Oh! The efficiency of the current U.S. health care system

I know that the most recent posts have focused on the mortgage fiasco, but I'd like to insert a quick thought on health care/medical issues.

I'll begin by laying my cards on the table---I am a strong proponent of a single-payer health care system. I've spent too much time talking with medically bankrupt families to have much use for anything else. One of the scare tactics used by opponents of universal health care is telling Americans that if we provide health care for everyone, well, gosh, the wait time for medical attention will be very, very long. Let me be blunt: This is hogwash, and my guess is that many folks who have tried to get in to see a doctor lately know it to be true. 

Case in point. Just this morning, I called to get an appointment with my husband's doctor. You see, I got a flu shot three weeks ago, the injection site was my shoulder socket, and now I cannot lift my arm to save my soul. So I need to get in fairly soon, before things get worse. Unfortunately, my husband's doctor will not see any new patients until June 2008. So I called another local doctor. Same thing. That's almost seven months! (And I even tried to bribe them with the fact that I have insurance. No luck.) I'm sorry, but seven months is not acceptable. My option now is urgent care. Which is where I go tomorrow.

This isn't the first time I've run into this crazy wait time. And I'm not the only one to whom this happens. So tell me again why our current system is so great? It's the efficiency of the thing, right?

Comments

[Paige]

We have a certain number of doctors today, and they have a capability of treating only so many patients in a fixed period of time. Unfortunately, for some medical needs right now, you have to wait to get care. That is simply an unavoidable fact.

Let's now try a thought experiment ... let's assume that tomorrow, we wake up and a single-payer health insurance plan is in effect nationwide. Does the capability of doctors to see patients change? Do the waiting times change? Are either the ability of doctors to see patients or the waiting times in any way dependent upon the health insurance system?

The waiting times are what they are because of the number of doctors, and not because of the health insurance system.

[Katie Porter]

Paige: Thanks for your comment. I fail to see what is "unavoidable" about having to wait to get care. If the market were perfect, supply and demand would align. You seem to accept an undersupply of care as unchangeable reality. I think Dr. Thorne's point is that the debate is often presented as "if the U.S. had single payor care, then people would have to wait," but that ignores the reality that many people have to wait for (or can't pay for and can't access at all) many kinds of care already. The thought experiment question is interesting: if we moved to single payor, is it true as some have argued that becoming a doctor would be less attractive and waits would grow? Or has managed care and the headaches of multi-party payors already become onerous enought to shift our most talented people into fields like dentistry, cosmetic surgery, or something non-medical?

[Mark Seecof]

Next time you want to entice a doctor's office, don't tell them you "have insurance." That just means that either (a) they can't accept it because your insurance carrier will only pay for visits to "approved" doctors, or (b) after the doctor accepts assignment of benefits your insurance company will "lose" the first bill, reject the second bill for some reason both trivial and bogus, rewrite the third bill by changing the CPT codes (without contacting the doctor's office), then reject it as inconsistent with your diagnosis, finally accept the fourth bill but unilaterally cut down the value 50% to match a "UCR (Usual, Customary, Reasonable)" rate schedule compiled in Montana in 1997, then cut another 10% for "prompt payment(!)," then not actually pay anything until nearly a year after your visit.

If you want to entice a doctor's office, promise to pay cash on the spot.

(Have you ever tried to get an orthodontic appointment? Easy, wasn't it? Because people pay for orthodontics themselves.)

(As for urgent care centers, you do realize that they provide "urgent care," right? Why do you think single-payer would somehow relieve all of the family doctors you wish to visit of, say, half of their patients so they could sit around their offices reading newspapers while they wait for you to request an immediate visit?)

Single-payer could relieve doctors of dealing with different insurance companies, but it could not relieve them of seeing a normal "patient load." In fact, since single-payer would reduce the apparent cost of medical services to many people, it would increase demand for doctors' services. Doctors would still "turn away" patients when their appointment books were full.

When you announce that you are a strong proponent of single-payer and then try to justify your views by telling a horror story which all students of the field know single-payer would make worse, not better, you destroy your own credibility.

All single-payer systems in first-world countries (including those most similar to the USA like Canada and Australia (where I have lived)) ration care through delay (since they can't ration it through the price system, having abolished prices). This is not some kind of "evil right-wing propaganda." It is a simple statement of fact which even a brief perusal of the literature will confirm for you; a fact which all health-care financing experts left, center, and right agree upon. The big question in health-care financing is how to structure insurance schemes of any kind (private, government-sponsored, whatever) to incentivize providers to care for patients efficiently without wasting money on people who "game the system." (For example, Medicare "durable medical equipment" suppliers-- you know, the $150 pair of crutches folks.)

In fact, many (though not all) single-payer advocates favor schemes which they believe would use doctors more efficiently by breaking links between patients and doctors. The idea is, when you go to the clinic you'll see one of the staff doctors at random. Now, this is in no way a required consequence of single-payer but it is a possible one (look at how big HMO's work). So you should not expect "single-payer" to magically save you from visiting the urgent-care center!

There isn't enough room here to explore the whole field of modern medical economics. There are many good books available. Let me know if you want recommendations. But please trust me, it is not at all obvious that the average person would get better care under any single-payer plan seriously proposed in the USA. Some poor people might do better. Many middle class (really, not rich-- median household income) would certainly do worse.

[Debb Thorne]

Paige:
First, thanks for posting a reply. I enjoy the interaction with people who are reading the blog. The purpose of my post was to illustrate the flawed logic in the argument that a single-payor health care system would necessarily result in long wait times for medical attention. The fact is, we already have long wait times. Thus, the "boogie-man" argument that is too-often lobbed at the supporters of universal health care doesn't seem to hold water.
Again, thanks for your post---and wish me luck with the shoulder problem. Debb

[Steven Savage]

I am fortunate to live in an area of California that has a lot of health care providers. It's a change from where I used to live (Ohio), and that also shows disparaties of coverage in different locations. However, even with the many health care providers, it can be chaotic - and emergency room waits can be very long.

Frankly, I am an advocate of single-payer health for ethical reasons (I feel that society should provide a minimum level of survivability for members), and practacal - when you compare our overall health care to the world, we score incredibly bad considering how much money we spend. I'm no fan of government bureaucracy, but it's quite apparent one can do effective single-payer health in a variety of models.

In short, it looks like a better option than what we have, with minimal downside.

Also, frankly, I'm betting that with universal healthcare, we could weather financial turmoil much easier. Stability is usually a good thing.

[Star]

First, you might have frozen shoulder. Check out: http://www.mayoclinic.com/health/frozen-shoulder/DS00416

I read the other day it is common in middle-aged women, tho I don't know your age.

As a variation on Stupid Insurance Tricks--today I was told my mother could not see a new doctor because they didn't take her insurance (Secure Horizons). I said, OK, we'll pay cash. No--we can see anyone with an insurance we don't take. Even if they want to pay.

[Star]

I meant, we CAN'T see anyone with insurance we don't take. These people make me ungrammatical.

[Enobarbus37]

Mark Seecof,

I live in France. It is the position of the French government that everyone living within its borders will have medical insurance and receive medical care.

Waits for medical care are no longer than they are in the United States, where I lived and practiced medicine for 30 years.

Medical care for pregnant women in France, just to name one instance, is far, far superior to that which is available in the United States, and the results show it. I know, because I participated in it in practice here.

You are wrong Marc, dead wrong. Not quite as dead as the victims of the bizarre "system" of health care in the US, but wrong.

[AMC]

1. Every other industrialized county insures all of their citizens, not just those who can afford it.

2. The United States spends twice as much as most other industrialized, "first-world" country on health care:

http://www.oecd.org/dataoecd/52/34/38976588.pdf

http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita

3. For our money, we get a health care system that does not rank very high, as a system, in any of the commonly accepted objective criteria, like life expectancy and infant mortality:

http://unstats.un.org/unsd/demographic/products/socind/health.htm

4. Our health care system (medical/insurance/pharma) has one of the most politically influential lobbies in this country. So, the pain from our inefficient health care system is not going to change until things get really, really bad.

5. With the rate at which the cost of health care is exceeding the rate of inflation, the number of employers who are dumping health care coverage for their workers, the time frame for when it is going to get really, really bad isn't that far away:

http://www.cbsnews.com/stories/2007/02/21/health/main2496919.shtml

http://afp.google.com/article/ALeqM5gKHT3OO579Mudwlh8Qt4ks51BBLQ

6. Because the United States relies on employers to pay for health care, instead of a system primarily funded by tax payers, U.S. manufacturing costs are far greater than in counties with "socialized medicine" (i.e., most of the rest of the industrialized world).

[Paige]

Debb: Yes, good luck with the shoulder problem. I myself am waiting for back surgery -- at least I think I'm waiting for back surgery. I had an MRI 3 weeks ago, and will find out Friday the diagnosis (why did it take so long? I dunno, maybe the doctor is busy...) I agree with you there is a lot of flawed logic in this "single-payer" debate; I was trying to illustrate another example of flawed logic that I haven't seen discussed elsewhere.

To Katie Porter: I never said that long waits are inevitable. I tried to make the claim that waits today are what they are, and doctor throughput today is what it is, and if magically tomorrow we have single payer, the waiting times remain the same. Nothing changes ... doctors can't/won't see more patients just because the insurance has changed.

In fact, the problem of long waiting times is something that is fixable if there is the will, and if certain incentives are put in place. But that is an entirely different issue than how health insurance is handled. It is an entirely different issue than single payer.

[Jan]

I do not favor a single-payer health care system because the government is too inefficient and self-serving.

First, let us weed out the inefficiencies, most of which are caused by the government.

Health insurance mandates should be eliminated. They add cost.

One improvement might be H.R. 1174 to require public reporting of health care-associated infections data by hospitals and ambulatory surgical centers and to permit a pilot program to provide incentives to hospitals and ambulatory surgical centers to eliminate the rate of occurrence of such infections. Treating infected patients is extremely expensive.

Another improvement might be H.R. 4460, which would allow purchasers of health insurance the option of purchasing policies across state lines, giving consumers a much broader range of choices.

I am opposed to extending current government programs, like Medicare, Medicaid, EMTALA, ERISA, SCHIP, ERISA, etc. They're expensive and inefficient.

Did you know, for example, that 60% of SCHIP (State Children's Health Insurance Program) recipients in Minnesota are adults, not children. In Wisconsin, 40% of recipients of SCHIP benefits are adults. In Colorado, 20% of recipeints, etc.

Government-run health care systems do not work because they treat health care as a "right" and citizens come to believe someone else pays for their care.

We should eliminate preferential tax-exempt status of employer-provided health insurance. The tax code must change to treat all Americans equally with respect to how they purchase health insurance and medical services. It's unjust to those without employer-sponsored insurance and to those with such insurance. It gives preferential tax treatment to those with health insurance, and treats those same employees as helpless dependents by making it economically unsound for them to choose and pay for their own insurance plans.

[jacksmith]

The US has an over supply of doctors. More doctors per patient than any other country in the world. But you cant get in to see one. Go figure. :-(

Insurance mandates are not universal health care. And politicians should stop calling it that. Nothing is Universal Health Care except "Single Payer Not For Profit Tax Supported Government Managed Health Care" (HR 676). Insurance mandates will be worse than what you have now. And what you have now is a complete, and total disgrace, and horror show. Insurance mandates will (require) you to buy insurance from the private insurance companies that have been ripping you off, and killing you by the thousands.

The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. Contact with the American medical health care system is the #1 risk factor now for injury, disability, and premature DEATH in America. This fact is a catastrophic indictment of the entire US Health Care System.

Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.

This is an emergency. America is in a crisis. And more Americans have died from this health care crisis than have died in all the wars in US history.

But the tide has turned. And the message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that "HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)" is the way to go. Like all the other developed countries have done. Americans want government managed, tax payer supported health care Now. Medicare for all. Like other developed countries have. And like older Americans have now. Accept no substitute.

I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company's that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don't put up with that.

Just look at what is already happening with Massachusetts insurance mandates. It's a catastrophe. Financially, and medically for all the people of Massachusetts. And the private insurance companies just raised their rates by as much as 16%. And everyone has to pay now. It's a slaughter.

It's NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).

Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It's the best way to go on health care. It's the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago. See sickocure.org, and http://www.house.gov/conyers/news_hr676.htm

I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And increase momentum for HR 676 at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.

Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don't be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.

There is no good reason HR 676 cannot be passed into law well before the coming elections. And SCHIP should have been passed by now. Even if it was for 3x the 35 billion congress ask for. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections. This is supposed to be a democracy. And well over the majority of Americans want tax payer supported single payer government managed health care for free for all Americans as a right. Many of the politicians will be soliciting your financial, and political support for the coming elections. Make sure you send a note telling them that you expect them to support HR 676 if they expect you to support them.

Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.

Keep fighting. Pickup that phone, and call your fellow Americans. It's the right thing to do. You will win. Bless you all...

[Doug]

Mark: When you appeal to reason and about the simple laws of supply and demand, but then end your comment with this:

"Some poor people might do better. Many middle class (really, not rich-- median household income) would certainly do worse."

you destroy your own credibility.

[Mt57]

I think Paige is absolutely correct and that argument is also responsive to many of the other issues expressed above. The population has grown but the number of graduates from medical school is stagnating. Regardless of the insurance system, free market or single payer, access to healthcare depends in a meaningful measure on the supply of providers of healthcare. We need to accelerate the time between deciding to become a doctor or nurse and entering practice, e.g., by having year-round education available so that they can get through college in 3 years and not 4, and we also need to increase substantially the number of medical and nursing school teachers and the number of medical and nursing schools. Doing these things takes time and money but would reduce costs and wait time and make for less debt burdens of healthcare providers, all of which would benefit everyone ratably.

[Paige]

I was thinking very similar things, Mt57. A manufacturing company can increase its supply to meet demand by hiring more workers, running the factory an extra shift, etc. This is a low barrier to meeting the market demand.

If society has a demand for more doctors, there is a high barrier to meeting this demand. Even if you could magically double the number of students going to medical school, it is (I'm guessing, I don't really know) 7 years before those extra doctors are available. And of course, you can't really double the number of students going through medical school. There are a finite number of schools, classes and teachers. This is why I feel that our society needs to put into place incentives to make this happen faster -- incentives to medical schools to increase class size or make more classes and hire more teachers; incentives to students to study year round so they can graduate quicker, etc. Even having said that, I wonder if it can be done...

But providing incentives for behaviors that benefit everyone in our society is something America lately has been very reluctant to do. I can't understand why; this reluctance is deplorable, if you ask me.

[Mark Seecof]

http://www.nytimes.com/2006/02/26/international/americas/26canada.html?_r=1&oref=slogin

New York Times: As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging

http://www.city-journal.org/html/17_3_canadian_healthcare.html

City Journal: The Ugly Truth About Canadian Health Care

http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/FrenchHealthCareSystem.pdf

The French system provides lots of care but at great expense: about 20% payroll tax on everyone, plus private expenditures of 25-35% in copayments and supplementary insurance premiums (the poorest 10% are subsidized). The high level of spending and the copayments/lack of "assignment of benefits" keep delays down, though they are not lower than in the USA. The USA could adopt the French system, but that form of "single-payer" would not produce any national savings.

http://www.civitas.org.uk/pdf/hpcgSystems.pdf

Civitas (a UK think-tank): Report on Options for Healthcare Funding. This is a good survey of European and American funding systems. While criticizing both the "inequities" and the level of waste in the US system, it points out that "[w]aiting lists are very short in the USA" (and modest in some other countries such as France). Waiting lists are long in many countries with "single payer."

A brief note on international comparisons of "national health" based on infant mortality and/or life expectancy. National summaries of those numbers are influenced by ethnic/racial/immigrant trends in national populations. The US has a much higher proportion of racial minorities and more immigrants from poor countries than most OECD countries, making US national numbers look artificially worse.

[AMC]

Mark -

Funny how in every other industrialized country in the World, there is no significant popular support for moving to a U.S.-style health care system.

And in surveys of public statisfaction - as opposed to an anecdotal approach to comparing health care systems - the for-profit U.S. system doesn't do so well either:

http://www.ecosante.fr/index2.php?base=OCDE&langs=ENG&langh=ENG&valeur=&source=1

In contrast, there is significant popular support in the United States for universal health care coverage.

http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml

http://abcnews.go.com/sections/living/US/healthcare031020_poll.html

http://www.usatoday.com/news/health/2003-10-19-health-poll_x.htm

http://www.dailycardinal.com/article/1556

Canada was almost as unique as the United States in its health care system in that it essentially PROHIBITED private medical care. That is now changing, and bringing Canada more in line with the way the rest of the World provides universal health care. However, while there is significant support in Canada for allowing private health care, I don't see any popular support in Canada for abolishing universal health care coverage and/or implementing a U.S.-style system. For some reason, the Canadaians seem to prefer the "inefficient" (but somehow, stangely, less expensive) government system to the good times provided by our 'prior existing condition' exclusions, HMOs, and denial of claims battles.

As for your dismissal of all the objective criteria regarding health care systems - that's always a convenience way to deal with objective evidence that doesn't fit your argument. But, let's look at the life expectancy statistics from a different perspective. There is one group of American Citizens who enjoy universal health care coverage - old people. And those Americans actually live almost as long, or longer, than people in countries that have far better overall statistical life expectancies (when our non-governmentally insured population is included in the overall life expectancy statistics).

http://content.nejm.org/cgi/content/abstract/333/18/1232

[AMC]

And, the most recent comparative study of health care systems shows the U.S. trailing the rest of the industrialized world. Badly. While spending twice as much.

http://afp.google.com/article/ALeqM5hGPrKA627R1svhAL7yih15Ap-bFg

France is healthcare leader, US comes dead last: study

WASHINGTON (AFP) — France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.

The study by the Commonwealth Fund and published in the January/February issue of the journal Health Affairs measured developed countries' effectiveness at providing timely and effective healthcare.

http://health.usnews.com/articles/health/2008/01/08/not-so-good-at-preventing-premature-death.html

Not So Good at Preventing Premature Death

By Michelle Andrews
Posted January 8, 2008

Dying before your time is bad enough. Dying from something like heart disease, diabetes, treatable cancer, or a bacterial infection that never should have killed you is worse. Yet a new study finds that the United States ranks last among industrialized countries when it comes to such preventable deaths and that our performance actually got worse instead of better over a five-year period.

http://www.news-medical.net/?id=34164

France, Japan and Australia top in dealing with preventable deaths...U.S. bottom!

Medical Research News
Published: Wednesday, 9-Jan-2008

When it comes to dealing with preventable deaths researchers have found that the French, Japanese and Australians are at the top of the league and the Americans at the bottom.

A team of researchers at the London School of Hygiene and Tropical Medicine say if the health system in the United States was as good as those of the top three countries 101,000 lives would be saved each year.

I'm not a big fan of the Canadian system, but give them their due:

http://www.canada.com/topics/news/politics/story.html?id=4bd42888-8023-49a8-8478-471344c04f7d&k=60977

Canadian health care better and cheaper than U.S., says research

Joanne Laucius , CanWest News Service; Ottawa Citizen
Published: Tuesday, January 08, 2008

OTTAWA - Canada's health care system offers "excellent value for the money" says a British researcher who has studied preventable deaths in 19 industrialized nations.

The study, to be released today in Health Affairs, looks at "amenable mortality" - deaths that would not have occurred if effective health care had been available.

Conditions that caused these deaths included bacterial infections, treatable cancers, diabetes, some cardiovascular disease and the complications of common surgical procedures. The study, which looked at figures from 2002-03, updated a similar report based on 1997-98 figures. Its goal was to compare amenable deaths in the United States with 14 western European nations, plus Canada, Australia, New Zealand and Japan.

But hey, who needs objective facts when our health care industry can come up with really scary anecdotes? Right?

[AMC]

http://www.reuters.com/article/health-SP-A/idUSN1549047220080116

Emergency waits get dangerously long in US -study

Tue Jan 15, 2008 10:58am EST

WASHINGTON, Jan 15 (Reuters) - Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, especially people with heart attacks, U.S. researchers reported on Tuesday.

They found a quarter of heart attack victims waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36 percent longer between 1997 and 2004, the team at Harvard Medical School reported.

Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40 percent longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs.

Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found.

[AMC]

http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20080205/OPINION03/802050375/1035/Opinion

Cost-wary employers cutting health benefits

February 5, 2008

In the United States, working a job can be as much about having health insurance as it is about getting paid. More than half of Americans rely on an employer (or a spouse's employer) for access to health insurance. This is the only country in the world that ties health care to employment.

It's a setup that discourages workers from starting their own businesses and forces them to remain in dead-end jobs. American companies saddled with the high cost of health coverage are less competitive in a global economy where other governments play a bigger role in spreading costs of health coverage for their citizens.

Employer-based health insurance began during the labor shortage of World War II. Wage controls prohibited pay increases, so health coverage became a job perk to attract workers. Today, it's a burden.

But Congress has failed to adopt health-care reforms that would relieve individual businesses of the costs of providing and administering insurance. So now, businesses are relieving themselves of the responsibility.

In 2007, 60 percent of employers offered group health coverage, down from 69 percent in 2000, according to the nonpartisan Kaiser Family Foundation. Some companies that have dropped coverage may offer workers money to purchase insurance on their own.

It's hard to blame businesses for bailing out, but the trend hurts American workers.

Employer-based coverage is group insurance, which prevents insurers from denying coverage to workers with health problems. If you don't have the help of an employer and have a heart problem or diabetes or asthma, good luck finding affordable insurance and coverage for expenses related to your health condition.

Also, workers who obtain health insurance through an employer pay no income or payroll taxes on the value of the benefit. Individuals who purchase policies on their own don't get tax breaks, so coverage costs them more.

[AMC]

http://news.yahoo.com/s/nm/20080218/hl_nm/cancer_usa_dc

More advanced cancer seen in uninsured Americans

By Will Dunham
Mon Feb 18, 1:30 AM ET

WASHINGTON (Reuters) - Uninsured Americans and those in a government health program for the poor are far more likely to have advanced diseases when diagnosed with cancer than those with private coverage, researchers said on Sunday.

A major factor seems to be that many of these people are not getting routine screenings for various types of cancer that could detect the disease in its early stages when it is most treatable and least deadly, according to the researchers.

[AMC]

http://www.nytimes.com/2008/02/24/health/24dna.html?bl&ex=1204088400&en=bf40f56bc53d308f&ei=5087%0A

Insurance Fears Lead Many to Shun DNA Tests

Victoria Grove wanted to find out if she was destined to develop the form of emphysema that ran in her family, but she did not want to ask her doctor for the DNA test that would tell her.

She worried that she might not be able to get health insurance, or even a job, if a genetic predisposition showed up in her medical records, especially since treatment for the condition, alpha-1 antitrypsin deficiency, could cost over $100,000 a year. Instead, Ms. Grove sought out a service that sent a test kit to her home and returned the results directly to her.

Nor did she tell her doctor when the test revealed that she was virtually certain to get it. Knowing that she could sustain permanent lung damage without immediate treatment for her bouts of pneumonia, she made sure to visit her clinic at the first sign of infection.

But then came the day when the nurse who listened to her lungs decided she just had a cold. Ms. Grove begged for a chest X-ray. The nurse did not think it was necessary.

“It was just an ongoing battle with myself,” recalled Ms. Grove, of Woodbury, Minn. “Should I tell them now or wait till I’m sicker?”

[AMC]

http://abcnews.go.com/GMA/OnCallPlusBreastCancerNews/story?id=4338818

Health Insurer Must Pay $9 Million for Canceling Sick Woman's Policy

After Precedent-Setting Judgment, Health Net Said It Will Stop Controversial Practice

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When Bates, a 52-year-old hairdresser, found out she had breast cancer in 2004 she thought she had reliable health insurance.

But her insurer, Health Net, dropped her coverage while she was in the middle of breast cancer chemotherapy, leaving Bates with $129,000 dollars in unpaid medical bills and no choice but to abandon her lifesaving treatment.

Bates said she had undergone surgery to remove a tumor and had received her first two chemotherapy treatments when doctors stopped treating her because her bills were going unpaid.

"I was devastated. I didn't know what was going to happen," Bates said. "It's boggling that someone can do that to you."

"I have breast cancer and I need my insurance and these people walk away from me," she said. "I was traumatized. Who wouldn't be?"

Angry and sick, Bates sued her insurer. And now, four years later, she has won a significant victory.

Not only did she receive a $9 million punitive damages settlement against Health Net Inc., one of the largest for-profit insurers in California, but the company also announced Friday that it had stopped the controversial practice of canceling sick policyholders' policies.

In the landmark ruling, the outraged judge wrote: "She had valid health insurance … when the rug was pulled from underneath, and that occurred at a time when she is diagnosed with breast cancer, one of the leading causes of death for women."

William Shernoff, Bates' attorney, said, "People count on health insurance when they get sick and if the rug is pulled from them, that's probably just as bad as not having insurance at all."

Health Net said Bates had made mistakes on her insurance application, citing a weight discrepancy and a heart condition. But after the ruling Health Net, which made more than $2 billion in gross profit last year, said in a statement that it planned to immediately stop rescinding policies without an independent third-party review.

[AMC]

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/26/BUV6V8FD2.DTL&feed=rss.business

Health care spending projected to rise to $4.3 trillion by 2017

Big hit seen for government as costs rising fast, Boomers about ready for Medicare

Kevin Freking, Associated Press
Tuesday, February 26, 2008

By 2017, consumers and taxpayers will spend more than $4 trillion on health care, accounting for $1 of every $5 spent, the federal government projects.

The 6.7 percent annual increase in spending - nearly three times the rate of inflation- will be largely driven by higher prices and an increased demand for care, the Centers for Medicare and Medicaid Services said Monday. But other factors in the mix include a growing and aging population. The first wave of Baby Boomers become eligible for Medicare in 2011.

With the aging population, the federal government will be picking up the tab for a growing share of the nation's medical expenses. Overall, federal and state governments accounted for about 46 percent of health spending in 2006. That will increase to 49 percent over the next decade.

"Health is projected to consume an expanding share of the economy, which means that policymakers, insurers and the public will face increasingly difficult decisions about the way health care is delivered and paid for," economists at the Centers for Medicare and Medicaid Services said.

Health care spending in 2017 was estimated to increase to $4.3 trillion.

In 2006, people and the government spent $2.1 trillion on health care, an average of $7,026 a person. In 2017, health spending will cost an estimated $13,101 a person.

[Mark Seecof]

http://www.nytimes.com/2008/02/21/world/europe/21britain.html?_r=1&hp&oref=slogin

Britain's National Health Service refuses most effective drug to woman with life-threatening cancer, then forbids her to pay for it herself.