Forbes: Medicaid managed-care makes up for other private insurance losses

Quick...imagine you're a US health insurance exec and one of your (expensively) sick and festering customers asks you this:

John Q. Public: How do you stop hemorraghing (profits) when your body (politic) begins eating you alive from the inside-out but you can't afford the premiums for medicines or expensive tests and all that fancy stuff?

Shameless Insurance Exec: You feed-off of what's left and enjoy the ride (to the bank)...Yeeeee-haaa!!

A similar yet metaphoric conversation has been uncharacteristically chronicled by Forbes today in a revealing piece about health insurer stock losses, likely due to their persistence in privatizing a basic human right despite vast public outrage and skyrocketing costs that normally line their CEO's pockets with profits.

Interestingly, the only health insurance stock winners in today's casino (known as Wall Street to those in higher-income brackets) was the Medicaid managed-care private venture, Centene, who's stock jumped 16%. How 'bout that? Ahhh, the joys of sickness and absent preventive/primary care access on the wallet. "Makes my piggy-bank jiggle with joy!", screams the giddy middle-man a.k.a. privatized Medicaid insurer.

But could the jig be up soon?

Yes, if the crack in support for managed-care-as-our-Savior continues to erode the public's confidence in their government to see past politics and create public health policies that work for us all, like a national health plan, or NM's Health Security Act. These single-payer models have the evidence to support their effective and efficient use when applied universally, as every other modern nation has managed to do to the benefit of their people's health.

Must we wait to fix it 'till investors in the health insurance sham feel the pain that uninsured folks feel every day? And if so, will we bail those investors out but leave the rest of us to rot some more?

What do you think?

Terry

"...Goldman Sachs (nyse: GS - news - people ) analyst Matthew Borsch said the key takeaway from UnitedHealth's earnings miss and lowered outlook is that the multi-year commercial underwriting cycle has worsened significantly, and investors should expect downward pressure on margins for the next two to three years - chiefly in the commercial risk segment that makes up most earnings for major insurers ...Meanwhile, Centene surged after the Medicaid health insurer reported better-than-expected quarterly results and its revised full-year profit outlook still topped the average Wall Street estimate. Shares of the St. Louis-based company spiked $2.19, or 16 percent, to $16.14."

Unnatural Causes: Is Inequality making us sick?

How's that for a NM movie project?

It wasn't filmed here, but don't miss a second of the new six-part film series on racial health inequalities. It's a public health primer for the masses...as if we didn't already know.

Nevertheless, it's great to see epidemiology & data about our health crises made understandable and human on the big screen. And on the little screen: tune in to KNME this month to catch it!

NM's rich get richer and the rest of us get...sick

Kids' enrollment in Medicaid in NM slows despite enormous need and a widening of the income gap between high- and low-income New Mexicans, according to local headlines, heartbreaks and purse strings.

But, wait...NM's Business Community has a plan! "Spread the pain around", they say. Translation por la gente: tax the poor! Talk about a Reverse Robin Hood. These are the same people who brought us healthcare as a market commodity (a.k.a. "managed care") and not a human right.

According to recent ABQ Journal reports, NM can't afford to enroll all our kids-in-need in Salud Medicaid Managed Care programs despite Gov. Richardson's stated commitment to universal healthcare in the recent legislative session. NM business leaders would skimp even more.

Perhaps the Guv (and Big Business) forgot to read the report he commissioned in 2007 which noted preventable 18% administrative waste (a.k.a. "nonmedical costs") inherent in private insurance models (including Medicaid), and how a single-payer system like the Health Security Act would curtail costs relative to other market-driven models the Gov's commission studied thanks to eliminating the profiteering insurance middle-man.

No wonder Big Business, like NM' s Association of Commerce and Industry, according to the ABQ Journal, opposes universal healthcare unless we raise the Gross Receipts Tax ...it's a regressive tax which lands on our poor like a bulls-eye. Besides, Bernalillo County DID raise the GRT in 2007 under the visionary leadership of County Commissioner Deanna Archuleta. It worked, and it hits our poor harder than the rest. So, if we want to spread the pain around, we'll come up with a rational tax plan to proportionally pay for healthcare as a basic human right like every other modern nation has managed to do. Enough of the insanity, already.

Speaking of insanity, if you attended tonight's speak-out against poverty at the South Broadway Cultural Center and across the nation, you heard 300 low-income 'Burquenos dissing the privatized healthcare industry and demanding their basic human rights to medical care AND housing, food for their families, public transportation, a living wage and fair immigration reform. More on this important event later....

"Something is rotten in Denmark."

But you already knew that.

The political economy of healthcare is a funny thing in its predictability.

Like a tourniquet applied to the wrong vein, a defunded public health infrastructure in NM - where many say we need it to function the most- is sure to stop the flow of fresh & vigorous ideas into the body politic...and take the life out of our healthcare systems which are responsible for assuring care to the masses. We hurt it; it hurts us. "What goes around comes around", "Actions speak louder than words". Etc.

Our public hospitals and clinics and our State Department of Health perform vital functions, but tax-cuts to the wealthy in NM have been granted by a "progressive" Dem Gov amidst a state budget surplus at the expense of ample funding for these institutions, and the result has been sick people, cities and villages and disconnected public healthcare administrators. And fat cat healthcare and insurance profits - who can forget them?

Democratic, public discussions of healthcare needs in our communities are few and far between in a health system like ours, but things are starting to change in 'Burque, at least. Here's a quick local example, below. (For a detailed report, check out our Community Health Promotion presentation at the upcoming Head 2 Toe: A Conference on School Health in ABQ, April, 17.)

What kinds of healthcare do we need, and at what level of access in NM? Low-income folks in Albuquerque have been telling their public health leaders the answers to that question in an organized way since 2002. They weren't satisfied with a public trauma-care and teaching hospital that ignored the call for primary care clinics under its nose. And, voila, after years of community pressure UNMH plans two new clinics in ABQ's low-income neighborhoods, though they are still a good year away from door-opening.

The political economy of health will have the final say about whether or not we can staff those clinics with docs, nurse practitioners, PA's and social workers amidst a primary care provider pool in complete disarray. If recent history's any clue, we'll still need to be brought to the ER in a privatized medi-copter, first, before we can get a medical home at one of these shiny new clinics.

But the genie's out of the bottle in Albuquerque, and people are demanding justice and the elimination of health access inequities from their public health institutions. Slowly but surely, some of those institutions are responding. One day, they'll catch up and offer that justice first, because it's the healthy and right thing to do.

Until then...onward!
Terry

A public-service back-alley abortion

That was fast!

My head's still spinning from a fruitful yet aborted 7 month stint on the inside of the NM Department of Health and, yowza, was it fun. I had much support from knowledgable public health professionals inside DOH and my community partners while there, and got some sharp new glasses and medical benefits for a while. Thx for that, NM taxpayers ;). I truly appreciated it and am so sad that our regional DOH public health executive branch can't seem to retain all of their well-trained public health practitioners.

Oh well. Been told by many - including public officials - that it's another badge of honor in a long and shameful line of highly skilled community health workers who've rotated through the NM DOH Region 3 Health Promotion Team, like flies in a fan: Veronica Plaza, MD, MPH; Francisco Ronquillo, PA; Lorenzo Garcia; Miguel Acosta; Michelle Melendez; Enrique Cardiel and others, con carino y amor. Talk about a public service brain-drain....

Seems I'm in great company for being "not a good fit" -but (y)our tax dollars are being mysteriously wasted by this local revolving door.

Questions? Ask your Regional DOH PH Division Director, Margy Wienbar, and HPT manager, Jerry Montoya, about it. Then let me know. (You have my permission to access my DOH personnel file.)

And our public health crises march on.

During my DOH tenure I was honored & able to co-produce some important public data reports on UNMH healthcare access (en englais y espanol) and teen pregnancy outcomes in Bernalillo County, and clean-up one very big mess of a county report on teen pregnancy (originally called a "gap analysis" but resembling nothing of the sort) in Bernalillo County. More about that later when the dust settles. Rest assured the BC Community Health Council did the right thing, eventually. In the spirit of disclosure, I chair their Health Access subcommittee.

The plot thickens...

Fondly yours,
Terry

Good-bye for now...

Greetings & Goodbye!
I am retiring this blog for now - but keeping it and it's links available for public use - as I settle in to my new job as a Health Promotion Specialist with the NM Dept. of Health in ABQ's SE Heights Public Health Office. I'll be fortunate to be working with the amazing community groups in the region who are working for real universal access and the elimination of health gaps and disparities. Preventable public health problems like these require the attention of us all, both insiders and outsiders to the system.

For fear of a conflict of interest with my new job, I won't be blogging about the policy issues related to universal access in NM anymore. But I have always been in good community company, so I rest assured knowing the movement for truth and a rational, humane solution to our human/healthcare rights political problems will continue to grow.

Hit me up at my new email if I can help you with evidence-based data requests, public health or community organizing best practices, strategic planning assistance or other technical assistance from the inside...
terry.schleder@state.nm.us

Fondly,
Terry

Do The Right Thing, NM.

Greetings from The NM Roundhouse!

We're coming to you live from the final report on 3 models of Universal Healthcare for NM and, guess what? The Health Security Act (HSA) wins again for our low-income families. Check the link to the right, Insure NM, for the complete report.

Here's the mid-day wrap. More to come!:
1. Multi-payer models of healthcare financing - like we have now- subsidize our private insurance industry to create administrative waste and broker/sales jobs at the expense of clinical care,
2. A centralized-payer for healthcare financing - like the HSA, your local fire deparment, police department and public school - concentrates our precious resources on actual services and away from marketing, spin and staff who specialize in excluding people from care,.
3. Rural and Metro NM will see an increase in jobs, tax-base and primary/preventive clinical services under the HSA model, vs the other two models, and,
4. A real universal model will reduce the inefficient "churning" effect of people coming and going in an "enrollment" process.

More later. Check out "What if you knew?": Terry Riley's new blog and analyses of these models at the link to the right.

In solidarity,
Terry