Sick State Budgets, Sick Kids

[pickledpepperRN]

Published on Friday, January 9, 2004 by the New York Times

Sick State Budgets, Sick Kids

by Bob Herbert

While headlines continue to tell us how great the economy is doing, states across the U.S. are pulling the plug on desperately needed health coverage for low-income Americans, including about a half-million children.

Even as the Bush administration continues its bizarre quest for ever more tax cuts, the states, which by law have to balance their budgets, are cutting vital social programs so deeply that tragic consequences are inevitable.

The cruel reality is that Americans at the top are thriving at the expense of the well-being of those at the bottom and, increasingly, in the middle.

A new report by the Center on Budget and Policy Priorities shows that 34 states have made potentially devastating cuts over the past two years in public health insurance programs, including Medicaid and the very successful children's health insurance programs known as CHIPS. More cuts are expected this year.

"Almost half of those losing health coverage (490,000 to 650,000 people) are children," the report said. "Substantial numbers of low-income parents, seniors, people with disabilities, childless adults and immigrants are also losing coverage. Cutbacks of this depth in health insurance coverage for low-income families and individuals are unprecedented."

The worst of the cuts are in Texas. "The Lone Star State has adopted deep cutbacks in its State Children's Health Insurance Program that will cause about 160,000 children-one-third of its SCHIP caseload-to lose coverage," the report said.

Texas is also making Medicaid available to fewer pregnant women, a dangerous move that increases the number of women without coverage for prenatal care and the actual deliveries. "All told," the report said, "Texas is eliminating coverage for between 344,000 and 494,000 children and adults. Census data showed that, even before these changes, the percentage of people who were uninsured was higher in Texas than in any other state."

A loss of health coverage frequently leads to a reluctance to seek needed care. "In poor or low-income families, where there is not a lot of disposable income, people will avoid going to the doctor or getting a prescription," said Leighton Ku, one of the authors of the report. "Certain diseases can then become much more severe. With children, it's likely that they won't get treatment for ear infections, asthma, diabetes-conditions that can ultimately lead to hospitalization."

When treatment can no longer be avoided, the financial consequences can be ruinous. Medical expenses are one of the leading causes of bankruptcy in the U.S.

Officials at the center noted the case of a woman in St. Louis who works but whose annual income is below the poverty line. Under eligibility rules in effect until 18 months ago, she would have qualified for Medicaid. Under the new rules, she does not.

The woman became ill and was told upon her release from the hospital to seek follow-up care. But without any health insurance, her medical bills have been overwhelming. According to the center, "[The woman] has occasional abdominal pain but is not getting any treatment.

She intends to declare bankruptcy because she cannot pay the $47,000 she owes in medical bills, but so far has been unable to save the funds needed to pay for a bankruptcy filing."

People caught in this kind of squeeze often find themselves "sicker, much poorer, or both," said Robert Greenstein, the center's director.

It seems extremely strange that in the United States of America, the richest, most powerful nation in the history of the world, we are going backward in the 21st century in our ability to provide the most fundamental kinds of health care to ordinary people, including children.

The health insurance cutbacks would have been even worse if not for the $20 billion in emergency state aid that was reluctantly approved by the Bush administration and the Republican-led Congress last year. Despite the economic upturn, states are still struggling. They face a collective budget deficit of $40 billion to $50 billion for the coming fiscal year, and there is little sentiment among Republican leaders in Washington for another round of fiscal relief.

Maybe the nation itself needs a doctor. Shoving low-income people, including children, off the health care rolls at a time when the economy is allegedly booming is a sure sign of some kind of sickness in the society.

Copyright 2004 The New York Times Company

[VivaLasViejas, ASN, RN]

That last line says it all------this society's priorities are SERIOUSLY screwed up. And with GWB and his party of the rich and powerful running things, it's never going to get any better......in fact, it will only get worse.

John F. Kennedy once said, "A rising tide lifts all boats". The problem with trickle down economics is, when the tide rises, it swamps the boats which aren't as well built as the yachts of the upper class.

I fear for these next few generations if America doesn't wake up and smell the $5 lattes. I don't believe the Democrats really have the answers either, but almost anything---or anyone---would be better than what passes for leadership nowadays.:angryfire

[nekhismom]

OH, how lovely, Bushie and his friends will relly be sitting HIGH on the horse now! :angryfire

Yet another reason why we need a national health care system.

[pickledpepperRN]

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/01/16/BUGT64APEP1.DTL

What premiums pay for

David Lazarus

Friday, January 16, 2004

©2004 San Francisco Chronicle

The United States squanders more money every year on health care bureaucracy than it would cost to provide medical coverage for the 43 million Americans now lacking insurance.

That's the finding of two respected Harvard Medical School researchers, David Himmelstein and Steffie Woolhandler, in a study appearing this week in the International Journal of Health Services.

They determined that of $1.6 trillion in total health care spending last year, at least $399 billion was eaten up by administrative costs such as clerical work in hospitals and processing a vast array of insurance forms.

But if a national health care plan like Canada's were implemented in this country, the researchers found, administrative overhead would be slashed by about $286 billion.

This amount, in turn, would be sufficient to not only provide health coverage for every uninsured American nationwide but also allow millions of underinsured people to improve their quality of care.

Himmelstein, who is also a physician, said in an interview that 10 percent of revenue at his Cambridge practice now goes to an outside billing firm that handles much of his insurance work.

"That amount could be used instead to care for more patients," he observed. "It could be used to hire additional people and fund a huge expansion of care."

Similarly, Himmelstein estimated that at least 15 percent of his time every day is spent dealing with paperwork.

"That's 15 percent of my time that I'd much rather spend on patients or learning more about medicine," he said.

Private health insurers, who would be decimated by taxpayer-funded universal coverage, oppose creation of a Canadian-style system in the United States. Instead, they prefer adjusting the existing system to expand the number of people covered.

But Himmelstein and Woolhandler argue that the existing system is grossly inefficient and needs to be completely overhauled. The findings of their research may be speculative, but they say it points the way toward legitimate cost reductions.

In California, they found, nearly $163 billion was spent last year on health care. Of that total, $45 billion, or about 28 percent, went to administrative costs.

With Canadian-style universal coverage, the researchers concluded, Californians would save almost $34 billion annually on administrative overhead. This would provide more than $5,000 for each of the state's nearly 7 million uninsured.

"As it stands," Himmelstein said, "you could insure all uninsured people for about $1,500 per person. The administrative savings would thus leave plenty of money to upgrade coverage for others."

The Canadian single-payer system is frequently cited as a model for how the United States might go about offering health coverage to all citizens. The Canadian system, begun nationally in 1971, guarantees all citizens access to essential medical services regardless of employment, income or health.

The system is administered regionally but overseen at the federal level. It's not perfect. A 2001 study found that patients requiring elective surgery wait an average of 16 weeks before reaching the operating table. Investment is slow in new technologies and equipment.

On the other hand, Canadian hospitals and physicians spend substantially less time on administrative chores because the single-payer system is relatively streamlined. Hospitals receive lump-sum payments each year from local authorities but have wide discretion as to how their resources are used. Paperwork is minimal.

Would Canada's system work in the United States? Probably not without some tweaking. Experts say a U.S. universal health care system probably would require strong regulatory oversight to ensure cost controls and quality (and such oversight likely would cut into at least some of the projected savings).

Government authorities might also need more say over distribution of medical resources. Just as few communities would want or need two fire stations within a block of each other, regulators would help decide where hospitals are built to avoid wasteful duplication of expensive technologies.

"Health care shares many of the same characteristics of fire departments and police departments," Himmelstein said. "Hospitals should be treated the same way."

Karen Ignagni, president of AAHP-HIAA, the leading trade group for health insurers, challenged the methodology of Himmelstein and Woolhandler's study, and said administrative costs in the report "are wildly inflated."

Many of the expenses included in the study, she said, "actually involve activities that improve the quality of health care. It's not just paper pushing."

U.S. health insurers support extending coverage to all Americans, Ignagni stressed, but are "against a one-size-fits-all approach."

For its part, the drug industry's leading trade group, Pharmaceutical Research and Manufacturers of America, also opposes creation of a single-payer health care system.

Jeff Trewhitt, a spokesman for the association, said private insurance plans offer consumers more choice and "allow pharmaceutical and biotechnology research companies to avoid innovation-stifling, government-mandated price controls."

Harvard researcher Woolhandler responded in an interview that the insurance and drug industries have resisted change for years. "They're extremely happy with how things are now," she said. "For them, it's a life-or- death struggle."

Yet in the face of such politically powerful opposition, most experts agree it's unlikely nationwide universal coverage will be adopted in the United States anytime soon. Then again, Canada began its system more than half a century ago on a province-by-province basis.

That may bode well for Californians.