The Cost of Dying, 60 Minutes, November 22, 2009

60 Minutes presented an outstanding program that tells the story in human terms about how our country manages to waste so much money while not properly caring for those we love at the end of life. If you missed the program, take 14 minutes of your time to watch this outstanding piece of excellent TV journalism.

The Cost of Dying, CBS TV 60 Minutes, November 22, 2009

Two News Stories that Help to Make It Clear Why We Need Comprehensive Health Care Reform

Big insurers spend much less on medical care than previously reported

Dow Jones Newswire reports that a US Senate Commerce Committee investigation found that the six largest US health insurers spent less on medical care than what industry officials estimated. Of the total amount received in premiums by the companies in the individual insurance market, 74 cents of every dollar were spent on medical care, according to a review of publicly available of data on industry earnings. Meanwhile, America's Health Insurance Plans estimated that the industry spent an average of 87 cents of every premium dollar on medical care. Click Here for Complete Story

HMOs planning large 2010 premium increases despite strong 3Q earnings.

Forbes Magazine notes that although "most of the major managed-care companies" have announced strong 3Q results, the message "during this earnings season is that HMOs are focused on rebuilding margins, even if it makes insurance even less affordable." Goldman Sachs analyst Matthew Borsch "calls it 'the highest pricing trend in years.' The premium increases he's seeing are in the neighborhood of 13 to 15 percent for next year." Analysts say HMOs are concentrating on making up for operating profit margins, which "reached zero last year for the industry as whole." Moreover, the companies not only want recompense for the "higher costs" they incurred this year from COBRA, they must "cover rising ordinary medical costs that show no signs of slowing down." Barclays analyst Joshua Raskin predicts overall health spending in 2010 will "climb 9 percent."

Click here for the complete story

The bill is HR 3962, the Affordable Health Care for America Act

The Whatcom Alliance for Health Care Access is a long time community health care study group that I participate in, which is dedicated to improving access and quality of care in Whatcom County, Washington. It is composed of citizens from all walks of life and segments of society. On November 2, 2009, they reviewed HR 3962 and released their findings. What follows is my edited version of their conclusions.

General Comments on the Bill

• This is a very comprehensive reform package that lays the ground work for providing changes and incentives to the delivery system that will reduce waste and improve outcomes overtime.
• Strong, thoughtful approach to Medicare payment reform that will result in implementation of recommendations over time
• Recognition and inclusion of reform initiatives. Specifics include a focus on wellness and prevention, expanding support for primary care training, creating opportunities for state and community level pilot projects and innovations and recognition of the importance of consumer engagement in reducing costs and improving outcomes.

Specific Comments Relative to Principles of Reform

1. Need to provide coverage and care for all people at all times regardless of age, employment status, economic circumstances and preexisting conditions
• Bill effectively addresses underwriting issues relative to age, health status and pre-existing conditions and creates level playing field for public and private market
• Bill provides options for all individuals (including low income) and most businesses to access affordable and in some cases subsidized health coverage through the exchange or through Medicare or Medicaid

2. Need to improve patient outcomes and reduce waste through improved care coordination, and a focus on primary care and preventive care.
• Emphasis on reduction of waste and fraud throughout bill including provisions in Medicare and Medicaid changes are seen as addressing this issue
• Reform elements throughout bill to increase primary care training including expanding residency options seen as positive
• Medical home recognition and including support of medical home pilot programs and shared decision making seen as effective
• Elimination of co-payments and deductibles for preventive services in Medicare and Medicare supports access to preventive care
• Grant program to help small employers to strengthen workplace wellness programs and support of community preventive services grants seen as important steps.

3. Need to assure consumer choice of providers and public and private plans
• Addressed through establishment of exchange and creation of a self sustaining public option.

4. Need to simplify the system (insurance administration, etc.) so that it is user friendly (understandable and transparent to consumers.)
• Creating level playing field in terms of underwriting and enactment of administrative simplification to reduce paperwork, standardize transactions and improve transparency seen as important step forward

5. Need to control costs and improve quality of care by reforming the payment system so that it rewards results and not activity and holds providers accountable for outcomes not procedures.
• Increased payments for primary care under Medicaid important step
• Addressing of Medicare payment rates based on geography and geographic variations in health spending through IOM studies with provisions for adopting recommendations is needed for cost control and quality improvement in Medicare
• Provisions for Center for Medicare and Medicaid Innovation creation and empowerment, creation of Accountable Care Organization program and Comparative Effectiveness Research Agency all needed to identify quality measures, provide the science to implement evidence based care and provide the incentives for the delivery system to implement those changes
• Changes to Medicare Advantage plans seen as supporting this principle

Some Persisting Questions and Issues

1. Affordability will be an ongoing challenge that needs to be monitored and addressed. How will that be handled?
2. What role will the public options play in health reform proposals to drive innovation?
3. Is financing adequate and sustainable?

A Sad Irony

Senate Democrats lost a key vote October 21st on a $247 billion dollar measure to avoid decreased Medicare reimbursement payments to doctors over the next 10 years. This would not have been an increase, but would have simply kept them at the same level they are now. The proposal was blocked in a 47-to-53 vote and thirteen Democrats broke with their party's leadership to join a unanimous Republican opposition.

Why is this a big deal? Well, the irony of this vote is that is that we may be passing health care reform to expand care availability to the general public, while decreasing access for Medicare patients to needed primary care if this vote stands.

This measure had been separated from broader proposals to overhaul the nation's health care system, because it is a separate problem that predates health care reform proposals. Under the current formula, Congress balances the Medicare budget by decreasing doctors payments to compensate for increased utilization by the public. Primary care is hit particularly hard, since those doctors have high office overhead costs that must be paid. A 21% cut is planned for January 1st, and 10% cuts are foreseen every year thereafter. Since doctors are already limiting access for Medicare patients due to existing low payments, it does not take a genius to understand that this payment decrease will be a catastrophe for Medicare patients. How sad that 53 members of the United States Senate either do not to understand that, or cynically do not care.

What doctors think about health care reform

What do doctors think about proposed health care reform? The voices of physicians in the current debate have been almost exclusively from national physicians’ groups and societies, and little has been known about "the doctor in the trenches" and how they view things. A recent study the The New England Journal of Medicine sheds new light on this issue.

Turns out that a majority of physicians (62.9%) support reform that includes both a public and private plan options. 27.3% support reform offering only private options.

Read the entire article here

One reason medical care is so expensive: We All pay a Hidden Tax

Those of us who currently have private health insurance pay a "hidden tax", included in our premiums, to pay for costs incurred by those without coverage. A new study now calculates that cost to be $1,017.00 per family in 2008, which is in addition to the actual taxes paid to support Medicaid and other government programs.

In 2008, the uninsured received $116 billion worth of care from hospitals, doctors, and other providers, which was usually provided for emergencies that could no longer be ignored. Those costs had to be paid for somehow, and they were covered in the following ways:

• On average, the uninsured themselves paid for more 37 percent of the total costs of the care they received.
  
• Government programs and charities, paid for another 26 percent of that care.
• The rest, approximately $42.7 billion in 2008, was unpaid (So called "uncompensated care").

To cover the rest of this "uncompensated care", the cost was shifted to private insurers by charging more for health services. These charges then result in the higher premiums we all pay. In 2008 the extra charge for family health care coverage was $1,017.00 and for a single person was $368.00.

The next time you here someone bemoan "increased taxes" to pay for health care reform, remember the truth. We need to get rid of the tax we already bear, and substitute a planned system that actually gets people in for needed care before things fall apart, thereby saving us all money.

Click here to read a full copy of the report.

Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?

"Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance." Nicholas Kristof tells the true story of Nikki White in an Op-Ed column in the New York Times on September 13, 2009.

The story of Nikki White graphically explains what is wrong with our current system, and why health care reform is so desperately needed. After she lost her job and health insurance, Nikki tried everything to get medical care, but no insurance company would accept her. As Kristof explains, "She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.

Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care."

Here is the irony - “When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” said her step-father, “But that’s not when she needed the care.”

By then it was too late. In 2006, Nikki White died at age 32. Her doctor, Amylyn Crawford, said, “Nikki didn’t die from lupus, Nikki died from complications of the failing American health care system.”

Access to early, appropriate health care is something that any of us can loose without warning. We need reform. I do not want to live in the only rich nation in the world that lets anybody die because they can’t get health insurance.

Click here to read the entire article by Nicholas Kristof.