Enemies of Reform
3 Recycling Blunders in Failed Healthcare Policy
Published October 05, 2009 @ 06:00AM PT
Washington, D.C. denizens have done it again. Under the guise of innovative compromise, they have recycled Bush Jr.’s failed “Great Healthcare Bailout of 2002.” Never heard of it? Well, bailouts weren’t the Hollywood stars then that they are today. They called them strategies instead. This one went straight into the failed policy bucket.
Observe: In 2002, Bush tried giving away $40 million in grants to high-risk pools "as part of the Bush Administration's broad strategy for expanding access to health care for the more than 40 million Americans without health insurance." Um, the plan was to spend $1 per person? Really? But I digress.
Insurance Companies Are Cutting Their OWN Benefits: The Best of the Weekend
Published October 04, 2009 @ 10:10PM PT
Every weekend, I present the three articles or videos that best enhanced my own understanding of the myriad issues wrapped up in our national health care debate. All three selections this weekend made the list for one simple reason: much like the Spanish Inquisition, I don’t think anyone ever expected stories like these!
1.) Bloomberg, “WellPoint Cuts its Own Health Benefits as Recession Trims Sales”
In Will Ferrell’s celebrity-studded and satirical public service announcement, “Protect Insurance Companies,” actor Jon Hamme pointed out that health insurance companies needed to make millions and billions in profits... to pay for health insurance for their employees. Well, it turns out that’s not a joke. Given that WellPoint has also been at the forefront of creating “astroturf” consumer-friendly Web sites, ad campaigns and push polls to activate its customer base against health care reform, one could be forgiven for thinking this is but poetic justice.
The company will also raise deductibles and premiums for some of its employee health benefits, the Indianapolis-based insurer told workers in a memo today obtained by Bloomberg.
WellPoint, like its competitors, has seen health plan enrollment shrink this year as employers cut jobs and benefits amid the recession… In the memo from Randy Brown, WellPoint’s chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. “Your cost per paycheck will probably increase,” the memo said. WellPoint has 42,000 employees.
(By the way, in case you’re wondering what the heck the picture on this post is, it’s a “Medical Data Loss Dress,” designed to incorporate private medical data that WellPoint carelessly left unsecured on its Web site for 13 months. Good times.)
Read the full article on Bloomberg’s Web site.
2.) Swampland, “Bill Frist on Health Bill: I'd Vote For It”
So let me get this straight. Former Senate Majority Leaders for the G.O.P. Bob Dole and Howard Baker not only have spoken in favor of health care reform (and endorsed a plan through the Bipartisan Policy Center that closely tracks the proposals in Congress), but now Bill Frist has, too? This would be the same Bill Frist who was not only one of the Republican Congressional leaders for years, but also was a heart and lung transplant surgeon? The one whose conservative credentials are so rock-solid he nearly ran for president last year? That Bill Frist?
And yet we’re thinking the chances of a Republican not from Maine voting for this same reform bill is between slim and none?
OK, just checking.
However, he strongly supports other aspects of the bill--most notably, its requirement that individuals be required to purchase coverage, if they do not receive health insurance through their employers or under government programs. And he also lauds the provisions that would eliminate practices that allow insurance companies to discriminate against people based on their health history, including pre-existing conditions.
Frist also faults some in his own party for injecting alarmism into the debate. "Clearly, the death panels and public plan arguments have been overblown," he says. Frist noted that Republicans themselves voted for a Medicare prescription drug bill that would have established a version of a public plan--with the government negotiating directly with drug companies--if private-sector competition had failed to materialize.
Read the whole blog post on Swampland.
3.) Nicholas Kristof, “Dad’s Life or Yours? You Choose”
There are so many basic injustices and indignities with the way our insurance industry operates, it’s hard to know where to begin. But clearly at the top of the list is the injustice of rejecting coverage for those with pre-existing conditions -- discriminating against the very population most likely to need health care, because they’re most likely to need care. Kristof today supplies a dramatic example where pre-existing conditions actually impeded two generations from getting the care they need and the preventative care they still might need.
Mr. Waddington has polycystic kidney disease, or PKD, a genetic disorder that leads to kidney failure. First he lost one kidney, and then the other. A year ago, he was on dialysis and desperately needed a new kidney. Doctors explained that the best match -- the one least likely to be rejected -- would perhaps come from Travis or Michael, his two sons, then ages 29 and 27.
Travis and Michael each had a 50 percent chance of inheriting PKD. And if pre-donation testing revealed that one of them had the disorder, that brother might never be able to get health insurance. As a result, their doctors had advised not getting tested. After all, new research suggests that lack of insurance increases a working-age person’s risk of dying in any given year by 40 percent.
“At the time David needed a transplant, the people closest to him couldn’t even offer a lifesaving donation -- for insurance reasons,” said Mr. Waddington’s wife, Susan.
Read the full column at NYTimes.com
[Programming note: This is my last blog post as the primary editor of this cause for Change.org. Thanks for reading! However, I’m leaving you in the more than capable hands of Gillian Hubble. I’ll be guest blogging in this space in the weeks and months to come, though not at my usual frequency. Whether you’re a health care reform skeptic or activist, we are truly in unprecedented times. There simply has never been as good a chance of having a comprehensive health care reform bill passed by Congress and signed by a president. But stay vigilant and stay active -- we still have a long way to go, and much work to do to ensure it’s a bill we can all be proud of.]
(Photo credit: http://www.flickr.com/photos/plurimus/ / CC BY 2.0)
Making the Opposition to Reform a Punchline
Published October 04, 2009 @ 07:33AM PT
The disruptive town halls made for good theater on the nightly news, but scarcely seem to have made a dent in the momentum for health care reform. Once the hot August was over, the president made his address to Congress, Sen. Max Baucus got off the dime and released his bill, and we were back in business. A march on Washington by some million 100,000 50,000 people with a somewhat incoherent message that didn’t do anything to impede progress, or even slow it down. And now that the Senate Finance Committee has all but completed its work, we’re moving to unprecedented floor debates in the House and the Senate.
So what did they accomplish, other than ratings? Well, they seem to really have challenged progressives to open up their vast reservoir of sarcasm.
The rock video “We’re Number 37” was of course a direct reaction to the town halls. This new video, “Don’t Ruin American Healthcare” is more of a direct-to-camera PSA, in the style of Will Ferrell’s “Protect Insurance Companies.” But it doesn’t take much to take some of the actual talking points you hear from regular people whipped into a furor over the prospects of reform, and make them laugh-out-loud funny.
Healthcare Reform Following the Football Playbook
Published October 02, 2009 @ 06:00AM PT
I’m a healthcare wonk in a year of unprecedented healthcare reform activity, very jaded by all the political gamesmanship that goes with it. So reading a recent Yahoo news story, I encountered lots of familiar themes.
There were comments on ridiculous votes, and how the archaic system is designed to protect power and allow cronies to fleece the public. Dan Wetzel, the author, bemoaned that policy is:
“… determined by a popularity vote from people who … [have] proven good for two things, voting based on marketing and reputation, and subscribing to a groupthink mentality that assures their ballot doesn’t stand out.”
Rep. Grayson and the Face of Uncompromising Reform
Published September 30, 2009 @ 10:35PM PT
If you’ve been watching C-SPAN 3, you’ve seen a Senate Finance Committee compromising away affordability, compromising away shared responsibility, compromising away the public option, even compromising the notion that we should only heavily invest in peer reviewed and evidence-based teen pregnancy prevention programs. But Rep. Alan Grayson’s back-to-back impassioned speeches from the House floor on health care reform gave me a reason to flip back to C-SPAN 1.
I hadn’t planned to write about the comments made by Rep. Grayson at all. As witty as his diatribe about the complete absence of a Republican plan for universal health care was, it was still a diatribe. Somewhat predictably, the same minority party which had rushed to defend Rep. Joe Wilson’s breach of decorum, and who had filled up the House record with fear-mongering and baseless flights of rhetorical fancy about how the public option would “kill people,” and how health care reform would “put seniors in a position of being put to death by their government,” and how the health care bill told seniors to “drop dead,” now rushed to demand an apology against Grayson’s own hyperbolic flourish. We’ve seen this picture before. If we’re lucky, it would become a tit-for-tat. If we’re unlucky, it would be a capitulation. In any case, it would be a distraction.
It may yet prove to be -- but it's not tonight. Say what you want about Grayson, but he gets what this debate is really about. Tonight he took the floor to apologize, not for the feigned injured pride of thick-skinned politicians looking for a partisan advantage, but for those who truly deserve an apology: the Americans who we fail year in and year out because we haven’t fixed health care reform, the Americans who have no other choice but to go bankrupt when they get sick, and the 45,000 Americans who die every year for no other reason than we lack health insurance.
Health care isn’t just a political football. For many, it’s life and death. And it’s about time one of our elected officials stood up and said so!
The Good, the Bad, and the Stupid in Yesterday's Public Option Debate
Published September 30, 2009 @ 12:01AM PT
Yesterday was public option day in the Senate Finance Committee mark-up, as amendments by Sens. Rockefeller and Schumer that would have created public health insurance options for the Baucus bill were debated for hours before going down to defeat. Outlets like Huffington Post and the Politico promised everything short of actual bloodshed in a Democrat vs. Democrat battle royale. But that didn’t even remotely happen. Instead, we got an honest-to-God debate. But senators will be senators, and there was some inanity to be had as well.
These were weighty issues, and they got the consideration they deserved. From Sen. Rockefeller’s impassioned arguments that private insurance companies have treated the American people so badly that they need and deserve the security of a public option; to Sen. Grassley’s stern admonishment against introducing a player into the marketplace who could come to dominate it; to Sen. Schumer being the first politician I’ve heard yet make the argument that those already with insurance would see lower costs due to the competition from a public option, there was much matter here.
For a sampling, check out Sen. Rockefeller’s argument and questions for the Senate Finance Committee policy staff:
Good stuff! Tough questions! And no willful ignorance in sight. Sadly, the whole day did not match this level of erudition. Also demonstrated during the proceedings is that some of our senators aren’t quite masters of reading comprehension.
Sen. Kent Conrad had to go and ruin the erudition when, once again, he held up France as an example of universal health care that works even though it’s not government-run. Conrad seems to have preposterously newly gotten this observation from T.R. Reid’s new book, which he read just a few weeks ago. To which I say, Senator, please stop skimming! (Regular readers of this blog will remember that French citizens are covered for public hospitals and most doctors through the government-run program Sécurité Sociale, which the supplement with complimentary private insurance on top). Weirdly, this complete misreading of the French system served as the basis for Conrad voting against both public option amendments, even when his initial complaint of too-low Medicare rates for the Rockefeller version was sated by the Schumer version.
Similar, opponents of the public option constantly cited a study that suggested that millions -- no, tens of millions -- no, hundreds of millions would sign up for a public option, leading to the crumbling of private insurance. Of course, this was not the projection of the Congressional Budget Office, the authoritative estimated numbers which Sen. Kyl later referred half-jokingly as “our holy grail.” The CBO projects only 10, maybe 15 million people would sign up for a public option, were it offered alongside equivalent private insurance plans in the Health Exchange for individuals and small businesses.
No Sens. Grassley et al. were quoting the Lewin Group’s analysis of a public option, which dramatically estimated 103.4 million people would enroll in it, with 83.4 million leaving private insurance to do so. There’s a huge problem here -- well, two, really. That Lewin Group model presumes the public option would be available to everyone, but it’s not. Only small businesses and individuals can sign up for it. It also presumes that the public option pay providers based on Medicare rates -- something the Rockefeller version would do for two years only, and the Schumer version would never do. In short, the entire model does not apply to what they’re talking about. You won’t hear Grassley or Hatch or Ensign or anyone else quote the other set of numbers from the Lewin Group -- the ones that more accurately model the proposal in the amendments and conclude 78% of people in private insurance now would stay right where they are, with a modest 33.6 million enrolling for the public option. This despite the fact that it’s in the exact same report!
Oh, and by the way, I’ve made this plea before, so I may as well copy it verbatim: “please, please, for the love of God, please find someone else to crunch your numbers. The Lewin Group is a wholly-owned subsidiary of Ingenix, the database company that provides information on provider rates for most of the major insurance companies, and is itself a division of UnitedHealth, the nation’s largest insurer.”
Yesterday’s Senate Finance Committee showed several members at their best. It also showed several members flunking basic reading comprehension.
So let me ask you -- how nervous should we be that the latter group of senators were the ones who successfully voted down the public option amendments?
Getting Medicare and Health Reform Backwards
Published September 28, 2009 @ 08:03PM PT
I’ve noticed that many opposing health care reform -- many of them Republicans -- have started using “don’t let them cut any money from Medicare under any circumstances” as their favorite argument. But the “Bizarro world” quality of seeing the minority party so defensive over a program that they have long sought to prevent outright, cut or entirely replace or privatize doesn’t just stop with the applause line. A lot of the arguments they’re using have a similar “up is down” quality.
Take John Goodman’s blog today (the conservative economist, not the guy in The Big Lebowski) devotes a post to perverse incentives waiting for our medical system if reform passes. “At the risk of oversimplification,” he lays out a vision of perverse incentives for physicians if reform is passed. With government setting fee-for-service rates for all medical procedures, doctors have the incentive to do more services. But then if Medicare growth exceeds a certain limit, the federal government “will impose an across-the-board percentage reduction in all doctor fees.” The behavioral anarchy is shocking to Goodman. Each individual doctor has a miniscule ability to affect Medicare growth, and so will continue following his or her natural instinct to do more services -- even though in aggregate, that will cause the across-the-board cut to trigger. Paradoxically, this cruel blind injustice will just make it more likely that more doctors will do more services. More care means more wasteful care, and it perpetuates the situation it was designed to curtail.
Yes, that sounds massively inefficient.
However, Goodman has described a problem that exists now, not a projected future. The exact adjustment he describes was strongly advanced by the Gingrich Congress of the late 1990s -- called the Sustainable Growth Rate, it cuts doctors rates across-the-board by an arbitrary rate if aggregate Medicare growth crosses a certain threshold. It does, indeed, create that system where doctors are powerless to fix the situation but incentivized to perpetuate it. In fact, it creates a situation that is slightly worse -- the cut has never materialized. Every year, Congress passes a law at the last second to put a one-year postponement on the cut. So all the fear and perverse incentives to waste more Medicare dollars are there, but Medicare spending is never, ever reduced. Curiously, the legislators most inclined to believe Goodman’s economic theories are the ones who have consistently voted against delaying or removing the SGR cut -- including last year where a newly-diagnosed Ted Kennedy needed to walk onto the Senate floor to break a Republican filibuster that would have let the cut take place.
But here’s the kicker -- fixing the SGR is one of the main adjustments to Medicare in the House bill. Goodman’s projected inefficiency isn’t what happens when health reform passes -- it’s what health reform would prevent.
I suppose I shouldn’t be surprised that Goodman’s offered solution -- “Services provided over three visits, for example, might be provided with one visit plus a phone call or two, or one visit plus an e-mail exchange -- provided that the government pays more for the one visit” -- exactly describes the medical home model of care, a better, higher quality and more cost-effective model of delivering care which the proposals in Congress, in fact, double down on in terms of investments. After all, when it comes to arguments against health reform these days, up is down, and black is white.
(Photo credit: http://www.flickr.com/photos/sico_activa/ / CC BY 2.0)
