Obama and Congress
What Happened to the Healthy Americans Act?
Published October 25, 2009 @ 09:00AM PT
Watching the Senate difficulties this week – failing to work around fancy math, having to dump fair physician payments as a result, and trying to substitute an ineffective opt-out public option for even more impotentco-ops – it makes you wonder about Wyden-Bennett. Remember S. 391, aka the Healthy Americans Act? It was billed as market-provided “single payer”, supposedly had bipartisan support, and was universally recognized as superior to the Baucus bill. And we’ve heard … nothing. Why ignore HAA (much more personal than a number, no?), a bill with much higher credibility and without a pesky public option at all? The answer turns out to be two-fold.
First though, let’s review what it had going for it. Back in August, HAA had 5 republicans and 7 democrats publicly backing it in an op-ed, including Mary Landrieu and Joe Lieberman (both none too keen on a public option.) However, three of its co-sponsors, Maria Cantwell, Jeff Merkley, and Arlen Specter, were remarkably quiet. It seems they didn’t want to step on any White House dictates, and Baucus’ process was one of them. Still, the bill was truly a bipartisan feat: it incorporated universal coverage in free-market exchanges designed to empower consumers to shop for the best value.
CBO scored HAA as revenue-neutral, the holy grail of healthcare coverage. Further, it empowered consumers to seek out the best healthcare value in a larger pool of Americans that meant better risk spread. And the basic plan was to be equivalent to the Federal Employee Health Benefits Program. Not bad! Even better, premiums could only vary based on geography and smoking status. No age or health status discrimination, period.
But on to the bad news …
Meet Medicare Part E
Published October 23, 2009 @ 06:00AM PT
How much time-consuming bluster did it take to get to this simple and obvious option? Open up Medicare to everybody, like Ted Kennedy originally proposed in the Senate HELP bill. Part E does stand for “Everybody.” While it’s only one of the three public options being considered by the House, it’s the strongest. Keith Olbermann gives us a great introduction to the concept in the video clip above. Meet Medicare Part E.
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 …
5 Moves to Watch in Healthcare Reform
Published October 19, 2009 @ 06:00AM PT
With the frenetic activity of the last few months, you may be wondering what’s going to happen next in the healthcare reform carnival. First there was the breathless buildup to bill … after bill … after bill. Then the ensuing media circus took over. Tea partyers continue to spout hyperbolic nonsense we hope bears no resemblance to 18th century history, and many members of Congress regularly emit scaremongering tripe that has nothing to do with campaign contributions from the insurance industry. Really. Meanwhile private insurers progressively expose their ugly underbellies. What’s next?
Take a deep breath and take heart: there is an actual semi-logical legislative process. And you can follow it, in between sideshows. In fact, here is a simplified outline of the complexities, adapted from the National Health Council (you can also download the entire Health Reform Legislation: Potential Impact on Patients PDF):
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.
