle (under the tutelage of their employer), the penalty, for many, will be higher out-of-pocket payments.
Corporate America has long been shifting the burden of medical costs onto workers. Cost-sharing negotiated with unions or, more commonly, imposed unilaterally by non-union firms has raised labor’s share of health insurance premiums to an average of 18 percent for individual coverage and nearly 30 percent for families. Workers or their dependents also face escalating deductibles, co-pays and co-insurance, which can add hundreds or thousands of dollars to their annual healthcare spending.
Now, under the banner of health promotion, management is making some workers pay more for their insurance based on individual differences in their medical condition or lack of adherence to “wellness” standards. This new, more individualized form of cost-shifting threatens to stigmatize and penalize the chronic health conditions of millions of workers, expose some to job discrimination and undermine labor solidarity in the process. In addition, workplace privacy advocates are warning about the invasiveness of so-called “health risk assessments”—now commonly required in corporate wellness programs—because these surveys probe off-duty behavior related to sex, drugs and alcohol.
Under the federal Health Insurance Portability and Accountability Act (HIPAA), management can already compel some workers to pay up to 20 percent more than others covered by the same medical plan. According to Lewis Maltby of the National Workrights Institute, “all that is required is that the penalty be ‘designed to promote good health.’ The employer is not required to demonstrate that the amount approximates the increase in cost due to an employee who engages in any unhealthy behavior.” Under President Obama’s Affordable Care Act, “this abuse will continue to grow,” Maltby predicts, “when the penalty employers can charge without justification increases to 30 percent” next year.
Among the other groups sounding the alarm about this trend are Families USA, Georgetown University’s Health Policy Institute, the American Cancer Society and the American Heart and Diabetes Associations. A report by the HPI at Georgetown called in February 2012 for new federal and state standards that will protect consumers from “programs that inappropriately punish workers in poor health, are overly coercive, or create perverse financial incentives that result in poorer health outcomes.”
As Cancer Society lobbyist Dick Woodruff told National Public Radio, “The whole point of healthcare reform is to make sure that everyone gets insurance. And if people have to pay more because they’re unhealthy, that’s a barrier. It defeats the whole purpose.”
California Nurses Association co-president DeAnn McEwan, a nurse for nearly forty years, sees great risk of “discrimination through backdoor redlining for individuals with pre-existing conditions and disabilities.” She points out that the workers “more likely to have the health conditions that wellness programs target are low-income individuals and racial/ethnic minorities.” By no coincidence, she says, they also “face barriers to health such as unsafe neighborhoods; poor air quality; substandard, decaying housing; and lack of access to affordable, healthy food.”
Despite these warnings, many other unions are buying into wellness schemes under management pressure for more costly contract concessions. Employers and their consultants pitch these programs, initially, as a way to provide “discounts” for workers who sign up for annual health evaluations, subsidized gym membership, smoking cessation classes or other forms of health counseling. In Chicago, for example, the Chicago Teachers Union returned from its inspiring strike last September with a freeze on insurance rates but a new wellness plan similar to the one covering 38,000 other city employees. According to one top CTU official, it “was definitely one of the least popular parts of the contract settlement” because of “concerns that what we’re seeing is just the thin edge of the wedge.”
The teachers’ program begins early this year with biometric testing for cholesterol, blood pressure and sugar levels, weight and body mass index. Teachers with an identified problem may be assigned a health coach who works for a third-party vendor. All must log into a wellness website, every month, earning points for reading articles or watching videos; the penalty for failing to do so will be $50 monthly fine. A family with two adult members that opts out of the program entirely will pay $1,200 more annually for their insurance. In the union’s next round of bargaining, this CTU leader worries that management “may try to attach penalties for being overweight or a smoker” in a profession where “many negative health outcomes have a lot to do with job stress.”
Efforts to promote better eating, more walking, bike-riding or working out at the gym would be quite positive—and far more effective—if they were part of a broader campaign that addressed the societal roots of bad nutrition, obesity, diabetes, high blood pressure or heart and lung problems. As CNA’s McEwan points out, many chronic, costly conditions have socioeconomic causes, including exposure to hazardous workplace environments. They’re not just the product of bad individual choices by workers or their family members—some of whom are just showing the side-effects of consuming their own employer’s heavily marketed food products.
Consider, for example, the chutzpah of PepsiCo’s insistence that its Teamster-represented drivers and warehouse workers in upstate New York pay a “sin tax” of $50 a month if they smoke or have weight-related medical issues like hypertension, high-blood pressure, and diabetes. As PepsiCo spokesperson Dave DeCecco told Bloomberg News in February 2012, “These programs enable our associates and their families to have a healthier lifestyle.” DeCecco didn’t say whether that lifestyle shift should also include not eating the salty, sugary, high-fat junk food that generates billions in profits for PepsiCo, while playing a major role in our national epidemic of obesity.
In California, such corporate hypocrisy takes a different form in healthcare. Some of the same hospital chains that have pushed hardest for “wellness” penalties don’t want to make changes in working conditions that would reduce job stress, fatigue, unsafe workloads and other causes of occupational illness and injury. Better nurse/patient staffing ratios, limits on forced overtime, guaranteed lunch and break time, and more lift equipment to reduce back injuries would all contribute to employee wellness (and lower healthcare costs, by increasing patient safety). But Kaiser Permanente, Sutter Health, Dignity Healthcare and Daughters of Charity Health Systems all want to shift the focus, in bargaining, from their own unhealthy practices to the off-duty behavior of individual employees, reports John Borsos, a contract negotiator for the National Union of Healthcare Workers (NUHW), which recently affiliated with the CNA
Borsos is particularly critical of the “Total Health Program” created at Kaiser Permanente (KP), with the backing of unions involved in Kaiser’s Labor-Management Partnership (LMP), led by the Service Employees International Union (SEIU). “Total Health” is being touted by SEIU as “a long-term business strategy for KP” that will give it a “competitive advantage” over other health maintenance organizations. If cost savings are achieved, Kaiser promises a monetary bonus for work groups that complete an annual health assessment, update their “biometric risk screenings,” and “maintain or make steady improvements on key biometric risks (weight, smoking, blood pressure and cholesterol).”
Individual compliance will be “encouraged” by a network of “Wellness Ambassadors”—derided as “wellness cops” by the NUHW– who will get paid time off from Kaiser for their activities. Borsos predicts that Kaiser personnel who decline to participate “will be subject to enormous pressure from co-workers when a portion of their future pay is tied to everyone’s participation.” For more on the NUHW-CNA critique of “Total Health” at Kaiser, see “Which Way to Wellness: A Workers Guide to Labor and Workplace Strategies for Better Healthcare.” (http://www.stopseiucuts.com/wp-content/files_mf/whichwaytowellnesswinslow.pdf). Labor Notes has also published an excellent guide for unions engaged in bargaining about wellness issues. (See http://labornotes.org/2013/01/what-do-when-boss-catches-wellness-fever.)
The danger of a membership backlash to the wrong kind of wellness plan is very real. In 2011, labor organizations represented on Oregon’s Public Employee Benefits Board (PEBB), agreed to a new “Health Engagement Model” (HEM), that required mandatory “risk assessments” (including waist measuring), plus penalties for non-compliance. According to one labor educator in the state, the HEM “riled up many workers, who turned their fury and frustration on the unions.” The Service Employees International Union was among those soon apologizing for “a poorly communicated change to our health plans that included a punitive surcharge” and “got us started on the wrong foot.” Labor officials later persuaded the PEBB that non-participants in “health engagement” should no longer be subject to the surcharge; instead, participants are now rewarded with an additional $17.50 per pay period. However, the health plan forces non-participating workers and their families to pay $100 to $300 more in deductibles, a “punitive aspect” still opposed by their unions.
A survey of 355 private companies by Towers Watson, a leading HR consultant, showed a 50 percent increase in their use of such financial incentives and penalties between 2009 and 2011 Thirty-eight percent of these firms reported further plans to penalize workers who fail to meet health improvement goals tied to their cholesterol levels or body mass index. Clearly, if unions don’t get their act together on “wellness,” their members are going to get rolled, one way or another.
The best labor response to these schemes would be to shift the terms of the wellness debate, at the bargaining table and in public policy arenas. Unions need to take a more holistic approach to their members’ health problems, one that doesn’t let Corporate America off the hook for its role in producing the social determinants of poor health, including poverty, inequality and unhealthy jobs.
Labor should also make wellness controversies a teachable moment for workers upset by punitive medical plan changes but not previously supportive of or well-informed about single payer healthcare. “Medicare for all” would eliminate job-based benefit coverage and the new forms of cost-shifting and differential treatment now being introduced under the guise of “getting healthy.” In nations with social insurance systems, health outcomes are better, in part, because achieving public health goals, like reduced obesity, isn’t left to companies more concerned about their bottom line than workers’ waistlines. American workers who don’t want their boss playing “wellness cop” need both short-term legal protection and a longer-term political solution.
Steve Early spent many years helping members of the Communications Workers of America bargain about health insurance issues. He is the author, most recently, of The Civil Wars in U.S. Labor from Haymarket Books. He can be reached at Lsupport@aol.com.
Florida Gov. Rick Scott was elected in 2010 almost entirely thanks to his activism opposing the Affordable Care Act, better known as Obamacare. Scott spent $20 million of his own considerable fortune attacking the law, and the Republican backed the state’s lawsuit challenging its constitutionality all the way to the Supreme Court. Scott had declared last summer that Florida would implement the law basically over his dead body, including the optional part that would provide federal funding to expand Medicaid to people making up to 138 percent of the poverty line.
So it was a bit of a surprise Wednesday when he announced suddenly that he had changed his mind: Florida should embrace the Medicaid expansion. We’d like to think that this article might have had something to do with his decision; Scott himself claims that mother’s death inspired his change of heart. But it’s more likely that the decision was a direct result of the US Department of Health and Human Services agreeing to grant Florida a waiver that would allow it to move more Medicaid recipients into private managed-care plans—many of which are part of huge corporate insurance companies waiting to cash in on the latest installment of Obamacare. (The Medicaid expansion is expected to send $66 billion in federal funds to Florida in the next decade.)
Scott has been saying for months that if HHS approved Florida’s waiver request, he might be more willing to take the Medicaid expansion. He was in DC in January meeting with HHS Secretary Kathleen Sebelius over the issue. But HHS’s decision to grant the waiver was somewhat surprising, given that the state was asking to expand a very troubled pilot project going back to the Bush era. The pilot project, which also required a waiver from HHS, allowed the state to put Medicaid recipients in five counties into private, HMO-type health plans rather than the traditional government health plan for the poor and disabled. Scott has championed the pilot as an innovative way of keeping government spending in check. Health care advocates, though, saw the program as a major disaster.
A study by the Georgetown University Health Policy Institute backed up their claims, finding that the biggest problem with the “reform” was that insurance companies got into the program thinking they’d make a lot of money, only to discover that they actually had to care for people who were expensively sick. Nine plans dropped out of the pilot project in a year, leaving many patients without access to any primary health care. There were horror stories, too: the woman denied a kidney transplant, the man with a lifelong seizure disorder who suddenly found he couldn’t get the Botox injections that calmed his seizures. If the patients weren’t getting dropped by the managed-care plans, they were fleeing them for whatever other options they could find. There’s no evidence that the private plans saved the state any money.
“We’ve been raising hell for a couple of years saying this is a problem,” says Laura Goodhue, executive director of Florida CHAIN, a consumer advocacy group that works for the uninsured in Florida. “When you’re caring for an expensive population with multiple conditions, lots of mental-health issues, the only way to make a profit is to delay and deny services, and that’s what we saw in Florida.”
Some of the companies chosen to lead the Medicaid “reform” pilot project weren’t exactly stellar performers before they got there. Wellcare, one of the HMOs in the project (and a major donor to Florida’s GOP), paid out $80 million in 2009 to settle charges federal criminal charges that it had lied about how much it actually spent on health care for poor kids and other vulnerable clients. Last year it paid out another $137.5 million to settle False Claim Act lawsuits alleging schemes to wring extra money out of Medicaid programs, including those in Florida, as well as cherry-picking customers and other abuses.
Despite experiences like these, the Florida Legislature in 2011 voted to expand the pilot project, and big insurers have been jumping to get into this market, (The insurance giant WellPoint, for instance, recently bought Amerigroup, a large Medicaid managed care company, to get in on new business thanks to Obamacare.) But to fully implement its new privatization law, Florida needed the federal government, which pays for about half the program, to waive certain requirements designed to protect patients.
Consumer advocates had fought the law and have been lobbying the Obama administration against granting Florida a waiver. And they had some success. Recently, HHS refused to allow Florida to let HMOs charge Medicaid enrollees $10 co-pays for doctor visits or $100 for emergency room visits for non-emergency care, as the state law allows.
And while Scott has heralded this week’s news about the latest waiver approval as a victory, what HHS actually agreed to is less than the governor and the HMO companies lobbying for the changes were probably hoping for. Among other things, HHS said that the state still has a long way to go to protect consumers enrolled in private plans, and that the approval of the waiver was “conditional,” premised on Florida developing “robust” community input and data-driven goals and strategies.
Goodhue says the new waiver has many more consumer protections built into it than the one granted under the Bush administration, and that hopefully it will prevent some of the problems that occurred under the state’s pilot program. She still doesn’t think that managed care is the way to go to improve Medicaid. But in the end, she’s pleased that it’s not as bad as it could be, and if it means that a million Floridians will get new coverage, that’s something advocates can get behind.
We’re excited to announce that Rep John Conyers (D-Mich.) reintroduced HR 676, the Expanded and Improved Medicare for All Act, last week. The bill had 37 initial cosponsors and an additional three signed on soon after it was reintroduced.
Rep. Conyers has introduced HR 676 every Congress since 2003. He remains committed, despite the passage of the Affordable Care Act (Obamacare), to national, single-payer healthcare legislation.
“I am pleased to announce the reintroduction of H.R. 676, ‘The Expanded And Improved Medicare For All Act,’ in the 113th Congress. I have introduced the bill in each Congress since 2003 and I will continue to do so until the bill is passed,” said Conyers.
“Many Americans are frustrated with high out-of-pocket costs, skyrocketing premiums, and many other serious problems that are part and parcel of a healthcare system dependent on private health insurance plans. H.R. 676 would reform this broken system.”
Like Rep. Conyers, Healthcare-NOW! is committed to building the movement for national, single-payer healthcare and we sincerely hope that you will call and email your Representative to ask them to become a cosponsor of the bill.
HR 676 is still very important to our movement.
Obamacare doesn’t address the unsustainability of our healthcare system. It won’t keep insurance prices down, more than 30 million people will remain uninsured, and insurance companies will weasel their way out of regulations.
Right now Congress and the President are fighting over how much to slash Medicare and Medicaid benefits. Rather than cutting benefits, HR 676 is the solution we can point to in this fight.
So please take a moment to contact your House Representative.
And call the U.S. Capitol Switchboard toll-free at (866) 220-0044, ask for your representative’s office, and then ask them to sign as a co-sponsor.
Once you do so, please ask your friends and contacts to do so as well.
Winston Churchill once remarked, “Americans will always do the right thing, once they’ve exhausted all alternatives.” His observation, at least the second half of it, is proving itself as we continue to struggle with our health care system, especially its out-of-control costs that are crippling the budgets of businesses and government alike.
There is a lot of money in our health care system, and no enforceable budget. That leads to carelessness when it comes to spending that money.
What are some of the reasons health care costs continue to rise? Here are a few examples.
For at least the past 40 years, I’ve heard colleagues say, “We’d better get our fees and charges up now, because next year they’re really going to crack down on us.” It has never happened, yet. The problem is intensifying as outpatient “providers” have morphed from being real people into being corporations.
The Los Angeles Times reported on a case where a teacher’s group health plan was billed $87,500 by an “out of network” provider for a knee procedure that normally costs $3,000. Her health plan was willing to pay it. Outraged, the teacher ratted on the orthopedic surgicenter to California’s attorney general. After the press got involved, the charge was “reduced” to only $15,000. Not a bad pricing strategy, from the surgicenter’s point of view.
The New York Times reported an incident where a student who needed emergency gallbladder surgery ended up with a couple of “out-of-network” surgeons through no fault of his own. He was billed $60,000. His insurance company was willing to pay only $2,000. He was left to deal with the rest of the bill on his own.
There are many more examples. Privately insured patients are not the only ones affected. Governors around the country are continuing to struggle with how to pay for their Medicaid programs. In Oregon, Democratic Gov. John Kitzhaber is trying to find ways to impose a fixed budget on Oregon’s Medicaid program without adversely affecting Medicaid beneficiaries. But, he acknowledges, disciplining Medicaid alone will not do the job. He hopes his approach will be adopted by most other health insurance programs.
In Maine, Republican Gov. Paul LePage is struggling not only with how to keep up with burgeoning current Medicaid costs, but also how to pay the state’s almost $500 million past-due Medicaid debt to hospitals. He has proposed lowering liquor prices to boost sales, and mortgaging Maine’s future liquor revenues to secure bonds to pay the debt. His Republican colleagues in the Legislature have described this idea as “creative.”
One of the central features of Obamacare is the creation of “health insurance exchanges,” or online marketplaces. But the law has recognized that many people will need help making the right choices. So it has created an army of “navigators” to help them. A recent Washington Post story points out that a huge number of such experts will be necessary (California alone plans to certify 21,000 of them). Their cost will be reflected in higher health insurance premiums and has sparked opposition from insurance brokers who view them as competition. That will be an expensive fight, without increasing the amount going to actual health care by a single dollar.
Then there is the purchase of politicians by powerful corporate interests. When the Medicare prescription drug benefit was enacted in 2003, it was prohibited from negotiating lower drug prices, even though the veterans health system and many Medicaid programs are permitted to do so. The lead congressman pushing that provision retired from Congress soon after it was passed to take a lucrative job with the pharmaceutical industry. This has become standard practice in Washington.
And don’t forget the for-profit levels of compensation paid to the executives of nonprofit hospitals.
Meanwhile in Massachusetts, where Obamacare was born, health care costs are expected to rise six to 12 percent next year. Last year, their legislature passed a law capping increases in total private and public spending statewide, limiting them to the rate of growth of the Massachusetts economy. But the job of figuring out how to actually get it done was turfed to an “expert panel” of “stakeholders.” My bet is that such cost control will be difficult or impossible to achieve unless we simplify and centralize the way we finance health care.
Why does this financial abuse of taxpayers and patients continue? Because we let it. Americans often react to structural problems by simply throwing more money at them. We seem to be unable to say “no more.”
Maybe it’s time to revisit the part of Churchill’s comment about Americans always doing the right thing — by emulating the policies of most other wealthy countries. They have health care systems that are more popular than ours, provide better access to care, get better results, and are far less expensive.
Maybe it’s time to put everybody into a single, nonprofit system we can all support, within a budget acceptable to the majority of people. That arrangement would eliminate the political fights among people in different health insurance programs, each questioning change by asking, “How does it benefit me?”
Such a system would be best if done at a national level. But it could work initially at the level of individual states, such as Maine. That’s how the Canadians did it — one province at a time. If Maine could be one of the first states to do that, the people of Maine could truly say “Dirigo, I lead.”
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at email@example.com.
Today, Representative John Conyers, Jr. (D-Mich.) reintroduced H.R. 676, “The Expanded And Improved Medicare For All Act.” This bill would establish a privately-delivered, publicly-financed universal health care system, where physicians and non-profit health care providers would be in charge of medical decisions — not insurance companies.
H.R. 676 would expand and improve the highly popular Medicare program and provide universal access to care to all Americans. The program would be primarily funded by a modest payroll tax on employers and employees, a financial transaction tax, and higher taxes on the wealthiest Americans.
H.R.676 has been introduced in Congress since 2003, and has a broad base of support among universal health care activists, organized labor, physicians, nurses, and social justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians For A National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, and the NAACP. Last Congress, 77 other Members in the House of Representatives signed on as cosponsors of the legislation. In 2011, the Vermont legislature passed legislation that lays the foundation for a single-payer health care system in the state.
Representative Conyers issued this statement following the release of the bill:
“I am pleased to announce the reintroduction of H.R. 676, ‘The Expanded And Improved Medicare For All Act,’ in the 113th Congress. I have introduced the bill in each Congress since 2003 and I will continue to do so until the bill is passed,” said Conyers.
“Many Americans are frustrated with high out-of-pocket costs, skyrocketing premiums, and many other serious problems that are part and parcel of a health care system dependent on private health insurance plans. H.R. 676 would reform this broken system.
“Passage of the Patient Protection and Affordable Care Act was an important initial reform, which will provide health insurance to millions of our nation’s uninsured and eliminate many of the worst practices of the private health insurance industry.
“However, it is my opinion, and the belief of many leading health care practitioners and experts, that establishing a non-profit universal single-payer health care system would be the best way to effectively contain health care costs and provide quality care for all Americans. It is time for Members of Congress, health policy scholars, economists, and the medical community to begin a serious discussion of the merits of a universal single-payer health care system.”
Ask your Representative to become an original cosponsor of HR 676: “The Expanded & Improved Medicare For All Act.” today!
Rep. John Conyers is going to reintroduce national, single-payer healthcare legislation very soon–sometime this week.
Before he introduces the bill, Mr. Conyers would like to have as many original cosponsors as possible. Please call your Representative today and ask them to cosponsor HR 676.
Call the U.S. Capitol Switchboard at (866) 220-0044, ask for your representative’s office, and then ask them to sign as a co-sponsor.
Be sure to mention that in order to become an original cosponsor of H.R. 676, your Representative will need to contact Michael Darner from Rep. Conyers’ office at firstname.lastname@example.org or (202) 225-5126.
If you don’t know your US House Representative, find out here.
Current Representatives already on board (thank them if you’re in their district): Nadler, Schakowsky, Pingree, Grijalva, Ellison, Hank Johnson, Eddie Bernice Johnson, Takano, Holmes-Norton, Lofgren, Rangel, Moore, Chu, Al Green, Farr, McGovern, Welch, Clarke, Lee, Nolan, Pocan, Doyle, Engel, Gutierrez, Frederica Wilson, Cohen, Edwards, McDermott, Clay, Huffman, Roybal-Allard, Cummings, Yarmuth, George Miller, Honda, Christensen, Rush.
Here is the “Dear Colleague” letter from Rep. Conyers:
I invite you to become a cosponsor of H.R. 676, “The Expanded & Improved Medicare For All Act,” which enjoyed the support of 77 cosponsors in the 112th Congress. HR 676 also has the support of over 17,000 doctors, 14,000 nurses, and hundreds of labor unions from across the nation.
Under H.R. 676, the American health care system would transition to a privately-delivered, publicly-financed non-profit universal health care system. The United States remains the only country in the industrialized world that has a for-profit health care delivery system that is unable to contain health care spending. This dysfunctional system places a heavy burden on the budgets of states, municipalities, and American families.
Under H.R. 676, every resident of the United States would receive a card at birth that would guarantee access to a full range of medically necessary services, including primary care, dental care, prescription drugs, mental health services, and long-term care. There would be no restrictions on choice of physician or health care provider. Americans would have greater freedom to pursue work opportunities because health insurance would no longer be tied to employment.
In addition to expanding access to care, H.R. 676 would curb the growth of health care spending and place our country on a sustainable fiscal path. H.R. 676 would provide approximately $300 billion dollars in savings by improving efficiency in our health care system.
An Oregon house bill sponsored by Rep. Michael Dembrow, D-Portland, is not expected to pass, but advocates claim momentum
Nearly a thousand people swarmed the front of the Oregon Capitol Building for the opening session Monday, demanding that Oregon become the second state to enact single-payer healthcare legislation, which would set up a government financing system to pay for and provide health care coverage and access for all Oregon residents.
Protestors at the Health Care for All Oregon rally hoisted signs, listened to speeches, heard woeful tales of the current health care system, and sang along to bluesman Norman Sylvester: “I don’t care what party you’re in, Democrat or Republican, we don’t need to fight, healthcare is a human right.”
“The brother said we don’t need a fight, but they’re going to fight us,” said Rep. Michael Dembrow, D-Portland, leading the crowd. Dembrow is the chief sponsor of the single-payer legislation, House Bill 1914. “We don’t necessarily need to fight back, we need to organize. Let’s go forward and organize this state, everybody in, nobody out.”
Dembrow said HB 1914 and companion legislation in the Senate already had 19 co-sponsors, all Democrats — eight more sponsors than its predecessor from the last session, HB 3510.
One of those new sponsors, Rep. Jennifer Williamson, D-Portland, said she supported the legislation because her sister was one of the thousands of Oregonians who each year file for bankruptcy under the weight of medical bills.
“I’ve been a legislator for three weeks now,” Williamson said. “The first bill I signed onto as chief legislator was a bill for universal healthcare.”
Dr. Paul Gorman, a member of Physicians for a National Health Program, said he ran a free clinic where a man came in complaining of pain in his abdomen. The man had no insurance and he put off seeing a doctor for a long time, allowing his pain to get worse and worse. “By the time he came to see us, his liver cancer was advanced, and he died.” Gorman said 500 Oregonians die each year because they don’t have insurance.
Health Care for All Oregon argued that while the Affordable Care Act signed into law by President Obama in 2010 does improve access for some people — expanding Medicaid and offering private health insurance subsidies to others — the single-payer advocates said the reforms were inadequate and would do little to rein in skyrocketing costs.
Single-payer healthcare would work similar to Medicare, with a single government fund paid for through taxes rather than paying premiums to several private companies.
HB 1914 isn’t expected to pass the Legislature or even come to the floor for a vote this session. But Dembrow expected to double the number of legislative sponsors and asked everyone in the crowd to lobby their representatives to support single-payer, hoping to find three more legislators by the end of the day.
The number of sponsors didn’t immediately grow to the goal of 22 legislators, but Marissa Johnson, an aide for Dembrow said they hoped to exceed that goal by the end of the week.
“We have interest from more than a handful of representatives and [Dembrow] will be following up with them today,” Johnson said.
Dembrow said at the rally he expected a million votes would be needed to pass a statewide measure while withstanding millions of dollars of negative advertising from groups like the for-profit private health insurance industry, which would be cut out of healthcare under the proposed system.
“The real work is not going to be done inside this building,” he said. “It’s going to be solved by a million people in Oregon, organized.”
“I think it’s going to take a lot of people stepping outside their comfort zones,” said Rio Davidson of Newport, who volunteered at the end of the rally handing out lists of legislators and asking people to contact their representatives. “Unfortunately, a lot of people who want single-payer are working low-wage jobs.”
Longtime advocate Betty Johnson said afterward that 60 organizations had been involved in the Health Care for All Oregon rally, and the group had recently hired a full-time field organizer. “Absolutely we are growing. We are organizing a number of chapters throughout the state,” she said.
Gov. John Kitzhaber has not shown support for single-payer, putting his energies instead into implementing a private health insurance exchange and transforming the healthcare delivery system through coordinated care organizations. Despite his position, Johnson said she hoped he would meet with single-payer advocates to discuss how it could work in tandem with the CCO model.
“He’s strengthening the delivery system,” Johnson said. “We really want to change the financing system. When we pass single-payer, the CCO system will work alongside it.”
Dembrow said there are restrictions in the federal Affordable Care Act that prevent states from passing single-payer laws without special permission before 2017. He lamented the added restriction, but said it also gave single-payer supporters three years to build support, get better organized, and develop a plan that would work for Oregon.
The state of Vermont enacted single-payer legislation in 2011 to cover all of its residents, but funding mechanisms are still being worked out and the state will also have to wait until 2017 to receive federal waivers.
Dembrow is introducing a second bill this session that would call on the Legislature to support a formal study of how single-payer would work in Oregon. Activists on Monday called on supporters to ask their legislators for public money, but Johnson said Dembrow believes the study could be paid for with private money.
Hundreds of people from all over Oregon rallied in Salem on the first day of the legislative session to call attention to what they claim is a broken health care system and call on lawmakers to enact reforms.
An estimated 1,000 protesters, many brandishing signs and wearing red “Health Care Is a Human Right” T-shirts, packed the Capitol steps to hear a dozen speakers tell horror stories of out-of-control medical costs and urge support for a single-payer health care bill.
Ten buses — including two from the mid-valley — delivered people from as far away as La Grande and Bandon, Ashland and Prineville for the lunchtime rally, organized by Health Care for All Oregon.
Rep. Michael Dembrow, D-Portland, got a hearty cheer as he took the stage to talk about his plans to reintroduce the Affordable Health Care for All Oregon Act, which foundered in the 2011 session.
This time, he said, the notion of a comprehensive taxpayer-supported health care system for all Oregonians has broader support, with 19 co-sponsors already on board, compared to 11 last time.
But he also predicted that a statewide ballot measure would ultimately be required to enact a single-payer system in Oregon. Using emotionally charged language, he exhorted the audience to work toward passing an initiative in the 2016 election.
“Brothers and sisters,” Dembrow said, “the real work here is not going to be done inside this building. It’s going to be done outside this building, in all parts of Oregon, by all of you.”
Two of his co-sponsors, Reps. Jennifer Williamson of Portland and Dave Gomberg of Lincoln City, also spoke in support of the bill.
Monday’s rally had a festive air, with musicians performing protest songs, a 10-foot-tall puppet dubbed Big Nurse, and activists wearing open-backed hospital gowns that exposed padded foam derrierres to illustrate what private insurance just won’t cover.
The crowd, roughly six times the size of a similar gathering two years ago to support Dembrow’s previous single-payer bill, chanted and sang, cheered and shouted for a parade of speakers lamenting the ills of private heath insurance.
Wes Brain of Ashland recounted his daughter’s nine-year struggle with leukemia — and with a succession of insurance companies that didn’t want to pay for her care.
He recently marked the fourth anniversary of her death — and began his own battle against cancer. Unlike his daughter, Brain has no insurance.
“The bills are coming in,” he said, “and I just don’t have the money to pay them.”
The Rev. Joel Miller, pastor of the Unitarian Universalist Fellowship of Corvallis, spoke of his personal conversion from a free market capitalist whose parents ran a small business to a single payer advocate who sees how runaway health care costs are crippling the economy. Now that he’s an employer himself, he said, his eyes have been opened to the shortcomings of a system that ties health care access to employment.
“The system of coverage I’m working with is expensive, inefficient and flat-out immoral,” he said. “My employees live in terror of losing their health coverage. We all live in terror.”
Between speakers, event organizer Jess Hoffman of Health Care for All Oregon urged attendees to meet personally with their local legislators and lobby for single-payer health care.
“We really want to make sure we capture the energy of this moment today,” she said, “so we can use it for the rest of the movement.”
From the New York Times –
The Internal Revenue Service has issued a hugely disappointing ruling on how to calculate the affordability of health insurance offered by employers. Its needlessly strict interpretation of the Affordable Care Act could leave millions of Americans with modest incomes unable to afford family coverage under their employers’ health insurance but ineligible for subsidies to buy coverage elsewhere.
The problem arises from murky language in the law. It says a worker cannot get taxpayer-subsidized coverage on the new health insurance exchanges, starting in 2014, unless the cost of employer-based health coverage for that worker exceeds 9.5 percent of the worker’s household income.
Both the I.R.S. and the Congressional Joint Committee on Taxation have interpreted the law to consider only the cost of covering the individual employee in calculating the 9.5 percent, not the much higher cost for a family plan.
Although some analysts had offered persuasive legal and social arguments for adopting a more expansive and generous interpretation of what the law requires, the strict interpretation prevailed in a final rule issued by the I.R.S. last week.
There is no doubt that this pinched approach will put a significant number of workers and their dependents in a bind. A Kaiser Family Foundation survey found that in 2012, employees’ annual share of insurance premiums averaged $951 for individual coverage and $4,316 for family coverage. Under the I.R.S. rule, such costs would be considered affordable for an employee with a household income of $35,000 a year — making the employee’s spouse and children ineligible for a public subsidy on a health exchange, even though that family would have to spend 12 percent of its income for the employer’s family plan.
Estimates made in 2011 by respected research organizations suggested that some 2 million to 3.9 million non-working spouses and dependents would be harmed by the strict ruling. Looking only at children who were uninsured but supposed to gain coverage under health care reform, the Government Accountability Office estimated last June that 460,000 might remain uninsured because of the affordability definition, and that 1.9 million might stay uninsured if an existing children’s health insurance program is phased out as currently planned. This outcome is exactly the opposite of what health care reform is supposed to achieve.
It is hard to see what might be done to reverse this deplorable result. The ideal solution would be for Congress to clarify that the 9.5 percent calculation is based on a family plan, and that dependents can get subsidies on the exchanges if there is no affordable coverage at work. But House Republicans, who are bent on obstructing the health reform law, would never agree to helpful changes, especially one that would increase federal spending.
This problem increases the need to retain the children’s health insurance program, which is financed only through 2015. And it will be crucial to assess the impact that this misguided provision has on coverage, access to care, and the financial burdens on families of modest means.
An eleventh-hour loophole in the “fiscal cliff” deal confirms our worst suspicions about how Congress operates.
By Bill Moyers –
The inauguration of a president is one of those spectacles of democracy that can make us remember we’re part of something big and enduring. So for a few hours this past Monday, the pomp and circumstance inspired us to think that government of, by, and for the people really is just that, despite the predatory threats that stalk it.
But the mood didn’t last. Every now and then, as the cameras panned upward, the Capitol dome towering over the ceremony was a reminder of something the good feeling of the moment couldn’t erase. It’s the journalist’s curse to have a good time spoiled by the reality beyond the pageantry. Just a couple of days before the inaugural festivities, The New York Times published some superb investigative reporting by the team of Eric Lipton and Kevin Sack, and their revelations were hard to forget, even at a time of celebration.
The story told us of a pharmaceutical giant called Amgen and three senators so close to it they might be entries on its balance sheet: Republican Minority Leader Mitch McConnell, Democratic Senator Max Baucus, chair of the Senate Finance Committee, and that powerful committee’s ranking Republican, Orrin Hatch. A trio of perpetrators who treat the United States treasury as if it were a cash-and-carry annex of corporate America.
The Times story described how Amgen got a huge hidden gift from unnamed members of Congress and their staffers. They slipped an eleventh-hour loophole into the New Year’s Eve deal that kept the government from going over the fiscal cliff. When the sun rose in the morning, there it was, a richly embroidered loophole for Amgen that will cost taxpayers a cool half a billion dollars.
Amgen is the world’s largest biotechnology firm, a drug maker that sells a variety of medications. The little clause they secretly sneaked into the fiscal cliff bill gives the company two more years of relief from Medicare cost controls for certain drugs used by patients who are on kidney dialysis, including a pill called Sensipar, manufactured by Amgen.
The provision didn’t mention Amgen by name, but according to reporters Lipton and Sack, the news that it had been tucked into the fiscal cliff deal “was so welcome that the company’s chief executive quickly relayed it to investment analysts.” Tipping them off, it would seem, to a jackpot in the making.
Amgen has 74 lobbyists on its team in Washington and lobbied hard for that loophole, currying favor with friends at the White House and on Capitol Hill. The Times reporters traced its “deep financial and political ties” to Baucus, McConnell and Hatch, “who hold heavy sway over Medicare payment policy.”
All three have received hefty campaign donations from the company whose bottom line mysteriously just got padded at taxpayer expense. Since 2007, Amgen employees and its political action committee have contributed nearly $68,000 to Senator Baucus, $73,000 to Senator McConnell’s campaigns, and $59,000 to Senator Hatch.
And lo and behold, among those 74 Amgen lobbyists are the former chief of staff to Senator Baucus and the former chief of staff to Senator McConnell. You get the picture: Two guys nurtured at public expense, paid as public servants, disappear through the gold-plated revolving door of Congress and presto, return as money changers in the temple of crony capitalism.
Inside to welcome them is a current top aide to Senator Hatch, one who helped weave this lucrative loophole. He used to work as a health policy analyst for — you guessed it — Amgen.
So the trail winds deeper into the sordid swamp beneath that great Capitol dome, a sinkhole where shame has all but disappeared. As reporters Lipton and Sack remind us, just weeks before this backroom betrayal of the public interest by elected officials and the mercenaries they have mentored, Amgen pleaded guilty to fraud. Look it up: fraud means trickery, cheating and duplicity. Amgen agreed to pay $762 million in criminal and civil penalties; the company had been caught illegally marketing another one of its drugs.
The fact that their puppet master had been the subject of fines and a massive federal investigation mattered not to its servile pawns in the Senate, where pomp and circumstance are but masks for the brute power of money.
Peter Welch, Vermont’s Democratic congressman, has just introduced bipartisan legislation to repeal the half billion–dollar giveaway to Amgen. Its co-sponsors include Republican Richard Hanna of New York and Democrats Jim Cooper of Tennessee and Bruce Braley of Iowa.
The Amgen deal “confirms the American public’s worst suspicions of how Congress operates,” Representative Welch told us this week. “As the nation’s economy teetered on the edge of a Congressional-created fiscal cliff, lobbyists for a private, for-profit company seized an opportunity to feed at the public trough. It’s no wonder cockroaches and root canals are more popular than Congress.”
In his inaugural address, Barack Obama said the commitments we make to each other through Medicare, Medicaid and Social Security don’t make us a nation of takers. But the actions of Amgen and its cronies under the dome on Capitol Hill show who the real takers are — not those who look to government for support in old age and hard times but the ones at the top whose avarice and lust for profit compel them to take as much as they can from that government at the expense of everyone else.
U.S. citizens suffer from poorer health than nearly all other industrialized countries, according to the first comprehensive government analysis.
U.S. citizens suffer from poorer health than nearly all other industrialised countries, according to the first comprehensive government analysis on the subject, released Wednesday.
Of 17 high-income countries looked at by a committee of experts sponsored by the National Institutes of Health, the United States is at or near the bottom in at least nine indicators.
These include infant mortality, heart and lung disease, sexually transmitted infections, and adolescent pregnancies, as well as more systemic issues such as injuries, homicides, and rates of disability.
Together, such issues place U.S. males at the very bottom of the list, among those countries, for life expectancy; on average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country, Switzerland. U.S. females fare little better, ranked 16th out of the 17 high-income countries under review.
“We were stunned by the propensity of findings all on the negative side – the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society,” Steven H. Woolf, a professor of family medicine at Virginia Commonwealth University and chair of the panel that wrote the report, told IPS.
“It’s unclear whether some of these patterns will be experienced by other countries in the years to come, but developing countries will undoubtedly begin facing some of these issues as they take on more habits similar to the United States. Currently, however, even countries in the developing world are outpacing the U.S. in certain outcomes.”
Although the new findings offer a uniquely comprehensive view of the problem, the fact is that U.S. citizens have for decades been dying at younger ages than those in nearly all other industrialised countries. The committee looked at data going back to the 1970s to note that such a trend has been worsening at least since then, with women particularly affected.
“A particular concern with these findings was about adolescents, about whom we document very serious issues that, again, stand out starkly from other counties,” Woolf says.
“Not only do they risk being killed in greater numbers, but they are also experiencing illness, and a variety of mental health concerns, at far higher rates than similar cohorts in other countries. These include significant implications for tomorrow’s adults.”
The unusually high levels of population who lack health insurance in the U.S. would certainly seem to be one factor at work here. In 2010, some 50 million people, around 16 percent of the population, were uninsured – a massive proportion compared with the rest of the world’s high-income countries.
Of course, after a rancorous debate and more than a decade of political infighting, in 2010 President Barack Obama did succeed in putting in place broad legislation that will bring the number of uninsured in the United States down significantly.
Further, Obama’s winning of a second term in office, coupled with a recent decision by the Supreme Court, will now undercut most attempts by critics to roll back Obama’s new health-care provisions.
And yet, according to the new findings, the insurance issue has relatively little impact on the overall state of poor health in the United States. (In fact, those 75 years old or more can expect to live longer than those in other countries, a clear indication of the tremendous money and effort that has gone into end-of-life care.)
“Even advantaged Americans – those who are white, insured, college-educated, or upper income – are in worse health than similar individuals in other countries,” the report states. Likewise, “Americans who do not smoke or are not overweight also appear to have higher rates of disease than similar groups in peer countries.”
Indeed, some of the few categories in which U.S. citizens are found to do better than their peers in other countries include smoking less tobacco and drinking less alcohol. They also appear to have gained greater control over their cholesterol levels and blood pressure.
At the same time, people in the United States have begun to suffer inordinately from a host of other problems that can contribute to a spectrum of additional health concerns.
Sky-high obesity rates, for instance, are undergirded by findings that people in the U.S. on average consume more calories per person than in other countries, as well as analysis that suggest that the U.S. physical environment in recent decades has been built around the automobile rather than the pedestrian.
Confusingly, people in the United States not only record far lower health indicators on average when compared to other high-income countries, but also score far lower on seemingly unrelated issues related to environmental safety – for instance, experiencing inordinate numbers of homicide and car accidents.
The committee clearly had trouble putting together these seemingly disparate datasets.
“No single factor can fully explain the U.S. health disadvantage,” the report states. “More likely, the U.S. health disadvantage has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions.”
According to Samuel Preston, a demographer and fellow committee member, “The bottom line is that we are not preventing damaging health behaviours. You can blame that on public health officials or on the health care system … But put it all together and it is creating a very negative portrait.”
Over the past decade, one of the most puzzling aspects of the opposition to greater insurance coverage in the United States was the belief espoused by many in the country that the U.S. health system, unique in its lack of state “interference”, was better than those in most other countries.
One of the committee’s central recommendations is the need to “alert the American public about the U.S. health disadvantage and to stimulate a national discussion about its implications.”
Amidst widespread discussions of austerity, lawmakers here in Washington are continuing to debate new ways to impose steep cuts on government spending. In this, the new findings could offer some caution.
“Policymakers must recognise the potential implications of current decisions that have to be made about public health and social programmes that are currently in jeopardy because of fiscal concerns,” Woolf says.
“Understanding how cuts to those programmes might help balance budgets will probably exacerbate the country’s current health disadvantage – and make greater demands on the system later on. We need to help them understand the larger economic implications, if not the human toll.”
The Shumlin administration released two financing plans Thursday evening: one for funding a publicly financed health care system and another to pay for portions of the state’s new health benefit exchange.
The much-anticipated single-payer financing plan provides more of a map of the state’s health care finance landscape than it does a course of action through it. The document itself alludes to the need for a plan with substantive revenue-generating measures.
“A future financing plan will likely feature a substantial and regular individual and employer contribution, similar to current law, albeit one paid through a public system,” the plan says.
The plan — which was drawn up by the University of Massachusetts for a price tag of $300,000 — estimates that the total savings of reforming the system would be about $35 million in 2017. The total $5.91 billion cost of the system would place a burden of $1.61 billion on taxpayers, after federal funding, and a $332 million chunk would be placed on employers who continued to enroll their employees on their insurance plans after the system takes effect.
While the plan points to a slate of tax bases for raising such revenues, the architects of the plan acknowledge the lack of information they had to work with — and, therefore, the potential inadequacy of their findings.
“Many details regarding the structure of a single payer system in Vermont have not been determined,” they write. “These details may significantly affect the assumptions underlying our models and therefore the results of our models.”
When Gov. Peter Shumlin and the Legislature approved Act 48 in 2011, they set the state on a track towards a publicly financed health care system. Part of that legislation called for a financing plan to be submitted to the Legislature by Jan. 15, 2013, that “shall recommend the amounts and necessary mechanisms to finance Green Mountain Care and any systems improvements needed to achieve a public-private universal health care system.”
On Thursday, Director of Health Care Reform Robin Lunge said the plan met the statutory goal.
“It has amounts, and it has necessary mechanisms included; it just doesn’t have one,” she said. Furthermore, she added, the plan seeds the Statehouse for constructive debate over how to pursue and implement such a health care system.
Jeffrey Wennberg, who runs the anti-single payer group Vermonters for Health Care Freedom, panned the report for its lack of substance.
“The report … contains surprisingly little information within its 91 pages,” he said in a public statement. “There is no multi-year budget or projection, and the Act 48-required recommendation for a funding source is completely absent.”
A top CEO plan to curb social programs will be bad for everyone – except them.
The new recommendations for Social Security and Medicare released by the Business Round Table are beyond belief. It’s as if the people who wrote them never gaze outside of the tinted windows in their limousines.
As I wrote earlier in “Stop Obama’s Grand Charade“, the newest tactic to impose more austerity measures in the US comes from a group of over 80 CEOs who are starting with $60 million to spend on a campaign called “Fix the Debt“. They plan to convince people in the US that not only are cuts to vital programmes necessary, but that such cuts will strengthen them when exactly the opposite is true.
These CEOs are members of the Business Round Table, an elite corporate club that claims to create 7.3 trillion in annual revenues. That gives them a lot of political clout. The real reason for their push to cut spending on important programmes like Social Security and Medicare is so corporate tax rates can be cut further. Of course, they don’t say that. They say things like Social Security and Medicare are running out of money and we must preserve and strengthen them (preserve and strengthen sound eerily like the language we used in 2010 when we were fighting cuts by the Deficit Commission). This push for corporate tax cuts comes although corporate profits have grown by 171 percent during the Obama presidency alone, the highest growth in profits since 1900.
Here is a quote from one CEO, Gary Loveman of Caesar’s Entertainment Corporation:
Medicare and Social Security were not designed to cope with America’s new demographic realities. CEOs are calling for gradual changes that will modernise these programmes and preserve the safety net for future generations of retirees.
Cutting social programmes
His language is slick. It is true that these programmes were not designed to cope with the new demographics. But I’m not talking about an ageing population as he purports (although our life expectancy is actually dropping), I’m talking about the job insecurity, falling wages and increasing wealth divide that exist today. Social Security and Medicare were created as social contracts for a working population to provide for those who need help and for all to have access to income and health care when they retired.
Social Security and Medicare were not designed for a population in which the vast majority of wealth is funnelled to the top 1 percent who avoid paying taxes. The Business Round Table report makes it sound as if the Social Security trust funds will be drained by 2033. What they don’t say is that modest changes such as lifting the cap on the Social Security tax or treating investment income the same as income from wages would make Social Security solvent for many decades after that.
Instead they call for raising the retirement age to 70, restricting the growth of benefits and converting the Cost of Living Adjustment to a chained CPI. They also recommend that people save more. In today’s economy, in which poverty is increasing, changes that delay or decrease benefits would be just plain cruel. Our older population is carrying high credit card debt and experiencing growing food insecurity. Future seniors are expected to face even greater poverty. They cannot bear further reductions in benefits. And many American families are struggling to meet basic necessities, let alone put money into savings. In fact 38 percent of families have no savings at all.
The Business Round Table is also sounding an alarm on Medicare. Their purpose is to push more people into private insurance and further privatise Medicare while keeping those who need health care services in public programmes. They would do this by increasing the Medicare eligibility age to 70 and opening Medicare up to more private health insurance plans that can be sold across state lines (code for allowing insurers to locate in states with the weakest regulations).
This is wrong on so many levels. Increasing the Medicare age will cause more deaths, especially in minority and low-income communities. And while it would save the federal government some money, it would shift even greater cost onto individuals who are unable to handle that increase. This means seniors would face greater difficulty meeting their basic needs.
The changes put forth by the Business Round Table are destructive, unnecessary and counterproductive. The US already spends a low portion of its GDP on public programmes when compared to other wealthy nations and we are suffering from the results. Restricting social spending further and privatising our social insurances will drive us towards greater poverty, economic stagnation and worse social outcomes. On the contrary, there is strong evidence that investing in social infrastructure stimulates the economy and shortens recessions.
There are real solutions that would address our current crises and actually preserve and strengthen Social Security and Medicare. For example, reclaiming taxes that the wealthy avoid paying would raise enough revenue to strengthen and expand both programmes.
Because Social Security is the most successful and popular pension plan in the US, there is a solid argument that we would be better off if benefits were doubled, a sort of “Social Security Plus”. Steven Hill of the New America Foundation describes this in more detail. Hill concludes:
Social Security Plus would provide a stable, secure retirement for every American and contribute greatly toward a solid foundation from which to build a strong and vibrant 21st century economy. All Americans should have retirement benefits they can count on, not the crumbling casino of retirement overseen by the same Wall Street bankers and financial managers who drove the US economy off the cliff.
And Medicare does not add to the deficit, it is self-funded. The primary challenge for Medicare is that it operates within a market-based health system fraught with runaway health care costs. The most popular and effective solution would be to expand traditional Medicare to every person in the US and ban private health insurance. This would immediately institute proven cost controls and create a system that values health of the population rather than profit. Over time, our Medicare system could be improved. Dean Baker estimates that if our health care costs were brought in line with what other wealthy nations spend, nations who have universal coverage and better health outcomes, we would not have a national deficit.
It’s up to us to save Social Security and Medicare. These top CEOs have money and political persuasion. We have the truth on our side and greater numbers of people. Let us raise our voices now for a healthier and more prosperous future for all of us.
Margaret Flowers, MD served as Congressional Fellow for Physicians for a National Health Program and is on the board of Healthcare-Now. She is co-director of It’s Our Economy and co-host of Clearing the FOG Radio Show.
You can follow her on Twitter: @MFlowers8