Healthcare, Guaranteed

Over the last decade we have filled our libraries with treatises written on reforming health care. Yet, our health care system remains largely unchanged. Many of these volumes are overly complex or duplicative, quoting the same figures about the shocking percentage of GDP spent on healthcare (close to 17%) and the poor results achieved (well behind almost all industrialized countries). In this sea of undifferentiated policy work, Ezekiel Emanuel’s book Healthcare, Guaranteed: A Simple, Secure Solution for America stands out for its clarity of approach. If we were President for a day (or maybe even Ezekiel’s brother, who is Obama’s Chief of Staff, Rahm Emanuel), we would mandate that Healthcare, Guaranteed be required reading for all members of Congress. Check out the great review written by the newest member of the Women's Bioethics Project advisory board, Margaret Lane.

Five Misconceptions About Health

Here's a brief summary of an article Shannon Brownlee and Ezekiel Emanuel wrote for the Washington Post (reprinted in the Minneapolis Star Tribune):

1. America has the best health care in the world.


Let's bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name.


2. Somebody else is paying for your health insurance.


Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.


3. We would save a lot if we could cut the administrative waste of private insurance.


The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn't really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Tracking the rate of heart attacks from drugs such as Avandia, for instance, is key to ensuring safe pharmaceuticals.


4. Health-care reform is going to cost a bundle.


Only if you think that covering the uninsured is our only priority. Yes, making health care available to all citizens is the right thing to do. But it isn't the only thing to do. We also have to fix the spectacularly wasteful and expensive way doctors and hospitals deliver care.


5. Americans aren't ready for a major overhaul of the health-care system.


A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.

I strongly suggest everyone go and read the full article. It's not terribly long, and it offers some pretty eye-opening information. For example, did you realize that the average family of four spends $29,000 a year for health care via taxes, lower wages and out-of-pocket medical expenses? While I knew it was taken out of wages, taxes, etc, I had no idea it was that high.

A lot of these things are part of the broader discussion I've seen in comments on this and other health blogs, so they're worth considering as we go into what will hopefully be a new era of health care in America.
-Kelly Hills

NYT: Women pay more for same health insurance

From the NYT:

Women Buying Health Policies Pay a Penalty

It has been found that women could be charged as much as 31 percent more than men when buying the same health care plan. With more and more deregulation of health care, more individuals have to shop around for plans offered by private insurance companies, who are free to set up their own standards for pricing. Justifications for charging women more include childbearing-related issues and higher frequency of going in for regular checkups.

“Women often fare worse than men in the individual insurance market,” said Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee.

Insurers say they have a sound reason for charging different premiums: Women ages 19 to 55 tend to cost more than men because they typically use more health care, especially in the childbearing years.

But women still pay more than men for insurance that does not cover maternity care. In the individual market, maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.

Crystal D. Kilpatrick, a healthy 33-year-old real estate agent in Austin, Tex., said: “I’ve delayed having a baby because my insurance policy does not cover maternity care. If I have a baby, I’ll have to pay at least $8,000 out of pocket.”

In general, insurers say, they charge women more than men of the same age because claims experience shows that women use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy group that has examined hundreds of individual policies, said: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

This is akin to employers who will deny a woman a promotion or a critical job position because they perceive a potential for her to go on maternity leave or to leave the job completely. In addition to being discriminatory, this practice also does not reflect the real impacts of differential use of medical services. Other than for maternity issues, I predict that men tend to have more need for acute treatment because they tend to not be as regular about periodic screenings and checkups as women, and that would be more expensive or at least a wash in the long run.

Once again, a focus purely on profits is getting in the way of fairly providing services to human beings.

Good news for S-CHIP

Last week, the State Children's Health Insurance Program (S-CHIP) got a shot in the arm from a General Accounting Office legal opinion. Some states have tried to expand health insurance coverage to children of middle-income families, only to be blocked by presidential veto. The GAO opinion (PDF here) holds that the Administration's policy is a sea change from previous interpretations of applicable law, and that as such it would require Congressional authorization. You can read more here. Given current economic conditions, it can only be a good thing to make sure that kids' health is taken care of as families struggle to make ends meet.

Blue Cross Proposes Their Own Fix For Uninsured Americans

Earlier this week, Blue Cross released a proposal called "Pathway to Covering America", their own plan to cover 30-35 million of the estimated 47 million uninsured Americans. Blue Cross CEO Scott Serota told reporters that "We believe it's time to act, [and] [w]e're not going to wait for the government to move."

The plan combines ideas to improve general population health, with a focus on shifting to preventive medicine, and tax credits to encourage people to buy coverage.

Blue Cross did not name specific levels for its proposed tax credits but said they would go to low-wage workers in small businesses, people whose health premiums represent a large share of their income, people without access to employer coverage and those who have lost a job.

The association also proposed helping states find and enroll people who are eligible for existing public health insurance programs but are not using them.

The Blue Cross and Blue Shield Association said the tax credits envisioned would cost the U.S. government $50 to $100 billion per year, but the overall proposal also would yield other savings as uninsured people get coverage and cut down, for example, on hospital emergency room costs.

Of significant interest, given recent conversations and posts regarding the FDA and Big Pharma here on the Women's Bioethics Blog, is the Blue Cross proposal to create "an independent institute to back research comparing the effectiveness of new and existing drugs, devices and medical procedures."

I haven't had a chance to read more than the media coverage of the proposal itself, but if you're interested, the BBC has a link to the proposal pdf for download.
-Kelly

Ten Biggest Health Stories of 2007 (from Alternet)

Okay, I promise this is my last 'top ten' post (at least for today and mostly likely for 2007 -- Can you tell I love these lists?). For the next few days, I will be en route to Indonesia and East Timor, so you won't hear much from me, but I do hope to do some blogging in Bali!

From criminal health care to outrageous diet plans, these are AlterNet's most-read health stories of the year:

10. Even Republicans Hate Our Health Care System

9. Are You One of the Shrinking Americans?

8. I'll Have My Cosmetics with a Side of Infertility, Please

7. The Toxic Chemistry of Everyday Products

6. Private Health Insurance Is Not the Answer

5. The Stone Age Diet: Why I Eat Like a Caveman

4. Controversial Michael Moore Flick 'Sicko' Will Compare U.S. Health Care With Cuba's

3. The Frightening New Normalcy of Hating Your Body

2. You Call Yourself a Progressive -- But You Still Eat Meat?

1. Michael Moore Rips Wolf Blitzer on CNN: "Why Don't You Tell the American People the Truth" [VIDEO]

For links to all the above stories, click here.

Wishing you all a happy, joyous, and abundant 2008!