By Michele Leight
If you have ever spent a frustrating morning hanging on the phone to find out why a portion of a medical bill has not been paid, you are one of the lucky ones, because you have health insurance.
Almost 47 million Americans do not, because it is too expensive - almost one sixth of the population.
Healthcare is big business in America, and the tactics used by some managed care and health insurance companies are no different to those used by some large phone and credit card companies. Their goal is maximum profits, and right now the health insurance companies - not the patient - are in control, calling the shots. But change must come.
The "wear them down" approach, not paying part of the medical bill, and endless rounds of form filling and waiting is costing the nation a fortune. If we saved these productive work hours lost "waiting," or being aggravated, we'd be rich and happy.
More importantly, the current "wait untill its life threatening" approach makes large profits for "the system," at the expense of patients, who would benefit from prevention and treatment much earlier. Without wishing to sound cynical, prevention is just not as profitable, and the insurance companies are quite happy with the status quo.
An out of control healthcare system is one in which insurance companies would rather pay bills for a foot amputation than cover early screening and preventive treatment for Type 2 Diabetes. The expensive surgical procedures, treatments and medications are preferable to all branches of the healthcare businesses because they make tons of money. However, as things stand, the customer - the patient - is not benefiting, because health insurance companies like insuring healthy people! Now there's a challenge.
Insurance companies get to pick and choose who they will, or will not, insure - but who ever heard of that in a real business, where the customer is the one who is wooed? Patients with "pre-existing" health conditions are increasingly left out in the cold. Now how fair is that? Anyone could rake in billions of dollars not insuring people, including children with serious medical problems.
A growing number of companies in America say they cannot afford to provide health insurance for their employees because it is so expensive. Healthcare costs have soared from 5.2 percent of America's GDP in 1960, to a staggering 16 percent in 2005, and costs are still climbing. In 2006 approximately 61 percent of employers provided healthcare coverage - down 8 percent from 2000 - while over the same period health insurance premiums increased by 87 percent, according to the Kaiser Family Foundation. That is a staggering increase.
Healthcare costs are exploding in the United States, exceeding $2.2 trillion in 2006.
With all this expense, however, it is ironic that in the wealthiest nation in the world, honest, hard working middle class people that cannot afford health insurance are at far more risk than a middle-income wage earner in India, for example, who can access excellent medical attention at a fraction of the cost. American health insurance companies are flying patients to India to have operations.
While America has the best doctors in the world, some doctors and surgeons are not taking patients with health insurance. They have wealthy clients who can pay them out of pocket, and they don't want to play the waiting game while insurance companies make a litany of excuses, and stall on paying insurance claims - their bills. Others are pulling out because they spend more time filling out forms than treating patients, or because their liability insurance is in the stratosphere because of frivolous lawsuits.
Surrounded by state-of-the-art medical treatments, doctors, surgeons, and facilities, for the uninsured in America it is like looking upon the "promised land," but not being able to partake. For this growing segment of the population, postponing a visit to the doctor is a ticking time bomb, because necessary check-ups do not occur, and preventive care for any unknown health condition goes untreated. The longer a chronic disease like diabetes is neglected, the more damage occurs, and the more expensive it becomes to control.
After this battery of negatives about the current healthcare crisis, it is a pleasure to report on a heartening bi-partisan effort by four senators and a congressman that have been leading the charge on healthcare reform - and they want Congress to do something about it fast. They have authored four important pieces of healthcare legislation currently circulating in Congress that was the topic of a recent forum at The New School in New York, entitled "Reforming Healthcare: Four Solutions from the U.S. Congress."
The standing-room only auditorium was packed on October 29, 2007 and all were focused on the panelists, Senators Bob Bennett, (R-UT), Richard Burr, (R-NC), Tom Coburn, M.D., (R-OK) and Ron Wyden, (D-OR). New School President Bob Kerry, a former U.S. Senator (D-NB), was the moderator and the panel was later joined by Congressman John Conyers, Jr., (D-MI).
An atmosphere of bi-partisanship prevailed even though very different views about healthcare reform were expressed - the main difference between the panelists being that "free" healthcare carried the risk of a lower standard of care.
This is a realistic concern - horror stories from nations with free healthcare abound - but if we fly people to the moon, and deploy thousands of troops to foreign lands, how difficult is it really to provide affordable, quality healthcare to all citizens in the wealthiest nation in the world?
What was hugely appealing was that although the senators and congressman on this panel serve constituencies with different needs across America, there were noticeable areas of overlap in their proposed healthcare reform legislation, which the reader will discover. Hopefully, some of these proposals will make their way through the fog of the current healthcare crisis, offering relief to the entire nation - but it is important for us to understand our options, and make informed decisions, so change comes fast.
I cannot guarantee that hasty notes taken in a darkened auditorium will attribute the exact comments to the appropriate senators and congressman, so I will refrain from attributing them. Here are some of their comments, followed by an analysis of the four different healthcare reform proposals, with links provided for further research:
"Every single industrialized nation on the planet has it (healthcare) but we do not."
"We have 47 million without any insurance - 22 million mostly 'working people,' and 20 to 30 million who are undiagnosed until they show up at the hospital or the doctor."
"Healthcare is a universal right. We have bought into it - but we don't practice it."
"There are ERs refusing to take people, and doctors moving away from Medicaid."
"There are so many small businessmen that cannot afford healthcare....and please don't tell me about the people that go to the ER and have a $30,000 bill mailed to them!"
"I can tell you about a woman who had to put down $500 before they would take care of her. If that was an African-American they would not have made it."
"Doctors have been forced to close their offices because they are doing administrative work instead of acting as medical staff."
"Swollen incomes are paid to some CEOs: $1.6 billion to one!"
"50% of the healthcare dollar goes back to the pharmaceutical companies to fund their 'research.' The EU (European Union) is providing the same amount of medical research except they are doing it for far, far less."
"We have done a lot right and a lot wrong. We need to improve access where we have done well."
Co-authored by a Republican and a Democrat, Senator Bennett and Senator Wydenm who is also a medical doctor, The Healthy Americans Act has the potential to appeal to a broad range of people, illustrated by two endorsements below, (made in 2007), one by the CEO of a nationwide supermarket chain, the other the head of a powerful healthcare workers union.
"The Healthy Americans Act is an innovative proposal that lays a foundation to begin a serious discussion on health care reform in this country. Our nation is facing a crisis that requires immediate attention. Working together, business, labor, government, consumer groups and healthcare providers can collectively solve this problem," said Steve Burd, CEO of Safeway.
Andy Stern, President of SEIU, the nation's largest union of healthcare workers, also gives The Health Americans Act the thumbs up:
"It is time for fundamental, not incremental change, and this is a plan that is practical, principled, and sets down a moral test....On behalf of the 1.9 million members of SEIU and their families, we believe The Healthy Americans Act makes a critical contribution to the debate that Congress must attend to next year."
By James Leight (Young
Friends of Ashraya-New York)
The Healthy Americans Act
Co-authored by Senator Bob Bennett, (R-Utah), and Senator Ron Wyden, (D-Ore)
Why is reform necessary? The number of Americans without any government or private health insurance coverage has been steadily increasing since 1987 to its current figure, which is almost 47 million individuals. Furthermore, health expenditures have more than tripled in the last four decades from 5.2 percent of the US GDP in 1960 to 16 percent in 2005.
The Healthy Americans Act would
be implemented as follows. The Act would establish a number of
regional "Health Help Agencies" (HHAs) from which individuals
could purchase private health insurance plans. Each state would
establish an HHA with financial support from insurance companies
and the federal government. HHAs would coordinate payments from
employers, individuals and the government, as well as provide
consumers with information on competing plans so they can choose
the most affordable, quality coverage available.
Employers would be required to terminate their existing health
insurance plans and return the money saved to their employees
in the form of increased wages. A new "health premium"
tax deduction (which is fixed and cannot be increased by purchasing
more coverage) would be created to ensure that the increased wages
do not increase income tax payments.
Participants in the plan would pay their premiums through their
income tax filings. The program would fully subsidize those below
100 percent of the Federal Poverty Level (FPL) (currently $10,210
for an individual and $17,170 for a family of 3) and the premium
would "phase in" for those living between 100 percent
and 400 percent of the FPL. Since the plan is paid through tax
filings, those without enough income to pay income taxes are regarded
as eligible for the subsidized program, and this eliminates the
need to apply for assistance separately through Medicaid. Additionally,
employers would be required to pay an assessment ranging from
2 to 25 percent of the national average premium for the minimum
benefits package.
The Healthy Americans Act would cover 246.8 million people and
national health spending, which is projected to be $2.3 trillion
in 2007, would decline by an estimated $4.5 billion due to reduced
administrative costs and increased price competition for insurance.
The Act offers a number of advantages, one being that individuals cannot lose their coverage due to changes in employment, income or marital status.
Additionally, it provides consumers with incentives to demand lower-cost health coverage (due to the fact that the employees bear the full cost of insurance and must pay the full difference if they elect to enroll in a more costly plan).
Finally, administering the program is much more streamlined due to their being no income-testing at the point of enrollment (as under Medicaid) and because plan selection is organized through regional HHAs with employers administering open enrollment for employees.
Since the debate at The New School on October 29, 2007, there have been encouraging developments in the "The Healthy Americans Act," (S. 334) outlined in a March 15th, 2008 press release.
The Healthy Americans Act, which now has a total of 14 Senate sponsors. They are: Senators Ron Wyden (D-Ore.), Bob Bennett (R-Utah), Daniel Inouye (D-Hawaii), the Chair of the Senate Commerce Committee and second-most senior member on the Senate Appropriations Committee, Senator Bob Corker (R-Tenn.), a former mayor, state finance commissioner, and entrepreneur who knows first-hand the health care challenges faced by businesses and local governments, Lamar Alexander (R-Tenn.), Bill Nelson (D-Fla.), Judd Gregg (R-NH), Debbie Stabenow (D-Mich.), Chuck Grassley (R-Iowa), Mary Landrieu (D-La.), Norm Coleman (R-Minn.), Joe Lieberman (D-Conn.), Mike Crapo (R-Idaho) and Tom Carper (D-Del.).
Introduced by Wyden and Bennett, The Healthy Americans Act is the first bipartisan, comprehensive health reform bill in more than 13 years. In addition to guaranteeing that every American can afford quality, private health insurance, Wyden-Bennett would give Americans choice in where they get their health care, break the link between employment and insurance to make health care portable from job to job (and continue if you lose your job), promote personal responsibility and preventive medicine and reform the insurance markets so that insurers are forced to compete on price, benefits and quality. An independent analysis conducted by the Lewin Group estimates that even covering all Americans, the Healthy Americans Act could save more than $1.5 trillion in health care spending over the next 10 years.
In the Senate, the Healthy Americans Act is awaiting action by the Finance Committee. Senator Grassley is the ranking member and Senators Crapo, Stabenow and Wyden are members of the Committee.
Senator Bob Bennett is counsel to Republican Leader Mitch McConnell, and retains his seat on the leadership team of the party, advising McConnell on legislative strategy and policy priorities. Senator Bennett is at the center of national economic policy discussions, and serves as a senior member of the Senate Banking Committee., the Joint Economic Committee, and ranking Republican member on the Senate Rules Committee. Senator Bennett is in his third term and has received many awards for his service and contribution to the U.S. Senate
Senator Ron Wyden has a reputation for pursuing innovative bi-partisan solutions to difficult issues, and offering unprecedented accessibility to his constituents. Senator Wyden authored the bi-partisan Healthcare That Works for All Americans law, implemented in 2005 and 2006, that shows the difficult healthcare choices facing Americans, and reforms the healthcare system through public input and political accountability. Senator Wyden is a member of the Senate Finance Committee. He authored the first law protecting seniors from predatory, unscrupulous Medicare insurance scams, and exposed the tobacco companies for hiding the addictiveness of nicotine.
To learn more about S.334 visit http://wyden.senate.gov/haa and http://bennett.senate.gov.
Every American Insured Health Act
This Act would change the tax code to treat all Americans equally when they purchase health insurance. It offers Americans the ability to save for future health care costs by putting some of their tax credit money into a healthcare spending account, and provides states the incentive to make health insurance more affordable and accessible by connecting tax credit refunds to competitive health markets, ensuring a variety of health insurance options.
Senator Richard Burr (R) serves his constituents in North Carolina,and sponsored the Every American Insured Health Act. Senator Burr has been a tireless legislator on healthcare issues, working to restore accountability to the federal government. He is committed to finding solutions to increase access to affordable quality health care for all North Carolina families. He is a vocal advocate for the military and their families, and for the increasing population of veterans across North Carolina. He is the ranking member of the Senate Veterans Affairs Committee, working hard to improve the quality of healthcare and service veterans receive. Senator Burr sits on the Health, Education, Labor and Pensions Committee, the Senate Intelligence Committee, the Energy and Natural Resources Committee and the Indian Affairs Committee.
http://www.govtrack.us/congress/bill.xpd?bill=s110-1886
Universal Healthcare Choice and Access Bill
This bill transfers tax rebates from businesses to individuals by providing patients with federal MediChoice tax rebates to be used to purchase healthcare coverage tailored to their medical needs. It advocates prevention by reforming federal prevention programs and requiring results and accountability, while focusing on the top five chronic diseases that currently cause two-thirds of American deaths. It releases the poor from substandard government care by offering states the option to provide their Medicaid beneficiaries the kind of healthcare coverage that wealthier Americans have.
Senator Tom Coburn, M.D. (R) serves his constituents in Oklahoma and is the sponsor of the Universal Healthcare Choice and Access Bill. His priorities in the Senate have included balancing the budget, reducing wasteful spending, improving access and affordability to healthcare, and protecting the sanctity of all human life. He is a member of the Senate Judiciary Committee, Homeland Security and Government Affairs Committee, the Indian Affairs Committee, and the Committee on Health, Education, Labor and Pensions. Senator Coburn is a doctor and citizen legislator and has pledged to serve no more than two terms in the Senate so that he can continue to care for patients.
The United States National Health Insurance Act (HR676)
As the name of this Act suggests, this is a single-payer healthcare system that proposes to reduce overall annual healthcare spending by over $50 billion in the first year, primarily by reducing paperwork and purchasing medications in bulk. By containing health spending over a period of time, it seeks to ensure affordable health care for all services without co-pays or deductibles to present and future generations of Americans. Employers will be required to pay 3.3 percent payroll tax for each employee instead of covering the costs for company-wide private health insurance, and 1.45 percent employee and employer Medicare payroll tax will continue. A health income tax will be assessed on the wealthiest 5 percent of Americans.
Representative John Conyers, Jr., (D) serves his constituents in Michigan and is the sponsor of The United States National Health Insurance Act (HR676). He entered the House of Representatives in 1964 as a Detroit Democrat, and is now in his 21st term. He is the second most senior member in the House of Representatives. Senator Conyers has led efforts to reform the healthcare system for over three decades, and is the founding chairman of the Congressional Universal Health Care Task Force, a 45-member caucus with a mission to pass universal health care legislation. Representative Conyers is now working on legislation that would protect worker's pensions and health care in cases of bankruptcy, like those involving Worldcom, National Steel and Enron.
John.Conyers@mail.house.gov
www.house.gov/conyers/news_hr676.htm
At the end of the forum, the audience was invited to ask questions, and some made comments:
"Be careful of a single-payer government-run system that does not look out for the patient."
Another member of the audience said:
"We want what you people in Congress have!" (applause)
Congressman John Conyers said:
"What we have is not so hot!"
The senators and congressman raised the issue of personal responsibility:
"$27 billion is being spent on prevention programs and $26 billion on other programs that do not work. This bill (The Healthy Americans Act) takes all the money and measures it against effectiveness."
A member of the audience asked if they would be covered by their health insurance if they chose to focus on prevention, through holistic or chiropractic treatment.
"If you have insurance, you can see any kind of doctor you want," came the encouraging response (The Healthy Americans Act).
This is a refreshing departure for patients that are used to being told which method of healing they may or may not use. It is great to think that in the future we may have the option to choose from all kinds of treatments, instead of being railroaded into using addictive painkillers for chronic back pain and other painful health conditions - expensive prescription drugs that create dependency.
Healthy competition has been the lifeblood of this country. Competition fosters excellence and innovation. This does not, however, include the "There Will Be Blood," predatory brand of competition as portrayed in the film adaptation of Upton Sinclair's novel "Oil." There is an uncanny resemblance in "There Will Be Blood" to some of today's predatory business practices, including healthcare.
The tobacco industry skillfully swept the addictiveness of nicotine under the carpet for years, damaging people's health permanently, while raking in huge profits. Those that have not yet seen "The Insider" (starring Russell Crowe), might like to know it is based on a true story about the cover-up. It can be purchased at any online DVD store.
Senator Wyden, who co-sponsored The Healthy Americans Act, helped end the corruption and denial surrounding nicotine. Congressman Conyers, who sponsored The United States Health Insurance Act, is working to ensure that Enron does not happen again.
America sets the bar on health
treatments and cures globally, but in an ironic twist of fate,
almost 47 million of its own citizens are barred access to them.
As the important debate at The New School demonstrated, one of
the greatest challenges facing America is to find a way to obtain
healthcare for everyone, without lowering the standard of care.
It is time for healthcare "business" entities to win
our confidence and trust because we are impressed by how they
treat us - and by proven, successful results - like any other
successful, well run, customer-oriented business.
In return, we will have to change the way we think about our health,
and what we are willing to do to preserve it. Those endless rounds
of milk shakes, sugary sodas, onion rings and fries will have
to go - except a couple of times a week if our healthcare score-card
comes up clean. Our co-operation in preventing illness will be
rewarded, offering us an incentive to stay healthy.
At present, a profitable game is being played with taxpayers and private sector money - hard earned money - that is not benefiting millions of Americans, including many that are insured or those with "pre-existing" health conditions. Here is a statistic that needs no further explanation:
"The United States spends nearly $100 billion to provide uninsured patients with health services, often for preventable diseases or diseases more efficiently treated with early diagnoses. This burden is shouldered by everyone." (www.Voicefortheuninsured.org)
Visit the links provided if you would like to find out more about your choices for healthcare reform - and access to affordable health insurance that will not be linked to your job - in the not too distant future.
For programs at The New School, visit www.thenewschool.org