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INDIVIDUAL RESPONSIBILITY FOR HEALTH CARE, DATA
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HEALTH SECURITY IN AMERICA, May 9, 2007
72% - The time has come for universal healthcare in America.
63% - We need universal healthcare in America, even if it means increasing taxes.
For this article from Catholic Healthcare West CLICK HERE
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KAISER TOLD TO REINSTATE COVERAGE
The Department of Managed Health Care ruled that Kaiser Foundation Health Plan illegally canceled coverage for a Northern California woman in urgent need of medical attention for large kidney stones. The cancellation was illegal, the agency ruled, because there was no evidence the woman intended to deceive the health maintenance organization about her medical history. The agency's action is the latest salvo in a growing controversy over cancellations of individual health insurance policies that have saddled patients with huge medical bills. With the order against Kaiser, all three of the state's largest health plans are now embroiled in the controversy.
Blue Cross of California recently settled more than 70 lawsuits and claims filed by patients who accused them of illegally canceling their coverage after they got sick. Suits have also been filed against Blue Shield of California. The woman and her family had Kaiser coverage through her employer for 20 years. When she left her job, the family purchased from Kaiser a continuation plan commonly known as COBRA that is protected by a federal law. After that expired, the woman and her family bought individual coverage from Kaiser.
Four months after the switch, the HMO dumped her. Kaiser claimed she omitted information about her health from the application the HMO required her to fill out when it sold her the individual plan. Kaiser also threatened to report her to law enforcement for fraud and billed her for $13,000 worth of treatment. The problem, regulators concluded, was that Kaiser faulted the woman for not disclosing an appointment she had for arm and neck pain with a Kaiser physician. The enrollee had no reason to believe that Kaiser was not on notice of her arm and neck pain at the time she filled out her Personal Advantage application. Not only did a Kaiser physician treat her . but Kaiser also filled and paid for her pain medication. [Like any other private health insurer they are experts in premium collection and in denying coverages. That's why they earn the big bucks. Don't expect help when you are sick or have an acute need.]
For a copy of this article By Lisa Girion, Los Angeles Times, October 19, 2006 CLICK HERE
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HOSPITAL SUES BLUE CROSS FOR PAYMENTS
A class-action lawsuit on behalf of all California hospitals accused Blue Cross of California of routinely violating state law by refusing to pay hundreds of hospitals statewide for patient care it authorized. Hospitals provided care to those Blue Cross patients in good faith. In many cases that care is pre-authorized by Blue Cross. When they cancel coverage after that care has been provided, that causes a problem for the hospital.
To view or request this article from the LA Times By Lisa Girion, Los Angeles Times, October 14, 2006 CLICK HERE
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PROBLEMS AMERICANS ARE HAVING BECAUSE OF HEALTH CARE COSTS
One in four Americans say that they or a family member in their household had problems paying medical bills during the past 12 months. That’s the highest share of Americans reporting a problem paying medical bills in a series of Kaiser surveys taken since 1997. Among those reporting a problem this year, 69% have health insurance.
About one in four Americans say that in the past year they or a family member have put off medical treatment because of its cost. Of those who delayed treatment, seven in 10 say that the care was for a serious medical condition. Among those with health insurance, 60% are worried about not being able to afford coverage over the next few years, with 27% saying they are very worried. More than half of those without health coverage say the main reason is because they can’t afford it, while another 15% say they can’t get it due to poor health, illness or age. In comparison, just 4% say the main reason they lack health insurance is because they think they don’t need it. Eight in 10 Americans say they are dissatisfied with the overall cost of health care to the nation. When asked about their own concerns about the health care system, cost comes out far ahead of quality. Four in 10 say that they are dissatisfied with their personal health care costs, compared with one in 10 who say they are dissatisfied with the quality of their health care. The Health Care in America Survey is a nationally representative survey of 1,201 adults conducted between Sept. 7 and 12, 2006. The margin of sampling error is plus or minus 3 percentage points for results based on total respondents.
These results are from the ABC News/Kaiser/USA Today Poll Spotlights, Monday, October 16, 2006
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THE RELATIONSHIP BETWEEN HEALTH PLAN ADVERTISING AND MARKET INCENTIVES: EVIDENCE OF RISK-SELECTIVE BEHAVIOR
By A Mehrotra, S Grier, RA Dudley
Health plans are often paid a fixed premium for each enrollee, regardless of the enrollee's health status. In such a situation, patients with chronic illnesses are a potential financial liability, because they are more likely to incur high costs. Compared with reducing costs or improving quality, risk selection is a relatively easier mechanism for health plans to increase profits. A substantial body of research demonstrates that Medicare managed care enrollees are, on average, healthier than Medicare fee-for-service (FFS) enrollees. Provisions in MMA attempt to deter risk selection, but there is concern that these provisions are insufficient and that health plans will still have an incentive to engage in risk selection.
We found that the use of ads that are attractive to healthy patients increased nationally from the 1970s through the 1990s as HMOs became more common and gained market share. Furthermore, in 2000, the use of such ads was more common in markets with higher HMO market share than in those with lower market share.
These correlations suggest that as competition increases, health plans attempt to risk-select through advertising. Health plans spent more than $70 million on newspaper advertising alone in 2000. The total advertising budget is MUCH higher if all media types are included. Our findings imply that health plans are using that advertising to attract healthier patients. From a societal and clinical perspective, these resources are being misused.
This article is from Health Affairs, May/June 2006 and may still be available CLICK HERE
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PUBLIC HEALTH PRINCIPLES FOR UNIVERSAL COVERAGE
Assuring universal coverage for health care will significantly reduce and redistribute the burden of health care costs that drives too many households into financial distress, including bankruptcy, at the same time reducing the social and economic disparities that contribute to many illnesses. Universal coverage is essential for a population-based approach to maintaining health, and preventing and treating illness. Such an approach includes understanding population health conditions and outcomes, and the ability to effectively recommend public health interventions.
In the early 1990's, the APHA Executive Board enunciated principles for use in evaluating proposals for health care reform, distilled from policies adopted by the APHA Governing Council over the years. They are attached to this testimony, and we are gratified to note how closely SB 921 addresses the concerns, as expressed in these principles. In summary, our principles call for:
A focus on population health, which requires universal coverage, and also comprehensive benefits that support disease prevention and health promotion, and support for a strong public health system;
Affordability, which requires financing based on ability to pay, without financial barriers to access including co-payments;
High quality, assured by both organizational and financial incentives, and planning by users and providers, and the efficient organization and allocation of services;
Accessibility, addressing cultural and geographic barriers to care;
and Publicly accountable and simplified administration, with a major role for state and local government agencies.
The New York City Public Health Association coordinated a study of other countries’ universal health care systems, and come to similar conclusions. That report is also attached below. It appeared in the January 2003 edition of the American Journal of Public Health, which also reports on the California Health Care Options Project.
The California Health Care Options Project clearly established that a single payer system, as proposed by SB 921, is the most direct, effective and cost-efficient program for achieving all of these objectives. We are grateful for Senator Kuehl’s leadership in assuring that the urgent issue of universal coverage, and this important policy solution, are once again receiving the significant attention they well deserve.
PUBLIC HEALTH COMMUNITY COMMITTED TO PROGRESS
Our members are enthusiastic in their support for SB 921. We note with great appreciation the interest of many California legislators in expanding health care coverage, through a variety of routes. The people of California and the nation have suffered too long from preventable illness and death in the face of an inhumane and inequitable health care system, one that cannot be justified in the face of our tremendous resources. We look forward to collaborating with Senator Kuehl and her colleagues to build support for SB 921, and also to working closely with other members of the Senate and Assembly who are motivated to make swift progress on this pressing problem. Then we can turn our attention more fully to dealing with the root causes of poor health and health inequities. Thanks again to the committee for holding this important hearing, and for the opportunity to speak.
California Public Health Association North
office@cphan.org
Southern California Public Health Association
scpha@earthlink.net
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| Ref-1 The Commonwealth Fund,
January 27, 2005, "
Half of Insured Adults with High-Deductible Health Plans Experience
Medical Bill or Debt Problems" CLICK HERE |
SHARE OF EMPLOYER BENEFIT SPENDING GOING FOR HEALTH BENEFITS
There are Hidden Public Costs in Health Care Crisis
Workers have given up other needed benefits, to maintain health coverage
From Employee Benefit Research Inst & US Dept of Commerce
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RACIAL DISPARITY WITH KIDNEY TRANSPLANTS
Percent of Adult Dialysis Patients (age 18-64)
Only Clinically Approved Patients Counted
From NEJM 2000 343:1537
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When Welsh health care economist RT Edwards spent a year in Seattle, she was overwhelmed by the choices available to her: for coffee, TV channels, ice cream flavors--just about everything. But her brush with illness caused Edwards to question the value of choice in health care. Edwards describes her experience navigating the US health system after she developed a serious sinus infection. Not only does she report having trouble tracking down a provider who would agree to accept her "comprehensive" health insurance, she says she even found it difficult to schedule a timely appointment. Choice--among health plans, providers, and treatments--can only work well in a competitive market in which consumers are fully informed, goods or services are homogeneous, and there is free entry into and out of the market. None of these conditions, she argues, exist in the U.S. health care system today. "[Choice] certainly is not a rational alternative to universal coverage or even wider basic health care coverage for all," Edwards concludes. "The market mechanism has not led to high-quality health care in the US, even for those with health insurance."
Proponents of the individual health insurance market and health savings accounts promise they can provide consumers choice among health plans, providers, and even treatments. Such policies are grounded in economic theory positing that the "invisible hand" of the competitive market can efficiently balance supply and demand. This can work when consumers are fully informed, goods or services are homogenous, and there is free entry into and out of the market. But, Edwards argues, none of these conditions exists in the U.S. health care system. Rather than freely choosing among providers, patients typically depend on their doctors to act in their best interest. Edwards cites a 2002 Harris Interactive survey of U.S. adults that found only 1% respondents had made a decision to change health plans, doctors, or hospitals on the basis of performance evidence.
Her entire essay may still be available: CLICK HERE
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1 For example in an article that appeared in the JAMA in the spring of 2004 it was shown that about half of all deaths in the U.S. can be attributed to largely preventable behaviors and exposures, with tobacco use and poor diet/physical inactivity accounting for the majority of preventable deaths. The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1 percent of total U.S. deaths), poor diet and physical inactivity (400,000 deaths; 16.6 percent), and alcohol consumption (85,000 deaths; 3.5 percent).
"Our findings indicate that interventions to prevent and increase cessation of smoking, improve diet, and increase physical activity must become much higher priorities in the public health and health care systems."
(JAMA. 2004;291:1238-1245.) |
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