Consumer Reports and Health Care

I suspect that almost all my readers have at some time turned to a reliable source for information about the safety, reliability, and value of a home appliance, a car, an electronic device, a computer, a packaged food product, or even a mutual fund. One such source stands out for its fairness, thoroughness, independence, and reliability: Consumer Reports, published by the Consumers Union. We know their ratings by the familiar circles:
On the other hand, we have also probably made choices based on a friend's preference, celebrity association, or what "a guy who knows a guy" said. Some of those choices have come back to bite us. That's why we learned to go to a reliable source.

So when the internet, the airwaves, the cable networks, and the water cooler talk is full of all kinds of ridiculous claims about health care reform, we need a place to turn. Some say the proposals will solve all our health care problems. Does anyone really believe that? Others say to adopt these proposals will set us on the path of becoming like Soviet Russia. That is also preposterous. So where can we go to hear from someone who is looking out for consumers? Glen Beck? Ken Olbermann? I don't think so. Both of them are trying to sell us something, to get their fingers in our wallets.

That's why when the Consumer Union provides a report on health care reform, I am interested. They are not trying to play with my emotions or trick me with a sleight of hand. They have in mind specific proposals that can help consumers, and others that can hurt us. They tell about both.

And the Consumers Union says that key elements of health care reform will make a big difference to help the masses of us who are drowning in rising health costs. Take a little time to look at what they say about requiring insurance companies to do things such as

• "Spend at least 85% of your premium on health care (at least 80% if you buy an individual policy or get your plan from a small employer), or rebate you the difference." That would stop them from robbing consumers to pay huge executive salaries.
• "Openly compete against each other for your business based on better care and price."
• "Clearly list what they charge, and what they cover, so you can easily comparison shop on the Internet."

They go on to say, "Of course, the industry is terrified that these controls will stop their greedy practices. Maybe that’s why they’ve been spending millions on lobbying and scary ads to make sure you don’t get these and other guaranteed benefits in the health reform bill." For specific information about how the current proposals will keep costs down, look at their paper on Oversight of Insurance Companies, Control Over Costs.

For more good information, go see their proposals about health care reform at their Consumer Reports Health website.

Isaiah and Economic Justice 5: Forcing People from Their Homes

Isaiah 5:8-10

Ah, you who join house to house,
...who add field to field,
until there is room for no one but you,
...and you are left to live alone
...in the midst of the land!
The Lord of hosts has sworn in my hearing:
Surely many houses shall be desolate,
...large and beautiful houses, without inhabitant.
For ten acres of vineyard shall yield but one bath,
...and a homer of seed shall yield a mere ephah.

The foreclosure crisis in which we are wallowing in our time is not the first one ever to happen. Isaiah brings it up as one of the main issues of economic injustice in his day. We know how the system works. Some people who have control of large amounts of money finance home construction and offer homebuyers mortgage loans by which they can move into a house before they can pay for it. If all does not go according to plan, the homebuyer may lose everything, including the home. All the while, the creditor was making money hand over fist from the interest on a long-term loan.

Mortgage loans and interest are not inherently evil. In a prosperous economy they can give workers access to home ownership with enough time to earn the money and pay for a home. Yet when the economy is not so strong, the system can lead to disaster for the homeowner. Moreover, when an economy moves step-by-step down a path of greed and injustice, homeowners may be put at a great disadvantage, shifting more and more risk onto them.

For instance, in an economy in which health costs have risen rapidly and growing numbers of workers become uninsured or underinsured, one illness or injury can lead to loss of income, loss of job, enormous debt, mortgage foreclosure, and bankruptcy. The bank adds another house. In another case, when businesses export jobs overseas and leave entire towns and neighborhoods without opportunity for earning a wage, people lose their homes. The lender adds house to house. When industrial farms use their political influence and polluting ways to undercut hard-working farmers, old family homes, farms, and lands are lost. The wealthy add house to house and add field to field. Entire towns, neighborhoods, and subdivisions may be emptied of occupants, until the foreclosed homes occupy all the land and there is no room for anyone else. The wealthy financiers are left alone to live in the midst of the land.

So around Phoenix and Las Vegas, in Los Angeles and Seattle, in Florida, Ohio, and Michigan, surely many large and beautiful houses are without inhabitant. The gimmick in such a system is to "get mine, and get out." Many mortgage bankers believe they have done this. For insurance, they got the government to bail them out so that whatever they lost in the crash was reimbursed to them out of our pockets. But at some point, somebody has to bear the cost of getting mine and getting out. Isaiah says that the cost will ripple to the point that the productive economy will diminish to near nothing.

The point is to fix this before it gets so bad. Find a way to get people into homes and keep them there. An economic system can't stand on this kind of self-serving injustice.

The Priest and the Levite

This morning, Rev. Charles "Dewey" Williams delivered a powerful message on the Lukan text best known as The Good Samaritan. The implications for our current economy were jumping out of the text and out of his words, even though that was not directly the focus of his message. He talked about the way that things happen to us along the road we travel. Sometimes they are caused by people who are out to harm us or to take what we have in whatever way they can. But he held back and did not hammer away at the titans and swindlers of the economy. He left that for us to ponder, and ponder it we did.

When he got to the story of the priest and the levite, the place where we all become vulnerable, he shook us by the shoulders for all the times we allowed our church duties to turn us away from helping those whom God sends us to meet. And while we had our minds on our own failures, then he expanded the horizon dramatically.

He said, "The priest and the levite examined the situation, and they would have helped the man on the side of the road. But they determined that he had a pre-existing condition. They could not help him since he was already beat up before they came along." Boom! Then he expanded on the issues of health insurance companies doing the opposite of what they claim to be about--denying rather than providing access to health care.

Thanks, Dewey, for your insight and faithfulness to speak the truth in these critical times.

Some Health Priorities

Saturday morning the Laymen's League at my church, Mt. Level Missionary Baptist Church, asked me to lead a discussion on health insurance reform. The people there were quite knowledgeable and had convictions about how these matters should be settled. We agreed on a list of priorities, which we put into a letter, signed, and sent to Representative David Price and Senators Kay Hagan and Richard Burr. If you agree with these priorities, why not contact your Congressional representatives, too. Here is a copy of our letter.

Members of the Laymen’s League

Mount Level Missionary Baptist Church

316 Hebron Road

Durham, NC 27704

September 19, 2009

Rep. David Price

411 W. Chapel Hill Street

NC Mutual Building, 9th Floor

Durham, NC 27701

Dear Rep. Price,

Today we met to discuss health insurance reform as part of our Laymen’s League Men’s Breakfast. Many of us are concerned about this issue because of its direct effects on our families. We want to make clear to you what we believe is important to include in any legislation that will set out to reform health insurance and health care access.

1. Everyone should have access to quality health care, regardless of income or age.
2. Young people should be able to continue longer on their parents’ insurance policies.
3. Insurance companies should not be able to exclude pre-existing conditions, drop coverage, deny benefits, and other forms of discrimination against the sick.
4. Insurance coverage should be fully portable regardless of whether a person gets a new job, loses her or his job, retires, or experiences other changes in employment.
5. Medicare should remain strong for senior citizens.
6. There should be caps on out-of-pocket expenses for any person or family, both annually and for a lifetime.No one should have to go bankrupt over health care costs.
7. Large employers should continue to contribute to health insurance costs.
8. Small businesses should have opportunities for the same affordable health insurance plans that large businesses have.
9. There should be prescription drug coverage without gaps.
10. People should be able to keep health insurance they like.
11. People should be able to choose their doctors.
12. Big insurance and health care monopolies should have to face real competition to bring prices down.
13. Health disparities affecting minorities should be addressed.
14. Chronic diseases such as diabetes, glaucoma, high blood pressure, and others should be priorities for affordable treatment.

We would appreciate hearing back from you concerning our priorities. Thank you for your hard work on our behalf.

Sincerely,

Robert Crouch, Chair (signatures on attached page)

Even if You Have Employer-Subsidized Health Insurance, You Don't Really

At the excellent "think-tank" blog on economics and finance, The Baseline Scenario, James Kwak has posted an article on health insurance that draws back the curtains, blows away the fog, and shatters the mirrors of illusion. The "in-your-face" title is "You Do Not Have Health Insurance." He says that unless you are over 65 in the U. S., the word "insurance" does not really apply. I'll quote the first section to spell out the heart of his argument, which will knock you over.

Right now, it appears that the biggest barrier to health care reform is people who think that it will hurt them. According to a New York Times poll, “69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone.” Since most Americans currently have health insurance, they see reform as a poverty program – something that helps poor people and hurts them. If that’s what you think, then this post is for you.

You do not have health insurance. Let me repeat that. You do not have health insurance. (Unless you are over 65, in which case you do have health insurance. I’ll come back to that later.)

The point of insurance is to protect you against unlikely but damaging events. You are generally happy to pay premiums in all the years that nothing goes wrong (your house doesn’t burn down), because in exchange your insurer promises to be there in the one year that things do go wrong (your house burns down). That’s why, when shopping for insurance, you are supposed to look for a company that is financially sound – so they will be there when you need them.

If, like most people, your health coverage is through your employer or your spouse’s employer, that is not what you have. At some point in the future, you will get sick and need expensive health care. What are some of the things that could happen between now and then?

Your company could drop its health plan. According to the U.S. Census Bureau (see Table HIA-1), the percentage of the population covered by employer-based health insurance has fallen every year since 2000, from 64.2% to 59.3%.

You could lose your job. I don’t think I need to tell anyone what the unemployment rate is these days.

You could voluntarily leave your job, for example because you have to move to take care of an elderly relative.

You could get divorced from the spouse you depend on for health coverage.

For all of these reasons, you can’t count on your health insurer being there when you need it. That’s not insurance; that’s employer-subsidized health care for the duration of your employment.

Once you lose your employer-based coverage, for whatever reason, you’re in the individual market, where, you may be surprised to find, you have no right to affordable health insurance. An insurer can refuse to insure you or can charge you a premium you can’t afford because of your medical history. That’s the way a free market works: an insurer would be crazy to charge you less than the expected cost of your medical care (unless they can make it up on their healthy customers, which they can’t in the individual market).

In honor of the financial crisis, let’s also point out that all of these risks are correlated: being sick increases your chances of losing your job (and, probably, getting divorced); losing your job reduces your ability to afford health insurance.

There is more in the article, explaining some further dangers about companies rescinding policies, denying claims, not covering various critical procedures, and COBRA that help us realize how precarious our health coverage is. As he points out, unless your job is insured (there is no way you can lose your job or go out of business), your access to health care is not insured.

We need this reform. Make it plain to your Congressional Representatives.

Pay to Play: Health Lobbies Buy Their Access

"This is not a democracy. It's an auction." Those are the words of a bumper sticker we stuck on a car I used to own. The obscene amount of money that are spent to elect and influence government officials keeps growing because it works. Money keeps buying access. If you might have money to give, then candidates and incumbents want to talk with you. If you already gave money, they want to keep the relationship for next time. And savvy lobbyists know what kinds of assistance and treatment specific legislators want. They also know how to sway the direction of corporate news and the TV-watching and talk show-listening public. In U. S. politics, money makes the world go 'round.

Michael Winship of truthout reports that enormous amounts of money have been spent on lobbying against health care reform in the second quarter of 2009: over $133 million in three months from insurance companies, pharmaceutical companies, and hospital corporations alone. This does not include spending by other organizations such as the Chamber of Commerce and political action groups which is also on a grand scale.

According to community organizing, there are two kinds of power: organized money and organized people. Theodore Lowi, in The End of Liberalism, wrote that organized money had managed to dominate U. S. politics so heavily that we now operate by a de facto new constitution. Representative government flows from powerfully organized lobbies. Theologian John Howard Yoder warned Christians not to be fooled by the rhetoric of democracy, the rule of the people, when the U. S. polity is better described as a plutocracy, the rule of the wealthy.

There is faint hope in that community organizing has experienced a renaissance in the past quarter century. But grassroots movements still have most of their influence at the local level, and occasionally at the state level. There are ambitions for more national power from grassroots groups, but for now the organized money is in the lead.

I'm going to keep on asking folks to demand that Congress listen to the people and get us a universal health care plan that cuts costs and promotes preventive care. We may be a voice crying in the wilderness, but the voices of Isaiah and John both made a difference when they stood up for the truth.

Where Does Hagan Stand on Health Reform?

I am trying to find out where Senator Hagan stands on health care reform. Here is the letter I sent her today.

Hello, Senator,

A while back I sent a letter asking you four questions about your position on health care reform.

We live in a difficult time for most people, and a major cause of our economic difficulties is the out-of-control health care system. On the one hand, the medical profession and hospitals operate as quasi-monopolies, keeping numbers of physicians low and buying up smaller practices to eliminate competition.

On the other hand, the business invokes the free market as justification for excessive charges, as if persons seeking medical care can shop around the way they do for a hamburger, a pair of shoes, or a gallon of milk. The powerful insurance companies and health care institutions already place severe limits on which doctors we can see, what treatments we can get, and even how long our doctors can talk to us. That is not a free market.

US costs double or triple the costs of excellent health care systems in other parts of the world. Something must be done to get this runaway train to stop.

That is why I support a public insurance option immediately for all people who want to choose it. The highest priority is to get rid of layer upon layer of administrative costs, all focused on keeping me from getting medical care paid for rather than focused on keeping me healthy.

So again, I want to know the answers to four questions.

1. Do you support a public healthcare option as part of reform?

2. Do you support a public healthcare option that is ready on day one?

3. Do you support a public healthcare option that is national, available everywhere, and accountable to our government?

4. Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

Don't listen to the critics who say this will create long lines: we already cannot get an appointment to see a doctor without waiting months.

Don't listen to critics who say this will lead to bureaucrats making health decisions for us: we already have to put up with that from the insurance companies.

Don't listen to critics who say this will be unfair competition: they want to maintain their high executive salaries and focus on profit rather than trim their costs and organizations to make health care affordable.

Don't listen to critics who say this will make medicine less attractive for bright people to choose as a career: the insurance and health care management companies are already driving doctors out of the profession because of the regimentation and demand for shorter and shorter patient visits.

Stand with all of us for a better health care system. Stand for the public plan option.

Questions to Ask Congress About Health Reform

I sent the following to the senators from NC about health reform. Something has to change. For now, my family is getting by pretty well, but it keeps getting harder. My wife and I have good jobs (at the moment), but many people who make less or have been laid off must be struggling seriously in this economy. Being poor ought not to mean that a person does not deserve medical care. I encourage you to ask for answers from your Senators and Congressional representatives.

My wife and I have watched our health costs skyrocket. Insurance is eating up more of our income each year. We worry about our kids who are approaching the age that they will not be our dependents. What will they do in an entry level job if health benefits keep being diminished?

Health care ought not to be a luxury. Everyone needs access. People should not have their finances ruined by a standard hospitalization.

A public healthcare option should be available to all citizens. That way, the semi-monopoly that exists as "private insurance" plans will have to compete with a plan that has its primary purpose the public health, not profits.

Do you support a public healthcare option as part of healthcare reform?

If so, do you support a public healthcare option that is available on day one?

Do you support a public healthcare option that is national, available everywhere, and accountable our government?

Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

As a constituent, I would really like to know the answers to these questions. Please respond to these questions in writing via email.

BCBS Talking Out of Both Sides of Their Mouths

Not many days ago on May 11, executives from health insurance companies, hospitals, the AMA, and other players in the health industry met with President Obama to announce their initiative and cooperation in cutting the rising costs of health care in the U.S. They said they would voluntarily work to reduce the rate of growth of health care costs in coming years. Everyone knew that it was not an extensive promise, but it was something. If nothing else, it was their effort to "get on the team" so that they could have some influence in the decisions about health reform.

By May 15, they were already trying to take it back. They said that President Obama had overstated their pledges. Although the letter they wrote and signed says they will act in support of the goal to reduce the rate of growth of health care costs by 1.5% per year, the New York Times reports they say they did not mean they would support this as a yearly reduction. I read the letter. Any reader would agree that they did say what they now claim they did not say.

Today, the Washington Post reported that the high-profit non-profit, BlueCross BlueShield of North Carolina, is putting together a slick media campaign to oppose one of the key elements of the health reform proposal: a public insurance option, especially for those whose employers do not provide quality health insurance as a benefit, but for anyone who chooses to enroll in it.

That got my goat. My health insurance premiums keep going up. My wife's premiums are skyrocketing, and BCBS has a contract to manage her State Employees' Plan. BCBS of NC has been in hot water for the huge amounts of profit and bonuses to executives they achieve as a non-profit with protected tax status. And now they want to spend the money they are squeezing out of us to make sure that the health care industry can continue to operate without serious competition.

The only competition in the industry is between giant corporations who "wink-wink" compete for big contracts that leave average people like me with no choices about health care. In addition, when our kids get out on their own and take entry-level jobs, they get offered insurance packages that have coverage caps of only $10k to $15k.

So this is the state of health care in our society. Waiting in the emergency room takes longer than watching a feature film at the cinema. More people die of medical mistakes than in auto accidents each year. More people died from lack of health insurance than from homicide last year.

I went to the BCBS of NC website to figure out how to offer a complaint about this ad campaign. I finally settled on the web form to report possible fraud and abuse. I listed BlueCross BlueShield of NC as the one committing the potential abuse. Then I wrote the following.

The Washington Post reported today that BCBS is planning to spend my premiums to run a media campaign opposing real options in health insurance. If the insurance industry is serious about reducing costs, then the best way to do that is to make sure that people whose companies cannot or do not offer quality insurance plans have access to a public insurance plan. Otherwise, the quasimonopoly will continue and many who can't afford health care will pay with their livelihood and health while the rest of us will pay higher premiums.

Give people choices.

DO NOT SPEND OUR HEALTH CARE PREMIUMS ON A SMEAR CAMPAIGN. This is not what I am paying you for. Save that money and reduce our premiums.

Health Insurance Options

Last week it became clear that the discussion, soon to be a debate, on health care is beginning to hit its stride in Washington. The first big news was that people in the medical and insurance industry were making big promises about keeping down the rate of growth in health costs. Up to now we've been told by them that the expenses were unavoidable. Hmmm.

Then the analysts came into the discussion speculating on what it might mean that these people in the industry were willing to make such a public promise. Discussions of how many lobbyists have been hired were supplemented by figures on how much the insurance industry, pharmaceutical industry, and other medical interests are paying to lobbyists. People with deep pockets and big profits at stake will get the best representation that money can buy.

The rest of us suckers will have to take what they decide is best for us. Or maybe not. We may not have the money, but we have the people to stand up to these interests. If the Republicrats and Demicans in Congress are inclined to do what the medical interests say, we need to let them know that they are in for a few million wake-up calls from the people who are suffering under the current system which is force-fed to us as if the experts know what is best for all of us clueless people with and without paychecks they want us to sign over to them.

Here is a letter I wrote to the Durham Herald-Sun, and it showed up in this Sunday's edition.

Insurance Options

I know that the health insurance industry made a big public show of saying they will cut back the rise in health care costs. If they can, why haven't they done it already?

As it stands, people who still have health insurance have been losing real wages in a giant wealth transfer to the insurance companies and their allies. And so many more people have simply lost insurance coverage.

This is not a system of choices. It is a system of betting against the odds that one illness or injury won't make you go broke.

A real option would be to make these insurers compete with a public plan available to anyone who needs or wants it. A fair and competitive public insurance plan will force the insurance industry to cut profits and big bonuses so people can afford to go to the doctor.

We can't let Washington give in to the medical lobbies that want to maintain the costly, inequitable system we now have. They need to listen to the voters and make a quality public health plan available to all. That would be a real choice.

MIKE BROADWAY
Durham
May 17, 2009