In its present form, health care will bankrupt us. Even the most conservative of experts warn of impending disaster without comprehensive reform. Premiums, deductibles, co-pays are rising dramatically faster than wages are. We cannot balance the budget and reduce the federal deficit without comprehensive health care reform. Half of all bankruptcies are due to medical bills and 75% of these people HAD health insurance. (28) Even the healthiest among us are only 1 serious accident or illness away from financial ruin. The elderly have to choose daily between meals and medicine. Parents must choose between clothing their children and taking them to a doctor.
Meanwhile, health insurance bureaucrats cherry-pick, accepting only the young and healthy with no pre-existing conditions. Then they ration and practice medicine without a license and override doctors orders. This is done greedily-- based not on healing or medical necessity, but based on profit margin. So we have drive through mastectomies and insurance employees in business suits making life and death decisions that fatten their wallets. Every dollar denied is a dollar more in profit for them. Then if the insured dare get seriously sick, they are kicked off the policy (retroactive rescission) with a pre-existing condition now documented that precludes getting other insurance. Something is wrong with this picture! Our health care system is broken!! Insurance companies are not models of fiduciary responsibility. They fail miserably in bringing down costs-- they selectively provide health care coverage.
Wendell Potter testified before a Senate committee in Jun 09 about the corruption of the health insurance industry and how people are sacrificed and their claims routinely denied---for the purposes of more money and happy stockholders. Potter was a head of Public Relations for CIGNA and became a whistleblower. He started his journey to becoming a health reformist when exposed to a temporary health clinic where hundreds of people were in the rain awaiting medical attention in stalls built for livestock. (23)
Also testifying was Robin Beaton whose pre-authorization for a double mastectomy was rescinded by Blue Cross the night before surgery. Since the hospital demanded a deposit of $30,000, she had to cancel the much needed surgery. Beaton had never missed a premium payment but was red-flagged and her policy dropped or rescinded by Blue Cross for acne and a fast heartbeat in her past. By the time, her representative (Joe Barton, R-TX) was able to successfully intervene, Robin’s tumor had doubled in size and her lymph nodes had to be removed as well. (23) A House committee discovered that private health insurers had made a practice of rescission and in a 5-year period had dropped the policies of 20,000 clients to avoid paying $300 million in legitimate claims. (7)
In LA, average insurance premiums have increased by 91% in the last 9 years. Out of pocket expenses have gone up 30% in the past 5 years. And if that is not bad enough, within 10 years, family premiums in LA will cost $8000 more than they do now per year. LA is at the bottom of the heap in healthcare outcome and at the top of the heap when it comes to number of uninsured. No state needs health care reform more than we do. Something must be done. Doing nothing is not an option. (14)
A strong public option is the only thing large enough, ready enough and competitive enough to bring down soaring health care costs. It would force prices of private insurance down --in order for private insurance to compete and stay in the game. Automatically, a strong public option would cost much less than private insurance as there is no profit to be made and no money to waste on executive bonuses, marketing, advertising, billing, administrative overhead, massive paperwork, pre-authorizations, appeals, and denials. (16) Health care reform without a public option is NO reform at all. According to Paul Krugman, Nobel Prize winning economist, without a strong public option, the U.S. will wind up with an ineffective, fragmented system like Massachusettes has, and our rising health care costs will not be curbed. (18) Polls consistently show that 60% of the American public supports a public option. (1, 33)
The public option is just a beginning. Once the public option is healthy and well and solvent, who in their right minds would choose private insurance (other than as supplements to pay for non-essential stuff like cosmetic surgery)? The insurance industry has a reason to be quaking in its boots. Its gravy train must be derailed in order to fix health care-- and insurance companies, as well as bought legislators, are fighting contemptibly and callously. They are lying and purposefully stoking fears of the elderly and the uninformed. These are despicable acts from desperate opponents of real health care reform.
Big health insurance companies spend $641,000 a day to lobby for their own self-preservation and against true health care reform. Since the year 2000, they have spent over $3 billion in lobbying for special favors. They have donated over $373 million to members of Congress since 2000. Of this, $178 million was earmarked for legislators on 5 committees or sub-committees overseeing health care. (36)
America’s Health Insurance Plans (AHIP) is a national association representing nearly 1,300 health insurance companies. AHIP donated almost $37 million in 2008 alone to candidates for Congress. Memo leaks show them falling back on the same tactics they used in 2007 to attack Michael Moore’s movie Sicko. (10) AHIP is investing big bucks for media ads with the specific intent of misleading the public into believing they favor bi-partisan health care reform and are part of the solution. This is so far from truth that it boggles the mind. Rather than the saviors, private insurance companies are the reasons we are in crisis. At the same time, they are engendering fear and distrust for big bad government-funded national insurance. What do they think Medicare is anyway? Should we abolish it since big bad government is involved?
Private insurance companies have undermined Medicare making sure the government takes all the risky-elderly while they make money subcontracting the healthiest elderly who are persuaded to purchase HMO’s for added coverage. Medicare pays the insurance companies item by item instead of a monthly lump sum. It costs us 13 to 14% more per patient to go through insurance companies than for traditional Medicare. All the risks go to government—all the profit goes to the insurance and pharmaceutical industries. Another bureaucratic noose around Medicare’s neck is not being allowed to negotiate for lower drug prices. This gives the pharmaceutical industry a bigger chunk of the market and resultant profits on a silver platter without having to pay for them or bargain with the govt. They came out smelling like the middle-man rose and the elderly came out paying far more than if government had done the job it is quite capable of doing for so much less. (20)
AHIP is making others do some of their dirty work. Pay attention to whom is paying for the anti-govt ads you see on television. These are 2 of the names you are likely to see— Conservatives for Patients’ Rights (CPR). (34) This is the same firm that did the Swift Boat ads against Sen. Kerry-- and are spending $20 million to portray patients in Canada and Great Britain as unhappy. For every foreign disgruntled patient CPR can manufacture, hundreds of disgruntled Americans can be found who are unhappy with private insurance atrocities.
Patients United Now is another dirty work companion to AHIP. (9) Patients United is the newest astroturf front group for Americans for Prosperity (AFP). Patients United targets the defeat of health care reform and is under the umbrella of Americans for Prosperity. Americans for Prosperity fakes grassroots causes to deceive the public when all it is out to do is defeat real reform. It is run by a former associate of Jack Abramoff. To give you a flavor of what other reforms and causes that Americans for Prosperity has attacked—
--Global warming and environmental regulations with The "Hot Air Tour".
--Employee Free Choice Act paying Joe the Plumber to smear it with The "Save My Ballot Tour".
--Clean Energy Economy legislation with the "No Climate Tax" ads.
--Recovery Act passage with the "No Stimulus" ads.
--Those against domestic drilling with the "Free Our Energy" push.
--President Obama with the orchestrating of anti-tax tea party protests last April.
The newest ad has a woman doctor falsely claiming that Medicare will be bankrupt in 8 years in addition to the tired old lies of govt coming betw you and your doctor, rationing care, reducing your choices and blasting Canada and Gr Britain (which she wrongly refers to as Eng). (3)
Don’t be fooled. The grassroots togetherness and concern is all a façade. Large health insurance companies only want to hold onto what they’ve enjoyed for so long—unfettered profit margins. In 1993, health insurance executives promised Congress that they would work for universal coverage and would no longer omit those with pre-existing conditions. (19) Not only did they not hold true to this, they did everything in their power to kill reform.
A really disturbing story is playing out in Maine, where Blue Cross/Blue Shield is suing the whole state because the insurer did not realize a certain expected profit margin. We are in a recession, people are losing jobs going and coming, and yet the largest insurance company in the nation, WellPoint, through its affiliate, Blue Cross Blue Shield, is demanding blood from a turnip. WellPoint realized 2 and a half billion dollars in profits in 2008, yet they feel justified in going after the citizens of Maine. (8)
The number of small insurance companies has dwindled as large conglomerates gobble up more of the market share. In LA, 74% of the health insurance market is controlled by 2 companies. 61% is controlled by Blue Cross/Blue Shield of LA. (12) 400 mergers in the health insurance industry have been allowed in the past 13 years creating virtual monopolies in states. These monopolies are responsible for higher premiums and the higher cost of health care. Profits are soaring as well. The 10 largest insurers increased profits by 428 % from 2000 to 2007. They went from earning a measly $2.4 billion to a whopping $12.9 billion 6 years later. (13 The cornerstones of a successful free market—choice and transparency—are both glaringly absent in the health insurance industry of today. (4)
In response to accusations that insurance companies are driving up costs and should be investigated for anti-trust violations, (2) AHIP turn-coated, finger-pointed and shifted the blame to doctors and hospitals—you know-- it’s all the fault of providers not the health plans! (11)
In 2008, the U.S. spent $2.4 trillion on health care and we are expected to almost double this by 2016. (27) We spend more per capita than other countries. But do we enjoy better health from our investments? Nope. In a field of 19 industrialized countries, the U.S. landed in 15th place in 1997-1998 for preventable deaths. 5 years later in 2002-2003, we landed in 19th place. (7) Preventable deaths are those which occur too soon, though there are treatments available. Included here would be deaths due to premature births, influenza, pneumonia, measles, skin cancer, ulcers, epilepsy, diabetes, stroke, hernia and surgical complications. Dr Steffie Woolhander, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts says, "For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent." (15)
Big insurance is not just upset with the possibility of a public option. It is also against government regulations in the Congressional health care reform bills. It does not want to accept pre-existing conditions nor does it want to be told what coverage must be included. Demanding higher standards by increasing the actuarial boundaries translates into insurers paying more and patients paying less. Dictating minimum-coverage-allowed is a means to protect customers from death-knell medical expenses. Present individual policies have average actuarial values at 55 to 60%. This means the plan covers 55 to 60 percent of the medical charges and the patient pays the remaining 40 to 45%. Proposed changes in the Senate and the House bills increase the actuarial value so that patients pay only 5 to 35% of the bill. But of course the plans that pay more also cost more---coverage vs affordability. (26)
We need the principle of insurance—large pools to distribute risks across the whole population. But we do not need the inefficiency of for-profit health care. We do not need the middle profit man taking money from clients to pay doctors and hospitals. 50% of us cost the system very little and 5% of us require 25% of the total medical care. (25) Sloughed off to the government are the high-cost-people like elderly, disabled, impoverished children and military veterans. The health insurance industry then assumes the costs of largely healthy folks with a hefty slice taken out for the industry as payment for such middle-man service. They do not provide medical care. They have been blessed with taxpayer subsidies and 7 decades of legislation slanted to support them. The hefty profits they make could better be spent paying for actual medical services. Insurance companies siphon $350 to $400 billion dollars from paid premiums each year that do not go to pay for medical care services. (35)
Small and medium-sized businesses have had to dramatically drop health care coverage to their employees. Within the 13 years from 1995 to 2008, businesses providing employee health care insurance decreased from 67% to 38%. This is according to the National Small Business Association. (5) The recession has made things even worse so fewer and fewer Americans can avail themselves of affordable, accessible health care.
Doctors are saddled with mountains of unnecessary insurance paperwork which costs each doctor about 10% of gross revenue to pay for the staff and labor time. (25) There are different forms and procedures depending on which of the 1300 insurance vendors is being billed. Doctors have to fight for approvals before care, and haggle for justified payments after care, and so do hospitals and so do patients. The complexity of the broken system wastes money needed badly elsewhere. (32)
5 bills are alive in Congress, 2 in the Senate (Finance, HELP or Health, Education, Labor and Pensions) and 3 in the House (Commerce, Ways & Means, Labor). All but one include a public option though not necessarily a strong public option. All 5 expand Medicaid which marches on treacherous ground for states who must shoulder 50% of the costs and who are already fiscally drowning. And Medicaid only pays doctors 72% of what Medicare pays them. (17) One of these 5, the House 3200 bill is 1,017 pages long. To understand it, one must read all the referred links and references too, which means over 9 or 10 thousand pages. (32)
Consider all the hundreds of amendments being filed for each bill and you can appreciate the big time complexity of health care reform. Sen. Ron Wyden (D-Oregon) offers an amendment to allow all consumers to be eligible to shop around among the offerings in the exchange --even those 180 million who have employer-sponsored insurance. Sen. Bernie Sanders (I-Vermont) offers an amendment to defuse the advantages given to pharmaceutical companies to postpone availability of generic drugs. Rep. Anthony Weiner (D-NY) on the commerce committee insisted on an amendment that would allow the House to vote on a replacement of its reform bill with single-payer. Sen. Bernie Sanders (I-VT) is proposing something similar to allow the Senate to vote on a replacement of its reform bill with single-payer. Rep. Dennis Kucinich (D-OH) on the labor committee added an amendment that would allow states to replace whatever plan is passed to their own single-payer plan. (32)
The Senate Finance Committee bill would cost $829 billion over a 10 year period and would reduce the federal deficit by a net savings of $81 billion claimed the nonpartisan Congressional Budget Office on Oct 7, 2009. It would also include coverage for 94% of Americans vs the present 85% coverage. (21) It would not provide fierce enough competition, though, to force down health care costs without a strong public option.
Just what is single-payer and how does it differ from the public option? Single-payer eliminates the need for the insurance company middle-man role. A single governmental entity funds privately-delivered health care much like Medicare operates. Doctors are not owned nor are they employed by govt. They practice their medicine privately. Government just writes their monthly checks. Hospitals are privately owned and paid with one check for the month’s expenses. Citizens pay taxes, not premiums, deductibles or co-pays. (35) This is not socialism, any more than paying police, firefighters, librarians and teachers with tax money is socialism.
Sixty percent of physicians support single-payer, as do the U.S. Conference of Mayors and 39 state labor federations and hundreds of local unions across the country. (29) Rep. John Conyers (D-MI) has introduced HR 676, which is a single-payer bill in the House. Sen. Bernie Sanders (I-VT) has introduced the first single payer bill, S 703, in the Senate since the late Paul Wellstone, (D-Minn), did it in the 1990’s.
The advantages of large-scale budgeting and purchasing-in-bulk, inherent in single-payer, drive down costs. The bureaucratic cost of running an exchange to regulate private insurance companies is eliminated. Eliminated also are the astronomical costs of private insurance administrative overhead, billing and paperwork to the tune of $350 to $400 billion annually—almost $4 trillion in 10 years. Another bonus is the single-payer system places the focus on preventative care rather than ER care, and returns medical decisions to doctors and their patients who freely choose them. (30, 29)
Single-payer is where health care reform advocates and the White House should have started. (31) Starting high would have given wiggle room and more bargaining chips. It would have forced opponents to claim that since government sponsored health care in the form of single-payer is so terrible then so must Medicare be bad. If a compromise was needed to assuage both sides, then the public option would not loom as such a bad idea. Robert Reich states that only a large and fiercely competitive public option, like what Medicare extension can provide, will have the power to reduce costs. Though he prefers single-payer, he believes the political forces are too formidable right now for it to pass. Time Magazine calls Robert Reich one of the ten most effective cabinet secretaries of the last century. He implemented the Family and Medical Leave Act, and headed Clinton's successful effort to raise the minimum wage. (22)
People are worth more than profit! Health care for all is RIGHT—it is JUST and mightier than the almighty dollar. Getting rich by denying care is WRONG --dead wrong.
Callous corporate pirates make money hand over fist, while millions of us go without health care. And many, many more millions of us are under-insured and teetering on the brink of financial ruin.
Instead of our elected officials fighting to defeat meaningful health care reform---something that is so patriotic and so morally right---these elected officials should be working feverishly to discover the best ways to pay for it. As Senator Ted Kennedy said, "End the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people."
Our senators and representatives should side with everyday people over insurance fat cats—consumers over industry. They should fight for us—for you and me—and not for the profit margins of the greedy. They should vote for The American Plan which equals a strong public option now which equals affordable, accessible health care for all. They must quit kissing up to parasitic predators by donating to charity the hefty sums their campaigns have accepted from health insurance companies.
Health care reform is a crossroads in our national welfare. It is history in the making. We must all stay energized and let our collective voices be heard without becoming discouraged or giving up. We have the moral high-ground on this. Healthy citizens are productive workers. We cannot afford to lose any more of our work force productivity. As a moral people, we must do whatever it takes to make broad access to affordable health care happen. When you know something is right, you prioritize and find a way to pay for it. I ask you, "If you lost your family's health coverage from work, what would you do?"
The American Plan = Public Option Now = Affordable, Accessible Health Care for All! It is long overdue and should not be dependent on the money one makes. We can’t delay for a non-existent, perfect compromise to be crafted. Had we waited for such, slavery would still exist and Medicare and Social Security would not.
Winston Churchill—"You can always rely on Americans to do the right thing after they've exhausted every other possibility."
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