Another problem with a patchwork national health care system? Patchwork family coverage.

Neda Semnani of CQ Healthbeat wrote last week about the issue of having both insured and uninsured members in a family, focusing primarily on the problem of insured parents with uninsured children.

“If only some members of a family have insurance, a new study notes, the most typical pattern is that parents go without while their children are insured—particularly since the 1997 creation of the State Children’s Health Insurance Program (SCHIP). Still, for policy makers trying to figure out how to widen coverage, covering uninsured kids whose parents have health insurance benefits is a big part of the puzzle, the study suggests.”

Families with uninsured children and insured parents are most likely to be low- to moderate-income (not among the nation’s poorest), of Hispanic ethnicity, and living in the South or West.

First steps toward covering uninsured children include expanding SCHIP and boosting outreach and enrollment efforts for this program (considering two-thirds of the children eligible for SCHIP are not covered due to lack of awareness).

Another policy solution could be based in the private insurance market and involve the expansion of partial assistance programs that make private coverage more affordable for families looking to have all members insured under one plan.

See the full article, titled “Solving the Riddle of Patchwork Family Coverage,” here.

Health care subsidies for individuals, rather than businesses, is more effective way to cover the low-income uninsured

The daily newsletter, CQ Healthbeat, reported last week on a new study released by the Urban Institute claiming subsidies targeted for insuring low-income individuals, rather than encouraging small businesses employers to purchase insurance, is a more effective strategy of covering those most vulnerable in the health care system.

While bipartisan legislation in the Senate has favored subsidizing small business employers’ provision of insurance, employer-based coverage through small businesses is less efficient and more costly than through larger employers.  Small businesses also typically have a lower-wage working force, making it difficult for many workers to purchase employer-based insurance even when offered.

Considering small businesses have a combination of high- and low-wage workers, the study says that targeting low-income individuals for coverage subsidies would better focus resources on those with the greatest need.

So how do the presidential candidates’ health care proposals size up by this logic?

While McCain’s plan does focus on individual- and family-based refundable tax credits ($2,500 and $5,000, respectively) and has no mention of employer subsidies, this proves problematic in that the subsidies are not relative to income and are therefore inefficient at targeting populations at higher risk of uninsurance.  And while the study released by the Urban Insitute finds that subsidies targeted to the individual are most efficient, there remains the policy concern of undermining the employer-based insurance system, which provides the best option for many people under the current system.

Meanwhile, Obama’s plan is thought to work better with the findings of this study because of its emphasis on income-related subidies to individuals.  For political reasons the plan also includes refundable tax credits to small business employers offering coverage, which Urban Institute policy analysts are wary of because of the inefficiency of small businesses in providing coverage.

See the full article, titled “Report: Subsidies for Low-Income Individuals Better Way to Cover Uninsured,” here.

America desperately needs a national health care program.

By Bob Caylor

The News-Sentinel
Fri. Oct. 17, 2008

Even a few years ago, a Fort Wayne physician laying out an impassioned argument for national health insurance – at the Greater Fort Wayne Chamber of Commerce, no less – might have seemed like an elaborate put-on.

Dr. Jonathan Walker, a retinal surgeon, wasn’t kidding anyone. In his own highly specialized practice, he sees a toll in people with disabilities and avoidable catastrophic expenses, and he knows that it’s only a minuscule fraction of the human suffering and economic damage caused by tens of millions of Americans lacking health insurance.

As he began his talk Thursday before an audience of about 40 people, he said that the provisions for the uninsured – the network of hospitals and clinics providing charity care – too often fails. “The safety net is full of holes. That’s why they call it a net,” he said.

“America is the only developed country where you have to worry about getting sick and going bankrupt,” Walker said. “You are only one diagnosis away from bankruptcy, from loss of access to health care.”

Not having a system of national health insurance causes thousands of unnecessary deaths a year, he said. That’s only the beginning of the impact. Paying for the uninsured through uncompensated emergency care raises prices for everyone else. Paying excessive health-care costs puts American companies at a financial disadvantage in competing with many foreign companies.

Walker acknowledged that many factors contribute to Americans spending more on health care, per capita, than any other developed country, but he focused on two factors: private, for-profit health insurance and drug companies.

He cited a 2003 analysis that found 31 percent of total health-care spending went to “layer after layer of administration.”

“It just creates this strange, bizarre system where all we’re doing is filling out paperwork,” Walker said.

He said that through the American approach to health care, “we get quadruple-dipped:”

• We pay for the poorest and sickest people through Medicaid

• We pay for the uninsured

• We pay our own co-pays and deductibles

• We pay for private insurance

Walker did not advocate a particular program of national health insurance. His talk, sponsored by the Fort Wayne Medical Society, was the first of four planned in the next six months or so, said Dr. Steve Smith, who introduced Walker. The point of the series, Smith said, is “to prepare this community … for probably what will be the certainty of health-care reform sometime this next year.”

Walker’s case certainly didn’t go unchallenged.

One listener said 55 percent of all medical care is necessary because of “stress, weight or substance abuse” – factors individuals can control on their own. (One of the later programs in this medical society series will be devoted to the impact of such risk factors on health care.)

Another suggested that requiring mandatory private health insurance, just as carrying automobile insurance is mandatory, would alleviate many of the problems.

To view the article, click here.

How to Take American Health Care From Worst to First

By BILLY BEANE, NEWT GINGRICH and JOHN KERRY

 

Published: October 24, 2008

IN the past decade, baseball has experienced a data-driven information revolution. Numbers-crunchers now routinely use statistics to put better teams on the field for less money. Our overpriced, underperforming health care system needs a similar revolution.

Data-driven baseball has produced surprising results. Michael Lewis writes in “Moneyball” that the Oakland A’s have won games and division titles at one-sixth the cost of the most profligate teams. This season, the New York Yankees, Detroit Tigers and New York Mets — the three teams with the highest payrolls, a combined $486 million — are watching the playoffs on television, while the Tampa Bay Rays, a franchise that uses a data-driven approach and has the second-lowest payroll in baseball at $44 million, are in the World Series (a sad reality for one of us).

Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.

It is no surprise then that the United States spends more than twice as much per capita on health care compared to almost every other country in the world — and with worse health quality than most industrialized nations. Health premiums for a family of four have nearly doubled since 2001. Starbucks pays more for health care than it does for coffee. Nearly 100,000 Americans are killed every year by preventable medical errors. We can do better if doctors have better access to concise, evidence-based medical information…..

 

For the Complete Article, Please Visit: http://www.nytimes.com/2008/10/24/opinion/24beane.html?scp=4&sq=health%20care%20election%202008&st=cse

 

Will Health Care Reform Help – or Hurt – Women?

By Kay Steiger
Created Oct 23 2008 – 8:00am
In August this year, the infamous “Harry and Louise” ads of 1993 returned. This time, Harry and Louise weren’t complaining that the government would take away their options [1] on health care. Instead, they called for health care reform [2] and worried about skyrocketing costs. Health care reform remains a top domestic concern, and the candidates for president have proposed very different ideas of how to correct rising medical costs. The two different plans would affect women in very different ways.
Push Toward the Individual Market vs. Expansion of Federal Benefits
Republican presidential nominee Sen. John McCain’s plan promotes the individual health care market. Currently, Americans pay for employer-sponsored health care premiums with pre-tax income. McCain’s plan would require workers to pay for insurance out of post-tax income; his plan would offset this by extending a tax credit of $2,500 for individuals and $5,000 for families. This tax credit can either be applied to a person’s employer-sponsored plan or to one on the individual market. Additionally, McCain calls for opening up options by allowing people to purchase health care plans from providers in other states.
But this push to the individual market isn’t optimal for women. According to a report [3] recently released by the National Women’s Law Center, women have a hard time finding equitable coverage on the individual market, often paying more and getting less. Right now about two-thirds of women get coverage though an employer, 16 percent of women get coverage through public programs like Medicaid, and just 7 percent of women currently get coverage through the individual market.
Of women who bought insurance on the individual market, the NWLC report found that they pay more in monthly premiums at almost every age than men–6 to 45 percent more for women aged 25 and 4 to 48 percent more at age 40. How can this be legal in the individual market and not in employer-sponsored coverage? Courts have ruled that Title VII of Civil Rights Act applies to employer insurance coverage. Only ten states prohibit such discrepancies in individual market premiums, and two states limit it….

For the Complete Article, Please Visit: http://www.rhrealitycheck.org/blog/2008/10/17/will-health-care-reform-help-or-hurt-women

Quality of Maternity Care in Serious Jeopardy

Childbirth is the leading reason for hospitalization in the USA and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, a new report says. U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, the authors write. More than $2.5 billion a year is spent on unnecessary C-sections, which now represent nearly a third of all deliveries. Reducing expensive techniques such as C-sections and increasing low-cost approaches such as childbirth assistants called doulas would improve mothers’ and babies’ health while cutting costs, the authors say.
“Everybody recognizes that our health care system’s in trouble,” says Childbirth Connection’s Maureen Corry, co-author with colleague Carol Sakala. “But when it comes to maternity care, no one talks about it.”
 
Read the report click here: http://www.childbirthconnection.org/article.asp?ck=10575&ClickedLink=919&area=27

To read related news articles, check out the ones below:
http://www.usatoday.com/news/health/2008-10-08-childbirth-costs_N.htm?loc=interstitialskip
http://www.usatoday.com/news/health/2008-10-08-childbirth-fixes_n.htm
http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm

Families USA Puts Health Care Reform on the Air

Families USA created an online resource that lists radio talk shows, which is a perfect way to get your voice heard on the need for health care reform. The resource includes call-in information for over 40 nationally syndicated and regional shows as well as numerous local shows in select states.
To learn more on about the radio talk show or how to call in, please visit http://www.familiesusa.org/resources/tools-for-advocates/tips/talk-radio.html

MORE CHANCES TO COMPARE THE PRESIDENTIAL CANDIDATES’ HEALTH CARE PLANS

Key Differences Spelled Out in Three Formats   
1. A new, consumer-friendly guide to Senator John McCain’s and Senator Barack Obama’s health care proposals lets women see what might happen to them under each plan. The report, Health Care Reform and the 2008 Election – A Guide for Women, takes a number of critical health policy issues for women [ http://www.brighamandwomens.org/ConnorsCenter/images/HealthCareReformFINALREPORT.pdf ] - including coverage, access , costs, and pre-existing conditions – and brings them to life through descriptive vignettes.

2. Presidential candidates Barack Obama and John McCain offer their uniquely different health care reform ideas to the readers of the New England Journal of Medicine [ http://content.nejm.org/cgi/content/short/359/15/1537?query=prevarrow ]
 
3. Listen to political scientist Jonathan Oberlander give a thoughtful and coherent comparison of their proposals on a late summer episode of NPR’s “Fresh Air.” [ http://www.npr.org/templates/story/story.php?storyId=93975730 ]

Report Emphasizes Comprehensive Reproductive Health Care

A new analysis published by the Columbia University Mailman School of Public Health makes a case for a comprehensive “wellwoman standard of care” and underscores why such a standard must include reproductive health. The analysis, Women’s Health Care and Health Reform: The Key Role of Comprehensive Reproductive Health Care, makes a scientific, data-driven case that reproductive health is a key determinant of women’s overall health, and therefore, the treatments and services that promote reproductive health should be part of any national health plan.

For the complete article, please visit: http://www.jiwh.org/attachments/Women%20and%20Health%20Care%20Reform.pdf

NEW REPORT ON WOMEN AND INDIVIDUAL HEALTH INSURANCE MARKET

National Women’s Law Center Shows Major Flaws for Women’s Needs
The National Women’s Law Center has released a new report, Nowhere to Turn: How the Individual Health Insurance Market Fails Women, illustrating the harsh realities of this market and what its impact is on women who are forced to consider purchasing this type of health insurance on their own. 

To Read about the report and download it, please visit: http://action.nwlc.org/site/PageServer?pagename=nowheretoturn&JServSessionIdr001=7treklvjy2.app13a