Archive for the ‘Health care’ Category

A History of Overhauling Health Care – Interactive Feature – NYTimes.com.

Com todas as limitações da aprovada healthcare bill, a América tornou-se hoje mais justa. Não nos esqueçamos, contudo, que 15 milhões de americanos continuam excluídos, assim como um número incerto de indocumentados, e que o fundamentalismo neoliberal excluíu uma mais que necessária public option.

healthcareFear Strikes Out, by P. Krugman

How does US healthcare compare to the rest of the world?

Medicare (United States)

Michael’s Moore open letter to our Republican friends after last night’s health care vote

Yes We Can ! E. U. A. – França

Vodpod videos no longer available.

Read Full Post »

A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation’s health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from “integrated” systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

Yet Obama is not prepared to grasp the nettle. His speech was even weaker than the spin preceding the joint address to Congress suggested. I thought the Obama people were lowering expectations with a view toward a big positive surprise and they managed to go even lower than the bar they set. He took caricatured positions on single payer in order to create a false “centrist” option. The President has basically has reduced the public option to a marginal welfare style program for 5% of the population, rather than seeing it as a way to break the monopoly of the private health insurance companies, thereby helping to reduce costs. He’s basically forcing everybody into a private health insurance run program.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. The Obama Admininstration remains under the influence of the health insurance and pharmaceutical industry lobbyists, and is captive to a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.

We need affordable health care, not health insurance. Just look what is happening in MA. It’s not solving the problem at all, because there was no mechanism introduced to REDUCE HEALTH INSURANCE COSTS. Physicians for a National Health Program’s (PNHP) study of the Massachusetts model found that the state’s 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics:

“We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits — all at the expense of American consumers,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “Massachusetts’ failed attempt at reform is little more than a repeat of experiments that haven’t worked in other states. To repeat that model on a national scale would be nothing short of Einstein’s definition of insanity.”

Yet Massachusetts seems to be the implicit model. Despite the obvious popularity of Medicare, there was no serious discussion of expanding it as a possible public health care option (as we had suggested earlier) and there was no attempt to use the public option as a means of expanding choice and competition if a worker was unhappy with the health care program offered by his employer.

The Clinton health care version at least tried to deal with the issue of portability, so that health care did not get tied in directly to employment (a highly germane consideration in a time of double digit unemployment and mounting economic insecurity). There is no hint of that in the Obama plan. If anything, it represented a retrograde step from what was on offer in last year’s campaign via the Clinton or Edwards health care proposals. Most advanced countries have dealt with the defects of private health insurance in a straightforward way, by making health insurance a government service. Through Medicare, the United States has in effect done the same thing for its seniors. We get the status quo. The paucity of imagination of the proposals themselves were completely at variance with the President’s soaring rhetoric, something which is unfortunately becoming a recurrent theme of the entire Obama Presidency.


Read Full Post »

That was a great speech, as usual. It left people energized. It sounded like he’s going to take the fight to the other guys. Obama knocks it out of the park again.

So, why do I have to be bah humbug about this again? Because the speech went almost exactly as predicted. Great rhetorical flourishes, but did anyone hear him say that he was definitely going to fight for the public option? No.

I said before the speech that he would say very good things about the public option. That was never the question. He is savvy enough to know that he can’t say something negative about it when he has promised it over and over in the past and that his base is obviously very animated about it. In fact, I think he means what he says – he really does believe in the public option. But again, that’s not the question. The question is whether he would draw the line on it. Tonight he did the opposite.

He said it was a rigidly ideological position of the left to insist it must be in the bill. Here are the exact words he had for progressives on the public option:

“It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.”

He went on to say the public option would only apply to five percent of the population anyway, a clear attempt to diminish its importance. He mentioned co-ops as a good alternative. And he said vaguely that he will insist on some sort of “choice” for the consumer (“But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice.”). He didn’t say what choice that would be. That’s a long way away from insisting on the public option. In fact, an excellent case could be made that he is signaling a willingness to negotiate something less than the public option.

But he covered up those facts with so much praise for the public option that a lot of people left feeling like he was really in favor of it. Being in favor of it and insisting on it are two different things.

Look, I hate to do it to you. And I am positive a lot of people will be really pissed at me for being pessimistic after that lovely speech. They already are. We covered the speech live on our show and we were flooded with comments afterward saying that Obama proved me wrong by showing that he would fight for the public option. I still have hope, and his position might harden in favor of that option as we move forward, but that is not what he said tonight.

I don’t want people to get me wrong. It was a great speech. I loved the way he finally went after the Republicans in a forceful way. He made clear and convincing arguments for nearly every provision in his proposal, including the public option. He did a great job of pointing out the other important parts of the bill – getting rid of the practices of denying coverage because of pre-existing conditions and rescission.

The reason I bring up my criticism here is because we can’t afford to let up (also, simply because it is true). If you think it’s enough for Obama to say he wants the public option, you’re not right. He has to go to battle for it – and in the end, there is no way around it – he has to insist it’s in the bill when the Republicans, the lobbyists and health care industry fight him tooth and nail on it.

Unfortunately, we do not have nearly enough evidence that he will do that. We must continue to push him in that direction. If we don’t, then it will be just as much our fault as his for not getting it done. The other side never lets up. They never stop pushing. If we do, then we still haven’t learned the political realities of Washington. So, it’s more important than ever not to get seduced by just appealing words. We must demand action.

Cenk Uygur: The Problem with Obama’s Speech.

Read Full Post »

Vodpod videos no longer available.

Read Full Post »

Hoping for audacity

Hoping for audacity President Obama will give his big health-care speech tomorrow. Let’s hope he does it right.What does that mean? It means not playing professor; it means not having the speech read as if it were written by a committee like that woefully weak op-ed in the Times a couple of weeks back; it means showing real passion about health care, which has been sadly lacking so far.I, for one, won’t be obsessing about exactly which pieces of proposed reform he emphasizes — because that’s not what’s driving the politics. Americans haven’t become skeptical about Obamacare because they’d rather shave an extra $30 billion a year off the cost; they have not, contrary to “centrist” fantasies, been turned off by the details of the stimulus plan or cap-and-trade. What has been missing is a vision. And this is probably the last chance to supply that vision.

Full article at Paul Krugman Blog – NYTimes.com

Read Full Post »

UnitedHealth Group Inc., the largest U.S. health insurer, last month reported that its second quarter profit more than doubled to $859 million, while its revenues surged 79% even as enrollments fell. In other words, the company made more money from fewer people. Not every health insurer had such strong results, but a look at recent second quarter earnings reports shows that most continue to earn large profits even as the economy stagnates and tens of millions of Americans go without health insurance.

The comments these insurance company executives made to Wall Street offer an enlightening account of how they plan to grow their profits and how attention to the bottom line trumps their ostensible mission of providing affordable health care to all Americans. This view was articulated most clearly by Aetna Inc. CEO Ron Williams, who said on a conference call with industry analysts, “We would be willing to forgo membership growth if necessary. We have a clear bias toward profitability over growth.”

Because each health insurer has a unique mix of medical, dental, and prescription drug operations as well as different combinations of Medicare, Medicaid, and employer-sponsored enrollees, each has its own strong points and problem areas. What unites them all is a determination to profit from whatever economic trends emerge in the future. This is, of course, to be expected from publicly-traded companies with a legal responsibility to maximize earnings to shareholders. It does, however, illustrate how efforts to profit from health care can be inherently at odds with making health care widely available and affordable. These two cross purposes become most apparent when the health industry addresses the financial community.

Some highlights:

More cutbacks in coverage are on the table. Aetna, which earned a $347 million profit in the latest quarter but saw earnings drop 28% from year-ago levels, told Wall Street analysts that “provider behavior changes” contributed to the increased costs that resulted in lower profits. “While this behavior seems generally permissible under current reimbursement arrangements, it does deviate from prior practices,” said CEO Ron Williams. “It’s being addressed.”

Higher costs are causing many people to drop their insurance. Most people know this, but when the trend is confirmed by the very business selling the insurance, it carries more weight.  Coventry Health CEO Allen Wise recently told Wall Street analysts that the company started a proactive “pricing push” in the beginning of 2008. While the pricing push itself was successful, Wise said, “We paid a real price with renewals.”

By insurers’ own admission, lack of health insurance contributes to higher medical costs. Asked whether new enrollees who had picked up coverage after a period of being uninsured had contributed to higher costs, Aetna’s Williams concurred. “We always see that pressure to some degree of people coming in from being uninsured, and we factor that into our rates,” he said. (EPI research has addressed the costly problem of people churning in and out of coverage, pointing out that even people who do have employer-sponsored insurance frequently spend part of a year uninsured because of job changes).

Many unemployed can’t afford COBRA. United Healthcare’s Helmsley said the company’s COBRA take-up rates – the portion of enrollees who had retained their insurance by paying all the costs out of pocket after losing a job – were “roughly in the 20% range.” Translation: the majority of people who left their jobs did not keep their insurance. A new study shows government subsidies provided under the Recovery Act have made COBRA affordable for more laid-off workers, but many continue to decline coverage. (A recent EPI analysis shows how COBRA is prohibitively costly for many Americans, and even with the subsidy, represent a high portion of unemployment benefits).

Even as they protest the creation of a public health insurance option, many insurers profit from rising unemployment and increased Medicaid and Medicare enrollment. “Every 1% rise in unemployment is somewhere around 50,000 additional lives that are added to our books,” said UnitedHealth’s Helmsley. He added: “We expect this year’s revenue growth in public and senior business to continue to more than offset the potential for further pressure in the employers’ market.” Insurer Humana Inc. has reaped huge profits from its Medicare business, which has also helped offset declining enrollments and cost pressures in its commercial business.

Cost cutting is planned to achieve further growth in the face of worsening economy. Cigna Inc grew its second quarter profit to $313 million from $303 million last year and continues to target a $1 billion operating profit for all of 2009, despite a tough combination of rising costs and declining enrollment. In a conference call, Cigna executives said they expected unemployment to rise to between 10.5% and 12% by year end, resulting in a membership decline of 5% to 5.5%. They said they would cut costs and outsource certain operations to keep profit projections on track.

Pharmaceuticals remain hugely profitable. Earnings at UnitedHealth’s prescription drug benefit unit grew 77% in the latest quarter.

via Health insurance providers find ways to prosper as more people lose coverage.

Read Full Post »

Read Full Post »

BLAME it on the weather or the silly-season absence of more serious news, but arguments about America’s health care have become a touch delirious over the past couple of weeks. People have accused each other of being evil-mongers, dealers in death or even un-American; a sad substitute for a thoughtful debate about a complicated subject that intimately affects every citizen and ties up some $2 trillion a year, a seventh of the world’s largest economy.

Now the distemper has spread across the Atlantic. The enemies of Barack Obama’s health-reform plans have no more potent weapon, it seems, than to accuse him of seeking to replicate Britain’s dreaded National Health Service on American soil. Even David Cameron has been dragged into the affair. An unhelpful Conservative MEP has been caught joining in the NHS-bashing in America, leading to the predictable and unfair charge that Mr Cameron’s henchmen are secretly bent on unravelling the system.

Complete article in American health care: Keep it honest | The Economist.

Read Full Post »

At a time when we Americans may abandon health care reform because it supposedly is “too expensive,” how is it that we can afford to imprison people like Curtis Wilkerson?

Mr. Wilkerson is serving a life sentence in California — for stealing a $2.50 pair of socks. As The Economist noted recently, he already had two offenses on his record (both for abetting robbery at age19), and so the “three strikes” law resulted in a life sentence.

This is unjust, of course. But considering that California spends almost $49,000 annually per prison inmate, it’s also an extraordinary waste of money.

Astonishingly, many politicians seem to think that we should lead the world in prisons, not in health care or education. The United States is anomalous among industrialized countries in the high proportion of people we incarcerate; likewise, we stand out in the high proportion of people who have no medical care — and partly as a result, our health care outcomes such as life expectancy and infant mortality are unusually poor.

It’s time for a fundamental re-evaluation of the criminal justice system, as legislation sponsored by Senator Jim Webb has called for, so that we’re no longer squandering money that would be far better spent on education or health. Consider a few facts:

¶The United States incarcerates people at nearly five times the world average. Of those sentenced to state prisons, 82 percent were convicted of nonviolent crimes, according to one study.

¶California spends $216,000 annually on each inmate in the juvenile justice system. In contrast, it spends only $8,000 on each child attending the troubled Oakland public school system, according to the Urban Strategies Council.

¶For most of American history, we had incarceration rates similar to those in other countries. Then with the “war on drugs” and the focus on law and order in the 1970s, incarceration rates soared.

¶One in 10 black men ages 25 to 29 were imprisoned last year, partly because possession of crack cocaine (disproportionately used in black communities) draws sentences equivalent to having 100 times as much powder cocaine. Black men in the United States have a 32 percent chance of serving time in prison at some point in their lives, according to the Sentencing Project.

Look, there’s no doubt that many people in prison are cold-blooded monsters who deserve to be there. But over all, in a time of limited resources, we’re overinvesting in prisons and underinvesting in schools.

Indeed, education spending may reduce the need for incarceration. The evidence on this isn’t conclusive, but it’s noteworthy that graduates of the Perry Preschool program in Michigan, an intensive effort for disadvantaged children in the 1960s, were some 40 percent less likely to be arrested than those in a control group.

Above all, it’s time for a rethink of our drug policy. The point is not to surrender to narcotics, but to learn from our approach to both tobacco and alcohol. Over time, we have developed public health strategies that have been quite successful in reducing the harm from smoking and drinking.

If we want to try a public health approach to drugs, we could learn from Portugal. In 2001, it decriminalized the possession of all drugs for personal use. Ordinary drug users can still be required to participate in a treatment program, but they are no longer dispatched to jail.

“Decriminalization has had no adverse effect on drug usage rates in Portugal,” notes a report this year from the Cato Institute. It notes that drug use appears to be lower in Portugal than in most other European countries, and that Portuguese public opinion is strongly behind this approach.

A new United Nations study, World Drug Report 2009, commends the Portuguese experiment and urges countries to continue to pursue traffickers while largely avoiding imprisoning users. Instead, it suggests that users, particularly addicts, should get treatment.

Senator Webb has introduced legislation that would create a national commission to investigate criminal justice issues — for such a commission may be the best way to depoliticize the issue and give feckless politicians the cover they need to institute changes.

“There are only two possibilities here,” Mr. Webb said in introducing his bill, noting that America imprisons so many more people than other countries. “Either we have the most evil people on earth living in the United States, or we are doing something dramatically wrong in terms of how we approach the issue of criminal justice.”

Opponents of universal health care and early childhood education say we can’t afford them. Granted, deficits are a real constraint and we can’t do everything, and prison reform won’t come near to fully financing health care reform. Still, would we rather use scarce resources to educate children and heal the sick, or to imprison people because they used drugs or stole a pair of socks?

Op-Ed Columnist – NICHOLAS D. KRISTOF- Priority Test – Health Care or Prisons? – NYTimes.com

Read Full Post »

“Or a carton of milk, or a loaf of bread.

Both George Will and Greg Mankiw basically argue that we don’t need a government role because we can trust the market to work — hey, we do it for groceries, right?

Um, economists have known for 45 years — ever since Kenneth Arrow’s seminal paper — that the standard competitive market model just doesn’t work for health care: adverse selection and moral hazard are so central to the enterprise that nobody, nobody expects free-market principles to be enough. To act all wide-eyed and innocent about these problems at this late date is either remarkably ignorant or simply disingenuous.”

Paul Krugman Blog – NYTimes.com

Read Full Post »