Health Insurance

Next week the U.S. Census Bureau will release its updated estimate of the number of uninsured people—now officially at 47 million. David Colby at the Robert Wood Johnson Foundation helpfully assembled some accessible foundation-backed papers and issue briefs on who the uninsured are, what being uninsured means, what the federal environment for change looks like now, and how the states have or have not stepped up. Here's the link to the series "The State of Research on the Uninsured: Putting Census Estimates in Perspective" and we're providing a few of the summaries and abstracts below. We'll post a similar brief guide to some of our own issue briefs and papers on the uninsured before the Census numbers come out.

Harry and Louise are back. Older and ever so much wiser.

The infamous Harry and Louise ads were created by the insurance industry in the early 1990s and widely credited with helping kill President Clinton's health care plan.

Now Harry and Louise are back, urging the next president—whoever that turns out to be—to finally fix U.S. health care.

Lots of things have changed since 1992-94. For starters Harry (whose real name is Bob) and Louise (whose real name is Louise) are married in real life now. They have a website. www.HarryandLouisereturn.com. And naturally they are on YouTube:

A penny saved is a penny earned, but cutting back on routine and preventive health care can cost you down the road.

A survey released this week from the National Association of Insurance Commissioners finds that 22 percent of respondents had cut back on the number of times they see a doctor because of bad tough economic times and 11 percent had reduced their use of prescription drugs.

Over at Health Matters, Kristin Gerencher notes the irony of such penny-wise pound foolish behavior in health care that, in the long run, leaves people physically and financially worse off. We found NAIC president Susan Praeger commentary within the post particularly on target:

That's why health reform is urgently needed, said Praeger, an elected official who describes herself as a moderate Republican. "As these costs go up, people are going to be demanding action. It's time....We can get to universal coverage with a combination of subsidies for low-wage workers, for high-cost utilizers and helping to spread the cost over the broader population," she said.

The Kaiser Family Foundation has done its part to track the post-Katrina progress of New Orleans and the Gulf Coast, to make the rest of us remember what the people of New Orleans can't forget. Kaiser released its latest survey this weekend, and it's a moving testimony about resilience, about how people can somehow live simultaneously with both enduring hope and increasing pessimism. The Kaiser survey went beyond health care to look at how residents of Orleans parish feel about crime, housing, schools, the job market, and other aspects of post-storm life and you can see the whole report here. But we're going to focus mostly on health in a city where health infrastructure took a heavy hit.

The city is about half the size it was three years ago, and almost all the residents are those who chose to stay or return to rebuild, hoping perhaps to create a "new" New Orleans free of the social problems that had plagued it long before the levees broke. The survey provides ample data that those high hopes haven't been matched by the facts on the ground, but most people living in New Orleans continue to believe that their city will slowly come back, even if many are dissatisfied by the pace of progress in crime control, housing, fixing the schools and access to health care. The most visible area of improvement was levee-rebuilding and flood control.

The Commonwealth Fund and Harris Interactive have a new poll out on health care, showing 80 percent support for fundamental change or a "completely rebuilt" health system. The poll differs a bit from some surveys we've seen with its emphasis on how people get care, not just how it should be financed. The survey of 1,004 adults found that people across income brackets have difficult getting timely, efficient and well-coordinated care. And the frustration is not only among the uninsured.

Eight-of-ten adults (81percent) who were insured all year and nine-of-ten (89 percent) who were uninsured at some point during the year called for fundamental change or complete rebuilding. Although there's a widespread perception that patients demand unnecessary tests and procedures and things they saw on TV or heard from a neighbor or stumbled across on the Internet, this survey found that many people thought they were getting unnecessary and duplicative care. One-of-three adults said they had experienced inefficient or unnecessary care in the past two years.

If you need to brush up on the lessons of supply and demand, U.S. emergency rooms provide an all too vivid example. Demand is up. Supply is down. The system is a mess.

Emergency room visits jumped more than 32 percent from 90.3 million in 1996 to 119 million in 2006, the most recent year statistics are available, according to the National Center for Health Statistics, a division of the CDC. About 13 percent of the patients get admitted to the hospital, meaning they are pretty sick. That proportion is pretty stable but the overall numbers are increasing. By 2006, more than half of all admitted patients had shown up first in the ER. That's a 36 percent increase since 1996, and it says a lot about the increasing problems people face in getting primary care.

And before you assume that this is the inevitable result of having 47 million uninsured Americans, think again. Increasingly, the ER patients are insured.

"There are more people arriving at the ERs. And there are fewer ERs," Dr. Stephen Pitts, author of the report and a CDC fellow who teaches emergency medicine at Emory University's School of Medicine was quoted by the AP as saying. The number of emergency departments fell from 4019 to 3833.

The health advocacy group Families USA has created a new website Stand Up for HealthCare aimed at ordinary people who may not understand all the intricacies of health economics, but who know our country needs a change. Families is advocating a hybrid system of public and private health plan options, subsidies for working families who can't afford health insurance, rules to make the insurance marketplace fairer, and a health care system that includes prevention and wellness instead of the current system geared toward acute illness. As Families' executive director Ron Pollack noted, health reform won't happen without people telling politicians they want it to happen. Check it out.

It's a far cry from the comprehensive health care overhaul California Governor Arnold Schwarzenegger envisioned just a few months ago, but the Republican governor and Democratic state lawmakers are negotiating three related bills that would regulate health insurers, specifically the meager policies sold in the individual market that can leave people with big gaps in coverage if they become sick, the Los Angeles Times reports.

About three million Californians buy their insurance in the individual market, which as currently structured often means they are getting scanter protection and bigger shares of their medical expenses than people who get their insurance through their employer. Schwarzenegger and the legislators are trying to negotiate legislation that would set minimum benefits (although not necessarily a standard benefit package), cap insurers' profits on these policies, and restrict insurers' ability to cancel policies retroactively, a practice known as rescissions, Times reporter Jordan Rau writes. The state recently banned health insurance companies from rewarding employees with bonuses for rescissions.

We've posted twice today (here, here) about the need for state, versus federal, health reform, which reminded us that we need to catch you up on events in Ohio, the latest state to see how far it can go in fixing health care even in the absence of that federal solution.

A task force appointed by Ohio Gov. Ted Strickland, a Democrat, made its recommendations last week, according to Cliff Peale of the Cincinnati Enquirer. The expert panel urged that Ohoians be required to buy at least a basic benefit package, with subsidies for low-income people. Insurers would be required to cover anyone who applies. The state would seek to get more people into Medicaid, both by more outreach to those already eligible and by raising income eligibility levels. The Dayton Business Journal also reported that adult children would be able to remain dependents on family's group health insurance policies up to age 29, and the state would also create a reinsurance program to provide affordable coverage to uninsured small businesses, sole proprietors, workers and individuals.

If you've been reading this blog, you know I've done a fair amount of reporting in the past few years on palliative care and end of life care (they aren't synonyms, but we'll leave that for another day). I haven't blogged as much about pain management, per se, but untreated pain has huge implications for the health care system (not to mention the toll it takes on the millions of people who suffer needlessly.) People in pain miss work or underperform. They may be less physically active, increasing their risk for chronic diseases or aggravating diseases they already have. A diabetic, for instance, isn't going to get off the couch if he aches terribly because of some other health problem. For our elderly, chronic pain can further isolate them. And if you find yourself in an overcrowded emergency room, look around and find how many people are there simply because their pain—including cancer pain—just got unbearable.