But Moore’s primary focus in the movie is on those who feel secure with their health insurance only to find that claims can be denied or that one’s coverage can be dropped.
As a solution to the problems he identifies in the movie, Moore suggests a single-payer system similar to the programs in England and Canada where the government administers payment for healthcare.
Critics call such an approach “socialized medicine,” and see the expansion of a government role in healthcare as a threat to a free market economy.
In response Moore points out that our education system, our police and fire departments, as well as other agencies providing public services, are all “socialized.”
Pastor of the First Congregational Church of Christ in Salem Gail McDougle agrees.
“Doctors and drug companies have convinced everyone that it is communism or socialism to provide healthcare. People still want to be doctors in England, Germany and Canada. It won’t destroy the medical profession. Most doctors have been taught to be afraid,” McDougle said. “If it’s not a threat to our education system, then it isn’t a threat to our healthcare.”
Democratic presidential candidates are scrambling to put forth healthcare reform proposals that chart a middle ground between a single-payer system and universal coverage where insurance companies still play a role but everyone is covered.
Meanwhile Republican candidates are responding with the “socialized medicine” critique and offering nothing in the way of reform.
As of this writing, President George Bush says he will veto bipartisan legislation to expand the federal children’s health insurance program.
Healthcare advocates point to Moore’s film and say that universal healthcare is the answer, while the health insurance industry and pharmaceutical companies call into question many of Moore’s claims.
The movie raises a fundamental question: How can the richest country in the world allow so many of its citizens to live without adequate healthcare?
The 2006 Oregon Population Survey shows that nearly one million Oregonians lacked healthcare coverage at one point in the past two years. Last year 15.6 percent of Oregonians (576,000) were without health insurance and 12.6 percent of children under the age of 19 (116,000) lacked healthcare coverage.
Given these figures, Salem Monthly decided to take a closer look at the issue of healthcare and how it is impacting local families and businesses.
Health coverage fears
Salem residents Heather Brown and her husband T.J. tried for eight years to have a baby. Three years ago Heather found out she was finally pregnant with twins. She began having problems at 17 weeks, and required some bed rest but she could continue working. Eventually she went to total bed rest and she lost her job as a paralegal. The family didn’t qualify for the Federal Medical Leave Act.
Heather underwent an emergency caesarian section and Luke and Grace were born almost three months premature. Luke weighed two pounds, four ounces; Grace weighed one pound, 15 ounces.
“Grace’s head wasn’t as big as my palm. Her length was from my wrist to my elbow,” Heather said.
“Their skin was transparent, you could see everything inside, blood vessels, everything.”
Grace was the sicker of the two and she spent a total of 65 days in the neonatal intensive care unit. Both of the twins have had medical issues that required costly surgical procedures, and they will continue to need healthcare services as they grow up.
Prior to her pregnancy and the loss of her job, Heather had a larger income than her husband and the family’s health insurance had been provided by her employer. T.J. now has insurance through his employer and the premium for covering Heather and the twins is $800 a month. T.J. is not covered by the insurance plan — that would cost $1100 month, beyond the Brown’s budget.
“To me it is a bill that is just as important as a mortgage payment,” Heather said. “It is something that has to be paid. If not, we’d be bankrupt.”
When the Browns were added to the group coverage provided by her husband’s employers, the insurance company refused to renew coverage for the entire company the following year.
“I knew it was us. They were paying more out than what they were taking in with premiums,” Heather said.
The next insurer did renew coverage after one year but charged $150 more a month.
For Heather, the biggest concern is for the future and keeping adequate health coverage.
“What happens if my husband is in a car wreck or gets fired? We can’t get health insurance on our own.”
While the rising costs of co-payments, premiums, and drug prescriptions trouble most folks who have healthcare coverage, it is fear of losing coverage that plagues many people.
Linda and Ken Ingham both work for the State of Oregon and live in Salem. The State provides their insurance coverage through Kaiser Permanente.
Their son Kenny has cystic fibrosis. He needs expensive inhalants and takes enzyme treatments with every meal. The dosage of the enzymes will continue to increase over time. Kenny’s prescriptions now cost $3200 every month, and with no insurance it would become an issue for the Inghams. Right now they pay about $20 out-of-pocket.
The contract with Kaiser is reviewed every two years and the Inghams constantly fear what could happen.
Linda Ingham asked, “What happens if Kaiser drops Kenny from coverage? We’re in pretty good shape right now but what’s going to happen?”
“Healthcare is broken and it’s going to take years to fix it,” Ken Ingham said. “We don’t necessarily dwell on the future but we do think about it. How many other people are there in a similar situation?”
Rising costs are making healthcare unaffordable for many who already have some kind of coverage as employers try to shift the financial burden back to their employees. These costs could affect access to healthcare.
Todd Londin owns two small cleaning companies in Salem: ABC Window Cleaners and First Impressions Last. Between the two companies he has 27 employees, both full and part-time.
“We did try to provide health insurance for two or three years and the second year the rates doubled,” Londin said. “As a small, local company, we can’t compete and absorb that kind of expense. It’s very difficult to afford it and stay profitable. It almost put me under.”
Londin said that other expenses such as rising fuel costs make it impossible for him to consider health coverage for his employees at this time.
“I do encourage all of my employees to register with NW Human Services Medical Facility. They use a sliding scale for payment depending on how much you earn.”
Pastor Gail McDougle says that as a small business administrator at Salem’s First Congregational Church, providing healthcare for her employees has been challenging.
“We pay benefits but one has to be very creative,” McDougle said. “Our premiums increased 36 percent in 2005 while co-pays and out-of-pocket minimums doubled. We’ve had double-digit increases every year. It will come to roost in any small business.”
McDougle fears that jobs will be lost as employers try to absorb the costs of providing healthcare coverage to their employees.
Director of Legislative and Regulatory Affairs with Regence BlueCross BlueShield of Oregon Mike Becker said that new technologies, new services, new procedures, as well as the increasing volume of healthcare recipients, all drive up the cost of healthcare.
“The public perception is that it is all about profits and administrative costs. But they are minor compared with the cost of new technologies. In 2007 administrative costs were less than 10 percent of every healthcare dollar.”
Commondreams.org points out, however, that many CEOs of insurance providers enjoy healthy salaries. According to the Web site, William McGuire of UnitedHealth Group, the nation’s leading insurer, was the third highest paid CEO on a recent Forbes list. He receives $124.8 million, which the Web site says “would cover the average health insurance premiums of nearly 34,000 people.”
August Laws, who has worked as an intern and volunteer at the YWCA’s Salem Outreach Shelter for homeless families, said that many of the people she has seen have no health insurance or have recently lost their coverage. One woman worked at the State Department of Human Services for 10 years until she was involved in a debilitating car accident. She came to the shelter after losing her job, her health insurance, and finally her home.
McDougle deals with similar problems at her church.
“As a church, our doorbell rings all the time,” McDougle said. “Seventy-five percent seem to have mental health issues. We see Viet Nam vets, and almost always we see people who are homeless. When the Oregon Health Plan was cut back our doorbell started ringing more. Diabetics were at our door.”
McDougle said people are discharged from the hospital with nowhere to go.
“They are released from the ER at Salem Hospital with three prescriptions. Now what do they do? They can’t pay for them. We take them over to Rite Aid and help them fill their prescriptions. Other churches are doing it too.”
Carol Stoebig at First United Methodist Church in Salem helped create “Congregations Helping People” to address some of these problems. CHP is comprised of 13 Salem churches who all contribute funds to assist the needy, primarily with healthcare costs. Stoebig tries to get those who need help into federal and state run programs such as Social Security and the Oregon Prescription Drug Program.
Doctors in distress
It isn’t only patients and healthcare consumers who are feeling the stress of a “broken” healthcare system. Doctors, particularly family practitioners with small practices, are finding it difficult not only to provide healthcare to their own employees, but in getting paid for their services according to their agreements and contracts with health insurance providers.
Salem office administrator at Vida Family Medicine David Kenny said they are relatively fortunate because 80 percent of their patients have insurance coverage with larger commercial companies and that some providers, such as Marion-Polk Community Health Plan and Regence BlueCross BlueShield of Oregon, are better at paying claims than others.
“Many insurance policies are `get rich quick’ schemes for those who run smaller companies,” Kenny said. “They collect premiums but don’t pay on claims. It is rare that you bill $100 and that you get $100. This can affect overhead and our ability to continue providing healthcare.”
Kenny said these smaller companies will use any excuse to deny a claim, and often include a lot of qualifying clauses in contracts to wriggle out of payment.
Larger institutions such as hospitals have similar problems but not to the same extent as those experienced by smaller medical practices.
Patient Financial Services Director at Salem Hospital Jaime Nichols said that nonpayment of claims does happen at the hospital but that the majority of insurance carriers pay correctly and the hospital has a review process set up and contracts in place to avoid these situations.
For a larger medical provider such as Salem Hospital, the challenge is one of keeping up with the constant changes in rules and policies established by insurance carriers.
“It seems the rules are constantly changing and we often have to re-submit claims,” Nichols said.
Independent Physicians Associations emerged in the 1980s so that doctors would have an organization to help negotiate with insurance providers as managed care became the model of delivering healthcare.
“They are akin to a farmer’s cooperative,” said Steve Howard, Director of Corporate Communications and Provider Affairs for the Mid Valley Independent Physicians Association. “Our doctors are independent business people but they need an organization to look out for them and to work on their behalf.”
Howard said MVIPA has worked closely with the state on healthcare reforms and it helps coordinate benefits for the Oregon Health Plan.
They also have helped to implement the new electronic health records program that connects doctors and pharmacies, making the process of filling prescriptions “more seamless.”
For Howard and MVIPA, the biggest challenge is the lack of doctors in Marion and Polk Counties.
“It’s particularly hard for Medicare patients to see a doctor. These counties are unique; there are almost 500 doctors, less than two doctors per clinic in 170 offices.”
Even with adequate coverage, access to a doctor may be limited to local residents simply because there aren’t enough of them.
The political response
Oregon has been at the forefront of reforming the healthcare system at both federal and state levels. Besides all the reform packages proposed by the presidential candidates, Oregon Senator Ron Wyden has proposed a healthcare overhaul that is getting bi-partisan support in congress.
The senator has introduced a universal healthcare plan that insures everyone and health insurance providers would continue to play a role in providing coverage.
His plan would shift responsibility for seeking insurance to individuals who would be required to have coverage. Employers could continue to help their employees if they choose, but Wyden’s plan cuts the link between employment and health coverage.
Wyden’s plan also calls for revamping the tax code to provide individuals with extra money to pay insurance premiums. Medicaid, which serves the poor, would no longer be necessary and would be eliminated.
The plan also would impose new rules on insurance companies to prevent them from covering only the healthiest individuals.
Mike Becker with Regence BlueCross BlueShield said there are things they support in Wyden’s bill and others that they are “less enthusiastic about.”
“We believe Wyden’s plan is the right approach to healthcare reform,” Becker said. “It has to be in that middle ground.”
Regence has been actively involved with reform at the state level and has worked on many of the new initiatives being proposed and debated in the Oregon legislature. It has supported bills requiring more transparency from insurance companies regarding rates, including a new state government Web site (www.oregon.gov/DAS/OHPPR/comparehospitalcosts.shtml) which provides data about the cost of over 80 medical procedures. Oregon is one of the first states in the country to provide this kind of information.
Oregon also has an external review process that normally takes up to 30 days in which an individual can dispute the actions of an insurance company regarding a specific claim. The case is reviewed by an outside agency.
The Oregon Health Plan began in 1987 to assure access to healthcare for all Oregonians. Since July 2004 it has received no funding from the state general fund resulting in service reductions and since then enrollment has been closed to new recipients. Voters will decide on a new cigarette tax that will be on the ballot in November as one way to generate revenue for the state program.
The Oregon Medical Insurance Pool is a state insurance program available to those who have been turned down for coverage by a commercial insurance company for a preexisting condition.
Oregon’s Department of Consumer and Business Services has an insurance division that advocates on behalf of individuals who have a disputed claim with an insurance provider.
In the last session of the legislature, other bills have expanded coverage for individuals and the Healthy Kids Plan expands coverage for children. Governor Ted Kulongoski has proposed his own healthcare reform package and HB 329 provides a roadmap to reform in Oregon.
Local State Representative Brian Clem said that public input is necessary before moving forward with any specific plan.
“We need the involvement of the public to guide the direction of reform,” Clem said. “There is a role for government in healthcare. It’s a free market system versus the government wanting some accountability. I’m not convinced that private insurance companies competing for profits have worked well. There are people they will not cover. The free market doesn’t serve everyone.”
Becker says that public perception plays against insurance providers.
“The insurance industry is much maligned by the public and the medical community. But if you ask people about their own individual plans, surveys tell us they are satisfied.”
But for others such as Pastor Gail McDougle, more needs to be done.
“It’s a moral issue for the trustees of our church — it is a justice issue,” McDougle said. “To think wealth should be built around making money on people’s health. Do we want to be drug kicking and screaming to adopt a more noble way of caring for people?”