Doctors, nurses and health advocates denounce Institute of Medicine’s PPACA recommendations

[eridani]

FOR IMMEDIATE RELEASE
Dec. 1, 2011
Contact:
Steffie Woolhandler, M.D., M.P.H.
Oliver Fein, M.D.
Danny McCormick, M.D., M.P.H.
Mark Almberg, PNHP, [phone], [email protected]

More than 2,400 doctors, nurses and health advocates denounce Institute of Medicine’s health coverage recommendations.

IOM panel ‘riddled with conflicts of nterest’ in violation of agency’s own guidelines, signers of protest letter charge

In a letter (appended below) sent to Secretary of Health and Human Services Kathleen Sebelius and posted on the Internet today, more than 2,400 physicians, nurses and other health advocates condemn the recommendations of an Institute of Medicine (IOM) committee regarding the “essential benefits” to be mandated under the 2010 federal health reform law.

The signers, most of whom are physicians, charge the committee’s recommendations amount to prescribing skimpy coverage that would “sacrifice many lives and cause much suffering,” and urge the Obama administration to reject them.

“The IOM panel endorsed insurance coverage similar to that offered by small employers rather than the more comprehensive coverage offered by large employers,” said Dr. Danny McCormick, an internist, assistant professor at Harvard Medical School and former IOM fellow who helped circulate the letter. “The recommendation was widely viewed as a victory for the health insurance industry, which has long opposed mandating comprehensive benefits.”

The panel also recommended that coverage under the new law be defined by a premium target – an approach often called “defined contribution” – rather than by a list of medically necessary benefits, McCormick said.

The protest letter accuses the IOM panel of being “riddled with conflicts of interest” and notes that many of the panel members have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms” whose businesses would be affected by the panel’s recommendations.

The IOM committee’s members include Sam Ho, executive vice president of UnitedHealthcare; Leonard D. Schaeffer, director of the biotechnology company Amgen and former chairman and CEO of WellPoint (Schaeffer’s family foundation donated $2 million to the IOM in 2010); as well as executives from 3M Health Information Systems, a medical supplier, Milliman Inc., an actuarial consulting firm with close ties to the insurance industry, and The Blackstone Group, a private equity firm with major health care interests.

“Many committee members’ strong ties to the health industry violate the guidance offered in a 2009 report issued by the IOM which recommended that those with industry conflicts of interest should generally be excluded from such panels,” said Dr. Steffie Woolhandler, professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School, who served as an IOM fellow in 1990-1991. Woolhandler also circulated the letter.

The signers of the protest letter include several prestigious members of the IOM, as well as several former fellows. The letter was first circulated to colleagues by attendees at the IOM’s annual meeting near Washington in October. After learning of the letter, IOM officials instructed security officers to block its distribution at the meeting.

The letter was also circulated by Physicians for a National Health Program, which advocates for a single-payer health system, and by other health professional groups.

Besides being submitted to Secretary Sebelius and other administration officials, the letter has been accepted for publication in the International Journal of Health Services, Woolhandler said.

An Open Letter to Secretary Sebelius and President Obama regarding the Institute of Medicine’s recommendations on the Essential Benefits under the 2010 Health Reform Law

We protest the Institute of Medicine’s (IOM) recommendation that cost rather than medical need be the basis for defining the “essential benefits” that insurance policies must cover when the federal health reform law takes effect in 2014. If adopted by the Department of Health and Human Services, this recommendation will sacrifice many lives and cause much suffering. We call on Secretary Sebelius and President Obama to reject them.

The IOM proposal would base the required coverage on the benefits typical of plans currently offered by small businesses – enshrining these skimpy plans as the new standard. These bare-bones policies come with a long list of uncovered services and saddle enrollees with unaffordable co-payments and deductibles.

Already, millions of underinsured Americans forgo essential care: adults with heart attacks delay seeking emergency care1; children forgo needed primary and specialty care2; patients fail to fill prescriptions for lifesaving medications3; and serious illness often leads to financial catastrophe4.

The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness. Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising co-payments and deductibles over the past two decades have failed to stem skyrocketing medical inflation. And nations that assure comprehensive coverage – with out-of-pocket costs a fraction of those in the United States – have experienced both slower cost growth and greater health gains than our country.

Our patients urgently need what people in these other nations already enjoy: universal and comprehensive coverage in a nonprofit system that prioritizes human need over corporate profit.

The IOM committee was riddled with conflicts of interest, many members having amassed personal wealth through their involvement with health insurers and other for-profit health care firms. Its recommendations were lauded by insurance industry leaders who have sought to undermine real health reform at every turn. As the Lancet noted on its Dec. 5, 2009, cover: “Corporate influence renders the U.S. government incapable of making policy on the basis of evidence and the public interest.”5

Sadly, the committee’s damaging recommendations suggest that this corporate bug has also infected the IOM.

1. Smolderen KG, Spertus JA, Nallamothu BK et al. Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction. JAMA 2010;303:1392-1400.

2. Kogan MD, Newacheck PW, Blumberg SJ et al. Underinsurance among Children in the United States. N Engl J Med 2010;363:841-51.

3. Doty MM, Edwards JE, Holmgren AL. Seeing Red: Americans Driven into Debt by Medical Bills. The Commonwealth Fund, August 2005.

4. Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical Bankruptcy in the United States, 2007: Results of a National Study. Am J Med 2009;122:741-6.

5. Cover. The Lancet: Volume 374, Number 9705, 5 December 2009.

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call [phone].

[mmonk]

1. I was thinking of changing my policy to a higher deductable because

my premium was about to increase. The insurer offered it but said I could "lose" benefits if I changed whereas the policy with the increased amount would be grandfathered in after the changes in the health care law. I imagine there is a connection. And of course, the increase is being blamed on the health care act.

I'm so tired of the freaking games in this country when it comes to life's essentials and profiting. I truly wish I lived in a country that gave a damn about its people.

[eridani]

2. The increase is because insurance companies are useless parasites n/t

[mmonk]

4. Well certainly. They are a for profit middle man that rations care.

This runs counter to any idea of more access to healthcare to more citizens.

[area51]

5. +1 n/t

[pipoman]

3. For those with no health insurance at all

high deductibles for policies which provide coverage for catastrophic medical expense certainly is better than no coverage. A person with a high deductible will not be denied care as someone with no coverage could/have been. Having been self employed for many years, the cost of a 'good policy', was simply cost prohibitive. I carried a $5k deductible for years, $5k isn't impossible for most people who work to pay in installments if needed. For those with no income, a hospital or doctor will not deny care for catastrophic conditions knowing it wouldn't take long to far exceed that bringing them to a point of coverage.

I certainly would like to see lower copays and deductibles and less burden on insureds. There is at least some merit in not making it too low as the waiting rooms would be full of people seeking care for ailments which really don't require medical services. One of my peeves are those who drag their kids to the doctor every time their kid's nose is runny.

Bottom line is that this problem cannot get better as long as medical services and pharmaceuticals cost more here than any other place on the planet. I think medical providers including those who deal in medical supplies and equipment must be legislatively reformed. Prices for products in the US should be mandated to not exceed the lowest price charged in any other market.

[eridani]

6. HIgh deductible policies are good only for healthy people

For sick people, they do nothing to prevent the slide into bankruptcy or death. They make the situation worse because the money that could be used to buy care has been lost to insurance premiums.

I agree that price controls (that exist in every other developed country) are the answer. Unfortunately, HCR provides none.

[pipoman]

7. On the contrary,

high deductible policies are only good for those who are very sick. This is about availability of health care for catastrophic illness. As I stated, nobody would be denied services for major illness because of an inability to pay the $5k. If someone is so close to bankruptcy that $5k would send them over the edge, it really isn't the $5k which got them into trouble. Benefit bake sales and garage sales, etc. could easily cover that, not so much the cost of heart surgery or cancer treatment. It certainly isn't ideal, but as I stated I have personally had to decide and choose high deductible, catastrophic coverage health insurance.

[eridani]

8. Health care only for catastrophic illness is pennywise and pound foolish

There is NO provision for the kind of early intervention that can prevent catastrophic illness. People are stripped of the ability to pay for this by the high deductible policies that only feed insurance parasite profits.

[pipoman]

9. I get annual physicals and eye exams

they usually cost me $400 per year. The cost of low deductible policies cost far in excess of that $400 in additional premium cost. If I ended up needing $3k in expense for medical procedures, it would still be cheaper than low deductible policies. I'm not saying I like it, just that higher deductible policies are far better than no policies at all. Many who don't get medical attention when needed because of high deductibles think nothing of a $400 monthly car payment plus $150 insurance or $80 cable bill, or eating out for $250 per month or...

[eridani]

10. If all you need is physicals and eye exams, you are one of the 85% who account for

--15% of all health care costs. Therefore your opinion of how good your insurance is is similar to your opinion of how good your fire extinguisher is. How in bloody hell would you know?

[pipoman]

12. Yet not a word about the actuarial cost savings between

low deductible policies and higher deductible being exceeded by premiums. I know exactly what my policy will and will not do...unlike the vast, vast majority who have never bothered to read their policy (not to mention those who couldn't understand it if they did), I read and understand my policies...all of them. If I end up needing 100k worthy of treatment, the 5k will not bother me as much as being turned away for not being able to afford a low deductible policy. To proclaim people are better off with no insurance than with catastrophic expense policy is simply irresponsible of you. Frankly, the reason low deductible policies are so expensive is because people insist on going to the doctor for minor ailments which they would simply treat themselves if they had to actually pay the bill themselves.

[ljm2002]

13. Glad you sorted that out for us...

...but I do have a question for you: If, as you say, "the reason low deductible policies are so expensive is because people insist on going to the doctor for minor ailments which they would simply treat themselves if they had to actually pay the bill themselves" -- then why are health costs lower in other developed nations such as Canada, France, England, etc. ... even though people can go see a doctor anytime they wish to? And on top of that, with their overall health care costs at about one-half to two-thirds of what we shell out here in the states, they get better outcomes overall.

Besides that, the real expense comes not from people who would have used health care for a case of the sniffles; a larger contributor is that people delay required treatments for serious ailments because they don't have enough money to pay the often exorbitant prices of treatment and medications (or the copays and deductibles, if they have coverage). Then they go downhill and require much more intervention, which is more costly and tends to have worse outcomes due to the delay in treatment in the first place.

Personally, one of my pet peeves are people who say things like "I know exactly what my policy will and will not do...unlike the vast, vast majority who have never bothered to read their policy (not to mention those who couldn't understand it if they did)" -- sheesh. Condescend much? First, the policies are often written to confuse people as much as possible, especially in the fine print. So you may be in the minority in reading and understanding your policy, but the real question is, why should our health insurance / health care system be set up in an adversarial way in the first place?

[pipoman]

14. Apparently you didn't read the whole exchange

I covered that in my very first post in this thread. I know people don't read their policies, are you disputing that? They are complex because the are legal contracts. It is the system we have and our own party failed to actually fix it, until they grow a set and fix it then we all live within the system. Don't like it? Who does (except doctors, health providers and insurance companies)?

[ljm2002]

15. Oh I read the whole exchange all right...

...like this statement of yours:

"I certainly would like to see lower copays and deductibles and less burden on insureds. There is at least some merit in not making it too low as the waiting rooms would be full of people seeking care for ailments which really don't require medical services. One of my peeves are those who drag their kids to the doctor every time their kid's nose is runny."

Again -- it sounds like you think that people should not seek care unless they are "really" sick, and you somehow know this based on observation. Yet in countries with universal health care, so that people can be seen whenever they choose to, this is not deemed to be much of a problem if any.

As to contracts being complex because they are legal contracts: nonsense. Contracts can be written clearly, but in general they are not, especially when the contract is between a mega corporation and an individual. They do it on purpose, and it works very well for them.

In any case, I will stipulate that most people don't read their policies. I do not agree that the contracts must necessarily be complex. I wholeheartedly agree that our own party failed to fix the system, it's a crying shame.

[eridani]

16. Insurance companines don't have to abide by their policies

Sure, you can complain to your insurance commissioner, but by the time the resolve your issue, it could be too late for you. If you do have high expenses, nothing stops them from exorbitantly raising everyonee's rates exactly the way they have been doing for the past 30 years.

BTW, actuarial calculations in health insurance amount to legal mass murder.

[pipoman]

17. That is where being a good consumer comes in

doing a little research on the company, asking your provider, etc. Most mainline insurers pay their claims. My state has historically had a pretty strong insurance commissioner. I get that you don't like insurance companies, I don't love them either, but as I said before, this is the system we have now like it or not. I choose to insure myself for catastrophic illness. To advocate people refuse to insure is irresponsible under our current system.

[eridani]

18. The concept of "good consumer" is horseshit--

--when you are talking about fire protection, police protection and health care.

[pipoman]

19. Horseshit

we apparently disagree on this entire topic..farewell doll..:hi:

[eridani]

20. Sure. Thanks ever so much for cheering for health care as an unregulated commodity

Quite a few people think it ought to be a regulated public good. Health care as a commodity amounts to mass murder.

85% of your stupid "consumers" account for only 15% of health care costs, so all that good living has jackshit to do with controlling those costs. How about just taking care of actual sick people?

[highplainsdem]

11. +1,000