Archive for the ‘Principles of health care reform’ Category

Exchange Politics – It’s Personal

The latest Republican strategy – cutting off your nose to spite your face.

No, this is not about plastic surgery.

The phrase refers to one who attempts to do harm to another, but in so doing harms themselves

Yep, we are talking about health reform.

The Affordable Care Act as Republican policy

President Obama has rebutted criticism that his health care reform was too radical by arguing that it is modeled after successful legislation that became law in Massachusetts under then Republican Governor, Mitt Romney – and that was based on ideas originally proposed by the Heritage Foundation.

From the perspective of the ivory tower of the Heritage Foundation, or from the myopic world of Republican health care policy, there may actually be some arguable distinction.

But from the perspective of real health care reform, say single payer, it is a distinction without a difference.

The only thing that separates Obama’s Affordable Care Act from Mitt Romney’s Massachusetts imitative is the political affiliation of its author.

As soon as Obama and the Democrats signed on, Romney signed off.

The Affordable Care Act as Democratic policy

But Romney wasn’t the only one to turn and run from an idea they once embraced.

Tim Pawlenty, a Republican contender for president briefly, thought Mitt Romney was on to something in 2006, the year of the Massachusetts healthcare reform law.

He expressed openness to the concept of the individual mandate and support for the idea that everyone should be in a health care plan.

Likewise John Huntsman was an eager proponent of health reform measures that would expand coverage.  He openly supported the individual mandate until it was obviously going nowhere in Utah.  He settled for a more modest version of the insurance exchange concept that distinguished Romney’s legislation.  Utah and Massachusetts are the only working models for the other states trying to implement health care exchanges.

The pickle

Three of the current field of Republican candidates endorsed in some way, the concepts central to what is now derisively referred to as Obamacare – individual responsibility, make the markets work better, allow for profit insurance companies.  Don’t they sound like concepts that are more likely to come from the Republican side of the aisle?

But they have the name of the current President associated with them and for that reason, Republicans will not allow them to succeed.  It’s personal, you see.

State Exchanges

Take the state health insurance exchanges.  Another idea that is more likely to be associated with Republicans than Democrats – allow each state flexibility in setting up their own exchanges.  But if they don’t create their own exchanges, the federal government will do it for them.

This seems to put some Republican governors in a rather curious pickle.  If they do create an exchange for their own state, they would be adopting values traditionally associated with Republicans:  individual responsibility, the growth of a new market for insurance companies, local autonomy.  The alternative is generally not attractive to Republicans – let the federal government do it.

But there is a catch.  It is a catch that some Republican governors just cannot bring themselves to overcome.  By consenting to the creation of their own exchange they would be acquiescing to the will of President Obama.

It’s personal, you see.

Kansas Governor, Sam Brownback (R) turned down federal seed money to start its exchange.  He piously asserts that, given pressure on the federal government to reduce expenditures, states should not rely on the feds in setting up their own exchanges.  But the absence of federal funds has halted Kansas’ progress to create its own exchange, which may prompt a federal takeover.

Oklahoma Governor, Mary Fallin (R), turned down federal money to help it build its own exchange.  Sounds noble enough.  They want to do it themselves.  Or do they?  According to the Governor, she was “pleased to announce this agreement that accomplishes my goal from the very beginning: Stopping the implementation of the President’s federal health care exchange in Oklahoma.”

Florida Governor Rick Scott (R), has declined federal funds to set up an exchange in Florida, an exchange the state has yet to authorize.  Remember Rick Scott? – the guy who made his money as the head of a for profit hospital chain that pleaded guilty to defrauding the federal government and paid almost $2 billion dollars in settlements.

Texas Governor, Rick Perry, (R), presiding over the state with one of the highest rates on uninsured residents,  has vowed to oppose any effort to create an exchange in Texas as long as the legal questions around the Affordable Care Act are unresolved.  That does not mean he cannot accept the grant money handed out by the feds to create the non-existent exchange, not to mention $60 million in Early Retiree Reinsurance program grants – also a part of the Affordable Care Act.

Louisiana Governor Bobby Jindal (R), has also refused to set health care insurance exchange in his state because it would advance Obamacare regulations.

It’s personal, you see.

It doesn’t have to be rational.

Photo Credit:     FLICKR  Sara_Mc
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Ryan Plan – A Budget to Plan For

Paul D. Ryan (R-WI)

Boy do I have a plan to fix Medicare.  Well, actually, it’s not my plan.  This guy, Paul Ryan, thought it up.  He’s some kind of chairman in Washington.

Medicare is the program that pays for health care for old people.  Also disabled people, but mostly old people.  It seems it is going broke.

That’s what this guy Paul Ryan says.  His logic is a bit hard to follow but it goes something like this.

Too many old people

There are too many old people.  The government spends too much on their health care.  The government isn’t smart enough to fix it, so it should turn the money over to those old people.

Of course, the old people can’t do it by themselves, so they have to buy insurance from insurance companies.

Since the insurance companies have lots of money and the government doesn’t this makes perfect sense.

But here is where it gets confusing.  The insurance companies have lots of money because they don’t pay for health care and the government doesn’t have money because it does pay for health care.  So won’t this situation just reverse itself in a few years?

Old people aren’t too keen on this idea.  They think the insurance companies will continue to not pay for health care.  I’m not sure I get that. If the insurance companies have all this money, why wouldn’t they spend it on health care.  What else are they going to spend it on?  Themselves?   That’s stupid.

But hey, this is where this guy Ryan shows his smarts.  I mean the guy is no dummy.  You see his plan won’t take effect until 2022.  That means it won’t effect anyone older than 55.   I think he figures they aren’t paying attention.

Time to save

And here is the beauty of his plan.  They will have 10 years to save the extra $182,000 the plan will likely cost them in retirement.  Of course, they need to be paying attention to that part; otherwise they may forget to save that much.

Extra is the key word here.  Everyone knows it is going to cost them between $330,000 and $390,000 to pay for health care in retirement under the current plan.  Presumably, these under-55 year olds have that much stashed away already.  So they will just need to save about an extra $15,000 per year until they reach 65.  How difficult can that be?

But wait!  If it looks like you aren’t going to make it, you could try going out on social security disability before 2020.  Then maybe you can get into Medicare under the old rules.

Some people just don’t get it.  It’s all about Medicare.  It’s not about people.  Some people have this silly idea that government is supposed to be here for people in need.  Remember what John Kennedy said, “Ask not what your government can do for you.  Ask what you can do for your government.”

Well our government needs us to stop asking it to do things for us.  That way it will be able to do things for people who are not in need – the rich.

This is an idea whose time has come.  Its beauty is in its simplicity.  Those who need, pay; and those who don’t, get tax cuts.

The Republicans may be backing away form this Ryan fellow, because they think people are against the idea.  But they’re just kidding.  Elect them and find out.

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Health Care is a Human Right – or Not

In a recent discussion someone posed the question, “Is health care a right or a privilege?”

This should be the wrong question!  In part, because those opposed to health care, tend to be opposed to any expansion of “rights.”  It should be the wrong question, because people should feel embarrassed to assert that health care is a privilege.

Rally in Vermont

The right question is, “Is health care a private good or a public good?”

It is the right question because proponents of expanding health care have already won it, even if those on the other side don’t know it yet.

Health care is a public good

If health care is not a public good, why do we have a Surgeon General and the U.S. Public Health Service?

Why do we have a Center for Disease Control?

Why do we have the National Institute of Health?

Why do we have the Agency for Health Care Research and Quality?

More importantly, why do we have Medicare?

Why do we have Medicaid?

Why do we have the Indian Health Service?

Why do we have the Veteran’s Administration?

Why does Congress pass laws like the Women’s Health and Cancer Rights Act, or the Mental Health Parity Laws?

All of these government agencies point to one inescapable conclusion – the citizens of this country have consistently supported what they thought were expansions of health care.  They have consistently stood on the side of the principle that says – keeping you healthy is in my interest.  Keeping everyone healthy is in my interest.

As one wag put it, we recognize the state’s role in educating the public, but frankly if I were sitting next to you, it is far bigger concern to me whether you are healthy than whether you are smart.

Health care is not a right

The right to health care grows out of the recognition that it is a public good.

The bible does not ask the sick to stand up and demand to be cared for.  No, it says “care for the sick”. “As you did it to one of the least of these my brothers, you did it to me.”

The first hospitals in this country were established not because the sick insisted on being treated, or because they demanded health care as a right.  They were established by communities that felt a responsibility to care for those who needed it.  Health care was perceived as an obligation, not a business model.

The public good in the private sector

The concept of “public good” extends to the private sphere.  Does anyone really think that when employers endorse wellness programs in the workplace, they are doing so to respect some “right” to a healthy life style?   No, instead, they recognize that the individual welfare of its employees serves the welfare of a larger group of people; in a sense a broader “public” good. It serves the corporate bottom line by lowering health claim costs, decreasing injuries, decreasing absenteeism and presenteeism. Yes, in this example, it is not quite “public” as an economist might understand it.  But it is definitely no longer a “private good” whereby an individual’s actions have no impact beyond his or her own life.

For the same reasons, corporations endorse disease management programs that attempt to engage employees much more proactively in the management of their own chronic conditions.  Some employers will go so far as to make participation in such programs mandatory.  Isn’t this also a recognition that health care is not a private good?  Just because it occurs within the sphere of the employment relationship does not make it less a “public” good.

Employers recognize that they need healthy workers, but keeping the workforce healthy means taking care of them when they can’t work.  And that, by definition, cannot occur within the employment relationship.  Health care is a public good.

Health care is not a right!  It is an obligation.  We have a collective obligation to make health care available to others and we also have an obligation to take care of ourselves.

The health care as a right or privilege debate taps into the same common theme – the focus on me.  Who is more important – you or me?  If we are going to break the conservative ideological hold on debate in this country we need to change the way the debate is framed.  The focus should be on we, not me.

Nothing scares conservatives more than the idea that all Americans would share something in common.  A national health care system could unify Americans in ways that truly frighten them.

But let’s face it.  “Health care is a right” does sell.  Just ask the people in Vermont.

Photo credit:   Health Care is a Human Right Campaign

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Arizona Shootings, Mental Health, and Civility

The phrase “Arizona shootings” will forever be associated with Congresswoman Gabrielle Giffords (D-AZ) and with young Jared Loughner, and with even younger Christina Taylor Green.

The gunfight at OK Corral is history.

“Cousin-in-law” and author of the Nelson Report, Chris Nelson, described the incident as the “deadly intersection of three horrible moral and political dilemmas which are a genuine cancer in this country”.  Chris is not the only one to cite the contributing causes:

  1. The issue of access to effective treatment for mental disorders
  2. The lack of willpower to enact meaningful and rational gun control laws.
  3. The rising vitriol of US politics.

I will leave gun control to others and instead, focus on the intersection of the first and last.

Vitriol as culprit

Is the rising vitriol of US politics to blame?  I come down firmly in the camp of those who say yes? Continue reading ‘Arizona Shootings, Mental Health, and Civility’

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2010 – The Year of the Brutes! And 2011?

The National Public Radio news program “All Things Considered” declared 2010 – The Year of Mean.

NPR, not a media outlet to go too far out on a limb, couched their declaration in a bit of tongue in cheek satire.

But even NPR couldn’t shy away from the question underlying the truth of their observation.

Brute

What kind of country are we becoming?

I toyed with a number of labels for this “mean” movement.  Evil-doers was already taken.  Tyrants or oppressors?  No, not yet.  Pigwidgeons had some appeal despite its association with Harry Potter.  A pigwidgeon is described as a stupid and contemptible elf.  But pigwidgeons are not normally nasty, just stupid; so pigwidgeon may work for a certain ex-half-governor but not for the broader movement.

Meanie is too wimpy.  The word caitiff has some appeal.  Webster describes it as a “base and despicable person, a mean and wicked man”.  To add to the word’s appeal, it also describes a certain kind of vampire.  But this blog is not likely to catapult the word “caitiff” into the popular lexicon.  So I continued my search.

Ruffians didn’t seem inclusive enough.  It may describe some of the gun-toting extremists in the movement, but not John Boehner.

So I settled on brutes.  I am open to other words, but for now, it’s brutes.

Brutes

2010 saw the brutes attack a variety of issues and concerns of working Americans, but my focus is health care.

Their cause gained some momentum in the first month of 2010 when the Democrats lost the seat held by the long time champion of universal health care, Ted Kennedy.  Scott Brown (R-MA), with support from the brutes, ambushed the Democrats by upending their  feckless candidate, Martha Coakley.

It is a sad commentary on American politics when a Senate majority of 59% is not considered a safe margin to pass anything.

Are we becoming a country of minority rule instead of majority rule?

The Brutes and health care reform

Health care reform ultimately did pass in 2010.  It was indeed an historic achievement.

It was not a great bill, but it does make an effort to expand access to care, contain costs and improve health care quality.  Given its poor foundation (the current health care and insurance industries), it should be no surprise that the result is less than ideal.

It was an important milestone in American politics.

One of the groups that stands to benefit significantly is young Americans.  Employers are now required to permit young adults to stay on their employer-sponsored plans to age 26.  Together with other significant reforms, the bill supporters claim that it will cut the number of uninsured in America by half.

The Brutes and working Americans

Almost all of these people are on the fringes of the working middle class.  They may work for an employer, sometimes several employers, but none of them offer health insurance.  They may be sick and trying to get back to work.  They may be young and trying to enter the work force.  They may be entrepreneurs who are not only drawing on their bank accounts to start new businesses, but also banking that their health will sustain them until their businesses can.

The brutes don’t like these Americans.  They prefer tax breaks for the rich.

Are we becoming a country that is turning its back on the people whose backs build this country?

The Affordable Care Act has a number of initiatives designed to make the market for health insurance more transparent and therefore more accessible.

The brutes don’t like government regulation.  Therefore they want to repeal the Affordable Care Act.

Are we becoming a nation that places ideology ahead of practical solutions?  Isn’t that what toppled the Soviet Union?

The future of America?

As a result of the 2010 Congressional elections the brutes will now be able to parade their disdain for working Americans and their bias for the rich and powerful on a more prominent stage.  I don’t expect 2011 to be less mean.

I can only hope that the true nature of the brutes will become exposed for all to see.

Maybe then we can cast the meanness and the brutes aside and move America forward.

Photo credit:   Lonnie Dunkin III
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