the death panels of private insurers

Six of California’s biggest insurance companies have rejected more than one in five claims the past seven years.  Researchers from the California Nurses Association 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

While not every denial results in patient death or injury, far too many do. As CNA/NNOC co-president Deborah Burger put it, “Care denials have a human face, a real patient enduring unnecessary pain and suffering.”  It’s also a reason why private insurers divert up to 30 cents of every healthcare dollar to overhead — much of it spent to support warehouses full of claims adjustors needed to deny care, to keep down their “medical loss ratio” or profits lost on approving claims. (calitics)

Racial disparities related to health care can be broken down into two categories: access and outcomes. Nonwhites are 52 percent of the uninsured population, the largest proportion of which is Hispanic, at 30 percent — but those numbers don’t tell the whole story about access. Even when people of color are covered, their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods. The facilities that exist are often of lower quality and lack the resources institutions located in primarily white areas have.

What this means is that even when minorities are covered by health insurance, they’re less likely to have quality care and less able to afford the associated out-of-pocket expenses — and the results are staggering. Children born to black women are more than twice as likely to die within their first year of life as are children born to white women. This disparity is unaffected by income or education level. According to the Kaiser Family Foundation, the mortality rate for infants of college-educated black women is 11.5 deaths for 1,000 live births, more than twice that for infants of similarly educated white women, 4.2 for 1,000 live births.

It’s not just infant mortality. According to a 2004 analysis published in the American Journal of Public Health, if the mortality rate of blacks had been the same as that of whites between 1991 and 2000, 880,000 deaths could have been avoided. People of color are more likely to suffer and die from chronic diseases such as diabetes, cancer, and cardiovascular disease, they’re less likely to get the kinds of life-saving treatments that whites get, and they’re more likely to receive the kinds of treatments you would avoid if you could — such as limb amputation for diabetes.

African Americans made up almost half of the new cases of HIV infection recorded in the 2000 Census. People of color are less likely to have seen a dentist. Only 27 percent of African Americans and Hispanics, 36 percent of Asian and Pacific Islander Americans, and 41 percent of Native Americans and Alaska Natives reported seeing a dentist in the past year, compared to nearly half of whites who had. A fifth of black adults report being in poor or fair health, slightly more than Hispanic adults and nearly twice as many as white adults. Some of these conditions are due to disparities in employment, education, and wealth. Language and cultural barriers also hinder effective care, preventing patients and doctors from communicating effectively about medical problems and treatments. But disparities persist even when controlling for income and education levels, the most reliable indicators of quality coverage.

the “failephant.” Health Care For America NOW! Blog

the “failephant.” Health Care For America NOW! Blog

this is why we have a bar exam

Protester at town hally rally: I got a book here called the U.S.S. Constitution. I’m sure everybody’s seen this before. And you know what? I’ve this book three times now, and I’ve referenced it dozens of times and I can’t find one little paragraph in here that says the government has the right to take over our health care. (thinkprogress)

now NEVER TALK TO ME ABOUT THE 10TH AMENDMENT EVER AGAIN.

medical divorce

If you haven’t yet, please read Nick Kristoff’s column on his friend M’s divorce. To make a long story short, her husband was diagnosed with early-onset dementia which made it predictable that over the course of the years he was going to need a great deal of long-term medical care. In the American health system, a family with those kinds of health care needs can get the government to pick up the tab via Medicaid, but only if it burns through all of its assets first. So M was advised by social workers, medical professionals, and attorneys alike to divorce her husband, thus being able to shelter assets earmarked for her kids’ future from the coming medical maw.

In a decent system, everyone would pay a bit more in taxes and nobody would wind up facing that kind of decision. And note that in the end the government winds up picking up the tab for extreme medical scenarios anyway. (yglesias)

Photo by R. E. ~ via LAist Featured Photos on Flickr

Photo by R. E. ~ via LAist Featured Photos on Flickr

great review of ted kennedy’s health care work. warning: may be tear-inducing. (via @minorjive)

ableism and death panels

from an awesome comment by amndaw at shapely prose:

We are so terrified of facing up to the possibility that we may ever be incapacitated in any form. I think most people are OK with the dying part, on some level. But to imagine ever being in a state before the death part, where you find yourself unable to perfectly understand everything going on in your body and mind and your financial situation and what kind of care is available and what treatment is best — AND find yourself unable to communicate your understanding to anyone outside your skin — that terrifies people.

To sit down and go through all these things beforehand requires that people actually imagine themselves in that condition. And that’s a boundary the vast majority of people are not comfortable crossing.

It’s understandable why. It’s completely frightening to most people. And there’s simply the force of inertia. But…

The people who are making the political argument that by acknowledging the possibility of incapacitation and death, you are volunteering for those positions beginning immediately — I think those people are the most terrified of it. And I hate them for their political disingenuity, but I also feel awful for them because yes — it’s scary. It’s hard to deal with.

Thing is, we need more of the “death panels” of the sort you describe. Giving people the space and the support necessary to think through these things. If we supported every human being with respect and dignity no matter their physical/mental state, it wouldn’t be so gdawful scary to think about it.

i’d also argue that part of the resistance comes from the belief/tightly-held-hope that none of these issues can arise until one is very very old. this erases the possibility of suddenly becoming disabled through an accident or illness and lets us think that we will continue to be able bodied until the very distant future. but the underlying belief that being incapacitated is so fucking horrible that we have to put it off through vigorous words and actions is both disappointingly ableist and seemingly deeply entrenched.

the content of death panels

via shakesville, a hospice medical director shares the details of the end of life counseling that is being characterized as a death panel. i found it interesting, and there’s a resource for anyone wanting to set up their own directives. (PSA: think about organ donation!)

Mr. Jones, I’d like to talk to you about a dificult subject. I’d like to know if you’ve given any thought to how decisions about your health would be made if you were unable to make them. I ask all my patients this question – I’m not trying to sneak anything by you.

Are you asking about a living will?

A living will is one way to help make your wishes clear. As long as you can make your own decisions, the living will doesn’t matter. We’re talking about a time when you might not be able to help us decide what we should do. If we can talk about this now, I can help your family make those decisions if we’re ever in that situation.

I don’t want to be kept alive on machines.

OK, I understand that. But sometimes the machines only need to be used for a little while, and people can recover. If you needed a ventilator for 24 hours, and could recover completely, would that be worth it?

Sure. I’d do anything for 24 hours if I could get completely better.

That makes sense. What if you couldn’t get completely better? Some people feel that their life is worthwhile as long as they can communicate, even if they  need a lot of physical assistance. Other people feel that they really need to be completely independent.

Well, as long as I can talk to my family and enjoy my food, that’s enough for me.

So if we can use medical technology to help you return to being able to talk to your family and eat, then it’s worth it?

Yes.

OK. And of course we’d hope for a guarantee that we could do that, but more often we only know the chances. If we could use technology that had a 50% chance of leading to that kind of recovery, is that good enough?

Sure. 50% is a great shot.

What wouldn’t be a good enough chance?

I’d say 20%. If it’s less than a 20% chance, don’t do it.

So what I hear you saying is that if we can use medical technology to give you a better than 20% chance of recovery, you want us to go ahead.

Yes, that’s right.

OK. I don’t think you need to make a decision about the specific technology – it’s my job to help your family decide which interventions would meet your goals. As long as you can make your own decisions, then you and I will talk it over, but if it ever gets to the point where you can’t talk to me about it, this will help a lot.

Should I do a living will?

I think that’s a good idea. Have you talked to your family about this?

Well, my wife and I have discussed it a few times.

Do you want your wife to make decisions for you if necessary?

No, I think that would be too hard for her. I think my daughter would be a better choice.

Well, then I’d suggest you talk with both of them. If it would help, you can bring them in and I’ll talk to them, too. I’d also like to give you a copy of the Five Wishes, which will serve as both a living will and a Durable Power of Attorney, so you can write out your preferences and make sure your daughter will be able to do what you want.

OK, Doc. Thanks a lot. I’ve always kind of worried about being stuck on machines. I’m glad we talked about it.

I’m glad we did, too. If you have any other questions – or you change your mind about anything we discussed – let me know. And I hope it’s a long, long time before we need to make any of these decisions.

people terrify me.

people terrify me.

reason to support health reform: improve the entire system

#10 Long overdue steps to modernize the system, improve the quality of care provided, and curb unnecessary spending so our American health care system delivers the best possible care.
What’s in the bills:
Health reform will bring down the cost of health coverage by making sure doctors and patients have the information they need to work together and decide on the most appropriate course of care.
To improve quality of care, doctors and hospitals that provide better-quality care and demonstrate improved health outcomes will be rewarded.
All health care providers will be encouraged to work together to coordinate care, avoid duplication, develop complementary treatments, and prevent errors.
Why this change is needed:
100,000 Americans die each year from medical errors that could have been prevented.
To truly achieve patient-centered care, patients and their families must be equipped with tools to make informed decisions about their own treatment. (familiesusa pdf)

everyone in the debate seems to agree that health care in this country could be improved. we pay a lot more than other countries do for outcomes that are either as good or not as good, depending on who you ask. but even rich people have a desire to pay less for health care.

the point about patient-centered care is also important. i met a man who had been to the emergency room for closed-skull head trauma. from his medical records, i figured out that he’d gotten a CT scan, they’d inserted a tube to drain fluids from inside his skull, he’d been given an anti-convulsant medication and pain medications. he did not understand any of it. he’d gone to the ER, they did “something” and gave him “some pills to take.” that level of confusion or lack of information is not at all uncommon.

reason to support health reform: THINK OF THE CHILDREN

#9 Better access to coverage for uninsured children so they can get the care they need.
What’s in the bills:
Health care reform will expand Medicaid eligibility for parents that will allow whole families to qualify for Medicaid together. Research shows that when parents and kids have the same coverage, kids are more likely to get enrolled and get necessary care.
Reform efforts include a guarantee that all babies born in this country start life with health coverage.
Uninsured children in middle-class working families with incomes that make them ineligible for Medicaid and CHIP will be able to get coverage with their families in the exchange. Subsidies for families with moderate incomes will help families with incomes as high as 400 percent of the federal poverty level ($88,200 for a family of four in 2009) afford coverage.
Improved outreach and retention policies will make it easier for families get their children covered and keep them covered.

Why this change is needed:
8.6 million children are uninsured. CHIP reauthorization is expected to cover approximately 4 million of these children, but many uninsured children live in families with incomes too high to qualify for CHIP. Health reform will help uninsured children get coverage by providing new assistance to moderateincome families. (familiesusa pdf)

you know what leads to being a healthy adult? prenatal care, pediatric care, preventative care. that can prevent any number of chronic health conditions which affect a kid’s ability to get a good education, work regularly - all those things we need from future adults in order to keep our society and economy functioning. plus, even if you’re a conservative who thinks that being poor or an immigrant is a moral failure, you can’t blame kids. there is no tenable argument against providing this care. THE CHILDREN ARE OUR FUTURE.

reason to support health reform: reform medicare

#8: Improvements to Medicare that will help seniors and people with disabilities afford their drugs and their cost-sharing. (familiesusa pdf)

i’m going to skim over this one, because getting people to care about the doughnut hole in medicare part D coverage is close to impossible, i can barely pay attention and i have to know about it for work.

but basically, when the bush white house managed to pass the prescription drug reform and implement medicare part D, they made it infinitely more difficult for seniors and people with disabilities to get medications. this leads to people deciding whether to get all their meds for the month and not afford to eat, or skip a few meds in order to buy food. this is obviously not what a program to cover health care costs should do, nor is it a decision a health program should ever ask people to make.

reason to support health reform: help small businesses provide benefits for their employees

#7 Much-needed relief for small businesses so they can afford to offer coverage to their employees.
What’s in the bills:
Health reform will provide tax credits to a growing number of small businesses to make coverage more affordable.
Why this change is needed:
More than half of the uninsured—26 million Americans—are small-business owners, employees, or their dependents.
Small businesses pay higher premiums than their larger counterparts, and many cannot afford to offer coverage as a result. Among firms with 3 to 9 workers, fewer than half are able to offer health benefits to their workers.
Our current system, where some employers offer coverage and others do not, promotes so-called “job lock,” which happens when people stay in a job just for the health insurance. Leveling the playing field so that all workers have coverage no matter what will increase job mobility, labor market efficiency, and economic growth. (familiesusa pdf)

losing my health insurance is always the first thing i think about when i fantasize about quitting my job to perfect my lying-on-the-beach skills, even before i remember i wouldn’t have any income. i know other people with chronic health conditions who think the same way - preserve health coverage at all costs, because if there’s a gap, there’s no way anyone will ever start covering me again.

it seems that democrats should be hitting this point harder - this kind of job lock impairs the functioning of the free market. it encourages people to stay at jobs they no longer want and do just enough to skate by.

reason to support health reform: limiting out-of-pocket health care costs

#6 Limits on out-of-pocket spending, giving Americans real health security
and peace of mind.
What’s in the bills:
Health reform will include caps on how much individuals are required to pay out of pocket for their health expenses.
Why this change is needed:
Even when people have coverage, the high cost of health care can—and does—send millions of people into debt every year.
In 2009, an estimated 53.2 million Americans with insurance will spend more than 10 percent of their income on health expenses.
Nearly two-thirds (62.1 percent) of bankruptcies in 2007 were due, at least in part, to medical causes.

this is an incredibly important point. i have health coverage through work, and it’s comparatively good coverage. i still pay around $100/month for my medications and can easily top $200 if i have to go see a doctor, get labs done, or anything else requiring co-pays. and that’s just for me - if i had kids, i’d be paying co-pays way more often. i know people who have bought private insurance but can’t afford to pay the deductible, so can’t use it unless they have a life-threatening emergency. this means that having health insurance can still be very different from being able to access regular primary care services.

bankruptcies due to medical debt are an increasing problem. according to a harvard study in the american journal of medicine (pdf) “the rate of bankruptcies caused by illness-related income loss and medical debt rose by nearly fifty percent between 2001 and 2007. More than sixty percent of bankruptcies filed in 2007 were caused by loss of income due to illness or medical debt.”