Health Care

League of Women Voters^®
of Schenectady County

We are truly a grassroots organization...

Health Care

Health Committee Report 2009-2010. HEALTH CARE REFORM + THE OPPOSITION. Health Care Reform- The Opposition 2. The U.S. Economy And Changes In Health Insurance Coverage.

Health Committee Report 2009-2010

Submitted by Carol Furman, Chair
The Health Committee decided to focus on three areas of interest this year: monitoring legislation concerning health care reform; understanding long term care alternatives including The Eddy Village Green; and understanding community health assessment results in the county. The committee visited the new "Medical Home" at The Ellis Health Center and spoke with two nurse navigators to understand their role in reaching out to the community and assisting those without insurance to apply for it, and to help those without a primary physician to find one. We shared information about the Eddy Village Green and intended to explore this further. We invited the Schenectady County Health Commissioner, the CEO of Ellis Hospital and the CEO of Hometown Health Centers to present a program in April on "Health in Schenectady, Where Do We Stand Now and Where Are We Going?" This well attended program gave us an idea of the results of community assessments completed in 2009, as well as, an update on initiatives of the three organizations. We developed a survey tool to speak with various representative organizations in the community about their thoughts on unmet health needs in the community. Committee members met individually with more than twenty organizations. Survey results will be utilized to advocate for funding and development of needed services on a local and state wide basis. Results will be shared with the Schenectady County Public Health Advisory Committee. The committee will not meet during July and August. The Health Committee will meet next on September 29th at 12 noon at the Moon and River Cafe in downtown Schenectady. We will discuss a strategy to share the results of a survey of unmet heath needs in Schenectady that we undertook. We plan to advocate for services and funding to meet those needs. Please join us. Contact Carol Furman at 346-2746 if you have questions, or if you will be attending for the first time. Members are Betsy Chase, Pat Kessler, Kathy Nye, Jenny Overeynder, Carol Possin and Mary Pritchard.

HEALTH CARE REFORM + THE OPPOSITION

In recent months, we've provided articles for this newsletter to describe the need for health care reform. This month, I've decided to talk about some of the objections. You may have heard some of these positions from friends or family... or maybe you share some of these views. Some of the common objections to reform are listed below. Others will be included in upcoming issues of the newsletter. Please let us know about your concerns (or your friends). We'll try to address them!
1. "It's not necessary, we already have the best health care in the world."
It's true that many Americans do enjoy the best health care in the world. If you can afford to purchase whatever you want; or if you work for one of the country's major corporations (or the government); you probably have access to your choice of medical plans, doctors, and hospitals. However, many other Americans are uninsured or underinsured. Our health care system is not well coordinated. The US health care has a very low rating when compared to other industrialized countries. Longevity, infant mortality, and other critical factors do not score well when you average in ALL of our citizens. Many insured person's find themselves bankrupted by catastrophic medical expenses, despite their coverage!
2. "Reform is too expensive"
All of the proposals for health care reform are required to have an accompanying price tag at some point of the discussion. And the price tags are huge. Estimates for the proposals from Senator Clinton and John Edwards are $110 billion and $120 billion, respectively. The fact that health care in America is already too expensive is one point people on both sides of the argument can probably agree on. The US is already spending about twice as much as other industrialized countries (who cover all citizens) and getting far less bang for the buck. We need to look at how we are spending those dollars. Many advocates believe we can provide basic health care for everyone without spending more money. Some of current high expenses that could be reduced include:

Reduce administrative overhead which is presently 15-30% of the cost in the insurance industry
Negotiate the price of medication with Pharmaceutical industry
Reduce use of expensive emergency room care by providing everyone access to primary care
Emphasize and reward prevention and disease management

3. "Health care reform means socialized medicine"
Actually, NO ONE has proposed "socialized medicine" for the United States. Great Britain is one of the few industrialized nations that has this type of medical care. The hospitals are owned by the government and the doctors work for the government; although there is also a private health system available for those who can pay for it. Here in the United States, reform plans vary from mandates on employers to provide health insurance, or mandates on individuals to purchase health insurance, to providing individuals with a choice of purchasing public or private insurance (with lots of variations and other important reforms included in each proposal). There is only one proposal that would institute a "single payer" plan but that proposal allows everyone to choose their own providers (doctors and hospitals). "Single payer" COULD eliminate private insurance; but it could also operate like Medicare with supplemental plans available through private companies. The NYS League of Women Voters has endorsed the single payer approach because it is that plan that addresses all of the Leagues' concerns about needed health care reforms. Many analysts believe that a single payer approach will also be the least expensive reform that guarantees universal coverage.
Next month, we'll address some of the questions about the ability of the Government to handle health care reform and other issues such as individual responsibility. You can address your questions to either: Pat Kessler, 374-2713, patkessler@aol.com Carol Furman, 346-2746, cfurman@earthlink.net

Health Care Reform- The Opposition 2

Currently our health care system costs too much, does not compare favorably with other developing countries in regards to outcomes of care, and leaves 47 million uninsured. A recent AARP editor's article indicates that half of Americans with health insurance say they delayed doctor visits due to higher out of pocket expenses, two thirds say they limit care to just the most serious conditions or symptoms, and 28 percent indicated they skipped or did not fill prescribed medicines due to cost. We spend 16% of our Gross National Product on health care, yet do not do as well as other countries who cover all their citizens. Our costs are rising faster than inflation and wage growth despite our less than stellar performance. We can hope and work toward electing a president and legislature who will move our country toward a better system but we need to get behind some key issues. The following are some points of conflict in considering solutions. "Government is not capable of running a universal health care system". There is concern and suspicion of the Government having oversight of the health care and treatment of every citizen. Recent unhappiness with Iraq; the Hurricane Katrina debacle; and constant stories about government inefficiencies cause many of us to worry that government controls will make health care worse. But the bigger worry should be fair and adequate funding for our health care delivery system. Presently the government provides the oversight of the Medicare and Medicaid systems. And many people point to the Medicare program and ask why every citizen should not have a right to the same kind of coverage! One current legislative proposal is "Medicare for All". The Medicare program presently operates through Intermediaries, private insurance companies, who are under contract with the Government to manage the benefit and payment for the program, or through "Medicare Advantage" products offered through private Managed Care Companies who must provide benefits according to the Medicare Conditions of Participation. Administrative costs are much lower. There are standard benefits for all enrollees across the country. There are reportable quality measures. There are standard appeal procedures. Having Universal access to care does not mean that the Government will provide the direct management of the program. "People want choices and do not want the Government telling them what to do" Choices can be preserved in a Universal Health Care System. If everyone had a right to health care coverage, there could be a standard list of services or benefits available to every citizen. Hopefully, gone would be the question of "is this covered by my insurance" or the surprise, when you find out something your Doctor ordered, was not covered! Supplemental insurance policies could be available for services not included in the standard health care package. People could choose a supplemental policy that meets their needs. All qualified Physicians could have the ability to participate in the program, and you would not need to change physicians when you change insurance. Physicians would not close their practice to some insurers because the fees were not sufficient! There could be an incentive to require that preventive care be provided to reduce the need for emergency care. Citizens could have the ability to see their physican with early signs of illness, instead of putting it off till it became more difficult to treat. These are choises many people currently do not feel they have! Information on the best treatments for an illness can be made part of the guidelines for care and coverage, so that the most effective care is covered. Currently, we seek care based on what and where it is covered by insurance. In a Universal system there are more incentives to find the most cost effective and efficient way to provide care, starting with prevention! More alternatives may be within our options. "Health Care for All will eliminate Private Insurance Companies" Although some people would like to see the elimination of private insurance companies, it probably will not happen! As mentioned above, the Government currently utilizes Private Insurance Companies to manage the Medicare benefits, and contracts with Health Maintenance Companies (HMO)s to provide the Medicare Advantage Programs. There could be much efficiency with a Universal benefit for all citizens. The paperwork could be all the same across all companies, services covered could be the same, all qualified physicians could participate, and marketing and profits would not play the role they do today. Do your part in communicating the importance of addressing access to health care for all citizens to your elected and proposed officials.

The U.S. Economy And Changes In Health Insurance Coverage

Excerpted from Health Affairs, February 20, 2008 The U.S. Economy And Changes In Health Insurance Coverage, 2000-2006 Americans continued to lose their health insurance even as the economy improved. by John Holahan and Allison Cook
Between 2000 and 2004, a period of economic recession, the number of uninsured Americans increased by 6.0 million. The number increased by 3.4 million (1.0 million children and 2.4 million adults) between 2004 and 2006, despite improving economic conditions. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Employer coverage declined most for self-employed or small-firm workers, in the South, and among non-citizens. The rate of employer coverage continued to decline even when the economy improved.
For children, the decline in employer coverage was offset by large growth in Medicaid and SCHIP in the first four years of the decade. As states experienced deteriorating fiscal conditions, they adopted policies that restricted growth in these programs. As a result, the number of uninsured children increased by 1.0 million between 2004 and 2006, after having fallen by 400,000 between 2000 and 2004.
The decline in employer coverage can be traced to greater increases in health insurance premiums and not to increases wages. As health insurance becomes more and more expensive, it adds more to the cost of a worker's total compensation package. To the extent that firms cannot shift this back to workers in the form of lower wages, they become less likely to offer coverage.
It is striking that the rate of employer coverage declined and the number of uninsured people increased even after the U.S economy rebounded from the recent recession. This erosion will likely continue, particularly for low-income workers, because the basic factors underlying it seem unlikely to change.
Comment by Don McCanne, former President of the Physicians for a National Health Program.
� The fact that the number of uninsured continues to increase is certainly not news. But there are a couple of points in this article that should alarm us.
� A rebounding economy was unable to stop the decline in coverage. In spite of favorable economic trends, employers found their health benefit programs to be less affordable, and more dropped their employees from coverage. Clearly we will not be able to rely on improvements in the economy alone to expand coverage to more individuals.
� This report demonstrates that the decline in coverage is impacting all sectors of our society, though some more than others. This indicates that targeted programs cannot eliminate the problem since some sectors inevitably will be left out. Also alarming is the fact that incremental reforms more narrowly targeting populations is not working either.
� As an example, the greatest "success" in recent years has been insuring more children through the SCHIP and Medicaid programs. Yet the gain of 400,000 insured children during 2000-2004 was more than offset by a loss of 1.0 million during 2004-2006 (years of economic recovery). That certainly cannot be classified as a health policy success, yet that is the best we can show for all of our incremental efforts.
� When you look at the leading comprehensive proposals, policies are included to target the more vulnerable populations. Yet they are very weak on policies that will help the largest vulnerable group of all:
middle-income individuals and families.

� Relying on improvements in the economy for most of us, with safety-net welfare programs for the poor, will never get us to a program that guarantees reasonably comprehensive care for all of us. It will require the adoption of a health care financing system that automatically includes all of us, for our entire lives.

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