“Insurance And Freedom”: How Many Americans Will Be Denied Essential Health Care In The Name Of Freedom?
President Obama will soon release a new budget, and the commentary is already flowing fast and furious. Progressives are angry (with good reason) over proposed cuts to Social Security; conservatives are denouncing the call for more revenues. But it’s all Kabuki. Since House Republicans will block anything Mr. Obama proposes, his budget is best seen not as policy but as positioning, an attempt to gain praise from “centrist” pundits.
No, the real policy action at this point is in the states, where the question is, How many Americans will be denied essential health care in the name of freedom?
I’m referring, of course, to the question of how many Republican governors will reject the Medicaid expansion that is a key part of Obamacare. What does that have to do with freedom? In reality, nothing. But when it comes to politics, it’s a different story.
It goes without saying that Republicans oppose any expansion of programs that help the less fortunate — along with tax cuts for the wealthy, such opposition is pretty much what defines modern conservatism. But they seem to be having more trouble than in the past defending their opposition without simply coming across as big meanies.
Specifically, the time-honored practice of attacking beneficiaries of government programs as undeserving malingerers doesn’t play the way it used to. When Ronald Reagan spoke about welfare queens driving Cadillacs, it resonated with many voters. When Mitt Romney was caught on tape sneering at the 47 percent, not so much.
There is, however, an alternative. From the enthusiastic reception American conservatives gave Friedrich Hayek’s “Road to Serfdom,” to Reagan, to the governors now standing in the way of Medicaid expansion, the U.S. right has sought to portray its position not as a matter of comforting the comfortable while afflicting the afflicted, but as a courageous defense of freedom.
Conservatives love, for example, to quote from a stirring speech Reagan gave in 1961, in which he warned of a grim future unless patriots took a stand. (Liz Cheney used it in a Wall Street Journal op-ed article just a few days ago.) “If you and I don’t do this,” Reagan declared, “then you and I may well spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” What you might not guess from the lofty language is that “this” — the heroic act Reagan was calling on his listeners to perform — was a concerted effort to block the enactment of Medicare.
These days, conservatives make very similar arguments against Obamacare. For example, Senator Ron Johnson of Wisconsin has called it the “greatest assault on freedom in our lifetime.” And this kind of rhetoric matters, because when it comes to the main obstacle now remaining to more or less universal health coverage — the reluctance of Republican governors to allow the Medicaid expansion that is a key part of reform — it’s pretty much all the right has.
As I’ve already suggested, the old trick of blaming the needy for their need doesn’t seem to play the way it used to, and especially not on health care: perhaps because the experience of losing insurance is so common, Medicaid enjoys remarkably strong public support. And now that health reform is the law of the land, the economic and fiscal case for individual states to accept Medicaid expansion is overwhelming. That’s why business interests strongly support expansion just about everywhere — even in Texas. But such practical concerns can be set aside if you can successfully argue that insurance is slavery.
Of course, it isn’t. In fact, it’s hard to think of a proposition that has been more thoroughly refuted by history than the notion that social insurance undermines a free society. Almost 70 years have passed since Friedrich Hayek predicted (or at any rate was understood by his admirers to predict) that Britain’s welfare state would put the nation on the slippery slope to Stalinism; 46 years have passed since Medicare went into effect; as far as most of us can tell, freedom hasn’t died on either side of the Atlantic.
In fact, the real, lived experience of Obamacare is likely to be one of significantly increased individual freedom. For all our talk of being the land of liberty, those holding one of the dwindling number of jobs that carry decent health benefits often feel anything but free, knowing that if they leave or lose their job, for whatever reason, they may not be able to regain the coverage they need. Over time, as people come to realize that affordable coverage is now guaranteed, it will have a powerful liberating effect.
But what we still don’t know is how many Americans will be denied that kind of liberation — a denial all the crueler because it will be imposed in the name of freedom.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 7, 2013
“Doing Nothing Was Not An Option”: Obamacare Is Lowering Some Health Care Costs
The snippy tone of the letter from my health insurance company really threw me for a minute. Very officious, very much this-is-totally-not-our-fault-the-bad-government-made-us-do-it, the letter informed me that because of the Affordable Care Act, my premium might change. Under the law, as of this year, insurance carriers would no longer be allowed to differentiate (or discriminate) on the basis of gender, and this, I was informed in a letter dripping with derision, might end up affecting how much I have to pay for my individual insurance each month.
Well, it did. My premiums are now 7 percent lower than they were.
Yes, that’s lower. Despite the fact that foes of Obamacare are screaming about how the law will bankrupt families and small businesses (the impact on buyers of individual policies never seems to come up), despite all the pols showing that Americans are terrified that their health care costs will grow, my premium went down. This will not be true for everyone—it was women who were routinely charged more for insurance for no other reason than their gender. That includes, incidentally, the handful of states in which it was perfectly legal for insurance companies to deem victims of domestic violence as having a “pre-existing condition.” But it’s reason to believe that the worry—verging on hysteria—over the law might be a bit much.
Health care costs are absurdly high in this country, and they must be reined in. And it’s not because we have the best health care in the world; we don’t. If you need a heart transplant, yes, this is where you want to be. But for most of the health care most of us will need in our lives, we are simply not getting the bang for our buck.
Health care premiums may indeed go up for many people, but they were going up before Obamacare was passed. That was the point of trying to do health care reform. That was the point during the Nixon administration, when both parties worried about the social and financial impact of the uninsured. It was the point in 1992, when Bill Clinton was running for president, and at nearly every campaign stop, someone told a sad story of a child with leukemia, and an insurance company refusing to pay for the treatments, or of someone who got laid off and couldn’t get a job because he had a “pre-existing condition” the new employer would find too expensive to cover through its insurance. The problem has merely gotten worse every single time Congress and the White House built the momentum to do something and came close but ultimately failed.
Is Obamacare the cure? The reality is, three years after the law was passed, is that we simply don’t know. House Democratic Leader Nancy Pelosi was criticized for saying we don’t know what the law will do until it’s in place, but she was right. That’s true of a lot of sweeping legislation (No Child Left Behind being the best recent example). The idea is to give it a shot, and then tweak it where necessary.
One thing is clear—doing nothing, yet again, was not an option.
By: Susan Milligan, U. S. News and World Report, March 22, 2013
“Victory For The Middle Class”: On Obamacare’s Third Birthday, There Are Already Reasons To Be Grateful
On March 23, 2010, Obamacare — formally known as the Patient Protection and Affordable Care Act — was signed into law by President Obama.
Three years later, the bulk of the first serious attempt at near-universal health care has not yet taken effect. Health marketplaces are still being formed, states are still deciding if they’ll take Medicaid expansion and the subsidies that will help tens of millions of Americans afford health care won’t roll out until January 1, 2014.
Implementing Obamacare won’t be easy, as even some of the biggest fans of the program admit. Expanding Medicare to cover all Americans would have to be an even simpler solution but a complete political impossibility — given that Joe Lieberman (I-CT), whose vote was necessary to pass the law, single-handedly vetoed a provision that would allow 55- to 64-year-olds to buy into Medicare. It’s a compromise solution that uses unpopular provisions — like the individual mandate — to achieve extremely popular results — ending lifetime limits and banning insurance companies from dropping patients once they become sick.
There will be plenty of time to debate the efficacy of Obamacare — especially with insurance companies enjoying record profits threatening to raise rates in order to justify changes to the law.
But right now we should celebrate the greatest victory for the middle class since Medicare and Medicaid. At its heart, Obamacare is a program that asks the rich and corporations to pay a little more to help working Americans get insurance they can count on, thus lowering the cost of health care for everyone. We already pay for each other’s health coverage, but just in the dumbest possible way — emergency rooms.
Here are five reasons to be grateful for Obamacare, which is already making life better for the middle class.
Obamacare Frees Workers And Entrepreneurs
One of the most popular aspects of Obamacare is that beginning in 2014, insurance companies will no longer be able to deny people coverage because of pre-existing conditions. Because insurance companies had been able to do this, many people avoided going to the doctor for fear of being diagnosed with a disease or condition that would brand them for the rest of their lives. Some stayed in jobs they didn’t want and others didn’t take the leap to start a new business for fear of not being able to get coverage. These changes especially free women — who by federal law can no longer be charged more for care because of their gender — to pursue new opportunities.
Insurance Companies Pay You Back
Insurance companies are required for the first time to prove that they’re spending between 80 and 85 percent of premiums, depending on the size of the company, on actual health care. If companies don’t spend that amount on coverage, they have to return that money to their customers — $1.2 billion was returned in 2012 to self-employed Americans whose insurers didn’t hit the proper ratio.
Millions Of Young People Already Covered
An estimated six million college students are already taking advantage of Obamacare’s provision that lets them stay on their parents’ insurance until the age of 26. This has led to a record drop in uninsured young people, allowing them to go back to school or pursue graduate degrees without taking on as much student loan debt.
Seniors Spend Less On Drugs
One of the most immediate benefits of Obamacare was the closing of the Medicare D prescription drug “donut hole,” which requires seniors to pay for the coverage gap between their deductible and yearly limit, at which point the plan covers all medication — $6.1 billion in drug coverage has already been distributed to seniors, which leads to the irony that Republicans ran and won in 2010 on saying that Obamacare cuts Medicare when, in fact, benefits for seniors have only increased. All the savings come from reforming the way providers are paid.
The Red States Get To Pay The Blue States Back
When the Supreme Court ruled that the mandate in Obamacare was Constitutional, it also gave states the chance to opt out of the Medicaid expansion that will provide free public health care for those not already on Medicaid, but who earn up to 133 percent of the poverty level. The states that are turning down the expansion, unfortunately, are some of those that need it the most. All of the states that have rejected the federal extra funding — which begins at 100 percent of the cost of the expansion and goes down to 90 percent — are states that generally vote Republican.
You probably know that most red states take in more federal money than they contribute, as Republican policies encourage growth of programs like food stamps. Though Republican governors can reject the benefits of Medicaid expansion, their richest citizens and corporations will still have to pay the taxes. As a result, they won’t be such “takers.”
Unfortunately, the working poor of red states — who earn too much to be on basic Medicaid — will suffer without the health insurance they need. Those on Medicare and Medicaid will likely see fewer doctors who want to accept clients from these programs, as Medicaid expansion was supposed to make up for the cut in reimbursement rates that begins in 2014. And all residents will not enjoy the slowdown in the growth of health care costs that will come from shrinking the number of the uninsured.
For red state governors, it’s a chance to fulfill the prophecies of doom Republicans made when Obamacare passed. But for residents of blue states, it’s a chance to make America’s health care system more equitable, with red states finally paying closer to their fair share.
By: Jason Sattler, The National Memo, March 22, 2013; Photo: The Advisory Board Company
“The Ultimate Seller’s Market”: How Big Medicine Plays Us All For Suckers
Sometimes the best journalism explains what’s right under our noses. In Steven Brill’s exhaustive Time magazine cover article “Bitter Pill: Why Medical Bills Are Killing Us,” it’s the staggeringly expensive, grotesquely inefficient and inhumane way Americans pay for medical care.
“In the U.S.,” Brill reminds us, “people spend almost 20 percent of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.”
Obamacare or no Obamacare, ever-increasing prices show few signs of abating. For all the fear and uncertainty the president’s health insurance reform will eliminate from people’s lives, it’s almost incidental to the overall question of costs.
Moreover, had the law attempted to seriously restrain profiteering hospital chains, pharmaceutical companies and medical equipment manufacturers that Brill depicts as largely responsible for the current morass, there’s no way it could have passed.
Yes, it’s a fiscal issue. If Medicaid and Medicare paid the same amounts for health care as, say, Switzerland or France—the economist Dean Baker has repeatedly pointed out—the Federal budget deficit would virtually disappear. (Although the two federal programs are infinitely more frugal and efficient than the rest of the system.)
But it’s an economic and moral issue as well. Brill was inspired to research the article after noticing the gleaming spires of the Texas Medical Center in Houston, of which M.D. Anderson is the brand name. It’s a great hospital, dispensing world-class care (at world-class prices). But how exactly, Brill wondered, had hospitals become five of Houston’s 10 largest employers? It’s a pattern repeated nationwide, as hospital chains have come to dominate local economies.
Essentially, he found, by gaming what the article describes as “the ultimate seller’s market”—an economic realm where buyers (i.e. hospital patients) are normally ignorant, often frightened and sometimes literally helpless. And who often think they’ve got adequate insurance, until they examine the fine print.
Granted, nobody bargains over a cancer diagnosis or heart attack. Even so, Brill wondered “why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car?”
Good questions, all. Brill answers them by taking readers on a guided tour of the Alice-in-Wonderland world of medical billing as experienced by ordinary patients for whom getting the bill became an ordeal equal to and sometimes surpassing the illness itself.
Such as “Steve H.,” who never asked the cost of outpatient treatment for his ailing back because his union-sponsored health insurance plan had $45,000 remaining on its annual $60,000 spending limit. “He figured, how much could a day at Mercy [hospital] cost?…Five thousand? Maybe 10?”
The bill came to $89,000—including $45,000 for an electronic stimulator Brill learns that Mercy Hospital bought from the manufacturer for $19,000, which spent roughly 25% of that amount making and shipping it. (An arbitrator persuaded the hospital to settle for $10,000 of the $44,000 it said Steve H. owed.)
Moreover, as medical markups go, Steve H. got off relatively easy. The “chargemaster” computerized system hospitals use to prepare bills routinely assesses patients 10 times and more what commonly used items like gauze pads and surgical gowns actually cost. If baseball teams treated their captive audiences like that, they’d be selling $40 beers.
At times, Brill’s mordant deconstruction of hospital bills can be grimly funny—even if Alice D., left facing a $900,000 bill for her dead husband’s futile cancer treatment, can be pardoned for not laughing. In the end “her losses from the fixed poker game that she was forced to play in the worst of times with the worst of cards,” persuaded Alice she could never afford to remarry.
Even chemotherapy patients who survive can be staggered to learn that a miracle drug cost Genentech roughly “$300 to make, test, package and ship to M.D. Anderson for $3,000 to $3,500, whereupon the hospital sold it to [patient Steve] Recchi for $13,702.33.”
Ultimately, many of these humongous bills are never collected; the industry average is around 35 percent, although prestigious hospitals like M.D. Anderson collect 50 percent of what they charge. Most are “non-profits” only in the sense of having no stockholders; instead, administrators are paid princely multi-million-dollar salaries. They occupy themselves with building empires.
In the end, Brill concludes that Americans pay an enormous price for refusing to admit that “because the health care market deals in a life-or-death product, it cannot be left to its own devices.”
He and Time have done a great public service.
By: Gene Lyons, The National Memo, March 13, 2013
“Warmed Over Pablum”: Marco Rubio’s Lies About Healthcare Reform
Marco Rubio’s rebuttal to the State of the Union address was remarkable for being unremarkable—it contained much of the same warmed-over pablum we heard from the stage in Tampa Bay at the Republican National Convention six months ago. President Obama “believes [the government] the cause of our problems” and that “More government isn’t going to help you get ahead. It’s going to hold you back.” There was even a Solyndra reference.
But the most interesting and substantive part of Rubio’s speech was the attack he leveled against healthcare reform. The Affordable Care Act will be implemented over the next—wait, sorry. I’m incredibly thirsty. I need some water before I finish this post.
Okay, back. In any case, as the ACA is implemented over the next few years, Republicans must continue to launch rhetorical bombs at it, because a negative public perception of the law would create cover for Republican governors to deny Medicaid expansion in their state, and might also blunt “Obamacare” as a powerful Democratic talking point in 2014 and 2016.
So here’s what Rubio said about the ACA:
[M]any government programs that claim to help the middle class, often end up hurting them instead.
For example, Obamacare was supposed to help middle-class Americans afford health insurance. But now, some people are losing the health insurance they were happy with. And because Obamacare created expensive requirements for companies with more than fifty employees, now many of these businesses aren’t hiring. Not only that; they’re being forced to lay people off and switch from full-time employees to part-time workers.
Rubio is explicitly trying to scare people into thinking they’re about to either lose their health insurance or get fired because of Obamacare. But none of this is true.
Let’s start with the first claim: that “some people are losing the health insurance they were happy with.” Rubio is eliding the fact that in the final telling, ACA is projected to insure 30 million Americans who otherwise don’t have health insurance. It’s not immediately clear who Rubio thinks is losing their policies, because after all, insurance companies can no longer just drop people from coverage because of pre-existing conditions.
Rubio goes on to say that “because Obamacare created expensive requirements for companies with more than 50 employees, now many of these businesses aren’t hiring” and others are switching from full-time to part-time workers because of the ACA. But that’s just not the case.
A study this summer from the Midwest Business Group on Health found that “there is little indication that employers plan to drop healthcare coverage.” The “expensive requirements” Rubio alludes to will be about 2.3 percent, according to one international consulting firm, and other studies show that healthcare reform might ultimately help small businesses because of the subsidies they receive and the fact they are offering a more attractive compensation package for employees. That’s what happened in Massachussets under Romneycare.
Sure, some right-wing business titans who run places like Applebee’s and Denny’s may say they’re going to cut back hours because of the dread of Obamacare, but they are the exceptions to the rule. Moreover, their actions are just one small part of a disturbing trend of large companies shifting healthcare costs onto low-wage workers—as would be any employer who cuts his full-time employees to part-time so he is not responsible for increased coverage requirements under the ACA.
And this gets to the real problem with Rubio’s speech. His case here is that Obamacare is hurting middle-class Americans—but then he specifically describes companies who would cut workers’ hours so they aren’t entitled to health insurance. It’s these vicissitudes of the free market that the ACA was trying to address, like when insurance companies drop people from coverage because they once took heartburn pills. Rubio’s larger case—his whole case in this speech—is that the government is hurtful, not harmful. But he was simply unable to prove it.
By: George Zornick, The Nation, February 13, 2013
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