Paul Krassner : Is There a Doctor in the House?

Doctors provide free medical care at the Riverside County Fair Grounds in California's Coachella Valley earlier this year. Image from KESQ.com.

California tops in most uninsured:
Is there a doctor in the house?

The insurance industry has a preexisting condition known in technical terminology as greed.

By Paul Krassner / The Rag Blog / December 19, 2013

Although Coachella Valley in Southern California has become synonymous with music festivals, Goldenvoice, the company that produces those events, also helped sponsor the first massive four-day health clinic this year. Free medical, dental, and vision care was provided to nearly 2,500 uninsured patients at the Riverside County Fairgrounds.

According to the California Healthcare Foundation, this state now has the largest number of people without health insurance -- 6.9 million –- more than any state in the country. More than 20% of Californians remain uninsured. Employees in businesses of all sizes are more likely to be uninsured in California than any other state. About 60% of the uninsured population are Latino.

Pamela Congdon, president of the Remote Area Medical’s California affiliate (RAM CA) and Volunteer Coordinator, told me that

The California Association of Oral and Maxillofacial Surgeons (CALAOMS) helps sponsor RAM CA. They allow us to use their office, use our staff, including myself and our Associate Director, without any charges.

I work for CALAOMS, and when I asked if they would help us bring RAM in Northern California, they agreed. Stan Brock asked me to start the affiliate -- RAM CA –- which ran the clinic in Coachella. Please say that the clinic is run by the greatest group of volunteers.

Indeed, over 1,200 general and healthcare professionals volunteered to provide more than 10,000 individual services with more than $1,000,000 in value. Over those four days, 12 hours a day, an estimated 600 custom pairs of eyeglasses were cut, 750 medical exams administered, and 1,300 dental patients treated.

There were 615 general volunteers, 395 dental professionals, 60 vision professionals, and 190 medical professionals of all kinds. There were 1,766 dental patients, 1,435 medical, and 798 vision. One patient hadn’t seen a doctor for 17 years. Of the 2,419 patients, 1,796 were Latino. Oh, yes, and 234 stuffed animals were handed out to children.

One patient sent this message:

My name is Jennifer and I wanted to say thank you from the deepest of my heart! I found out about RAM in Indio at 11 p.m. on Thursday. By 2:30 a.m., I had made my way across the valley, and joined in line with the rest of the people you helped. Not a SINGLE person I interacted with was anything but kind, courteous, and understanding. No one judged us for being there, no one thought we were a burden.

I had all of my wisdom teeth pulled, something I avoided due to an overbearing phobia of dentists in general. Both my dentist and the dental assistant were comforting, and made the procedure almost painless, and fast. I am almost in tears as I write this email, due to the overwhelming gratitude I have for everyone involved in this amazing project that has changed and saved so many lives, including my own.

I’m writing this in the middle of the Open Enrollment time frame, during which my wife Nancy and I finally signed up for a Medicare Advantage plan. Stemming from an old police beating, I use a cane to walk from room to room, and a walker outside the house. The new healthcare plan includes free access to a gym, and I picture myself using my walker on a treadmill.

That image reminds me of a New Yorker cartoon depicting a group of people on stationery bicycles in a park. In the process of enrolling in the Medicare Advantage plan, we were told that we would have to pay a penalty because we hadn't joined a Medicare (or any other “creditable”) prescription drug coverage. We were never informed about that requirement, which began in 2006.

Since we’ve always avoided taking prescription drugs, we never felt the need for it. I called the Health Insurance Counseling Advocacy Program and learned that the penalty would be $32 for each of us. That means $64 every month for the rest of our lives. It seems somewhat absurd and unfair that we could be penalized for not taking any prescription drugs.

Ironically, “This penalty is required by law and is designed to encourage people to enroll in a Medicare Drug Plan when they are first eligible,” yet we had no way of knowing there was such an option to consider. Another irony is that Medicare doesn’t cover any dental procedures, even though rotten teeth and gums can cause internal illness that Medicare does cover.

I asked RAM CA volunteer Dr. Peter Scheer, a world-renowned oral surgeon, about that. His response:

In regard to Medicare and covering dental needs, it has always been an issue. Medicare stands strong in only providing benefits for services that are deemed medically necessary and has always excluded anything related to dentistry, surgical or restorative.

Yes, there are situations where a patient may have an atrocious dental infection that can become life-threatening if not treated. The times where this situation really hits a grey area is when the patient also has other medical issues that may be affected by the infection or contributing to it. Unfortunately, most instances we come across are a decrease in the quality of life due to a poor oral condition rather than a life-threatening event.

However, a research team from Columbia University’s School of Public Health has just released the results of a three-year study of 420 men and women, concluding that the improvement of gum health can help slow the development of atherosclerosis, the build-up of cholesterol-rich plaque along artery walls, which can lead to heart attacks and strokes.

Meanwhile, Goldenvoice has invited RAM CA to return next year. I asked Pamela Congdon, “Will the Affordable Care Act affect that event, or is it too early to tell?” She replied, “The ACA won’t affect the event in terms of people needing service. We are going to have the Borrego Community Health Foundation there to help people sign up for the ACA.”

As inspiring as this year’s four-day free clinic has been, in a truly compassionate culture, there would be no need for its existence.

But the insurance industry has a preexisting condition known in technical terminology as greed. Not to mention the pharmaceutical industry; the annual turnover of revenue for prescription drugs by the top 10 companies is estimated to be worth $700 billion dollars.

In my new Medicare Advantage Enrollment Kit, there are listed a few thousand prescription drugs, from Abacavir to Zyvox. Okay, now cue that soothing voiceover to recite all their side effects, from anal leakage to zits.

As for me, I owe my longevity to never taking any legal drugs.

The above piece was first published on AlterNet and was cross-posted to The Rag Blog by the author.

[Paul Krassner’s latest book, an expanded, updated edition of his autobiography, Confessions of a Raving, Unconfined Nut: Misadventures in the Counterculture, available at Source paulkrassner.com. Read more articles by Paul Krassner on The Rag Blog.]

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Ted McLaughlin : Are We Moving Towards Single-Payer?

Photo by Glyn Lowe Photoworks / Flickr. Image from OtherWords.
The pressures moving the U.S. closer
to a single-payer health care system

There will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program.

By Ted McLaughlin / The Rag Blog / July 3, 2012

It looks like the Affordable Care Act (Obamacare) is here to stay. After last week's Supreme Court decision, the only way it can be overturned now is for the Republicans to win the White House and both houses of Congress in the coming election (which is very unlikely) -- and even then, they might find public pressure would prevent its repeal.

Right now, a slight majority of people don't like Obamacare. Some have projected this to mean that a majority of Americans would like to see it repealed. That is just not true. One recent poll showed that 79% of Americans like most of the reforms and don't want it all repealed.

The only part they're not crazy about is the individual mandate. But as the program kicks in fully in the next couple of years, people will begin to realize that the individual mandate only applies to between 2% and 5% of the population -- and the program will become more and more popular.

Another fact commonly overlooked is that among those who are against Obamacare, about 22% don't want it repealed but made stronger. These people would like to see a public option at a minimum (and really want a single-payer system like those in other developed countries). When the program was first passed, I was among those opposing it because it didn't go far enough. I was afraid that all it really did was to delay the United States from going to a single-payer health insurance system.

But after a lot of thinking about it, and a few facts coming to light, I'm starting to change my opinion. I now believe that Obamacare might actually hasten America's progress toward a single-payer system, instead of delaying it. That's because the program is responsible for creating (or increasing) three pressures on the health care system as a whole to move toward a single-payer system. These three pressures are:

1. Forcing private insurance companies to pay a bigger percentage of their premiums for real medical care.
2. The continuing decline in employer-based insurance coverage.
3. The refusal of many states to increase Medicaid coverage for the poor.

Let me take these in order. First, in the past the insurance companies have not been required to spend the money they get for real medical care. While government-run Medicare has an overhead expense of 3% to 4%, many of the private insurance companies were putting 30% to 40% of their premiums toward "overhead."

And the more they put into this area (and the less into medical costs for consumers), the more profit they had. This was a primary reason for the record-breaking profits those companies were showing.

Obamacare ended that. A private insurance company must now put at least 80% of its premium income toward actual medical costs of its consumers (and the giant companies must spend at least 85% on medical costs).

The companies tried to get around this by declaring some administrative costs as medical costs (like the money spent paying their salesmen to sell the policies), but the government didn't go for it. They demanded medical costs be actual medical costs (rather than hidden administrative costs). And if an insurance company fails to spend the proper percentage on medical costs, then they must refund a big enough part of premiums received to get them down to the proper percentage (and the first refunds are currently being issued).

While this still allows the insurance companies to make a decent profit, it has put a serious crimp in the outrageous profits they were making (by denying claims and raising premiums). Now if they raise premiums, they must also increase the amount they spend for medical costs (or wind up refunding the raise).

In other words, the large insurance companies no longer have a license to steal -- and they don't like that. Forbes Magazine reports that some insurance companies are already getting out and searching for other, more lucrative, ways to do business -- and this movement out of insurance to other things will probably just continue to grow.

Second, is the move away from employer-based insurance for workers. This started before Obamacare was created (or the recession hit). As the chart above shows, the percentage of Americans covered by employer-based insurance fell from 69.2% in 2000 to about 58.6% in 2010 -- and the trend continues to move downward. If 2010 had the same percentage of coverage as 2000, then 28 million more people would have employer-based insurance than currently have it.

The hope of the writers of Obama's reform program was that the law would stop this decline in employer-based insurance coverage (through tax breaks for businesses, creation of health insurance exchanges, and a penalty charged for companies that don't provide insurance). I think that's mostly wishful thinking. Any business with less than 50 workers will be exempt, which means there is no incentive for small businesses to provide insurance. And as medical costs (and therefore insurance premiums) rise, many other businesses may decide it is cheaper to pay the penalty than to provide insurance coverage.

And those companies choosing the penalty over insurance coverage will just be a short step away from approving of single-payer insurance (which would most likely be funded by employee/employer contributions just like Social Security), as they realize it would be cheaper for them than providing their employees with ever-rising private insurance.

Third, and perhaps the biggest pressure for single-payer insurance, is the Republican state governments refusing to institute the Medicaid reforms called for in the program. The red states in the map above (from ThinkProgress ) are those with Republican leadership. The 10 states in dark red have already said they will not adopt the Medicaid reforms to cover most of the poor (even though the federal government would pay all of the cost for three years and then pay 90% of the cost). And it is extremely likely that the lighter red states will soon follow suit.

That means many millions of Americans who thought they would be getting insurance coverage because of the reforms, will be denied it because the Republicans will just continue the current inadequate Medicaid programs. They will do this because they don't consider medical care to be a right, but only a privilege available to people who can afford it.

For them, their ideology is more important than the lives and health of many millions of their fellow citizens. And they can get away with this because the Supreme Court killed the provision that would have forced the states to reform Medicaid.

Now one of the primary reasons Obamacare was passed was that there are 50 million people in this country without any kind of medical insurance. Some of these will now be able to get private insurance because of the health insurance exchanges and government subsidies. But a large part of this 50 million (the poor and the working-poor) were meant to be covered through Medicaid.

If this doesn't happen, there will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program (like Medicare). And the easiest way to do that is to let those making less than a certain salary qualify for Medicare (and do away with Medicaid).

This huge swell in Medicare, combined with decreasing employer-based insurance and insurance companies leaving the business, will bring great pressure to go to a government-run single-payer insurance system.

The experience of other countries has shown us that the money spent on medical care overall will then decrease (since we spend much more per capita than any single-payer country). It will also decrease premium costs for both individuals and businesses (since high overhead and huge profits will be eliminated).

The way I see it, Obamacare did not delay going to a single-payer system. In fact, it has probably created (or increased) the pressures propelling us to adopt a single-payer system much sooner. It has to happen. There is no other real solution to our current broken health care system. Obamacare made some improvements, but it didn't fix the broken system. But maybe it is pushing us much closer to the real solution.

[Ted McLaughlin, a regular contributor to The Rag Blog, also posts at jobsanger. Read more articles by Ted McLaughlin on The Rag Blog.]

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Dr. Stephen R. Keister : Saving Granny from Vouchercare

Political cartoon by Nick Anderson / Houston Chronicle.
Unkindest cut of all:
Saving Granny from Vouchercare

By Dr. Stephen R. Keister / The Rag Blog / June 15, 2011

"Avarice has so seized upon mankind that their wealth seems rather to possess them than they possess their wealth." -- Pliny the Younger, Letters, IX, c. 110.

It would appear that the American media, including the so-called "liberal" media, have lost their way among the mundane and the meaningless. Even the "progressive" commentators on MSNBC have become so enamored of Anthony Weiner's indiscretions and Sarah Palin's travels that little else of import has been reported to the American public.

Little of economic interest is discussed in a meaningful way, virtually no mention is made of the worsening unemployment situation, the increasing numbers of those without medical insurance, and nothing, absolutely nothing, about the China-Pakistan mutual defense treaty reported on by Paul Craig Roberts.

One can find little hope in a culture of fragmentation as our news organizations contribute to the further dumbing down of our citizens. In this atmosphere we must tolerate continuous reporting on the likely Republican presidential candidates, including their physical presence on the Sunday morning talk shows. Which brings to my mind H.L. Mencken's comment:

As democracy is perfected, the Office of President represents more and more closely the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart's desire at last and the White House will be adorned by a downright moron.

In my June 1 article on The Rag Blog I expressed concern about a full-fledged counterattack on the Democratic commitment to preserve Medicare in its present form. The deluge of misinformation, obfuscation, and pure fabrication has already begun.

Already the standard conservative think tanks -- the Cato Institute, Hoover Institute, Hudson Institute, American Enterprise Institute, and Americans For Prosperity -- have sped up the flow of trash through newly formed on-line "organizations” like the Institute for Policy Innovation, Heartland Institute, Social Security Institute, and the 912 Super Seniors organization.

Because of the lack of transparency we remain uninformed about who funds these organizations, but one might assume that these groups include the Koch Brothers, the DeVos Family, the Prince Family, and the Waltons of Walmart.

All this proceeds as the health insurers are making record profits and as many citizens are forced to postpone care (as reported in The New York Times), and as corporations keep shifting health care costs to their workers (as Roger Bybee reported at In These Times), and as the death rate among the uninsured remains around 45,000 a year. I would give CNN some credit for reporting that the U.S. has the second worst newborn death rate in the modern world.

Paul Krugman reports in a New York Times op-ed that medicare is sustainable. (Also read his piece entitled "Vouchercare Is Not Medicare.") Even the suggestion of raising the retirement ago for Medicare would disadvantage the poor as pointed out by Kevin Drum in Mother Jones.

We noted in our last presentation on The Rag Blog that the opponents of Medicare, which date as far back as the Truman Administration, will try their utmost to confuse the elderly public about the necessity of cuts in government subsidization of Medicare Advantage with cuts in the Medicare Trust Fund.

Many folks who have Medicare Advantage believe they are on Medicare and are not aware that they have private insurance. I would point out that there are various "Medicare Advantage" plans, plans administered by multiple insurance companies, and not by the Medicare Administration, although several insurance companies have recently dropped their plans because of insufficient profits.

There are many Medicare Advantage plans, for which the subscriber is charged variable amounts relative to the benefits provided. To review, we have:

1. Medicare HMOs, which require the subscriber to use network providers in all cases except in emergency situations;
2. Medicare HMO-POS, which provide a “point of service” option adding a little freedom to a traditional HMO as one can pay more for limited outside the network coverage;
3. Medicare PPO, which are network-based plans that allow you to go out of network for an additional amount of cost sharing; and
4. Medicare PFFS, which are private fee-for-service plans that allow you to use any provider that accepts Medicare assignment as long as the provider will also accept the plan payment terms and conditions.
   

Some of these plans, at an extra cost, may include certain dental care, and hearing and vision care, but with, of course, specified limits.

There is very valuable information available to the voting public here. It outlines the hazards to the elderly and poor if there is compromise by the Democratic leadership in specific Congressional districts. For instance, in my Congressional district, the Third District of Pennsylvania, the Ryan plan would increase prescription drug costs for 13,000 Medicare beneficiaries, deny 460,000 individuals aged 54 and younger access to Medicare's guaranteed advantage, and increase the out-of-pocket costs of health coverage by over $6,000 per year in 2022 and by $12,000 per year in 2032 for the 107,000 individuals in the district who are between the ages of 44 and 54.

The good news is that the Vermont legislature has passed single-payer health care, and the bill has been signed by the governor. The federal health insurance law would not allow Vermont to enact single payer until 2017; but Vermont is asking the administration to grant a waiver so that it can get there faster, by 2014. It is projected that a single payer plan will be 25% cheaper for consumers, businesses, and the government, than the current system of private health insurance, saving about $500 million in just the first year.

Here I would like to once more call your attention to France, which, according to the World Health Organization (WHO), has the best health care in the world. In case you missed it, please read David Hamilton's Rag Blog analysis of the French health care system, written from on the scene in Paris.

One further encouraging observation amid so much very depressing news. Agence France-Presse reports that, according to a group of prominent world leaders, the so-called "war on drugs" has failed, and that decriminalizing marijuana may help curb drug-related violence and social ills.

The commission includes former Brazilian president Fernando Cardoso, former Columbian president Cesar Gaviria, Mexico's former president Ernesto Zedillo, and ex-UN chief Kofi Annan. The report notes that the "global war on drugs has failed, with devastating consequences for individuals and societies around the world."

The conclusion is that purely punitive measures have led to a situation where "the global scale of illegal drug markets -- largely controlled by organized crime -- has grown dramatically." The panel suggests that governments experiment with models of legal regulation of drugs (especially cannabis) to undermine the power of organized crime and safeguard the health and security of their citizens.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : Democrats, Medicare, and the 'Jaws of Victory'

Jaws: Leaving an opening for the Republicans.
From the jaws of victory...
The Democrats, Medicare and
the 'winning message'

By Dr. Stephen R. Keister / The Rag Blog / June 1, 2011

"In a country well governed poverty is something to be ashamed of. In a country badly governed wealth is something to be ashamed of." -- Confucius, Analects VIII, c.500 B.C.

I share the great joy of the progressive community at the Democratic victory in the New York 26th District. All of the pundits appearing on TV news, amid the pharmaceutical commercials ad nauseam, inform us that the Democrats have a "winning message" relative to Medicare come 2012. Pause for a moment, please, and consider how in recent years the Democrats have shown an aptitude for grabbing defeat out of the jaws of victory.”

Yes, maintaining Medicare, and Social Security in their present forms is a very inspiring message. But we have some 17 months ahead for the message to be distorted and overwhelmed by the Republican smear machine. We must recall that we are not dealing with a terribly well informed, cognitively alert population.

I have worked in the area of educating the public about single payer health care for some years. At many a seminar I have been approached by a senior citizen who heatedly informs me, "I don't need government health insurance; I have Medicare! " A similar situation exists among many of the elderly who have Medicare Advantage plans and feel that they are on Medicare.

They do not realize that they were conned by slick salesmanship into giving up their Medicare and signing up for a private insurance plan underwritten by the government at 17% more per year cost to the Medicare Trust Fund.

They are unaware that their "benefits" are set by a profit-making insurance company (why have an insurance industry except to profit the owners and stockholders?) who have by slight-of-hand modified their "benefits" in a manner that appears on superficial examination to provide something better than Medicare per se.

They overlook the deductions, the exclusions, the co-pays, that are not inherent in regular Medicare. I wonder how many Medicare Advantage members will have their way paid to the Mayo Clinic or Johns Hopkins should they wish? My regular Medicare does not restrict my choices. Many Medicare Advantage plans do limit choice save within a specified area or to specified doctors or institutions.

In any event, the current health care legislation progressively reduces the payout from the Medicare Trust Fund to private insurance companies for underwriting the Medicare Advantage plans. Rest assured that the Republican spin machine will play on the naive Medicare Advantage customers with the slogan "the Democrats are going to cut your Medicare."

I would hope that the Democrats will immediately take up this discussion and explain in very simple terms that Medicare Advantage is not Medicare and, indeed, in the long run Medicare Advantage plans will worsen the fluidity of the Medicare Trust.

Granted Medicare expenses, when compared to income from the current wage tax, have become excessive, especially in view of the high unemployment. Medicare costs must be reduced. There are many factors involved, but let us begin with a paragraph from Maggie Mahar's book, Money Driven Medicine:

All too often, hospitals employ some of their most sophisticated tools crudely, even callously, in futile end-of-life care. While roughly 80 percent of Americans hope to die at home, 75 percent end their lives in hospitals or nursing homes. Of these, a third die after 10 days in an ICU. This helps explain why roughly one-quarter of all Medicare dollars are spent during the final year of a patient’s life, thanks in part to the cost of drugs and devices that prolong not just life but pain and suffering.

Perhaps this is a place that rational, fearless, public servants can begin cutting expenses. Here are some suggestions:

1. A presidential panel consisting of medical ethicists, perhaps from Georgetown, Princeton, and The New School, joined by specialists in geriatric medicine and internists or family doctors with university connections (pray not Liberty or Pat Roberts universities) to study a rational end of life program to be incorporated into the Medicare law. Of course the Republicans, who turn away from the 45,000 Americans who die each year sans health care insurance, will shout "death panels!" There are situations, however, where we must turn to rational planning and ignore the cries of the idiots.


2. The wage tax must be extended to all income levels and not be arbitrarily cut off for those with an income of $100,000 or thereabouts.


3. A reasonable additional fee must be enacted for Medicare coverage for those with a joint retirement income over $150,000.


4. There must be subsidized medical school tuition for those candidates who contract to do general practice, internal medicine, or pediatrics for a period of 10 years after graduation, while at the same time fees paid by Medicare for physicians in these specialities must be increased, and the disproportionate fees for those in the "invasive specialities" must be reduced to reasonable levels.


5. The payouts of billions in Medicare funds to the pharmaceutical and insurance industries under Medicare Part D must be curtailed.


6. Medicare fraud must be curtailed and we must take a close look at medical equipment companies that advertise extensively on TV. Are all these gadgets necessary?


7. A rational plan for prescription medicine costs, like they have in Canada and Europe, must be enacted as a part of the Medicare law.


8. The cost of procedures must be reviewed. For instance, a CT Scan in the United States costs more than twice what it would cost in most developed nations, and the same can be said for MRI scans. Of course the reason our scans cost more is that every hospital that possibly can has invested in the equipment in the hopes of increasing their profits.
   

In the meantime another player has appeared on the scene. The hospice industry is now being commercialized. Some 40 years ago the hospice movement began to provide humane end-of-life care to those facing death. This was a movement started by compassionate, dedicated volunteers. Happily, we in Erie, Pennsylvania, have one of the outstanding programs in the country.

Now big business has entered the scene and once again will profit from the dying and their grieving families. Read more about this at the Physicians for a National Health Program website. This article is based on a more detailed study in the Journal of Law, Medicine and Ethics. I felt for many years that the predatory burial industry had stretched the limits of decency in the United States but the advance of corporatism into the realm of dying is beyond my ethical comprehension.

Once again ProPublica is at the forefront in exposing the collusion between the pharmaceutical industry and sections of the medical establishment. We never see generic medications advertised on television -- only brand name products, many of which are remakes of older products. Some we see advertised have had limited clinical trials, like the anti-inflammatory medication that was widely marketed several years ago, but was -- after prolonged clinical testing -- found to be a cause of heart disease and is no longer on the market.

Again quoting Money Driven Medicine:

In 2002, when Families USA, a non-profit health care consumer advocacy group, reviewed the financial reports submitted to the SEC by nine of the largest U.S. based pharmaceutical companies, the group's analysis showed drugmakers investing only $19 billion in R & D, while shelling out some $45 billion for marketing, advertising, and administration. Meanwhile the industry pocketed $31 billion in profits.

Finally, our elderly population must be informed -- and then informed once again -- that the Ryan Plan will do away with Medicare as we know it, with its "vouchers" for buying health insurance from private companies. We must remember that no private insurance company is required to insure any specific individual, and that currently private insurance companies do all in their power not to insure the elderly.

So, if an older person is even able to obtain insurance, in all probability with a large deductible, the voucher will be sent directly to the insurance company. Some estimates suggest that, on the average, the individual will be required to spend $6,000 out-of-pocket to supplement the voucher.

I close with a sobering quote from Mahatma Gandhi: " You assist an evil system most effectively by obeying its orders and decrees." Let us encourage the average citizen not to fall for the blather of the politicians who are in the pay of the corporations.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Lamar W. Hankins : The Republicans and 'Medicare As We Know It'

Rep. Paul Ryan and 'medicare as we know it.' Photo by J. Scott Applewhite / AP.
(but should be made ineffective...)
Republicans agree that Medicare is essential

By Lamar W. Hankins / The Rag Blog / April 13, 2011

This past week, House budget kingpin Paul Ryan (R-Wis.) announced the Republican plan to privatize Medicare through a medical voucher system that, instead of paying for health care directly, would help elderly and disabled Americans purchase private insurance. Many people have said that the scheme will "end Medicare as we know it," which is undoubtedly true. But it represents an interesting turn of events in our politics.

Ryan’s announced plan tacitly concedes that Medicare is needed by the overwhelming majority of seniors and the disabled and is an important part of the social/economic safety net. Although we agree about this issue, we have to consider how such care can be delivered in the best and most efficient way. Clearly, that will not be through a voucher system.

Almost 55% of medicare recipients are low-income or disabled. This means, generally, that their incomes are below $14,355, according to studies done by the independent Kaiser Family Foundation. The Congressional Budget Office (CBO) predicts that purchasing insurance comparable to the current Medicare benefit will cost more than $20,500 per year.

A large majority of seniors and the disabled will not be able to afford the privatization of Medicare, even with an $8,000 voucher as proposed by Ryan, and continue to feed, clothe, transport, and house themselves.

Another problem with Ryan’s plan is that the private sector has not proven able to provide Medicare services as cheaply and efficiently as has the traditional Medicare system. We know this because we have had a version of a voucher system for several years called Medicare Advantage. The only advantage seems to be that it enriches the insurance companies at the expense of seniors.

Medicare Advantage companies spend more than 13% on overhead costs as opposed to 1.7% overhead for traditional Medicare, according to Kaiser figures. That 11.3% difference is taken out of seniors’ health care services. In this case, less is certainly not more.

It seems reasonable to conclude that no politician who is a fiscal conservative would want to waste government money by enriching private corporations and shortchanging program recipients. Yet this is just what Ryan’s proposal on behalf of the Republican majority in the House would do.

Thirty-one years ago, my parents, after a cumulative work history of 75 years for the same company, retired on modest pensions supplemented by Social Security and Medicare. Without those two programs, paid for largely by payroll deductions, they would not have outlived their pensions.

And they were among the middle class. The situation among less well-off retirees is far worse. According to US News, about 44% of households over 65 have a yearly income below $25,000. Without a good health care insurance program (such as traditional Medicare), those families will not have much money left over for the other necessities of life.

Most Republican presidents in my lifetime have recognized these basic facts and believed that this country has an obligation to assure the welfare of all Americans, not just the 1.5% who make $250,000 or more per year. That’s right, 98.5% of American households have annual incomes below $250,000.

According to Newsweek, Richard Nixon indexed Social Security for inflation, helping ensure that the elderly and disabled at least stayed even financially as the cost of living rose. Nixon also introduced a comprehensive health insurance reform bill that would have created a government-run “public option,” something president Obama would not agree to in spite of his campaign promises to the contrary.

To assist with these proposals, Nixon raised taxes on the wealthiest Americans for the first three years he was in office.

President Ronald Reagan raised taxes on most Americans in 1982, 1983, 1984, and 1986. President George H. W. Bush’s final budget increased tax rates and phased out exemptions for high-income taxpayers. And even the least among recent Republican presidents, George W. Bush, got passed a drug benefit for Medicare recipients, while he succeeded in reducing taxes on the most wealthy 3% of all Americans, tax reductions which have been continued under President Obama, even when he had a majority of Democrats in control of both houses of Congress.

If tax rates now stood where they were during the Reagan years, we would not have a fiscal crisis and even Paul Ryan might not be trying to further impoverish millions of elderly and disabled American families by enacting an ineffective health care voucher system to replace traditional Medicare.

As most honest political observers admit, the Tea Party Republicans, which means basically most of the Republican Party, along with most Democrats, don’t believe that the government should be run for the benefit of all Americans. They do everything they can to make the government work for the corporations that largely fund their campaigns.

They don’t believe that those responsible for the economic meltdown of the last three years should be held accountable in either our civil or criminal justice systems. They are perfectly willing to continue to prosecute three wars that are not funded but are fought on borrowed money, destroying my granddaughter’s future if not the future of her parents.

They are perfectly happy to create loopholes that allow corporations to pay no -- or almost no -- taxes, including ExxonMobil, Bank of America, General Electric, Chevron, Boeing, Valero Energy, Goldman Sachs, Citigroup, ConocoPhillips, and Carnival Cruise Lines. And some of these companies made record profits while being bailed out of their poor and reckless business decisions by the taxpayers.

From mutilating Medicare, to giving tax breaks to millionaires and billionaires, to serving the interests of the corporations, most of our politicians do not serve the general welfare. The most optimistic among us believe that the only way to overcome these unAmerican, undemocratic, unjust, and unpatriotic forces is to work against them day by day, one small way after another, until the system is overwhelmed by the sheer weight of Americans who are fed up with politicians that sneer at true democracy in favor of oligarchy.

I don’t have that much optimism, but I am unwilling to quit fighting the corporatists and oligarchs until that day when the words of the Rev. Martin Luther King (quoting Amos) are fulfilled, and justice does indeed roll down like waters and righteousness like a mighty stream.

But I’m not holding my breath.

[Lamar W. Hankins, a former San Marcos, Texas, city attorney, is also a columnist for the San Marcos Mercury. This article © Freethought San Marcos, Lamar W. Hankins.]

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Health Care : High Drama at Blair House

Health care debate: it even hurts to listen. Image from A Blog of My Own.
High drama at Blair House:
The Republican response and the 'independent voter'

By Dr. Stephen R. Keister / The Rag Blog / March 3, 2010

With considerable concentration I endured the ennui and was able to watch much of the recent TV "debate" on health care. I must admit that save for the President and a few Democratic Congress-folks, the Republicans were much better choreographed and were able to impart their "message" with more vigor and zest. A message directed largely at the “independent” or swing voters who are generally the least informed and most detached part of the electorate,

These are the folks that our TV commentators would have us believe live with a civics textbook in one hand and a copy of the Constitution in the other. When I hear the likes of Wolf Blitzer work under this assumption I am reminded of the “good Germans” of 1932-1944 who were not imbued with Nazi doctrine or anti-Semitism but periodically read Dr. Goebbels’ newspapers, watched Leni Reifstahl's propaganda films, thumped their beer mugs and sang the Horst Wessel Song at Octoberfest -- and lived in fear, terrified that the Poles would attack them from the east.

These people, moved by unemployment and uncertainty, were only too glad to go to war in 1939 when, according to Dr. Goebbels, the Poles had attacked German border posts and killed several small garrisons manning these posts.

At a recent upscale cocktail party full of professional and executive types, I was chatting with a local business leader, but unfortunately allowed the conversation to devolve into a discussion of Social Darwinism. He became visibly angry when I mentioned the U.S.A.'s 700-plus military bases around the world. He took great umbrage, asking me where I had gotten such an unpatriotic and absurd idea.

I referenced Chalmers Johnson's book The Sorrows of Empire, and also suggested he research the question on Google. He responded by muttering something about “darned liberals” and removed himself to more cordial surroundings. It is people like this gentleman, along with the tea-baggers, who proudly carry absurd signs and write anonymous angry letters, lacking in facts, to various publications. The inclination is to become upset with such persons, but perhaps pity would be more appropriate.

Returning to The Blair House seance, and the Republican response, I was reminded of a pocket-sized volume, by Dr. Harry G. Frankfurt, a retired moral philosopher at Princeton University. It’s title: On Bullshit. The opening paragraph:

One of the most salient features of our culture is that there is so much bullshit, Everyone knows this. Each of us contributes his share. But we tend to take the situation for granted. Most people are rather confident of their ability to recognize bullshit and avoid being taken in by it. So the phenomena has not aroused much deliberate concern, nor attracted much sustained inquiry.

The remaining 67 pages have to do with the difference between bullshit and out and out lying, or the purposeful spreading of deceptive misinformation. All who are students of the Republican spin machine should avail themselves of Dr. Frankfurt's publication.

One of my first observations, as a retired physician, was that three of the Republican attendees were physicians. All three of these elected representatives were from the high-paid surgical specialties. They generally defended the status quo.

One of the great concerns that face this country, and I have alluded to this in prior Rag Blog articles, is the fact that the United States is greatly lacking in primary care physicians -- internists, pediatricians, and general practitioners. Doctors in these fields are not only in short supply, but are also underpaid, probably making 10% net of what our physician Congresspersons took home before becoming politicians.

Not once did the Republican doctors suggest the need for government subsidy to train more primary care physicians, nor did they rise to the defense of these doctors who are headed for a 12% reduction of their income under the current Medicare provisions, something that the American College of Physicians has repeatedly warned us about. If we do not train more primary care doctors and pay them adequately, those on Medicare will soon have great trouble finding a physician. This is a legitimate fear. (Forget the ridiculous Republican contention that the Democrats intend to cut funding for Medicare benefits.)

Decent health care legislation will decrease the excessive profits made by private insurance companies for underwriting Medicare Advantage programs, will phase out the terrible drain on the Medicare Trust Fund produced by the Medicare Part D program, and will provide adequate policing of fraud and deception in the administration of the program, thus helping to fund the present Medicare program.

I would suggest that holders of Medicare Advantage polices ask their providers this question: "If I am seriously ill, and want to make an appointment at the Mayo Clinic, will you pay for it?" My regular Medicare will not interfere with my choices, but when my late wife had a far advanced cancer, when we were under Medicare Advantage, and wished to go to the Sloan-Kettering Clinic, we were informed that it was “out of area"; hence, we paid Sloan-Kettering ourselves.

Unfortunately, neither the President nor any of the Senators chose to promote the need for a "public option,” an omission that should greatly concern all of us, since single payer, or Medicare for All, has been ruled out. There was some impetus given to including the Health Insurance Cartel under anti-trust law -- a must if we are to control prices (and without price control the entire exercise is futile). It should be noted that the House has now passed this legislation with Republican support.

There appeared to be unanimity of opinion, even with some Republican assent, that there should be insurance available for those with pre-existing conditions, and that the insurance companies should be banned from the capricious policy of dropping of an insured individual when he/she becomes ill. The cost differential to those with pre-existing conditions was not addressed. The matter of "mandates" the purchase of insurance was left open. I was initially opposed to the idea of mandates; however, I now realize the need it for spreading the pool of the insured -- if it is administered with foresight.

The matter of taxes to finance the program was addressed, but far from settled. I personally favor the House plan to increases taxes on the upper 1% of the wealthy, rather than taxing the insurance benefits of the middle class. (A year ago I learned about a vault in a Swiss bank that collapsed under the weight of gold bullion stored there by the American well-to-do during the financial crash of 2008.)

Nothing was even mentioned regarding the excessive salaries and bonuses of the insurance and pharmaceutical CEOs or the billion dollars a year added to our prescription drug prices by the money spent on TV advertising for prescription drugs. The Republicans still blabber about "tax-deductible health care savings accounts,” which would be great for those with six figure salaries.

There was some discussion about those forced to buy cheaper insurance having a $3,000-5,000 deductible and thus, though insured, being unable to afford routine medical care. There was passing mention of the fact that under many insurance policies the insurer, rather than the physician, determines how long a seriously ill person can stay in a hospital. Little concern was expressed about the fact that much of the Senate Bill would really not become active for 3-4 years.

The malpractice bogeyman was repeatedly raised by the Republicans, though costs stemming from malpractice suits affect less than one third of one per cent of current medical care. Granted this may be a minor factor in overall costs; however, I believe that it is an issue that should be legislated separately -- taking into account the absurd contingency system of payment of lawyers in the United States, the fact that the malpractice insurance companies are not covered under antitrust laws, and that there should be much better surveillance of physician disregard for conscientious practice patterns. Perhaps we should take a look at the uncontroversial Canadian system of malpractice insurance.

At the end of the debate I was reminded of a paragraph in Steven Hill's great book Europe's Promise. He tells us that

Russell Shorto, an American writer living in Amsterdam, reporting that when he lived in the U.S. with his family of four, he paid about $1400 a month for a policy that didn't include dental care and was rife with co-pays, deductibles, and exemptions of coverage. A similar Dutch policy, by contrast, has cost him about $390 per month with no co-pays, and included dental coverage; about 90% of the costs of his daughter's dental braces was covered.”

The Netherlands does not have “socialized medicine”; all citizens, who are required to participate, are covered by private, nonprofit insurance. Obviously, if a nation has a will, a realistic program can be worked out -- a program that does not require 2,000 pages of legislation. HR 676 -- which has been largely ignored by Congress even though is is backed by the majority of physicians, nurses, health care professionals, and union members -- is included in only 30 pages of legislation.

Asclepois, from the Medicare Rights Center, is now available on Twitter, and you can sign up for the newsletter here. Current articles report that health reform will improve Medicare drug coverage, and that health reform will strengthen Medicare's financial outlook as well as making Medicare more affordable and improving the quality of Medicare. This non-profit, Medicare consumer advocacy update is available weekly.

Finally, Jim Hightower reports that “Big Pharma Divorces Billy Tauzin,” the ex-congressman from Louisiana who guided the Bush Administration Medicare give-away to the insurance cartel and PhARMA via the Medicare Part D drug plan. Immediately after Tauzin did that for the Bush administration he was hired as a lobbyist for the Pharmaceutical Industry at $2 million per year.

But poor Billy cut a deal with the Obama White House that cost him his job.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform.]

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Private Health Insurance : Going the Way of the Dinosaur

CLICK ON IMAGE TO ENLARGE

In the map above, the countries with universal health care are in blue. Those trying to get it are in green. Note that the United States proudly takes its place among the third-world countries of Central Asia, Africa, and parts of South America. We should be ashamed.

Private insurance:
Bound for extinction

By Ted McLaughlin / The Rag Blog / March 3, 2010

One of the things the Democrats were elected to do was to fix our badly broken health care system. It looks like they are going to fail to do that. They might wind up passing the anemic and pitiful Senate health care reform plan, but that falls far short of really reforming the health care system. It does little but continue the broken system we currently have with a few modest and mainly cosmetic changes.

One of the worst failures is to leave Americans with no choice except to purchase private health insurance. While this will guarantee huge profits for the large private insurance companies for some more years into the future, it is ultimately doomed to an ignoble failure. We are already beginning to see that these private companies just can't do the job indefinitely. Consider the current situation with Wellpoint (whose subsidiary is Anthem Blue Cross of California).

Anthem Blue Cross is the company that recently announced it is raising most of its premiums by a whopping 39%. The Wellpoint CEO recently went before Congress and said they have to raise the premiums that much because, "One, people are getting older. Two, people are becoming unemployed, and if they're healthy they're dropping out of the insurance pool. Three, the cost of diagnostic testing is soaring." She asked for government help.

But frankly, there is little the government can do for these problems (and the terrible Senate bill does nothing to solve them). The fact is that the jobless situation is going to be around for quite a while, because it was not only caused by the recession, but by outsourcing jobs which continues unabated. And of course, people are going to keep getting older and medical costs and testing will continue to get more expensive.

That means the private insurance companies will continue to raise the price of their premiums and cut the number of things those premiums will cover. I can remember that years ago a private insurance policy would cover virtually all medical costs. These days a person is lucky if their private insurance covers a significant part of the costs (and there are many medical procedures not covered at all because private insurance considers them too expensive).

With each rise in premium cost, more people are squeezed off the insurance rolls -- thus making it necessary for the companies to again raise premium costs and further cut coverage. Soon we will be left with expensive private insurance policies that cover virtually nothing.

I believe the CEOs of the insurance companies know they can't keep their spinning plates in the air indefinitely. They know that at sometime down the road their policies will become so expensive and cover so little that the health care system will implode. They just don't care as long as they can continue getting windfall profits for as long as they can stretch this farce out.

Consider the following: Anthem Blue Cross brags that a woman can still get a private insurance policy for only $156 a month. That may sound good to some until they consider this policy has a $1500 deductible, and then only pays for 30% of most medical procedures and tests, makes the woman pay up to $500 a day for a hospital room, and doesn't cover pregnancy or delivery costs at all. How good a policy is that?

Whether the Republicans and the private insurance companies want to admit it or not, the days are numbered for private insurance health care policies. In an effort to continue their profits, they will keep raising premiums and cutting coverage until they price themselves out of the marketplace. Then they will be replaced by a single-payer government health care system like other developed nations have.

It is not a question of whether we want it to happen -- it has to happen. There is no other option. The Congress could have saved a lot of time, money, and heartache by passing a public insurance plan this year, but they're going to blow it. So we're going to get more years of insurance companies raising rates and denying coverage, of many more Americans going bankrupt, and millions more Americans dying because their insurance (if they have any) won't pay for their treatment.

Teddy Roosevelt failed, Bill Clinton failed, and now Barack Obama has failed, but single-payer public insurance will come. If for no other reason, the economics of the situation demands it. The right-wingers and blue dogs need to get used to the idea. There is literally no alternative.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

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Health Care Blues : Citizens Suffer While Insurance Profits Soar

Photo from Public Option Health Care Now.
Health care blues:
Insurance profits soar, Congress fiddles,
Teabaggers rail against 'socialist' Obama

By Dr. Stephen R. Keister / The Rag Blog / February 21, 2010

As I write, we await the President's open discussion about health care on CSPAN. How illuminating it will be to have an open forum to which the American people will have access, unlike the previous behind-closed-door consultations with the health care insurance executives and the lobbyists for PhARMA.

What a rare privilege for the physicians, nurses, and public health workers to finally have some real understanding of the politicians' plans, since they have been kept on the periphery of any substantive discussions and have been denied constructive input regarding the issues that involve them and their patients.

In the meantime we who are interested in genuine health care for the nation watch hopefully as the roll of senators signing on to a bill containing a public option, to be passed through the “reconciliation” process, continues to grow. Perhaps, just perhaps, our elected representatives will actually turn their backs on their corporate donors and look, just this once, to the welfare of their constituents.

It should certainly be noted that the five largest U.S. health insurance companies sailed through the worst economic turndown since the Great Depression by setting new profit records in 2009, while leaving behind 2.7 million Americans who had been in private health plans. For customers who kept their benefits, the insurers raised rates and cost sharing, and cut the share of premiums spent on medical care.

According to Insurance and Security Exchange Commission filings the executives and shareholders of the five biggest for-profit health insurers, UnitedHealth Group, Inc, Well Point Inc, Aetna Inc, Humana, Inc. and the Cigna Corp, enjoyed a combined profit of $12.2 billion in 2009, up 56% from the previous year. It was the best year ever for Big Insurance.

The proportion of premium dollars spent on health care expenses went down for three of the five firms, with higher proportions going to administrative expenses and profits. The shedding of 2.7 million members from private health plans is part of the industry’s long-term shifting of responsibility for millions of sick, older, or low-income customers to tax-payer-supported government health programs such as Medicaid and the states' children's health insurance plans.

The Center For Responsive Politics reports that WellPoint spent $4.7 million last year to lobby in Washington against comprehensive national health reform proposals while United Health spent $4.5 million; Cigna, $1.6 million; Aetna, $2.8 million; and Humana, $3.2 million.

The President should join with the Progressive Caucus in the House in demanding that the health insurance industry be brought under the anti-trust laws, as well as finally supporting Medicare for All as proposed by the Physicians for a National Health Program, and their hundreds of co-endorsing organizations. At the very least Obama could support an unencumbered public option. It is time to stand up for the American people rather than the large corporations that were complicit in the current financial meltdown.

I saw in the morning paper that the recession is causing the states to cut back on Medicaid payments, thus decreasing the amount of medical care funding for our poorest citizens. According to Steven Hill's outstanding book Europe's Promise, the national health plan in Germany has also had to reduce services due to the recession.

Viagra and certain other medications are no longer covered, as well as fertility-related treatments, breast implants, artificial insemination, sterilization procedures, and certain eyeglasses and dentures. A $12 co-payment has been introduced on doctor’s visits. These are the horrors of a government supervised health system!

Incidentally, Hill points out that Germany, France, Belgium, Switzerland, and Japan have programs in which universal coverage is provided by private, non-profit insurance companies at 50% of the cost, or less, that we pay here in the United States. This is not to say that their care is better, or worse, than in the U.K., Sweden, Denmark, or Canada, where health care is directly supervised by the government. Europe's Promise contains a wealth of information about planning and methodology within the E.U. and it also discusses in detail energy, environment, governance via social-capitalism, national security, immigration, and social welfare.

According to Bloomberg News, the average income reported by the 400 highest-earning households grew to almost $345 million in 2007, up 31% from a year earlier. These figures, for the last year of economic expansion, show the average income reported by the top 400 earners more than doubled from $131.1 million in 2001. Each household in the top 400 paid an average tax rate of 16.6%, the lowest figure since the IRA began tracking data in 1992. The average tax rate in 1993 was 29.4%.

I find it a mystery why the Republicans and their right wing followers hate President Obama so much. I am particularly baffled by these folks calling him a “socialist,” when he seems to me to be just the opposite. He appointed to his treasury department the top rung folks from Wall Street and the big banks, and has pursued a very non-socialist agenda, not pushing hard for strict financial controls on Wall Street, the Federal Reserve, or the big banks. And he has continued the Bush policies of surveillance and detention. He has expanded the Bush war policies and has increased our military bases (we now have more than 700 worldwide) with no apparent concern about cost.

Jim Hightower provides a useful breakdown of how these mobs that rant against reform are financed, much of the support coming from the brothers Charles and David Koch, both billionaires and sons of Fred Koch, who was a founder of the John Birch Society in 1958. Other family foundations contributing to the Cato Institute, Americans for Prosperity, and others cited by the New York Times (the Friends of Liberty, the Oath Keepers, the Freedom Works), are the Bradley Foundation, the Coors Foundation, the Olin Foundation, and the Scaife Foundation -- as well as Glenn Beck of Fox News.

The ironic thing is that the majority of these white middle class and working class people are demonstrating against their own best interests, demanding an end to Medicare, Social Security, and Medicaid. The New York Times tells us that leaders of the movement -- like former Arizona Sheriff Richard Mack -- rail against a “despotic government,” Interpol (!), the council on Foreign Relations, the Bilderberg Group, the Brady gun control law, the major TV networks (excluding Fox News), immigrants, and secularists.

A February 2, 2010, CBS News poll indicates that a majority of Americans do not know that they got a tax cut. The survey showed that 24% of respondents said that they recently have had taxes increased, 53% said taxes were the same, 12% said taxes were decreased. Of those identifying with the Tea Party movement, only 2% think taxes have been decreased, 46% say taxes are the same, 44% say taxes have been increased.

In reality the Obama administration has passed 25 different tax cuts. Taxes have been cut for 95% of working families, for first-time home buyers, for 8 million Americans paying for college. And the administration wants to end the Bush era tax cuts for the wealthiest families, set to expire next year. Maybe the teabaggers somehow see this as a tax increase that will affect them. Or, perhaps, they still believe in the discredited "trickle-down" hypothesis.

We are surely at a crossroads, with the direction of social policy in this country up for grabs -- challenging whether we can continue with a true democracy in the kind of America conceived and established by our founders who were products of the Age of Reason. It was, for instance, their intention to create a secularist society where all are free to choose a religious affiliation of choice, or no religion at all. We should recall the words of Eric Hoffer:

It is easy to see the faultfinding man of words, by persistent ridicule and denunciation, shakes prevailing beliefs and loyalties, and familiarizes the masses with the idea of change. What is not so obvious is the process by which the discrediting of existing beliefs and institutions makes possible the rise of a new fanatical faith. For it is a remarkable fact that the militant man of words who ‘sounds the established order to its source to mark its want of authority and justice’ often prepares the ground not for a society of freethinking individuals but for a corporate society that cherishes utmost unity and blind faith.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform.]

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Report : Skyrocketing Profits for Big Insurance Companies

Photo by Tanya J. Harding from stock.xchng.
Report: Big insurance companies out of control

The top five insurers made $12 billion in profits last year, while dropping coverage for 2.7 million people.

By Chris Frates / February 12, 2010

With health reform floundering, Democrats have renewed their attacks on the insurance industry and they hope that a new report out yesterday will bolster their case that insurance company practices need to be reigned in. The report finds that the top five largest for-profit insurance companies increased their profits by $12.2 billion last year while dropping coverage for 2.7 million Americans.

As a group, WellPoint, Aetna, UnitedHealth Group, Humana, and Cigna saw their profits jump 56 percent in 2009, up $4.4 billion over the previous year, according to the report. Four out of five companies saw profits increase while insuring fewer people. Cigna increased earnings by 346 percent while UnitedHealth shed 1.7 million beneficiaries. Aetna, which increased its membership and percentage of premiums spent on medical care, was the only company to see less income in 2009 than 2008.

"Increasing your profits, dropping people is a specific corporate strategy," said Richard Kirsch of Health Care for America Now, the progressive coalition that prepared the report. "What the big health insurance companies do to please Wall Street denies affordable health insurance to millions of Americans, millions more Americans every year."

The report comes as the Obama administration and House Democratic leadership have seized on Anthem Blue Cross' decision to raise rates by up to 39 percent in California. Health and Human Services Secretary Kathleen Sebelius wrote a letter to Anthem this week asking them to justify their rate hike and House Energy and Commerce Chairman Henry Waxman announced that his committee will hold a hearing on increases this month.

Robert Zirkelbach, a spokesman for the industry trade group, America's Health Insurance Plans, said that for every dollar spent on health care, less than a penny goes to health insurers' profits, which are below other health care industries.

“According to new government data, in 2009 the portion of premiums that went towards administrative costs declined for the second year in a row, while spending on hospitals, physicians, and prescription drugs continued to soar. The real focus needs to be on the increase in the underlying cost of medical care, which is putting health care coverage out of reach for many families and small businesses,” he said.

But Rep. Rosa DeLauro (D-Conn.) isn't buying that explanation.

"They're going to try to hide behind the actuaries to tell us the increases are justified, but you have to remember these are the same insurers that for months have been manufacturing reports claiming that health insurance reform will cause them to raise premiums," she said. "The fact is they can't have it both ways."

Source / Politico

Thanks to S.M. Wilhelm / The Rag Blog

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Health Care Reform : 'This Won't Hurt a Bit'

Cartoon by Puckett from Stand Up For America.
Congress' health care fix:
Cure worse than the disease?

By Dr. Stephen R. Keister / The Rag Blog / January 4, 2010

"History records that the money changers have used every form of abuse, intrigue, deceit, and violent means possible to maintain their control of government." -- James Madison (With thanks to Steve Berry, The Paris Vendetta)

Christmas arrived with the much publicized terrorist “almost” incident in Detroit, thus giving Fox News and the Republicans another issue to distort and with which to further spread fear among the American public. This worked quite well for Bush/Cheney in 2001; however, perhaps, just perhaps, the American people will have a more mature, more sophisticated reaction to the present episode.

Chart from Firedoglake.
Firedoglake published an article that helps to put the situation into perspective. It charts selected causes of death in the United States for 2009 as follows:

1. Lack of insurance 45,000
2. Traffic related 43,000
3. Unintentional falls 20,000
4. Firearm homicide 12,000
5. Swine flu 10,000
6. Salmonella 1000
7. Terrorism 16.

With that in mind we return to the ongoing discussion of health care reform, while asking if the pending legislation before Congress will indeed reduce those 45,000 deaths or whether it is, as it has been called by some, "The Health Insurance Enrichment Act.”

In recent days the progressive press has placed more and more attention on the bill’s potential encroachment upon our civil liberties through mandating that an individual be forced by fiat to purchase health insurance from American's for profit insurance cartel.

An article on Firedoglake by emptywheel entitled “Health Care on the Road to Neo-Feudalism” tells us that "the bill, if it becomes law, would legally require a portion of Americans to pay more than 20% of the fruits of their labor to a private corporation in exchange for 70% of their health care costs." The author continues,

Consider a family of four making $66,150 -- a family at 300% of the poverty level and therefore, hypothetically, at least 'subsidized.’ That family would be expected to pay $6482.70 (in today’s dollars) for premiums -- or $540 a month. But the family could be required to pay $7973 for copays and so on. So if that family had a significant -- but not catastrophic -- medical event, it would be asked to pay the insurer almost 22% of its income to cover health care.

Senate Democrats are requiring middle class families to give the proceeds of a month of their work to a private corporation -- one allowed to make 15% or maybe even 25% profit on the proceeds of their labor. It is one thing to require a citizen to pay taxes -- to pay into the commons. It's another thing to require taxpayers to pay a private corporation, and to have 25% of that go for paying for luxuries like private jets and gyms for the companies CEOs.

Previously on The Rag Blog I have suggested that legislation requiring Americans to buy from a private corporation is unconstitutional.. This question again arises in an article by Ellen Hodgson Brown, J.D. , published in Truthout. Ms. Brown is not a newcomer to the health care discussion; she is co-author of a Forbidden Medicine, Natures Pharmacy, and The Key To Ultimate Health.

Ms. Brown says:

The health reform bills now coming through Congress are not focused on how to make health care cheaper or more effective, how to eliminate waste and fraud or how to cut out expensive middlemen. As originally envisioned, the public option, would have pursued those goals. But the public option has been dropped from the Senate bill and radically watered down in the House bill.

Rather than focusing on making health care affordable, the bills focus on how to force people either to buy health insurance if they don't have it, or to pay more for it if they do. If you don't have health insurance and don't purchase it, you will be subject to a hefty fine. And if you do purchase it, premiums, co-pays, co-insurance payments and deductibles are liable to keep health care cripplingly expensive. Most of the people who don't have health care can't afford to pay the deductibles, so they will never use the plans they have been forced to buy.

The author continues,

…compulsory health insurance is like compulsory selective military service (the draft), except that all our numbers have come up. The argument has been made that auto insurance is compulsory so why not health insurance? But the obvious response is that you can choose to drive a car. The only way to escape the vehicle we call a body is to give up the ghost.

Terrance Heath’s lengthy and well-written article at Campaign for America's Future entitled "The Window or the Stairs: Kill the Mandate or Kill the Bill,” makes this point:

My take is that it is unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. It'd be forcing everyone to attend baseball games, but instead of watching the Yankees, they were forced to watch the Kansas City Royals. Or Washington Nationals. It would effectively be a tax -- and a huge one -- paid directly to a private industry.

Where are the civil libertarians regarding this issue? Where is the ACLU, of which I have been a member for years? Perhaps the ACLU had best forget complaining about total body scanning at our airports and redirect its attention to this much larger issue of personal rights. I prefer to be safe when flying, and did not object to a strip search by El-Al in London some 25-30 years ago. And I did not object to El-Al's “profiling” that had nothing to do with race or ethnic background, nor to the extra stewards on the flights, well aware that these gentlemen were subtly armed, en route from Kennedy to Tel Aviv, or Tel Aviv to London.

Jane Hampshire in FireDogLake cites reasons that the Senate Bill is unfriendly to the Average American, including the fact that it will be paid for by taxes on the middle class insurance plan you have right now through your employer. It will cause the employers to cut back benefits and increase co-pays.

Many of the taxes to pay for the bill start now, but most Americans won't see any benefits until 2014 when the program begins. It allows insurance companies to charge older people 300% more than others and grants monopolies to drug companies that keep generic versions of expensive biotech drugs from ever coming to market. It doesn’t allow importation of prescription drugs, which could save consumers $100 billion over 10 years. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year.

We must remember that this legislation, especially the Senate version, is to a great extent the product of lobbyists for the health insurance and pharmaceutical industries. Common Cause, a nonpartisan, nonprofit watchdog group, blames a “toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.

Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.

If indeed this legislation passes without placing the health insurance industry under the Fair Trade Act, the entire exercise is a sham and a farce. There will be no restrictions on price fixing and collusion among the health insurance carriers. The idea that a few government regulators can control these predators is absurd. Each insurance giant will outmatch the regulators by a personnel ratio of at least 20:1 in defining methods to bypass the regulations and maintain their profits. One can imagine a high school football team playing the New England Patriots. The American public is once again being scammed by their corporate masters and their elected prostitutes.

There is nothing in this legislation that frees the physician to do his duty without interference from the insurance industry. Nothing to free the family doctor from overburdening paper work when he should have that time for seeing the sick. Health care will continue to be rationed to the consumer by the executives and stockholders of the health insurance cartel. The pharmaceutical industry will continue to overcharge the American public and to deprive many folks of lesser means of the medications which they need.

It is not a pretty picture. Our elective representatives have, without shame, taken their constituents to the cleaners.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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Health Care Plan : No Cause for Celebration

Drawing from West Midlands No! Campaign.
Health Care Reform:
Progressives must stand their ground

This bill is not universal, not equitable, not affordable. It will not end bankruptcies, and will not end deaths due to denials and delays in health care.

By Dr. Stephen R. Keister / The Rag Blog / December 27, 2009

I have been reading Charles C. Mann's excellent book 1491, New Revelations of the Americas Before Columbus. Included is a half-joking quotation from the celebrated anthropologist Clifford Geertz:

All states can be parceled into four types: pluralist, in which the state is seen by its people as having a moral legitimacy; populist, in which the government is viewed as an expression of the peoples will; 'great beast', in which the rulers' power depends on using force to keep the populace cowed; and 'great fraud' in which the elite uses smoke and mirrors to convince the people of its inherent authority.

It would appear that we in the current United States fit rather neatly into the fourth group. Example:

President Obama has been arguing vociferously that did he did not campaign on the public option as an alternative to health care dominated and controlled by the health insurance cartel. In my files I came upon a souvenir of that campaign, a 46 page booklet entitled "Keeping America’s Promise.” Three pages are devoted to Obama's concept for health care; in the interest of brevity I quote only selected paragraphs.

Easy enrollment: The new PUBLIC PLAN will be simple to enroll in and provide ready access to coverage... Portability and Choice: Participants in the new PUBLIC PLAN and the National Health Insurance Exchange... will be able to move from job to job without changing or jeopardizing their health care coverage.

Does President Obama have so much on his plate that he has forgotten that he campaigned with the commitment to forcefully support a PUBLIC PLAN? Where does this omission lie in his failure to face down, or even negotiate with, such Senators as Lieberman and Nelson? Why the listless support for any progressive health care program? This is not the candidate that I, or many other progressives, voted for.

Last evening I watched my favorite opera, La Boheme, on PBS. Though not of the quality that I had seen at the Met or Opera Bastille it was well done with a first rate tenor, a pleasing soprano, and those haunting duets in the first and final acts. As I watched the failing health and finally the death of Mimi I was somehow struck that I was watching a study in health care for the poor and disadvantaged in the present day United States. Which brought me back to the problem at hand: the travesty, the fraud, that the Senate has passed in the guise of "health care for all." Indeed something is amiss in our political process.

We should take note that, even though the health insurance cartel made such a show of opposing reform legislation, once the Senate bill passed, the following occurred: the stock of Coventry Health Care, Inc. rose 31.6%; CIGNA Corp rose 29.15; Aetna Inc. rose 27.1%; WellPoint, Inc. rose 26.6%; United Health Care Group Inc. rose 20.5%; and Humana rose 13.6%.

This bill is not universal, not equitable, not affordable. It will not end bankruptcies, and will not end deaths due to denials and delays in health care. And further, there is nothing in the legislation to bring the health insurance cartel under the anti-trust laws. Smoke and mirrors indeed!

When most people consider health care they think about physicians, nurses, adjunctive therapists -- practitioners. Yet conspicuously absent in the past year's discussion have been these very people. We hear from the politicians on CSPAN, and on the TV news shows we are inundated with the opinions of media consultants, of “experts” from the think tanks; however, rarely, very rarely, has the public had an opportunity to hear from a medical profession that has expressed 60% support for a public option.

Many, or most, physicians are tired of being vassals of the insurance cartel, and wish once again, as is still the case in most other free nations, to have the ability to make medical decisions based on medical findings and not to be subject to the profit-making needs of their insurance overlords.

The practice of medicine, from the standpoint of the patient and the physician, should not be dominated by politics, profit, or profit wrapped in the cloak of religion. Physicians for a National Health Program was founded some 25-30 years ago by a group of dedicated, idealistic physicians who realized that the machinations of the health insurance cartel would indeed turn medicine from a healing profession into a profit-making business for Wall Street.

PHNP, which now includes 17,000 members, has meticulously developed a health care plan that would include all citizens, reduce costs by 40%, and give choice to the patient and his or her doctor. The plan, in brief, would be administered by a public insurance entity, not the government. The public corporation would be overseen by a board of directors from the medical profession, academia, business, and labor, with hired managers.

There would be government oversight, not by politicians who would undoubtedly corrupt the workings, but by civil servants, as they are now incorporated in the congressional budget office. It would be treated as an independent organization, like the Federal Reserve Board or the U.S.Post Office. The structure would be apolitical as is PNHP.

Never in the extensive PNHP planning have I seen the word "abortion" mentioned. PNHP deals with health care and the practice of compassionate, caring medicine, not quasi-theological subjects. "Abortion" has been injected into the present debate by the insurance industry, playing to the "right to life movement," as a political ploy.

On December 22, PNHP came down in opposition to the Senate Health Bill. The negatives of that bill include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, new restrictions on abortion, the unfair taxing of high-cost health plans, and cuts in $43 billion in Medicare payments to safety-net hospitals. Moreover, at least 23 million people will remain uninsured when the plan finally takes effect. Full details can be found here.

The American Nurses Association has also come out in opposition to the legislation. Thus, we have the corporations and their political prostitutes favoring legislation to increase the profits of the insurance industry, and the healing professions standing for the rights of the patient-physician relationship and decent affordable health care.

The apologists for the senate bill inveigh "that it is better than nothing" and that it can always "be corrected in the future.” The first statement is patently absurd, and the second unrealistic, for as sure as Obama has deserted his progressive and younger voter bases, the Democratic majorities in both House and Senate will be less than robust come 2010.

We hear that the legislation as passed provides the right to purchase insurance despite pre-existing conditions; however, few sources mention that the cost can be three times the rate otherwise. Few news outlets mention that older folks will pay much more for insurance than others. There is little mention of future cost control of the insurance premiums, largely because there has been no ongoing consideration of the continued exclusion of the insurance industry from the anti-trust laws. (Major league Baseball being the only other exemption.)

The other frightening situation is the "individual mandate" which forces everyone, under the penalty of law, to buy health insurance. Even many conservatives are rightfully disturbed by this interference with our civil liberties. Never in the history of the Republic have we been forced to buy from a public company under threat of punishment. There finally is the beginning of a debate about this problem, which we referenced some months ago in The Rag Blog.

We have a constitutional question which will ultimately end up in the courts. I would suggest reading a thoughtful discussion of the case law involved in this very important area, published in AfterDowningStreet.Org and also posted on The Rag Blog. The low cost commercial health insurance that we would be forced to buy could be loaded with co-pays and deductibles that could cost the insured $4000-5000 before the insurance becomes active.

The one encouraging feature of the Senate bill is the fact that it includes an amendment by Sen. Bernie Sanders allotting $10 billion for establishment of community health centers, providing medical and dental care, and training primary health care physicians and nurses. It is noted that Senator Sanders is working with House Majority Whip James Clyburn to include $14 billion in the House version of the legislation.

Concurrently, in the House there is a move afoot once again to consider permitting the importation of prescription medications, a feature that was recently defeated in the Senate with the odd cooperation of several of our “progressive” senators. If these provisions become law many of our citizens will have the same access as our elected representatives, who have free government health care at the Office of The Attending Physician right under the Capitol dome. Here they get free health care from physicians, specialists, nurses, med-techs, pharmacists and others working as government employees.

As Jim Hightower points out,

The service is primo. Let's say that one of the 39 Republican grumps gets gaseous or suffers a tongue cramp while giving a Senate speech denouncing socialism. He or she can scoot just a few yards away for socialized care at the OAP -- no appointment necessary, no bothersome insurance forms to fill out, no co-pay, no waiting. Just care.

Perhaps even President Obama will set aside much of Rahm Emanuel's advice and once again come on board as a friend of the young, the disadvantaged, and the unemployed, rather than being the cat’s paw of Wall Street and the corporations that dominate our society.

As I look around, it seems that things have changed little since Eugene V. Debs spoke in 1908:

Now my friends, I am opposed to the system of society in which we live today, not because I lack the natural equipment to do for myself but I am not satisfied to make myself comfortable knowing there are thousands of my fellow men who suffer for the barest necessities of life.

We were taught under the old ethic that man's business is to look out for himself. That was the ethic of the jungle; the ethic of the wild beast. Take care of yourself, no matter what happens to your fellow man. Thousands of years ago the question was asked; 'Am I my brothers keeper?' That question has never yet been answered in a way that is satisfactory in a civilized society.

Yes, I am my brother's keeper. I am under moral obligation to him, that is inspired, not by any maudlin sentimentality but by the higher duty I owe myself. What would you think if I were capable of seating myself at a table and gorging myself with food and saw about me the children of my fellow beings starving to death.

We progressives must stand up and support the few dedicated, honorable senators, and we know who they are, who are a profile in courage and who fight like hell for the public good.

We must encourage the progressive caucus in the House of Representatives to stand their ground on funding of the health care bill by requiring the wealthy to pay their fair share rather than burdening the working man with further taxes. We must encourage the progressive caucus to stand firm for a public option and to demand that the health insurance industry be included under the anti-trust in order to prevent price fixing and excessive rate increases.

We become the Greeks at Marathon, the final defense of what is ethical and morally correct.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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