Health Care For America Now

If you’re looking for more evidence that the individual health insurance market (that unwelcoming place where people buy coverage directly from insurance companies) is failing us in pretty much every way possible, add this new brief from the Commonwealth Fund to the pile. Aptly titled “Failure to Protect,” it uses findings from a 2007 survey to illustrate why the individual insurance market is anything but a reliable source for comprehensive and affordable health coverage. Consider these findings:

• Most adults who shopped for coverage in the individual market found it very difficult or impossible to find a plan that fit their needs—they were either denied due to a preexisting health condition or were offered a plan that was too expensive or that didn’t cover the care they needed.  The majority (73%) never ended up buying a plan.
• Adults who do purchase individual market plans spend considerably more on health care than those with employer-sponsored insurance (ESI); 51% of people with individual market coverage spent 10% of their income or more on out-of-pocket costs (all medical expenses, premiums, and prescription drugs), compared to 29% of those with ESI. Median spending for those with individual market coverage was more than twice that for people with ESI ($6,750 vs. $2,250).
• Those with individual market plans also report higher rates of problems with their coverage (e.g. dollar or visit limits on covered services, or expensive medical bills that aren’t covered by their plan) and are more likely to avoid or delay needed care because of cost.

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(Cross posted from the Huffington Post)

By Robert Creamer

Today it would be hard to find one member of Congress who openly advocates the abolition of Medicare or Social Security. It's true that during the Bush Presidency, right-wing Republicans tried to weaken, dilute and privatize both. But their proposals were always passed off as attempts to "strengthen" these programs that have become two of the most popular and widely respected institutions of government.

Of course it wasn't always so. Both Social Security and Medicare were incredibly controversial when they were passed - the first in 1937 and the second in 1964. In fact, their opponents sounded very much like today's Republicans as they denounced them for being "big government takeovers" - or, in the case of Medicare, "socialized medicine."

But it wasn't long after they were enacted that Social Security and Medicare became "third rails" in American politics. Former Senator Bob Dole once made a speech where he said: "I was there, fighting against Medicare." The TV spot reprising that speech during his 1996 campaign against Bill Clinton helped seal Dole's defeat.

The view shared by most Americans - and all senior citizens - was summed up in the slogan for the 2005 campaign to defeat Bush's privatization program: "Hands off my Social Security."

No one brags that their father or grandfather lead the fight to oppose Social Security or Medicare - any more than they brag that their forbearer lead the fight against civil rights. But of course in the 1960's, civil rights did not have the universal acclaim it has today.

Dr. Martin Luther King, Jr. had many detractors who thought his agitation for justice was downright subversive. Others thought that he wanted to move too fast. That extended to the Pastors - many men of good will - who asked him to call off his protests in Birmingham, Alabama in 1963. It was to those Pastors that he wrote his famous letter from the Birmingham jail: "Why We Can't Wait."

In 1963 most people would not have dreamed that just a few decades hence, a national holiday would be named after the young organizer and agitator, Martin Luther King.

Every major social advance is surrounded by controversy and conflict. That's because every time there is change in the status quo there are winners and losers. The controversy over President Obama's health care reform does not center mainly on "differences in approach" or academic disagreements over the way that health care systems should be designed in some ideal world. They center instead on battles over wealth and power - just as they did when the Congress created Social Security or Medicare, or passed the Civil Rights Act of 1964.

That's why the 19th Century abolitionist leader Frederick Douglass was right: "You can't have the rain without the thunder and lightning," he said. Of course Douglass was referring to the granddaddy of all major social change in our history - the end of slavery . That required a horrific civil war.

Health care reform involves one out of every six dollars spent in America today. It involves the jobs and livelihoods of millions of people and the fortunes of huge corporations. Of course change in the health care system is going to be controversial. Luckily it is not controversial with average Americans. On the health care issue, Democrats - and the President - have the political high ground. But that doesn't mean it isn't controversial with the insurance companies or with wealthy Americans who may be asked to pay a small increase in taxes (bringing their rates to the level they were in the Reagan Administration) in order to pay for needed reform.

Members of Congress can't avoid the controversy. If they want to, they should look for another line of work. All they can do is hope to be on the right side of history - to take positions that their grandchildren will brag about after they are long gone.

All that they can hope - or any of us can hope - is that the things we do will stand up to the test of history - that they will make future generations proud.

Forty years ago today, for the first time in history, human beings first set foot on another celestial object when Neil Armstrong planted his boot print on the moon. I was one of the millions of Americans who got up in the early morning hours to witness first-hand the historic event live on television. It was extraordinary - a phenomenal evolutionary advance for our species - brought to us live from outer space.

Less than a decade before, another young President challenged American to put that man on the moon. John Kennedy's vision put America in the forefront of the technological revolution that created the jobs of the future — for a generation of Americans.

This year, President Obama challenged us again - to create the jobs of the future for our generation: millions of clean energy jobs.

Last month, the House of Representatives voted to meet that challenge - passing an energy bill that will finally begin to break our dependence on foreign oil and make America a world leader in clean energy technologies of the future. Now, members of the Senate will have to decide which side of history they will be on when it comes to creating a clean energy economy.

In the next two weeks, Members of both the House and Senate will be called upon to decide which side of history they will be on when it comes to ending our status as the only nation in the industrial world that does not guarantee health care as a human right.

The Obama health care bill is controversial because it will control the growth of health care premiums for American families. That, in turn, will take money from the pockets of some of the most powerful special interests in the country - most notably the insurance industry.

But it is safe to say that one day, future generations will look back on this battle and wonder way it wasn't obvious to everyone that every person has a right to health care - they same way we look back today and wonder how anyone could have supported slavery. Remember we still had slavery in America just 150 years ago.

Our grandkids will wonder why anyone would balk at beginning to rationalize the bloated, inefficient American health care system that leaves us 37th in the world in health care outcomes and costs us 50% more per person than any other country on the planet.

They will look back on those who tried to stand in the way of serious health care reform, the way we look back on those who tried to block the creation of Social Security or Medicare or the Civil Rights Act.

Often, when political leaders are faced with historic choices, they are forced to choose between the next election - and the next generation. This time, with the political wind at our back, they don't have to make that choice. But they do have to choose to stand up against special interest pressure and act decisively to take the actions that are necessary to build a foundation for the long-term economic success of future generations of Americans.

So in the next few weeks, talk to your Members of Congress. Ask them each what kind of legacy they want to leave after their political career is done. Tell them to stop worrying so much what the lobbyists and big contributors think about their decisions and ask themselves how those decisions will be viewed by history.

Robert Creamer is a long-time political organizer and strategist, and author of the recent book: "Stand Up Straight: How Progressives Can Win," available on amazon.com.

It’s become something of a running joke in political circles in Minnesota: people wonder which 312 voters get to take credit for providing Senator-Elect Al Franken with his margin of victory. This, of course, is not an academic question. With your 312 votes should come the right to demand that your issue, constituency, members, aunts, uncles, and cousins get a seat at the table, right? The people who can and should take credit for Senator-Elect Franken’s victory are many:

Was it progressive Democrats?

Was it union members?

Was it base activists in the Twin Cities?

Obama voters in swing suburbs?

The environmental movement?

Choice voters?

The Tribes?

Rural Somali voters?

St. Paul’s Hmong voters?

College students?

Seniors?

The residents of any given block in south Minneapolis?

Senator-Elect Franken has been very gracious in acknowledging the breadth of support that got him 42% of the vote. (Remember, this was a three-way race.) However, the case for Senator-Elect Franken offering strong support for health care reform runs a lot deeper than election politics. It is a part of solid strategy to build his leadership by using his Senate seat to actually and demonstratively improve the lives of Minnesotans.

1) Minnesotans in every part of the state need health care reform. I’ve sat in rooms from Preston, MN (near the Iowa border) to Red Lake, MN (near the Canadian border) from St. Paul, MN (urban) to Willmar, MN (rural) and heard health care stories that range from frustrating to outrageous. There can be no doubt Senator-Elect Franken has heard similar stories during his 2+ years of crisscrossing the state.

2) Minnesotans strongly support a public health insurance option. The recent NYT/CBS and NBC/WSJ polls outlining broad support for the public health insurance option represent the baseline of such support in Minnesota. If 72-76% of Americans are supportive, Minnesotans are at least this supportive. After all, Mr. Franken will take over the Senate’s desk #94, the seat that, literally, held the late Senator Paul Wellstone.

3) Senator-Elect Franken is perfectly positioned to lead for Minnesota. With his impending assignment to the Senate’s HELP Committee Senator-Elect Franken will, from day one, be immersed in marking up Senator Kennedy’s Affordable Health Choices Act. There are 306 million American citizens. Only 23 of them sit on the HELP Committee. There are 312 voters and another 5.1 million Minnesotans that need Mr. Franken to bring us to that table.

Chris Conry is the Health Care Field Coordinator at TakeAction Minnesota.

A recent analysis by the Commonwealth Fund shows that women experience cost-related health access barriers at higher rates than their male counterparts. These new findings echo those of a similar study conducted by the National Women’s Law Center and the Commonwealth Fund two years ago. Though women are no more likely to be uninsured than men, they are more likely to skip or delay necessary health care because of cost, and they report more problems paying medical bills and with accrued medical debt. These inequities are a result of women’s lower incomes (in 2007, women earned 0.78 cents for every dollar men earned) and the fact that they need and use more health care than men. Women’s responsibility for their children’s health care is an additional factor, as women with medical debt or bill problems are more likely than their male counterparts to be single with children.

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America is more open to a public conversation about government regulation of companies than at any time in many, many years. (Yesterday in a discussion with union leaders in a highly regulated industry they could not agree on the starting date for this wave of deregulation. Was it 1965 or 1971?)

Congress is talking about regulating credit cards. Remember, they used to be regulated, state-by-state. Then they all moved to South Dakota or some other lawless place. Now, America wants Congress to start minding the store again. There is strong popular sentiment to outlaw sub-prime mortgage scams and predatory lending practices. The word “predatory” is used openly to describe giant financial companies. Again, Americans want Congress to mind the store.

Yesterday’s “let us do it” letter from big health care industry stakeholders can be seen in this context. They see the regulatory wave growing, and want to be out ahead of it. The only proper response is to step up the call for regulation with teeth. If the industry mends its ways, regulations won’t bother them. If they don’t, the machinery will be in place to act quickly.

We can help people see the need by shining a light on “predatory” practices by insurers. After all, they are financial institutions like banks and credit card companies. Denial of payment should be treated the same as a bank refusing to give you your money. It’s not the insurance company’s money. They are just holding it to pay for my health care.

“Sub-prime” insurance should be outlawed. A policy that does not cover the purchaser is a scam. High-deductible policies are sub-prime. Bare-bones policies are sub-prime. If we don’t demonize them, the other side will describe them as bargains and run a “one size does not fit all” media blitz. If ever there was a time to set a reasonable floor on health coverage, it is right now.

We have to wage this regulatory fight to make the “level playing field” attack less damaging. A public health insurance plan should not have to compete with a high-deductible, low coverage, low premium rip-off plan. The power of the public option is magnified when combined with a strong regulatory wall keeping insurance companies from a big part of their plundering and pillaging business model.

We should join the industry in the call for a “specific focus on obesity prevention commensurate with the scale of the problem.” A good place to start is corporate fat cats and bloated bureaucracies. The recent Georgetown/RWJ study [pdf] shows people can’t figure out their policies, can’t figure out what is covered and what isn’t, and can’t estimate what the real costs will be. They call for truth in packaging. We should add strong content standards.

The public hates insurance companies for a reason. Even Luntz sees it. Turn up the heat on insurance company predatory practices. It’s regulation time for American health care.

It came via certified mail, which was enough to make her nervous, but a quick glance at the return address actually made her stomach drop.  A certified letter from a health insurance company—could that ever mean good news?  For my close friend Margaret it most definitely did not.  Her health insurance company—one of the largest in her state and in the country—had begun digging into her medical history to scrutinize her original health insurance application.  Nine months had passed since she was approved and enrolled in the health plan, but now the company had some concerns. Enter the “Dear Health Plan Enrollee” letter.

When Margaret called me two weeks ago, letter in hand, she was confused and a little angry, but she was mostly just terrified.  Was the company allowed to do this? Why were they doing it now? Would she lose the health insurance that she so desperately needed?

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Today, April 28th, is Blog for Fair Pay Day. In recognition of this important day, our guest post by Lisa Codispoti, Senior Counsel for Health and Reproductive Rights, National Women’s Law Center, relates to health care and equal pay.

Between 2000 and 2006, health insurance premiums increased 87.5 percent—4 times more than wages. In addition to the burden of inflated health care costs, women are still paid only 78 cents for every dollar earned by men—with women of color earning even less. In a world where women are earning significantly less than men for comparable work, how can they also afford health care?

Pay inequity for women compounds the issues that already exist with our broken health care system. This is a system that makes unfair practices by insurance companies flourish, such as allowing health to be more expensive for women. For example, women pay higher premiums than men when they try to buy health insurance directly from an insurance company through the individual health insurance market (a practice known as gender rating.) Even worse is that many of these health plans do not cover maternity care or expect women to pay an additional fee (what is called a rider) to gain maternity coverage. Women are then left trying to stretch their already smaller paycheck for a much larger health care bill.

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Rural Americans, such as those that make up 65% of Montana's population, are being hit hardest by America's health care crisis.

We are far more likely to pay higher out-of-pocket medical costs and incur greater expenses for emergency room care, and we are 70% more likely to be underinsured, according to a research paper published in Health Affairs entitled "Out of Pocket Health Spending and the Rural Underserved." As Lil Anderson, Jim Paquette, and Nicholas Wolter - all Montanan health care providers - explained in the Billings Gazette last week, one in five Montanas is uninsured, rising health care costs are squeezing even families that have health insurance, and Montana's small businesses and by extension, our families, are suffering:

We all have a stake in fixing the health care system, and the fix is one vital step toward reviving the U.S. economy. As the economy falters, businesses - especially small businesses - are struggling under the weight of rising health costs. Many businesses are forced to choose between providing health coverage or eliminating jobs. And families are forced to spend more of their incomes on health care. We need to get the economy back on track and develop a health care system that protects human dignity while delivering high-quality, affordable care to everyone.

Montanans are suffering in a large part because there is no meaningful competition in our state's health care market. According to the American Medical Association [pdf], one insurer, Blue Cross Blue Shield of Montana, controls 75% of the market. With competition like that, no wonder prices are soaring even faster here than in other regions of the country!

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Comprehensive health care reform is front and center in the nation's policy debate.  As President Obama has said, "Health care reform cannot wait, it must not wait, and it will not wait another year."

Now, you have an opportunity to help shape health care reform to meet the needs of working families.

The AFL-CIO and Working America want to know about your experiences with America's health care system-what's working, what isn't, what costs too much and more. Make your voice heard by taking the 2009 Health Care for America Survey.

Tallied results of the survey, sponsored by the AFL-CIO and its 2.5 million-member community affiliate Working America, will be shared with national and state leaders and the media. Congress, the administration and the media are hearing plenty about health care reform from drug makers and insurance companies - they need to hear from working families, too.

Millions of working families are paying a steep price for a health care system that's just not working anymore:

• Forty-one percent of working-age Americans had problems paying medical bills in 2007, and four in 10 of those used all their savings to pay their health care bills.
• About half the families that file for bankruptcy do so at least in part because of health care debt.
• In December and January, nearly 50 million people had no health insurance. About 14,000 people a day lost their coverage during those months.
• Uninsured adults are 25 percent more likely to die prematurely than adults who have insurance.

The survey asks specific questions about your household's health care coverage and costs. Does you family have health care coverage? Does your health insurance cover the care you need at a price you can afford? Has an insurance company denied you coverage or treatment because of a pre-existing condition? What should be included in health care reform?

The 2009 survey also provides an opportunity to tell your health care story in your own words-in writing or in a video.

While individual survey responses are confidential, the AFL-CIO will share the compiled results with Congress, the Obama administration and state lawmakers, as well as print and broadcast media. Last year, more than 26,000 people completed the 2008 survey, and 7,500 shared poignant stories about their families' health care experiences. That survey gained widespread media coverage and kept health care at the top of the national agenda during the 2008 elections. The 2009 Health Care for America Survey is expected to receive even more responses and media attention as health care reform moves forward.

Take the survey here. Encourage your friends, co-workers and family members to do so as well. No one can make America's leaders understand what working families go through in today's health care system like you can.

At 12:30 this afternoon, I joined a line of people that had formed by the White House gate, eager to enter and begin the critically important task of debating and advancing the effort to achieve health care reform this year. A beautiful, warm day, the talk was of the thaw in Washington — and not only regarding the weather. I had the chance to talk with leaders on health care reform in the House and the Senate, from both parties and with varying positions and approaches, and to press them and the many others who were there to address the needs of women and their families. There were close allies of the National Women's Law Center sitting next to those with whom we do not often agree, trading ideas and business cards.

While it would be foolhardy to think that all differences will magically disappear, the tone was constructive (dare I say even friendly), the mood hopeful and the setting a powerful reminder that the public good must prevail. What was striking was that a positive tone existed, not only in front of the cameras but in private conversations throughout the day. Wanting to read it tonight, one Republican member of the House asked me for my own copy of the Center’s report on the outrageous practice of many insurance companies to charge women more than men when they buy insurance directly — even with maternity coverage excluded! This “gender-rating” practice underscores how unfair and arbitrary the system can be, and the extra hurdles that women have to overcome.

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