While the national debate on health care reform heats up in anticipation of the 2008 election, individual states have been working on their own solutions to the health care crisis.
In Colorado, where 17 percent of residents lack health insurance, the state legislature created the 208 Commission last year to develop ideas on how to best reform the state's health care system. The group is now examining a comprehensive analysis created by an independent consulting firm that lays out four potential plans for reform.
The four options include proposals to expand current government programs, require employers to provide coverage or pay a certain amount per employee to a group plan, mandate that all Coloradans buy insurance and subsidize those who cannot afford it, and create a single-payer system to cover all residents.
Pay attention to the progress of Colorado's 208 Commission, because
"The states are the laboratories right now," said Alwyn Cassil, public affairs director for the Center for Studying Health System Change in Washington, D.C.
"There's motivation at the state level, because states are living with this every day," she said.
The motivation in Missouri, for example, just got even clearer. A study found that both employers and individuals in the state have seen their health care costs rise rapidly in the past few years:
The study by Compdata Surveys, a national compensation survey and consulting firm, said 72.3 percent of Missouri employers paid more than $450 a month per family for health plan premiums as of March 1, 2007, compared with 45.3 percent in 2003.
At the same time, 52.9 percent of employees paid more than $250 in monthly premiums for family coverage this year, up from 30.1 percent in 2003.
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“Individuals often believe they are carrying the majority of health-care cost increases on their own,” Amy Kaminski, Compdata’s manager of marketing programs, said in a statement. “However, in actuality, both parties are sharing the burden of increasing costs at various degrees.”
The double edge of the health care crisis in crucial, because it means that momentum for reform is likely to increase on both sides. It's going to take a strong, widespread coalition to achieve the necessary reforms to guarantee coverage for all.
This Labor Day the AFL-CIO will launch a major new health care initiative. The campaign, developed at a meeting of the AFL-CIO Executive Council earlier this month and encouraged by CWA President Larry Cohen, will involve a massive mobilization effort to achieve real health care reform. The effort is similar in scope to CWA’s major Health Care For All Campaign recently approved by the Executive Board. The two campaigns will complement and reinforce one another.
The goal of both efforts will be to win quality affordable health care for all in America by making the 2008 elections a mandate on health care reform and electing a president and Congress pledged to that end.
We will do this by engaging with other unions and allied groups to mobilize a massive army of workers and families committed to establishing high-quality health care for all.
The AFL-CIO program will begin on Labor Day with an effort to support enactment of the State Children's Health Insurance Program (SCHIP) reauthorization bill that Congress recently passed. President Bush has vowed to veto SCHIP, which is a crucial program that provides millions of children with health coverage. We must do all we can to ensure that legislation improving it is signed into law.
The CWA and AFL-CIO health care programs will also focus on the following:
* Education of union members and their families about the necessity for federal action to preserve their hard-won benefits;
* Mobilization of union members to participate in the 2008 elections and demand that candidates for federal office champion comprehensive health care reform;
* Recruiting employers to support comprehensive reform
* Linking national health care reform to the important reform work at the state level; and
* Working with allied organizations to establish a broad alliance for reform.
Through Health Care Voices we will provide you with regular updates on the CWA and AFL-CIO initiatives as they unfold.
Medicare will no longer pay the extra costs of treating patients for ailments resulting from hospital errors, according to new rules unveiled today and taking effect next fall. This reform is meant to save lives and to save millions of dollars for Medicare.
It also shows the power that the federal government has to restore balance to the health care system. By refusing to pay for poor quality care delivered by hospitals and doctors, the government will help save precious health care dollars and improve the quality of care to better protect patients.
Moreover, because of Medicare's size and market clout, its new rules will likely have a ripple effect among private insurers:
Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”
This move will make hospitals more accountable. They will be forced to be more careful in preventing infections, injuries, and medical errors, since they will now be on the hook for the costs of treating these preventable health problems. The new rules expressly forbid hospitals from charging patients for treating these preventable medical problems.
One example of the ailments covered by the new rules are infections developed during hospital stays. According to the Centers for Disease Control, patients develop 1.7 million such infections each year, contributing to the deaths of 99,000 people annually.
In Michigan, systemic efforts to reduce infection rates in hospitals had terrific success, and they did it in ways that did not require big cost increases for hospitals:
The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.
Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.
That should allay some hospital administrators' fears of higher costs, and it should certainly make patients feel safer within the hospital walls.
Our nation's health care system is failing the more than 40 million Americans who lack health insurance. But it's also failing millions more who do have coverage, yet must fight tooth and nail to get their entitled benefits from their insurance companies.
MSNBC.com recently posted a story listing nine things insurance companies don't want you to know. The tips are centered around getting the treatments you are entitled to when filing a claim, and avoiding being denied or having your policy rescinded. Knowing the ins and outs of your policy, knowing your rights, and knowing where to turn when your insurer improperly denies you benefits are the chief takeaways from the list.
In response to this article, MSNBC received a flood of comments from readers who went head-to-head with their insurers – and won. They posted several of the stories on their website. Here are a few of them:
I was a breast cancer patient in 2006. I had to fight for 9 months to get my insurer to pay for my wig. I kept providing them with the information they needed, but it seems their representatives are incapable of coordinating that information. I ended up contacting a healthcare advocacy group my employer makes available to me. These are internal staff who help people like me in a similar situation. One phone call from them and my insurer agreed I should be paid. I learned that if you have all the right codes (either diagnosis and/or other medical codes), the claim will be paid more quickly. I'm a very persistent individual. You have to keep hammering at them till a claim is paid to your satisfaction, not theirs.
— Anonymous, N.J.
I was shocked to get a bill for double the copay for some nine visits to a therapist. I made several phone calls and kept a record of who I spoke to each time. Then I made a written appeal and had to take it to the second level after the first appeal was denied. Eventually, the appeal board agreed that I should only pay the original copay on those nine visits that occurred before the rate hike supposedly took effect. My perseverance saved me over a hundred dollars!
— S., Belchertown, Mass.
I have found some success in getting denied claims approved. For me, the key is to keep calling and calling and calling to figure out why the claim is not processed correctly. Also, I make sure when I am speaking with them that I have the bill, the denial letter, and my plan's benefits right in front of me. ... Every time I use this method, action is taken. Although, it can take several attempts to get the correct action taken!
— Brittany, Tulsa, Okla.
The common themes here are knowing all the details of your policy and being very persistent when dealing with your insurers. Fortunately, all these people had their charges reduced and got the treatments they needed.
To make sure that happens for CWA members, in several of the contracts we have negotiated a Health Benefits Coordinator position that is a union appointed, company paid job whose responsibility is to interface with health plan administrators on behalf of our members and get them all their benefits.
Still there's something very wrong with a health care system in which even the lucky ones – those with health coverage – must jump through so many hoops just to get the benefits to which they're entitled.
Health Care Voices is all about giving real Americans a voice in the nationwide health care debate. Our country's policymakers must understand how our broken health care system affects real Americans in order to craft effective solutions to the problem.
In this spirit, the National Coalition on Health Care -- which is comprised of dozens of organizations, corporations, and unions, including the CWA -- is sponsoring a survey to capture people's thoughts on the state of the health care system and the best ways to fix it. Their goal is to get 50,000 responses by the end of August, and use that information to influence the national debate on health care reform. As the NCHC website says,
We want to learn what the American public values when it comes to health care. With the 2008 Presidential elections looming on the horizon, we believe it is time to ask the American public what they value and what they want in any new health care system.
Preliminary findings show that Americans are truly fed up with their health care system. Overall 56 percent of respondents were "'very unsatisfied" or "not satisfied" with the health care system, compared to just 21 percent who were "satisfied" or "very satisfied."
The United States is the wealthiest country in the world. We spend more money on health care than any other nation. So Americans should live the longest, right?
Wrong.
According to the latest statistics, the United States ranks 42nd in the world in life expectancy, down from 11th 20 years ago and behind most of Europe, Japan, Andorra, Jordan, and Guam. Yes, the average Guamanian will live longer than the average American.
And what's the chief reason Americans' life expectancy ranks so poorly? Take a guess:
Researchers said several factors have contributed to the United States falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say.
Moreover, Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington, said that
improved access to health insurance could increase life expectancy. But, he predicted, the U.S. won't move up in the world rankings as long as the health care debate is limited to insurance.
Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.
Each of these issues, though, comes back to insurance. Without quality health coverage, people aren’t able to receive the preventative care they need to stay healthy, instead of getting treatment once they become ill.
The way our system is set up, the uninsured and underinsured wait until they have catastrophic and costly medical problems – like heart attacks, strokes, and diabetes – to seek out the necessary care. That leads to earlier deaths and adds significant costs to the health care system.
That is the definition of dysfunction. But perhaps it could be worse – we could be living in Swaziland.
Earlier this week the AFL-CIO hosted a debate in Chicago for the Democratic presidential candidates. The star of the show wasn’t one of the candidates – it was Steve Skvara, a retired steelworker from Indiana whose touching health care story received a standing ovation from the crowd. Watch Steve tell his story:
Health Care Voices is full of stories like Steve's – honest, hardworking Americans failed by their health care system and by their elected leaders. By telling these stories, we're making it clear just how badly we need true health care reform with quality, affordable health coverage for all.
Our country's nine million uninsured children got a big lift from Congress last week. Both the House and the Senate passed bipartisan legislation reauthorizing and improving the State Children's Health Insurance Program (SCHIP). Most importantly, the Senate vote was 68-31, a strong enough majority to overcome the promised veto from President Bush.
SCHIP provides health insurance to children who are not poor enough to qualify for Medicaid, but whose parents don’t earn enough to purchase private insurance. Last year the program covered 7.4 million children, but it was set to expire on September 30. Once the bill makes it out of conference committee, it will allow SCHIP to continue past that expiration date.
The new legislation will also increase funding for SCHIP, allowing it to cover even more children than before. It will do so by raising taxes on tobacco, which is certainly a fair tradeoff to insure our nation's children.
But to President Bush and a handful of his allies in Congress, the SCHIP bill goes too far. The president promised to veto the SCHIP bill, but now it appears the Senate is primed to override that decision. As Senate Finance Committee Chairman Max Baucus said,
"For the life of me, I can't understand why the president would want to veto this legislation. It's moderate, it's bipartisan, it helps low-income kids. ... It's just the right thing to do for the country."
President Bush's reasoning is that children's health care should be left up to the states and to the private insurance companies. But considering that nine million kids – and nearly 50 million people in general – don’t have any health coverage, leaving health insurance up to the free market doesn’t seem to be working, at least not for regular Americans. Health insurers are making out well, but our health care system is supposed to be about helping the American people, not the insurance industry.
The Commonwealth Fund recently released its 2007 State Scorecard on Health System Performance, a thorough report on health care access and quality in each state. While the state-by-state comparisons are useful, the most interesting parts of the report are the larger, more general trends that emerge from the data.
The two chief takeaways from the study are
* Better access to health care leads to better quality of care and healthier people
* Higher quality of care does not necessarily mean higher costs
The authors of the State Scorecard found a strong relationship between health care access and quality. Four states – Hawaii, Massachusetts, Iowa and Rhode Island – rank in the top five in both measures. States with more uninsured residents also performed poorly on quality of care indicators.
The study showed that there's no great mystery behind better health care: "The best-performing states in the access dimension of performance are among those with the most expansive eligibility polices for public health insurance coverage." SCHIP, for example, has gone a long way toward reducing the ranks of uninsured children.
As the report summarizes,
"The deterioration in coverage and the relationship between better coverage and better care point to a pressing need for national action to expand insurance coverage and ensure access to care."
Which brings us to the second key finding in the State Scorecard: better care doesn’t have to mean higher costs. The report finds that
"there is no systematic relationship between the cost of care and quality across states. Some states achieve high quality at lower costs.
"States with higher medical costs tend to have higher rates of potentially preventable hospital use, including high rates of readmission within 30 days of discharge and high rates of admission for complications of diabetes, asthma, and other chronic conditions. Reducing the use of expensive hospital care by preventing complications, controlling chronic conditions, and providing effective transitional care following discharge has the potential to improve outcomes and lower costs."
This cuts to one of the main inefficiencies in our health care system – its failure to focus on preventative medicine and control of chronic illnesses. By only treating people after they get sick – or when a chronic condition worsens – our system dramatically inflates the costs of care.
The consequences of having a health care system that costs too much and covers too few are far-reaching. As the State Scorecard summarizes,
The proportion of uninsured working-age adults across the nation is high and rising, jeopardizing the health of millions of working adults and putting states and the nation at risk a we lose access and financial security for the nation’s workforce. A healthy economy and society require a healthy, productive workforce.
In the latest issue of Newsweek, columnist Jane Bryant Quinn takes aim at the scare tactics used by the health insurance industry and its allies in Congress to prevent progress toward universal health coverage.
Here are the most common claims made by health insurers, along with Quinn's rebuttals:
* Universal coverage costs too much – Quinn argues the opposite, that our current system costs too much because of a variety of inefficiencies: a lack of bargaining for better prices, health insurers' screening and marketing costs, and the billions in profits being made by insurers.
* Universal care will cause higher taxes – Again, because of inefficiencies in our current systems, a single-payer system would be able to insure everyone for the same amount Americans currently spend on health care.
* Quality of care in the U.S. is excellent; universal coverage would cause declines – By most measures, Quinn says, our overall care actually lags behind many other developed nations like Canada and France, which have single-payer systems.
* Even the uninsured end up getting care – Quinn says they might get emergency treatment, but little else like preventative care or rehabilitation. Data shows that overall the uninsured are sicker and die sooner than those with insurance.
In addition to debunking the frightening claims made by health insurers against universal coverage, Quinn suggests a perfect model for such a system in the U.S.:
I do agree that we can't afford to cover everyone under the crazy health-care system we have now. We can't even afford all the people we're covering already, which is why we keep booting them out. But we have an excellent template for universal care right under our noses: good old American Medicare. When you think of reform, think "Medicare for all."
Medicare is what's known as a single-payer system. In the U.S. version, the government pays for health care delivered in the private sector. There's one set of comprehensive benefits, with premiums, co-pays and streamlined paperwork. You can buy private coverage for the extra costs.
Bargaining power, efficiency, and universality are clear advantages of a single-payer system like Medicare. That scares health insurers, so they in turn try to scare the American people with sensational claims. It's going to take strong, united effort to stop them.
