The U. S. Health Care Financing System Is In CRISIS — NOW!!!

How do we know that the “U. S. Health Care Financing System Is In CRISIS — NOW?” Because a society that places its citizens in a position where their choices are between financial devastation or the life of their loved ones cannot long survive.

Below are two articles: one from the NY Times and the other from a Washington Post Staff Writer in Charlotte, NC. Both articles were published on the same day Monday, April 20, 2009 and discuss the identical topic – the Crisis in our health care financing system.

People are really getting hurt, here are a couple of quotes from the articles: “In the past two years, North Carolina’s number of uninsured has climbed to 22.5 percent, the biggest jump in the nation, according to an analysis by the North Carolina Institute of Medicine, a quasi-state agency. Nationwide, about 22 percent of adults do not have health insurance. Here in North Carolina, 25 percent of adults — or 1.8 million people — have no coverage. An additional 9 percent are underinsured.”

And,

“Since the day she was laid off in October, Ms. Walker and her husband, Russ, co-owner of a struggling feed store here on the outskirts of Houston, have mounted a largely fruitless quest to find affordable coverage for (their son) Jake’s pre-existing condition. Their odyssey has become all too familiar to millions of newly uninsured Americans who suddenly find themselves one diagnosis away from medical and financial devastation.

The Walkers, both 46, are among nine million people who have lost employer-sponsored insurance since December 2007, according to projections by the Kaiser Family Foundation. Some have qualified for government insurance, and others have bought individual policies. But an estimated four million have joined the ranks of the uninsured, heightening the urgency in Washington to close the coverage gaps in American health care.

Like many others, the Walkers live on a knife’s edge of risk. Without insurance to cover her high blood pressure or his diabetes, they defer doctors’ visits when possible and obtain their prescriptions — nine between the two of them — for $4 apiece at Wal-Mart.

But their primary concern has been finding insurance for Jake, who, after four operations, two stem cell transplants and round after grueling round of chemotherapy, has been cancer-free for a year.

He continues to face a significant threat of recurrence and requires regular monitoring for at least two years. His twice-a-year CT scans cost $3,000 each, and quarterly blood tests and X-rays run more than $1,000.

It is imperative that we immediately reform the U.S. Health care financing system.

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/19/AR2009041902239.html?referrer=em

In North Carolina, Recession Breeds a Health-Care Crisis
Job Losses Leave State With Highest Percentage of Uninsured

Rise in Unemployment Overwhelms Clinics
North Carolina’s rise in unemployment, the highest in the country, coincides with a surge in patients at HealthServe Community Clinic in Greensboro.

By Ceci Connolly
Washington Post Staff Writer
Monday, April 20, 2009

GREENSBORO, N.C. — It’s right there on the wall, hectoring David Talbot as he races from one exam room to another.

“You want to see the recession? There it is,” Talbot says, pointing to a row of multicolored graphs. “We began to spike in October 2008, and we’re losing the battle now. We just can’t keep up.”

Recessions are tallied in numbers — jobless claims, home foreclosures, plant closings and bailout dollars. Here at the HealthServe community clinic, Talbot, the medical director, tracks the recession in days — the number of days that patients wait to see a doctor.

Just six months ago, the clinic delivered same-day care to most callers, the gold standard from a health perspective. But in October the delays crept to four days, then 19 in November and 25 in December. In January, HealthServe temporarily stopped accepting new patients, and almost immediately 380 people put their names on a waiting list for when the crunch eases.

In North Carolina, more than any other state, the recession has triggered a burgeoning medical crisis. A steep rise in unemployment has fueled a commensurate increase in the number of people who do not have health insurance, including many middle-income families.

“I used to be upper middle class,” said Amy, who called HealthServe every morning for weeks before getting in to see Talbot. “I’ve paid my taxes for 30 years.”

Last fall, when she moved here from Florida to care for her parents, she got trapped in the economic tailspin. The former resort manager who bought jewelry in tony Palm Beach now does temp work and sits in the clinic’s crowded waiting room with dozens of others who cannot afford insurance.

“I haven’t told anyone I’m coming here,” she said, asking that her last name be withheld because she is embarrassed to be seeking discounted medical care.

Though in relatively good health, Amy, 54, needs a doctor to monitor her allergies and high cholesterol. “It’s kind of depressing,” she said. “But thank God it’s here.”

In the past two years, North Carolina’s number of uninsured has climbed 22.5 percent, the biggest jump in the nation, according to an analysis by the North Carolina Institute of Medicine, a quasi-state agency. Nationwide, about 22 percent of adults do not have health insurance. Here in North Carolina, 25 percent of adults — or 1.8 million people — have no coverage. An additional 9 percent are underinsured.

For most Americans, health insurance and employment are linked. Every 1 percent increase in the jobless rate translates into 1.1 million people losing coverage nationally, according to the independent Kaiser Family Foundation. North Carolina’s unemployment rate has doubled in the past year to 10.7 percent, making it the fourth-highest in the country.

“Relative to other states, North Carolina is still a manufacturing state,” said North Carolina State University economist Michael Walden. “And manufacturing takes it on the chin during a recession.”

The downturn has hit the state’s textile industry, auto-parts factories and real estate businesses. Charlotte, the nation’s second-largest financial hub, has seen layoffs. Drugmakers in the Research Triangle are scaling back, and so is Dell Computer.

Unsure where to turn, many patients head to the nearest hospital, said R. Timothy Rice, president and chief executive of the nonprofit Moses Cone Health System. Emergency room traffic there has risen 3.6 percent in the past six months. That increase, coupled with the surging demand at HealthServe, which the system runs, has prompted Rice to open another clinic just a mile away.

The clinics cost Moses Cone between $1.5 million and $2 million a year, but they are cheaper than treating those patients in the emergency department, Rice said.

“I can lose some money in one place or lose a lot more in the other,” he said. And at the clinics, social workers and pharmacists provide additional services that patients do not get in the ER.

At Piedmont Health Services in central North Carolina, chief executive Brian Toomey measures the recession in job applicants. Until the economic meltdown, health professionals had their choice of good jobs. Many changed often for higher pay and benefits.

A year ago, Toomey scrambled to fill 40 openings. Now there are five. When Piedmont recently advertised for a part-time dentist, he received 10 résumés. “It’s just unheard of” in the normally recession-proof industry, he said.

With revenue down and the number of uninsured patients up, Toomey had been poised to trim the staff. But an infusion of $680,000 in federal economic recovery aid means he can retain 10 to 15 positions.

In all, North Carolina community health centers have received $11.2 million in stimulus money, said Mary Wakefield, head of the U.S. Health Resources and Services Administration.

The clinics are lifelines for people such as Becky Pattishall who do not qualify for Medicaid but have been buffeted by the economic squalls.

Last month, her full-time job as a dental hygienist in Durham was cut to two days a week and her health insurance disappeared. At age 62, private coverage is exorbitant, and her 401(k) “has tanked.”

Pattishall’s boyfriend, a 49-year-old computer technician who has had blood clots in his lungs, was laid off in the fall. Keeping his health insurance is a top priority.

“We just didn’t see this coming,” Pattishall said. “I’ve gone back on my anti-anxiety medication.”
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North Carolina’s hospitals, which have received no stimulus money, count the recession in dollars lost.

The sprawling University of North Carolina Health Care System provided $215 million in free care in the fiscal year that ended last June, said chief executive William Roper. This year, the nonprofit hospital network is on track to deliver $270 million in “uncompensated care.”

It’s not just the uninsured who are adding pressure to the system, Roper said. Even the insured are reluctant to come in for profit-generating “optional” procedures such as eye surgery or knee replacement because of fears about the eventual impact of the bad economy.

“Our paying customers are slowing down, and our nonpaying customers are surging to unprecedented numbers,” he said. “We’re getting hit in both directions.”

At the HealthServe clinic, Talbot’s team has whittled the waiting list to about 180. But that number troubles him, too. Decades of experience tell him that many people will fall through the cracks, discouraged by the long waits, unable to get transportation to the clinic or overwhelmed by the succession of woes that accompany an unemployment rate near 11 percent.

“The problems just cascade. It’s that last little blow to the household income that puts them in crisis,” he said. “And the scary thing for them is they know if they lose their insurance now, there’s a good chance they’ll never get it back.”

And,

http://www.nytimes.com/2009/04/21/us/21uninsured.html?pagewanted=2&th&emc=th

With Son in Remission, Family Looks for Coverage
Michael Stravato for The New York Times

Danna and Russ Walker, both 46, lost their insurance after she was laid off from DHL. Their son Jake has been cancer-free for a year, but needs expensive monitoring.

By KEVIN SACK
Published: April 20, 2009

HUMBLE, Tex. — When Danna Walker left the second-floor conference room and returned tearily to her desk — where someone had already deposited a packing box for her belongings — her first thought was not of the 14 years she had worked for DHL or the loss of her $37,000-a-year salary.

It was of Jake. In three months, once her benefits ran out, how in the world would she provide health insurance for Jake, her mountainous, red-headed 21-year-old son, who had learned three years earlier that he had metastatic testicular cancer?

Since the day she was laid off in October, Ms. Walker and her husband, Russ, co-owner of a struggling feed store here on the outskirts of Houston, have mounted a largely fruitless quest to find affordable coverage for Jake’s pre-existing condition. Their odyssey has become all too familiar to millions of newly uninsured Americans who suddenly find themselves one diagnosis away from medical and financial devastation.

The Walkers, both 46, are among nine million people who have lost employer-sponsored insurance since December 2007, according to projections by the Kaiser Family Foundation. Some have qualified for government insurance, and others have bought individual policies. But an estimated four million have joined the ranks of the uninsured, heightening the urgency in Washington to close the coverage gaps in American health care.

Like many others, the Walkers live on a knife’s edge of risk. Without insurance to cover her high blood pressure or his diabetes, they defer doctors’ visits when possible and obtain their prescriptions — nine between the two of them — for $4 apiece at Wal-Mart.

But their primary concern has been finding insurance for Jake, who, after four operations, two stem cell transplants and round after grueling round of chemotherapy, has been cancer-free for a year.

He continues to face a significant threat of recurrence and requires regular monitoring for at least two years. His twice-a-year CT scans cost $3,000 each, and quarterly blood tests and X-rays run more than $1,000.

Late last month, in a race against the clock, the Walkers obtained a short-term policy for Jake through Oklahoma State University, where he is a junior studying animal science on a scholarship. Doing so could be crucial to his future insurability because federal law allows insurers to deny coverage for pre-existing conditions when there has been a gap in coverage of at least 63 days.

With a week to spare, they scraped together $335 to pay the quarterly premium by delaying a house payment and pleading with the power company for a 10-day extension. But the policy will expire on May 16, and its coverage limits will afford minimal protection against bankruptcy if the cancer returns before then.

Now the Walkers face the possibility that Jake will no longer be seen at Houston’s renowned M.D. Anderson Cancer Center, which they credit for his remission.

“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the maternal ferocity of a black bear. “You just — not give up — but you just feel that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really have to lose my home to save my son’s life?’ ”

Neither of the Walkers has been able to land a job with the kind of large group coverage that would disregard Jake’s health status. His cancer history effectively makes him uninsurable on the individual market. He is too old to qualify for Medicaid as a child, and it is virtually impossible in Texas to qualify as an able-bodied adult.

Because the Walkers own their modest house, they have been told they do not merit other government assistance. With little predictable income beyond Ms. Walker’s $688 unemployment check every two weeks, the family cannot afford the state’s high-risk insurance pool or continuation coverage through the federal Cobra law.

To date, Jake’s treatment has cost nearly $2 million. Almost all of it has been paid by Cigna under a preferred-provider family policy that Ms. Walker paid $426.28 a month for through DHL, the troubled shipping company where she worked as a billing agent.

Until last fall, Mr. Walker was the co-owner of a business that supplied DHL with trucks and drivers, but it too fell victim to downsizing. The feed store, the last in an area where suburbs are swallowing ranchland, has been losing money.

What has made the Walkers feel most helpless, though, is that their son has been left so exposed, after all he has endured.

“Your job as a parent is to protect your children at any cost,” Ms. Walker said. “I really felt like I had let him down.”

At 6-foot-2 and 285 pounds, Jacob Walker often dwarfs the prize livestock he parades in the show ring. He first noticed that his left testicle had become larger than the other as a senior in high school. He waited a few weeks to tell his parents so he would not miss the county fair, where his favorite heifer and goat both won grand-champion ribbons. By then, the cancer had spread to his abdomen, and he received a Stage 3 diagnosis.

Over the next two years, surgeons would remove the testicle and slice off diseased sections of his abdomen and liver. The chemotherapy preceding the stem cell transplants was so toxic that it peeled his skin.

Through it all, Jake maintained an optimistic determination. “Life’s tough,” he would say. “Sometimes you have to get a helmet and run with it.”

His mother left the hospital once in 26 days during the stem cell transplants. When he started college online from his hospital bed, she read to him from his world-literature text. His father, not often given to emotion, started telling his son every day that he loved him, before going home to cry. During Jake’s chemotherapy, his buddies in Future Farmers of America shaved their heads in solidarity.

Late in 2007, Jake’s doctors at Texas Children’s Hospital told him that they had done all they could and gave him a 20 percent chance of surviving the next year. The Walkers were not ready to quit, and sought out Dr. Lance C. Pagliaro, a specialist at M. D. Anderson.

Dr. Pagliaro recommended an experimental chemotherapy regimen, and Jake has shown no sign of cancer since the treatments ended in March 2008. “Needless to say, we’re very pleased with how he’s doing,” Dr. Pagliaro said.

But during Jake’s check-up in December, Ms. Walker told the hospital that her son would be uninsured at the end of January. She said a hospital official then told her that if she was not able to pay up front, she should take her son elsewhere.

Dr. Pagliaro pledged that he would do what he could to make sure that Jake would be seen. “To deny him the relatively inexpensive follow-up that is so crucial,” he said in an interview, “just makes absolutely no sense.”

But the doctor has yet to intercede with the business office about waiving fees, saying it would be premature. Last month, when the Walkers showed up for an appointment with Jake’s oncologist, only a last-minute dispensation enabled him to be seen without payment in advance. The Walkers left with the impression they would be billed $700; the hospital says it will be $1,507. In either event, they have no way to pay it.

The hospital has suggested that Jake have his next tests elsewhere and send the results to Dr. Pagliaro to review, with payment to be negotiated in advance.

The Walkers are now completing the voluminous paperwork to apply for M. D. Anderson’s charity care program for Texas residents. The hospital, which had $2.2 billion in net patient revenue last year, spent $209 million on such uncompensated care.

But Dr. Ron Walters, the hospital’s vice president for medical operations, said economic pressures had made it more difficult to assist patients who were not under active treatment. Dr. Walters said it had been “good financial counseling” to advise the Walkers to explore other options, and questioned whether they would qualify for charity care because they had assets. Among the criteria, he said, is whether a patient can receive comparable treatment elsewhere.

Dr. Walters said requests for deferred payment by uninsured patients had risen tenfold in four years. But Ms. Walker said she could not help taking the hospital’s stance personally.

“You feel like you’ve been kicked to the curb,” she said. “It’s like, ‘As long as you have insurance, we’re willing to go over the moon to see you and make sure that everything is taken care of.’ And the minute you don’t, they don’t want you.”

The Walkers had not heard about the Texas Health Insurance Risk Pool, which provides coverage to 26,550 otherwise uninsurable people. Once they learned about it, they concluded they could not afford the most useful policy for Jake, a plan with a $1,000 deductible that would cost $414 a month.

Now they are revisiting whether they might extend their P.P.O. coverage under Cobra, which allows laid-off workers to continue their insurance at full price for up to 18 months. When Ms. Walker first investigated, she learned it would cost $1,359 a month to replicate her coverage.

The recently enacted federal stimulus package includes a 65 percent subsidy for nine months of Cobra coverage for the newly unemployed. That would reduce the Walkers’ price to $476 a month, which they said they still could not afford.

They are now inquiring about whether they can cover only Jake. If they can find a policy for him for less than $200 a month, Ms. Walker said, she would find a way.

“It will happen,” she said, “if I have to walk up and down the street and collect tin cans.”

Brent McDonald contributed reporting.