From Health Care for All’s blog, reporting on the public input meeting of the “Connector”, the state’s new agency charged with implementing the new health care law:
Next up was a panel from the Greater Boston Interfaith Organization (GBIO). Members of the panel told their personal stories of hardship and inability to afford Commonwealth Care premiums. The first panelist had held a steady, full time job for 25 years before being laid off. She now works part time, has no health insurance, and is ineligible for MassHealth. Further, she is a cancer survivor and a diabetic and cannot afford the co-pays and premiums for Commonwealth Care. The second panelist had cut her hand and, since she had no health insurance, she tried to care for it herself. But her hand became infected and forced her to go to the hospital where she stayed 5 days, had surgery, and now faces a bill of $8,000. She feels that while paying off this debt, she cannot afford Commonwealth Care premiums. The third panelist told the story of a family of five with an income of $60,000 a year. Both parents have full time jobs, they own their home, have no debt, and spend only $150 a week on food. Despite doing so well, this family can still only afford $100 per month for health insurance, less than half of what Commowealth Care will require that they pay.
… Paul Hattis, a professor at Tufts Medical School, spoke about the GBIO affordability sessions. At these sessions, over 500 people filled out worksheets to calculate their monthly expenses and cash flows. Some 220 people were in the 100%-300% fpl range and many of them had negative cash flows. Fully 48% cannot afford Commonwealth Care premiums without shifting money away from other essential expenses or going into debt. Paul recommends that the Board cut premiums or offer fast track appeals for affordability determinations under the individual mandate. He also reminded the Board that it is important to watch out for a disparate impact on minorities.
And that’s the quandary: If the state doesn’t properly subsidize these folks, they either a.) go into debt trying to pay the premiums, b.) go into debt trying to pay their medical bills, and/or c.) get hit with state penalties for not being able to pay for the premiums.
This is just a tightly-wound knot. Stay tuned.
I didn’t warn ya.
I may have to rethink what was, tepid support for this Legislation. Price controls don’t work. Perhaps there’s no reason to think they may work, even when used in small quantity.
in order to inject more–and very much needed–realism into this “health care debate” (that phrase has such a sterile ring to it when juxtaposed with people’s real life experiences and needs like those shared at Sat. Nov 18 Connector Board hearing).
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The new health law Chap 58 has created momentum for change as did the launching of the citizens health care amendment campaign that began 4 years ago, as well as the ACT ballot initiative run by HCFA that began 2 years ago and was abandoned in July. Since 2005 the citizens supporting the health care amendment (over 70,000 voters signed the petition) have been dutifully seeking the 2nd and final ConCon vote of 50 leges in order for the amendment to be placed on the statewide ballot in 2008.
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We have the opportunty to keep this health reform work on track moving in the direction of affordable sustainable quality health care for all. If enacted, the health care amendment language will provide all of us, including those who testified about their health care plight at the Nov 18 Hearing, an immensely valuable tool to keep the Commonwealth on track to complete the job of health care reform. It gives us the leverage and the clear standards to make sure we keep at it until it really works, and works for all of us. The following list explains the value of this amendment effort and why I hope you will CLICK THIS LINK NOW to join it đŸ™‚ The list is taken from a post by Barbara Roop, JD, PhD made previously on BMG.
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1 It sets a goal – universal coverage – and sets standards that all health policy experts and major stakeholders agree must be met to have a sustainable health care system – affordable, comprehensive, equitably financed coverage.
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2 It makes the Legislature and Governor accountable for achieving that goal.
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3 It locks in progess along the way to ensure we’re always moving forward instead of fighting to defend what’s already been accomplished at the same time we’re fighting to finish the job.
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4 It gives the people a legal and political lever to make sure it happens within a reasonable period of time.
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5 It does not replace the legislative process. Quite the opposite – it demands legislative action and the negotiation and compromise that comes with it to solve the problems of affordability, uninsurance and underinsurance – and we all face at least one of them.
Without addressing whether Universal coverage is correct policy or not, it’s hard to imagine it happening:
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1: MostAmericans like the system whether they admit it to pollsters or not. They like the comparatively low co-pays, tests, choice of physician and the like. And they fear change particularly if the change puts at risk their current system.
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2: Big expense is the end of life care, and Universal can’t do anything about that, except ration it.
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3: Short of a political coup, there’ll still be immigrants who’ll not have medical insurance coverage, therefore millions of uninsured residents.
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Number 1 seems the real stopper, with 2 & 3 as ancillary.
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Now, I know you seek Universal, but how do you address #1? That is, most people like the current system, and the minority of people (the uninsured) are the minority and aren’t, for the most part, voters.
Most Americans don’t like it. For starters, the uninsured aren’t so pleased. Add to the list the folks who know they have swiss cheese insurance, like my father. Add in folks like my mother, who’s getting squeezed in to part time work and her insurance will dive bomb because of it.
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Most people do like low co-pays, tests, choice of physician and the like. Most folks do not like the high and climbing rates, the donut hole, that insurance is tied to employer whenever they are changing/losing their job, dealing with the mysteries that determine just how much insurance will cover, fighting with the insurance company for them to cover treatments, etc.
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The nuance is that the bulk of dollars raised in US income tax are paid by people who like the system. Yeah, that matters, and I think you’d agree with this claim.
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To respond to your question, here’s what I would do:
expand medicaid. I’d try to implement Vermont’s plan of dramatically extending coverage to all people under 18 years of age. I’d try to expand coverage to adults too, by increasing the monthly net income qualification. I’d work really hard to make it easier and cheaper for doctors and hospitals to deal with medicaid instead of other insurance institutions. I’d try like heck to negotiate for lower drug prices. I’d work very hard with public health & policy folks to figure out exactly where an ounce of prevention really is a pound of cure — and then encouraging that ounce, thereby lowering long term medicaid costs.
Here’s where I’m coming from to conclude that the majority of Americans are happy. Not “whoopin’ it up” happy, but happy enough to resist a dramatic change:
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-Medicare is a expensive but extremely successful program. The elderly aren’t all pleased with the drug coverage. The uninsured ‘donut hole’ is one complaint but the ‘donut hole’ only hits 25% of the seniors, so most (75% ?) are happy with coverage.
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-Of the non-seniors, 18% are uninsured. The uninsured are probably unhappy and would like Universal coverage of some sort.
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-The rest. I don’t know. I’m happy enough with my own coverage and I pay the entire premium. I’m willing to guess that all Mass state/municiple employees are darn happy with their 85% assist. Corporate employees, if they receive some assist from employer are probably content for the most part.
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Probably true. So, upper middle class and up are pretty content.
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Look at the size of the voting block we have who is happy with the system: 1) most elderly 2) most of the upper middle class and up. 3) all state and municiple employees. Weigh that voting block against 1) noninsured 2) a small portion of elderly.
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Still disagree that ‘most Americans are happy with their health insurance’ or at least happy enough to resist dramatic change?
25% are hitting the donut hole — but it won’t be the same 25% every year. I’d bet that anyone who hits the donut hole in any year will be unhappy with the current system. Additionally, there are plenty of seniors who aren’t in the hole, but are afraid that they might hit it one of these years. So, I’d argue that the minimum unhappiness is 25%, but its likely higher. Wal*Mart’s $4 prescriptions will actually help to keep seniors more happy, since generally speaking, folks are either “happy” or “unhappy” with the process, without really filtering out which parts are better or worse.
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As for the 18% who are uninsured — yes, I’d bet most of them are not happy, although some of them are likely young and currently indifferent.
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The rest: roughly 60% of the US population is covered through non-military employment insurance. The thing is, plenty of them aren’t particularly happy. Anyone who’s changed jobs recently is likely frustrated. Those who work part-time or have swiss cheese insurance aren’t impressed either. So, of that 60%, not all of ’em are happy.
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I agree that most folks are happy enough to resist a dramatic change, especially if you look at (a) the voting people, or even (b) the campaign donating people. That being said, the change doesn’t have to be sudden. Expanding medicaid as I outlined it isn’t sudden nor dramatic. We’re talking about moving cut-off lines for medicaid (and maybe also medicare?!), not for eliminating the private health insurance industry in one fell swoop. Insurance companies are like lawyers… the public generally doesn’t trust them, believes they make more money than they deserve, and will badmouth them every chance they get… until they need their services. Then, if they win (the case or the coverage), they love ’em; if they don’t, they hate ’em. If you agree with this, you probably agree that a Congress which publicly fights for the insurance companies isn’t likely to win many voters.
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So, we agree that there isn’t a groundswell of support for an instant overhaul of all things related to medical billing. But, I suspect that there’s enough people who are unhappy or less-than-thrilled that an expansion of public funding for medicine could take place without much resistance from the middle class, especially if it starts with better coverage for children and if it comes with the belief that the government will turn bureaucracy and waste into economies of scale (like bargaining for prescription drugs, a la the Veterans Administration).
End of life care is indeed where the largest dollar amounts are spent in our health care system; analysis after analysis reveal that nearly one quarter of the entire federal Medicare budget is spent on care during the last year of beneficiaries’ lives.
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The realted fact that is not as well or as widely understood is that MANY PEOPLE DO NOT WANT THAT CARE. It’s quite tragic, really. And the answers to why this is happening are wrapped up in our reimbursement-driven “health care system” that treats health care and death care as a commodity, where a death=failure attitude still pervades both our popular culture and that of medicine in the U.S.
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There are reasons to be hopeful that the needed changes will come. MA is helping lead the way as clinicians, policy makers, ethicists, families and others are providing leadership in this important area. It is actually one of my top interests as a nurse and a nurse educator (my master’s is in Oncology/HIV-AIDS, minor concentration in health policy). THis topic is something that no matter what course I am teaching with I bring up and have a dialogue among students. I eventually encourage them to seriously and intentionally take on the role as ambassadors of culture change where death and dying will become seen as a more natural part of the life cycle, not soemthing to be feared and to be put off at all cost.
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And there’s more to #1 as well (surprise, surprise)
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In addition to the “satisfaction” quotient being a driver of support for needed reforms, in poll after poll most Amercians, I am happy to say, are VERY MOTIVATED to support fundamental system reforms by what is viewed as a positive moral and ethical imperative to ensure that everyone has good health care. Period.
but what percent is “many”? That is, I’m sure that some people don’t want the care when death is inevitable, but I wonder just how much of that “nearly one quarter” is spent on folks who’d prefer less medical interaction in the final chapter of their lives.
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In other words, just how much would medicare save if it stopped spending money on those who considered the medical attention to be interference?
and ealier I had tried to find the Pew Foundation-commissioned study that was done about a decade ago that shed some much-needed light on what the percentage is and how to improve it, but I couldn’t find it right away.
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There’s also an Inst. of Medicine project and book that might even include the Pew study data. Here’s the link for the IOM report Approaching Death: Improving Care at the End of Life. Scroll down to the Table of Contents section and you can skim various sections. Please let me know if you find something specific to the data on your question. I’ve gotta run pick up the kids and then cook some dinner then it’s bath time then… Thanks!