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News and Opinion Concerning Health Savings Accounts, Medical Costs and Health Care Reform

• New York Times, courtesy of Welcome to Pottersville: The Waiting Game, by Paul Krugman. Full excerpt: Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

  This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

  O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

  The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

  Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

  A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

  A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

  We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance.

  Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.

  This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”

  To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their “medical losses” — the industry term for actually having to pay for care.

  On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

  That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

  The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

• Economic Policy Institute: Employer-provided health coverage declining for college grads in entry-level jobs. By Liana Fox and Elise Gould. Excerpt: A college degree is no guarantee of receiving health insurance on the job. Over the recent recession and recovery, college graduates in entry-level jobs (defined as employed college graduates between 23 and 27 years old) have become increasingly less likely to receive employer-provided health insurance coverage.1 The Chart below illustrates the recent trends in employer-provided health insurance for this group. Their incidence of employment-based insurance has fallen roughly nine percentage points from 1999-2000 to 2004-05, from 69.6% to 60.5%.
• Physicians for a National Health Care Program: Upgrading To National Health Insurance (Medicare 2.0). The Case For Eliminating Obsolete Private Health Insurance. By Leonard Rodberg & Don McCanne. Excerpts: Private health insurance was an idea that worked during part of the last century; it will not succeed through the 21st Century. With jobs increasingly service-based and short-term, the large employment-based risk pools that made this insurance system possible no longer exist. Medical care has become more effective and more essential to the ordinary person, but also more costly and capital-intensive. The multiple private insurance carriers that emerged during the last century can no longer provide a sound basis for financing our modern health care system.

  Alone among the nations of the world, the U.S. has relied upon private insurance to cover the majority of its population. In the mid-20th Century, when medical care accounted for barely 1% of our gross national product, medical technology was limited, and jobs lasted for a lifetime, health care could be financed through such employment-based, premium-financed health insurance. But the time for private insurance has passed.

  Health care has now become a major part of our national expenditures. The premium for an individual now averages more than $4,000 per year, while a good family policy averages more than $10,000 per year, comparable to the minimum wage and nearly one-fourth of the median family income. As a consequence, though the US spends far more on health care than any other nation, we leave millions of our people without any coverage at all. And those who do have coverage increasingly find that their plans are inadequate, exposing them to financial hardship and even bankruptcy when illness strikes. [...]

  Supporters of insurance companies claim that they create efficiency through competition. However, the truth is that insurance industry is increasingly concentrated, with three national firms, United Health, Wellpoint, and Aetna, dominating the industry. And the high and rising cost of health care shows that whatever competition there was in the past has not worked to hold down costs.

  Supporters of private insurance also claim that it expands consumer choice. However, the choice of plans that these companies offer is not what consumers want; it is the choice of their physician and hospital, exactly the choice that private insurance plans, in the guise of managed care, increasingly deny us. [...]

  In sum, we will not be able to control health care costs until we reform our method of financing health care. We simply have to give up the fantasy that the private insurance industry can provide us with comprehensive coverage when this requires premiums that average-income individuals cannot afford. Instead, the U.S. already has a successful program that covers more than forty million people, gives free choice of doctors and hospitals, and has only three percent administrative expense. It is Medicare, and an expanded and improved Medicare for All (Medicare 2.0) program would cover everyone comprehensively within our current expenditures and eliminate the need for private insurance. This is the direction we must go.

• U.S. House of Representatives Committee on Education and Labor Press Release: Reps. Courtney, Miller Introduce Legislation to Boost Healthcare Coverage for Workers with Chronic Illnesses. Bill Would Increase Access to Comprehensive Health Care for 94 Million Americans. Excerpts: U.S. Rep. Joe Courtney (D-CT), joined by U.S. Rep. George Miller (D-CA), unveiled new legislation today that would protect workers with chronic illnesses and pre-existing medical conditions from losing health care coverage when they switch jobs. The bill, H.R. 2833, would end loopholes in current law that allow employers to refuse to provide critical health care coverage for new employees – increasing access to comprehensive health care for the 94 million American workers who suffer from chronic illnesses.

  “Americans who go to work every day to earn a living should be able to get the care they need to live their lives in the healthiest, most productive way they can,” said Miller, the chairman of the House Education and Labor Committee. “This legislation would correct a glaring injustice by ensuring that workers don’t lose health care coverage for their chronic illnesses, like diabetes and high blood pressure, when they switch jobs. I commend Rep. Courtney for introducing this important legislation, which is a huge step towards ensuring better access to comprehensive health care coverage for all workers and is a key part of our efforts to strengthen the nation’s middle class.”

• ABC-TV News, courtesy of The Foundation for Taxpayer and Consumer Rights: When Insurance Won't Pay. Excerpt: All right. We are back with our series "GMA Gets Answers." We keep hearing these stories and we keep weighing in about people in battles with their insurance companies, whatever their doctors have said. And Chris Cuomo is back with another story this morning.
• CNN: Tips to effectively battle your insurance company. By Elizabeth Cohen. Excerpts: Todd Robinson doesn't need Michael Moore to tell him the health insurance system in the United States is in crisis. Robinson's 7-year-old son, Bailey, suffered from adrenoleukodystrophy, a rare genetic disorder affecting the brain, portrayed in the movie "Lorenzo's Oil."

  The Robinsons say their insurance company refused to pay for $200,000 worth of medical bills. The company stamped "denied" on bill after bill, refusing to pay for countless medical services right up until the day Bailey died in 2005.

  The Robinsons are not alone. Tales of frustration with insurers abound. In an Internet survey that included 1,000 consumers, nearly one out of four said he or she had had a legitimate claim denied by their health insurance, according to PNC Financial Services Group.

New on the Alliance@IBM Site:

• New Collective Agreement ratified at Canadian IBM Global Services firm. Excerpts: The 240 members of Local 911, the Communications, Energy and Paperworkers Union of Canada voted 85% in favor of accepting an eleventh - hour contract offer from ISM Information Systems Management Canada on June 21, 2007. Seven days earlier this group of ISM Canada (IBM Global Services) employees had voted 75% in favor of striking after having rejected the employer's initial offer.

  The workers accepted a new two - year contract with wage increases of 4% retroactive to December 29, 2006. An additional 4% increase will occur at the end of 2007 and improvements to benefits will become effective immediately. [...]

  CEP Local 911 is an established bargaining unit that has represented Saskatchewan IT workers since 1973. It is one of two bargaining units at ISM Canada, a wholly - owned subsidiary of IBM Canada. The other group is represented in the Province of British Columbia by the BC Government and General Employees Union.

• From the Job Cuts Status & Comments page (Note: There were a massive number of posts to this page during the last week. The following is a sampling of the large list of posts received by the Alliance@IBM.)
  • Comment 07/19/07: http://articles.moneycentral.msn.com/Investing/Dispatch/070719markets.aspx "This was a really strong quarter, close to firing on all cylinders," Chief Financial Officer Mark Loughridge said on a conference call late yesterday afternoon. Sounds like more RA's to me. I sure do think they are poising Global Services for some kind of sale. Artificially creating profits by stock buy-backs and layoffs. Hmm -Anonymous-
  • Comment 07/19/07: Hurray! Great quarter, everyone! All that hard work sure was worth it. Raises for everyone! Well, for almost everyone! Well, for a few of you. Well, for fewer of you, since there will be fewer of you. But your executives thank you. And really, at the end of the day, isn't that what life is all about? Now shut the hell up and get back to work. -Whee What Fun-
  • Comment 07/20/07: I was "resourced" 5/31 (after my mgmt team flew me out to NY for a week that same month, talk about a waste of money), however, it's the best thing that has happened to me in 7 years of service with big blew! Took a month off with package money, found a new job making 10k more a year about a week after starting to look and am absolutely loving it.

    For everyone left at IBM think long and hard about what you are actually achieving by staying around and doing your "bloated" projects which in my experience typically accomplish nothing each month other than continuous customer let down, creating jobs for technically ignorant long time ibm'ers, and excuses from mgmt on why your career (and salary) are stagnant.

    I was once told IBM is a "way" of life ... you got that right! I finally gave that life up and now after only 1-2 months in a new career am more successful than I was in over 7 years with IBM and am actually smiling while at work. Maybe it’s not IBM, maybe it’s simply big business and sell out CEO’s who care more about the money in their pocket than the sweat and tears put in by their dedicated (not to mention fellow American) employee’s.

    IBM just isn’t what it was, I agree it used to be THE place to work, something to say with pride, now it's simply comedy. Sorry to say but in my opinion a union won't do anything, the company (and its name) is garbage now. To end my rant, thanks IBM (and all of my fellow (ex)co-workers for training me only to let me go so another company can reap the benefits of IBM, now that's lean (only I leaned IBM out of my life) ;) -Thank you IBM and thank you LEAN!-

  • Comment 07/20/07: there will be a layoff at the end of july of 1500 people from the poughkeepsie and fishkill sites. local police told to assist in removal of employees if neccessary.does anyone have more information on this.. -Anonymous-
  • Comment 07/20/07: I work in the Rational brand of SWG. Engineer. Our director recently sent email to the group extolling the virtues of "agile" programming. Much of the material he recommended was related to the LEAN process. How worried should we be? We're already offshoring projects, so that's nothing new. Expect to see it accelerate? Is LEAN being pushed from the top of IBM, and some divisions just choose to use it as the justification for what they'd already planned to do (chop-chop)? While others really try to use it for what value it has? Or is it a corporate-wide chop-chop strategy, couched in happy-looking wrapping? I note that the director mentioned scheduling "agile training" for us next month. If it's the Poppendiecks, should I just jump out the nearest window and save them the trouble? :-) -Anonymous-
  • Comment 07/20/07: In companies where employees can trust the management to do the right thing, a union is not needed. When a company degrades to the point the workers can't trust management, the workers need a union. Looking at history, the American auto companies were non-union and fairly decent places to work until the depression, when the auto companies massively abused their workers. Due to that abuse, the UAW was formed. As I used to so say to my IBM managers (much to their chagrin): "Workers unionize when management fails them." Needless to say, IBM needs a union! -ExRochBeamer-
• From the General Visitor's Comment page:
  • Comment 07/15/07: PDM's were RA'd in GTS - ITS (div 23). They removed the PDM model and went back to a traditional manager model. PDM's who didn't find jobs had their last day on 6/29. -Ex-PDM-
  • Comment 07/15/07: Almost all the PDMs (around 70%) and a few RDM's (about 15%)in IGS GTS sales and delivery have been RA'd. The rest will either be made into delivery or sales leaders or be RA'd in the planned 9/1 RA. -GTS Grunt-
  • Comment 07/16/07: Our department of about 22 people moved our data center to a new location over the weekend. We went from shared offices, to a cube farm in a renovated warehouse. The noise level is too high for the level of concentration we need for our work (it might be saving IBM money in real estate, but it's hurting them in our productivity). It's really a mess from the lighting (ceiling is up about 22 feet) to smells coming out of floor drains in the bathrooms. Signs in the bathroom above each toilet say "Please FLUSH after use". I'd hope we're hiring people that know how to at least do that. But I guess it could be worse. Another smaller department busted their rear ends all weekend to move their equipment, and management thanked them in a meeting today by changing their job titles to a lower level. I guess they had to find the money for the stock buyback and Sam's raise somewhere! What a great thing to tell these people after they've moved. I guess it's good management waited until after the work was done to tell them the news. -Anonymous-
  • Comment 07/18/07: Wonder how IBM made their 2nd qtr. results? A good part of it was the lack of decent raises given out on June 15th. What IBM didn't give you for working your arse off for them is what went to the profit. And guess who is going to get real big bonuses now? Not you! But Sam and his boys. So just work harder IBMers! Give up more of everything for your beloved company and the way IBM will say thank you is cut your benefits and give you less and less. And maybe an extra thank you when you get LEANed before September is through. A contract would level the playing field and give us our share of the quarterly profits. Are you interested? -Anonymous-
  • Comment 07/21/07: The team based decision meetings are to be held next week. Can anyone tell us more about it? Did we ever have it years ago? As far as I understand, every 1st line manager and their 2nd line manager are discussing and determining the ranking of their fellow employees. -Team Based Decision-
• Pension Comments page
  • Comment 07/18/07: I wouldn't be surprised IBM will not only freeze the pension plan on 1/1/2008 but they will terminate it if it saves them money and just give everyone who is vested for a pension the lump sum and be done with it just to save paying the paltry interest credits on the frozen pension balances. -Anonymous-
  • Comment 07/18/07: i work at east fishkill. ive been with the company 28 years. i remember about 20 years ago reading on the bulletin board at work that ibm had 27 billion in the pension fund. now they say they have 2 billion. to say they screwed the employees is an understatement. they stole our pension, plain and simple. -Anonymous-
• Raise and Salary Comments
  • Comment 07/16/07: Salary = $42.900; Band Level = 6; Job Title = IT Specialist; Years Service = over 6; Hours/Week = 40; Location = Canada; Message = I started drinking already. I'm getting screwed year after year. Oh yes, the Salary is in Canadian dollars. Sorry band 6 for dropping your average. -Test-
  • Comment 07/16/07: Here is the monthly salary survey update.
    • Band 2: 3 respondents, avg: $35K, standard deviation: $9K, range: (min/max reported): $24K to $40K
    • Band 3: 1 respondent, $25K
    • Band 4: 11 respondents, avg: $46K, standard deviation: $11K, range: $32K to $60K
    • Band 5: 3 respondents, avg: $58K, standard deviation: $16K, range: $48K to $77K
    • Band 6: 28 respondents, avg: $62K, std dev: $8K, range: $48K to $79K
    • Band 7: 59 respondents, avg: $71K, std dev: $14K, range: $49K to $110K
    • Band 8: 60 respondents, avg: $99K, std dev: $16K, range: $60K to $130K
    • Band 9: 30 respondents, avg: $118K, std dev: $17K, range: $89K to $152K
    • Band 10: 11 respondents, avg: $148K, std dev: $25K, range: $107K to $190K

    Notes: It has been reported that the "official" range for band 8 (Software Engineer, 01A) is 60K to 144K; - I have added Bands 2, 3, and 5 for completeness, even though the number of respondents is small; - Only US respondents figure in the above since there is too much fluctuation in exchange rates to take into account non-US salaries. -Anonymous-

  • Comment 07/17/07: Salary = 42000; Band Level = 2; Job Title = ssr; Years Service = 10; Hours/Week = 40 to 50 any more isn't worth it; Div Name = igs; Location = central; Message = IBM means service award twice in 10 years. Told in symposium were the top 5%. The best of the best. Why doesn't compensation reflect that? 3% raise in this economy is an insult. -1 check from the poorhouse-
  • Comment 07/18/07: Salary = 64K; Band Level = 7; Years Service = 3; Hours/Week = 40; Location = Tulsa; Message = Finally got a promotion to band 7. Yee haw. Oops, there must be a error in the payroll system since I only got a 3% raise for my promotion. Seeing that this is the first raise that I've received in the 3 looong years that I've been exiled here, I guess it probably isn't an error after all. I'm sure I won't get anything next year, even though IBM just announced wonderful quarter 2 results. Time to look elsewhere. -stupid for staying-
  • Comment 07/19/07: Salary = $120,000; US Band Level = 8; Job Title = Consultant; Years Service = 1; Hours/Week = 45; Div Name = GBS; Location = NY; Message = No raise and a 2% bonus. Ex-employee by the end of the month. -Blue Moon-
  • Comment 07/19/07: To "stupid for staying": Congratulation on your promotion! But as you will see getting promoted in IBM is no big deal now. Certainly it doesn't mean big $$$ or even the potential for bigger $$$. I hope your management doesn't drop your PBC rating since now "they have raised the bar" when you got promoted. This has happened to me and has happened to others and will continue to happen as long as we don't get some protections and a fairer appraisal process through a union contract. -band_on_the_run-
• PBC Comments

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