What healthcare crisis?

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Registered: 06-17-2004
What healthcare crisis?
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Sat, 09-25-2004 - 10:57pm

What Health Insurance Crisis?
August 29, 2004


http://www.manhattan-institute.org/html/_latimes-what_health.htm


By David Gratzer


Who and where are the 45 million Americans that the Census Bureau found without health insurance? With little fanfare last year, the BlueCross BlueShield Assn. released a report based in part on analyzing the Census Bureau data. Its findings may surprise some.

A full 16% of the uninsured, the study found, have incomes above $75,000 a year and could obviously afford insurance if they chose to buy it. Roughly a third of those lacking insurance earn $50,000 a year or more.

You may think that a poor single mom with three children living in South-Central Los Angeles is among the uninsured, but in fact, she is eligible for Medicaid, as are her children. The BlueCross BlueShield study notes that 1 in 3 of the uninsured are eligible for — but not enrolled in — a government-sponsored health program. Because Medicaid and children's health programs allow patients to be signed up literally in the ER, these individuals could be covered; they just choose not to do the paperwork.

And of the remaining uninsured, 6 million lack insurance for only a few months.

The bottom line: About 8.2 million Americans, not 45 million, are chronically uninsured and low-income. And they are the working poor. They have jobs but, because of the high cost of insurance, no coverage.

In some ways, of course, even they are covered. In the event of a disaster, they can find care in emergency rooms . They are thus covered for their heart attacks, car accidents and strokes. For the most part, the care will be excellent and very likely free; the expenses are written off or, perhaps, buried in the bills of those with insurance. But when it comes to more routine care — basic primary and preventive care — too many go without. It's these individuals that need the most attention. After all, the chronically uninsured often have no choice.

Why? Insurance is expensive. For middle-class Americans, though, paying a few thousand dollars a year for a simple plan isn't an obstacle. But what of the minimum-wage earner? Yet rather than working to ensure less expensive insurance, state governments have done the opposite. "Iatrogenic" is the term doctors use to describe a simple phenomenon — when the medical profession causes the patient's problem. What do we make of politicians whose policies end up hurting the very people they are aimed at helping?

That is exactly what politicians did in the 1990s. In an attempt to make health insurance more equitable and fair, regulation after regulation was added to the books. Many states now dictate what health insurance must cover (including pastoral counseling in Vermont), who must be covered and at what price. In New Jersey, according to the Coalition Against Guaranteed Issue, it now costs more to purchase a family health policy than to lease a Ferrari. That millions of people lack insurance isn't surprising: Millions of Americans would lack clothes too, if governments insisted that we shop only at Saks.

What, then, to do about the uninsured? Both the president and his Democratic challenger have ideas — and both miss the point. President Bush wants to give every uninsured person a tax credit for $1,000 to help with the cost of coverage. The plan offers too much help to those who don't need it and does too little for the working poor. Sen. John F. Kerry has an expensive and complex plan that ultimately will create even more regulations and government control.

State regulations have crippled insurance choices and driven up the cost of coverage in many jurisdictions. Washington can address this by allowing people the option of buying insurance from insurers that are registered in states other than the one in which they live. By shopping around, uninsured Americans could find a low-regulation (and thus low-cost) state in which to buy coverage.

Second, make smarter use of the money already spent on the uninsured. According to a recent study published in Health Affairs, the government spends almost $35 billion a year providing care to those lacking coverage. Because these programs primarily fund emergency care provided by hospitals rather than insurance, they end up serving hospitals' interests more than patient health.

Here's an alternative: Washington should offer states block funding (using welfare reform as a model) and allow them to experiment with coverage options. Some states would spend the money on the people who need it most: the chronically uninsured. By not focusing on the higher-income uninsured, or those eligible for government insurance, a state-created voucher program could potentially offer thousands of dollars per person for coverage — enough to buy insurance in any state in the nation.

There are, of course, numerous issues to work out, but this much is clear: A small number of Americans are in need, and a large amount is already spent.

David Gratzer, a physician, is a senior fellow at the Manhattan Institute.

Renee ~~~

Renee ~~~

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iVillage Member
Registered: 11-11-1999
Sun, 09-26-2004 - 12:03am
Survey Shows Private Health Insurance Premiums Rose 11.2% in 2004




Premiums Increased at Five Times The Rate of Growth in Workers’ Earnings and Inflation



About Five Million Fewer Workers Covered By Their Own Employer’s Health Insurance Since 2001



Washington, DC – Employer-sponsored health insurance premiums increased an average of 11.2% in 2004 -- less than last year’s 13.9% increase, but still the fourth consecutive year of double-digit growth, according to the 2004 Annual Employer Health Benefits Survey released by the Kaiser Family Foundation and Health Research and Educational Trust (HRET). Premiums for employer-sponsored health insurance rose at about five times the rate of inflation (2.3%) and workers’ earnings (2.2%).



In 2004, premiums reached an average of $9,950 annually for family coverage ($829 per month) and $3,695 ($308 per month) for single coverage, according to the new survey. Family premiums for PPOs, which cover most workers, rose to $10,217 annually ($851 per month) in 2004, up significantly from $9,317 annually ($776 per month) in 2003. Since 2000, premiums for family coverage have risen 59%.



The survey also found that the percentage of all workers receiving health coverage from their employer in 2004 is 61%, about the same as in 2003 (62%) but down significantly from the recent peak of 65% in 2001. As a consequence, there are at least 5 million fewer jobs providing health insurance in 2004 than 2001. A likely contributing factor is a decline in the percentage of small employers (three to 199 workers) offering health insurance over this period. In 2004, 63% of all small firms offer health benefits to their workers, down from 68% in 2001.



“The cost of family health insurance is rapidly approaching the gross earnings of a full-time minimum wage worker,” said Drew Altman, President and CEO of the Kaiser Family Foundation. “If these trends continue, workers and employers will find it increasingly difficult to pay for family health coverage and every year the share of Americans who have employer-sponsored health coverage will fall.”



“Since 2000, the cost of health insurance has risen 59 percent, while workers wages have increased only 12 percent. Since 2001, employee contributions increased 57 percent for single coverage and 49 percent for family coverage, while workers wages have increased only 12 percent. This is why fewer small employers are offering coverage, and why fewer workers are taking-up coverage,” said Jon Gabel, vice president for Health Systems Studies at the Health Research and Educational Trust.



The survey was conducted between January and May of 2004 and included 3,017 randomly selected public and private firms with three or more employees (1,925 of which responded to the full survey and 1,092 of which responded to an additional question about offering coverage). This is the sixth year the joint survey was conducted by Kaiser and HRET, and the 17th year this survey has been conducted overall. Findings appear in the September/October issue of the journal Health Affairs

http://www.kff.org/insurance/chcm090904nr.cfm

dablacksox


Cynic: a blackguard whose faulty vision sees things as they are, not as they ought to be.---Ambrose Bierce, The Devil's Dictionary.

iVillage Member
Registered: 11-11-1999
Sun, 09-26-2004 - 12:08am
Words, Actions at Odds on Children's Health Care U.S. Poised to Take Back $1.1 Billion Despite Bush's Vow

By Ceci Connolly Washington Post Staff Writer Saturday, September 25, 2004; Page A05

In his convention address in New York, President Bush announced a new $1 billion initiative to enroll "millions of poor children" in two popular government health programs. But next week, the Bush administration plans to return $1.1 billion in unspent children's health funds to the U.S. Treasury, making his convention promise a financial wash at best.

The loss of $1.1 billion in federal money means six states participating in the State Children's Health Insurance Program face budget shortfalls in 2005; it is enough money to provide health coverage for 750,000 uninsured youngsters nationwide, according to two new analyses by advocacy organizations.

"If the Bush administration really cared about covering uninsured children, one of the things it could do immediately is make sure this $1 billion is used for SCHIP," said Debra Ness, president of the National Partnership for Women and Families. "The irony is this president talks constantly about not leaving any child behind and how he is going to cover so many kids. In truth, that ended up being false. He's just moving money around."

Over the objections of the National Governors Association and a bipartisan coalition of lawmakers, Bush opposes giving states more time to spend the money. In previous years he supported an extension, but he struck it from this year's proposed budget. Even if Bush belatedly endorses a bill extending the SCHIP spending deadline, it will come at a price: Congress is required to trim $1.1 billion elsewhere in the budget if it lets states keep the money.

SCHIP, created in 1997, is a federal-state initiative widely popular among public officials and the private sector that provides $40 billion in health care matching funds to states over 10 years. Despite its popularity, the most recent Census Bureau data show that 8.4 million American children remain uninsured, prompting Bush to declare his desire to enroll many more in SCHIP.

"America's children must have a healthy start in life," he said in his convention speech. "In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs. We will not allow a lack of attention, or information, to stand between these children and the health care they need."

The statement was one of the few new health ideas Bush has introduced in the 2004 campaign, and it sparked enthusiasm in social policy circles. Soon, however, state officials, budget analysts and children's advocates discovered there was no new money for SCHIP.

"When you do outreach, it doesn't help if there's no money to cover people," said Ron Pollack, whose liberal consumer group Families USA calculated the impact of the $1.1 billion reduction. Based on current formulas, that translates into coverage for 2,500 children in the District, 13,900 in Maryland and 6,600 in Virginia.

Initially, states had difficulty enrolling many of the millions of children eligible for the program. In some instances, language barriers or a parent's reluctance to register with the government prevented broad participation; in other cases states had devised complicated multi-page applications or were unwilling to spend their portion of the funds.

But SCHIP enrollment has steadily risen from fewer than 1 million in 1998 to the current 5.8 million, and most experts say states are depleting previous years' surpluses.

"SCHIP spending is now exceeding annual allotments," said Edwin Park, a senior health policy analyst at the Center on Budget and Policy Priorities. According to the center's analysis, six states will drain those surpluses this year if the $1.1 billion is returned to the Treasury as planned at midnight Sept. 30. By 2007, 17 states are projected to run out of money.

Kevin Keane, spokesman for the Department of Health and Human Services, said the vast majority of states estimate they cannot spend their entire 2005 federal allocation. If some states have shortfalls, he said, the HHS secretary can shift some funds. Keane said the administration views the president's new "Cover the Kids" campaign as an additional $1 billion for SCHIP. The money will be distributed over two years in grants to some states, community groups and religious organizations, he said.

"The president believes we need to try a new, community-based approach to enrolling children in SCHIP," Keane said. "The Cover the Kids campaign is his vision for more effectively reaching eligible children and getting them enrolled."

To Pollack, even the name of Bush's initiative is "extraordinarily disingenuous." For several years, he noted, the Robert Wood Johnson Foundation has run a 50-state outreach project called "Covering Kids and Families."

dablacksox


Cynic: a blackguard whose faulty vision sees things as they are, not as they ought to be.---Ambrose Bierce, The Devil's Dictionary.

iVillage Member
Registered: 08-07-2004
Sun, 09-26-2004 - 12:46am
David Gratzer is a Canadian, not a US citizen or even a resident. He wrote 2 books on Canadian health care that he's trying to sell. His website indicates he is available for speaking engagements. He joined the Manhattan Institute, a conservative think tank. He appears to be a self promoter.

He admits the US has 35 to 40 million uninsured in another interview, you can see it here;

http://www.davidgratzer.com/news/2000_07_31.php

It's news to me that you can sign up for medicaid in the ER. How would he know? He's not practicising medicine in the US. I'd like to talk to someone who has successfully done that.

iVillage Member
Registered: 03-27-2003
Sun, 09-26-2004 - 11:48am

What gets me is one of the reasons health care is soo expensive! The lawsuits. Doctor's have to pay a lot in mal-practice insurance to cover their butts. So in turn, they charge more. If the govenment did more to protect against frivolous lawsuits, that would help.


Yes, there are cases of negligence and I agree in those cases, but some of them are sooo stupid, and you know the person suing is just going for the wallet without a true case. But they have seen so many others do it, that they think they can.


They (the govt)

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~ ~ Follow your passion!:&n

iVillage Member
Registered: 07-05-2003
Sun, 09-26-2004 - 7:33pm
A few other things...life expectancy has risen, I also believe consumers now have higher expectations..we want things like breat reconstructions after cancer surgery, annual mammographies, soon to be follwed by obesity treatments. Where do people think the money comes from to pay all this?
iVillage Member
Registered: 08-05-2004
Sun, 09-26-2004 - 9:42pm
On the obesity treatments I wouldn't suggest it unless it was a health issue or something. If someone is using it as an easy way out then they don't need it and can easily diet and workout and just be more of an active and healthy person. I remember watching an MTV "True Life" thing on obseity and there was three different people who they featured. One was a woman who definietly needed the surgery and then there was a girl who was fine and didn't need anything but they featured how you don't have to be skinny to have a healthy and happy life and then they showed this guy who really didn't care and he ate so much and he tried to gain more weight so he'd be sure to get the treatment/surgery. His mother really tried to get him to change his diet and his attitude about dieting etc, but he just wanted an easy way out and he wasn't going to change his attitude or anything. Now something like that I don't agree with. Unless you have the money for it or something of course, then it's your money to blow it on stuff that you could fix without surgery. It'd just take time and effort. I'd rather use my money for paying bills, food, school, etc. XOXO.
Avatar for momeebear
iVillage Member
Registered: 03-25-2003
Sun, 09-26-2004 - 11:13pm
I don't know about reconstruction and/or obesity treatments (I'm guessing you mean the Roux-n-y, or "gastric bypass" surgery?), but wouldn't it be cost effective to provide annual mammography? You detect many cancers early that way, thereby avoiding the need for more expensive treatment (radiation, chemotherapy) later, if the cancer ISN'T caught in time.....just kind of thinking out loud here......

FYI, while I'm on the subject, October is breast cancer awareness month......

iVillage Member
Registered: 05-12-2004
Mon, 09-27-2004 - 12:52am
that study was paid for by none other than on of the largest health insurance companies in the United states. Does that tell you anything at all? Anyway I do believe that the mother of three that is mentioned is only elligible for medicaid if she is currently pregnant. It was that way in my state a last time I checked.

iVillage Member
Registered: 05-12-2004
Mon, 09-27-2004 - 1:23am
Simply not having insurance is only part of the crisis. Making a payment monthly that rivals your home loan payment is part of the crisis. Another part is being sent across the state by your insurance company to get your cancer radiation because your insurance will not cover it if you go to the hospital ten minutes away because it is across the river and in another state. Here's more crisis, youapy your insurance company to cover your drugs, then they begin to dictate what drugs you can take, they tell you you have to use generic, though generic has been proven less effetive, and the doses less regulated. When your insurance decides you need to use a general practicioner to have your baby instead of finding an obgyn in your area to add to their network. When your insurance will not cover pre-existing conditions, or will not cover any preventative medications or surgeries, though, your doctor feels it is necessary. When your insurnce fails to cover anything they have not heard of, or are able to buy bulk for. When people go through ten years of med school and an internship and work in ER for ten years, only to go into private practice and get pushed around by an insurance company because thier "on staff doctors" say Mrs. Jones does not need a hip replacement, becaus it is not cost effective.... That is a healthare crisis in my book.
iVillage Member
Registered: 07-05-2003
Mon, 09-27-2004 - 9:40am
Oh, I'm not saying things like mammograms do not have value...my point is that when you start adding more and more things to the list of items covered an increase in premiums is inevitable. Regarding obesity, we're not just talking about surgery, we're also talking about paying for the drugs to treat it, which was frequently not covered by private insurance.

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