Beth's Health Care Reform Blog

[roxybeast]

Individual Mandates, New Taxes, and the Reverse Trigger Idea?

I think eventually Congress will compromise on the public option by adopting a trigger approach as suggested by Sen. Snowe, but gosh I really like the idea proposed here of a "reverse trigger," i.e., pass the public option, but take it out if insurance companies clean up their act! Since we all know the insurance companies are not going to clean up their greedy act, so why wait?

Why, Oh Why, Do They Never Listen?
by RJ Eskow, Health Analyst
Huffington Post, Sept. 21, 2009

Why, oh why, do they never listen? I've been warning the Democrats since 2005 that an individual mandate without meaningful out-of-pockets limits would be a hardship for working Americans -- and that eventually Republicans would figure out how to call it a tax hike and run against it.

Now Politico writes:

... Questions about tax increases are part of an emerging Republican line of attack. Senate Republican leader Mitch McConnell on Sunday said "... We don't think it's a good idea to raise taxes on small businesses and on individuals in the heart of a recession."

Democrats: They have ears, Lord, but they hear not. I was especially disappointed to see the President defend himself from these charges by claiming they're not new taxes ...

1. Obama's New Taxes

... when they are. It's bad enough that the Baucus bill says "the consequence for not maintaining insurance would be an excise tax" and the House bill requires a "tax on individuals without acceptable health care coverage." I could defend these provisions if there were a strong public option and other cost containment measures. That might make this mandated insurance affordable to middle-class Americans.

But those things aren't there.

Now PresidentSenator Olympia Snowe is reiterating the position that 13% of income is an acceptable maximum out-of-pocket cost for health premiums. That is financially devastating for families at 400%-700% of the Federal Poverty Level (and many at higher levels). Since the President has ceded extraordinary power to her (as Robert Reich explains), this is likely to become law if she so chooses. It's a windfall to the insurers and body blow to working Americans (what should they sacrifice? That savings account for their kids' college education?)

The President also spoke up in favor of the tax on "Cadillac benefits." That's his other new tax. The idea might have some merit if a) it prevented insurers from passing on these new taxes to their customers and b) it was actually based on benefits. If most Americans pay deductibles and copays, a plan that covers 100% of out-of-pocket costs might legitimately be considered taxable income. (Although even than union plans should be excluded, since many workers gave up wages for their benefits.)

But this new Democratic tax is based on plan cost, not benefit design. So plans with older Americans will be more highly taxed than others. That will hurt older Americans and encourage businesses to discriminate against them. Plus, it's indexed to general inflation, which rises much more slowly than healthcare costs. So more and more plans will be taxed every year. As currently designed, those costs will go back to the consumer.

Let's not pretend Democratic health reform doesn't include new taxes -- and mandated fee payments to highly profitable private companies. If their bill passes in this form they'll pay a heavy political price for it. And they'll deserve to.

2. We're Not Swiss

While we're at it, let's stop defending this proposal by using Switzerland as an example. Paul Krugman and others keep doing it - but we're not Switzerland. First, Switzerland is a wealthier country: OECD figures show that the median household income there in 2007 was $60,288, versus $50,233 in this country. Despite their greater prosperity, roughly one-third of its citizens receive government assistance paying premiums. (Granted, they don't have an employer health insurance system and we do - but that system is eroding quickly.)

All insurance companies in Switzerland are non-profit. What's more, the Swiss system includes rigorous price controls that would never pass ideological muster in the US. And to top that off, the Swiss system includes strong managed care components that Americans would find unacceptable. The Swiss can't "choose their own doctor," to use that well-worn catchphrase.

Needless to say, the Swiss pay much less in healthcare costs than we do, and their costs are rising much more slowly. But we don't intend to do things the Swiss way. You can't impose a Swiss-style mandate on a system that is more expensive, has less control, and is profit-based.

Next topic.

3. Reverse Triggers

Sen. Snowe (sorry about that "President" crack - "Czar" might be more appropriate) is bringing up triggers again, apparently with the help of Rahm Emanuel. So, apparently to woo her, the President is opening the door to the idea that a public option would be "triggered" in states where "affordable" healthcare isn't available through the private market.

This is very bad, in two ways: First, it's a state-by-state solution, not a national one. A state-specific public option will be costlier to maintain and run. That will costs the rest of us money. Secondly, what's Sen. Snowe's definition of "affordable"?

Thirteen percent of income!

They have ears, Lord, but they hear not. Fortunately for our sanity, we have the satirical (also politically incorrect and pretty foul-mouthed - but funny) blogger Bobblespeak. Bobble posted this "tweet" yesterday: "Reverse trigger: public option is created, to be taken away from the people if the insurance industry completely fix US health care by 2012."

Now that makes sense! But wait ... a public option is optional by definition. If the insurance industry fixes US health care, nobody will join it. That's a good enough "reverse trigger" for me.
It should be good enough for Olympia Snowe, too.

Source: http://www.huffingtonpost.com/rj-eskow/ ... 93742.html

[roxybeast]

New GOP Attack: Democratic Health Care System Will Discriminate on the Basis of Race!

The ability of the radical right to come up with new lines of specious attach never ceases to amaze me! And this one's actually from Republican Senators!

Senate GOP Mailer Suggests Dem Health Care System Will Discriminate By Race
by Sam Stein
Huffington Post, Sept. 21, 2009

Senate Republicans are mailing out a "survey" insinuating that the president's health care reform agenda includes the creation of a lottery system to determine who gets medical treatment and a quota system that based on race and age.

Written under the vague and non-partisan title of "U.S. Senate Health Care Task Force," the mailing, which includes a fundraising letter, was commissioned by the National Republican Senatorial Committee and passed to the Huffington Post by a Democratic source. It asks recipients to respond to several misleading questions, including:

Are you concerned that health care rationing could lead to:
23. Denial of treatment in cases where the patient's prospects are deemed not good?
24. A "lottery" system of determining who will get priority treatment?
25. A "quota" system which would determine who would determine who would get treatment on the basis of race or age?

The mailer also suggests that the legislative proposals being considered by Congress would give the federal government the power to:
• Pick who is "eligible" for certain medical procedures?
• Pick your doctor for you?
• Restrict certain medical procedures on the basis of age?
• Put strict price controls on medicine and drugs?
• Penalize you for choosing to see a private doctor
• Seriously undermine private health care insurers who currently serve tens of millions of Americans?

All of these descriptions are either intentionally misleading or deeply contested interpretations of the health care provisions put forth by Democrats. And while the name and NRSC title -- "Chairman" -- of Senator John Cornyn, (R-Texas) is listed in the header, there is no mention of the fact that he's a Republican. Only in the sixth paragraph is it revealed that "Republican leadership of the United States Senate" commissioned the survey.

In addition to asking recipients to fill out the survey, Cornyn also encourages donations "of at least $25, $50, or even $100 to help finance this project and elect Republicans to the U.S. Senate."
Mailers such as these are standard fare in legislative and political battles, certainly those as hotly contested as the current health care debate. But recently they seem to be the preferred practice of Republican campaign committees. Several weeks ago, the Republican National Committee was roundly criticized for sending out a mailer which erroneously suggested that President Obama's health care proposal would discriminate against Republicans.

"It has been suggested that the government could use voter registration to determine a person's political affiliation, prompting fears that GOP voters might be discriminated against for medical treatment in a Democrat-imposed health care rationing system," read the mailer. "Does this possibility concern you?"

To read the full GOP mailer, click here: http://columbian.com/article/20090825/N ... 61/-1/NEWS


Source: http://www.huffingtonpost.com/2009/09/2 ... 93332.html

[roxybeast]

Think You're Safe Because You Have Health Insurance? Think Again!

Consider this article ... More employers are dropping coverage.

Why the Insured Should Support Health Care Reform: Employer Sponsored Health Insurance is an Endangered Species
by Anne Mai Bertelson
Huffington Post, Sept. 19, 2009

South Carolina Republican Congressman Joe Wilson's decidedly un-Congressional outburst during President Obama's speech on health care reform was met with swift censure from his colleagues on both sides of the political fence. But while he was publicly called out for his inappropriate and disrespectful behavior toward the President, no one has taken him on for the slanderous allegations that he and other anti-health reformers have propagated for months: allegations that characterize the uninsured as illegal aliens, scofflaws, uneducated and poor. Allegations that have successfully convinced the insured that health care reform is detrimental to their health.

Yet, these charges distort the facts and divert attention from a troubling trend: employer-sponsored insurance is an endangered species and without health care reform, including a public option, many more Americans will join the ranks of the uninsured. Including, potentially, my family.

Of course, we are not illegal immigrants, scofflaws, uneducated or poor. We look like the majority of the uninsured, according to US Census Bureau and the Agency for Health Care Research and Quality. We are American citizens like 85 per cent of the non-insured. One of us has a year-round, full time job, as do 67 per cent of the non-insured. We are college-educated, as are 31 per cent of the non-insured. We are white or "other" as are 30 percent of the non-insured.

What happened to us is what has happened to many of the 14.5 million who are unemployed: we lost our employer-sponsored health insurance when my husband was laid off last year. We did not have the luxury of turning to my employer. Like 17 million other Americans, I am self-employed, a sole proprietor whose health insurance was covered by a spouse's employer.

With signs that the economy is slowly rebounding, many families hope finding a job will restore their health insurance. After all, more than half of all Americans receive health insurance through their employers. But full time employment is no guarantee of health insurance coverage.
The number of private employers offering health insurance has declined steadily this decade. Back in 2000, more than 69 per cent offered their employees health insurance, according to research from the Kaiser Family Foundation and Health Research and Education Trust. By last year, that number dropped to 63 per cent.

The biggest decline came from small businesses, particularly those with fewer than 26 employees. Only 49 per cent of these small businesses offer coverage - down from 57 per cent in 2000. The National Small Business Association corroborates these findings: they found that only 38 percent of their members offer coverage; 14 years ago, 67 percent offered their employees coverage.

The decline in health care coverage by small business employers is particularly troubling since this sector accounted for 94 per cent of all new jobs created in the U.S. in the last two decades. More than 70 million Americans work for a small business today. But small businesses have been crippled by the ever-escalating costs of health insurance and many have been forced to forgo this luxury benefit.

If left unaddressed, this trend of businesses dropping health insurance coverage could add another eight million Americans to the ranks of the uninsured in ten years, bringing the total to 54 million Americans without health insurance, according to estimates by the Congressional Budget Office.

So far our family has not lost its insurance. Unlike others who lost theirs due to unemployment, we were fortunate enough to not only have access to COBRA - a continuation of our health insurance for 18 months - but, also the financial well being to pay the $1500 monthly premiums. Others have not been so fortunate. Some had no access to COBRA when their companies closed up; others had to make the difficult trade off between food and shelter or health insurance because their unemployment payments couldn't cover both.

COBRA ends this month and, with it, our options. While we will save some money, we will pay higher out-of-pocket costs, see a reduction in level of coverage and greater restrictions placed on which doctors, hospitals and procedures we can use. But, at some point, if my husband continues to be unemployed and my business continues with its revenue halved, $1200-a-month health insurance may be an unaffordable luxury for us too. And then we will officially join the ranks of the un-insured. Not as illegal immigrants, scofflaws or the uneducated. But as the working poor, our savings depleted by health insurance premiums.

Source: http://www.huffingtonpost.com/anne-mai- ... 92449.html

[roxybeast]

How Do We Reform a Health System to Control Prices When the Real Price Of Procedures Are Hidden and Insurance Companies Won't Even Tell Us How Many Claims They Are Actually Denying and Why?

"We say we have a free market. But we really don't if you don't know what the price is."

Health Care Costs: Hidden Prices Hindering Reform
by Carla K. Johnson
Huffington Post, Sept. 18, 2009

Until he got the bill, he didn't know what the surgery would cost him.
"At a coffee shop, you can see that your latte is $2.50 and your grande is $3.50," Hausheer said. But not in health care. "This is the only industry that I know of that does things like that," he said. "Prices are not understood upfront."

Until now, the push for price transparency hasn't played much of a role in the national debate over health care reform. However, the Senate Finance Committee version of health care overhaul would require hospitals to list their standard charges for services.

The bill, unveiled Wednesday by committee Chairman Max Baucus, D-Mont., also would require health plans to report how much of each dollar paid in premiums goes to items other than medical care.
President Barack Obama supports creating an insurance exchange where consumers and small business owners could shop for health insurance. But it's unclear whether such an exchange would promote publishing prices for procedures, said Elizabeth McGlynn, associate director of Rand Health, a nonpartisan research program. It's also not clear that provisions in the Baucus bill would offer useful information for consumers, McGlynn said.

"Health reform may offer an opportunity for that agenda to be pushed forward on a broader scale than it would be otherwise," McGlynn said. "One of the biggest challenges people face is getting access to information that makes them smart shoppers."

Finding out how much a medical procedure costs is more difficult and mysterious than buying a new car. With a new car, there's a sticker price. With health care, there's no starting line for haggling.
The dealmaking happens behind closed doors long before patients get involved. Insurance companies make agreements with hospitals and doctors about what they will pay for knee surgeries, tonsillectomies and hernia repairs.

For the uninsured, the hospital and doctors charge more – sometimes much more – than what they charge insurance companies. Medicare, the government plan for people 65 and older, sets its own rates, generally lower than what commercial insurance is able to negotiate.
"The pricing model is ridiculous," said Brad Myers, who helped found Pensacola, Fla.-based NewChoiceHealth Inc., an online tool for consumers who want to compare prices in health care. The site is based on estimates derived from Medicare data.

In parts of the country, some commercial insurers and nonprofit groups do post average costs for certain common treatments online. Two states – Maine and New Hampshire – also have online cost comparison tools that are even more accurate because they're based on insurance claims paid for procedures on patients in those states. Consumers can use prices posted on the sites to shop around or to strike better deals.

A few clicks on Maine's site finds that one hospital charges the uninsured $1,326 for a colonoscopy. People with commercial insurance pay the same hospital from $800 to $950 for the same procedure, depending on their insurance company. And Medicare pays the same hospital $793.

There are vast regional differences too. One insurance company is paying providers in Maine from $559 to $4,526 for a colonoscopy.
"The consumer might look at this and say, 'Wait a second! We're getting ripped off!'" said Al Prysunka, the Maine government director of the program.

More states are following Maine and New Hampshire, Prysunka said, and there's an effort to encourage uniformity in the new online tools to make comparisons between states possible.

"This is information that ought to be available on a more widespread basis," said Anne Elixhauser, a senior research scientist at the Agency for Healthcare Research and Quality, a federal agency supporting research on health care including price transparency.

Increasingly, consumers have an incentive to shop around because of high deductibles that require them to open their own wallets before insurance kicks in. A growing number of employers are shifting more costs to workers through these high deductible plans.

This year, 22 percent of all covered employees had annual deductibles of at least $1,000, according to a report released Tuesday by the Kaiser Family Foundation and the Health Research and Educational Trust, a nonprofit research group affiliated with the American Hospital Association. That was an increase from 18 percent last year and 10 percent in 2006. Those working for a small business are likely to have a high deductible.

"People who have high deductible plans are learning it's very difficult to get this information before they show up for the procedure," said Patrick Miller of the University of New Hampshire.

If health care were a retail store, there would be no price tags, Miller said, and you wouldn't find out how much you paid until your credit card statement arrived.

"We say we have a free market. But we really don't if you don't know what the price is," Miller said.

Don't expect lifting the veil on prices to magically restrain health care costs, said Ha Tu, a senior health researcher for the Center for Studying Health System Change in Washington.

If a hospital system is powerful in a market, just making prices public doesn't give insurance companies enough leverage to work out better deals, Tu said.

And patients may not have much choice in the network of providers approved by their insurance companies, Tu said. Patients dislike asking doctors about cheaper prices and, without good ways to compare quality, patients can't know whether paying more is worth it or whether paying less is worth the risk, Tu said.

Besides, people who need health care aren't in any condition to haggle.
"Someone who is about to undergo surgery is not going to try to bargain with the anesthesiologist," Tu said.

Source: http://www.huffingtonpost.com/2009/09/1 ... 91927.html

And ...

In Health Care, Number Of Claims Denied Remains A Mystery
by Huffington Post Investigative Fund, Sept. 18, 2009

Are health insurance companies generally being fair and honest when they reject claims from policy holders?

That would seem to be an important question in deciding how best to fix the U.S. health system. But it hasn't been a focus of the raging health-care debate -- possibly because the answer is not publicly available.

"This is one of the dark corners of the black box that is private health insurance," said Karen Pollitz, a professor at the Georgetown University Health Policy Institute.

Data on how often insurance claims are denied -- and for what reasons -- is collected and analyzed by the insurance companies themselves. But except in California, the companies aren't required to provide those records to any state or federal agency. "The number is knowable, but not known by regulators or policy makers or patients," Pollitz said.

The main health-care reform bill being considered in the House does seek to address the matter. It would require health insurance companies to report data on claims policies, practices and denials to a central commissioner.

The issue of claims surfaced recently in California. The state Nurses Association issued a press release saying that data it obtained from the Web site of the state's Department of Managed Health Care showed that in just the first half of 2009, California's six largest HMOs had rejected more than 31 million claims -- 21 percent of those they had received.

The way the nurses group tells it, state officials didn't even know they had the data.

Don DeMoro, a policy director for the nurses' association, said that he received a phone call from the managed care department after its press release came out.

"They said, 'You couldn't have gotten this data from us. We don't collect it ourselves,'" DeMoro said. "'The data is there,' I told them, 'but it's hard to find.' I walked them through the steps and waited while they clicked through their own Web site. Once they saw that the data was there, they politely said, 'Thank you' and hung up."

Lynne Randolph, spokesperson for the state agency, said she does not know what DeMoro might have been told, but said, "We've always known about this data."

(To check the California data, go to the managed care agency's searchable financial reports. On the pull down menu, select 'full service,' choose a company name and 'annual.' When the list comes up, click on the company name and you will download a spreadsheet. The claims data is contained on the tab labeled 'Schedule G.')

In any case, Randolph contends that the nurses' group misrepresented the meaning of what it found. She said the total number of "claims denied" include duplicate claims and claims that were eventually appealed and accepted, in addition to actual denials. "You can't just look at the numbers in schedule G," she said. "I guess it might look that way to a layman, but that data obviously does not reflect actual denials."

Tim Labas, assistant deputy director in the Office of Health Plan Oversight at the state agency, estimated that the actual denial rate across the board in California is probably somewhere between 10 and 20 percent. "That might still seem high," he said. "But there are legitimate reasons why claims are denied."

The state officials said they consider the claims data they collect to be a kind of early warning system. If they notice large jumps in claims denials for an insurance company, they have the authority to request more specific information, said Mark Wright, an official in the health plan oversight office. The office said it could not cite an example of when it made such a request.

"We could require the insurance companies to report all of the data to us, but I think it would just be too much information for us to handle," Wright said. "We'd be overwhelmed."

The National Association of Insurance Commissioners (NAIC), whose stated mission is to "assist state insurance regulators, individually and collectively, in serving the public interest" said the group did not know the state reporting requirements for insurance companies, nor does it collect data on the actual number of claims denials.

State regulators tend to focus on individual complaints from consumers. But only a fraction of consumer problems with health insurance result in formal complaints.

A national survey published by the Kaiser Family Foundation in June 2000 found that 51 percent of those surveyed had experienced some type of problem with their health insurance, but only two percent had made a formal complaint. Nearly 90 percent of those surveyed could not name the agency that regulates health insurance in their state.

In recent testimony before the House Subcommittee on Domestic Policy, Pollitz, the Georgetown professor, said that collecting claims data is important because "regulators must be able to monitor patterns of health insurance enrollment and disenrollment in order to know whether insurers are avoiding or shedding."

Robert Zirkelbach, spokesperson for the insurance industry's trade association, America's Health Insurance Plans (AHIP), said his organization had not taken a position on the proposed reporting requirement in the House bill.

AHIP represents, among others, UnitedHeathOne, Wellpoint, Inc., Aetna, Inc., Humana, Inc., CIGNA Healthcare, and the Health Care Service Corporation, all of whom sent executives to testify before the subcommittee on Thursday.

AHIP submitted testimony to the record as well, noting that the organization had completed an internal investigation of 700 million claims voluntarily submitted by 19 unnamed insurance companies in 2006 and found the denial rate to be only about 2.36 percent.

But Pollitz said that consumers and regulators, not insurers, need more "detailed, descriptive information about how coverage works." This data about health insurance is generally lacking at both the federal and state levels.

Last year the House Committee on Oversight and Government Reform requested information from 50 state health insurance regulators. They found that most states didn't know the answers to basic questions.

Only four states -- Hawaii, Kansas, Texas, and Washington -- knew how many times insurers had dropped people's coverage. Only ten states knew how many individual health insurance policies were in effect in their jurisdictions. More than one-third of state commissioners did not know which health insurance companies even offered policies in their state. The federal agency responsible for maintaining health insurance standards and oversight, the Center for Medicare and Medicaid Services, does not gather compliance data, nor does it track state enforcement.

"It is time for the federal government to take a more active role in health insurance regulation," Pollitz said.

Watch Video of Health Insurance CEOs Telling Congress That They Know that They're Denial of Claims Will Cause More Illness & Even Death of Some Patients: http://www.youtube.com/watch?v=R9HqynCAp8A

Source: http://www.huffingtonpost.com/2009/09/1 ... 91881.html

[roxybeast]

Other Articles Addressing Various Aspects of the Health Care Debate ...

Time to Just Say No to Giant Corporate "Parasites" -- and Recognize Them for What They Are
http://www.huffingtonpost.com/robert-cr ... 91102.html

An Open Letter to Our Leaders/Concerns with the Baucus Bill http://www.huffingtonpost.com/chris-cam ... 89533.html

Hope for Compromise Is Dead
http://www.huffingtonpost.com/david-vin ... 90256.html

Are We Finally Done With This Bipartisanship BS?
http://www.huffingtonpost.com/dan-sween ... 89892.html

The Constitution & Health Care: Would Glenn Beck Say James Madison Was an Unelected Constitution Czar?
http://www.huffingtonpost.com/dan-manat ... 90523.html

Dissecting the Baucus Bill
http://www.huffingtonpost.com/lindsay-b ... 90969.html

Health Care Fight Distraction to Real Issues
http://www.huffingtonpost.com/grant-car ... 87548.html

New DNC Obama Ad: Get "Fired Up" and "Ready To Go" About No Public Option
http://www.huffingtonpost.com/jane-hams ... 91617.html

GOP Party Chairman Michael Steele: Co-ops 'Backdoor' To Public Option
http://www.huffingtonpost.com/2009/09/1 ... 89668.html

Call Health Care What It Is: A Basic Human Right
http://www.huffingtonpost.com/allen-kel ... 78765.html

Reality Check (Comparing Health Care Costs to Costs of Iraq War)
http://www.huffingtonpost.com/lara-m-ga ... 84678.html

Max Baucus' Plan: What Do We Want? Less Quality! When Do We Want It? Now!
http://www.huffingtonpost.com/david-day ... 78737.html

My Life with Public Health Care (A Vet's Take on Public Health Care)
http://www.huffingtonpost.com/richard-a ... 78985.html

Peaceful Revolution: When Compromise Is a Dirty Word
http://www.huffingtonpost.com/joan-blad ... 93941.html

Health Care: Let's Liberate the Masses by Dylan Ratigan of MSNBC: "Being forced into an Employer-based health care system encourages the exorbitant spending that is bankrupting our country."
http://www.huffingtonpost.com/dylan-rat ... 94234.html

The Rally Against Obamacare for the Banks - yes, you can be angry at the bank/wall st. bailout & still support health care reform!
http://www.huffingtonpost.com/dean-bake ... 94247.html

HHS Investigates Medicare Providers' Massive Misinformation Campaign
http://www.huffingtonpost.com/dawn-teo/ ... 93891.html

Senate Bill to Boost Doctor Pay Fails Key Vote
http://blogs.wsj.com/health/2008/06/13/ ... -key-vote/

Medicare for All? ‘Crazy,’ ‘Socialized’ and Unlikely
http://prescriptions.blogs.nytimes.com/ ... #more-6823

Supporters of Public Option Plan Nationwide Protest
http://prescriptions.blogs.nytimes.com/ ... t-tuesday/

What’s an Affordable Premium for You?
http://prescriptions.blogs.nytimes.com/ ... e-premium/

The Amendments Are In — All 564 of Them ... deadline has passed for filing amendments to the health care legislation in the Senate Finance Committee.
http://prescriptions.blogs.nytimes.com/ ... ucus-plan/

[roxybeast]

Child Health as a Critical National Security Issue

Seems like I'm not the only one to see the connection ...

Child Health as a Critical National Security Issue
by Marian Wright Edelman
Huffington Post, Sept. 21, 2009

In April 2005, a group of scholars at the George Washington University School of Public Health and Health Services published a policy brief on "National Security and U.S. Child Health Policy: The Origins and Continuing Role of Medicaid and EPSDT." (.pdf) The Department of Health Policy chair, Dr. Sara Rosenbaum, and her colleagues studied how Medicaid and its comprehensive benefit package for children, the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, were seen from the beginning as a key way to help ensure that we would have enough healthy young Americans prepared to serve and defend the country. As Congress and the nation focus more on health care reform now, it's well worth reexamining the history of how this vital connection was made between child health and national security.

As Rosenbaum and her colleagues looked at the roots of this link, they focused on an important 1964 government report titled, "One Third of a Nation: A Report on Young Men Found Unqualified for Military Service." This study was commissioned as a response to the 50 percent rejection rate among young men drafted into the military in 1962, a rate so high it raised red flags about the nation's ability to develop a well-prepared military. The rate among men who had stepped forward as volunteers was slightly better, but overall, approximately one-third of prospective recruits were being turned away in the early 1960s. In September 1963, President Kennedy asked the Secretaries of Defense, Labor, and Health, Education, and Welfare to lead a Task Force on Manpower Conservation to study why this was so and determine what could be done to fix it.

What they learned was that far too many prospective recruits just weren't healthy enough for service. The Task Force's final report, Rosenbaum and her colleagues found, "concluded that the military draft failure rate provided powerful evidence of 'the unfinished business of the Nation.'" They note, "Among [the report's] most significant findings: the majority of young men rejected for compulsory military service in the early 1960s failed as a result of physical and mental health conditions, many of which could have been diagnosed and successfully treated in childhood and adolescence. These young adults typically came from impoverished families and had experienced unrelenting deprivation in health care, education, and employment. The report's findings provided compelling evidence for an underlying tenet of President Johnson's conclusion that "improving the health and well being of the nation's poor required strategies aimed at ameliorating the effects of social, economic, and health disparities."

President Johnson said after the report was released in January 1964 that "The findings of this Task Force are dramatic evidence that poverty is still with us, still exacting its price in spoiled lives and failed expectations. For entirely too many Americans the promise of American life is not being kept." Ultimately the Task Force, and the politicians who shaped its initial findings into policy, concluded that one answer was for the government to take a more active role in safeguarding the health of the nation's children, especially the poorest children who needed the most help. They realized that fighting the inequalities that existed and keeping all children as healthy as possible was necessary for them to grow up to be productive citizens -- including members of the military.

Forty years later, evidence still overwhelmingly shows that early intervention and prevention make a critical difference in children's health. Meanwhile, our national security needs -- as well as our nation's overall needs for healthy, educated citizens prepared to compete in a globalized economy -- are more serious than ever. Rosenbaum and her colleagues say in their conclusion, "The importance of a continuing commitment to broad child health policy endures, even as the health system itself is transformed. National security depends on the growth and development of children; in view of the demographics of those who serve, this dependence is particularly striking in the case of the low-income children who are at greatest risk for poor health outcomes."

Health disparities still exist for poor children and children of color. But Congress has the opportunity and responsibility this year to make certain that the promise of American life is being kept for all children by committing to real child health system reform. They can include amendments by Rep. Bobby Scott that provide comprehensive child-appropriate EPSDT benefits for all children and they can enact amendments offered by Rep. Bobby Rush to simplify the health bureaucracy and to make sure that millions of children are better off, and not worse off, than they are today. We must ensure that health coverage in any final health care reform bill will guarantee all children the comprehensive health and mental health care they need and be affordable and simple to get and keep. Our children's and our nation's security still depend on making sure that our children really get the health care they need now.

Source: http://www.huffingtonpost.com/marian-wr ... 93246.html

[roxybeast]

Cost Does Not Excuse Failure to Do the Right Thing!

My friend Cheryl wrote this next article. She is disabled. She is a conservative. She supports universal health care for the reasons she gives in her article. I like it, so reposting it here:

Universal Health Care
by C. A. Morgan

The debate goes on regarding health care in this country, and like every one else, I care about getting something done about this problem. But unlike everyone else, I have no interest in the details of the current bill on the table. I understand that conservatives are very opposed to the plan and they can give you a list of reasons, but the main one is that it is being sponsored by a liberal. If the roles were reversed, the liberals would be screaming about what's wrong with the program, even if it were the exact same program.

This may not make sense to many of you, but the reality is the details are not important. We all know there has never been a single bill to make it out of Congress that has been agreed upon by all parties, so why should this one be different. I'm surprised at the level of what I know has to be misinformation about the current bill. The reason I say "has to be" is because I have no idea what's in the bill and don't care. But I do know that some of the things I've read and heard make absolutely no sense to me, so I have to question whether they are just sheep being thrown out by the wolves to keep the population close to the pack for the next time they become hungry for notoriety.

For every citizen to have health care in this country, it's going to cost a lot of money. Guess what? I don't care! For every citizen to have health care in this country, there will have to be some government oversignt of the insurance companies and health care providers. Guess what? I don't care! For every citizen of this country to have health care, the government is probably going to have to run some of the programs, much as they do now with Medicaid and Medicare. Guess what? I don't care!

What I do care about is that every citizen in this country be able to go to the doctor whenever they need to without worrying about feeding their family next week or paying their mortgage next month. What I do care about is that every person on a fixed income be able to purchase their medications and see their physicians without worrying about keeping a roof over their head. What I do care about is that every child in this country be able to get the medical and dental care they need so they don't have to worry about facing the health issues prior generations have had to deal with as they get older. What I do care about is that all our medical professionals be able to earn a living, not just those who overcharge for their time because they are "specialists".

It is time for health care in this country to become a fundamental right, the way an education is a fundamental right. Our educational system suffers from lots of flaws, but you don't see us keeping our children at home while we wait on the politicians to work it out. But for years, a large portion of our population has gone without medical care waiting for our government to figure it out. Well, I say no more! Get a program up and running, even if it isn't 100% perfect, and maybe our educated, healthier population can work towards making it better as we travel the same road together.

Until later....

Source: http://c-a-morgan.com/blog/2009/09/univ ... _care.html

I disagree with her that liberals would oppose a Republican bill with all the same features, but I do agree with her overall assessment.

[roxybeast]

Health Care Systems in Other Leading Countries:

Switzerland

Health Care Abroad: Switzerland
By Anne Underwood
New York Times, Sept. 18, 2009

BY THE NUMBERS
Switzerland
Life expectancy: 82
Infant mortality: 4 per 1,000 live births
Health spending as a percentage of GDP: 11.3
Percentage of health spending that is private: 40
Doctors per 10,000 people: 40
Source: World Health Organization. U.S. statistics.

Timothy Stoltzfus Jost is a law professor at Washington and Lee University and frequently writes on comparative health care policy. His work includes an examination of insurance coverage in Switzerland and a comparison of the Swiss and Dutch systems. He spoke to the freelance writer Anne Underwood.

This is the fourth in a series of posts describing health care delivery in other countries. Previous posts have described Canada, Japan and France.

Q. The Swiss health care system relies on public-private approaches that have been recommended as models for the United States. What are the similarities?

A. In 1996, Switzerland instituted an individual mandate by which people are legally required to purchase health insurance in a competitive market. People buy coverage from private insurers, and the government provides subsidies for those who can’t afford coverage. About a third of the population receives subsidies.

Q. Is there an employer mandate, too?

A. No, it’s an individual mandate. Group health insurance does not exist in Switzerland.

Q. That’s a major difference between the Swiss system and most of the proposals in Congress. Are there others?

A. The most important difference is that health insurance in Switzerland is provided by nonprofit insurers — though some are affiliated with for-profit companies that offer supplemental policies along the lines of Medigap in the United States. The basic benefit package is defined by law and is quite generous. Maximum drug prices are regulated.

Q. Do many people buy supplemental insurance?

A. About a third of the population purchases voluntary supplemental insurance that covers things like private hospital rooms and dental benefits.

Q. Do the Swiss have a choice among policies and insurance companies?

A. They do. The policies differ mainly on deductibles. The standard annual deductible is 300 Swiss francs, or about $200 for adults. There is no deductible for children under 18. Individuals can reduce their premiums by electing plans with higher deductibles — up to 2,500 Swiss francs, or about $2,000. Once the deductible has been met, you pay coinsurance of 10 percent of covered expenses, up to a maximum of 700 Swiss francs. For brand-name prescription drugs, you pay 20 percent of the price if there’s a generic equivalent.

There are also some managed care plans, in which about 12 percent of the people are enrolled.

Q. In the United States, it can be quite confusing trying to purchase an insurance policy on your own. How do the Swiss navigate the system? Is there a national insurance exchange like the one that’s being proposed here — a sort of marketplace where it’s easy for people to go and compare policies?

A. There is no insurance exchange, but Internet comparison sites are available and forms are standardized to minimize switching costs. Most people, however, stay with their insurer and seldom switch.

Q. Are the policies expensive?

A. Yes. In 2004, 40 percent of households — or one third of individuals — received subsidies.

Q. Is there a public option in Switzerland?

A. There is no government-run plan to compete with the private nonprofit plans. But health insurance is considered social insurance. It’s not a for-profit enterprise.

Q. Can the Swiss go to any doctor they want?

A. For the most part, although there are some managed care plans with networks. Otherwise, the Swiss have a free choice of physicians and specialists. There is no “gatekeeper” system limiting their access to specialists.

Q. What does the Swiss health system do particularly well?

A. They’ve achieved near universal coverage. But even before the reform, 96 percent of the population was covered. They’re a very risk-averse society. The culture is that you just don’t go uninsured. Now, with reform, they’re close to 99 percent. But the country is still struggling with how to handle individuals who fail to comply with the mandate — mainly the poor and recent immigrants.

Q. How is the quality of care?

A. The quality of care is excellent. Waiting times are not reported to be a serious problem in Switzerland, and most people can get the services they need quite expeditiously. Modern, high-technology services are readily available. Coverage of some new drugs and procedures, however, is reviewed for effectiveness, and some drugs and procedures available in other countries may not be available in Switzerland if they are not considered to be cost-effective.

Q. What is your biggest criticism of the Swiss system?

A. It hasn’t done well at controlling costs. Switzerland is second only to the United States in the percent of G.D.P. spent on health care. It’s also second to the United States in the rate of health care inflation. Probably the most important reason is that Switzerland is a wealthy nation, and wealthy nations spend more on medical care. But a particular problem is that the Swiss use more health care resources than even we do in the United States, with more doctors, hospitalizations and certain high-tech procedures.

Q. So competition among companies doesn’t keep prices down?

A. In theory, insurers compete with each other to bring down prices. In fact, it doesn’t work all that well. There is also enough wiggle room in the system that insurers are able to cherry-pick — to attract enrollees who are good risks and get rid of those at higher risk. As long as insurers have control over the plan design and some control over the premium classifications, they can manipulate the risk pool. For example, if they give good service to the healthy and less adequate service to the less healthy, the less healthy may try to move on to another insurer.

Q. What is the most important lesson Americans should learn from the Swiss system?

A. You can achieve universal coverage through an individual mandate, coupled with subsidies for people who can’t afford health insurance. But it’s not going to get you cost control unless you enact further measures.

Source: http://prescriptions.blogs.nytimes.com/ ... itzerland/

France

Health Care Abroad: France
By Anne Underwood & Sarah Arnquist
New York Times, Sept. 11, 2009

BY THE NUMBERS
France
Life expectancy: 81 years
Infant mortality: 4 per 1,000 live births
Health spending as a percentage of GDP: 11
Percentage of health spending that is private: 20
Doctors per 10,000 people: 34
Source: World Health Organization. U.S. statistics.

Victor G. Rodwin is a professor of health policy and management at the Wagner School of Public Service at New York University and co-director of the World Cities Project, International Longevity Center-USA. He teaches courses on health system comparisons and has widely published on the French health care system. He spoke with the blog contributors Sarah Arnquist and Anne Underwood.

This is the third in a series of occasional posts describing health care delivery in other countries. Previous posts have described Canada and Japan.

Q. In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree?

A. I question the W.H.O. methodology, which has serious problems with data reliability and the standards of comparison. A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs. They examined avoidable mortality — that is, deaths whose risk of occurrence would be far lower if the population had access to appropriate health care interventions. In that study, based on data for the year 2000, France was also ranked No. 1, with the lowest rate of avoidable deaths. The United States was last, in 19th place, with the highest rate of avoidable deaths. That’s a severe indictment of our health care system in my judgment and calls attention, quite justifiably, to the high performance of the French health care system.

Q. That finding implies that the French have good access to health care. Do they?

A. On most measures, they do. They don’t do a better job of cancer screening than we do. But when it comes to timely access to primary care, the French are superb.

An important and well-recognized measure is avoidable hospitalizations. People should not end up in the hospital for failure to manage routine, controllable conditions such as asthma, bacterial pneumonia, diabetes or congestive heart failure. Based on studies with my colleagues Michael Gusmano and Daniel Weisz, the United States has exceedingly high rates of avoidable hospitalizations compared with Britain, Germany or France. Comparing Paris and Manhattan, we have 2.5 times the rate of avoidable hospitalizations that they do in Paris.

Moreover, when it comes to specialty care, the French also have ready access. For example, my colleagues and I found that contrary to conventional wisdom, the French provide higher rates of bypass surgery and angioplasty than we do.

Q. As I understand the French health care system, doctors are private, but patients are enrolled in national health insurance. Is it sort of like Medicare for all?

A. Very much so. It’s not government run but government financed. Like Medicare and Social Security, it is funded by compulsory payroll taxes with some income tax contributions. But doctors work predominantly in private, office-based, fee-for-service practices, and there is a mix of public and private hospitals. The main difference from Medicare is that the entire resident population is covered and the benefit package is more generous.

Almost the entire population has some degree of private supplementary insurance, too, much like Medigap policies for Medicare beneficiaries in the United States, to provide better coverage for certain services and to cover a portion of co-insurance.

Q. So it’s not a single-payer system.

A. That’s correct, but it operates much like one. In France, nobody has a choice of insurer for basic coverage. There are three major plans — one for most people who are employed (77 to 78 percent of the population), a smaller one for agricultural workers (4 to 5 percent), and another small one for the self-employed (6 to 7 percent). In addition, there are some very small plans — for railroad workers, the clergy and so forth. But all of these health insurance programs operate under the same rules. Like Medicare, they can’t turn you down for preexisting conditions. They can’t terminate you if you change your job. And they can’t stop paying when your expenses exceed a certain amount.

Q. If the French system resembles Medicare, does that mean that it also faces the problem of rising costs?

A. Yes, all health care systems face the pressures caused by expensive new medical technologies and prescription drugs. Since there are no enforceable budget ceilings on French national health care expenditures, annual increases tend to exceed spending targets, which in turn leads to frequent cries that the system is “unsustainable.” Nonetheless, the French do a better job of controlling health care costs than we do. They spend about half as much per person on health care ($3,200), and spending accounts for 11 percent of the French gross domestic product, versus 17 percent in this country.

Q. How do they control health care costs?

A. Three ways. First, the government negotiates prices for doctors, hospitals and prescription drugs. Second, France has far fewer private health insurers, so the system requires less expenditure on administrative costs for marketing, underwriting and managing complex reimbursement rules. Third, France’s investor-owned insurance sector is far smaller than in the United States, and its medical-industrial complex is far less powerful, so the government can negotiate stronger cost controls.

Q. But you also said the French have no choice in their plan. Americans seem to want choice.

A. The French have no choice among insurers for the basic plan. But French National Health Insurance gives them more choice of doctors and hospitals than the average American has.

Q. Does insurance cover the entire cost of an office visit, or are there additional charges?

A. There are no deductibles. French National Health Insurance typically pays 70 percent of an office visit. A G.P. typically charges the patient 30 percent of the $35 fee, and a specialist will charge 30 percent of the $45 fee. But co-insurance is waived for all patients with serious chronic medical conditions such as asthma, diabetes, cancer, heart disease or any other medical condition requiring more than $100 per month in payments.

Most physicians in private practice accept negotiated N.H.I. fees. However, in large cities and for most subspecialties, 50 percent to 80 percent of physicians have chosen to “extra bill.” These physicians must pay higher premiums for their own health insurance coverage (as subscribers of the fund for the self-employed). Most of their patients can use their supplemental policies to cover some of these additional costs. But such extra billing does create hardship for people with few resources, who forgo seeing these specialists and must therefore go to hospital outpatient departments or to health centers. That’s one of the big issues now.

Q. Are the insurance companies nonprofit?

A. All health insurance funds that provide benefits under the national plan are legally private nonprofit organizations. The companies that provide supplemental insurance are a mix of for-profit and nonprofit entities. But they represent only 8 percent of total health care expenditures. It’s a smaller industry because benefits under French N.H.I. are extensive. Prescription drugs, for example, are covered exceedingly well. What’s not covered well is dental care and vision care.

Q. Is there rationing of care?

A. There is no explicit health care rationing in France. There are no waiting lists for specialized hospital treatments. There is very easy access, perhaps too easy, to specialized services. An important characteristic of the French system is that the sicker you are, the better you’re reimbursed.

Q. What does the French system do particularly well?

A. They have great access to primary care. In addition, they make specialty care available to anyone needing it. They have excellent prescription drug coverage, and they give extraordinary choice and freedom to people to navigate the system as they see fit.

Q. What’s your the biggest criticism of the French system?

A. There is poor care coordination between general practitioners and specialists, and also between hospitals and patients who move into ambulatory care. It’s a problem for people with chronic diseases.

Q. Medical malpractice has become an issue now in the debate over health care reform in this country. How much of every health care Euro in France goes to pay for malpractice costs?

A. I’ve never seen such an estimate, but even in the U.S. this figure is much smaller than people generally believe — less than 1 percent of health care expenditures.

Q. Doctors in the United States complain about having to practice “defensive medicine,” ordering unnecessary tests just to cover any potential charges of negligence later on. Is that an issue in France?

A. No, this is not an important issue in France for two reasons. First, since 2002 there has been a national no-fault compensation scheme. Second, the number of attorneys per capita in France is far smaller than in the United States.

Q. Have the French achieved universal health care?

A. Yes, the entire population legally residing in France is covered — more than 99 percent of the population. There are always people who fall through the cracks. But they are covered under a special plan that covers people whenever they show up at the E.R., the hospital outpatient department or health center.

Q. Are the French happy with their health care system?

A. Eurobarometer, Harris Interactive and other studies of consumer perceptions have consistently reported high rates of satisfaction among the French — among the highest in the European Union and certainly higher than in the United States. Still, my French colleagues were surprised when the W.H.O. report came out, ranking their system No. 1, because they are typically critical of their system. I don’t know any health system about which you can’t tell a horror story that occurred to a patient. That’s why it is so important to avoid cocktail party anecdotes of health system performance and rather examine evidence in a more systematic fashion.

Q. What key lessons can the United States learn from France?

A. The French health system demonstrates that it is possible to achieve universal coverage without a government-run system that regulates how doctors practice medicine. In fact, U.S. physicians should note that their French colleagues are not constrained by private managed care insurance plans and have greater clinical autonomy.

The French system also demonstrates that in contrast to some single-payer systems, universal coverage does not preclude the existence of private insurers. In France, there’s a whole private insurance sector — not enormous, but big enough — and that’s important for the insurance industry to recognize.

Source: http://prescriptions.blogs.nytimes.com/ ... ad-france/

[roxybeast]

Michelle Obama Weighs In On Health Care Debate

Michelle Obama: Health Care Overhaul Is ‘Next Step’ for Women
By Jeff Zeleny
New York Times, Sept. 18, 2009

The first lady, Michelle Obama, said Friday that overhauling the nation’s health care system was of critical importance to women and part of “the next step” in their long quest to assure full opportunity and equality.

“Women aren’t just disproportionately affected by this issue because of the roles that we play in families,” Mrs. Obama said. “Women are affected because of the jobs that we do in this economy.”

In a morning speech to leaders of several women’s groups at the Eisenhower Executive Office Building on the grounds of the White House, the first lady took one of her biggest steps yet into the health care discussions under way in Congress. She urged women to pay attention and get involved in the debate, saying it should be of particular concern to them and their families.

“We all know that women are more likely to work part-time or to work in small companies or businesses that don’t provide any insurance at all,” Mrs. Obama said. “Women are affected because, as we heard, in many states, insurance companies can still discriminate because of gender. And this is still shocking to me.”

She cited instances where women were denied coverage because of a pre-existing condition – “like having a C-section, or having had a baby.”

“These are the kind of facts that still wake me up at night,” Mrs. Obama said.

In her speech, Mrs. Obama also told the story of how her daughter Sasha would not stop crying when she was 4 months old. A doctor’s visit revealed she might have meningitis; she ultimately did not, but the illness produced a scare.

“It is that moment in our lives that flashes through my head every time we engage in this health-insurance conversation,” Mrs. Obama said. “It’s that moment in my life because I think about, what on earth would we had done if we had not had insurance? What would have happened to that beautiful little girl if we hadn’t been able to get to a pediatrician, who was able to get us to an emergency room?”

In the first eight months of the Obama presidency, the first lady has only occasionally weighed in on policy discussions, a strategy intended to keep her away from controversial topics. But the speech Friday signaled the start of an increasing role for her in the health care debate.

“She’s obviously a very popular figure in America,” said Robert Gibbs, the White House press secretary. “If she can help out, we’re happy to have her.”

Source: http://prescriptions.blogs.nytimes.com/ ... -to-women/

[roxybeast]

Former President Clinton Weighs In on Whether Some Opposition to President Obama and His Health Care Plan Is Based on Race

Really fascinating interview of the former President by Larry King last night ... in which President Clinton agreed with President Carter that some of the opposition is indeed race-based, but noting that virtually 100% of the opponents would still be opposing President Obama's plan even if he were white and concluding that Obama needs to continue to set any such concerns aside and focus on winning the health care debate on the merits of his plan for reform.

Bill Clinton: Not all fighting health reform motivated by race
CNN, Sept. 22, 2009

(CNN) -- While some criticism targeting President Obama is racially motivated, the fight over health care isn't, former President Bill Clinton told CNN Monday.

Former President Bill Clinton says Democrats need to win the health care debate "on the merits."

"I believe that some of the right-wing extremists which oppose President Obama are also racially prejudiced and would prefer not to have an African-American president," Clinton told CNN's Larry King in a wide-ranging interview aired Monday evening. "But I don't believe that all the people who oppose him on health care -- and all the conservatives -- are racists. And I believe if he were white, every single person who opposes him now, would be opposing him then."

Clinton discussed a variety of issues facing the Obama administration -- from health care to the war in Afghanistan -- on the eve of the fifth annual meeting of the Clinton Global Initiative.

Regarding race, the former president was referring to an outburst from Rep. Joe Wilson, a South Carolina Republican, who shouted, "You lie," at Obama during the president's joint address to Congress, and also former President Jimmy Carter's assessment that racism is an obstacle for the current president.

"While I have devoted my life to getting rid of racism, I think this [health care] is a fight that my president and our party -- this is one we need to win on the merits," Clinton said.

Source: http://www.cnn.com/2009/POLITICS/09/21/ ... index.html

I think former President Clinton is dead on in his analysis of this issue.

[roxybeast]

Baucus and Snowe Move to the Left

In light of dwindling support on the right, Sen. Baucus reformed his bill to cut penalties for not complying with the individual mandate and to increase subsidies to make insurance more affordable for poor and middle class families. Sen. Snowe levied a new series of attacks on the affordability of the insurance under the Baucus bill in line with some progressives attacks on the bill, signaling that she may be beginning to move to the left on the issue.

Baucus Muzzles Misleading Insurance Companies
by Ryan Grim
Huffington Post, Sept. 22, 2009

Read more at: http://www.huffingtonpost.com/2009/09/2 ... 94782.html
As Republicans in the Senate steadily drift away from Max Baucus (D-Mont.), the finance committee chairman is beginning to move the opposite direction. After getting pounded by progressives for a bill that required middle-class Americans to purchase unaffordable health care from private insurance companies (as no public option would be available), Baucus revised the proposal to make the mandated coverage more affordable and reduced the cost of the penalty for not buying it.

At the same time, Baucus fired a shot across the bow of the insurance industry, urging the Centers for Medicare & Medicaid Services to go after insurance companies who are sending letters to seniors with frightening warnings about supposed Democratic attempts to cut their benefits. (See Dawn Teo's reporting on this here.)

CMS responded by muzzling the insurance companies and threatening legal action, writing that "we are instructing you to immediately discontinue all such mailings to beneficiaries and to remove any related materials directed to Medicare enrollees from your websites."

They made clear they weren't playing around: "Please be advised that we take this matter very seriously and, based upon the findings of our investigation, will pursue compliance and enforcement actions."

The Wall Street Journal op-ed page hit the roof, complaining that Bacucus' "latest bullying tactics are hard to believe." And the insurance industry trade group, America's Health Insurance Plans, denounced the "gag order."

"Seniors have a right to know how the current reform proposals will affect the coverage they currently like and rely on," said AHIP spokesman Robert Zirkelbach.

Minority Leader Mitch McConnell (R-Ky.) took the Senate floor Tuesday to decry the CMS move. "'Shut up,' this gag order says," McConnell said. "'Be quiet and get in line.'" Sen. Lamar Alexander (R-Tenn.) followed him and read the First Amendment on the Senate floor.
Baucus insists that the insurers have no right to mislead seniors into believing that Medicare benefits would be cut. And CMS has a say over the companies' communication with seniors, because it foots the bill.
Story continues below

"It is wholly unacceptable for insurance companies to mislead seniors regarding any subject -- particularly on a subject as important to them, and to the nation, as health care reform," said Baucus.

Baucus is free to swing away at the insurance industry with little risk because he has fewer and fewer Republicans to woo.

Sen. Charles Grassley (R-Iowa), the committee's ranking Republican and a member of the erstwhile Gang of Six, made clear just how distant he is from the negotiating table during his opening statement Tuesday, when he accused the Baucus bill of providing federal funds for abortion.

(The bill is clear that no federal funds can be used for abortion, and insurance companies are able to distinguish which services are covered by federal dollars and which aren't. PolitiFact has called Grassley's claim "false.")

And the top Republican target for a pro-reform vote, Maine Sen. Olympia Snowe, has been critiquing the Baucus bill from a liberal direction, citing concerns about the affordability of the required coverage.

In her opening statement Tuesday morning, she reiterated her concern about mandating that people purchase coverage that might not be affordable. During Gang of Six negotiations, she had often pushed for more generous subsidies, balanced by her worry about paying for them with cuts or tax hikes elsewhere. Snowe also struck a note that resonates with progressives, arguing that where private insurance faces no competition and is unaffordable, consumers should have access to a public health insurance option.

Snowe has long backed a "trigger" proposal that would implement a public option if private insurers showed they were unable to provide affordable access after a predetermined amount of time.

Source: http://www.huffingtonpost.com/2009/09/2 ... 94782.html

And here's an article which discusses insurance companies scare tactics to seniors about Medicare benefits being cut ...

Humana Mailer Targets Elderly, Claims Medicare Benefits To Be Cut
by Dawn Tao
Huffington Post, Sept. 22, 2009

Many elderly Las Vegas residents were alarmed and confused Wednesday after receiving a mailer with an enclosed letter signed by the Chief Medical Officer of Humana Medicare, Philip Painter, claiming that Congress and the President are considering proposals to cut "important benefits and services" of Medicare.

The letter enclosed in the mailer tries to convince Medicare recipients that their benefits could be cut if the current health insurance reform plans are enacted (bold text same as original):

Leading health reform proposals being considered in Washington, D.C., this summer include billions in Medicare Advantage funding cuts, as well as spending reductions to original Medicare and Medicaid. While these programs need to be made more efficient, if the proposed funding cut levels become law, millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable.

To ensure Humana customers read the packet, it arrives in an envelope claiming to contain "IMPORTANT INFORMATION about your Medicare Advantage plan" and imparts urgency upon the recipients to "OPEN TODAY!" But the mailer contains no information about the recipients' medicare plans. Rather, upon opening Humana's "Guidance when you need it most" envelope, recipients find a recruitment packet asking them to join Humana's Partner Program to "show Congress the importance of Medicare Advantage."

Humana's Partner Program is Humana's community corporate organizing arm. Using scare tactics (convincing Grandma that her Medicare benefits could be cut), an enclosed Humana Partner Program flyer asks Medicare recipients to sign up (and to sign up their friends and family) to:

• receive (policy propaganda) Congressional updates
• view member profiles of other Partner members
• learn how to use your voice for (Humana profits) reform
• receive quarterly (disinformation) newsletters
• learn about local (tea bagger parties) Humana Partner opportunities

As an added bonus, Humana Partner also gives members "fun brain teasers, quizzes, and puzzles." (They probably include crossword puzzles with answers like "death panels" and "socialism")

An enclosed card says, "We want you to be informed," then asserts,
Some in Washington want to cut billions of dollars out of the Medicare Advantage program. If that happens, patients could lose many of the important benefits and services that make Medicare Advantage so valuable: Low premiums, Low deductibles and co-pays, Wellness and enhanced preventive benefits, Coordinated care and disease assistance programs.

The enclosed letter asks recipients to call their Congressional representatives, contending, "Congress is considering significant cuts to Medicare Advantage now, and your Members of Congress will want to know why this program is valuable to you because these cuts could mean higher costs and benefit reductions to many on Medicare Advantage."

Alyce from Las Vegas says she was furious after hearing from her distraught 90-year-old, wheel-chair-bound mother who, along with many of her fellow residents, received the mailer Wednesday. Alyce asks, "How do we counter these deceptive mass mailings to the elderly? They are organizing the elderly using a public relations firm to spread the lies." She says she was particularly troubled because Humana mailed this to her mother despite the fact that her mother has been diagnosed with Alzheimer's Disease.

The enclosed letter includes this disclaimer at the bottom, "Neither the Centers for Medicare and Medicaid Services nor the Medicare has reviewed these materials for accuracy or misrepresentation." (Now that's irony.)

The mailer also directs recipients to visit the Humana Partner Program website, which features an update on the front page in bold text, "Congressional Update: Medicare Advantage funding cuts proposed...again," along with the following text (bolding is original):
Now, to pay for health care reform, some in Washington have again proposed deep cuts to the Medicare Advantage program. This time, the proposed cuts could be as high as $177 billion from the Medicare Advantage program if people like you who appreciate the Medicare Advantage value don’t stand up and have your voice heard. This means seniors and disabled individuals in the Medicare Advantage program, like you, may be asked to pay for nearly a third of the initial projected cost of health care reform through higher Medicare Advantage premiums and copays and lower benefits and choices.

Obama has repeatedly said that Medicare benefits will not be cut, and that Medicare funds will not be used to pay for health insurance reform. Last week, he told Minnesotans at a health care rally, "Not a dollar of the Medicare trust fund will be used to pay for this plan -- not one dollar. We will not be lowering benefits for senior citizens."

Other sources have confirmed the President's statement. The American Association for Retired Persons (AARP) recently told the Washington Post that currently proposed cuts to Medicare would not affect benefits. AARP also told the Wall Street Journal that these types of statements are "misleading and alarmist," and "the proposed Medicare savings do not limit benefits."

At the end of 2008, about 12.5 percent of Medicare Advantage subscribers were Humana clients, and Humana receives a just over half its revenue from Medicare Advantage.

Source: http://www.huffingtonpost.com/dawn-teo/ ... 89421.html

[roxybeast]

Tort Reform Is Not the Answer and Here's Why
by Beth Isbell
Attorney, Musician & Freelance Writer
©Sept. 22, 2009

In one of the articles I posted yesterday from the New York Times regarding health care systems in France (Source/link: http://prescriptions.blogs.nytimes.com/ ... ad-france/), a noted health care systems expert made an important point, malpractice costs account for less than 1% of overall medical expenses in the United States. Therefore, to think that any serious cost reduction in the current U.S. health care system can be obtained by ramming through "tort reform" is highly misleading.

"Tort reform" by itself, is sort of an empty and meaningless term - what does it mean? In most cases, proponents want to cap the damages that a jury or court may award a person or family that have been maimed or killed by a doctor who failed to comply with community standards for the practice of medicine established by all the other doctors in his community, sometimes even through gross neglect or even intentionally. Does that sound fair to you? A doctor chooses not to comply with the minimum standards of care (not even the "best" level of care) set by all of his fellow doctors (important: not set by lawyers) and is rewarded with legislation to severely limit his exposure to paying for serious damage or death to a patient he cause because he chose not to comply with the standards other doctors expect of him. Does that sound in the least bit fair?

That is the issue in a nutshell.

As I pointed out in one of my earlier blog posts, if one actually wants to enact meaningful tort reform, one needs to focus on what the actual community standards of minimally safe care set by doctors actually are and look at ways to revise those standards, and not just take out a sledgehammer and beat patients and families injured by a doctor's failure to behave like other good doctors senseless with arbitrary caps which do not consider individual factors such as the amount of pain or trauma suffered, or the earning capacity devastated, or other legitimate reasons why damages need to be higher in order to provide truly fair compensation under any reasonable view.

If doctors want to limit their exposure, all they have to do is agree with other doctors in their community that expensive tests and procedures are simply no longer required. They don't because these practices actually do prevent negative outcomes and save a lot of lives.

These medical standards are also localized to each community. That's to make sure that a doctor is not subject to unfair standards just because he's in a rural or smaller community that does not have the resources or access to the latest greatest medical tests, equipment and technology that might be available in a larger city, like New York or L.A.

Tort reform proponents neglect to tell you that all judges, federal and state, have broad power to throw out frivolous lawsuits and to punish the lawyers and parties who bring them with large fines and making them pay the full legal costs of the doctor who was frivolously sued. Judges regularly exercise that power to prevent frivolous lawsuits. I once called a local conservative Republican judge hosting a radio show who was railing on the air about the need for tort reform to curb frivolous lawsuits and reminded him that he had the power to simply throw out any lawsuit he thought was frivolous. He hung up on me.

Before an attorney can even bring a medical malpractice suit, a doctor expert has to provide an affidavit to the judge testifying under oath that they have reviewed the medical records and concluded that the doctor against whom the suit is brought did indeed violate the minimum standards of care that other doctors in his own community think that he should follow. The doctor's attorneys then have multiple opportunities to convince the judge to throw out the lawsuit by presenting testimony from colleagues that the doctor in question acted appropriately and did not violate community standards. Most malpractice lawsuits do not survive these procedural safeguards.

It is only after all this safeguarding, which is far more rigorous than for any other kind of lawsuit an attorney can bring, that a claim might be allowed to go to a jury. The claim can still be subject to rigorous jury instructions which often favor doctors and even protect them if they simply acted in "good faith." While a jury may award damages, that does not mean that the patient will receive the amount awarded. In 46 states the amounts are already subject to severe caps. If the amount awarded exceeds the arbitrary cap imposed by the state legislature, that excess amount is cut off. Further, the judge still has the authority to set aside the jury verdict if he concludes it is unfair, or to further lower the damages awarded if he thinks it is too much.

"The Congressional Budget Office and Government Accountability Office have looked at tort reform multiple times, and said it will save practically no money. They also found no evidence of so-called 'defensive medicine,' finding that doctors run more tests because of the fee-for-service structure, or because of the benefits extra tests have on patient care. Additionally, a 2006 study from Harvard found that 97% of cases were meritorious, totally debunking the idea that frivolous lawsuits plague our courts. And while 46 states have enacted some kind of tort reform, health care costs have continued to skyrocket, while injured patients or their families often can't seek justice."
Source: http://www.huffingtonpost.com/anthony-t ... 94896.html

They enacted tort reform and imposed arbitrary damage caps in the state in which I practice, Texas. Did malpractice insurance companies reduce their policy rates? No. Did more doctors move to Texas to start practicing? No. Are patients any safer? No. Did it reduce costs or stop the practice of "defensive medicine"? No. Did it work as expected? No.

Lawyers are not unreasonable people. We care about protecting you and your family. We are willing to consider reform proposals that have been proven to actually work to lower costs while keeping patients safe. We are willing to help doctors look at the community medical standards for reasonable care that they themselves, and only they, have the power to adjust and help them come up with some ideas for areas in which their standards might be adjusted to reduce costs while still ensuring a good outcome for their patients. But let's be clear. Imposing arbitrary caps has been proven time and time again not to work. Caps only hurt patients and families maimed or killed by avoidable neglect, reckless or even sometimes intentional abuse. Arbitrary damage caps only reward bad doctors, they do not protect the good ones. Most importantly, they do not lower either patients or doctors insurance costs.

----------------------

Well, that's my take on the issue. Here's another take ...

Tort Reform: A Bad Bargain That Won't Fix Health Care
by Anthony Tarricone
Huffington Post, Sept. 22, 2009

On Friday, the Associated Press reported that a southern Illinois woman died after catching fire on the operating table during surgery. This woman unfortunately joined the least discussed, but most far-reaching statistic in health care: according to the Institute of Medicine, 98,000 people die annually from preventable medical errors.

To put this into perspective, 98,000 deaths is like two 737s crashing every day for a whole year. If this were the case, would lawmakers consider giving the airlines immunity, or make air travel safer instead?

As part of a "grand bargain" to create a bipartisan health care bill, some have said tort reform should be included. For most people, the term "tort reform" is empty and meaningless. But here's what it means: taking away the legal rights of patients, injured through no fault of their own, and preventing them from obtaining legal recourse. And it isn't fact-driven or grounded in reality; rather, it's just part of the Washington sideshow to distract from what really plagues our country's health care system.

Look at what the actual data says: 98,000 people dead every year from preventable medical errors, at a cost of $29 billion. Countless more are seriously injured with astronomical costs. The Congressional Budget Office and Government Accountability Office have looked at tort reform multiple times, and said it will save practically no money. They also found no evidence of so-called "defensive medicine," finding that doctors run more tests because of the fee-for-service structure, or because of the benefits extra tests have on patient care.

Additionally, a 2006 study from Harvard found that 97% of cases were meritorious, totally debunking the idea that frivolous lawsuits plague our courts. And while 46 states have enacted some kind of tort reform, health care costs have continued to skyrocket, while injured patients or their families often can't seek justice.

It's no coincidence that the same people who have hijacked our health care system -- the insurance companies -- are the same folks who want tort reform. Insurers charge exorbitant amounts for malpractice coverage, raking in billions of dollars off the backs of doctors. Then, the insurance companies lobby for tort reform, and promise to pass the savings onto physicians and consumers. Of course, the savings never materialize, while injured patients are left holding the bag. We've been fooled once before, and shouldn't let it happen again.

Watching all the health care debate and cable news punditry, you hear about different parties having to "give something up." For example, the insurers, drug companies, the AMA, and hospital associations have all been involved in trades or negotiations so their own interests are taken care of in the health care bill.

But what about the interests of actual patients, who know better than anyone what good health care should look like? Or the interests of injured patients, who know better than anyone the consequences of bad health care? Their rights and concerns aren't being considered, and in fact, lay on the chopping block.

Injured patients have suffered enough. They shouldn't have additional barriers thrown in their way to seek justice, or be told their life is worth a set arbitrary amount. Instead, we should focus on preventing these people from being injured in the first place. Fewer errors equals fewer injuries, and fewer injuries means less litigation. Fix the problem on the front-end, rather than discussing ways to bargain away the rights of already injured patients.

Forty-six states have tort reform, and American families still shoulder exorbitant health care costs. All the facts and data say it doesn't work. There's still 98,000 people dead every year from medical errors. But when political gamesmanship and backroom deals take over, the facts fly out the window.

This health care bill has a long way to go. But let's be perfectly clear: patients' rights aren't negotiable. Tort law changes won't fix health care, but only make it more difficult for injured patients to seek justice. Instead of bargaining away patients' rights, Congress should their safety first. There's 98,000 reasons why they should.

Source: http://www.huffingtonpost.com/anthony-t ... 94896.html

[roxybeast]

Humor: New PSA on Protecting Insurance Company Profits!

This is hilarious!!! ... new ad by Will Ferrell & other TV stars on why we should support the plan to protect insurance company profits! , ...

http://www.funnyordie.com/videos/041b5a ... panies-psa

[roxybeast]

Health Care Abroad: France

Don't Americans Deserve a Health Care System as Good as the One In France?
by Robert Creamer
Huffington Post, Sept. 23, 2009

A few years ago there was a great uproar from the Right Wing against France because its government opposed the War in Iraq. The Republican Congress went so far as to rename the "French Fries" in the Congressional cafeteria "freedom fries."

Of course, the Republican response was stupid and parochial - and not many years after, most Americans had come to agree with the French that the War in Iraq was a huge mistake.

I think of myself as an internationalist, but my latent sense of nationalist competitiveness is indeed aroused by the fact that, per capita, France spends less than half of what we do on health care and yet the World Health Organization ranks their health care outcomes as number one in the world, and we are only 37th.

We spend $7,290 per person and end up in 37th place. They spend only $3,601 and they are number one. That's just not right.

On the average, Frenchmen live almost three years longer than the average American. That's infuriating.

What's more, every legal resident of France is covered by health insurance, and in the U.S. 46 million people are uninsured. When someone in France goes to the hospital, everything except a small co-payment is covered - it's that simple.

The government doesn't deliver health care in France. Private doctors and hospitals do most of that. It just provides health insurance for everyone.

If you walk into one store and a suit you like costs $600 - and next door the very same suit is $300 - most people would call you a chump for spending $600. In this case the French are paying $300 and getting a better suit. What are we, idiots?

I, for one, refuse to believe that we are not as smart as the French. I can't believe that we willingly allow ourselves to continue to be fleeced by the private insurance executives who make millions off our current broken health care system.

In their private moments, those executives must not believe their luck. They are laughing all the way to the bank - laughing at us that we could be such suckers - and doing everything they can to keep things just the way they are.

Just today, they and their Republican defenders in Congress will try to prevent the Senate Finance Committee from ending the current practice (put in place by Bush and the Republicans) of subsidizing private insurance firms 14% to provide Medicare Advantage members the same benefits as Medicare. Do they think we are complete fools?
President Obama's health insurance reform plan finally offers us a chance to end the national embarrassment of being the world's biggest health care chumps. We can finally begin the process of ending the stranglehold of private insurance companies over our health care system with strong regulation, and by offering Americans a choice of keeping their private insurance or joining a strong public health insurance plan.

Of course the private health insurance companies hate the thought of a public health insurance option because it would force them to compete, cut profit margins, cut executive salaries, and control costs - just what America needs. And most Americans understand that. In a poll conducted just a week ago, 62% said they would be more likely to support President Obama's health insurance reform proposal if they had a choice of a public option. Only 28% said they would be less likely.
The only reason we wouldn't get a public option is if the insurance companies and their allies are allowed to hold our health care hostage by threatening to stop any form of health insurance reform if Congress limits their unfettered ability to fleece us through the current system. It is up to us to make sure that doesn't happen.

Call your Senators today. Tell them that - as Americans-- we're done with being the world's biggest health care chumps.

Source: http://www.huffingtonpost.com/robert-cr ... 96040.html

[roxybeast]

GOP Favors Public Option for Property, Not People
by David Cay Johnston
Huffington Post, Sept. 23, 2009

Atop the front page of the New York Times today is a color photo of Georgia homes flooded up to their rafters, an image that illustrates how when it comes to insurance our Congress applies two standards, separate and unequal, one for property and a lesser one for people.
Unlike people without health insurance, homeowners have access to public option flood insurance.

Even those who fail to take personal responsibility to buy insurance to protect their property can get benefits, thanks in good part to politicians who are leading opponents of public option healthcare.

Consider the example of Trent Lott of Mississippi, who was that state's senior senator when Hurricane Katrina hit in 2005, flooding his home looking out on the Gulf. Lott had not exercised personal responsibility by taking out flood insurance even though it was available from the federal government at low cost. He did have private insurance, but his insurer refused to pay much of the claim, saying it was not wind damage (which was covered by the policy), but water damage (which was excluded).

Weeks later Lott introduced Senate Bill 1936, which would have authorized retroactive flood insurance. The idea came from Representative Gene Taylor, a Democrat who represented the Mississippi Gulf Coast, which should remind us that when there is voter demand for reform, and campaign contributions are not the driving force, the parties have worked together.

Lott's bill would have let flood victims pay 10 years of flood insurance premiums after-the-fact plus a 5 percent late payment penalty. Since this storm was rated a once in 500 years occurrence, even 10 years of premiums would not come close to covering the real costs, meaning a taxpayer subsidy was built into the Lott bill.

Instead of being laughed at by his fellow Republicans for promoting socialism, the concept of retroactive relief was warmly embraced, although not the idea for retroactive insurance. Instead the government went with handouts.

Senator Thad Cochran, also a Mississippi Republican and at the time chairman of the Senate Appropriations Committee, was key to getting taxpayer benefits for flooded property, according to Taylor's staff. The benefits were issued and expanded twice, a total of about $18 billion in all, Taylor's staff estimated.

Contrast the two Mississippi Republican senators' determined action to get welfare for flooded buildings with their votes against expanding SCHIP health insurance for poor children.

Cochran opposes a public option in health care; Lott, now a lobbyist, says Obama should just declare victory after some minor tweaks, a way to oppose without quite saying so.

Mississippi Governor Haley Barbour, the former head of the Republican Party, has spoken cautiously, but also appears to oppose a public option. But he, too, was an enthusiastic supporter of retroactive benefits for flooded property. Barbour even got the relief expanded and urged everyone to get their government property benefits.

There is also an interesting twist in this public option for another aspect of the health care debate - what to do about those who decline to buy insurance.

In Mississippi the relief for flooded buildings came with a requirement that owners buy flood insurance. It went further, requiring a covenant be added to their property deeds requiring the current and all future owners of that property to maintain public option flood insurance.

There is another word for that: government mandated insurance.

How about a similar retroactive option for people with a pre-existing condition who do not have health insurance? Many of these people had insurance before the recession cost them their jobs and with it, their health care coverage. Even people who took personal responsibility and had health insurance now may be without healthcare insurance because the recession cost them their jobs or their employers enough revenue to continue coverage.

Why should those who lost their jobs and thus their healthcare insurance be held to a different standard than irresponsible homeowners like former Senator Lott?

I call federal flood insurance a public option because it is provided by the federal government., It is sold, however, through individual insurance agents who collect commissions on the policies.

Private, for-profit insurers could sell this insurance if they wanted. The problem is that rating the risk of a once-in-a-century or even once in-a-millennium event is difficult and requires a huge pool of capital held in reserve to cover benefits that may be due tomorrow on in the year 2805.

Socializing these risks makes sense, and so does trying to minimize them with building codes that discourage building in some areas and require mitigating designs (like putting the first floor 15 feet above sea level). Individual policies for flood insurance, which many people must now rely on for health care coverage, would be like selling insurance for kindergarten in case of pregnancy or prosecution insurance in case you are a crime victim.

Congress is so generous in its subsidies for property that the public option for flood insurance even covers property built in flood prone areas. And you can literally buy insurance on the day of a flood in some cases, and 1 day before in others.

Along the Gulf Coast, on the barrier islands on the Atlantic, in below-water expanses behind river levees and in desert communities plagued by flash floods, our federal government is there using tax dollars to help take care of damaged property.

But people? Providing a public option so people can buy health insurance through the federal government is "socialism," according to Senator John Kyl, the Republican senator from Arizona, a desert state where flash floods are as permanent a feature of reality as sickness and injury. Will someone ask Kyl why he favors what he calls socialist policies for property, but not people?

And what about the denial of coverage you paid for, which so enraged Lott that he filed a lawsuit against his insurer, State Farm? Lott, like others, was told that their policies would cover the modest damage like broken windows and torn roofs caused by the hurricane's winds, but not the surge of storm waters, even though the wind drove those waters into Lott's living room.

Health insurance companies have found more than 1,400 reasons they can retroactively take away health insurance benefits from people, Congressional investigators found after digging through the fine print of insurance contracts. (You, of course, have read and understand every word in your health insurance contract, right?) A woman who had acne was denied breast cancer coverage, for example, though she later got her coverage restored.

And health insurance companies have become masters at digging up excuses to rescind policies, as shown by the recent hearings held by Representative Henry Waxman, who chairs the House subcommittee on Oversight and Investigations.

For-profit health insurers literally reward doctors who deny costly care to people, making corporate-run death panels a lucrative enterprise. As recounted in my book FREE LUNCH, Dr. Linda Peeno denied a heart transplant to a man she never met even though she was certain it would cause him to die. She did so in Kentucky, where she had a medical license, by stamping "denied" on a form even though the man was in California, where she was not licensed. Humana, one of the biggest for-profit health insurers, rewarded her and Dr. Peeneo got a conscience that caused her to stop that work and start working to end such abominations.

We have elevated property above human lives. That members of Congress who frequently proclaim their religious faith and cite the Bible as their guide would put property above people suggests they need to actually read the texts they claim guide them. Neither Jesus nor the Old Testament prophets ever put property first. They did however denounce those who did, labeling their deeds with a simple word: evil.
Two standards, separate and unequal, for the health of property and the health of people, are un-American. This bias in favor of property over people should be ended with all deliberate speed by raising the standard for people to that of property. A public option would be one small step in that direction.

Source: http://www.huffingtonpost.com/david-cay ... 96703.html