mykeystrokes.com

"Do or Do not. There is no try."

“Veterans And Zombies”: The Hype Behind The Health Care Scandal

You’ve surely heard about the scandal at the Department of Veterans Affairs. A number of veterans found themselves waiting a long time for care, some of them died before they were seen, and some of the agency’s employees falsified records to cover up the extent of the problem. It’s a real scandal; some heads have already rolled, but there’s surely more to clean up.

But the goings-on at Veterans Affairs shouldn’t cause us to lose sight of a much bigger scandal: the almost surreal inefficiency and injustice of the American health care system as a whole. And it’s important to understand that the Veterans Affairs scandal, while real, is being hyped out of proportion by people whose real goal is to block reform of the larger system.

The essential, undeniable fact about American health care is how incredibly expensive it is — twice as costly per capita as the French system, two-and-a-half times as expensive as the British system. You might expect all that money to buy results, but the United States actually ranks low on basic measures of performance; we have low life expectancy and high infant mortality, and despite all that spending many people can’t get health care when they need it. What’s more, Americans seem to realize that they’re getting a bad deal: Surveys show a much smaller percentage of the population satisfied with the health system in America than in other countries.

And, in America, medical costs often cause financial distress to an extent that doesn’t happen in any other advanced nation.

How and why does health care in the United States manage to perform so badly? There have been many studies of the issue, identifying factors that range from high administrative costs, to high drug prices, to excessive testing. The details are fairly complicated, but if you had to identify a common theme behind America’s poor performance, it would be that we suffer from an excess of money-driven medicine. Vast amounts of costly paperwork are generated by for-profit insurers always looking for ways to deny payment; high spending on procedures of dubious medical efficacy is driven by the efforts of for-profit hospitals and providers to generate more revenue; high drug costs are driven by pharmaceutical companies who spend more on advertising and marketing than they do on research.

Other advanced countries don’t suffer from comparable problems because private gain is less of an issue. Outside the U.S., the government generally provides health insurance directly, or ensures that it’s available from tightly regulated nonprofit insurers; often, many hospitals are publicly owned, and many doctors are public employees.

As you might guess, conservatives don’t like the observation that American health care performs worse than other countries’ systems because it relies too much on the private sector and the profit motive. So whenever someone points out the obvious, there is a chorus of denial, of attempts to claim that America does, too, offer better care. It turns out, however, that such claims invariably end up relying on zombie arguments — that is, arguments that have been proved wrong, should be dead, but keep shambling along because they serve a political purpose.

Which brings us to veterans’ care. The system run by the Department of Veterans Affairs is not like the rest of American health care. It is, if you like, an island of socialized medicine, a miniature version of Britain’s National Health Service, in a privatized sea. And until the scandal broke, all indications were that it worked very well, providing high-quality care at low cost.

No wonder, then, that right-wingers have seized on the scandal, viewing it as — to quote Dr. Ben Carson, a rising conservative star — “a gift from God.”

So here’s what you need to know: It’s still true that Veterans Affairs provides excellent care, at low cost. Those waiting lists arise partly because so many veterans want care, but Congress has provided neither clear guidelines on who is entitled to coverage, nor sufficient resources to cover all applicants. And, yes, some officials appear to have responded to incentives to reduce waiting times by falsifying data.

Yet, on average, veterans don’t appear to wait longer for care than other Americans. And does anyone doubt that many Americans have died while waiting for approval from private insurers?

A scandal is a scandal, and wrongdoing must be punished. But beware of people trying to use the veterans’ care scandal to derail health reform.

And here’s the thing: Health reform is working. Too many Americans still lack good insurance, and hence lack access to health care and protection from high medical costs — but not as many as last year, and next year should be better still. Health costs are still far too high, but their growth has slowed dramatically. We’re moving in the right direction, and we shouldn’t let the zombies get in our way.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, June 19, 2014

June 23, 2014 Posted by | Health Care Costs, Health Reform, Veterans Administration | , , , , , , | Leave a comment

“Why So Many Are Clueless”: Shameful Coverage Of Obamacare’s Real Impacts

If you read my column last week about a Senate hearing that showed how Obamacare has affected Americans, you might have wondered if I was in the same room with reporters who presumably covered the event.

The disparity goes a long way toward explaining why so many of us are clueless about the actual impact the law is having on our lives.

The title of the May 21 Senate Commerce Committee hearing: “Delivering Better Health Care Value to Consumers: The First Three Years of the Medical Loss Ratio.” I was one of four witnesses talking about the part  of the law that requires health insurers to issue rebates to policyholders if they spend more than 20 percent of premiums  on non-medical expenses, including profits — the so-called Medical Loss Ratio.

Prior to the passage of the law, insurance company executives — who consider what they spend on medical care to be a loss — were in many cases devoting up to half of premiums they collected to pay for advertising and other administrative functions and to reward executives and shareholders.

As I wrote last week, consumers have saved at least $3 billion since the provision of the law that mandates insurers must spend at least 80 percent of our premiums on medical care went into effect in 2011.

The hearing wasn’t just about numbers, however. Katherine Fernandez, a small business owner from Houston, testified about how the MLR provision and other aspects of the law have enabled her family to pay less for far more comprehensive coverage than was possible in the past.

She told the committee that because both her husband and son had pre-existing conditions, the only policies available to them pre-Obamacare would not cover any medical care pertaining to those maladies. And even then the policies had both high premiums and high deductibles. She said that during the 14 years prior to the law’s passage, her family paid more than $100,000 in premiums for what she described as bare-bones coverage. And the premiums went up sharply every year — 165 percent between 2000 and 2003 alone.

She said she was elated when the Affordable Care Act passed. “No more pre-existing condition clauses … and insurance companies had to refund some of what we paid if they didn’t spend enough. What reasonable ideas.”

If you read the accounts of the hearing in The Washington Post, USA Today, Politico or CBS News — the only news outlets I could find that provided any coverage — you would not have read anything about the $3 billion consumers have saved as a result of the MLR provision or how the law has benefited the Fernandez family.

The focus of all those stories was a brief exchange toward the end of the hearing between Committee Chair Jay Rockefeller, a West Virginia Democrat, and GOP Sen. Ron Johnson of Wisconsin about whether the color of President Obama’s skin might explain why some people are opposed to the law.

Rockefeller suggested race might be a factor, which provoked a spirited denial from Johnson. Politico’s only hint about the hearing’s actual subject was this: “His (Rockefeller’s) critiques of the GOP again came in a sparsely attended committee hearing, this time during an analysis of health-care spending.”

The only one of these pieces that even mentioned “medical loss ratio” was the CBS story, and it, too, was primarily about the exchange between Rockefeller and Johnson. In the USA Today article, which apparently was based on a National Journal transcript, the only hint of a hearing was in the very last sentence:  “Rockefeller then veered into another topic before adjourning the hearing.”

That other topic, of course, was the medical loss ratio.

The Washington Post likewise found medical loss ratio of no interest. Its story, too, was about the back-and-forth between Rockefeller and Johnson during what the reporter dismissed as “an otherwise sleepy committee hearing.”

Granted, it is challenging to substantively cover the Affordable Care Act. The U.S. health care system is dizzyingly complex, and so is the law. It’s far easier to write about constant political sparring than to take the time to educate readers about what’s actually in the law and how it affects people. It’s not a heavy lift to review a transcript and write the kind of “he said, she said” — in this case the “he said, he said” — coverage that passes for journalism.

There are a lot of reasons why Americans don’t know how the law affects them or why they believe things about Obamcare that aren’t true. The Democrats have done a lousy job of explaining it. And more than $400 million has been spent by opponents attacking it — 15 times as much as has been spent by supporters. But one of the biggest reasons is the failure of many in the media to provide anything other than the most superficial coverage. As a former reporter who used to cover hearings on the Hill, I consider that shameful.

 

By: Wendell Potter, The Center For Public Integrity, June 2, 2014

June 6, 2014 Posted by | Affordable Care Act, Media, Reporters | , , , , , | 1 Comment

“GOP’s Fuzzy Math On Obamacare Enrollments”: Creating A Bubble That Keeps Reality Out, Then Reinforcing The Bubble With Nonsense

If the point of a press stunt is to generate some attention for your cause, House Republicans are waking up this morning happy: stories like these were picked up by quite a few news outlets.

House Republicans on Wednesday said they have data from insurance companies that shows only 67 percent of people who selected a health plan under ObamaCare have paid their first month’s premium. […]

The House Energy and Commerce Committee’s subpanel on Oversight and Investigations said it contacted every insurance company involved in the federal marketplace, and based its data on people who had paid by April 15.

It’s the latest evolution in the GOP’s anti-healthcare line. What started with “no one will want to sign up” eventually became “no one should sign up,” which morphed into “not enough people are signing up,” and finally “those who did sign up don’t count.”

Notice, of course, that Republicans involved in this debate make no effort to hide the degree to which they’re rooting for failure.

In this case, though, the trouble with the new GOP argument is that’s painfully, demonstrably wrong. It’s so wrong, in fact, that I’m a little insulted – regular ol’ hackery is occasionally functional, but this latest scheme is just sad. It’s one thing for House Republicans to try to mislead the public, it’s something else for them to be lazy about it, treating voters and journalists as if we were all easily fooled children.

How deceptive is the report from the House Energy and Commerce Committee’s panel? Let us count the ways.

First, note that the Republican numbers are sharply at odds with the numbers from the insurance companies themselves, most of which put the total of enrolled customers who’ve paid their first premium at between 80% and 90%. Given this, either the insurers or GOP lawmakers are exaggerating, and since insurers have no incentive to lie about this, it would appear Republicans are trying to pull a fast one.

Second, GOP lawmakers picked an arbitrary and misleading cut-off date: they only count customers who paid premiums by April 15. But that’s ridiculous – as Charles Gaba explained, literally millions of Americans enrolled very close to the March 31 deadline and they were still receiving their first bill around April 15.

Third, as Jonathan Cohn reminds us, insurers specifically told these lawmakers that the data as of April 15 would be incomplete and paint a misleading picture. Republicans ignored this in order to launch a cheap attack intended to mislead.

And while these factual errors are obviously important, and were very likely deliberate, there’s also a thematic problem hanging over the effort itself: House Republicans, who can’t produce a health care plan of their own despite promises to the contrary, still believe ACA enrollment totals are both too high and too low at the same time.

Remember, if these conservative lawmakers had their way, the total number of consumers signing up for coverage through exchange marketplaces and paying premiums would be zero. For them to keep whining about the successful enrollment process, looking for new areas to complain about, is effectively an “Annie Hall” moment: “Two elderly women are at a Catskill mountain resort, and one of them says, ‘Boy, the food at this place is really terrible.’ The other one says, ‘Yeah, I know, and such small portions.’”

Whether or not Republicans understand any of this is unclear. At a certain level, I suspect the substance doesn’t much matter to them either way – it’s about making an attack, hoping the media will repeat it, and counting on at least some of the public to buy it.

But in a case like this, even this is self-defeating, since the actual data will soon be published and we’ll have a new round of evidence that the Republican attacks were plainly untrue.

So why do they bother? To establish the basis for a bogus talking point: thanks to yesterday’s misleading committee “report,” conservative media will repeat as gospel that “only 67%” of consumers paid premiums, so the right no longer has to believe the evidence about the Affordable Care Act exceeding its enrollment projections.

It’s about creating a bubble that keeps reality out, then reinforcing the bubble with nonsense.

Update: The “report” itself is online here. Note how it fits comfortably on one page.

 

By: Steve Benen, The Maddow Blog, May 1, 2014

May 2, 2014 Posted by | Affordable Care Act, GOP, Obamacare | , , , , , | Leave a comment

“Rick Scott Gets An Earful In Florida”: Talking To Regular People Who Don’t Have A Script To Follow Could End Your Career

There’s a reason so many politicians embrace carefully managed, pre-scripted events: they never know what actual people are going to say. The spontaneity may be refreshing for the rest of us, but for politicians and their aides, it’s frustrating when the public goes “off-message.”

Almost exactly two years ago, this happened to Mitt Romney’s presidential campaign in Pennsylvania, when aides arranged for the candidate to chat with a group of regular folks about the economy. One voter said, “None of us like to pay more taxes, but sometimes that’s necessary.” Another added, “It’s a necessary evil.” “Right, right,” a third person said as the group nodded.

The Republican presidential hopeful didn’t do too many unscripted events after that.

This week, Florida Gov. Rick Scott (R) ran into similar trouble. The Republican governor, facing a tough re-election fight, is heavily invested in condemning the Affordable Care Act, so he visited a South Florida senior center for a roundtable chat with retirees he assumed would agree with him.

Oops.

The 20 seniors assembled for a roundtable with Scott at the Volen Center were largely content with their Medicare coverage and didn’t have negative stories to recount. And some praised Obamacare – a program that Scott frequently criticizes.

“I’m completely satisfied,” Harvey Eisen, 92, a West Boca resident, told Scott.

Eisen told the governor he wasn’t sure “if, as you say,” there are Obamacare-inspired cuts to Medicare. But even if there are, that would be OK. “I can’t expect that me as a senior citizen are going to get preferential treatment when other programs are also being cut.”

Ruthlyn Rubin, 66, of Boca Raton, told the governor that people who are too young for Medicare need the health coverage they get from Obamacare. If young people don’t have insurance, she said, everyone else ends up paying for their care when they get sick or injured and end up in the hospital.

Twisting the knife, Rubin added, “People were appalled at Social Security.  They were appalled at Medicare when it came out. I think these major changes take some people aback. But I think we have to be careful not to just rely on the fact that we’re seniors and have an entitlement to certain things…. We’re all just sitting here taking it for granted that because we have Medicare we don’t want to lose one part of it. That’s wrong to me. I think we have to spread it around. This is the United States of America. It’s not the United States of senior citizens.”

The underlying point of Scott’s visit was to try to complain about Medicare Advantage reforms and how awful recent “cuts” must be for seniors. But when the governor asked one elderly woman if she’d seen any changes, she said, “Not really.” Another member of the roundtable said he’s “very happy” with the current coverage. A third person said he’s had “no problems.” A fourth said she and her husband are “very pleased.”

When Scott asked if they’ve found doctors opting out of Medicare, most said, “No.”

It was at this point that the governor probably decided he no longer wants to talk to regular people who don’t have a script to follow.

For the record, as Scott probably knows, these so-called “cuts” to Medicare Advantage aren’t really cuts to beneficiaries. At issue are Medicare cost-savings embraced by the Obama administration through the Affordable Care Act. The so-called “cuts” are changes to the way in which the government reimburses insurance companies, which have been overpaid in the Medicare Advantage program.

What’s more, congressional Republicans – not exactly a moderate bunch – have already endorsed and voted for these “cuts.”

It’s likely the governor understands this, but hopes to fool voters. If yesterday was any indication, his efforts aren’t going well.

 

By: Steve Benen, The Maddow Blog, April 30, 2014

May 1, 2014 Posted by | Affordable Care Act, Obamacare, Rick Scott | , , , , , , , | 1 Comment

“Conservative Crybabies Lose Again”: The Right’s Laughable New Obamacare Conspiracies, Officially Debunked

If you click through a few conservative news websites, you’ll learn all about the latest and most nefarious bit of lawless chicanery from the Obama administration as it tries to paper over the Affordable Care Act’s obvious failures. Jumping off from a New York Times report that the Census Bureau “is changing its annual [healthcare] survey so thoroughly that it will be difficult to measure the effects of President Obama’s health care law in the next report,” conservatives have put two and two together and come up with CONSPIRACY.

Megan McArdle asks, “Is Obama cooking the Census books for Obamacare?” Townhall’s Guy Benson suspects this change was implemented to boost Democratic fortunes for the midterms: “The brand new survey questions will unquestionably ‘reveal’ a dramatic decrease in the uninsured population, bureau experts say, which will deliver Democrats a super handy talking point. And oh-by-the-way, the artificially improved numbers will be released … this fall.” Mediaite’s Noah Rothman writes that the conservatives who argle-bargled in 2009 about the White House politicizing the census now look prescient. “The fears of some that the Census Bureau could be corrupted by the imperatives of the political operatives in the White House was today proven accurate.”

Nonsense. The timing of the switch is obviously not ideal, though, as Vox’s Sarah Kliff notes, the new methods will be used to collect data for 2013, before the state marketplaces went up and the Medicaid expansion took effect. The suggestion of political interference from the White House, however, is a bombshell accusation that, despite Rothman’s insistence, is nowhere near being “proven.” Evan McMorris-Santoro of BuzzFeed talked to a census official who said that the White House had precisely zero involvement in the changes implemented, and that the bureau had been discussing the shift “way before the ACA was an idea.”

Regardless, it’s a big story on the right, and not just because conservatives love a good conspiracy. In the past week or so, conservatives have seen their reliable avenues for attacking the Affordable Care Act evaporate right in front of them.

The announcement that Kathleen Sebelius was stepping down as Health and Human Services secretary sparked a brief round of schadenfreude and some enthusiastic sand-kicking at Ezra Klein, but ultimately Sebelius’ departure means that Republicans and conservatives have lost one of their favorite ACA punching bags. Her successor-in-waiting, Sylvia Mathews Burwell, is an experienced administrator and the rarest of rare things: an Obama administration official who is actually on good terms with key Republicans in Congress. They’ll have a tough time painting her as controversial, and (assuming she’s confirmed) Burwell will assume control of Obamacare as it swings upward from its functional and political nadir.

Speaking of which, as conservatives are trying to suss out White House manipulation of the Census Bureau, Obamacare keeps on doing exactly what it was intended to do. This week the Congressional Budget Office found that Obamacare will cover more people for less money than initially estimated, and that insurance premiums likely will not spike next year, thus driving a stake through three core conservative attacks on the health law.

Health insurers, who just last month were floating anonymous warnings of massive premium increases, are now starting to warm to the state health exchanges. “At least two major national insurers intend to expand their offerings,” reported Politico on April 16, “although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.”

And, in a development that should shock no one, Gallup found that in states that embraced Obamacare (i.e., set up their own health exchanges and expanded Medicaid) the rate of uninsured adults declined three times faster than in those states that rejected the Medicaid expansion or had the feds set up their insurance marketplace. All told, Gallup’s findings translate to about 10 million newly insured Americans.

Obamacare works in states that want it to work, and the tangible benefits of that success are putting pressure on Republicans who have to date been antagonistic toward the law. As Greg Sargent observed, Republican Senate candidates are now suddenly reticent when it comes to discussing the Medicaid expansion. Most notable among them is Tom Cotton in Arkansas, where Medicaid was expanded under a compromise measure in which federal dollars are used to purchase private plans. Cotton supports the full repeal of Obamacare, but won’t comment specifically on Arkansas’ “private option” for Medicaid, amusingly dismissing it as “a state-based issue.”

I certainly don’t want to leave the impression that the Affordable Care Act has been neutralized as a political issue or that it won’t face problems down the road – a looming increase in healthcare costs, for example. But for now Obamacare is shoring up some of its biggest political vulnerabilities, leaving conservatives to sputter about census conspiracies.

 

By: Simon Maloy, Salon, April 17, 2014

 

April 18, 2014 Posted by | Affordable Care Act, Conservatives, Obamacare | , , , , , | Leave a comment

Follow

Get every new post delivered to your Inbox.

Join 2,701 other followers

%d bloggers like this: