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“Just Die Already!”: GOP Would Bar Poor From Health Care Altogether

During a Republican primary debate in the last presidential election cycle, there was a dispiriting moment in which Tea Party audience members cheered at the idea that a comatose uninsured American — unable to afford health insurance — would be left to die. That infamous outburst, among others, has prompted GOP bigwigs to try to cut back on primary season debates, hoping to limit appearances that might expose the party’s baser impulses.

But that mean-spirited and contemptuous attitude toward the sick is alive and well in the Grand Old Party, as its maniacal (and futile) resistance to Obamacare has made clear. Now, one Republican politician is pushing that callousness to new lows: He wants to bar the uninsured from hospital emergency rooms.

Last week, Georgia Gov. Nathan Deal criticized a decades-old federal law that requires all hospitals that receive Medicare funds and have emergency facilities — and that’s most — to treat any patient who walks in needing care, regardless of his ability to pay. “It came as a result of bad facts,” Deal said, according to The Atlanta Journal-Constitution. “And we have a saying that bad facts make bad law.”

Deal says that many people use emergency rooms unnecessarily, and those patients inflate health care costs. He is factually correct. But there are other facts that undercut his arguments and reveal his hypocrisy.

First off, Deal is among those red-state Republicans who have vociferously opposed the Affordable Care Act, which makes health insurance available to hundreds of thousands of people who couldn’t otherwise afford it. If more people had health insurance policies that paid for doctors’ visits, fewer would use emergency rooms for routine complaints.

Second, Deal, like many Republican governors, has refused the Medicaid expansion made possible by Obamacare, even though the federal government would pick up 100 percent of the cost for the first three years and 90 percent until the year 2022. That expansion is the best chance many Georgians without means have for getting health insurance.

So, to sum up, Deal hates Obamacare and refuses its Medicaid expansion, which would keep the working poor out of emergency rooms. In addition, he wants to deny them access to emergency rooms unless they can pay. Really, governor? Don’t you insist that your values are “pro-life”?

It’s no wonder that GOP strategists shuddered when audience members responded so cruelly during the CNN/Tea Party Express debate in September 2011. It portrays the party as pitiless — a reputation unlikely to attract a majority of voters.

Quiet as it’s kept, most Americans support keeping Obamacare, despite the relentless pounding it has taken from Republicans. (And despite a website rollout that was infuriatingly incompetent.) A new poll by the Kaiser Family Foundation found that 56 percent of Americans favor keeping it in place, while just 31 percent want to repeal it. (Twelve percent want to replace it with a GOP plan.)

That’s likely because most voters, no matter their reservations about Obamacare, know that the Republican Party has no good solution for the millions of Americans who work every day but still don’t earn enough money to buy a health care plan. Americans have struggled with the nation’s dysfunctional health care “system,” and they know it’s overdue for an overhaul.

Meanwhile, as the midterm elections draw closer, the GOP struggles to come up with a plan that pretends to overhaul the health care system. Looking to avoid being painted as mere obstructions, House Republican honchos are working to draw their caucus together behind a bill that would replace Obamacare with a workable alternative.

But the most sincere plan so far — one offered by Sens. Richard Burr (R-NC), Tom Coburn (R-OK) and Orrin Hatch (R-UT) — would probably offer policies too skimpy to do any good once a policyholder gets sick.

Besides, even that replacement idea seems unlikely to draw broad support among the far-right Tea Partiers, who believe that allowing the uninsured poor to die is the appropriate government response to the health care crisis.

That’s a hulking bit of hypocrisy for a party that advertises itself as “pro-life.” Deal’s latest proposal is one more reminder of how little that label means.

 

By: Cynthia Tucker, The National Memo, March 1, 2014

March 4, 2014 Posted by | GOP, Health Insurance | , , , , , , , , | 1 Comment

“Obamacare And Emergency Rooms, A Bit Of Perspective Needed”: Oregon Study Doesn’t Undermine Affordable Care Act Claims

Headlines based on a study of emergency room visits by a few thousand Oregon Medicaid beneficiaries undoubtedly gave the Obama administration heartburn last week. Although the study predated the Medicaid expansion authorized by the Affordable Care Act — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicaid beneficiaries would make greater — not less — use of the ER for routine care.

I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And that’s because more Americans will finally have insurance.

Reform advocates have long suggested that getting folks out of the ranks of the uninsured should cut down on visits to the ER for noncritical medical care. Many people who lack coverage don’t have a primary care physician and all too often make trips to the ER when their illness or injury could have been treated more appropriately and inexpensively in a clinic or doctor’s office.

The Oregon study, which was published in the journal Science, would seem to disprove that theory.

In 2008, two years before the ACA was enacted, Oregon increased the number of Medicare beneficiaries in a novel way: by lottery. Many Oregonians who had been on a waiting list for the state’s Medicaid program got lucky when their names were drawn and they were added to the rolls.

The researchers who wrote the Science article studied the emergency room use of about 25,000 of the successful and unsuccessful lottery participants and found that those who won coverage actually made more trips to the ER over 18 months than those whose names were not drawn.

Headline writers were quick to draw their conclusions: Obamacare would not reduce unnecessary ER visits.

“Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday.

“Obamacare Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg.

And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Emergency Rooms, Undermining Central Rational for Obamacare.”

“For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,’ said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion.”

There is more than a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can’t pay for their ER care. That’s because the hospital shifts the cost of that “uncompensated care” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn’t have to occur.

Bringing uninsured people into coverage eliminates much of that cost shifting. And that’s a good thing, considering that the vast majority of Americans with health coverage — even after the Medicaid expansion — get it through private insurance companies, either at work or on their own.

The actual increase in the number of visits per person among the newly insured in Oregon via the Medicaid lottery was 0.41. In other words, each new enrollee made 0.41 visits more on average during the 18 months than the 1.02 ER visits made by those who remained uninsured.

When you look at it from the perspective of those numbers, and the actual amount Oregon spent per person, as University of Chicago health policy expert Harold Pollack did in a healthinsurance.org post, this is far from a “sky is falling” disaster in the making. And it is actually reducing the cost shifting.

Also, as Pollack pointed out, “the emergency departments will be reliably paid for care they provide … (With coverage expansion) providers don’t have to fear the burdens or uncompensated care, and…they don’t need to cruelly pursue low-income patients over bad debts.

It’s also important to keep in mind that private insurers now manage most of the states’ Medicaid populations, and they will be vigilant in their efforts to steer their new Medicaid enrollees away from the ERs and to more appropriate and cost-effective settings. WellPoint subsidiary Amerigroup described in a recent policy brief, for example, how its efforts to reduce primary care-treatable ER visits among Medicaid beneficiaries resulted in a savings of more than 50 percent.

Rather than rushing to conclusions, let’s see how the Medicaid expansion under Obamacare actually plays out in the years ahead.

 

By: Wendell Potter, The Center for Public Integrity, January 6, 2014

January 8, 2014 Posted by | Affordable Care Act, Health Care Costs, Medicaid Expansion | , , , , , , | Leave a comment

“Death By Ideology”: Among The Lying Liars, Mitt Romney Doesn’t See Dead People

Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the ugly reality of what will happen if he and Paul Ryan get their way on health care.

Last week, speaking to The Columbus Dispatch, Mr. Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on an earlier remark by Mr. Romney — echoing an infamous statement by none other than George W. Bush — in which he insisted that emergency rooms provide essential health care to the uninsured.

These are remarkable statements. They clearly demonstrate that Mr. Romney has no idea what life (and death) are like for those less fortunate than himself.

Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required by law to treat people in dire need, whether or not they can pay. But that care isn’t free — on the contrary, if you go to an emergency room you will be billed, and the size of that bill can be shockingly high. Some people can’t or won’t pay, but fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.

More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.

So the reality, to which Mr. Romney is somehow blind, is that many people in America really do die every year because they don’t have health insurance.

How many deaths are we talking about? That’s not an easy question to answer, and conservatives love to cite the handful of studies that fail to find clear evidence that insurance saves lives. The overwhelming evidence, however, is that insurance is indeed a lifesaver, and lack of insurance a killer. For example, states that expand their Medicaid coverage, and hence provide health insurance to more people, consistently show a significant drop in mortality compared with neighboring states that don’t expand coverage.

And surely the fact that the United States is the only major advanced nation without some form of universal health care is at least part of the reason life expectancy is much lower in America than in Canada or Western Europe.

So there’s no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year. But that’s not a fact Mr. Romney wants to admit, because he and his running mate want to repeal Obamacare and slash funding for Medicaid — actions that would take insurance away from some 45 million nonelderly Americans, causing thousands of people to suffer premature death. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage, too, leading to still more unnecessary mortality.

Oh, about the voucher thing: In his debate with Vice President Biden, Mr. Ryan was actually the first one to mention vouchers, attempting to rule the term out of bounds. Indeed, it’s apparently the party line on the right that anyone using the word “voucher” to describe a health policy in which you’re given a fixed sum to apply to health insurance is a liar, not to mention a big meanie.

Among the lying liars, then, is the guy who, in 2009, described the Ryan plan as a matter of “converting Medicare into a defined contribution sort of voucher system.” Oh, wait — that was Paul Ryan himself.

And what if the vouchers — for that’s what they are — turned out not to be large enough to pay for adequate insurance? Then those who couldn’t afford to top up the vouchers sufficiently — a group that would include many, and probably most, older Americans — would be left with inadequate insurance, insurance that exposed them to severe financial hardship if they got sick, sometimes left them unable to afford crucial care, and yes, sometimes led to their early death.

So let’s be brutally honest here. The Romney-Ryan position on health care is that many millions of Americans must be denied health insurance, and millions more deprived of the security Medicare now provides, in order to save money. At the same time, of course, Mr. Romney and Mr. Ryan are proposing trillions of dollars in tax cuts for the wealthy. So a literal description of their plan is that they want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income.

It’s not a pretty picture — and you can see why Mr. Romney chooses not to see it.

By: Paul Krugman, Op-Ed Columnist, The New York Times, October 16, 2012

October 17, 2012 Posted by | Election 2012 | , , , , , , , | 2 Comments

“Wrong Again Mitt”: Romney Says People Don’t Die Because They Lack Insurance

In an interview with the Columbus Dispatch in Ohio published Thursday, Mitt Romney repeated a claim that already got him in trouble once this cycle and has reflects an enduring belief among Republicans: that people in the U.S. don’t die because they lack health insurance.
“[Y]ou go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital,” Romney said. “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

It’s eerily reminiscent of a statement President George W. Bush made in 2007 that haunted Republicans during the 2008 campaign — “[P]eople have access to health care in America. After all, you just go to an emergency room.”

There’s just one problem: It’s not true.

Numerous studies over the past 10 years conclude that tens of thousands of Americans die each year because they lack insurance.

A 2009 study conducted at Harvard Medical School and Cambridge Health Alliance, and published in the American Journal of Public Health concluded that “[l]ack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease. … The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance.”

A 2012 report by the health care reform advocacy group Families USA concluded that 26,100 people died prematurely in America in 2010 due to lack of insurance. That report extrapolated from a 2002 Institute of Medicine study — conducted when the uninsurance rate was lower — which concluded that 18,000 people died prematurely because they weren’t covered.

In a 2009 update, the IOM concluded that uninsured patients are at higher risk of mortality or poor health outcomes in the aftermath of both acute medical issues (heart attacks, serious injury, stroke) and chronic ones (cancer, diabetes).

In 2008, the Urban Institute’s Stan Dorn concluded that “[b]ased on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006. Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.”

Conservatives have attacked these findings and methods and argued that, controlling for health status, there’s no difference in survival probabilities between insured and uninsured people. When the Families USA report came out, Avik Roy, a Romney health adviser, called its findings “statistical hogwash.”

To buttress his argument, he cited a thorough study by Richard Kronick — a University of Rochester health policy expert who served in the Obama administration and was a senior adviser to Bill Clinton during his push for health care reform. His conclusion? “[I]f two people are otherwise similar at baseline … but one is insured and the other uninsured, their likelihood of survival over a 2-16-year follow-up period is nearly identical.”

Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.

However, Kronick conceded that “[g]iven the inherent uncertainties in inferring causality from the results of observational analyses, the results presented here are not able to provide a definitive answer to the question, ‘How many fewer deaths would there be in the United States if all residents were continuously covered by health insurance?’”

In an interview, Urban’s Stan Dorn praised Kronick but defended his and his colleagues’ conclusion.

“I’m aware of Rick’s study and he’s a great researcher. And I guess what I’d say is it’s an outlier,” Dorn said in an interview. “There’s a lot of research that goes beyond what we did, and it’s an outlier.”

Dorn noted that other studies focusing on particular ailments make the link between uninsurance and death quite clear. “We know that women with cervical cancer who are uninsured get their cancer detected later…. We know that people with heart disease don’t take their medicine because they can’t afford it…and sometimes die.”

And as Boston University health economist Austin Frakt noted when he engaged this same controversy in February 2010, “among recent studies in this area the evidence is greater than three-to-one in favor of an insurance-health outcome link, including mortality.”

In 2006, then-Massachusetts governor Romney himself agreed — at least to an extent. Though he did not address the mortality issue specifically, in an April 2006 presentation before the Chamber of Commerce he conceded that uninsured people who seek health care at emergency rooms experience worse outcomes.

“There ought to be enough money to help people get insurance because an insured individual has a better chance of having an excellent medical experience than the one who has not. An insured individual is more likely to go to a primary care physician or a clinic to get evaluated for their conditions and to get early treatment, to get pharmaceutical treatment, as opposed to showing up in the emergency room where the treatment is more expensive and less effective than if they got preventive and primary care.”

 

By: Brian Beutler, Talking Points Memo, October 12, 2012

October 14, 2012 Posted by | Election 2012, Health Care | , , , , , , , | Leave a comment

“The Other Mitt”: No Health Insurance? Romney Says “Freeloading” In The ER Is Now All Good

Whether you support the candidacy of Mitt Romney or not, we all should be able to agree that his experience as Governor of Massachusetts—at the time when the first universal healthcare law in the nation was conceived and placed into operation—makes him something of an expert on the subject of health care economics.

And that is precisely what makes his comments during last night’s edition of “60 Minutes” all the more bizarre.

When asked whether the nation has a responsibility to provide health care to the 50 million Americans who do not currently have coverage, the Governor responded;

“Well, we do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”

Never mind that ‘60 Minutes’ interviewer Scott Pelly was quick to accurately point out that ER care is the most expensive form of treatment that one can access. What is far more interesting is that the remark so clearly puts Governor Romney at odds with the other candidate seeking the presidency—and I don’t mean Barack Obama.

I refer, of course, to the ‘other’ Mitt who seems to come and go at various moments in the campaign, offering up direct contradictions to the positions of the Mitt Romney we watched last night on the CBS news show.

You see, it was the ‘other’ Mitt who said during a 2010 interview over at MSNBC—

“It doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility.”

And it was the ’other’ Mitt who told Glenn Beck in a 2007 interview—

“When they show up at the hospital, they get care. They get free care paid for by you and me. If that’s not a form of socialism, I don’t know what is. ”

Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.

It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.

As noted by the current incarnation of the GOP candidate, when a patient turns up at the ER with severe stomach pain, that patient will be treated until her condition is stabilized. But it is the ‘other’ Mitt Romney who understands that, when the tests administered in the ER reveal that the patient has Stage One stomach cancer, it will not be up to the ER to administer the six months of chemotherapy that will be required to save the patient’s life. For that, the patient better be insured or face a truly precarious situation.

The ‘other’ Romney understands that ER care is insufficient to truly treat many patients and that, even when it was possible to get the desired result via ER care, it is the worst possible way to administer health care.

Here’s a thought—maybe current candidate Romney should consider getting rid of his failing campaign staff and see if he can entice the ‘other’ Mitt Romney to join the campaign as a strategist and adviser.

At the end of the day, I think we’d all be better off for it.

 

By: Rick Ungar, Contributor, Forbes, September 24, 2012

September 25, 2012 Posted by | Election 2012 | , , , , , , , , | Leave a comment

   

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