There are statistics, and then there are scary statistics. The Center for American Progress estimates that 1.3 million Americans have lost their health coverage in the last 4 months.

We estimate that 2.4 million workers have lost the health coverage their jobs provided since the start of the recession, based on data from the U.S. Census Bureau and the Bureau of Labor Statistics. Approximately, 1.3 million of these losses have occurred in the last four months. More than 320,000 Americans lost their employer-provided health insurance in March alone, which amounts to approximately 10,680 workers a day.

10,680 workers a day. Wow. Scarier still, the sectors where jobs are being shed. Not only in the traditional areas, like manufacturing and retail, but an astounding 594,000 in the professional and business services sector alone. That’s a huge number, exceeding the number lost in the durable manufacturing sector. If the number doesn’t boggle your mind, this chart should:

The only sectors experiencing substantive growth in coverage were public sectors — government, education and health services. Worse yet, there is unlikely to be any growth until the availability of health insurance is not in the exclusive hands of employers, particularly in a time where so much of the workforce is unemployed.

There is only one message to take away from these statistics: a public health insurance plan is a must. It is no longer a given that the broadest coverage will be met via employer-based health insurance.

The rapid loss of health coverage demonstrates the fundamental instability of health insurance protections in our current system and the need for comprehensive health reform. As President Barack Obama asserted in a White House forum in March, “Health care reform is no longer just a moral imperative, it is a fiscal imperative… If we want to create jobs and rebuild our economy, then we must address the crushing cost of healthcare this year, in this administration.” The time to deliver quality, affordable health care coverage to our nation’s families is now. The American people cannot afford another missed opportunity.

Download the full report here. (PDF)

(cross-posted to the Bipartisan Report)

I’ve just read a Huffington Post article on the issues surrounding women’s health and what’s needed in health care reform. The author pointed to the fact that nearly one in five women lacks health insurance, and therefore delays care. The article, of course, is meant to draw the attention of the Obama administration to the plight of women just as we sit down to discuss reform.

Uninsured Americans are more likely not to comply with medication regimens, seek needed care, or incur further debt if they can possible help it. They are also more likely to take jobs they may not be suited for and don’t like, and hang on to these jobs “for dear life,” to use an old turn of phrase, just because of the medical benefits.

When they are laid off, they lose their insurance, and very often since they are heads of households, their children lose, too.

Trust me, this is not a woman’s problem, however. You can skew the statistics any way you like, but men have the same problem, and in this recession men are being laid off faster than women. Last month, 663,000 more people lost their jobs. I see them in every Blueprint for Survival workshop, and their first issue is always health insurance. And if it isn’t, I make sure to bring it up because it should be.

When this recession is over, we will be confronting a profoundly changed America. We may have different kinds of jobs in different kinds of companies. Who knows whether the very companies we want to create “green” jobs, most of which are small and innovative (and not rich) can afford to pay benefits? Why should they have to?

I worry about how much of what has trickled out about Obama’s reform plans still depends on the old industrial economy with its big companies (that are now going under because of their health insurance costs) and employer-sponsored benefits. Putting it back on the employer just won’t work anymore. Nor will mandating that unemployed people buy health insurance.

There’s no way I want the health care system nationalized. There’s no way I want people to stop making a living. But I do want health care made into a social enterprise, perhaps even with non-profit status. Remember when we had non-profit hospitals? Church-run hospitals? It wasn’t on the backs of the government, nor was it on the back of the employer.

The way insurance companies and drug companies have been profiting at the expense of their customers is insane and unsustainable, and is no better than the banks.

We’ve seen where greed got the banks. Greed has gotten the health care industry into the same “pickle.” Like the small community banks, we need small, non-profit community health centers. Wouldn’t that drive down the cost of health care? Can’t we treat it like a public utility?

Let’s at least discuss this — here, on Friendfeed, anywhere you want — and get some new ides on the table.

I was going to write a nice dry post about all the changes that the economic stimulus package (ARRA) made to COBRA, but then I noticed that it has been done by many who have spent a considerable amount of time researching it.

Instead, I’m going to update my COBRA story.

I. Draconian Decisions

Like any employee working for a large company, at the time of my layoff I was given the option to extend my health coverage, at the low, low price of $1400/month for health coverage and an extra $100/month for vision and dental. I also had a dilemma: Part of the terms of severance was a short extension of health coverage, but as far as I could tell, I had to opt-in to COBRA to receive it.

So I did. I also set aside the $1500 for the February coverage from savings, leaving me with very little in the way of cash to get by, but for us, health insurance is an imperative. Beyond February, I wasn’t sure what to do. There was no way I could afford another $1500 payment, and if I didn’t have another job I wasn’t going to have coverage, so it was back to comparing plans that were no comparison at all to what I had.

My current plan is a PPO with a low deductible, pharmacy benefits, and decent catastrophic coverage. The individual plans I was comparing had $10,000 deductibles, no pharmacy benefits, and I would more or less be out of pocket for any doctor visits. The upside? I could get one for about $700/month.

I tried to estimate what doctor/pharmacy costs would be entirely out of pocket, and realized my net cost would be about $500/month on top of the $700/month, because without the pharmacy benefit, I pay full retail for medications that are necessary for our family.

It wasn’t much of a choice, because adding a monthly cost equal to a decent-sized house payment to the budget in a time where I wasn’t working (and freelance work is scarce, too) really meant I would have to risk having no insurance at all, and paying the out-of-pocket costs for the medications.

It also meant that I did not have the means to go down the route of self-employment and a reinvented career, and most importantly, the risk of having no insurance meant we could lose our house or declare bankruptcy if one of us became seriously ill.

These are not light decisions to make. No matter which way we went, the pathway was dark and uncertain. They are decisions millions and millions of laid-off workers are making every day. I am not unique at all.

II. President Obama understands that health care reform is the center of recovery

My light came in the form of the House version of the economic stimulus bill. The original version included an 18-month subsidy for laid-off or terminated workers (provided it wasn’t for cause) of 65% of the COBRA premium. Do the math for me, and it comes out to something far more manageable (around $490/month, plus $100 for the dental/vision if I opt into that).

As I watched the bill go from the House to the Senate, my hopes were dashed. The Senate version of the bill had no provision for COBRA subsidies, and the rumors I was hearing said they had no intention of including them. Fortunately, enough noise was made about it (from those within the administration and those like me, who were urging calls to Senators) that it was included in the compromise.

Unfortunately, the compromise watered down the subsidy to 50% and 12 months. Still, better than nothing.

Now we have the final version. It provides for the 65% subsidy for a 9-month period. This means that those of us who have joined the ranks of the unemployed can now breathe a little easier while we figure out what to do next, whether it be to launch a new venture, find a new job, or do whatever we have to for our families to eat and have shelter.

III. Real stories of how it works

Health care reform is at the center of our economic well-being. Extending COBRA gives unemployed workers a chance to breathe and get affordable insurance to bridge the unemployment gap. It also leaves those same workers with a far higher percentage of disposable income to put back into the economy in the form of spending, or perhaps simply being able to swing their house payments and stave off foreclosure while getting back on their feet. Either outcome works to better the economic big picture.

My neighbor’s story is similar to mine, except that she is a casualty insurance underwriter who has been out of work for nearly six months. At the time of her layoff, she’d just managed to renegotiate her mortgage to a manageable level and was getting back on her financial feet after nearly losing her home.

Being laid off meant she had to make a choice between health insurance and mortgage payments. She chose the mortgage. Opportunities in her line of work are scarce and far between. She goes on interviews all the time for related jobs, but a job with her skills is hard to find right now. When AIG has to be bailed out and bought by the federal government, it’s not a great time to be looking for casualty underwriter jobs.

The stimulus bill, though, offers hope. All of those projects to build bridges, fix roads? They’re going to be bid on by contractors, and those contractors are going to have to have casualty insurance as part of their package, which in turn means that casualty underwriters, particularly ones with experience in the building/contractor market, will be in demand.

That means she may have employment sooner than she thinks. When she’s employed, she can catch up on her mortgage, and begin to buy things that may be more than the absolute minimum to get by. It means her college-aged daughter can go back to school instead of working full-time at a minimum wage job to help with family expenses.

For me, I now have the space to consider the possibility of launching my own business or at the very least, working freelance while the web community landscape stabilizes a bit. If I go the route of self-employment, I will be putting funds back into the economy and becoming part of the backbone of what makes this country great: the small business meeting niche needs in creative and cost-effective ways.

Remember these two stories when you hear the naysayers tell you that the country is going to hell in a handbasket because the government is spending money. Make no mistake: The government has been spending money for years, long before President Obama was elected. It just wasn’t spending it on us.

Now it is. And we have a responsibility to be responsible, too, and take care of business, try to find jobs, try to invent ones. I honestly think there will need to be a second piece of legislation that extends the 9 month period, because the key to true, long-lasting economic recovery is going to be true, deep health care reform that doesn’t put a bandaid on an ailing system.

Tell us how you’re affected by the stimulus package. Do you have more hope for your future? Do you see opportunities? Leave a comment.

…and shoots across the bow of obstructionists in Congress. Expanded SCHIP benefits were widely supported on a bipartisan basis and sailed to President Obama’s desk where he signed it into law with a flourish and a warning.

The flourish:

This is not who we are. We are not a nation that leaves struggling families to fend for themselves. No child in America should be receiving her primary care in the emergency room in the middle of the night. No child should be falling behind at school because he can’t hear the teacher or see the blackboard. I refuse to accept that millions of our kids fail to reach their full potential because we fail to meet their basic needs. In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation – health care for our children is one of those obligations.

The Warning

President Obama made it clear that he views his Economic Recovery and Reinvestment Plan as a key first step toward comprehensive health care reform.

Think about this – if Congress passes this recovery plan, in just one month, we’ll have done more to modernize our health care system than we’ve done in the past decade.

We’ll be on our way to computerizing all of America’s medical records, which won’t just eliminate inefficiencies, save billions of dollars and create tens of thousands of jobs – but will save lives by reducing deadly medical errors. We’ll have made the single largest investment in prevention and wellness in history – tackling problems like smoking and obesity, and helping people live longer, healthier lives. And we’ll have extended health insurance for the unemployed, so that workers who lose their jobs don’t lose their health care too.

He also made it clear that he was committed to getting this work done, and that he was not going to tolerate politics as usual with regard to Americans’ futures:

Now, in the past few days I’ve heard criticisms of this plan that echo the very same failed theories that helped lead us into this crisis – the notion that tax cuts alone will solve all our problems; that we can address this enormous crisis with half-steps and piecemeal measures; that we can ignore fundamental challenges like the high cost of health care and still expect our economy and our country to thrive.

I reject these theories, and so did the American people when they went to the polls in November and voted resoundingly for change. So I urge members of Congress to act without delay. No plan is perfect, and we should work to make it stronger. But let’s not make the perfect the enemy of the essential. Let’s show people all over our country who are looking for leadership in this difficult time that we are equal to the task. Let’s give America’s families the support they need to weather this crisis.

Any meaningful effort for health care reform has to include the participation of the IT community and continued progress toward electronic health records, streamlined claims procedures, and ability to disseminate public health information efficiently. The National eHealth Collaborative aims to partner the public and private technology communities to create a “secure, interoperable, nationwide health information network.”

From their press release:

The National eHealth Collaborative brings together these stakeholders to accelerate development of the health IT systems, infrastructure, standards, protections, participation, and education needed to create a secure, interoperable, nationwide electronic health information network. The Collaborative provides a needed and credible forum for stakeholders to transparently vet and prioritize national advancement efforts and leverages the value, resources and best practices offered by both the public and private sectors. The Collaborative works in close partnership with the Health Information Technology Standards Panel (HITSP), the Certification Commission for Health Information Technology (CCHIT), and the Nationwide Health Information Network (NHIN), as well as other health and IT member organizations.

The complete list of their directors is here.

Here is a list of their goals:

• Consistent standards to guide the development, sharing and updating of confidential individualized health information within a secure national network;
• Education, guidance and incentives for widespread adoption of electronic health records by health systems, health professionals and individuals;
• Creation of the secure, interoperable network that enables immediate, consistent, protected access to relevant personal health information at the point of care, anywhere and anytime it is needed;
• Collaboration among a wide variety of institutions and organizations to enable broad, efficient, seamless and confidential exchange of secure, individualized health information—leading to system-wide improvements in health outcomes, access, and quality of care, as well as reduced costs over time; and
• Partnership with members of the Nationwide Health Information Collaborative and others to develop a governance plan for the Nationwide Health Information Network.

While I view this as a positive movement toward health care reform, their board members seem to come from insurance companies and corporate interests, with no representation from the technology sector. Shouldn’t companies that actually create the platforms be a key player in the discussion?

Science Daily: U.S. Congressional Health-care Reform Proposals Would Offer Coverage To Many Without Insurance

With health reform high on the agenda of the incoming Congress and President, a new analysis of legislative proposals—including the plans of President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus (D-MT)—shows that several proposals already put forth could substantially reduce the number of uninsured Americans, and would either reduce health care spending or add only modestly to annual health care expenditures.

The proposals demonstrate that it is possible to cover everyone with little or no additional total health spending, but to do so means requiring that everyone have coverage, and achieving administrative savings and purchasing efficiencies by building on public programs and group purchase of private insurance—either through employers or insurance exchanges.

SEIU: Six Diverse Groups Unite in Nationwide Call for Health Care Reform as Key to Economic Reform

Washington, D.C. – Six organizations representing consumers, physicians, insurers, patients and pharmaceutical research companies are banding together to launch a new multi-million dollar national television advertising buy. Their common message: In order to fix the ailing economy, the nation needs health care reform that addresses the related problems of health care costs and people losing health coverage.

HCAN (Health Care for America Now): Richard Kirsch: “We’re going to have to be in our communities talking to people whether it’s by text message or phone or on the Internet but also in people’s faces, in the street demonstrating – everything it takes to make it clear to Congress and this country that it’s about time we all had good affordable health care.”

From the WSJ Health Blog:

A bullet point within his economic agenda says:

Obama and Biden will create an exemption in bankruptcy
law for individuals who can prove they filed for bankruptcy because of
medical expenses. This exemption will create a process that forgives
the debt and lets the individuals get back on their feet.

This is great news for those who are facing bankruptcy or have already declared bankruptcy because they simply couldn’t pay the bills.

What isn’t clear is how debt forgiveness will work. Right now, declaring bankruptcy does not release individuals from the obligation to pay the bills. Discharging debt will leave hospitals and providers with a need to write off assets, which will certainly cause a tilt on their balance sheets.

Still, it’s a step in the right direction, no question.

Just over a year ago, US Senator Barack Obama spoke these words:

One year from now, we can stop campaigning on the outrage of 47 million uninsured Americans and finally start doing something about it.

That time is NOW. Yes, the economy is in the tank, Israel is bombing Gaza, we have troops in Iraq and Afghanistan is looking gloomier by the day. Still, the true foundation of the ‘fierce urgency of now’ is reforming our health care system and opening access to all citizens of this country without regard to employment or pre-existing conditions.

As employees are laid off and jobs outsourced to foreign countries, more and more people are faced with this choice: Go bankrupt paying for health insurance or go bankrupt paying for health care. I know this from personal experience. I am a self-employed person who was also a full-time employee with health insurance benefits until December 31st, when I also made the layoff list.

The fierce urgency of now means that I must maintain my health insurance for me and the family no matter what the cost, because of pre-existing conditions which require that I have continuous coverage in order for them to be covered in the future. Did you follow that? It’s an important distinction for many, many Americans facing layoffs and looking for new jobs.

The cost for me to continue this insurance is exhorbitant. It costs twice what I can get as an individual, except that if you are an individual and you have COBRA continuation available, you must exhaust the COBRA coverage first. That means that I will pay $1,300 per month instead of $650 per month for similar coverage as an individual.

Or, I can go without coverage and take the risk that no catastrophe strikes our family before I find another job with insurance. That would also mean we would be forced to wait six months before getting any coverage for pre-existing conditions, which could be a catastrophe in itself.

I’m one of the lucky ones. Other families have no means with which to pay for health coverage and have to rely upon good luck and Medicaid, which means they are less likely to focus on wellness, much more likely to wait until a condition becomes an emergency, and ultimately become the responsibility of the government.

On the business side of things, profit margins drop with every new enrollment period. Employers shave away benefits without dropping them completely in order to stay afloat.

Health care is not optional. When George Will rather sneeringly suggests that the issues surrounding Medicare are a function of overutilization, price-fixing, and — gasp! — recipient ignorance about the cost of goods and services being furnished to them while ignoring the fact that the patient is a captive audience, he misses the larger and far more urgent picture: People die without health care. If they can’t pay for it, the government picks up the tab. This is because health care is as urgent a need as shelter, food, and warmth, and it is slipping from our grasp in real time.

I have paid (or my parents, their employer and my employers have paid) for health insurance since the day I was born. After 50 years, I do not wish to be told that I am responsible for a drain on the national budget or a spike in the national debt. Amortize what has been paid by me and on my behalf for 50 years and it will surely exceed the average lifetime cost of health care that has been provided to me, even with the birth of three children on that tab.

This is it: the future of our country in real time. ‘Bankrupt or bare’ are not viable options. Health care reform has to be on the agenda at the very first Cabinet meeting on January 21st. President-elect Obama has asked for our stories, suggestions, and solutions to the problem. Let’s be ready to serve them up on the first day of his Presidency.

Here are my suggestions for the first steps to take:

• Establish baseline federal standards for health care that override the widely varying current state-to-state standards.
• Begin an immediate public audit of the payor/payee system, beginning with insurers and related entities. There should be full transparency as to actuarial assumptions used to calculate premiums, criteria for claims processing, administrative fees and costs, as well as any profit-taking from related companies. In particular, examine the relationships between Pharmacy Benefit Managers and Insurers, which appear to me to be rather incestuous in some cases. This audit must be undertaken in public, in real time, either via streaming video, webcam, or on CSpan so that the public will have the opportunity to follow and participate.
• Give immediate education financing incentives to qualified pre-med and medical students to enter the field of general medicine rather than specializing.
• Streamline and consolidate medical records. Electronically, of course.
• As a stopgap measure, open enrollment in the Federal government plans to private citizens at the same rates (as candidate Obama promised) so that laid off, unemployed and self-employed individuals have the opportunity to buy health insurance at a cost that won’t bankrupt them and get coverage that will be meaningful when needed.

These are my first-blush ideas. We have 2 weeks until Barack Obama’s inauguration. I hope you’ll add your ideas, thoughts, suggestions and stories in the comments. As more voices rise, so will the best ideas rise, answering the urgency, the absolute need of NOW.