Health Care Affordability

For the Health of the Nation: Ensure a Public Option

Leo Gerard — Tue, 14 Jul 2009 10:52:04 -0400

Just days ago, America celebrated her birthday with fireworks, spontaneous renditions of the Star Spangled Banner and chants of, “We’re Number One!”

In a crucial area, health care, the chant is untrue. Many of us love the individual doctors who may have saved our lives or the lives of loved ones. But the health care system in this country is not top-ranked. It’s not even close to number two. Its poor quality and excessive expense are sucking the life out of America. For the health of the nation, both physically and economically, we need a system with a public option – that means a government-sponsored and managed alternative. And we need it now.

First, the issue of ranking. In the year 2000, the last time the World Health Organization stacked up countries’ health systems, the United States came in 37th, behind the likes of Chile, Morocco, Cyprus, even drug war-torn Colombia, to which the U.S. donates hundreds of millions in foreign aid. The U.S. Centers for Disease Control and Prevention pointed out late last year that the U.S. ranked 29th in the world for infant mortality in 2004, a statistic that steadily worsened since 1960, when the U.S. ranked 12th. Twenty-two countries’ rates were below 5 deaths per 1,000 live births. The U.S. rate was 6.78 deaths.

Similarly, the U.S. ranks 42nd for life expectancy, down from 11th two decades ago. Contributing to that decline is the parallel drop in Americans covered by health insurance, researchers said. While 46 million Americans lack insurance, Canadians and residents of European Union countries benefit from universal health care.

We are 37th – Yea! We are 29th – and falling! We are 42nd -- and dying! These are not the chants of proud Americans. These are not the chants of vibrant Americans. In fact, these are not the chants of Americans who could continue financially supporting this sick system even if they wanted to. And they don’t.

The cost of the American system, with its private health insurance industry in the business of profiting off of illness by limiting care, cutting corners and denying access to those with “pre-existing conditions,” is suffocating the U.S. economy. In this one unenviable area – spending -- the U.S. is number one. Health care expenditures are a shocking 16 percent of U.S. gross domestic product (the value of all goods and services produced in a nation in a year), far ahead of the closest competitor. That would be France, where it’s only 11 percent. That’s followed by Switzerland, Germany, Belgium, Canada and Austria, where it ranges from 10.8 down to 10.1 percent. These are all countries that provide national health care.

Looking at it another way, the average expenditure per individual, America remains in the undesirable position of most profligate spender. The average for an American was $7,290 in 2007, the latest year for which comparable statistics were available. But the average for the 30 countries in the Organization of Economic Cooperation and Development was a mere $2,964, with the closest to the U.S. being Norway at $4,763.

Those costs marginalize U.S. manufacturers as they attempt to do right by their American workers while scrambling to compete in international markets. Here’s how Dr. Atul Gawande put it in his June article, “The Cost Conundrum,” in “The New Yorker:” “Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance . . . By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

President Obama warned the American Medical Association, which opposes national health care, about exactly the same thing in June when he said this: “If we do not fix our health care system, America may go the way of G.M.” Would those wealthy physicians bail out the government then?

Clearly these costs don’t contribute to quality since U.S. rates of infant mortality and life expectancy are so relatively poor. And they factor large in personal bankruptcies and delay of care as individuals are unable to keep up with medical care’s morbidly obese costs.

A Kaiser Family Foundation poll in February found that 53 percent of Americans cut health care because of cost in the previous year. A quarter reported putting off health care they needed such as doctor’s visits and surgery, and twenty percent said they have not filled a prescription. Another part of the poll explains this: “13 percent say they have used up all or most of their savings trying to pay off high medical bills in the past 12 months, and just as many say their medical debt means they have difficulty paying other bills. A similar proportion (12%) say they have been contacted by a collection agency, while a smaller share (7%) report being unable to pay for basic necessities like food, heat or housing.”

We are Number One? This is cruel. This is wrong. This must stop.
I know that many Americans view my native land, Canada, not as a country, but as an unofficial 51st state. But the difference between Canada and the 50 states is that Canada has national health care, thanks to Tommy Douglas, the former premier of Saskatchewan, and a party leader. One huge difference between the American system and Canada’s national health care is the extreme cost of administering private insurance in the U.S. A study published in 2003 in the New England Journal of Medicine showed that administrative costs were $1,059 per person in the U.S. but only $307 per person in Canada. That excessive $752 in administration costs paid in the U.S. for each insured person has only grown larger in the ensuing years. The study concluded: “A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.”
In 2004, the Canadian Broadcasting Company conducted a poll to determine the country’s greatest citizen. People everywhere could vote, for anyone they wanted, so an actor, like Tommy Douglas’ grandson, Kiefer Sutherland, could have won, or a famous singer like Celine Dion or Shania Twain. But Canadians chose a politician -- Tommy Douglas, the father of national health care. That’s how we feel about the national health care system in Canada.

Don’t let the Republican Party-of-No stop this. Don’t let big vested interests like the pharmaceutical, insurance, and for-profit hospital corporations keep America down. In poll after poll, Americans have made it clear they want a public option. They want care as good as Canadians get. They’re paying more than twice the price for it. To ensure that America is Number One, Congress better deliver it before the end of August.

Hip-Hop For Health Care Reform

Isaiah J. Poole — Thu, 09 Jul 2009 14:42:57 -0400

Hip-hop artists are being mobilized in the battle for health care reform, and in this video the mother of rapper and producer J Dilla, Maureen Yancey, explains how health care for her son overwhelmed her with medical bills after his private insurance expired.

Hip-Hop Caucus CEO Rev. Lennox Yearwood Jr. equates the health care reform fight to the battle against Jim Crow segregation, arguing that a "Jennifer Crow MD" is pushing policies that reinforce health care disparities among communities of color.

A member of the pioneering group A Tribe Called Quest, Malik Taylor, discusses his illness and how he managed to cope.

The Campaign for America's Future is a member of the Health Care for America Now coalition, which advocates a health care reform plan that includes a public plan choice, which would make health insurance more widely available and more affordable.

If You Don't Want the Public Option, Get the Hell Out of the Way

OurFuture.org Staff — Thu, 09 Jul 2009 12:01:41 -0400

Real Health, Real Reform

OurFuture.org Staff — Thu, 09 Jul 2009 11:45:54 -0400

What is a Reasonable Compromise on Health Care Reform?

OurFuture.org Staff — Thu, 09 Jul 2009 11:37:05 -0400

Death Tax for the Rest of Us

Tom Sullivan — Thu, 09 Jul 2009 08:46:53 -0400

Art and Edna (not their real names) are long-retired and both are having memory and other health troubles. Their son and daughter-in-law have taken them in to see to their care. Even in a down market, Art and Edna’s small home in Florida sold quickly. Too quickly.

Within months, their son and daughter-in-law realized that the seniors would need more care than the working couple could provide at home, so they began looking at nursing homes – a costly option. Because the seniors have few resources, their relatives applied for Medicaid assistance. But because they now have cash from the home sale, they are not poor enough, and thus ineligible for Medicaid.

Had they transferred their home to their son and daughter-in-law instead of selling prior to their application, Medicaid would have picked up the nursing home costs. Now, after long, productive lives, Art and Edna will turn over their remaining money – and probably a lot of their childrens’ – to America’s for-profit health industry to pay for nursing home care until they are poor enough to qualify for Medicaid. Unless they die first.

Under America’s for-profit health care system, this is the real Death Tax. And a majority of Americans will pay it.

Rapping Without Health Insurance

Isaiah J. Poole — Wed, 08 Jul 2009 21:49:47 -0400

Try telling Maureen Yancey that health care reform is too expensive for the country to tackle right now, or that we should leave everything to the private insurance market.

Yancey is among the millions of Americans who can't afford the status quo. She's already paid too high a price—not just in dollars, but in the loss of her son, who died of lupus three years ago without health insurance.

The fact that her son, James Dewitt Yancey, was the up-and-coming rap artist and producer J Dilla, did not keep him from falling through the cracks of our current health care system. The truth is that music artists, like most entrepreneurs, have to struggle in a private market of expensive and inadequate policies—if they can get insurance at all. In fact, 60 percent of the more than 45 million uninsured Americans are either self-employed or work in small businesses that don't offer health benefits.

So Yancey joined forces with J Dilla's compatriots in the hip-hop community Wednesday to urge fans of their music to join the fight for meaningful health care reform. The "health care remix" event was hosted by the Service Employees International Union.

Health Care Remix

Hip-Hop Caucus CEO Rev. Lennox Yearwood Jr., Malik "Phife Dawg" Taylor of A Tribe Called Quest and Maureen Yancey, mother of J Dilla (James Dewitt Yancey), speak at a panel on health care reform hosted by the Service Employees International Union.

"How are we going to build a strong economy when people have to choose between healthy living and paying their bills and keeping the water on?" asked Dr. L. Toni Lewis, the president of SEIU's Committee of Interns and Residents.

Or face more than $1 million in medical bills, as Yancey does.

The disease that claimed James Yancey at the age of 32, a form of lupus, is an autoimmune disorder in which the body literally begins to attack itself. It is a disease that particularly affects African-American women—the Lupus Foundation of America says women of color are two to three times more likely to have the disease than white women. Researchers don't know what causes the disease, but some scientists believe genetics is a factor. That appears to be the case in the Yancey family: not only did J Dilla have it, but so does his mother and his aunt.

The diseased is chronic and can be debilitating and ultimately deadly. Treatment can be expensive, as Maureen Yancey saw first-hand when her son James began requiring extended hospital stays. At first, the hospital visits were covered through an insurance policy James Yancey had obtained through his job. But when he was unable to continue working, his mother picked up the full cost of the premiums through COBRA, the federal law that allows workers to continue policies they have through their job as long as they pay the full cost.

But COBRA only extends policies an additional 18 months, and when that time period elapsed, the Yanceys had no other insurance options. And the bills started coming in. Maureen Yancey said her son in the last years of his life was in the hospital for extended periods three to four times a year, and she was getting bills that were upwards of $250,000.

If she could have chosen a public plan to continue care for her son, she said, she would not have had to face those costs.

Her sister, meanwhile, is also without insurance and living with lupus. "She's just praying that everything is good," she said.

The Rev. Lennox Yearwood Jr. said that for today's generation of young African Americans the fight for health care reform is comparable to the 20th-century fight against Jim Crow segregation. Today, he said, we're dealing with "James Crow, Esquire" and "Jennifer Crow, MD," people who "are literally drinking lattes at Starbucks" while making decisions that exacerbate racial and class disparities in health care. "They are much more sophisticated in disenfranchising us," he said.

Yearwood shared the story of an uninsured young mother who did not have a primary care physician. Her infant child had symptoms that appeared to be cold- or flu-like, but she could not afford to take her child to a doctor to see if the symptoms were an indication of something worse. It turned out they were: a pancreatic disorder that ended with the gland literally exploding inside her, killing her.

"There is nothing like burying that baby and having that mother literally hanging onto that casket saying, 'I want to be buried with my baby,'" Yearwood said, a note of anger in his voice. "Nobody should have to see that."

That's why whether you listen to hip-hop or Handel, it's critical to share these kinds of personal stories to members of Congress and challenge them to pass meaningful health care reform with a public insurance option. "This is not a game," Yearwood said. "We really got to go to Capitol Hill. We've got to get serious."

Sick America

OurFuture.org Staff — Wed, 08 Jul 2009 11:51:36 -0400

What's So Scary About Offering People the Option of a Public Health Plan?

OurFuture.org Staff — Wed, 08 Jul 2009 11:47:44 -0400

Symbolic Blather: Washington's Congenital Disease

Robert Borosage — Wed, 08 Jul 2009 11:10:53 -0400

This Congress potentially could be the most productive in over 40 years. It has passed the largest recovery plan in the nation's history. It extended health care to millions of children. It passed Obama's first budget with its significant down payment on education and energy. The House just passed the comprehensive energy bill. Health care reform and the most extensive financial reform since the New Deal are next up.

Yet this same Congress will take the time to debate legislation that might best be considered symbolic blather. Its only effect is symbolic and the symbolism is loony.

The best example of this is the bill championed by Blue Dogs in the House and Senate—the conservative Democrats that the media labels "moderates"—called "paygo." Paygo is the Washington shorthand for a rule that requires the Congress to pay for any expansion of entitlements (guaranteed benefits like Social Security Medicare) or decrease in taxes. It's supposed to "discipline" the Congress on spending. Although discretionary spending—the appropriations that Congress approves annually for the running of the government—is not covered, the rule is designed to put significant pressure on Congress to limit spending.

Now House Blue Dogs are pushing to pass this self-imposed rule into legislation. At a time of unprecedented deficits, they want to parade their righteous commitment to cutting spending and balancing the budget. Since Democrats have already imposed paygo rules on their actions in the House and Senate, the legislation is purely symbolic. And the symbolism is utter blather.

For one thing, Blue Dogs are the first to line up to vote for massive spending on wars and adventure abroad, all of which is exempt from paygo rules. Thus Bush's $3 trillion war in Iraq would not have violated paygo, nor does the special supplemental to fund the continuing war in Iraq and the escalating one in Afghanistan.

Beyond that, the message sent by the bill is wrong-headed. In the short term, it puts an emphasis on cutting spending and balancing the budget. But we're in the midst of fighting the worst economic collapse since the Great Depression. In these conditions, with consumers and businesses cutting back, workers getting laid off and families losing their homes, the federal government must step in to boost the economy. Deficit spending is essential, not evil. In fact, as unemployment heads to double digits, states and localities face staggering cutbacks, banks aren't lending, and as businesses are cutting capacity, not expanding it, we will need to borrow more money to spend on a second stimulus plan (as Paul Krugman, among others, argues). Paygo heads exactly in the wrong direction.

In the long term, paygo puts the focus on controlling "entitlement" costs. But virtually the entire long-term structural deficit problem comes from projected soaring health care costs. We don't have an entitlement problem; we have to get health care costs under control. Ironically, the same Blue Dogs, like Sen. Max Baucus, that champion paygo are the ones doing the most to weaken the public option in health care reform, which will do the most to control costs by offering a choice to private insurance.

Paygo also is translated into the need to cut spending and limit tax cuts to balance the budget. In fact, as Clinton's experience showed, the way to balance the budget is to get the economy going. Without growth, budget deficits will increase and should do so.

Washington's dirty little secret is that we need more investment, not less. We're running a debilitating public investment deficit—failing to invest adequately in areas vital to our future from modern infrastructure to research and development to new energy and education. In the new economy emerging out of the calamity, we need progressive tax reform, with the wealthy paying far more in taxes than they do now, and increased public investment.

Finally, as economist Dean Baker argues, paygo is an atavistic throwback to the conservative economics that led us off the cliff. Growth, we were taught, comes from balancing the budget, sustaining a high dollar, deregulating banking, adhering to corporate trade policies, and ignoring the inequality and loss of good manufacturing jobs that resulted. That didn't work out so well. One would have thought that even the Blue Dogs understood that.

This week, progressive legislators will try to figure out where they stand on this lemon. At the very least, they should demand something sensible as a price for holding their noses as the symbolic blather passes. They could demand an investment bank or a capital account in the budget. Either would put the U.S. in the same position as a family or state and local governments, financing investments in buildings or homes or education or research and development rather than budgeting their entire costs in the first year.

House Speaker Nancy Pelosi supports paygo as a way of keeping the Blue Dogs as least partially on the leash. The question is why do the Blue Dogs so stridently demand it? It's like an ideological tic. They don't seem to understand how deep a hole we are in nor have a clue about how to get out. They simply want to croon the old ditties of a bygone and tawdry age.