Anthony Wright
Executive Director, Health Access California

Lots of happenings on health today in Sacramento:

* The Appropriations Committee (Frank Russo gives some flavor here) passed the health care reform plans, as expected.

* More information came out about the release of Sicko, the Michael Moore film, including a premiere that night hosted by Speaker Fabian Nunez in Sacramento on June 12th, as well as a 2p.m. rally that day with Sen. Kuehl and the California Nurses Assocation. (Jon Myers at KQED and Jordan Rau at LA Times have reports).

* On the other side of the spectrum, the Pacific Research Institute hosted a luncheon panel at noon attacking any health care reform, from the Governor Schwarzenegger's proposal to Senator Kuehl's.

* Together for Health Care, a pro-reform coalition that includes California Medical Association, Catholic Healthcare West, California Labor Federation, SEIU, Blue Shield of California, Kaiser Permanente, HealthNet, AARP, Silicon Valley Leadership Group and the California Teachers Association have launched their first ad. The tagline: "If we don't make health care better, it will keep getting worse." Hard to disagree.

The coalition is one of the rash of new health policy coalitions at the state and federal level. (Here's a scorecard.) It's a sign of the times that momentum is gaining on reform, and that is in itself is positive. Yet the diversity of the group (which includes some members and allies as well as sometime and frequent adversaries of Health Access California) means that their agreement is general, not too much beyond broad principles. (Here's one press report.)

[Cross-posted at the Health Access California blog.]

May 31, 2007 at 06:25 PM | Permalink | Comments (0) | Trackbacks (0)

By Anthony Wright
Executive Director, Health Access California

I would be remiss if I didn't point out some articles in the papers. Not because Health Access California is mentioned, but because they offer poignant stories from actual California families about our health system today.

* Bill Ainsworth at the San Diego Union-Tribune features real stories of people dealing with high-deductible plans, and how they would be impacted by an individual mandate, for better and worse. A companion story also documents about how people make tough life decisions simply for the security of health coverage.

* Aurelio Rojas of the Sacramento Bee has the story of Senator Gil Cedillo, not as a legislator, but as a son, dealing with his mother's hospitalization. (Calitics and Working Californians picks up on the story)

That's why our organizing is so focused on having California health care consumers simply tell their stories. It is what should inform the current debate on how to make the health system better. (Sometimes, those stories help inform our policy development work. Other times, with the explicit permission of the person, we connect real people with the media, as with the Union-Tribune story. As Victoria Colliver in the San Francisco Chronicle reports, we also did this with Michael Moore's new movie, Sicko.)

[Cross-posted at the Health Access California blog.]

May 30, 2007 at 01:22 PM | Permalink | Comments (0) | Trackbacks (0)

By Anthony Wright
Executive Director, Health Access California

No sooner do we try to tease out the profit motives of BlueCross in opposing new rules and oversight, than we find that the stakes are even higher than we think.

Lisa Girion at the LA Times has the scoop:

State regulators are investigating whether a $950-million dividend Blue Cross of California sent to its Indianapolis-based parent violates an agreement the companies made to limit such payments to keep premiums down and maintain the quality of healthcare benefits, officials said Friday.

Officials said the parent, healthcare giant WellPoint Inc., should have taken no more than $141 million out of California. They called the higher amount excessive, particularly as Blue Cross, which serves more than 7 million state residents, has continued to raise premiums. The state Department of Managed Health Care also is considering expanding its probe to determine whether there are any other potential violations of the three-year agreement, part of a deal to win the agency's approval for a corporate marriage that created the nation's largest health benefits provider.

Cindy Ehnes, director of the Department of Managed Health Care, said she was shocked to learn of the $950-million payday for WellPoint, whose total profit last year was $3.1 billion on $57 billion in revenue.

The merger of Wellpoint and Anthem in 2004, creating the nation's largest health insurer, was controversial, for everything from massive executive payouts, to the question of whether it would truly help patients, not just profits. Then-Insurance Commissioner Garamendi extracted a series of "undertakings," or conditions that the new insurer would have to agree to, in order for the merger to be deemed in the public interest and approved.

The question is whether California BlueCross ratepayers are paying inflated premiums to finance the business expenses and profits of the parent company, Wellpoint.

Normally, the state doesn't look at such information. But the Department of Insurance (and the Department of Managed Health Care) used the merger as a leverage point to place some oversight over BlueCross' behavior. But that authority to keep BlueCross in check has a three-year expiration date.

Let's see how the regulator use this authority. Let's make sure that health reform includes additional oversight over insurers that won't expire.

The undertakings are here. Here's Blue Cross' 2005 report on its compliance with the undertakings.

[Cross-posted on the Health Access California blog.]

May 29, 2007 at 09:27 AM | Permalink | Comments (12) | Trackbacks (0)

By Matt Ortega
It's OUR Healthcare

This week, Blue Cross launched a $2 million advertisement campaign aimed at promoting “responsible” healthcare reform in California.

The new group, Coalition for Responsible Healthcare Reform, cautioned would-be healthcare advocates with a gloomy comparison to the energy crisis from several years ago.

Remember how the rash deregulation of the energy market in California spawned power outages and soaring rates? Let’s not go there again.

“[I]f the energy crisis is the analogy,” wrote Anthony Wright, Executive Director of Health Access California, “then Blue Cross is Enron, taking advantage of an unregulated California market and leading to a blackout of coverage for millions.”

Wright continued:

But even the now-disgraced Enron never had the gall to run ads arguing that they should be allowed to continue to manipulate the market.

Yet Blue Cross does.

The campaign slogan appears to be:

We can’t guarantee they’ll always be healthy,
but we can guarantee they’ll always have coverage.

It is probably a good thing they scrapped the original third line – “… unless we cancel it.”

Wright warned of the potential “unintended consequences” of the Blue Cross-backed ad, borrowing language from the recently released print advertisement.

BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.

D-Day, writing at Calitics, a California community blog, adds an analogy and a prediction of his own:

But having Blue Cross argue about responsible health care policy is like having Tony Soprano argue about gun control. And it's up to us constituents to let the politicians know that. If Blue Cross is the face of health care status quo, I'd say change is a-comin'.

Strangely, Blue Cross is noticeably absent from the coalition website. At the publishing of this post, the only place to find “Blue Cross” is in the fine print of their ad.

May 25, 2007 at 09:25 AM | Permalink | Comments (1) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

A big piece of health reform rhetoric -- coming from multimillionaire CEOs -- is the need for personal responsibility and healthy lifestyle choices.

This LA Times story today re-highlights what I thought was a long-established fact, poor women -- many of whom happen to be minorities -- suffer disproportionately from chronic diseases such as diabetes, heart disease, stroke etc.

The study notes that poverty and lack of insurance are complicit in causing these diseases in this population.

As health advocates, we know that the uninsured are twice as likely to forgo medical care and half as likely to fill prescriptions they need, causing their chronic conditions to get worse.

And as members of Congress and various others are learning this week in an empathy exercise, a $3-a-day food stamp allowance that as many as 26 million Americans live on is not enough to live healthy lives. Healthy fresh fruits and vegetables are perishable and more expensive, so what's left is higher sodium, higher sugar, higher calorie foods.

If this emphasis on "healthy lifestyles'' and "healthy choices" really is going to be a part of the reform debate, let's be real about the "choices" that are out there for poor people. Will Safeway stop stocking up on potato chips and candy and offer discounts on fruits and vegetables? Will health insurers start eliminating copays and coinsurance to help people manage their chronic diseases?

Otherwise, there doesn't really seem to be much of a choice.

[Cross-posted at the Health Access California blog.]

May 24, 2007 at 08:46 AM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

The Chamber of Commerce has just released its annual list of "job-killer'' bills. Among them – AB8 and SB48, the Legislature's healthcare reform legislation. You’ll recall that both bills propose businesses dedicate 7.5 percent of their income to pay for health care for their employees.

(They also opine about "green energy'' and "green building" bills. Maybe global warming doesn't kill jobs.)

Now maybe nobody at the Chamber ever gets sick. But I’m guessing that many of the Chamber’s member businesses know better. According to the National Committee for Quality Assurance, sicker employees are less productive (Duh) and more expensive. Businesses lose about $1.2 billion annually due to heart disease, asthma, hypertension, depression, diabetes, and smoking-related illness. And that 7.5 percent, if anyone up there in the Chamber ivory tower cared to do the math – is less than many businesses pay now for healthcare.

And, to take the Chamber on its own terms, I can think of no worse "job-killer'' than an employee being dead. (You think I'm exaggerating, but 18,000 people die a year because they are uninsured, making it the sixth leading cause of death in the U.S., according to the Institute of Medicine).

So what do you say?

Will it be a job killer? Or people killer?

May 23, 2007 at 05:07 PM | Permalink | Comments (1) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

This LA Times story over the weekend helps consumers strategize and build a patchwork health coverage plans for their family, based on what they anticipate their health needs will be.

It's an interesting concept requiring families to look at their past few years of medical bills to determine if they really need a traditional, more comprehensive plan, or can go with a high deductible.

It sounds kind of like looking at a mutual fund's past performance, and anticipating how much it will earn in the future.

The story says that traditional plans, with lower deductibles and good coverage "are still costly."

For a family with a risky medical history, the cost of these policies is stratospheric.

Uh. Yeah. But a family with a risky medical history is most likely to need good coverage to ensure they don't get sicker.

The story emphasizes the notion that insurance is there to protect assets. But what good is insurance if it deters you from seeing the doctor because of cost. What good is insurance if you have to predict what kinds of services you'll need? You might as well just get a fortune teller to help you plan your child's broken arm and your unexpected heart attack.

May 21, 2007 at 11:40 AM | Permalink | Comments (0) | Trackbacks (0)

Anthony Wright
Executive Director, Health Access California

With all the attention on the financing details of the legislative leader proposals, we shouldn’t ignore the universal health care proposal, SB840(Kuehl), and the attention it has been getting.

There was a good article by Tom Chorneau in the San Francisco Chronicle about the continuing effort. Senator Kuehl says that she plans to put her bill on the Governor’s desk, but it might be in 2008, regardless of what happens this year with the other proposals.

I think Steve Maviglio at the California Majority Report mis-read the article. Kuehl was quoted as saying, "People might say, why are you doing this if we passed that other bill? And I'll say I still think this is the better answer," said Kuehl. "This is will not go away because someone passed a half-assed bill." Unlike Maviglio, I don’t think she was referring to the Nunez bill or the Perata bill--the latter of which she voted for and is a co-author.

She *has* been a critic of the Schwarzenegger proposal--and rightfully so, in our opinion. There are components that don't meet the "do no harm" test that we share with Senator Kuehl. And we agree with her about being vigilant about whatever comes out of the negotiation between the legislative leaders and the Governor.

She is also right that whatever passes and is signed this year--even if it is really good--will probably not be truly universal, and there will be room for improvement. Last year, California passed a global warming bill. It didn’t stop the conversation—it increased interest. There are dozens of new bills on the subject. A health care bill this year—even a good one—will not stop the momentum. (This dday post at Calitics makes the same point.)

Maviglio is right about the opportunity we have this year—to provide security and affordability for those who have coverage, to dramatically expand it for those that don’t, to take several steps toward the goal of universal coverage. Yet he falls into the construct he criticizes.

There’s no conflict between advocating for the vision of a universal single-payer system, and working for positive reforms in this year’s debate--in fact, it is strategic. For the last four years, many advocates and groups have advocated on multiple tracks, supporting a range of health reforms, from expanded children's coverage to an minimum employer contribution to single-payer. There's no need to attack one reform in order to promote another--in fact, it can be counterproductive.

It's good we have an active leader like Senator Kuehl, promoting the vision of a truly universal system. It helps the debate to have SB840 on the table. It's also good that she is supporting and playing an active role in helping shape the legislative leadership proposals to see what we can win this year, toward the goal of quality, affordable healthcare for all.

May 18, 2007 at 01:33 PM | Permalink | Comments (2) | Trackbacks (0)

By Nick DeLuca
It's OUR Healthcare

Why do we need good, affordable healthcare for everybody? Here’s Chapter 257, straight from the (elementary school) classroom.

Around her, more than 100 low-income elementary school students from across San Francisco stood in lines at several tables, their chatter and giggles creating an echoing din in the indoor arena. “Each waited for a free, comprehensive eye exam and a final stop at the table full of frames, part of a weeklong event intended to provide more than 1,000 children with a vision check and glasses, sponsored by the Ohio-based Give the Gift of Sight Foundation and a long list of corporate sponsors.

"Most of the children have never had any kind of eye care at all," said Troy Macdonald, a mission manager for the organization, as he looked out at the sea of children.

The punch line comes a few paragraphs later.

An estimated 1 of every 4 schoolchildren has a vision problem, according to a recent national study.

Yet low-income children don't always have insurance or resources to seek treatment, Macdonald said.

So these kids (totally adorable, when you see the pictures that went with the story) sit in a classroom, day after day, where they can’t see; as once upon a time, your blogger did as well. But unlike your blogger who grew up in a family with insurance, so that squinting to see the blackboard, and edging up toward the front of the room were cues for a visit to the eye doctor – these kids keep sitting there, unable to see, missing out – until this ocular road show (and bless them for doing it) hits town, and they get eye exams and glasses. These 100+ kids do, and thousands of other kids who aren’t on one of these stops get nothing.

Which is just one of the thousands of stories of what’s wrong with health care, so long as we don’t have health care that works for everyone that everyone can afford.

May 18, 2007 at 09:45 AM | Permalink | Comments (1) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

It kind of sounds like saline implants for chicken breasts. Whatever it is, it's certainly not "natural."

Apparently, Tyson Foods, Inc. and Pilgrim's Pride Corp. have been calling their chickens -- which are kept moist with injections of a salt water, seaweed concoction and "natural flavor" -- "100% All Natural Marinated Fresh Chicken'' or something like that. (Here's the story in the WSJ.)

Gross.

Their claim is that the chickens have no "artificial ingredients'' because salt and seaweed are both natural. ** So is the saline (sterile salt water) in some breast implants, but no one calls them natural. **

Anyway, this labeling is making real poultry farmers mad because their chickens are really natural.

"Seaweed occurs naturally in the ocean, -- not in chickens,'' said Lampkin Butts (his real name), president of Sanderson Farms.

Now, what does this have to do with health reform?

Here's the nexus. Lots of people are suddenly calling for "healthier living,'' which includes healthier eating.

The problem with the saline-breast chickens is that they contain more sodium than au"naturale chickens. More sodium means "potential health implications,'' according to the American Medical Association.

But the information about the exact "natural'' content of the saline-breast chickens isn't clear unless consumers read the really, really tiny print on the label. Most people don't read the tiny print. They just read the "100% natural" and assume that it's true.

This type of misleading labeling is pervasive in the packaged food industry.

The same problem exists for labeling of trans fats, which are bad for reasons I won't go into here. A person should not eat more than 2 grams of trans fats a day.

So, you could feel really virtuous and check the label on everything you eat and think you've hit the target. But if a food item contains less than .5 grams of trans fats, then it can be listed is zero. So if you have six items of food with .4 grams of transfats, you've exceeded your limit.

My rambling point is this, that everyone is complicit in our unhealthy behaviours. Sure, we need to watch what we eat and exercise, but another part of reform and prevention is also changing the culture that enables companies to dupe consumers -- whether it's about food, or health insurance.

[Cross-posted at the Health Access California blog.]

May 17, 2007 at 12:08 PM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

We already knew that the U.S. ranks 21st in life expectancy and 23rd in infant mortality, in spite of spending more than any other industrialized nation on health care, according to OECD stats.

The Commonwealth Fund yesterday just released a report reaffirming that notion.

It's not a surprising revelation for those of us working in health care, but hopefully, it will provide a jolt to those who insist that America has the best health care in the world.

That's not to say the other systems (in Australia, Canada, Germany, NZ and the UK) are perfect -- but they spend about half as much money -- per person -- being imperfect than we do.

Key findings of the report are that the U.S.:

Hopefully, such a report will help convince proud Americans who are convinced that we have the best health care in the world, that while America is great on many things -- it's not really on health care.

May 16, 2007 at 02:59 PM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

This Wall Street Journal (subscription required) story this AM made me cock my head.

Here's the first sentence:

"Major U.S. health insurers appear to remain on steady footing even though some companies said that they had spent an unexpectedly high percentage of premium revenue in the latest quarter on patients' health bills." (italics is mine)

Cue the violins, because the story goes on to say:

UnitedHealth Group Inc. posted a disappointingly high medical-loss ratio.

(Translation: Medical-loss ratios is the technical term for spending money paying for health care.)

Let me get this straight: so it's a sad and "disappointing" day when health insurers have to do their job? Pay for health care?

If I were a health insurer today, I'd hide my face in shame.

This story unwittingly illustrates exactly what is wrong with the current system -- an emphasis on bottom-line profits -- not patients.

[Cross-posted at the Health Access California blog.]

May 15, 2007 at 08:58 AM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

The Assembly just passed AB1324 (De La Torre), which clarifies that insurers can't rescind coverage if the policy holder had completed applications in good faith.

The bill attempts to address a rash of instances, uncovered in the LA Times, where Blue Cross cancelled patients' coverage after expensive claims were made, leaving them uninsured and on the hook for hundreds of thousands in treatments.

About 6,000 patients later joined together in a class action suit against the insurer, and have been joined by doctors and hospitals.

On Friday, Blue Cross agreed to change its policy on how it decides to cancel coverage.

AB1324 passed on Monday on a bipartisan vote. Seven Republicans, including Bill Emmerson and Alan Nakanishi who are both members of the Assembly Health Committee, voted in favor of the bill.

[Cross-posted at the Health Access California blog.]

May 14, 2007 at 01:04 PM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

Blue Cross now says it's no longer going to willy-nilly cancel people's insurance policies when they have a suspicion that policyholders didn't disclose *everything* about their health history since they were 1.

Now, the health insurance giant says it will ask policyholders when they see a problem with their applications before deciding to cancel their policies.

It's nice to see, now, that Blue Cross believes in the presumption of innocence unless proven guilty.

Not only are they going to make applications easier to understand, they're saying that if applicants made an honest mistake, then the insurance company will continue the patient's insurance.

Is Blue Cross saying they were wrong to unilaterally -- and without notice -- cancel patients' policies while they were in the middle of expensive medical treatments?

Not quite. With 6,000 former policyholders suing the company, it was getting kind of expensive.

Their 180-degree change in policy isn't quite the stunning admission I would have hoped for, but I'll take it.

[Cross-posted at the Health Access California blog.]

May 11, 2007 at 12:40 PM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

The governor, a bunch of California CEOs and some lawmakers aligned themselves outside the Capitol this morning – squinting, sweating and soaking up cancerous sun rays – and showing how excited they are to fight for health care reform.

It’s Safeway CEO Steve Burd’s Jet-Setting CEO Show. Earlier this week, he was in Washington D.C. promoting the Coalition to Advance Healthcare Reform. (Here's a San Diego Union-Tribune story about Burd and his coalition).

Joining him today was Del Monte Foods, BumbleBee Foods, Long’s Drug Stores and a smattering of other big businesses. Altogether, nearly 40 corporations – including a number of insurers (except Blue Cross) have signed on with Burd to campaign for health reform.

First thing’s first. We’re glad that after years and years of fighting and disagreeing with us, California’s deep-pocketed CEOs, agree that we need to fix health care and make sure people can lead healthier lives, and get the health care they need, when they need it.

We appreciate that one of the coalitions core tenets is “Financial Assistance for Low-Income Individuals” and encouraging healthier lifestyles. We’re all for that.

But (you knew there had to be a “but”) I want to quibble with a few of their assertions and kvetch a bit.

First, Burd said “25% of the uninsured have the financial wherewithal to pay for insurance.’’

I’m not sure where he gets his numbers.

Judging from the latest California Health Interview Survey, if everyone who is currently uninsured and made more than $50,000 a year purchased health care, we could cross off 18%. That’s significantly below the “quarter of the uninsured’’ that Burd talks about. And we can’t really assume that all 18% can afford coverage. A number of those are families who have children. A family, with an income of $50,000 in Oakland, is unlikely to be able to afford health coverage. Backing out the families with kids, we’re down to 14%.

Secondly, many of speakers referenced the role that individual responsibility plays in leading healthy lifestyles. In particular, the CEO of Del Monte Foods talked about nutritious eating to ensure that people live longer.

I think that’s a fabulous idea -- but since when is canned fruit (steeped in sugar) a health food? Del Monte’s pear halves contain more than twice as many carbohydrates and nearly twice the calories as the same fresh piece of fruit (I'm an obsessive calorie counter). Of course – canned fruits are also less expensive – which will be part of my point.

Really, though, the point these CEOs are trying to make is that diabetes, heart disease, asthma and obesity (the biggest cost drivers in health care) are easily preventable if people take responsibility and take care of themselves. That means exercising, taking your meds, seeing the doctor when you're supposed to, etc.

First off, a lot of what determines whether or not you get one of these chronic diseases is genetics. So, if I could have chosen a father who doesn’t have heart disease and diabetes (my father is 130 pounds, a tennis player and hiker, NOT overweight), that would have been the best way for me to exercise prevention.

But many people are able to manage their diseases with healthier living...

....That assumes, though, that struggling families, who are considered middle-income, have time after working two jobs to exercise.

...That assumes that you can afford to buy or rent a house far from the carbon-spewing industrial areas, further from the freeway, away from fields where they are spraying pesticides (or even away from Fresno, where Bay Area smog rolls in).

...That assumes that you can afford fresh fruits and vegetables, not ones preserved in cans.

...That assumes that your neighborhood is safe enough for your children to actively play in the streets, and walk to school.

...That assumes that you can afford the regimen of drugs, inhalers and follow up visits that are required to manage your disease.

(** Note: while plans say they cover 100% of "preventive" care, they don't mean managing chronic diseases, although covering chronic disease is a new "phenomenon" that is written about in this WSJ article that I blogged about yesterday)

If CEOs are going to insist on individual responsibility, the other pieces (government and employer and corporate responsibility) need to be a piece of the solution too.

I was disappointed that Burd didn't come out and definitively say -- as he has in the past -- that an employer mandate is necessary and 4% contribution from employers is too low. This is an important point because without being in an employer-pool, workers making $15 an hour ($30,000 a year) would have to go out and buy insurance on their own at exhorbitant rates.

Again, I do appreciate that big business is pushing health reform and annoying some of their smaller compatriots.

But loosely saying that "the market'' should be allowed to work, when it hasn't been controlled thus far, is no longer enough. Emergency rooms are packed to the gills and sick people are dying because they can't get in.

We've been talking about health reform for decades, it's time to get specific and move forward.

May 10, 2007 at 06:22 PM | Permalink | Comments (73) | Trackbacks (0)

… if it doesn't insure you?

By Nick DeLuca
It's OUR Healthcare

That's Alexa Wild's story. (San Francisco Chronicle, 5/08)

As the Chron reports, Wild is a freshman at San Jose State, who is in pain everyday, in her hands and her feet, because she has rheumatoid arthritis.

Wild also has a doctor who has found a medicine that relieves her pain. And Wild even has insurance – but her insurance won't pay for her medicine – so her pain gets worse, and worse.

"It's so expensive, and the insurance only covers so much," said Wild, a former competitive cheerleader and swimmer from San Bruno. "If I were to get more ... there's no way we could afford that."

She's not alone either. Not according to the Chronicle article, and not according to the stories we get every week. Having insurance is certainly better than not having insurance; but these days, even having insurance isn't enough. Not when pharmaceutical companies charge so much for drugs, and not when insurance companies can decide they're not covering your medicine.

So as we look at all the different healthcare proposals on the table now in Sacramento -- one question we need to ask, one question each proposal needs to answer – is whether the end result actually delivers good healthcare.

May 9, 2007 at 08:46 AM | Permalink | Comments (0) | Trackbacks (0)

By Hanh Kim Quach
Health Access California

Here's an interesting story in the L.A. Times this past weekend that highlights the inefficiencies in our current health system.

Blue Cross-Blue Shield health plans have agreed to pay $128 million to more than 900,000 physicians who charged that the Blues systematically paid them for less expensive procedures than the ones that were performed.

In addition to the $128 million settlement, the physicians will also have about $49 million in legal fees.

Rather than paying $172 million on the back-end, why didn't the Blues (and other health plans that were initially sued and settled) not pay the right amount in the first place, saving themselves and physicians the expense, energy and stress of going to court.

All that effort that went into fighting over claims could have actually gone to patient care.

This Wall Street Journal article (subscription required) from February that reported insurers and providers were spending an extra $20 billion a year -- in administrative costs -- to sort out claims need to be re-submitted several times and routinely denied by insurers.

$20 billion!

That's enough to:

[Cross-posted at the Health Access California blog.]

May 2, 2007 at 11:23 AM | Permalink | Comments (0) | Trackbacks (0)

By Matt Ortega
It's OUR Healthcare

In the last few weeks, three major healthcare proposals were passed through the Health Committees of their respective chambers -- Senator Sheila Kuehl's (D-Santa Monica) SB 840, Speaker Fabian Nunez's (D-Los Angeles) AB 8, and Senate Pro Tem Don Perata's (D-Oakland) SB 48. The movement on healthcare legislation recently has a lot of people asking Health Access Executive Director Anthony Wright, "What's next?"

In a technical sense, both bills now go to Appropriations Committees this month, where they get evaluated for their fiscal impact. While both leaders are not expected to have a problem getting their bills out of committeee, both Speaker Nunez and Senate President Pro Tem Perata have said they are expected to release the result of the fiscal modeling of their plans in the near future. Then, it will be more clear the level of costs and benefits (literally) to make the plans pencil out.

Stay tuned.

May 2, 2007 at 09:35 AM | Permalink | Comments (0) | Trackbacks (0)

By Matt Ortega
It's OUR Healthcare

IOH supporter Dale L. made an interesting observation about the injured driver of the truck that exploded and severely damaged part of the MacArthur Maze in Oakland this past weekend.

The first description I read yesterday of the overturned gas tanker made me think of "It's Our Healthcare." It seems amazing that after such an accident, the driver's concern is not to get to the nearest hospital, but to get to a Kaiser hospital -- in a cab. He has second degree burns, is crying, and all he is worried about how to pay for treatment!

"In an interview with KGO, the driver of that cab, identified only as Anthony, said ... Mosqueda was crying and in pain, and had severe burns on his hands and on his head. Mosqueda asked to be taken to a Kaiser hospital as quickly as possible. ..." [link added]

Since we cannot get inside Mosqueda's head as to why he asked for Kaiser specifically, we do not know if Dale's speculation is true, however, it is certainly plausible. And what does that say about the state of healthcare in California when it is plausible that a burn victim, in need of immediate medical attention, worries about the cost instead of seeking treatment at the nearest hospital?

May 1, 2007 at 10:09 AM | Permalink | Comments (0) | Trackbacks (0)