Today's political puff piece in the Washington Post on Senate Finance Committee Chair Max Baucus tells us that his approach to health reform "has been to pull together stakeholders and hold them as long as possible; no idea is ruled out, no policy change dismissed. His mantra is always the same: "Suspend judgment, if only for a nanosecond."
In case we were wondering about editorial bias at the Post, they ignored their own (already slanted) reporting on Baucus' notorious refusal to entertain any discussion of single payer at his hearings, including the infamous arrest of single payer advocates. Surely a decision that will haunt his political future, with unknown consequences for the future of health reform.
Here's how the Post called it at the time:
Police eject protesters from Senate health hearing
The Associated Press Tuesday, May 12, 2009; 10:53 AM
WASHINGTON -- Police have ejected five doctors and nurses who back government-run health care after they disrupted a Senate hearing. Dozens of others protested outside.
The protesters says supporters of government-run health care are being excluded from congressional debate. The Senate Finance Committee met Tuesday to debate how to pay for overhauling the nation's health care system.
At the start of the hearing more than a dozen nurses stood in silent protest and turned their backs on Finance Committee Chairman Max Baucus as he spoke. They had signs attached to the back of their shirts supporting single-payer _ or government-run _ health care and protesting industry influence.
After they left, five others stood up, spoke in favor of single-payer, and were taken out by Capitol Police.
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/23/AR2009052301893.html?hpid%3Dtopnews&sub=AR
Sunday, May 24, 2009
Monday, May 11, 2009
HEALTH INDUSTRY SCRAMBLES ~ REPUBLICANS: “THROW THEM UNDER THE BUS”
The health care industry is playing its final card. Even the Republican Party is ready to "throw the health insurance industry under the bus," according to strategist Frank Luntz – while taking every opportunity to block all reform proposals.
To avert genuine cost control, they are promising to voluntarily hold down prices, per a letter from the America’s Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America; as well as the AMA, the Hospital Association, the Advanced Medical Technology Association, and the Service Employees International Union. Voluntary efforts have been effective in the past at staving off real health reform, but each time have failed to truly reduce costs.
To avoid the political fight of imposing genuine cost control, the Administration may accept the offer. Advocating health reform as a measure to help save the failing economy, it has suggested reducing costs by transforming how health care is delivered. An array of sensible and important proposals, from increasing primary care and incentives to improve quality, to addressing the social and economic causes of illness, are on the table. These proposals are well and good. Our fragmented, profit-driven system means that Americans spend more for using fewer health care services, and get worse health outcomes, compared with other countries. Improving care will help some people.
But the Congressional Budget Office has testified that it will not give much credit to these proposals for savings on costs. CBO and the health care industry know what would work, and it's the third rail of the current debate: In every other country, the government takes responsibility for assuring that health care is affordable and available. Since they know individuals can't bargain over prices when they're sick, the government does it for them, by setting limits on total health care spending, and prices.We're mustering the political will. The question is, will Congress propose a plan like Medicare, that can ensure the government can play its role, and hold down costs while assuring universal coverage? Let's look for robust proposals that can secure the transformation of the health system that policymakers are promising.
Online also at http://www.huffingtonpost.com/ellen-r-shaffer/health-industry-scramble_b_201882.html
To avert genuine cost control, they are promising to voluntarily hold down prices, per a letter from the America’s Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America; as well as the AMA, the Hospital Association, the Advanced Medical Technology Association, and the Service Employees International Union. Voluntary efforts have been effective in the past at staving off real health reform, but each time have failed to truly reduce costs.
To avoid the political fight of imposing genuine cost control, the Administration may accept the offer. Advocating health reform as a measure to help save the failing economy, it has suggested reducing costs by transforming how health care is delivered. An array of sensible and important proposals, from increasing primary care and incentives to improve quality, to addressing the social and economic causes of illness, are on the table. These proposals are well and good. Our fragmented, profit-driven system means that Americans spend more for using fewer health care services, and get worse health outcomes, compared with other countries. Improving care will help some people.
But the Congressional Budget Office has testified that it will not give much credit to these proposals for savings on costs. CBO and the health care industry know what would work, and it's the third rail of the current debate: In every other country, the government takes responsibility for assuring that health care is affordable and available. Since they know individuals can't bargain over prices when they're sick, the government does it for them, by setting limits on total health care spending, and prices.We're mustering the political will. The question is, will Congress propose a plan like Medicare, that can ensure the government can play its role, and hold down costs while assuring universal coverage? Let's look for robust proposals that can secure the transformation of the health system that policymakers are promising.
Online also at http://www.huffingtonpost.com/ellen-r-shaffer/health-industry-scramble_b_201882.html
Monday, March 30, 2009
Save Health Reform - Expand Medicare for All
President Obama has created a unique opportunity to transform the health system. Health care consumers, women and public health advocates know we need an Equitable, Quality, Universal, Affordable health system. But special interests in D.C. have other ideas. Sign up to let the President and Congress know we need a publicly financed, publicly administered plan like Medicare. We'll send the message to them by April 6, when the White House health care forum convenes in Los Angeles. Ask your friends and colleagues to sign too!
Go to:
http://org2.democracyinaction.org/o/5890/t/5559/petition.jsp?petition_KEY=307
Dear President Obama,
Thank you for taking leadership towards winning national health reform. We want to help. We are asking you and our members of Congress:
1. Give us an American solution we know and trust. Expand Medicare to make sure everyone in America is covered by this popular, affordable, publicly financed and publicly administered program.
2. We have learned a lot since the last time. Special interests cant scare us about government-run health care, and losing our choices. Too many of us have had to struggle at our sickest for the care we deserve, even when we were insured. We know that everyone on Medicare can choose our own doctor and hospital, and we do not lose coverage when we get sick. That is the choice we care about.
3. Expand Medicare benefits to address all our needs for preventive, acute, and long-term care, including reproductive health services, prescription drugs, dental, mental health, vision, and alternative and complementary medicine.
4. Stick with your plans to let our doctors and nurses know which treatments are most effective, and encouraging team practices. We all deserve the best quality care.
5. Thank you for investing in public health. It is time to make sure all our social and economic policies make us healthier, from the environment to education, from the dinner table to our transportation systems.
We know that keeping the coverage we have is not a real choice for many in todays economy.
Covering everyone under a publicly-financed, publicly- administered program like Medicare slashes administrative costs from 30% to 3% of the health care dollar, and saves money for individuals, employers, and the government.
Go to:
http://org2.democracyinaction.org/o/5890/t/5559/petition.jsp?petition_KEY=307
Dear President Obama,
Thank you for taking leadership towards winning national health reform. We want to help. We are asking you and our members of Congress:
1. Give us an American solution we know and trust. Expand Medicare to make sure everyone in America is covered by this popular, affordable, publicly financed and publicly administered program.
2. We have learned a lot since the last time. Special interests cant scare us about government-run health care, and losing our choices. Too many of us have had to struggle at our sickest for the care we deserve, even when we were insured. We know that everyone on Medicare can choose our own doctor and hospital, and we do not lose coverage when we get sick. That is the choice we care about.
3. Expand Medicare benefits to address all our needs for preventive, acute, and long-term care, including reproductive health services, prescription drugs, dental, mental health, vision, and alternative and complementary medicine.
4. Stick with your plans to let our doctors and nurses know which treatments are most effective, and encouraging team practices. We all deserve the best quality care.
5. Thank you for investing in public health. It is time to make sure all our social and economic policies make us healthier, from the environment to education, from the dinner table to our transportation systems.
We know that keeping the coverage we have is not a real choice for many in todays economy.
Covering everyone under a publicly-financed, publicly- administered program like Medicare slashes administrative costs from 30% to 3% of the health care dollar, and saves money for individuals, employers, and the government.
Thursday, March 5, 2009
The Health Care Summit: Or, What Were They Thinking?
The White House health care summit started out inspiringly. Single payer advocates organized their way into the room. The President had originally refused to invite Rep. John Conyers, the lead co-sponsor of the House’s Medicare for All bill, HR 676. The bill would virtually eliminate the private insurance industry, something the President had taken off the table in a nod to that industry’s power and past political clout. But Physicians for a National Health Program and other activists generated massive phone calls in protest, and threatened to demonstrate in front of the proceedings. Rep. Conyers was invited in, along with PNHP President Oliver Fein, MD.
It was a bracing early victory.
Compared with last week’s economic summit, the health care event had the aura of a classroom political science exercise rather than a call to address a pressing financial and humanitarian crisis, with causes and effects, as well as known – if politically difficult - solutions.
Government officials have spent months excoriating the malfeasance of corporate executives and lax regulators who brought the economy to rack and ruin. And then turned around and given them more bucks. The economic summit ended on a forceful note: Fix the health care system, or we doom prospects for economic recovery.
But once at the health care discussion, no actor was excluded from a civil hearing (including, ultimately, single payer). The insurance industry, pharmaceutical manufacturers, hospitals, employers, doctors and nurses, and national leaders of health care consumer groups flanked members of Congress to describe the crises in access, costs and quality. They broke into several groups to talk about the issues for about an hour and a half, then reconvened to chat further with the President.
In the group televised on C-Span, and moderated by Melody Barnes and Bob Kocher, members of Congress provided the most grounded and the most pointed comments in the face of nearly surreal assertions by others on the panel. Business Roundtable Chair Ken Powell, CEO of General Mills, a processed food giant that has lost 30% of its stock value since September and experienced its share of layoffs, waxed eloquent about how employers are firmly committed to continuing to play a central role in providing health benefits to their employees. They love doing it and by golly they feel good about how good they are at doing it! They’re offering wellness programs that make a real difference in their employee’s lives. He didn’t exactly address how we should deal with the 40% of employers who offer no benefits at all (a detail Rep. Rob Andrews of New Jersey pointed out). In other words: they don’t want the government to do it.
Blue Cross Blue Shield likewise marveled at its own wellness programs. Though they did agree it was time for reform. (Probably need to do something about those pesky pre-existing condition exclusions.) As long as everyone is required to pay into the system. Well actually, to pay them. They didn’t really see the need for a competing public insurance plan.
It was up to Rep. Allyson Schwartz to mention that there are no hospitals left in northeast Philadelphia that deliver babies. She also mentioned the newborn baby who had jaundice for the first five days of life and was denied insurance coverage just about straight out of the womb, because of the risk that she might someday develop liver disease. Rep. Baron Hill of Indiana confessed that 60% of his generally conservative constituency thought that the government should take over the health care system, though they were divided about exactly how. A somewhat ambivalent Jan Schakowsky soldiered on in allegiance to an Obama-like hybrid plan, but stuck up for Medicare as a program popular with its beneficiaries, and well run. Republican Jo Ann Emerson spoke movingly about the failures of access in rural areas, and nodded to Sen. Byron Dorgan who continues to team up with her to propose legal reimportation of affordable drugs. (PhRMA CEO Billy Tauzin was in a different breakout group.)
Rep. Earl Pomeroy and Sens. Whitehouse and Hatch bemoaned the perverse incentives and poor outcomes of the delivery system.
But John Dingell took the cake. In a few sentences, he recalled his father introducing the first single payer bill in the U.S. Congress in 1943, though he was beaten to the punch by “those socialists, Edward VII of England and Bismarck in Germany.” He agreed with his colleagues who suggested, in a masterful stroke of understatement, that the current system is too administratively cumbersome and should be simplified.
I have yet to watch the rest of the discussions online, including the one attended by the ever-eloquent Dr. Fein. The group of Congress members I watched clearly reveres the President, and no one’s breaking ranks just yet. And they all knew they were on TV. But are they ready to contract out the job of controlling health care costs to the same cast of characters that dug us into this hole in the first place? One makes predictions about health care politics only at great peril. So for now the best answer is, maybe. And maybe not.
It was a bracing early victory.
Compared with last week’s economic summit, the health care event had the aura of a classroom political science exercise rather than a call to address a pressing financial and humanitarian crisis, with causes and effects, as well as known – if politically difficult - solutions.
Government officials have spent months excoriating the malfeasance of corporate executives and lax regulators who brought the economy to rack and ruin. And then turned around and given them more bucks. The economic summit ended on a forceful note: Fix the health care system, or we doom prospects for economic recovery.
But once at the health care discussion, no actor was excluded from a civil hearing (including, ultimately, single payer). The insurance industry, pharmaceutical manufacturers, hospitals, employers, doctors and nurses, and national leaders of health care consumer groups flanked members of Congress to describe the crises in access, costs and quality. They broke into several groups to talk about the issues for about an hour and a half, then reconvened to chat further with the President.
In the group televised on C-Span, and moderated by Melody Barnes and Bob Kocher, members of Congress provided the most grounded and the most pointed comments in the face of nearly surreal assertions by others on the panel. Business Roundtable Chair Ken Powell, CEO of General Mills, a processed food giant that has lost 30% of its stock value since September and experienced its share of layoffs, waxed eloquent about how employers are firmly committed to continuing to play a central role in providing health benefits to their employees. They love doing it and by golly they feel good about how good they are at doing it! They’re offering wellness programs that make a real difference in their employee’s lives. He didn’t exactly address how we should deal with the 40% of employers who offer no benefits at all (a detail Rep. Rob Andrews of New Jersey pointed out). In other words: they don’t want the government to do it.
Blue Cross Blue Shield likewise marveled at its own wellness programs. Though they did agree it was time for reform. (Probably need to do something about those pesky pre-existing condition exclusions.) As long as everyone is required to pay into the system. Well actually, to pay them. They didn’t really see the need for a competing public insurance plan.
It was up to Rep. Allyson Schwartz to mention that there are no hospitals left in northeast Philadelphia that deliver babies. She also mentioned the newborn baby who had jaundice for the first five days of life and was denied insurance coverage just about straight out of the womb, because of the risk that she might someday develop liver disease. Rep. Baron Hill of Indiana confessed that 60% of his generally conservative constituency thought that the government should take over the health care system, though they were divided about exactly how. A somewhat ambivalent Jan Schakowsky soldiered on in allegiance to an Obama-like hybrid plan, but stuck up for Medicare as a program popular with its beneficiaries, and well run. Republican Jo Ann Emerson spoke movingly about the failures of access in rural areas, and nodded to Sen. Byron Dorgan who continues to team up with her to propose legal reimportation of affordable drugs. (PhRMA CEO Billy Tauzin was in a different breakout group.)
Rep. Earl Pomeroy and Sens. Whitehouse and Hatch bemoaned the perverse incentives and poor outcomes of the delivery system.
But John Dingell took the cake. In a few sentences, he recalled his father introducing the first single payer bill in the U.S. Congress in 1943, though he was beaten to the punch by “those socialists, Edward VII of England and Bismarck in Germany.” He agreed with his colleagues who suggested, in a masterful stroke of understatement, that the current system is too administratively cumbersome and should be simplified.
I have yet to watch the rest of the discussions online, including the one attended by the ever-eloquent Dr. Fein. The group of Congress members I watched clearly reveres the President, and no one’s breaking ranks just yet. And they all knew they were on TV. But are they ready to contract out the job of controlling health care costs to the same cast of characters that dug us into this hole in the first place? One makes predictions about health care politics only at great peril. So for now the best answer is, maybe. And maybe not.
White House Health Summit: Off to a Good Start
The White House Forum on health reform will include two single-payer supporters: Rep. John Conyers, sponsor of HR 676/Medicare for All, and Dr. Oliver Fein, President of Physicians for a National Health Program. Advocates nationwide called the White House to protest the exclusion of the single-payer perspective - and the WH responded. Watch C-Span starting at 1 p.m. EST on March 5, and watch this Blog for comments.
Tuesday, March 3, 2009
A First 100 Days Health Agenda To Improve Health
How should we start? Then what? A proposal:
Halt erosion of traditional, public Medicare.
■ Stop excess payments to Medicare Advantage plans. – Proposed in Budget
■ Cancel the 2010 Medicare Comparative Cost Adjustment demonstration. - Cancelled
■ Eliminate the arbitrary 45% cap on general revenue funding for Medicare. - Waived
■ Eliminate means-tested (income-based) premiums for Medicare Part B.
Extend and expand health coverage and access.
■ Children – Reauthorize SCHIP - Enacted
■ Expand SCHIP to cover ages 0 – 25.
■ Medicare – Expand coverage to start at age 50
• Eliminate the 24-month wait for Medicare benefits for persons with qualifying disabilities.
■ Medicaid – Increase enrollment and access:
• Increase the federal match in Medicaid funding and minimize cost shifting to patients.
• End categorical eligibility. Extend eligibility to everyone living in poverty, and to all uninsured recipients of unemployment compensation, as proposed by Sen. Baucus.
• Simplify documentation and application requirements.
• Increase transparency of the state waiver process that is eroding federal standards for Medicaid.
■ Safety-net institutions: Increase funding for public hospitals, and for community and migrant health centers. Proposed in budget.
Improve access to affordable medications.
■ Create a public prescription drug benefit within traditional Medicare, requiring CMS to negotiate drug prices. - Proposed in Durbin/Berry bill.
■ Allow the re-importation of prescription drugs. - Proposed in budget
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Policy and Program Initiatives for the First Year
Improve the health of the nation
■ Link action across government sectors (employment, housing, education, environment, commerce and trade, health) to address the social and economic conditions and policies that make people sick and produce health inequities: economic deprivation, discrimination, and adverse conditions at work, in the environment, and in communities. Make improving health and reducing health inequities a criterion for all government initiatives. - Tax proposals reduce income inequality
(See report of the World Health Organization's Commission on the Social Determinants of Health: http://www.who.int/social_determinants/final_report/en/index.html)
Build a basis for effective, efficient financing and delivery of health care
■ Propose adequate, stable Medicare financing with cost-growth containment to ensure Medicare’s continued ability to meet beneficiary needs without being burdensome financially.
■ Investigate the effectiveness, efficiency, and discriminatory practices in the health insurance industry.
■ Strengthen primary care capacity. - Proposed in budget
■ Compare effectiveness of medical treatments, implement best practices. - In Recovery Act
■ Eliminate the barriers (financial, administrative, gender) to timely health care for veterans. - Proposed in budget
■ Enact universal coverage for quality, affordable, publicly accountable health care.
Proposed by:
Center for Policy Analysis www.centerforpolicyanalysis.org
Rekindling Reform www.rekindlingreform.org
Halt erosion of traditional, public Medicare.
■ Stop excess payments to Medicare Advantage plans. – Proposed in Budget
■ Cancel the 2010 Medicare Comparative Cost Adjustment demonstration. - Cancelled
■ Eliminate the arbitrary 45% cap on general revenue funding for Medicare. - Waived
■ Eliminate means-tested (income-based) premiums for Medicare Part B.
Extend and expand health coverage and access.
■ Children – Reauthorize SCHIP - Enacted
■ Expand SCHIP to cover ages 0 – 25.
■ Medicare – Expand coverage to start at age 50
• Eliminate the 24-month wait for Medicare benefits for persons with qualifying disabilities.
■ Medicaid – Increase enrollment and access:
• Increase the federal match in Medicaid funding and minimize cost shifting to patients.
• End categorical eligibility. Extend eligibility to everyone living in poverty, and to all uninsured recipients of unemployment compensation, as proposed by Sen. Baucus.
• Simplify documentation and application requirements.
• Increase transparency of the state waiver process that is eroding federal standards for Medicaid.
■ Safety-net institutions: Increase funding for public hospitals, and for community and migrant health centers. Proposed in budget.
Improve access to affordable medications.
■ Create a public prescription drug benefit within traditional Medicare, requiring CMS to negotiate drug prices. - Proposed in Durbin/Berry bill.
■ Allow the re-importation of prescription drugs. - Proposed in budget
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Policy and Program Initiatives for the First Year
Improve the health of the nation
■ Link action across government sectors (employment, housing, education, environment, commerce and trade, health) to address the social and economic conditions and policies that make people sick and produce health inequities: economic deprivation, discrimination, and adverse conditions at work, in the environment, and in communities. Make improving health and reducing health inequities a criterion for all government initiatives. - Tax proposals reduce income inequality
(See report of the World Health Organization's Commission on the Social Determinants of Health: http://www.who.int/social_determinants/final_report/en/index.html)
Build a basis for effective, efficient financing and delivery of health care
■ Propose adequate, stable Medicare financing with cost-growth containment to ensure Medicare’s continued ability to meet beneficiary needs without being burdensome financially.
■ Investigate the effectiveness, efficiency, and discriminatory practices in the health insurance industry.
■ Strengthen primary care capacity. - Proposed in budget
■ Compare effectiveness of medical treatments, implement best practices. - In Recovery Act
■ Eliminate the barriers (financial, administrative, gender) to timely health care for veterans. - Proposed in budget
■ Enact universal coverage for quality, affordable, publicly accountable health care.
Proposed by:
Center for Policy Analysis www.centerforpolicyanalysis.org
Rekindling Reform www.rekindlingreform.org
Responding to Bob Rosenblatt, LA Times, March 2009
Responding to Bob Rosenblatt, LA Times. http://tinyurl.com/b5yo2n
Are Americans really happy with the status quo, and fearful of change?
Sen. Max Baucus' health proposal notes,
More than 70 percent of Americans rate our health care system as “fair” or “poor.”41 When asked whether our health system needs a complete overhaul, major repairs, or minor tinkering, 90 percent of Americans respond that the system should be “completely rebuilt” or that “fundamental changes” are needed.4.
He continues:
At the same time, those who currently have health coverage do not want to lose those benefits. Many people are satisfied with their personal providers or their current coverage and do not want to jeopardize those connections to the system.
Do people really care about their health plan? Avoiding disruption, yes, as Medicare could do. Warm and fuzzy about UnitedHealth? He doesn't provide evidence (or a citation - though I'm sure there is one; Celinda Lake's latest comes close).
Americans do not necessarily agree on how to achieve it (see Figure 1.5). Although a majority of respondents would support a mandate on employers to provide coverage, a “Medicare-for-all” single-payer option, or a mandate that all individuals purchase coverage, opposition to each of these options is also somewhat substantial. Moreover,some of this support erodes when respondents are asked whether they would be willing to have more government responsibility or higher taxes — though half of all surveyed in 2007 said they would support reform even under these circumstances.46 (2007 survey figures)
http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf
These are pretty close odds and the numbers are 2 years old. Given that a Medicare for all option would undoubtedly work, and the other 2 options are iffy at best, does it make sense to just abandon the one that's workable? Conventional wisdom says yes; as it has in the many states that have tried it and failed. Admittedly, the federal government has greater authority to mandate employer contributions than do states, because of ERISA. Maybe this can work. Beats me how.
Are Americans really happy with the status quo, and fearful of change?
Sen. Max Baucus' health proposal notes,
More than 70 percent of Americans rate our health care system as “fair” or “poor.”41 When asked whether our health system needs a complete overhaul, major repairs, or minor tinkering, 90 percent of Americans respond that the system should be “completely rebuilt” or that “fundamental changes” are needed.4.
He continues:
At the same time, those who currently have health coverage do not want to lose those benefits. Many people are satisfied with their personal providers or their current coverage and do not want to jeopardize those connections to the system.
Do people really care about their health plan? Avoiding disruption, yes, as Medicare could do. Warm and fuzzy about UnitedHealth? He doesn't provide evidence (or a citation - though I'm sure there is one; Celinda Lake's latest comes close).
Americans do not necessarily agree on how to achieve it (see Figure 1.5). Although a majority of respondents would support a mandate on employers to provide coverage, a “Medicare-for-all” single-payer option, or a mandate that all individuals purchase coverage, opposition to each of these options is also somewhat substantial. Moreover,some of this support erodes when respondents are asked whether they would be willing to have more government responsibility or higher taxes — though half of all surveyed in 2007 said they would support reform even under these circumstances.46 (2007 survey figures)
http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf
These are pretty close odds and the numbers are 2 years old. Given that a Medicare for all option would undoubtedly work, and the other 2 options are iffy at best, does it make sense to just abandon the one that's workable? Conventional wisdom says yes; as it has in the many states that have tried it and failed. Admittedly, the federal government has greater authority to mandate employer contributions than do states, because of ERISA. Maybe this can work. Beats me how.
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