Shawn Donahue is an attorney at Blue Cross & Blue Shield of Rhode Island and last Tuesday he spoke at the House Corporations Committee meeting to oppose a bill that would ensure “no pregnant applicant for medical insurance coverage would be denied coverage due to her pregnancy.”

I want to stress at the outset that Donahue seems like a decent man, and I sensed that he was somewhat uncomfortable speaking out against this bill.

“No one believes in the importance of pre-natal care more than Blue Cross,” said Donohue, “We’ve invested in it.”

That’s true. “Getting early and regular prenatal care is one of the most important things you can do for the health of both you and your baby,” says Blue Cross on its website. The site contains a wealth of information and advice on healthy pregnancies. But we don’t have to assume that Blue Cross is promoting neonatal care out of any sense of public service. Healthy pregnancies are cheaper for insurance companies. An insured baby, with proper neonatal care, is less likely to have expensive health problems going forward.

The importance of prenatal care is underscored by the health risks associated with not having such care.

“Women in the United States who do not receive prenatal care have an increased risk of experiencing a neonatal death… Lack of prenatal care is associated with a 40 percent increase in the risk of neonatal death overall…” says the Guttmacher Institute, citing a study, “Black women are more than three times as likely as white women not to receive prenatal care, and regardless of their prenatal care status, their infants are significantly more likely to die within their first 27 days of life than are infants born to white women.”

Other risks from not receiving adequate prenatal care include low birth weight for the infant, and pre-eclampsia, a form of organ damage, that affects the mother. From a human perspective, this is terrible and unnecessary. From the perspective of an insurance company, such health problems are expensive.

Yet, said Donohue, speaking for Blue Cross at the Rhode Island State House, “The only way insurance works is if you purchase it when you don’t need it so it’s there for you when you do. If you allow people a special enrollment period, whether they’re diabetics, cancer patients or pregnant people, they won’t buy it until they need it.”

The Affordable Care Act (ACA or Obamacare) mandates that Rhode Islanders buy private insurance on the state run health insurance exchange, HealthSourceRI. “If you’ve missed the open enrollment period,” said Donohue, “ you’ve broken the law and now you are penalized for that, and the penalties start to grow.”

Donahue is talking about financial penalties of course, but the real penalties from a societal point of view are dead babies, or babies and mothers with terrible health outcomes. Suddenly the financial penalty for not complying with the ACA mandate seems rather small and meaningless, doesn’t it? But more to the point, it’s exactly these negative health outcomes that Obamacare was supposed to address.

“We don’t let people buy insurance on their way to the hospital in an ambulance,” said Donahue. I would say that having to worry about financial issues during a medical emergency is a major system failure, and further, these gaps in care for vulnerable Americans expose the weaknesses in today’s for-profit health insurance industry, of which Blue Cross & Blue Shield of Rhode Island is a big part.

According to Physicians for a National Health Program (PNHP), “Single-payer national health insurance, also known as ‘Medicare for all,’ is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

“The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.”

On the national scene Bernie Sanders has championed single payer, calling it Medicare for All. “Health care must be recognized as a right, not a privilege,” says Sanders, “Every man, woman and child in our country should be able to access the health care they need regardless of their income. The only long-term solution to America’s health care crisis is a single-payer national health care program.”

State Representative Aaron Regunberg has introduced, for the second time, a bill to bring the benefits of a single payer health insurance program to Rhode Island. His bill would “act would repeal the ‘Rhode Island Health Care Reform Act of 2004 – Health Insurance Oversight’ as well as the ‘Rhode Island Health Benefit Exchange,’ and would establish the Rhode Island comprehensive health insurance program.”

His bill deserves our support.

A single payer system could save the country over $400 billion a year says Dr. Oliver Fein, but he would prefer we call it “Improved Medicare For All.” Fein says that a system based on private insurance programs, like the one we have now, will not lead to universal coverage and will not create affordable coverage, whereas a Medicare for All system can lead to universal comprehensive coverage without costing more money.

In concert with Physicians for a National Health Program (PNHP-RI), gave a talk to a class of med students at Brown University’s Warren Alpert Medical School in Providence.

Bernie Sanders has been a strong advocate for a Medicare for All approach to our health care, including the idea among his campaign issues. “The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people,” Sanders said. “Meanwhile, we spend far more per capita on health care with worse results than other countries. It is time that we bring about a fundamental transformation of the American health care system.”

What Fein does in the lecture below is explain how our present healthcare system fails us, how a Medicare for All system will improve health care outcomes, and outline a possible path from our present system to universal health care for everyone.

[Adam Miner provided additional reporting, video and photographs.]

Dr. Oliver Fein, representing Physicians for a National Health Program (PNHP-RI), gave a talk Monday night to a class of second year med students at Brown University’s Warren Alpert Medical School in Providence. The talk was open to the public, but due to the snow storm attendance was low. That’s too bad, because Dr. Fein’s talk was an informative and eye opening examination of both the history of public healthcare in the United States and the possibility of transforming the current system beyond Obamacare and towards a system of truly universal coverage, what supporters call, “Medicare for All.”

In the video, Dr. Fein covers the history of healthcare in the United States, starting with President Truman’s suggestion that some sort of universal health care program might be a good idea, right up to President Obama’s successful passage of the Affordable Care Act. (For Dr. Fein’s summary, go here.)

At the 17 minute 30 second mark Fein leaves history behind and explicates the ideas behind a single payer healthcare model, or what he calls an “Improved Medicare for All.” Such a system would build upon and expand Medicare to the entire population, improve and expand coverage in the areas of preventive services, dental care and long term care, eliminate deductibles and co-payments, expand drug coverage (eliminating the “donut hole”)  and redesign physician reimbursement.

Several points leapt out at me during Dr. Fein’s presentation. Using data from 2009, Fein reported that 62% of personal bankruptcies were due to medical expenses and 75% of those who declared bankruptcy had health insurance. For too many people, it seems, health insurance did nothing to prevent financial disaster.

Fein also reported that overhead costs in administering Medicare run about 3.1%. Commercial healthcare runs near 20%. This means that 17 cents (or more) of every health care dollar is wasted on administrative costs or corporate profits under our current system of private insurance. This is money that could be going towards patient care.

Fein concluded that a system based on private insurance programs will not lead to universal coverage and will not create affordable coverage, whereas a Medicare for All system can lead to universal comprehensive coverage without costing more money.

“What will happen if we don’t do this?” asked Fein in conclusion, “By [the year] 2038 a person’s entire household income will… have to pay for health insurance. A condition that’s not compatible with life.”

Rhode Island

Gerald Friedman, a PhD and Professor of Economics at the University of Massachusetts at Amherst released a 41 page report earlier this month on the possibility of adopting a single payer healthcare system here in Rhode Island. Friedman maintains that a single payer plan would result in significant savings for most Rhode Islanders and only increase healthcare spending for those making over $466,667 a year.

Representative Aaron Regunberg, from the East Side’s District 4, is planning to introduce legislation for a statewide single payer healthcare plan this session. Model legislation from the PNHP is available here.

More information about the Rhode Island branch of the PNHP can be found at their website.