Health Care Reform: Stage Two

Last week, my editorsat  the Health Insurance Resource Center (Healthinsurance.org) challenged me to write a letter to President Obama and suggest what he should do next to advance reform. They were looking for a “new, big idea.”

After thinking about it, I concluded that we don’t need another big idea.  The Affordable Care Act (ACA) contains a great many ideas. Now we need to implement them.

Critics of Obamacare have suggested that as we approach 2014, Washington needs to turn its attention to containing healthcare costs. In particular, they suggest that Medicare is too expensive.

But the fact is that if you read the legislation (and I have, more than once) , you’ll find that it already cuts Medicare spending by some $716 billion. And it does this without cutting medical benefits and without slashing Medicare’s reimbursements to doctors.

In addition, the ACA includes many carrots and sticks designed to encourage hospitals and doctors to provide more efficient, less costly, safer care. In the future they won’t be paid for doing More;  they’ll be paid for doing it Better–for Less. Only health care providers have the power to truly reform our wasteful health care system. Already we’ve seen some evidence that they are responding to the incentives: Medicare spending has slowed.

Finally, and most importantly, President Obama should reject any attempts to re-negotiate the ACA during budget talks. The ACA is not on the table. It is now the law of the land. The American people do not want to listen to politicians continue to debate healthcare. (They want their elected leaders to focus their attention on just one Big Idea: Jobs)

The election gave the president the green light to go ahead with reform.. Now, the administration needs to implement the legislation to so that we can see what works and what doesn’t. This will take time–but only then will we be in a position to revise, refine and improve on reform legislation. .

I hope you’ll read the entire post--and come back here to comment.

 

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The Nation is Divided, Not between Whites and Minorities, But between the Past and the Future

Women, minorities, and young people re-elected President Obama. 

Pundits have pointed out that the president won only 39 percent of the vote among whites—down from 43 percent four years ago. But exit polls reveal that among women, Obama enjoyed an 11 percent advantage. “Fifty-five percent of women chose Obama,” Blooomberg observes —and clearly, this group included many white women. Sixty percent of voters ages 18 to 24 favored Obama—again, many were white voters. Among Latinos, the fastest growing demographic in the U.S., Obama won with a 44-point advantage. Romney secured just 27 percent of the Hispanic vote, down from the 31 percent who voted for the Republican candidate four years ago. Ninety-three percent of  African-Americans voted for the president, along with 73% of Asians (who now make up 3% of the electorate.)  And in the rust belt, Obama appealed to enough of the Democratic Party’s old blue-collar base  (which is largely white) to carry that section of the country.

Romney captured just two groups:  Americans over 65 and white men.  Romney’s cohort is made up of the people who ran this country in the 1980s. In a word, his supporters represent the past. Obama won among the young people, Latinos and women who will shape this nation’s future. They will be our leaders.  We have reached an inflection point in our history.

                                             Women in the Senate

 When Massachusetts elected Elizabeth Warren this was the first time that the Commonwealth sent a woman to the Senate. Thanks to last night’s election a record number of women will be serving in the U.S. Senate. There are currently 17. While two are retiring, at least four more have won — Democrats Tammy Baldwin in Wisconsin, Warren in Massachusetts, Mazie Hirono in Hawaii, and Republican Deb Fischer in Nebraska.  Claire McCaskill of Missouri, once considered the party’s most vulnerable Senator, held off a challenge by her Republican challenger, U.S. Representative Todd Akin (one of two Republicans who learned that during an election it is never a good idea to talk about rape) 

This is not to say that, going forward white men will not also be in positions of power. But in the future, a more mosaic leadership will reflect a new majority.  As Ross Douthat observed in today’s New York Times: “conservatives must face reality: The age of Reagan is officially over, and the Obama majority is the only majority we have.  (It is worth noting that Douthat describes himself as a conservative, though less “starry-eyed” than George Will.) 

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The Future of Health Reform May Turn on Senate Races

Below, the introduction to a post that I published earlier today on Healthinsurance.org

While all eyes focus on the presidential race, the ultimate fate of the Affordable Care Act (ACA) could depend on the Senate contests in the states.

Even if Mitt Romney were elected, he alone could not overturn major provisions of healthcare reform. Only Congress can pass the legislation needed to change the ACA.

Republicans are expected to maintain control of the House, but if Democrats hold the Senate, they will be able to block House bills aimed at eviscerating “Obamacare.”

Republicans are expected to maintain control of the House, but if Democrats hold the Senate, they will be able to block House bills aimed at eviscerating “Obamacare.”

What is At Stake

If Republicans take the Senate, the two chambers could pass legislation that would:

  • eliminate the premium subsidies designed to make health insurance affordable for middle-income and low-income families
  • bring an end to Medicaid expansion, and
  • rescind the individual mandate that everyone buy insurance or pay a tax.

Under “budget reconciliation,” Republicans would need only a simple majority to pass such legislation. In the Senate, 51 votes would do it. Today, Republicans hold 47 seats.

Razor-sharp margins in many states make it impossible to predict outcomes. Polls only give us a blurry snapshot of one moment in time – and in states like Arizona, candidates have been trading leads from week to week.

Much will depend on the demographics of who turns out to vote.

What Could Happen: Three Scenarios . . .

To read the rest of this post please go to HealthInsurance.org

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Truth Squad: Is “Obamacare” Pushing Health Care Spending Higher? What Will Happen in 2014?

In last Tuesday’s debate Mitt Romney suggested that, under Obamacare, health insurance premiums have spiraled by $2,500 per family. Not true.  (Hat tip to Healthcarefinancenews.com.)

 First let’s get the number right: According to an annual survey of employer plans  by the Kaiser Family Foundation and Health Research & Educational Trust, since the Affordable Care Act (ACA) passed in 2010, the average annual premium for family coverage has risen by $1,975 not $2500.  $1975 is a hefty sum, but 20% less than Romney claimed.

More importantly, $1,975 represents the combined increase in contributions made by employers and employeeswith employers picking  up the lion’s share of the hike. “In reality, premiums paid by employees haven’t changed that much.Factcheck observes. In fact, when you look at the rise in how much employees contributed, “the federal health care law was responsible for a 1 percent to 3 percent increase because of more generous coverage requirements.” In other words, employees were paying a little more, but getting value for their dollars.

After telling a whopper about how much employee’s health care premiums have risen in the past, Romney went on to assert that if Obamacare is  “implemented fully, it’ll be another $2,500 on top” of that. His evidence?  None.

                                              The Media Spreads the Myths

Yet the media continues to swallow the notion that under “Obamacare” health care spending will levitate. A few days ago, the Washington Post’s Robert J. Samuelson wrote: “Almost every expert agrees that controlling health costs is the crux of curing chronic budget deficits. Health-care spending already exceeds a quarter of federal outlays. With Obamacare’s coverage of the uninsured starting in 2014 and retiring baby boomers flooding into Medicare, the share is headed toward a third.”

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Breakfast with Atul Gawande

Sunday, Boston Surgeon Dr. Atul Gawande spoke at the New Yorker Festival about the importance of a hospital being able to “Rescue Success from Profound Failure.”   (Long-time Health Beat readers will recognize Gawande as the author of Complications: A Surgeon’s Notes On An Imperfect ScienceThe Checklist Manifesto  and a number of brilliant New Yorker articles that I have written about in the past, including: “Letting Go: What Should Medicine Do When it Can’t Save Your Life?”,  “It Will Take Ambition It Will Take Humility,” and  “The Fight for the Soul of American Medicine”  (Hat-tip to the New Yorker for publishing so many stellar articles illuminating an extraordinarily complicated subject: healthcare and healthcare reform.)

Before Gawande’s talk began, IBM, the event’s sponsor, hosted a small breakfast where Gawande spoke informally to a group of doctors, health plan executives, hospital administrators and people from IBM who are in the vanguard of healthcare reform. The New Yorker was kind enough to invite me to attend the breakfast and blog about the conversation.

                              Less Expensive Medical Care Can Mean Better Care   

At Sunday’s breakfast Gawande began by observing that “in just the past four or five years we have seen a huge shift in the national conservation about health care.” Since 2007 or 2008 many have come to realize that when it comes to medical care in the U.S., “there is no direct relationship between the amount of money spent and positive results.”  In other words, although we spend twice as much as many other developed countries on health care, medical care in the U.S. is not twice as good. In some ways it is worse.

Yet this epiphany is not as discouraging at it sounds. As Gawande pointed out, “Recognizing that expensive care does not necessarily equal top-quality care has enabled a decoupling of the two issues in the public mind, and opened up the possibility for real beneficial change in the system. The Affordable Care Act’s goal” of securing high quality care for everyone is, in fact, affordable. “We don’t have to ration care.”
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“The Third Rail of Payment Reform”–Tackling Wide Variations in How Much Providers Charge

Gallery

Why do some hospitals and doctors charge far more than others for exactly the same routine procedure?   “Because they can; it’s not any more sophisticated than that,” says Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and … Continue reading

Why Market Competition Will Not Lower the Cost of Health Insurance

 “Competition drives improvements in efficiency and effectiveness, offering consumers higher quality goods and services at lower cost. It can have the same effect in the health care system, if given the chance to work.”– Mitt Romney

Creating “robust competition” is at the core of Mitt Romney’s approach to Health Care Reform. He would be right–if health care were commodity like any other.  In many industries when more sellers compete for customers, prices come down. Think of thin-screen TVs.  But the healthcare market is not like other markets, as a great many health care economists have explained.

When it comes to medical care, the consumer does not have the leverage that he enjoys in other markets because there is too much uncertainty about a) what he needs, and b) the value of what is, in the end, a very complicated product.

First, consider his needs: Should he purchase an expensive, comprehensive policy with no caps on annual or lifetime payouts? If he has a big family, he knows he needs a big car. But he has no way of knowing whether he, his spouse or one of his children will develop cancer, MS., Alzheimer’s or be in an accident that leaves one of them paralyzed for life. So there is no way that a savvy consumer can bring down insurance prices by shopping for the “least expensive policy that fits his needs.”

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Paul Ryan’s Plan for Medicare: A Disaster for Seniors (Why Doctors Might Stop Taking Medicare)

“Robin Hood in reverse, on steroids”–that’s how Robert Greenstein, President of the Center on Budget Policy and Priorities (CBPP),  has described vice-presidential candidate Paul Ryan’s blueprint for the 2013 budget: It could likely produce the largest redistribution of income from the bottom to the top in modern U.S. history.”

I quoted Greenstein in April, in a post that originally appeared on HealthInsurance.org. There, I explained that Ryan’s budget would shift Medicare costs to seniors  and slash Medicaid, while simultaneously offering tax breaks for Americans perched on the top of a our income ladder.

Under the newest version of the Ryan plan, Washington would give seniors a voucher equal to the cost of the second-cheapest private-sector Medicare plan in their region. In theory, this gives seniors “choice” — the opportunity to pick a Medicare policy that best suits their needs, and their pocketbook.

If they don’t want to buy a plan from a for-profit insurer, they could, if they wish, use the voucher to buy traditional government-sponsored Medicare–though if it costs more than that second-cheapest private plan in their area, they will have to make up the difference.

Romney and Ryan are convinced that the private sector is always more efficient than government. Thus, for-profit insurers will be bound to offer better care at a lower price. Their faith is remarkable, given that past attempts to privatize Medicare (Medicare + Choice and Medicare Advantage) have largely failed on both counts.

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The Democratic National Convention, 1980 and 2012: Turning Points in American History

I originally published this post on HealthInsurance.org (www.healthinsurance.org) Check there for other posts on the election–just click on “Blog” at the top of the page.

Ted Kennedy’s speech at the 1980 Democratic convention still echoes in my mind. It remains the finest, most inspiring political oration that I have ever heard. Kennedy was speaking from a position of defeat. He had just lost the Democratic nomination to Jimmy Carter.

And yet this was a full-hearted, rousing speech delivered by a man who realized that in the battle ahead, the issues at stake were far, far more important than his own loss. Intuitively, he knew that the country had reached a turning point. (You can listen to the speech at The  History Place.

At that moment, Conservatives were ready to launch a revolution, and they would succeed. In November, Ronald Reagan won the White House, and his administration would set the tone for much of the next 30 years. Tax cuts for the rich, deregulation, a campaign to privatize both Social Security and Medicare. Health care reform would be off the table for many years.

Kennedy saw the danger ahead and addressed it: “My fellow Democrats and my fellow Americans, I have come here tonight, not to argue as a candidate but to affirm a cause. I’m asking you–to renew the commitment of the Democratic Party to economic justice.

“I am asking you to renew our commitment to a fair and lasting prosperity that can put America back to work.” Then, as now, unemployment was a pressing issue. In April of 1980, the unemployment rate jumped to 6.9%; in May it hit 7.5%.  “Let us pledge that employment will be the first priority of our economic policy,” Kennedy declared. “We will not compromise on the issue of jobs.”

Universal Coverage “The Passion of My Life”

Kennedy understood that “we cannot have a fair prosperity in isolation from a fair society. So,” he declared, “I will continue to stand for a national health insurance.”

“We must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real control over what doctors and hospitals can charge, and let us resolve that the state of a family’s health shall never depend on the size of a family’s wealth.”

Kennedy had witnessed what economic inequality can mean when a child is sick.  Many years later he recalled “One of the searing memories in my life was being in a children’s hospital in Boston, where my son had lost his leg to cancer. He was under a regime that was going to take three days of treatment, every three weeks, for two years …
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As the Republicans Take Tampa, Consider What a GOP Victory Would Mean for Women’s Health

For decades, Republicans have opposed abortion. This, we know, and so it comes as no surprise that Mitt Romney, the Party’s presidential candidate, has called “Roe vs. Wade“ one of the darkest moments in Supreme Court history.” 

But what some call the “war against women” is escalating.  This year, the Republican platform calls for a constitutional amendment that would make abortion illegal.

In 1976, the GOP blueprint acknowledged that “the question of abortion is one of the most difficult and controversial of our time,” and the Party called for “a continuance of the public dialogue on abortion,” which it called a “moral and personal issue.”  Just eight years ago, the preamble to the Republican platform declared: “we respect and accept that members of our party have deeply held and sometimes differing views.”  But today, there is no such language in a platform that calls for “a human life amendment to the Constitution,” and declares that “abortion is detrimental to women’s health and well-being.”

Meanwhile Alabama, Arizona, Idaho, Indiana, Kansas, Louisiana, Nebraska, North Carolina, Oklahoma, and Ohio all have passed legislation outlawing abortion after 20 weeks, even though, as the Center for American Progress’  Emillie Openchowski points out “complications are sometimes discovered after this point in a pregnancy that could cause serious harm to the woman. In those states, a woman would be forced to continue the pregnancy, no matter the risk to her health.”  This is frightening.

While Republicans parade women across their Tampa stage– and avoid talking about what they have quietly embedded in the Party platform–it seems a good time to consider what a Republican victory would mean for women’s health.

Turning Back the Clock: Contraception 

Susan Faludi’s Pulitzer-prize winning 1991 book, Backlash, is subtitled: “The Undeclared War Against American Women.” Twenty-one years later, it seems the war is out in the open . As a recent New York Times editorial observes:  “Having won on abortion, social conservatives are turning to birth control.”

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