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CNA Responds to Schwarzenegger's Health Reform Plan
Six responses from the California Nurses Association on Schwarzenegger’s health reform plan.
The slippery slope of market-based medicine
By Rose Ann DeMoro | Sacromento Bee
Healthcare packages all inferior, except for one
By Deborah Burger | Ventura County Star
Kuehl’s plan, not Arnold’s, is answer
By Deborah Burger | Los Angeles Daily News
On the Governor’s Health-Care Plan More insurance is not the answer
By Deborah Burger | San Francisco Chronicle
Arnold-Care Is A Bad Deal
By Rose Ann DeMoro | TomPaine.com
Why insurers love the new health plan
By Zenei Cortez | San Francisco Bay Guardian
The slippery slope of market-based medicine
By Rose Ann DeMoro
Sacromento Bee
Published Saturday, December 30, 2006
As Gov. Arnold Schwarzenegger recovers from his fractured leg, he has access to the finest medical care California has to offer, as he should. But don’t all Californians deserve the same degree of medical attention and health care security?
In a few days, the governor is expected to unveil a sweeping health care proposal, following the leaders of the Senate and Assembly, who already have proposed changes to the state’s dysfunctional system.
Yet for all the talk of a “bipartisan” consensus for reform — following years of inaction despite a worsening crisis — it appears most options being suggested will exacerbate the problem, retard efforts to achieve genuine reform and further enrich the corporate elite in the health care industry who produced the present shambles.
If your head is spinning from reading all the various ideas being thrown around, here’s a Cliffs Notes version. Essentially, all the choices can be distilled into two general areas — patient-based reform with public accountability, or market-based approaches.
In the market category fall most of the alternatives being swooned over today by the insurance companies and others invested in pure market-based solutions, the politicians who cater to them and those pundits who counsel us to lower our expectations. Among these proposals are laws to force individuals to purchase their own insurance; starting health savings accounts; and expanded mandates that employers provide benefits for their employees or pay into a pool for coverage for those without insurance.
Their common theme is a reliance on commercial mechanisms that created the present crisis by sacrificing quality, affordability and access for private profit. And all these solutions are doomed to repeat that cycle.
Consider the current fashion of the moment, the Massachusetts model. Every adult in that state is required to buy insurance coverage by July or face penalties. Subsidies are provided for low-income residents.
But the plan has gaping holes. Parents are not obligated to buy insurance for their children. Moderate-income or even middle-income adults who would have to spend hundreds of dollars more each month for full family coverage may choose to gamble with their children’s health or just cut back on other basic needs.
Further, the plans available to middle-income residents typically have deductibles that can run into thousands of dollars. Consumers are likely to foot the bill for many health care services in addition to the premiums the law would require them to pay. And, in the event of a serious illness or accident, they may find their cut-rate plan abandons them to financial ruin.
Consumers are even likely to lose the choice of a physician because they will be forced to pick among the doctors whose services are covered by the low-cost plan they can afford.
The Massachusetts plan is loved by the health care industry because it transfers huge pots of public money to private health care corporations.
Health savings accounts, marketed as “consumer-directed” solutions because they pair a high-deductible plan with a tax-free personal spending account, are similarly catastrophic. HSAs simply shift the cost of coverage from insurers to individuals, promote rationing of care and do nothing to reduce the number of uninsured.
Rather than reduce the bloated 30 percent of every health care dollar spent on administrative overhead and waste, HSAs actually increase administrative costs with servicing fees paid to the financial institutions that are climbing over each other to grab their chunk of this new lucrative market.
By contrast, consider the approach in every other industrialized nation in the world: either a national health system with public administration and public hospitals and clinics, or a single-payer system, with one entity that pays for all health care services with adequate funding to the private caregiver, hospital and clinic of the consumer’s choice.
Poll after poll documents that Americans overwhelmingly support either approach. A single-payer system is not just a dream, it’s legislation — HR 676 in Congress, and a measure in California by Democratic state Sen. Sheila Kuehl of Santa Monica, Senate Bill 840, which was vetoed by Schwarzenegger in September. It will be reintroduced in 2007.
While politicians clamor to come up with inferior alternatives, it will be up to all of us to remind them why this country’s inferior market-based plans will simply extend our national disgrace.
About the writer: Rose Ann DeMoro is executive director of the California Nurses Association. She can be reached at execoffice@calnurses.org.
Healthcare packages all inferior, except for one
By Deborah Burger, RN
Ventura County Star
January 10, 2007
With Gov. Arnold Schwarzenegger unwrapping his long-anticipated healthcare package Monday and talk about reform building in Sacramento, Californians may well be wonder if our long healthcare nightmare is finally coming to an end.
Sadly, virtually none of the proposals now being touted in the Capitol is universal, strengthens quality of care or reduces rising costs to consumers.
The sole exception is a single-payer approach, as contained in a bill by state Sen. Sheila Kuehl, D-Santa Monica, that was vetoed by Schwarzenegger in September, but will be reintroduced soon.
Under single-payer, one public entity collects all the financing and pays for all medical services through the existing private-care delivery system, with adequate funding for our doctors, hospitals, clinics and other care.
All the other approaches are fundamentally flawed. They continue to rely on a wasteful insurance industry whose focus is on making money by denying care to those who need it the most and other market-based mechanisms that created the current mess.
Californians should be especially wary of legislation requiring individuals to buy insurance. The likely result is to criminalize the uninsured, and saddle far too many with cut-rate plans with huge out-of-pocket costs and caps on payments that expose you to financial ruin in the event of a serious illness or major accident.
There’s a better way, the course charted by every industrialized nation in the world. That’s the main reason why the U.S. spends more than the 21 other wealthiest countries on healthcare yet Americans trail them all in life expectancy, infant mortality and a host of other health barometers.
Here’s 10 ways a similar, single-payer-type system, would benefit all Californians, not only those who profit in healthcare:
1. Everybody in, nobody out. Universal means access to healthcare for everyone, period — the desire of 81 percent of all Californians, as reported in a recent Field Poll.
2. Portability. Even if you are unemployed or lose or change your job, your health coverage goes with you.
3. Uniform benefits. No Cadillac plans for the wealthy and Moped plans for everyone else, with high deductibles, limited services and no protection in the event of a catastrophe. One standardized level of comprehensive care no matter what size your wallet.
4. Prevention. By removing financial roadblocks, a single-payer system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected, and societal cost in the overutilization of emergency rooms or the spread of communicable diseases.
5. Choice of physician. Most private plans restrict what doctors, other caregivers or hospital you can use. Under a single-payer system, patients have a choice and the provider is assured a fair reimbursement.
6. Ending insurance industry interference with care. Caregivers and patients regain the autonomy to make decisions on what’s best for a patient’s health, not what’s dictated by the billing department or the bean counters. No denial of coverage due to pre-existing conditions or cancellation of policies for “unreported” minor health problems.
7. Reducing administrative waste. One third of every healthcare dollar in California goes for paperwork, such as denying you care, and profits, compared to about 3 percent under Medicare, a single-payer, universal system.
8. Cost savings. Numerous studies suggest a single-payer system would produce the savings needed to cover everyone, largely by using existing resources without the waste. Taiwan adopted a single-payer system in 1995, boosting health coverage from 57 percent to 97 percent with little if any increase in overall healthcare spending.
9. Common sense budgeting. The public system sets fair reimbursements applied equally to all providers while assuring all comprehensive and appropriate healthcare is delivered, and uses its clout to negotiate volume discounts for prescription drugs and medical equipment.
10. Public oversight. The public sets the policies and administers the system, not high-priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or stocks.
While our politicians debate inferior alternatives, it’s up to all of us to insist that Californians deserve the best.
Deborah Burger is president of the California Nurses Association
Kuehl’s plan, not Arnold’s, is answer
BY DEBORAH BURGER
Guest Columnist
Los Angeles Daily News
01/11/2007
WITH Gov. Arnold Schwarzenegger unwrapping his long-anticipated health care plan, Californians may well expect our long health care nightmare is finally coming to an end.
Sadly, neither the governor’s proposal nor most of the other plans floated meet the test of being truly universal, effectively controlling costs, and assuring a single standard of quality care for all.
The sole exception is a single-payer approach, as contained in a bill by Sen. Sheila Kuehl, D-Los Angeles, that was vetoed by Schwarzenegger in September but will be reintroduced soon.
Under single-payer, one public entity collects all the financing and pays for all medical services through private doctors, hospitals, clinics and other care.
All the other approaches are fundamentally flawed. They continue to rely on a wasteful insurance industry whose focus is on making money by denying care to those who need it the most, and other market-based mechanisms that created the current mess.
The governor’s plan, for example, would criminalize the uninsured by forcing them to buy health insurance, yet there are no standards on what plans would be available and no limits on premium costs.
Worse, the most affordable bare bones plan all would be required to buy would saddle consumers with out-of-pocket costs of up to $10,000, meaning they would likely end up paying for all the health services they actually use in addition to the premium costs. Insurers will gain millions in additional profits from millions of new customers who, for the most part, will receive virtually nothing in return.
Another huge flaw is the promotion of health savings accounts, which primarily benefit the healthy and wealthy who can afford them. There’s a better, simpler way, the path charted by every industrialized nation in the world, a single-payer or national health system. Here’s how a single-payer type system, would benefit all Californians, not just those who profit in health care:
Everybody in, nobody out. Universal means access to health care for everyone, period. Even if you are unemployed, or lose or change your job, your health coverage goes with you. Uniform benefits: no Cadillac plans for the wealthy and moped plans for everyone else. By removing financial roadblocks, a single-payer system encourages preventive care that lowers an individual’s ultimate cost, pain and suffering, and societal cost in the over-utilization of emergency rooms or the spread of communicable diseases. Most private plans restrict what doctors, other caregivers or hospital you can use; under a single-payer system, patients have a choice.
Caregivers and patients regain the autonomy to make decisions on what’s best for a patient’s health, not what’s dictated by the billing department. It would also reduce administrative waste: One-third of every health care dollar in California goes for paperwork, compared with about 3 percent under Medicare.
Taiwan adopted a single-payer system in 1995, boosting health coverage from 57 percent to 97 percent with little if any increase in overall health care spending. The public system sets fair reimbursements applied equally to all providers, and uses its clout to negotiate volume discounts for prescription drugs and medical equipment. The public sets the policies and administers the system, not high-priced CEOs making decisions based on what inflates their compensation packages or stock wealth.
Deborah Burger is president of the California Nurses Association.
On the Governor’s Health-Care Plan More insurance is not the answer
Deborah Burger
San Francisco Chronicle
Thursday, January 11, 2007
While Gov. Arnold Schwarzenegger deserves credit for finally responding to the state’s imploding health-care crisis, his plan as designed has major flaws, most notably forcing the uninsured to buy what for many will mostly likely be substandard, unaffordable health plans that primarily serve to further enrich big insurers.
Some provisions in the governor’s package are welcome — notably the intent to end the disgraceful denials of coverage based on age or health status, and his pledge to assure access to health services for the undocumented.
However a plan that begins by criminalizing the uninsured with no controls on skyrocketing premiums and, at this point, no standards on what those health plans will include, is a train wreck waiting to happen. Let us hope that the state would establish uniform and comprehensive benefits for all.
In a state where health insurance typically runs up to $12,000 a year for a family of four, it’s a safe bet that many will gamble with their health and opt for the cheapest plan available. As defined by the governor’s proposal, those plans would require families to spend up to $10,000 a year in out-of-pocket medical costs. In other words, the average consumer will have to pay for presumably all of their health services in addition to the premiums the law will force them to pay.
If it sounds as if someone is making out like a bandit, that bandit has a name - the insurance industry. Insurers will gain millions while consumers will receive little in return. A mandate on individuals to buy insurance is the centerpiece of the Massachusetts health plan as well. The experience there to date does not recommend this approach. Many people are choosing not to sign up, even with the tax penalties, because they cannot afford the plans, and due to funding problems, the state has cut back on public education about the program. That’s in a state with 500,000 uninsured as compared to California’s 6.5 million uninsured.
A second area of concern is the proposal to shift some $2 billion in tax funds that now goes to hospitals to cover indigent care and use it to buy coverage for the uninsured. It takes money used for direct delivery of care, and hands it to insurance companies, which take 25 percent to 30 percent off the top for wasteful administrative expenses.
Moreover, the proposal has an ugly underside: Because 70 percent of those funds go to public hospitals and clinics, the proposal will starve the public sector of desperately needed revenue, hastening the closure or privatization of more public facilities. This could have a particularly deleterious effect on low-income communities where most public hospitals are located.
That demonstrates the biggest fundamental problem with the governor’s entire package: A market-based system always puts increased revenues and profits over the health and well-being of those patients it is supposed to serve. As was the clear intent of a number of the free-market architects of the plan, it reinforces and expands the role of the market in health care, the very source of the present crisis. If the governor’s goal is truly universal health coverage, improved quality and effective cost controls, the state should embark on the same tried-and-true course taken by every other industrialized nation, either a national health system, or a single-payer approach as embodied in the single-payer bill, SB840 authored by state Sen. Sheila Kuehl. Kuehl’s bill was vetoed by the governor last year. It will be reintroduced this year.
Under a single-payer system, such as Medicare, one public entity collects all the financing and pays for all medical services through the existing private-care delivery system, with adequate funding for our doctors, hospitals, clinics, and other care.
It’s the only plan that assures everyone is covered with one high standard of benefits and care, as opposed to good care for the wealthy only. It assures choice of physician, reduces administrative waste, provides commonsense budgeting, and ends insurance industry interference in the form of high premiums, high deductibles and denials of care.
Americans spend twice as much per person on health care as the other 21 wealthiest countries, yet World Health Organization data shows Americans live the shortest time in good health and have poorer patient outcomes in category after category from infant mortality to life expectancy to doctor visits.
Being number 21 is hardly good enough. By enacting the single-payer Kuehl bill this year, we could finally have the plan Californians need and deserve.
Deborah Burger, R.N., is the president of the California Nurses Association.
Arnold-Care Is A Bad Deal
Rose Ann DeMoro
TomPaine.com
January 16, 2007
Rose Ann DeMoro is executive director of the California Nurses Association .
Sparked by the embarrassment of nearly 47 million uninsured Americans and, more notably, the growing agony of even large business that are staggering under intolerable premium costs, our long national health care scandal is finally beginning to prod our political leaders into action.
Unfortunately, many of the proposals being promoted with such fanfare may well exacerbate the crisis and simply prolong the disgrace.
The latest example comes from California Gov. Arnold Schwarzenegger, who has pledged to achieve “universal” coverage for all the state’s residents with a smorgasbord of every scheme floating around the national policy debate—with the exception of the only one that would actually work: some form of a national health care program or single-payer system, the course taken by every other industrialized country.
Like the Massachusetts law before it, on which it is largely modeled, the Schwarzenegger plan has produced fawning editorials across the country and calls from some politicians in state capitals and on Capitol Hill to use it as a blueprint for other states and Washington.
It has as its centerpiece a mandate forcing every individual buy health insurance or face penalties, along with state subsidies for the low income to buy insurance, a limited tax on businesses who fail to provide health benefits and promotion of health savings accounts.
All the components have a common theme: reinforcement and expansion of the role of the market in health care, the very same market that created the current mess by placing the pursuit of increased revenues and profits ahead of increased access, affordable care and enhanced quality.
Nothing better symbolizes the ascendancy of the market than the mandate on individuals to buy insurance. It stands the central premise of health care on its head—to help people, not to criminalize them. And the Schwarzenegger plan goes beyond Massachusetts, which simply sets tax penalties, by proposing that health insurance become a pre-requisite to getting a job or enrolling your children in school.
Individual mandates shift all the risk from insurers or government onto the back of individuals. Neither the Massachusetts nor the California plan includes limits on premiums or standards to assure the plans have comprehensive or uniform benefits.
With ever-escalating premiums, it’s a safe bet that the average family not eligible for the low-income subsidies will opt for the bare bones plan which, Schwarzenegger has recommended, would specify deductibles of up to $10,000.
Most would thus end up paying for most, if not all, of the health care services they actually use, in addition to the premiums the law would force them to buy. Further, many would simply gamble with their health by limiting medical visits and the prevention that is critical to reducing greater pain and suffering and higher overall healthcare costs down the road.
Someone is making a killing here, and you probably guessed who: California insurers would reap hundreds of millions in profits from the 6.5 million new customers marched into their offices at gunpoint by the state. No wonder Blue Shield of California CEO Bruce Bodaken says of the plan, “There’s a lot to like.”
It reflects a neoconservative political ideology that individuals are solely responsible for their health status, ignoring corporate and commercial factors, from cancer-causing pollution to contaminated agriculture to fast food.
California’s model also undermines the social structure of pooled insurance—that healthier and younger individuals help pay the health costs for the less healthy through collective insurance pools. These would ultimately help everyone who will eventually need coverage, while reducing overall health care costs that mount when large numbers don’t have or don’t use health services.
Another stellar example of that free market fundamentalist philosophy is health savings accounts, a side product of the Bush administration’s 2003 Medicare drug benefit fiasco.
HSAs are tax-free savings accounts to be used solely for out-of-pocket medical expenses, typically used in combination with a low-cost, high deductible catastrophic health insurance plan, in most cases offered by an employer as a cheaper alternative to the health benefits they currently provide. Like the Bush tax cuts, they ultimately look like another tax break for the wealthy.
HSAs bear strong similarities to individual mandates in encouraging the user to play Russian roulette with their health and discouraging the use of preventive care—hence the euphemism “consumer-driven care,” which could also be termed “lack of meaningful insurance” or “no care.”
And, like individual mandates, HSAs do nothing to control rising costs or to reduce administrative waste. In fact, HSAs add a new layer of bureaucracy and profit to yet another well-heeled industry that will of course operate and manage the accounts—the financiers. The banks are scrambling to get into this booming new market and expecting $20 billion in HSA accounts by 2010.
There’s a better way. The opportunity has never been greater to mount a national campaign for real reform for a single payer system, as is embodied in H.R. 676 in Congress or S.B. 840 in California.
Single-payer plans, like Medicare, have everything the market-based plans lack:
Americans will be covered with one high standard of benefits and care—as opposed to good care for the wealthy only—and portable. They assure choice of physician and other providers. By removing financial roadblocks to care, they emphasize prevention.
Single-payer plans reduce administrative waste (about three percent in Medicare, vs. over 30 percent with most private insurance), thus producing cost savings. They allow for common sense budgeting in which care, not profit is the primary focus, and they end the disgraceful insurance industry interference with care. And, they are accountable through public oversight.
H.R. 676, introduced by Rep. John Conyers, D-Mich.,, now has 78 congressional co-sponsors, and should get a hearing in the new Congress. California’s SB 840 was vetoed by Schwarzenegger last fall but will be re-introduced.
It’s time we joined the rest of the world in achieving this basic humanitarian right.
Why insurers love the new health plan
By Zenei Cortez
San Francisco Bay Guardian
January 17, 2007
If you’re one of the 6.5 million Californians without health coverage, get ready to find a lot of hands in your pocket.
Gov. Arnold Schwarzenegger’s much-trumpeted health plan is the most ambitious overhaul of the state’s health care system since … well, since SB 840, the far simpler, more universal, more comprehensive, single-payer health plan sponsored by Sen. Sheila Kuehl, which the governor vetoed last September.
Unlike a single-payer system, with one entity that pays for everything using existing private hospitals and doctors and offers one standard of quality care for all, the Schwarzenegger plan is a mishmash likely to saddle more Californians with unaffordable, inferior coverage while opening a new gilded age for insurers and banks.
Once the legislature prunes away the proposed new tax on employers, hospitals, and doctors (which is likely) and eliminates the laudable pledge to assure coverage for the undocumented, the governor’s plan is apt to end up stripped down to its worst elements — a mandate that all individuals have to buy health insurance and the dubious promotion of a Bush administration scheme, health savings accounts.
Individual mandates turn the whole purpose of health care on its head — they criminalize people, rather than helping them. If you don’t sign up for a plan, you could become ineligible to get a job and enroll your child in school or face tax penalties.
With no controls on skyrocketing premiums, comprehensive plans will be out of reach for millions of Californians. Most could end up with junk insurance, with up to $10,000 in out-of-pocket payments for any medical care, meaning the average person will likely pay for all his or her medical expenses on top of the premiums. And many may forgo any medical care, risking worse health problems and greater health costs down the road.
Even lower-income people who qualify for the state subsidy could end up paying out 6 percent of their income. Presumably, they’ll just cut back on food or rent — at the same time that the governor has announced plans for welfare cuts.
Then there’s the $2 billion now used for indigent care at mostly public hospitals that will be siphoned off into the pool for buying insurance, ravaging our public health social safety net.
But the insurance companies will suddenly get millions of new customers, who will be buying insurance at gunpoint. No wonder Blue Shield CEO Bruce Bodaken says of the plan, “There’s a lot to like.”
If nothing else, the Schwarzenegger plan — and the lite versions proposed by the Democratic leaders of the Senate and Assembly — should be a call to action for the rest of us to press harder than ever for the enactment of the soon-to-be-reintroduced single-payer Kuehl bill.
Zenei Cortez, RN, is the vice president of the California Nurses Association.