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Dr. Ben Carson: Health Care Is 'Upside-Down'

March 11, 2013

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Dr. Ben Carson is known for blazing trails in the neurological field � including breakthrough work separating conjoined twins. Now he's making waves for his political views. Host Michel Martin talks with Carson about the current state of health care in America and his upcoming speech at the Conservative Political Action Conference.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. We're going to start off the week by meeting people who are involved with some of this country's more challenging debates around health care. In a few minutes, we'll meet the first person in this country to try out a new method for prostate cancer treatment. The treatment worked and now he's hoping his experience would persuade other skeptics, especially other African-Americans to participate in clinical trials.

But first we want to speak with a man of medicine who is now making a splash in the political arena. You might know Dr. Benjamin Carson as one of the preeminent neurosurgeons in the world. He was the first man to successfully separate twins who were born joined at the head. You might know him from his remarkable life story that inspired a movie starring Cuba Gooding, Jr. Or you might know him from his interview on this program after he was awarded the Presidential Medal of Freedom.

But lately, he's been getting a lot of attention for this speech that he gave at the National Prayer Breakfast last month.

(SOUNDBITE OF BREAKFAST SPEECH)

DR. BENJAMIN CARSON: It's very difficult to speak to a large group of people these days and not offend someone. I know people walk around with their feelings on their shoulders waiting for you to say something - ahh - did you hear that? And they can't hear anything else you say. The PC police are out in force at all times.

MARTIN: He went on to criticize President Obama's policies on everything from health care to taxes - all this while the president sat just a few steps away. After the speech, the Wall Street Journal ran an editorial titled "Ben Carson for President." The Atlantic called him a, quote, "new conservative folk hero." Now all eyes are on Dr. Carson for his next speech at the Conservative Political Action Conference, or CPAC, which is this week.

And Dr. Carson took time from his busy schedule to speak with us about it. Dr. Carson, welcome back to the program. Thanks for joining us.

CARSON: Thank you. Good to be back.

MARTIN: Now your concerns about health care in this country, the health care system overall, how it's practiced, are not new. For example, you talked about these issues when you were on this program. Are you talking more about these issues or are more people listening now?

CARSON: Well, you know, I've been talking about it for a long time. If you go back and read my 1999 book called "The Big Picture," a lot in there about health care. I've been very concerned about how we do it. And I wouldn't characterize myself as criticizing the president. I've been talking about these things long before he was on the scene. So it's not so much a criticism of him as it is placing out there some other ideals about how we get this thing under control.

And, you know, we spend twice as much per capita on health care in this country as the next closest nation and yet we have tremendous access problems. And I believe there are some ways that we can do it which would provide very excellent access to everybody at substantially less cost.

MARTIN: Why do you think your speech at the National Prayer Breakfast got so much attention?

CARSON: Well, I think it resonated with a huge number of people. You know, I've gotten literally thousands of contacts from people across the country - and the most poignant ones being elderly people - who said I had given up on America and I was just waiting to die. And now they felt revived. And I think what I really talked about, again, was not a criticism of anything but just some stuff that makes sense, logical things that make sense.

People are starving for that coming out of Washington. And it's not a Democrat thing or a Republican thing. I think it's a politician thing.

MARTIN: I do want to talk more about the substance of some of your ideas, particularly for people who haven't had a chance to read some of your books. In fact, you talk a lot about your ideas about health care in your latest book "America the Beautiful: Rediscovering What Made This Nation Great."

But I want to spend just a couple more minutes talking about where you decided to make these comments, about the conservative syndicated columnist Cal Thomas, who's one of the organizers of the prayer breakfast, said that he felt your remarks was inappropriate for the occasion, that you turned a non-political occasion into a political occasion. And he said it's not about politically correct; it's about being rude.

And I've personally heard you speak about the importance of being courteous. He says you owe the president an apology. Do you think you do?

CARSON: I don't think so at all. In fact, I don't believe that expressing your opinion, regardless of who is there, is being rude. And it's a shame that we've reached a level in our country where we think that you don't have the right to put your opinion out there. And the setting, I think, is extraordinarily appropriate because we're talking about the health of our nation, not only the physical health of our nation but also the spiritual health of our nation.

MARTIN: Do you think that your race plays some role in the attention that is being gotten here? I mean, the fact is that you and the president are both highly achieving African-American men from humble beginnings, if I can put it that way, and that there's something delicious in that confrontation.

CARSON: I suspect that in some people's minds that probably did create a little tasty tidbit, particularly those individuals who tend to think that if you're black you have to think a certain way and you have to act a certain way, which I find really quite offensive.

MARTIN: If you're just joining us, I'm speaking with Dr. Ben Carson. He's the director of pediatric neurosurgery at the Johns Hopkins Hospital. He's speaking at the Conservative Political Action Conference later this week and he's getting a lot of attention for comments he made at the National Prayer Breakfast which was last month. Talk a little bit more, if you would, about - I know your interest in some of these issues goes beyond health care, but health care is, I think, the area that you know best.

What is it that you think - the particular nugget that you would want people to come away with? What you think would be better?

CARSON: Well, first of all, in order to have good health care you need a patient and you need a health care provider. Along has come the middle man to sort of facilitate the relationship and now the middleman has become the primary component with the patient and the health care provider at its beck and call. This is totally upside down, and anything that we do that enhances that middleman and decreases the doctor-patient relationship actually exacerbates the situation rather than making it better.

So what - the reason that I proposed health savings accounts for everybody starting at birth, is because you very quickly accumulate an amount of money that you can use for your interactions with those health care providers. Also, you develop a very good doctor-patient relationship and also because you now have some responsibility for that account, you're going to be looking for good bargains. Other people are going to be making sure that they provide good bargains. You bring the whole health care system into the free market. And that's going to help to control cost as well.

MARTIN: You also talk, though, about the need for some sort of catastrophic insurance to address truly catastrophic situations.

CARSON: Yes.

MARTIN: Is that getting an equal amount of attention?

CARSON: Well, no one's really asking me about that. I appreciate you asking about it. Yes, that obviously does have to be a component of the plan. And that is the place where you can bring the government and where you can bring Medicare or Medicaid in. We can work out a system whereby that's done for considerably less money than we're spending now. Because you're taking the middleman out of the equation for 80 percent of the medical encounters.

MARTIN: I noted that you are talking with the Conservative Political Action Committee next week, CPAC which is, well, in Washington circles it's a big deal. It's considered a platform for people with political aspirations. Do you consider yourself a conservative?

CARSON: I consider myself a logical person and, you know, a lot of people try to categorize me in one way or another. You know, there are some of the things that I say that probably would be considered very much non-conservative. For instance, I think that the medical insurance industry needs to be reformed dramatically because we've put them in an untenable situation.

They make money by denying people care. That's an inherent conflict of interest. That situation needs to be addressed. Some people would say that's not a conservative way of thinking. But I don't think really conservative or liberal; I think what makes sense? What's going to help the American people? What's going to give them what they need? Not only in health care but in terms of jobs, in terms of education, in terms of a whole host of issues that, you know, I addressed in the most recent book, "America the Beautiful."

MARTIN: The Wall Street Journal editorial, as I mentioned, the title of it is "Ben Carson for President." We mentioned that CPAC has been a springboard for people who are aspiring to kind of a broader place in the public debate. Do you have aspirations for a career in public service? Do you have any intention of perhaps finding other platforms to discuss your ideas about policy?

CARSON: Certainly that has been pushed upon me many times in the past and there's no way I'm getting into the cesspool of special interest groups. Wouldn't do it anyway in the world. People say, well, why don't you run for Congress? You could get there very easily. Why would I want to run for Congress and continue to get tainted with all the things that people get tainted with as they come along the system.

I think perhaps a much better role would be to use my voice and to use my influence to help change the tone of this nation, to help us to realize that, you know, we're not enemies. A very wise man once said a house divided against itself cannot stand, and here we find ourselves in a situation where we're more divided than ever and we need to develop the kind of leadership that encourages people to work together, to join together, to utilize their strengths in order to improve our situation, not to continue to exacerbate it.

MARTIN: But on the question of the tone and the timing, could a reasonable person say, you know, the time for you to be heard on this issue was when healthcare reform was being debated, and that was not for a short amount of time. More broadly, one could argue, it's been debated for 40 years; narrowly, in this administration, one could argue, it was debated in the first two years of the administration.

I mean at this point could a reasonable not mean person say that this is a heckler's veto?

CARSON: Well, let me put it this way. During the healthcare debate, I was contacted by the administration to get my views and I was having quite a very decent conversation with the gentleman until he asked me what did I do for the president during the campaign, and I said that I'm an independent and that was the end of that conversation. Two months later I get another call. I guess they thought better of it and I was teaching a lesson.

I said I'm in the middle of teaching a lesson, can we talk in 40 minutes. The person was offended. I mean how could you possibly be doing anything more important than taking to the White House. That was the end of that conversation. You know, I talked to David Axelrod about that, and I tell him about those two conversations. He said, well, you know, we have some young people who perhaps don't exercise the best judgment and you shouldn't judge the whole administration on that basis.

I take him at his word that you shouldn't, but it's not that I haven't made an attempt to influence the direction of things.

MARTIN: That was Dr. Benjamin Carson. He's the director of Pediatric Neurosurgery at Johns Hopkins Hospital. His latest book - he's written many of them - is "America the Beautiful: Rediscovering What Made This Nation Great," and he was kind enough to take time out of his busy schedule to join us from member station WYPR in Baltimore. Dr. Carson, thanks for joining us.

CARSON: My pleasure.

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Strike Debt Abolishes $1.1 Million of Medical Debt

Strike Debt, a group that emerged from the Occupy Wall Street movement, has planned a week of actions in multiple cities across the country to mark the abolition of $1.1 million in medical debt belonging to 1,064 people as part of the �Rolling Jubilee� project.

While that may already seem like a huge number, Strike Debt claims it�s only getting started and ultimately hopes to abolish around twenty times what they raised, which would be nearly $12 million.

�What we do is buy debt for pennies on the dollar,� Jacques, a member of Strike Debt, explained to activists gathered at Bryant Park on Thursday evening. �And instead of collecting on it like the debt collectors, we basically abolish it. We�re here today because we purchased over one million dollars of medical debt from over a thousand people in Kentucky and Indiana who had emergency room debt.� (A full report of the purchased debt can be found at the Rolling Jubilee�s transparency site.)

In order to kick off the �Life or Debt� week of action, protesters planned a medical bankruptcy tour to the various health insurance companies who Strike Debt sees as being exploitive of the sick and vulnerable by using insurance payments to fatten the wallets of the companies� CEOs instead of using that money for actual healthcare.

Paused before Aetna�s offices on Park Avenue, an activist announced to the group that Aetna�s CEO Mark Bertolini received over $10 million in total compensation last year, which is around 300 times the average worker�s pay.

A woman named Jamie spoke in front of Aetna�s office about how she wrote a letter to Bertolini after being denied coverage by the company due to a chronic work industry.

�I was frightened and heartbroken,� Jamie said. �I just couldn�t believe it. How could someone in charge of care turn their back on someone in unrelenting pain?�

Jamie�s letter was returned, unopened.

At the front of the procession, Strike Debt activists carried a banner that read �62% of all bankruptcies are due to medical debt.�

Another activist carried a sign: �Medical bills: death by spreadsheet.�

In front of the insurance giant CIGNA, a protester recounted the death of 17-year-old Natalie Sarkisyan, who died after having her liver transplant surgery first denied and then later delayed by the company.

In 2007, Natalie�s mother addressed a crowd of supporters in front of CIGNA�s Philadelphia headquarters.

�CIGNA killed my daughter,� Nataline�s mother Hilda told security. �I want an apology.� Sarkisyan was not able to speak to [CIGNA CEO] Hanway; a communications specialist talked to her instead. After their conversation, employees heckled the group from a balcony; one man gave them the finger. CIGNA called the police and had the family and their friends escorted from the building.
A CIGNA executive later apologized for the incident in a letter about a month later.

Over the weekend, Strike Debt activists have planned a free health fair and march to highlight hospital closings. The march will feature sites like the closed St. Vincent�s community hospital, which will enjoy a �second life� as the site of luxury condos priced between $1.4 and $8.2 million. The tour will be followed by free legal advice and health care at Judson Church. On Saturday, practitioners will also be on call to answer medical questions at Strike Debt�s website.

�These debts are literally killing patients, students, providers and communities,� the group states at its website. �They deepen the already entrenched inequalities that divide races, classes, and genders. Our healthcare system doesn�t make us well; it prolongs our illnesses in the name of profit.�

Affordable Care Act at 3: Increased Savings for Seniors

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less -- or about $200 billion� in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely.� It means that those who count on Medicare -- our grandparents, parents, our friends, and neighbors � will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law�s closing of the prescription coverage gap known as �the donut hole.�

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: �I take seven different medications. Getting the donut hole closed � gives me a little more money in my pocket.�

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, �splitting pills, taking doses every other day, missing doses, stretching their medications.� �But he says this has begun to change with the savings resulting from the Affordable Care Act, and that�s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services -- such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits -- with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself.� She knows they struggle with the costs of staying healthy. �If it weren�t for the health care reform, many of our seniors would not get to a doctor,� to get a check up, Helen says. �It is expensive for us to keep good health.�

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they�re discharged. This also gives Medicare beneficiaries � and other taxpayers � more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

To learn more about how the Affordable Care Act is saving seniors on prescription drug costs by closing the donut hole coverage gap, visit www.hhs.gov/news/press/2013pres/03/20130321a.html

Follow Secretary Sebelius on Twitter at @Sebelius.

Affordable Care Act at 3: Increased Savings for Seniors

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less -- or about $200 billion� in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely.� It means that those who count on Medicare -- our grandparents, parents, our friends, and neighbors � will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law�s closing of the prescription coverage gap known as �the donut hole.�

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: �I take seven different medications. Getting the donut hole closed � gives me a little more money in my pocket.�

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, �splitting pills, taking doses every other day, missing doses, stretching their medications.� �But he says this has begun to change with the savings resulting from the Affordable Care Act, and that�s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services -- such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits -- with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself.� She knows they struggle with the costs of staying healthy. �If it weren�t for the health care reform, many of our seniors would not get to a doctor,� to get a check up, Helen says. �It is expensive for us to keep good health.�

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they�re discharged. This also gives Medicare beneficiaries � and other taxpayers � more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

To learn more about how the Affordable Care Act is saving seniors on prescription drug costs by closing the donut hole coverage gap, visit www.hhs.gov/news/press/2013pres/03/20130321a.html

Follow Secretary Sebelius on Twitter at @Sebelius.

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As Health Law Turns Three, Public Is As Confused As Ever

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Pennsylvania Cuts Medicaid Coverage For Dental Care

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Disability, Disparities and the Health Care Law

As we commemorate National Minority Health Month, we can take the opportunity to not only highlight the health disparities experienced by racial and ethnic minorities and our progress toward health equity, but also the health disparities facing persons with disabilities. �For they, too, encounter considerable barriers to getting quality health care.

In fact, according to a report from last summer, �by every measure, persons with disabilities disproportionately and inequitably experience morbidity and mortality associated with unmet health care needs in every sphere. Minorities with disabilities are doubly burdened by their minority status.�� Access to providers, inadequate training and cultural competency among providers, and limited data and research in disability disparities are just some of the challenges they face.

Because of the Affordable Care Act, that�s changing.

It�s helping people like Sonia from Baltimore. Because of serious injuries from a car accident, Sonia feared she would have to spend the rest of her life in a nursing home, denied the ability to raise her young children and provide for her family. Instead, thanks to the law�s Money Follows the Person program, Sonia has been able to get help with home modifications and long-term attendant care from someone she trusts � critical help she needs to live at home. Now, she can support her family, play with her children, and be a part of her community.

Programs like these are so important, as is good research. Because of the law, HHS has developed new data collection standards on race, ethnicity, sex, primary language, and disability status for population health surveys, helping us to better identify disparities and target programs to reduce these disparities. And we�re helping propose new standards for medical diagnostic equipment, including mammography machines and exam tables, which can be difficult to use, especially for people with mobility disabilities.

The law has also provided coverage to over 55,000 uninsured Americans with chronic conditions and disabilities who previously would have been unable to obtain affordable health insurance. Insurance companies can no longer exclude kids with pre-existing conditions like asthma or diabetes from getting coverage, and by 2014, adults cannot be excluded because of pre-existing conditions either. We will also ensure that Affordable Insurance Exchanges and Medicaid enrollment and eligibility systems are accessible to people with disabilities.

Much remains to be done to better define and address disparities on the basis of disability. HHS is determined to continue making strides in achieving increased health equity through this vital work.

To learn more about what the new health care law does to help address disparities for persons with disabilities, view an updated fact sheet here.

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Legislation Introduced to Make Health Care a Right in New York State

Doctors, Nurses, Patients Advocates Applaud Updated Single Payer Medicare for All Legislation by Gottfried, Duane and 70 lawmakers

Doctors, nurses, patients, senior citizens, anti-poverty advocates, faith leaders and medical administrators joined Assemblymember Richard Gottfried and Senator Thomas Duane in unveiling an updated and revised single payer legislative proposal for New York State. More than 70 state lawmakers are cosponsors

Assemblymember Gottfried had initially drafted a single payer plan for New York in the early 90s. The revised legislation incorporates changes that have been made in the state’s oversight of health care in the interim, advances in how to provide medical services, and the recent federal changes in the health care system. The legislation builds upon the momentum from last May when Vermont became the first state to enact a universal health care system which the Governor plans to make a single payer system, where on programs pays all bills.

�The current system doesn�t work for patients or health care providers, or for the employers, individuals, and taxpayers who pay for care and coverage today,� said Assembly Health Committee Chair Richard N. Gottfried, author of the bill. �We can get better coverage, get all of us covered, and save billions by having New York provide publicly-sponsored, single-payer health coverage, like Medicare or Child Health Plus but for everyone.�

�Our current health insurance system is driven by uncertainty. Will my family have coverage? Can we afford it?,� said Senator Duane. �Single-payer is about removing that fear from peoples� lives. It will allow all New Yorkers the same comfort that our seniors get from Medicare, and that our veterans get from TRICARE. It will allow entrepreneurs to worry about product innovation, not health insurance costs. It is time for single-payer in New York.�

Joining Assemblymember Gottfried and Senator Duane at the press conference were Katie Robbins of Health-Care Now!, Vito Grasso, Executive Vice-President of the NYS Academy of Family Physicians, Dr. Asiya Tschannerl of Physicians for a National Health Program, Mark Dunlea of Single Payer NY / Hunger Action Network of NYS, Shaun Flynn of the NYS Nurses Association, and Rev. Bebb Stone.

Assemblymember Gottfried convinced lawmakers four years ago to fund a study of the most cost-effective way to provide health care to all New Yorkers. The answer was single payer, which would reduce overall health care expenditures in New York by $20 billion annually by 2019. The state study said that single payer would be $28 billion cheaper annually by 2019 than the insurance mandate enacted by Congress. In addition to saving money, single payer was the only plan that guaranteed that everyone would have access to health care services.

“The Presbyterian Church U.S.A. has called single payer health care reform ‘a moral imperative’ since 2008. If I want health care coverage for myself ( and I do), how can I not want it equally for my neighbor whom I am commanded to love as myself?” asked Rev. Bebb Stone. “We believe that the value of persons requires that each person have full access to essential services without regard to ability to pay and on terms that enhance the dignity of the individuals” according to the 2008 resolution.

The proposal would provide comprehensive health coverage for all New Yorkers. Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no premium, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc.

“Even if the recent federal health insurance mandates survives the legal challenges, it fails to provide health care coverage to everyone and is financially unsustainable. Tens of millions of Americans will discover that the insurance they are forced to buy fails to pay for the health services they will need. Everyone knows that there is a better solution – single payer, expanded and improved Medicare for all – and New York should be the first one to put it in place,” said Mark Dunlea, Executive Director of Hunger Action Network.

“The simplest and quickest way to reduce health care costs is to eliminate the money wasted on health insurance, its profits and administrative costs, and the bureaucratic barriers it presents to health providers and consumers. If we got rid of insurance companies nationally, the annual savings would be more than $400 billion,” added Dunlea, chair of the state legislative committee of Single Payer New York, an umbrella organization.

“As a physician working in the Bronx, I see every day the profound limits of medicine when patients must ration their care due to high copays and deductibles,” said Dr. Asiya S. Tschannerl with Physicians for a National Health Program. “And too many patients have told me that they earn just a few dollars too much to qualify for Medicaid, and are now facing the horrible dilemma of – “do I reduce my income? or go without insurance since I couldn’t afford it.” Enough is enough. We need a truly universal healthcare system like every other industrialized nation on this planet. Healthcare is a human right, not a privilege! A Single Payer expanded and improved Medicare for all would guarantee healthcare for all,” added Tschannerl, a member of Doctors for the 99% and Occupy Wall Street.

“We must end funding the waste, greed, and corruption of the health insurance companies, and move these resources to funding and providing actual healthcare. Insured or not, the Affordable Care Act pits people’s needs against profits for corporate-run healthcare. We can reverse this trend and recognize the right to healthcare by implementing the New York Health bill,” stated Katie Robbins of Healthcare-NOW! NYC.

“The Nurses Association firmly supports the establishment of a more equitable coverage system that directs scarce healthcare dollars towards providing universal access to high quality, cost-efficient health care for all New Yorkers – regardless of their age, income, health or employment status,” according to Deborah Elliott, RN, MBA, Deputy Executive Director, New York State Nurses Association.

Under the revised bill, health care would no longer be paid for by insurance companies charging a regressive �tax� � premiums, deductibles and co-pays � imposed regardless of ability to pay. Instead, New York Health would be paid for by assessments based on ability to pay, through a progressively-graduated payroll tax (paid 80% by employers and 20% by employees, and 100% by self-employed) and a surcharge on other taxable income. A specific revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor.

Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The �local share� of Medicaid funding � a major burden on local property taxes � would be ended.

Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents.

Assemblymember Gottfried, in his official sponsor memo, noted that “New Yorkers have experienced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured.

“Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated.”

States Taking the Lead in Strengthening Consumer Protections

Recently, five more States strengthened their laws protecting consumers in disputes with their health insurance plans. The District of Columbia, Massachusetts, New Hampshire, Ohio and Wisconsin have bolstered their laws surrounding the part of the appeals process known as �external review.� �These five States join 33 others that provide these State-based external review protections that ensure consumers have a voice. The remaining States� consumers are protected by a Federal process.

The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act. Having a meaningful appeals process ensures that you actually receive the benefits that your insurer has promised.

So, what exactly is an external review?�

It means having an independent third party review your insurer�s decision, no matter where you live, thanks to the Affordable Care Act.

Often, you can resolve disputes with your health plan by asking your insurer to reconsider its decision, in a process known as an �internal appeal.� But if, for example, your insurer still denies payment after the internal appeals process, you now can ask for an external review by an independent review organization to decide the matter.� Insurance companies must accept the outcome of this external review.� This means that your insurance company no longer gets the final say, and that patients and doctors get a greater measure of control over health care decisions.

These protections are important because when an insurer refuses to pay for a covered health care service, consumers could be faced with a large unplanned bill, and may not be able to afford the care their doctors say they need.

The Affordable Care Act sets these new important appeals standards for consumer protections and encourages States to take the lead in ensuring their own residents benefit from them.� Where States have not yet passed laws implementing these consumer protections, HHS has set up a process to ensure that consumers in these States also benefit from the same protections and standards.� If a State changes its external review process in the future, the State may request a new determination at any time.�

Having DC, Massachusetts, New Hampshire, Ohio and Wisconsin step up to the plate to ensure consumers� external review rights is a perfect example of how the Affordable Care Act empowers States to protect consumers.

Protesters outside and inside White House health care forum in Iowa

By O.Kay Henderson for Radio Iowa–

There were protesters outside and inside this morning’s White House health care forum in Des Moines.

About 20 protesters stood on the street outside, waving signs and chanting. A psychiatrist from University of Iowa Hospitals in Iowa City stood in the middle of the group, wearing his white lab coat and chanting “Everybody in, nobody out” along with the others. Dr. Jess Fiedorowicz is a member of Physicians for a National Health Program. “‘Everybody in, nobody out’ truly universal health care. Universal health care has become a buzz word in the elections, but if you look at the proposals people are proposing, they truly do not intend to cover everybody,” the doctor said. “�We’re interested in everybody being covered.”

Sixty-one-year-old Vashti Winterburg of Lawrence, Kansas — another protester — opposes any plan that keeps health insurance companies in business. Winterburg said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly. “It costs us a thousand dollars per policy, per employee, per month,” Winterberg said. “That’s horrible.”

Iowa Farmers Union president Chris Peterson of Clear Lake said he’s glad the forum was held in the Midwest, as most Americans don’t understand the challenges rural citizens face. “Rural Iowans struggle with finding affordable insurance. Even solidly middle class farmers are feeling the pinch. Nearly one in eight Iowa farmers battle outstanding health debt,” Peterson said. “I am one of them.”

Peterson, who is 53, was kicked off his private insurance plan about two years ago for what the company said was a preexisting condition. Peterson and his wife, who has no private insurance either, have accumulated $14,000 in medical debts in the past two years. “The health care system in this country is dysfunctional and burdensome,” Peterson said of the private insurance industry. “…Personally, what I’ve been through, it seems at times it’s a ponzi scheme — they’re taking your money — or (it’s) just the robber barons pulling money out of your pockets.”

Once the forum got underway, protester Mona Shaw of Iowa City stood to call the event “shameful” because health insurance companies were participating. As she was escorted out of the event hall, Shaw accused insurance companies of ignoring the needs of their customers. “Governor Culver has taken $20,000 from Blue Cross-Blue Shield, of course he’s not going to let the insurance industry take any of the flack for this,” Shaw shouted toward reporters as she left. “Iowans are dying.”

President Obama’s White House advisor on the health care issue sat on a panel that included Iowa Governor Chet Culver, the governor of South Dakota and Senator Tom Harkin. Seventy-five-year-old Darlene Neff of Iowa City, a retired school teacher, told the group she’s survived breast cancer and a brain tumor. “We who are retired and have insurance as well as Medicare know how good we have it as far as health care goes, but we know, too, that there are millions out there who don’t have good health care,” Neff said. “That basic health care should be available to everyone today.”

Small business people like John Piper of Des Moines were among those who talked of their difficulties in keeping employees because they cannot offer health insurance as a benefit. “I reduced the size of my company because of health insurance,” Piper said. “So now, it is a one-person company.”

Those who provide health care services were part of the discussion, too. Karen Van De Steeg , executive director of a cancer center in Sioux City, urged officials to consider private companies are doing things to control the cost of health care. Van De Steeg manages Siouxland Pace which provides inhome care to the elderly.

“Essentially, the private sector, our company has taken on risk for taking care of these patients,” Van De Steeg said. “We are providing some of the poorest, oldest, most-frail people the absolute best care they could possibly get in their homes. It’s an alternative to nursing home care and the whole reason we’re successful is it’s about prevention. We do everything possible to keep that person well.”

A couple of state legislators and a pharmacist from eastern Iowa were among those who also stepped to the microphone to air their thoughts on health care reform, too.

From Radio Iowa.

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Health Care Costs To Exceed A Record $20,000 Per Year For Families

Health care costs for a family of four covered by workplace health insurance will exceed $20,000 for the first time ever this year — $20,728 to be precise — according to a new study released Tuesday. That’s $1,335 more than in 2011.

A family of four will pay $5,114 in premiums for a preferred provider organization plan, a common type of health insurance, along with $3,470 in out-of-pocket costs like co-payments for doctor visits and prescription drugs, according to the report issued by Milliman, a firm that consults with companies on employee benefits. The remainder of the expenses will be paid by employers, though money spent on health care and other fringe benefits is money not spent on higher wages.

Relentless increases in health care costs, which the federal government says rose to $2.6 trillion in 2011, are squeezing employers, workers, families and government budgets every year.

Almost 50 million Americans had no health insurance as of the 2010 census, more people are going without medical care they need because of cost, employees are being asked to shoulder a greater share of the burden for health care costs while seeing their benefits scaled back, and more companies are dropping coverage for workers. Meanwhile, the United States falls behind other industrialized nations on measures of health care quality, in spite of all this spending.

Family health care costs grew by 6.9 percent between 2011 and 2012, slower than in previous years, but Milliman suggests there’s little comfort in that.

“The rate of increase is not as high as in the past but total dollar increase was still a record,” the report says. “The dollar amount of the increase overshadows any relief consumers might derive from the slowing percentage increase.” The health care reform law enacted by President Barack Obama in 2010 “has had only a limited effect” on health care costs, the report continues.

Spending on physician services will reach $6,647 and spending on hospital stays will rise to $6,531, making them the two biggest components of a typical family’s annual health care expenses, the report says.

Health care costs varied among the 14 metropolitan areas that Milliman analyzed. Miami and New York City are the most expensive, with costs about 20 percent higher than the national average. The report says that Phoenix, Atlanta and Seattle were the only three cities where annual costs are projected to be less than $20,000 this year.

Single-payer health care would save billions for Massachusetts

The House and Senate health care proposals would set imaginary limits for spending growth enforced by secret �improvement plans� and wrist slaps for hospitals that overcharge; establish tiered payment schemes to consign the poor and middle class to second-tier hospitals and doctors; push most residents of the Commonwealth into HMOs (oops, we forgot, now they�re called �accountable care organizations,� or ACOs); and wipe out small doctor�s offices by �bundling� their pay into ACO payments. Apparently the legislators� theory is that forcing health care providers to consolidate cuts costs. Oligopoly saves money?

Here are six alternative steps the Legislature could take that would actually save money while still preserving care.

- Cut out the middlemen. Why exactly do we pay private insurers 10 cents of every premium dollar? The plan that covers all 13 million residents of the Canadian province of Ontario has overhead of only 1 percent. Adopting that single-payer approach in Massachusetts would save about $2 billion in insurance overhead in 2013 alone.

- Pay hospitals the way we pay fire departments: real global budgets that cover all operating costs, not the per-patient schemes that are masquerading as global payments. Billing, collections, and paperwork consume nearly one quarter of hospitals� revenues. Eliminate billing for individual patients and you�d cut that nearly in half. The savings: about $3 billion in 2013.

- End the medical arms race and enforce real health planning. Hospitals and clinics vie for affluent patients needing lucrative high-tech care. They reap surpluses, a.k.a. profit, which they use to buy fancy machines and superluxe buildings � usually situated where there�s already a surplus of such facilities. Inevitably, the surplus facilities induce unnecessary, even harmful overcare. Meanwhile, underserved communities and under-provided services like mental health and substance abuse are starved of investment. Hospital payments should go for patient care, not new buildings. Money for new buildings and technology should flow to a separate fund, and be allocated according to need, not profitability, through a transparent public process. Investing in what�s needed instead of what�s profitable would save billions and improve care for both the poor and the affluent.

- Right-size the physician work force: more primary care, fewer specialists. Massachusetts hospitals take pride in training super-specialists who go on to provide profitable but often unneeded care (see above). Meanwhile, the primary care shortage persists. The public, through Medicare, already pays for residency training and should use the power of the purse to make hospitals train the doctors that the public needs. And physicians� fee schedules should be altered to assure that best students are attracted to the most needed, important, and difficult fields � primary care � and that doctors make as much for talking to patients as for putting them through a scanner.

- Negotiate drug prices statewide. Canadians pay 40 percent less for drugs than we do because they use single-payer buying power to drive down prices from pharmaceutical companies. Why can�t we?

- Cap health executives� incomes. Why should a hospital CEO make more than the president of the United States?

David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H. co-founded Physicians for a National Health Program. They are professors at the City University School of New York School Public Health and visiting professors at Harvard Medical School. They worked as primary care doctors in Massachusetts from 1982-2010.

Breaking It Down: The Health Care Law & Cost Control

For too long, too many hard working Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives families the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.�

The new law also includes a number of key provisions designed to help make health care more affordable � and help address the drivers of health care costs.� The new health care law is already making a difference.� Many Americans are seeing lower costs, and health care spending growth in 2009 and 2010 decreased to record lows.

Here are more ways the law helps control costs for families and small businesses:

The law�s small business tax credit has lowered health insurance costs for small business owners. On average, small businesses have paid about 18 percent more than large firms for the same health insurance policy.� If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35 percent (up to 25 percent for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.Holding insurance companies accountable for how they spend your premium dollars.� In 2011, if health insurers don�t spend at least 80 percent of your premium dollar on medical care and quality improvements rather than advertising, overhead and bonuses for executives, they will have to provide you a rebate for that excessive overhead.� The first rebates will be made in the summer of 2012.�Preventing insurance companies from raising rates with no accountability or transparency.� In every State and for the first time ever, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. These efforts are paying off.� In the last quarter of 2011 alone, States reported that premium increases dropped by 4.5 percent. And, in States like Nevada, premiums actually declined.�Recommended preventive benefits without deductibles or copayments. Millions of Americans with Medicare and private insurance have seen their out-pocket costs go down to zero for recommended preventive care like flu shots or cancer screenings now covered with no cost sharing under the law. This puts more money back into people�s pockets, while making sure they get the preventive care they need.

Mental Health and the Call for Single-Payer Healthcare

Join Healthcare for the 99% in recognizing Mental Health Awareness Month this May. Mental health is an integral part of overall health, and its prevalence and severity are yet another reason to demand single-payer healthcare. About one in six adults lives with a disorder of the brain such as depression, bipolar disorder, schizophrenia and post-traumatic stress disorder. The pain caused by mental illness radiates even further, through family, friends, neighbors, co-workers and more, into the fabric of our society. Mental health is also a key issue for our veterans, many of whom return home with PTSD caused by violence seen and experienced in combat. The pervasiveness of mental illness calls for a single-payer healthcare system, as such a system would finance mental healthcare for many of those who cannot afford it on their own.

So if one in six adults lives with a mental illness, why don�t we all know a lot of mentally ill people? You do. However, stigma prohibits many people from speaking openly about their mental health problems. Our language is riddled with offensive terminology (�schizo�, etc). Incorrect ideas about mental illness abound, such as the idea that mentally ill people are obviously strange or abnormal, or that mentally ill people will never recover from their illnesses.

Contrary to popular belief, some mental illnesses do in fact go away with treatment, and those who do have lifelong illnesses can still live extremely normal lives. However, this requires treatment, generally a combination of medication and therapy, and that requires insurance and money. Mental illness left untreated often leads to poverty and eventually to homelessness. When people cannot get out of bed or perform daily activities, they soon end up out of work, and this can snowball into homelessness and abject poverty. All of this can be prevented by treatment of the mental illness. However, therapy can cost two hundred dollars a session or more, and even good insurance often covers only 12 sessions a year. This is absolutely inadequate, and yet further sessions are often prohibitively expensive. Add to that the cost of medication, which drug companies drive up as much as possible by patenting their drugs so that no generic form is made, causing some drugs to cost as much as $8 per pill without insurance, or when insurance companies refuse to pay. Additionally, since in American society health insurance is tied to jobs, when one loses one�s job one loses health insurance as well, compounding the problem: exactly when the mental health treatment is most needed, all funding for it is taken away. It�s simple: some people can afford treatment and can lead relatively normal, healthy lives, and others who cannot afford treatment get sicker and sicker as society turns away.

It has also been established that poverty and homelessness can themselves lead to mental health problems, as the impoverished and homeless face factors the rest of us don�t. The stress of having many unpaid bills or not having food or shelter, as well as a lack of security for the future, can be the catalyst for a mental illness, or can exacerbate an existing one. The homeless are also far more likely to be victims of crime and trauma. The poor and the homeless generally do not have the money for early treatment that can stop the disorder from becoming severe (or for any treatment at all).

When mental illness becomes severe, with a person of any socioeconomic class, suicide is always a concern. A death by suicide is always a tragedy, yet becomes even more tragic when one realizes how preventable these deaths are. Ninety percent of those who die by suicide have a psychiatric illness that is not only diagnosable, but also treatable. But if people are denied the means to treat their mental health problems, they are often quite literally being left to die.

America needs single-payer healthcare. It will ensure that all of the mentally ill get the treatment they deserve and that they can live normal, successful lives. Insurance companies must stop letting people fall through the cracks by refusing to provide adequate mental health benefits. When single-payer healthcare becomes a reality, the mentally ill will have the support and resources to live the fruitful and happy lives they were meant to live.

Learn all you can about health care alternatives

The following editorial is from www.Courier-Journal.com.

The challenge is for citizens to get involved. the public must do its part by educating itself about the various alternatives, and letting their representatives in Washington know what they conclude.

How broken is our current system?

Some 47 million Americans are uninsured; another 50 million are underinsured (not fully covered).

About 8.7 million children are uninsured.

Most bankruptcies have a health reason as a major cause, and 68 percent of those people who have gone belly up do have health insurance policies.

The World Health Organization ranks the level of U.S. health care at 37th in the world.

Private health insurance companies, which have doubled the premiums since 2000, have a bureaucratic overhead of 28-31 percent while Medicare operates at 3 percent efficiency. Therein lies a large part of the problem. These companies have an incentive to reduce benefits to patients.

The most persistent solution on the grassroots level is a single-payer system, the single payer being the federal government. This program involves a Medicare-type approach for everyone, but it would be expanded to include dental care, vision care and preventive programs. Overall, it would cost about the same — maybe a little more, maybe a little less — as the present 15 percent of the Gross National Product (GNP). All other industrialized nations with full coverage for all citizens average about half the costs in total medical care.

A single-payer system is best outlined in congressional bill HR676, which would set up the National Health Insurance (NHI) program. What it is not is “socialized medicine.” England and Spain have socialized medicine, wherein the doctors and hospitals are all employees of the federal government. Under HR676 the present system would stay; doctors would remain private vendors and would submit their bills to one payer, the U.S. government, not to the 1,500 private health insurance companies. Patients would still choose their doctors. (More about HR676 later)

Is a single-payer system just the blue-sky proposal of some Washington, D.C., think tank? Not by a long shot. It is the work product of Rep. John Conyers and has 90 other congressmen as co-sponsors. This is about one in five House members. Also endorsing HR676 are the U.S. Conference of Mayors (a nonpartisan group of 1,100 members), Physicians for National Health Care Program (more than 10,000 doctors), League of Independent Voters, the United Church of Christ and the United Methodist Board of Church and Society, 32 city councils (including Louisville, Indianapolis, Baltimore, Detroit and Boston), 14 national and international labor organizations, the American Medical Students’ Association, the National Family Farm Coalition and more.

There was a time when the doctors would (and did) kill any national health care plan in the womb. Today a solid 59 percent of U.S. physicians now support national health insurance. Particularly strong on the issue are psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general internists (64 percent) and family physicians (60 percent). Doctors and hospitals have to employ huge staffs just to process insurance claims from a multiplicity of insurance firms. About 20 percent of private doctors’ income goes to pay for this staff.

Businesses are now leaning toward a national program. The Business Coalition for Single Payer Healthcare in New York (www.BusinessCoalition.net) poses this scenario: “If you own a small business with a $100,000-per-month payroll, your health care costs can be reduced from typically $15,000 per month to just $3,300 — from 15 percent to 3.3 percent of wages, a savings of $140,400 per year.”

General Motors, which says health care adds at least $1,500 to each car, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. This may help the bottom line and the company can compete better, but it is a sad commentary on the state of American health care, especially for the newest of workers.

Neither of the two major presidential candidates favored a single-payer program. Democrat Barack Obama comes up with a halfway reform that includes the insurance companies in the mix. His plan would offer help to nearly half of the uninsured people and would cover all children. Republican John McCain’s plan was only a small reform that features a tax credit plan of $5,000 for a family. This wouldn’t come close to paying a normal $12,000 premium for family health care. And the McCain plan, from some analysts’ viewpoint, would offer help to only about 4 to 5 million uninsured people.

Neither Republican nor Democrat solutions take advantage of the tremendous savings realized from eliminating the waste in the private health insurance industry. This waste alone, by the estimates of several studies, would pay for health coverage for all of the uninsured. More than several states have tried systems of mandating and subsidizing policies from insurance companies. Minnesota, Tennessee, Vermont, Washington and Massachusetts have learned the hard way in failing to fix the system by including the health insurance industry.

Where else would the money come from to support a national program? HR676 calls for a modest payroll tax on all employers and employees of 3.3 percent each, in addition to a 1.45 percent tax that they are already paying for a total of 4.75 percent each. Also there would be a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the richest 1 percent . A small tax on stock and bond transfers is also envisioned along with the closing of corporate tax loopholes and repealing the Bush tax cut for the highest 1 percent of income earners.

When you subtract the cost of insurance premiums, the deductibles and the co-pays, most businesses and most people would pay less for national health care than they do today. Even if the cost did go up some, the coverage would be much broader and medical needs would be met much more easily.

What we are learning is that the United States is all alone among its peers in the whole world. This is the only country that treats health care as a commodity distributed according to ability to pay, rather than as a social service distributed according to medical need.

The challenge is to get fully informed citizens involved in changing things for the better.

DAVID ROSS STEVENS
Borden, Ind.

Mr. Stevens is a member of the Southern Indiana branch of Hoosiers for a Commonsense Health Plan (whose Kentucky counterpart can be reached at www.kyhealthcare.org).

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Learn About Prevention – Free Preventive Care and Services

You take your car in for a yearly smog check, change the battery in your kitchen�s smoke detector, and file your taxes. These are all things that keep your life running smoothly and help prevent problems before they start.

But what about you? Do you use health services to help prevent illness? Unfortunately Americans use preventive health services at about half the recommended rate, often because of cost concerns. This is dangerous to our health because chronic diseases such as heart disease, cancer, and diabetes are responsible for 7 of 10 deaths among Americans each year and are often preventable.

Now, under the Affordable Care Act, you and your family may be eligible for important preventive services� � �for free. If you or your family enrolled in a new health plan on or after September 23, 2010, then your plan is required to cover certain recommended preventive services without charging you a copay, co-insurance or deductible. This means wellness and prevention services are now free and more accessible for you and your family.

For example, you may now have access to free preventive services such as:

Blood pressure readings, cholesterol tests, and nutrition counselingMany cancer screenings, including mammograms and colonoscopiesFlu and pneumonia shotsRoutine vaccinations against diseases such as measles, hepatitis, and meningitis

For people enrolled in Medicare, you may now qualify for a yearly wellness exam and many preventive services for free.�� More than 150,000 seniors and others with Medicare have received an annual wellness visit. The health care law is bringing new preventive benefits while helping to cut costs for seniors and keep them healthy.

Please visit this page for a complete list of covered preventive services.� To learn more about what preventive services are recommended for you, please visit http://finder.healthcare.gov/.�

Health Care and Profits, a Poor Mix

Thirty years ago, Bonnie Svarstad and Chester Bond of the School of Pharmacy at the University of Wisconsin-Madison discovered an interesting pattern in the use of sedatives at nursing homes in the south of the state.

Patients entering church-affiliated nonprofit homes were prescribed drugs roughly as often as those entering profit-making �proprietary� institutions. But patients in proprietary homes received, on average, more than four times the dose of patients at nonprofits.

Writing about his colleagues� research in his 1988 book �The Nonprofit Economy,� the economist Burton Weisbrod provided a straightforward explanation: �differences in the pursuit of profit.� Sedatives are cheap, Mr. Weisbrod noted. �Less expensive than, say, giving special attention to more active patients who need to be kept busy.�

This behavior was hardly surprising. Hospitals run for profit are also less likely than nonprofit and government-run institutions to offer services like home health care and psychiatric emergency care, which are not as profitable as open-heart surgery.

A shareholder might even applaud the creativity with which profit-seeking institutions go about seeking profit. But the consequences of this pursuit might not be so great for other stakeholders in the system � patients, for instance. One study found that patients� mortality rates spiked when nonprofit hospitals switched to become profit-making, and their staff levels declined.

These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. They raise a broader, more important question: How much should we rely on the private sector to satisfy broad social needs?

From health to pensions to education, the United States relies on private enterprise more than pretty much every other advanced, industrial nation to provide essential social services. The government pays Medicare Advantage plans to deliver health care to aging Americans. It provides a tax break to encourage employers to cover workers under 65.

Businesses devote almost 6 percent of the nation�s economic output to pay for health insurance for their employees. This amounts to nine times similar private spending on health benefits across the Organization for Economic Cooperation and Development, on average. Private plans cover more than a third of pension benefits. The average for 30 countries in the O.E.C.D. is just over one-fifth.

We let the private sector handle tasks other countries would never dream of moving outside the government�s purview. Consider bail bondsmen and their rugged sidekicks, the bounty hunters.

American TV audiences may reminisce fondly about Lee Majors in �The Fall Guy� chasing bad guys in a souped-up GMC truck � a cheap way to get felons to court. People in most other nations see them as an undue commercial intrusion into the criminal justice system that discriminates against the poor.

Our reliance on private enterprise to provide the most essential services stems, in part, from a more narrow understanding of our collective responsibility to provide social goods. Private American health care has stood out for decades among industrial nations, where public universal coverage has long been considered a right of citizenship. But our faith in private solutions also draws on an ingrained belief that big government serves too many disparate objectives and must cater to too many conflicting interests to deliver services fairly and effectively.

Our trust appears undeserved, however. Our track record suggests that handing over responsibility for social goals to private enterprise is providing us with social goods of lower quality, distributed more inequitably and at a higher cost than if government delivered or paid for them directly.

The government�s most expensive housing support program � it will cost about $140 billion this year � is a tax break for individuals to buy homes on the private market.

According to the Tax Policy Center, this break will benefit only 20 percent of mostly well-to-do taxpayers, and most economists agree that it does nothing to further its purported goal of increasing homeownership. Tax breaks for private pensions also mostly benefit the wealthy. And 401(k) plans are riskier and costlier to administer than Social Security.

From the high administrative costs incurred by health insurers to screen out sick patients to the array of expensive treatments prescribed by doctors who earn more money for every treatment they provide, our private health care industry provides perhaps the clearest illustration of how the profit motive can send incentives astray.

By many objective measures, the mostly private American system delivers worse value for money than every other in the developed world. We spend nearly 18 percent of the nation�s economic output on health care and still manage to leave tens of millions of Americans without adequate access to care.

Britain gets universal coverage for 10 percent of gross domestic product. Germany and France for 12 percent. What�s more, our free market for health services produces no better health than the public health care systems in other advanced nations. On some measures � infant mortality, for instance � it does much worse.

In a way, private delivery of health care misleads Americans about the financial burdens they must bear to lead an adequate existence. If they were to consider the additional private spending on health care as a form of tax � an indispensable cost to live a healthy life � the nation�s tax bill would rise to about 31 percent from 25 percent of the nation�s G.D.P. � much closer to the 34 percent average across the O.E.C.D.

A quarter of a century ago, a belief swept across America that we could reduce the ballooning costs of the government�s health care entitlements just by handing over their management to the private sector. Private companies would have a strong incentive to identify and wipe out wasteful treatment. They could encourage healthy lifestyles among beneficiaries, lowering use of costly care. Competition for government contracts would keep the overall price down.

We now know this didn�t work as advertised. Competition wasn�t as robust as hoped. Health maintenance organizations didn�t keep costs in check, and they spent heavily on administration and screening to enroll only the healthiest, most profitable beneficiaries.

One study of Medicare spending found that the program saved no money by relying on H.M.O.�s. Another found that moving Medicaid recipients into H.M.O.�s increased the average cost per beneficiary by 12 percent with no improvement in the quality of care for the poor. Two years ago, President Obama�s health care law cut almost $150 billion from Medicare simply by reducing payments to private plans that provide similar care to plain vanilla Medicare at a higher cost.

Today, again, entitlements are at the center of the national debate. Our elected officials are consumed by slashing a budget deficit that is expected to balloon over coming decades. With both Democrats and Republicans unwilling to raise taxes on the middle class, the discussion is quickly boiling down to how deeply entitlements must be cut.

We may want to broaden the debate. The relevant question is how best we can serve our social needs at the lowest possible cost. One answer is that we have a lot of room to do better. Improving the delivery of social services like health care and pensions may be possible without increasing the burden on American families, simply by removing the profit motive from the equation.

White House Overwhelmed with Requests for Obama to Meet with “Mad as Hell Doctors” about Single Payer

The “Mad As Hell Doctors” from Oregon are making themselves heard at the Obama Administration with an email campaign that threatened to shut down the White House inbox.

The road-tripping, physician-activists from Oregon known as the “Mad As Hell Doctors” received a pressing call from the White House this week to demand they remove a letter on their website requesting a meeting with President Obama to discuss “the moral, social and fiscal imperative” of a single payer health care system. The reason for the call: too many emails from supporters have overwhelmed the White House inbox.

Adam Klugman, National Creative Director for the Mad As Hell Doctors campaign and the person who received the call, puts it this way. “Chris Whitty from the White House Office of Scheduling called me and said that he has been ‘besieged with emails’ from within the millions of single payer supporters in this country who feel that Congress and the President have completely turned their back on them. It told him that it’s not our campaign that’s applying pressure. It’s the people. I also told him that we’d be glad to take the letter down, just as soon as the President agrees to meet with us.”

When Dr. Paul Hochfeld, an E.R. physician from Corvallis, Oregon and a fellow Mad As Hell Doctor, heard about the call he was encouraged. “Getting a phone call like this from the White House means it’s working. They hear us. They know we’re here. And now they know that we speak for much of the Single Payer Nation who absolutely deserve to be heard on this issue. The only question is, will the White House listen?”

“We have to keep putting pressure on the White House,” says Klugman. “We’re getting through to the people who make the decisions. That means it is critical that all of us intensify the letter writing campaign. Single payer supporters need to log on to our website, go the ‘Letter to Obama’ page and fill out the support letter today. It’s obviously working but we’ve got to step it up.”

Supporters can log on at www.MadAsHellDoctors.com to find out more.

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Texas Slow To Review Health Insurance Rate Hikes

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Looking Ahead to 2014: Competitive Affordable Insurance Marketplaces

Since the Affordable Care Act was signed last year, reforms have given Americans new rights and benefits by ending lifetime limits, allowing young adults to stay on their parent�s health plan until age 26, and giving many patients access to recommended preventive services without cost-sharing. These are among the many other benefits Americans across the country are accessing on a daily basis.

Yet too many individuals and small businesses still struggle to provide their families and employees with quality, affordable health care. But, all of that is coming to an end.

Today, we are entering the next phase in implementing the health reform law. The Department of Health and Human Services (HHS) announced a proposed framework to assist states in building Affordable Insurance Exchanges.

Exchanges are State-based competitive marketplaces where individuals and small businesses will be able to purchase affordable private health insurance and have the same insurance choices as Members of Congress. Insurance companies will compete for business on a transparent, level playing field, driving down costs. Exchanges will have the same purchasing clout as big businesses and will give consumers a choice of plans to fit their needs.

To learn more about Exchanges, go to www.Healthcare.gov/law/features/choices/exchanges/.

Together, states and the federal government are partnering to build these improved markets and help Americans get and keep the health coverage that is right for them. An Exchange can help you:

Look for and compare health plansGet answers to questions about your health coverage optionsFind out if you�re eligible for health programs or tax credits that make coverage more affordableEnroll in a health plan that meets your needs

HHS proposed new rules offering States guidance and options on how to structure their Exchanges in two key areas:

Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange, and;Ensuring premium stability for plans and enrollees in the Exchange, especially in the early years as new people come in to Exchanges to shop for health insurance

These proposed rules set minimum standards for Exchanges, give States the flexibility they need to design Exchanges that best fit their unique insurance markets, and are consistent with steps States have already taken to move forward with Exchanges.

We look forward to 2014 when consumers are able to access quality health insurance on a level playing field.

For more information, visit www.Healthcare.gov/law/features/choices/exchanges/.

View the press release here.

Annie-Care: Providing Preventive Services to Patients in Community Health Centers

Annie Neasman, a nurse and chief executive of the Jessie Trice Community Health Center in Miami, FL., recently shared with us her thoughts as she walks the hallways of the community health center and sees the people who are cared for there. Jessie Trice serves more than 30,000 people, who made more than 120,000 visits to the center last year. From pre-natal care to primary care for adults to special services for the elderly, the Jessie Trice Center provides care regardless of a person�s ability to pay.

Annie is proud of the health center�s efforts in keeping the residents of the community well. She says the Affordable Care Act, the health care reform law, has made it possible for so many more of them to get the preventive care they need to maintain their health and avoid worsening conditions.

�We have seen our Medicare population be able to go in and get preventive services without having to pay those co-payments and those deductibles,� she says. The Affordable Care Act �has impacted the lives of those individuals who now don�t have to wait because they don�t have the co-payment to get a mammogram � [or] those individuals who wait and say, �I�m not gonna go get that flu shot because it�s gonna cost me $20 up front.� And these have been real life stories � at the Jesse Trice Community Health Center.�

�The Affordable Care Act,� Annie says, �allows us to make sure that patients are treated early by being able to get preventive services and by treating patients early in a primary care setting and not going to the emergency room. In the long run that�s going to help all communities because the economic impact will be less.�

The community center is partly funded by grants in the Affordable Care Act.

Do you have a story like Annie�s? Share it at www.HealthCare.gov/MyCare.