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Health care reform and the role of insurance companies “why we NEED a public option”!

I wrote my first speech about the need for health care reform and the contributions insurance companies were making to skyrocketing medical costs when I was a freshman in college.  Very little has changed in the 3 decades since.  … Except in the negative direction.

What I’m sure about:

1)  I am sure that relying on big insurance companies to monitor themselves hasn’t worked in decades and that our health care costs have continued to skyrocket. In the last decade alone the increase in health care costs has been – 119% which is 3 times as fast as wages and 4 times as fast as inflation (Kaiser Family Foundation, 2009).

2) I am sure that these increases is unsustainable and hurt American families. In 2007, nearly 2/3 of personal bankruptcies were linked to medical expenses; 80% were people with insurance (Journal of American Medical Assn., 2007).  1,500,000 American families lose their homes each year due to medical costs (Health Matrix, 2008).  In 2008, about 57 million Americans were in families that had problems paying medical bills, and nearly three-quarters had health insurance coverage (National Coalition on Health Care, 2009).

3) I am sure that these increases are unsustainable and hurt American businesses. The current system decreases American manufacturers’ competitiveness. We spend: $2.38 per worker /per hour for health care costs   vs.$0.96 per worker /per hour for US trading partners (Heritage Foundation, 2008). While some would say the problem is that we pay benefits that are too high to labor union workers, this misses the point! Passing on the costs to workers hurts workers (see numbers above) and does NOTHING to make the cost of health care sustainable. The problem isn’t workers, it’s that COSTS ARE TOO HIGH!  Health care costs are the fastest-growing business expense in the U.S. (National Coalition on Health Care, 2009). They drag down earnings and wages, slow job growth,  and decrease dollars available for research and development.

4) I am sure that shifting the burden of health care insurance and health care costs to American families is NOT the answer (see #2 above). For those firms providing coverage, nearly 3/4ths of those surveyed (73 percent) say they are struggling to continue to provide coverage due to high insurance costs (Small Business Majority, 2009). In the Hewitt Associates 10th annual health care report, results of surveys with 343 executives “found that over half (52%) of employers believe the economic downturn will affect their health care programs in 2010. In addition, 19 percent of these employers are planning to move away from directly sponsoring health care benefits in the next 3 to 5 years, which is almost 4 times as many who reported this in 2008” (National Coalition on Health Care, 2009).

5) I am sure that increased competition is critical. From where I sit the provision of health insurance in many states looks a lot like a monopoly and one that rapidly is growing.

In 2007,  the American Medical Association reported that a single insurance carrier controlled at least 30% of the insurance market in more than 95% of insurance markets.  For 15 of the 44 states reporting, the top two insurance providers controlled 75% or more of the market. Twenty-two more states have 50%  to 74% of the market controlled by the top two insurance companies. For a breakdown of the percentage of the market is controlled by the top 2 insurance providers in the 50 states and the District of Columbia, see  Health Care for America Now, available at http://hcfan.3cdn.net/dadd15782e627e5b75_g9m6isltl.pdf

A look at the Government Accountability Office report on Small Group Health Insurance Carriers by State released in February, 2009 comparing 2002, 2005 and 2008 results illustrates how the dominance of a few insurance companies is growing:

In 2008,

•   The median market share of the largest carrier in the small group market was about 47%, with a range from about 21% in Arizona to about 96% in Alabama. In 31 of the 39 states supplying market share information, the top carrier had a market share of a 1/3rd – 33% or more.
•   The five largest carriers in the small group market, when combined, represented 3/4ths – 75% or more of the market in 34 of the 39 states supplying this information, and they represented 90% or more in 23 of these states.
•   Thirty-six of the 44 states supplying information on the top carrier identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier, and in all but 1 of the remaining 8 states, a BCBS carrier was among the 5 largest carriers.
•   The median market share of all the BCBS carriers in the 38 states supplying this information was about 51%, with a range of less than 5% in Vermont and Wisconsin and more than 90% in Alabama and North Dakota.

In comparing what states reported in 2008 to what they previously reported to GAO in 2005 and 2002, they found:
•   The median market share of the largest small group carrier has increased to about 47% in 2008 from the 43% reported in 2005 and the 33%  in 2002. Twenty-four of the 29 states providing information in both 2002 and 2008 saw increases in the market share of the top carrier that ranged from about 2 to 39 percentage points. In contrast, the top carriers in 5 states lost market share with decreases ranging from about 1 to 16 percentage points.
•   The number of states with a combined market share of the 5 largest carriers of 75% or more has also increased since 2002. The combined market share of the five largest small group carriers represented 75% or more of the market in 34 of 39 states, compared to 26 of 34 states reported in 2005 and 19 of 34 states reported in 2002.

The full report can be found at: http://www.gao.gov/new.items/d09363r.pdf

6) I am sure that it’s time we stand up to insurance companies who DO NOT have our best interests at heart – as evidenced by CEO compensation packages. Below from the Seton Hall University School of Law, Health Law and Policy Program website http://www.healthreformwatch.com/2009/05/20/health-insurance-ceos-total-compensation-in-2008/ are the total compensations for CEOs of insurance companies for 2007 & 2008.  Following is a “humorous” analysis of just how much money this is!

“Perhaps a slight bit of context is in order, however: it has struck me that Aetna’s Ronald Williams received $24,300,112 last year. That’s $467,309.85 per week. That’s a house. Maybe not a house that Mr. Williams would live in, but a house nonetheless. The man makes a house a week. And interestingly enough, if Mr. Williams were to eschew the purchase of a house on any given week and instead look to deposit the money in a bank– in order to remain FDIC insured (up to $250,000)– he would actually need to open more than one account–every week. Lest we lament the fate of the other CEOs on the list, in 2008 Ms. Braly had to get by on $189,311.76 per week, and Mr. Hemsley had to somehow manage on $62,327.73 per week (but perhaps he was able to save a little from last year when he made $253,164.02 per week).  May 20, 2009 by Michael Ricciardelli Health Reform Watch weblog Seton Hall University.”

Ins. Co. & CEO With 2007 Total CEO Compensation

  • Aetna Ronald A. Williams: $23,045,834
  • Cigna H. Edward Hanway: $25,839,777
  • Coventry Dale B. Wolf : $14,869,823
  • Health Net Jay M. Gellert: $3,686,230
  • Humana Michael McCallister: $10,312,557
  • U.Health Grp Stephen J. Hemsley: $13,164,529
  • WellPoint Angela Braly (2007): $9,094,271
    L. Glasscock (2006): $23,886,169

Ins. Co. & CEO With 2008 Total CEO Compensation

7) I am sure that a public option that will offer competition to private insurance companies, and if properly formed, will help bring the cost of health care insurance down.

The following video by Robert Reich (Secretary of Labor in the Clinton administration, Professor at UC Berkeley outlines succinctly the points that it’s not too late to get a public option and that insurance companies want it to fail.

http://pol.moveon.org/call/oneoffs/index_1165.html?cp_id=1165&tg=FSKS_1.FSKS_2&id=17692-17258418-IqgG0_x&t=1

8 ) I am sure that it is up to us, the American people, to hold our Congressional leaders accountable and to demand that this decades old problem be addressed, that a workable solution be found, before we permanently damage the economic viability of families and business nationwide. Phone, tweet, blog, email, write your Congressional representatives and demand that they get the job done on health care reform.

Health care should be a right, not a privilege!

Dear Senator Reid – GET A GRIP!

As a long time Nevadan and recent transplant to Kansas, I would like to express the sincere and deep displeasure of myself and many Americans with the sorry state of the U.S. Congress. For the first time in a long time democrats have the majority, have the capacity to make real change to benefit the American people, and have failed to show the leadership necessary to carry that change through. Unfortunately, historically this has been too often the case.

The opposition utilizes clear, concise (often blatantly erroneous if not flagrantly false) statements to support their positions. The democratic response is to pretend these are reasonable claims and to try to answer them – illegal immigrants covered under the reform plans, euthanizing your granny, the list seems endless. What the democratic leadership and the democratic members of Congress NEED to do is state clearly what they stand for and work for real, quality, necessary change, not chase phantoms designed to distract, dissemble and disable quality initiatives.

The democratic desire to compromise on basic principles is flawed and futile as evidenced by the Senate’s inability to support a public option in health care reform. The American people gave President Obama a clear mandate by both electing him and giving both houses democratic majorities. The American people in poll after poll have told you they want a public option in health care reform. You are squandering that mandate to the disadvantage of the American people. You are not acting in the best interests of the American people.

Get it right, Senator Reid. You are wasting the capacity you have as Senate Majority Leader and it is the American people who will ultimately pay for this.

Reflections on 9/11/01 and my life since

Eight years ago, in the midst of my busy, getting-ready-for-school morning, my ex-husband called and said “turn on the TV”. I asked, “what station?” He said, “any of them”. I asked, “what is it?” He said, “I can’t talk about it. Just turn on the TV. You’ll see.” And I saw.

I awoke this morning, eight years later, to a lovely sunrise. Colors muted by a light fog.  It was ethereal. I smiled.  As the morning progressed, it got gray and overcast. Appropriate, it seemed, for this day.

I decided to take  time to reflect on that morning eight years ago and my path since to where I am now. First, I paid tribute to that day. I pulled up facebook and YouTube and searched for tributes. I read what my friends were posting on twitter. I listened to music. I cried.  It amazes me sometimes how something that long ago can still have such a powerful impact.

I am reminded how the difficult, as well as the lovely moments, both take our breath away and define our lives. Mine will never be the same.

The feeling of despair and fear was overwhelming that morning as I watched repeated images of the planes flying into the World Trade Towers, and later, the images of the towers falling, the plane in the Pennsylvania field, the damage to the Pentagon. I felt such vulnerability for myself, for our nation. In the days following, I was so proud of how we, as a nation, as a people responded. I was gratified at the kindness and compassion of the rest of the world. I felt more tuned in to both my place in this nation, and my place as a citizen of the world. I felt humble. I strove to understand.

I vowed, as many did, to live more fully in the present, to move more slowly, to make more thoughtful choices, to make certain that those I love always know it. It seems like a good time to reflect on how I’m doing.

Since 9/11/2001, I’ve made many changes in my life. I moved to Ohio for six months, back to my home town, so my daughter could go to school with her cousin. My daughter and I moved to Kansas so I could take my dream job. I purchased my dream house. “Invested” in real estate (I can’t sell my Reno house because the market is so bad, so that’s how I’ve decided to frame it for myself). I left my son in Reno to pursue college and dance. I could not have imagined how much I would miss our day-to-day patterns of living together. I’ve watched my daughter move from elementary school to high school and marveled at the amazing people my children are. I’ve recently become almost painfully aware that my time as a full-time mother is coming to an end. It’s amazing how years can pass in mothering, filling the gaps and the empty moments with “kid” activities. My daughter drives now and while we share a car, her independence is growing.

For the first time, I am required to take time to think about what I want for the next phase of my life, my post full-time mommy phase. Today seems like an appropriate day to review and reflect. So back to those vows I made to myself on that overwhelming day eight years ago.

1) to live more fully in the present

My prior to 9/11 self could easily be described as a multitasking over achiever. I juggled a significant number of tasks ALL the time. I could never say “no” and my mantra was “I can do that”. I didn’t always know HOW, but I knew that somehow I WOULD do whatever needed to be done. There are a number of characteristics of this style that I ultimately viewed as problematic. I was always focusing on the future. I didn’t take time to appreciate what I had accomplished and was instantly off to the next thing. That meant both that I didn’t appreciate what I had accomplished as it was just something to cross off the list and, more importantly, because I was always focused on the future, I didn’t adequately appreciate the present – except as the space within which I was “getting something done”. Don’t get me wrong, these characteristics have helped me accomplish all I have in both my professional and personal life and in many ways I’m grateful to have had that approach. That said, it became clear to me that I noticed and enjoyed the  awe inspiring  moments, sunrises, sunsets, the sound of my daughter’s laughter, watching my children perform. Those moments could bring me up cold, stop me in my tracks as it were. I was not so good, however, at noticing the beautiful in the everyday, mundane, process of my life. I was not so good at “being” in the moment. I had to either be “doing” or observing, OR and even worse, if I could make myself just stop, just be, I felt guilty for NOT getting anything done, for WASTING time. Historically, I lived too much in my head and not nearly enough in the “real” world.

2) to move more slowly

Related to living more fully in the present is slowing down. When I multitasked, I moved very quickly. When that happened, I  missed the details of what was going on around me. I forgot to eat. I slept poorly and for only 4-5 hours a night. I sat for hours at a time at my desk, my computer. I worked through sickness, exhaustion, I stayed up all night to complete a task. I told my students, “make me make eye contact if you need my full attention”. I told my children, “you’ll likely need to tell me that again because I might not remember”. Productive, yes. Fulfilling, no.

3) to make more thoughtful choices

I’ve always been thoughtful. What I hoped for was to take more time to think through choices. My strategy in my prior life was to take every opportunity that came my way. It was fun, exciting! It led to the multitasking thing I mentioned earlier. I had always had goals. Now I wanted to take time to consider alternatives more carefully, to choose my path.

4) to make certain that those I love always know it

This has probably always been one of my strengths. Those I care about know it. I say it. I show it.

I’ll close for now, at 7:54 p.m. on September 11. In my next post, I’ll assess how I’ve done.

Reflections on the candlelight vigil for Dr. Tiller in Wichita May 31, 2009

I know many people have written about Dr. Tiller’s murder. I know that his death will galvanize and polarize those who supported as well as those who disagreed with his beliefs and actions. I did not personally know Dr. Tiller, but I was compelled to attend the candlelight vigil last night.  I was impressed with the civil, thoughtful, compassionate assembly.  Those in attendance were kind to one another; members of Dr. Tiller’s church passed out candles and walked through the crowd of around 400 people relighting candles that were blown out by the wind.  Strangers stood side by side and shared their sadness, their determination for the future of women’s health, their fears for the future, and lit and relit one another’s candles.  People met and embraced friends who shared their sadness at this tragedy. I left when the singing began with a greater appreciation for Wichita. I appreciate both diversity and conviction. I keep being surprised by both here. I appreciate the careful, thoughtful way those who spoke talked about Dr. Tiller’s life and contributions to the community and to women’s health choices in general. I appreciate the courage of conviction and ability to look at the bigger picture of those who spoke.  It’s always easier not to make waves, to choose the safe, nonthreatening path.  Dr. Tiller lived for years consciously, publicly taking the most difficult of paths, living the courage of his convictions. I am saddened that such a tragedy occurred in my adopted city. I am heartened by those who attended and spoke at Dr. Tiller’s vigil.   In the face of a tragedy, Wichitans in Old Town last night pulled together in thoughtful compassion and proved that the actions of one man did not reflect the views of many. On balance, Wichita earned positive marks from me yesterday.