“Beating The Odds”: Health Care, Guns And The Will To Win
For supporters of the urgent push for sensible gun laws, the fierce national battle over health care is a good example of how folks can beat the odds.
One of the most extraordinary things about the campaign to win Obamacare was the sheer will of its supporters — the ability to maintain momentum and keep going in the face of one challenge after another. The campaign for commonsense gun laws needs the same thing right now. While advocates have been slogging away for years, the horrific massacre at Sandy Hook Elementary School and so many other places have created an historic opportunity for change. We cannot afford to let the momentum and attention slip away.
We can already see the obstacles. Just a few days after the National Rifle Association (NRA) had a press event where they offered a shockingly stupid and tone deaf response to the massacre in Newtown, Conn., they’re back to doing what they do best — telling everyone what they’re against. Anything that smacks of regulating guns is a bad idea, they say. The only way to end senseless firearms violence is more guns, they say.
Already the apologists for the NRA and the gun manufacturers are out in full force, explaining that there are so many factors that contribute to this problem that we can’t possibly tackle one of the solutions that’s within our reach.
This time, it appears, members of Congress are not cowering. Many former opponents of sensible gun laws are announcing their support for measures like criminal background checks for all gun-buyers and bans on military-style assault rifles and high-capacity magazines — the equipment used in the most recent mass shootings. Polls show that the public and most NRA members are on their side.
The outcome of the gun debate, as in the health care battle, will be determined by political will and the courage of individual members of Congress to stand up for what they believe to get results.
When she was Speaker of the House, Nancy Pelosi was a big reason we won health care. She defined what it means to be a leader. She was smart and strategic, and she got others to follow. But perhaps most importantly, in the dark days of January and February of 2010, when it looked like health reform would fall short in Congress, Pelosi was willful. She wouldn’t give up. Pelosi boldly told the American people what it would take to win — and gave us a roadmap for this fight:
We’ll go through the gate. If the gate’s closed, we’ll go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in, but we’re going to get health care reform passed for the America people.
We must ensure that the innocent victims of Newtown and other mass shootings, along with the 12,000 people killed each year by gun violence, did not die or suffer in vain. The fallen and their families deserve better. It’s time for Congress to pole vault in and break the political inertia that leaves us all at risk.
We took on the mammoth task of reforming a broken health care system, and our political leaders beat the odds through sheer force of will. Now our leaders must use the same single-minded determination to end rampant gun violence.
By: Ethan Rome, Executive Director, Health Care for America Now, The Huffington Post, December 26, 2012
“Promoting Untrue Choice”: Paul Ryan’s Health Care Proposal Would Shrink The Medicare Doctor Pool
The federal budget proposed by Representative Paul Ryan, the Republican vice-presidential nominee, extols the benefits of “promoting true choice” for Medicare beneficiaries.
In truth, though, the Ryan plan would substantially reduce choice for many people on Medicare — by cutting them off from their current doctors.
Doctors see Medicare patients, despite the relatively low payments they receive for doing so, partly because Medicare represents such a large share of the health-care market.
If a substantial number of beneficiaries moved out of Medicare and into private plans, as Ryan proposes, doctors would have much less incentive to see Medicare patients. And the elderly who want to remain in traditional Medicare would risk being stranded.
The evidence suggests that, in time, this problem could well affect a large share of Medicare beneficiaries. To put that evidence in context, though, it helps to first review the history of the Ryan plan.
The proposal has changed since it was presented in 2011. In the original version, traditional Medicare was eventually to be replaced in its entirety by private plans. The Congressional Budget Office found that this shift would raise health-care costs drastically because the private plans wouldn’t be large enough to enjoy Medicare’s leverage in negotiating prices with hospitals and other large providers. The savings that private plans could achieve because beneficiaries would share more of the costs, and therefore economize more, would be more than offset by that loss of leverage — and by the private plans’ higher overhead and need to turn a profit.
Ryan Revision
In response to the devastating CBO report, Ryan revised his proposal. Under Ryan 2.0, private plans would co-exist with traditional Medicare. (The CBO hasn’t fully evaluated the revised plan yet.)
Many supporters argue that the new plan can’t be as big a problem as the old one, since beneficiaries could always choose to remain in traditional Medicare. In health care, however, choice isn’t always innocuous — and can sometimes be harmful.
I have previously described two downsides to expanding private plans in Medicare. First, it would undercut Medicare’s ability to help move the payment system away from fee-for- service reimbursement and toward payments based on value, because no private plan is large enough to accomplish that shift by itself. Second, the mechanism for adjusting premiums to even out the health risks of individual beneficiaries is far from perfect, so plans can easily game the system, raising total costs. In effect, the plans would end up being overpaid.
The reduced choice of doctors for those who remain in traditional Medicare is a third adverse consequence of moving beneficiaries out of the program.
Currently, Medicare beneficiaries almost universally enjoy excellent access to doctors. And the great majority of beneficiaries never have to wait long for a routine appointment, the Medicare Payment Advisory Commission has found. Roughly 90 percent of doctors accept new Medicare patients.
Doctors provide this access even though they are reimbursed by Medicare at rates that are only about 80 percent of commercial rates — partly because Medicare is such a large share of the market. Which brings us to the concern about the Ryan plan.
Medicare Doctors
How important is Medicare’s market share in influencing physician participation? The evidence is limited, but the best study to date suggests it is significant. In the 1990s, Peter Damiano, Elizabeth Momany, Jean Willard and Gerald Jogerst, all associated with the University of Iowa, surveyed Iowa physicians and examined variation among counties. They found that for each percentage-point increase in the share of Medicare beneficiaries in a county’s population, doctors were 16 percent more likely to accept patients on Medicare. The only other study I know of on this topic, an unpublished analysis by Matthew Eisenberg of Carnegie Mellon University, also found an effect from Medicare’s market share, albeit one that was substantially smaller than the one Damiano and his colleagues found.
About 10 percent of the U.S. population is now enrolled in traditional Medicare, and an additional 5 percent has private Medicare plans. Let’s assume, for the sake of argument, that the Ryan plan would cause another 5 percent of the population to shift, and to be conservative let’s cut in half the Damiano estimate of the impact from that reduction in Medicare’s market share. Then the chance that a doctor is willing to see traditional Medicare patients would be expected to decline by a whopping 40 percent. The share of doctors accepting Medicare would fall from about 90 percent to 54 percent.
To be even more conservative, let’s average the reduced Damiano estimate (already been cut in half and applied only to today’s market share rather than the higher one that will exist in the future when more people are on Medicare) with the Eisenberg estimate. Still, about 20 percent of doctors would be expected to stop accepting Medicare patients.
Supporters of the Ryan approach might argue that fewer people would shift into the private plans, so the impact would not be that great. After all, the existing Medicare program already offers Medicare Advantage plans, so perhaps anyone who wants private insurance already has it. But then, what is the point of Ryan’s Medicare reform?
Another defense might be that the government could simply raise doctor-reimbursement rates to encourage providers to continue treating a shrinking population of traditional Medicare patients. And that’s true. However, Ryan has not included the extra cost in his budget.
So, which is it, Mr. Ryan? Will your plan cause Medicare beneficiaries to lose access to their doctors, or are your budget numbers too rosy because you haven’t counted the extra payments needed to keep doctors in the program?
By: Peter Orszag, Council on Foreign Policy, Business Insider, September 24, 2012
“By The People, For The People”: Proof Obamacare Puts Control Of Healthcare In The Hands Of The Consumer
One of the key talking points consistently mouthed by opponents of the Affordable Care Act is their declaration that the law wrests control of healthcare out from the hands of the consumer and places it squarely under the control of the federal government.
And yet, the meme—like so many others employed by dedicated Obamacare bashers— is simply not true.
Now, we can prove it.
You have likely never heard about the section of the ACA that provides federal loans to help launch consumer owned and controlled health insurance plans. The money is available for insurance plans showing a reasonable chance for success, are owned by the membership (people like you and I) and operated by a board of directors where members comprise the majority -not passive investors looking to make a buck.
It is health insurance by the people and for the people.
Tufts Medical Center in Massachusetts—along with their physician group and a company which owns and operates two hospitals in the region—has acted on this provision of the law and received $88.5 million in federal funds to create the state’s first member owned and controlled health insurance plan. While the program is being put together by a panel of experts, once the insurance plan is qualified to do business by the state’s insurance regulators, they will begin signing up individuals and small businesses who will not only become the owners of the plan, they will ultimately end up running the company.
How’s that for putting control of our healthcare back into the hands of the consumer?
The not-for-profit plan entitled the Minuteman Health Initiative—which expects to offer health insurance coverage in Eastern and Central Massachusetts beginning in 2014—is looking to bring down the cost of premiums to its members by streamlining the billing process and allowing providers to work directly with employers.
According to Dr. Jeff Lasker, chief executive of the Tufts physician group, New England Quality Care Alliance, “Imagine working closely with an employer who can help us gather data and, with employees’ permission, to be able to share that data with their primary care providers. “
Imagine, indeed.
Physicians, hospitals and consumers working alongside one another to design coverage options that better meet the needs of all the participants in the healthcare equation in the effort to bring about a better result for everyone—and done in an environment where the consumer is in control of the board of directors rather than profit driven executives whose bonuses are determined by how much money is left in the till at the end of the quarter.
Can there be anyone who does not see the great potential in this concept?
We are a nation where our health care is, for most of our citizens, controlled by private insurance companies—not the United States government. If you don’t believe that, just ask your physician what he or she must go through to get an insurance company to approve a treatment or procedure you need and how you end up paying for all this time your doctor invests in fighting for your care.
Will the Minuteman Health Initiative work? Will it accomplish the goal of lowering costs and providing appropriate benefits to consumers while allowing for a workable compensation structure to health care providers—all under the direction of the very people who depend on the plan for their health care needs?
We’ll see.
But if you don’t try something, you never find better solutions. And should the Minuteman plan work out, we can expect to see similar programs launched in every state in the union—insurance plans designed to work for both provider and beneficiary and all under the control of the people who actually pay the premiums and depend upon the benefits for the security of their families.
I don’t care how much you think you detest Obamacare. If you aren’t rooting for success in the case of the Minuteman Health Initiative—and the law that made it possible—you simply are not paying attention.
By: Rick Ungar, Contributor, Forbes, September 1, 2012
“A Slave To The Right Wing”: Romney’s Health Care Dilemma Returns
Mitt Romney has been so busy securing his Republican base that he hasn’t had time to court independent voters, the ones who will actually decide this election. But now, probably by accident, he has an opportunity to show them that he’s something other than a slave to his party’s right wing. Will he take it?
When Romney spokesperson Andrea Saul committed the apparently unpardonable sin of praising the health care law Mitt Romney passed as governor of Massachusetts, was she making a horrible mistake that made everyone in Romney headquarters gasp in horror, or was she just reflecting what her candidate actually believes? The answer to that question would tell us where Romney is going to go from here on health care, and whether he may at long last try to find some issue on which he can convince voters he’s something more than a vessel for whatever his party’s right wing wants to do to the country.
Most everyone, myself included, initially assumed that Saul just spoke out of turn. After all, Romney had been trying to avoid any discussion of health care all through the primaries. And from a logical standpoint, there really is no good argument for him to make. Since what Romney did in Massachusetts and what President Obama did with the Affordable Care Act are identical in their major features, either they were both wise policy moves or they were both horrible mistakes, but it just can’t be the case that one was great and the other was a nightmare. That is, in fact, the argument Romney makes when he’s forced to talk about the Massachusetts reform, but you can tell he realizes how absurd what he’s saying is, and he wants to change the subject as soon as possible.
But Noam Scheiber argues that it’s oversimplified to just say that Romney has turned his back on Romneycare in order to assure Republicans that he hates Obamacare as much as they do:
As we await the Romney campaign’s decision about Saul’s fate, it’s worth reflecting on one under-reported aspect of this latest conservative blow-up: Saul was saying precisely what her superiors in the Romney campaign believe, not least of them Mitt Romney.
I spent a lot of time talking to Romney campaign officials while reporting my recent profile of Stuart Stevens, his chief strategist. The unmistakable impression I got from them is that, to this day, Romney remains extremely proud of having passed health care reform in Massachusetts.
And why wouldn’t he be? He approached a difficult problem, then came up with a solution acceptable to both parties, and by all accounts the resulting policy has been a success. There are only a small number of uninsured people left in Massachusetts, and the reform is widely popular within the state. It was without a doubt the most significant accomplishment of Romney’s one term as governor. The fact that he is running a campaign for president in which he dares not mention the best thing he did in the one job he had that was something of a preparation for the job he wants is quite insane.
Of course, it’s one thing for him to be justifiably proud of Romneycare, and it’s another for him to actually talk about it on the campaign trail. If he were to do that, it would require two things he has little desire to do: angering his base, and admitting, at least tacitly, that Barack Obama actually did something right. The former is really the biggest problem; there has not been a single occasion during this campaign (or the one he ran in 2008, for that matter), when Mitt Romney has said or done anything he thought might get the right wing of the Republican party upset. The chances that he’ll start now are slim to none.
By: Paul Waldman, Contributing Editor, The American Prospect, August 10, 2012
“Short Memories”: If Only The President Would Make Speeches, Everything Would Be Different
The bizarre idea that Obama never tried to convince the public on health care reform.
Yesterday, psychologist and political consultant Drew Westen had yet another op-ed in a major newspaper (the Washington Post this time) explaining that all of Barack Obama’s troubles come from a failure to use rhetoric effectively. Don’t get me wrong, I think rhetoric is important—in fact, I’ve spent much of the last ten years or so writing about it. But Westen once again seems to have fallen prey to the temptation of believing that everything would be different if only a politician would give the speech he’s been waiting to hear. There are two problems with this belief, the first of which is that a dramatic speech almost never has a significant impact on public opinion. The second is that Barack Obama did in fact do exactly what Drew Westen and many other people say they wish he had done.
This is only one part of Westen’s piece, but I want to focus on it because it’s said so often, and is so absurd:
In keeping with the most baffling habit of one of our most rhetorically gifted presidents, Obama and his team just didn’t bother explaining what they were doing and why. To them, their actions were self-evident. But nothing is self-evident when your opponents are spending millions of dollars to defeat you. Instead, the White House blundered around with memorable phrases such as “bending the cost curve,” which didn’t speak to the values underlying the need for health-care reform.
My God, do people ever have short memories. They “didn’t bother explaining what they were doing and why”? Oh sure, if only Obama had, say, given a major speech about health-care reform, explaining to the public the principles behind his plan and the practical steps he would take! That would have changed everything! Oh, but wait—he did. Multiple times. Here‘s a speech he gave on it in June 2009. Here‘s a speech he gave on health-care reform to a joint session of Congress that September—maybe you’ve forgotten about it, but it was a pretty big deal at the time. Here‘s another speech he gave on it. We could go on.
Any time you’re tempted to say, “The President has never said X!,” you really ought to take some time to see if it’s true, because chances are he has. And in this case, the president made the case for health care hundreds of times. He did it on an almost daily basis for an entire year. The fact that his campaign of persuasion wasn’t as successful as many of us wanted it to be doesn’t mean he and his administration just forgot to talk to the public about health-care reform.
In fairness, when President Obama himself was asked about his biggest mistake in an interview not long ago, he said it was that he had spent all his time on getting the policies right and hadn’t spent enough time communicating with the American people. But that’s the presidential version of the job interview response, “My greatest weakness? I guess it’s that I work too hard.” The fact that he says it, and the fact that you might like to believe it’s true, doesn’t make it so.
By: Paul Waldman, Contributing Editor, The American Prospect, July 30, 2012
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