Thursday, April 29, 2010

Health Insurance Bill is a Ticking Bomb

I have been showing how the new federal bill that requires people to buy health insurance resembles the system we have here in Massachusetts, which is wrong and unfair. It forces people to buy coverage without actually getting care. It plays Robin Hood in reverse by sending working- and middle-class people's money to rich insurance companies and hospitals. It stigmatizes women who exercise their right to obtain an abortion. People who don't have health insurance yet think the Massachusetts plan doesn't give them what they need, and they resent having to pay for something that doesn't save them any money.

(It may be true, as my friend Larry Lennhoff says, that people will realize the value of health insurance the moment they have a catastrophic illness. For most of us, fortunately, that means never realizing it. It may also not be true. If the public was going to be on the hook for your care before, and now you are paying for insurance yourself, how does that make you happy?)

What I fear most about the new health insurance bill is that it may make people oppose ALL forms of publicly funded health care. Some people think this has happened already. They read the recent election of State Rep. Scott Brown to the U.S. Senate seat as a referendum on health care. I believe this is a whopping big mistake: the Democratic candidate, State Attorney General Martha Coakley, failed to mount any real campaign after she won the Democratic nomination. In effect, she gave the election away. Furthermore, I believe people took their frustrations with the corrupt Democratic monopoly of the Massachusetts legislature out in the Senate race. It doesn't matter that the two have nothing to do with each other.

Still, I do hear people complaining about the Massachusetts bill in casual conversation--in the public library, for instance, checking out books. People are forming the impression that if the government runs it, it's bound to favor the rich and hurt them. They have a lot of reason to think that, and the mandatory health insurance bill just adds one more. To me, that's the biggest reason to oppose it and want to replace it. When you're alienating voters who should be your strongest supporters, you need to think again--before it blows up in your face.

Tuesday, April 20, 2010

Stigma against Abortion: What's to Oppose in the New Health Care Bill. part IV

Abortion is a legal right. What's more, it gives women the opportunity to refuse to give their bodies to pregnancies they don't want, or spend years raising children they may not have the money or the will to raise. No man has to make that choice: the least we can do is support women in the choices they make. Yet the new mandatory health insurance bill passed by Democrats in Congress and signed into law by President Obama paints a scarlet letter on women who choose abortion.

Sharon Lerner wrote in The Nation:

When the debate moved to the Senate... another Democrat, Ben Nelson, led the charge to restrict abortion coverage, proposing an amendment requiring any woman who wants insurance to cover the procedure to write a separate check for that premium. The Nelson Amendment also requires health plans to keep funds for abortion separate.
Apparently, there is no problem with funding agencies that bomb civilians and torture prisoners, but health plans that pay for women to exercise their legal rights are so shameful the government of the people, by the people, and for the people cannot be seen to support them. This is a tremendous step backward for women's rights and health, as well as for equality in America.

Thursday, April 15, 2010

Uninsured Don't Think the Answer is Forcing Them to Buy

I've been recapping the Massachusetts experience with mandatory health insurance, asking what it can tell us about the federal plan just passed. Back in 2008, I wrote:

If you believe the papers, the politicians, or the pundits, the Massachusetts plan to make sure everyone has health insurance--by forcing them to buy it for themselves--is a great success. The uninsured don't believe it, however. Neither do low-income people in Somerville, where I live. Neither do I.

According to the Boston Globe, "The number of uninsured adults in Massachusetts fell by almost half last year." Proponents of mandatory health insurance said "that not only are more people getting coverage, but that only a fraction of taxpayers contested the health insurance mandate."

Sounds like great news, right? It does--until you look at who supports mandatory health insurance and who doesn't. People who already have insurance favor the plan by 71%. Not surprising: it doesn't cost them anything out of pocket, and the taxes needed to fund the plan haven't kicked in yet. But a majority of people who don't have health insurance yet--the people the plan is theoretically supposed to benefit--don't support it, according to a study by the Massachusetts Dept. of Revenue.

In Somerville, where I live, we recently [in 2008] surveyed 537 mostly low-income residents or employees. We asked them what should be the top priority of CAAS, the anti-poverty agency where I work. Keeping housing safe and affordable was the $1 priority (not a surprise, given the high cost of housing in our area). English literacy and finding a job, or a better job, were essentially tied at #2. "Access to health insurance" ranked #3. The people who need health insurance the most are telling us that the Massachusetts plan is still a problem and not yet a solution.

Friday, April 9, 2010

You MUST Buy Health Insurance--Corporations Need Your Money!

I've been sharing the Massachusetts experience with mandatory health insurance with my readers, so you can know what to expect from the federal plan that's modeled on Massachusetts. Expect Robin Hood in reverse: a big subsidy by the working poor and middle to the richest of the health care providers. I originally published this piece last summer.

Massachusetts requires all residents to buy health insurance, even if it means coverage without care. Buying a health plan with a high deductible means paying for nothing, which is what thousands of Massachusetts residents are doing. But it's worse than that.

It turns out that our state government forced struggling young people and families into the insurance business partly so that hospitals didn't have to give them free care any more. "Today, hospitals typically spend about 1 percent of expenses on free medical care, as measured by the attorney general, half of what they spent before reform made insurance available to many more low-income people," according to the Boston Globe.

Meanwhile, nonprofit hospitals are making a profit out of their tax-exempt status--an exemption granted to them largely so that they could offer free care!

The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children's Hospital. Overall, the 10 hospital companies' tax breaks and other benefits were worth $264 million more than the value of the "community benefits" - care for the poor and other charity work - they reported to the state attorney general that year.
It's important to mention the hospitals that ARE offering a lot of free care: "Three companies - Tufts Medical Center, UMass Memorial Health Care (owner of UMass Memorial Medical Center in Worcester) and Boston Medical Center - reported spending more on community benefits than the value of their tax breaks as estimated by the Globe." But they are the shining exceptions--and Boston Medical Center is having severe financial troubles because of its commitment to serving the poor.

In short, so-called nonprofits like MGH and Children's Hospital are stiffing the poor, and we are giving them a tax break at the same time. This should be the shame of Massachusetts.

Saturday, April 3, 2010

Coverage Without Care: What's to Oppose in the New Health Care Bill. part I

OK, so last week, in all fairness, I pointed out that the health insurance bill does contain some provisions that will help people--especially really poor people or really young adults (26 and under). In general, however, the national health insurance plan follows the path already trod in Massachusetts. Having lived under it, the Massachusetts plan is not one I would recommend.

What's wrong with it? Plenty. Let's start with one issue I have been observing for almost a year now: coverage without care.

I wrote on May 4, 2009, "Across Massachusetts, people are facing a stark choice: pain or poverty. The mandatory health insurance law forces people to buy some kind of coverage, but often, what people can afford won't pay for the care they need. In today's Boston Globe, Judi Campbell of Northampton says she's putting off hip surgery because she already owes the hospital $1,000 for arthritis-related surgeries her insurance wouldn't cover."

"And yet the Globe and many policy makers proclaim the "success" of the Massachusetts health insurance plan. For shame!"

On June 21, I wrote:

"The Globe reports:

People with robust [sic] health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.
"All right, let's give the reporters credit. Never mind the logical impossibility of health insurance plan being "robust" if you can't actually use it. (The operation was successful, but the patient went broke?) Also, forget about the fact that this only becomes news when it affects middle-class people, the kind who thought they were already well insured. "

"Let's be happy that finally, it's front-page news that the Massachusetts individual mandate to buy health insurance is failing to deliver actual health care to a large and growing number of people. The key word here is "failing." This is not a model for national health insurance. It's an object lesson in what happens when the hospitals, insurance companies, and doctors all design a health plan without the slightest thought for its effects on actual patients."

Next installment: how the Massachusetts health insurance plan is Robin Hood in reverse--and the federal government follows suit.