mykeystrokes.com

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

“Obscuring The Bigger Picture”: The Republican Tempest Over The Affordable Care Act Diverts Attention From Three Large Truths

Having failed to defeat the Affordable Care Act in Congress, to beat it back in the last election, to repeal it despite more than eighty votes in the House, to stop it in the federal courts, to get enough votes in the Supreme Court to overrule it, and to gut it with outright extortion (closing the government and threatening to default on the nation’s debts unless it was repealed), Republicans are now down to their last ploy.

They are hell-bent on destroying the Affordable Care Act in Americans’ minds.

A document circulating among House Republicans (reported by the New York Times) instructs them to repeat the following themes and stories continuously: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.”

Every Republican in Washington has been programmed to use the word “disaster” whenever mentioning the Act, always refer to it as Obamacare, and demand its repeal.

Republican wordsmiths know they can count on Fox News and right-wing yell radio to amplify and intensify all of this in continuous loops of elaboration and outrage, repeated so often as to infect peoples’ minds like purulent pustules.

The idea is to make the Act so detestable it becomes the fearsome centerpiece of the midterm elections of 2014 — putting enough Democrats on the defensive they join in seeking its repeal or at least in amending it in ways that gut it (such as allowing insurers to sell whatever policies they want as long as they want, or delaying it further).

Admittedly, the President provided Republicans ammunition by botching the Act’s roll-out. Why wasn’t HealthCare.gov up and running smoothly October 1? Partly because the Administration didn’t anticipate that almost every Republican governor would refuse to set up a state exchange, thereby loading even more responsibility on an already over-worked and underfunded Department of Health and Human Services.

Why didn’t Obama’s advisors anticipate that some policies would be cancelled (after all, the Act sets higher standards than many policies offered) and therefore his “you can keep their old insurance” promise would become a target? Likely because they knew all policies were “grandfathered” for a year, didn’t anticipate how many insurers would cancel right away, and understood that only 5 percent of policyholders received insurance independent of an employer anyway.

But there’s really no good excuse. The White House should have anticipated the Republican attack machine.

The real problem is now. The President and other Democrats aren’t meeting the Republican barrage with three larger truths that show the pettiness of the attack:

The wreck of private insurance. Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people – young adults, people at low risk of expensive diseases, groups of professionals – while rejecting people with preexisting conditions, otherwise debilitated, or at high risk of heart disease, diabetes, and cancer. And have routinely dropped coverage of policy holders who become seriously sick or disabled. What else would you expect from corporations seeking to maximize profits?

But the social consequences have been devastating. We have ended up with the most expensive healthcare system in the world (finding and marketing to healthy people is expensive, corporate executives are expensive, profits adequate to satisfy shareholders are expensive), combined with the worst health outcomes of all rich countries — highest rates of infant mortality, shortest life spans, largest portions of populations never seeing a doctor and receiving no preventive care, most expensive uses of emergency rooms.

We could not and cannot continue with this travesty of a healthcare system.

The Affordable Care Act is a modest solution.  It still relies on private insurers — merely setting minimum standards and “exchanges” where customers can compare policies, requiring insurers to take people with preexisting conditions and not abandon those who get seriously sick, and helping low-income people afford coverage.

A single-payer system would have been preferable. Most other rich countries do it this way. It could have been grafted on to Social Security and Medicare, paid for through payroll taxes, expanded to lower-income families through Medicaid. It would have been simple and efficient. (It’s no coincidence that the Act’s Medicaid expansion has been easy and rapid in states that chose to accept it.)

But Republicans were dead set against this. They wouldn’t even abide a “public option” to buy into something resembling Medicare. In the end, they wouldn’t even go along with the Affordable Care Act, which was based on Republican ideas in the first place. (From Richard Nixon’s healthcare plan through the musings of the Heritage Foundation, Republicans for years urged that everything be kept in the hands of private insurers but the government set minimum standards, create state-based insurance exchanges, and require everyone to sign up).

The moral imperative.  Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.

The other day I heard a young man say he’d rather pay a penalty than buy health insurance under the Act because, in his words, “why should I pay for the sick and the old?” The answer is he has a responsibility to do so, as a member the same society they inhabit.

The Act also depends on richer people paying higher taxes to finance health insurance for lower-income people. Starting this year, a healthcare surtax of 3.8 percent is applied to capital gains and dividend income of individuals earning more than $200,000 and a nine-tenths of 1 percent healthcare tax to wages over $200,000 or couples over $250,000. Together, the two taxes will raise an estimated $317.7 billion over 10 years, according to the Joint Committee on Taxation.

Here again, the justification is plain: We are becoming a vastly unequal society in which most of the economic gains are going to the top. It’s only just that those with higher incomes bear some responsibility for maintaining the health of Americans who are less fortunate.

This is a profoundly moral argument about who we are and what we owe each other as Americans. But Democrats have failed to make it, perhaps because they’re reluctant to admit that the Act involves any redistribution at all.

Redistribution has become so unfashionable it’s easier to say everyone comes out ahead. And everyone does come out ahead in the long term:  Even the best-off will gain from a healthier and more productive workforce, and will save money from preventive care that reduces the number of destitute people using emergency rooms when they become seriously ill.

But there would be no reason to reform and extend health insurance to begin with if we did not have moral obligations to one another as members of the same society.

The initial problems with the website and the President’s ill-advised remark about everyone being able to keep their old policies are real. But they’re trifling compared to the wreckage of the current system, the modest but important step toward reform embodied in the Act, and the moral imperative at the core of the Act and of our society.

The Republicans have created a tempest out of trivialities. It is incumbent on Democrats — from the President on down — to show Americans the larger picture, and do so again and again.

 

By: Robert Reich, The Robert Reich Blog, November 22, 2013

November 25, 2013 Posted by | Affordable Care Act, Health Reform | , , , , , , , | 1 Comment

“Hey, Obamacare Complainers”: You Hypocrites, Regular Insurance Has Tons of Glitches Everyday

The nation’s new health-insurance exchanges, the online marketplaces for medical coverage that are an integral part of Obamacare, opened for business last week. Immediately the trouble began. Web pages went blank. Attempts to enroll in coverage were delayed, or altogether stymied, as sites crashed. Critics of the law pounced. “Too many unanswered questions and too many unsolved problems,” said U.S. Sen. Orrin Hatch, Republican of Utah.

Yet there’s another way to see these growing pains: as evidence not of change but of continuity for consumers of health insurance in America. With each misstep, government officials are simply catching up to the  record of headache-inducing frustrations produced by the longstanding private medical insurance system.

Whether you’re one of the 50 percent or so of Americans who already have private health insurance (mostly through an employer, as I do) or one of those who may now turn to the exchanges to buy coverage, the bureaucracy is often maddening. Sure, the Affordable Care Act may seem opaque and unwieldy, but make no mistake: Employer-provided healthcare—which offers plans by the very same companies now on the exchanges—is equally Byzantine. No wonder that only 22 percent of American consumers reported themselves as satisfied with the health care system in a 2012 survey from the Deloitte Center for Health Solutions.

A few weeks ago I had an all-too-typical experience. My insurance company, Anthem Blue Cross, sent me a letter saying, “It has come to our attention that we have been paying for certain . . . drugs that are not covered under your existing benefit plan.” Going forward, the letter added, my doctor would need to prescribe something different or I’d have to start paying for these particular medications myself.

And when would this kick in? According to one part of the letter, January 1, 2014. According to a different part of the letter, right away.

It concluded with the sentence I’ve come to dread most: “If you have any questions or concerns, please call the customer service number on your ID card.”

Bravely, I did. Forty-five minutes later, I had yet to talk to an actual human being. Finally, at the 50-minute mark, a customer-service representative showed up on the line. She was cheerful and peppy. I was not.

The Anthem representative was unable to clarify anything in the letter and asked if she could put me on hold while she did a little research. I said OK, but I made a special plea: to call me back if we somehow got disconnected. Just a week before, on another Anthem call—concerning a paid claim that Anthem said was unpaid—I’d gotten cut off after an hour or so on the phone. She assured me that she’d call me back, if need be.

Ten minutes later, the representative returned to tell me that the answer to when Anthem would stop covering my prescriptions was neither January 1 nor immediately. It was December 1.

Where did this new date suddenly come from? She couldn’t explain. I asked to speak to her supervisor directly. She countered with a classic chess move: I was put on hold for another 15 minutes. Then: “Thank you for calling Anthem Blue Cross. Good-bye.” The line went dead. Checkmate.

Despite my plea and the representative’s promise, no one from the company called me back. I have yet to find the stomach to phone Anthem again.

Sure, the implementation of the Affordable Care Act is hitting some bumps, especially in its early days. But before critics falsely brand these as the inevitable consequence of a “government takeover” of our healthcare system, let’s remember that when it comes to medical coverage, bureaucratic snafus are hardly the province of Obamacare alone.

 

By: Randye Hoder, Contributor, Time Magazine, October 9, 2013

October 12, 2013 Posted by | Affordable Care Act | , , , , , , , , | Leave a comment

“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

September 25, 2012 Posted by | Health Reform | , , , , , , , , | Leave a comment

“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

September 4, 2012 Posted by | Election 2012, Health Reform | , , , , , , , | Leave a comment

“The Rising”: Return Of The Big GOP Medicare Lie

The participant’s in last night’s GOP presidential debate once again took the opportunity to pretend that the Affordable Care Act (“Obamacare”) put a massive dent in Medicare by cutting $500 billion from the program.

Michele Bachmann told us that “We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare.” Mitt Romney intoned “He cut Medicare by $500 billion. This is a Democratic president the liberal, so to speak, cut Medicare.”

Yeah…except that nobody stole anything and Medicare was not cut by $500 billion.

Here are the facts:

For starters, nobody cut anything from the Medicare budget in the health care reform bill. The actions taken in the legislation are designed to slow the growth of Medicare spending without cutting benefits. Further, not one cent that would have gone to Medicare is somehow being shifted over to a program created by Obamacare (for first time readers, I readily use the term Obamacare because I believe that this name will ultimately stand as an honor to the President who made it happen.)

With respect to the infamous $500 billion, the non-partisan Congressional Budget Office has made it clear that the bulk of the projected savings will come from two primary sources—ending the subsidies to health insurance companies who offer Medicare Advantage programs and reining in the growth of payments to physicians. The remainder will, hopefully, come from cutting back on the waste and fraud that have long been rampant in the Medicare system.

Let’s begin with the Medicare Advantage program. Established via the Medicare Modernization  Act of 2003. the program—a Bush/GOP creation—was ostensibly invented to encourage Medicare beneficiaries to gravitate towards privately operated insurance programs pursuant to the theory that the private sector could do a better job of  delivering care to our seniors than the government.

I say ‘ostensibly’ because the true purpose was to create a windfall for the private insurance companies who have done so much for so long for so many Republican elected officials.

The way the script played out, the private  insurance companies said that they would only be able to paricipate in the program if, and only if, the government gave them a head start by agreeing to subsidize their “start up costs” until the year 2010.

As  a result of the deal, Medicare found itself paying, on average, an 11%  surcharge on medical services and procedures provided by Medicare Advantage plans. This was enough to guarantee the insurance providers  a tidy profit fully comprised of the government subsidies, creating one of the greatest examples of corporate welfare in the history of the nation.

Not surprisingly, the health insurers took advantage of the windfall to attract customers by offering very low premium charges, not  to mention free gym memberships, one pair of eyeglasses per year, spa treatments, zero co-pays and  assorted other benefits not available to those who opted to take their Medicare  directly from the government. And why not? The insurers don’t need to make a penny from those who were insured as each customer guarantees them an 11 percent return on any medical benefit receieved courtesy of the Medicare program. Thus, they are more than happy to offer a free toaster to anyone who agrees to sign up.

What Obamacare did was put an end to the subsidies, thereby reducing future costs to the program by billions while continuing to provide Medicare beneficiaries with the benefits promised.

By any standards, this was a no-brainer in terms of reigning in the growing costs of Medicare and creating a system that is fair to all beneficiaries.

Now, the doctors.

This gets a bit tricky and, to be honest, I don’t really believe that these savings will ever materialize.

At the heart of the discussion is a formula that was designed during the Clinton Administration called the Medicare Sustainable Growth Rate, or SGR. The approach was created in an attempt to control Medicare spending for physician services with the idea being that the yearly increase in the expense per Medicare beneficiary should be tied to the growth in GDP. Thus, when actual Medicare spending exceeds the annual target in a given year, the SGR requires that physicians, and other system providers, must take a cut in order to bring the spending back in line with the annual spending targets.

The docs, understandably, do not like the idea of taking less in their Medicare payments. As a result, Congress has been delaying the cuts for years, constantly rolling them over into the next year at which time they roll them over again and again. Were Congress to ever stop delaying the SGR cuts, the physicians would find themselves feeling the cumulative pain of the delays with a one time Medicare rate reduction in excess of 20 percent.

These cuts are factored into the Medicare savings projections, along with hoped for savings to come by encouraging physicians to try some different approaches to practicing medicine.

Will this ever happen? Probably not.

So, while a skeptic can argue that these projected savings may never materialize, one cannot argue that this is, somehow, a cut to the Medicare program.

The bottom line is that there is nothing in the ACA that takes anything away from Medicare beneficiaries, now or in the future. Yet, the GOP continues to do its best to scare the hell out of seniors, the most reliable voter block in the nation.

We need to take this very seriously.

If the 2010 elections taught us anything, it is that a frightened voter  population will do some crazy things. So, it’s on us to make sure that our grandparents and parents understand that Repubican fear peddlers are selling nothing but lies and that falling for the lies could result in the end of Medicare as we know it if the Republicans are permitted to gain full control of the government.

If you would like more information on this to share with family and friends, just let me know. The effort to mislead our senior citizens worked well in 2010. We simply cannot permit it to work again in 2012.

 

By: Rick Ungar, Mother Jones, September 13, 2011

September 13, 2011 Posted by | Affordable Care Act, Class Warfare, Congress, Conservatives, Consumers, Democrats, Elections, GOP, Health Care Costs, Health Reform, Ideologues, Ideology, Medicare, Middle Class, Politics, Public, Republicans, Right Wing, Tea Party, Uninsured, Voters | , , , , , , , , | Leave a comment

%d bloggers like this: