My guest today is Dr. Stephani Woolhandler, professor of medicine at Harvard University and a member of Physicians for A National Health Program [PNHP]. Welcome back to OpEdNews, Steffie. You and several colleagues issued a press release today regarding the new study that appears in the March 8th issue of the American Journal of Medicine. In it, you evaluated the Massachusetts health plan vis a vis personal bankruptcies due to medical bills. What did you find?
Wendy Maeda, staff photographer for the Boston Globe
Both Massachusetts Gov. Deval Patrick and President Obama have used the medical bankruptcy issue to justify their health reforms. Unfortunately, what Massachusetts reform has done is to take many of the previously uninsured, and make them UNDER-insured. That is, much of the new insurance is so skimpy that families can still be bankrupted when faced with a prolonged and expensive illness.
What do you mean, Steffie? I thought reducing medical bankruptcies was one of the justifications for passing health care reform in Massachusetts.
We found that medical bankruptcies did not fall significantly after Massachusetts's health reform. 59 percent of bankruptcies in early 2007 had medical illness or medical bills as a cause. In mid-2009, after the reform was fully implemented, 53 percent of bankruptcies had a medical cause --- a non-significant drop. The absolute number of bankruptcies that occurred in the wake of illness actually rose.
That's quite disturbing. Was this an unexpected development, Steffie?
The Obama administration told us from the outset that the new law would have coverage similar to the Massachusetts bill. So we could take a look at the coverage actually offered in Massachusetts through the insurance exchange, which in Massachusetts has the name "The Connector" and see what to expect. For someone in their late fifties, the least expensive (and most-commonly purchased) insurance offered by the Connector carries a premium of $5616 dollars annually, but comes with a whopping deductible of $2000 and then covers only 80% of the next $15,000 in expenses. Someone with a chronic condition like anxiety or diabetes could easily be out-of-pocket by $10,616 annually, year after year. No wonder we're still seeing medical bankruptcies in the state.
Yikes! Now what? Where does that leave us?
We still need single payer, non-profit national health insurance --- an expanded and improved Medicare for all. That's the model other countries have used to affordably cover all their residents. Medical bankruptcy is rare in Canada, which has national health insurance. Obama's 2010 national reform did little for families who already have insurance, which is usually full of gaps like co-payments, deductibles and uncovered services. In order for insurance to protect American families from bankruptcy, it needs to be not only universal, but comprehensive. That is, it needs to fully cover all medically necessary care.
How can we help to make single payer happen, Steffie?
One hopeful note is the political situation in Vermont. The single-payer movement in Vermont has pushed the state's politicians to embrace single-payer reform for that state, and Gov. Shumlin and Sen. Bernie Sanders are publicly committed to fighting to get the federal waivers necessary to implement such reform. At a national level, it is clear to policy analysts that the Obama reform did not resolve the two major problems in U.S. health care -- access to care and costs. And this will become clear to the American people very soon after the Obama plan is implemented in 2014. A resurgence in popular interest in real health reform will quickly emerge.
So that's moderately encouraging. Anything to add before we wrap this up?
Private health insurance is a defective product. We need to do what most other developed nations have done -- build a system of universal coverage based on non-profit, national health insurance.
Amen. I appreciate your bringing us up to date on this important issue, Steffie. Thank you very much.
***
Both Massachusetts Gov. Deval Patrick and President Obama have used the medical bankruptcy issue to justify their health reforms. Unfortunately, what Massachusetts reform has done is to take many of the previously uninsured, and make them UNDER-insured. That is, much of the new insurance is so skimpy that families can still be bankrupted when faced with a prolonged and expensive illness.
What do you mean, Steffie? I thought reducing medical bankruptcies was one of the justifications for passing health care reform in Massachusetts.
We found that medical bankruptcies did not fall significantly after Massachusetts's health reform. 59 percent of bankruptcies in early 2007 had medical illness or medical bills as a cause. In mid-2009, after the reform was fully implemented, 53 percent of bankruptcies had a medical cause --- a non-significant drop. The absolute number of bankruptcies that occurred in the wake of illness actually rose.
That's quite disturbing. Was this an unexpected development, Steffie?
The Obama administration told us from the outset that the new law would have coverage similar to the Massachusetts bill. So we could take a look at the coverage actually offered in Massachusetts through the insurance exchange, which in Massachusetts has the name "The Connector" and see what to expect. For someone in their late fifties, the least expensive (and most-commonly purchased) insurance offered by the Connector carries a premium of $5616 dollars annually, but comes with a whopping deductible of $2000 and then covers only 80% of the next $15,000 in expenses. Someone with a chronic condition like anxiety or diabetes could easily be out-of-pocket by $10,616 annually, year after year. No wonder we're still seeing medical bankruptcies in the state.
Yikes! Now what? Where does that leave us?
We still need single payer, non-profit national health insurance --- an expanded and improved Medicare for all. That's the model other countries have used to affordably cover all their residents. Medical bankruptcy is rare in Canada, which has national health insurance. Obama's 2010 national reform did little for families who already have insurance, which is usually full of gaps like co-payments, deductibles and uncovered services. In order for insurance to protect American families from bankruptcy, it needs to be not only universal, but comprehensive. That is, it needs to fully cover all medically necessary care.
How can we help to make single payer happen, Steffie?
One hopeful note is the political situation in Vermont. The single-payer movement in Vermont has pushed the state's politicians to embrace single-payer reform for that state, and Gov. Shumlin and Sen. Bernie Sanders are publicly committed to fighting to get the federal waivers necessary to implement such reform. At a national level, it is clear to policy analysts that the Obama reform did not resolve the two major problems in U.S. health care -- access to care and costs. And this will become clear to the American people very soon after the Obama plan is implemented in 2014. A resurgence in popular interest in real health reform will quickly emerge.
So that's moderately encouraging. Anything to add before we wrap this up?
Private health insurance is a defective product. We need to do what most other developed nations have done -- build a system of universal coverage based on non-profit, national health insurance.
Amen. I appreciate your bringing us up to date on this important issue, Steffie. Thank you very much.
***
Previous interviews with Steffie:
Exclusive Interview with Dr. Steffie Woolhandler , September 20, 2009
Physicians for a National Health Program ( www.pnhp.org ) is an 18,000-member organization advocating single-payer national health insurance for the United States. PNHP had no role in funding the study mentioned above. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.
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