Looking at millions of individual bills that makeup the 2.7 trillion dollars of annual health care costs opens a gigantic window on the massive waste, redundancy, profiteering, fraud and sometimes criminal over-billing.

Here is a partial example of what I mean, in the words of Philip M. Boffey, the estimable science writer for the New York Times:

“Why does an appendectomy in Germany cost roughly a quarter what it costs in the United States? ($3,285 compared to $13,123). Or an MRI scan cost less than a third as much, on average, in Canada? ($304 compared to $1,009).”

“Americans continue to spend more on health care than patients anywhere else. In 2009, we spent $7,960 per person, twice as much as France, which is known for providing very good health services. And for all that spending, we get very mixed results–some superb, some average, some inferior–compared with other advanced nations.”

Moreover, France and Germany, Italy, England, Canada, Belgium, Sweden and all other western countries plus Japan and Taiwan cover almost all their citizens, unlike the U.S. where 50,000,000 people are uninsured.

Boffey, who wrote a book on the National Academy of Sciences, (The Brain Bank of America: An Inquiry into the Politics of Science), under our sponsorship in 1975 goes on to cite the comparative price report of the International Federation of Health Plans in 2010. They are stunning! For Britain, Canada, France, Germany and the U.S. respectively, the average cost in dollars for bypass surgery is $13,998, $22,212, $16,325, $27,237 and in the U.S. $59,770. For cataract surgery the bill is $1,299, $927, $3,352, N.A. and in the U.S. $14,764.

Boffey adds other explanatory factors. These include higher administrative costs to deal with insurance paperwork, higher insurance company profits and executive compensation and less developed electronic health records leading to costly errors.

Except for Germany there are somewhat longer waiting times for some patients to see a specialist in these countries. But in the U.S. seeing specialists is often prohibitively expensive, and if you cannot afford such services, that is the longest waiting time of all.

A recent commentary in the Mayo Clinic Proceedings last August by Charles. W. Slack and Warner V. Slack, MD suggests another compelling comparison–between outcomes in different states in the U.S. They ask “why, for example, do Mississippi, Louisiana, and Georgia have such a high rate of mortality amenable to health care when compared with Idaho, Oregon and Washington.” Wide differences between states and counties have been documented regarding the cost of identical operations, frequency of operations such as cesarean sections or hysterectomies and other surgical disparities studied under controlled variables.

Health care bills come with hefty levels of fraud. From the historic study twenty years ago by the then General Accounting Office of the Congress to the present estimates by the nation’s leading expert in this field, Professor Malcolm Sparrow at Harvard University, fully ten percent of all health care expenditures are the result of computerized billing fraud and abuse. That will be $270 billion this year.

Dr. Sparrow, an applied mathematician, says it could be higher if the federal government would simply do a more detailed study. He adds that the enforcement budget should be one percent of the estimable volume of fraud. In actual practice, the enforcement budget is less than one/tenth of one percent, even though every dollar of enforcement brings in at least seventeen dollars back. (See Dr. Sparrow’s website: http://www.hks.harvard.edu/fs/msparrow/)

Obviously the corporate fraud lobby is stronger than the taxpayer/consumer lobby in Washington, D.C. But why the health insurance companies, a formidable force in their own right when it comes to protecting its turf against single payer or full Medicare insurance (see singlepayeraction.org) do not do more to stop fraudulent billing practices, is a puzzle.

All in all, the health care industry is replete with rackets that neither honest practitioners or regulators find worrisome enough to effectively challenge. The perverse economic incentives in this industry range from third party payments to third party procedures. Add paid-off members of Congress who starve enforcement budgets and the enormous profits that come from that tired triad “waste, fraud and abuse” and you have a massive problem needing a massive solution.

So, voters, why not start challenging all candidates for elective office to make this vast daily heist a front burner campaign issue?

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book – and first novel – is, Only The Super-Rich Can Save Us. His most recent work of non-fiction is The Seventeen Traditions.

More children lost Medicaid coverage in Pennsylvania in December than in the previous three months combined, according to new Department of Public Welfare numbers that show a total of 88,000 cut since August.

Advocates for the poor and disabled say orders to quickly process a backlog of eligibility reviews, which has mushroomed to more than 700,000 cases, have pushed an already overwhelmed workforce over the edge. Many cuts that legal-services and social workers challenged turned out to involve paperwork that they say DPW lost – sometimes repeatedly, even when clients had receipts – or that had never been sent in the first place.

The official numbers don’t count an additional 23,000 children whose benefits were cut and eventually restored retroactively, often with legal help. But poorer people may be less likely to call a lawyer, and child advocates believe thousands have no idea they are now uninsured.

“Our fear is that there are many out there,” said Renee Turchi, a pediatrician in St. Christopher’s Hospital for Children’s special needs clinic, where about 50 children have lost coverage at some point.

On Friday, an infant who was born three months prematurely was brought in for a monthly immunoglobulin injection and was denied, to the surprise of hospital workers and family, when the staff ran the insurance card. Without the preventive shot, Turchi said, complications of a virus could be life-threatening.

The Inquirer reported last week that DPW plans to tighten food-stamp eligibility. That proposal, if implemented on May 1, would be an official change in policy. DPW described the Medicaid cuts, in contrast, as simply the result of catching up on a backlog by enforcing current law, which requires cases to be reviewed for eligibility every six months. (Federal law prohibits the state from changing Medicaid policy.)

Both moves have been touted as part of DPW Secretary Gary Alexander’s efforts to reduce waste, fraud, and abuse. Alexander has also made clear that he intends to revamp entitlement programs in Pennsylvania to focus more on short-term emergency needs, with an eye toward reducing clients’ dependency and saving the state money – a goal too complex to attempt in his first year on the job.

This year’s budget ax chopped deep into education, largely sparing public welfare. But DPW’s $10.6 billion allocation accounts for nearly 40 percent of all state spending. And with Harrisburg facing a shortfall next year officially projected at $800 million but likely to be much more, Alexander’s money-saving ideas may be hard to ignore.

Still, squeezing savings out of entitlements is difficult. They are highly regulated, giving states little leeway to make changes. Federal matches mean the state often loses roughly $2 for every $1 it saves.

And in the current situation, if people are losing benefits by mistake, as advocates believe, many will eventually be reinstated. If not, they may put off seeing doctors and show up as uninsured emergency room patients.

“We’re petrified about that,” said A. Scott McNeal, a medical director for the North Philadelphia Health System’s hospitals and Delaware Valley Community Health’s four community health centers. Medicaid accounts for more than half of all revenue for each.

Losing much of those reimbursements, combined with the cost of providing care to what would then be the uninsured, “could destroy certain organizations,” McNeal said.

Ripple effects could be felt throughout Philadelphia and other big cities, said Donald F. Schwarz, deputy mayor for health and opportunity. Schwarz said little financial impact had been seen so far, perhaps because many people who recently lost coverage don’t often seek care or have not yet needed a doctor.

Medicaid, he said, “is a safety net.”

The new enrollment numbers for Philadelphia show 25,516 fewer children on state Medical Assistance through Thursday compared with August, a 9.3 percent drop. The 88,071 children cut statewide represented a 7.6 percent decline.

DPW reported data for adults as well, but it used a new method that makes comparisons with previous monthly numbers unclear.

Most of the reductions resulted from backlogged eligibility reviews that DPW ordered on July 7 and that are now about 80 percent complete.

Ray Packer, program executive in the Office of Income Maintenance, said the backlog was identified in Harrisburg in June or July and most cases were less than a year overdue.

It “would be speculation on our part to say what actually caused it,” Packer said.

Advocacy groups and the caseworkers’ union say years of staff cuts in DPW’s County Assistance Offices, combined with a recession-driven increase in cases, caused work to pile up. Attacking what was first thought to be a smaller backlog on what was originally a five-week deadline added another layer of dysfunction; handling disaster aid after summer floods was yet another.

Data that Packer compiled show that reviews for 579,230 children and adults were processed by Jan. 6 and benefits ended for one-third of them; a quarter of those were later restored.

Three percent of the reviewed cases closed so far involved deceased people, although it was not clear how much money was paid, mainly to managed-care companies, to cover the dead. An additional 7 percent were cut due to income levels.

About 62 percent were closed for “failure to provide information” or “failure to respond.”

“It tells me there is something wrong with the process they are using,” said Richard Weishaupt, senior attorney at Community Legal Services of Philadelphia. That nearly two-thirds of people who depended on Medicaid “have suddenly become so disorganized they can’t send in their paperwork on time . . . just defies imagination. Why did they apply in the first place?” Weishaupt said.

But Packer and Kim Holt, acting of chief of staff for his office, said that nonresponse rate was typical in Medicaid reviews.

Advocacy groups asked the department last month to temporarily suspend case closures for children and vulnerable patients but have not gotten a response.

Anne Bale, a DPW spokeswoman, said that as far as she knew, no attempt had been made to prioritize reviews based on medical need or any other factor. Other officials said suspension was unnecessary because there was no reason to believe eligible people had lost benefits.

There has been no change in policy, they said, adding that DPW procedures guarantee the scenarios described by beneficiaries, legal advocates, and the union representing caseworkers could not have happened.

“They have chosen to send a signal, and I believe it is very callous, because they have captured people in that signal who are likely to be eligible,” said Donna Cooper, senior fellow at the Center for American Progress, a Washington think tank, and secretary of policy and planning for former Gov. Ed Rendell.

Sen. Vincent J. Hughes (D., Phila.) said he believed the reviews were part of a pattern – along with the planned tightening of food-stamp eligibility and last February’s demise of the state’s health insurance program for low-income working adults, which was quickly followed with business tax breaks – of the Corbett administration’s “putting their foot on the neck of poor people.”

On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

“He had been homeless for about two weeks. He hadn’t showered or eaten a lot. He asked if we had a meal tray,” said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. “It seemed almost as if he was interested in being admitted.”

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies – attempted suicide, severe depression, psychosis – as states slash mental health services and the country’s worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

“These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital’s psychiatric emergency department have climbed 20 percent in the past three years.

“We’ve seen actually more very serious suicide attempts in that population than we had in the past as well,” she said.

Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go.

On top of that, doctors are seeing some cases where the patient’s most critical need is a warm bed.

“The more I see these patients, the more I realize that if it’s sleeting and raining outside, the emergency room is the only place they have,” said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.

Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years.

But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.

A WORSENING PROBLEM

The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities.

In that same time frame, demand for community-based services climbed 56 percent, and demand for emergency room, state hospital and emergency psychiatric care climbed 18 percent, the organization said.

“This wasn’t one round of cuts,” says Ted Lutterman, director of research analysis at NASMHPD Research Institute. “It was three or four for many states, and multiple cuts during the year.”

If the economy doesn’t improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare.

“It’s been horrible,” she said. “Those that need it the most – the unemployed, those with tremendous family stress – have no insurance.”

In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency department, taking up beds that could be used for traditional types of trauma.

More than 70 percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2010 survey of 600 hospital emergency department administrators by the Schumacher Group, which manages emergency departments across the country.

Ten percent said they had “boarded” patients for a week or more.

And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.

California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.

“They don’t have secure holding rooms. They don’t have quiet spaces. They don’t have a lot of things you need to help calm down a person in an acute psychiatric crisis,” Hagar said.

“Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed,” he said.

FROM CITIES TO SMALL TOWNS

In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005, says Dr. Bret Nicks, an emergency physician at Wake Forest Baptist Medical Center in Winston-Salem and a spokesman for the American College of Emergency Physicians.

Nicks points to a report from the Institute of Medicine released in 2006 that found U.S. emergency departments were already overtaxed and overcrowded.

“Now you are adding in patients who are unsafe to leave but yet have nowhere to go,” he said. “I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now.”

Dr. Stephen Anderson is an emergency department doctor at Auburn Regional Medical Center, a mid-size suburban hospital outside of Seattle.

“When the economy is hurt they are some of the first to drop off the healthcare rolls,” he said of local residents in the largely blue-collar community.

Anderson, who heads the Washington Chapter of the American College of Emergency Physicians, said the state has lost a third of its inpatient psychiatric beds in the past decade.

Lately he is seeing a marked escalation in patients with psychiatric problems turning up in the emergency department. In early December, a third of its beds were occupied with people in a psychiatric crisis who were not safe to return to the community.

The problem extends out to small towns.

Sullivan splits his time between the big emergency department at the University of Illinois Medical Center at Chicago and St. Margaret’s Hospital, a tiny facility in Spring Valley, Illinois, about 100 miles southwest of the city.

On a recent shift, a young woman with schizophrenia arrived at the hospital. She had just lost her job and apartment and was living with relatives. She could not afford the medications that were keeping her illness in check.

The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores.

“I didn’t feel comfortable doing that,” Sullivan said, noting that emergency physicians are being asked to deliver specialized care that should be handled by a psychiatrist.

He found a healthcare facility about 25 miles away with a psychiatrist who could help, but even that presented a problem for the woman, who had no way of getting to the appointment.

“It’s almost akin to having a cardiac patient come in and say, ‘I need someone to adjust my defibrillator.’ In the emergency department, we can do a lot, but there are some things we have to leave with the specialists,” he said.

The last time Mark Stella went to the dentist he didn’t need an insurance card. Instead, he pulled out a Groupon.

Stella, a small business owner, canceled his health insurance plan more than three years ago when his premium rose to more than $400 a month. He considered himself healthy and decided that he was wasting money on something that he rarely used.

So when a deal popped up on daily deals site Groupon for a teeth cleaning, exam and an X-ray at a nearby dentist, Stella, 55, bought the deal — which the company calls a “Groupon” — for himself and another for his daughter. He paid $39 for each, $151 below what the dentist normally charges.

Daily deal sites like Groupon and LivingSocial are best known for offering limited-time discounts on a variety of discretionary goods and services including restaurant meals, wine tastings, spa visits and hotel stays. The discounts are paid for upfront and then it’s up to the customer to book an appointment and redeem a coupon before it expires. Merchants like the deals because it gives them exposure and a pop in business. Customers use them to try something new, to save money on something they already use, or both.

The sites are increasingly moving beyond little luxuries like facials and vacations and offering deals that are helping some people fill holes in their health insurance coverage. Visitors to these sites are finding a growing number of markdowns on health care services such as teeth cleanings, eye exams, chiropractic care and even medical checkups. They’re also offering deals on elective procedures not commonly covered by health insurers, such as wrinkle-reducing Botox injections and vision-correcting Lasik eye surgery. About one out of every 11 deals offered online is for a health care service, according to data compiled by DealRadar.com, a site that gathers and lists 20,000 deals a day from different websites.

“I was accustomed to going to the dentist every six months,” said Stella who owns SmartPhones, a store and wholesale business in Miami that sells mobile phone covers and accessories. “This filled the gap.”

The deals are popping up across the nation. In New York, a full medical checkup with blood, stool and urinalysis testing sold for $69 in December on Groupon — below the regular price of $200. In Seattle, a flu shot was offered on AmazonLocal for $17, down from $35. In Chicago, LivingSocial sold a dental exam, cleaning, X-rays and teeth whitening trays for $99, a savings of $142.

About 9 percent of all offers on daily deal websites in November were for dental work or some kind of medical treatment, up from 4.5 percent in the beginning of 2011, said Dan Hess, CEO and founder of Local Offer Network, which runs DealRadar.com. The growth in health-related deals is good news for millions of Americans. According to the Centers for Disease Control and Prevention, 46.3 million Americans under 65 have no health coverage.

The number of health care deals began rising as copycat websites attempted to get a piece of the market. Search leader Google and shopping site Amazon.com have recently gotten into the game.

Not all have been successful. In August, social networking site Facebook dropped its plan to start a daily deal business, and Yelp, a site that allows customers to write reviews of restaurants and other businesses, scaled back its daily deal efforts. Many smaller sites have closed. But the shakeout in the industry hasn’t hurt the number of health deals being offered since the industry leaders, like Groupon, are offering more deals and are moving into more markets, Hess said.

The health care deals may be attractive for people with gaps in their coverage or no insurance, but jumping from one health care provider to the next isn’t ideal. Visiting the same doctor or dentist makes it easier to monitor how a patient’s health is progressing, said David Williams, co-founder of medical consultancy group MedPharma Partners and author of HealthBusinessBlog.com.

Also, it’s important for patients to do their own research before buying a medical or dental deal, Williams said. “A referral from someone you trust is the best path,” said Williams.

Dental deals are the most popular among users of local deal websites — likely because even more people lack dental insurance than health insurance. Among the 172 million people under 65 who have private health insurance in the U.S., about 45 million don’t have dental coverage, according to the CDC.

Dentists have traditionally offered deals by mailing out coupons, but paper coupons have a low redemption rate, Williams said. Local deal sites are more attractive to doctors and dentists because they get paid up front and they reach new clients.

“We reached a whole new demographic who otherwise wouldn’t find us,” said Dr. Gregg Feinerman, an ophthalmologist who runs Feinerman Vision Center in Newport Beach, Calif. He offered a 58 percent discount on Lasik eye surgery through Groupon. “It’s a better way to market,” he said.

He used Groupon as a way to bring in patients under 30-years old with the hope that they would recommend his services to friends and rate him on review website Yelp. A good review might persuade someone else to visit his office, Feinerman said. He charges $5,000 for the surgery on both eyes; a price that he said can be “overwhelming for 20-to 30-year-olds.”

Feinerman approached Groupon about listing the eye surgery for $3,000. Groupon, which is based in Chicago, pushed him to lower the price to $2,100.

Feinerman got exactly the type of patient he was looking for in Thomas Cho. Cho, 29, bought the offer and after the surgery wrote a review on Yelp. He gave the vision center five stars — the highest rating on the website.

Cho said in an interview that his health insurance plan only covers 20 percent of the regular price of Lasik since it is considered a cosmetic procedure. He would have paid about $4,000 if he had used his insurance discount.

Cho decided to buy the Groupon, paying $2,100 initially. After consulting with the doctor, he upgraded his surgery to an all-laser procedure for $1,000 more. At the time, Cho’s credit card issuer was offering a 20 percent cash back promotion on Groupon purchases. In all, he saved more than $1,300.

“I had my post-op checkup and I am seeing 20/20,” Cho wrote on Yelp. “I couldn’t be happier.”

By Dominic Rushe for The Guardian –

Pity Wall Street’s bankers. Once the highest-paid bosses in the land, they are now also-rans. The real money is in healthcare and drugs, according to the latest survey of executive pay.

There are no bankers in the top 10 of this year’s GMI survey of CEO pay. In fact, they have been out since 2007, when Goldman Sachs boss Lloyd Blankfein competed for the top slot with Richard Fuld, boss of soon-to-be-bust Lehman Brothers, and Angelo Morzillo, head of Countrywide, once the largest sub-prime home loan firm.

With the bankers still recovering from their tussle with hubris, old age and infirmity were 2010′s boom businesses – at least in terms of pay. Leading the pack was John Hammergren, chief executive of McKesson Corporation. The firm’s 52-year-old chairman, chief executive and president took home $145,266,971 in 2010.

McKeeson is probably the biggest company you’ve never heard of. Headquartered in San Francisco, the company is the largest pharmaceutical distributor in North America, distributing a third of the medicines used in the US. McKeeson’s sales topped $112bn last year.

Hammergren’s next closest rival was Joel Gemunder, outgoing boss of Omnicare, where he had been president since 1981. Omnicare is a pharmacy company that dispenses drugs in nursing homes – among other services – and had sales of $6.15bn last year. When Gemunder started at the firm it had sales of $150m. His 2010 total pay package was worth $98,283,242.

CVS Caremark, which operates 7,000 pharmacies across the US, awarded chief executive Thomas Ryan $68,079,823 in 2010. Caremark’s share price was $71.70 on 1 May 1998, when Ryan joined the firm, and ended 2010 at $34.29.

Ronald Williams, boss of health insurance giant Aetna, made $57,787,786 in 2010. Another recipient of a golden goodbye, Williams made $50.4m on his stock options last year. Williams is one of the US’s most prominent African American business leaders, and has campaigned against healthcare reforms that would have introduced a government-backed public insurance option to compete with private insurers. Since he became CEO, Aetna’s stock price declined by 70%.

Dr. Lynn Chacko put her money where her philosophy is.

Chacko told those gathered at a speakout on health care Saturday that she gave up a profitable job as a private physician in South Florida to work for the Veterans Administration in Gainesville.

“I had a wonderful group of patients, but I could not keep practicing in that environment. My conscience would not let me — because of the way our health-care system is, I could only spend less than 15 minutes with most patients. Otherwise I wouldn’t be able to meet my overhead,” Chacko said. “In 2010, I decided to leave private practice and took a huge pay cut, but it was the best decision I ever made in my professional career. I work for the Veterans Administration, which is probably the closest thing to national health care we have in this country.”

Saturday’s speakout was organized by the Alachua County Labor Party along with Occupy Wall Street and Occupy Gainesville. The event was held in the Bo Diddley Community Plaza in downtown Gainesville.

Chacko said that the insured patients she saw in private practice were having difficulty affording co-pays as the economy weakened. Many could not afford specialists or preventative medicine.

While the veterans health-care system is not perfect, she added, the health outcomes are better for its patients than for those with private insurance.

Other speakers related their experiences with health care and insurance. One recurring theme was that of excessive costs, whether for patients or insurance companies. Those companies also came up for criticism.

Albert Meyer, of Gainesville, recalled how he fell while competing in a 5K race and cut his face. He went to the emergency room and was hit with a bill that included $12,000 for CT scans.

University of Florida graduate student Christina Van Houten, who also teaches classes, said she will soon be earning her doctorate degree but added she fears not being able to find a job that will offer adequate and affordable health insurance.

“I’m tired of health care being a privilege,” she said. “I’m tired of my health care being inconsistent. I’m tired of my health care having to be more cost-effective for my employer and my insurance provider.”

We are not surprised.

We didn’t need a Super Committee to tell us how to solve the United States’ ballooning national debt: we already know that universal single-payer healthcare would give people–regardless of age, race, pre-existing condition or socioeconomic status–the medical care they need while reducing annual healthcare costs by $400 billion.

However, the fight’s not over yet. As part of the original agreement that spawned the formation of the Super Committee, its members’ failure to propose a $1.2 trillion reduction to the deficit will cause that amount to be automatically cut from both domestic and defense spending–including $123 billion in cuts to Medicare between 2013 and 2021, the bulk of which would be reductions in physician reimbursement rates.

Politicians are trying to tout this as a protection for Medicare beneficiaries, but slashing the amount the federal government reimburses healthcare providers who care for Medicare enrollees will make it more difficult for senior citizens and people with disabilities to find doctors who will care for them.

We at Healthcare-NOW! see this as another attack on our society’s most vulnerable populations. When Medicare was implemented nearly 50 years ago, our government acknowledged healthcare as a human right for people 65 and older in the United States.

Now it is time to make healthcare a human right for all.

Instead of cutting Medicare funds, we should be improving and expanding Medicare-for-all. Here’s how you can help:

- Join us at our annual National Strategy Conference on January 28th and 29th in Houston, Texas to help develop our action plan for 2012. We will be discussing how to organize for single-payer Medicare-for-all in an election year, and how to protect Medicare from being cut any further.

- Join a local single-payer group near you (check out our local contacts page for more info).

- Organize a single-payer group if there isn’t one in your area (we have some great organizing resources on our website).

- Become a monthly donor to Healthcare-NOW!.

We can’t count on Congress or the President to insert single-payer into the national debate, but we know we can count on you.

For questions, comments, or ideas about next steps, email vanessa@healthcare-now.org.

Premiums for employer-sponsored health insurance have risen faster than incomes in every state in the nation, according to a report released Thursday.

The analysis of federal data by the Commonwealth Fund, an independent research organization, shed new light on the state-by-state picture while essentially confirming a national trend, highlighted in other recent surveys of employer-sponsored insurance, of greater premiums for skimpier benefits.

The District of Columbia had the highest annual total premiums, including both the employer’s and the worker’s share. In 2010, they averaged $5,644 for a single policy and $15,206 for a family version — a rise of 51 percent and 41 percent, respectively, since 2003.

But the costs were significant even in states with some of the lowest average rates, such as Alabama, where a single policy averaged $4,571 in total premiums and a family version reached $12,409. Maryland and Virginia were roughly in the middle of the pack.

“Although employees typically don’t see the total cost of their insurance, the sharp increase, in effect, means lower wages and salaries as employers make the trade-off between increasing wages and offering insurance,” said Cathy Schoen, a co-author of the study.

There was also little correlation between a state’s average premiums and its cost of living. States such as New Mexico and West Virginia, where incomes are lower than average, had some of the highest premiums in the nation.

Schoen said the variation was caused by a range of factors, including how generous employers’ plans were in any given state.

“Premiums are lower if deductibles tend to be higher,” she noted. So in states such as Montana, where the average family deductible was $2,295, lower total premiums mask high out-of-pocket costs. By contrast, the District had among the lowest average deductibles.

Increasing deductibles is only one way employers are attempting to shift health costs onto their workers. Another is asking employees to shoulder a larger share of the premium.

Workers in Virginia were among those who made the highest contributions — paying $1,114 for an individual plan and $4,477 for a family plan. That was a 76 percent increase since 2003 for individuals, and 64 percent for families.

Across all states, total premiums now amount to a sizable proportion of typical incomes. In 2003, 13 states had annual premiums that comprised less than 14 percent of the median income. In 2010, there were none. And 62 percent of Americans now live in a state in which health insurance premiums equal 20 percent or more of median earnings for adults younger than 65.

Schoen cited an earlier Commonwealth Fund study predicting that the nation’s new health-care law could help curb future premium increases through measures that encourage providers to give less expensive care, subject insurers to greater scrutiny and foster more competition.

That report found that the net effect would be to slow annual premium increases by 1 percent — a more optimistic assessment than those of the Congressional Budget Office and other government sources. Thursday’s report considered the effect of a decrease of 1 percent per year and found that it could amount to substantial savings over the long haul: $2,161 in annual premium cost savings for families by 2020, for instance.

From the Commonwealth Fund –

The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care, according to a Commonwealth Fund–supported study that appeared online in the journal Health Policy this week and will be available in print on October 25th as part of the November issue. According to the study, other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.

Preventable Death In “Variations in Amenable Mortality—Trends in 16 High Income Nations,” Ellen Nolte of RAND Europe and Martin McKee of the London School of Hygiene and Tropical Medicine analyzed deaths that occurred before age 75 from causes like treatable cancer, diabetes, childhood infections/respiratory diseases, and complications from surgeries. They found that an average 41 percent drop in death rates from ischemic heart disease was the primary driver of declining preventable deaths, and they estimate that if the U.S. could improve its preventable death rate to match that of the three best-performing countries—France, Australia, and Italy—84,000 fewer people would have died each year by the end of the period studied.

“This study points to substantial opportunity to prevent premature death in the United States. We spend far more than any of the comparison countries—up to twice as much—yet are improving less rapidly,” said Commonwealth Fund Senior Vice President Cathy Schoen. “The good news is we know lower death rates are achievable if we enhance access and ensure high-quality care regardless of where you live. Looking forward, reforms under the Affordable Care Act have the potential to reduce the number of preventable deaths in the U.S. We have the potential to join the leaders among high-income countries.”

Nolte and McKee noted that while preventable death rates declined in all 16 countries, the rate of decline varied significantly. Ireland, which ranked last with the highest preventable death rate in 1997–98, improved 42 percent by 2006–07. As a result, Ireland narrowed the gap with France, the country with the lowest “amenable mortality,” with 55 preventable deaths per 100,000 people. France was followed closely by Australia (57 per 100,000), and Italy (60 per 100,000). The U.S. ranked last, with 96 preventable deaths per 100,000 in 2006–07, down from 120 in 1997–98. The United Kingdom, which like Ireland began the decade with preventable death rates higher than the United States, now has rates that are considerably lower (83 per 100,000), reflecting more rapid improvement.

According to the study’s authors, the United States’ poor performance and relatively slow improvement compared with other nations may be attributable to “the lack of universal coverage and high costs of care.”

“Cross-national comparisons consistently find that people in the U.S. have a harder time getting and paying for the health care they need than people in other countries,” said Commonwealth Fund President Karen Davis. “The good news is that Affordable Care Act reforms are targeted at specifically the areas that are responsible for this divide—costs and access to health care.”

None of the components of President Obama’s health care law that have taken effect appear to be affecting insurance coverage of adults over 26, according to a new poll Friday.

The percentage of adults with no health insurance is the highest on record, with 17.3 percent of adults being uninsured in the third quarter of 2011, statistically tying the high set in the second quarter, Gallup found. Three years ago, in the third quarter of 2008, only 14.4 percent of adults lacked health insurance.

Gallup cautions, however, that the record high coincides with a methodological change that samples cell-phone only respondents, which tend to be younger and thus more likely to be uninsured. Thus, some of the increase in the figure could be linked to this change.

One part of Obama’s health care reform that has already drawn results is the change allowing young adults to stay on their parents’ health care plan until they are 26. This has lead to an uninsured rate of only 24.2 percent for 18-25 year olds, down from 28 percent in mid-2010.

However, while adults from 18-25 have seen an increase in coverage, older adults have not. In fact, 19.9 percent of 26-64 year olds are uninsured, up from 18.1 percent in mid-2010.

Gallup says it appears that some of the new health care reforms that were passed in 2010, including tax credits to help small businesses provide health insurance and the establishment of a Pre-Existing Condition Insurance Plan, are not improving the health care coverage of adults over the age of 26.

“(T)he percentage of Americans who are uninsured is on the rise again after remaining fairly steady throughout 2010,” Gallup said. “If more employers stop offering health insurance and the cost of purchasing insurance for individuals remains a barrier, it is possible that the uninsured rate will continue to rise — at least until additional parts of the 2010 healthcare legislation take effect.”

The overall increase in uninsured rates among adults over 26 was matched by a decline in employer-based health insurance coverage.

Since Gallup started tracking health insurance sources in 2008, the percentage of Americans getting insurance from their employer has dropped steadily from 49.8 percent to 44.5 percent in the third quarter of 2011.

This poll was conducted from July 1 to Sept. 30, 2011, with a random sample of 90,070 adults nationally. The margin of error is plus or minus one percentage point.