Enemies of Reform
It's Annual Enrollment Time: Brace Your Wallet
Published November 02, 2009 @ 05:00AM PT
Halloween tricks were a warm-up. While Congress argues partisan, special-interest driven healthcare reform politics these next few weeks, many employees will be faced with a stark reminder of the need for reform. Yes, November is here – annual enrollment time for 60% of insured Americans. It is rapidly becoming known as “spend more, get less” time for group health plan participation.
Now, Joe Lieberman thinks healthcare reform is going too far, that a public option is “just unnecessary” and private health plan premiums will go up. He’s threatening to join a Republican filibuster because of his “concerns.” Uh, Joe? Don’t you dare. Those premiums have already gone up, with medical costs rising three times as fast as inflation. Premiums are skyrocketing with no public option, and AHIP has promised they will continue to do so. So if you filibuster to strip the people of their power, Joe, we will strip you of yours within the Senate.
But back to reality outside the Beltway. Group health plan premiums have risen 131% in the last 10 years, according to the Kaiser Family Foundation. Employee contributions have risen 128%. Since 2006, the percentage of individual insured employees responsible for deductibles of $1,000 or more has more than doubled, from 10 to 22%. Companies still offering health benefits in 2009 downsized them – 86% now offer only one plan. That group ironically includes Blue Cross Blue Shield of Florida, whose 5,000 employees will now be offered only a high-deductible plan. Meanwhile AHIP is decrying government involvement in healthcare due to supposed lack of consumer choice.
Public Option Popularity in Limbo
Published October 22, 2009 @ 06:00AM PT
Consider this a watch list update. Things are looking rosy for a public option right now. The majority of Americans support it, up to 57% from 52% two months ago. Bipartisanship is no longer in vogue, with 51% preferring a public option to a bipartisan one. Nancy Pelosi is rumored to be inserting a strong public option in the House bill, one that may be cheaper and cover more people than the combined Senate bill. Even Harry Reid is considering including “public option lite” in the Senate bill, with a state opt-out clause. So why all the talk about the public option being in limbo, of looking for alternative ways to try and keep private insurers in check?
"Doc Fix" Shows (AGAIN) Why the House's Health Reform Bill Is Better Than the Senate's
Published October 21, 2009 @ 11:03AM PT
The last House committee to work on comprehensive health reform finished at the end of July. The last Senate committee (Sen. Max Baucus's Senate Finance Committee) finished last week. But the House has not been idle. News comes today that an initial score from the Congressional Budget Office says the House has refined its bill to only cost $871 billion over 10 years. Of course that is likely to get overshadowed by the train wreck in the Senate concerning Medicare's "Doc Fix." So many commentators are focused on the political clumsiness of pushing a separate bill in the Senate to fix the Medicare Sustainable Growth Rate (SGR) that they may miss what this Three Stooges-esque vignette tells us about the policy strength of these House and Senate bills.
Simply put, the House has its act together. The Senate's got a lot of work to do.
The SGR was an attempt to curb skyrocketing costs in Medicare which has not only failed, it's become the second-worst accounting trick in the federal budget over the past decade (the worst being leaving the costs of the wars in Iraq and Afghanistan out of the budget every year of the Bush Administration so the deficit wouldn't look so big.) A brainchild of the Gingrich Congress and an amendment to the 1997 Balanced Budget Act, the SGR is a formula intended to prevent physician compensation for Medicare from rising above the rate of growth in GDP each year. If physician fees were threatening to go higher, all doctors' fees across the board in Medicare would be cut to keep them within that limit. Not inherently a bad idea, but it has a huge flaw -- in most years, medical costs rise at several times the rate of growth in GDP whether you're talking public coverage or private insurance. The net result is that SGR would guarantee a major cut to Medicare nearly every year, at least until we get an explosive economic growth like we had in the 1990s. And we're not talking obvious waste like Medicare Advantage subsidies for HMOs or those motorized scooters you see in ads on cable TV -- we're talking doctors' fees. You know, the whole point of having health coverage.
So every year, Congress passes a one-year moratorium on the SGR. Every year, all Democrats in the Senate vote for it. Every year, almost all Republicans vote against the moratorium and for the cuts to take place (including every single one of the conservatives who are making "how dare we cut Medicare in any way, shape or form!" their rallying cry for defeating reform. Gotta love that blatant disregard for consistency.) Every year, doctors' fees in Medicare continue to rise at roughly the same "way, way over inflation" rate they do for private insurance, meaning if the cuts took place this year, it'd yield a 21% cut across the board. But every year, the cut never actually happens. It's like a bad sitcom whose punchline you can see coming from miles away. It's absurd. And it needs to be fixed.
Enter health care reform -- an obvious spot to fix it.
Health Reform Lite or Value Meal?
Published October 21, 2009 @ 06:00AM PT
For anyone fazed by healthcare reform histrionics, take heart. We’ve been here many times before. The real question is, for all the political, capitalistic, and social angst, what’s changed? According to medical economist J.D. Kleinke, who first arrived on the scene in 1989, only one big thing: now everybody gets to whine about the status quo on Facebook. He goes so far as to call the healthcare bills moving forward today “a violent endorsement of the status quo.” I can’t say I disagree with his logic, but two women just gave me hope for this go-round.
Kleinke points out that in 1989 we had a dysfunctional third-party payer insurance system based on fee-for-service. Some insurers, hospitals, doctors, drug companies, and even employers figured out how to game the system and make out like bandits. Medicare was forecasted to become insolvent, Medicaid programs were underfunded, and malpractice costs were supposedly bankrupting healthcare. Costs were skyrocketing along with the number of uninsured. Does all this sound familiar?
Yet in 20 years, he says, all we can come up with is to fit more insured patients into our current mess and make it harder for insurers to kick them out. Each time the smallest of reforms is proposed (like adding prescription benefits to Medicare) entrenched US stakeholders rally mass hysteria, and the result is government funding of more corporate services. That’s true, J.D., but times have changed; about that Facebook phenomenon …
Laughing at Healthcare Climate Change Denial
Published October 15, 2009 @ 06:00AM PT
Today, we are joining over 7,700 blogs addressing climate change as part of Blog Action Day 2009. Now, I could go straight to addressing green practices in healthcare. But that would be too obvious. Instead, let’s focus on grassroots (hey, grass is green.) Besides being at the top of Obama’s agenda, what climate change and healthcare reform have in common is that grassroots movements got them – and keep them – in the public eye. They can be convenient punching bags, yes, but they are unable to be ignored.
It’s easy to dismiss the subtle signs of climate change until you’ve been hit by a typhoon, seen your crops die from drought, or witnessed polar bears drown as the ice melts beneath them. Similarly, it’s easy to deny the healthcare crisis until you’ve been dropped by your insurer and are unable to buy coverage. Or maybe you’ve been maimed and bankrupted by our over-priced, Swiss cheese, variable quality system-less healthcare mess. The good news is that the public is warming (pun intended) to reform. For healthcare, we can call that positive healthcare reform climate change.
But as our over 47,000 Change.org Healthcare members know, the media is in denial. Thanks to Change.org member Martin Bring for bringing a fun Daily Show clip to my attention addressing just that (caution: bleeps ahead.) When a spoof news show offers the best coverage of healthcare reform issues, while CNN continually has to “Leave it there” when news threatens to become balanced, we have a problem. Apparently it has Tea Party blinders on.
Big Insurance Promotes a Public Option
Published October 13, 2009 @ 06:00AM PT
Big Insurance just made the most convincing argument yet for a public insurance option. In a memo explaining a highly questionable study that AHIP commissioned from PriceWaterhouseCoopers, Karen Ignani explicitly promised that private insurance prices would rise dramatically under proposed healthcare reforms (I didn’t think they would confirm my wallet-stealing point so quickly.) Now we have it straight from the horse’s mouth – thanks, AHIP!
Actually, private insurance prices have already risen dramatically with NO healthcare reform. We can rest assured they will continue to rise. But it’s nice to have a scapegoat, isn’t it? Obviously the point of this study is to disrupt the passage of Max Baucus’ bill. AHIP isn’t satisfied with the millions of new enrollees it will reap, or the no-strings-attached government handouts (otherwise known as subsidies) to pay for those enrollees’ inflated premiums. Nope, they want more for all their lobbying millions.
First, they want a stronger individual mandate to lock in the maximum number of captive customers. Second, they want the excise tax on high-cost plans to go away. Third, they assume reflexive higher provider private insurance reimbursement rates due to Medicare cuts (though a Milliman, Inc. study already debunked the myth of cost-shifting.) Fourth, they promise to pass any industry taxes straight on to consumers – yep, we told you that was a lame idea. Is there any better combined argument for a public option to remove the private insurance choke-hold on our outlandish healthcare costs?
Democrats Borrow the Tea Party Approach
Published October 08, 2009 @ 10:59AM PT
Rachel Maddow just announced an amazing three-part Democratic strategy to ensure healthcare reform, and it’s an attention-getter (see the first 4:50 of the video clip.) We’re all fairly familiar with part three, using the reconciliation process to pass a bill with just 51 votes, instead of 60. But it’s the first two steps that borrow from the Tea Party approach.
It’s power broker time, ramping up techniques to dramatically increase political pressure for healthcare reform. That pressure is specifically aimed at 6 key Democratic senators who must allow a vote. What's the first step? Massive free health clinics in Arkansas, Louisiana, Nebraska, Nevada, and Montana. Hoping to shame senators Max Baucus, Mary Landrieu, Blanche Lincon, Mark Pryor, Ben Nelson, and Senate Majority Leader Harry Reid, doctors and nurses will donate their time to provide free care to thousands of the senators’ constituents who can’t afford it, making for a dramatic and heart-wrenching third-world spectacle. Houston’s recent clinic drew 1,500 people seeking treatment.
Second, if seeing thousands of their constituents in need of care doesn’t shame them, two major (and nameless) power brokers are encouraging a Senate strategy to revoke Democratic chairmanships if they block healthcare reform. Specifically, committee chairmen and sub-committee chairman who allow Republicans to force a 60-vote requirement, regardless of whether these chairmen ultimately vote in favor of the bill, will have their leadership positions revoked. Yep, that would be busting a Lieutenant Colonel down to Private in a very public demotion. It’s head-cracking time!
Last but not least, they will invoke the reconciliation rules. Just like the Republicans did to pass the $1.3 trillion and $350 billion Bush tax cuts. Apparently Republican Senator James Inhoff can’t remember that period in history, so it must have been in some other country. Maybe Canada?
