Press Release - December 24, 2007 - NewsReleaseWire.com

American Consumer Council Criticizes Cigna and Healthcare System in Death of Teenager

The American Consumer Council criticized health insurance giant Cigna Corp for denying approval for a liver transplant operation that led to the death of 17-year old Nataline Sarkisyan.

Thomas Hinton, president of the 82,000 member non-profit American Consumer Council (ACC), said, “Health insurance companies like Cigna continue to put their financial interest ahead of patient survival and urgent treatment when medical procedures such as liver transplants are deemed too costly. Ms. Sarkisyan and her family suffered needlessly because of Cigna’s flip-flopping and delay tactics.”

Hinton added, “This tragedy is further proof that America’s healthcare management system is broken. Despite the fact that we have the world’s best-trained medical professionals and cutting-edge technology, patients like Nataline Sarkisyan are dying because health insurers are making profit-based decisions that ultimately deprive patients of treatments that could extend or save their lives. This is immoral and unacceptable to consumers.”

Sarkisyan was diagnosed with leukemia when she was 14. She received a bone marrow transplant from her brother the day before Thanksgiving but later developed complications that caused her liver to fail. In a December 11 letter to Cigna, four UCLA doctors pleaded their case seeking authorization from Cigna for the liver transplant operation. Cigna refused to pay citing the procedure was experimental. Nine days later, Sarkisyan died.

“How many more young lives will be sacrificed before the present healthcare system is changed to benefit patients and not the health insurers,” Hinton asked?
Earlier this year, the American Consumer Council proposed a comprehensive healthcare reform program that would ensure every American and legal visitor to the United States receives primary and urgent care at no cost to the patient. ACC’s proposal calls for the creation of a voluntary, not-for-profit healthcare initiative to be established by Congress and administered by the U.S. Department of Health & Human Services. The system would place medical care decisions in the hands of physicians and other licensed care professionals instead of health insurers.

ACC’s proposal calls for a voluntary program that would transform America’s current healthcare management system into a not-for-profit network of hospitals and clinics to provide primary and urgent care for American citizens and visitors. ACC estimates its plan would attract the participation of more than 90 percent all of medical professionals, universities, clinics, non-profit service agencies, and industry organizations that currently serve the healthcare industry in the United States because fees-for-services would be paid for by the government at fair market value costs.
Details on ACC’s National Healthcare Foundation can be found on ACC’s blog entry dated Tuesday, October 9, 2007 at: www.americanconsumercouncil.blogspot.com

Below is the text of Thomas Hinton’s speech on October 11, 2007 detailing ACC’s proposed healthcare initiative:

Mr. Hinton: Good morning and thank you very much for attending this briefing. I think the large turnout today reflects the serious concern American consumers have for the troubled state of healthcare management in our country.

I am here today because American consumers are unhappy with the cost and accessibility of healthcare in our country. It is apparent from the emails, letters, and comments made by thousands of American consumers that the overwhelming majority of people in this country are both frustrated and angry with the current healthcare management system. They are frustrated because of the escalating cost of medical insurance and fees-for-services; and, they are angry because politicians and policy makers have failed to act and reform healthcare.

But, consumers are especially angry and the discriminatory practices of health insurers to deny urgent and potentially life-saving treatment recommended by their physicians. This practice is both immoral and contrary to the health-related interests of all Americans.

Specifically, American consumers want three things in healthcare reform. First, they want unlimited access to primary and urgent healthcare. Secondly, they want that access at an affordable cost. And, thirdly, they want assurances that doctors, nurses, and other licensed healthcare providers will be thoroughly-trained and educated in terms of medical technology, the treatment of diseases, and place the concerns of their patient above all other competing interests. Given these three priorities, let me share with you our solution. We believe this solution will fix our healthcare management and delivery systems, and ensure the three objectives I just listed are met.

We believe the long-term healthcare solution for America requires a shift is how we think about healthcare. The United States Congress and the healthcare leaders of this nation need to embrace the proposition that every citizen -- in fact, all human beings -- have the right to health and wellness given the tremendous medical advancements and technological capabilities we have made in this country.

While the United States arguably has the finest healthcare professionals and treatment facilities in the world, many Americans -- more than forty million by current estimates -- cannot access our healthcare system because of the prohibitive cost, insurance restrictions, and arcane government regulations that work against health and wellness in this country.

It’s time to move beyond the finger pointing, political bickering, and posturing among special interest groups who are stifling healthcare innovation and continuous improvement, and adopt a national healthcare reform program that guarantees every American access at no cost. To date, we have only heard politicians and policy-makers offer “band-aid” solutions to a problem that requires radical surgery -- sweeping reform that is innovative and all-encompassing. For these reasons, bold leadership is now required at the highest levels of government and the healthcare management industry.

I believe the solution is the adoption of a progressive healthcare reform program for the United States which would be enacted by Congress, paid for (mostly) by taxpayers like you and me, and managed by an independent, non-profit organization under the direction of the Secretary of the Department of Health and Human Services.

The heart of this progressive healthcare reform program is a lucrative, but voluntary, enrollment program for medical providers and healthcare facilities. In other words, medical providers have a choice. They can continue to do business-as-usual and treat those patients who elect to support them through direct payment or insurance, or they can enlist in a new national healthcare program known as the National Healthcare Foundation.

We believe this innovative approach will attract, within three years, more than 90 percent all of medical professionals, universities, clinics, non-profit service agencies, and industry organizations that currently comprise the healthcare industry in America. I also think it will set a precedent for other nations that wish to provide a comprehensive, national healthcare program for their citizens.

But, who will pay for it, you might ask? The honest answer is that it will be paid for by you and me -- the taxpayers of the United States of America. There are certain things that every American needs and should demand from their government. A quality education and comprehensive healthcare are two such needs that will raise our standard of living and create a stronger nation. I also believe a national healthcare program is the most efficient and comprehensive way to ensure healthcare for all and keep the costs from spiraling out of control.

Our motive in proposing a national healthcare initiative is selfish. We want access to the best healthcare in the world for the rest of our lives -- whether we live a thousand days or 10,000 days; and, we don’t want to be told by some faceless individual working for a for-profit healthcare insurance company, that a vital medical procedure, treatment, or drug will not be authorized because their bottom line is valued more than our life. It’s that simple!

As I read the many heartbreaking stories of patients who are dying because treatment is being denied by for-profit health insurers, it angers me because nobody should deserve to suffer and die -- let alone go broke -- when we have the best medical care in the world -- if it were only made available to all citizens.

Regrettably, the interests of healthcare are not served by for-profit health insurance companies who make many of their treatment decisions based on the cost of a particular procedure rather than professional medical recommendations. We believe that healthcare must become a not-for-profit service and any profit motive should be removed when it comes to primary and urgent care treatment.

So, here is our proposal to remedy the healthcare management and delivery problem in America. It is not perfect and will require some refinement. But, this initiative does provide a good start to move us forward and create a national healthcare program we can all benefit from.

Step 1. Establish the National Healthcare Foundation of the United States.
The United States Congress should approve and fund a National Healthcare Foundation (NHF) within the Department of Health and Human Services. The role of the NHF would be to administer a national healthcare program through a network of state agencies that entitles every American citizen and authorized visitors (tourist, student, visa holders, etc) to unlimited primary, urgent, and emergency healthcare services for any treatment that will enhance their wellness or preserve their life. This includes examinations, diagnoses, surgery, and rehabilitation.

At the core of this innovative national healthcare program would be a network of medical facilities, hospitals, shelters, clinics, and providers who would “opt-in” to participate in the NHF and be fairly compensated for their services. All participants would be required to operate as independent, self-operated, not-for-profit entities. In other words, no for profit businesses would be entitled to receive moneys from the NHF for primary, urgent, or emergency care services. This requirement will protect the integrity of the new healthcare initiative and remove the profit motive from healthcare. Obviously, this would require some for-profit medical corporations and hospitals to change their current status to “not-for-profit” in order to participate in the NHF. Of course, any existing entity can choose not to convert to a non-profit status since it is a voluntary program. Individual physicians and other medical professionals who are incorporated as for-profit entities would be exempt from this requirement and eligible to participate in the NHF provided their billings are directed through a bona fide not-for-profit entity such as an NHF member hospital or clinic.

Step 2. The National Healthcare Foundation (NHF) will be funded and paid for primarily by the United States Government through its taxpayers. This program will operate under the premise that every citizen has the right and privilege for primary, urgent, and emergency healthcare.

We estimate the annual cost for this program as outlined would be $390 billion in its first year (2009). It would not be cheap; the cost of excellent healthcare never is. But, this is also a way to control the spiraling costs of healthcare, and, as you’ll read, we can achieve a significant return-on-investment within three years of this plan through some innovative methods and self-funded programs. In three years, this program could actually cost us less than we are currently spending on healthcare today.

As part of the new NHF, all physicians, nurses, clinicians, pharmacists, researchers, technicians and other healthcare professionals -- as well as all healthcare facilities such as hospitals, teaching universities, clinics, and laboratories -- would be paid a fair market wage or fee for their services based on current year wages and fees-for-services. These wages and fees would also be reviewed annually for cost-of-living adjustments. This proposal does not require anyone -- doctors, dentists, nurses, clinicians, teachers, administrators, or technicians -- to take a pay cut. These people are professionals and deserve to be paid a premium wage commensurate with their skills, years of service, education, and training. In other words, this program will reward and incentivize medical providers to further their education and training by paying them more for advanced skills.

As part of this proposal, Congress would create an independent Healthcare Compensation & Insurance Commission (HCIC) consisting of fifteen individuals appointed by the president and confirmed by the Senate from the private and public sector who would establish a code of ethics for all NHF participants, a compensation schedule for all professional skills based on state or regional wages, and a Fee-for-Services schedule that ensure fair compensation for all medical professionals and participating non-profit healthcare and educational institutions. The HCIC would also establish regional malpractice insurance rates and set jury award limits for financial claims against medical professionals and institutions that are sued for malpractice and related claims. While mistakes and errors will happen, this aspect of the program will dramatically reduce the exorbitant cost of malpractice insurance and allow doctors and other healthcare providers to focus on serving their patients instead of worrying about malpractice insurance premiums and lawsuits.

Step 3. The National Healthcare Foundation (NHF) would consist of ten divisions. The purpose of these divisions is to oversee the new national healthcare reform program and ensure all Americans receive primary and urgent healthcare as well as foster the research, education, and advancement of the healthcare profession. Each division is described below in general terms outlining their major roles and responsibilities. Additional divisions could be created as warranted.

Primary Care
Urgent Care and Emergency Services
Assisted Care, Long-term Care, Child Services, Shelters, Hospices, and Therapy Services
Research & Technology
Organ Donor Programs
Education, Training, and Accreditation
Wellness Treatments
Licensing, Regulations, and Insurance
Payment, Audits, and Enforcement
Administration

1. Primary Care would include primary treatment areas of medicine including, but not limited to the following:
Adult Psychiatry
Anesthesiology/Pain Management
Cardiology
Cardiovascular Surgery
Chiropractics
Dentistry
Pediatric Dentistry
Ear, Nose & Throat
Emergency Medicine
Endocrinology
Family Medicine
Gastroenterology
General Surgery
Gynecology
Infectious Diseases
Internal Medicine
Neonatology
Nephrology
Neurology
Neurosurgery
Obstetrics
Oncology/Hematology
Oral Surgery
Ophthalmology
Orthopaedics
Pain Management
Palliative Care
Pathology
Pediatric Cardiology
Pediatrics
Physiatry (Rehabilitation)
Plastic Surgery
Podiatry
Preventive Medicine
Pulmonology
Radiation Therapy
Radiology
Urgent Care
Urology

Primary Care would also include care for the developmentally disabled, mentally impaired, and treatment programs for diseases such as alcoholism and drug addiction. The NHF would pay for one hundred percent of these services based on a regional matrix formula that fairly reimburses participating physicians and/or medical providers such as hospitals, clinics, and social services agencies at current billing levels. In other words, a family physician in New York City might be reimbursed using Schedule A while a community clinic in Albany might be reimbursed according to Schedule B. The drug treatment center in Macon, Georgia might be paid according to Schedule C, and so forth.

2. Urgent Care and Emergency Care is defined as any medical treatment that requires emergency room-related services and ambulatory services to treat life-and-death situations such as heart attacks, seizures, car accidents, shotgun wounds, etc. Such care would be provided by licensed emergency rooms or 24-hour emergency care clinics located across the nation. This non-profit network currently exists with the exception of several rural and poor communities that desperately need medical professionals and local facilities. This level of service would also apply to animal care through veterinarians with a limited annual dollar amount for pet owners. The NHF would pay for one hundred percent of these human services based on a regional formula and payment schedule that fairly reimburses the medical providers for their services and procedures. Veterinarian care would be reimbursed at fifty percent of the cost with pet owners paying the remaining balance.

3. Assisted Care, Long-Term Care, Child Services, Shelters, Hospice, and Therapy. This division would advance the needs of those persons who are unable to independently care for themselves including persons suffering from mental illness, Alzheimer, AIDS, and terminal illnesses. This division would also be the champion of children who require adoption, foster homes, and day-care services for working parents. This division would also support the needs of persons requiring mental or physical therapy.

This division of services also would include those patients who require assisted care living or long-term care situations including hospices. Also, it would apply to those patients who are under psychiatric care, medical counseling, the aged, infirmed, developmentally disabled, persons suffering from physical injuries including paralysis, or persons requiring rehabilitation treatment and therapy.

This division would also fund homeless shelters, runaway shelters, and homes for victims of family violence or spousal abuse. The NHF would also provide greater grant funding to support various state and county government social service agencies.

The NHF program would pay for ninety percent of these services. The other ten percent would be funded through private contributions, grants, and fundraising activities. Patients or family members would not be charged any fee for receiving these services.

4. Research and Technology would advance and encourage the development of innovative medical practices including new medical procedures and treatments, product design, drug research, and other such developments that would enhance the advancement of medicine and its treatment of patients. The NHF program would pay for eighty percent of these services to bona fide not-for-profit institutions and research centers. The other twenty percent would be funded through private sector and public sector grants, individual contributions, and fundraising or advancement campaigns. For profit entities including drug manufacturers would fund their own research and be eligible for grants under other federal agency programs as is currently the case.

5. Organ Donor Programs. This division would advance the existing international network of organ donors, recipients, maintain a national database, and work to promote public awareness and support for organ donations while expanding the international network. This program would be completely funded by NHF including the costs associated with transporting patients, immediate family members, and organs for a medical procedure.

6. Education, Training and Accreditation. This division’s mission would be to advance enrollment and training capabilities of teaching universities and hospitals as well as all other certified and licensed not-for-profit educational institutions that train medical professionals including doctors, nurses, and technical professionals. The NHF would pay for ninety percent of a student’s educational and medical tuition or training that requires a medical degree or healthcare professional certificate. The remaining ten percent would be paid for by the student or through scholarships and grants. The cost of continuing medical education programs would be borne by the individual unless it leads to a medical degree or post-degree certification.

A scholarship program would be required of each participating not-for-profit teaching institution to fund “special need” applicants and non-residents (foreign citizens). Institutions would be required to fund all non-educational programs and services such as administration, facilities management, and human resources as is currently the case. All students receiving funding support from NHF would be obligated to serve-with-compensation in an NHF-certified healthcare facility or practice of their choosing for an period of time equal to the funding they received from the NHF. The current system for accrediting medical colleges, schools, and universities would remain in place and not be funded by NHF.

7. Optional Treatment and Wellness Programs. This division of the NHF would be responsible for overseeing and advancing those medical treatments that are deemed non-life threatening but do enhance the health and self-esteem of individuals. Cosmetic surgery, plastic surgery (not required from a related illness or medical emergency such as an auto accident or burn incident), and wellness treatments such as spas and weight loss clinics would be covered under this section. The NHF program would pay for twenty-five percent of all such services with an annual and lifetime limit expenditure-per-person to be set by the HCIC.

8. Licensing, Regulations, and Insurance. This division of NHF would be responsible for overseeing three key areas -- licensing, regulations, and insurance programs associated with the NHF.

In the Licensing area, all not-for-profit medical facilities seeking to participate in the NHF program, and receiving any federal funds through the NHF, would be required to be certified by NHF or its designees. For example, a not-for-profit medical lab in St. Louis would have to apply for “NHF Licensing” in order to participate in the volunteer NHF program. Certain licensing reciprocity would be available -- including any hospital, laboratory, or medical facility that is accredited by the Joint Commission -- so long as that facility maintained its Joint Commission certification.

The Regulatory unit of NHF would oversee two major reforms that effect healthcare. First, the creation of a national malpractice insurance fund to protect all practitioners and facilities; and, secondly, oversight for the regulation, distribution, and enforcement of all “Re-classified Prescription Drugs” including many of those drugs that are currently deemed illegal today such as marijuana, cocaine, and heroin. These particular reforms are urgently needed in order to curb excessive malpractice insurance rates and end America’s fledgling war on illegal drugs which is costing taxpayers hundreds of millions of dollars. Here is how these two reform programs would work in concert with other federal agencies.

A special Malpractice & Medical Claims Insurance Fund (MMCIF) would be established by Congress as part of the enabling NHF legislation to cover all medically-related lawsuits or malpractice claims against program participants. Why? Because this element of the NHF is the “hook” that will single-handedly encourage over 90 percent of all physicians, dentists, and other healthcare practitioners, who must pay costly malpractice insurance premiums, to enroll in the NHF and support its success. Also, as a volunteer program, the benefits of participating in the NHF must be significant in order to attract widespread national participation among medical professionals and medical care facilities. Regardless of their status as not-for-profit entities or for-profit businesses, medical professionals and healthcare institutions will follow the money! It’s the American way.

Under this proposal, the MMCIF would pay up to ninety percent of all medical malpractice insurance premiums -- as established by the HCIC -- and have the power to cap the dollar amount for all malpractice claims as part of their independent administrative law authority. Participants (physicians, dentists, and healthcare facilities) in the NHF program would pay the remaining ten percent which would sufficiently fund the malpractice program as well as other activities of the NHF. The NHF would be able to contract with insurance companies and agents across the country to administer this program and ensure all participants are in compliance. A reasonable fee-for-service, as approved by the HCIC, would be paid to these companies and agents for their services.

The second major reform deals with solving America’s problem with illegal drugs. Each year, the United States Government spends billions of dollars trying to stop the flow of illegal drugs into our country and arrest, prosecute, and imprison drug offenders and traffickers. While the merits of this effort are laudable, it is a costly war that requires a different solution in today’s global environment. That solution is not the legalization of drugs, but rather, a program that would allow for the regulation and distribution of those drugs under a system similar to our current prescription and pharmaceutical distribution of prescribed drugs.

Under this proposal, the Food and Drug Administration would authorize American-owned drug companies to manufacturer certain drugs in various dosages -- including marijuana, cocaine, and heroin -- to ensure these prescriptions meet rigid federal guidelines for dosage and/or treatment. Federal and state healthcare agencies that oversee current licensing requirements for pharmacies and other prescription drug providers, would license certain drug distribution facilities to dispense medically-approved prescriptions of those drugs to persons who require them for medicinal purposes or to treat their addiction. As part of any legal prescription from a physician, every patient using these “recreational” drugs would be required to participate in a licensed counseling and treatment program which would be paid for by the NHF as part of its Primary Care Division.

This drug reform program would have many beneficial effects. First, it would severely reduce the activities of illegal drug cartels in foreign countries and allow the Drug Enforcement Agency (DEA) to focus its vital resources on other important activities. Secondly, it would reduce property crimes and felonies by drug users who must “feed their addiction.” Thirdly, it would reduce gang violence in major cities and reduce the need for gang involvement. Fourthly, it would allow the medical community to adequately treat people with addictions. Fifth, it would reduce the prison population since more people will receive treatment for substance abuse in a medically-controlled environment and, thus, they will not be engaged in criminal activities nor be imprisoned for criminal offenses. This program would be funded completely by NHF. The cost savings to DEA and other drug-fighting agencies justifies this reform proposal.

9. Payments, Audits, and Enforcement. The NHF would establish a Payments, Audit, and Enforcement Division to handle all claims and funding requests from program participants. By law, payments for treatment and services would be paid within thirty days of billing to all approved, first-party payees (physicians, hospitals, clinics, etc) or the NHF would be required to pay interest to those providers. The NHF could contract out payment services to approved third party contractors or state agencies.

The Audit Division would be responsible for overseeing compliance of all NHF and HHS rules and requirements for billings and payments.

The Enforcement Branch would be given full federal law enforcement powers and be responsible for enforcing all NHF and HHS laws and regulations. Alleged violators would be referred to the United States Attorney for prosecution. Violators also could be fined, imprisoned, or banded from NHF program participation if found guilty of fraudulent activities or unethical conduct.

10. Administration. This division would encompass the typical administrative and support functions of a major government agency including but not limited to: human resources, government relations, inspector general, legal, regulatory affairs, and budget.

In Conclusion:
This description is not meant to be all encompassing, but rather, it is an attempt to advance the discussion on how to establish a progressive healthcare program that ensures all Americans will receive the finest medical care in a timely and affordable manner. The cornerstone of this proposal is that it is national in scope, available to all Americans, voluntary in its participation, and it removes the profit motive from healthcare through the not-for-profit participation requirement.

Certainly, there will be some people who do not believe in offering free primary and urgent medical care. Others will argue the national cost for such a program is too high. We would strongly disagree with both arguments because we believe that every human being has the right to health and wellness in America. If we do not create a meaningful healthcare solution soon, the costs will soar beyond our control. A progressive healthcare program is the right thing to do given who we are as a people and what we stand for as a nation.
And, in response to the cost of this program, certainly, a network of not-for-profit healthcare facilities, staffed by America’s best-and-brightest medical professionals, would be money well spent and enhance the quality of life for all Americans.

Finally, let me comment on the naysayers who are critical of national healthcare programs in England, France, Canada, Australia, and elsewhere. I am not suggesting that these programs must become our model. Nor am I suggesting that we must emulate all of their practices. But, we are suggesting that these programs work and they work well. If those programs were inept, citizens would be protesting in the streets. So, there must be some merit in their programs. Our question is this. What are their best practices? And, secondly, can we apply those best practices to a “Made in America” national healthcare model?

In closing, all Americans deserve excellence in healthcare. We have outstanding healthcare professionals, medical facilities, and educational institutions. It’s time we unleashed the power of these people and institutions to create a national healthcare system that gives all Americans the best healthcare experience in the world. Through this proposal we can achieve something significant that all Americans will be proud of.

Thank you.

Tom Hinton (Tom@americanconsumercouncil.org)
President & CEO
American Consumer Council
P.O. Box 503016
San Diego, CA 92150-3016
Phone : 800-544-0414
Fax : 760-788-2024