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FROM SOAK THE RICH TO SOAK THE POOR: RECENT TRENDS IN HOSPITAL PRICING
Hospitals charged uninsured and self-pay patients 300 percent of their Medicare- allowable costs and 250 percent of the amount private insurers paid for the same services in 2004. The gap between rates charged to self-pay patients and those charged to other payers for hospital care has widened dramatically since the mid-1980's.
from Anderson G, Health Affairs 26, No.3 2007
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INSURANCE HORROR STORIES
When Steve and Leslie Shaeffer’s daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs. But shortly after Selah’s medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively. So begins a Sept '06 report in The LA Times titled "Sick but Insured? Think Again" which offers a series of similar horror stories, and suggests that these stories represent a growing trend: more and more health insurers are finding ways to yank your insurance when you get sick.
Have you asked, why is the health insurance industry growing rapidly, even as it covers fewer Americans? Between 2000 and 2005, the number of Americans with private health insurance coverage fell by 1%. But over the same period, employment at health insurance companies rose a remarkable 32%. What are all those extra employees doing? Now we know at least part of the answer: they’re working harder than ever at identifying people who really need medical care, and ensuring that they don’t get it. In the past, they mainly concentrated on screening out applicants likely to get sick. Now, it seems, they’re also devoting a lot of effort to finding pretexts for revoking insurance after they’ve already granted it. They typically do this by claiming that they weren’t notified about some pre-existing condition, even if the insured wasn’t aware of that condition when he or she bought the policy.
Welcome to the ugly world of American health care economics. The point isn’t that the insurance bureaucrats are evil or greedy. The fact is that cruelty and injustice are the inevitable result of the current rules of the game. Blue Shield of California is a nonprofit insurance provider, yet as a spokesman put it, if his organization doesn’t follow the for-profit practice of selectively covering only the healthiest people,
Every other wealthy nation manages to provide almost all its citizens with guaranteed health insurance, while spending less on health care than we do. And there’s no mystery why: we’re paying the price for pointless, destructive reliance on private insurers. Medicare, which is a universal health insurance program for older Americans, spends less than 2 cents of every dollar on administrative costs, leaving 98 cents to pay for medical care. By contrast, private insurance companies spend only around 80 cents of each dollar in premiums on medical care; much of the remaining 20 cents is spent denying insurance to those who need it.
See the archives or request a copy from the NYTimes of this article By PAUL KRUGMAN, September 22, 2006
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HEALTH SAVINGS ACCOUNTS (HSA) AND HIGH DEDUCTIBLE HEALTH PLANS (HDHP),
GAO estimated that HSA-eligible plan enrollees would incur higher annual costs than the common "preferred provider plan" (PPO) enrollees for extensive use of health care, but would incur lower annual costs than PPO plan enrollees for low to moderate use of health care. HSA-eligible plan enrollees generally had higher incomes than comparison groups. 51% of tax filers reporting HSA contributions had an adjusted gross income of $75,000 or more, compared with 18% for all tax filers under age 65 in 2004. [At the time it was first proposed, EINO said it was a health care benefit designed for the "relatively privileged and healthy" to enhance their privileges. GW MISSION ACCOMPLISHED]
Most participants said they would recommend HSA-eligible plans to healthy consumers. Some participants said they enrolled in the HSA-eligible plan specifically because they did not anticipate getting sick, and many said they considered themselves and their families as being fairly healthy. However, participants would not recommend these plans to people who use maintenance medication, have a chronic condition, have children, or may not have the funds to meet the high deductible.
To view this document from the Government Accountability Office (GAO) August 2006 CLICK HERE
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FAMILIES AFFECTED BY CANCER WHETHER WITH OR WITHOUT HEALTH INSURANCE OFTEN SUFFER SERIOUS FINANCIAL HARDSHIPS
One in four families affected by cancer say the experience led the person with the disease to use up all or most of their savings, and one in eight say they borrowed money from relatives. The illness also made it harder for some to find and keep health insurance - with about one in 10 saying they couldn't buy health insurance because they had been diagnosed with cancer, and 6% saying they lost their coverage as a result of the disease. Having health insurance at all times during treatment helped to limit the financial consequences of a cancer diagnosis, but even those with consistent coverage faced difficulties - one in five used up all or most of their savings, one in 10 borrowed money from relatives and 9% were contacted by a collection agency.
Among those who did not have health insurance consistently during their illness, the financial burden was even greater. More than one in four said that they delayed or decided not to get treatment because of its cost - five times the rate reported by those who had health insurance consistently. Nearly half used all or most of their savings; four in 10 were unable to pay for basic necessities; one in three sought the aid of a charity or public assistance program; and 6% filed for personal bankruptcy.
"This is one of the most disturbing of the hundreds of surveys we have done," said KFF CEO Drew E. Altman. [EINO: Yeah, and so when will KFF admit that we have a system of covering the healthy for most of their health needs until such time as they need regular, costly care? Then maybe Kaiser FF will put 5 or 10% of their funding into the kind of fundamental change that correcting our crisis would demand. Yeah, they'll probably do that once they're certain fundamental change is just a few months away. They're not all that disturbed!!]
For the Kaiser Family Foundation, Nov 20, 2006, USA Today/Kaiser Family Foundation/Harvard School of Public Health National poll CLICK HERE
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The tax cuts instituted by GW Bush since 2001 had totaled in excess $4 TRIL by the end of 2005 (in both personal and corporate tax cuts).
Additional cuts that GWB is seeking for 2006, including the repeal of the Estate Tax, will throw an additional $11.6 TRIL at the wealthiest few percent of Americans. This post 2005 additional tax cut that GWB is so certain the nation can afford could not only reverse the deficit of Social Security, but could resolve the shortfalls in Medicare and still have enough left to provide free prescription drugs for all Americans (not just partial coverage, of certain prescriptions, for just elderly Americans).
There are three major sources of federal revenue: personal income tax, corporate income tax and payroll tax. Since 1977 personal income tax has held steady at about 44.5% of total federal revenue, while the corporate tax share has fallen steadily from 14.4% to 7.4% (in 2003) and the payroll tax has grown from 29.9% to 40.0% according to data from the official US Budget (GPO, 2004). The payroll taxes surplus collected since 1983 (being more than the payout for Social Security and Medicare each year) were spent to offset general budget deficits, or the cost of reducing corporate taxes by half through 2003.
Payroll taxes are poorly understood by most Americans. They are a regressive tax, the greater your income the less you pay as a percentage. A household earning $270,000 per year pays the same payroll tax (or 1/3 the rate) as a household with an income of $90,000 a year, while someone earning $2.7 MIL pays about 3.3% of the $90,000/ yr family. Furthermore, its a myth that employers are paying half of the payroll tax. Employers consider the total cost of hiring (or retaining) each worker and that includes ALL taxes, if the share the federal government collected directly from them were much less that money would go towards other aspects of salary and benefits. Essentially, corporations collect any payroll taxes they must pay by reducing worker pay by the same amount.
The steady 44.5% share of federal revenue paid through personal income tax is itself very misleading. From 1965 to 2002 the effective federal tax rate nearly tripled for the US Median Income Family while it fell by 69% of its 1965 rate for the top 1% of earners by the year 2002. (US Treasury CBO and Erasmus book pg. 101)
Prior to 2001 the Estate Tax applied to only 2% (52,000) of the 2.5 million "head of households" who died that year -the other 98% of Americans had already been exempted from any such tax. Even for the 2% to whom the tax applied in 200 there was a $1.35 MIL exemption before the tax kicked in for the remaining inheritance. Under the current (2001) revisions by 2009 the exemption will rise again to $7 MIL and only some 2,400 Americans will be subject to any estate tax. Nonetheless, Bush and the GOP congress are campaigning heartily to save these 24,000 loyal subjects to the throne. [Not surprising, I suppose, if one is familiar with the personal achievements of the silver-spooned president.]
From Jack Rasmus "The War At Home: The Corporate Offensive From Ronald Reagan to George W. Bush", 2005, published by Kyklos Productions, San Ramon, CA, ISBN : 0977106209
Can look for the Institute on Taxation and Economic Policy for additional information
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Infant mortality is one of the most common statistics used to compare health care systems or changes over time. The era of "managed care" shows worsening African-American/ Caucasian health conditions.
From: Children's Defense Fund
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White (W), Hispanic (H) and Black (B) Physicians Taking on Patients with Reduced Access to Care
Black physicians are 40% more likely to care for uninsured patients and 70% more likely to care for poor patients than are white physicians.
From AJPH 1997 87:817
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Percentage of African Americans in the First Year of Medical School
While a preceding graphic showed that the underserved US populations depend on minority health providers, this graphic shows that the number of such providers has not been increasing.
From: RWJ Foundation 1987; JAMA 266:917 ; 272:698 ; 276:714 ; 278:744 ; 282: 844
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US ECONOMIST QUESTIONS IRAQ COSTS
Andrew Walker, BBC economics correspondent
The study includes costs official estimates do not
A Nobel prize-winning US economist has said the war in Iraq could
cost the US far more than official estimates. A study by Professor Joseph Stiglitz of Columbia University and
Linda Bilmes, a budget expert from Harvard, concludes the cost could
be two trillion dollars.
The figure is so large because it includes
costs that official estimates do not. The cost of the lifetime medical care for 16,000 injured American
personnel, for example. Some 20% of injured US personnel have brain
injuries, 6% have had amputations and another 20% have other serious
injuries. On the strength of evidence from previous conflicts, he said, still
others will have various health and mental problems in the future.
There will be disability pay and health care costs to the US budget
that will continue for several decades. His figures also include the loss to the economy from injured people
being unable to contribute as productively as they would other wise
have done.
From BBC world news: CLICK HERE
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VETERANS DENIED HEALTH COVERAGES
A quarter of a million veterans (263,257) were denied enrollment for VA health coverage in 2005, according to the Department of Veterans Affairs. The veterans exceeded the income limit (usually around $25,000 to $30,000) and did not have service-related injuries or illnesses. Additional veterans might not have even attempted to enroll because they were aware that they would not qualify. The VA suspended enrollment for such veterans in January 2003 to reduce costs (AP/Los Angeles Times, 1/24/06).
From the Associated Press story in the LA Times Jan 24, 2006
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HEALTH DISPARITIES BASED ON SOCIO-ECONOMIC INEQUITIES: IMPLICATIONS FOR
URBAN HEALTH CARE, by Kevin Fiscella, David R. Williams
ABSTRACT: Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article highlights the effects of institutional, individual, and internalized racism on the health of African Americans, including the insidious consequences of residential segregation and concentrated poverty. Health disparities are reviewed based on socioeconomic status across the life cycle, beginning in fetal health and ending with disparities among the elderly. Potential explanations for these socioeconomic-based disparities are addressed, including reverse causality (e.g., being poor causes lower socioeconomic status) and confounding by genetic factors. The article underscores social causation as the primary explanation for health disparities and highlights the cumulative effects of social disadvantage across stages of the life cycle and across environments (e.g., fetal, family, educational, occupational, and neighborhood). The article concludes with a discussion of the implications of health disparities for the practice of urban medicine, including the role that concentration of disadvantage plays among patients and practice sites and the need for quality improvement to mitigate these disparities.
This report was published in the scientific peer-reviewed journal Academic Medicine (2004) 79: 1139-1147 which you can find at your nearest medical library. The abstract should remain available online CLICK HERE. |
*1 Journal of American Medical Association 284
(2000):2325
*2 Analysis of Survey of Consumer finance data by Edward Wolff, published in the American Prospect of May 2003 pg. A5, article by Robert Kuttner
*3"Medicare as a Catalyst For Reducing Health Disparities"
June Eichner; Bruce C. Vladeck Health Aff. 2005; 24 (2): 365-375.
*4"Late Enrollment in Medicaid May Explain Worse Cancer Outcomes" NEW YORK (Reuters Health) Mar 15, based on Cancer 2005;103 |
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A 9/11 TRAGEDY EVERY TWO MONTHS
18,314 Americans Die Annually (in excess)
Due to Lack of Insurance (shown by age group below)
"Care Without Coverage", Institute of Medicine 2002
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WOMEN FORGOING PRENATAL CARE
After Knowing they are Pregnant
More than 11% of women fail to get timely prenatal care although they know they are pregnant
These children (and adults they become) may suffer lifetime of hardship for
treatable problems, not found during pregnancy.
This added cost to society has never been calculated, or figured into the savings to society of adopting universal health coverage.
From Morbidity and Mortality Weekly Reports May 12, 2000 Vol 49 Iss 393
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US BLACK: WHITE INFANT MORTALITY RATIOS
What kind of opportunities are we providing for American children? And what are we doing to demonstrate
that this is a country of opportunity for all? Shown below is the the ratio of mortality (1.0 would mean no disparity shown in infant mortality).
From Children’s defense fund
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INFANT DEATHS BY INCOME IN CANADA
Aren’t the poor health quality measures for the US just due to high poverty? Shown as deaths per 1000 infants. US overall average infant mortality rate is greater than even among the poorest Canadians.
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