Joanne Silberner, NPR News, Author at ��ϳԹ�� News

New Health Law Brings Better Coverage For Women

Joanne Silberner, NPR News — Mon, 26 Apr 2010 00:00:10 +0000

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Among the many goals of the new health law is one that hasn’t received much attention: to improve women’s experiences in the health insurance world. For some women, insurance policies cost far more than those for men their age; some women simply can’t find an insurer to cover them. And, even for women who have insurance, sometimes it just doesn’t cover certain scenarios, like pregnancy.

Take the case of Jody Miller, an exercise physiologist who wanted to have a baby. She had insurance, but it didn’t cover most of her infertility costs. So, she paid about $22,000 out of pocket.

After her triplets were born, she and her husband went looking for a less expensive insurance policy. Miller says one company told them, “Fine, we’re happy to insure your children, but because of your infertility, we won’t insure you or your husband.” That was even without infertility coverage. Other insurers denied her as well.

“I’m as healthy as they come,” Miller says. She wound up in a special Maryland state pool for people who can’t get insurance.

Or consider Jenifer Wilson of Vancouver, B.C., who used to live in Indiana. She had an unexpected pregnancy seven years ago. She and her husband then discovered their insurance didn’t cover her pregnancy. It only would have covered the pregnancy if they paid an additional $350 a month, starting before conception.

That means they had to pay for an emergency cesarean section out-of-pocket. And when they subsequently looked for a different insurance policy, they couldn’t get one.

“That’s when I realized I wasn’t eligible,” says Wilson. Her C-section counted as a pre-existing condition.

High Hopes For The New Health Law

Wilson had a work visa and a job with a Canadian company at the Vancouver Olympics, which got her into the Canadian health insurance plan. She has another baby due in August, but her work visa runs out at the end of July, so her Canadian health insurance does, too.

Even if she can’t find a way to extend it, she’s going to stay in Canada. The out-of-pocket costs for a C-section are about a third of what they are in the U.S., she says. But she might come back to the U.S. eventually because she has “really high hopes” for the new health law.

In fact, she would be helped, but not until 2014, when the new health insurance exchanges kick in. Those exchanges will offer health insurance policies that include pregnancy coverage. And under the new law, Wilson’s rates would be the same as everyone else’s her age; they won’t be based on her personal health history or her sex.

A Lot To Gain

Wilson’s and Miller’s problems are due in part to the fact that they were getting individual insurance policies — not group policies through a mid- or large-sized company. Even without the new law, those group policies don’t cost more for women, and pre-existing conditions don’t come into play.

But it’s different for individual and small-group policies. In 2009, the National Women’s Law Center, an advocacy group that worked hard to get the new law passed, found that insurance companies charged women up to 84 percent more than men for the exact same health insurance policy, even without coverage for maternity care.

“Women have an enormous amount to gain from this bill,” says Marcia Greenberger of the National Women’s Law Center. Other provisions of the new law will help women who get their insurance through mid- and large-sized employers, she says.

“The health care bill requires employers with 50 or more employees to provide a place and time for nursing mothers to lactate,” she says. And new insurance plans that start up five months from now and later will have to allow women to go directly to obstetrician/gynecologists without a referral from a primary care doctor. Insurers also won’t be allowed to charge co-payments and other upfront costs for preventive services like mammograms and pap smears.

Gail Wilensky, an economist who headed Medicare during George H. W. Bush’s presidency, says these provisions will help women who’ve previously been shut out of the insurance market, though, “in the short term at least, they’re going to bump up the cost of health care.”

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Bipartisan Agreement: Health Insurers Shouldn’t Revoke Coverage

Joanne Silberner, NPR News — Mon, 01 Mar 2010 10:18:00 +0000

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If you listened carefully to the White House summit on health care last week, you could hear, among all the disagreements, a few points of agreement. One of those agreements is on something called rescission, where health insurance companies cancel policies after people run up heavy bills. Capitol Hill watchers say there could be legislation outlawing the practice within a few months.

At the summit, President Obama said insurance companies practice rescissions all the time. “I’ve got a bunch of stories in here of folks who thought they had insurance, got sick, the insurance company goes back and figures out a way to drop them,” he said.

And Senate Majority Leader Harry Reid told of a constituent, Jesus Gutierrez. Gutierrez and his wife had a baby who had a cleft palate. Surgeons fixed the cleft palate, but then, Gutierrez says, his insurer wouldn’t pay. “They told us that she cannot be insured,” he says. “My wife and I can be insured, but she cannot be insured because she had a pre-existing condition.”

Gutierrez and his wife were left with $98,000 in medical and surgical bills. They now buy their insurance from another company.

Rescission is, at least technically, illegal, except in cases where people deliberately lie in order to hide an expensive condition from their insurer, says Karen Pollitz of Georgetown University.

The Health Insurance Portability and Accountability Act (HIPAA) says insurers can’t just cut people off. But states have conflicting rules about rescissions, she says, “and it is still happening. We don’t have very good data about how often, but at congressional hearings last year, three insurers owned up to 20,000 cases in the last few years.” A new law clarifying the prohibition would help, she says.

Individual And Small Business Policyholders Hit Hardest

People who get their insurance from medium and large employers don’t have to worry about losing their policies through rescission, because as part of a large group, they don’t have to fill out a health history form in order to get insurance. It’s people who buy their own policies, or are in a small employee group, who have to fill out that form and who have to worry. Overall, that’s a small part of the insurance market, but some of the individual cases are tragic.

Earlier this month, a jury awarded a Colorado woman $37 million in damages from Time Insurance Co., which also does business as Assurant Health. Her car was hit by a car that was fleeing police. She was in a hospital and rehab center for months, and ran up massive medical bills. The insurer wouldn’t pay the bills because the woman had failed to mention in her application that she had some gynecologic problems and had once been to an emergency room because of shortness of breath, problems that were unrelated to the accident or her subsequent medical care. There’s no word on whether the company will appeal.

The position of the insurance industry trade group, America’s Health Insurance Plans, is that rescissions are disruptive, cause hardship to families and should be avoided. If the government passes a law requiring everyone to have health insurance, then there wouldn’t be a problem, according to an insurance spokesperson. If that were the case, insurers would be freed from the concern that people will wait until they’re sick to buy insurance, and wouldn’t have to go back and check to see if that’s what happened.

With the bipartisan support, some sort of legislation specifically preventing health insurance rescissions is likely to go through this year, says health policy analyst Alex Vachon, head of consulting firm Hamilton PPB and a former Senate staffer.

“Rescission has very strong bipartisan support,” he says. The Democrats already passed a health insurance stand-alone bill this week – an antitrust bill – which suggests, he says, that Congress could also pass a stronger anti-rescission law, independently of an omnibus health care plan.

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Health Bill Would Affect Food, Drug Industries

Joanne Silberner, NPR News — Wed, 02 Dec 2009 09:29:00 +0000

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The health insurance system isn’t the only thing getting revamped should Congress pass a health bill; both the Senate and the House bills include provisions that might mean big changes for the food, drug and medical devices industries. One of the more unlikely changes in the health care overhaul bill has to do with vending machines. Nutrition advocates want people to realize how many calories there are in non-diet sodas, potato chips and snack cakes. And there’s a sentence in both the House and Senate bills that says that vending machine operators would have to provide that information on the machines.

Steven Grossman blogs about the Food and Drug Administration and is a consultant for companies and patients’ groups. He used to work on Capitol Hill, and he’s seen this happen before: A few marginally related sentences get added to a giant bill, with no debate.

“When you have fewer people buying the snacks and then add on this additional cost of having to label, it’s pretty expensive. If with our machines the operator has to label every snack on every spiral on every machine in every factory in America – it’s going to cost jobs,” said Munroe.

A venture of that size would cost not only jobs, but also money. The trade group estimates implementing the changes in the bill would cost it $56 million.

Promoting Health

Another decision in the health insurance bill would affect chain restaurants from McDonald’s to Applebee’s. All chain restaurants would have to post calorie counts for their products. In some states, they already have to.

It may seem that rules about vending machines and chain restaurants don’t belong in a bill overhauling the nation’s health care system. But Michael Jacobson of the consumer advocacy group Center for Science in the Public Interest says it definitely does.

“Because they will actually promote health,” he says. “Most of the rest of the legislation will pay for people who are sick, but having calorie information prominently posted will reduce the obesity problem.”

And if health problems go down, presumably health costs will, too.

Generic Drugs

Another potential cost saver has been hotly debated for years: a provision that would allow manufacturers of generic drugs to make cheaper versions of high-tech biologic drugs, called follow-on biologics.

This provision has been close to passage several times but always blocked by a detail or two not acceptable to the biotech companies or the generics’ manufacturers. Putting it into a larger bill like the health care overhaul bill may be the only way to get it through, says Grossman.

“I don’t think it’s a matter that could help or hurt the bill,” he says. “The bill is going to be either adopted or not based on things that have nothing to do with follow-on biologics.”

The bill addresses other issues not directly related to how you get health insurance. One proposal is to tax medical devices like heart valves and stethoscopes. But none of these provisions seem to have a high public profile. So whether they stay, go or change will be a matter of what the interest groups can do behind the scenes in the coming months.

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Evidence-Based Medicine: Hard For Some To Swallow

Joanne Silberner, NPR News — Sun, 22 Nov 2009 19:29:35 +0000

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This week two panels of medical experts recommended fewer screening tests for breast and cervical cancer. And recently, men got similar advice about prostate cancer screening.

The recommendations come from something called evidence-based medicine, and are being met with resistance from some consumer groups and physicians.

Evidence-based medicine is a pretty simple concept. “The basic principle of evidence based medicine is that clinical decisions that are made between doctors and patients should be driven by data,” says Peter Bach, now a physician at Memorial Sloan Kettering Cancer Center, and once an adviser to the head of the Medicare system.

“What it means is the careful application of information from well-designed studies to decide what medical practices work, and how well they work,” says Alan Garber, head of the Center for Health Policy at Stanford University.

People Don’t Always Pay Attention To Data

Evidence-based medicine can be used to determine how often someone should be screened for cancer, and it can be used to determine what sort of treatment is best. But people don’t always want to do what the data say to do.

As a family practitioner in North Carolina, Lori Heim sees that a lot. It comes up all the time with sinus infections, she says. She remembers one patient who demanded antibiotics for her viral sinusitis, even though multiple studies show that’s the wrong thing to do.

“The previous doctors gave her antibiotics and she got better,” Heim says. But that’s probably because she would have gotten better anyway, even without the antibiotics.

Heim is president of the board of directors of the American Academy of Family Practitioners, and she says her group will take a close look at the mammography recommendations announced by the U.S. Preventive Services Task Force earlier this week. New information and new ways to analyze it mean that guidelines often change.

That can make patients nervous, Heim says. “They want medicine to be absolute, and perfect, and unfortunately it’s not.”

Decisions Based On Science

Insurers already use evidence-based medicine to some degree. The current health overhaul bills under consideration encourage it without any strict requirements. The Senate bill, for example, uses the U.S. Preventive Services Task Force as a baseline, but not as a limit, for some parts of Medicare. Both bills provide money for more research.

Economist Uwe Reinhardt of Princeton University says the U.S. ought to pay more attention to evidence-based medicine. “You cannot have a health system where every doctor, every patient is completely free to use their imagination and hunches to make clinical decisions,” he says.

Researchers estimate that anywhere from one half to two-thirds of current medical practice is based on concepts that have not yet been proven. And there’s a history of procedures turning out to be useless. Years ago, many doctors periodically X-rayed smokers’ lungs, thinking that detecting lung cancer early and starting treatment right away would reduce the death toll. But research showed that periodic X-rays didn’t reduce the mortality of lung cancer among smokers.

Resisting Change

So what if people insist on mammograms in younger, lower-risk women, or lung cancer screening for smokers, or other procedures of questionable value?

“Then I would say but please why don’t you go ahead and buy it,” says Reinhardt, and don’t depend on your health insurance or the government to pay for it.

The pushback against the mammography and pap smear recommendations shows that getting people to accept change is difficult, says Alan Garber of Stanford University. “If you come out with a study that says that something that people thought worked well maybe doesn’t, that message may not go down so well,” he says.

Garber is not as discouraged as some of his colleagues about the public confusion and reluctance regarding the new recommendations. He says what’s needed is public education, which suggests some long study sessions and talking with your doctor.

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Health Co-Ops Touted As Alternative To Public Plan

Joanne Silberner, NPR News — Tue, 18 Aug 2009 00:00:00 +0000

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The Obama administration appears to be backing away from the idea that a health care overhaul has to include the option of a government-run insurance program. If this public plan is removed from the bills currently under construction in Congress, it could be replaced by nonprofit health insurance plans run on the co-op model, where people who buy the insurance are the ones who own the insurance company.

Sen. Kent Conrad (D-ND) is pushing for health co-ops; he sees them as a way to provide competition to conventional insurers without the political negatives of a government-run plan.

But health co-ops as part of a nationwide health care fix are controversial. Robert Laszewski, who heads a Washington, D.C.-area consulting firm, says, “I think they’re the single dumbest idea I’ve heard in 20 years of being in Washington and working on health care policy.”

Laszewski says there’s no need to promote co-ops. They can already form on their own. As for the nonprofit advantage, he says there are plenty of nonprofit health insurers around, including many of the Blue Cross/Blue Shield plans. The only difference is that they’re run by board members who are appointed, rather than elected. Laszewski says any kind of new insurer will need a lot of cash on hand to line up doctors and hospitals willing to treat patients, and to set up health IT and billing systems.

“Actuaries have figured it will cost about $6 billion to establish the insurance reserve requirements that cooperatives will need, and 12 million people will sign on,” Conrad said in an interview with NPR on Monday.

“Those of us who have to count votes know that the public option does not have the votes,” he says. But he’s confident he can get the votes for co-ops.

But how exactly do health co-ops work?

NPR spoke with Pam MacEwan, executive vice president of public affairs with the nation’s oldest health cooperative, Group Health Cooperative. Group Health covers 11 percent of the health insurance market in Washington state. It offers various types of insurance, at average or just below average prices. Its HMO was recently ranked the nation’s best by Consumer Reports magazine. Here are some excerpts from the interview, edited for clarity:

How does Group Health work?

We are a nonprofit organization, and we’re cooperatively governed. The members, that is, the patients, actually elect the board of trustees, and each of our trustees receives care here.

What does that mean for someone who buys health insurance from Group Health?

We consider you a member, and you’re eligible to vote in the organization, and you have a say in how we organize care and design benefits. Our members participate in reviews of grievances and in discussion about the benefits packages. Most of the work is done by the board of trustees that’s elected by members.

What kind of care do members of Group Health get?

We have really different kinds of packages. You can buy individual coverage for your family with a high deductible that would look very much like any other insurance package. We offer full coverage through employers and Medicare Advantage plans. Some people purchase a policy that allows them to go to any doctor; other people purchase something that’s a little more restrictive that just allows them to go to Group Health doctors.

So how would a member feel the difference?

You would feel in control; you have access on e-mail to your doctor; you can make appointments on e-mail; you have access to your medical record. Overall, there’s a sense of transparency, with you being in the middle and calling the shots.

Would member-run health co-ops work as part of the overhaul plan in the place of government-run health plans?

I would need to know much more about how they intend to put the cooperative plan together to know if that will be the answer to how we design public plans.

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Are Insurers’ Profits As Low As They Claim?

Joanne Silberner, NPR News — Wed, 05 Aug 2009 00:00:00 +0000

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As the health care overhaul battle moves out of Washington and onto the airwaves and Main Streets during the August recess, America’s Health Insurance Plans (AHIP), the trade association for the nation’s health insurers, is fighting a familiar battle.

It is fighting the perception that health insurance companies focus more on their shareholders’ bottom lines than the interest of their patients.

To negate this notion, AHIP features a dollar bill with one tiny slice out of it on their , illustrating that their members only make 1 cent of every dollar spent on health care.

That may be the case, says Princeton economist Uwe Reinhardt, but “whether it’s fair or not depends on what it is you want to describe,” he says.

“All that statement says is, if you eliminated all our [insurance company] profits, national health spending in America would be 1 percent lower. It has meaning only in that context,” Reinhardt says.

Insurers are measuring their profits against total health care spending. That’s all the money you and I and employers and insurers and the government spend for doctors’ visits, hospitalizations, drugs and other things.

By using the total health care costs, their profits look lower.

But many economists calculate insurance company profits differently. Just like for any other business, they look at what the companies take in – in this case in premiums – versus what they pay out directly, as in claims.

Fortune magazine economists calculate insurance company profits this way:

For the 10 biggest insurers in the year 2006 (the year the insurers used for the 1 cent out of every dollar depiction above), profits were anywhere from , or two to 10 pennies on the dollar. That’s two to 10 times as much as what the insurance industry group suggests in its illustrations.

Robert Zirkelbach, a spokesperson for the insurers, defends the dollar-bill depiction.

“Health plans are providing value-added services to people across the country, and the vast majority of people are expressing very high satisfaction with their health care coverage,” he says.

And, Zirkelbach adds, health plan profits are in line or even lower than other health care industries. But that may not be enough to give them cover as the Obama administration searches for places to cut the nation’s health care bill.

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Health Effects Of Comparing Care: No Easy Answers

Joanne Silberner, NPR News — Tue, 21 Jul 2009 08:26:00 +0000

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The Obama administration and Congress are moving forward with plans to evaluate the strengths and weaknesses of the various medical treatments for common health conditions, despite concerns of some lawmakers and the drug and device industry that it will lead to rationed health care.

But how the government uses this comparative effectiveness research and how it might benefit – or complicate – the decision-making of average people and their doctors are also matters of some debate.

On a human level, it gets down to people like Jay Allen. He does security work for the government and has been an exercise enthusiast all his life. Last year, at the age of 44, he started having problems on his 14-mile bike ride from his suburban Virginia home to his office in Washington, D.C.

“I’d have onset of shortness of breath, and then occasionally I’d get the same shortness of breath just sitting at my desk or waking up in the middle of the night,” Allen says.

A cardiologist diagnosed a condition called atrial fibrillation, or a-fib. It’s a very common condition – 2.2 million Americans have it. In a-fib, the top part of the heart occasionally shivers instead of beats, causing shortness of breath, fatigue and palpitations. In some people, a-fib can lead to heart failure; in others, it can cause blood clots that in turn cause strokes.

There are a lot of treatment options: a lifetime of anti-clotting drugs, which can cause a different kind of stroke and can react with other drugs; there are drugs that slow the heartbeat; there are anti-arrhythmic drugs that have their own side effects, like lung damage.

Doctors can also apply an external shock to the heart to reset the heart’s rhythm, although in about 50 percent of cases, the irregular beating eventually reoccurs. Another option is something called radiofrequency catheter ablation, where doctors thread a catheter through your arm or leg, up to part of the heart that plays a key role in generating the abnormal beats, and use radiofrequency to destroy that part. Earlier this month, the federal Agency for Healthcare Research and Quality concluded that while there’s good data showing the procedure is effective for a year, not much is known about its long-term effects.

The drug regimen is inexpensive, for the most part – dollars a day. The Food and Drug Administration just approved a new anti-arrhythmia drug, but the manufacturer has yet to announce a price. The heart shock technique is about $1,000 or $2,000 in Washington. The surgical procedure is tens of thousands of dollars.

In terms of effectiveness, cardiologist Stuart Seides, a partner of the doctor taking care of Allen, says to think of it like buses, trains and planes. Taking the bus means slowing the heart rate and using blood thinners to prevent clots; taking the train means getting a normal heart rhythm back with drugs or an external shock; the plane is radiofrequency catheter ablation.

“All will probably get you where you’re going reasonably safely,” Seides says. “You can lead a long and active life with atrial fibrillation.”

But he can’t tell his patients which approach will mean the longest life. “There is no data at present to be able to say to a person that one or another treatment is superior in terms of the hard endpoints,” he says.

Right now, Seides and his patients work out treatment decisions based on whether the patients are comfortable with and can afford daily medications, or whether they want to go through anesthesia and surgery for a chance at a quick fix. Allen chose the ablation because he wanted his heartbeat to go back to normal, and he didn’t want to rely on drugs, although he will be on drugs for some period of time. Allen says he is happy with his decision.

Seides would love to be able to give his patients comparative information about longevity and quality of life. But thinking about such a study makes him anxious, as well. He doesn’t want it to result in a set of cookbook rules that will require him to treat all his patients the same way.

“We don’t want to stifle innovation by creating large studies, getting some outcomes and saying this is the way we treat a-fib,” he says. A relatively inactive patient may be happy with just anti-clotting agents; someone very active may want to try getting rid of the a-fib once and for all with the ablation approach.

Carolyn Clancy understands his concern. She is head of the Agency for Healthcare Research and Quality, the government agency that just did the analysis that found that not enough is known about a-fib treatment. “Our intent is to be descriptive, not prescriptive,” she says.

Her agency does not look at the comparative costs, just the risks and benefits. She says the studies won’t get done if left up to the drug and medical device makers – discovering that their approach doesn’t work as well as another one wouldn’t be in their best interest. She says comparative effectiveness should be respected the same way biomedical research is, because it helps doctors determine the best approach for their patients.

Clancy says determining which treatments are the most effective for specific conditions will cut the nation’s health spending, because some of the choices currently made by doctors and patients – some of them quite expensive – aren’t necessarily the best ones.

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Co-Op Option Offers Compromise In Health Debate

Joanne Silberner, NPR News — Wed, 01 Jul 2009 10:06:13 +0000

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A new health insurance idea is circulating through the Senate Finance Committee and may appear in its final plan for revamping the nation’s health care system. The idea is to stimulate the creation of co-ops where people could go to buy low-cost, high-quality health insurance.

Health co-ops are not a new idea. Two large ones, Group Health in Seattle and HealthPartners in Minneapolis, are more than 50 years old. But the thought that co-ops could win enough support to keep health overhaul plans rolling along has only just come up.

The co-op idea is being pressed by Sen. Kent Conrad (D-ND). “I believe they’re a good idea because they can provide competition to for-profit insurance companies, and one of the things we need in the system is more competition,” he says.

Conrad is trying to deal with objections from the insurance industry, as well as from some health care providers and some Republicans, to something called a public option. This would be a government-run plan designed to nudge private insurers into lowering prices and make health insurance more widely available. Opponents are concerned the government plan would pay too little to doctors and hospitals and would drive private insurers out of business because they couldn’t demand the same kind of deals from doctors and hospitals.

Health co-ops, says Conrad, “have some of the strengths of public option in that they are not for profit and will provide competition for the insurance companies. On the other hand, it meets some of the objections from others who don’t want a government-run plan, because co-ops are membership-run and membership-controlled, not government-controlled.”

George Fell is a member of HealthPartners, a 1.25 million-member health co-op in Minneapolis. He loves the plan. “I’m happy, my wife is happy, and we never thought of moving into any other program,” he says.

As with nonprofit insurers, any money left over at the end of the year gets plowed back into the company. Unlike nonprofit insurers, members get to vote.

With HealthPartners, members elect a board of directors, and the board appoints the CEO. Fell has been a member since 1982, but he hasn’t voted yet. He says he’ll start if the quality of care goes down, or the costs go up.

Several co-ops have failed because of tension between the board and health care providers such as doctors and hospitals. The providers wanted more money or autonomy or better facilities than the co-op was willing to provide. The relationship between doctors and HealthPartners appears to be good.

Family physician Art Wineman has been with HealthPartners since 1994, working in its HMO. “The nice thing about working here is we have the resources to support excellent patient care,” he says. He likes the way HealthPartners collects data on how people are doing and gives him and the other doctors feedback on what works. “I also like the fact that being part of a group like this, I don’t have to focus on profits,” he says. “I can focus on what’s good for the patient.” The average family physician at HealthPartners made $185,000 last year, a little above the national average. He says the member-run board does a professional job of management.

Current CEO Mary Brainerd says she’s very aware of whom she works for. “It’s really clear to me whose interests I represent,” she says. “It’s not the interest of HealthPartners the institute. It’s the interest of the consumer.”

In 1999, people complained about long wait times to see a doctor, so HealthPartners started a program to reduce wait times. In three years, wait times came down from 18 days to four days. You can now get a same-day appointment in many cases.

HealthPartners has an appeals committee that board member Tom Brinsko says is the heart and soul of the board. He remembers when a couple filed an appeal a few years ago. They were trying to have a baby, and they had exhausted their plan’s fertility benefits. “I’ll just never forget how much they wanted a child,” he says. The committee voted to ignore the contract limits and give the couple another chance.

Brainerd, the CEO, says as a co-op, HealthPartners is well-designed to hold down costs. Without the need to create the high profits that stockholders like to see, it has developed preventive care programs for diseases like diabetes, so people don’t develop more serious problems. HealthPartners has invested in electronic medical records to make sure patients get the tests they need, not the tests they’ve already gotten. And by doing things like hiring most of the doctors and owning most of the hospitals where people get care, HealthPartners’ administrative costs are half those of for-profit insurers.

Health economist Karen Davis, head of the nonpartisan Commonwealth Fund, likes health co-ops. “Health co-ops are a good way to deliver care. It’s running health care to benefit patients, instead of shareholders.”

Michael Tanner of the Cato Institute, a libertarian think tank, says, “There’s nothing intrinsically wrong about co-ops, but there’s no evidence that they would do anything to help our health care system.” His concern is that legislation will create a de facto government-run plan, essentially a national co-op run and subsidized by the federal government.

But Conrad says his intention is to stimulate the development of health insurance co-ops owned and run by members, not by the government.

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Doctors Say Current System Impedes Patient Care

Joanne Silberner, NPR News — Mon, 15 Jun 2009 15:59:00 +0000

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Today, President Obama told the American Medical Association that the health care system costs too much, includes too few people and is unsustainable without major changes.

“But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam’s dime, but still fail to meet their responsibilities,” Obama says.

Many doctors agree that lack of health insurance is a big problem. But their day-to-day concerns also include a lack of time with patients and a system that has evolved into a confusing web of paperwork.

Dr. Nancy Nielsen, president of the American Medical Association, says the biggest problem is when patients don’t have health insurance.

“Every study that’s been done has shown that people who lack health insurance don’t go to the doctor for preventive care, they delay care,” she says.

Nielsen says doctors face other challenges as well, such as coordinating care when patients’ insurance plans limit the choice of doctors and hospitals. Doctors often have to pick drugs off a list of covered pharmaceuticals. And they are trying to incorporate health information technology systems into their practice, without assurances that the systems they are buying will be able to exchange information with other systems.

Family physician Richard Roberts has been practicing in tiny Belleville, Wis., for 23 years. He says the health care system’s biggest problems are that not everyone is covered, and it is very complex. He describes a mother who brought in her young son for an ear exam. He noticed she didn’t look happy, so he asked her what was wrong. Further questioning revealed that she had depression, and that her husband had started drinking. Roberts spent some time counseling her, but in the end could only bill for the 15 minute ear exam.

Roberts is most troubled by what has happened to the doctor-patient relationship.

“We don’t structure our health system to support that,” he says. Patients jump from health plan to health plan, and have to switch doctors. Physicians are paid to do procedures, not to talk to people.

But talking with patients is a vital part of being a doctor, says Roberts. “That’s the real joy of what we do, that’s the insight that allows us to do our work,” he says. “If we can redesign the system to support that, not only will people be happier but the costs also go down, because more appropriate things get done.”

Time Spent On Paperwork, Not Patients

Roberts is also disturbed by what he calls “administrivia.” He estimates he spends 15 to 20 hours a week filling out forms – Family and Medical Leave Act forms, disability forms, and insurance forms, though he says in Wisconsin the insurance forms aren’t too bad.

Oncologist Robert Fein in Somerset, N.J., says things for him are getting worse week by week. “I think the health care system is ready to implode.”

Oncologists used to be paid significantly more than it cost them to buy chemotherapy. In effort to reduce costs, both the government and insurers have substantially cut back on what they pay for chemotherapy. Fein says he sometimes gets paid less than it costs him to buy chemotherapy, and in addition, more and more patients aren’t able to pay the copayments, leaving him stuck with the balance.

He tries to help his patients by assisting them apply to drug companies for free or discounted chemotherapy drugs. But that puts him in an awkward position with his patients.

“I am now having to ask many of these patients for their tax returns so I can fill out paperwork so they can get alternative coverage for their drugs. I’m a physician, I’m not an accountant,” he says. And this isn’t what he studied in medical school.

Many Delay Care, Escalating Illness

For emergency department doctors, one of the big problems with the current health care system is the recession.

“We’re seeing newly uninsured patients, we’re seeing patients who as they get into greater financial distress are cutting corners, and delaying the care that they need,” says Arthur Kellerman, professor of medicine at Emory University. He works in the emergency department at Grady Hospital in Atlanta and sees patients who have delayed getting treatment for too long.

“By the time they come to us, they are in legitimate emergency condition with problems that are far more costly, and sometimes impossible to treat. And that’s heartbreaking,” he says.

Kellerman has seen patients with advance cancer, with heart attacks, with strokes that could have been avoided with earlier care.

In Wisconsin, family medicine doctor Richard Roberts says the health care system has to change – soon. “It’s beginning to collapse of its own stupidity,” he says.

But how should it change? He won’t say.

“The debates about whether it needs to be single payer or multipayer, I’m going to leave that to the politicians … I just want to get it done and have everybody covered.”

And, Roberts wants to go back to being a doctor full time.

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