More and More Americans Forgo Medical Care Due to Cost

The US is the only wealthy, industrialized nation that does not have a universal health care system, and average working Americans are paying the price.   Moreover, although Americans spend twice as much on healthcare as people in other developed nations; in return, they receive lower quality and less efficient medical care.

52 million Americans have no health insurance. 41% of working age Americans have medical bill problems, not to mention, medical bills prompt more than 60% of U.S. bankruptcies, and 45,000 annual deaths are associated with lack of health insurance, according to a study published by the American Journal of Public Health.

In the meantime, while health insurers are posting record profits, an increasing number of Americans are going without medical care because they can't afford it.

More working-age Americans are going without health insurance and not seeking physician care for injuries or illness because they can't afford it, according to two new studies released in March.

A report by the New York-based Commonwealth Fund found that the portion of patients delaying medical treatment in the last year is trending upward. Findings from the group's biennial health insurance survey in 2010 show that an increasing percentage of working-age adults skipped office visits, medical tests and prescriptions because of costs.

■Money troubles mean less care
■Medicaid pay commission releases first report
■See related content
■Topic: Uninsured
Many survey respondents are going without health coverage after losing a job during the economic recession, said Sara Collins, an author of the Commonwealth Fund study.

"This is largely because there are few affordable options for health insurance when job-based coverage is lost," she said. "We found that more than 70% of an estimated 26 million adults who tried to buy coverage in the individual market in the past three years reported difficulties finding affordable plans that met their needs. Nine million were turned down, charged a higher price or had a condition excluded from their coverage because of a preexisting condition."

An estimated 43 million working-age adults reported that they or their spouses lost their jobs within the past two years, according to the study. Among those reporting a job loss, nearly half said they initially lost health benefits, too. Only 14% of those people continued coverage through COBRA, while a quarter were able to go on their spouses' insurance plans or find coverage elsewhere. This meant 57% of those losing both a job and health coverage were added to the ranks of the uninsured.

16% of U.S. working-age adults were contacted by a collection agency for unpaid medical bills in 2010. The number of uninsured adults rose during the last decade to an estimated 52 million, or 28% of the working-age population, from 38 million, or 24%. The rate of young adults and minorities without coverage is relatively high -- 44% of 19- to 29-year-olds, 51% of Hispanics and 37% of blacks.

The study found that those with insurance are paying more for their coverage. Premiums in employer plans increased 41% between 2003 and 2009, and deductibles rose 77%. Nearly half of working adults spent at least 10% of their income on out-of-pocket costs and premiums in 2010.

The organization Families USA in Washington, D.C., conducted a similar study with the Lewin Group, based in Falls Church, Va., and found out-of-pocket costs are rising and becoming a burden for more Americans. A cap under the new health system reform law on what consumers will be expected to pay will curb spending increases starting in 2014, the group said. In the meantime, the study estimates that 15 million Americans younger than 65 will be spending a combined $24.7 billion above those cap levels this year.

"These families are terribly vulnerable to financial devastation caused by unexpected illness or injury, and they generally face only bad alternatives, including massive credit card debt," said Ron Pollack, executive director of Families USA.

In 2011 dollars, the upcoming cap is $5,950 for individuals and $11,900 for families with incomes between 200% and 300% of the federal poverty level, Pollack said.

The Commonwealth Fund estimates that nearly a third of non-Medicare adults had problems paying medical bills in 2010 and that 16% were contacted by a collection agency for unpaid medical bills.

Links:


Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief—Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010

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Big Profits for Insurers, but Almost Nothing for the Insured

Mini-med plans, a very limited health-care benefit package that limits payouts to as low as $2,000 a year, often leaving over two million  unsuspecting customers on their own.   Of course, it's the firms with low-wage, and/or part-time workers who rely on  these junk insurance policies.

By 2014, President Obama's new health-care law eliminates them entirely, and starting this year, all are required to up their annual coverage limit to at least $750,000. Sounds good, right? Not so fast. As usual, the Obama administration caved in to corporate threats, and  granted waivers to 1,040 "mini-med" plans.

Making a Killing on "Mini-Med" Plans, by Wendall Potter

One of the reasons I left my job as a PR executive for the health insurance industry was because I could not in good conscience be a pitchman for the sort of fabulously profitable benefit plan that often provides little more than the illusion of coverage.

Known as "mini-meds," these plans have become popular among businesses like fast-food chains that have many low-wage employees. The common features of these plans: high deductibles, modest benefits and low annual caps on medical coverage. Some of these plans provide as little as $2,000 worth of care each year.

Consumer advocates call these plans "junk insurance." That's because what workers get in these plans for their hard-earned money may actually put them at risk of going bankrupt or losing their homes if they get seriously sick or injured.

My view is that these mini-med plans should be illegal -- and they will be in 2014, thanks to the health care reform law. They would disappear even sooner if employers and insurance companies that sell these plans had to comply with a provision of the law already in effect that requires them to provide at least $750,000 in medical coverage annually. Trouble is, many insurance firms and employers are squirming their way out of complying with that provision.

Corporations Threaten; Obama Administration Issues Waivers

They're doing so with a time-honored form of sabre-rattling. Many employers that offer mini-meds -- most notably McDonalds -- say they will stop doing so if they have to meet the annual limit this year, because adequate coverage would cost them more money. McDonalds, by the way, is a $79 billion company that makes a tidy profit. Most Wall Street analysts who cover the fast-food industry recommend to investors that they buy the company's stock, and for good reason. Last year, according to Yahoo! Finance, McDonald's profit margin was 20.55 percent, and its return on equity was almost 35 percent.

But the threats seem to be working. The Obama administration is worried that many Americans would be dumped into the ranks of the uninsured if it doesn't offer temporary exemptions from that $750,000 annual cap. So the administration has been granting waivers of that provision to hundreds of employers, insurers and even unions that provide benefits to members. Republicans and other critics of "Obamacare" have cited the number of waivers as evidence that the law isn't working.

The administration counters that the ability to grant waivers shows both that the government is flexible and that it is taking prudent steps to ensure that people can keep what coverage they have, until better options are available when the law is fully implemented in 2014. In 2014, states must have health care "exchanges," or virtual insurance marketplaces, up and running.

Here's what Stephanie Cutter, assistant to the president for special projects, wrote in a White House blog post last October as the first round of waivers were about to be granted:

"In extreme cases, when this new policy will cause market disruption and decrease access to health care, the law allows the Department of Health & Human Services (HHS) to issue waivers from the ban on restrictive annual limits for mini-med policies."

She noted that the waivers would be approved only if the insurers, employers and unions requesting them could show that the new annual limit rules would lead to significantly higher premiums or a significant decrease in access to care.

"The good news is that in 2014 'mini-med' policies will be a thing of the past," Cutter added. "The bad news is that today they are the only option for many Americans who can't afford coverage in the individual market."

The growth of mini-meds is a key reason why the ranks of the underinsured had reached 25 million by 2008, according to a Commonwealth Fund study. Mini-med growth is also a reason why some insurance firms have been reporting record earnings.
Big Profits for Insurers, but Almost Nothing for the Insured

I talked about mini-meds in June 2009 testimony before the Senate Commerce, Science and Transportation Committee. I told the panel that big insurers, Aetna and CIGNA in particular, have spent millions acquiring companies that specialize in mini-meds. CIGNA, for instance, paid $175 million to buy Phoenix-based Star HRG and its 200,000 policyholders in 2006. To explain why big insurers wanted to get into this business, I noted in my testimony that the underwriting criteria established for these plans essentially guarantee big profits. It is almost like shooting fish in a barrel.

Money bagsIn CIGNA's Starbridge Select mini-med plan, according to a Web site entry that was removed after my Senate appearance, pre-existing conditions are not covered during the first six months, and employers offering the plan must have an annual turnover rate of 70 percent or more, so most of the workers don't even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don't pay any of the premiums -- the employees pay for everything.

In May 2009, Consumer Reports carried an investigative story revealing that many mini-meds provide little or no hospitalization. The magazine also reported that people who buy these plans are often misled by marketing materials into thinking they're purchasing far more comprehensive care. In many cases, the magazine noted, it is not until they actually try to use the policies that they realize the insurer will provide little help in paying the bills.

Of the 1,040 one-year waivers that have been granted by HHS so far, most have been to employers. Two of the largest, as measured by the number of people affected, however, went to -- you guessed it -- Aetna and CIGNA. A government Web site listing the waivers shows that each of the insurers has more than 200,000 people currently enrolled in mini-meds. While that is not a big percentage of the their total number of policyholders, the premiums those people pay to be underinsured make a substantial contribution to the firms' bottom lines. No wonder the insurers want to use mini-meds to the max.

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Fed Up! Fight to Save America From Texas.

More specifically, Rick Perry, a man who clearly stands for injustice, as he not only proudly took the "Texecutioner" title away from George Bush, with 225 executions under his belt; in addition,  did everything he could to cover up evidence that would clear an innocent man, and save him from state sanctioned execution. Yet, this man, on top of winning a third term, fully expects to lead GOP governors group.

“Texans elect folks like me. The kind of guy who goes jogging in the morning, packing a Ruger .380 with laser sights and loaded with hollow-point bullets and shoots a coyote that is threatening his daughter’s dog.”

And the sad part is he's right, they do. He is now entering his tenth year as governor. He will soon be the longest-serving chief executive in Texas history.

I didn't think Texas could get any dumber, but apparently, dumbing down Texas was/is Rick Perry's strategy for staying in office forever. What else could explain his reelection for a third term, with a state budget deficit of $25 billion? Not to mention the highest uninsured rate in the nation with plans to increase that rate as lawmakers in Texas plan to use the  $25 billion shortfall in the state budget over the next two years to impose sweeping cuts to social services, including a massive cut to public schools and universities.  Yes, to make Texans even dumber!

Rich Perry and conservative Texan lawmakers want to ditch Medicaid due to its expansion under The Affordable Care Act, which will expand the program rapidly by subsidizing insurance for all Americans up to 133 percent of the poverty line. Yes, to make Texans even less insured!

Why is Texas bad for America?

“You prioritize what is important to the people in the state and then you reduce spending without raising taxes.” - Rick Perry

As Robert Perkinson, author of Texas Tough, said "Texas is America's new bellweather state...ground zero of the prison boom." The state's ideology has become the template for today's America, and its priorities, America's priorities.

In a sign of how far the far right has regained its confidence since its thrashing in 2008, in April, TX State board of education voted to radically overhaul their social studies curriculum that influences textbook purchases nationwide. Out went Thomas Jefferson, whose deism questioned the piety of the founders; in came Jefferson Davis who fought for state's rights. Less noticed was the elimination of justice from the list of virtues Texas school children have to master, as well as the phrase, responsibility for the common good. Launching the latest salvo in the nation's ceaseless culture war, but also brought the curriculum in line with the state's unequal social order. With its laissez faire corporate climate and anemic social services Texas simultaneously leads the nation in carbon emissions and children without health insurance.


Texas is wide open for business as the governor's economic development office proclaims but it's always had an uneasy relationship with lady justice. This is clearest of all in its criminal justice system which historically has always privileged ferocity over fairness...revenge over rehabilitation. -- Robert Perkinson

We, the People need to wake up to the thugs that have infiltrated our state and federal government. We need to stop voting them into office. However, there is no excuse for the Texans who voted Rick Perry into office for a third term...they are no better than he is. Having said that, I realize there are many good and decent Texans who should not be lumped in with the Texans so eager to follow psychopathic leaders.

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Obama Health Care "Reform" Continues to Serve the Interests of Insurers at Cost of Patients.

And so it continues--the massive transfer from average Americans to the wealthy.

The top executives at the nation's five largest for-profit health insurance companies pulled in nearly $200 million in compensation last year — while their businesses prepared to hit ratepayers with double-digit premium increases, according to a new analysis conducted by Health Care for America Now.

But that's going to change, right? After President Obama's health care reform - the "reform" that the private health insurance lobby most likely wrote - kicks in? 

No, according to the Physicians for a National Health Plan (PNHP). At least 23 million people will remain without health insurance after Obama's health care goes into effect after 2014. The hype surrounding the new health bill is belied by the facts:

* About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.

* Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.

* Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.

* The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.

* People with employer-based coverage will be locked into their plan's limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.

* The much-vaunted insurance regulations - e.g. ending denials on the basis of pre-existing conditions - are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.

* Women's reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

U.S. citizens pay the highest out-of-pocket amounts for health care, and therefore are much more likely to reduce their use of health care in tough times. The Patient Protection and Affordable Care Act (PPACA) will intensify this problem because "most of the subsidized private plans will have low actuarial values, requiring larger deductibles, higher coinsurance (percentage of costs paid by the patient), and higher copayments (dollar amount paid by the patient)."

Once again the corporations win. The insurance and pharmaceutical lobbyists got their way, and the for-profit, private health insurance industry will continue to profit immensely at the expense of those who need health care most. Congress, President Obama, the insurance industry have masked their health care rationing legislation as health care reform.

The 2,000-page piece of legislation, according to figures compiled by Physicians for a National Health Plan (PNHP), will leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. It will permit prices to climb so that many of us will soon be paying close to 10 percent of our annual income to buy commercial health insurance, although this coverage will only pay for about 70 percent of our medical expenses. Those who become seriously ill, lose their incomes and cannot pay skyrocketing premiums will be denied coverage. And at least $447 billion in taxpayer subsidies will now be handed to insurance firms. We will be forced by law to buy their defective products. There is no check in the new legislation to halt rising health care costs. The elderly can be charged three times the rates provided to the young. Companies with predominantly female work forces can be charged higher gender-based rates. The dizzying array of technical loopholes in the bill - written in by armies of insurance and pharmaceutical lobbyists - means that these companies, which profit off human sickness, suffering and death, can continue their grim game of trading away human life for money.-- Chris Hedges

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Health Care: Who Do We Believe?

Health care in the industrial world...is it a privilege or a right?

The nation is divided on this issue. Clearly, the 50% who subscribe to "health care is a privilege" idea, the complacently covered, have decent health care insurance. I mean, what's the worst thing that can happen to you if you don't have health care? Oh yeah, you can die. No big deal, we all die anyway, but let's walk along the razor's edge of madness, and assume health care is a right, anyway. I know...insanity!

Okay, so the GOP wants to continue using the private marketplace to expand coverage and reduce costs. Uh...been there, done that. We already know that profit selects for the healthiest people with the stingiest policies. We already know that our current system leaves the people who need health care the most, submerged in a black hole of hopelessness. Yet, despite those facts, and that the results of a purely profit driven health care system, deliver huge profits for private industry, we continue to allow this tea bagging, GOP and corporate generated tide of propaganda re-baptize us into the "all-knowing" omniscient cult of the corporate enslaved market. Why? Because it's advertised as, "free", and we always believe what we're told.

So what if 50 million people lack access to health care insurance in the wealthiest, most powerful nation on earth...as long as we're not one of them, what do we care? Well, considering the escalating unemployment and the escalating cost of anything and everything health care related, that hungry black hole may be closer than we think.

Now, last Thursday, President Obama, the Democrats and the Republicans gathered together to discuss live on television the overhaul of our health care system, however, Factcheck.org found the Health Care Summit ripe with errors and misleading remarks. Who are we to believe?

Well, rather than listen to the politicians beholden to the 35,000 lobbyists in Washington that dole out money to shape legislation, for example, the Pharmaceutical Research and Manufacturers of America who spent $26 million last year and drug companies who spent tens of millions more to buy off both the Democrats and Republicans, maybe we should, instead, take a look around, and look at the increasing number of good people losing health care insurance, look at the facts, the statistics, all of which come much closer to telling the truth than either party.

The Internet has made information as easy to acquire as ever before in history. Most of us don't even have to leave our homes...it's all right there at our fingertips. Nevertheless, it can be very confusing, and creating a workable health care policy for a nation this large is a daunting task. Our job, as regular citizens is to make sure our politicians are working for us and not against us, because that is what it is happening right now.

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World Life Expectancy

World Life Expectancy's purpose is to stimulate meaningful research on this subject and their goal is to assist people everywhere in living longer and more productive lives.

Links:
USA Life Expectancy. - Hawaii has the longest life expectancy at 80-years old and D.C., the lowest at 72-years old.

USA Cause of Death by County

Face of Age

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Healthcare Insurance, Baseball and Antitrust Laws.

The insurance industry has everything to lose from real health care reform, that is, reforming the health care industry to serve we, the people, in the most efficient and effective way. The reason is obvious: profit. The better our health care system facilitates and benefits the health of we, the people, the less the insurance industry gains.

Americans United for Change, a grassroots organization working to return America to the "traditional progressive values that have defined America – economic fairness, opportunity, national and economic security and democratic leadership" released a TV ad airing on cable stations in Washington, D.C. noting that Major League Baseball (MLB) and health insurance companies are two of the few organizations exempted from antitrust laws.

"When baseball players fix the games, they get in trouble. When health insurance executives fix the game, they get … rich."

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Poverty in the US is Trending Upwards

Poverty in the United States: 2008

Under the official poverty definition, an average family of four was considered poor in 2008 if its pre-tax cash income for the year was below $22,025. It's hard to imagine a family of four existing on twice that amount today.

In 2008, 39.8 million people were counted as poor in the United States—an increase of 2.6 million persons from 2007, and nearly the largest number of persons counted as poor since 1960. The poverty rate, or percent of the population considered poor under the official definition, was reported at 13.2%; up from 12.5% in 2007, and the highest rate since 1997. The recent increase in poverty reflects the worsened economic conditions since the onset of the economic recession in December 2007. Many expect poverty to rise further next year, and it will likely remain comparatively high even after the economy begins to recover. The incidence of poverty varies widely across the population according to age, education, labor force attachment, family living arrangements, and area of residence, among other factors.

Income, Poverty, and Health Insurance Coverage in the United States: 2008

Data presented in this report indicate the following:

• Real median household income fell between 2007 and 2008, and the decline was widespread. Median income fell for family and nonfamily households, native-and
foreign-born households, households in 3 of the 4 regions, and households of each race categoryand those of Hispanic origin. These declines in income coincide

• The poverty rate increased between 2007 and 2008.

• The percentage of uninsured in 2008 was not statistically different from 2007, while the number.

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Higher Premiums for Elderly Under Comprehensive Health Care Reform?

One of the central goals of comprehensive health care reform is to eliminate discrimination by health status in order to reduce the financial burdens associated with poor health. Congress has discussed eliminating health-status discrimination, although there is much debate about whether it’s fair to charge people who are different ages different rates for insurance. Older adults tend to use more health care, so the question becomes, is it fair to set higher premiums for the same coverage for older Americans?

The Urban Institute calculated the financial implications of age-based premiums under three different scenarios (5:1, 2:1, and 1:1) for households of different ages, incomes, and sizes. Some have proposed allowing premiums for the older adults to be as much as 5 times as high as those for younger adults (5:1 rating), while others would limit the highest premiums to be twice that of the lowest (2:1 rating).

They found that the affordability of health care costs (premiums plus out-of-pocket expenses after government subsidy) will be strongly related to the age-based premium rating.

The full analysis, Age Rating Under Comprehensive Health Care Reform: Implications for Coverage, Costs, and Household Financial Burdens Timely Analysis of Immediate Health Policy Issues, can be found here.

This analysis uses the Health Insurance Policy Simulation Model (HIPSM) to compare the financial implications of the premium rating choice

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Republican Health Care Reform: Don't Get Sick and Die Quickly

When lobby firms are spending millions ($380 million in the last few months) fighting Obama healthcare reforms, and considering there are six lobbyists for every member of Congress, I'm afraid propriety and protocol just won't do.

Finally, a Democrat with guts, who doesn't sound like he will cave to special interests, stood up to the Republicans regarding health care reform. Alan Grayson, a Democrat with guts Harvard educated attorney and former businessman from Florida, took to the floor of the House of Representatives with a set of cards that demonstrated his interpretation - based on a recent Harvard study that concluded the US health care crisis is costing more than 44,000 lives each year and that uninsured, working-age Americans have a 40% higher risk of death than their insured counterparts - of the Republican Health care plan.

The first card stated that step one of the Republican health care plan was “Don’t get sick”. Step two stated: “And if you do get sick...”. Step three stated: “Die quickly”.

When Republicans demanded an apology, Grayson issued an apology to the dead:

"In the face of demands for an apology from the House GOP, he went back to the floor on Wednesday and offered an apology -- not to the GOP, but "to the dead," people who've died for a lack of health insurance. "I apologize that we haven't voted sooner to end this holocaust in America," he said. On CNN, he called Republicans "foot-dragging, knuckle-dragging Neanderthals."

Later, Grayson issued another apology, but again, not the Republicans, but to the Anti-Defamation League, saying, “In no way did I mean to minimize the Holocaust… I regret the choice of words, and I will not repeat it."

America's healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms promised by Barack Obama. The campaign against the president has been waged in part through substantial donations to key politicians.

Supporters of radical reform of healthcare say legislation emerging from the US Senate reflects the financial power of vested interests ‑ principally insurance companies, pharmaceutical firms and hospitals ‑ that have worked to stop far-reaching changes threatening their profits.

The industry and interest groups have spent $380m in recent months influencing healthcare legislation through lobbying, advertising and in direct political contributions to members of Congress. The largest contribution, totalling close to $1.5m, has gone to the chairman of the senate committee drafting the new law.

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Obama Healthcare Overhaul Timeline

Timeline of Obama's healthcare overhaul.

Chronology of President Barack Obama's efforts this year to overhaul health care:

--Feb. 24: In a speech to Congress, Obama says the "crushing cost" of health care is driving families and small businesses into bankruptcy and hobbling U.S. companies in global economic competition.

--Feb. 26: Obama's first budget seeks $634 billion over 10 years as a down payment on health care overhaul.

--March 5: Obama hosts health care summit. Says Sen. Edward Kennedy, D-Mass.: "I'm looking forward to being a foot soldier in this undertaking, and this time we will not fail."

--March 10: Obama's budget director, Peter Orszag, rebuffs congressional demands for specifics on the administration's multibillion-dollar plans for health care, telling lawmakers that deciding how the money is spent is largely up to them.

--May 11: Obama praises the health care industry's promise to cut $2 trillion in costs over 10 years.

--May 12: Senators are considering limiting, but not eliminating, the tax-free status of employer-provided health benefits to help pay for health care plan.

--May 14: House Democrats are crafting a plan that would require all Americans to carry health insurance and would help families making less than $88,000 pay the premiums.

--May 21: Sen. Max Baucus, D-Mont., says illegal immigrants won't be entitled to medical insurance under the health legislation.

--May 28: Obama warns that if Congress doesn't deliver health care legislation by the end of the year, the opportunity will be lost.

--June 1: Health industry officials seek to make good on a $2 trillion savings proposal but come up short by several hundred billion dollars.

--June 3: Obama releases a letter to Kennedy and Baucus saying he believes strongly in the need for a new public plan.

--June 9: Obama proposes budget rules that would allow Congress to borrow tens of billions of dollars and put the nation deeper in debt to jump-start the health care overhaul.

--June 10: Sen. Kent Conrad, D-N.D., offers possible compromise in health care debate. His plan would create health care cooperatives owned by groups of residents and small businesses.

--June 17: American Medical Association signals it will work with Obama, leave door open to public option insurance.

--June 20: The pharmaceutical industry agrees to spend $80 billion over the next decade improving Medicare drug benefits and defraying the cost of Obama's health care legislation.

--June 23: Obama says a government-run health insurance option is needed "to discipline insurance companies."

--June 28: The Obama administration leaves open the possibility that the president would break a campaign promise and raise taxes on people earning less than $250,000 to support his health care overhaul.

--July 15: With a 13-10 party-line vote, the Senate health committee approves a plan to revamp health care. The panel's action comes as the president's campaign organization rolled out television ads to build support for his top domestic priority.

--July 18: Obama says his health care overhaul is financially sound, but an analysis by congressional budget experts of emerging House legislation says it would increase deficits by $239 billion over a decade.

--July 20: Obama pushes back hard against Republican critics of his health care overhaul plan, dismissing the "politics of the moment" marked by GOP comparisons of his efforts to socialism.

--July 22: House Speaker Nancy Pelosi says Democrats command the votes needed to pass a sweeping health care bill through the House.

--July 23: Senate Democrats tell Obama to slow down, dashing hopes of rushing his sweeping health care overhaul to a summertime vote. Obama says Senate's delay in health care bill is "OK."

--July 29: Obama travels to Raleigh, N.C., and Bristol, Va., for town halls. Meanwhile, House Democratic leaders give in to numerous demands from conservative "Blue Dogs," who had been blocking the health care bill's passage in the last of three committees.

--July 31: Democrats narrowly push health care legislation through the House Energy and Commerce Committee by a 31-28 vote, the last of three panels.

--Aug. 2: White House adviser Larry Summers says he can't rule out a tax on middle-class Americans to pay for Obama's health care overhaul.

--Aug. 3: White House says Obama remains opposed to any tax increase for families earning less than $250,000.

--Aug. 5: In Indiana, Obama says he's determined to get an overhaul of the health care system before the end of the year and, if necessary, without bipartisan support.

--Aug. 7: Former Alaska Gov. Sarah Palin calls Obama's health plan "downright evil."

--Aug. 11: In New Hampshire, Obama says that while government bureaucrats should not meddle with people's care, bureaucrats at insurance companies should not, either.

--Aug. 16: Bowing to Republican pressure and an uneasy public, Obama administration members suggest the administration is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

--Aug. 18: White House spokesman Robert Gibbs insists the Obama administration has not shifted its goals on health care reform or distanced itself from a government-run public insurance option.

--Aug. 22: Obama challenges critics of his push to overhaul the health care system to stop making "phony claims" about proposals now the subject of intense coast-to-coast debate.

--Sept. 2: Obama announces plans to address to a joint session of Congress on health care on Sept. 9.

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Healthcare and the Free Market

Tom Tommorrow takes a closer look at healthcare and the free market.

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Money Driven Medicine

Increasingly, over the last century, the history of U.S. health care has been shaped by corporate interests' and market forces have splintered our health care system. As it is, $1 out of every $3 is wasted on redundant or ineffective treatments, and in ten years, health care costs will double. Costly and inefficient, our health care system ranks very low amongst industrialized nations.

-Health care spending is 4.3 times the amount spent on national defense

-U.S. health care spending reached $2.4 trillion last year/ est. $4.3 trillion in 2017

-U.S. spends 6 times more per capita to administer our health care system than its peer Western European nations

-We spend more on health care for nearly 46 million uninsured Americans than other industrialized nations who provide health insurance for all their citizens.

-Electronic medical records still are not a reality.

-20 percent of Americans visit an Emergency Room each year

-64 percent of U.S. residents are overweight (30 pounds over their proper weight)

-Health care expenditures continue to increase annually at twice the rate of inflation

-Our government currently pays more than 50 percent of all health care costs in America.

-80% of health care dollars are currently spent on patients who are chronically ill.

Market forces do not keep prices down in the health care market as they do in other markets. Normally, consumers have the power to bring prices down as producers compete with each other, because in other markets, consumers can afford to wait until prices fall to what they are willing to pay. Not so when it comes to health care. Sick people cannot wait for prices to fall. They can't comparison shop. They have no choices.

Money-Driven Medicine is a new documentary based on Maggie Mahar's book Money-Driven Medicine: The Real Reason Health Care Costs So Much

Healthbeat is Maggie Mahar's blog.

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Delivering Health Care to the People

US Health Care Spending

Whose health does the "health care" industry care about when they spend $1.4 million per day in an effort to block health-care reform? Obviously, it's not the health of American citizens. The "health care" industry is now the "profit care" industry as the pursuit of profit has totally replaced the pursuit of optimum health.

So, how do we get our health care system back? A health care system that places the needs of people before profits. How do we transform the inefficient, wasteful, fragmented health care structure we have today? That does not deliver value - defined as patient health outcomes per dollar spent - to the patient, only to the corporation.

Well, according to Harvard Business School professor, Michael Porter, author of Redefining Health Care: Creating Value-Based Competition on Results and founding member and member of the Executive Committee of the Council on Competitiveness, and The Institute for Strategy and Competitiveness.

Porter believes significant improvement in value to the patient requires fundamental restructuring of our health care delivery system. In order to achieve this, it's not enough to track only patient survival rates, health care outcomes must be measured as well, including: degree of patient recovery, length of recovery process, side effects, complications, relapse, sustainability, etc. In other words, data and result measurements must be created that allow for good decisions and which motivates and informs the provider community so that the quality of health care continuously improves.

The nature of competition in the insurance industry, as it is, destroys value to the patient by encouraging the exclusion of sick people, beating up on doctors and forcing down reimbursement so that physicians must cut the time spent with their patients

"While competition can be a powerful force that results in creation of value, this has not been the case in health care. In health care, an organization can have financial success without creating value for patients. This is because the type of competition that has existed— zero-sum "bad" competition—is not aligned with value. Competition has focused on shifting costs, increasing bargaining power, and restricting patient choice and services."

The inefficient piecemeal system we currently have must be replaced with an integrated structure that coordinates and streamlines care which will result in better outcomes at lower cost.

Three organizations must be created to oversee this type of health care system :

1. Coordinate the outcome measurement process.
2. Sort out electronic medical records.
3. Sort out reimbursements.

How Physicians Can Change the Future of Health Care

Redefining Competition in Health Care

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Market Based Health Care Does Not Work!

45.7 million Americans lack health insurance and 25 million more Americans are underinsured, up from 16 million two years ago. In 2008 alone, the 25 million under insured will have paid $30 billion in out of pocket expenses.

While these numbers show slight improvement, this does not mean our health care system has improved, as the decreased number of uninsured comes solely from government funded programs.

We are the only wealthy, industrialized nation that does not have a universal health care system yet we spend more on health care as a proportion of gross domestic product (GDP) and on a per-capita basis, than any other nation in the world. In 2007 we spent approximately $2.26 trillion on health care.

So, why is it that we spend so much money on health care in comparison to other countries, yet so many people in our country are underinsured or are without insurance altogether?

Could it be the administrative and profit costs of private insurance? According to a study by the New England Journal of Medicine, the US spends 300% more in administrative costs than Canada and we're not any healthier for it.

The Employer Health Benefits 2008 Annual Survey will come out at the end of September. In the meantime, here is a look at 2007 list of exhibits...every kind of exhibit imaginable. Here is one example:

Since 2001, premiums for family coverage have increased 78%, while wages have gone up 19% and inflation has gone up 17%.

Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent).

Overall, it's clear our healthcare system needs a major overhaul. It can't be said enough that McCain's plan will only make things worse.

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McCain Healthcare Plan Underinsure Overinsured Americans

At a time when more and more Americans are having trouble paying for health insurance, and insurance coverage has deteriorated over the past six years, with moderate-income families showing the most severe declines in coverage, according to the Commonwealth Fund,
McCain's plan is to underinsure Americans and get rid of employer based insurance coverage altogether.

"As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses)."

McCain’s healthcare plan embraces market forces, and promotes individual purchase of insurance. He bases it on the premise that more competition in the market will keep costs down so individuals can buy their own policy. Keep in mind that insurers will not offer the same deal to an individual that it offers to an institution whose purchasing power is much greater.

Now, the young and healthy might be able to find a better deal on the “street”, however employers will be left financing the sick, the old and the bad risks, in other words, the all too expensive uninsurables, which will speed up the demise of employer provided coverage.

How does McCain's plan work? It doesn't...not for us, anyway, however, it will work just fine for the insurance companies. In a nutshell:

Firstly, workers will be required to pay taxes on the value of the health insurance their employer currently pays. The employer, of course, can deduct the costs for providing that coverage. Eliminating the tax exclusion for employees will generate approximately $3.6 trillion over a ten year period, which, in turn will pay for the refundable tax credits issued to individuals to buy healthcare in the private market.

$2500/ individual
$5,000/family

That's great, but when you consider employers pay approximately $5,000 per individual and $12,500 per family for each policy, currently, it's hard to imagine how Americans are going to pay for healthcare with the meager amount allotted by the McCain plan. Those insurance costs are based on what companies pay now, and the cost is already much lower than it will be for the individual. How is the average guy going to get comprehensive medical insurance?

Despite what the numbers show, according to McCain and some health economists, Americans are overinsured. MeCain’s plan will force us into buying high deductible insurance products covering very little, rather than the comprehensive insurance we are accustomed. Our lack of coverage will ensure that we will not take advantage of health insurance like a school kid, might, let's say, an unlimited hall pass.

In addition, the tax credits will only lessen in value because healthcare costs increase much more rapidly than the general inflation rate, that healthcare costs will likely be indexed. Ten-years from now, the credits will be useless.

Than there is the issue of insuring the uninsurable…those individuals who are considered bad risks or who have pre-existing conditions. Under McCain’s Guaranteed Access Plan (GAP), or state high risk health insurance pools, where each state would create its own high-risk pool for those people, with the same entry and exclusion rules that exist now (34 states currently have high risk pools). GAP does not eliminate medical underwriting (a practice considered unethical prior to the 1960s), therefore the people who need insurance the most will continue to be weeded out and the uninsurable will remain uninsurable.

How is it OK to determine health insurance eligibility by evaluating the “health” of the patient?
What is the point of private insurance if it doesn’t insure people who need it most? The young and healthy may benefit, that is, until they get too old, too sick or too whatever to insure.

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Pain Begets Pain and More Pain. Part I

We have made more medical breakthroughs in the last century, especially in the last few decades, that it's hard to believe pain management is no different on the battlefield today than it was during the Civil War. An injection of Morphine is administered to the injured soldier, which provides short-term relief but does not do anything to prevent the pain from continuing long-term.

People in our macho culture wear pain as if it were a badge of courage...as if it's something to be celebrated. This "Look at me...the pain is 'off the charts' excruciating, but it's not going to stop me!"attitude, perhaps, may contribute to the lack of advancement in pain releif.

What is "off the charts" excruciating, anyway? Do any of us have a clue?

My friend's wife was about to have her first baby. Late one night, his wife's water broke. After arriving at the hospital and anxiously waiting a few hours, her pain intensified and hysterically she declared, "This baby must come out...I'm in hard labor"! Do something!

The nurse on duty replied, "If you were in hard labor, you would be in a hell of a lot more pain than you're in right now."

Furious, my friend's wife told the nurse that she had no idea what she was talking about. She then turned to her husband and proceeded to scream and curse at him for using her to house what could only be the creation of Roman Polanski or Richard Donner.

Finally the doctor induced my friend's wife and she went into the hardest labor imaginable. Not only that, the epidural she received caused a severe reaction in her and she was not allowed any more pain medicine. The "Antichrist" did not budge. She spent hours writhing in honest to goodness pain. Needless to say, after experiencing authentic "off the charts" pain, she found she would have welcomed the level of "pain" she experienced earlier with open arms.

Since the degree of pain we feel cannot be measured objectively, only subjectively, it's not a good idea to designate yourself the pain police, unless you have subjected yourself to all types of brutal, horrific pain. The nurse made an educated guess and lucked out, however there are far too many medical professionals who have no idea what real pain feels like, yet act as if they are experts. A person's tolerance for pain and the scale of intensity each person feels differs even when the injury is the same.

Recent studies show early exposure (babies or children) to pain that is not controlled actually enables an overgrowth of the pain neuron system in the spinal cord which increases the level of reactivity (pain) that person feels to the same level of stimulus that someone else who did not endure severe pain as a child would feel.

Pain has evolved as a protective function to warn those suffering that some type of action needs to take place ranging from yanking your hand off a flaming hot burner or getting yourself to the hospital ASAP after crashing into a tree face first in the middle of the night, running at top speed. It may be so dark you can't see a thing including an over-sized, thorny trunked, Honey Locust tree, however the pain felt post-collision clearly lets you know its there and even though you can't see the blood pouring out of every orifice, the pain felt clearly lets you know it's do or die time. Yes, this happened to me...another reason I choose to remain a faceless blogger, however, looking at me now it's barely noticeable except for the embedded thorn.

The longer pain goes untreated, the higher the chances that changes in the mechanics of the muscles involved in the area of injury will occur, thus increasing the amount of time pains signals are sent from the periphery.

Here's the rub...resulting changes in the spinal cord and brain may permanently activate the pain, resulting in chronic pain or Chronic Regional Pain Syndrome, where the smallest movement or the slightest movement of air can activate the pain system.

In addition, because the patient will normally avoid using the affected area, he or she will experience bone absorption, contractures (a shortening or distortion of muscular or connective tissue due to spasm, scar, or paralysis of the antagonist of the contracting muscle) and other problems that create new neural pathways of pain!

How does pain work?

When injured, a signal immediately goes from the wounded tissue into the nerves to your spinal cord and then it is relayed through a set of relay stations in your spinal cord to two parts of your brain, one part of the brains says it’s in my left arm and it’s bad or not so bad, and the other part of the brain says this hurts and I hate it, suffering part.

Then the brain sends a message back down to the spinal cord or the descending control mechanism that says this is really important, this is not so important.

Then you have a reaction around the tissue involved in the injury inflammatory cells are activated and the inflammatory process begins.

Then either healing begins, if the area is stabilized or if it’s a disease process or a disease process that interferes with healing or continues to do something to activate the injury then healing won’t begin.

Next: Part II...More pain.

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Our Decisions Regarding Health Care Could Result in a New Enlightenment Age or the Beginning of the End

Our current health care system is weakening and tearing apart the strands that hold together the fabric of our society more and more every day. Since 2000, employment-based health insurance premiums have increased 87%, rising four times faster than wages. Our out of pocket expenses, co-pays, deductibles etc, have increased 115% and the average employee contribution to company-provided health insurance has increased more than 143%.

The hospitals, insurance companies, and the government health care system are all driven by "economies of scale" thinking which base its decisions, not on what is best for the patient, rather decisions are based on what will result in enormous profits for the industries involved.

There is no safety net. Medicaid only covers a small fraction of people without health insurance. The eligibility rules vary widely state to state, and most states require people to be completely destitute parents to qualify. In some states working adults without children can get Medicaid coverage for themselves but only if they make less than, let's say 30-40% of the federal poverty level, or in other words, $3-4,000/year. Medicaid eligibility discourages people from working because most programs only allow people to earn a salary below the poverty level in order to qualify. Where is the incentive to work more hours or find better employment?

The bottom line is that it's next to impossible to secure health benefits for the average American today unless their employer offers it, and even then it's becoming prohibitively expensive. If we allow the health of American citizens to deteriorate in the most affluent country on earth, not only does it place a great burden on our labor force, infrastructure, and market system, it calls into question how civilized "We the People" really are. Ignoring the needs of the sick so that big industry can profit is heartless, insensitive, greedy and self-serving and much more characteristic of a barbaric society than the enlightened, continually evolving nation we claim to be.

We cannot continue to allow billions of our tax dollars to fund what is ultimately destructive to the public interest, and at the same time, refuse citizens who work hard, pay taxes, and play by the rules, decent health care. If we permit American citizens to fall into economic hardship because of health care costs, we are no different than the many"civilizations" that have gone before us, failing because of their inability to transcend the selfish, power hungry part of human nature.

"A chain is only as strong as its weakest link”, is a common metaphor often applied to groups of people from small organizations to -- in an era of global economies and growing interdependence -- the world at large. However, although this statement is true as far as a chain and a broken link, fortunately, this analogy is only partially true when applied to society or government, because one broken link will not render society or government useless. The reality is the strength of the other links will normally compensate for the broken one and society will continue to function. "Fabric is only as strong as its weakest threads" might be more accurate when referring to how groups of people function. A broken health care system, if not mended soon, will inevitably unravel the societal fabric weaving us all together.

We are at a crucial crossroads in American history and our decisions regarding the value we place on the quality of human life could either result in a "New Enlightenment" age or signal the beginning of the end of what was a very noble experiment in democracy.

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How Many Hours of War Spending Would it Take to Fund Health Insurance?

"We the People" apparently have no problem with spending over $14 million dollars an hour to injure and kill others but can't scrape up the cash to provide health care for our own children. I know I'm repeating myself over and over, trying to present the information in a slightly different way each time, but the basic message is we better liposuction the lip-service and start proving what our priorities are with the real deal, cold hard cash.

It's too easy to blame Bush. Just as Hitler would be powerless without the Nazis, Bush would be powerless without "us". I didn't vote for Bush but I include myself as a "Bush supporter" because it took me far too long to catch on to his plans to eliminate the "New Deal" and shred the Constitution.

I sit safely at my desk typing whatever the hell I feel like without worrying about whether I am risking anything but my eyesight or if I'll hear my alarm clock tomorrow morning. At the same time, I realize all this freedom and security I enjoy could disappear in a flash if America becomes victim to another act of terror.

The opportunity cost of this war is incomprehensible. Not only are we paying out $3,850 per second to fight this war but the cost of what we could be doing with the time and energy devoted to this war is astronomical.

"That translates into $333 million a day, $14 million an hour, $231,000 a minute and $3,850 a second. Even for the world's richest country, this is serious money."

On top of what this war is costing Americans, the toll this war is taking on Iraqis is beyond comprehension.

"Many of the internally displaced Iraqis -- IDPs in the language of aid organizations -- live in grim conditions, in makeshift camps without running water, electricity, even latrines.

[...]

This summer, the Iraq Chief of Mission of the International Organization of Migration (IOM), Rafiq Tschannen, said "only a fraction" of internally displaced Iraqis were getting basic assistance. It was difficult to understand, he said, why there was so little response to appeals for help.

[...]

U.S. contributions to various relief organizations quadrupled in 2007, to just under $200 million from $43 million in 2006, pocket change in terms of the war's cost. The sharp increase makes Washington the biggest single donor in the refugee crisis, according to the U.S. Department of State.

As to the $85 million appeal by the IOM, made in June -- by September, the organization had received $6 million, 5 million from the United States and 1 million from Australia.

The shortfall, $79 million, would be covered by less than six hours of war spending.

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Child Dies From a Toothache...No Insurance.

In a wealthy country like ours no child should ever die from a toothache. Our government literally throws billions of dollars at Iraq without blinking an eye, and then cannot account for any of it, yet 45 million people in the United States do not have health insurance and cannot afford the most basic health care. I wonder how many people those billions of dollars unaccounted for, much of it in cash, could have covered?

Some poor children have no dental coverage at all. Others travel three hours to find a dentist willing to take Medicaid patients and accept the incumbent paperwork. And some, including Deamonte's brother, get in for a tooth cleaning but have trouble securing an oral surgeon to fix deeper problems.

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