Union Behavior Might Be Obstacles in Transforming American Healthcare

Some interesting articles in USA Today regarding union positions about the H1N1 vaccine which suggest that transforming American medicine so that it is higher quality, improved access, and even more affordable will be extremely difficult if not impossible.

Some hospitals, healthcare organizations, and the state of New York attempted to have staff required to get the seasonal and H1N1 vaccines. Even though, Infectious Diseases Society of America recommended all healthcare workers get flu shots, the Service Employees International Union (SEIU) opposed this and won.

Although patients are lining up demanding flu shots, doctors and the Centers for Disease Control want those at risk, SEIU indicates that the issue is education, rather than attaining compliance by fiat. To be completely fair, too many doctors don't get vaccinated either which is equally as disturbing. In healthcare, we make too many exceptions rather than require that the right thing gets done at all times.

While I was troubled by the behavior of SEIU, I can understand while disagree with their opposition to mandatory vaccination. It seems more of a political decision rather than scientific.

Yet, later that week SEIU was again in the news. This time upset about the distribution of flu vaccine to companies that have employed in-house doctors and clinics. Specifically, the union had a problem with companies like Goldman Sachs which received vaccinations from the City of New York in a equitable system where only those at highest risk (chronic illnesses or pregnancy) were to be immunized and the original distribution was reserved for pediatricians and obstetricians who requested vaccine. Sadly only about half of the pediatricians in New York City wanted it. As a result, the city moved on to give vaccines to those doctors caring for adults, which included the physicians working at Goldman Sachs as well as the Federal Reserve Bank, Columbia hospital, and Time. From the article:

"Wall Street banks have already taken so much from us. They've taken trillions of our tax dollars. They've taken away people's homes who are struggling to pay the bills," union official John VanDeventer wrote on the Service Employees International Union website. "But they should not be allowed to take away our health and well-being."

The union has about 2 million members, including health care workers.

Um, so wait. Healthcare workers are considered a high-risk group as defined by CDC. Naturally healthcare workers should be among the first in line to get the vaccine. If you had agreed to a mandatory vaccination program for those in the union who are healthcare workers, wouldn't that mean those in your union therefore are vaccinated and kept healthy? Getting the vaccine, which is in short supply wouldn't be a take away, but a benefit!

Having mandatory vaccinations in really only a small issue in a much larger problem. How can employers and unions get together and transform American healthcare?

To be clear, I'm not opposed to unions. One of the most successful organizations ever is Southwest Airlines, which to the surprise of many who don't know, is among the most unionized airline in the country.

I'm troubled because companies like General Motors failed because unions and employers were unable to see eye to eye. As a result, it failed because it was unable to compete with foreign competitors. Unlike the auto business, there foreign national healthcare organizations wishing to take over the US marketplace.

What it does mean, however, that making healthcare better and cheaper won't happen. Result? Government takeover or increasingly more Americans uninsured, worsening healthcare quality, and increased costs.

Voluntarily uninsured isn't a calculated risk but a gamble. Can you really afford to lose?

This recent NPR piece on Voluntarily Uninsured: A 'Calculated Risk' got my attention. There are some people who don't buy health insurance. They are healthy. They can afford health insurance. They don't feel the need.

They are wrong.

As a practicing doctor, it is worrisome to hear people are voluntarily uninsured because of a false belief. Having good health is highly unpredictable. Children develop cancer without having a family history or adequate time to assault their bodies with cigarettes or alcohol. Women with healthy pregnancies may need a crash C-section, which is far more expensive than a vaginal delivery. Too many people are injured from motor vehicle accidents requiring significant medical care. Non-smokers do develop lung cancer and the astronomical costs of chemotherapy.

Good health is somewhat unpredictable the same way the chances of you getting into a car accident is a crap shoot.

Assume you are an excellent driver. Never speed. Never had a traffic violation. In fact, you abide by the rules and recommendations to stay safe that other drivers honk you incessantly when you drive 25 miles an hour in a residential area and that even the police department flags you down when going 55 miles an hour on the highway because it is such an anomaly. Your passengers groan when you buckle up simply to move your car from the street into the driveway.

A drunk driver seriously injures you on your way home from work.

You did everything right and yet there you are. An accident occurred and no fault of your own.

At least you have auto insurance and can get some of the costs back.

Serious car accident or serious illness. While we have some control, in many cases it is out of our hands. In other words, while we can decrease risk by staying healthy, as a doctor I see too many times people getting seriously ill with no definable cause. Voluntarily uninsured is not calculated risk but rather a gamble. It's a gamble none of us can afford to lose because of a misconception.

As the subject in this NPR article finally admitted in the end, serious illness could bankrupt her and cause her to lose her business. She is seeking some catastrophic insurance. In the end, some insurance is better than none.

Uninsured Driving Healthcare Costs for the Insured

A recent Associated Press article found that the uninsured are adding $1000 to a family's health insurance premium annually and an additional $370 per year for an individual. Families USA which sponsored the study called this additional surcharge a "hidden tax" that is simply growing as more people becoming uninsured.


No one should be surprised about the findings. When people require medical care and are uninsured, they still get medical care. They might not be able to pay the bill. Since the medications, professional services, laboratory, and imaging testing all have costs and are not free, who ends up paying the bill? Those employers and families who purchase health insurance.


Clearly this must stop. We need to require an individual mandate that requires everyone to purchase health insurance to stop this escalating cycle. As Aetna CEO Ron Williams noted:

• "Our members then say, 'Well, why is health insurance so expensive?'" Williams said in an interview. "And the answer is because you're paying for your own care as well as for the care of some of the uninsured in the community."

Understanding the basics of insurance it is clear why insurers want an individual mandate. Risk of the few must be spread across the entire population. Anything less than that will simply result in cost shifting and increasing premiums resulting with more uninsured. Repeat cycle.

The entire AP article follows:


Study says uninsured are costly for all
By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – 1 hr 1 min agoWASHINGTON – The average family with health insurance shells out an extra $1,000 a year in premiums to pay for health care for the uninsured, a new report finds.
And the average individual with private coverage pays an extra $370 a year because of the cost-shifting, which happens when someone without medical insurance gets care at an emergency room or elsewhere and then doesn't pay.
The report was being released Thursday by advocacy group Families USA, which said the findings — which it calls a "hidden tax" — support its goal of extending coverage to all the 50 million Americans who are now uninsured. Congress and the Obama administration are working on a plan to do that.
Families USA contracted with independent actuarial consulting firm Milliman Inc. to analyze federal data to produce the findings.
"As more people join the ranks of the uninsured, the hidden health tax is growing," said Ron Pollack, Families USA executive director. "That tax hits America's businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health care coverage."
The report found that, in 2008, uninsured people received $116 billion in health care from hospitals, doctors and other providers. The uninsured paid 37 percent of that amount out of their own pockets, and government programs and charities covered another 26 percent.
That left about $43 billion unpaid, and that sum made its way into premiums charged by private insurance companies to businesses and individuals, the report said.
The major government insurance programs — Medicare for the elderly and Medicaid for the poor — are structured in a way that doesn't easily allow payments to insurers to adjust upward. And somebody has to pay.
Ronald A. Williams, chairman and chief executive of Aetna Inc., gave the example of a local community hospital that provides care to someone without insurance who arrives at the emergency room. When it's not paid for, the hospital has to raise its rates to insurance companies, and they pass that on in higher premiums, Williams said.
"Our members then say, 'Well, why is health insurance so expensive?'" Williams said in an interview. "And the answer is because you're paying for your own care as well as for the care of some of the uninsured in the community."
Aetna was not involved in writing or funding the report but Williams planned to appear at a news conference Thursday with Families USA officials to release its findings.
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On the Net: http://www.familiesusa.org/