Analyst, Center for Public Integrity; Former insurance company executive; Author
Got Health Insurance Through Your Employer? Maybe Not for Long (But Not Because of Reform)
Posted: 06/16/11 10:05 AM ET
The global consulting firm McKinsey & Company set off a firestorm when it released a report last week suggesting that 30 percent of U.S. businesses will stop offering health care benefits to their employees after most of the provisions of the Affordable Care Act go into effect in 2014.
The White House was quick to challenge the validity of the report, noting that McKinsey has so far refused to provide any details of the methodology used to reach its conclusion. All McKinsey will say is that its report was based on a survey of 1,300 employers and "other proprietary research."
White House deputy chief of staff Nancy-Ann DeParle, who previously headed the president's office of health care reform, called it an "outlier" and cited other studies predicting that that few if any employers would drop coverage because of the Affordable Health Care Act.
Congressional Republicans were just as quick to defend the McKinsey report, which they are citing as fresh evidence that the new federal law -- crafted in part to protect the employer-based system -- will have disastrous consequences.
Who's right? Well, pardon the cliché, but only time will tell. What we can say with certitude right now is that the hubbub over the McKinsey report has obscured a reality neither side is acknowledging. What is indisputably true is that the employer-based system has been crumbling for several years. And, with or without the Affordable Care Act, it's very possibly on its last legs. Repealing the law, as every GOP presidential candidate pledged to do during the debate in New Hampshire Tuesday night, would probably only hasten its complete collapse.
When I began working in the insurance industry in 1989, the vast majority of Americans -- well over two-thirds of the population -- got their coverage through employers. Just about every year since then, the percentage has been declining.
According to the Economic Policy Institute, the share of Americans with employer-sponsored health insurance declined from 64.2 percent in 2000 to 58.5 percent in 2008. Most of that decline occurred during the Bush administration, and before the most recent recession began.
The figure is undoubtedly lower today because millions of workers lost their jobs -- and along with them, their health insurance -- during the recent economic downtown. When the recession officially began in December 2007, the U.S. unemployment rate was just 5 percent. It peaked at 10.1 percent in October 2009, four months after the official end of the recession, but it is still more than 9 percent today.
Another factor in the decline of Americans with employer-sponsored coverage is that the number of businesses still offering it has also dropped precipitously in recent years. The Kaiser Family Foundation, which keeps track of health insurance trends, found that the number of firms offering coverage fell from 69 percent in 2000 to 60 percent in 2009. The erosion was even more pronounced among companies with fewer than 10 workers, falling from 57 percent to 46 percent during the same period.
According to Gallup, the situation has only gotten worse since 2009. In a November 2010 Gallup poll, just 44.8 percent of American adults reported having health insurance provided through their employer.
One of the less obvious reasons for the unraveling of the employer-based system is that an ever-increasing number of workers are taking a pass on the coverage even if their employers still offer it, according to the Employee Benefit Research Institute. Why? Because employers are requiring that their workers pay a bigger portion of the premiums, and they're making them pay more out of their own pockets in the form of higher deductibles and co-payments. Many workers simply can't afford to take on the additional financial burden.
The insurance industry has also played a leading role in the decline of the employer-based system. The reason more and more small employers are no longer offering coverage is because many of them have been "purged" by their insurance carriers. Insurers routinely "purge" employer customers they believe have become too much of a risk to profits. All it takes is one employee of a small business -- or the spouse or child of one employee -- to get critically ill for the company's insurer to jack up rates so high that the business owner has no choice but to drop coverage for everyone.
A survey conducted last month by Crain's Detroit Business of 300 Michigan small businesses found that 24 percent considered canceling their health care coverage this year, primarily because of premium increases demanded by their insurance carriers.
Behind all these numbers are real people. In the coming weeks, to take us from the abstract world of figures to the real world of American-style health insurance, I will be writing about the experiences of several small business owners who say they want to continue offering health care benefits to their employees but are finding it increasingly difficult to do so.
New York Times - June 12, 2011
By PAUL KRUGMAN
Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.
And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.
Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.
And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.
The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.
And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.
Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?
Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?
Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.
O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.
Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kinds of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”
The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.
As Republicans battle with Democrats and President Barack Obama over the future of the health care law, Donald Berwick, the administrator of the Centers for Medicare and Medicaid Services, is focused on something else.
"I go to work every morning with 100 million people in mind, Medicare and Medicaid beneficiaries," Berwick says, adding, "I can actually think about how to make things better for these people who depend on CMS to work in their interests."
Berwick, the former president and chief executive officer of the Institute for Healthcare Improvement, has been criticized by Republicans for his praise of the British National Health Service, as well as some of his past speeches and writings, which Republicans said showed that Berwick supported health care rationing – a charge he rejects. The controversy stalled his nomination and Obama moved Berwick into his post with a recess appointment last summer.
In a recent conversation with KHN's Mary Agnes Carey, Berwick discussed the agency's work with governors on Medicaid, how to make Medicare more efficient and what he's hearing from health care providers about a proposed Medicare regulation to create accountable care organizations, or ACOs, networks of doctors and hospitals that share responsibility for providing care to patients. This is an edited excerpt of that interview.
Q: Many state governors want federal officials to allow more flexibility on Medicaid. How is CMS responding to those concerns?
A: Each state is looking hard at Medicaid, which is a significant portion of state costs, and we need to be working with them to preserve the lifestyle and the well-being of the beneficiary and also to help the states with their problems. It's an area of a lot of work right now.
We have Medicaid action teams, which are available to any state. We'll be working together with states on the flexibilities they want and need, even while we are mindful of protecting the beneficiaries’ well-being and the proper stewardship of funding. We have many ways to help states and we are reaching out to them now.
Q: There's legislation pending on Capitol Hill that would waive the health law's maintenance of effort requirement for Medicaid. Are you concerned that proposal will become law?
A: I think it's important to maintain Medicaid coverage. The way out of the Medicaid dilemma is the same as it is for the rest of the American health care system, which is to improve care. Medicaid beneficiaries are very vulnerable. Their costs rise for the states as well as for them and the federal government when we don't properly coordinate their care, when we don't help them in their journeys through the care system. So we're focused on the improvement of care as the way to maintain the coverage and the well-being of the beneficiary.
Q: You're hearing a lot of complaints about the proposed regulation for accountable care organizations, or ACOs. Based on those comments, what changes might we see in the final regulation?
A: We're listening really closely. The comment period to me is exciting. Criticism is help. In this case, it's people coming at us with ideas about how to make the rule better. We'll be taking these comments very seriously so the final rule, I'm quite sure, will be improved over the current one from the viewpoint of the people we want to get engaged in the ACO world. We're on track to meet our deadline of having the program launch on Jan. 1, 2012. That's our goal and we're not giving up on that right now.
Q : You and others have been critical of Rep. Paul Ryan's "premium support" plan for Medicare. What's wrong with limiting the amount the federal government spends on beneficiaries?
A: I' not a fan of cutting care as the remedy to this problem. I think the focus should be on improving care and that's where the focus is. Most of the proposals I've seen on that side of the coin aren't about improving care at all. They are about shifting burdens to states and individuals who already are struggling to do the best they can. Medicare is a solid program. I go to work every morning with 100 million people in mind, Medicare and Medicaid beneficiaries. We're in a good partnership with states on Medicaid. I've got the back of the Medicare beneficiary. I can actually think about how to make things better for these people who depend on CMS to work in their interests.
Q: Short of major Medicare reform, what steps could the Medicare program take to reduce spending?
A: The main way we can work on costs while improving care is partnering with care providers. It's about pulling everybody together and deciding we are going to be cooperative with each other at getting what patients really want – better care at lower costs.
Q: You've given lectures to CMS employees. What do you talk about?
A: I want to help them understand more about how to improve their own work, and what it takes for a doctor or a nurse or a hospital to improve their work so we can be better partners with them. I've been teaching improvement. I've taught four, 90-minute classes, open to all employees. Those have been focused on quality and what's its nature and how does it improve? Customer focus, what does it mean to listen to a person you're trying to help? What Medicare does that can affect safety.
I'm a believer in that Gandhi quote, "You have to be the change you wish to see in the world." So we want health care to be continually improving, highly reliable, focused really on the needs of the people we're trying to help, joyful to work in. That's what we want from CMS, too, so we're working on internal change and external change.
Q: Your current recess appointment lasts until the end of this year. Have you had any conversations with anyone about your future?
A: This is a hard and exciting job. The way I'm dealing with the job is in the present. Every day, I'm going in and doing the very best I can do. The rest, what happens, happens. The [health care law] is a major, massive change in our policy opportunities. I really can work on behalf of improvement, which has been my life's work. And I'm doing that every day.
LCSP Annual Meeting
Greetings from the nation’s capitol! This past weekend, under the sponsorship of my local UAW-CAP Council, I attended the Labor Campaign For Single Payer (LCSP) annual meeting at the National Labor College in Silver Spring, MD. The meeting convened on Friday afternoon at AFL-CIO Headquarters in Washington DC. Joining us there were Congressmen John Conyers (H.R. 676) and Dennis Kucinich. Congressman Jim McDermott (H.R.1200) called in by phone. They all expressed their appreciation for advocates keeping the drive for universal health care alive and well in the wake of the federal Patient Protection and Affordable Care Act (PPACA) that passed last year. Also addressing the gathering was the President of the AFL-CIO, Richard Trumka. President Trumka expressed his support for further reforms needed in order to advance single payer healthcare. While we were always aware of the shortcomings of the PPACA, President Trumka, for the first time of which I am aware, publicly expressed his disappointment with the result and even publicly apologized to Congressman Kucinich for not having done more to support Single Payer. He pledged to rectify that going forward and pointed to the AFL-CIO endorsement of Senator Sander’s S.915, American Health Security Act of 2011, as a concrete example of that forward looking approach. I believe we are witnessing a positive change in the approach labor organizations will be taking on our issue.
Tomorrow, June 7, 2011, I have an appointment with Senator Sherrod Brown’s staff to make a more formal request for Senator Brown to co-sponsor S915, the American Health Security Act of 2011. Please call Senator Brown’s office (202) 224-2315 and voice your support. Though I didn’t get an appointment with Ohio’s Senator Rob Portman (202-224-3353) call and tell him as well. I’ll be dropping in to tell his staff! When you call, tell them: MEDICARE WORKS and you support MEDICARE FOR ALL, and you want the Senator to support the American Health Security Act of 2011 (S.915), which ensures that all Americans have equal access to comprehensive health care and frees patients from fear of medical bankruptcy while bringing skyrocketing costs under control. Our friends in the California Nurses Association and National Nurses United will be on the hill as well.
Columbus local action: Sponsored by Ohio Alliance For Retired Americans
What: “Hands off Medicare”—“Don’t Make Us Work ’Til We Die” – Walk and Press Conference
When: Thursday June 9, 2011 11:30 a.m-12:15 p.m. Gather at 11:15 a.m.
Where: Jerry Hammond Building – Franklin County Job Center
1111 East Broad Street, (Broad and Ohio across from Jenkins Terrace Senior Housing Complex) Columbus, Ohio.
Kurt Bateman, Director SPAN Ohio
New York Times, May 21, 2011
By ABBY GOODNOUGH
MONTPELIER, Vt. — Many people move to Vermont in search of a slower pace; Dr. Deb Richter came in 1999 to work obsessively toward a far-fetched goal.
She wanted Vermont to become the first state to adopt a single-payer health care system, run and paid for by the government, with every resident eligible for a uniform benefit package. So Dr. Richter, a buoyant primary care doctor from Buffalo who had given up on New York’s embracing such a system, started lining up speaking engagements and meeting with lawmakers, whom she found more accessible than their New York counterparts.
“I wrote a letter to the editor, and the speaker of the House called me up to talk about it,” Dr. Richter, 56, recalled recently. “It was astounding. In New York, I couldn’t even get an appointment with my legislator.”
Twelve years later, Dr. Richter will watch Gov. Peter Shumlin, a Democrat, sign a bill on Thursday that sets Vermont on a path toward a single-payer system — the nation’s first such experiment — thanks in no small part to her persistence. Though scores of people pushed for the bill, she was the most actively involved doctor — “the backbone,” Mr. Shumlin has said, of a grass-roots effort that helped sway the Democratic Legislature to pass it this spring even as other states were suing to block the less ambitious federal health care law.
“We wouldn’t be where we are without Deb,” Mr. Shumlin said in an interview. “She’s made this her passion. And like anyone that’s making significant social change, she has qualities of persuasiveness and leadership and good judgment that are hard to find.”
As in all states, the cost of health care has increased sharply in Vermont in recent years. It has doubled here over the last decade to roughly $5 billion a year, taking a particular toll on small businesses and the middle class. All 620,000 of the state’s residents would be eligible for coverage under the new system, which proponents say would be cheaper over all than the current patchwork of insurers. A five-member board appointed by the governor is to determine payment rates for doctors, what benefits to cover and other details.
But much remains to be worked out — so much that even under the most optimistic projections the plan might not take effect until 2017. Most significantly, Mr. Shumlin still has to figure out how much it will cost and how to pay for it, possibly through a new payroll tax. Whether he will still be in charge by 2017 is among the complicating factors.
“If we had the exact same Legislature and the same governor we could get it done,” Dr. Richter said. “It’s a big if, because the opposition has a ton more money to convince people that the governor is evil and this is socialized medicine and all kinds of other scary stuff.”
The opposition will probably include insurance companies, drug makers and some employers who say there are too many unknowns. Many doctors, too, are wary of the change and what it might mean for their income. Dr. Richter said she believed a “slim majority” of the state’s 1,700 licensed physicians were supportive.
“One of the bigger worries I have is we’ve had all this hoopla and nothing’s going to happen,” she said at a coffee shop here recently on a rare quiet afternoon. “But it might also be helpful to us, because it’s going to be hard for any opposition to be steadily pushing for seven years.”
The federal health care law has complicated Vermont’s plans, requiring the state to first create a health insurance exchange to help residents shop for coverage by 2014. The state would then need a federal waiver to trade its exchange for a government-run system.
Dr. Richter said she embraced the idea of a single-payer system as a young doctor in Buffalo, where many of her patients put off crucial treatments because they were uninsured. As a medical student, she saw a patient with a life-threatening heart infection caused by an infected tooth that had gone untreated because he lacked dental insurance.
“He was in the hospital for six weeks, and I was like, ‘This makes no sense,’ ” she said.
She went to a meeting of Physicians for a National Health Program, a group that advocates for a national single-payer system, and started researching the concept. Before long she became a vocal advocate, even becoming president of the physicians’ group, and moved to Vermont.
John McClaughry, a former Republican state senator who is against the new law, said Dr. Richter meant well but did not understand the “long-term damage” it would wreak. In particular, he said the law would drive away businesses that did not want to help pay for it. “She’ll tell you that putting in single-payer will attract businesses from all over the place,” said Mr. McClaughry, vice president of the Ethan Allen Institute, a conservative research group. “I don’t think she has any appreciation of business decisions at all.”
Since moving with her husband and two sons to a rambling old house within view of the State House, Dr. Richter has given about 400 talks on the single-payer concept, tutored lawmakers in the State House cafeteria and testified before the Legislature more times than she can remember. Once, she presented a printout of all the insurance companies her small practice in Cambridge had billed over five years.
“It was like 190 pages long,” she said. “Here we were, this tiny rural clinic having to bill all these different addresses. And all of them have different rules and reimbursements; I mean, it’s ridiculous.”
Some supporters of single-payer health care say Vermont’s law does not go far enough, mostly because it would allow at least a handful of private insurers to stay in the market indefinitely. Self-insured businesses like IBM, the state’s largest employer, could continue providing health coverage to workers under the law, though they would have to help finance the new system, possibly through a payroll tax.
Physicians for a National Health Program is among the critics, saying the law “falls well short of the single-payer reform needed.” Allowing private insurers to remain in the state will prevent meaningful savings, the group says.
Dr. Richter acknowledges that the law will not allow for “strict single-payer,” but said it still promised “health care for everybody, for less cost.”
“This is not the top of the mountain, but it’s the first time anyone has headed up the mountain,” she said. “No other place in the country has gotten this far.”
Today, it is official. Two amazing and courageous elected officials stood with nurses and patients to introduce legislation that moves beyond the current health reform effort and forward to a healthy system for all.
Sen. Bernie Sanders, I-VT, and Rep. Jim McDermott, D-WA, have been allies in the cause for decades. There are not young fellows in terms of legislative or life experience.
Both stood together to introduce the American Health Security Act of 2011 – single-payer, Medicare for All style coverage that would be administered by the states. S915 and HR 1200. Sound policy. Sound thinking. Perfect timing.
Rep. McDermott (D-WA) on the left and Sen. Sanders (I-VT) on the right.
We can all look at the statistics and the motivations of those who offer the numbers, but these two elected officials stand with us —the patients, the nurses, the workers, the people – as surely as night follows day. It is rare to see moments when the people’s business intersects with the political moment. And it is even more rare to see those elected officials who look to the needs of their constituents and the nation and stand up for policy that uplifts – even if some powerful financial interests see things another way.
The work ahead may be daunting, but with advocates like National Nurse United, and co-president Jean Ross, RN, standing in support of AHSA of 2011, S915/HR1200, the path seems navigable, if challenging. Jean was convincing and committed today as she mentioned her own son and his struggle to secure healthcare in the midst of the current for-profit system that often leaves patients left behind and nurses holding hands and hearts. “We hear the stories,” said Ross, “We hear what others do not.”
The American Health Security Act is also backed by the AFL-CIO and its 13 million members. Arlene Holt-Baker, executive vice president, spoke on behalf of the national AFL-CIO at today’s press conference.
Jean Ross, RN, NNU co-president
This was not an effort to criticize or condemn the Patient Protection and Affordable Care Act of 2010, said Sanders and McDermott, but the opportunity to move beyond and to finally realize the goal of workers all over this nation to provide healthcare as a basic human right to all.
As a patient and as someone who went broke (though supposedly fully insured), I watched today’s events with a combination of wonder and worry and praise. I continue to believe – even in the face of all evidence to the contrary – that with the help of the nurses we will achieve healthcare as a human right and we will do so without outright revolution because of lawmakers like Sen. Sanders and Rep. McDermott. We can do it if we stand together with enough clarity and enough solidarity.
My worry related more to the wonderful man I married who is in every way my partner in this struggle and who was at the moment of the press conference in consultation about his own most recent health crisis. Even with full coverage, it is still up to his supplemental insurance carrier to determine if the care his doctor wants to give will be approved. My worry for him would be so very much different if we would change the motivations from profit first to healthcare first. The American Health Security Act of 2011 reaches ever closer to that day.
Finally, I stood with labor leaders – and I am not one of their stature – who have worked so hard to advance anything related to healthcare reform and with whom I have sometimes had differences. But today, we stood as Americans who believe that working class people and our kids and our grandkids deserve the right to healthcare as a human right provided under the social insurance model and not as some privilege granted only to the wealthy and the powerful.
Great day. A celebration of life. The American health Security Act of 2011.
S915/HR1200 – Sen. Bernie Sanders and Rep. Jim McDermott. We can do this.
View Sanders News Conference
Read the AFL-CIO blog
Read about the event in The Nation
Last Tuesday I participated in a conference call with others from across the country that explored the progress within Vermont to enact a bill H202. Dr. Deborah Richter explained that the finance committee was poised to pass the legislation on to the full Senate within days and that the final vote could come as early as Friday April 22, 2011. As it turns out Vermont budget considerations pushed the consideration into this week.
Tuesday April 26, 2011 the Vermont Senate held final debate on and voted on H202 the Health Care Reform that will establish what will eventually be called Green Mountain Care. This law will initially establish an exchange in Vermont as stipulated under the Federal PPACA and form a board to organize health care provision in Vermont that will eventually evolve into a universal single payer system. For the first time in Vermont, health care will be considered a public good and human right. The final vote count in the Senate at 3:00 PM was 21-9 for passage. Since some provisions were added in the Senate, the full measure must be sent back to the Vermont House of Representatives for concurrence. The initial passage in the House was by a margin of 94-49 therefore passage of the amended bill on concurrence is expected soon. Hear Rachel Maddow interview of Vermont governor Peter Shumlin on this issue.
Kurt Bateman, Director
April 21st, 2011 9:51 PM
By Wendell Potter
Rep. Paul Ryan's plan to privatize Medicare would accelerate a trend started several years ago by corporate CEOs and their political allies to shift ever-increasing amounts of risk from Big Business and the government to workers and retirees.
If enacted, the Ryan plan would represent a windfall of unprecedented proportions for insurance corporations and other businesses.
For millions of average Americans, many of whom already are finding it impossible to save for retirement, it would represent financial calamity. The nation's middle class would pay dearly for Ryan's proposed shredding of the social safety net that Medicare currently provides.
Ryan, chairman of the House Budget Committee, wants to dismantle the Medicare program and replace it with a system of vouchers. Starting in 2022, the government would give the average 65-year-old Medicare beneficiary $8,000 a year to buy coverage from a private insurer. That's the amount health care analysts estimate will be what the Medicare program will spend on every 65-year-old in 2022 if the government doesn't turn it over to private insurance companies.
While that might sound fair on the surface, it would actually be a very bad deal for people who turn 65 that year, compared to those who turn 65 in 2021. That's because commercial insurance plans are much more expensive, and operate far less efficiently, than the current Medicare program.
The amount of money commercial plans actually spend to pay medical claims has been declining rapidly over the past several years while the amount they spend on administrative activities such as marketing and underwriting -- and to pay executives and reward shareholders -- has been increasing. That's why Congress included a provision in last year's health care reform law to require insurance firms to spend no more than 20 percent of their policyholders' premiums on overhead. By contrast, the current Medicare program spends just 3 percent of its budget on administration.
The nonpartisan Congressional Budget Office says the $8,000 voucher won't be nearly enough for seniors to buy comparable coverage from private insurers and pay the additional out-of-pocket costs that those insurers would require them to pay. The amount the average 65-year-old would have to shell out to buy private insurance in 2022, according to the CBO, will actually be $20,510. Seniors would have to pay the difference -- $12,510. If Medicare is not privatized, the difference would be $6,150.
Here's why this would be a dream-come-true for the insurance industry: The more health plan enrollees have to pay out of their own pockets, the less insurers have to pay for medical care. The money that insurers avoid paying out in claims goes straight to their bottom line -- and into shareholders' pockets.
Insurers have been shifting more and more of the cost of care to their policyholders over the past several years by enticing -- or pushing -- them into plans with ever increasing deductibles. This trend is part of what Yale professor Jacob S. Hacker called "the personal responsibility crusade" -- making people more responsible for the management and financing of the major economic risks they face -- in his 2006 book, The Great Risk Shift.
This crusade has been led by Republicans and insurance company executives who have been saying for years that the best way to control medical costs is for Americans to have more "skin in the game." That's an expression that former Aetna CEO Jack Rowe used often before he retired in 2005, the year he made $22.2 million. It was also a sound bite favored by the CEO I used to work for, CIGNA's Ed Hanway, before he retired in 2009. Hanway's total compensation that year was almost $111 million.
The problem is, most Americans have far less skin to put in the game than CEOs like Rowe and Hanway or even Rep. Ryan, who makes $174,000 as a member of Congress. The median household income in the United States was just $49,777 in 2009, which was down $335 from 2008.
That decline, by the way, was the continuation of another trend that began as the Clinton era was ending and the George W. Bush era was beginning. Median household income in the United States peaked in 1999 at $52,388 (adjusted for inflation). It fell more than $2,000 during the eight years of the Bush administration.
During that time, health costs rose dramatically. According to the Kaiser Family Foundation, the average annual health insurance premium for family coverage increased from $5,791 in 1999 to $13,770 in 2010. The average amount that workers contributed out of their own pockets for family coverage increased from $1,543 to $3,997.
With household incomes declining, Americans have had far less money to put into retirement. According to a recent survey conducted by Opinion Research Corp. for America Saves and the American Savings Education Council, less than half of current workers are saving enough to have a "desirable standard of living in retirement."
If workers are having this much difficulty saving for retirement, where in the world will they find the money to pay what Rep. Ryan would make them pay for Medicare coverage when they turn 65?
Ryan's "blueprint" is one that will take America back to the pre-1965 days when senior citizens were losing their homes and their farms to pay for medical care. They were becoming destitute -- and dying much earlier than they are today -- because insurers would not sell them coverage because they were too much of a risk to insure, and there was no safety net for them.
That's exactly the same place future senior citizens would find themselves if Ryan's plan to privatize Medicare ever becomes public policy. #
21 April 11
Earlier this week, The Times reported on Congressional backlash against the Independent Payment Advisory Board, a key part of efforts to rein in health care costs. This backlash was predictable; it is also profoundly irresponsible, as I'll explain in a minute.
But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to "make government health care programs more responsive to consumer choice."
Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car - and their only complaint is that it isn't commercial enough.
What has gone wrong with us?
About that advisory board: We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.
Hence the advisory board, whose creation was mandated by last year’s health reform. The board, composed of health-care experts, would be given a target rate of growth in Medicare spending. To keep spending at or below this target, the board would submit “fast-track” recommendations for cost control that would go into effect automatically unless overruled by Congress.
Before you start yelling about “rationing” and “death panels,” bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money. And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.
And the point is that choices must be made; one way or another, government spending on health care must be limited.
Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”
What’s wrong with this idea (aside from the grossly inadequate value of the proposed vouchers)? One answer is that it wouldn’t work. “Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.
But the fact that Republicans are demanding that we literally stake our health, even our lives, on an already failed approach is only part of what’s wrong here. As I said earlier, there’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.
Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.
That’s why we have medical ethics. That’s why doctors have traditionally both been viewed as something special and been expected to behave according to higher standards than the average professional. There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers.
The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.
On Saturday April 16th advocates for a universal single payer health care system for Ohio came together in Columbus. At the start of our day attendees were treated to a skit “911….It’s an Emergency” performed by the Not Ready for Prime Time SPANiacs. The premise was that of a call to 911 from a desperate homeowner whose house is being invaded and spouse accosted. Hilarity ensues when the operator must first identify the homeowner’s policy particulars including contract number, level of coverage, deductable and co-pays all while the intruder is threatening life and limb. Let’s hope John Q Public chooses the right network before it’s too late. Stellar performances were turned in by Drew Hellebrand, Debbie Silverstein, John Ross and Mary Nichols-Rhodes.
How preposterous that our disease treatment health care non-system actually functions in this way!
Donna Smith, CNA/NNU national community organizer, and PDA Healthcare not Warfare national co-chair then led the meeting through the torturous way in which too many Americans’ lives are turned inside-out by an insurance/medical complex when they fall ill. Donna’s powerful personal story as depicted in the Michael Moore documentary “Sicko” lays bare the lack of caring and empathy the health care industry shows for us all. Quoting Ms. Smith from a message she sent to the One Payer States collaborative today:
“I had the good fortune to spend the weekend in Columbus, OH, at the SPAN Ohio annual conference. It was an incredible reminder and affirmation of why we all came together in this collaborative effort a year ago in Wayne, PA. Ohio, like so many of our states, has well-informed and passionate advocates for single-payer healthcare, and also like so many of our states faces daunting challenges in moving forward in the current political environment. Yet, through the association with other states and with each other, potential for progress even in this period is made much stronger.”
David Steil, president of healthcare4allpa.org, business owner and former Pennsylvania state representative with the Republican Party made the next presentation which illustrated his realization that the best and most efficient way to make provision of the health care all people need is the single payer concept we all advocate. David’s 35+ years of management experience making products and meeting payroll have left him with no doubt what is needed. He expounded on the precepts that government exists to do what “we cannot do for ourselves”. He even quoted a French philosopher from 1762 who observed “Man is not free when deprived of education and health”. A concept we in SPAN Ohio have endorsed in our recognition of empathy as the soul of democracy. Who said there were none but Democrats that could support such a concept?
The afternoon sessions were dedicated the PPACA vs. HCFAOA, a seminar on lobbying techniques by our lobby committee co-chairs and Mr. Steil’s presentation on how to win the support of business leadership. Mr. Steil expressed his appreciation for the intense questions and stimulating dialog that gave him new energy for the work ahead at home in Pennsylvania. Vann Seawell, SPAN Secretary, and Barb Walden, SPAN Treasurer, did a fantastic job on the entire event.