Have you wondered why health insurance costs have skyrocketed in recent years?

And, are you inclined to think we need more competition in order to lower costs? If so, you’re probably hoping Congress will see fit to tighten anti-trust regulations in whatever health care reform measures come out of both houses, while the insurance companies are begging for exemptions.

Fact is, the most egregious anti-trust infractions have already occurred, according to the blog Cab Drollery, published by a California attorney.

Blogger Diane lays it all out, citing a Los Angeles Times story that explains how, during the Bush years, more than 400 health insurance mergers occurred under the noses of Justice Dept. watchdogs, who sniffed at only two: 

Health economist James Robinson found in 2003 that three large firms controlled more than 50% of enrollment in almost every state -- and that was before the biggest insurers launched a huge effort to snarf up their chief competitors, a trend exemplified by the 2004 mega-merger of WellPoint Health Networks Inc. and Anthem Inc. By 2008, according to the American Medical Assn., in nearly 90% of the metropolitan areas of the country, a single insurer controlled 30% or more of the market.

Is it merely a coincidence that health premiums have soared over the last decade -- up by 131% for family coverage from 1999 to 2009, according to the Kaiser Family Foundation?

"Competition in the health insurance industry is insufficient," Leemore S. Dafny, a health economist at Northwestern's Kellogg School of Management, told me last week. "It's becoming less competitive over time and it's causing higher premiums than we otherwise would see." [Emphasis added]

See http://cabdrollery.blogspot.com/2009/11/red-herrings-are-not-kipper-snacks.html for the entire enlightening blogpost. 
 
 
We knew all along that reform would not come easy. There are so many issues to consider.

What exactly is fair, and to whom? Can you close coverage gaps without discriminating? 

Here’s something to ponder from Kaiser Health News, a terrific resource for health policy news:  

Fight Erupts Over Health Insurance Rates For Businesses With More Women
From Kaiser Health News

The Pennsylvania home health care company Linda Bettinazzi runs is charged about $6,800 per worker for health insurance – $2,000 more than the national average for single coverage. One reason: nearly every one of her 175 employees is a woman.

Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. But Bettinazzi, the president and CEO of Visiting Nurse Association of Indiana County, believes there's something inherently wrong in charging her company more because it hires a lot of women.

"There's a great sense of unfairness," Bettinazzi says. "I feel angry, and maybe betrayed would be a good word."

Gender rating is the norm today, part of a complex formula of risk factors – including health history and age -- insurers say has been necessary to fairly price policies. But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal.

To read more, go here: http://www.kaiserhealthnews.org/Stories/2009/October/23/gender-discrimination-health-insurance.aspx
 
 
From Kathy in Massachusetts
I appreciate the info you supply about health care reform on your blog.

From Larry in Iowa
What we clearly do not need is a massive piece of costly legislation that masks the symptoms or creates even more, but does nothing to cure the disease.  What we clearly cannot afford is to put off making these decisions another two or five or ten years or more.

From Joan in New Jersey
Good health is NOT a privilege, it is a human RIGHT.  

From Darlene in Arizona
The only weapons we have to fight the obscene funds trying to defeat meaningful reform are our voices. I urge everyone to repeatedly contact their representatives until a bill is passed.

From Karen in California
Affordable access to medical care for ALL persons to guarantee "life" is implied, in my opinion, by our founding fathers. It's past time for the partisan wrangling to be done so that some serious negotiating can begin for crafting legislation that can pass Congress. 

From Kathleen in Texas
I'd settle for creation of ...non-profit insurance coops giving small businesses the benefits of mass-purchasing--so that EVERY WORKER, from the guy who cuts the grass to the local accountant, can afford insurance and not get cut for pre-existing conditions. Big companies get these concessions from insurance companies because of mass purchasing, why not make it possible for the heart of the American work force?

From Kathleen in Texas
Having a response from the Senate Majority Leader's office is encouraging. No one should have to go without medical care because they can't afford it. 

From Cynthia in California
Recently we had a free clinic here, sponsored by Remote Area Medical, and an LA Times columnist described the scene as something from the Third World. I wish people who oppose reform would …become aware of how desperate so many people are.

From Alexandra in Massachusetts
I'm proud to live in a state that decided no one should go without medical care! 

From Jacqui in the UK
The health identity begins inside with an inherent feeling of self, and extends outwards in times of crisis. In the UK this extension is largely met by a NHS for everyone. I wish my friends in the US the same. .

From Sarah in Massachusetts
As the parent of a child with Down Syndrome and as a survivor of life-threatening illness, I can tell you that one of the most frustrating things about our current system is its inequity. An acquaintance and I, who were being treated for the same disease at the same time (and living in the same state), had very different medication options because her HMO was trying to save money instead of her life. She eventually wound up getting the same medication my docs had prescribed in the first place (which they described as the "standard of care" and which worked beautifully for me), but only after she'd gone to the emergency room to treat side-effects from the substandard protocol. I find this intolerable, and I attribute that kind of craziness to being in a profit-motivated health-care system.

From Deputy Director of New Media, Office of Senate Majority Leader Harry Reid
I also wanted to thank your loyal readers for keeping up with this critical topic of health care reform. We need everyone's support!
 
 
Here's an op-ed written for The Washington Post and carried in many newspapers today.


Over 50, out of luck in health care 
10/23/2009 

WASHINGTON - I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath - and it isn't pretty.

Recently, I left my job with the federal government - I was a political appointee, so my tenure was limited - and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51 year old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication, and I have mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "preexisting conditions" - conditions that millions of Americans my age experience - was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

Read the entire op-ed at http://www.gazettenet.com/2009/10/23/over-50-out-luck-health-care
 
 
from today's New York Times:

October 23, 2009
Senate Leader Takes Risk Pushing Public Insurance Plan
By Robert Pear and David M. Herszenhorn

WASHINGTON— In pushing to include a government-run  health insurance plan in the health care bill, the Senate majority leader, Harry Reid, is taking a calculated gamble that the 60 members of his caucus could support the plan if it included a way for states to opt out.

Mr. Reid met with President Obama at the White House Thursday to inform him of his inclination to add the public option to the bill, but did not specifically ask the president to endorse that approach, a Democratic aide said. Mr. Obama asked questions, but did not express a preference at the meeting, a White House official said.

Mr. Reid’s outlook was shaped, in part, by opinion polls showing public support for a government insurance plan, which would compete with private insurers. Speaker Nancy Pelosi said again Thursday that the House would definitely include a public option in its version of the legislation.

Just six weeks ago the public option appeared to be dying, under fierce attack by the insurance industry. A clear majority of Democratic senators favor a government-run plan. But public statements by other senators indicate that the proposal lacks the 60 votes ordinarily needed to secure Senate approval for hotly contested legislation.

Democratic champions of the public plan, like Senator Charles E. Schumer of New York, have urged Mr. Reid to take an aggressive posture, by putting the public plan in the bill and forcing opponents to try to strip it out.

“There is a growing sense that we need to lead on this issue and not wait for it to be offered on the Senate floor,” a senior Democratic aide said. “The idea is that it’s better to show some fight.”

As word of Mr. Reid’s intention spread Thursday, centrist senators from both parties said they had come together in an informal group to resist creation of a uniform nationwide public insurance program.

Leaders of the group, including Senators Ben Nelson, Democrat of Nebraska, and Olympia J. Snowe, Republican of Maine, said they wanted to be sure the bill was not rushed to the floor.

One of the centrists, Senator Mary L. Landrieu, Democrat of Louisiana, said: “I am pressing to get a government-run, taxpayer-supported public option out of the bill. I want to rely on a reformed private marketplace.”

Go to The New York Times for the rest of the story:
http://www.nytimes.com/2009/10/23/health/policy/23health.html?hp

 
 
For those of you confused over where we are in the health care reform progression, there’s an excellent graphic in the New York Times showing the status of health care legislation before Congress. Click here to see it.

Basicially, there are five bills on the table: two in the Senate and three in the House. Each body must merge multiple bills into one, and vote on that single bill.  Then, two houses work to negotiate one bill between themselves. After that, the combined bill must pass both houses. The resulting bill will be sent to the White House and, presumably, signed as law.

In the Friday conference call with Sen. Harry Reid’s office, aides told five or six bloggers (including me) they were hopeful the Senate would pass a bill by Thanksgiving. The president has said he wants legislation on his desk by the end of the year. Whether that’s possible or not remains to be seen.

 
 
 
Four or five bloggers (including this one) had a second opportunity to talk to several aides from Sen. Majority Leader Harry Reid's office this morning. This call and the last gave us a chance to ask questions, pass along some comments from our readers and find out what the next steps are in the legislative process.

Several interesting bits of information came out of this call, including these: 

1.    Your opinions count!

All calls, emails and letters to Senators are tallied and included in daily/weekly reports that members read to learn how many contacts they have received regarding pending legislation, pro or con. These contacts actually affect voting,  according to the aides.

If you want to comment on a Senate bill, they recommend you contact Reid’s office and/or your own senator.

2.    If you’re in favor of a public option (or not), be sure to voice your opinion NOW. Majority Leader Reid is in an interesting position, at the moment. The Senate bill could go either way, when it comes to the public option. It's really up to Reid.  

Here is something very interesting that Sen. Charles Schumer (D-NY) said on The Rachel Maddow Show earlier this week, that's in keeping with what aides told us this morning: 
 
 
In the ongoing health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals. 

We’ve also heard from those who have great faith in our current system and sincerely believe we should leave it alone.

It may work well for some people, but, on the whole, our nation does not hold up well in international comparisons. In fact, we came in 37th on the World Health Report 2000 and, according to a London School of Hygiene and Tropical Medicine report, the U.S. has the highest rate of preventable deaths among 19 industrialized nations. Clearly, there’s room for improvement. 

My question is, if we spend billions on health care reform, will that improve public health, or not?

For answers, I turned to Howard K. Koh, M.D., assistant secretary for health in the U.S. Department of Health and Human Services (HHS). Koh is senior health advisor to the Secretary of HHS, and he oversees the Office of Public Health and Science, the Commissioned Corps of the U.S. Public Health Service, and the Office of the Surgeon General. Previously, he served as associate dean and director of the Division of Public Health Practice and Center for Public Health Preparedness at Harvard School of Public Health. From 1997-2003, he was commissioner of public health for Massachusetts.

In a recent interview, Koh told me we can “absolutely” expect overall public health to improve if we provide quality, affordable health care coverage for all Americans.

“Health insurance reform will link people to health care services and assure access to quality health care,” he said. “Reform will also protect people against unfair insurance practices so they won’t be denied coverage as a result of a job loss or a pre-existing condition.

”Right now, millions of Americans cannot get coverage and 14,000 more lose their insurance every day," Koh said. “When Americans go without health insurance, they suffer.”

That suffering isn’t limited to the uninsured. Many with insurance fear they will lose their benefits. According to Koh, one in six Americans who had employer-sponsored insurance coverage in 2006 lost that coverage by 2008. As a result, many children and adults went without preventive care, immunizations, basic dental services and prescription medicine.

“When sick, [the uninsured] are more likely to experience poorer health outcomes” than the insured.
 
“We are the only advanced democracy that allows this hardship on millions of its people,” according to Koh.

So exactly how will health care reform impact public health in the US?

Koh explained:

1.Reform will promote prevention.
“We’re developing a wellness care system that protects health, promotes healthy behaviors and strengthens community prevention…

“A national report recently found that 100,000 lives could be saved each year by investing in five basic preventive services that are available through a doctor’s office…[including] flu shots [for] adults and daily aspirin use counseling for men over 40 and women over 50.“

2.Reform will lead to better quality and continuity of care, in part through the expansion of health information technology.
"Expanding the use of electronic health records is fundamental to reforming health care and reducing preventable medical errors.”

3.Reform will help address chronic diseases.
“Right now, seven out of every 10 Americans who die each year die of a chronic disease. That’s 1.7 million people. And without health insurance reform and an emphasis on regular primary care and prevention, that number is only going to get bigger.”
 
4.Reform will end denial of coverage based on a person’s medical history, a practice that disproportionately hurts minority populations.
“Many minorities are discriminated against by health insurance companies when they try to get insurance, and we can’t continue to allow this.”

“We can’t eliminate all disease,” Koh said, “but …we can reduce chronic disease by ensuring Americans have the care they need to prevent and treat these diseases so that if they do get sick and need care, they have the best possible chance of getting better.”

In our current system, low-income Americans, including racial and ethnic minorities, are less likely to receive preventive care than others.

“The data are undisputed,” he said. “Minority groups have higher rates of disease, fewer treatment options, and reduced access to health care….this contributes to widening health disparities in our country.”
 
When it comes to closing the gap on health disparities, Koh said, “we should remember that this isn’t a partisan issue. It’s a moral issue.” 

 
Picture
 
 
Liberal columnist Nicholas Kristof suggests those serving in Congress or working for the government buy their own health insurance like everyone else. 

This column ran two days ago and, in that short time, has kicked up quite a storm. You can follow the link at the bottom of the column to access Kristof's blog and comment roll.

See what you think: 

The New York Times
October 8, 2009
Op-Ed Columnist

Let Congress Go Without Insurance
By NICHOLAS D. KRISTOF

Let me offer a modest proposal: If Congress fails to pass comprehensive health reform this year, its members should surrender health insurance in proportion with the American population that is uninsured.

It may be that the lulling effect of having very fine health insurance leaves members of Congress insensitive to the dysfunction of our existing insurance system. So what better way to attune our leaders to the needs of their constituents than to put them in the same position?

About 15 percent of Americans have no health insurance, according to the Census Bureau. Another 8 percent are underinsured, according to the Commonwealth Fund, a health policy research group. So I propose that if health reform fails this year, 15 percent of members of Congress, along with their families, randomly lose all health insurance and another 8 percent receive inadequate coverage.

Congressional critics of President Obama’s efforts to achieve health reform worry that universal coverage will be expensive, while their priority is to curb social spending. So here’s their chance to save government dollars in keeping with their own priorities.

Those same critics sometimes argue that universal coverage needn’t be a top priority because anybody can get coverage at the emergency room. Let them try that with their kids.

Some members also worry that a public option (an effective way to bring competition to the insurance market) would compete unfairly with private companies and amount to a step toward socialism. If they object so passionately to “socialized health,” why don’t they block their 911 service to socialized police and fire services, disconnect themselves from socialized sewers and avoid socialized interstate highways?

 Click on Read More (below right) for the rest of the piece.
 
 
I’ve always been fascinated with the Human Genome Project (HGP), perhaps because that single effort by thousands of scientists from around the world offered such extraordinary promise to this generation, and to those that will follow.

With a map of the genes that form human chromosomes and with an outline of the sequence of all three billion units of DNA that constitute one set of those chromosomes, scientists could begin to actually quantify and describe what makes a human, human. (Not much, it turns out!)

They also could point to the miniscule differences that (might) make each of us unique. Those differences might help us succeed as athletes or mathematicians, or could predict how well or poorly our body will respond to the myriad environmental assaults it will endure through a normal life.

Every week, we read about research that picks up new connections between genetic combinations or anomalies, and disease. Thanks to the science that went into the HGP, we know there are markers for certain cancers, Huntington’s disease (remember Dr. 13 on House?) and some aspects of cardiovascular disease, among many other conditions.

According to a 1997 story in The Judges’ Journal of the American Bar Association, the Human Genome Project has given science a great set of tools to understand and, perhaps, fend off some human suffering caused by disease.

Using information gathered from genetic testing, physicians counsel patients on their risk for a number of medical conditions. Sometimes, they can help a person build a lifestyle or find other ways to reduce that inherited risk. Sometimes, they can’t.

After all, risk is -- by definition – a numbers game.  

Within our family, I can think of at least four people – three of them, young – who have considered genetic testing to determine whether or not they carry a marker for a particular cancer. In all cases, a parent’s cancer was considered familial long before there was science to prove it.

All four have declined testing. I don’t know why, but this op-ed in Sunday’s New York Times may provide a clue:

The New York Times
October 4, 2009

Dad’s Life or Yours? You Choose
By NICHOLAS D. KRISTOF

So what would you do if your mom or dad, or perhaps your sister or brother, needed a kidney donation and you were the one best positioned to donate?

Most of us would worry a little and then step forward. But not so fast. Because of our dysfunctional health insurance system, a disgrace that nearly half of all members of Congress seem determined to cling to, stepping up to save a loved one can ruin your own chance of ever getting health insurance.

That wrenching trade-off is another reminder of the moral bankruptcy of our existing insurance system. It’s one more reason to pass robust reform this year.

To read the whole piece, click here