Having a divide along political lines is far from a new phenomenon. What we must never forget is that issues can unite us where politics divide. For instance, while national healthcare has been politically divisive, there are few that would argue that our current form of health care coverage is successful. So it may be surprising to know that of all the people who had Medicaid or ACA coverage in 2016 , nearly three-quarters of adults said they are satisfied with their plans. According to The Hill, "Overall, 71 percent of people who have plans through the ObamaCare marketplace or Medicaid said their healthcare plans were good, very good or excellent, according to ... the nonprofit Commonwealth Fund." And yet, when Trump and the Republicans were successful in eroding funding and limiting access for the ACA, satisfaction went down to 22% in 2017.
So, what we now know is that people are again going without health coverage and still believe it is important to address. Governing listed health insurance as the second top priority for states for 2018. An AP-NORC poll showed that healthcare is the #1 concern on domestic and economic issues.
What is missing is a push from the public to make it front and center to our expectations from our legislators. Not uncoincidentally, voters believe that their lawmakers won't get far with their priority this year as 72% believe the government won't make progress on this as the survey below shows.
As usual, as long as politics divide us, progress on the things that matter to people get side-stepped. In this less than optimistic time, it is important to note that when we join together on the things that we hold in common, stuff gets done. A popular catch phrase is "pick a lane" and we all need to do it around the issues we mostly agree on.
The following information comes from Bill Hawthorne, Public Outreach Assistant at the Mesothelioma and Asbestos Awareness Center. If you know anyone who has been affected by Mesothelioma, it is very expensive to afford the treatment because research has not found a cure for this type of cancer. My thanks to Bill and his organization.
Health Care Reform Will Help Everybody
Many Americans assume the new health care reform act will benefit mostly the poor and uninsured and hurt everyone else, according to polls. As Matt Yglesias wrote, “Basically, people see this as a bill that will take resources from people who have health insurance and give it to people who don’t have health insurance.” Those who still oppose the reform say that people ought to pay for their own health care.
We all believe in the virtues of hard work and self-reliance, but these days it’s a fantasy to think that anyone but the mega-wealthy will not, sooner or later, depend on help from others to pay medical bills. And that’s true no matter how hard you work, how much you love America, or how diligently you take care of yourself. The cost of medical care has so skyrocketed that breaking an arm or leg could cost as much as a new car. And if you get cancer or heart disease — which can happen even to people who live healthy lifestyles — forget about it. The disease will not only clean you out; it will leave a whopping debt for your survivors to pay.
And the truth is, we all pay for other peoples’ health care whether we know it or not. When people can’t pay their medical bills, the cost of their health care gets added to everyone else’s bills and insurance premiums. When poor people use emergency rooms as a doctor of last resort, their care is not “free.” You pay for it.
Another common fantasy about medical care is that the “free market” provides incentives for medical companies to develop innovative new drugs and treatments for disease without government subsidy. It’s true that private enterprise is very good at developing profitable health care products. But not all medical care can be made profitable.
For years, the U.S. government has been funding medical research that the big private companies don’t want to do because there is too much cost for the potential profit. This is especially true for diseases that are rare and expensive to treat. An example of a recent advance made possible by government grants include new guidelines for malignant pleural mesothelioma treatment developed by Memorial Sloan-Kettering mesothelioma researchers. Another is a blood screening test for mesothelioma developed by thoracic surgeon Dr. Harvey Pass. The health reform act provides for more dollars for such research, from which even many of the tea party protesters will benefit.
The biggest fantasy of all was that people who had insurance didn’t have to worry about health care costs. But the fact is that in recent years millions of Americans have been bankrupted by medical costs, and three-quarters of the medically bankrupt had health insurance. And yes, insurance companies even dumped hard-working, law-abiding patriots. But the health care reform act will put an end to that, and now America’s hard-working, law-abiding patriots are more financially secure, whether they like it or not.
Factcheck has an interesting report about the effects of reducing malpractice claims and the impact on health care reform. Factcheck quotes the Congressional Budgeting Office that says that reducing malpractice claims would be equal to .5% cut in health care costs. While that figure may sound like small change, it is equal to $11 billion today and up to $41 billion over the next ten years.
While this is much smaller than some politicians have claimed (for example Rep. John Boehner on Oct. 2 said "We could save over $100 billion a year in less medicine being practiced if in fact we were to have real reform of medical malpractice laws."
The CBO also said "there's no consistent evidence that damage limits would keep doctors from ordering unnecessary tests.
Researchers say there's no good data on how much defensive medicine is being practice. Doctors could order additional tests for many reasons, including boosting their income and because patients ask for them. And it's difficult to separate the effects of tort reform from other factors that affect health care spending.
Thirty-six states already limit the compensation that patients can receive for medical errors. The 14 states that have not done so are Arizona, Delaware, Iowa, Kentucky, Minnesota, North Carolina, New Hampshire, New York, Oregon, Rhode Island, Tennessee, Vermont, Washington and Wyoming.
Insurance giant WellPoint Inc. said in a May report that malpractice suits are one of the popular explanations for rising health care costs. However they point out this is much less true than costs associated with advances in medical technology, increasing regulation and rising obesity.
Will tort reform help without hurting patients? A study by UCLA/Rand Research claims, according to FactCheck, "that a 10 percent reduction in costs related to medical malpractice liability would increase the nation’s overall mortality rate by 0.2 percent. It concluded that the savings in money would not be worth the cost in lives." FactCheck cites another study published in the Journal of Health Economics, by health economists from Duke University and the University of North Carolina at Chapel Hill, which "concludes that "tort reforms" don’t have any significant effect on patient outcomes."
The idea of reducing costs without harming those who have been medically harmed due to caregiver malfeasance is tricky territory given limits already in place. The proportion of medical malpractice verdicts among the top jury awards in the U.S. has declined during the past 20 years, according to data compiled by Bloomberg News. "Of the top 25 awards so far this year, only one was a malpractice case. At least 30 states cap damages in medical suits, primarily for “pain and suffering” awards." Still, if there are reasonable ways to reduce drawn out trials, perhaps these can be considered as the House bill does by allowing financial incentives for states that try alternative medical liability programs that don't limit damage awards. All Business reports "States, for example, could require patients to first get a medical expert to certify that a case is "medically meritorious," or they could set up "early offer" programs that encourage doctors to admit errors and offer restitution as a way of discouraging lawsuits."
In the fight to reform health care, it seems like an even-handed approach to make it easier for medical treatment to occur and for providers and patients not to see each other as "the problem" is just what the doctor (and patient) have ordered.
To hear it from antagonists of a public healthcare option, the possibility of "Guvment Run Health Care" is likened to a Big Box store moving into town and killing off the Mom and Pop local operations. The only thing is, the Mom and Pop's in this scenario are not the local hardware store or five and dime, they are Fortune 500 companies with revenues that exceed the GNP of Israel and Venezuela combined:
1. UnitedHealth Group Fortune 500 Rank #21 (Revenues $81,186,000,000) 2. WellPoint #32 ($61,251,100,000) 3. Aetna #77 ($30,950,700,000) 4. Humana #85 ($28,946,400,000) 5. Cigna #132 ($19,101,000,000) 6. Health Net #165 ($15,366,000,000) 7. Coventry Health Care #226 ($11,913,600,000) 8. WellCare Health Plans #381 ($6,521,900,000) 9. Universal American #494 ($4,659,200,000) 10. Amerigroup #509 ($4,516,000,000)
It seems implausible to me that a public option would be capable of crippling all of these giants. If such an option makes a dent, it is likely because the insurance giants' profits are well above the cost of doing business or not serving people who can least afford their products. If a not-for-profit can compete and can service areas where competition is less than robust or even where there is limited competition, isn't that the way economies are supposed to work?
Progressive States Network, a group representing state legislators across the country, announced today that 1057 state legislators from all fifty states have signed letters to Congress asking for real health reform, including a public health insurance option, strong affordability protections, and shared responsibility among individuals, employers and government for health care costs.
State legislative leaders, along with mayors from around the country, will be coming to Washington, D.C. next week to bring this message of state support for reform to Capitol Hill and the White House.
“State legislators have been on the front lines of health care reform for decades,” said Texas Representative Garnet Coleman, co-chair of Progressive States Network, “Most proposed elements of federal reform are based on ideas already debated and in many cases enacted in the states. So state legislators know what is needed to make reform work.”
In addition to these letters showing broad-based state legislator support for reform, the National Conference of State Legislatures (NCSL) in August voted to support federal health care reform, including a public health insurance option. The vote at the annual NCSL conference was overwhelming, with representatives of 38 states supporting the resolution. As Iowa State Senator Jack Hatch (D, Des Moines), who introduced the amendment, said at the time, “We sent a very clear message to people dragging their feet in Washington: the time to act on health reform is now. We need a public health insurance option to make sure working families and small businesses are free to choose the best health care available at a price they can afford.”
“Talk radio and television may generate a lot of noise,” said Nathan Newman, PSN’s executive director, “but the over 1000 legislators in all fifty states supporting affordable, quality health care for all Americans, including a public insurance option, reflects the voices of communities across our nation. These legislators are asking to fix a broken health care system and improve both individual lives and the economic competitiveness of our nation.” The list of 1057 legislators supporting reform reflects 943 legislators signing a letter to Congress and President Obama sponsored by Progressive States Network itself, along with two separate letters from legislators in the states of Connecticut (92 additional names) and New Mexico (25 additional names) reflecting advocacy of similar reforms.
The text of the PSN letter was developed in consultation with national health care reform advocates, including the AFL-CIO, AFSCME, Community Catalyst, Families USA, Herndon Alliance, National Women's Law Center, Northeast Action, SEIU, and Universal Health Care Action Network.
Speaker Bios:
Karen Keiser (D) has been serving as a state senator in Washington since 2001. She currently is chair of the Senate Health and Long-Term Care Committee where she has earned a reputation as a tireless advocate for improving the nation’s outdated, inefficient and fragmented health care system.
Kyrsten Sinema (D) serves as the Assistant Leader to the Democratic Caucus in the Arizona House of Representatives. Now in her third term, she is the ranking Democrat on the House Appropriations Committee and the ranking Democrat on the House Judiciary Committee.
Herb Conaway (D) has been a member of the New Jersey Assembly since 1998 and is a private practice physician specializing in internal medicine. Dr. Conaway currently chairs the Health and Senior Services Committee and is the immediate past chair of the NCSL Health Committee.
Jim Campbell (R) is a second term state representative from Maine. He is very devoted to issues relating to the elderly, as is evidenced by his participation on the board of the Southern Maine Agency on Aging which serves Cumberland and York counties.
Jack Hatch (D) serves as Assistant Majority Leader in the Iowa Senate where he is also Chair of the Senate Health & Human Services Budget Committee. In June 2009, he was selected to chair the White House Working Group of State Legislators for Health Reform.
Nathan Newman is Executive Director of the Progressive States Network, which works to promote national reforms benefitting working families in the states working with progressive state legislators and allied community groups, unions, and advocacy organizations.
Senators taking a beating from the folks back home are looking for a way to not appear to be kowtowing to insurance interests by proposing a "trigger" in the Senate's health care bill that would allow a public option to take place if the private market fails to provide more access, more affordability, and more competition in 3 to 5 years.
On CNN's "State of the Union" Nebraska's Sen. Ben Nelson said that President Obama needs to support the trigger, "he has to say if there's going to be a public option, it has to be subject to a trigger. In other words, if somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail/safe backstop to the process. And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger. I mean a true trigger, one that would only apply if there isn't the kind of competition in the business that we believe there would be."
So where are we? Companies like Aetna, American Association of Retired Persons,American Family Insurance, Blue Cross and Blue Shield Association, Cigna, Fortis, Humana Inc., etc. provide insurance for millions of Americans. 76.2% of Medicare health spending in 2002 was on chronic diseases like diabetes, heart disease, cancer, and Alzheimer's disease. According to a white paper "Health-Care Cost Projections for Diabetes and other Chronic Diseases:The Current Context and Potential Enhancements", 49.2% of the US population is projected to have at least one chronic disease (47% projected on 2010) and 25.9% to have two or more by 2030 (Projected to be 23.5% in 2010).
Out of curiosity, I went to gohealthinsurance.com's website and projected the cost of insuring my wife and myself based on me having one chronic disease (in this case, I chose diabetes). Between my wife and I, we earn slightly under $48,000. Selecting the least expensive plan (provided by United Health One which is "the brand name of the UnitedHealthcare family of companies that offer personal health insurance products, including Golden Rule Insurance Company and United HealthCare Insurance Company" aka "the largest single health carrier in the United States" with 70 million customers)which had a $10,000 per person deductible and a cost of $180.43 for a plan that covered no office visits, but had a 20% co-pay after the deductible had been met and a $6,000 out-of-pocket limit. The plan does not include any prescription drug coverage. If my wife and I had ne stay in the hospital or routine check-ups on my "diabetes", we would pay $28,168.76 out of our incomes and/or savings or 59% of our income for the insurance. There were other plans, of course, but each had a higher monthly payment which a person seeking insurance would have to consider no matter how good the overall coverage was. I had a total of four options to choose from, which is not to say there aren't other options, just no other one's with on-line quotes.
The prevention of chronic diseases is tied to two controllable variables, prevention and maintenance of chronic disease. Both require doctor visits and access to prescription drugs. Based on my small experiment, it is clear that persons who would have difficulty accessing health care on there own would likely have less access to the very things that help them not to overuse it; doctors and drugs. Regardless of the plan I would have chosen, there would not be one that would offer the basic elements that Medicare offers, again--doctors and drugs.
This is an example why a public-option is so needed. The private market fails to address the very needs that would keep more of us healthy or healthier. Regardless of income, all of us deserve at least this much coverage. Given the lack of competition, access, and affordability that many experience today, why should we wait another three to five years to hear that it's still a broken system?
Epilogue: For the record, I didn't look up the profits for UnitedHealthCare until just now. On July 21, UnitedHealth Group Inc. reported a soaring second-quarter profit. The Minnetonka-based company said its profit more than doubled compared with the same quarter last year, when hefty legal charges weighed down earnings. UnitedHealth also said revenue rose 7 percent, as it saw strong growth in its public and senior health insurance. How did they do this, getting out of "unprofitable markets, paying off a fine based on business practices, paying doctors less, and yes, increased premiums.
Robert Reich, Bill Clinton's old Secretary of Labor and a pretty good economist in his own right (A graduate of Dartmouth College, Reich is a former Harvard University professor and the former Maurice B. Hexter Professor of Social and Economic Policy at the Heller School for Social Policy and Management at Brandeis University. He is currently Professor of Public Policy at the Goldman School of Public Policy at the University of California, Berkeley. Reich also serves on the board of directors of Tutor.com, and is a trustee of Economists for Peace and Security.), had this to say about health care reform:
1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperitive [sic], but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured --unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don't get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.
2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers -- including those who have been bailed out by taxpayers over the last year -- are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.
3. Finally, I want a true public insurance option -- not a "cooperative," and not something that's triggered if certain goals aren't met. A public option is critical for lowering health-care costs. Today, private insurers don't face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.
Reich wrote a great column about the need for a public health-care plan in June, which is a must read.
The American public is decidedly split on what to do, but most agree reform is needed, though most don't want to foot the bill for the uninsured. The August Penn, Schoen and Berland Associates poll on "ATTITUDES TOWARD HEALTH CARE REFORM" shows that 79% of Independents, Democrats and Republicans favor "starting a new federal health insurance plan that individuals could purchase if they can’t afford private plans offered to them." However when asked to define what the public option means, only 37% of the respondents knew that it meant "Creating a government-funded insurance company that competes with existing private insurers to offer health coverage at market rates."
Coupled with this is the opinion that the single-payer system that has been proposed is likely to be D.O.A. with only 20% of all respondents strongly favoring such a plan. While 61% of Democrats support this plan, 18% of Republicans do and 34% of Independents.
The divide is wide, but for any real reform to happen, at a minimum, what Reich proposes needs to occur. The question is will the plan that President Obama is preparing for Congress going to incorporate Reich's ideas and make it clear what the public option is--we'd better hope so.
Meet Kevin Shilling from Greenfield, Iowa. Kevin has voted for Reagan, Nixon, George W. Bush and Republican Senator Chuck Grassley. Like me, he also supports a public health care option. Some things should be beyond partisanship.
This is yet another example of why we need health care reform. Some people in this story are taking unpaid leave from their work to access free medical/dental/vision care because their employers do not provide health care benefits, nor can they afford their own plan.
I marvel at my fellow Americans. In our individual pursuits of happiness, we some times forget that we are also a nation of individuals that rely on other individuals to keep us free, to keep us well, to care for our kids, to educate us, and on and on. In other words, despite our dependency on each other, we don't always play nice.
Yet, time after time, I have seen the good of our coming together in times of trouble. A neighbor's house catches fire, everyone on the block is there to lend a hand to the family. If a person passes away, family, friends, and even strangers come together to mourn. When a soldier goes off to war, other people look in on their families. If there is a natural disaster, people line up to help. We have a great compassion and obligation to others in our country's fabric.
As I think about the future of health care reform, I see that things are not likely to get better unless we can agree on a plan that works, even if it is incrementally instituted. And to arrive at a place where our elected representatives can do their jobs and practice due diligence, it is good that real people with real concerns are attending the townhall meetings as well as sycophants to the either side of the free market divide. I'd actually like to have more opportunity to hear what those in need have to say than those who are fundamentally opposed to any changes to our current system.
Our representatives should hear what people need in the way of health care for their families, but more than that, the rest of us need to hear it too. We need to listen and think about what we can do to support our neighbors, members of our communities and the agencies, like local free medical and dental clinics, that are often the difference between some people being treated and no care. We need to push against anybody who would get in the way of health care being limited to a person in need and support those, in the meanwhile, who are stepping up and filling a gap to the best of their ability.
And we need to commend those in the health field that bend the rules. When I was unemployed a year ago, I was extremely thankful for my medical doctor's creativity to treat me such that we didn't end up in bankruptcy court. For us it also meant buying prescription drugs that we needed through a pharmacy in Canada that imported them from a pharmaceutical house in India. Yes, I'm admitting that we broke the law, but we needed the medication and we could not afford it otherwise. You'll forgive me if I'm not apologetic about it.
When I attend a townhall meeting in the next week or so, I'll ask why any industry should hold that much sway over what you and I receive in the way of health care. Personally, I think having a universal insurance exchange with a public insurance option is a reasonable compromise so that neither the insurance companies nor the government receive our complete confidence in their abilities to do what is best for us.
If you live long enough, you realize that everybody needs help. Everybody deserves to be able to be as healthy as they can be. The problems that we are facing call for our shared responsibility and we need to play nice with others. That is the only way health care reform can and should happen.
Jon Stewart and his writers do a wonderful job of distilling silliness and everybody gets skewered. In case you are actually interested in debunked myths, Fact Check has 7 for you to consider.
This post comes courtesy of from the White House's David Axelrod:
8 ways reform provides security and stability to those with or without coverage:
Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick. Learn more and get details: http://www.WhiteHouse.gov/health-insurance-consumer-protections/
8 common myths about health insurance reform: Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors. You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.
Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html
Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html
Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html
Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes
Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline
The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction
Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html
The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf
Lost in the battle of wills and words over health care reform is the fact that 46 to 48 million of our fellow Americans have none and more may join them until the economic recession we are in dies down. It hasn't escaped my notice that those screaming the loudest on both sides of the aisle likely have what Ralph Nader calls "gold-plated health insurance." So who is really focusing on those in the most dire of straits?
Those without care are pawns in the middle of a war. The basic conflict playing out here: whether I should be able to profit on you being healthy or not.
If health care is a right, as in "the pursuit of happiness", then the profit motive comes across as crass, if not criminal. If health care is a commodity like soy beans or corn, then why shouldn't anyone be able to take a risk, invest, and turn a profit? From this 10,000 foot level, it is a philosophical discussion that can be debated for eons and likely will be.
However, here on earth, people's lives are greatly affected by their access to reliable, equitable, affordable health care services. And there is not a doubt that these services are not evenly distributed throughout or even available in all communities. This is patently indefensible.
The fact that a PhD economist who writes for the Cato Institute has a level of health care that a poor, rural or urban person with a sixth grade education can only dream about is unfair. Intellectual exercises and fomenting have no place in deciding the fate of who gets health care and who doesn't, particularly when what we are doing as a society is not working and costing all of us in the end.
So let's go back to the basics. Government is in the business of doing what the free market/private sector is unwilling or unable to do. Business is good at generating revenue, but historically not as good at sharing profits.
So let's focus on the 46 to 48 million people without health insurance. If it makes the most economical sense to put them under a public-funded single-payer, government-run (dare I say it, a non-profit monopoly) program, so be it. If the private sector could do it better, they would have by now. Let's face it, if everybody had access to reliable, affordable health care, this argument wouldn't be going on.
In July, Rep. John Dingell of Michigan and eight fellow Democrats (Rep. Robert Andrews [D, NJ-1], Rep. Dale Kildee [D, MI-5], Rep. Carolyn Maloney [D, NY-14], Rep. George Miller [D, CA-7], Rep. Frank Pallone [D, NJ-6], Rep. Charles Rangel [D, NY-15],Rep. Fortney Stark [D, CA-13], and Rep. Henry Waxman [D, CA-30]) introduced H.R. 3200, America's Affordable Health Choices Act of 2009--a.k.a "the health care reform bill", in the House. The bill includes Section 1233, "Advance Care Planning Consultation," which requires Medicare to pay for one session of end-of-life counseling every five years for the purpose of:
A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses. C) An explanation by the practitioner of the role and responsibilities of a health care proxy. D) The provision by the practitioner of a list 13 of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965). E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
On July 18, Rep. John Boehner (R-Ohio) said that the House's health care reform bill could be "a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself."
Last week, Sarah Palin wrote that she doesn't want her parents or her disabled son "to stand in front of Obama's 'death panel' so his bureaucrats can decide . . . whether they are worthy of health care. Such a system is downright evil."
In Section 1233 of the original version of the House bill, Congress requires Medicare to cover one session of "advance care planning consultation" every five years for Medicare patients to talk about living wills, hospice care, durable powers of attorney and more. Does the bill require Medicare patients get counseling? Nope. Does it prevent counselors from raising assisted suicide and euthanasia with patients as an option? Nope.
So with a legitimate gray area in the bill, Blue Dog Rep. Mike Ross (D-Ark.), who along with Baron Hill of Indiana, Jim Matheson of Utah, Zack Space of Ohio, John Barrow of Georgia, Bart Gordon of Tennessee, and Charlie Melancon of Louisiana, struck a deal with Rep. Henry Waxman to narrow the health care bill's scope and cost. Ross' amendment to the bill addresses the question of end-of-life care.
Ross' amendment makes it illegal for counselors to promote or list as an option suicide or assisted suicide. Ross also states that the counseling is entirely optional, and that seeking counseling on a living will, for example, will not be interpreted by a hospital as declining full and aggressive treatment. For more on states' stands on assisted suicide, see here.
In its current form, the health care reform bill does not push euthanasia or assisted suicide. Rather it prevents health care providers from discussing these options. If anything, people should be more concerned that a physician is unable to discuss all options to their patient, rather than being worried that the physician will force euthanasia on an unwilling patient.
Heart throb to the Right, Ronald Reagan, was known for defusing his often younger opponents' views by using the phrase "there you go again" and following up with his more seasoned if not reasoned viewpoint. It was a remarkably effective technique that made me wonder how he would have fared with the kind of "hotheads" that are showing up at health care townhalls and actively disrupting them. The strategy for these disruptions is in a memo that has been widely circulated on the web from Bob MacGuffie, a "founding member" of Right Principles, a group whose core values includes "to the fullest extent possible that governmental power should be devolved to the state and local level and that a free society prospers from and depends on the unbridled self-initiative of its people."
Apparently the "unbridled self-initiative" part includes shouting down the elected representatives of their districts so that any kind of meaningful dialogue cannot take place. As it stands Americans are evenly divided about what to do about the health care reform. And certainly with millions of dollars being pumped into reframing health care reform around who do you trust more "us", the corporate and free-enterprising citizens or "them", the socialist, over-blown government that wants to control your lives (or, as seen from the other side of the fence, "us" the greedy, self-absorbed corporations and their right-winged henchmen and "them" the government whose job is to fill the gaps that the private sector is unable or unwilling to do).
In the middle of all this is the loss of rational thought and clear facts. And that is what needs to prevail on an issue as electrically charged as this. We need a national debate about health care that allows both sides to lay out their arguments for and against and what solutions they propose for those who are uninsured and those who will be if health care costs continue to rise.
There is nothing wrong with vigorous debate, but if no one can hear the debate, no good can come from it. With apologies to Elvis what we need is "a little less talk, a little more conversation."
Amy Logsdon provided this link to this Citizens for Tax Justice proposals to pay for health care without hurting the bottom 60% of taxpayers in Iowa. If you are in the top 1% of income earners, you won't like this but at least you can afford it. CTJ proposes:
If Congress enacts the surcharge included in H.R. 3200, the richest one percent of taxpayers in Iowa would have an average tax increase of $12,637 in 2011 while middle-income taxpayers would have no tax increase at all.
If Congress instead enacts the Medicare tax expansion described here, the richest one percent of taxpayers in Iowa would have an average tax increase of $11,454 in 2011. The middle fifth of taxpayers would have an average tax increase of just $56.
Finally, Congress could enact the President's proposal to limit itemized deductions for the wealthy. The richest one percent of Iowa taxpayers would have an average tax increase of $5,796 in 2011 while middle income taxpayers would have no tax increase at all.
The CTJ folks say that these proposals could raise between $260 to $543 Billion dollars over the next 10 years. how many Iowans would be affected? 2100, the majority making over $200,000.
In March Families USA released a report that said one out of three Americans under 65were without health insurance at some point during 2007 and 2008. The study, commissioned by the consumer health advocacy group Families USA, found 86.7 million Americans were uninsured at one point during the past two years.
Among the report's key findings:
• Nearly three out of four uninsured Americans were without health insurance for at least six months.
• Almost two-thirds were uninsured for nine months or more.
• Four out of five of the uninsured were in working families.
• People without health insurance are less likely to have a usual doctor and often go without screenings or preventative care.
One would wonder if the folks in DC really are trying to fix the problem or create a slew of new ones by attempting to bring everyone in the pool all at once. With the predictions from the Congressional Budgeting Office showing that the current plans are not likely to produce a reduction in government outlays in the long run, it might be a good time to retrench and develop a plan that helps those most at risk. To do this almost assuredly calls for a single-payer system to achieve affordable care.
The questions then become, what's that system and who pays for the average of 46 million people who are uninsured annually? Answers: "Medicare plus" and we all do. If every worker and employer paid into the system, like they do for social security and unemployment insurance, we could cover those who are the most at risk today. If we learn that the coverage is equal to or superior to the private sector, there is not a doubt in my mind that the demand would be there for a single-payer health care system for everyone who wanted to be in the pool.
The point is that it moves us in the right direction. Providing needed care to those who can ill afford any insurance is a moral imperative, if not an absolute right. If we can do this and do this well, the skeptics and opponents of universal health care will be forced to provide better reasons why the private sector is more credible or become truly competitive.
I've been taking some time away from blogging because, let's face it, problems never really go away and everyone needs a chance to chill out. In my absence, the national health care debate rages on. Many people actually thought there was a national health care bill ready to go when President Obama was elected. Certainly his plan was shopped publicly when he was running for the office. But apparently there is not a "shovel-ready" health care bill or enough money to pay for the bill, depending on who you ask.
This is my solution. No holidays for Congress until a bill is forwarded for the President's signature that makes sure that 100% of Americans have access to affordable health care. At this point I don't care if it is a single-payer or gazillion-payer model, just that it is universal and affordable to all.
As for those Congressional leaders who line up he pieces on the chess board who need to get this done, lock down Capitol Hill and take your fellow public servants off the grid. This means no lobbyists, cell phones, or computers (except in the capable hands of the recorders who will write up the final bill). No tweeting, crackberry texting, facebooking, etc. Clearly this bunch is overly distracted and needs time to focus. If necessary, cut off the air conditioning (think of it as reliving the Continental Congress).
The point is that health care is the one thing that is needed by every worker and the thing that American industry claims keeps it from being competitive globally. If we really want to rev up the economic recovery machine, make sure everyone has the opportunity to be healthy--even corporate personages.
Trial lawyers, unions, big biz, doctors, and insurers beware, you can not dictate the discourse on this issue any more. You had your chance. If you are found within 100 miles of the halls of Congress, you should expect to be deported to Palau (we should at least get our money's worth out of that deal). We know you have been assailing us with your ideas of what is best for us, but really, it is always about what is best for you.
We the people are sick of being sick because the pursuit of profits are involved. We want health care as a fundamental right--after all what is the pursuit of happiness if you can't get out of bed to pursue it?
So listen up Congress--drop everything else you are doing and get this legislation done. If it isn't perfect coming out of the gate, don't worry about it--we'll make you keep working on it until it is or elect people who can. Congressmen Braley, Loebsack, Boswell, Latham, and King and Senators Grassley and Harkin, this means you.
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