Category Archives: Health Care

Public Option Still Breathing

Posted on by

Mike Soraghan reports on The Hill:

First he was for it. Then he was against it. Now Rep. Mike Ross is back on board with a government-run healthcare plan. Sort of.

Ross (D-Ark.), who had emerged as a leader among centrist Blue Dog Democrats opposing the public health insurance option, has suggested something his colleagues consider even more drastic – opening Medicare to those under 65 without insurance. …

…His statement went on to say that he does “not support a government-run public option” and he does “not endorse this idea” of opening up Medicare.

As Steve Benen says, huh?

Making Medicare available to everybody would have been the most sensible approach, of course. There must be a catch.

On the other hand, here’s this from The Politico:

The forces in favor of a public health insurance option roared back Thursday on Capitol Hill after weeks when their cause looked bleak.

House Speaker Nancy Pelosi (D-Calif.) looked closer than ever to including a robust U.S. government-run insurance program in the House bill — saying recent attempts by the health insurance industry to undercut reform prove insurers can’t be trusted.

And in the Senate, a weekly policy lunch turned into a heated debate when liberals went after the Senate Finance Committee bill and made clear they won’t roll over for legislation that doesn’t include a public option.

See also Brian Beutler, who says Harry Reid is working an “inside game” in support of the public option.

The Washington Insider gasbags keep telling us that the public option is dead and that the health care bill will pass without it. Yet it refuses to die. Paul Krugman explains how the insurance industry is helping keep progressive reform alive.

More Apologizing to the Dead

Posted on by

Start your weekend right by listening to Alan Grayson and Ed Shultz discussing how to fight back. When hit by Republican smears that Grayson is “unstable”, Grayson replied:

GRAYSON: My response is WHATEVER. America is sick of you, Republican Party. You are a LIE FACTORY – that’s all you ever do. Why don’t you work together with the Democrats to solve America’s problems instead of making stuff up?

Personally, I can’t get enough of this guy’s attitude. Go Alan!

One Death Every Twelve Minutes

Posted on by

John Geyman, Professor Emeritus of Family Medicine at the University of Washington School of Medicine:

Americans are dying at a faster rate — 1 every 12 minutes, 5 an hour, 120 a day, 45,000 a year — not from war or natural disaster, but from lack of health insurance.

That’s the stunning finding of a study published today in the American Journal of Public Health by leading researchers at Harvard Medical School. The report, “Health Insurance and Mortality in U.S. Adults,” reveals that the uninsured have a 40 percent higher risk of death than those with private insurance, resulting in 45,000 preventable deaths annually. …

… The Institute of Medicine estimated in 2002 that more than 18,000 Americans between the ages of 19 and 64 were dying each year as a result of being uninsured. The new number is two and a half times that figure.

The people ginning up terror over “death panels” will deny Americans are dying for lack of health care, of course.

Strangling Ourselves With Selfishness

Posted on by

The headline on Shailagh Murray’s WaPo piece is “Young Adults Likely to Pay Big Share of Reform’s Cost,” and of course righties who have seen the headline are quivering with outrage on the burden that’s about to be put on the young folks.

This is what Murray writes,

A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

This is the part that has the libertarians so upset:

Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums — effectively subsidizing coverage for their parents.

One of the relatively milder reactions, from one of the unfree thinkers at Reason:

Despite rhetoric to the contrary, government policies tend to take from the relatively poor and give to the relatively wealthy (see the Medicare prescription drug plan for an example). And so it is with health insurance reform, where it’ll be the kids who pay for the rest of us.

The more I wade around in rightie ideas about health care and insurance, the more I think they just plain don’t understand risk pooling.

I share the concern that young people will be required to buy insurance that is too expensive for their entry-level budgets. That’s one of the reasons a public option is so important. On the other hand, at least some of those young, healthy folks will have catastrophic accidents or unexpected illnesses, and their medical care will be paid for by the premiums of other healthy people. And the rest of the young, healthy folks will eventually grow into older and less healthy folks.

But here’s another piece of the puzzle the righties don’t get — the uninsured drive up health care costs. In fact, the uninsured may be one of the biggest drivers of rising health care costs.

Last week the Los Angeles Times published a letter from Dr. Robert W. Robertson Jr., former director of emergency services at Western Baptist Hospital in Paducah, Kentucky. Dr. Robertson wrote,

In 2005, there were 44.8 million who had no medical insurance. In 2006, that number had grown to 47 million. Presently, it is estimated that there are 50 million who have no coverage, and that number will rise to over 52 million at the end of 2010. …

  1. The uninsured numbers are constantly increasing.
  2. The unreimbursed expenses incurred by hospitals in treating those ever-increasing numbers of the uninsured are constantly increasing.
  3. Hospitals must increase their charges in order to cover the ever-increasing costs of treating the uninsured.
  4. Medical insurance companies must increase the premiums of those they insure in order to pay for the increased hospital charges when their insureds seek treatment.
  5. Each time insurance premiums increase, another portion of the population opts out of carrying insurance. Individuals or companies reach a point, finally, when they can no longer afford insurance, and individual policyholders or employees of companies which drop their benefits enter into the pool of the uninsured.
  6. More uninsured people = increased, unreimbursed hospital costs = increased hospital charges = increased insurance premiums = more uninsured people…. The upward spiral is incessant.

The pressure created by the ever-increasing number of the uninsured is the driving force behind the ever-increasing cost of medical care in the United States. That force is unrelenting. It can only accelerate. It has created a system which is unsustainable.

If you want to fully appreciate how unsustainable it is, take a look at these numbers from the Kaiser Family Foundation. The average cost of a family health insurance policy in 2009 is $13,375. If insurance costs continue to rise at the same rate they’ve risen in recent years, by 2019 the average cost of a family health insurance policy will be $30,803.

It follows that to put an end to the spiral, we must choose one of these three options:

  1. Get everyone insured.
  2. Allow hospitals to turn away people who don’t have insurance. Of course, that could be any one of us if we lose our wallets in an accident and show up at an emergency room with no identification. Instead of death panels, we’ll have a death lottery.
  3. Scrap insurance altogether and go with single payer.

My guess is that libertarians will go with Option 2, figuring they can have their insurance information tattooed on their butts. Or, we can have microchips inserted under our skins so the hospital can scan us and determined we’re covered by Blue Cross, or whomever. Because, you know, everybody could buy insurance if they really wanted it. That’s how Reason sees it, anyway:

To me, Reason‘s video presents a great argument for mandates. I have no way to know what percentage of young people are willfully choosing not to get insurance and what percentage cannot afford insurance, but let’s remember how some of them are coping with not having insurance —

They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.

Enough, I say. We’re strangling ourselves with our own selfishness.

Spiting Ourselves to Death

Posted on by

Wingnuts don’t seem to realize they’re already paying for the health care of illegal aliens. Every time an uninsured or underinsured person gets treatment in an emergency room and can’t pay the bill, the cost is added to everyone else’s bill, and to insurance premiums. As far as I know, ERs are not turning people away who can’t prove citizenship.

But, shhhh, keep this entre nous. If this gets called to wingnut attention they’ll demand that ERs get proof of citizenship before they treat anyone. None of us will dare leave home without our passports, never mind our insurance cards. Sorry about your Grandma. We couldn’t treat her because we weren’t sure she was a citizen.

After Wednesday night’s heckling the Super Weasel team of Senators Kent Conrad (D-ND) and Max Baucus (D-MT) hustled to do Rep. Joe Wilson’s bidding and close an imaginary loophole in the health care proposal. No one is proposing that any subsidies go to illegal aliens (see “Read the Bill“). But now Baucus and Conrad want to prevent illegal aliens from buying health insurance on the individual market with their own money.

Matt Yglesias:

This will have a direct cost to taxpayers since some verification mechanism will need to be put into place. It will also have an indirect cost to you and me and everyone we know—the vast majority of people, after all, aren’t undocumented immigrants but we’re all going to need to go through a citizenship check hassle before we buy health insurance. It will probably also make average premiums higher, since the exchanges will be left with a smaller risk pool and there’s no real reason to believe that the subset of undocumented immigrants who are capable of affording an unsubsidized insurance policy are below-average health risks. Last, of course, this will make the undocumented immigrant population sicker with negative public health consequences for their coworkers, friends, family, and the customers of the businesses they walk at.

There’s an old saying, “cutting off the nose to spite the face.” It refers to doing something for revenge or spitefulness that is really self-destructive. This describes the Right’s attitudes toward health care reform. Apparently it’s more important to punish illegal aliens than to provide health care for ourselves. Better to let 18,000 Americans die every year for lack of health care than to allow illegal aliens use the proposed exchanges to buy insurance with their own money. And you know if there are subsidies some illegal aliens will be able to scam the system; better to drive tens of thousands of Americans into medical bankruptcy than to let some illegal aliens have a few crumbs of benefits.

And let’s not even think about making sure agricultural and food service workers get flu shots. Epidemics are a small price to pay to be sure people aren’t getting benefits they don’t deserve. It’s a moral thing, see.

There is data showing that the enormous majority of uninsured and underinsured patients are citizens. But if some uninsured citizens really need health care, they can always move to Mexico.

The President’s Speech

Posted on by

Live blog tonight. comment away.

Taegan Goddard has a partial transcript.

Notice the red, white and blue — Biden in blue, Pelosi in red, Obama in blue suit and red tie. Planned?

Well, you can sure tell where the Democrats are sitting in the audience.

“No one should be treated that way in the United States of America.” Amen.

Details:

1. No change for people who have insurance now. Repeat.
2. Insurance cannot be denied for preexisting condition.
3. Insurance companies cannot drop or reduce coverage people are paying for.
4. No annual or lifetime caps.
5. Limit on patients’ out of pocket expenses.
6. Checkups and preventive care will be covered.

Quality, affordable choice:

1. Insurance exchange. I’m not excited about the exchange. Tell me about the public option. Repubs are applauding the exchange.

2. Tax credits for low income insurance purchasers.

3. OK, I’m lost with the McCain thing. I’ll have to check that.

Oh, those risk-taking young folks who don’t buy insurance. Mandatory health insurance. I think that’s the only way any of this can work.

Key controversies. Death panels. Lie, plain and simple. Republicans not applauding. Look at those meatheads.

Who is yelling about the illegal immigrants?

Paying for abortion — under the bus. Sad.

PUBLIC OPTION. He finally mentions it.

Stress competition. Good point.

Not for profit public option. Must have. Less than 5 percent of Americans would sign up? Hmmm. Taxpayers not subsidizing. Option self-sufficient? Compare to public and private colleges. Good comparison.

Yeah, we’re open to other ideas, but the public option is a minimum.

“If Americans can’t find affordable coverage, we will provide you with a choice.”

“No government bureaucrat or insurance company bureaucrat will get between you and the coverage you need.”

Not one dime to deficit. OK.

Waste, fraud, abuse. Talk to seniors. Demagoguery and distortion. History of Medicare.

“Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.” I’m skeptical, but maybe it’s possible

“I don’t believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” It isn’t, but even doctors believe it is. He’s throwing a bone to the Right.

Add it all up, and the plan I’m proposing will cost around $900 billion over ten years – less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration.

Let’s put that on a T-shirt.

Most of these costs will be paid for with money already being spent – but spent badly – in the existing health care system.

Exactly.

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it.

The NY Times has the full transcript. Ted Kennedy comin’ up.

Obama is pulling the guilt strings. All you Republicans knew Ted Kennedy. Heh.

And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter – that at that point we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.

He’s getting emotional.

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road – to defer reform one more year, or one more election, or one more term.

But that’s not what the moment calls for. That’s not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it’s hard.

Standing applause.

OK, that was the speech. I still don’t know what the yelling was about with the immigrants.

Rachel Maddow thinks we liberals will be happy with the latter part of the speech.

Republican Response:

First impression: Charles Boustany is less of a dork than Bobby Jindal.

Summary: Lies, lies, lies, lies, lies.

No insurance across state lines. It’s a scam.

Olbermann: Dr. Boustany has been sued for malpractice three times.

The yeller was Congressman Joe Wilson of South Carolina, who yelled “You lie!” when the President said there would be no coverage for illegal aliens.

Boutique Insurance

Posted on by

I want to comment a little more on Newt’s op ed in the Los Angeles Times today, because he says some things that I have seen popping up in a lot of right-wing commentary.

One key proposal is to mandate an “essential benefit package” for every private insurance policy sold in the United States. Currently, individuals and employers usually make these coverage decisions. This legislation creates a new federal Health Benefits Advisory Committee that would decide instead. For example, if you are a single male with no children, the legislation still requires you to have maternity benefits and well-baby and well-child care coverage. You don’t want or don’t need that coverage? Sorry, you have to pay for it anyway.

Putting aside the fact that single men father children all the time, and in a perfect world those single men would be just as responsible for maternity and well-baby bills as married ones —

Insurance works by risk pooling — everybody throws money into a pot so that there’s money for people who are hit with unexpected expenses. In order for this to work, in any given year most of the people in the pool throw more money into the pot than take it out. Generally, the bigger the pool, the better it works. Insurance companies invest the premium money, and they make most of their profits from investments.

Maternity and well-baby care can be horrendously expensive, because horrible things can go wrong that require megabucks to care for. If the only people who are paying for maternity and well-baby care insurance are young couples who plan to have children, probably few of them could afford the insurance. It is made more affordable by throwing maternity and well-baby insurance into the big pot with toenail fungus, prostate cancer, high cholesterol and the flu.

But let’s be more frank about what Newt really is saying. Essentially, he is arguing against consumer protection. In many states, people are paying premiums for junk policies that turn out not to cover whatever medical problems they eventually develop. For example, we learned recently about a Blue Cross/Blue Shield policy that supposedly had maternity benefits. However, the maternity benefits didn’t cover the mother’s labor, delivery, or hospital stay, and a couple got hit with a $22,000 medical bill for the routine vaginal delivery of a healthy baby.

I’m not likely to ever need maternity benefits again, either, nor am I likely to get prostate cancer. But although there are a small number of conditions that are age and gender specific, the enormous majority of ailments in the world can strike anyone. Non-smokers sometimes get lung cancer. Long distance runners sometimes get heart disease. Young women sometimes get breast cancer. Ya never know. And because ya never know, it’s extremely stupid to pick and choose in advance what diseases or conditions your insurance does and does not cover.

What this is really about: The insurance companies want to separate people into low-risk and high-risk pools, because selling junk policies to low-risk clients is where the money is.

But in the doubletalk of the Right, consumer protection is painted as government interference. Shawn Tully of Fortune says the government wants to deprive you of the freedom to choose what’s in your plan. Righties seem to think people ought to have boutique insurance plans that only cover the ailments they are most likely to get, given their ages, genders and lifestyles.

But what happens when you develop a condition that’s not in your coverage? Oops, sorry, you’re not supposed to have heart disease at your age. You’re not covered for that. Is this not also a form of rationing?

I’ve seen this same “boutique” proposal from other conservative writers. There’s a dippy woman at the Manhattan Institute named Regina Herzlinger who wrote in the Washington Post last year,

In order for employers to get big discounts, they have to buy health care in bulk, offering just one or two basically identical plans to their employees. The result is consistent mediocrity. After all, how can Chrysler find a single health plan that works just as well for a 55-year-old diabetic with a bad back as it does for a 30-year-old triathlete who sees a doctor once every few years for a sprained ankle? Splitting the difference in these cases means that people do not get treated in the preventative or chronic-care settings that they really need.

How many ways does this not make any sense? First, it ignores risk pooling. Second, it ignores the fact that the triathlete will not be 30 years old and healthy forever. In fact, the triathlete could die of cancer next year, and the diabetic could live to be 90. Third, she seems to assume that the insurance companies are the ones directing the patient’s care, and not doctors. Well, that last one is too true.

The whole point of “not getting in between doctors and patients” is that whoever is paying for the care shouldn’t be second-guessing the doctors. In rightie world, it’s OK if the health insurance company kills you.

Newt repeats a pack of lies about Dr. Ezekiel J. Emanuel, already debunked by Alex Koppelman at Salon. He also wants to let people buy insurance across state lines, which I’ve written about in earlier posts. This would allow insurance companies to set up shop in low-regulation states and sell junk policies across state lines. According to the president of the National Association of Insurance Commissioners, Sandy Praeger,

Insurers will set up shop in states with few regulations and market low-cost policies to people across the country. These policies will offer minimal coverage and appeal primarily to younger consumers.

“It will be a race to the bottom,” Praeger said, and there will be “very few consumer protections. … You’ll have plans that don’t cover the benefits that people need. … And healthy people are going to buy those less costly plans, because they don’t think they need [the protection].”

That may be a good deal for young people who don’t have health problems, but it would probably become a bad deal for everyone else, Praeger said. The policies that sell comprehensive coverage would draw a sicker, older customer base, becoming more and more expensive.

The end result will be a segmenting of the insurance market into the “haves and have nots,” Praeger said. One segment of the market will become more affordable, but the other segment will become less so, disadvantaging those who need coverage most.

Rationing, anyone?

Mobs on Medicare

Posted on by

[Updated below.]

A rightie blogger with comments disabled posts photographs to show that “the mob” isn’t scary after all, and writes,

I am the mob. My kids are the mob. My grandma is the mob. My family members did not shed blood for this country so that their elected officials could silence them into shame if they dared to speak out and voice their concerns.

I don’t see anyone in the photographs being silenced. Many of them appear to be old enough for Medicare, however. Are they so committed to “no government-run health care” that they refuse Medicare? I doubt it. It’s fine for them to get their health care paid for by the taxpayer dollars of others, but everyone else can go bleep himself?

And does anyone on the Right have a brain in his or her head? Not that I’m seeing.

Update: Some right-wing blogs are picking up these photographs, repeating the claim that it shows people who are representative of others whose rights to free speech have been curtailed. Not one has noticed the photographs show people calmly participating at a meeting and even speaking into microphones, so certainly the people in the photographs are speaking freely. And not one has noticed that many are old enough for Medicare, which is a government-run health care system very similar to Canada’s.

Update: Via Brian Beutler:

“Based on the news that health care events are edging into violence, an anti-health care reform protester in New Mexico named Scott Oskay is calling on his hundreds of online followers to bring firearms to town halls, and to ‘badly hurt’ SEIU and ACORN counter protesters.”

People are calling SEIU and making not-too-veiled threats of gun violence against Union members.

Threats of violence qualify as terrorism, even if they don’t carry it through.

What’s Not to Like?

Posted on by

Matt Yglesias quotes a commenter at Marginal Revolution.

At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands. This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference.

Sources: CDC national vital statistics 2004, www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf and RIVM 2007 levensverwachting, www.rivm.nl/vtv/object_document/o2309n18838.html (in Dutch).

Matt jumps in and points out what was invisible to the commenter — after 65, Americans get health care through Medicare.

Americans over the age of 65 participate in a Canadian-style national health insurance scheme known as Medicare. The data, if we want to take it seriously, indicates that the Dutch system is better than private sector medicine but worse than Medicare and tends to support a “Medicare for all” approach.

In a recent post I cited an article in Roll Call that said states whose citizens have the least access to health care also have the highest Medicare costs, per person. The authors speculate that the bump in Medicare costs reflects lifetimes of health care neglect.

Put another way, if you want Medicare costs to go down, give people better health care in the first 65 years of their lives.

Regarding Medicare costs, Paul Krugman wrote recently,

Here’s the raw fact, from the National Health Expenditure data: since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%. The rise in Medicare costs is just part of the overall rise in health care spending. And in fact Medicare spending has lagged private spending: if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.

How do these numbers not show us that Americans are getting substandard medical care? But as Jonathan Alter says, our current system is great! What’s not to like? (Read Alter before commenting.)