Health Care Crisis
45 Million Americans without Health Insurance
illustration: "45 Million" - Tim Nyberg
On this page:
Synopsis - Paul Krugman
Bush's Health Plan 1/07 - Gold-Plated Indifference - Paul Krugman
How Drug Companies WANT you to be SICK
Neither you nor your company can afford it - David Batstone
A Plan for a Healthy America - Center for American Progress
The Deadly Doughnut - Medicare's terrible prescription coverage plan
Don't Make the American Worker Pay... - David Batstone
There are 45 Million Americans without health insurance. America continues to spend far more per person on health care than any other country, yet many Americans lack health insurance (45 million) and don't receive essential care. Watch this flash video to get a glimpse of the health care crisis that is affecting our county and what it means for you and your family.
Journalist Paul Krugman has these observations about America's health care:
Synopsis:
American health care is unique among advanced countries in its heavy reliance on the private sector. It's also uniquely inefficient. We spend far more per person on health care than any other country, yet many Americans lack health insurance and don't receive essential care.
This week yet another report emphasized just how bad a job the American system does at providing basic health care. A study by the Robert Wood Johnson Foundation estimates that 20 million working Americans are uninsured; in Texas, which has the worst record, more than 30 percent of the adults under 65 have no insurance.
And lack of insurance leads to inadequate medical attention. Over a 12-month period, 41 percent of the uninsured were unable to see a doctor when needed because of cost; 56 percent had no personal doctor or health care provider.
Our system is desperately in need of reform. Yet it will be very hard to get useful reform, for two reasons: vested interests and ideology.
I'll have a lot more to say about vested interests and health care in future columns, but let me emphasize one key point: a lot of big companies are essentially in the business of wasting health care resources.
The most striking inefficiency of our health system is our huge medical bureaucracy, which is mainly occupied in trying to get someone else to pay the bills. A good guess is that two million to three million Americans are employed by insurers and health care providers not to deliver health care, but to pass the buck to other people.
Yet any effort to reduce this waste would hurt powerful, well-organized interests, which have already demonstrated their power to block reform. Remember the "Harry and Louise" ads that doomed the Clinton health plan? The actors may have seemed like regular folks, but the ads were paid for by the Health Insurance Association of America, an industry lobbying group that liked the health care system just the way it was.
But vested interests aren't the only obstacle to fixing our health care system. We also have a big problem with ideology.
You see, America is ruled by conservatives, and they have a private obsession: they believe that more privatization, not less, is always the answer. And their faith persists even when the evidence clearly points to a private sector gone bad.
I could cite many examples of this obsession at work. But a particularly good illustration of ideology-induced obliviousness is the 2004 Economic Report of the President, which devotes a whole chapter to health care that can be read as a sort of conservative manifesto on the subject.
The main message of that report is that U.S. health care is doing just fine. Never mind the huge expense, the low life expectancy, the high infant mortality; it's a market-based system, so it must be good.
The report even takes a Panglossian view of uninsured Americans - one that is completely at odds with the grim statistics I cited above - suggesting that "many of them may remain uninsured as a matter of choice," perhaps because "they are young and healthy and do not see the need for insurance."
The president's economists had only one criticism of the system: insurance is too comprehensive, which encourages people to consume too much health care. As they see it, insurance covers too large a percentage of medical costs. The answer to this problem is the creation of, you guessed it, private accounts, which have now superseded tax cuts as the answer to all problems.
Indeed, a new paper by Martin Feldstein of Harvard, which clearly reflects the administration's views, suggests that Social Security privatization and health savings accounts - tax shelters designed to encourage people to pay medical costs out of their own pockets - are only the beginning. "Investment-based personal accounts," he says, are the way to go for unemployment insurance and Medicare, too.
O.K., let's not turn this into a Bush-bashing session. President Bush didn't cause the crisis in American health care. His health care policies have made things only a little bit worse.
The point, instead, is that even though all the evidence suggests that we would be much better off under a system of universal coverage, any such move will be fiercely opposed, on principle, by conservatives who want us to move in the opposite direction.
And reform will also be opposed by powerful vested interests - my next subject in this series.
Originally published in The New York Times, 4.29.05
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January 22, 2007
Gold-Plated Indifference
By PAUL KRUGMAN, New York Times Op-Ed Columnist
President Bush’s Saturday radio address was devoted to health care, and officials have put out the word that the subject will be a major theme in tomorrow’s State of the Union address. Mr. Bush’s proposal won’t go anywhere. But it’s still worth looking at his remarks, because of what they say about him and his advisers.
On the radio, Mr. Bush suggested that we should “treat health insurance more like home ownership.” He went on to say that “the current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance.”
Wow. Those are the words of someone with no sense of what it’s like to be uninsured.
Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an “incentive” to buy insurance; they need something that makes getting insurance possible.
Most people without health insurance have low incomes, and just can’t afford the premiums. And making premiums tax-deductible is almost worthless to workers whose income puts them in a low tax bracket.
Of those uninsured who aren’t low-income, many can’t get coverage because of pre-existing conditions — everything from diabetes to a long-ago case of jock itch. Again, tax deductions won’t solve their problem.
The only people the Bush plan might move out of the ranks of the uninsured are the people we’re least concerned about — affluent, healthy Americans who choose voluntarily not to be insured. At most, the Bush plan might induce some of those people to buy insurance, while in the process — whaddya know — giving many other high-income individuals yet another tax break.
While proposing this high-end tax break, Mr. Bush is also proposing a tax increase — not on the wealthy, but on workers who, he thinks, have too much health insurance. The tax code, he said, “unwisely encourages workers to choose overly expensive, gold-plated plans. The result is that insurance premiums rise, and many Americans cannot afford the coverage they need.”
Again, wow. No economic analysis I’m aware of says that when Peter chooses a good health plan, he raises Paul’s premiums. And look at the condescension. Will all those who think they have “gold plated” health coverage please raise their hands?
According to press reports, the actual plan is to penalize workers with relatively generous insurance coverage. Just to be clear, we’re not talking about the wealthy; we’re talking about ordinary workers who have managed to negotiate better-than-average health plans.
What’s driving all this is the theory, popular in conservative circles but utterly at odds with the evidence, that the big problem with U.S. health care is that people have too much insurance — that there would be large cost savings if people were forced to pay more of their medical expenses out of pocket.
The administration also believes, for some reason, that people should be pushed out of employment-based health insurance — admittedly a deeply flawed system — into the individual insurance market, which is a disaster on all fronts. Insurance companies try to avoid selling policies to people who are likely to use them, so a large fraction of premiums in the individual market goes not to paying medical bills but to bureaucracies dedicated to weeding out “high risk” applicants — and keeping them uninsured.
I’m somewhat skeptical about health care plans, like that proposed by Gov. Arnold Schwarzenegger, that propose covering gaps in the health insurance market with a series of patches, such as requiring that insurers offer policies to everyone at the same rate. But at least the authors of these plans are trying to help those most in need, and recognize that the market needs fixing.
Mr. Bush, on the other hand, is still peddling the fantasy that the free market, with a little help from tax cuts, solves all problems.
What’s really striking about Mr. Bush’s remarks, however, is the tone. The stuff about providing “incentives” to buy insurance, the sneering description of good coverage as “gold plated,” is right-wing think-tank jargon. In the past Mr. Bush’s speechwriters might have found less offensive language; now, they’re not even trying to hide his fundamental indifference to the plight of less-fortunate Americans.
Originally published in The New York Times, 1/22/07
return to top of pageHow the Drug Companies Want Us to Be Sick
By Stan Cox, AlterNet
Posted on May 16, 2006, Printed on May 17, 2006 http://www.alternet.org/story/36174/
You see a TV show or a commercial featuring medical problems, and you start feeling the symptoms yourself: a twinge in the leg or maybe a moment of doubt about your emotional stability.
If so, you, like millions of Americans, could be suffering from a serious condition known as telechondria. But help is here, with new Advertil(R) in the green-and-yellow caplet. Ask your doctor …
No, wait, don't really ask. Telechondriacs have not yet been recognized by science. Pharmacists are not dispensing drugs like "Advertil," and they probably never will. The last chemical that pharmaceutical executives would want to sell you is one that makes it harder for them to convince you that you're sick and need their products.
Drug corporations and their "awareness" groups, as we're all painfully aware, have defined and redefined a host of medical conditions -- including female sexual dysfunction, erectile dysfunction, restless legs, sleeplessness, bipolar disorder, attention deficit disorder, social anxiety disorder and irritable bowel syndrome -- to include larger and larger segments of the population in the United States and other Western nations.
Accepting for a moment the industry's claims about the numbers of people suffering from the eight diseases listed above, we could do some simple calculations showing that up to 93 percent of adult women and men in the United States suffer from at least one of them. Throw in a few more conditions like depression, bone density loss and premenstrual dysphoric disorder, and industry figures make it appear that virtually every American has a disease in need of a treatment.
Last year, Ray Moynihan and Alan Cassels called attention to the epidemic of disease marketing in their book "Selling Sickness." Last month, health professionals, academics, journalists and consumers gathered in Newcastle, Australia, for the Inaugural Conference on Disease Mongering. A set of papers from that meeting was published free by the online journal PLoS Medicine. Also last month, the Prescription Access Litigation Project (PALP) in Boston announced its "2006 Bitter Pill Awards," recognizing drug companies that engaged in the year's worst "overzealous and questionable marketing practices."
These and other recent activities make it all too clear that the profitable practices exposed in Lynn Payer's 1992 book "Disease Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick" have been refined and amplified in recent years, with the apparent goal of medicating an entire population.
Unruly body parts
The evolution of "restless legs syndrome," documented by Steven Woloshin and Lisa Schwartz in a paper from the Disease Mongering Conference, is a case study in how a pharmaceutical company, with help from the media, can turn what is a serious problem for some people into a contrived medical condition for millions more.
Woloshin and Schwartz analyzed media coverage in the interval between 2003, when GlaxoSmithKline Inc. first issued press releases about trials of its drug Requip for relief of restless legs syndrome, and 2005, when the U.S. Food and Drug Administration (FDA) approved that use.
Of 187 major newspaper articles published during those two years, 64 percent relayed without comment the industry's claims that millions of Americans -- as many as "1 in 10 adults" -- suffer restless leg. Forty-five percent of the articles stressed that many people may be unaware they're sick, even though, according to 73 percent of the articles, the syndrome can have extreme physical, social and emotional consequences. Reports of the relief provided by drug treatment used "miracle language" 34 percent of the time, while 93 percent of articles failed to quantify Requip's side effects.
Yet the relief people get from Requip appears to be anything but miraculous. In one trial, 73 percent of subjects saw improvement -- compared with 57 percent whose symptoms improved with a placebo! Side effects that occurred in clinical trials at least twice as often with Requip as with a placebo included nausea (40 percent of subjects), vomiting (11 percent), somnolence (12 percent), dizziness (11 percent) and fatigue (8 percent).
My attempts to obtain responses from several drug companies to charges of mongering restless leg and other conditions went unanswered. Quoted last month by the Guardian (U.K.) as he defended his company against bad publicity generated by the conference, David Stout of GlaxoSmithKline said, "You need to talk to the patients. Things like restless leg syndrome can ruin people's lives. It is easy to trivialize things when you don't have them. If people did not want the treatments, they would not seek them."
Restless leg syndrome in its most serious form is indeed no joke. My father was tormented for years by near-constant symptoms, until, without ever having seen an advertisement, he sought treatment.
But, says Dr. David Henry, who is a physician, professor at the University of Newcastle and co-organizer of the Disease Mongering conference, "When you extend a drug beyond the [most severely afflicted] group on which claims of its effectiveness are based, you see a falling ratio of good to harm. The benefits of the drug diminish, while the side effects tend to stay the same."
Henry told me, "The companies know quite consciously that they're going into areas where they're doing net harm."
In their conference paper, Woloshin and Schwartz note that restless legs syndrome is one of those "disease promotion stories" that the press loves to cover: "The stories are full of drama: a huge but unrecognized public health crisis, compelling personal anecdotes, uncaring or ignorant doctors, and miracle cures."
Irritable everything syndrome
The story of another disease, irritable bowel syndrome, has all of those dramatic elements, plus dead patients.
In "Selling Sickness," Moynihan and Cassels describe public-relations offensives by Novartis Pharmaceuticals and GlaxoSmithKline to popularize a condition called irritable bowel syndrome (symptoms of which are described as "abdominal pain or discomfort associated with changes in bowel habits in the absence of any apparent structural abnormality").
The companies stood to gain billions in sales if, as they claimed, as many as 20 percent of Americans had the syndrome. GlaxoSmithKline's drug Lotronex received FDA approval for treatment of irritable bowel in 2000, and Novartis' Zelnorm was approved in 2002. In statements to the FDA and the public, the companies tended to characterize irritable bowel syndrome as it is experienced by the worst-afflicted patients -- a tiny percentage of the total -- while emphasizing claims that the syndrome hits vast numbers of Americans.
TV star Kelsey Grammer and his wife Camille Grammer, who suffers from the disease, made the rounds of talk shows in a publicity effort quietly funded by GlaxoSmithKline, while Novartis deployed former Wonder Woman Lynda Carter to stress that common stomach problems might be irritable bowel, a "real medical condition." The FDA wrote to Novartis in 2003, demanding that the company discontinue other advertising that it considered misleading because it exaggerated the drug's benefits and the numbers of people who need it while minimizing its side effects.
Lotronex can now be prescribed only by doctors who have enrolled in a GlaxoSmithKline "Prescribing Program." According to Moynihan and Cassels, the drug came under fire in late 2000 when three FDA scientists wrote to their superiors expressing alarm over a rising toll of deaths and hospitalizations of irritable-bowel patients during the nine months that Lotronex had been on the market. (The concern was spurred by the remarkably increased rates; the deaths had not been shown in a clinical trial to have been caused by Lotronex.)
"Selling Sickness" contains this frightening description of one side effect: "For some of those who experienced severe constipation after taking the drug, their feces would become so impacted within their bowel that the bowel wall perforated, leading to potentially fatal infections inside the body."
Head games
A conference paper by David Healy traced the expanding definition of bipolar disorder over the past quarter century. The disease officially entered the manual of mental disorders in 1980, and based on its original diagnostic criteria -- which included an episode of hospitalization -- bipolar disorder is a devastating disease for 0.1 percent of the U.S. population. Over time, it has been broadened with additional criteria based on community surveys, so that the disease once known as "manic depression" is now said to affect 5 percent or more of Americans.
According to Healy, there is "almost no evidence" that drug treatment works for that much broader group of "community-based" disorders. Yet manufacturers like Eli Lilly and Co. and Janssen L.P. have heavily promoted pharmaceutical treatment of bipolar, as broadly defined, through websites, patient literature and new scientific journals devoted to the disease.
Evidence is accumulating that one drug prescribed for bipolar disorder (Lilly's Zyprexa) causes withdrawal symptoms, that patients on drugs for bipolar tend to be hospitalized more often than those who are not, that the drugs are associated with a heightened risk of suicide and that antipsychotic drugs in general are associated with increased death rates.
Despite such problems, says Healy, there is a recent "surge of diagnoses of bipolar disorder in American children." He cites one book that actually appears to accept the possibility that bipolar disorder may first show up in hyperactive fetuses.
The drug industry has thoroughly penetrated the juvenile market for another well-known disease, attention deficit disorder (ADD, also called attention deficit hyperactivity disorder, ADHD). The numbers of prescriptions to be written are huge; the National Institutes of Mental Health estimates that there's an average of at least one afflicted child per typical-size classroom. But people spend many more years as adults than as children, and stiff competition among the major ADD drugmakers -- among them Shire PLC, Novartis and Lilly -- guaranteed that the larger pool of potential adult patients would be targeted.
All three companies contribute or have contributed funds to the organization Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), which calls ADD "a lifespan disorder, affecting children, adolescents and adults." In "Selling Sickness," Moynihan and Cassels describe a talk by a Shire executive at a CHADD charity golf event, in which he estimated that 8 million U.S. adults could benefit from treatment. CHADD gets about 20 percent of its funding from drug firms, and its website provides detailed advice on medication for ADD. One example:
Although there is little research on utilizing short-acting and long-acting medications together, many individuals, especially teenagers and adults, find that they may need to supplement a longer-acting medication taken in the morning with a shorter-acting dose taken in mid- to late afternoon. The "booster" dose may provide better coverage for doing homework or other late afternoon or evening activities and may also reduce problems of "rebound" when the earlier dose wears off.
The marketing of ADD can venture into bewildering territory. One of PALP's 2006 Bitter Pill Awards went to Lilly for a TV commercial plugging its drug Strattera. In the ad, information on approved uses and risks is accompanied by wildly distracting sights and sounds of a video game. The FDA issued Lilly a mild rebuke over the ad: "The overall effect of the distracting visuals and graphics is to undermine the consumer's ability to pay attention and comprehend the risk information …"
The Bitter Pill Awards stressed the obvious irony of an attention-confounding ad targeted at a clientele who have difficulty paying attention. It could also be that the well-known practice of drawing notice away from side-effects information had to be cranked up a couple of notches in this ad to help persuade people who don't really have a serious ADD problem that they might just need Strattera.
Anxiety blitz
"Selling Sickness" traces another history of market expansion: the memorable publicity blitz that started with the FDA's 1999 approval of GlaxoSmithKline's antidepressant Paxil for a condition called "social anxiety disorder." An early press release insisted that social anxiety disorder is "not just shyness" but something far worse.
Enough people were convinced that they had that "something worse" to make Paxil the country's biggest-selling antidepressant for a time in 2000. Moynihan and Cassels write that GlaxoSmithKline avoided the term "social phobia," which was preferred by psychiatry for what can be a seriously debilitating condition, probably because "a lot more people can be categorized as being ill if you apply the definition of an anxiety disorder rather than a phobia."
It also couldn't have hurt that the initial letters of GlaxoSmithKline's name for the disease spelled "SAD."
The pinking of Viagra
Seeing the continuing deluge of advertising for impotence remedies in the American media, a visitor from the planet Zefitor could be forgiven for wondering how Earth, with such seemingly dysfunctional male humans, ever came to be inhabited by 6.5 billion of the species.
At the Disease Mongering Conference, Joel Lexchin traced the history of the Pfizer Inc. campaign that transformed the father of all impotence drugs, Viagra, "from an effective product for erectile dysfunction due to medical problems, such as diabetes and spinal-cord damage, into a drug that 'normal' men can use."
Pfizer spent $303 million in direct-to-consumer advertising for Viagra in 1999-2001, often featuring younger-looking men and sports stars. That effort paid off handsomely, by extending the market well beyond men with well-defined medical conditions and attaining its greatest sales growth in the 18 to 45 age group. Pfizer's salesmanship broke the age barrier for Viagra, but the company failed to extend the drug's market to that half of the human population that is completely immune to erectile dysfunction: women.
A paper by conference speaker Leonore Tiefer traced the term "female sexual dysfunction" (FSD) back to 1997. In the years that followed, demand for a "pink Viagra" was boosted by sisters Jennifer and Laura Berman, who, says Tiefer, "became the female face of FSD, opening a clinic at UCLA in 2001, and continuing to popularize FSD and off-label drug treatments on their television program, website and books; in appearances on the television show Oprah; and in innumerable women's magazines."
Pfizer aggressively promoted FSD, which it labeled "female sexual arousal disorder." But its plans for a women's Viagra eventually fizzled because of "consistently poor clinical-trial results."
Tiefer is coordinator of the Campaign for a New View of Women's Sexual Problems, which runs the media-watchdog website fsd-alert.org. The Campaign and other groups have been fighting back against the medicalization of sex with some success.
Sleeping sickness
What latest malady is the pharamaceutical industry selling? It's turning out to be a hard-to-escape one-two punch: sleeplessness and sleepiness.
In the past year, any TV viewer who's managed to stay awake through commercials knows that the drugmakers' latest target is sleeplessness. The media blitzes of two companies, the sanofi-aventis Group (that's their lower-case), which makes Ambien, and Sepracor Inc., which makes Lunesta, earned them a 2006 Bitter Pill Award "for overmarketing insomnia medications to anyone who's ever had a bad night's sleep."
Last month, at the request of government- and industry-funded groups, the National Institute of Medicine issued a report concluding that 50 million to 70 million Americans suffer from sleep problems and that U.S. businesses lose as much as $100 billion a year because of sleepy workers.
In a Baltimore Sun op-ed column, Ira R. Allen, vice president of the Center for the Advancement of Health, blasted the Institute for having been "co-opted." He stressed to me that he was not criticizing the report's methods or results, that "sleep is an important issue" and that "there were some legitimate partners in sponsoring the report." But, he said, "The report was issued right on the heels of National Sleep Awareness Week (March 27-April 2), and just as advertising for sleep aids was reaching a peak."
That, he said, is just too much of a coincidence: "I doubt that the United States has suddenly been invaded by tsetse flies! I'm not naive; I know the country's economy is built on advertising. But our organization's message is 'Transparency, transparency, transparency.' Don't hide your motive."
Even if we accept the Institute's and the drug industry's claims of a sleep-loss epidemic, other research has shown that the benefits of drug treatment are far from overwhelming. The class of drugs to which Ambien and Lunesta belong provide an extra half-hour of sleep per night, on average. (And Ambien made headlines earlier this year when reports revealed that some patients who took the drug were eating and even cooking in their sleep.)
The lack of a clearly superior pharmaceutical solution to sleeplessness may partly explain the recent orgy of advertising for sleep problems and sleep aids in general. Drug companies spent $345 million on ads for sleep drugs in 2005 alone, and that's expected to increase this year.
Wake up and smell the coffee
But, you say, you're already getting enough sleep? Well, maybe it's too much! The latest, and perhaps most disturbing, wave of sleep-controlling drugs are designed to let you stay awake for up to 48 hours with no ill effects.
According to the Feb. 18, 2006, print edition of the British magazine New Scientist, Cephalon Inc., the maker of one such product called Provigil, insists that the drug is meant only for treating serious diseases like narcolepsy and sleep apnea. But Provigil is also becoming a "lifestyle drug" for people who can't fit everything they want to do into 16 hours a day. And it can't help but beckon employers with the promise of an always-alert work force.
New Scientist reports that the Pentagon's Defense Advanced Research Projects Agency (the notorious DARPA) "is one of the most active players in the drive to conquer sleep." Sometime this year, DARPA will test an experimental wakefulness drug, CX717, on combat soldiers engaged in hard work for four straight nights with only four hours of "recovery sleep" in between. Tests have shown that monkeys awake on CX717 for 36 straight hours had better memory and alertness than undrugged monkeys after normal sleep.
Yet another generation of drugs that skew sleep toward the most restorative, so-called "slow wave" phase are on the horizon. Due for release as early as next year, Merck & Co. Inc.'s gaboxadol, says New Scientist, holds out "the promise of a power nap par excellence." The temptation to seek approval for the broadest possible labeling (and profit base) for drugs like Provigil, CX717 and gaboxadol will likely be overwhelming.
Patient pending
What kinds of medical conditions will expand to embrace millions of newly diagnosed "patients" in the coming months and years? I put that question to Dr. Richard Lippin, an occupational-health physician, health forecaster, and co-founder of a health-care reform blog, Critical Condition. His response:
"My guess is anything to do with pain, fatigue or feeling stressed. The first two are related to medicalizing the avoidance of aging and death among baby boomers and the third -- stress -- is due to very real anxiety people should feel about a host of worldwide and U.S. megatrends that legitimately create anxiety and depression -- trends like global warming, wars, economic collapse, political corruption, etc. But the answers are not pills. The answer is to elect sane political leaders. There is no pill for the 'white water' that's ahead for all of us."
David Henry says that the disease-mongering documented at his conference "can't be stopped. It's a consequence of our political economy, the domination of marketing in all areas of life. So we need to build counterforces. People are becoming more skeptical, and that needs to be encouraged. We should exercise the same healthy skepticism when being sold a drug as we do when being sold a secondhand car."
He says greater use of the attention-getting term "disease mongering" will prove useful in changing the behavior of medical professionals, the media and even pharmaceutical public-relations departments. "We want it to be an idea that pops up in their heads, so PR people will say, 'Hey, we don't want to run this ad and be accused of disease mongering!'"
Where would be a good place for average Americans to start exercising the healthy skepticism that's needed to fight disease mongering by the pharmaceutical industry? Ask your doctor.
Stan Cox is a plant breeder and writer in Salina, Kan.
© 2006 Independent Media Institute. All rights reserved.
View this story online at: http://www.alternet.org/story/36174/
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What can be done?
The Center for American Progress has developed a Plan for a Healthy America.
Read this story with links to statistics listed within by clicking this link.
A Plan for a Healthy America
Since 2000, the number of uninsured Americans has risen by five million, to 45 million, or nearly 16 percent of all Americans. Millions more are struggling to pay soaring Medicare premiums, which routinely dwarf annual wage increases. The result is that many Americans are left to "overcrowded emergency rooms, under-funded clinics, or no health care at all." Today, the Center for American Progress presents a comprehensive plan to improve the health of all Americans. The Plan for a Healthy America provides an innovative blueprint for affordable, quality health coverage, building on the strengths of our current system while responding to its serious shortcomings.
COVERING EVERYONE: The United States spends $41 billion per year on "uncompensated" care for people with no insurance, while the economy loses between $65 billion and $130 billion in productivity. More than 18,000 25- to 64-year-olds die every year because they don't have health insurance. Under American Progress's plan, health coverage would be available and affordable for all Americans, through either employee-sponsored insurance, Medicaid, or a new group insurance pool modeled on the system used by federal employees and members of Congress. The pool, based on the Federal Employees Health Benefits Program (FEHBP), would assist all those who lack access to job-based insurance – a problem for about 80 percent of all uninsured people. American Progress's plan would also ensure that cost is not a barrier to coverage by providing income-related financial assistance. In return for guaranteed access to affordable coverage, all Americans would be expected to enroll in one of the available options or pay an income-related charge to support the care they will inevitably use.
ADDING VALUE: American Progress's plan seeks to improve the value of health coverage in three ways. First, the plan puts wellness ahead of illness by calling for a national focus on disease prevention and health promotion. Coverage for preventive services would be taken out of the insurance system and coordinated through a new, nationwide but community-based benefit focused on training people to be better managers of their own health. Second, the plan would increase funding for research on "comparative effectiveness," so individuals and their providers would have access to the information required to make good treatment decisions. Finally, the plan would seek to improve health care productivity through information technology. Right now, only a small fraction of America's medical transactions are conducted electronically. An investment in cutting edge technology would eventually lead to better quality and more efficient health care.
FINANCING THE INVESTMENT: Because of the fiscal deterioration that has occurred under President Bush's watch – transforming a record surplus into a record deficit – the Plan for a Healthy America calls on Americans to make an investment in improving their health care. The plan seeks to do this through a small value-added tax (VAT), the revenues from which would go to a trust fund used exclusively to finance the plan. A VAT is a tax on the value of a good or service during various stages of production. Targeted exemptions would ensure the tax is broad-based and fair, and would reduce its impact on low-income individuals.
OUR OBLIGATION TO ACT: The United States remains one of the only developed nations that has not met our moral obligation to provide health insurance to our citizens. At the Center, we disagree with those – like Senate Majority Leader Bill Frist (R-TN) – who say it is "impossible" to provide quality health insurance for all Americans. In fact, public opinion polling shows Americans believe in the right to quality health care and they are willing to make sacrifices to achieve it. Almost two-thirds (63 percent) of U.S. adults cite lowering the costs of health care and health insurance as a top priority for the president and Congress. When asked to name the single most important issue for Congress to address in 2005, five times as many (10 percent) say health care as say Social Security (2 percent).
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Health Care: Neither You Nor Your Company Can Afford It
by David Batstone
I just received notice from my primary employer, the university, that my personal contribution to cover health care premiums will rise 20 percent per year for the next 3 years. My per medical visit deductible fee also went up 50 percent. I promised that my family would not fall ill anymore, but my plea fell on deaf ears.
If you work for a U.S. company, I am sure you could share your own story of rising medical insurance costs; that is, if your employer still covers you. Employer-sponsored health insurance is becoming scarcer and more costly according to the annual health coverage survey conducted by the Kaiser Family Foundation and Health Research & Educational Trust. Their report shows that premiums for job-based health insurance is rising 9.2 percent on average nationwide in 2005, about three times the general rate of inflation. More worrying, the slice of companies even providing health benefits to employees dropped to 60 percent in 2005, down from 69 percent in 2000.
I don't blame my employer for the bigger bite out of my paycheck, nor should you. The problem resides way beyond your bosses' control. Health care costs have become a major burden on businesses that provide insurance coverage: General Motors now spends about $1,525 on health care for every car it produces - or roughly $6 billion in 2005.
Howard Schultz, the chairman of Starbucks, made the jolting revelation last week that Starbucks will spend more on health insurance for its employees this year than on raw materials needed to brew its coffee. Schultz, whose Seattle-based company offers health care coverage to employees who work at least 20 hours per week, said Starbucks has paid double-digit increases in health insurance costs over the past four years. "It's completely non-sustainable," even for companies like his "that want to do the right thing," Schultz told a gathering of U.S. senators.
Indeed, these costs are so burdensome to US corporations that more and more companies either don't offer health coverage, or coverage is so expensive that few employees can afford to participate in the plan. Clearly the system is broken.
The U.S. Congress rejected attempts to more tightly managed care in the late 1990s. Although a single-payer, universal health care plan works fine and dandy in most European countries, Australia, and Canada, a high-powered medical care lobby in Washington DC fights any attempt to reform the medical care system. So we are stuck with half-baked measures to contain runaway medical costs, and they consistently fail.
As a nation, the U.S. cannot rely solely on private-sector insurance. According to the 30-member-country Organization for Economic Cooperation and Development, "the United States spent $5,635 per person on health [in 2003], more than twice the OECD average and around ten times more than the lowest-spending countries, Mexico and Turkey." The United States devotes 15 percent of its gross domestic product to health spending.
Fortunately, American business leaders are engaging lawmakers in a new conversation around health insurance that transcends traditional conservative-liberal labels. For instance, last week, Schultz was joined by Dawn Lepore, president and CEO of Drugstore.com, Costco CEO Jim Sinegal, and Ivan Seidenberg, chariman and CEO of Verizon Communications in sharing concerns about what they identify as a growing health care crisis.
Shultz traces his passion about health care back to his youth in New York City when he saw his dad struggle to hold down a series of low-wage jobs, none of which included health insurance. "I wanted to try and build a company that my father never got a chance to work for," Schultz said.
The fact that skyrocketing health care costs make U.S. employers less competitive in the global marketplace will be the factor that will tip the scale in favor of a dramatic revision of the health care system. One clear sign: more U.S. companies are looking at Canada as a possible site to relocate their operations due to more affordable health care costs up North. Furthermore, as U.S. health costs continue to soar - and believe me, they will - more would-be entrepreneurs are reluctant to quit Corporate America and its blue-chip benefits to start companies. That trend impacts on innovation and job growth, when both are vital to the U.S. economy.
"As a company, we spend more on health care than we do on steel," Bill Ford, chairman and CEO of the Ford Motor Company told the U.S. Chamber of Commerce late last year. Ford followed this shocking admission to business leaders with a call to arms that makes more than sense: "What we seek is a partnership with the government to find solutions to America's health care needs. Our goal should be to make affordable, quality care more accessible to everyone."
David Batstone is Senior Editor of Worthwhile Magazine and National Endowment for the Humanities Chair at the University of San Francisco
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November 11, 2005
The Deadly Doughnut
By PAUL KRUGMAN, New York Times
Registration for Medicare's new prescription drug benefit starts next week. Soon millions of Americans will learn that doughnuts are bad for your health. And if we're lucky, Americans will also learn a bigger lesson: politicians who don't believe in a positive role for government shouldn't be allowed to design new government programs.
Before we turn to the larger issue, let's look at how the Medicare drug benefit will work over the course of next year.
At first, the benefit will look like a normal insurance plan, with a deductible and co-payments.
But if your cumulative drug expenses reach $2,250, a very strange thing will happen: you'll suddenly be on your own. The Medicare benefit won't kick in again unless your costs reach $5,100. This gap in coverage has come to be known as the "doughnut hole." (Did you think I was talking about Krispy Kremes?)
One way to see the bizarre effect of this hole is to notice that if you are a retiree and spend $2,000 on drugs next year, Medicare will cover 66 percent of your expenses. But if you spend $5,000 - which means that you're much more likely to need help paying those expenses - Medicare will cover only 30 percent of your bills.
A study in the July/August issue of Health Affairs points out that this will place many retirees on a financial "roller coaster."
People with high drug costs will have relatively low out-of-pocket expenses for part of the year - say, until next summer. Then, suddenly, they'll enter the doughnut hole, and their personal expenses will soar. And because the same people tend to have high drug costs year after year, the roller-coaster ride will repeat in 2007.
How will people respond when their out-of-pocket costs surge? The Health Affairs article argues, based on experience from H.M.O. plans with caps on drug benefits, that it's likely "some beneficiaries will cut back even essential medications while in the doughnut hole." In other words, this doughnut will make some people sick, and for some people it will be deadly.
The smart thing to do, for those who could afford it, would be to buy supplemental insurance that would cover the doughnut hole. But guess what: the bill that established the drug benefit specifically prohibits you from buying insurance to cover the gap. That's why many retirees who already have prescription drug insurance are being advised not to sign up for the Medicare benefit.
If all of this makes the drug bill sound like a disaster, bear in mind that I've touched on only one of the bill's awful features. There are many others, like the clause that prohibits Medicare from using its clout to negotiate lower drug prices. Why is this bill so bad?
The probable answer is that the Republican Congressional leaders who rammed the bill through in 2003 weren't actually trying to protect retired Americans against the risk of high drug expenses. In fact, they're fundamentally hostile to the idea of social insurance, of public programs that reduce private risk.
Their purpose was purely political: to be able to say that President Bush had honored his 2000 campaign promise to provide prescription drug coverage by passing a drug bill, any drug bill.
Once you recognize that the drug benefit is a purely political exercise that wasn't supposed to serve its ostensible purpose, the absurdities in the program make sense. For example, the bill offers generous coverage to people with low drug costs, who have the least need for help, so lots of people will get small checks in the mail and think they're being treated well.
Meanwhile, the people who are actually likely to need a lot of help paying their drug expenses were deliberately offered a very poor benefit. According to a report issued along with the final version of the bill, people are prohibited from buying supplemental insurance to cover the doughnut hole to keep beneficiaries from becoming "insensitive to costs" - that is, buying too much medicine because they don't pay the price.
A more likely motive is that Congressional leaders didn't want a drug bill that really worked for middle-class retirees.
Can the drug bill be fixed? Yes, but not by current management. It's hard to believe that either the current Congressional leadership or the Mayberry Machiavellis in the White House would do any better on a second pass. We won't have a drug benefit that works until we have politicians who want it to work.
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Don't Make the American Worker Pay for Corporate Graft in Health Care
by David Batstone
I was very surprised that President George Bush brushed over the health care crisis in his State of the Union address earlier this week. "Crisis" is not an exaggeration. Nearly one-quarter of Americans walk around in a precarious state absent health care insurance, yet this country expends nearly 15% of its gross domestic product (GDP) on health care. That figure is almost double the percentage of GDP expended by other industrialized nations.
Burdened down by rising costs, American businesses are finding it increasingly difficult to compete in a global economy.
Mind you, I was not anticipating any creative solutions to the health care crisis to come out of the State of the Union address. The Bush administration's recent rhetoric focuses on consumer-driven reforms.
Translation: the weight of higher health care costs will be shifted to individual Americans. It is an alarming trend.
At the moment, the majority of Americans receive health insurance through their employer, and we are paying considerably more today to maintain those policies than we did even two years ago. American companies are not simply turning mean; truth is, most companies cannot keep pace with the runaway costs of health insurance and stay competitive. Companies are passing along a portion of those rising costs to their employees.
So, instead of doing the hard work of addressing the corporate graft that pushes health care costs upward, the Bush administration plans to put the squeeze on the average American worker to make choices about how much health care his or her family "really" needs. In this new paradigm, risk for illness or injury is not distributed across the board; rather, each individual must assume that risk for oneself. Pay as you go; if you need health care, that's your problem.
What do I mean by "corporate graft that push health care costs upward?" A personal story will help me make the point. Last year I was flying back to San Francisco from a East Coast event. I pulled out my Apple Powerbook - you know, the silver one with the apple illuminated that you often see in movie ad placements - and started typing away. After a few minutes, the woman in the adjoining seat interrupted my train of thought: "Excuse me, but do you like that computer?" I gushed a bit - I do love my Mac. I guess I convinced her, because she concluded, "Well, good, I am going to get my client to buy me one of those."
Well, that piqued my curiosity; after all, what kind of "client" buys high-priced computers for a consultant? So I politely asked her what line of business she is in. "I'm a surgeon," she replied. "Hmm," I paused then said, "so your hospital will buy you a laptop?"
"Oh no, not my hospital," she said with a laugh, "the medical device company that I use will do that without blinking." She went on to describe how she and her daughter (sitting in front of us) were on a junket to San Francisco, all paid for by her medical device company. Once assured of my interest, she carried on to tell me about the fabulous all-expenses trip to the Caribbean she took over the summer under the guise of training and education of company products.
My airplane encounter came to mind this past week when my eyes ran across a feature story on the front page of The New York Times business section: "Whistle-Blower Suit Says Device Maker Generously Rewards Doctors." The suit, accuses Medtronic, one of the country's largest medical device makers, with $10 billion in sales, of giving surgeons "excessive remuneration...and bribes in other forms for purchasing goods and medical devices." Because the devices that Medtronics - and believe me, they are not the only guilty party in the medical device field - sells are so expensive, providing perks to the doctors is a relatively cheap cost of sales.
Please do not assume that all medical doctors are on the gravy train. I know a gaggle of doctors who are committed to delivering the best care possible for their patients. However, I did uncover in my latest book, Saving the Corporate Soul, that graft in the Medicaid system and unscrupulous business arrangements between pharmaceutical companies and physicians is rampant. For example, some physicians, in exchange for money, allow pharmaceutical sales reps into their examining rooms to meet with patients, review medical charts and even recommend which medicines to prescribe. In a somewhat recent survey of doctors in the state of Maryland 37 percent of physicians admit that they accept some kind of compensation from pharmaceutical companies.
Addressing the graft in the system takes political courage from our elected officials. Unfortunately, such fortitude is lacking in the Beltway. They, too, are probably getting perks for their considered interest. How much easier is it to ask individual Americans to tighten their belts, and take responsibility for runaway health care costs?
The immorality of the system makes me sick.
This article may be found online at http://www.rightreality.com/wag_items/issues/060203wag.html
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