Being a Patient
When Health Insurance Is Not a Safeguard
By JOHN LELAND, NYTimes, October 23, 2005
...Never have patients had so many medical options to extend, enrich or
alter their lives. But these new options are expensive, and with them
has come a change for which many Americans - even those with health
insurance - are financially ill prepared.
After decades in which private and government insurance covered a
progressively larger share of medical expenses, insurance companies are
now shifting more costs to consumers, in the form of much higher
deductibles, co-payments or premiums. At the same time, Americans are
saving less and carrying higher levels of household debt, and even
insured families are exposed to medical expenses that did not exist a
decade ago. Many, like the Dorsetts, do not realize how vulnerable they
are until the bills arrive.
Lawyers and accountants say that for the more than 1.5 million American
families who filed for bankruptcy protection last year, the most common
causes were job loss and medical expenses. New bankruptcy legislation,
which went into effect Oct. 17, requires middle-income debtors to repay
a greater share of their debt....
In a study of 1,771 people who filed for bankruptcy, reported this year
by four researchers at Harvard and Ohio University, 28 percent said the
cause was illness or injury. Most were middle class, educated and had
health insurance at the start of the treatment. Many lost phone
service, went without meals or skipped medications to save money.
Although the study relied largely on people's own accounts of their
finances, the figure suggests that as many as 400,000 American families
file for bankruptcy each year because of medical expenses.
"Not only are the bills higher, but the way we pay for care has
changed," said Elizabeth Warren, a professor at Harvard Law School and
one of the study's authors. "My mother always carried a bill with the
doctor, but every dollar she paid went to principal.
"Today, the doctor takes a credit card, and a family might be paying
that off at extraordinary interest rates. So people may recover
physically from major medical injury, but may not recover
financially."...
Some Experts Say It's Time to Evacuate
the Coast (for Good)
By CORNELIA DEAN (NYTimes) 1530 words
Published: October 4, 2005
...He added, ''I have never been an advocate for the federal government
telling people that they have to move out, but it's important to have a
discussion at all levels of government about what can be done to make
sure more people do not put themselves in harm's way. It will not be an
easy dialogue.''...
...A.R. Schwartz, a Democrat who for decades represented Galveston and
much of the Texas coast in the State Legislature, said he now regretted
some of the legislation he had pushed that subsidized development on
the coast, particularly a measure that provides tax relief to insurance
companies faced with wind damage claims.
Mr. Schwartz, whose constituents knew him as Babe, said that measure
was ''a terrible mistake -- in my mind, as opposed to my heart, because
the people need the insurance -- because it has been an invitation for
people to build homes on barrier islands and on peninsulas that are
exposed to storms, at public expense.''
''We are facing a crisis now because of that law I passed,'' said Mr.
Schwartz, who now lives in Austin where he works as a lobbyist and
lawyer.
Daniel P. Schrag, director of the Harvard University Center for the
Environment, said that as coastal areas, and islands, recover ''there
has to be a discussion of what responsibility we have not to encourage
people to rebuild their houses in the same way.''
Even the fate of New Orleans should be open to discussion, Dr. Schrag
said. ''Spending hundreds of millions of dollars to rebuild a city that
puts it in harm's way once again and relying on technology such as
higher dikes and levees seems to me a very dangerous strategy,'' the
more so in an era of global warming.
Erosion already threatens 70 percent of the nation's coastline, and is
especially severe on the east and gulf coasts. In a report to Congress
in 2000, the Federal Emergency Management Agency said that more than a
quarter of the houses within 500 feet of the coast might be lost to the
sea by 2060. The report said these losses would put an intolerable
burden on the federal government, which insures many of the structures
through its flood insurance program....
Like others who study this issue, he said two good candidates for
retreat were Dauphin Island in Alabama, much of it wiped out by
Hurricane Katrina, and North Topsail Island, N.C., which, he said,
''gets wiped out routinely.''
But plenty of people reject the idea that those who live on the coast
are any more at risk than those who live in areas prone to tornadoes,
earthquakes or forest fires, even in an era of increased storms.
''There are engineering solutions to almost any problem we face,'' said
Mr. Simmons of the beach association, who is mayor of Caswell Beach,
N.C., near Cape Fear. He said the problem with places like North
Topsail Island is too little infrastructure support, not too much. ''We
are not doing a good enough job maintaining things'' like beaches, he
said.
In the past, the promise of engineering has prevailed against efforts
to get the federal government out of the coastal development business.
More than a decade ago, for example, FEMA scientists suggested imposing
new limits on federally subsidized flood insurance and government
support for roads, sewers and other infrastructure in erosion hazard
areas. But advocates for development denounced the move as undue
federal interference, and it was defeated.
Setback requirements have been successfully challenged as
unconstitutionally limiting people's use of their property....
Sept. 8, 2005, 8:35PM
Coastal rates must rise, group argues
By PURVA PATEL
Copyright 2005 Houston Chronicle
HURRICANE KATRINA
The Texas Windstorm Insurance Association wants to raise rates 10
percent, citing rising construction costs and the possibility of a
hurricane like Katrina hitting the Texas Coast.
The windstorm association, a state backstop created to take on the
riskiest properties along the coast, said if not for a 10 percent cap
on its rate increases, it would seek to raise rates up to 58 percent
for homeowners and 42 percent for commercial policyholders, said Jim
Oliver, the association's executive director.
Texas insurers could face a major cash crunch if such a hurricane hit
the state, industry officials said, because the association may not be
able to absorb a catastrophe on its own and would have to rely heavily
on private insurers to pay its claims.
Those higher projections are based on models commonly used by the
insurance industry that look at hurricane losses going back 100 years
and simulate future losses.
But state law prohibits it from using such models and instead requires
the association to look only at historical losses going back at least
30 years. It can break the 10 percent cap only if a catastrophe
occurs....
'Clearly insufficient'
Geeslin suggested looking at all the options available, including
allowing the association to issue bonds, restructuring how the
association uses reinsurance, and re-examining how the funds are
accumulated.
"There's no magic fix here," Geeslin said. "You really need all your
tools in the toolbox."
Rep. John Smithee, R-Amarillo, pushed legislation during the last
session that would have, among other things, allowed the association to
issue up to $1 billion in bonds.
Smithee, chair of the House Insurance Committee, also thinks the 10
percent rate cap should be lifted.
But lawmakers on the coast were reluctant to pass anything that would
raise rates, he said, and others couldn't agree on how those bonds
should be repaid.
"We've got a fund that is clearly insufficient by any standard and the
system won't withstand any kind of major storm that hits the coast,"
Smithee said, adding that if the state endures more hurricanes as
predicted by scientists, "rates will go through the roof. It makes more
sense to get rates up now then have them suddenly balloon up."
Viewpoint,
THE NEW
MEDICARE LAW: A BAD DEAL FOR SENIORS
On December 8, 2003, President Bush signed into law the Medicare
Prescription Drug, Improvement and Modernization Act of 2003.
For more than 38 years, Medicare has successfully provided basic,
nearly universal health coverage to America's older and disabled
citizens. Because older Americans generally have higher health care
costs than any other segment of our population, they are mostly shunned
by private health plans. Before Medicare was enacted, about half of all
seniors had no health insurance, and nearly 35 percent lived in poverty.
Medicare changed all that. By creating a universal insurance pool,
Medicare allowed the previously uninsurable senior population to share
their risks and resources, providing affordable coverage where little
had existed before. But the Medicare program had one major shortcoming
[^] it did not provide seniors with out-patient prescription drug
coverage.
The National Committee to Preserve Social Security and Medicare has
spent years advocating for a comprehensive, affordable prescription
drug benefit. What we now have instead is a complicated program that
places the interests of the drug manufacturers and private health
insurers before the interests of seniors. While the law will help
subsidize the cost of medications for some, its glaring flaws erode the
value of what seniors are receiving, and could undermine the Medicare
program itself. We believe Congress must revisit this law before it is
fully implemented in 2006 to allow for an affordable drug benefit
offered to all through the traditional Medicare program....
The Privatization of Medicare: Proponents of the new Medicare law claim
that injection of competition between private providers will result in
better benefits to seniors at lower cost. But it is clear that private
companies simply cannot match Medicare for its low administrative costs
and efficiency, and they'll only participate in the program if they are
given more money than it costs Medicare to provide the same benefit.
The 2004 Medicare Trustees report bore this out as it projects the
Trust Funds have lost 2 full years of solvency due in large part to the
extra costs of privatization in the new Medicare law.
The truth is that most proponents of the new law don't support a
national social insurance program, and want to transform Medicare to
individual [base "]risk pools of one[per thou]. Healthier seniors may do better in such
a system for a time, while older, sicker seniors are left with fewer
choices and higher costs. Ultimately, dismantling the national
insurance risk pool will likely cause the entire system to collapse,
taking us full-circle back to the days before Medicare began providing
universal, affordable insurance coverage to all of America's seniors....
The
mission of the National Committee to Preserve Social Security and
Medicare, a membership organization, is to protect, preserve, promote,
and ensure the financial security, health, and the wellbeing of current
and future generations of maturing Americans.
