Written by Ron Rabatsky   

Health Care.


"Health care is not just another commodity. It is not a gift to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American."
Ted Kennedy


From the Bangor Daily News:

“The moral of the story is that the political rightwing has to stop pretending they have the blessings of the Founding Fathers as their excuse to oppose whatever this president has to.

"One of the most common objections to the health care overhaul legislation passed by the 110th Congress is that it is unconstitutional for one of two reasons: The federal government can’t compel citizens to buy health insurance; and, the states, not the federal government, should determine health insurance standards. A corollary is that universal health insurance would have been anathema to the Founding Fathers.

"We don’t have to speculate about what men like Thomas Jefferson and John Adams thought about health insurance. We can just look at their actions.

"In 1798, Congress passed “An Act for the Relief of Sick and Disabled Seamen,” which created a system of government-operated marine hospitals. Privately employed sailors were required to pay a tax to support it.

"The act was passed by the 5th Congress, which included many drafters of the Constitution and signed by President John Adams, also an author. Then president of the Senate, Thomas Jefferson, who wrote extensively about limiting the power of the federal government, also supported the marine hospital system.

"As should be the case today, the push for health care — and a way to pay for it — came from businesses. Shipping was a major part of the U.S. economy in the 18th century. Injuries and illnesses — often from travels to faraway lands — often left maritime ships with too few sailors. This was bad for business and the economy.

"So, Congress stepped in. Even though sailors were privately employed, every one was required to pay a tax — about 1 percent of their earnings — to pay for health care. The ship’s owner withheld the money and turned it over to the government. If a sailor didn’t pay, he wasn’t allowed to work. Ships that had not collected the tax were not allowed to dock at U.S. ports.
The money was used to set up the Marine Hospital Service. Ailing sailors were treated in these federally run hospitals. Sick and injured sailors, after proving they had paid their tax, were given vouchers for treatment at one of the hospitals.

"The program was later expanded to cover those who worked on the country’s rivers.

“Clearly, the nation’s founders serving in the 5th Congress, and there were many of them, believed that mandated health insurance coverage was permitted within the limits established by our Constitution,” Rick Ungar wrote on his blog for Forbes last week. Mr. Ungar was the first to post the details of the sick and disabled seaman legislation and point out its similarities to the current health care bill." Mr. Ungar wrote,
“History makes it abundantly clear that they did not.”

We need to review the ObamacareS Health Plan to look for ways to make it more efficient and fair to all, as Congressional obstructionists did not do their job helping to formulate a bipartisan program. Changing to a single payer system—call it Medicare For All for lack of a better name—makes health care more affordable to all, while increasing the competitiveness of both small and large businesses which would not have to pay for the health benefits of their workers. The Medicare Trust would have the ability to negotiate prices for all drugs and medical devices to reduce their costs to Medicare. We can see no reason not to include this generally accepted good business practice in a revision to the ObamacareS Health Plan.

Some degree of tort reform is also required so that Doctors can afford to practice efficiently, not worrying about being sued for using his/her best medical judgment. Also, there needs to be some sort of reasonable cap for “pain and suffering” so that there are hard numbers on which to calculate appropriate medical malpractice. In order to cut back on malpractice awards without allowing bad doctors to continue practicing, stiffer standards must be applied to licensing and renewing the licenses of doctors so that bad doctors are weeded out of our system of medical care.

Based upon how the Affordable Health Care Act went through the Congress, there are undoubtedly other modifications which could be made to improve the bill.

Again the CBO would be involved to check the numbers and see what the cost of this program will be. Minimum charges will be charged to all, just as is done now with Medicare parts A and B, except we advocate means testing for Medicare eligibility. Those with incomes above a certain level would pay more or completely for their Medicare. Likewise, those with incomes below a certain level would pay less or nothing for their Medicare. According to the National Council on Aging, one of every three seniors is economically insecure, living on an annual income of less than $22,000. These people cannot afford to pay for health care, nor can they afford to live with any reductions in their Social Security income.

We now have reason for hope—The Affordable Health Care Act. Forbes Magazine writes that “Recent data provided by the nation’s largest health insurance companies reveals that a provision of the Affordable Health Care Act – ObamacareS – is bringing big numbers of the uninsured into the health care insurance system.

“And they are precisely the unuinsured that we want – the young people who tend not to get sick.

“The provision of the law that permits young adults under 26, long the largest uninsured demographic in the country, to remain on their parent’s health insurance program resulted in at least 600,000 newly insured Americans during the 1st quarter of 2011.

“The HHS Department had estimated that changes in the law would result in about 1.2 million new enrollees in 2011. However…it now looks like that umber will be exceeded.”

This is great news for several reasons:

For every young person “added to the rolls of the insured is one less young adult who will turn to the emergency room to fix a broken leg and then find themselves unable to pay the bill—leaving it to the rest of us to pay the tab.”

Additionally, because those under 26 tend not to get sick, adding them to the system will help to lower premiums. According to the health insurance companies, they turned in record profits for the 1st quarter of 2011, to fewer people seeking medical treatment.

“Further improving the outlook, the IRS has, in the past month, issued guidelines for small businesses which very much bolster the tax credits offered. Included in those guidelines are provisions that clarify that the tax credit will not be reduced by a state health care tax credit; that small businesses can receive the credit not only for traditional health insurance coverage but also for add-on dental, vision, and other limited-scope coverage.”

“Health care reform is working—and we have yet to get to the really big benefits which kick in in 2014. The time has arrived for even the most critical to take another look at health care reform. Facts and figures don’t lie – if accurately presented. And while the full jury won’t be in for a few more years, maybe the time has come for average Americans more interested in what is best for their country rather than grinding a political axe, to reconsider their views.”

“Successful flacks know how to use a variety of public relations tricks to obscure the truth -- being selective in the disclosure of information, for instance, or using statistics in misleading ways. Or pointing the finger of blame at someone else or "reframing" the issue about which reporters are asking.

“I have kept that framed quote all these years. Now, though, I'm thinking it would have a better home in the office of the chief flack for the health insurance industry.”

This past week, Robert Zirkelbach, spokesman for America's Health Insurance Plans (AHIP) took aim at the health care advocacy group Health Care for America Now (HCAN). HCAN took issue with AHIP's assertion that the average profit margin for health insurance firms is just 4.4 percent. Zirkelbach did not explain how he came up with that figure, but considering the fact that the big for-profit insurers had significantly higher margins than 4.4 percent last year (according to Yahoo! Finance), AHIP's calculations must have included the insurers that, at least in theory, don't make profits at all, like the so-called nonprofit Blue Cross and Blue Shield plans.

In a memo to editors and reporters Thursday afternoon, HCAN took issue with the 4.4 percent figure and accused AHIP of trying to pull the wool over journalists' eyes.

"AHIP's focus on profit margins is misleading and designed to protect their massive income by shifting attention away from their return on equity -- a key measure of profits as a percentage of the amount invested," HCAN's executive director, Ethan Rome, wrote.

"That return is a phenomenal 16.1 percent as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. The health insurance industry has a higher return for investors than cell phone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies, or grocery stores."

Zirkelbach, the health insurers' flack, responded in a Reaganesque, "there you go again," fashion. "Shocking," he wrote. He said Health Care for America Now had "released yet another deceptive, ideologically based attack on health plan profits. The data continue to show that this is an efficient, low-margin industry. It's time for them to get over the fact that the American people rejected the government-run plan and to start focusing on what's really driving health care cost growth."

So what are the "real drivers" of health care costs? Zirkelbach sent reporters a link to a chart on AHIP's blog called "Putting Health Plan Profits in Perspective." The chart shows, surprise, surprise, that health plan profits of $13.1 billion pale in comparison to those real drivers. The biggest such driver by far, according to AHIP's chart, is "defensive medicine" as practiced by doctors worried about getting sued, followed closely by "fraud and abuse in the entire system."

The source of that chart, according to AHIP, is an October 2009 white paper by Thomson Reuters entitled, " Where Can $700 Billion be Cut Annually from the U.S. Health Care System?" The title of the report is hyperlinked, but when you click on it, you get a page of gobbledygook.

I searched hard for the report, found it, and read it closely. Guess what? There is no such chart in the Thomson Reuters white paper and no breakdown of cost drivers as depicted by AHIP. In fact, had AHIP executives actually read the paper, they surely would not have brought it to the attention of the media. The insurance industry does not fare well at all.

A major point of the Thomson Reuters paper is that up to $700 billion that we spend on health care in the U.S. is wasted and that a big reason for that waste is our multi-payer system of private health insurance companies.

"Health care providers must deal with dozens of health benefit plans to bill successfully for services rendered," the report said. "Health plans must support systems for underwriting, claims administration, provider network contracting, and broker network management... Simplifying our health care system's administration could reduce annual health care costs by almost $300 billion."

Then there were these bullet points that surely will never appear in a health insurance industry presentation:

• The average U.S. hospital spends one quarter of its budget on billing and administration, nearly twice the average in Canada. American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than Canada.

• In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

I guess we actually should thank Zirkelbach for drawing our attention to the Thompson Reuters report. You won't find the chart AHIP says is in it, but you will find a lot of other useful information that, to AHIP's horror, might make you wonder what value private insurers actually add to the American health care system.

Looking at Medicaid, medical coverage for those who cannot afford any health coverage, Philly.com reports that N.J. Governor Chris Christie wants to lower the guidelines for Medicaid coverage from the current $30,000/year for a family of 4 to $6,000/year. In other words, “a single mother raising 3 kids earning $118/week would not qualify for this government funded medical coverage.”

The FDA.

In 1997 the FDA found and investigated Mexican strawberries infected with Hepatitis A. Also in 1997, Guatemalan raspberries with cyclospora. 2001-3 saw investigations into the safety of Mexican cantaloupes with salmonella, and green onions with Hepatitis A. 2008 saw an investigation first identified as bad tomatoes and found to be Serrano and jalapeno peppers from Mexico with salmonella. 2008 was also the year of melamine being found in Chinese milk, infant formulas, and pet foods. And that is just the tip of the iceberg.

In January, President Obama signed the Food Safety Modernization Act to overhaul the agency, enhancing its ability to deal with these offshore problems. They do not have the manpower to be everywhere all the time, so they have hired and are training third party staffers in places like Mexico City; Santiago, Chile; Guangzhou China; Shanghai, China; Beijing, China; Brussels; London; New Delhi and Mumbai, India--among other places from where we import our food. The number of FDA foreign food inspection facilities has grown from 95 in 2007 to 600 today.

But there are two forces standing in the way of implementing President Obama’s policy—politics and money. The radical Ryandontcare bill calls for trimming the agency’s budget by $220 million. The conservatives’ opinion is that while food safety is certainly important, the rarity of food-borne illnesses means that the current system is effective. Tell that to the 48 million people who contracted a food-borne illness last year, 3000 of whom died. Tell that to the parents who gave their babies melamine tainted formula or the people who fed their pets melamine laced pet foods. Should the frequency or intensity of food-borne illnesses get any worse, republicans should have to explain why they did not protect their constituents.

The FDA is probably best known as the agency responsible for testing new drugs, new medical devices, pet foods and medications, vaccines, cosmetics, any radiation emitting devices, and tobacco products. Essentially they are the consumer watchdog in America's healthcare system, and as such need additional support and funding rather than any cuts in their budget as conservatives would do.