Category Archives: health insurance industry

The Myth of the Greedy Geezer

The following appeared today as an opinion piece on Al Jazeera English.

Old people are becoming everyone’s favourite scapegoat for America’s economic woes. Among the growing ranks of self-styled deficit hawks, Social Security and
Medicare are depicted as an intolerable burden to the nation’s already crippled
economy, which can only be saved through massive cuts to these so-called old-age entitlement programs. To advance this agenda, proponents of entitlement cuts have attacked not only the programs themselves, but the people who benefit from them – the selfish old folks like myself, who insist upon bankrupting the
country for the sake of their own costly health care and retirement income.

We in the over-65 set have become the present-day equivalent of Reagan’s notorious “welfare queens,” supposedly living high on the hog at the expense of the taxpayer. According to what I call the Myth of the Greedy Geezer, we lucky
oldsters spend our time lolling about in lush retirement villas, racing our golf
carts to under-priced early-bird dinner specials and toasting our good fortune
with cans of Ensure – all at the expense of struggling young people, who will
never enjoy such pleasures since the entitlement “Ponzi scheme” will collapse
long before they are old.

The fervour for entitlement-cutting remains strongest among conservatives, but these days, even President Obama is taking part, promoting the recommendations of his National Commission on Fiscal Responsibility and Reform, commonly known as the Deficit Commission (and to its opponents as the Cat food Commission, since that’s what old people will be eating when the Commission finishes its work).

The appointed chair of the Deficit Commission, Alan Simpson, is one of the primary promulgators of the Myth of the Greedy Geezer. A former Republican senator from Wyoming who is known for his colourful turns of phrase, Simpson insists that “This country is gonna go to the bow-wows unless we deal with entitlements, Social Security and Medicare.” The majority of the people opposed to such cuts, he claims, are “These old cats 70 and 80 years old who are not
affected in one whiff. People who live in gated communities and drive their
Lexus to the Perkins restaurant to get the AARP discount. This is madness.”…

Read the rest at Al Jazeera.

Soylent Greenbacks: David Brooks Wants Some People to Die for Debt Reduction

To help solve the debt crisis, the best thing I can do is die. Maybe not right now, but certainly before I put too much strain on the public purse—and since I’m 74, that means pretty soon. If I should be lucky enough to contract a fatal disease, I can do the right thing by eschewing expensive medical care that might extend my life. If that doesn’t happen, and I enter a slow and costly decline, then in the interests of the greater good I should take the Hemingway solution.

That’s pretty much the message of David Brooks’s column in today’s New York Times. “This fiscal crisis is about many things,” he writes, “but one of them is our
inability to face death — our willingness to spend our nation into bankruptcy
to extend life for a few more sickly months.”

Here’s how Brooks comes by his position: To begin with, he says: “The fiscal crisis is driven largely by health care costs.” Never mind two futile wars and ten years of tax relief for millionaires—it’s primarily health care that’s driving us into national penury.

Furthermore, Brooks argues, the reason for these soaring health care costs is that very old and very sick people insist on clinging on to their miserable lives, when they ought to be civic-minded enough to kick off. It’s not the insurance companies, which reap huge profits by serving as useless, greed-driven middlemen. It’s not the drug companies, which are making out like bandits with virtually no government regulation. It’s not the whole corrupt, overpriced system of medicine-for-profit, which delivers the 37th best health care in the world, according to the WHO, at more than twice the cost of the best system (France). No. It’s all about us greedy geezers. We’re the ones who are placing an untenable burden on the younger, heartier citizenry, with our selfish desire to live a little longer.

Brooks cites the usual figures: “A large share of our health care spending is devoted to ill patients in the last phases of life,” he writes, and Alzheimer’s patients will soon cost us hundreds of billions. He continues: “Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside.” (Thanks, Dave.) “We are never coercively going to give up on the old and ailing.” Nonetheless, Brooks hopes than many “old and ailing” people will make the choice made by Dudley Clendinen, a man suffering from A.L.S., who wrote a moving essay in the Times about his decision to end his life before the disease takes its full course and renders him “a conscious but motionless, mute, withered, incontinent mummy of my former self.”

I have great respect for Clendinen’s decision. As I’ve written before in Mother Jones, I am a big supporter of what these days is called “choice in dying” or “death with dignity”—each person’s right to decide when and where and in what
circumstances they will die. But I don’t want anyone else making those decisions for me, or telling me when the time is right—not an insurance company or a Medicare bureaucrat, not Barack Obama or John Boehner, and certainly not
David Brooks. I have every intention of being my own one-man death panel. But I won’t be persuaded to die a moment sooner than I want to just because it might
save some money–money that could easily be saved by far more equitable and less draconian means.

Brooks writes that “it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing —confront death and their obligations to the living.” But why is it “hard to see us reducing health care inflation” any other way? Because conservatives like Brooks don’t believe in challenging the profit-driven health care system, and the people who pass these days for liberals lack the moxie to stand up to them.

Based on models from countries like France and Canada, we could bring about whopping savings in health care expenditures through a single payer system without rationing or compromising the quality of care. Short of this, we could opt for much more regulation and still save more money than we could by pulling the plug on every geezer in the land.

If I have any “obligation to the living,” it’s to leave them with a better health care system than we have now—a health care system that values all human life above profits. But I know that’s not likely to happen before my death—which, if I listen to Brooks, could be right around the corner.

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A Boomer’s Straight Talk

That’s a bit unfair,since Dave Lindorff (This Can’t be Happening blog) isn’t exactly the kind of person you’d label a boomer.He says he’s  turned 62. Even so, in this world of squirming,equivocating politicians and their Oh- so- smart expert slide rule advisors, his is a voice of passion about real things in real life. Such a relief after reading, or should I say, trying to read, all the sychophant journalists with their two bit sermons about how broke we are and how we all have to sacrifice.Do these guys seriously think this country is poor?

   Here’s a bit of Lindorff:

But here’s the thing. The reason these parties and lobbies are trying so hard now to use the recession and the national deficit as cover to decimate and destroy these two proven and critically important social programs into which all working Americans have been paying all our working lives, is that they realize what most 50 and 60-something Americans haven’t realized yet: that we are about to become the most powerful political force in the country, and that we are certainly going to demand both an excellent government Medicare program, and a decent retirement program.

Pres. Franklin Roosevelt signs the Social Security Act into law. Franklin Roosevelt signs the Social Security Act into law

The way I see it, we in the Baby Boom generation–those people born between 1946 and about 1964–are just starting to hit retirement age. In another 10 years, we will become a political force twice as powerful and certainly more than twice as noisy and demanding as the current senior lobby. We can either wait until then, after they have successfully gutted the two programs we depend on, making it so we have to fight to recreate or restore them, or we can start organizing now to defend and improve them, and save ourselves a whole lot of trouble.

Lindorff’s proposal,invoking what the Washington Post sneerlingly refers to as “common sense.”

Let’s start building a coalition of Baby Boomers, working through every conceivable organization–labor unions, churches, veterans organizations, alumni organizations, political chapters, etc.–with one goal: Defending and improving Social Security and Medicare.

Here’s the argument. Social Security is said to be in danger of “running out of money” in 2037, because there will supposedly be too many retirees drawing checks and too few younger workers putting money into the so-called Trust Fund. The Trust Fund itself had its trust broken by our politicians, Republican and Democrat, who have for years been raiding the money we put into it, leaving us with government IOUs. These IOUs, the Republicans and the corporatists now say, they don’t intend to honor. (The main reason for these raids has been to fund America’s imperialist wars, which the public never would support if they had to pay for them up front through higher taxes.) Well, first off, we need to demand that they honor those IOUs. Second, since that would mean raising taxes to fund our retirement, we need to demand that the money come not from our working kids and grandkids, but from the rich. It’s really an easy fix. Require that the FICA tax which pays for Social Security benefits apply to all income, not just the first $106,000 of income, and make it also apply to investment income, which currently pays no FICA tax. (I’m not talking about retirement investments. They can be exempted. I’m talking about regular taxable investment income.)

As for Medicare, which we’re told is going to run out of money sometime before 2017, the answer there is to stop making it a program just for disabled and old people, and to expand it to cover everyone, which is what President Obama should have proposed way back in 2008, instead of the outrageous health “reform” that was pushed through Congress and which is going to be undone by the courts anyhow.

 

As Numbers of Uninsured Soar, Health Insurance Companies Plan Rate Hikes

The latest report from the Census Bureau, which shows a significant rise in the number of Americans living in poverty in 2009, is making news today. Less widely reported are the figures for those living without health insurance, which indicate that in 2009 there were 50.7 million uninsured or 16 .7% of population, up from 46.3 million and 15.4% in 2008. Kaiser Health News has a roundup of stories on the sharp rise in the uninsured. The details from the Census Bureau report are as follows.

  • The number of people with health insurance decreased from 255.1 million in 2008 to 253.6 million in 2009. Since 1987, the first year that comparable health insurance data were collected, this is the first year that the number of people with health insurance has decreased.
  • Between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, while the number covered by government health insurance climbed from 87.4 million to 93.2 million. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million. The number with Medicaid coverage increased from 42.6 million to 47.8 million.
  • Comparable health insurance data were first collected in 1987. The percentage of people covered by private insurance (63.9 percent) is the lowest since that year, as is the percentage of people covered by employment-based insurance (55.8 percent). In contrast, the percentage of people covered by government health insurance programs (30.6 percent) is the highest since 1987, as is the percentage covered by Medicaid (15.7 percent).
  • In 2009, 10.0 percent (7.5 million) of children under 18 were without health insurance. Neither estimate is significantly different from the corresponding 2008 estimate.
  • The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.
  • In 2009, the uninsured rates decreased as household income increased: from 26.6 percent for those in households with annual incomes less than $25,000 to 9.1 percent in households with incomes of $75,000 or more.
  • These figures are sure to reignite the health care squabbling in Congress, and add to the Tea Party shrieks that Obamacare won’t cure the health care mess, which is now more of a disaster than ever. While their analysis is flawed, the Tea Partisans’ conclusion is, sadly, pretty much on the mark. 

    In the wake of health care reform, insurance companies are raising their rates–apparently, in preparation for the tepid new rules that won’t go into effect for years, and thus give the industry plenty of time to jack up their prices and protect their profits.  The Wall Street Journal reports that premiums for individuals and small businesses will go up in 2011, in some cases by as much as 20 percent. 

    Once the reform measures do go into full effect, the government is supposed to turn the 50 million uninsured into new customers for the price-gouging private insurance companies, which will enjoy no competition from a public option. As I have been arguing since this so-called debate over the future of health care began, it all looks like a sham exercise by Congress that will only end up extending the grip of the insurance and pharmaceutical industries in the health care market. 

    Any serious economic recovery will be stopped in its tracks by these numbers. And with more price hikes in store, God only knows what the 2011 figures will look like.

    Conservative Agenda Plays Out Through Health Care Reform

    Conservatives may complain bitterly about “Obamacare,” but they “are winning more than even they may realize in the current health care equation.” That’s the point made by Drew Altman, president of the Kaiser Family Foundation, in a recent column.

    [F]or all of the frustration and even anger within the conservative movement about where health care is headed, the fact of the matter is that they are winning more than even they may realize in the current health care equation. That’s because the nature of health insurance itself is being redefined and moving gradually but seemingly inexorably in the direction conservatives have long advocated: more consumer “skin in the game” through higher patient deductibles.

    Item: In our recent survey of people in the non-group insurance market, we found that the average deductible for an individual policy is now $2,498, and for families it’s $5,149. These are very high thresholds by any standard. Consider, for example, that a family with median income facing such a deductible would be spending almost 10% of their annual income just for their deductible before their insurance kicked in.

    Item: The percentage of workers facing high deductibles — $1,000 or more for single coverage —  has been growing rapidly. It doubled from 10 percent to 22 percent between 2006 and 2009, and increased from 16 percent to 40 percent in small firms.

    Item: Indications are that the share of workers with high deductibles is continuing to grow, a trend I expect our 2010 employer survey to confirm when we release it in September as we have every year for more than a decade now. And a substantial number of these high deductible plans are paired with tax-advantaged savings accounts, which conservatives have long advocated. Facing cost pressures without alternative answers, employers are moving to plans with less comprehensive coverage to reduce their expenses for employee benefits.

    Item: Health reform is unlikely to reverse these trends. Large employers will continue to look for ways to address the rising cost of health care. And, for the basic “bronze” insurance plan that people will be required to buy, deductibles could run several thousand dollars for individuals and double that for families. To be sure, other aspects of health reform cut the other way. For example, there will be no cost sharing for preventive services in newly-purchased plans, and insurers will be required to cap consumer out-of-pocket costs at defined levels. And, of course, there are substantial subsidies to reduce premium and out-of-pocket costs for lower-income people. But, for the first time, the government will be defining the threshold that decent insurance must meet, and that minimum coverage will have the kind of high deductibles that conservatives favor.

    There’s still another facet to all of this: While many of the effects of health care reform may actually suit a conservative agenda, Republicans will use this self-same health care reform as a “socialistic” bogeyman to help them win the 2010 Congressional elections.

    Meet the Real Death Panels: The Truth About Age-Based Health Care Rationing

    The latest issue of Mother Jones includes an article by me about the controversy over age-based health care rationing, which got transformed by the right into government “death panels.” Unfortunately, liberals have fallen into a different trap, because they refuse to take on the real enemies of affordable health care for all: the insurance companies, drug manufacturers, and other profiteers of our private health care system.

    As a result, old people are being asked if we would be willing to give up some expensive, life-sustaining treatment so that our grandchildren can have health care. This is a bogus question, and a bogus “choice.” The real question, as I say in the article, is whether we should give up the treatment “so some WellPoint executive can take another expensive vacation, so Pfizer can book $3 billion in annual profits instead of $2 billion, or so private hospitals can make another campaign contribution to some gutless politician.”

    It’s a long article, and I’m including just the opening here, with a link at the end to continue reading at the Mother Jones web site. Or you can read the whole thing at MotherJones.com by clicking here. And if you’re one of those geezers who still likes reading print and turning pages, the July/August issue is on newsstands now.

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    From Mother Jones, July/August 2010

    There’s a certain age at which you cease to regard your own death as a distant hypothetical and start to view it as a coming event. For me, it was 67—the age at which my father died. For many Americans, I suspect it’s 70—the age that puts you within striking distance of our average national life expectancy of 78.1 years. Even if you still feel pretty spry, you suddenly find that your roster of doctor’s appointments has expanded, along with your collection of daily medications. You grow accustomed to hearing that yet another person you once knew has dropped off the twig. And you feel more and more like a walking ghost yourself, invisible to the younger people who push past you on the subway escalator. Like it or not, death becomes something you think about, often on a daily basis.

    Actually, you don’t think about death, per se, as much as you do about dying—about when and where and especially how you’re going to die. Will you have to deal with a long illness? With pain, immobility, or dementia? Will you be able to get the care you need, and will you have enough money to pay for it? Most of all, will you lose control over what life you have left, as well as over the circumstances of your death?

    These are precisely the preoccupations that the right so cynically exploited in the debate over health care reform, with that ominous talk of Washington bean counters deciding who lives and dies. It was all nonsense, of course—the worst kind of political scare tactic. But at the same time, supporters of health care reform seemed to me too quick to dismiss old people’s fears as just so much paranoid foolishness. There are reasons why the death-panel myth found fertile ground—and those reasons go beyond the gullibility of half-senile old farts.

    While politicians of all stripes shun the idea of health care rationing as the political third rail that it is, most of them accept a premise that leads, one way or another, to that end. Here’s what I mean: Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the “experts” persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. Conservatives embrace this notion as the perfect expression of the all-powerful market; though they make a great show of recoiling from the term, in practice they are endorsing rationing on the basis of wealth. Liberals, including supporters of President Obama’s health care reform, advocate subsidies, regulation, and other modest measures to give the less fortunate a little more buying power. But as long as health care is viewed as a product to be bought and sold, even the most well-intentioned reformers will someday soon have to come to grips with health care rationing, if not by wealth then by some other criteria.

    In a country that already spends more than 16 percent of each GDP dollar on health care (PDF), it’s easy to see why so many people believe there’s simply not enough of it to go around. But keep in mind that the rest of the industrialized world manages to spend between 20 and 90 percent less per capita and still rank higher than the US in overall health care performance. In 2004, a team of researchers including Princeton’s Uwe Reinhardt, one of the nation’s best known experts on health economics, found that while the US spends 134 percent more than the median of the world’s most developed nations, we get less for our money—fewer physician visits and hospital days per capita, for example—than our counterparts in countries like Germany, Canada, and Australia. (We do, however, have more MRI machines and more cesarean sections.)

    Where does the money go instead? By some estimates, administration and insurance profits alone eat up at least 30 percent of our total health care bill (and most of that is in the private sector—Medicare’s overhead is around 2 percent). In other words, we don’t have too little to go around—we overpay for what we get, and we don’t allocate our spending where it does us the most good. “In most [medical] resources we have a surplus,” says Dr. David Himmelstein, cofounder of Physicians for a National Health Program. “People get large amounts of care that don’t do them any good and might cause them harm [while] others don’t get the necessary amount.”

    Looking at the numbers, it’s pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a “scarce” resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young.

    For years, any push to improve the nation’s finances—balance the budget, pay for the bailout, or help stimulate the economy—has been accompanied by rumblings about the greedy geezers who resist entitlement “reforms” (read: cuts) with their unconscionable demands for basic health care and a hedge against destitution. So, too, today: Already, President Obama’s newly convened deficit commission looks to be blaming the nation’s fiscal woes not on tax cuts, wars, or bank bailouts, but on the burden of Social Security and Medicare. (The commission’s co-chair, former Republican senator Alan Simpson, has declared, “This country is gonna go to the bow-wows unless we deal with entitlements.”)

    Old people’s anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on “waste,” they’ve allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost.

    Click here to the rest at MotherJones.com.

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    Why Medicare Benefits Won’t Fall

    Additional analysis on what the health care legislation means for older Americans can be found on the website of the National Committee to Preserve Social Security and Medicare. Here are a couple of key points: One is on the budget impact of the reform and why Medicare benefits won’t be cut. The other concerns private Medicare Advantage plans.For the entire statement, go here.

    Despite the fear mongers’ claims, Medicare benefits will not be cut to pay for covering the uninsured.  Before health reform, the federal government was projected to spend about $6 trillion on the Medicare program over the next decade.  After enactment of health reform, Medicare is still projected to spend about $5.6 trillion.  That means over the next 10 years about $450 billion less of American’s money will be spent on wasteful tests, haphazard treatment options, wasteful subsidies to private insurance companies and reimbursement policies that drive up costs without improving the quality of care seniors receive.  The rate of growth will be trimmed by about 1.0 percent over the next 10 years, from about 6.8 percent growth rate to 5.8 percent – hardly the destruction of Medicare that opponents have claimed.  

    As a result, the lifespan of the Medicare Trust Fund will more than double: its solvency will be extended from 2017 to about 2026.  Medicare will continue to grow to meet the needs of an expanding older population, but it will grow at a slower rate that will more closely match the growth of the rest of the economy.  And because health reform is designed to slow the growth of costs in the entire health care system at the same time, seniors’ out-of-pocket costs will be trimmed without driving providers out of the Medicare program or creating other barriers to care. 

    While these improvements are being made, health reform also provides new tools to help crack down on the fraud in the current Medicare program.  For example, by allowing the Department of Health and Human Services and the Internal Revenue Service to share information, it will be easier to stop Medicare payments to scam artists masquerading as legitimate providers.  The health reform legislation also gives the agencies more time to verify that providers are legitimate and that they have provided seniors with the wheelchairs, hospital beds, oxygen tanks and other lifesaving pieces of equipment that they are billing to the Medicare program.  Fraud in the Medicare program hurts us all by increasing costs. 

    Many people worry that curtailment of the Medicare Advantage ripoff plans signals the beginning of the end, denying care to millions and–as people always warn whenever there’s government “intervention” in medicine, driving the doctors out of business. Here’s what the Committee has to say about Medicare Advantage:

    Making changes in the Medicare Advantage program is another way of restoring the integrity of Medicare by reducing wasteful spending.  Medicare Advantage is the privatized part of Medicare whose growth has been fueled by the massive subsidies enacted in the Medicare Modernization Act of 2003.  Medicare Advantage plans are paid on average 13 percent more per enrollee than it costs to provide comparable care in traditional Medicare.  These subsidies, which cost over $11 billion in 2009 alone, are paid for by taxpayers and by all beneficiaries, whether or not they are enrolled in a private plan.  It is estimated that every couple receiving Medicare, including the 75 percent in traditional Medicare, will pay about $90 in additional Part B premiums this year to subsidize those in the private Medicare Advantage plans.  And although these plans provide some additional benefits, many require much higher cost-sharing from seniors for expensive services such as chemotherapy, extended hospital stays and skilled nursing home care – a shortcoming few seniors realize until they find themselves needing the service. 

    Despite what some are claiming, the health reform legislation does not eliminate Medicare Advantage plans or reduce the extra benefits they provide.  The legislation simply phases down the exorbitant subsidies they are currently getting so their payments end up more in line with what it would cost traditional Medicare to cover the same seniors.  It is up to each private insurer to decide how to absorb the reduced payments, and whether to continue providing extra benefits.  The insurers who run Medicare Advantage plans cannot cut guaranteed benefits – they are required to offer all benefits covered by traditional Medicare.  And under the new health reform law, they are now prohibited from charging seniors more than traditional Medicare for expensive services.  They are also, for the first time, required to spend at least 85 percent of their revenue on patient care rather than profits or overhead.  Finally, the legislation rewards Medicare Advantage plans that are providing high-quality care by giving them bonus payments.