Sicko Nation - USA

[Peter Lemkin]

One out of three Americans under 65 were without health insurance at some point during 2007 and 2008, according to a report released Wednesday.

The study, commissioned by the consumer health advocacy group Families USA, found 86.7 million Americans were uninsured at one point during the past two years.

Among the report's key findings:

• Nearly three out of four uninsured Americans were without health insurance for at least six months.

• Almost two-thirds were uninsured for nine months or more.

• Four out of five of the uninsured were in working families.

• People without health insurance are less likely to have a usual doctor and often go without screenings or preventative care.

"The huge number of people without health coverage is worse than an epidemic," Ron Pollack, executive director of Families USA, said in a press release. "Inaction on health care reform in 2009 cannot be an option for the tens of millions of people who lack or lose health coverage each year ... the cost of doing nothing is too high."

The study came out the day before President Obama plans to hold a health care summit at the White House. The President says reforming health care is one of his top priorities.

The number of Americans without health insurance reported by Families USA is much higher than those reported by the U.S. Census Bureau. According to the census numbers, in 2007 there were 45.7 million uninsured Americans. The Census Bureau only counts as 'uninsured' those without insurance all year.

[Peter Lemkin]

Cancer patients find that insurance has limits
Lifesaving treatments cost more than plans will pay
McClatchy Newspapers
Tucson, Arizona | Published: 07.20.2008
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HACKENSACK, N.J. — In 19 years with breast cancer, Gladys Lester has had a mastectomy, breast reconstruction, and a stem-cell transplant. She's had operations to remove cancer that spread to her liver, lungs and ovaries, and chemotherapy that left her bald five separate times.
But only in March, when she was told she'd used up her health coverage, did she feel she'd been handed a "death sentence."
She arrived at the hospital for chemotherapy that day and was told she'd hit her health plan's $1 million lifetime maximum.
"All these years, I've treated my cancer as a chronic disease," and not a terminal one, says Lester, 51, of Ramsey, N.J. "I live my life as best I can. I walk every day. I play with my kids."
She's not the only one whose life has hinged on a line of fine print in a health plan.
In Fort Lee, N.J., Australia Montoya, 42, defied doctors' expectations after being diagnosed with advanced colon cancer 20 months ago. She underwent surgery, 25 rounds of chemotherapy and a second major operation. Now back at her normal weight, she says she feels good.
Except for one thing: She has no more medical coverage for her cancer. She exhausted her plan's $150,000-per-illness limit months ago.
Her husband, Jose Montoya, spelled out the consequences when he appealed in writing to her health plan: "Failure to provide continued cancer treatment for my wife's condition will result in DEATH."
The appeal was denied.
Cancer patients like Lester and Montoya are inspiring examples of medical progress. They've survived tough treatments against long odds. Lester has lived long enough to see her son, 7 months old when she was diagnosed, grow up and go to college.
Yet their cases also show the high costs of such progress — and how those costs can exhaust insurance coverage.
When charges for new cancer drugs and the latest in high-tech imaging are toted up — year after year for long-term patients — a million dollars doesn't last long. Patients with advanced breast cancer can ring up $160,000 annually just for chemotherapy. One of Montoya's hospital stays was billed at more than $200,000.
Meanwhile, employers who want to control insurance costs limit — or cap — coverage.
When these two trends converge, the unthinkable happens. Who'd anticipate running up more than a million dollars in medical bills? Who'd expect to run out of insurance?
"The whole point of insurance is to protect people against catastrophic loss," says the American Cancer Society's Stephen Finan. "To cut them off at $1 million is to throw them into medical hell or bankruptcy."
A recent study found that the number of Americans with inadequate insurance coverage had risen dramatically — to 25 million people in 2007, a jump of 60 percent in four years.
On the other hand, helping people like Lester and Montoya will take more than raising the caps, says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an insurance industry group.
"Why are some of these treatments so expensive? What can be done to control the increasing cost of care?" he says.
"Maxing out" is still rare, but "it will become more common," says Dr. Andrew Pecora, chairman and director of Hackensack University Medical Center's cancer center. "Wonderful new drugs" that prolong life are great news for the patient, he says. But their price tag, for society, "represents a major problem."
He adds: "None of us ever wants to go into a patient's room and say, 'Your recent scan shows the tumor has completely faded away, but the chemo I've been giving you can't be continued because you've reached your maximum.' "
Caps come in many forms: lifetime caps, annual caps, prescription caps, caps per illness. Most people don't realize their policies are limited until they find out the hard way.
"Most medical plans impose a maximum annual or lifetime dollar limit," according to the Employee Benefits Research Institute. Fifty-five percent of covered workers have a lifetime cap, says the institute's Paul Fronstin.
While a third of workers have lifetime maximums set at $2 million or higher, 22 percent have caps between $1 million and $2 million. The caps are even lower for 1 percent of workers.
Gladys Lester's lifetime maximum was $1.25 million, though her "explanation of benefits" statements didn't reflect that. In a flurry of phone calls in the days after her chemotherapy appointment, she learned that Local 1262 of the United Food and Commercial Workers union, whose welfare fund provides her benefits, had raised the cap from $1 million in its 2001 contract negotiations with supermarket chains.
That gave her coverage for a few more rounds of weekly chemotherapy.
Hackensack University Medical Center agreed to proceed with her chemo on the day they told her she'd run out of coverage, Lester said. The hospital told her it would bill her health plan and see what happened.
At an emotional three-hour meeting, she talked with the billing supervisor and her medical social worker.
"I could not stop crying," Lester said. "All I could think about was that this was the end of the road for me: I am going to die. I worked so hard to stay ahead of this disease, all for nothing. My cancer cells need to be knocked down constantly. . . . I just wanted to run out of the room and scream, 'How can you do this to me?' "
In tight spots like this, patients figure out ingenious ways to work the system. Lester has used Local 1262's unlimited prescription plan to order chemotherapy drugs through her drugstore. By purchasing a drug like Herceptin — a $6,499 anti-cancer medicine that costs her a $30 copay under her prescription benefit — she keeps the charge off her hospital bill.
She then carries the drug to the hospital to be infused through the catheter above her heart.
Australia Montoya's husband works behind the deli counter at King's supermarket in Fort Lee and is a member of the Little Falls-based Local 464A of the United Food and Commercial Workers.
The benefits booklet for his plan says major-medical coverage has a "$150,000 maximum for each member and dependent per illness or injury due to the same or related causes per lifetime."
Montoya exhausted the benefit for her colon-cancer treatment Aug. 17, according to a letter the insurer faxed to her oncologist.
At that point, she still had several rounds of biweekly chemotherapy to go.
The health plan's board refused to cover her. "We cannot change or deviate from the guidelines of the plan," their letter said.
Subsequently, she spent 26 days in Englewood Hospital and Medical Center, a stay billed at $209,650. The health plan paid about half of that, under its hospital benefit, which is capped at 31 days. In all, the union health plan has paid Englewood close to $200,000 for her care, according to the hospital.
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Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds








February 3, 2005

• Rising Cost of Health Insurance at Center of Debate
• Health-Related Bankruptcies Up 50 Percent
• House Panel Hears From Consumers Who Lost Insurance
• Harvard Study: 60% of Bankruptcies Caused by Health Problems
• Hospital Stays Increase for Uninsured Americans
• Keeping Your Health Insurance When You're Unemployed
• Hospitals Score Low in Patient Survey
• Lack of Children's Health Insurance Increasing Across the Board
• Uninsured Aren't Primary Cause of Crowds in Emergency Rooms
• Census Report Shows Increase In Uninsured
• Hospital, Health Insurance Costs Skyrocket
• Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
• U.S. Health Care Most Expensive & Most Error Prone
• Retirees Underestimate Health Care Costs
• Per Capita U.S. Health Care Costs Triple Canada's
---
• More Health News ...

Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.

The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children.

Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy.

Most of the medical bankruptcy filers were middle class; 56 percent owned a home and the same number had attended college. In many cases, illness forced breadwinners to take time off from work -- losing income and job-based health insurance precisely when families needed it most.

Families in bankruptcy suffered many privations -- 30 percent had a utility cut off and 61 percent went without needed medical care.

The research, carried out jointly by researchers at Harvard Law School and Harvard Medical School, is the first in-depth study of medical causes of bankruptcy. With the cooperation of bankruptcy judges in five Federal districts (in California, Illinois, Pennsylvania, Tennessee and Texas) they administered questionnaires to bankruptcy filers and reviewed their court records.

Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."

Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878.

"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."

[Peter Lemkin]

Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds

February 3, 2005

• Rising Cost of Health Insurance at Center of Debate
• Health-Related Bankruptcies Up 50 Percent
• House Panel Hears From Consumers Who Lost Insurance
• Harvard Study: 60% of Bankruptcies Caused by Health Problems
• Hospital Stays Increase for Uninsured Americans
• Keeping Your Health Insurance When You're Unemployed
• Hospitals Score Low in Patient Survey
• Lack of Children's Health Insurance Increasing Across the Board
• Uninsured Aren't Primary Cause of Crowds in Emergency Rooms
• Census Report Shows Increase In Uninsured
• Hospital, Health Insurance Costs Skyrocket
• Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
• U.S. Health Care Most Expensive & Most Error Prone
• Retirees Underestimate Health Care Costs
• Per Capita U.S. Health Care Costs Triple Canada's

Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.

The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children.

Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy.

Most of the medical bankruptcy filers were middle class; 56 percent owned a home and the same number had attended college. In many cases, illness forced breadwinners to take time off from work -- losing income and job-based health insurance precisely when families needed it most.

Families in bankruptcy suffered many privations -- 30 percent had a utility cut off and 61 percent went without needed medical care.

The research, carried out jointly by researchers at Harvard Law School and Harvard Medical School, is the first in-depth study of medical causes of bankruptcy. With the cooperation of bankruptcy judges in five Federal districts (in California, Illinois, Pennsylvania, Tennessee and Texas) they administered questionnaires to bankruptcy filers and reviewed their court records.

Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."

Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878.

"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."

[Jan Klimkowski]

Whistleblower tells of America's hidden nightmare for its sick poor

When an insurance firm boss saw a field hospital for the poor in Virginia, he knew he had to speak out. Here, he tells Paul Harris of his fears for Obama's bid to bring about radical change

Paul Harris The Observer, Sunday 26 July 2009 Article history

Patients without health insurance get dental care at a free clinic in Wise, Virginia, held every July for the past three years. More than 25,000 were treated in a weekend

Wendell Potter can remember exactly when he took the first steps on his journey to becoming a whistleblower and turning against one of the most powerful industries in America.

It was July 2007 and Potter, a senior executive at giant US healthcare firm Cigna, was visiting relatives in the poverty-ridden mountain districts of northeast Tennessee. He saw an advert in a local paper for a touring free medical clinic at a fairground just across the state border in Wise County, Virginia.

Potter, who had worked at Cigna for 15 years, decided to check it out. What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements.

For Potter it was a dreadful realisation that healthcare in America had failed millions of poor, sick people and that he, and the industry he worked for, did not care about the human cost of their relentless search for profits. "It was over-powering. It was just more than I could possibly have imagined could be happening in America," he told the Observer

Potter resigned shortly afterwards. Last month he testified in Congress, becoming one of the few industry executives to admit that what its critics say is true: healthcare insurance firms push up costs, buy politicians and refuse to pay out when many patients actually get sick. In chilling words he told a Senate committee: "I worked as a senior executive at health insurance companies and I saw how they confuse their customers and dump the sick: all so they can satisfy their Wall Street investors."

Potter's claims are at the centre of the biggest political crisis of Barack Obama's young presidency. Obama, faced with 47 million Americans without health insurance, has put reforming the system at the top of his agenda. If he succeeds, he will have pushed through one of the greatest changes to domestic policy of any president. If he fails, his presidency could be broken before it is even a year old. Last week, in a sign of how high the stakes are, he addressed the nation in a live TV news conference. It is the sort of event usually reserved for a moment of deep national crisis, such as a terrorist attack. But Obama wanted to talk about healthcare. "This is about every family, every business and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades," he told the nation.

Obama's plans are now mired and the opponents of reform are winning. The Republican attack machine has cranked into gear, labelling reform as "socialist" and warning ordinary Americans that government bureaucrats, not doctors, will choose their medicines. The bill's opponents say the huge cost can only be paid by massive tax increases on ordinary Americans and that others will have their current healthcare plans taken away. Many centrist Democratic congressmen, wary of their conservative voters, are wavering. The legislation has failed to meet Obama's August deadline and is now delayed until after the summer recess. Many fear that this loss of momentum could kill it altogether.

To Potter that is no surprise. He has seen all this before. In his long years with Cigna he rose to be the company's top PR executive. He had an eagle-eye view of the industry's tactics of scuppering political efforts to get it to reform. "This is a very wealthy industry and they use PR very effectively. They manipulate public opinion and the news media and they have built up these relationships with all these politicians through campaign contributions," Potter said.

Potter was witness to the campaign against Michael Moore's healthcare documentary Sicko. The industry slammed the film as one-sided and politically motivated. Secret documents leaked from the American Health Insurance Plans, the industry's lobby group, detailed the plan to paint Moore as a fringe radical. Potter now says the film "hit the nail on the head". "The Michael Moore movie that I saw was full of truth," he admits.

Potter was also working for Cigna when it became embroiled in the case of Nataline Sarkisyan, whose family went public after Cigna refused to pay for a liver transplant that it considered "experimental" and therefore not covered by their policy. Cigna reversed this decision only hours before the Californian teenager died. "I wish I could have done more in that case," Potter said.

Such sentiments are rare in an industry that has given America a healthcare system that can be cripplingly expensive for patients, but that does not produce a healthier population. The industry is often accused of wriggling out of claims. Firms comb medical records for any technicality that will allow them to refuse to pay. In one recently publicised example, a retired nurse from Texas discovered she had breast cancer. Yet her policy was cancelled because her insurers found she had previously had treatment for acne, which the dermatologist had mistakenly noted as pre-cancerous. They decreed she had misinformed them about her medical history and her double mastectomy was cancelled just three days before the operation.

Last month three healthcare executives were grilled about such "rescinding" tactics by a congressional subcommittee. When asked if they would abandon them except in cases of deliberately proven fraud, each executive replied simply: "No."

To Potter that attitude has a sad logic. The healthcare industry generates enormous profits and its top executives have a lavish corporate lifestyle that he once shared. Treating patients for their expensive conditions is bad for business as it reduces the bottom line. Kicking out patients who pursue claims makes perfect economic sense. "It is a system that is rigged against the policyholder," Potter said. The congressional probe found that just three firms had rescinded more than 20,000 policyholders between 2003 and 2007, saving hundreds of millions. "That's a lot of money that will now go towards their profits," Potter said.

A lot of that money also goes into contributions to politicians of both parties - $372m in the past nine years - and in lobbying groups to run TV ads slamming Obama's plans. Many of these ads deploy naked scare tactics. One report said that the industry was spending $1.4m a day on its campaign. In the face of that, it is perhaps no wonder that the Senate has delayed its vote, dealing a massive blow to Obama. "I have seen how the opponents of healthcare reform go to work... they are trying to delay action. They know that if they keep the process going for months, and turn it into a big mess, then the political impetus behind it will lessen," Potter said.

Potter, who now works at the Centre for Media and Democracy in Wisconsin, says the industry is afraid of Obama's reforms and that is why it is fighting so hard. It wants to deal him the same blow as it did Bill Clinton when it scuppered his attempt at reform in the 1990s. Potter admits that he is worried the industry might win again. "I have seen their tactics work. I have been a part of it," he said. He knows he has no chance of ever working again for a major firm. "I am a whistleblower and corporate America does not tend to like that," he said. But there is one thing Potter is not sorry about: leaving the healthcare industry and speaking out. "I have absolutely no regrets. I am doing the right thing," he said.

http://www.guardian.co.uk/world/2009/jul...ack-change