Health Affairs
Abstract
Higher health care prices in the United States are a key reason that the nation’s health spending is so much higher than that of other countries. Our study compared physicians’ fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. We also compared physicians’ incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries’ national spending on physician services. Public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians’ counterparts in other countries. US primary care and orthopedic physicians also earned higher incomes ($186,582 and $442,450, respectively) than their foreign counterparts. We conclude that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending, particularly in orthopedics.
Thursday, September 29, 2011
Eliminate the Profit Motive in Health Care
Arnold S. Relman, M.D. Professor Emeritus of Medicine and Social Medicine, Harvard Medical School Former Editor-in-Chief, New England Journal of Medicine
There are two interrelated critical issues in health reform right now: how to extend and improve insurance coverage, and how to control the unsustainable rise in health care expenditures. Virtually all of the current legislative attention is focused on the first issue but, notwithstanding claims to the contrary, none of the proposals now on the table offers any credible solution for the control of rising costs. Without control of health cost inflation, the present system will not be viable much longer.
Expansion of coverage is of course a highly desirable goal, but it inevitably increases expenditures even beyond today's exorbitant levels. President Obama has repeatedly said he would veto any health proposal that is not "budget neutral" over the next decade. The legislation now under consideration claims to meet that requirement through savings promised by the insurance, drug and hospital industries and through reductions in Medicare expenditures (excessive payments to private insurers for Medicare Advantage plans would be a major target), possibly supplemented by taxes on employment-based health plans for high income employees. However, critics question whether these measures would fully pay for the almost one trillion dollars of new costs for covering most of the uninsured over the next decade.
But the estimate of the costs of expanded coverage does not include the cost of the constant inflationary rise in all medical expenditures, lately about 6 - 8 percent per year. This would increase total health spending by roughly another two trillion dollars over the next decade. Administration policy-makers speak hopefully of savings to be generated in the long term by switching to electronic records, using more preventive measures, and applying the information gained from studies of comparative effectiveness. But skeptics might call this "faith-based" savings, because there is no solid evidence to support such hopes. The sobering fact remains that something more must be done soon to slow medical inflation or the entire health system will inevitably slide into bankruptcy. And yet none of the legislation currently being considered addresses that problem. Adding more benefits to the system, and covering more people with public and private insurance, are certainly important, but even if those improvements were paid for, they would not slow down the numerous inflationary forces that make our medical care system unsustainable.
What are those inflationary forces? I believe the most important among them are the incentives in the payment and organization of medical care that cause physicians, hospitals and other medical care facilities to focus at least as much on income and profit as on meeting the needs of patients. I have discussed this subject in a recent book (A Second Opinion. Rescuing America's Health Care. Public Affairs, New York, 2007). The U.S., more than any other advanced country, has come to rely mainly on private markets to deliver medical care, and on fee-for-service to pay its physicians. The incentives in such a system reward and stimulate the delivery of more services. That is why medical expenditures in the U.S. are so much higher than in any other country, and are rising more rapidly. Our business-oriented system inevitably drives up expenditures because in medical care the balancing tensions between the suppliers and consumers of services that constrain costs in ordinary business markets do not exist. Physicians, who supply the services, control most of the decisions to use medical resources, and patients, who are the consumers of those resources, do not pay most of the costs.
The economic incentives in the medical market are attracting the great majority of physicians into specialty practice, and these incentives, combined with the continued introduction of new and more expensive technology, are a major factor in causing inflation of medical expenditures. Physicians and ambulatory care and diagnostic facilities, are largely paid on a piecework basis for each item of service provided. Hospitals also bill insurers according to the days of care and the services they provide, although payments for treatment of an illness may be aggregated. However, all providers compete for income and market share, often advertising and marketing for that purpose. They almost never compete on prices because public and private insurers, not patients, pay most of the costs. Competition in the current medical market therefore tends to drive up total costs because it results in greater use of services, while rarely lowering prices.
Control of medical expenditures is unlikely without a major reform of the payment and organization of medical care. Expanding and improving the medical insurance part of the health system will not solve the expenditures problem unless the perverse incentives in the delivery of care are also corrected. In fact, expansion of insurance benefits without this other reform would probably make matters even worse. A so-called "public option" will not solve this problem either, although its competition might force private insurers to reduce their premiums or increased benefits. But even if some sort of low-cost not-for-profit insurance plan were offered as an optional choice for the uninsured and those dissatisfied with their present coverage, the inflationary effects of fee-for-service payments and an entrepreneurial medical care system would still be operating. After all, Medicare is a low-overhead plan that costs its beneficiaries less than private plans, but the rate of inflation in its expenditures is nearly as rapid as the inflation in private medical insurance expenditures. The benefits of Medicare are just as threatened as those of the private insurance system because costs are rising rapidly in both the public and private sectors of health care.
Judging from the current debate in Washington, there is little evidence that lawmakers are aware of these facts or, if they are, that they have the stomach for resisting the powerful vested interests that stand in the way of major reform. That is why the Goldman Sachs prediction of a compromised legislative outcome is likely to be correct. At the end of this Congress we will probably end up in a position not unlike that facing the Commonwealth of Massachusetts. Over three years ago it enacted legislation that greatly expanded insurance coverage, but from the outset it faced serious financial problems in funding the increased costs. A special state commission has recommended to the Massachusetts legislature that it consider ways to eliminate fee-for-service payment of physicians in favor of some type of system that would be based on organizations of physicians and hospitals that could accept global prepayments for comprehensive care. It remains to be seen whether and how these recommendations can be implemented, but it is telling that Massachusetts seems now to realize what our national lawmakers have not yet grasped: Sustainable universal, or near-universal, coverage requires more than fixing the insurance system. It needs major reform in the payment and organization of medical care as well.
In my book, and in a recent article in the New York Review of Books (July 2), I have proposed a system of medical reforms that would deal with the cost problems in both the insurance and medical care sectors of our health care system and would ensure good care for everyone. I recommend replacement of the current mix of public and private insurance plans with universal coverage for comprehensive care that would be funded by a progressive national health insurance tax. Medical care would be provided through community-based not-for-profit multi-specialty group practices, which would be staffed by salaried physicians. When medical insurance is no longer a for-profit business, when physicians no longer are paid on a fee-for-service basis, and when the entire health care delivery system is not-for-profit, economic incentives to over- or underserve the needs of patients can be eliminated by appropriate regulation and we can expect improved quality of care at lower costs. The total national expenditure on medical care can be controlled by the level of national funding, while decisions about the proper use of medical resources can be safely left where they belong, in the hands of physicians and their patients.
Carrying out such a transformation of the health care system would of course be a formidable task, probably achievable only in gradual steps. It would require a sea change in the current political climate. A large part of the public, supported by most business leaders who are outside the medical-industrial complex, and by an awakened medical profession, would have to be convinced that a major reform of this kind offers the only chance for an equitable but affordable medical care system of good quality. In a just-published commentary in the New England Journal of Medicine ("Doctors as the Key to Health Care Reform", NEJM, September 24, 2009) I explain how crucial change in the organization and payment of medical services is to achieving a sustainable health care system. The medical profession will have to be a willing and active partner in carrying out these reforms.
Lawmakers need votes and public support even more than the money from vested interests, so they probably would act if a majority of voters were to make its wishes clear and if the medical profession were part of this awakening. But before public opinion can be galvanized to demand a sweeping change of this kind we may, unfortunately, have to experience a disastrous financial collapse of the health care system, with widespread loss of benefits. An expansion of coverage without changing the medical care delivery system and controlling medical inflation, might very well hasten such a collapse.
There are two interrelated critical issues in health reform right now: how to extend and improve insurance coverage, and how to control the unsustainable rise in health care expenditures. Virtually all of the current legislative attention is focused on the first issue but, notwithstanding claims to the contrary, none of the proposals now on the table offers any credible solution for the control of rising costs. Without control of health cost inflation, the present system will not be viable much longer.
Expansion of coverage is of course a highly desirable goal, but it inevitably increases expenditures even beyond today's exorbitant levels. President Obama has repeatedly said he would veto any health proposal that is not "budget neutral" over the next decade. The legislation now under consideration claims to meet that requirement through savings promised by the insurance, drug and hospital industries and through reductions in Medicare expenditures (excessive payments to private insurers for Medicare Advantage plans would be a major target), possibly supplemented by taxes on employment-based health plans for high income employees. However, critics question whether these measures would fully pay for the almost one trillion dollars of new costs for covering most of the uninsured over the next decade.
But the estimate of the costs of expanded coverage does not include the cost of the constant inflationary rise in all medical expenditures, lately about 6 - 8 percent per year. This would increase total health spending by roughly another two trillion dollars over the next decade. Administration policy-makers speak hopefully of savings to be generated in the long term by switching to electronic records, using more preventive measures, and applying the information gained from studies of comparative effectiveness. But skeptics might call this "faith-based" savings, because there is no solid evidence to support such hopes. The sobering fact remains that something more must be done soon to slow medical inflation or the entire health system will inevitably slide into bankruptcy. And yet none of the legislation currently being considered addresses that problem. Adding more benefits to the system, and covering more people with public and private insurance, are certainly important, but even if those improvements were paid for, they would not slow down the numerous inflationary forces that make our medical care system unsustainable.
What are those inflationary forces? I believe the most important among them are the incentives in the payment and organization of medical care that cause physicians, hospitals and other medical care facilities to focus at least as much on income and profit as on meeting the needs of patients. I have discussed this subject in a recent book (A Second Opinion. Rescuing America's Health Care. Public Affairs, New York, 2007). The U.S., more than any other advanced country, has come to rely mainly on private markets to deliver medical care, and on fee-for-service to pay its physicians. The incentives in such a system reward and stimulate the delivery of more services. That is why medical expenditures in the U.S. are so much higher than in any other country, and are rising more rapidly. Our business-oriented system inevitably drives up expenditures because in medical care the balancing tensions between the suppliers and consumers of services that constrain costs in ordinary business markets do not exist. Physicians, who supply the services, control most of the decisions to use medical resources, and patients, who are the consumers of those resources, do not pay most of the costs.
The economic incentives in the medical market are attracting the great majority of physicians into specialty practice, and these incentives, combined with the continued introduction of new and more expensive technology, are a major factor in causing inflation of medical expenditures. Physicians and ambulatory care and diagnostic facilities, are largely paid on a piecework basis for each item of service provided. Hospitals also bill insurers according to the days of care and the services they provide, although payments for treatment of an illness may be aggregated. However, all providers compete for income and market share, often advertising and marketing for that purpose. They almost never compete on prices because public and private insurers, not patients, pay most of the costs. Competition in the current medical market therefore tends to drive up total costs because it results in greater use of services, while rarely lowering prices.
Control of medical expenditures is unlikely without a major reform of the payment and organization of medical care. Expanding and improving the medical insurance part of the health system will not solve the expenditures problem unless the perverse incentives in the delivery of care are also corrected. In fact, expansion of insurance benefits without this other reform would probably make matters even worse. A so-called "public option" will not solve this problem either, although its competition might force private insurers to reduce their premiums or increased benefits. But even if some sort of low-cost not-for-profit insurance plan were offered as an optional choice for the uninsured and those dissatisfied with their present coverage, the inflationary effects of fee-for-service payments and an entrepreneurial medical care system would still be operating. After all, Medicare is a low-overhead plan that costs its beneficiaries less than private plans, but the rate of inflation in its expenditures is nearly as rapid as the inflation in private medical insurance expenditures. The benefits of Medicare are just as threatened as those of the private insurance system because costs are rising rapidly in both the public and private sectors of health care.
Judging from the current debate in Washington, there is little evidence that lawmakers are aware of these facts or, if they are, that they have the stomach for resisting the powerful vested interests that stand in the way of major reform. That is why the Goldman Sachs prediction of a compromised legislative outcome is likely to be correct. At the end of this Congress we will probably end up in a position not unlike that facing the Commonwealth of Massachusetts. Over three years ago it enacted legislation that greatly expanded insurance coverage, but from the outset it faced serious financial problems in funding the increased costs. A special state commission has recommended to the Massachusetts legislature that it consider ways to eliminate fee-for-service payment of physicians in favor of some type of system that would be based on organizations of physicians and hospitals that could accept global prepayments for comprehensive care. It remains to be seen whether and how these recommendations can be implemented, but it is telling that Massachusetts seems now to realize what our national lawmakers have not yet grasped: Sustainable universal, or near-universal, coverage requires more than fixing the insurance system. It needs major reform in the payment and organization of medical care as well.
In my book, and in a recent article in the New York Review of Books (July 2), I have proposed a system of medical reforms that would deal with the cost problems in both the insurance and medical care sectors of our health care system and would ensure good care for everyone. I recommend replacement of the current mix of public and private insurance plans with universal coverage for comprehensive care that would be funded by a progressive national health insurance tax. Medical care would be provided through community-based not-for-profit multi-specialty group practices, which would be staffed by salaried physicians. When medical insurance is no longer a for-profit business, when physicians no longer are paid on a fee-for-service basis, and when the entire health care delivery system is not-for-profit, economic incentives to over- or underserve the needs of patients can be eliminated by appropriate regulation and we can expect improved quality of care at lower costs. The total national expenditure on medical care can be controlled by the level of national funding, while decisions about the proper use of medical resources can be safely left where they belong, in the hands of physicians and their patients.
Carrying out such a transformation of the health care system would of course be a formidable task, probably achievable only in gradual steps. It would require a sea change in the current political climate. A large part of the public, supported by most business leaders who are outside the medical-industrial complex, and by an awakened medical profession, would have to be convinced that a major reform of this kind offers the only chance for an equitable but affordable medical care system of good quality. In a just-published commentary in the New England Journal of Medicine ("Doctors as the Key to Health Care Reform", NEJM, September 24, 2009) I explain how crucial change in the organization and payment of medical services is to achieving a sustainable health care system. The medical profession will have to be a willing and active partner in carrying out these reforms.
Lawmakers need votes and public support even more than the money from vested interests, so they probably would act if a majority of voters were to make its wishes clear and if the medical profession were part of this awakening. But before public opinion can be galvanized to demand a sweeping change of this kind we may, unfortunately, have to experience a disastrous financial collapse of the health care system, with widespread loss of benefits. An expansion of coverage without changing the medical care delivery system and controlling medical inflation, might very well hasten such a collapse.
Wednesday, September 28, 2011
Health Insurers Push Premiums Sharply Higher
NYTimes
Major health insurance companies have been charging sharply higher premiums this year, outstripping any growth in workers’ wages and creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.
A study released on Tuesday by the Kaiser Family Foundation, a research group, showed that the average annual premium for family coverage through an employer reached $15,073 in 2011 — 9 percent higher than in the previous year. And even higher premiums could be on the way, particularly in New York, where some companies are asking for double-digit increases for about 1.3 million New Yorkers in individual or small-group plans, setting up a battle with state regulators.
The higher premiums are particularly unwelcome at a time when the economy is sputtering and unemployment is hovering at about 9 percent. Many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. The cost of family coverage has about doubled since 2001, compared with a 34 percent gain in wages.
Aetna and United Health/Oxford said their requested rate increases in New York largely reflected actual hospital, physician and pharmacy costs. “Our rate requests are simply keeping pace,” said Maria Gordon Shydlo, a spokeswoman.
How much the new federal health care legislation pushed by President Obama is affecting rates remains a point of debate, with some consumer advocates and others suggesting that insurers have raised prices in anticipation of new rules that would, in 2012, require them to justify any increase of more than 10 percent. Kaiser pointed out that the increase this year could be an anomaly, after several years of 3 percent to 5 percent increases during the recession.
Kaiser estimates that one to two percentage points of the increase this year is related to provisions of the law already in effect, like coverage for children up to 26 years old and for prevention services like mammograms.
New York, along with states including California, Connecticut and North Carolina, has been exercising its regulatory muscle to try to tamp down some of the increases. The Obama administration this month funneled a total of $109 million to many states, in part to help fight against “unreasonable” increases.
The increases now under consideration in New York would affect 1.3 million of the 3 million residents in individual and small-group plans; the amounts vary considerably depending on the type of policy. The increases requested by Aetna, for example, range from 8.9 percent to 53.6 percent, while those from United Health Group/Oxford range from 13 percent to 34 percent, according to the State Insurance Department.
The state’s power to deny increases does not extend to rates for large employers; the Kaiser survey included large and small company policies, which cover about 60 percent of working-age Americans with insurance. Employers, on average, pay the bulk of premiums and absorb some of the increase each year while passing the rest onto workers.
The increase in premiums was striking because in a poor economy, many people put off going to doctors, to avoid co-payments and higher deductibles. Despite a decrease in the use of medical services, companies have defended higher premiums — and their high profits — reasoning that their costs would rebound once the economy recovered.
Insurers also say that the use and price of medical services have continued to rise in individual and small-group plans, in part because those policies tend to have a higher proportion of people with serious illnesses. If the health care law survives legal challenges and goes into full effect in 2014, increased competition will make it tougher for companies to charge those customers more, the administration says.
Aetna and United Health/Oxford said their requested rate increases in New York largely reflected actual hospital, physician and pharmacy costs. “Our rate requests are simply keeping pace,” said Maria Gordon Shydlo, a spokeswoman for United Health Group/Oxford, which secured rate increases of 18 to 24 percent last year.
Consumer advocates contend that the latest requests exceed any documented rise in costs, with some companies enjoying three years of record profits and paying millions of dollars in dividends and executive compensation.
“We’re at a watershed moment,” said Elisabeth Benjamin, who represents Health Care for All New York, a group of 100 organizations advocating affordable care. “The Cuomo administration has to decide, will the Department of Insurance stand up for the little guy, John Q. Public, or let the insurance companies get away with this nonsense?”
Since last year, the Insurance Department has posted more than 4,000 policyholder objections online. In one typical letter, a small businessman, citing six years of annual increases of more than 15 percent, raged, “There are no words to express how utterly greedy and unconscionable another double-digit increase in health care costs are to the world of small companies and those employed by them.”
Such messages are not lost on Benjamin M. Lawsky, the state’s superintendent of financial services, who oversees the department. “We get it,” he said. “These increases are often hitting people who just can’t afford it.”
“At the same time,” he added, “we have to make sure these companies stay healthy. What keeps us up at night is the need to strike a responsible balance.”
Decisions are expected in October. In the first round of reviews late last year, on premiums that took effect Jan. 1, the department approved a 10 percent increase, on the average, reduced from requests averaging 14 percent. Mr. Lawsky said the result showed the system was working.
But to Leslie Moran, senior vice president of the New York Health Plan Association, an industry group, the result confirms that under the new law, the process bows to political pressure, not actuarial reality.
“There was an effort to somewhat artificially suppress premiums to prove that the prior approval system was working,” she said, noting that New York requires at least 82 percent of premium revenue be spent on paying medical claims. (Nationwide, under the new health care law, the minimum is 80 percent.)
One company, MVP Health Care — asked about its highest rate increase requests: 40 percent, 55 percent and 56.8 percent in three plans in Rochester — said the requests had been made in error and were withdrawn last week. Gary Hughes, a company spokesman, said the plans had 805 policyholders and MVP intended to drop them at the end of the year. It was not clear what those customers would do.
Such changes can leave regulators with little recourse. Allan Evans, a musicologist who was undergoing chemotherapy for lymphoma last year, was notified that his Emblem Health premium would increase 270 percent, to $2,293 a month for his family’s $5,000-deductible policy, provided through his wife’s business, a small Italian language school in Greenwich Village. Emblem had eliminated his family’s category and offered a more expensive plan. That kind of increase is not reviewable by the state.
“We were in shock,” Mr. Evans, 55, said. What saved him, he said, was a change in his part-time contract at the New School that made him eligible for coverage.
Ilene Margolin, a spokeswoman for Emblem, said she could not comment on an individual case, but added: “We lost tens of millions on some of those products. For some people, we reviewed if they were in the right risk pool. I’m not saying this is pretty, but there were actuarially sound reasons.”
Although demand for care nationwide appears to be growing relatively slowly, insurers and benefit consultants also say prices for medical care continue to climb as drug makers and hospitals charge more. “If they’re a popular brand or anchor hospital, they’re going to negotiate a significant increase if they can,” said Edward A. Kaplan, a benefits expert with the Segal Company, which recently surveyed insurers about costs.
Some analysts and companies are already questioning the high increase found through Kaiser’s survey, saying costs are slowing down and increases in premiums would probably be more moderate in 2012.
Some small business say they expect their premiums not to rise as sharply, only because younger, healthier employees are keeping claims low. “Up until last year, we saw very hefty increases — double digits,” said Heather Gombos, an executive for R. M. Jones & Co. and affiliated businesses in New Britain, Conn., which insures about 50 of 80 employees.
Family coverage is now running $12,000 a year, Ms. Gombos said, and she is waiting to see what increases are proposed for the coming year. “What it comes down to is good luck,” she said.
Major health insurance companies have been charging sharply higher premiums this year, outstripping any growth in workers’ wages and creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.
A study released on Tuesday by the Kaiser Family Foundation, a research group, showed that the average annual premium for family coverage through an employer reached $15,073 in 2011 — 9 percent higher than in the previous year. And even higher premiums could be on the way, particularly in New York, where some companies are asking for double-digit increases for about 1.3 million New Yorkers in individual or small-group plans, setting up a battle with state regulators.
The higher premiums are particularly unwelcome at a time when the economy is sputtering and unemployment is hovering at about 9 percent. Many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. The cost of family coverage has about doubled since 2001, compared with a 34 percent gain in wages.
Aetna and United Health/Oxford said their requested rate increases in New York largely reflected actual hospital, physician and pharmacy costs. “Our rate requests are simply keeping pace,” said Maria Gordon Shydlo, a spokeswoman.
How much the new federal health care legislation pushed by President Obama is affecting rates remains a point of debate, with some consumer advocates and others suggesting that insurers have raised prices in anticipation of new rules that would, in 2012, require them to justify any increase of more than 10 percent. Kaiser pointed out that the increase this year could be an anomaly, after several years of 3 percent to 5 percent increases during the recession.
Kaiser estimates that one to two percentage points of the increase this year is related to provisions of the law already in effect, like coverage for children up to 26 years old and for prevention services like mammograms.
New York, along with states including California, Connecticut and North Carolina, has been exercising its regulatory muscle to try to tamp down some of the increases. The Obama administration this month funneled a total of $109 million to many states, in part to help fight against “unreasonable” increases.
The increases now under consideration in New York would affect 1.3 million of the 3 million residents in individual and small-group plans; the amounts vary considerably depending on the type of policy. The increases requested by Aetna, for example, range from 8.9 percent to 53.6 percent, while those from United Health Group/Oxford range from 13 percent to 34 percent, according to the State Insurance Department.
The state’s power to deny increases does not extend to rates for large employers; the Kaiser survey included large and small company policies, which cover about 60 percent of working-age Americans with insurance. Employers, on average, pay the bulk of premiums and absorb some of the increase each year while passing the rest onto workers.
The increase in premiums was striking because in a poor economy, many people put off going to doctors, to avoid co-payments and higher deductibles. Despite a decrease in the use of medical services, companies have defended higher premiums — and their high profits — reasoning that their costs would rebound once the economy recovered.
Insurers also say that the use and price of medical services have continued to rise in individual and small-group plans, in part because those policies tend to have a higher proportion of people with serious illnesses. If the health care law survives legal challenges and goes into full effect in 2014, increased competition will make it tougher for companies to charge those customers more, the administration says.
Aetna and United Health/Oxford said their requested rate increases in New York largely reflected actual hospital, physician and pharmacy costs. “Our rate requests are simply keeping pace,” said Maria Gordon Shydlo, a spokeswoman for United Health Group/Oxford, which secured rate increases of 18 to 24 percent last year.
Consumer advocates contend that the latest requests exceed any documented rise in costs, with some companies enjoying three years of record profits and paying millions of dollars in dividends and executive compensation.
“We’re at a watershed moment,” said Elisabeth Benjamin, who represents Health Care for All New York, a group of 100 organizations advocating affordable care. “The Cuomo administration has to decide, will the Department of Insurance stand up for the little guy, John Q. Public, or let the insurance companies get away with this nonsense?”
Since last year, the Insurance Department has posted more than 4,000 policyholder objections online. In one typical letter, a small businessman, citing six years of annual increases of more than 15 percent, raged, “There are no words to express how utterly greedy and unconscionable another double-digit increase in health care costs are to the world of small companies and those employed by them.”
Such messages are not lost on Benjamin M. Lawsky, the state’s superintendent of financial services, who oversees the department. “We get it,” he said. “These increases are often hitting people who just can’t afford it.”
“At the same time,” he added, “we have to make sure these companies stay healthy. What keeps us up at night is the need to strike a responsible balance.”
Decisions are expected in October. In the first round of reviews late last year, on premiums that took effect Jan. 1, the department approved a 10 percent increase, on the average, reduced from requests averaging 14 percent. Mr. Lawsky said the result showed the system was working.
But to Leslie Moran, senior vice president of the New York Health Plan Association, an industry group, the result confirms that under the new law, the process bows to political pressure, not actuarial reality.
“There was an effort to somewhat artificially suppress premiums to prove that the prior approval system was working,” she said, noting that New York requires at least 82 percent of premium revenue be spent on paying medical claims. (Nationwide, under the new health care law, the minimum is 80 percent.)
One company, MVP Health Care — asked about its highest rate increase requests: 40 percent, 55 percent and 56.8 percent in three plans in Rochester — said the requests had been made in error and were withdrawn last week. Gary Hughes, a company spokesman, said the plans had 805 policyholders and MVP intended to drop them at the end of the year. It was not clear what those customers would do.
Such changes can leave regulators with little recourse. Allan Evans, a musicologist who was undergoing chemotherapy for lymphoma last year, was notified that his Emblem Health premium would increase 270 percent, to $2,293 a month for his family’s $5,000-deductible policy, provided through his wife’s business, a small Italian language school in Greenwich Village. Emblem had eliminated his family’s category and offered a more expensive plan. That kind of increase is not reviewable by the state.
“We were in shock,” Mr. Evans, 55, said. What saved him, he said, was a change in his part-time contract at the New School that made him eligible for coverage.
Ilene Margolin, a spokeswoman for Emblem, said she could not comment on an individual case, but added: “We lost tens of millions on some of those products. For some people, we reviewed if they were in the right risk pool. I’m not saying this is pretty, but there were actuarially sound reasons.”
Although demand for care nationwide appears to be growing relatively slowly, insurers and benefit consultants also say prices for medical care continue to climb as drug makers and hospitals charge more. “If they’re a popular brand or anchor hospital, they’re going to negotiate a significant increase if they can,” said Edward A. Kaplan, a benefits expert with the Segal Company, which recently surveyed insurers about costs.
Some analysts and companies are already questioning the high increase found through Kaiser’s survey, saying costs are slowing down and increases in premiums would probably be more moderate in 2012.
Some small business say they expect their premiums not to rise as sharply, only because younger, healthier employees are keeping claims low. “Up until last year, we saw very hefty increases — double digits,” said Heather Gombos, an executive for R. M. Jones & Co. and affiliated businesses in New Britain, Conn., which insures about 50 of 80 employees.
Family coverage is now running $12,000 a year, Ms. Gombos said, and she is waiting to see what increases are proposed for the coming year. “What it comes down to is good luck,” she said.
Green Party of the US endorses, joins 'October 2011' protest against the Afghanistan and Iraq wars and 2012 austerity budget
GREEN PARTY OF THE UNITED STATES
Contacts:
Scott McLarty, Media Coordinator, 202-518-5624, cell 202-904-7614, mclarty@greens.org
Starlene Rankin, Media Coordinator, 916-995-3805, starlene@gp.org
Greens call for an end to the Bush-Obama post-9/11 decade of wars without end, bloated military budgets, skyrocketing hate crimes against Muslims in the US, torture and other abuses of power
Green Party Speakers Bureau: Green leaders available to speak on peace, foreign policy, and domestic issues http://www.gp.org/speakers/subjects.php
WASHINGTON, DC -- The Green Party of the United States has endorsed the "October 2011" protests and other events marking the tenth anniversary of the invasion of Afghanistan and the beginning of the 2012 federal austerity budget.
On October 6, 2011, thousands will gather on Freedom Plaza in Washington, DC to “occupy the plaza and hold a People's Assembly where we come up with just and sustainable solutions to the crises we face and demand that these solutions be presented and that the people's needs be addressed. We will plan and engage in creative acts of civil resistance and demand that our inherent rights and freedoms be protected, and that our children have a chance to live in peace, to breathe clean air, and to grow edible natural food,†according to the Octobr 2011 web site.
Participants hope that the event will spark a US equivalent to the pro-democracy 'Arab Spring' of early 2011. Green leaders said that, after the changes in the Middle East, the demise of Osama bin Laden, and the severe damage to the nation's economy and rule of law that resulted from the wars, it's time to restore peace and sanity in America.
"In making this endorsement, we're challenging the dangerous political direction of the US. We also challenge others who support 'October 2011' to recognize the Green Party's leadership on the issues these events will address, such as endless wars, the demand for Medicare For All universal health care and millions of new jobs, and the need to end the control of top corporations over our political system," said Sanda Everette, member of the Coordinating Committee of the Green Party of California and former co-chair of the Green Party of the United States. Ms. Everette will participate in the October 6 event.
"If participants in the next month's events mute their criticism of President Obama and affirm their intention to vote Democrat, despite the numerous retreats and betrayals of the Democratic Party during the past decade, they will undermine the whole point of October 2011. The wars in Afghanistan and Iraq, bloated military spending, economic meltdown and Wall Street bailouts, failure to help people facing home foreclosures and unemployment, attacks on Social Security and Medicare, and abuses of power and violations of the US Constitution -- on all of these, the Democrats and Republicans have converged. Without a strong protest against both ruling parties, there is no chance of change," Ms. Everette added.
Green Party leaders hope that 'October 2011' would shine a light on the following:
The cost of the wars has reached $3.7 trillion during the past decade and has contributed to the domestic economic crisis. A report from the Commission on Wartime Contracting in Iraq and Afghanistan notes that "spending on contracts and grants to support US operations [is] expected to exceed $206 billion by the end of the 2011 budget year" and revealed [w]idespread waste and fraud discovered in wartime spending.The 'War on Terrorism' after 9/11, with its own high costs, is now the longest war in US history.
The Green Party has opposed the Iraq and Afghanistan wars since President Bush ordered the invasions, and has called for a sharp reduction of military funding, with funds redirected towards job creation and other human needs (See "Green Party, responding to President Obama's Sept. 8 address, calls 'Green New Deal' the key to job creation," Green Party press release, September 9, 2011.
Hate crimes targeting people who are or perceived to be Muslim, South Asian, and Arab in the US have risen 1700% since 9/11.Thousands more have suffered months of detention without charges on suspicion of involvement with or sympathy for terrorism, apparently because of their ethnicity or religion and despite lack of evidence.
Since 9/11, Americans have seen widespread abuses of power and violations of the US Constitution and international law to which the US is signatory, such as indefinite detention and denial of habeas corpus, torture and extraordinary rendition, maintenance of 'black sites' outside of legal scrutiny, warrantless surveillance of US citizens, and harassment of whistleblowers.
The Obama Administration has maintained most of these policies and shielded Bush Administration officials who violated the law, while more vigorously targeting whistleblowers and even authorizing extra-judicial killing of suspects who are US citizens. As Scott Horton noted in a recent Harper's article,in the wake of 9/11 many US military functions have been privatized and removed from government and public oversight, the CIA has changed from an intelligence agency into a military force, the National Security Agency has migrated from foreign intelligence to domestic surveillance, and the Justice Department has become more and more a tool for political purposes.
MORE INFORMATION
Green Party of the United States
202-319-7191
Green candidate database and campaign information:
News Center
Speakers Bureau
Ballot Access Page
Livestream Channel
Video Page
Press conferences, forums, and other events at the Green Party's 2011 Annual National Meeting in Alfred, NY, broadcast and archived on the Green Party's Livestream Channel
2011 Annual National Meeting
Green Pages: The official publication of record of the Green Party of the United States (Summer 2011 issue now online)
~ END ~
___
Disclaimer: State, local, and candidate press releases made available here represent the opinions of the original source only. Opinions expressed by a state party or candidate do not necessarily represent the views of the Green Party of the United States. State party contact information, when provided with candidate releases, does not imply state party endorsement of the opinions expressed nor of the candidate (prior to gaining formal nomination by the party).
___
Office: PO Box 57065 Washington, D.C. 20037
Email: GPHQ--at--gp.org 202-319-7191 or toll-free (US): 866-41GREEN
Contacts:
Scott McLarty, Media Coordinator, 202-518-5624, cell 202-904-7614, mclarty@greens.org
Starlene Rankin, Media Coordinator, 916-995-3805, starlene@gp.org
Greens call for an end to the Bush-Obama post-9/11 decade of wars without end, bloated military budgets, skyrocketing hate crimes against Muslims in the US, torture and other abuses of power
Green Party Speakers Bureau: Green leaders available to speak on peace, foreign policy, and domestic issues http://www.gp.org/speakers/subjects.php
WASHINGTON, DC -- The Green Party of the United States has endorsed the "October 2011" protests and other events marking the tenth anniversary of the invasion of Afghanistan and the beginning of the 2012 federal austerity budget.
On October 6, 2011, thousands will gather on Freedom Plaza in Washington, DC to “occupy the plaza and hold a People's Assembly where we come up with just and sustainable solutions to the crises we face and demand that these solutions be presented and that the people's needs be addressed. We will plan and engage in creative acts of civil resistance and demand that our inherent rights and freedoms be protected, and that our children have a chance to live in peace, to breathe clean air, and to grow edible natural food,†according to the Octobr 2011 web site.
Participants hope that the event will spark a US equivalent to the pro-democracy 'Arab Spring' of early 2011. Green leaders said that, after the changes in the Middle East, the demise of Osama bin Laden, and the severe damage to the nation's economy and rule of law that resulted from the wars, it's time to restore peace and sanity in America.
"In making this endorsement, we're challenging the dangerous political direction of the US. We also challenge others who support 'October 2011' to recognize the Green Party's leadership on the issues these events will address, such as endless wars, the demand for Medicare For All universal health care and millions of new jobs, and the need to end the control of top corporations over our political system," said Sanda Everette, member of the Coordinating Committee of the Green Party of California and former co-chair of the Green Party of the United States. Ms. Everette will participate in the October 6 event.
"If participants in the next month's events mute their criticism of President Obama and affirm their intention to vote Democrat, despite the numerous retreats and betrayals of the Democratic Party during the past decade, they will undermine the whole point of October 2011. The wars in Afghanistan and Iraq, bloated military spending, economic meltdown and Wall Street bailouts, failure to help people facing home foreclosures and unemployment, attacks on Social Security and Medicare, and abuses of power and violations of the US Constitution -- on all of these, the Democrats and Republicans have converged. Without a strong protest against both ruling parties, there is no chance of change," Ms. Everette added.
Green Party leaders hope that 'October 2011' would shine a light on the following:
The cost of the wars has reached $3.7 trillion during the past decade and has contributed to the domestic economic crisis. A report from the Commission on Wartime Contracting in Iraq and Afghanistan notes that "spending on contracts and grants to support US operations [is] expected to exceed $206 billion by the end of the 2011 budget year" and revealed [w]idespread waste and fraud discovered in wartime spending.The 'War on Terrorism' after 9/11, with its own high costs, is now the longest war in US history.
The Green Party has opposed the Iraq and Afghanistan wars since President Bush ordered the invasions, and has called for a sharp reduction of military funding, with funds redirected towards job creation and other human needs (See "Green Party, responding to President Obama's Sept. 8 address, calls 'Green New Deal' the key to job creation," Green Party press release, September 9, 2011.
Hate crimes targeting people who are or perceived to be Muslim, South Asian, and Arab in the US have risen 1700% since 9/11.Thousands more have suffered months of detention without charges on suspicion of involvement with or sympathy for terrorism, apparently because of their ethnicity or religion and despite lack of evidence.
Since 9/11, Americans have seen widespread abuses of power and violations of the US Constitution and international law to which the US is signatory, such as indefinite detention and denial of habeas corpus, torture and extraordinary rendition, maintenance of 'black sites' outside of legal scrutiny, warrantless surveillance of US citizens, and harassment of whistleblowers.
The Obama Administration has maintained most of these policies and shielded Bush Administration officials who violated the law, while more vigorously targeting whistleblowers and even authorizing extra-judicial killing of suspects who are US citizens. As Scott Horton noted in a recent Harper's article,in the wake of 9/11 many US military functions have been privatized and removed from government and public oversight, the CIA has changed from an intelligence agency into a military force, the National Security Agency has migrated from foreign intelligence to domestic surveillance, and the Justice Department has become more and more a tool for political purposes.
MORE INFORMATION
Green Party of the United States
202-319-7191
Green candidate database and campaign information:
News Center
Speakers Bureau
Ballot Access Page
Livestream Channel
Video Page
Press conferences, forums, and other events at the Green Party's 2011 Annual National Meeting in Alfred, NY, broadcast and archived on the Green Party's Livestream Channel
2011 Annual National Meeting
Green Pages: The official publication of record of the Green Party of the United States (Summer 2011 issue now online)
~ END ~
___
Disclaimer: State, local, and candidate press releases made available here represent the opinions of the original source only. Opinions expressed by a state party or candidate do not necessarily represent the views of the Green Party of the United States. State party contact information, when provided with candidate releases, does not imply state party endorsement of the opinions expressed nor of the candidate (prior to gaining formal nomination by the party).
___
Office: PO Box 57065 Washington, D.C. 20037
Email: GPHQ--at--gp.org 202-319-7191 or toll-free (US): 866-41GREEN
Sunday, September 25, 2011
We Can No Longer Wait On Change: Come Protest October 6th
Tikkun Daily
On October 6th, 2011, ten years after the United States invaded Afghanistan, and as the 2012 federal budget goes into effect with its brutal austerity measures, I will join thousands of people who will converge on Freedom Plaza, just a few blocks away from the White House in Washington, DC. We will mount a deliberate, prolonged, nonviolent protest. We will congregate there because we have no other choice. On sundown on our second day there, I will begin my Yom Kippur fast, only this time it will mean so much more to me than it has before.
I am an Israeli American. I moved from Israel to the United States almost ten years ago – in October 2001 – and was very eager to get naturalized and participate in American democracy by voting here. I felt that this is going to be where votes count the most, because U.S. policy affects each and every corner of the world. Most importantly, I felt that United States has the political clout to bring about a peace in Israel and Palestine. I believed in American democracy even after watching with bated breath the 2000 election recount, and I thought that if only the “good” party holds on to power, then U.S. policy will be good. That was ten years ago. By the time I became a U.S. citizen five years later I took upon myself the civic and moral responsibility for a second sovereign government that flaunts international law, one which is embroiled in two horrific wars, with no end in sight. By then I had also lived in this country long enough to get better acquainted with the bleeding internal wounds that slash through this nation. As I became increasingly informed, I became increasingly vocal, and increasingly angry. Initially, in 2006 I was eager to vote, but was thoroughly frustrated at getting naturalized just a few weeks too late for the registration deadlines; by 2008 I voted begrudgingly, without much faith in the promised “Change.” And by 2010, I voted with contempt, knowing that my vote for a Democratic member of congress is a wasted vote. Next time, I will not vote for Democrats with the hope that they will represent me any more. I know better.
I, along with the rest of the American people, have both passively and actively lent my consent to a government that has proven time and again that it will not look out for our values or our interests. In fact, regardless of which of the two parties is in power, we have seen one president after another, and one congress after another, enact policies that directly undermine our individual and collective well-being. As a result, the very same popular consent that powers the democracy that we ostensibly enjoy has been continuously eroding. More and more Americans realize that they are not only ill-served by their elected officials, but also that they do not truly have a choice in the matter. We are presented with two parties on the ballot, neither of which is beholden to its voters. They share a common allegiance to the money – the inordinate amount of money that is necessary for winning a modern electoral campaign. The comprehensive control of moneyed interests over our political power structure guarantees that decisions at all levels of government are made at the service of those individuals, groups and corporations who control the nation’s wealth – a steadily diminishing sliver of the general public – rather than the people who actually cast the votes on election day; rather than the people whose life, liberty and pursuit of happiness the government is supposed to serve.
Those interests are as diverse as they are all-encompassing: from the military-industrial complex that president Eisenhower warned us about over 50 years ago, to the health insurance and pharmaceutical industries that effectively ensure that the U.S. maintain the most expensive, inefficient and inhumane health care system in the developed world. From the large energy multi-nationals that pollute our waters while enjoying lavish tax breaks, to the Wall Street bankers whose reckless gambling brought about a world-wide financial crisis. They are all very well regarded in the American corridors of power, because they fund American electoral campaigns.
We the people are left to suffer the fallout:
• War: A prolonged state of war, war with all its attendant atrocities and horrors, war with no regard for congressional (or popular) approval, war with dubious benefits to our national security, war by varied contrived names that drains our national treasury and swells our national debt. War is the hallmark of American foreign policy, whether it is our own troops carrying it out or, or our allies.
• Economy: Unemployment, poverty, homelessness, hunger. Decades of deregulation, “free trade” and other “pro-business” fiscal policies have rendered large swaths of our workforce idle. Entire industries have moved abroad, and in those that still offer some measure of domestic employment, workers often face a race to the bottom of the pay scale. The middle class – the bedrock of our economy – is gradually evaporating, as more and more of its former members find themselves among the ranks of the poor, even if they still have a job. Multitudes lose their homes to unscrupulous bankers, who then go on to receive taxpayer-funded bonuses. At every turn, the working poor and middle class are asked to “tighten their belts” as the rich get richer.
• Health care: Immense disparities in access to care, skyrocketing healthcare costs, mediocre public health outcomes. American health care providers offer the best care and medical services that money can buy, but more and more Americans can no longer afford the costs. Our society as a whole suffers from clinical outcomes comparable to those in developing countries, and among our peers, we are one of the only nations that does not regard health care as a fundamental individual right. We are still the wealthiest nation in the world, and we allow 45,000 of our fellow Americans to die every year because they could not get the medical care that could save their lives.
• Education: Immense disparities in access to education, ignorance, illiteracy. Government budgets consistently underfund our primary education teachers, ensuring that our children are undereducated. After that weak start, at early adulthood they have a choice of either saddling themselves with insurmountable college debt, or forgoing higher education and taking their chances in the inhospitable economy.
• Environment: Pollution, droughts, floods, famine, disease, mass extinctions. We are compelled to continue to rely on fossil fuels, barrelling down the road to catastrophic climate change, despite wide-reaching scientific consensus about our role in our own imminent demise. The relentless pursuit of more and more oil and coal obliterates our oceans and mountaintops. Despite the recent disaster in Japan, the government still support expansion of nuclear power plants. Like in so many other large-scale enterprises, risk is socialized, while profits are privatized.
It goes on. This list of oppressions is long and familiar, and both reason and compassion call us to respond to them. A free and sovereign people should be able to petition their government for redress of grievances. It is both our right, and our civic duty, and we are told that we can do just that in each election cycle. But after many changes of personnel in elected offices that have failed to deliver the necessary remedies, many of us have resigned to accept these hemorrhaging wounds in our communities. Some of us accept them explicitly by avoiding the ballot box when election time comes around. Some of us accept them implicitly – we continue voting for the candidate or party we consider “the lesser evil,” clinging onto the hope that this one will be different. But change does not come. Incumbents and challengers, legislators and executives, Democrats and Republicans – they all stock their campaign “war chests” with funds that flow in from the wealthy and pay for ads targeted at the poor. As electoral pundits will invariably tell us, in the swing districts, it’s all about getting out the vote. It’s pulling the merely downtrodden out from the ranks of the decimated, and getting them to participate in their own bludgeoning.
We are told that if we do not participate, everything will get much worse. Institutionally, the Democratic Party knows that progressive Americans are terrified of having another Republican president, or Senate. They only really compete for people who might vote Republican, so they ignore the left. Progressive slogans that are thrown around during the campaign season are quickly diluted into “centrist” legislation, which in most cases is pulled directly out of Republican bills. This is how we got a Republican health care reform package under a Democratic president with Democratic control of both houses of Congress. This is how we got the extension of the egregious Bush tax cuts, measures that were the bane of most Democratic voters. This is how our entire government got hijacked into a deceptive debate about the deficit and national debt. The previous Democratic president dismantled welfare, and the current one is proposing cuts to Social Security and Medicare. The Democrats blame Republican intransigence for their legislative failures, but many congressional matches are lost without a single political punch being thrown. As long as the prevailing Democratic political strategy is to hew as far toward the “center” as possible and the party continues to preemptively abandon their progressive constituents, they can never honestly claim defeat at the hands of their opposition. They are responsible for their own undoing.
And still – we are called to go out and vote. Not only that – we are expected to go out and vote unquestioningly. We are expected to vote and then go home and acquiesce, until the next cycle.
But this year is special. This year we have seen people all around the world rise up and take a strong nonviolent stand against governments that have failed them. In the Middle East they did so after decades of oppression. In Europe we are seeing masses congregate in the streets and city squares to protest economic austerity measures foisted down upon them. In Wisconsin the state capitol was taken over by the people, shining a bright light on the Republican campaign against workers’ rights. We have seen examples of homegrown, democratically organized movements sprouting up spontaneously. These are responses to government systems that grew so divorced from their citizens that they left the people no other choice. They were compelled to take a step beyond the mechanics of their current systems, be it despotic or electoral. These popular struggles are still unfolding, but regardless of their eventual achievements, they can serve to inspire the American body politic. They can wake us from our slumber and show us another way. Whether we like it or not, we have reached that very same point of no return. It is up to us to acknowledge the predicament that we are in, and to recognize that our elected “leaders” will not save us. It is not on their agenda because it does not serve their funders’ interests. We have no time for petitioning through “the proper channels,” or to wait for the next election cycle and voice our protest at the ballot box. We need to make our voice heard.
It is up to us to reclaim our rights as individuals and as a people. It is up to us to serve as an example to others and to educate. To that end, we too, will congregate peacefully and establish our popular assembly in Freedom Plaza. We will demonstrate that there is political power in the hands of the people. At the core of our demands will be the dismantling of the stranglehold that money has on the power structure. We will demand a focus on people and their lives, instead of on corporations and their profits. The specific demands that follow will inevitably include an end to war, socially-motivated fiscal policies, universal health care and education, responsible and effective environmental regulation and a genuine investment in renewable energy sources, to name a few. The details will be discussed and developed in assembly meetings on the ground.
Americans who can no longer tolerate their oppression will come to Freedom Plaza on October 6th, 2011. We will stay there; we will recreate our democracy.
As the sun sets this eve of Yom Kippur, I will fast and take stock. With eyes wide open, I will reflect on what I’ve done and what I have failed to do. I will cease to participate in the American electoral farce and I will instead take part in the most important movement of our generation. This is my tikkun olam. Will you join me?
On October 6th, 2011, ten years after the United States invaded Afghanistan, and as the 2012 federal budget goes into effect with its brutal austerity measures, I will join thousands of people who will converge on Freedom Plaza, just a few blocks away from the White House in Washington, DC. We will mount a deliberate, prolonged, nonviolent protest. We will congregate there because we have no other choice. On sundown on our second day there, I will begin my Yom Kippur fast, only this time it will mean so much more to me than it has before.
I am an Israeli American. I moved from Israel to the United States almost ten years ago – in October 2001 – and was very eager to get naturalized and participate in American democracy by voting here. I felt that this is going to be where votes count the most, because U.S. policy affects each and every corner of the world. Most importantly, I felt that United States has the political clout to bring about a peace in Israel and Palestine. I believed in American democracy even after watching with bated breath the 2000 election recount, and I thought that if only the “good” party holds on to power, then U.S. policy will be good. That was ten years ago. By the time I became a U.S. citizen five years later I took upon myself the civic and moral responsibility for a second sovereign government that flaunts international law, one which is embroiled in two horrific wars, with no end in sight. By then I had also lived in this country long enough to get better acquainted with the bleeding internal wounds that slash through this nation. As I became increasingly informed, I became increasingly vocal, and increasingly angry. Initially, in 2006 I was eager to vote, but was thoroughly frustrated at getting naturalized just a few weeks too late for the registration deadlines; by 2008 I voted begrudgingly, without much faith in the promised “Change.” And by 2010, I voted with contempt, knowing that my vote for a Democratic member of congress is a wasted vote. Next time, I will not vote for Democrats with the hope that they will represent me any more. I know better.
I, along with the rest of the American people, have both passively and actively lent my consent to a government that has proven time and again that it will not look out for our values or our interests. In fact, regardless of which of the two parties is in power, we have seen one president after another, and one congress after another, enact policies that directly undermine our individual and collective well-being. As a result, the very same popular consent that powers the democracy that we ostensibly enjoy has been continuously eroding. More and more Americans realize that they are not only ill-served by their elected officials, but also that they do not truly have a choice in the matter. We are presented with two parties on the ballot, neither of which is beholden to its voters. They share a common allegiance to the money – the inordinate amount of money that is necessary for winning a modern electoral campaign. The comprehensive control of moneyed interests over our political power structure guarantees that decisions at all levels of government are made at the service of those individuals, groups and corporations who control the nation’s wealth – a steadily diminishing sliver of the general public – rather than the people who actually cast the votes on election day; rather than the people whose life, liberty and pursuit of happiness the government is supposed to serve.
Those interests are as diverse as they are all-encompassing: from the military-industrial complex that president Eisenhower warned us about over 50 years ago, to the health insurance and pharmaceutical industries that effectively ensure that the U.S. maintain the most expensive, inefficient and inhumane health care system in the developed world. From the large energy multi-nationals that pollute our waters while enjoying lavish tax breaks, to the Wall Street bankers whose reckless gambling brought about a world-wide financial crisis. They are all very well regarded in the American corridors of power, because they fund American electoral campaigns.
We the people are left to suffer the fallout:
• War: A prolonged state of war, war with all its attendant atrocities and horrors, war with no regard for congressional (or popular) approval, war with dubious benefits to our national security, war by varied contrived names that drains our national treasury and swells our national debt. War is the hallmark of American foreign policy, whether it is our own troops carrying it out or, or our allies.
• Economy: Unemployment, poverty, homelessness, hunger. Decades of deregulation, “free trade” and other “pro-business” fiscal policies have rendered large swaths of our workforce idle. Entire industries have moved abroad, and in those that still offer some measure of domestic employment, workers often face a race to the bottom of the pay scale. The middle class – the bedrock of our economy – is gradually evaporating, as more and more of its former members find themselves among the ranks of the poor, even if they still have a job. Multitudes lose their homes to unscrupulous bankers, who then go on to receive taxpayer-funded bonuses. At every turn, the working poor and middle class are asked to “tighten their belts” as the rich get richer.
• Health care: Immense disparities in access to care, skyrocketing healthcare costs, mediocre public health outcomes. American health care providers offer the best care and medical services that money can buy, but more and more Americans can no longer afford the costs. Our society as a whole suffers from clinical outcomes comparable to those in developing countries, and among our peers, we are one of the only nations that does not regard health care as a fundamental individual right. We are still the wealthiest nation in the world, and we allow 45,000 of our fellow Americans to die every year because they could not get the medical care that could save their lives.
• Education: Immense disparities in access to education, ignorance, illiteracy. Government budgets consistently underfund our primary education teachers, ensuring that our children are undereducated. After that weak start, at early adulthood they have a choice of either saddling themselves with insurmountable college debt, or forgoing higher education and taking their chances in the inhospitable economy.
• Environment: Pollution, droughts, floods, famine, disease, mass extinctions. We are compelled to continue to rely on fossil fuels, barrelling down the road to catastrophic climate change, despite wide-reaching scientific consensus about our role in our own imminent demise. The relentless pursuit of more and more oil and coal obliterates our oceans and mountaintops. Despite the recent disaster in Japan, the government still support expansion of nuclear power plants. Like in so many other large-scale enterprises, risk is socialized, while profits are privatized.
It goes on. This list of oppressions is long and familiar, and both reason and compassion call us to respond to them. A free and sovereign people should be able to petition their government for redress of grievances. It is both our right, and our civic duty, and we are told that we can do just that in each election cycle. But after many changes of personnel in elected offices that have failed to deliver the necessary remedies, many of us have resigned to accept these hemorrhaging wounds in our communities. Some of us accept them explicitly by avoiding the ballot box when election time comes around. Some of us accept them implicitly – we continue voting for the candidate or party we consider “the lesser evil,” clinging onto the hope that this one will be different. But change does not come. Incumbents and challengers, legislators and executives, Democrats and Republicans – they all stock their campaign “war chests” with funds that flow in from the wealthy and pay for ads targeted at the poor. As electoral pundits will invariably tell us, in the swing districts, it’s all about getting out the vote. It’s pulling the merely downtrodden out from the ranks of the decimated, and getting them to participate in their own bludgeoning.
We are told that if we do not participate, everything will get much worse. Institutionally, the Democratic Party knows that progressive Americans are terrified of having another Republican president, or Senate. They only really compete for people who might vote Republican, so they ignore the left. Progressive slogans that are thrown around during the campaign season are quickly diluted into “centrist” legislation, which in most cases is pulled directly out of Republican bills. This is how we got a Republican health care reform package under a Democratic president with Democratic control of both houses of Congress. This is how we got the extension of the egregious Bush tax cuts, measures that were the bane of most Democratic voters. This is how our entire government got hijacked into a deceptive debate about the deficit and national debt. The previous Democratic president dismantled welfare, and the current one is proposing cuts to Social Security and Medicare. The Democrats blame Republican intransigence for their legislative failures, but many congressional matches are lost without a single political punch being thrown. As long as the prevailing Democratic political strategy is to hew as far toward the “center” as possible and the party continues to preemptively abandon their progressive constituents, they can never honestly claim defeat at the hands of their opposition. They are responsible for their own undoing.
And still – we are called to go out and vote. Not only that – we are expected to go out and vote unquestioningly. We are expected to vote and then go home and acquiesce, until the next cycle.
But this year is special. This year we have seen people all around the world rise up and take a strong nonviolent stand against governments that have failed them. In the Middle East they did so after decades of oppression. In Europe we are seeing masses congregate in the streets and city squares to protest economic austerity measures foisted down upon them. In Wisconsin the state capitol was taken over by the people, shining a bright light on the Republican campaign against workers’ rights. We have seen examples of homegrown, democratically organized movements sprouting up spontaneously. These are responses to government systems that grew so divorced from their citizens that they left the people no other choice. They were compelled to take a step beyond the mechanics of their current systems, be it despotic or electoral. These popular struggles are still unfolding, but regardless of their eventual achievements, they can serve to inspire the American body politic. They can wake us from our slumber and show us another way. Whether we like it or not, we have reached that very same point of no return. It is up to us to acknowledge the predicament that we are in, and to recognize that our elected “leaders” will not save us. It is not on their agenda because it does not serve their funders’ interests. We have no time for petitioning through “the proper channels,” or to wait for the next election cycle and voice our protest at the ballot box. We need to make our voice heard.
It is up to us to reclaim our rights as individuals and as a people. It is up to us to serve as an example to others and to educate. To that end, we too, will congregate peacefully and establish our popular assembly in Freedom Plaza. We will demonstrate that there is political power in the hands of the people. At the core of our demands will be the dismantling of the stranglehold that money has on the power structure. We will demand a focus on people and their lives, instead of on corporations and their profits. The specific demands that follow will inevitably include an end to war, socially-motivated fiscal policies, universal health care and education, responsible and effective environmental regulation and a genuine investment in renewable energy sources, to name a few. The details will be discussed and developed in assembly meetings on the ground.
Americans who can no longer tolerate their oppression will come to Freedom Plaza on October 6th, 2011. We will stay there; we will recreate our democracy.
As the sun sets this eve of Yom Kippur, I will fast and take stock. With eyes wide open, I will reflect on what I’ve done and what I have failed to do. I will cease to participate in the American electoral farce and I will instead take part in the most important movement of our generation. This is my tikkun olam. Will you join me?
Tuesday, September 20, 2011
Health Care Versus Wealth Care: Investors with a Conscience Should Divest from Health Insurance Companies
Tikkun.org
I was the doctor on duty one night in August when the ambulance rushed a man into our Midwestern hospital ER. As I walked into the room, the scene was right out of TV. A nurse was trying to start an IV. Someone was running an EKG. A student had just put oxygen in the patient’s nose. The room seemed crowded. The paramedics were sweating and slightly out of breath.
But my attention was on a pale, thin, fifty-five-year-old man sitting bolt upright on a gurney, clutching his chest and straining to breathe. Cold sweat dripped off his nose. I asked a couple of quick questions as I leaned him forward to listen to his lungs. Someone handed me his EKG showing an acute heart attack.
I slipped out of the room for a second to get the cardiologist on the phone. He would be right in, along with the rest of his team. But it was a Thursday night, late, and they were coming in from home. It would be at least twenty minutes until high-tech medicine could work its wonders, until the cardiologist could thread a thin plastic catheter into the patient’s heart and put in a stent to open his blockage.
I was back to the room in a flash, and he looked no better. We gave him intravenous nitroglycerin, morphine, and powerful blood thinners. He began to look less frightened and some color crept back into his face. We still had a few minutes before they would be ready for him in the cardiac catheterization lab.
Just then I became aware of a woman quietly sobbing in a chair in the corner of the room, probably his wife. I walked over toward her and, as I neared, I reached out to touch her shoulder. She suddenly turned a fierce face up at me, saying: “When he told you he’d been having pain for two hours, he was lying! He’s been having chest pains for the last two weeks!”
She didn’t let up: “We were in the ER six months ago with his chest hurting, and they told him to see his cardiologist, but we don’t have any insurance. They won’t see him again without cash up front! What are we supposed to do?”
Her voice rising, she added: “And you know what else? They’re suing us in small claims court right now over the bill from our last ER visit!”
Here was this poor woman, in my ER, not only deathly afraid that she might lose her husband tonight, but also afraid that whether he lived or died they might face an impossibly huge medical bill and lose their house, their car, everything.
The patient was a self-employed house painter, and he’d had a previous heart problem. Self-employed and a pre-existing condition — in America today with those two strikes, you are out. There is no way to afford health insurance. Is the Affordable Care Act going to fix this?
The Affordable Care Act and the Health Care Lobby
The Affordable Care Act (ACA) faces an uncertain future. The 11th Circuit Court of Appeals in August ruled the individual mandate unconstitutional. Judge Hull, who cast the deciding vote, was a Clinton appointee. The verdict states:
This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.
The ACA was essentially written in the Senate Finance Committee chaired by Max Baucus. The actual author was his chief health care aide, Liz Fowler. Her job before working for Baucus? Vice president of WellPoint/Anthem/Blue Cross, the country’s largest health insurer.
President Obama signs the Patient Protection and Affordable Care Act at the White House on March 23, 2010.
The health insurance industry played both sides against the middle during the congressional debate. While publicly claiming to be in favor of reform, they secretly funneled millions to front groups and organizations like the Chamber of Commerce, which fought the bill tooth and nail. What the insurers wanted most out of the deal was the individual mandate — a federally enforced requirement that all Americans buy their defective products, with taxpayer-financed subsidies for those who couldn’t afford the premiums. What they wanted least were regulatory burdens that might limit their profitability.
Not being able to buy insurance if you are sick is one of the catch-22 aspects of our crazy system. In the eyes of insurance bureaucrats, it seems that life itself is a pre-existing condition. The ACA’s ban on the use of pre-existing conditions to deny insurance coverage is scheduled to go into effect in 2014. Preventing that will be the next target of their lobbying fury.
It’s Good to Be an Insurance Company
In this down economy, there are few bright spots for investors. Thank God for health insurance.
The Big Five health insurers — WellPoint, UnitedHealth, Aetna, Humana, and CIGNA — together cover almost 100 million of us. Their profits from April to June 2011 totaled over $3.3 billion, 13 percent over their second quarter profits in 2010. Last year was their best year ever. For the twelve months ending in July 2011, these giants saw their average stock price rise almost 50 percent. These are huge corporations: WellPoint and UnitedHealth are in the top fifty of the Fortune 500.
What to do with all that profit? WellPoint, the behemoth created a decade ago from formerly nonprofit Blue Cross plans in fourteen states, spent $67 million on lobbying over the past three years. They paid their CEO, Angela Braly, $13 million in 2010, but that was paltry compared to the reimbursement package of UnitedHealth CEO Stephen Hemsley, who cleared $37 million, including the stock options he exercised.
Health insurance companies are raking in ever-rising profits, even as patients with insurance are driven into debt.
Those stock options take on extra significance when company stock repurchases are considered. WellPoint, to take only one example, spent $21.6 billion of patients’ premium dollars to buy back its own stock from 2003 through 2010.
Spending billions on stock buybacks benefits a tiny elite of CEOs, board members, and top officers, who are compensated largely with stock options. They buy the stock back to push the price upward. Their options increase in value as the share price rises. This is an enormous transfer of wealth from individuals and employers to top management. It benefits the largest Wall Street stockholders as well, but not you, not me, not patients.
This industry exists to collect premiums and process claims, and while they have no problems collecting our premiums, it’s a different story when they have to pay. The June 2011 AMA Health Insurer Report Card revealed commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of 2 percent compared to last year. The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year and added an estimated $1.5 billion in unnecessary administrative costs to the health system. Medicare, by comparison, had an error rate of less than 4 percent.
They are obviously not using their piles of cash to improve service. What about lowering premiums? In our dreams.
Health insurance premiums have more than doubled over the last ten years, rising at four times the overall rate of inflation. (Over the same period Medicare premiums have barely risen at all, with no increase in out-of-pocket expenses.) While premiums have risen, coverage has shrunk. Copays and deductibles increase every year. People with individual coverage can have annual deductibles of $10,000 and more. No wonder illness leads to bankruptcy, even if you have insurance.
Bankruptcy, Moral and Financial
Every business day in America, 3,700 families file for bankruptcy caused by illness and medical bills, and that number is rising. This shameful situation happens in no other wealthy democracy. It would be a scandal anywhere else. Most medically bankrupt families were middle-class before they suffered financial setbacks. Roughly 60 percent of them had attended college; twenty percent of families included a military veteran or active-duty soldier.
Unexpected stays in a hospital bed drive thousands of middle-class and working-class families to declare bankruptcy every day.
Most astoundingly, 60 percent of the individuals whose illness led to bankruptcy had private health insurance when they got sick. Don’t we buy health insurance to avoid financial ruin? High deductibles lead directly to bankruptcy and foreclosure. To make matters worse, they cause people to postpone needed care. All of which lead to higher insurance company profits.
The insurers don’t like to tell their customers this, but when they talk to their Wall Street masters, they sing a different tune. Angela Braly of WellPoint, speaking during a conference call for financial analysts in 2008, was asked if she would consider lowering premiums if that would increase enrollment in Anthem policies. Her reply, “We will not sacrifice profitability for membership,” was just what they wanted to hear.
That sentiment hasn’t changed. Recently Aetna’s chief financial officer, Joseph Zubretsky, made similar comments on a conference call. Concerned that investors might think Aetna was willing to grow by adding people to its rolls who could have substantial medical needs, Zubretsky soothed their fears, “We would like to have both profit and growth, but if you have to choose between one or the other, you take margin and profit and you sacrifice the growth.”
Recall that these are the same companies that developed algorithms to target women diagnosed with breast cancer so they could scour their health records for an excuse to cancel their policies. This inhuman practice, known as rescission, has supposedly been banned by the ACA.
Buying Doctors
If insurance companies are not lowering premiums to attract more customers or investing in infrastructure to reduce errors, what else besides their own stock (and some politicians) are they buying? Doctors! UnitedHealth is quietly buying medical groups who treat patients covered by its plans in several areas of the country. WellPoint announced in June that it would acquire CareMore, which operates twenty-six clinics in the Los Angeles area. CIGNA claims that it saves 9 percent on patients treated by doctors in a Phoenix medical group it controls. Is this a good thing?
In July, Kaiser Health News, in an article titled “Managed Care Enters The Exam Room As Insurers Buy Doctor Groups” said:
Some observers watching the developments say the health law, which in part was sold as a way to rein in insurers, has had the opposite result, opening the door for the companies to take control of even more parts of the health system.
“There’s a gigantic Murphy’s law emerging here,” said Ian Morrison, a California-based health care consultant who does some work for United, as well as most of its competitors. “The very people who were the demons in all of this, that the public can’t stand — managed-care firms — are the big winners.”
And the losers? Patients, and those of us paying premiums.
Health, Health Care, and Health Insurance
No other wealthy democracy spends as much on health care as we do. It’s not even close. Most of our peer countries spend about half as much per capita as we do.
If you hear politicians proclaim “America has the best health care in the world,” you can stop listening to them at that point. They are not reality-based. We may be paying the most on the planet for health care, but there is no objective evidence to support the claim that our health care is the best. Again, it’s not even close. The World Health Organization ranks U.S. health care thirty-seventh, just below Costa Rica.
No other wealthy democracy relies on for-profit insurance companies. Here we stand alone.
On August 10, 2011, the Saint Louis Post-Dispatch editorialized, “If America truly is serious about dealing with its deficit problems, there’s a fairly simple solution. But you’re probably not going to like it: Enact a single-payer health care plan.” The editorial goes on to explain that the “way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.”
The editorial asserts, “the ACA didn’t go far enough,” and concludes: “Eventually, the United States will have a single-payer plan. But we’ll waste a lot of money and time getting there.” Its authors could have added “and waste a lot of lives” too.
What is a “single-payer plan” like the Post-Dispatch endorses? Robert Reich, author, professor, and secretary of labor under Bill Clinton, explained it this way in February 2011:
If the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all.
Medicare is a single-payer plan. Everyone over age sixty-five is covered by this simple, single plan, which is publicly financed and privately delivered. How would a single-payer plan save money? The Post-Dispatch explains, “Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”
The respected journal Health Affairs published more evidence of the economic advantage of a single payer system on August 19, 2011. The article “US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers” found that U.S. physicians’ office staff “spent 20.6 hours per physician per week interacting with health plans — nearly ten times that of their Ontario counterparts. If U.S. physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year.”
The evidence is overwhelming: the for-profit insurance industry adds a huge amount of inefficiency, bureaucracy and cost to our system while adding no value, only hassle. These companies are parasitic middlemen we would be better off without. Their interest is in wealth care, not health care.
On top of that, the insurance industry is the single greatest barrier to achieving an efficient and affordable system to cover all Americans. If you have any doubt, read Wendell Potter’s Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. During the debate over the ACA, health insurance lobbyists sank the president’s public option, even though 70 percent of the public favored it. Their war chests overflow with money and their influence grows every day.
Hoping Congress will fix this leads only to despair. We need new ways to weaken the death grip this powerful industry has on us.
Divestment
There is a battle going on for the soul of America. Before he died, Ted Kennedy wrote to President Obama about health care reform, calling it “the great unfinished business of our society.” Kennedy avowed, “What we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
Back in the ER on that hot August night, I sent my man to the cath lab and they successfully stented his blockage. He went home the next day with a bill for $25,000. I tried to call him a few months later, but the phone number was “no longer in service.”
Congress and the politicians are “no longer in service.” We’ve got to look elsewhere.
Could we simply boycott health insurance? No, over 50 million are without insurance now, and they are living sicker and dying younger because they have barriers to care.
Stockholders with a conscience have tried for years to engage corporate leadership and have attempted shareholder resolutions to reform the industry from the inside. Despite their best efforts, they have had no significant positive effect so far.
It is time to move beyond resolutions and on to divestment.
The Divestment Campaign for Health Care is one group that is organizing a push in that direction.
From 1985 to 1990, over two hundred U.S. companies cut all ties with South Africa, resulting in a loss of $1 billion in direct American investment. This economic pressure hastened the fall of apartheid. It happened as a result of people power, democracy in action. Pension funds divested from companies doing business with South Africa. Faith communities declared they would not support injustice. Students called on their universities to cleanse their endowments. An idea was born — “socially responsible investing.”
There is nothing socially responsible about investing in the health insurance industry.
"Go to your church, your union ... your friends and neighbors, and tell them it’s time to get the health insurers out!" the author writes. Here, a Unitarian Universalist congregation in Cortland, New York, rallies for single-payer health care.
Up to now, they have received little scrutiny from investors. One exception is Domini Social Investments, whose Global Investment Standards give “support [for] government’s responsibility to provide basic public goods that are as varied as health care, prisons, primary school education, and national security.” Domini is “concerned about the extent to which health insurance privatizes a public good.” As a result, Domini has disqualified most health insurers from their portfolios.
In contrast, the $4 billion TIAA-CREF Social Choice Equity Fund holds $24 million in WellPoint stock, as well as Aetna and Humana from the health insurance Big Five. WellPoint stock may only represent 0.6 percent of the total fund, but in this large, diversified mutual fund, which includes over 800 individual stocks, WellPoint is in the top 5 percent of the fund’s largest holdings. TIAA-CREF has refused to exclude health insurance companies.
The Presbyterian Church USA, often in the vanguard of the faith community, is there again. Their General Assembly meets in the summer of 2012 and they will vote on an “Overture” to “implement divestment procedures as well as encourage individual Presbyterians and congregations to divest of holdings in the [publicly traded health insurance] companies.” Other faith groups cannot be far behind.
We have nothing to lose. Health insurance companies have everything to lose as their stock prices drop and their influence wanes. Go to your church, your union, your pension plan, your 401k advisor, your university endowment, your city council, your friends and neighbors, and tell them it’s time to get the health insurers out!
Who can defend these corporations? There is no business case, no health care case, no moral case to support their ongoing existence. They make their profits by avoiding taking care of sick people — by refusing to issue policies, canceling policies, or denying payment. I went to medical school in order to care for the sick.
The health insurance industry must go.
Rob Stone is a gardener, grandfather, and teacher. He has practiced emergency medicine in Bloomington, Indiana, since the early 1980s, and for the past year has been transitioning his medical career to hospice and palliative medicine. He is founder and director of Hoosiers for a Commonsense Health Plan and serves on the board of directors of Physicians for a National Health Program.
I was the doctor on duty one night in August when the ambulance rushed a man into our Midwestern hospital ER. As I walked into the room, the scene was right out of TV. A nurse was trying to start an IV. Someone was running an EKG. A student had just put oxygen in the patient’s nose. The room seemed crowded. The paramedics were sweating and slightly out of breath.
But my attention was on a pale, thin, fifty-five-year-old man sitting bolt upright on a gurney, clutching his chest and straining to breathe. Cold sweat dripped off his nose. I asked a couple of quick questions as I leaned him forward to listen to his lungs. Someone handed me his EKG showing an acute heart attack.
I slipped out of the room for a second to get the cardiologist on the phone. He would be right in, along with the rest of his team. But it was a Thursday night, late, and they were coming in from home. It would be at least twenty minutes until high-tech medicine could work its wonders, until the cardiologist could thread a thin plastic catheter into the patient’s heart and put in a stent to open his blockage.
I was back to the room in a flash, and he looked no better. We gave him intravenous nitroglycerin, morphine, and powerful blood thinners. He began to look less frightened and some color crept back into his face. We still had a few minutes before they would be ready for him in the cardiac catheterization lab.
Just then I became aware of a woman quietly sobbing in a chair in the corner of the room, probably his wife. I walked over toward her and, as I neared, I reached out to touch her shoulder. She suddenly turned a fierce face up at me, saying: “When he told you he’d been having pain for two hours, he was lying! He’s been having chest pains for the last two weeks!”
She didn’t let up: “We were in the ER six months ago with his chest hurting, and they told him to see his cardiologist, but we don’t have any insurance. They won’t see him again without cash up front! What are we supposed to do?”
Her voice rising, she added: “And you know what else? They’re suing us in small claims court right now over the bill from our last ER visit!”
Here was this poor woman, in my ER, not only deathly afraid that she might lose her husband tonight, but also afraid that whether he lived or died they might face an impossibly huge medical bill and lose their house, their car, everything.
The patient was a self-employed house painter, and he’d had a previous heart problem. Self-employed and a pre-existing condition — in America today with those two strikes, you are out. There is no way to afford health insurance. Is the Affordable Care Act going to fix this?
The Affordable Care Act and the Health Care Lobby
The Affordable Care Act (ACA) faces an uncertain future. The 11th Circuit Court of Appeals in August ruled the individual mandate unconstitutional. Judge Hull, who cast the deciding vote, was a Clinton appointee. The verdict states:
This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.
The ACA was essentially written in the Senate Finance Committee chaired by Max Baucus. The actual author was his chief health care aide, Liz Fowler. Her job before working for Baucus? Vice president of WellPoint/Anthem/Blue Cross, the country’s largest health insurer.
President Obama signs the Patient Protection and Affordable Care Act at the White House on March 23, 2010.
The health insurance industry played both sides against the middle during the congressional debate. While publicly claiming to be in favor of reform, they secretly funneled millions to front groups and organizations like the Chamber of Commerce, which fought the bill tooth and nail. What the insurers wanted most out of the deal was the individual mandate — a federally enforced requirement that all Americans buy their defective products, with taxpayer-financed subsidies for those who couldn’t afford the premiums. What they wanted least were regulatory burdens that might limit their profitability.
Not being able to buy insurance if you are sick is one of the catch-22 aspects of our crazy system. In the eyes of insurance bureaucrats, it seems that life itself is a pre-existing condition. The ACA’s ban on the use of pre-existing conditions to deny insurance coverage is scheduled to go into effect in 2014. Preventing that will be the next target of their lobbying fury.
It’s Good to Be an Insurance Company
In this down economy, there are few bright spots for investors. Thank God for health insurance.
The Big Five health insurers — WellPoint, UnitedHealth, Aetna, Humana, and CIGNA — together cover almost 100 million of us. Their profits from April to June 2011 totaled over $3.3 billion, 13 percent over their second quarter profits in 2010. Last year was their best year ever. For the twelve months ending in July 2011, these giants saw their average stock price rise almost 50 percent. These are huge corporations: WellPoint and UnitedHealth are in the top fifty of the Fortune 500.
What to do with all that profit? WellPoint, the behemoth created a decade ago from formerly nonprofit Blue Cross plans in fourteen states, spent $67 million on lobbying over the past three years. They paid their CEO, Angela Braly, $13 million in 2010, but that was paltry compared to the reimbursement package of UnitedHealth CEO Stephen Hemsley, who cleared $37 million, including the stock options he exercised.
Health insurance companies are raking in ever-rising profits, even as patients with insurance are driven into debt.
Those stock options take on extra significance when company stock repurchases are considered. WellPoint, to take only one example, spent $21.6 billion of patients’ premium dollars to buy back its own stock from 2003 through 2010.
Spending billions on stock buybacks benefits a tiny elite of CEOs, board members, and top officers, who are compensated largely with stock options. They buy the stock back to push the price upward. Their options increase in value as the share price rises. This is an enormous transfer of wealth from individuals and employers to top management. It benefits the largest Wall Street stockholders as well, but not you, not me, not patients.
This industry exists to collect premiums and process claims, and while they have no problems collecting our premiums, it’s a different story when they have to pay. The June 2011 AMA Health Insurer Report Card revealed commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of 2 percent compared to last year. The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year and added an estimated $1.5 billion in unnecessary administrative costs to the health system. Medicare, by comparison, had an error rate of less than 4 percent.
They are obviously not using their piles of cash to improve service. What about lowering premiums? In our dreams.
Health insurance premiums have more than doubled over the last ten years, rising at four times the overall rate of inflation. (Over the same period Medicare premiums have barely risen at all, with no increase in out-of-pocket expenses.) While premiums have risen, coverage has shrunk. Copays and deductibles increase every year. People with individual coverage can have annual deductibles of $10,000 and more. No wonder illness leads to bankruptcy, even if you have insurance.
Bankruptcy, Moral and Financial
Every business day in America, 3,700 families file for bankruptcy caused by illness and medical bills, and that number is rising. This shameful situation happens in no other wealthy democracy. It would be a scandal anywhere else. Most medically bankrupt families were middle-class before they suffered financial setbacks. Roughly 60 percent of them had attended college; twenty percent of families included a military veteran or active-duty soldier.
Unexpected stays in a hospital bed drive thousands of middle-class and working-class families to declare bankruptcy every day.
Most astoundingly, 60 percent of the individuals whose illness led to bankruptcy had private health insurance when they got sick. Don’t we buy health insurance to avoid financial ruin? High deductibles lead directly to bankruptcy and foreclosure. To make matters worse, they cause people to postpone needed care. All of which lead to higher insurance company profits.
The insurers don’t like to tell their customers this, but when they talk to their Wall Street masters, they sing a different tune. Angela Braly of WellPoint, speaking during a conference call for financial analysts in 2008, was asked if she would consider lowering premiums if that would increase enrollment in Anthem policies. Her reply, “We will not sacrifice profitability for membership,” was just what they wanted to hear.
That sentiment hasn’t changed. Recently Aetna’s chief financial officer, Joseph Zubretsky, made similar comments on a conference call. Concerned that investors might think Aetna was willing to grow by adding people to its rolls who could have substantial medical needs, Zubretsky soothed their fears, “We would like to have both profit and growth, but if you have to choose between one or the other, you take margin and profit and you sacrifice the growth.”
Recall that these are the same companies that developed algorithms to target women diagnosed with breast cancer so they could scour their health records for an excuse to cancel their policies. This inhuman practice, known as rescission, has supposedly been banned by the ACA.
Buying Doctors
If insurance companies are not lowering premiums to attract more customers or investing in infrastructure to reduce errors, what else besides their own stock (and some politicians) are they buying? Doctors! UnitedHealth is quietly buying medical groups who treat patients covered by its plans in several areas of the country. WellPoint announced in June that it would acquire CareMore, which operates twenty-six clinics in the Los Angeles area. CIGNA claims that it saves 9 percent on patients treated by doctors in a Phoenix medical group it controls. Is this a good thing?
In July, Kaiser Health News, in an article titled “Managed Care Enters The Exam Room As Insurers Buy Doctor Groups” said:
Some observers watching the developments say the health law, which in part was sold as a way to rein in insurers, has had the opposite result, opening the door for the companies to take control of even more parts of the health system.
“There’s a gigantic Murphy’s law emerging here,” said Ian Morrison, a California-based health care consultant who does some work for United, as well as most of its competitors. “The very people who were the demons in all of this, that the public can’t stand — managed-care firms — are the big winners.”
And the losers? Patients, and those of us paying premiums.
Health, Health Care, and Health Insurance
No other wealthy democracy spends as much on health care as we do. It’s not even close. Most of our peer countries spend about half as much per capita as we do.
If you hear politicians proclaim “America has the best health care in the world,” you can stop listening to them at that point. They are not reality-based. We may be paying the most on the planet for health care, but there is no objective evidence to support the claim that our health care is the best. Again, it’s not even close. The World Health Organization ranks U.S. health care thirty-seventh, just below Costa Rica.
No other wealthy democracy relies on for-profit insurance companies. Here we stand alone.
On August 10, 2011, the Saint Louis Post-Dispatch editorialized, “If America truly is serious about dealing with its deficit problems, there’s a fairly simple solution. But you’re probably not going to like it: Enact a single-payer health care plan.” The editorial goes on to explain that the “way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.”
The editorial asserts, “the ACA didn’t go far enough,” and concludes: “Eventually, the United States will have a single-payer plan. But we’ll waste a lot of money and time getting there.” Its authors could have added “and waste a lot of lives” too.
What is a “single-payer plan” like the Post-Dispatch endorses? Robert Reich, author, professor, and secretary of labor under Bill Clinton, explained it this way in February 2011:
If the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all.
Medicare is a single-payer plan. Everyone over age sixty-five is covered by this simple, single plan, which is publicly financed and privately delivered. How would a single-payer plan save money? The Post-Dispatch explains, “Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”
The respected journal Health Affairs published more evidence of the economic advantage of a single payer system on August 19, 2011. The article “US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers” found that U.S. physicians’ office staff “spent 20.6 hours per physician per week interacting with health plans — nearly ten times that of their Ontario counterparts. If U.S. physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year.”
The evidence is overwhelming: the for-profit insurance industry adds a huge amount of inefficiency, bureaucracy and cost to our system while adding no value, only hassle. These companies are parasitic middlemen we would be better off without. Their interest is in wealth care, not health care.
On top of that, the insurance industry is the single greatest barrier to achieving an efficient and affordable system to cover all Americans. If you have any doubt, read Wendell Potter’s Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. During the debate over the ACA, health insurance lobbyists sank the president’s public option, even though 70 percent of the public favored it. Their war chests overflow with money and their influence grows every day.
Hoping Congress will fix this leads only to despair. We need new ways to weaken the death grip this powerful industry has on us.
Divestment
There is a battle going on for the soul of America. Before he died, Ted Kennedy wrote to President Obama about health care reform, calling it “the great unfinished business of our society.” Kennedy avowed, “What we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
Back in the ER on that hot August night, I sent my man to the cath lab and they successfully stented his blockage. He went home the next day with a bill for $25,000. I tried to call him a few months later, but the phone number was “no longer in service.”
Congress and the politicians are “no longer in service.” We’ve got to look elsewhere.
Could we simply boycott health insurance? No, over 50 million are without insurance now, and they are living sicker and dying younger because they have barriers to care.
Stockholders with a conscience have tried for years to engage corporate leadership and have attempted shareholder resolutions to reform the industry from the inside. Despite their best efforts, they have had no significant positive effect so far.
It is time to move beyond resolutions and on to divestment.
The Divestment Campaign for Health Care is one group that is organizing a push in that direction.
From 1985 to 1990, over two hundred U.S. companies cut all ties with South Africa, resulting in a loss of $1 billion in direct American investment. This economic pressure hastened the fall of apartheid. It happened as a result of people power, democracy in action. Pension funds divested from companies doing business with South Africa. Faith communities declared they would not support injustice. Students called on their universities to cleanse their endowments. An idea was born — “socially responsible investing.”
There is nothing socially responsible about investing in the health insurance industry.
"Go to your church, your union ... your friends and neighbors, and tell them it’s time to get the health insurers out!" the author writes. Here, a Unitarian Universalist congregation in Cortland, New York, rallies for single-payer health care.
Up to now, they have received little scrutiny from investors. One exception is Domini Social Investments, whose Global Investment Standards give “support [for] government’s responsibility to provide basic public goods that are as varied as health care, prisons, primary school education, and national security.” Domini is “concerned about the extent to which health insurance privatizes a public good.” As a result, Domini has disqualified most health insurers from their portfolios.
In contrast, the $4 billion TIAA-CREF Social Choice Equity Fund holds $24 million in WellPoint stock, as well as Aetna and Humana from the health insurance Big Five. WellPoint stock may only represent 0.6 percent of the total fund, but in this large, diversified mutual fund, which includes over 800 individual stocks, WellPoint is in the top 5 percent of the fund’s largest holdings. TIAA-CREF has refused to exclude health insurance companies.
The Presbyterian Church USA, often in the vanguard of the faith community, is there again. Their General Assembly meets in the summer of 2012 and they will vote on an “Overture” to “implement divestment procedures as well as encourage individual Presbyterians and congregations to divest of holdings in the [publicly traded health insurance] companies.” Other faith groups cannot be far behind.
We have nothing to lose. Health insurance companies have everything to lose as their stock prices drop and their influence wanes. Go to your church, your union, your pension plan, your 401k advisor, your university endowment, your city council, your friends and neighbors, and tell them it’s time to get the health insurers out!
Who can defend these corporations? There is no business case, no health care case, no moral case to support their ongoing existence. They make their profits by avoiding taking care of sick people — by refusing to issue policies, canceling policies, or denying payment. I went to medical school in order to care for the sick.
The health insurance industry must go.
Rob Stone is a gardener, grandfather, and teacher. He has practiced emergency medicine in Bloomington, Indiana, since the early 1980s, and for the past year has been transitioning his medical career to hospice and palliative medicine. He is founder and director of Hoosiers for a Commonsense Health Plan and serves on the board of directors of Physicians for a National Health Program.
Saturday, September 17, 2011
Number of Uninsured Up Another Million
MedPage Today
A record 49.9 million Americans were without health insurance during 2010, up almost 2% from the 49.0 million uninsured in 2009, the Census Bureau reported.
The percentage of the population without insurance rose 0.2 percentage points, from 16.1% to 16.3%, though this was not significant at the P<0.1 level, the agency said.
Results from the agency's 2010 Current Population Survey also found increases in the number of Americans living below the poverty level (46.2 million versus 43.6 million in 2009) as well as declines in inflation-adjusted median household income. The proportion of the population with private health insurance overall also declined, as did the proportion with insurance provided by employers.
In a statement, the Census Bureau indicated that these trends were outgrowths of the recent recession, even though the economy was officially in recovery during 2010.
The agency noted that the first years after previous recessions were also typically marked by increases in poverty rates and declining income and health coverage.
Regionally, the biggest increase in being uninsured occurred in the Northeast, jumping 0.6 percentage points from the previous year, to 12.4%. But the 2010 rate was still lower than for any other region.
Southern states, on the other hand, had the highest overall uninsured rate, at 19.1%, but this was actually a slight drop from 2009 when the rate stood at 19.2%.
Ironically, individuals with jobs were more likely to be uninsured than the population as a whole. The survey found that, among people 18 to 64 years old who worked at some point during 2010, 28.0 million (19.5%) lacked health insurance.
Also, people with disabilities were hit hard in 2010. Whereas 16.0% lacked health coverage in 2009, last year the figure rose to 17.3%.
Other results from the survey concerning health insurance included:
•Percent covered by private health insurance: 64.0% in 2010, down from 64.5% in 2009
•Percent covered by employer-based plans: 55.3% in 2010, down from 56.1% in 2009
•Percent covered by Medicaid only: 11.2% in both years
In the Current Population Survey, lack of health insurance is supposed to mean that respondents had no coverage at any time during the year. The Census Bureau said the survey includes a series of questions meant to confirm the complete lack of insurance, but it acknowledged that misunderstandings by respondents are common.
A record 49.9 million Americans were without health insurance during 2010, up almost 2% from the 49.0 million uninsured in 2009, the Census Bureau reported.
The percentage of the population without insurance rose 0.2 percentage points, from 16.1% to 16.3%, though this was not significant at the P<0.1 level, the agency said.
Results from the agency's 2010 Current Population Survey also found increases in the number of Americans living below the poverty level (46.2 million versus 43.6 million in 2009) as well as declines in inflation-adjusted median household income. The proportion of the population with private health insurance overall also declined, as did the proportion with insurance provided by employers.
In a statement, the Census Bureau indicated that these trends were outgrowths of the recent recession, even though the economy was officially in recovery during 2010.
The agency noted that the first years after previous recessions were also typically marked by increases in poverty rates and declining income and health coverage.
Regionally, the biggest increase in being uninsured occurred in the Northeast, jumping 0.6 percentage points from the previous year, to 12.4%. But the 2010 rate was still lower than for any other region.
Southern states, on the other hand, had the highest overall uninsured rate, at 19.1%, but this was actually a slight drop from 2009 when the rate stood at 19.2%.
Ironically, individuals with jobs were more likely to be uninsured than the population as a whole. The survey found that, among people 18 to 64 years old who worked at some point during 2010, 28.0 million (19.5%) lacked health insurance.
Also, people with disabilities were hit hard in 2010. Whereas 16.0% lacked health coverage in 2009, last year the figure rose to 17.3%.
Other results from the survey concerning health insurance included:
•Percent covered by private health insurance: 64.0% in 2010, down from 64.5% in 2009
•Percent covered by employer-based plans: 55.3% in 2010, down from 56.1% in 2009
•Percent covered by Medicaid only: 11.2% in both years
In the Current Population Survey, lack of health insurance is supposed to mean that respondents had no coverage at any time during the year. The Census Bureau said the survey includes a series of questions meant to confirm the complete lack of insurance, but it acknowledged that misunderstandings by respondents are common.
Friday, September 16, 2011
Nader Rips Conyers for WilmerHale Bailout Bill
Corporate Crime Reporter
Consumer advocate Ralph Nader last week ripped Congressman John Conyers (D-Michigan) for his role in getting passed special interest legislation that would retroactively save corporate law firm WilmerHale more than $200 million.
“You got an amendment passed into law,”Nader wrote to Conyers in a letter dated September 9, 2011. “It wasn’t a raise in the stagnant minimum wage or some tougher measures on corporate crime or needed revisions to the Patriot Act or curbing official illegality by the Executive Branch.”
“No, it was to save a drug company and its law firm a great deal of money and allow higher prices for patients which included neutering the potential malpractice liability of the law firm – $214 million worth – retroactively of course,” Nader wrote. “This bailout is in an overall anti-small business, anti-small inventor, patent bill.”
President Obama is expected to sign the bill into law this week.
The Senate passed the bill last week, and the House passed it in June.
The bill is a patent system overhaul bill, with a special provision that would most likely let WilmerHale off the hook on a $214 million malpractice judgment.
The story spans more than a decade.
WilmerHale was handling a patent filing for a drug company – the Parsippany, New Jersey based Medicines Company.
The law firm missed the filing deadline by a day, causing the patent to be denied by the Patent and Trademark Office.
The company sued the law firm for malpractice.
WilmerHale settled the malpractice case by agreeing to pay $18 million, plus another $214 million in damages if a generic competitor for one of its drugs in question came on line before June 2015.
The bill – soon to become law – would retroactively grant the company the patent it was seeking by changing Patent Office rules on late filings.
The bill was sponsored by Conyers in the House and Orrin Hatch (R-Utah) in the Senate.
The bill was actively opposed by Senators Jeff Sessions (R-Alabama) and Tom Coburn (R-Oklahoma).
Nader is siding with Sessions and Coburn and the Wall Street Journal editorial board.
In a last ditch but failed attempt to stop the legislation from passing the Senate, Coburn and Session wrote a letter to their Senate colleagues.
“The key question is whether we will vote to bail out a law firm that made a mistake and now wants consumers and taxpayers to pay the freight for that error,” they wrote.
The answer from the Senate last week – yes.
The Senate voted to reject an amendment introduced by Sessions to delete the WilmerHale bailout provision from the bill.
The Wall Street Journal also weighed in against the bailout:
“There are few things as unbecoming as a law firm and drug company seeking special favors from Congress that would weaken patent law for their own self interest,” the Wall Street Journal editorialized last week. “Asking Congress to break the rules as a special favor corrupts the law.”
“Amazing who was on the right side here,” Nader wrote to Conyers. “Lamar Smith, Jeff Sessions, Tom Coburn. They argued against interfering with the litigation.”
“This is the same half of WilmerHale – that is, the merged Wilmer, Cutler and Pickering – that stood with the auto giants in 1966 in weakening the auto safety legislation. WCP lobbied successfully to delete the criminal penalty – properly defended by Tip O’Neill – provision from the bill for willful and knowing violation of safety standards.”
“So this is where we are with leading progressives in the Congress,” Nader wrote. “No authentic push for Obama’s 2008 promise to raise the federal minimum wage to $9.50. No push for a comprehensive corporate criminal law code in the midst of a corporate crime wave. And the most minimum attention to the runaway outlaw presidency that, with Congressional complicity, has turned Congress for a decade into an inkblot during these endless, costly unilateral wars and remote interventions.”
“Promises, nice words, meetings, but nothing like the activated, driven toughness of those who call themselves Tea Partiers, where you work.”
Consumer advocate Ralph Nader last week ripped Congressman John Conyers (D-Michigan) for his role in getting passed special interest legislation that would retroactively save corporate law firm WilmerHale more than $200 million.
“You got an amendment passed into law,”Nader wrote to Conyers in a letter dated September 9, 2011. “It wasn’t a raise in the stagnant minimum wage or some tougher measures on corporate crime or needed revisions to the Patriot Act or curbing official illegality by the Executive Branch.”
“No, it was to save a drug company and its law firm a great deal of money and allow higher prices for patients which included neutering the potential malpractice liability of the law firm – $214 million worth – retroactively of course,” Nader wrote. “This bailout is in an overall anti-small business, anti-small inventor, patent bill.”
President Obama is expected to sign the bill into law this week.
The Senate passed the bill last week, and the House passed it in June.
The bill is a patent system overhaul bill, with a special provision that would most likely let WilmerHale off the hook on a $214 million malpractice judgment.
The story spans more than a decade.
WilmerHale was handling a patent filing for a drug company – the Parsippany, New Jersey based Medicines Company.
The law firm missed the filing deadline by a day, causing the patent to be denied by the Patent and Trademark Office.
The company sued the law firm for malpractice.
WilmerHale settled the malpractice case by agreeing to pay $18 million, plus another $214 million in damages if a generic competitor for one of its drugs in question came on line before June 2015.
The bill – soon to become law – would retroactively grant the company the patent it was seeking by changing Patent Office rules on late filings.
The bill was sponsored by Conyers in the House and Orrin Hatch (R-Utah) in the Senate.
The bill was actively opposed by Senators Jeff Sessions (R-Alabama) and Tom Coburn (R-Oklahoma).
Nader is siding with Sessions and Coburn and the Wall Street Journal editorial board.
In a last ditch but failed attempt to stop the legislation from passing the Senate, Coburn and Session wrote a letter to their Senate colleagues.
“The key question is whether we will vote to bail out a law firm that made a mistake and now wants consumers and taxpayers to pay the freight for that error,” they wrote.
The answer from the Senate last week – yes.
The Senate voted to reject an amendment introduced by Sessions to delete the WilmerHale bailout provision from the bill.
The Wall Street Journal also weighed in against the bailout:
“There are few things as unbecoming as a law firm and drug company seeking special favors from Congress that would weaken patent law for their own self interest,” the Wall Street Journal editorialized last week. “Asking Congress to break the rules as a special favor corrupts the law.”
“Amazing who was on the right side here,” Nader wrote to Conyers. “Lamar Smith, Jeff Sessions, Tom Coburn. They argued against interfering with the litigation.”
“This is the same half of WilmerHale – that is, the merged Wilmer, Cutler and Pickering – that stood with the auto giants in 1966 in weakening the auto safety legislation. WCP lobbied successfully to delete the criminal penalty – properly defended by Tip O’Neill – provision from the bill for willful and knowing violation of safety standards.”
“So this is where we are with leading progressives in the Congress,” Nader wrote. “No authentic push for Obama’s 2008 promise to raise the federal minimum wage to $9.50. No push for a comprehensive corporate criminal law code in the midst of a corporate crime wave. And the most minimum attention to the runaway outlaw presidency that, with Congressional complicity, has turned Congress for a decade into an inkblot during these endless, costly unilateral wars and remote interventions.”
“Promises, nice words, meetings, but nothing like the activated, driven toughness of those who call themselves Tea Partiers, where you work.”
Wednesday, September 14, 2011
Muslim Council of America Opens Free Health Clinic in Braddock, PA
The Braddock Free Clinic is available to residents of the wider Braddock region including all of the area previously served by UPMC Braddock Hospital. The clinic will operate on Saturdays and Sundays from 9:00 AM to 5:00 PM in the Braddock Municipal Building. Volunteer doctors organized by the Muslim Council of America will operate the clinic. It is hosted by Braddock Borough Council and supported by SOCH. The open house will give everybody a chance to see the beginnings of a new medical care model in the Braddock area and meet the people who will be providing the services. New patients can also sign up at the open house.
Riffat Chugtai, Executive Director of the Braddock Free Clinic, said, “We want to reach a wide geographic area. Patients are not limited to Braddock. We target the service to adults without health insurance who have incomes below 350% of the poverty level. This is not a publicly funded program. It is a commitment by the Muslim community to the healthcare needs of the region. Doctors and administrative staff are volunteers committed to community healthcare.”
Jesse Brown, Braddock Borough Council President, said, “We want the clinic to be successful and serve the widest area possible. We won’t turn anybody away because of where they live. This is the seed of a new healthcare network in the Mon Valley and surrounding areas. I think it can be a model for other communities as well.”
Tony Buba, nationally known filmmaker, who is the spokesperson for SOCH said, “This is a small step toward restoring healthcare in Braddock and working toward access to healthcare by everybody. What we truly need is a single payer health system. We thank Dr. Akhtar and the Muslim Council of America for taking notice of our two years of struggle against the closure of UPMC Braddock and helping bring healthcare back to those who are uninsured and need care the most.”
For more information, contact:
Dr. Mohammad Akhtar, 724-538-3858, CEO, Muslim Council of America
Riffat Chugtai, 412-612-6381, Clinic Executive Director
SOCH: Tony Buba, 412-351-4808
Riffat Chugtai, Executive Director of the Braddock Free Clinic, said, “We want to reach a wide geographic area. Patients are not limited to Braddock. We target the service to adults without health insurance who have incomes below 350% of the poverty level. This is not a publicly funded program. It is a commitment by the Muslim community to the healthcare needs of the region. Doctors and administrative staff are volunteers committed to community healthcare.”
Jesse Brown, Braddock Borough Council President, said, “We want the clinic to be successful and serve the widest area possible. We won’t turn anybody away because of where they live. This is the seed of a new healthcare network in the Mon Valley and surrounding areas. I think it can be a model for other communities as well.”
Tony Buba, nationally known filmmaker, who is the spokesperson for SOCH said, “This is a small step toward restoring healthcare in Braddock and working toward access to healthcare by everybody. What we truly need is a single payer health system. We thank Dr. Akhtar and the Muslim Council of America for taking notice of our two years of struggle against the closure of UPMC Braddock and helping bring healthcare back to those who are uninsured and need care the most.”
For more information, contact:
Dr. Mohammad Akhtar, 724-538-3858, CEO, Muslim Council of America
Riffat Chugtai, 412-612-6381, Clinic Executive Director
SOCH: Tony Buba, 412-351-4808
Soaring Poverty Casts Spotlight on ‘Lost Decade’
NY Times
WASHINGTON — Another 2.6 million people slipped into poverty in the United States last year, the Census Bureau reported Tuesday, and the number of Americans living below the official poverty line, 46.2 million people, was the highest number in the 52 years the bureau has been publishing figures on it.
And in new signs of distress among the middle class, median household incomes fell last year to levels last seen in 1997.
Economists pointed to a telling statistic: It was the first time since the Great Depression that median household income, adjusted for inflation, had not risen over such a long period, said Lawrence Katz, an economics professor at Harvard.
“This is truly a lost decade,” Mr. Katz said. “We think of America as a place where every generation is doing better, but we’re looking at a period when the median family is in worse shape than it was in the late 1990s.”
The bureau’s findings were worse than many economists expected, and brought into sharp relief the toll the past decade — including the painful declines of the financial crisis and recession —had taken on Americans at the middle and lower parts of the income ladder. It is also fresh evidence that the disappointing economic recovery has done nothing for the country’s poorest citizens.
The report said the percentage of Americans living below the poverty line last year, 15.1 percent, was the highest level since 1993. (The poverty line in 2010 for a family of four was $22,314.)
The report comes as President Obama gears up to try to pass a jobs bill, and analysts said the bleak numbers could help him make his case for urgency. But they could also be used against him by Republican opponents seeking to highlight economic shortcomings on his watch.
“This is one more piece of bad news on the economy,” said Ron Haskins, a director of the Center on Children and Families at the Brookings Institution. “This will be another cross to bear by the administration.”
The past decade was also marked by a growing gap between the very top and very bottom of the income ladder. Median household income for the bottom tenth of the income spectrum fell by 12 percent from a peak in 1999, while the top 90th percentile dropped by just 1.5 percent. Overall, median household income adjusted for inflation declined by 2.3 percent in 2010 from the previous year, to $49,445. That was 7 percent less than the peak of $53,252 in 1999. Part of the income decline over time is because of the smaller size of the American family.
This year is not likely to be any better, economists said. Stimulus money has largely ended, and state and local governments have made deep cuts to staff and to budgets for social programs, both likely to move economically fragile families closer to poverty.
Minorities were hit hardest. Blacks experienced the highest poverty rate, at 27 percent, up from 25 percent in 2009, and Hispanics rose to 26 percent from 25 percent. For whites, 9.9 percent lived in poverty, up from 9.4 percent in 2009. Asians were unchanged at 12.1 percent.
An analysis by the Brookings Institution estimated that at the current rate, the recession will have added nearly 10 million people to the ranks of the poor by the middle of the decade.
Joblessness was the main culprit pushing more Americans into poverty, economists said.
Last year, about 48 million people ages 18 to 64 did not work even one week out of the year, up from 45 million in 2009, said Trudi Renwick, a Census official.
“Once you’ve been out of work for a long time, it’s a very difficult road to get back,” Mr. Katz said.
Median income fell across all working-age categories, but was sharpest drop was among the young working Americans, ages 15 to 24, who experienced a decline of 9 percent.
According to the Census figures, the median annual income for a male full-time, year-round worker in 2010 — $47,715 — was virtually unchanged, in 2010 dollars, from its level in 1973, when it was $49,065, said Sheldon Danziger, professor of public policy at the University of Michigan.
Those who do not have college degrees were particularly hard hit, he said. “The median, full-time male worker has made no progress on average,” Mr. Danziger said.
The recession has continued pushing 25-to-34-year-olds to move in with family and friends to save money. Of that group, nearly half were living below the poverty line, when their parents’ incomes were excluded. The poverty level for a single person under the age of 65 was $11,344.
“We’re risking a new underclass,” said Timothy Smeeding, director of the Institute for Research and Poverty at the University of Wisconsin, Madison.
“Young, less-educated adults, mainly men, can’t support their children and form stable families because they are jobless,” he added.
But even the period of economic growth that came before the recession did little for the middle and bottom wage earners.
Arloc Sherman, a senior researcher at the Center on Budget and Policy Priorities, said that the period from 2001 to 2007 was the first recovery on record where the level of poverty was deeper, and median income of working-age people was lower, at the end than at the beginning.
“Even before the recession hit, a lot of people were falling behind,” he said. “This may be adding to people’s sense of urgency about the economy.”
The suburban poverty rate, at 11.8 percent, appears to be the highest since 1967, Mr. Sherman added. Last year more Americans fell into deep poverty, defined as less than half the official poverty line, or about $11,000, with the ranks of that group increasing to 20.5 million, or about 6.7 percent of the population.
Poverty has also swallowed more children, with about 16.4 million in its ranks last year, the highest numbers since 1962, according to William Frey, senior demographer at Brookings. That means 22 percent of children are in poverty, the highest percentage since 1993.
The census figures do not count noncash assistance, like food stamps and the earned-income tax credit, and economists say that as a result they tend to overstate poverty numbers for certain groups, like children. But rises in the cost of housing, medical care and energy are not taken into account, either.
The report also said the number of uninsured Americans increased by 900,000 to 49.9 million.
Those covered by employer-based insurance continued to decline in 2010, to about 55 percent, while those with government-provided coverage continued to increase, up slightly to 31 percent. Employer-based coverage was down from 65 percent in 2000, the report said.
This article has been revised to reflect the following correction:
Correction: September 13, 2011
An earlier version of this article gave an incorrect figure for the number of people the Census Bureau found to be in poverty in the Unites States. The number is 46.2 million people, not 56.2 million.
WASHINGTON — Another 2.6 million people slipped into poverty in the United States last year, the Census Bureau reported Tuesday, and the number of Americans living below the official poverty line, 46.2 million people, was the highest number in the 52 years the bureau has been publishing figures on it.
And in new signs of distress among the middle class, median household incomes fell last year to levels last seen in 1997.
Economists pointed to a telling statistic: It was the first time since the Great Depression that median household income, adjusted for inflation, had not risen over such a long period, said Lawrence Katz, an economics professor at Harvard.
“This is truly a lost decade,” Mr. Katz said. “We think of America as a place where every generation is doing better, but we’re looking at a period when the median family is in worse shape than it was in the late 1990s.”
The bureau’s findings were worse than many economists expected, and brought into sharp relief the toll the past decade — including the painful declines of the financial crisis and recession —had taken on Americans at the middle and lower parts of the income ladder. It is also fresh evidence that the disappointing economic recovery has done nothing for the country’s poorest citizens.
The report said the percentage of Americans living below the poverty line last year, 15.1 percent, was the highest level since 1993. (The poverty line in 2010 for a family of four was $22,314.)
The report comes as President Obama gears up to try to pass a jobs bill, and analysts said the bleak numbers could help him make his case for urgency. But they could also be used against him by Republican opponents seeking to highlight economic shortcomings on his watch.
“This is one more piece of bad news on the economy,” said Ron Haskins, a director of the Center on Children and Families at the Brookings Institution. “This will be another cross to bear by the administration.”
The past decade was also marked by a growing gap between the very top and very bottom of the income ladder. Median household income for the bottom tenth of the income spectrum fell by 12 percent from a peak in 1999, while the top 90th percentile dropped by just 1.5 percent. Overall, median household income adjusted for inflation declined by 2.3 percent in 2010 from the previous year, to $49,445. That was 7 percent less than the peak of $53,252 in 1999. Part of the income decline over time is because of the smaller size of the American family.
This year is not likely to be any better, economists said. Stimulus money has largely ended, and state and local governments have made deep cuts to staff and to budgets for social programs, both likely to move economically fragile families closer to poverty.
Minorities were hit hardest. Blacks experienced the highest poverty rate, at 27 percent, up from 25 percent in 2009, and Hispanics rose to 26 percent from 25 percent. For whites, 9.9 percent lived in poverty, up from 9.4 percent in 2009. Asians were unchanged at 12.1 percent.
An analysis by the Brookings Institution estimated that at the current rate, the recession will have added nearly 10 million people to the ranks of the poor by the middle of the decade.
Joblessness was the main culprit pushing more Americans into poverty, economists said.
Last year, about 48 million people ages 18 to 64 did not work even one week out of the year, up from 45 million in 2009, said Trudi Renwick, a Census official.
“Once you’ve been out of work for a long time, it’s a very difficult road to get back,” Mr. Katz said.
Median income fell across all working-age categories, but was sharpest drop was among the young working Americans, ages 15 to 24, who experienced a decline of 9 percent.
According to the Census figures, the median annual income for a male full-time, year-round worker in 2010 — $47,715 — was virtually unchanged, in 2010 dollars, from its level in 1973, when it was $49,065, said Sheldon Danziger, professor of public policy at the University of Michigan.
Those who do not have college degrees were particularly hard hit, he said. “The median, full-time male worker has made no progress on average,” Mr. Danziger said.
The recession has continued pushing 25-to-34-year-olds to move in with family and friends to save money. Of that group, nearly half were living below the poverty line, when their parents’ incomes were excluded. The poverty level for a single person under the age of 65 was $11,344.
“We’re risking a new underclass,” said Timothy Smeeding, director of the Institute for Research and Poverty at the University of Wisconsin, Madison.
“Young, less-educated adults, mainly men, can’t support their children and form stable families because they are jobless,” he added.
But even the period of economic growth that came before the recession did little for the middle and bottom wage earners.
Arloc Sherman, a senior researcher at the Center on Budget and Policy Priorities, said that the period from 2001 to 2007 was the first recovery on record where the level of poverty was deeper, and median income of working-age people was lower, at the end than at the beginning.
“Even before the recession hit, a lot of people were falling behind,” he said. “This may be adding to people’s sense of urgency about the economy.”
The suburban poverty rate, at 11.8 percent, appears to be the highest since 1967, Mr. Sherman added. Last year more Americans fell into deep poverty, defined as less than half the official poverty line, or about $11,000, with the ranks of that group increasing to 20.5 million, or about 6.7 percent of the population.
Poverty has also swallowed more children, with about 16.4 million in its ranks last year, the highest numbers since 1962, according to William Frey, senior demographer at Brookings. That means 22 percent of children are in poverty, the highest percentage since 1993.
The census figures do not count noncash assistance, like food stamps and the earned-income tax credit, and economists say that as a result they tend to overstate poverty numbers for certain groups, like children. But rises in the cost of housing, medical care and energy are not taken into account, either.
The report also said the number of uninsured Americans increased by 900,000 to 49.9 million.
Those covered by employer-based insurance continued to decline in 2010, to about 55 percent, while those with government-provided coverage continued to increase, up slightly to 31 percent. Employer-based coverage was down from 65 percent in 2000, the report said.
This article has been revised to reflect the following correction:
Correction: September 13, 2011
An earlier version of this article gave an incorrect figure for the number of people the Census Bureau found to be in poverty in the Unites States. The number is 46.2 million people, not 56.2 million.
Tuesday, September 13, 2011
U.S. poverty rate reaches 15.1 percent
The Washington Post
The nation’s poverty rate spiked to 15.1 percent in 2010, the highest level since 1993, the Census Bureau reported on Tuesday, providing vivid new evidence about the country’s inability to escape the lingering effects of the recession.
About 46.2 million Americans lived in poverty last year, marking an increase of 2.6 million over 2009 and the fourth consecutive annual increase in poverty.
The total number of people living below the poverty line — which in 2010 was set at an income of $22,314 for a family of four — is now at the highest level in the 52 years the statistic has been collected.
The continued rise in poverty was just the latest manifestation of a troubled economy that has left 14 million Americans out of work and caused unemployment to hover above 9 percent for 25 of the past 27 months.
As poverty has spiked, median household income declined by 2.3 percent to $49,445 between 2009 and 2010. The typical household now earns less than it did in 1997, when inflation is factored in, a troubling sign of economic stagnation.
The decline in income has been most pronounced among those who earn the least. Overall, median household income has declined by 7.1 percent since peaking in 1999. The bottom 10 percent of earners have seen their income decline by 12.1 percent, while the top 10 percent have experienced a decline of 1.5 percent in that time period, the Census Bureau reported.
The Census Bureau also reported that 16.3 percent of Americans are without health coverage, a share that officials called statistically unchanged from 2009.
“Income down, poverty up, health insurance coverage down or flat,” said Ron Haskins, a senior fellow at the Brookings Institution. “The news on economic well-being in the U.S. is not good.”
The news was particularly bad for blacks, Hispanics, children and women. The poverty rate for Hispanics climbed to 26.6 percent from 25.3 percent, and for blacks it increased to 27.4 percent from 25.8 percent. For whites, the poverty rate in 2010 was 9.9 percent, a half percentage point increase from the previous year. Meanwhile, 12.1 percent of Asian Americans fell below the poverty line in 2010, which was statistically unchanged from 2009.
Among children, the poverty rate climbed to 22 percent. The black child poverty rate climbed to 39 percent, while the Hispanic child poverty rate reached 35 percent. The white child poverty rate was 12.4 percent.
Overall, Hispanics children account for 37 percent of the children in poverty, a share that has gone ups substantially since 2009, according to William Frey, a Brookings Institution demographer
“The Hispanic population has been hit hard by the recession,” Frey said. “They have been in jobs — construction and services — that have borne the brunt of what is going on in the economy.”
Meanwhile, record numbers of women were living in poverty, according to an analysis of the Census data by the National Women’s Law Center. The poverty rate among women climbed to 14.5 percent in 2010 from 13.9 percent in 2009, the highest level in 17 years.
More than 17 million women lived in poverty in 2010, including over 7.5 million in extreme poverty, with an income below half of the federal poverty line.
“Behind today’s grim statistics are real people who are finding it harder than ever to keep a roof over their heads, feed their families, get the health care they need and give their children a chance at a better life,” said Joan Entmacher, NWLC vice president for Family Economic Security.
The report found that the recession was forcing hard-pressed Americans — particularly the young — to double up in households with relatives and friends. Among Americans aged 25 to 34, the number of people doubled up in households has increased 25 percent since the recession hit in 2007.
The nation’s poverty rate spiked to 15.1 percent in 2010, the highest level since 1993, the Census Bureau reported on Tuesday, providing vivid new evidence about the country’s inability to escape the lingering effects of the recession.
About 46.2 million Americans lived in poverty last year, marking an increase of 2.6 million over 2009 and the fourth consecutive annual increase in poverty.
The total number of people living below the poverty line — which in 2010 was set at an income of $22,314 for a family of four — is now at the highest level in the 52 years the statistic has been collected.
The continued rise in poverty was just the latest manifestation of a troubled economy that has left 14 million Americans out of work and caused unemployment to hover above 9 percent for 25 of the past 27 months.
As poverty has spiked, median household income declined by 2.3 percent to $49,445 between 2009 and 2010. The typical household now earns less than it did in 1997, when inflation is factored in, a troubling sign of economic stagnation.
The decline in income has been most pronounced among those who earn the least. Overall, median household income has declined by 7.1 percent since peaking in 1999. The bottom 10 percent of earners have seen their income decline by 12.1 percent, while the top 10 percent have experienced a decline of 1.5 percent in that time period, the Census Bureau reported.
The Census Bureau also reported that 16.3 percent of Americans are without health coverage, a share that officials called statistically unchanged from 2009.
“Income down, poverty up, health insurance coverage down or flat,” said Ron Haskins, a senior fellow at the Brookings Institution. “The news on economic well-being in the U.S. is not good.”
The news was particularly bad for blacks, Hispanics, children and women. The poverty rate for Hispanics climbed to 26.6 percent from 25.3 percent, and for blacks it increased to 27.4 percent from 25.8 percent. For whites, the poverty rate in 2010 was 9.9 percent, a half percentage point increase from the previous year. Meanwhile, 12.1 percent of Asian Americans fell below the poverty line in 2010, which was statistically unchanged from 2009.
Among children, the poverty rate climbed to 22 percent. The black child poverty rate climbed to 39 percent, while the Hispanic child poverty rate reached 35 percent. The white child poverty rate was 12.4 percent.
Overall, Hispanics children account for 37 percent of the children in poverty, a share that has gone ups substantially since 2009, according to William Frey, a Brookings Institution demographer
“The Hispanic population has been hit hard by the recession,” Frey said. “They have been in jobs — construction and services — that have borne the brunt of what is going on in the economy.”
Meanwhile, record numbers of women were living in poverty, according to an analysis of the Census data by the National Women’s Law Center. The poverty rate among women climbed to 14.5 percent in 2010 from 13.9 percent in 2009, the highest level in 17 years.
More than 17 million women lived in poverty in 2010, including over 7.5 million in extreme poverty, with an income below half of the federal poverty line.
“Behind today’s grim statistics are real people who are finding it harder than ever to keep a roof over their heads, feed their families, get the health care they need and give their children a chance at a better life,” said Joan Entmacher, NWLC vice president for Family Economic Security.
The report found that the recession was forcing hard-pressed Americans — particularly the young — to double up in households with relatives and friends. Among Americans aged 25 to 34, the number of people doubled up in households has increased 25 percent since the recession hit in 2007.
Downward Mobility from the Middle Class: Waking up from the American Dream
The Pew Charitable Trusts, Economic Mobility Project, September 2011
The idea that children will grow up to be better off than their parents is a central component of the American Dream, and sustains American optimism. However, “Downward Mobility from the Middle Class: Waking up from the American Dream” finds that a middle-class upbringing does not guarantee the same status over the course of a lifetime. A third of Americans raised in the middle class — defined here as those between the 30th and 70th percentiles of the income distribution — fall out of the middle as adults.
The idea that children will grow up to be better off than their parents is a central component of the American Dream, and sustains American optimism. However, “Downward Mobility from the Middle Class: Waking up from the American Dream” finds that a middle-class upbringing does not guarantee the same status over the course of a lifetime. A third of Americans raised in the middle class — defined here as those between the 30th and 70th percentiles of the income distribution — fall out of the middle as adults.
Saturday, September 10, 2011
Failing Forward: Crisis among nation's children
NY Times
Sometimes I push back on my heels, look at this country and wonder aloud: “What on earth are we doing?”
We have a growing crisis among the nation’s children, yet our policies ignore that reality at best and exacerbate it at worst.
According to a report issued this week by the Guttmacher Institute, the unintended pregnancy rate has jumped 50 percent since 1994, yet a July report from the institute points out that politicians are setting records passing laws to restrict abortion. It said: “The 80 abortion restrictions enacted this year are more than double the previous record of 34 abortion restrictions enacted in 2005 — and more than triple the 23 enacted in 2010.” Add to this the assault by conservatives on Planned Parenthood, and what are we saying?
This is what we’re saying: actions have consequences. If you didn’t want a child, you shouldn’t have had sex. You must be punished by becoming a parent even if you know that you are not willing or able to be one.
This is insane.
Even if you follow a primitive religious concept of punishment for sex, as many on the right seem to do, you must at some point acknowledge that it is the child, not the parent, who will be punished most by our current policies that increasingly advocate for “unborn children” but fall silent for those outside the womb.
This is not how a rational society operates.
Aside from the raft of negative outcomes associated with unintended pregnancies, there are a host of other indicators that suggest a perilous world for the nation’s children.
A report from the Annie E. Casey Foundation last week found that “the official child poverty rate, which is a conservative measure of economic hardship, increased 18 percent between 2000 and 2009.”
According to the United States Department of Agriculture, the number of children facing food insecurity in 2009 soared to nearly one in four. And ABC News pointed out this week that a breathtaking 49 percent of all children born in this country are born to families who receive food supplements from the federal Women, Infants and Children assistance program.
As the World Bank points out, “undernutrition” in young children has been linked to delayed growth and motor development, lower I.Q.’s, behavioral problems and decreased attention, deficient learning and lower educational achievement.
Yet we wonder why our children’s educational outcomes are so low when compared with other wealthy nations. We even have the nerve to begrudge teachers for not being able to squeeze success out of children primed for failure.
It should come as no surprise that a C.D.C. report this month found a continued rise in the percentage of children being diagnosed with attention deficit hyperactivity disorder or that the country has continued its course of mass incarceration. The prison population in the United States has nearly quadrupled over the last 25 years. In fact, we have the highest incarceration rate of any Organization of Economic Cooperation and Development country. This isn’t only a moral outrage; it’s also budgetary lunacy. As a report released last month by the Children’s Defense Fund pointed out, “the U.S. spends almost two-and-a-half times as much per prisoner as per public school pupil.”
We simply can’t keep turning to pills and prisons to solve issues of poverty and poor parenting. This is unhealthy, unsustainable and unwise.
We have to do a better, more focused job of teaching sex education and providing contraceptive options (kudos here to the administration for moving this month to require insurance companies to provide birth control services to women at no extra cost). We have to remove the stigma and judgment around sex. Sex isn’t bad or unnatural. It’s one of the most natural things that we do. It just needs to be safe and responsible.
We also have to preserve women’s birth options should they become pregnant, including the option not to give birth. And, finally, for all the children who are born, we must make a valiant effort to give each and every one of them a fighting chance, which includes food and medicine when their parents can’t provide it. We must do this not as a boon or crutch to the parent, but as a selfish investment in the future of this great society.
They need our help now more than ever because the current economic stress may take some time to overcome.
As an updated Budget and Economic Outlook report issued by the Congressional Budget Office this week points out, the unemployment rate is expected to stay above 8 percent until the middle of the decade.
Now is when we need government to step up and be smart.
This is exactly the wrong time to do what the Republicans would have us do. In their 2012 budget, they propose cutting nutrition programs as part of austerity measures so that we don’t leave our children saddled with debt. Meanwhile, they completely ignore the fact that those cuts could leave even more children saddled with physical or developmental problems.
They want to hold the line on tax breaks for the wealthy, not paying attention to the fact that our growing income inequality, which could be reversed, continues to foster developmental inequality, which is almost impossible to reverse.
We have to start this conversation from a different point. We must ask: “What kind of society do we want to build, and what kinds of workers, soldiers and citizens should populate that society?” If we want that society to be prosperous and safe and filled with healthy, well-educated and well-adjusted people, then the policy directions become clear.
They are almost the exact opposite of what we are doing.
Sometimes I push back on my heels, look at this country and wonder aloud: “What on earth are we doing?”
We have a growing crisis among the nation’s children, yet our policies ignore that reality at best and exacerbate it at worst.
According to a report issued this week by the Guttmacher Institute, the unintended pregnancy rate has jumped 50 percent since 1994, yet a July report from the institute points out that politicians are setting records passing laws to restrict abortion. It said: “The 80 abortion restrictions enacted this year are more than double the previous record of 34 abortion restrictions enacted in 2005 — and more than triple the 23 enacted in 2010.” Add to this the assault by conservatives on Planned Parenthood, and what are we saying?
This is what we’re saying: actions have consequences. If you didn’t want a child, you shouldn’t have had sex. You must be punished by becoming a parent even if you know that you are not willing or able to be one.
This is insane.
Even if you follow a primitive religious concept of punishment for sex, as many on the right seem to do, you must at some point acknowledge that it is the child, not the parent, who will be punished most by our current policies that increasingly advocate for “unborn children” but fall silent for those outside the womb.
This is not how a rational society operates.
Aside from the raft of negative outcomes associated with unintended pregnancies, there are a host of other indicators that suggest a perilous world for the nation’s children.
A report from the Annie E. Casey Foundation last week found that “the official child poverty rate, which is a conservative measure of economic hardship, increased 18 percent between 2000 and 2009.”
According to the United States Department of Agriculture, the number of children facing food insecurity in 2009 soared to nearly one in four. And ABC News pointed out this week that a breathtaking 49 percent of all children born in this country are born to families who receive food supplements from the federal Women, Infants and Children assistance program.
As the World Bank points out, “undernutrition” in young children has been linked to delayed growth and motor development, lower I.Q.’s, behavioral problems and decreased attention, deficient learning and lower educational achievement.
Yet we wonder why our children’s educational outcomes are so low when compared with other wealthy nations. We even have the nerve to begrudge teachers for not being able to squeeze success out of children primed for failure.
It should come as no surprise that a C.D.C. report this month found a continued rise in the percentage of children being diagnosed with attention deficit hyperactivity disorder or that the country has continued its course of mass incarceration. The prison population in the United States has nearly quadrupled over the last 25 years. In fact, we have the highest incarceration rate of any Organization of Economic Cooperation and Development country. This isn’t only a moral outrage; it’s also budgetary lunacy. As a report released last month by the Children’s Defense Fund pointed out, “the U.S. spends almost two-and-a-half times as much per prisoner as per public school pupil.”
We simply can’t keep turning to pills and prisons to solve issues of poverty and poor parenting. This is unhealthy, unsustainable and unwise.
We have to do a better, more focused job of teaching sex education and providing contraceptive options (kudos here to the administration for moving this month to require insurance companies to provide birth control services to women at no extra cost). We have to remove the stigma and judgment around sex. Sex isn’t bad or unnatural. It’s one of the most natural things that we do. It just needs to be safe and responsible.
We also have to preserve women’s birth options should they become pregnant, including the option not to give birth. And, finally, for all the children who are born, we must make a valiant effort to give each and every one of them a fighting chance, which includes food and medicine when their parents can’t provide it. We must do this not as a boon or crutch to the parent, but as a selfish investment in the future of this great society.
They need our help now more than ever because the current economic stress may take some time to overcome.
As an updated Budget and Economic Outlook report issued by the Congressional Budget Office this week points out, the unemployment rate is expected to stay above 8 percent until the middle of the decade.
Now is when we need government to step up and be smart.
This is exactly the wrong time to do what the Republicans would have us do. In their 2012 budget, they propose cutting nutrition programs as part of austerity measures so that we don’t leave our children saddled with debt. Meanwhile, they completely ignore the fact that those cuts could leave even more children saddled with physical or developmental problems.
They want to hold the line on tax breaks for the wealthy, not paying attention to the fact that our growing income inequality, which could be reversed, continues to foster developmental inequality, which is almost impossible to reverse.
We have to start this conversation from a different point. We must ask: “What kind of society do we want to build, and what kinds of workers, soldiers and citizens should populate that society?” If we want that society to be prosperous and safe and filled with healthy, well-educated and well-adjusted people, then the policy directions become clear.
They are almost the exact opposite of what we are doing.
Study: Costs Keep Med Students From Much-Needed Mental Health Care
CommonHealth blog
Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.
In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.
Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.
Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.
For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment.
Nardin said the survey also revealed that “Private medical schools are more likely than public schools to offer worse-than-average cost-sharing for outpatient substance abuse treatment. The worst region in the country, she said, was the Northeast.
Boyd, a faculty psychiatrist and an outspoken advocate for physician health, served for six years as associate director of the Physician Health Services, Inc., a nonprofit subsidiary of the Massachusetts Medical Society that provides confidential consultation and support to at-risk medical students and doctors across the state.
“Over the past two decades,” he said, “I have seen medical schools try to humanize the student’s experience and observed hospitals ratcheting up easier practices along with their awareness of physician health.” But the reality remains that medicine is very intense and stressful for those who are vulnerable to depression, anxiety, and substance abuse.
Troubled students often resist seeking treatment at the onset of their symptoms, fearing high out-of-pocket costs and an accumulation of more school debt. “But with any psychiatric disorder or substance abuse,” said Boyd, “early intervention definitely correlates to better outcomes.”
“There is a lack of sympathy for this fear of debt,” he said. “Most people just assume doctors will make a lot of money. But mounting debt from long stints at expensive schools weighs very heavily upon the students and most will do anything they can to avoid increasing it.”
According to statistics from the graduating medical school class of 2008, Nardin said, the median debt for public school students was $145,00 and for private school students it was $180,000.
To provide context for the cost of outpatient substance abuse treatment, I spoke with Talbott Recovery Campus, in Atlanta, Georgia, well known by Boyd and others for its Impaired Professionals Program. Debbie Kingston of the intake department told me: “The 90-day residential treatment program costs $39,000 for out-of network plans. If in-network, most insurance plans only cover $2000-$8000 of the total cost.”
Kingston added that detox, even though required, was not included in this tab. Depending on the addiction, detox can take from two to ten days. These costs also do not include the need for on-going monitoring and mental health support once a patient completes their residential stay.
In an article posted recently on Commonhealth, Rachel Zimmerman reported on a study, also authored by Boyd, that points to a more general obstacle to mental health care. The study’s hypothesis, which was borne out, posited that availability of psychiatric services has greatly diminished “due to a combination of paltry reimbursement rates and budget cutbacks.” The study’s authors wrote: “Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible.”
Of the 64 medical facilities listed by Blue Cross and Blue Shield in the greater Boston area and contacted for the study, only four could offer an appointment within two weeks. Others refused to offer an appointment due to requirements that all patients be enrolled with a primary care doctor affiliated with that particular psychiatric facility. Study researcher Andy Lindenmeyer, a fourth- year resident in the Harvard Longwood psychiatric program, said, “I think the point here is that having health insurance does not equal access to care.”
Stephanie Woolhandler, a professor of public health at City University of New York and a visiting professor of medicine at CHA, summed up the state of mental health care in a recent email: "The reality is that access to mental health care is very poor in this country, even for people with private insurance. Because mental illness is stigmatized, the mentally ill are often unable or unwilling to fight their insurance company to get their care reimbursed. The result is a very uneven distribution of care, with abundant mental health resources available to those who can pay out of pocket, while those that must rely on their insurance find that mental health care is restricted or even unavailable.”
“We need our medical schools to push themselves to provide students with more affordable care,” said Boyd. “What’s best for the health of our students will result in better physicians and the future well-being of their patients.”
A note of disclosure: Both Drs. Boyd and Nardin, authors of the survey letter published in JAMA, are active members of the group Physicians for a National Health Program, an organization of physicians who advocate for single-payer national health insurance.
Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.
In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.
Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.
Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.
For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment.
Nardin said the survey also revealed that “Private medical schools are more likely than public schools to offer worse-than-average cost-sharing for outpatient substance abuse treatment. The worst region in the country, she said, was the Northeast.
Boyd, a faculty psychiatrist and an outspoken advocate for physician health, served for six years as associate director of the Physician Health Services, Inc., a nonprofit subsidiary of the Massachusetts Medical Society that provides confidential consultation and support to at-risk medical students and doctors across the state.
“Over the past two decades,” he said, “I have seen medical schools try to humanize the student’s experience and observed hospitals ratcheting up easier practices along with their awareness of physician health.” But the reality remains that medicine is very intense and stressful for those who are vulnerable to depression, anxiety, and substance abuse.
Troubled students often resist seeking treatment at the onset of their symptoms, fearing high out-of-pocket costs and an accumulation of more school debt. “But with any psychiatric disorder or substance abuse,” said Boyd, “early intervention definitely correlates to better outcomes.”
“There is a lack of sympathy for this fear of debt,” he said. “Most people just assume doctors will make a lot of money. But mounting debt from long stints at expensive schools weighs very heavily upon the students and most will do anything they can to avoid increasing it.”
According to statistics from the graduating medical school class of 2008, Nardin said, the median debt for public school students was $145,00 and for private school students it was $180,000.
To provide context for the cost of outpatient substance abuse treatment, I spoke with Talbott Recovery Campus, in Atlanta, Georgia, well known by Boyd and others for its Impaired Professionals Program. Debbie Kingston of the intake department told me: “The 90-day residential treatment program costs $39,000 for out-of network plans. If in-network, most insurance plans only cover $2000-$8000 of the total cost.”
Kingston added that detox, even though required, was not included in this tab. Depending on the addiction, detox can take from two to ten days. These costs also do not include the need for on-going monitoring and mental health support once a patient completes their residential stay.
In an article posted recently on Commonhealth, Rachel Zimmerman reported on a study, also authored by Boyd, that points to a more general obstacle to mental health care. The study’s hypothesis, which was borne out, posited that availability of psychiatric services has greatly diminished “due to a combination of paltry reimbursement rates and budget cutbacks.” The study’s authors wrote: “Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible.”
Of the 64 medical facilities listed by Blue Cross and Blue Shield in the greater Boston area and contacted for the study, only four could offer an appointment within two weeks. Others refused to offer an appointment due to requirements that all patients be enrolled with a primary care doctor affiliated with that particular psychiatric facility. Study researcher Andy Lindenmeyer, a fourth- year resident in the Harvard Longwood psychiatric program, said, “I think the point here is that having health insurance does not equal access to care.”
Stephanie Woolhandler, a professor of public health at City University of New York and a visiting professor of medicine at CHA, summed up the state of mental health care in a recent email: "The reality is that access to mental health care is very poor in this country, even for people with private insurance. Because mental illness is stigmatized, the mentally ill are often unable or unwilling to fight their insurance company to get their care reimbursed. The result is a very uneven distribution of care, with abundant mental health resources available to those who can pay out of pocket, while those that must rely on their insurance find that mental health care is restricted or even unavailable.”
“We need our medical schools to push themselves to provide students with more affordable care,” said Boyd. “What’s best for the health of our students will result in better physicians and the future well-being of their patients.”
A note of disclosure: Both Drs. Boyd and Nardin, authors of the survey letter published in JAMA, are active members of the group Physicians for a National Health Program, an organization of physicians who advocate for single-payer national health insurance.
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