They Don't Call It "Sick For Profit" For Nothing

The California Nurses Association has put together a fantastic report detailing the denial rates on claims by leading insurance companies.

Researchers from the California Nurses Association/National Nurses Organizing Committee analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six insurers rejected 45.7 million claims -- 22 percent of all claims.
For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

Claims denial rates by leading California insurers, first six months of 2009:
• PacifiCare -- 39.6 percent
• Cigna -- 32.7 percent
• HealthNet -- 30 percent
• Kaiser Permanente -- 28.3 percent
• Blue Cross -- 27.9 percent
• Aetna -- 6.4 percent

This has been the way that the 18 top insurers in America have received $16 billion dollars in profits last year. They deny care and make bank off it. As the Nurses report states, "If the private insurers are not paying for care, why do we have private insurers?"

After coverage of this report in the LA Times and the Sacramento Bee, Jerry Brown, the Attorney General of California, has opened an investigation into these allegations.

The inquiry was prompted by a report released Wednesday by the California Nurses Association. The report suggested that the insurers rejected a fifth of all claims received over the past seven years.

"The public is entitled to know whether wrongful business practices are involved," Attorney General Jerry Brown said Thursday in a statement.

The spokesman for the insurance industry in California blamed this on "paperwork issues." Lost in that paperwork are people like Nataline Sarkisyan and Nick Colombo, who died from denial of care.

As bad as these denials are, there's also the crisis that 2.2 million Californians have medical debts, with a third of those bills over $2,000.

"That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance," said E. Richard Brown, director of the UCLA center. "Current policies either do not offer enough coverage or offer full-coverage at a cost that is too expensive for many people to bear. The result is that too many people have health insurance plans that leave them financially vulnerable and force them to delay the care they need."

It's amazing that these kind of discussions aren't the number one subject when it comes to medical care, instead of people shouting in town hall meetings.

Out Come The Tough Ads

When the Obama campaign finally unleashed the 527s, albeit tacitly, to run some ads hitting John McCain the thought was that it would be too late to have an impact. Well over the last week, a stream of ads have been released by all kinds of organizations, and I think there will be a cumulative effect.

The fantastic Defenders of Wildlife ad, the best of the cycle IMO, is expanding into more swing states as its effectiveness is undeniable.

Then Planned Parenthood has readied an ad on the "Sarah Palin charged victims of rape for their own medical exams" controversy. It's similarly powerful and a clear recitation of fact; she approved city budgets in Wasilla with this policy on the record.



Campaign Money Watch has a Keating Five ad that ties that corruption to the current corruption of McCain's campaign manager Rick Davis taking secret payments for influence:



And the California Nurses Association hits McCain and Palin in the same ad in a pretty vicious way:



I don't know if all this negativity on the air is going to be a good contrast with Obama's attempt to carry a statesmanlike message these past few days, but politics ain't beanbag. These are facts which deserve to be in the public sphere.

Money Matters

Charlie Brown reported $225,000 in the first quarter of 2008, with over a million dollars raised throughout the campaign. He's had 12,000 donors thus far.

Russ Warner took in $100,000 in the first quarter and has $220,000 cash on hand.

But I was more interested in this story, which shows the CNA making an electoral play in two swing districts to help the Democrats reach a 2/3 majority.

This year the nurses union also is backing two Democrats vying for open seats which are being vacated by Republicans:

Up north, longtime San Ramon Valley School Board trustee Joan Buchanan seeks the East Bay’s open 15th Assembly District being vacated by termed-out Assemblyman Guy Houston. In January she reported a $166,000 war chest and most likely will face off against San Ramon Mayor Abram Wilson.

Down south, former Santa Barbara Assemblywoman Hannah-Beth Jackson wants to fill Ventura County’s open 19th District state Senate seat being surrendered by termed-out Tom McClintock, who’s heading north to run for an open congressional seat near Sacramento. Ex-Assemblyman Tony Strickland is the GOP’s anointed successor.

“We only need two more Democrats in the senate and six more in the assembly to have a two-thirds Democratic majority,” said CNA legislative director Donna Gerber, who spent six years as a Contra Costa County supervisor.

“When there are budget cuts those budget cuts pretty much happen in health care and education. So for sure we are supporting Hannah-Beth Jackson and Joan Buchanan. Those are two that we’re putting a lot of our energy into.”

If labor jumps in explicitly in these legislative races to aid in the drive for 2/3 then we'll have a distinct financial advantage. Remember that the CA Republican Party is essentially broke. This is the best news I've heard all week and I know the rest of labor will follow suit.

CNA Forces Insurer to Buckle, Provide Life-Saving Care for Sick California Teen

The CNA has been in the headlines for other reasons lately, but I don't think anyone can discount the incredible activism they have engaged in on behalf of patients being denied life-saving medical treatment. Word now comes of another victory against the "murder by spreadsheet" insurance industry who felt like saving a kid's life wasn't good for business.

In the face of a national campaign on behalf of Nick Colombo, insurance giant PacifiCare has reversed its decisions and agreed to critically needed cancer treatments for the 17-year-old from Placentia, Calif. The decision came after the company was overwhelmed by calls organized by Nick’s friends and family, along with RNs from the California Nurses Association/National Nurses Organizing Committee, and netroots activists.

Over 100 of Nick’s classmates, friends of the family with their young children, and nurses protested in front of the insurance company headquarters this morning to demand that the approval be put in writing, which a PacifiCare representative, surrounded by T.V. cameras, and promised to do.

“I am extremely happy about PacifiCare’s reversal, said Ricky Colombo, Nick’s 19-year old brother. “The goal was to get treatment for Nick, and CNA/NNOC and other allies helped us with that. We decided to go through with the rally in order to get their decision on the record and make sure they back up their words—and also because there are thousands of others in similar situations who can’t get the care they need. We feel blessed to have this community supporting our family.”

In the fight for universal health care, all sides of the debate on the left are going to be instrumental. The CNA's tenacity and effectiveness in organizing "patient revolts" like this is very valuable, particularly to show the inequities in the current broken health care system. Activists shut down PacifiCare's phone system on multiple occasions before they capitulated.

To beat the powerful interests that want to maintain the status quo you're going to need every activist and every strategy you can find. And we're going to win this fight, one patient at a time.

Give It Up For The California Nurses Association

We need organizations who aren't afraid of what is politically possible and talk about was is morally right. Today the CNA placed a full-page ad in 10 Iowa papers arguing strongly for not-for-profit health care, Medicare for All, taking the example of Dick Cheney's multiple heart problems, and noting that if he wasn't receiving the finest in government-run health care, he'd be dead by now.

The patient’s history and prognosis were grim: four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator and now an emergency procedure to treat an irregular heartbeat. For millions of Americans, this might be a death sentence. For the vice president, it was just another medical treatment. And it cost him very little.

Unlike the average American, the president, vice president and members of Congress all enjoy government-financed health care with few restrictions or prohibitive fees. They are never turned away for pre-existing conditions or denied care for what an insurance company labels “experimental treatments.”

The rest of us deserve no less.

We call on the presidential candidates to support HR 676, the National Health Insurance Act— an expanded and improved Medicare for all that:

• provides complete medical, dental, vision and long-term care
• eliminates deductibles, co-pays, hidden fees
• allows you to choose your doctor, lab, hospital, health care facility
• is completely portable and not tied to employment
• is free from interference or second-guessing by insurance companies.

We should have these conversations out in the open. The vagaries of what it politically possible should never be the outer edges of the debate. Let's actually find out if America rejects a Medicare-for-all system; they certainly haven't rejected Medicare. It takes an organization like the CNA to jumpstart this debate. Good for them.

Getting Ugly Over Health Care Non-Solutions

So after being peppered with criticism from both term limits groups and the California Nurses Association, the Speaker's office has chosen which group to strike back at: the nurses, of course, using the exact same standard of judgment that they called a "smear job" when it was used against Nuñez.

This is an argument over improving the delivery and cost of health care, and there's plenty of ideological rigidity to go around. What started as a promising "year of health care reform" has devolved into putative allies arguing about how much money the other spends on hotel rooms. Behind the mere gaining of political points is a serious debate about how to best allow all California citizens, not just the ones with full-time employment (us freelancers need health care too), the highest quality affordable health care they can manage. And the real truth of the matter, the one that nobody really wants to talk about, is that none of these state-based plans, by definition, have any hope of working and have serious potential consequences, besides. I think that's why everyone's getting so mad at one another, because it's easier to do so than to face the facts.

We’ve got all these great universal bills passing at the state level, and I’m here to tell you that, well, they are pretty great, but they’re not going to work. It didn’t work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn’t work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state’s revenues dropped. It didn’t work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.

The plans fall for a few small reasons, and one big one. The big one is that states don’t have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don’t exist the state can’t borrow the money. So they dismantle the program. It’s happened time and time again -- in some states, like Oregon, more than once.

Moreover, you don’t really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access – it’s actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don’t have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don’t trust them to fundamentally reform the system.

California is obviously one state that has the size, and certainly could float ever more bonds to spend the necessary money. But we're almost certainly on the cusp of a new recession, and the combination of massive debt passed on to grandkids and a pay-to-play system that still reigns supreme in Sacramento is unpalatable to reform.

I repsect the efforts of groups like Physicians for a Naitonal Health Plan, who have studied the issue and recommended some of the best possible solutions. But that word "national" is hard to get around; it's the only way to create the real economies of scale and managed risk necessary for a solution. I believe in health care for everyone, not simply in red states or blue states. As Ezra Klein notes,

You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the “laboratories of democracy.” But there’s another Brandeis saying that I think is more applicable: “If we would guide by the light of reason,” he said, “we must let our minds be bold.” And that’s what I’m asking: Be bold. Because nothing else will, in the long term, work.

UPDATE: I'll even give you a talking point: We want the same health care for every American that gives triple-bypass surgeries to members of Congress for virtually nothing. That'd be the simplistic version, but even with the details it's a bold, realizable goal.

Thoughts Turn To Health Care

With the budget resolution, the clock starts for the rest of the legislative session in Sacramento. The Assembly and the Senate have until September 14th to pass bills before them and send them to the Governor's desk for signature. And obviously the centerpiece of the session is health care reform. AB8 will be the organ for Democratic legislative leaders and the Governor to come to an understanding about how they want to fix the state's health care crisis. And the people are weighing in and saying that their preferred solution has a different bill number; SB 840.

Frank Russo reports:

36% of California voters support a new government run system--like Medicare--up from 24% in last December's survey. At the same time support for making "reforms with the framework of the current health insurance system, with shared responsibilities by government and individuals" has dropped from 52% to 33%. Reliance on "free market competition to improve the health insurance system" draws only 14%, down from 18% previously.

So after months of all actors in the health care debate talking to their constituents, more people want to see health care for all than a shared responsibility framework that keeps the current for-profit system in place. And the vast majority want to see something changed over the status quo. Frank Russo teases this out, and exemplifies why I think the aggressive strategy by groups like the California Nurses Association has moved the goalposts:

Only eight short months ago in December 51% of California voters described themselves as satisfied with the current system. That number has dropped to 28% while those responding that they are dissatisfied has risen to 69% from 44% previously. The numbers who are very satisfied with what we have now has dropped to 7% from 13% previously and those who say they are "very dissatisfied" is now the largest response with 42%, up from 20% in that category before.

Table 4 in the poll shows the direct correlation of dissatisfaction with the health care system and those who want single payor. It also shows that the largest proposition of Democrats (47%) and "non-partisan/others" (39%) support single payor, while for Republicans the largest response is to reform the current system with insurance and "shared responsibility" (37%).

While it is not surprising that 55% of "liberals" support single payor, perhaps one of the more salient points of the Field Poll is that self described "middle-of-the-road" voters are split between these two options at 34% apiece and with only 10% saying they want to rely on a free market approach. While 31% of "conservatives" support the free market approach, 35% want to reform the current insurance system and 19% even support single payor.

This focus on not-for-profit health care has made reform of the current system completely reasonable, EVEN TO CONSERVATIVES. Change is now demanded rather than sticking with the status quo. Of course, Republicans are not needed to pass health care reform. But they still have to vote on it, and so this can be a significant club to beat Republicans with in the next election, on the biggest domestic policy issue facing Americans.

As for how this will effect the actual legislation, it's clear that this ups the pressure for SOME reform. Democratic leaders should be emboldened by this, and should hold firm on the positive amendments that have already been added to the bill:

AB8, the Democratic plan, has been undergoing some work under the hood. Several amendments will hopefully be made to increase the affordability of health care, among those include a prescription dug purchasing pool that will have about 3-4 million participants. That will make it 2-3x larger than CalPERS. There is also talk of creating a public insurance program that everyone will be able to participate in. This is similar to a few of the Democratic presidential contenders plans to ensure there is an affordable option for health insurance for all residents. These amendments will be considered in hearings over the next few weeks.

It's obvious that the public wants as progressive a proposal as possible. The consequences of failure to reach a compromise are bad for everyone, but especially the governor. He's staked his entire year on this. So let's see a health care reform discussed out in the open so that everyone in the state knows where the main actors stand.

And the FIRST thing the Governor can do is to call the President and tell him to stop this campaign to deny children health care. The onerous new S-CHIP rules must be abandoned. If the Governor is serious about providing health care for all Californians, he must stand up to the President and live up to that responsibility. DFA has started a campaign on this; you can call the Governor and tell him:

"President Bush's new rules which reduce the availability of the Children's Health Insurance Program for uninsured kids must be repealed. Governor Schwarzenegger must call President Bush today and demand a complete rollback of the new rules. Can I count on the governor to stand up for our kids?"