Neil Davis on Sleep in Saturdays with Matt Want

Matt Want hosts a local talk show on 660-KFAR on Saturday mornings from 10 to 11 am, choosing a different topic each week. This Saturday's topic is the US health care system and Neil Davis has been invited to be on the show. You can call in with questions or ask for advice; the phone number is 907.458.8255 (458-TALK).

(Cross-posted on The Ester Republic blog)

Insuring the Uninsurable

In February's Dose of Reality, Davis looks at the some 60,000 Alaskans who are refused health insurance by the for-profit industry and the alternative they are provided by the state: health insurance so expensive that almost no one has purchased it:

The cheapest ACHIA policy is a PPO plan with a deductible of $15,000 and maximum out-of-pocket expense of $25,000. A person twenty-five years old can buy this policy for $1,848 per year, but it costs a sixty-year-old person $6,384. Each of those persons is at risk for another $25,000, the out-of-pocket maximum, and each will have to pay the $15,000 deductible before receiving any benefit whatsoever from the policy. Thus the twenty-five-year-old will pay out only $1,848 for health care if he needs no health care during the year (all money goes to policy premiums) but at worst he might have to pay out another $25,000 for the health care he needs before the policy covers all costs thereafter. Thus, his worst-case expenses are $26,848 per year.

How many 25-year-olds can afford $15,000 in deductibles?

The Health Care Reform War Opens

Democrats fired the opening shot of the Health Care Reform War in January with the introduction of a bill to allow Medicare to negotiate prescription drug prices with the pharmaceutical industry. Introduced in both the House and Senate, the Medicare Prescription Drug Savings and Choice Act of 2009 (H. R. 684) negates provisions of the Bush administration’s Medicare Prescription Drug Improvement and Modernization Act of 2003 that prevented such negotiations.

If the bill becomes law, Medicare will have the same power to negotiate as the Veterans Administration. That organization is able to buy pharmaceuticals for little over half what the Medicare D insurers pay. Consequently it is expected that major savings will accrue to both taxpayers and Medicare beneficiaries, perhaps as much as $40 billion annually.

Very likely, as with the stimulus package legislation just enacted, the passage of this legislation will shape up as a partisan battle. Our Senator Begich surely will vote for it, but the Republicans in Congress probably will stand almost unanimously against passage in order to protect pharmaceutical and insurance industry profits. Alaskans should watch how Senator Murkowski and Representative Young vote on this issue. It is an opportunity for them to display their true colors; are they on the side of the taxpaying public, or are they on the side of the for-profit insurance and pharmaceutical industries? There is no in-between on this one.

A pseudo-solution

In the latest Dose of Reality, Davis discusses the results of a recent study by Families USA:

Overall, it’s not a very pretty picture. Health insurance premiums for Alaskans increased 73.6 percent from 2000 to 2007. That increase is 5.7 times higher than the rise in median salaries, and to make matters even worse, out-of-pocket costs for health care not covered by health insurance also substantially increased.

Alaska Dispatch has a recent article on this same problem.

However, says Davis,

The public is starting to understand that the situation cannot continue in this direction, but only a portion of the public comprehends that the trend can be reversed by instituting a single-payer health care system. The health insurance industry is ahead of the public on this issue, and is very worried that increasing health insurance costs might actually drive the country into establishing a single-payer system that would put the industry out of business.…

Hoping to fight any reform disadvantageous to itself, the health insurance industry is going on the offensive. Its trade organization, America’s Health Insurance Plans…announced a self-seeking health care reform proposal designed to maintain the industry in the profitable lifestyle to which it has become accustomed.

The gist of the proposal is that the industry will agree to insure everybody—even those with pre-existing health conditions, but that the American taxpayer will pick up a big portion of the bill. In short, it is a bail-out akin to that now being given to the financial and auto industries. However, this one will not be a one-time grant, but rather a subsidy that will last forever.

Medicare for all: 2.6 million new jobs

According to the California Nurses Association, in a press release dated January 14, a single-payer health care system would:

• Create 2,613,495 million new permanent good-paying jobs (slightly exceeding the number of jobs lost in 2008)
• Boost the economy with $317 billion in increased business and public revenues
• Add $100 billion in employee compensation
• Infuse public budgets with $44 billion in new tax revenues

This is according to a study (be forewarned, it's a 39-page PDF) conducted by the Institute for Health and Socio-Economic Policy (a research arm of the CNA).

If the English can do it, why can't we?

December's Dose of Reality describes how the United Kingdom, which truly does have socialized medicine, continues to improve their system. In the United States, we have a serious shortage of primary care physicians. Yet, primary health care is vital to the wellbeing of a nation's population, and to keeping the costs of that health care down: nip a disease in the bud, or prevent its occurence in the first place, and it's a lot less expensive for everybody concerned. So the UK is taking a sensible approach:

The new emphasis on primary care in the United Kingdom follows two paths. One tactic is to use modern technology to maintain each patient’s lifelong health record; it details each visit to a primary doctor or specialist, lab results, and any treatment and medication received. That allows both the primary doctors and the specialists to easily download the information when needed, and thereby serve the patients better. The second approach is to make more use of interdisciplinary teams for taking care of patients in ways that maximize care and best utilize medical talents.

One consequence is that nurses are taking on an increasing proportion of the work. They may be the first to see patients with minor illnesses, and they are assuming more responsibility for routine management of chronic diseases. Another is that the role of the primary doctor is being emphasized to the extent that primary care doctors are making more money. Paid by a combination of risk-adjusted capitation and a 25 percent additional amount for performance, primary care doctors in the United Kingdom now have average annual earnings of $220,000. The average annual income of a primary care doctor in the United States is far less, about $150,000.

So the question is, if the UK can not only afford to improve health care but also increase doctors' salaries while at the same time reducing overall costs, why can't we? (Hint: they have universal health care and we don't.)

93 cosponsors for HR 676

The number of cosponsors for this legislation has crept up in the last Congress, to 93. The list below, in alphabetical order by co-sponsor, shows the date at which the representative signed on to this important legislation:

Rep Abercrombie, Neil [HI-1] - 1/24/2007
Rep Baca, Joe [CA-43] - 9/17/2007
Rep Baldwin, Tammy [WI-2] - 1/24/2007
Rep Becerra, Xavier [CA-31] - 6/13/2007
Rep Berman, Howard L. [CA-28] - 6/15/2007
Rep Bishop, Sanford D., Jr. [GA-2] - 12/11/2007
Rep Brady, Robert A. [PA-1] - 2/27/2007
Rep Brown, Corrine [FL-3] - 4/17/2007
Rep Capuano, Michael E. [MA-8] - 11/9/2007
Rep Carson, Andre [IN-7] - 7/10/2008
Rep Carson, Julia [IN-7] - 1/24/2007
Rep Christensen, Donna M. [VI] - 1/24/2007
Rep Clarke, Yvette D. [NY-11] - 2/16/2007
Rep Clay, Wm. Lacy [MO-1] - 1/24/2007
Rep Cleaver, Emanuel [MO-5] - 4/22/2008
Rep Clyburn, James E. [SC-6] - 4/24/2008
Rep Cohen, Steve [TN-9] - 2/7/2007
Rep Cummings, Elijah E. [MD-7] - 1/24/2007
Rep Davis, Danny K. [IL-7] - 1/24/2007
Rep Delahunt, William D. [MA-10] - 2/12/2007
Rep Doyle, Michael F. [PA-14] - 3/21/2007
Rep Edwards, Donna F. [MD-4] - 9/29/2008
Rep Ellison, Keith [MN-5] - 1/24/2007
Rep Engel, Eliot L. [NY-17] - 1/24/2007
Rep Farr, Sam [CA-17] - 1/24/2007
Rep Fattah, Chaka [PA-2] - 1/24/2007
Rep Filner, Bob [CA-51] - 1/24/2007
Rep Frank, Barney [MA-4] - 3/7/2007
Rep Green, Al [TX-9] - 1/24/2007
Rep Grijalva, Raul M. [AZ-7] - 1/24/2007
Rep Gutierrez, Luis V. [IL-4] - 1/24/2007
Rep Hare, Phil [IL-17] - 4/30/2007
Rep Hastings, Alcee L. [FL-23] - 1/29/2007
Rep Hinchey, Maurice D. [NY-22] - 1/24/2007
Rep Hirono, Mazie K. [HI-2] - 7/23/2007
Rep Holt, Rush D. [NJ-12] - 9/18/2008
Rep Honda, Michael M. [CA-15] - 1/24/2007
Rep Jackson, Jesse L., Jr. [IL-2] - 1/24/2007
Rep Jackson-Lee, Sheila [TX-18] - 1/24/2007
Rep Jefferson, William J. [LA-2] - 6/26/2007
Rep Johnson, Eddie Bernice [TX-30] - 1/24/2007
Rep Johnson, Henry C. "Hank," Jr. [GA-4] - 2/13/2007
Rep Jones, Stephanie Tubbs [OH-11] - 5/23/2007
Rep Kaptur, Marcy [OH-9] - 2/12/2007
Rep Kennedy, Patrick J. [RI-1] - 9/24/2007
Rep Kildee, Dale E. [MI-5] - 4/17/2007
Rep Kilpatrick, Carolyn C. [MI-13] - 1/24/2007
Rep Kucinich, Dennis J. [OH-10] - 1/24/2007
Rep Lantos, Tom [CA-12] - 10/1/2007
Rep Lee, Barbara [CA-9] - 1/24/2007
Rep Lewis, John [GA-5] - 1/24/2007
Rep Loebsack, David [IA-2] - 1/24/2007
Rep Lynch, Stephen F. [MA-9] - 10/9/2007
Rep Maloney, Carolyn B. [NY-14] - 1/29/2007
Rep McDermott, Jim [WA-7] - 1/24/2007
Rep McGovern, James P. [MA-3] - 1/24/2007
Rep McNulty, Michael R. [NY-21] - 1/24/2007
Rep Meehan, Martin T. [MA-5] - 1/24/2007
Rep Meeks, Gregory W. [NY-6] - 9/20/2007
Rep Miller, George [CA-7] - 1/24/2007
Rep Moore, Gwen [WI-4] - 1/24/2007
Rep Moran, James P. [VA-8] - 1/22/2008
Rep Nadler, Jerrold [NY-8] - 1/29/2007
Rep Napolitano, Grace F. [CA-38] - 2/27/2007
Rep Norton, Eleanor Holmes [DC] - 3/21/2007
Rep Olver, John W. [MA-1] - 2/16/2007
Rep Pastor, Ed [AZ-4] - 1/24/2007
Rep Payne, Donald M. [NJ-10] - 1/24/2007
Rep Rangel, Charles B. [NY-15] - 1/24/2007
Rep Richardson, Laura [CA-37] - 9/20/2007
Rep Roybal-Allard, Lucille [CA-34] - 1/24/2007
Rep Rush, Bobby L. [IL-1] - 2/6/2007
Rep Ryan, Tim [OH-17] - 5/8/2007
Rep Sanchez, Linda T. [CA-39] - 4/23/2007
Rep Sanchez, Loretta [CA-47] - 9/20/2007
Rep Schakowsky, Janice D. [IL-9] - 4/17/2007
Rep Scott, David [GA-13] - 9/20/2007
Rep Scott, Robert C. "Bobby" [VA-3] - 1/24/2007
Rep Serrano, Jose E. [NY-16] - 2/7/2007
Rep Solis, Hilda L. [CA-32] - 2/12/2007
Rep Sutton, Betty [OH-13] - 3/27/2007
Rep Thompson, Bennie G. [MS-2] - 6/12/2007
Rep Tierney, John F. [MA-6] - 9/6/2007
Rep Towns, Edolphus [NY-10] - 1/24/2007
Rep Udall, Tom [NM-3] - 2/27/2007
Rep Waters, Maxine [CA-35] - 1/29/2007
Rep Watson, Diane E. [CA-33] - 1/24/2007
Rep Weiner, Anthony D. [NY-9] - 1/24/2007
Rep Welch, Peter [VT] - 5/3/2007
Rep Wexler, Robert [FL-19] - 1/24/2007
Rep Woolsey, Lynn C. [CA-6] - 1/24/2007
Rep Wynn, Albert Russell [MD-4] - 1/24/2007
Rep Yarmuth, John A. [KY-3] - 2/27/2007

Those adding their names in 2008 were James Moran (VA), Emanuel Cleaver (MO), James Clyburn (SC), Andre Carson (IN), Rush Holt (NJ), and Donna Edwards (MD). Sponsor John Conyers has a frequently-updated list of endorsements and co-sponsors on his website.