"Didya Hear, Doc?"

by Anju 

I work as a family physician in a county clinic and hospital in Los Angeles and I’m actively involved in activism around the national health care reform process.  So this week as each new move played out – whether by congresspeople or health care advocates or the health insurance industry – it was exciting to hear on more than one occasion from my patients , "Didya hear, doc?"  It’s a testament to the fact that people are ENGAGED.

So,didya hear?  If ya didn’t, here’s a quick roundup of the national level health care reform updates/news, and please read on to see what some organizations have unveiled this week in response.  Because information without action is disempowering, and we’re not about disempowerment here.


This week, Congress passed the Credit Card Holders Bill of Rightsan exciting move forward for consumer rights, and arguably a move that shall improve the health of many Americans filled with anxiety over debt.  [Of note, the Bipartisan Patient Protection Act, a patients’ bill of rights introduced in the Senate in 2001, has yet to be passed.  Of note, the act includes an appeals process for patients whose claims were denied by health insurance companies, among other protections].

Also, the GOP unveiled a semblance of a health care reform plan – the Patients’ Choice Act of 2009 – that includes more of the same "tired" and true Republican strategies, including tax credits that do little to subsidize the cost of health care for families or individuals.  

The Republican Party has a deal for you: Under the health care proposal the GOP released Wednesday, you are fully entitled to spend your own money in the free market to purchase health insurance, a chief backer of the plan, Sen. Richard Burr (R-N.C.), said Wednesday.

Under the rubric of choice, the plan treats employer-based health insurance as income and taxes a worker's benefits. If it costs an employer $12,000 to cover your health care, for instance, you'd be responsible to pay taxes on that $12,000 as if it were paid out to you.

The plan also chips away at the employee based health insurance system that so many Americans rely on by taxing health benefits.  Taxing health benefits?!?  And it pushes people from Medicare and Medicaid to private health insurance plans through various mechanisms.

A few days ago, the Robert Wood Johnson Foundation released a stunning report – the first of its kind – on the amount of time and money spent by health care providers on dealing with the health insurance industry:  

...overall the costs of interacting with insurance plans is $31 billion annually and 6.9 percent of all U.S. expenditures for physician and clinical services...

On average, physicians spent three hours a week or nearly three weeks per year on these activities, while nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year interacting with health plans. More than three in four respondents said the costs of interacting with health plans have increased over the past two years.

In the past few days, the health insurance industry has escalated its war on reform.  In 1993 there was Harry and Louise.  In 2009, a whole new beast is being birthed.  This week, Blue Cross Blue Shield of North Carolina – a huge private insurer in North Carolina – hired a PR company to design ads that feature government bureaucracy and long wait times.  Blue Cross Blue Shield spokespeople remarked on how a government "run" system could result in less choice, longer wait times, and lower payments to health care providers.  Ironically:

It was BCBG of North Carolina that in 2007 lost a $128 million class-action suit for fraudulently underpaying physicians. According to the Durham Herald Sun, "Numerous state medical societies, including the N.C. Medical Society, were involved in the lawsuit, which charged that North Carolina Blue Cross and other Blues plans harmed doctors with unfair business practices that denied and delayed payments for medical care.

... The complaint identified numerous Blue Cross and Blue Shield plans as defendants in an alleged scheme to defraud doctors in violation of the federal Racketeer Influenced and Corrupt Organizations Act."  

And lastly, although President Obama has maintained his desire to build a robust, cost-effective, and high-quality public health insurance option into the national health reform effort and to have this plan compete head to head with private health insurance plans, some of our Democratic leaders are seriously infuriating us:

Senator Ben Nelson, a Nebraska Democrat and another member of the finance committee, said he favors the idea of a "trigger" that would expand government-provided health insurance only if other new attempts at expanding health-care coverage through the private sector appear inadequate. Nelson said he is wary of a big expansion of the government’s role in providing care.

The public option, he said, should be seen as a "backup."

Makes you wonder – when do we meet the criteria for "only if other attempts... appear inadequate"?  The reality-based answer:  YEARS ago.

The upsetting news is that Democratic Senator Baucus, chair of the Senate Finance Committee, has already stated that the (awfully named) "trigger" option is "on the table."  (by the way, who came up with the term "trigger"?)


This week, Health Care for America NOW (HCAN) – a broad based coalition of unions, business groups, health advocacy groups, and health care provider groups – threw a strategic one, two punch: they cited a study conducted in the past year about health insurance monopolies in many metropolitan areas in America.  They effectively stated that our current private health insurance system is UNAMERICAN.  How so?  Over the years, mergers have resulted in highly concentrated geographic areas of dominance by a handful of health insurance companies.  This begs the question – where’s our choice in health insurance plans?  What does choice even mean?

HCAN coupled this information with shocking statistics about how insurance companies have used this monopoly type power to take advantage of patients:

• More than 94 percent of all insurance markets in the United States are highly concentrated.
• The number of insurers has fallen by 20 percent.
• Premiums increased by more than 87 percent from 2000 to 2007.
• Private insurance spending is increasing at a rate 37 percent greater than spending for Medicare.
• The number of uninsured has increased to more than 47 million, or more than one out of seven Americans, as premiums are simply out of reach for increasing numbers of individuals and small businesses.
• The number of underinsured Americans is now at 25 million, excluding the tens of millions of Americans without adequate insurance who have yet to test the level of security their insurance offers.3,4
• In 2008, employer health insurance premiums increased by 5 percent – twice the rate of inflation.5
• Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period.6
• Profits of the 10 largest publicly traded insurers increased 428 percent from 2000 to 2007, from $2.4 billion to $12.9 billion.

And as user dday wrote at Hullabaloo:

"the health insurance industry's "compromise" solution for reform is to EXPAND THEIR MONOPOLY by mandating that everyone in America buy health insurance from them, without the opportunity for a public plan alternative. With nobody to compete with and essentially a forced market, insurers would have every incentive to consolidate further, the very action which has driven up health care premium costs over the years."

HCAN sent a letter to the US Department of Justice asking them to investigate the health insurance mergers and take appropriate action.  A brilliant move legally, and the talking points are a goldmine for framing the health care debate.

Progressive healthcare provider groups are up in arms
– organized and effectively advocating for their patients in stronger ways than ever before.  LAST week, physicians and nurses were arrested after speaking up at a Finance Committee hearing and asking Senator Baucus to include a single-payer (publicly financed, privately delivered) health reform option among the other options on the table.

A few days ago, Doctors for America (formerly Doctors for Obama before the presidential election) – which has gathered 12,000 medical student and physician signatures in support of health reform THIS YEAR, held a webcast with Dr Jacob Hacker, the lead architect behind the proposed public health insurance plan.  It can be viewed here.  Dr Hacker empowered physicians by encouraging them to collectively sit at the table with other stakeholders ("In other countries, doctors have a seat at the table routinely.  In the US, not so much").

And this week, the National Physicians Alliance, an organization representing thousands of physicians from around the country, unveiled a specific and bold petition for both Doctors and Nurses called Doctors for a Public Plan, and Nurses for a Public Plan, to ensure that healthcare providers’ voices are included in the formal support for a robust, high-quality, effective public health insurance option:

We, the undersigned health care providers, strongly urge Congress to support the choice of a public health insurance plan as an essential component of comprehensive health care reform this year.  The option of a public health insurance plan will:

* increase meaningful choice for our patients


* enable patients to keep their own doctor, regardless of changes in employment or health


* provide better care to patients by driving innovation in the quality of care we provide


* force private health insurers to compete on a level-playing field, especially in limited markets


* reduce health care costs


* provide everyone the security that quality, affordable coverage will always be there.


We have a professional and ethical duty to deliver quality, affordable health care.  But we cannot rely on the for-profit, private health insurance industry to put patients before profit.  The time is now.  We call on you to invest in the health and security of our nation by providing the choice of a public health insurance plan.

Bold and specific.  Ask your health care provider to sign it, or if you are one, please sign it and spread the word!


Everything mentioned above happened in the past ONE WEEK.  We’re not used to this pace in health care reform.  It’s a bit frightening but it’s good reason to stay on track with strategy, build people power, and be ready with our own stories.

Of course there’s huge public support for health reform.  During the webcast with Dr. Hacker, he cited two polls.  One was conducted by HCAN, and found that 73% of Americans support the idea of a public health insurance plan competing with private plans.  The second was conducted by the Kaiser Family Foundation and found that two-thirds of Americans would want a government administered plan like Medicare competing with private plans.

There’s overwhelming support for competition, high-quality health care, and a strong public health insurance.  But there’s a wide gaping rift in how policymakers and the public frame the broader issues of health reform, including health IT, costs, unnecessary care, comparative effectiveness research and so on.  Drew Altman, President of the Kaiser Family Foundation, said this about the public(as compared to policymakers):

The public has a very different world view: People think that underservice is a bigger problem than overservice. They want relief from the problems they are having now paying for health care and health insurance in very tough economic times. Under no circumstances do they want to pay more for their care. And many are worried that they will not be able to afford their health insurance in the future or may lose it altogether.


It’s hugely important to connect all these policy-wonky issues to how we and our friends, family and neighbors are affected.  The personal narrative and our shared experiences around health, wellness, and sickness are often more powerful than all the policy quotes and statistics in the world.  In that vein, think about sharing your personal experience with health, and further discussing the health care reform movement in the US, at Cure This, an online space for discussion around health and health justice.

A patient and activist shared her story at Cure This, including this powerful note:

so as you know, I've had incredible back problems the past week.  i just had to take a moment to note, that today, i went to the doctor for the first time in years and years with real health insurance--that is, insurance that is not poor people/county offered health insurance.  I got to go to a real doctor (as opposed to a medical student) at a real office (as opposed to a makeshift building transformed every tuesday and thursday into a doctors office)--and lawdy lawdy, it was like i was in heaven or something.  the doctor even told me, well, instead of getting you all drugged up with pain medications, let's see what we can do to make sure that this doesn't happen again. it was like angels came from the heavens and shared with me a piece of what the lord must promise to those who have clean souls.

i was on pins and needles the whole time, however--asking every five minutes--are you sure my insurance covers this?  are you sure my insurance covers that?  i want to make sure my insurance covers that!! please don't schedule me for anything until i've checked to make sure my insurance covers that!!!

i am waiting for the reply of four different emails to the same person begging them to make sure that everything is covered.

if you have ever wondered, what's so wrong with being poor--this is it:  if somebody is gentle with you, if somebody takes time to talk to you, if somebody wants to help you heal instead of drugging you until the pain goes away, if somebody believes you when you say it hurts--there must be a mistake.  there must be something wrong, somebody must be tricking you or must've filed the wrong paper work or fucked something up some where.  

And a physician shared an ingenious idea at CureThis.  He tells the story of a patient he took care of in the ER, who was not able to receive the medication that would have been indicated for her, and why he wishes to take pharmaceutical company and health insurance industry CEO’s on mandatory tours of emergency rooms:

But the people who work for Aetna and Merck haven't met Marisa. They don't know her story. They are are blissfully removed from her life, and from the lives of millions of other people they affect daily. For them, this 23 year-old Crohn's patient exists only as an account payable, a number to be spindled and manipulated and shifted into the proper column. If enough of these faceless numbers move in the right direction, the workers get a healthy year-end bonus. Hey, they're just doing their job. Nothing cruel or heartless about that.

Which is why it's time for the mandatory ER tours. Sign-up sheets will be posted soon.

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I don't really understand the purpose of "private" for profit health care. Seems to me health care is an issue of national security that is as important as the military. Profiting from poor health just seems morally and ethically wrong on so many levels. 

Absolutely. We should say it loud and clear.