Advocacy & Genetics Conference

If you have not registered for our Conference, "Advocacy & Genetics: Arenas of Engagement" this coming Friday, March 31, do it now! It promises to be a really compelling day, with Troy Duster keynoting and presentations on controversial intersections of advocacy and genetics. Email me or call 914-395-2371 if you have questions or need more information about the Conference.

“The Health Care Crisis and How to fix it” or “What to do about it”

This is—or rather, these are the titles of a must-read article by Paul Krugman and Robin Wells in the March 23, 2006 issue of The New York Review of Books. [Note: excerpts from this article are also posted on the Angry Bear blog] While not known for sensationalism, the cover title does suggest that Krugman and Wells will tell readers how to fix our broken health care system. The inside title is more realistic, promising only what we can “do about it.” And, indeed, while the authors do conclude that universal health coverage would “cover those now uninsured, and that it would be cheaper than our current system,” they go on to argue that the “political obstacles remain daunting” as they were more than a decade ago. In 1993 Clinton’s advisors knew that a single payer system would be the “least expensive way to provide universal coverage.” But Clinton rejected the single payer proposal for political reasons—and then got sideswiped anyway by insurers and a “baffled” public. Krugman and Wells regretably conclude that current compromise plans by political reformers would run into the same political problems as Clinton’s plan.

[I]t would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a system would bring. But this would mean taking on the drug and insurance companies rather than trying to co-opt them, and even progressive policy wonks, let along Democratic politicians, still seem too timid to do that.

So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break though the combination of powerful interest groups and free-market ideology.

But read the article yourself. Using as a vehicle a review of three new books on the American health care system, Krugman and Wells do an excellent job reviewing the three health policy crises that make up an overall crisis in medical costs:

First is the increasingly rapid unraveling of employer-based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attach. Third if the long-term problem of the federal government’s solvency, which is . . . largely a problem of health care costs.

In their article, Krugman and Wells review the inefficiency (and injustice) of our fragmented public/private system. They explain the “80-20 rule,” which describes how roughly 20 percent of the population account for 80 percent of health expenses (“half the population had virtually no medical expenses; a mere 1 percent of the population accounted for 22 percent of expenses”) and the impact of that rule on the peculiarly American phenomenon of employer-based health insurance. Until now, providing health insurance to workers has benefited the employer, but health costs are now so high that employers cannot cut benefits enough to stay competitive (recently announced attempts by GM to buy out a significant portion of their workforce illustrates this crisis).

Read the article for a good overview of Medicaid and Medicare, which account for the roughly half of our health care spending that comes from the government. Interestingly, Medicare—an extremely popular and efficient (only 2% overhead) program--IS universal coverage—but only for those 65 and over. Many of us would argue, as Krugman notes, that expanding Medicare to cover the whole population would give us a Canadian-like (also called Medicare) single-payer health insurance system. [Interestingly an NPR ad for the Medicare Rights Center today used the tag-line, “Medicare for All.”] And Krugman and Wells include the always convincing international health comparison table, comparing Canada, France, the UK and the US on a number of economic, health status, and health services parameters. But rather than summarize or site more, get the article yourself and hold onto it. It’s as good a review of the current economic status of the health care system, and as compact an argument for a single payer system (and ultimately a government health service that can actually ration care fairly and efficiently, as the VA is doing so well in the US today) as you are likely to find.

"Political Science"

I highly recommend everyone read Michael Spector's article in the March 13 New Yorker, "Political Science: The Bush Administration's war on the laboratory."

There is a great deal to say about the examples of politicized science Spector writes about, but let me start by giving the conch to a young friend, Deborah Popowski [deborah_a_popowski@yahoo.com]who emailed the following:

Dr. Reginald Finger is a member of the Advisory Committee on Immunization Practices (ACIP), an influential government committee linked to the CDC that advises the Administration on vaccine-preventable diseases.

His views on the policy considerations that the Committee would take into account should an HIV vaccine became available:

"'We would have to look at that closely,' Reginald Finger, an evangelical Christian and a former medical adviser to the conservative political organization Focus on the Family, said. 'With any vaccine for H.I.V., disinhibition' - a medical term for the absence of fear - 'would certainly be a factor, and it is something we will have to pay attention to with a great deal of care.'"

[This quote was] buried in a frightening article on the possibility that the Bush Administration will refuse to approve a highly effective HPV vaccine -- an immunization that would likely prevent cervical cancer, killer of nearly 5000 American women each year. Current opposition to the vaccine centers around the fear that inoculating high school girls against a sexually transmitted virus will send the wrong message. Meanwhile, studies show that more than half of Americans become infected with HPV at some point in their lives.

Dr. Finger speaks about the HIV vaccine in the hypothetical. But his views and power on HPV are very real, and very timely. And his statement strikes me as the most horrific, scandalous, and unforgivable thing I have heard in a long, long time - for a public official, a scientist, a father, a person to say. Apparently, he - and some of the other people running this country - value their daughters' virginity more than they do their daughters' lives. Given the power, they might choose not to eradicate cervical cancer. And one day, AIDS. Why get rid of fear of disease and death, as long as there's a chance it might dissuade women from having sex?

If this strikes any kind of chord in you, please e-mail me. And forward this on. I feel the need to do something. I think this man needs to be reviled, shamed on a scale so large that he will never be allowed to hold a public position ever again. Apparently, he steps down from ACIP this year, but who knows where he will go next. Someone should be keeping an eye on him, making sure that his views are widely known.

FYI:
FINGER, Reginald, M.D., M.P.H.
3470 Flying Horse Road
Colorado Springs, Colorado 80922
TERM: 04/22/03-6/30/06

The Ghost of Hospital Bills Past

This can't be happening. I have a client who was sent to collections for a medical debt. She called me in a panic and sent me the notice from the CA (collection agency). I called them, sent in my HIPAA, and faxed a notice of immediate dispute, requesting a validation of the debt.

A few hours later I am finally able to speak with a supervisor about it. It seems the CA bought the debt, sent out the notice, but has no paperwork on it - that won't be available for another month. So my dispute is, ummmm, unable to be posted because there is no place to post it - the paperwork hasn't arrived. And they won't send me a notice that I have placed it in dispute; which means that if 30 day passes it could go directly on her credit report.

But this is the best part: it's from 1996!! $522 from ten years ago. New York Hospital must be cleaning the closets.

Crossposted at http://www.signalhealth.com

The Uninsured are Special

Last night’s 60 Minutes lead story was just a tiny peek at a scandal that has remained almost entirely hidden: the way the uninsured are charged if they find themselves in the financially awkward position of needing hospitalization. Two examples were interviewed. The first was a family man who repairs gutters for a living, doesn't make enough to purchase health insurance, and fell off a roof. He owed nearly $250,000 for his hospitalization.

Another entrepreneur, darling of the Bush idea of the American Spirit at work, developed diabetes causing him to become uninsurable. He then had a mild heart attack and received two cardiac stents during a 72 hour hospitalization costing him $41,000. The complaint here was not the cost of the hospitalization per se, but that he was charged $19,000 for stents costing the hospital $4600.

Lest you think this only applies to big ticket items, think of an IV solution costing the patient $175 when the same solution is available to be purchased for $12.36, or a standard non-prescription item marked up 100 times what it would cost if I bought it at my local drug store, or my personal favorite, $53/pair for non-sterile disposable vinyl gloves. If the bills of these two individuals had been reviewed, there is little question these sorts of mark-ups would be found.

I called a local hospital to find out their policy for the uninsured: if the patient made less than $18,000 per year, they were eligible for Medicaid; other wise it was full price.
And I wouldn’t want you to believe this is only a hospitalization problem. I’ve seen providers billing for a surgical procedure at four or five times what an insurer would pay for the same service, and ten times what Medicare would pay. Negotiating with the doctor’s biller is like talking to a stonewall, so even if the hospital relents and gives the uninsured patient a break, the doctor simply says they won’t negotiate; the price is what it is. Without a finding of outright fraud (which I find with regularity, BTW), “negotiating” with a doctor earning in the mid six figures for a patient making $50,000 is nearly hopeless. They must, you understand, pay those high malpractice costs.

CrossPosted at http://www.signalhealth.com/node/617