Citizens’ Council on Health Care
CCHC HEALTH eNEWS
Tuesday, October 9, 2001


=====================================================
Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
=====================================================

* DOCTORS HAPPIER AFTER LEAVING HMOS

* TERRORIST ATTACK SHOWS NEED FOR NATIONAL HEALTH CARE, SAYS CAPLAN

* EMPLOYERS CAN ACCESS WORKER HEALTH INFORMATION

* DISABILITY GROUPS PROTEST PETER SINGER’S SPEAKING ENGAGEMENT*

* BUSH TRIES TO PREVENT VOTE ON HOUSE ANTI-TERRORISM BILL

* “HEALTH CARE RECORD” DEFINED BY HEALTH INFORMATION ASSN.*

* HOSPITAL SPENDING DRIVES U.S. HEALTH COST INCREASES

* CHILDREN INSURANCE PROGRAM NOT POPULAR WITH PARENTS*

=============================
* CCHC Commentary included
=============================

--------------------------------------------------------------
TO UPDATE YOUR EMAIL ADDRESS OR TO BE REMOVED FROM THIS LIST
INSTANTLY, LINK TO: http://www.cchconline.org/enews.php3
--------------------------------------------------------------


__________________________________
DOCTORS HAPPIER AFTER LEAVING HMOS

Doctors are successfully leaving HMOs in the dust. One Mountain
View California doctor, according to the American Medical News,
started by dropping out of the HMO that he consider the worst
offender. It gave neurologist Ron Hess, M.D. the most trouble,
didn’t pay him the most often, and paid the lowest rates.

After the loss of that HMO went well, he continued to drop
HMO after HMO. Hess found that patients were willing to pay
cash. The result: more satisfaction, more time with patients,
more money and less bureaucracy. He claims to get paid 25%
more for seeing fewer patients.

Although he’d planned on quitting the profession in four years
due to the stresses of working with HMOs, Hess now says that he
can continue being a doctor “until I’m 65 or 70 without a problem.”
He is age 55.

Dr. Bastian Wagner, a family physician in Portland Oregon, left
a group practice and built his own office - on property near his
home. Most of his Medicare patients changed from cheaper HMO
coverage ($30/mo) to non-HMO plans ($100/mo) to stay with him.
His earning remain the same, but he is closer to home, his work-
days are shorter, and he works only four days a week.

Source: “HMNOs: When doctors just say no to bad contracts with HMOs,”
Cheryl Jackson, AMNews, October 15, 2001.
http://www.ama-assn.org/sci-pubs/amnews/pick_01/bisa1015.htm

-Citizens’ Council on Health Care
-10/9/01


_______________________________________________
NATIONAL HEALTH CARE SYSTEM NEEDED, SAYS CAPLAN

”Everything” since the Sept. 11 terrorist attacks is different,
”[e]xcept we still have the same, pathetic, immoral health care
system we had the day before the terrorist assaults,” Arthur
Caplan, director of the University of Pennsylvania’s Center for
Bioethics, writes in an MSNBC op-ed.

Even though the economy is “reeling” and the country is preparing
for war, “this is precisely the time” to ensure that no American
has to worry how they will pay for health care, Caplan says. He
writes it is “time to do what’s right and make sure that the old
broken naive world of health care insurance is gone too. [And it
is] time to ... guarantee access to health care to every American.”
Although past efforts to create a national health care plan have
”foundered” because “private interests have defeated the public
good,” Caplan states that the country “can no longer afford to
put the public good behind private interest.”

Thus, he advises President Bush and Congress to develop a plan to
”mandate” that all Americans have access to health care through
private plans, employer-sponsored coverage or government-backed
vouchers. Caplan adds, “What we have done for our automobiles --
universally insure them—we must now do for our neighbors.”

Noting that veterans are “promised” health coverage, Caplan concludes:
”In the new world where each of us is a target and every American is
a veteran, we must make the same promise to one another. Every
American must know that regardless of what terrorists do there is a
safety net for them and their families” (Caplan, MSNBC.com, 9/28).

Sources: Taken directly from “Terrorist Attacks Show Need for
Universal Health Plan, Caplan Says,” Kaiser Daily Health Policy
Report, October 1, 2001.
Full article: “New world calls for new health care system,” MSNBC,
Arthur Caplan, 9/28/01, http://www.msnbc.com/news/635352.asp


______________________________________________
EMPLOYERS CAN ACCESS WORKER HEALTH INFORMATION

A Kaiser Family Foundation annual survey of employer health benefit
plans found that 17 percent of all employers have the ability to
link medical claims to individual employees, representing one-third
of all covered workers. Among the largest companies with 5,000 or
more workers—most of which self-insure rather than buy coverage
from a health insurance plan--41 percent said they can link claims
to workers. The survey also found that premiums for employer-sponsored
health insurance have increased an average of 11 percent in 2001.
The survey was released Sept. 6. A summary of the survey’s findings
is available at http://www.kff.org

Source: Taken directly from “Health Care Survey Finds Employers
Can Access Worker Health Info,” BNA Privacy Law Watch, Tuesday,
September 18, 2001. Report Summary: http://www.kff.org/content/2001/20010906a/EHB2001_sof.pdf


_______________________________________________________
DISABILITY GROUPS PROTEST N.H. COMMISSION ON DISABILITY
SPEAKER, EUGENICS ADVOCATE PETER SINGER

Australia’s notorious bioethicist Peter Singer spoke last
week to Gov. Jean Shaheen’s (D-N.H.) Commission on
Disability. Some 200 people in the audience applauded
Singer, who advocates the mass murder of handicapped
newborns. Twenty advocates from disability groups protested
outside the meeting. Among them was State Rep. Daniel Itse
(R.), who said: “Singer has a right to say what he wants.
That doesn’t mean we have to give him a forum.” Singer, who
teaches at Princeton, quoted the French philosopher
Voltaire: “I disagree with what you say, but I’ll defend to
the death your right to say it.” It seems the peripatetic
prof can’t complete a sentence without getting death in
there. Rep. Itse is right: It is shameful for New
Hampshire’s governor to give this man a forum.

Source: “Singer’s Dirge, Ken Connor, Family Research Council,
Washington Update, October 8, 2001.

------------------
CCHC COMMENTARY: In his treatise, “Rethinking Life and Death: A
New Ethical Approach, Singer has written that “a period of 28
days after birth might be allowed before an infant is accepted
as having the same right to life as others.” He also wrote “But,
for reasons we have already discussed, in regarding a newborn
infant as not having the same right to life as a person, the
cultures that practiced infanticide were on solid ground...”


__________________________________________
BUSH ADMINISTRATION PUSHES TO PREVENT VOTE
ON HOUSE ANTI-TERRORISM BILL

The Administration’s latest strategy is becoming clear:
preclude the House from voting on the anti-terrorism bill
as reported from the House Judiciary Committee.

A lot of groups worked very hard to make improvements (many
would say marginal improvements) in the anti-terrorism bill
in the House, and Chairman Sensenbrenner worked in good faith
with ranking Democrat Conyers to follow normal legislative
procedure.

In some respects the Senate bill is better, but the Senate
bill includes a number of provisions rejected by the House
as well as several extra titles covering subjects not in the
House bill.

Most notably, the House bill’s surveillance provisions “sunset”
[end] in two years.

Over the weekend, the Administration began pushing for a
”pre-conference.” That means that the House and Senate staff
and key Members would meet behind closed doors on Tuesday and
Wednesday, before the House votes, with the goal of getting the
House to accept provisions of the Senate bill and otherwise
return to the Administration’s initial proposal [without the
sunset language]. The result would then be presented to both
Houses, obviating the need for a conference.

It is not clear, of course, that a conference would produce an
outcome any more responsive to the concerns reflected in the House
bill - a conference could easily produce the worst of both bills.

But those concerned with preserving compromises made in either the
House or the Senate bills need to be aware that the Administration
is trying to ensure that such compromises never reach the Floor in
either chamber.
--
Jim Dempsey
Center for Democracy and Technology
1634 I Street, NW Suite 1100
Washington DC, 20006
voice: 202.637.9800 fax: 202.637.0968
jdempsey@cdt.org

Source: In Defense of Freedom (IDOF) email listserv.
(IDOF formed shortly after the terrorist attack as a result
of proposed federal legislation to expand surveillance and
police powers. IDOF is a group of more than 150 organizations,
400 attorneys and 40 computer specialists supporting the
protection of civil liberties.)
NOTE: Using words surrounded by [], CCHC has edited the letter
for better understanding.


_____________________________________________________
HEALTH INFORMATION ASSN. DEFINES “HEALTH CARE RECORD”

HIPAA privacy and security regulations inevitably draw attention
to what constitutes a healthcare record. Now the American Health
Information Management Assn. has developed one. Under its definition,
a legal healthcare record “excludes health records that are not
official business records of a healthcare provider organization
(even though copies of the documentation of the healthcare services
provided to an individual by a healthcare provider organization are
provided to and shared with the individual). Thus, records such as
personal health records that are patient controlled, managed, and
populated would not be part of the LHR.”

Source: taken directly from “AHIMA attempts to define legal health
record,” PrivacySecurityNetwork, Site Update, October 8, 2001.

------------------
CCHC COMMENTARY: This is important because organizations understand
that defining the record can increase or limit patient access to their
own medical records. The so-called federal medical privacy regulation
gave citizens limited access to certain medical record information
on themselves, but did not define what a medical record was. The
regulation states:

”Except as otherwise provided in...an individual has a right of
access to inspect and obtain a copy of protected health
information about the individual in a designated record set, for
as long as the protected health information is maintained in the
designated record set, except for...”

The regulation did not define a number of critical items, including
medical record, privacy, and confidentiality. Among the 21 pages of
definitions, the regulation did define “Designated record set,”
”health care.” “health information,” “protected health information,”
and “individually identifiable health information,” According to the
regulation:

”Designated record set means:

1) A group of records maintained by or for a covered entity that is:

i) The medical records and billing records about individuals
maintained by or for a covered healthcare provider;
ii) The enrollment, payment, claims adjudication, and case or
medical management record systems maintained by or for a health
plan; or
iii) Used, in whole or in part, by or for the covered entity
to make decisions about individuals.

2) For purposes of this paragraph, the term record means any item,
collection, or grouping of information that includes protected health
information and is maintained, collected, used, or disseminated by or
for a covered entity.”

”Protected health information means individually identifiable health
information:

1) Except as provided in paragraph (2) of this definition, that is:
(i) Transmitted by electronic media;
(ii) Maintained in any medium described in the definition of
electronic media at...or
(iii) Transmitted or maintained in any other form or medium.

2) Protected health information excludes individually identifiable
health information in:
i) Education records covered by the Family Educational Right
and Privacy Act, as amended,..., and
(ii) Records described at 20 U.S. C. 1232g(a)(4)(B)(iv).

Individually identifiable health information is information that is
a subset of health information, including demographic information
collected from an individual, and:

1) Is created or received by a health care provider, health plan,
employer, or health care clearinghouse; and

2) Relates to the past, present, or future physical or mental health
or condition of an individual; the provision of health care to an
individual; or the past, present, or future payment for the provision
of health care to any individual; and

(i) That identifies the individual; or
(ii) With respect to which there is a reasonable basis to believe
the information can be used to identify the individual.”


___________________________________________________
HOSPITAL SPENDING DRIVES U.S. HEALTH COST INCREASES

Hospital spending has overtaken drug costs as the leading driver
of health inflation in the U.S., according to a new study.
Hospital spending is increasing at a rate not seen since the
early 1990s, due to a combination of looser restrictions by
managed care plans that have increased utilization, rising labor
costs due to the nursing shortage, and increases in payments from
insurance companies to hospitals, according to a report from the
Center for Studying Health System Change.

o Hospital spending increased in 2000 around 2.8 percent on
the inpatient side and 11.2 percent for outpatient care.

o Together, both accounted for 47 percent of the overall
increase in health spending.

o By comparison, 27 percent of the increase is attributable
to more spending on drugs.

o Spending on physician services increased by 4.8 percent,
accounting for 25 percent of the total.

The overall health inflation rate of 7.2 percent in 2000 is the
largest increase in a decade. According to the study, the lagging
economy means that employers are far less likely to absorb the
premium increases.

A major reason for the slowdown in drug spending—costs rose
14.5 percent in 2000, compared with 18.4 percent the previous
year—has been the move toward “tiered” pricing structures, in
which consumers pay more out-of-pocket for more expensive drugs.
The combination of higher growth in health care costs, through
its effect on premiums, and a slowing economy threaten a major
increase in the number of people who are uninsured.

Source: Bradley C. Strunk, Paul B. Ginsburg and Jon R. Gabel,
”Tracking Health Care Costs,” Health Affairs, October, 2001;
”Hospital Spending Drives US Health Cost Increases,” Reuters
Health, September 26, 2001.

For Health Affairs report
http://www.HealthAffairs.org/Strunk_Web_Excl_92601.htm

For more on Economics and Cost
http://www.ncpa.org/pi/health/hedex2a.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, October 1, 2001.


________________________________________________________
SCHIP: CHILDREN’S HEALTH CARE PROGRAM CAN’T GIVE IT AWAY

Virtually every child in a low-income family is eligible for
either Medicaid or the State Children’s Health Insurance Program
(SCHIP), but 24 percent (or about 7.7 million) of the 32 million
children in low-income families remain uninsured. Many analysts
are puzzled why so many children remain unenrolled in these
government health programs. The answer may be that their parents
have decided they don’t need or want them.

The states have not been able to spend all the federal SCHIP
funds they were allocated. Nearly half of 1998’s $4 billion
allocation was returned unspent. Of the allocation for the last
three years, the states have spent just 24 percent of their
federal funds.

An Urban Institute study found that 88 percent of low-income
respondents had heard of SCHIP and/or Medicaid—but less than
one-fourth (24 percent) of those ever inquired about the
programs. Of low-income parents whose children had no health
care coverage (see figure
http://www.ncpa.org/ba/ba371/ba371fig2.gif):

o 22.1 percent said they “did not need or want” the program;
17.7 percent said they did not think their child was
eligible; 17.8 percent said their children had been
enrolled in SCHIP or Medicaid at some time in the past
year but no longer were; and 11 percent said they had
applied but never enrolled their children.

o 96.8 percent of those who “did not want or need” the
program considered their kids to be in excellent, very
good or good health.

o Of those surveyed, 24.2 percent said they had “no usual
source of care,” but only 9.8 percent said they had “any
unmet need.”

As an alternative, analysts suggest that the money spent on SCHIP
be used to help the uninsured buy private insurance.

Source: Greg Scandlen (NCPA senior fellow in health policy), “
Propping Up SCHIP: Will This Program Ever Work?” NCPA Brief
Analysis No. 371, September 7, 2001, National Center for Policy
Analysis.

For text http://www.ncpa.org/ba/ba371/ba371.html

For more on Uninsured Children
http://www.ncpa.org/pi/health/hedex6b.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, September, 2001.

------------------
CCHC COMMENTARY: The Bush Administration recently proposed
use approximately $11 million in SCHIP funds for insuring
adult dislocated workers impacted by the terrorist attack.
This disturbs national health care advocates who worry that
the funds for expanding government health care programs could
be depleted and the SCHIP program scuttled.



================================================
NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
================================================
CITIZENS’ COUNCIL ON HEALTH CARE
1954 UNIVERSITY AVE. W., SUITE 8
ST. PAUL, MN 55104, 651-646-8935
HTTP://WWW.CCHCONLINE.ORG
--------------------------------------------------------------
TO UPDATE YOUR EMAIL ADDRESS OR TO BE REMOVED FROM THIS LIST
INSTANTLY, LINK TO: http://www.cchconline.org/enews.php3
--------------------------------------------------------------

 

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.