I was the doctor on duty one night in August when the ambulance rushed a man into our Midwestern hospital ER. As I walked into the room, the scene was right out of TV. A nurse was trying to start an IV. Someone was running an EKG. A student had just put oxygen in the patient’s nose. The room seemed crowded. The paramedics were sweating and slightly out of breath.

But my attention was on a pale, thin, fifty-five-year-old man sitting bolt upright on a gurney, clutching his chest and straining to breathe. Cold sweat dripped off his nose. I asked a couple of quick questions as I leaned him forward to listen to his lungs. Someone handed me his EKG showing an acute heart attack.

I slipped out of the room for a second to get the cardiologist on the phone. He would be right in, along with the rest of his team. But it was a Thursday night, late, and they were coming in from home. It would be at least twenty minutes until high-tech medicine could work its wonders, until the cardiologist could thread a thin plastic catheter into the patient’s heart and put in a stent to open his blockage.

I was back to the room in a flash, and he looked no better. We gave him intravenous nitroglycerin, morphine, and powerful blood thinners. He began to look less frightened and some color crept back into his face. We still had a few minutes before they would be ready for him in the cardiac catheterization lab.

Just then I became aware of a woman quietly sobbing in a chair in the corner of the room, probably his wife. I walked over toward her and, as I neared, I reached out to touch her shoulder. She suddenly turned a fierce face up at me, saying: “When he told you he’d been having pain for two hours, he was lying! He’s been having chest pains for the last two weeks!”

She didn’t let up: “We were in the ER six months ago with his chest hurting, and they told him to see his cardiologist, but we don’t have any insurance. They won’t see him again without cash up front! What are we supposed to do?”

Her voice rising, she added: “And you know what else? They’re suing us in small claims court right now over the bill from our last ER visit!”

Here was this poor woman, in my ER, not only deathly afraid that she might lose her husband tonight, but also afraid that whether he lived or died they might face an impossibly huge medical bill and lose their house, their car, everything.

The patient was a self-employed house painter, and he’d had a previous heart problem. Self-employed and a pre-existing condition — in America today with those two strikes, you are out. There is no way to afford health insurance. Is the Affordable Care Act going to fix this?

The Affordable Care Act and the Health Care Lobby

The Affordable Care Act (ACA) faces an uncertain future. The 11th Circuit Court of Appeals in August ruled the individual mandate unconstitutional. Judge Hull, who cast the deciding vote, was a Clinton appointee. The verdict states:

This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.

The ACA was essentially written in the Senate Finance Committee chaired by Max Baucus. The actual author was his chief health care aide, Liz Fowler. Her job before working for Baucus? Vice president of WellPoint/Anthem/Blue Cross, the country’s largest health insurer.

President Obama signs the Patient Protection and Affordable Care Act at the White House on March 23, 2010. Credit: Creative Commons/Keith Ellison.

The health insurance industry played both sides against the middle during the congressional debate. While publicly claiming to be in favor of reform, they secretly funneled millions to front groups and organizations like the Chamber of Commerce, which fought the bill tooth and nail. What the insurers wanted most out of the deal was the individual mandate — a federally enforced requirement that all Americans buy their defective products, with taxpayer-financed subsidies for those who couldn’t afford the premiums. What they wanted least were regulatory burdens that might limit their profitability.

Not being able to buy insurance if you are sick is one of the catch-22 aspects of our crazy system. In the eyes of insurance bureaucrats, it seems that life itself is a pre-existing condition. The ACA’s ban on the use of pre-existing conditions to deny insurance coverage is scheduled to go into effect in 2014. Preventing that will be the next target of their lobbying fury.

It’s Good to Be an Insurance Company

In this down economy, there are few bright spots for investors. Thank God for health insurance.

The Big Five health insurers — WellPoint, UnitedHealth, Aetna, Humana, and CIGNA — together cover almost 100 million of us. Their profits from April to June 2011 totaled over $3.3 billion, 13 percent over their second quarter profits in 2010. Last year was their best year ever. For the twelve months ending in July 2011, these giants saw their average stock price rise almost 50 percent. These are huge corporations: WellPoint and UnitedHealth are in the top fifty of the Fortune 500.

What to do with all that profit? WellPoint, the behemoth created a decade ago from formerly nonprofit Blue Cross plans in fourteen states, spent $67 million on lobbying over the past three years. They paid their CEO, Angela Braly, $13 million in 2010, but that was paltry compared to the reimbursement package of UnitedHealth CEO Stephen Hemsley, who cleared $37 million, including the stock options he exercised.

Health insurance companies are raking in ever-rising profits, even as patients with insurance are driven into debt. Credit: Creative Commons/Images_of_Money.

Those stock options take on extra significance when company stock repurchases are considered. WellPoint, to take only one example, spent $21.6 billion of patients’ premium dollars to buy back its own stock from 2003 through 2010.

Spending billions on stock buybacks benefits a tiny elite of CEOs, board members, and top officers, who are compensated largely with stock options. They buy the stock back to push the price upward. Their options increase in value as the share price rises. This is an enormous transfer of wealth from individuals and employers to top management. It benefits the largest Wall Street stockholders as well, but not you, not me, not patients.

This industry exists to collect premiums and process claims, and while they have no problems collecting our premiums, it’s a different story when they have to pay. The June 2011 AMA Health Insurer Report Card revealed commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of 2 percent compared to last year. The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year and added an estimated $1.5 billion in unnecessary administrative costs to the health system. Medicare, by comparison, had an error rate of less than 4 percent.

They are obviously not using their piles of cash to improve service. What about lowering premiums? In our dreams.

Health insurance premiums have more than doubled over the last ten years, rising at four times the overall rate of inflation. (Over the same period Medicare premiums have barely risen at all, with no increase in out-of-pocket expenses.) While premiums have risen, coverage has shrunk. Copays and deductibles increase every year. People with individual coverage can have annual deductibles of $10,000 and more. No wonder illness leads to bankruptcy, even if you have insurance.

Bankruptcy, Moral and Financial

Every business day in America, 3,700 families file for bankruptcy caused by illness and medical bills, and that number is rising. This shameful situation happens in no other wealthy democracy. It would be a scandal anywhere else. Most medically bankrupt families were middle-class before they suffered financial setbacks. Roughly 60 percent of them had attended college; twenty percent of families included a military veteran or active-duty soldier.

Unexpected stays in a hospital bed drive thousands of middle-class and working-class families to declare bankruptcy every day. Credit: Creative Commons/misguidedsouls.

Most astoundingly, 60 percent of the individuals whose illness led to bankruptcy had private health insurance when they got sick. Don’t we buy health insurance to avoid financial ruin? High deductibles lead directly to bankruptcy and foreclosure. To make matters worse, they cause people to postpone needed care. All of which lead to higher insurance company profits.

The insurers don’t like to tell their customers this, but when they talk to their Wall Street masters, they sing a different tune. Angela Braly of WellPoint, speaking during a conference call for financial analysts in 2008, was asked if she would consider lowering premiums if that would increase enrollment in Anthem policies. Her reply, “We will not sacrifice profitability for membership,” was just what they wanted to hear.

That sentiment hasn’t changed. Recently Aetna’s chief financial officer, Joseph Zubretsky, made similar comments on a conference call. Concerned that investors might think Aetna was willing to grow by adding people to its rolls who could have substantial medical needs, Zubretsky soothed their fears, “We would like to have both profit and growth, but if you have to choose between one or the other, you take margin and profit and you sacrifice the growth.”

Recall that these are the same companies that developed algorithms to target women diagnosed with breast cancer so they could scour their health records for an excuse to cancel their policies. This inhuman practice, known as rescission, has supposedly been banned by the ACA.

Buying Doctors

If insurance companies are not lowering premiums to attract more customers or investing in infrastructure to reduce errors, what else besides their own stock (and some politicians) are they buying? Doctors! UnitedHealth is quietly buying medical groups who treat patients covered by its plans in several areas of the country. WellPoint announced in June that it would acquire CareMore, which operates twenty-six clinics in the Los Angeles area. CIGNA claims that it saves 9 percent on patients treated by doctors in a Phoenix medical group it controls. Is this a good thing?

In July, Kaiser Health News, in an article titled “Managed Care Enters The Exam Room As Insurers Buy Doctor Groups” said:

Some observers watching the developments say the health law, which in part was sold as a way to rein in insurers, has had the opposite result, opening the door for the companies to take control of even more parts of the health system.

“There’s a gigantic Murphy’s law emerging here,” said Ian Morrison, a California-based health care consultant who does some work for United, as well as most of its competitors. “The very people who were the demons in all of this, that the public can’t stand — managed-care firms — are the big winners.”

And the losers? Patients, and those of us paying premiums.

Health, Health Care, and Health Insurance

No other wealthy democracy spends as much on health care as we do. It’s not even close. Most of our peer countries spend about half as much per capita as we do.

If you hear politicians proclaim “America has the best health care in the world,” you can stop listening to them at that point. They are not reality-based. We may be paying the most on the planet for health care, but there is no objective evidence to support the claim that our health care is the best. Again, it’s not even close. The World Health Organization ranks U.S. health care thirty-seventh, just below Costa Rica.

No other wealthy democracy relies on for-profit insurance companies. Here we stand alone.

On August 10, 2011, the Saint Louis Post-Dispatch editorialized, “If America truly is serious about dealing with its deficit problems, there’s a fairly simple solution. But you’re probably not going to like it: Enact a single-payer health care plan.” The editorial goes on to explain that the “way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.”

The editorial asserts, “the ACA didn’t go far enough,” and concludes: “Eventually, the United States will have a single-payer plan. But we’ll waste a lot of money and time getting there.” Its authors could have added “and waste a lot of lives” too.

What is a “single-payer plan” like the Post-Dispatch endorses? Robert Reich, author, professor, and secretary of labor under Bill Clinton, explained it this way in February 2011:

If the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all.

Medicare is a single-payer plan. Everyone over age sixty-five is covered by this simple, single plan, which is publicly financed and privately delivered. How would a single-payer plan save money? The Post-Dispatch explains, “Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

The respected journal Health Affairs published more evidence of the economic advantage of a single payer system on August 19, 2011. The article “US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers” found that U.S. physicians’ office staff “spent 20.6 hours per physician per week interacting with health plans — nearly ten times that of their Ontario counterparts. If U.S. physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year.”

The evidence is overwhelming: the for-profit insurance industry adds a huge amount of inefficiency, bureaucracy and cost to our system while adding no value, only hassle. These companies are parasitic middlemen we would be better off without. Their interest is in wealth care, not health care.

Reprinted with permission from Mike Luckovitch (CMG-Atlanta).

On top of that, the insurance industry is the single greatest barrier to achieving an efficient and affordable system to cover all Americans. If you have any doubt, read Wendell Potter’s Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. During the debate over the ACA, health insurance lobbyists sank the president’s public option, even though 70 percent of the public favored it. Their war chests overflow with money and their influence grows every day.

Hoping Congress will fix this leads only to despair. We need new ways to weaken the death grip this powerful industry has on us.

Divestment

There is a battle going on for the soul of America. Before he died, Ted Kennedy wrote to President Obama about health care reform, calling it “the great unfinished business of our society.” Kennedy avowed, “What we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

Back in the ER on that hot August night, I sent my man to the cath lab and they successfully stented his blockage. He went home the next day with a bill for $25,000. I tried to call him a few months later, but the phone number was “no longer in service.”

Congress and the politicians are “no longer in service.” We’ve got to look elsewhere.

Could we simply boycott health insurance? No, over 50 million are without insurance now, and they are living sicker and dying younger because they have barriers to care.

Stockholders with a conscience have tried for years to engage corporate leadership and have attempted shareholder resolutions to reform the industry from the inside. Despite their best efforts, they have had no significant positive effect so far.

It is time to move beyond resolutions and on to divestment.

The Divestment Campaign for Health Care is one group that is organizing a push in that direction.

From 1985 to 1990, over two hundred U.S. companies cut all ties with South Africa, resulting in a loss of $1 billion in direct American investment. This economic pressure hastened the fall of apartheid. It happened as a result of people power, democracy in action. Pension funds divested from companies doing business with South Africa. Faith communities declared they would not support injustice. Students called on their universities to cleanse their endowments. An idea was born — “socially responsible investing.”

There is nothing socially responsible about investing in the health insurance industry.

"Go to your church, your union … your friends and neighbors, and tell them it’s time to get the health insurers out!" the author writes. Here, a Unitarian Universalist congregation in Cortland, New York, rallies for single-payer health care. Credit: Creative Commons/citizenactionny.

Up to now, they have received little scrutiny from investors. One exception is Domini Social Investments, whose Global Investment Standards give “support [for] government’s responsibility to provide basic public goods that are as varied as health care, prisons, primary school education, and national security.” Domini is “concerned about the extent to which health insurance privatizes a public good.” As a result, Domini has disqualified most health insurers from their portfolios.

In contrast, the $4 billion TIAA-CREF Social Choice Equity Fund holds $24 million in WellPoint stock, as well as Aetna and Humana from the health insurance Big Five. WellPoint stock may only represent 0.6 percent of the total fund, but in this large, diversified mutual fund, which includes over 800 individual stocks, WellPoint is in the top 5 percent of the fund’s largest holdings. TIAA-CREF has refused to exclude health insurance companies.

The Presbyterian Church USA, often in the vanguard of the faith community, is there again. Their General Assembly meets in the summer of 2012 and they will vote on an “Overture” to “implement divestment procedures as well as encourage individual Presbyterians and congregations to divest of holdings in the [publicly traded health insurance] companies.” Other faith groups cannot be far behind.

We have nothing to lose. Health insurance companies have everything to lose as their stock prices drop and their influence wanes. Go to your church, your union, your pension plan, your 401k advisor, your university endowment, your city council, your friends and neighbors, and tell them it’s time to get the health insurers out!

Who can defend these corporations? There is no business case, no health care case, no moral case to support their ongoing existence. They make their profits by avoiding taking care of sick people — by refusing to issue policies, canceling policies, or denying payment. I went to medical school in order to care for the sick.

The health insurance industry must go.

Rob Stone is a gardener, grandfather, and teacher. He has practiced emergency medicine in Bloomington, Indiana, since the early 1980s, and for the past year has been transitioning his medical career to hospice and palliative medicine. He is founder and director of Hoosiers for a Commonsense Health Plan and serves on the board of directors of Physicians for a National Health Program.

As Congress continued debt ceiling debates — the results of which could chop entitlement programs like Medicare — a group of New Jersey seniors and health care advocates gathered to celebrate the program’s 46th anniversary.

“We have an economy in crisis, but that crisis was created by Wall Street and greedy corporations,” said Ray Stever, president of the New Jersey One Plan, which co-sponsored the birthday party and rally. “Seniors should not have to sacrifice their coverage to save the debt. Our message is simple: hands off Medicare and Social Security.”

About 50 people, mostly senior citizens, gathered at the New Community Center on Orange Street in Newark to rally against cuts to the program and to push for a universal, single-payer system. Balloons and a large cake were set up near the speaker’s podium in celebration of the Medicare bill, which President Johnson signed into law on July 30, 1965.

Rep. Donald Payne (D-Newark) was scheduled to attend the rally, but remained on Capitol Hill in debt negotiations.

Lynn Petrovich, a member of New Jersey One and a certified public accountant, works with seniors in Monmouth County.

“I’ve prepared thousands of returns for senior citizens and watched as they spend tens of thousands a year, and it’s only going up,” Petrovich said. “This program is a means of survival for our seniors.”

Thelma Yansy, 68, addressed the crowd, saying she’s not above begging.

“I’m pleading with you,” Yansy said. “Please leave Medicare and Medicaid alone, just leave it alone. We paved the way for our children and our children’s children, and now we’re just trying to live out the best of our golden years.”

Chuck Gibson, 73, is a retired general contractor who has seen his co-pays and cost of medications rise consistently over the past few years. The 12 medications he takes for diabetes, arthritis and a weak heart have gone up by about $5 per medication in the past year.

“I know there’s a lot of panicking going on in government right now,” Gibson said. “But they’re gonna work it out, one way or another, and some things are gonna be cut. What gets cut is the question.”

Brother Ray Stever made a passionate, moving presentation outlining why Organized Labor should take a leading role in the expansion of Medicare for all of our people. I can attest to the greed of the “for profit” health care industry since my sister has to order her life sustaining meds from Canada or face the prospect of the “poor house.” This sort of predatory behavior must end, because it diminishes us as human beings. And considering the political climate in NJ the sooner we take Health Care “off the collective bargaining table,” the better.

As a Union man, I was proud that my local chose to follow the path of our National Union by supporting Universal Single Heath Care for all and I encourage all my Sisters and Brothers to do likewise and join us at NJ One Plan, One Nation.

In Unity,
Rich Raimonde
Secretary, Vineland NALC 534/AFL-CIO.

Both the abolition of slavery and the establishment of a truly universal healthcare system were based on human rights. The Universal Declaration of Human Rights, which was drafted in 1948 by a committee chaired by former First Lady Eleanor Roosevelt, holds that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.” It is truly an embarrassment that the United States is the only major industrialized nation that fails to ensure that all its people have access to medical care.

There are also solid business reasons to expand Medicare to cover everything for everyone. A single, efficient, not-for-profit, single-payer public system for paying for healthcare would provide many important economic and social benefits to the people of New Jersey, and not just to our 1.3 million uninsured.

Health insurance companies have been increasing their premiums by up to 20% per year, even while providing less coverage. The average annual cost of employee-based family health insurance in New Jersey is $13,750. Health insurance companies change a 31% overhead. Medicare’s overhead is only 3%. Under Medicare for All, individuals and families will pay less for health insurance. Patients will pick their own doctors. Patients and doctors, not insurance companies, will make treatment decisions. Patients will also be freed from the fear of medical bankruptcy. In the United States today, 62% of cases of personal bankruptcy result primarily from illness and medical debt. Of these cases, 70% had health insurance when the bankrupting illness or injury arose.

Large and small businesses, nonprofit organizations, and state and local government will also benefit from the single payer system because it will provide comprehensive medical insurance to all of their employees at a much lower cost. This cost savings will reduce the cost of government and provide a substantial boost to the competitiveness of businesses.

A single-payer system would largely solve New Jersey’s budget problems. The state government would save $2.6 billion per year on employees’ healthcare, charity care, and workers’ compensation. New Jersey would also eliminate more than $60 billion in unfunded obligations for retirees’ medical care. The City of Trenton would save $18.2 million per year. Camden would save $17 million per year (75% of Camden’s budget comes from the State of New Jersey).

Healthcare providers will also benefit from the single-payer system. Under the current system, doctors often find their professional judgment being second-guessed by anonymous insurance company clerks. Then, doctors and their staff must navigate a complicated bureaucratic maze if they hope to get paid. A single-payer system eliminates this bureaucratic nightmare, providing instead a simple and streamlined billing system. It will be like today’s Medicare system, except more inclusive, more comprehensive, and potentially more generous to healthcare providers.

Congress should be working to expand Medicare to cover all necessary care for everyone. Instead, some members of Congress are threatening to cut Medicare funding, even though 92% of Democrats, 73% of Republicans, 75% of independents, and 70% of Tea Party members oppose cuts to Medicare, according to a McClatchy-Marist poll conducted in April.

Like abolition, women’s suffrage, and the Civil Rights Movement, the passage of Green Mountain Care in Vermont was the product of a grassroots political mobilization. The movement for a simple, economical, and humane system for providing healthcare is the civil rights movement of our generation. New Jersey One Plan One Nation is leading that movement here in the Garden State. Join us at www.njoneplan.org.

Ray Stever, President
New Jersey One Plan One Nation Coalition

“This is great news. The Green Party has always worked to make sure the planet and the environment stayed healthy, said NJOPON President Ray Stever. “Now they will help us in supporting and educating the citizens of how Medicare for All will keep them Healthy.”

If passed through Congress, HR 676 will create a single-payer healthcare system administered by private entities and funded by the government. The legislation will provide access to health insurance for all Americans.

You can download the Fort Lee resolution here (.pdf).

New Jersey One Plan, One Nation members and healthcare activists Paula Friedman, Matt Shapiro, Bonnie Shapiro, Jeanine Ciliotta, and Edie Garbowitz organized the push to pass the endorsment as part of Healthcare-NOW!’s Win-Win Campaign targeting local government entities–cities, towns, counties, school boards-–in an effort to get them to endorse HR 676.

The activists began by finding their town’s budget and figured out the healthcare costs for one year. Next, they found the city’s total salaries. Under HR 676 employers pay about 4.75% payroll tax on employee salaries. Given Fort Lee’s current health insurance costs and total salaries, the city would save close to $5.5 million a year from the municipal budget alone. They suggested that the savings from the Board of Education budget would be similar, and the Mayor and Council later confirmed that.

The group identified a council person who they thought might be sympathetic. They met with him and gave him a small packet of information–some of which included resolutions passed by other towns, the Bergen County Board of Chosen Freeholders, and the United States Conference of Mayors, as well as evidence of NJ State Government savings of about $2.2 billion. The councilman met with the Mayor and other council members in an Executive Session to discuss the resolution. It was voted on, and passed, at the next open meeting on March 10.

See Donna Smith’s interview here.

See the interview with Dr. Sidney Wolfe and Dr. David Himmelstein here.