No Recovery in Sight -- Unless We Pass Health Reform

A new study came out today from the UC Berkeley Center for Labor Research and Education called "No Recovery in Sight: Health Coverage for Working-Age Adults in the United States and California". The report claims that half a million people in California have lost their health insurance coverage during the recession:

As the economy sheds jobs during the current economic crisis, health coverage for working-age adults is declining precipitously. Since the start of the recession an estimated 3.7 million working-age adults have lost coverage in the United States, and 500,000 have lost coverage in California. In the absence of health-care reform, even if the economy fully recovers, the coverage rates for working-age adults will not return to pre-recession levels, and the number of those without coverage will continue to grow even beyond the current recession-induced increases.

The key term here is "In the absence of health reform" -- Californians are suffering from the recession already, and this report shows that things will only get worse in terms of health coverage if we do NOT pass health reform SOON. I have family members, and I'm sure you do too, who are one illness away from bankruptcy. Even people who have insurance are paying exorbitant monthly premiums but have such high deductibles that they can't even afford to use what they have.

The president and the Democratic leaders in Congress agree that it's an urgent problem. Intense efforts are underway in the House and the Senate right now to write a health reform bill that can be signed by the president before the end of the Summer. The urgency is there for a variety of obvious reasons -- for the reasons outlined in this new study, but also because once Congress returns from its August recess, half of the House start running for re-election in 2010. In past years, that phenomenon has caused good pieces of legislation to languish and even die in the latter part of the year.

The Democrats will do their best, but there are a few controversial issues that will need to be resolved before a bill can be passed. Here is my best effort at explaining what these are in plain English:

1. Will everyone be required to buy health insurance? If so, that's called an "individual mandate". During the campaign, then candidate Obama objected to the idea of requiring all adults to get health insurance saying that he thought people would want to buy it if it was affordable but you wouldn't have to force them to do it. The California health reform effort last year failed in part because of concerns people had about an individual mandate -- but Massachusetts has one and so far it has worked pretty well.

2. How much will we have to pay to get coverage if a bill is passed? Will it be affordable? What is affordable anyway? For many families, $500 a month for a family premium breaks the bank and keeps food off the table. No one knows the answers to these questions right now.

3. Can we reform the health insurance industry so that they can't refuse coverage if you've ever been sick? That is called "medical underwriting" and "pre-existing conditions". Last week, America's Health Insurance Plans (AHIP) and the BlueCross BlueShield Association (BCBSA) wrote a letter to the president offering to drop those practices if everyone was required to have insurance. It's a start. They certainly didn't offer to do that back in 1993 when the Clintons were trying to reform health care.

4. A lot of people think that if we offer health plans to people who don't get insurance through their employers, that there ought to be a choice between a private insurance plan and some sort of publicly administered plan. That "public plan option" is being fiercely debated in Congress right now. The private insurance plans worry that they can't compete successfully with a public plan for a whole lot of reasons I won't go into here, so they are opposing it. Look for this to be huge source of debate in the next few months. But do yourself a favor -- do your homework about it and don't believe everything you hear, like it would be socialism or government telling your doctors what to do. Read about the public plan idea and see if it makes sense to you.

5. Should our health care benefits be taxed? Or should the portion our employers pay be taxed? This is a hot potato for sure. The problem with this idea is that there is a LOT of money to be collected by taxing the benefits of people who have insurance to help pay for those who do not. Very tricky.

These are just a few of the issues that will need to be resolved before we get health coverage for everyone. Despite the fact that this is complicated, all you need to do to answer your own questions is look around you -- do you know someone who has insurance but still can't get the care they need? People who are a paycheck away from losing what they have? People who have to rely on the emergency room because they have no other way to get care? If you do, then you understand the meaning of "No recovery in sight" UNLESS we pass health reform.

Comments

[mentalpestilence]

Nationally, health care costs occupy close to 16% of the total GDP in the United States. Barr also notes that "governments at all levels - federal, state and local - are responsible for a combined 46% of all health care expenditures".

The 140 Billion that will go towards health care from the stimulus package is a nice gesture, but its not going to cut it. As Arnold Relman, MD exclaims in his book A Second Opinion, "the average rate of increase in health expenditures since the late 1960's has been between nine and ten percent per year, which is more than twice the rate of general price inflation".

Do you see the problem yet? Government obtains the money it needs for health care through acquisition of taxes, and taxes generally rise at the same rate as GDP growth. But Barr sagaciously points out "health care expenditures rise faster than GDP". Thus, the government and all purchasers of health care have historically been playing an unachievable game of catch-up. Unless major reform is considered in the financing, organization and delivery of health care we are only going to be running into short sighted dead ends. That is the challenge we face - as patients, doctors, health care practitioners, politions and citizens.

www.mentalpestilence.com

[LeftRight]

BUT, once we can get rid of the insurance companies, we will find that health care costs are NOT going up faster than inflation. Not to mention the fact that on day ONE we will find costs going down, because Medicare spends three cents for every dollar on administration. By contrast, your average insurance company spends 35 cents for every dollar!!

[kalerik]

Oops, supposesd to say "universal healthcare for everyone" in previous post!

[kalerik]

We have got to get rid of the FOR PROFIT insurance companies and have universal healthcare for!!!

My own personal story: My husband was offered the opportunity of a lifetime to take over and eventually buy a very successful business from an old family friend who is wanting to retire in a few years. The only catch - we would have to buy our own health insurance. We are a family of three (one child), all healthy and active, not overweight, don't smoke, basically nothing except allergies. We applied with Blue Cross/Blue Shield of Texas. My husband and son were approved, but I was denied because a few years ago I had a small implant put into my big toe because the joint was getting sore and stiff. This implant was completely successful and I've never had another joint problem, anywhere in my body. I was declined coverage by BCBS and told I was "high risk" because of this. Because of my BIG TOE. Unbelievable. So because of this, my husband is going to miss the opportunity of a lifetime. This system is the absolute worst. It has to have a terrible effect on business.

[TinseltownEda]

We often feel so powerless when it comes to shaping laws that affect us because we 'never know enough'. Linda Bergthold's article and her links (as well as the subsequent comments) taught me enough in 20 minutes to write my Senators. We may not be able to shape the bills exactly as we want them, but the more our Congresspeople and Senators hear from us, the bolder they can be. Our e-mails and letters help 'sanitize' the words 'universal health care' and 'single payer' from the dirt and lies heaped upon them by the greedy. Once our reps understand that we are not afraid of these words and, in fact, WANT this kind of health care system, they can fight harder for the kind of health care this country needs and will prosper with. E-mail them now, before you get distracted! You don't even need to write a paragraph -- just type 'Vote for Bernie Sanders Health Care Bill' in the Subject line. It will go a long way to having an effect.

[DocTwain]

We needed single payer: it's cheapest and best.
But our politicians are too corrupt for that.

So what should be our goals?

1. There must be a public option. This is a no-brainer. The administrative costs (overhead, marketing, excess corporate executive remuneration, and PROFIT) of a private insurance plan average around 20%; the administrative cost of Medicare, which has no marketing, profit, or grossly overpaid executives, is only 3%. Thus private insurers unnecessarily devour 17 cents of every dollar paid to them in premiums--which otherwise would have paid for needed care. A government option, simply put, would save taxpayers a whole lot of money.

2. There must be a mandate: everyone should be covered. This creates a bigger pool and guarantees health care to everyone who needs it.

3. Private insurers must accept applicants with preexisting conditions and must charge everyone the same for the same coverage, regardless of health status.

4. Generous income-based subsidies should be provided to the working class. The extra funds should not come from taxing existing health care benefits, but from a progressive increase in income tax on the wealthy. The reason for this is that many employees with lower incomes who receive benefits simply cannot afford to pay more in taxes; their incomes have stagnated or decreased over the last decade, while the cost of premiums has increased. Tax the people who can afford to pay, whose incomes increased fantastically over the last deacde, and who've been chronically undertaxed: the rich.

[SelenicMagick]

As to your point # 2... A mandate WILL deny those who wish to opt OUT the CHOICE of doing so. How PRECISELY will you reconcile the loss of freedom of choice? AND How PRECISELY will that impact the argument that abortion is about "freedom of choice" when you have knowingly and willingly given up "freedom of choice" with regards to all things medical.

With regards to your point # 4... At some point those taxes WILL become high enough so that there is no incentive to create anything which might create what someone else perceives to be "wealth". How PRECISELY are we to define "wealth"... As an example... My grandmother was a VERY POOR woman... and yet because of LAND her estate is worth more than a million dollars. She NEVER made enough money to do anything other than look UP at the Federal poverty line.

[LeftRight]

You're TOTALLY right!!! We need to remove those pesky public safety laws! You don't want clean water? That's fine! You don't want clean air? No Problem! You don't want health insurance? GREAT!

The fact of the matter is that we are going towards single payer, in which case everyone will be insured ANYWAYS, so the mandate is a red herring anyway! As long as there's a public plan available (expand Medicare....) then there's no problem!

[DIdaho]

Here's precisely how you reconcile the loss of freedom with choice. You're a citizen. I thought the Iraq War was stupid. I've since concluded it's also immoral. And whether you agree or not, I think it was not just a mistake of intelligence, it was a willful chain of lies that put us into that war, and it's resulted in the deaths of thousands of Americans, the maiming of tens of thousands of Americans, and the deaths and maiming of hundreds of thousands of Iraqis.

So, I don't have to pay for it, right? I can OPT OUT, right? And anybody's who's a pacifist can completely OPT OUT of paying for any of the defense budget, right?

Nope. This is our country. We're in it together. And nowhere is that more true than health insurance. Unless everybody is in the pool, it doesn't work. Read a little further in these posts. There's a guy under a death sentence because he has diabetes and cannot get insured. If we don't have several dozen healthy people paying in but not drawing out, nobody can afford to cover him, private or public.

We already spend, right now, more tax money on health care than any country in Europe. We just don't get any return for it. Our model of private health insurance is destroying our economy. It is destroying jobs. And it is literally killing people. We owe it to each other to do better.

[SelenicMagick]

Having taken the time to read the public plan I can honestly say that it is the "best" of what have been so far the WORST of this far less than honest National discussion.

Healthcare is defined as: "The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions." That is NOT what has been under discussion... What has been under discussion (and the ENTIRE "public plan" is a continuation OF that decided lack of honesty) is something called COST. Cost is defined as: "An amount paid or required in payment for a purchase; a price."

HONEST people admit that what is under discussion is health COST rather than health CARE. EVERY portion of this discussion has been framed in reference to COST rather than CARE. Those of us who dare to point out the LIE that this is NOT about CARE but rather about COST are routinely crucified for doing so or accused of all manner of nefarious motives. Which is more nefarious... LYING about a National discussion or pointing out the LIE?

[LeftRight]

Well it's not really a lie, since to most people the COST of health care is the reason why they aren't GETTING health care...... Therefore to discuss the COST of health care is pretty reasonable....

[SelenicMagick]

Then be HONEST and call it a debate about controlling the COST of healthcare instead of continuing to LIE and say that it is a discussion about healthcare!

[SelenicMagick]

It is neither reasonable NOR honest when 100% of the discussion is about COST and 0% of the discussion is about CARE.

[RoloTomassi]

I think it is reasonable to say that this discussion is limited not by choice but by necessity; there are indeed many factors that should be a part of the discussion, but because we are dealing with healthcare as a commodity rather than a human necessity the cost issue is forced to the forefront.

It must also be noted that there are various factions that resist change for their particular niche in the system, and much of the needed discussion is hampered by egotistical posturing by these factions, and again, much of it is financial in origin--many doctor's want to maintain high income rates, pharmaceutical companies want to maintain their absurd profit margins, Insurance companies want to keep their foul grip on the system secure, and healthcare corporations want to keep hospitals in the role of human profit factories.

The bottom line is that we have to settle the issues of cost and means of application before these entities will show any concern whatsoever on the plethora of care issues that plauge the system.

But your point is well taken, and I have to say that if we are left with a situation where healthcare insurers remain primary players in the system, we are likely to end up with a poorly compromised half-measure that satisfies no one.

[SelenicMagick]

It would be FAR better to address the plethora of OTHER problems which drive the cost of health care up FIRST. You cannot address the cost of premiums for health insurance without addressing the COST of drugs and the COST of hospital care which is ever increasing due to the COST of the drugs involved since those costs are the excuse that the insurance industry uses to justify increased premiums in many cases.

[DIdaho]

"The private insurance plans worry that they can't compete successfully with a public plan"

Well, that's the long and short of it, isn't it? Why is it that those who preach that competition is the best economic policy are those most against public insurance plans?

This is, logically, very simple. Expand medicare, and tax what's necessary to cover everybody. Yes, it will increase that tax. But paying an extra $90 a month to replace a $400 a month policy will save money for everybody. And we pay increased taxes now, because the uninsured still get sick and the cost is shoved onto the backs of states in medicaid, which taxpayers ultimately pay anyway.

Will the government, then "stand between you and your doctor" and decide what to cover, maybe refuse to pay for expensive treatments? Of course. But private health insurance companies do that NOW - and which would you prefer, that a government bureaucrat (and therefore accountable) do that, or that some suit looking to squeeze an extra 2% profit do that?

You want better, or different? Fine. Just like public education, if you can afford it, send your kids to private schools. If you can afford better insurance, more choice, expensive procedures, go for it.

There is no question what policy we should have. There is only the question of the political will to do it.

[txkayrose]

It is past time that we (as a whole) realized that the insurance companies have become bloated, overgrown leaches on our health-care system. While it is possible to have a symbiotic system, that would require that the insurance companies act as responsible stewards of our health-care dollars. As I understand from other articles, this has been offered to them, and they balked. Apparently, that isn't profitable enough for them. I say, if they don't want to be a part of the solution, there is no place for them. We are seeing, in big, bold, technicolor, what greed and recklessness at the executive level creates. I prefer a single-payer system, but would be satisfied with a public/private plan. Some insurers would be able to compete. MOST would fail and disappear. As long as there is a not-for-profit public plan available, I'm ok with either system.
Oh, and all those folks telling you that 'socialized medicine would allow the government to dictate your care' FAIL to mention that the insurance companies already do that.

[RoloTomassi]

As with the absurd attitude towards Wall St. bankers and the current financial system, we are handling healthcare insurers with kid gloves; meanwhile GM and UAW get a boot in the a$$ and their contracts are likely to be rendered meaningless, rather than seen as holy writ.

Really, this is wholly impractical madness; HEALTHCARE INSURERS ARE OBSOLETE. They need to be completely eliminated as a prime factor in the healthcare equation. It is a long and valid tradition that obsolete industries and corporations be phased out when they no longer contribute to a positive outcome.

HR 676 is the only real, viable solution for healthcare, yet we dance around these insurance cretins in the same way that we allow the Wall St. bankers to continue calling the shots; once again we are allowing those who have run this ship aground to stay at the helm.

[tonyn999]

Very nice summary of where we are now. Thanks!

[Linda Bergthold - Huffpost Blogger]

Check out this organization --being helped by a PR firm who brought us the Swift Boaters -- Conservatives for Patients' Rights -- http://www.nytimes.com/2009/04/02/us/politics/02scott.html?_r=1&hp -- Richard Scott has money and he is spending it scaring Americans about the prospects of ANY government role in health reform. Many of the comments in this post rail against the insurance industry, but where is the outrage against organizations like CPR (and isn't THAT a clever acronym?)?
Many of the comments to this post point out real and dramatic failures of our health care system. I do not disagree that we need to reform the way care is delivered. I am just trying to point out that the way we pay for and finance health care in this country leaves out so many people and burdens even the ones who have coverage.

[npkincaid]

I have been a mom with two children--and NO health insurance. I have taken a sick child to a doctor's office only to be turned away despite my promise to pay for treatment. But no insurance card meant no service--period. It was sobering, humiliating and infuriating to have my child refused care. I remember thinking--if this is happening to us, how many others are having the same--or worse--experiences? We have insurance now--but I am ever mindful of all the people who do not. This country can do better. We have to.

[PlaceboStudman]

And your post points out a tragic tendency in this country. That it is now more beneficial to be a person without health care, who is only worried about a broken leg or a stubbed toe, or pneumonia, than it is to be a person with good or even very good health care insurance who is dying due to the poor quality of health care delivery, at any price.

[transparent]

Health Insurance companies should be redesignated to non-profit status. Bonuses to employees who qualify should be based on increase in client base. This would create competition for services provided and force patient care to be a priority.

This may cost upfront as we buy out private investors, but think about how much we are paying now as we pay for the ridiculously expensive coverage provided for every state, county, city and federal employee.--both working and retired. I wish somebody would do the numbers on what that is costing tax payers-- not to mention the "emergency" room coverage county hospitals must provide for treateable problems like strep throat that the uninsured don't get treated with personal physician.

[tomasedison]

they should get a 10% fee for processing legit claims
and a 50% fee for all the waste, fraud and abust they uncover, fix and prosecute

[transparent]

Good Idea!

[PlaceboStudman]

Can we do that with the FDA too and their approval methods of approving drugs which later have to be taken off the market because they cause more medical problems than they treat?

[fricodam]

MA health reform works pretty well? I would lough if I don't want to cry. I am from MA, since the reform took place our premium was raised again , and this year 10% coinsurance was added to the policy. Now we are paying the "second mortgage" for our health insurance. Isn't going "pretty well" ? Sure . For the insurance companies
Yes, most of the MA residents are covered, but on who's expense?
Do not let them to trick you - you won't be able to afford it and on the top have to pay a FINE if you can't afford it. And , guess what - insurance companies just love MA health reform. What a shame!
In the front of me is a peace of paper that I got from the radiology lab. If I pay directly for a mammogram, without any health insurance involved it will cost me $150. If I pay with my insurance - $370. Go figure.
I am agree as a hell.

[Lynwood Walker]

Yea the mandate idea really sucks in Mass. I go to school in Cambridge, and though I have relatively decent coverage through my school, I see what friends of mine go through with MassCare.

The mandate is just silly. Their is no guarantee of across the board decent care. The companies must offer plans for every tax bracket and you are fined if you refuse to pay or cant afford. However, for really poor people, the benefits that come from the cheap plans make it not worth having. The deductibles are insane, and some of the poorer plans only cover things like ER visits. Otherwise, stay as far from a hospital as you can or you will be paying debt until you die. I think plans like the Mass one are just the easy way out for craven politicians.

If we are serious about fixing health care then we need a government run plan that provides all citizens with the same level of care regardless of income. I don't trust mandating that everyone has healthcare and that they go to a private company to get it. All that is doing is creating another government sanctioned monopoly, and as has been proven time and time again, government sanctioned monopolies tend to be wasteful, overpriced, businesses that provide subpar services.

[econ1]

"government sanctioned monopolies tend to be wasteful, overpriced, businesses that provide subpar services."

Sort of like public schools, the post office, Amtrak....­....hmmmmm­.

[PlaceboStudman]

Could we please start having a conversation about how bad our health CARE is, before another word is spoken about the cost of health care? If I hear one more story about nursing home or hospital neglect, or how people are dying from liver and/or kidney failure due to the unnecessary cost boosting additives, fillers and preservatives that are added into our pharmaceuticals, I am going to scream. If it weren't for the fact that I'm chronically disabled and now terminally ill, partly due to the aforementioned organ failure caused by the medications I've taken, I would swear not to pay another red cent for the care I'm being given.

How many medication recalls have we faced recently when FDA approved drugs have been taken off the market, because they caused previously unknown ailments and injury which could have been better detected with better oversight?

Personally, I blame the FDA for being understaffed and under funded to be able to adequately monitor what goes into our medication, and I blame the government for underfunding the FDA to allow them to have the appropriate oversight to make sure that people aren't dying from the products that they approve

[NoFactsJustTruth]

I would suggest that health insurance lobbyists be banned from the entire reformation process, or any savings from a 'reformed system' will end up in the pockets of the 'undustry' they bribe for, exactly as seen in the republican't and AARP 'prescription drug handout' - to the insurance and the pharmaceutical industries.