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Reports from 2003, other than Kaiser and Commonwealth
MOST AMERICANS DON'T WANT HEALTH INSURANCE TO BE PROVIDED BY FOR-PROFIT COMPANIES
Thirty-one percent (31%) of the U.S. public thinks that government should provide most health insurance, 25% say non-profit organizations should do so. Only 22% would prefer for-profit insurance. A 42% plurality thinks that universities should conduct most medical research, followed by 16% who thinks companies should do so.
Read more on this Wall Street Journal/Harris Interactive PollCLICK HERE
NOT JUST A TRAGEDY: ACCESS TO MEDICATIONS AS A RIGHT UNDER INTERNATIONAL LAW, Yamin, AE, Boston University International Law Journal. 2003;21: 325-371.
The main articles of international human rights law that apply to access to medications are presented and discussed as an urgent matter of social justice addressing current inequalities. The "Right to Life" is discussed in detail regarding its recent history of expansion as a concept. The connections of this basic right to other basic human rights is also discussed and the obligations of states are then discussed under several international and USA signed agreements. Much of this discussion focuses specifically on the HIV/AIDS crisis, but is easily related more generally to medications and health care. Human rights, it is concluded, provides a set of principles according to which laws, policies and programs can be evaluated and reformed.
It is posted and free to download CLICK HERE
U.S. DEPARTMENT OF HUMAN SERVICES PUBLISHES HEALTH QUALITY REPORT: CANCER DEATH RATES ARE GREATER FOR AFRICAN AMERICANS AND LOW-INCOME AMERICANS
The Health and Human Services Department has found a higher death rate for cancer among blacks and low-income Americans in its review of the nation's health care system. Those groups are less likely to be screened for certain cancers and less likely to avail themselves of other preventive services, according to the two studies released Monday by the department. The reports also found low-income people are less likely to have a regular doctor and more likely to visit the hospital for conditions that could be treated elsewhere.
Summary of DHHS Quality Report at CLICK HERE
INSTITUTE OF MEDICINE'S HIDDEN COSTS, VALUE LOST: UNINSURANCE IN AMERICA
This report explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare. The estimated benefits across society in health years of life gained by providing the uninsured with the kind and amount of health services that the insured use are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year. The report does not include any savings from avoiding current administrative waste, negotiating pharmaceutical prices, regulating excessive lucre by health plan executives or other savings that would arise from a redesigned system of universal coverage.
Summary at IOM CLICK HERE
A survey of likely U.S. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border. Relative to the large volume of these procedures provided to Canadians within adjacent provinces, the numbers are almost undetectable. Hospital administrative data from states bordering Canadian population centers reinforce this picture. State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross- border care-seeking arguments. The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care.
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Profit from Pain: Where Prescription Drug Dollars Go
Details on CEO salaries and benefits, real pharmaceutical industry expenses on research and marketing. Provided by Families USA.
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this report
Americans overall are spending more these days for prescription drugs for three main reasons: We’re using more prescription drugs, new drugs (which tend to be costly) are emerging to treat diseases and prices for existing drugs are going up. This report by the Alliance for Retired Americans takes away the mystery. Offered free in ACROBAT.
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Health Care to Consume 18% of Income in 2002, Massachusetts,
by Alan Sager, Ph.D. and Deborah Socolar, MPH, Directors, Health Reform Program, Boston University School of Public Health
Rising costs and stagnant incomes are likely to boost health spending's share of Massachusetts personal income to 18.1 percent this year, the highest in at least a decade and up from 15.8 percent in 2000.
Although slightly over 17 percent of personal income here went for health care from 1993 through 1995, health care's share dipped steadily to 16.4 percent in 1999 and to 15.8 percent in 2000. But according to new estimates from Alan Sager and Deborah Socolar, directors of the Health Reform Program at the Boston University School of Public Health, the reductions of the previous eight years have been more than erased in 2001 and 2002 alone.
"Health care spending this year will impose the biggest burden in at least a decade on the pocketbooks of all who pay for care in Massachusetts-patients and their families, employers, and government," commented Sager.
View entire report at their website. CLICK
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ONE OUT OF EVERY 5 AMERICANS SUFFERING FROM THE CRISIS OF UNINSURANCE
Institute of Medicine, September 2002
The collective well-being of our nation threatened, since it rests, in part, on providing conditions for families to succeed in raising the next generation of Americans.
Fifty-eight million Americans - one fifth of the population - either don't have health insurance or are adversely affected by the fact that a family member doesn't have coverage. One in five families have at least one member who is not covered by health insurance.
``The stress of having even one uninsured family member can ripple through the household as other family members cope with their relative's illness, high medical bills and financial distress,'' said Dr. Arthur Kellerman, co-chairman of the panel that authored the report. ``Even in the healthiest of families, if one member has an accident, the resulting medical bills can affect the economic stability of the whole family''.
``Being without health insurance causes more problems for people than we would normally think,'' said Robert Blendon of the Harvard School of Public Health and a member of the panel that created the report. ``People think you can always walk into an emergency room or a free clinic, but that's not really the case,'' he said. People who are uninsured also tend to postpone medical care until symptoms are more developed and the disease is harder to treat, the report states.
Download or View entire report at IOM. CLICK HERE
DRUG INDUSTRY USES FRONT GROUPS FOR MULTI-MILLION DOLLAR CAMPAIGN BACKING REPUBLICAN INCUMBENTS
The American Prospect Vol 13, Iss 19. October, 2002.
Connecticut voters can be forgiven for asking themselves "who are these guys" after being inundated with radio and television spots sponsored by . Ads, by two senior-citizen groups that few had heard of before, tout the Republican-backed Medicare prescription-drug bill that narrowly passed the U.S. House of Representatives in June and go on to lavishly praise two Republican House incumbents.
The tag lines credit the United Seniors Association and the 60 Plus Association. Neither of those groups has anywhere near the resources necessary to run the spots. It's not surprising that PhRMA uses groups such as United Seniors as fronts. The drug industry's faltering image took an extra whack in Connecticut after Pfizer Inc. took tens of millions of dollars in free land and tax breaks and destroyed a neighborhood in downtown New London to build a new research facility. A front-page story in The Wall Street Journal in early September documented how dozens of local businesses and institutions lost millions of dollars investing in schemes tied to redevelopment plans that never materialized.
Download or View entire report at American Prospect. CLICK HERE
AFL-CIO RENEWS DRIVE FOR COMPREHENSIVE HEALTH CARE REFORM
AFL-CIO Executive Council Actions
The deepening health care crisisoccupies center stage in the life of the nation and in the lives of millions of Americans - an urgent situation that requires the union movement to show unstinting determination and unwavering leadership in leading a renewed campaign for comprehensive health care reform that will ensure affordable, high quality health care for all. No issue is more important to the men, women and children who have no health coverage or to the ever-growing ranks of those who are at risk of losing it. For unions and their members, health care is at the top of the bargaining agenda.
The economic downturn that is being aided and abetted by the failed policies of the Bush Administration is wiping out incremental gains in health care coverage achieved in the late 1990s. Once again, it falls to the American unions to mount the campaign for comprehensive health care reform.
In contract negotiations large and small, we need to hold the line against employer attempts to push health costs onto working family budgets. At the grass roots, we must demand action from both state and federal legislators to constrain costs, expand access to coverage, level the playing field among employers, and improve the quality of care.
As much as anything else, we need to turn the 2004 elections into a referendum on whether all Americans should finally be able to get affordable, high quality health care with their right to choose their own doctor.
A large and growing number of Americans have no health insurance at all: 41.2 million people had no insurance in 2001, 1.4 million more than the previous year. Out- of-control health care cost increases are putting enormous pressure on job-based health plans. State- based health insurance programs are threatened not only by spiraling costs but also by the growing state fiscal crisis and the lack of help from the federal government. And Medicare recipients still have no access to a comprehensive prescription drug benefit through that universal program.
Job-based health insurance is a critical but fragile source of coverage for Americans. Health care cost pressures are placing big strains on employer-sponsored plans, and many employers are reacting by passing costs onto workers and cutting back on coverage. Health care costs are rising at rates that cannot be sustained. Benefits experts expect the costs of employer-sponsored health plans to increase at double-digit rates for the third straight year in 2003 - by as much as 15 percent or more. Health care costs could double in just five years if that rate continued.
One Hewitt Associates survey found that many employers are likely to pass along at least 25 to 30 percent of these price hikes to their employees. A Kaiser Family Foundation survey of employer-provided health benefits similarly found that employers dealt with cost increases by passing along premium hikes to their employees. On average, worker premium costs increases by 27 percent for single coverage and 16 percent for family coverage in 2002. Three-quarters of the employers the foundation surveyed said they are likely to pass along even more costs to workers in 2003.
Health care cost shifting inevitably adds to the ranks of the uninsured: An earlier AFL-CIO study found that between 1989 and 1996, premium cost shifting accounted for 75 percent of the decline in employment-based coverage.
Workers are fighting to preserve hard-won health benefits at companies across the country - like GE, where 20,000 workers struck for two days in January to protest cost-shifting and like the Peterbilt company, where 700 workers have been locked out since the day after Labor Day. Workers are also fighting to win health coverage for those workers whose low wages and high health costs makes insurance unaffordable, such as janitors in Boston as well as other cities and hotel workers in Chicago.
Prescription drug costs are likely to lead to deep cuts in or elimination of retiree health coverage. Drug costs constitute 40 to 60 percent of employers' retiree health care costs, and steep price hikes are prompting employers to eliminate drug benefits, cap their contributions or drop their obligations altogether. The Kaiser Family Foundation survey found the share of large employers offering retiree coverage declined from 66 percent in 1988 to 34 percent in 2002. A significant share of employers that continue to provide retiree coverage has passed along substantial cost increases to retirees.
In addition to soaring costs, public need-based programs for the uninsured are facing increased demands for services during the economic downturn and the worst state financial crisis since World War II. The Kaiser Commission on the Uninsured reports that 40 states expect shortfalls in their fiscal year (FY) 2003 Medicaid budgets, and 49 states and the District of Columbia are implementing FY 2003 cost-containment plans for Medicaid spending. In California, Connecticut, Massachusetts, Missouri, Montana, Nebraska, Nevada, New Jersey, Oklahoma, Tennessee and Washington, at least one million people, largely in working poor families, stand to lose health care coverage altogether if the cuts proposed in these eleven states are implemented fully. And the crisis will only worsen next year when Medicaid enrollment is predicted to grow 7.7 percent on average because of the sluggish economy.
After so many years of talk in Washington, D.C., Medicare recipients- seniors and disabled workers - still do not have access to an outpatient prescription drug benefit as a standard feature of the Medicare benefits package. Beneficiaries desperately need a prescription drug benefit to address the significant role that prescription drugs play in modern health care and the soaring costs of drugs. Enactment of a truly comprehensive prescription drug benefit also would relieve some of the cost pressures being felt by state Medicaid programs and employer-sponsored retiree health plans.
The health care crisis confronting the nation demands real leadership, but President George W. Bush has failed to offer constructive responses to the countryââ'¬â"¢s health care challenges. Instead, he is playing a shell game with families'Medicare and Medicaid benefits and putting forward private insurance proposals that threaten to weaken the security of workers'health benefits.
The administration's proposal to change Medicare - by spending $400 billion over the next 10 years to create a prescription drug benefit within the Medicare+Choice program and propping up the floundering Medicare+Choice managed care program - is deeply flawed and falls short of meeting seniors' pressing needs. The president's plan forces seniors to leave the Medicare coverage they trust and turn instead to profit-motivated Health Maintenance Organizations (HMOs) for both their drug coverage and their basic health care. That means insurance executives rather than Medicare would decide how much to charge and what to offer.
Far more than the $400 billion the president proposes is needed to provide a meaningful drug benefit to seniors. According to the Congressional Budget Office's newest projections, the cost of outpatient prescription drugs for Medicare beneficiaries over the next 10 years (2004-2013) will total $1.84 trillion.
The president's plan also would not appear to reduce cost pressures on employers that provide drug coverage for their retirees. A key design feature of any drug plan is whether and to what extent it provides cost relief to existing employer health plans that provide prescription drug coverage to retirees. Although very few specifics have been shared with the public on the administration's plan, if it tracks last year's Republican congressional proposals, it will not provide any such relief because employer contributions do not count as payments that trigger Medicare coverage.
The states and their residents who depend on Medicaid for basic health coverage desperately need help from the federal government. But the president's response, outlined in his FY 2004 budget, is a proposed Medicaid block grant that provides no real financial relief for the states and leaves beneficiaries open to harsh benefit cuts and, for some, elimination of health coverage.
The president calls for an additional $12.7 billion in Medicaid funding over seven years - $3.25 billion in FY 2004 - but the added resources are limited to states that agree to convert to a Medicaid block grant with capped funding regardless of the number of new beneficiaries joining the program. States that prefer to continue under the existing program are ineligible for additional assistance. The president describes his approach as giving states a "choice," but at a time when states are starved for resources, "coercion" is a more apt description.
In fact, even states that go along with the president's plan will get no increase in funding over the next 10 years. The extra resources the president proposes stop after seven years; thereafter, participating states essentially are required to pay them back as federal Medicaid contributions decline.
The administration's flagship proposal to address the growing ranks of the uninsured - a refundable tax credit for the purchase of health insurance, costing $89 billion over 10 years - fails uninsured Americans and jeopardizes job-based coverage for low- and middle- income workers.
The proposed premium credit assistance ignores the high costs of individual polices and the difficult circumstances facing those most in need. According to a recent study by the Center for Studying Health System Change, premiums for individual policies in 1998 and 1999 ranged from $1,452 a year for a young adult (age 18 to 29) in excellent health to $3,276 per year for an early or near retiree (age 55 to 64) in poor health. Under the Bush plan, an individual who had $20,000 in annual income and no dependents would be eligible for a $556 premium credit, only slightly more than one-third the cost of the least expensive policy. Maximum benefits under the Bush plan are available only to individuals who earn $15,000 or less per year (in modified adjusted gross income) and who have no dependents and to all other filers with $25,000 or less in income.
The Bush tax credit proposals also threaten to undermine job-based coverage for low- and moderate- income workers. If young, healthy workers believe they can find adequate coverage with the tax credits, they may abandon employer-sponsored plans. As a result, employers' risk pools would dry up and lead to higher per-worker insurance costs for those who remain. Some employers - especially those with predominantly low-wage workforces - may eliminate their health insurance plans altogether and urge their workers to rely on the Bush premium credits even though they may be inadequate.
President Bush's proposal to create Association Health Plans (AHPs) raises troubling questions. AHPs are described often by proponents as a panacea for small businesses trying to purchase affordable coverage in an era of double-digit health care inflation. In fact, proposals, such as President Bush's, that would exempt AHPs from state regulation would do little to address the current small employer insurance crisis and would leave all working families paying more for less health coverage.
At best, AHPs would offer minimal benefits that are attractive only to young and healthy workers, raising costs for older and sicker workers remaining in other group health plans. The Congressional Budget Office has estimated that less than 1 percent of the uninsured will gain coverage through AHPs and four out of five workers in small firms will see their premiums increase.
To the extent that younger, healthier workers migrated to AHPs on the promise of lower costs, traditional group insurance coverage would see costs rise dramatically, especially for small and medium size firms, where costs are already rising over 20 percent per year. Insurers in this market, notably Blue Cross Blue Shield, believe that the group insurance market could be destroyed as a result, an outcome that many independent experts also believe possible.
At their worst, AHPs are at high risk for fraud and abuse. The strong consumer protections and solvency standards that exist in every state must be there to safeguard working families from the health insurance scams that have left millions of dollars in unpaid medical bills and thousands without coverage.
Far better alternatives to the president's flawed proposals exist. Congressional proposals to establish a meaningful Medicare drug benefit, with substantial cost relief for employers, are being advanced, as are proposals to lower prescription drug costs for all purchasers by making it easier to bring generic drugs to market. The AFL-CIO remains convinced that only comprehensive, national health care reform will solve the problems of health care cost, coverage and quality. A special challenge exists at time in recruiting employer support for comprehensive reform. In this regard, the work of the National Coalition on Health Care is especially important.
Congressional proposals have again been put forward that would require most, if not all, employers to provide health benefits or to enroll all Americans in a single, unified system of health care funded by contributions by employers and workers. National unions and labor movements at the state level, along with their community allies, are on the leading front of initiatives to expand coverage and reduce costs.
At the same time, the lack of leadership in Washington is leading states to tackle comprehensive reform at their level.
A number of states are exploring statewide health care reform, using a variety of models. In Wisconsin, the state labor federation is garnering support for a payroll-tax based system (similar to the states' unemployment insurance program), which would serve four purposes: first, extend coverage to all workers and their families; second, constrain costs by having all employers, union plans, and major public programs purchase care through a single insurance pool; third, level the playing field between employers who provide benefits and those who currently freeload; fourth, provide a platform for introducing proven methods of improving quality and reducing preventable medical mistakes. Though details remain to be worked out, preliminary cost estimates indicate that the plan is an affordable way to expand coverage without compromising care. Importantly, the Wisconsin approach preserves options for collectively bargained plans to expand on the basic coverage under the state program, either by providing richer benefits or absorbing greater shares of workers' costs.
The labor movement is working on coverage initiatives in other states, as well. A pay-or-play proposal, which would require employers to provide a minimum level of coverage or pay into a state fund, has been developed by the California Labor Federation and introduced in the California State Senate. A single-payer proposal is also being introduced in California, with considerable union backing. Other state labor federations also are developing new approaches to expanding health coverage at the state level.
State labor movements have also been major players in local efforts to control drug costs and to make drugs more affordable to seniors and low-income individuals. Spurred on by the groundbreaking Maine RxHealth law, numerous states have passed or are considering programs that use their states' bulk purchasing power to negotiate steep discounts on drugs. For example, the Washington State AFL-CIO is leading an effort to enact legislation that will create a statewide prescription drug purchasing pool that includes public, private and individual purchasers.
Unions are also seeking to use pooled purchasing arrangements to reduce overall health care costs. The American Federation of Teachers, for example, is promoting group purchasing for its members' health care through both voluntary cooperative agreements and statewide legislation.
Recent efforts to collect and report quality data on health care providers are an important step in promoting improved quality and reducing costs. The U.S. Department of Health and Human Services, under the leadership of Secretary Thompson, has led the way in health quality measures with its ground-breaking work on nursing homes and home health. In addition, efforts by hospital associations to report hospital performance measures represent meaningful progress.
AFL-CIO affiliated unions are playing singular roles in negotiating for programs that measure and control quality of care, reduce errors and address chronic disease and wellness. Their experience is that the front-end investments in these programs reap savings in the long run, both in overall program costs and quality of life for active and retired members and their families.
Unions are working directly with employers to reduce the rate of medical error in hospitals that contract with their plans, by agreeing to certain patient safety measures through contract language and through participation in national coalitions such as the Leapfrog Group. Implementation of the group's three top safety recommendations - requiring computerized entry of doctors' medication orders, evidence-based hospital referrals and staffing of intensive care units with doctors trained in critical care medicine - has been shown to reduce medication errors by 50 percent in the former case and to reduce the risk of death by 30 percent and 10 percent, respectively, in the latter two.
Unions also play an active role in the National Quality Forum, an outgrowth of the Clinton managed care commission that was created to develop and implement a national strategy for health care quality measurement and reporting. Other unions have developed new measurement tools on their own or in conjunction with local or national efforts such as the National Committee on Quality Assurance and the Foundation for Accountability. Finally, several unions and employers are working together in labor - management committees to jointly select providers based on agreed-upon quality measures.
Collectively, all of these approaches to quality and safety are designed both to improve patient outcomes and to reduce health care costs.
Now, even more than in the past, the AFL-CIO believes strongly that universal coverage is the best and ultimately only way to achieve the goal of extending affordable, high quality health care to all Americans. Until we are able to move to such a system, the AFL-CIO and its affiliated unions, along with state federations and central labor councils, will:
Maintain a broad-based and focused educational and informational campaign about the crisis in health care, targeting activities at the national, state and local level;
Explore and analyze the cost, feasibility and strategies to provide comprehensive, high quality and affordable health care to all Americans,
Continue to support federal legislative and regulatory initiatives to cut health care costs, improve quality and expand coverage, including efforts to enact an affordable, comprehensive prescription drug benefit within Medicare that is available to all beneficiaries and that recognizes and supports the contributions of employer- sponsored retiree plans,
At the federal level, seek waivers and other appropriate legislative and regulatory measures that will allow states to engage in responsible innovation designed to boost coverage, improve quality and lower costs,
Oppose irresponsible strategies that will not ultimately lower costs, improve quality or expand coverage, including specifically proposals such as President Bush's individual tax credit and AHP plans that threaten to undermine existing health coverage,
Oppose efforts to block grant the Medicaid program, while also pushing for more federal support to help states meet demands under their Medicaid programs and to expand coverage under State Children's Health Insurance Program to reach more low income children and their parents,
In bargaining and otherwise, urge our employers to join the union movement in backing and participating in campaigns and initiatives designed to boost health care coverage, reduce costs and improve quality,
Through legal actions and otherwise, resist efforts by industry giants and their trade associations, including the Pharmaceutical Research and Manufacturers of America, to block adoption and implementation of prescription drug plans and other initiatives, and
Host three regional meetings this spring and summer (one in the northeast, one in the Midwest and one on the west coast) to explore further the crises in health care bargaining and in health care in general, and to assist unions in health benefits bargaining and in broader public policy work.
NEARLY ONE OUT OF THREE NON-ELDERLY AMERICANS WERE UNINSURED FOR ALL OR PART OF 2001-2002
Families USA prepared a report, based on Census Bureau data, and found that 74.7 million Americans under 65 years of age - almost one out of three (30.1 percent) - were uninsured at some point during 2001-2002. Almost two-thirds (65 percent) of these uninsured people were without health coverage for at least six months, and nearly one-quarter (24 percent) were uninsured throughout the two-year period.
Ron Pollack, executive director of Families USA:
"The findings in this report should represent a sea change in the way we think about the uninsured. Now that almost one out of three non-elderly Americans experienced significant periods without health insurance, the uninsured problem is no longer simply an issue of altruism about other people, but it is also one of self-interest for us all.
"As the 75 million who were uninsured over the past two years reflect, working families are increasingly at risk of becoming uninsured - whether due to a pink slip from a job, unaffordable cost increases, or cutbacks in employer and public health coverage.
"With large and growing portions of the U.S. population becoming uninsured, we are moving towards a political tipping point that will require real and meaningful action to expand health coverage."
Download or View entire report at Families USA. CLICK HERE
SEVERAL OTHER RECENT DOCUMENTS
About 25 percent of the uninsured - 9.6 million people -are employees or dependents of employees at large firms with more than 500 workers. For example, at Wal-Mart, the nation’s largest private employer, new hourly workers must wait six months to sign up for benefits, and part-time workers must wait two years. Uninsured Wal-Mart employees cost California an estimated $20.5 million annually in health care costs. High cost-sharing requirements also restrict access to benefits. 46 percent of all low-income workers go without health insurance for at least part of the year. Meanwhile, about one in eight U.S. firms reimburse their executives for out-of-pocket medical expenses, in some cases even as their companies are cutting back on basic medical coverage for lower-level employees. (Commonwealth Fund, 10/22/03, Wall Street Journal, 5/20/03; NOW with Bill Moyers, 12/19/03, www.pbs.org/now/politics/walmart.html )
Compassionate Conservatism? The U.S. Supreme Court ruled unanimously that the state of Texas must comply with a 1996 ruling that it improve health care services for 1.5 million children on Medicaid. Texas families filed class action lawsuits in 1993 and 1998 to force the state’s program to meet federal standards, but the Texas attorney general, under then-Governor George W. Bush, appealed and tied up changes to the program in litigation for a decade (Arizona Republic, 1/15/04).
In fiscal year 2003, 25 states restricted eligibility for (Medicaid. States also cut benefits (18 states), expanded the list of drugs requiring prior authorization (32 states), increased cost-sharing (17 states), and froze or cut payments to doctors and hospitals (41 states), according to a survey by the Kaiser Family y Foundation. Medicaid covers 51 Million Americans. Increased enrollment of the elderly and disabled accounted for 60 percent of the growth in Medicaid spending over the past two years. Rising prescription drug costs also hurt the program (Kaiser Commission on Medicaid and the Uninsured; Pear, New York Times, 9/23/03).
The tomb of the uninsured soldier?: About 164,000 Category 8 Veterans - those with incomes over $30,000 and health conditions unrelated to their military service will not be permitted to begin receiving treatment at VA health care facilities. Over 100,000 veterans are waiting an average of six months for an initial appointment for a physician. While the number of veterans seeking services rose 66 percent from 1996 to 2002, the system’s funding rose about 35 percent (Chicago Tribune, 5/1/03).
Should this be called insurance? About 750,000 workers and their dependents at companies like Lowe’s, McDonald’s, and Wal-Mart have limited benefit health insurance plans. Limited benefit plans cost as little $40 a month and are often capped at $1,000 in benefits per year, leaving the workers unprotected in the event of a serious accident or illness. In addition, enrollees often face restrictions such as co-payments, deductibles, and waiting periods for pre-existing conditions. Sales of such plans are growing by 20 percent a year as premiums for comprehensive coverage continue to skyrocket and brand name insurers (Allstate, Safeco and CNA Financial) enter the cut-rate health plan market (Wall Street Journal, 5/14/03).
Emergency room patients at Los Angeles County-USC Medical Center regularly wait as long as four days for a bed, and some die before receiving critical medical treatment, according to sworn declarations by the hospital’s physicians. County-USC diverted ambulances 75 percent of the time in 2002 because it lacked beds, up from 25 percent in 1999. Some of the preventable deaths included a 40-year old woman with a pulmonary embolus who was kept in the ED for more than 30 hours because an ICU bed was not available; a 75 year old woman with broken hip who had to wait a week for surgery because o lack of beds and developed a blood clot; and a 30 year old pregnant woman with gallstones forced to wait 10 days for surgery who developed sepsis. She lived but her baby die (Los Angeles Times, 4/23/03).
U.S. health spending jumped 9.3 percent in 2002, to $1.6 trillion ($5,440 per capita), . percent of . In 2002, health spending grew 5. percentage points faster than the overall economy. The increase in health spending in 2002 (up 9.3 percent) was higher than in 2001 (up 8.5 percent) and marked the sixth consecutive year in which health spending accelerated.
Insurance overhead (one component of administrative costs) rose by a whopping 16.8 percent in 2002, after a 12.5 percent increase in 2001, making it the fastest growing component of health expenditure over the past three years. (CMS Press Release, 1/8/04 and Health Spending Rebound Continues in 2002, Levit, Health Affairs, January/February 2004, 147-159).
The Big Three automakers spend over $9,000 per worker on health care. GM’s medical, costs are about $1,200 per car. The absence of a national health system means that the Big Three take on social responsibilities that the government bears in Japan and Germany. Princeton economist Uwe Reinhardt called the U.S. automotive industry a social insurance system that sells cars to finance itself’ (Hakim, New York Times, 7/14/03).
A report on health care disparities issued by the Agency for Healthcare Research and Quality was rewritten by Bush administration officials to make it much more positive and upbeat. Instead of concluding that persistent disparities in the diagnosis and treatment of cancer, heart disease, AIDS, diabetes, mental disorders and other conditions are national problems that are pervasive with huge societal costs, the revised report concluded that some socioeconomic, racial, ethnic, and geographic conditions exist. In addition, the revised report replaced passages about the costs of health care disparities with ‘‘successes’’ such as ‘‘lower rates of hospitalization from influenza for Hispanics, and that Black and Hispanic patients are more likely to report that their provider usually asks about medication from other doctors. The rewrite also reduced the number of times the word disparity appeared, from 30 times to only two. (Vedantam, Washington Post, 1/13/04; Rovner, CongressDaily, 2/10/04)
A comprehensive bibliography of studies of racial and ethnic disparities in health care is now available on the web site of Physicians for Human Rights at wvw.phrusa.org. The site also includes a compilation of more than 400 detailed annotations on key studies across a spectrum of diseases (The Right to Equal Treatment, PHR, 9/03).
Senate Majority Leader Bill Frist owns more than $25 million in stock in HCA, the nation’s largest for-profit hospital company (formerly ColumbiaIHCA). HCA was fined $1.7 billion in 2003 for defrauding Medicare, the largest fraud settlement in U.S. history. Frist’s conflict of interest did not prevent him from voting for Medicare legislation favoring for-profit health care providers. Frist has another conflict of interest: HCA is the sole owner of the nation’s fifth largest malpractice insurance firm, Health Care Indemnity (HCI). HCI underwrites $260 million in malpractice premiums, including insurance for HCA hospitals and doctors. (Center for Taxpayer and Consumer Rights, www.consumerwatchdog.org 7/6/03
More HMO millionaires (2002): H. Edward Hanway, chairman of Cigna, received a $6.7 million cash payment in April, 2002, as part of a three year compensation agreement, in addition to his salary of $1 million that year. Larry Glasscock, CEO of Anthem, the for-profit Indianapolis firm that bought out several not-for-profit Blue Cross & Blue Shield plans, received $6.9 million in pay and $23 million in stock options in 2002. He received $12.4 million in compensation in 2001 after the firm’s initial public offering (Managed Healthcare Market report, 4/15/03).
More HMO Multi-Millionaires (2003): UnitedHealth Group’s CEO William McGuire and president Stephen Hemsley reaped huge gains ($84 million and $34 million, respectively) by exercising just 10 percent of their total stock options in mid-2003 (Managed Healthcare Market Report).
More Corporate Healthcare Millionaires (2002): Executives of for-profit hospital chains and specialty care facilities also reaped millions. The highest paid CEOs in 2002 (including cash and exercised stock options): Jeffrey Barbakow, Tenet ($117 million), Richard Scrushy, HealthSouth ($1 12.3 million), Alan Miller, Universal Health Services Hospitals ($20.3 million), Sam Brooks, Renal Care Group ($7.4 million) and others. (Modern Healthcare, 8/4/03)
The nation’s two largest health insurance trade groups are merging. The American Association of Health Plans (AAHP) and the Health Insurance Association of America (HIAA) spent $9.3 million on lobbying last year (excluding what individual insurers spent directly). The groups recently lobbied for (and won) billions in subsidies for Medicare HMOs, and for delivery of the new Medicare drug benefit through private insurers (with much higher overhead than Medicare). The two trade associations have a combined budget of $40 million and about 200 staffers to canvas Capitol Hill. Karen Ignagni, CEO of AAHP, will head the new group (Gerber, The Hill, 9/23/03).
Maine passed a major health reform bill on June 13, 2003 with the intention of making health insurance affordable to most of that state’s 180,000 uninsured residents by 2009. The bill will allow individuals, the self-employed, and small businesses to buy into a state-sponsored group plan that will also cover all state employees. Participation in the plan is voluntary, and benefits have not yet been determined. Employers who want to buy-in will be required to pay 60 percent of the premium for their workers, and the state is hoping to subsidize premiums for individuals earning less than $27,000 and families of four under $55,000. In contrast to most states, which are tightening their Medicaid eligibility rules, the bill also seeks to expand the MaineCare Medicaid program. Provisions for financing the Dingo Health Plan and holding down costs are still being developed, but do not include known-effective measures such as single-payer financing to garner administrative savings, negotiated fees for services and medications, or global budgets for hospitals. Instead, the state is proposing using $52 million in emergency aid from Congress to the states (a one-time measure), a 4 percent tax on insurers gross revenues and a voluntary one-year cap on prices by insurers, doctors, and hospitals. Meanwhile, a single-payer bill is still under consideration in Maine, and advocates have gained the support of a large coalition of small businesses. Stay tuned. (Maine Lawmakers Approve Plan for Universal Coverage, New York Times, 6/13/03)
Americans favor health reform at record levels, exceeding a previous high before the 1992 presidential election. Nearly three-fourths (74 percent) of Americans say that the health care system is not meeting the needs of most U.S. residents, and 70 percent say they are willing to pay higher taxes to support universal health care, according to a survey of 2,000 residents conducted by Republic pollster Bill McInturff and Democratic pollster Stanley Greenberg. Although support among Democrats was higher, a majority (54 percent) of Republicans also favored raising taxes; the median amount that respondents said they were willing to pay was $200, up from about $70 in 1992. In addition, the percentage of Americans saying that the health care system was meeting their individual needs (60 percent) was down from 1992. Health care tied with terrorism and national security as the issue voters said should be the highest priority for Congress and the president (American Hospital Association poll, CongressDaily, 1/14/03).
Nearly half (49 percent) of physicians support governmental legislation to establish national health insurance, compared to 40 percent who are opposed, according to a survey of 3,200 U.S. physicians. Support is highest among pediatricians, psychiatrists, general internists, physicians with more than 20 percent of their patients in Medicaid, and physicians with inner city practices. Support is lowest among anesthesiologists and surgical sub-specialists. Fewer respondents (26 percent) supported a national health insurance plan in which all health care is paid for by the federal government. However, among the 49 percent of all physicians supporting governmental legislation to establish national health insurance, 71 percent of primary care physicians and 58 percent of specialists supported having all care ‘‘paid for by the federal government.’’ (‘‘Support for National Health Insurance among U.S. Physicians: A National Survey. Ackermann and Carroll, Annals of Internal Medicine, 11 / 18/03).
The Corporate Transformation of Medicine and Its Impact on Costs and Access to Care, JP Geyman, JABFP003;16:3:443-454. 105 references. PNHP Board Member Dr. John Geyman examines the rise and impact of investor-owned, for-profit health care in the two decades since Arnold Relmarn, former Editor of the NEJM, warned that the emerging medical industrial complex would put profits before patients.
The Dismal Failure of Medicare Privatization, by CaPA member Thomas Bodenheimer MD, MPH. A 20-page report summarizing the evidence against Medicare HMOs with 45 references. Includes illustrative cases from seniors in California HMO’s with care disrupted, denied, and delayed (Senior Action Network, June 2003, www.SeniorActionNetwork.org).
Soaring Health Care Costs Sinking Employer-Based Benefits 12 pages. Produced by Jobs with Justice’s (JWJ) Washington, DC headquarters for use in labor struggles over cuts in employer-sponsored coverage. JWJ supports single payer national health insurance and is planning events for March 4, 2004 in several cities (www.jwj.org, info@jwj.org)
Quality of Care in Nursing Homes: An Analysis of Relationships among Profit, Quality, and Ownership by Charlene Harrington RN, PhD et al, Medical Care, 2003, Volume 41;12:1318-1330. (Harrington is the lead author of PNHP’s proposal on long-term care, A National Long-term Care Program for the United States: A Caring Vision JAMA, 12/4/91).
Taiwan’s New National Health Insurance Program: Genesis and Experience So Far by Tsung-Mei Cheng, Health Affairs, May/June 2003, 23:3:61-76
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