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ON HEALTH REFORM, UNCERTAINTY BREEDS PERIL.
Many supporters of health reform believe that systemic questions, such as whether or not reform will include a public insurance option, should inform the congressional and public debates. But the truth is that Americans, unsurprisingly, seem to be most concerned about coverage specifics. After reform, what procedures will and won't be covered? Will my array of choices expand or contract?
Those fears have been artfully exploited by the increasingly enthusiastic and radical conservative anti-health reform movement. In response, today the White House launched "Health Insurance Reform Reality Check", a website modeled after "Fight the Smears," a campaign season effort to dispel rumors about Barack Obama's background and positions.
The new site is built around a simplified, eight-point explanation of how consumers will benefit from health reform. Using this messaging, the administration plans a public relations push during the congressional recess, with a focus on drumming up grassroots support via the Obama's team's email list and outreach to the liberal blogosphere. But given the intensity of anti-reform protests over the last week, there is little doubt that the president seems to be on the defensive. The continued lack of one, concrete, completed health reform bill means that opponents of reform can grandstand on a number of hypothetical issues. For example, both the House tri-committee bill and the Senate HELP committee bill create an independent council of medical experts to advise HHS on what services will be covered in the new health exchanges. Conservatives have suggested that the council -- which, of course, does not yet exist -- will prevent terminally ill patients from receiving life support or continuing care, or will mandate abortion coverage.
Both of those outcomes are completely improbable. Neither are on the White House's agenda. But by kicking some tough choices on coverage down the line, to after reform passes, Democrats have opened the door to this kind of scare-mongering. Uncertainty is uncomfortable, and opponents of reform -- along with skeptical moderates -- are exploiting that simple truth.
Nowhere is this more apparent than in the abortion debate. None of the health reform proposals in Congress threaten the Hyde Amendment, which currently prevents the federal government from funding abortions. But anti-choice legislators are not satisfied. Many women will receive government subsidies to buy health insurance after reform, and Republicans -- including some senators in the all-powerful "Gang of Six" -- would like those women to be banned from accessing abortion with those funds, whether they are covered through private insurance plans or a potential public option. This would be a significant curtailing of reproductive rights, since most private insurance plans currently do offer some abortion coverage.
In this case, the current reform proposals actually do maintain the oft-heralded "status quo:" Medicaid won't cover abortion, but private insurance plans will. It is reform opponents who are pushing to change the way health care is delivered, by curtailing women's ability to access abortion coverage in the private insurance market. This morning, a senior administration official, speaking on background, told me that some moderate Republicans are choosing to understand health insurance subsidies as tax credits, and thus, from a libertarian point of view, might support a woman's right to access any health procedure she wishes with that "tax credit," including abortion. And yet, this official affirmed that abortion is among the issues holding up the Senate Finance Committee -- right alongside long term cost containment and debates over whether the federal or state governments will pay to expand Medicaid.
In other words, almost everything about health reform remains up in the air. Stay tuned.
--Dana Goldstein
COMMENTS (3)
Throw The Healthcare Obstructionist Out!
More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 76% of all Americans want a strong government-run public option on day one (85% of democrats, 71% of independents, and 60% republicans). Basically everyone.
We have the 37th worst quality of healthcare in the developed world. And the most costly. Costing over twice as much as every other county. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don't die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.
I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get without a robust government-run public option available on day one. Co-OP's ARE NOT A SUBSTITUTE FOR A GOVERNMENT-RUN PUBLIC OPTION. They are a fraud being pushed by the GREED DRIVEN PRIVATE FOR PROFIT health insurance industry that is KILLING YOU!
YOU CANT HAVE AN INSURANCE MANDATE WITHOUT A ROBUST PUBLIC OPTION. MANDATING PRIVATE FOR PROFIT HEALTH INSURANCE AS YOUR ONLY CHOICE WOULD BE A DISASTER AND UNETHICAL, CORRUPT, AND MORALLY REPUGNANT. AND PROBABLY UNCONSTITUTIONAL AS WELL.
These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!
Republicans and their traitorous allies have been trying to make it look like it's President Obama's fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.
But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.
But you don't have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.
Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will make you feel better too.
There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.
I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!
You have been AMAZING!!! people. Don't loose heart. You knew it wasn't going to be easy saving the World. :-)
God Bless You
jacksmith — Working Class
I REST MY CASE (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)
Republican Senators up for re-election in 2010.
* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah
Posted by: jacksmith | August 10, 2009 4:21 PM
Let's Respect others and discussion, not violence.
'What's in it' ? or 'violence and disruption', which one is the reason of slow-down ?
A healthy America is a strong America, “No patient left behind.”
The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.
In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have the function to keep it in check in terms of inflation, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' .
Under the circumstances the energy bill to determine human future and the other major issues is presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.
On the other hand, to make things worse, critics say the savings from the proposed public option is not enough to meet the revenue goal. Furthermore, on another hand, some say 'hands off' . Where do these No tax, No saving and the like intend to force this reform to go ? The conclusion by 'just-say-no' is no doubt. Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of question.
Of all choices, the best thing would be savings through efficiency. Considering the wasteful structure, the highest premium in the world, and the most expensive part of medicare, with the prevention / wellness program in place, an American style innovation, an 'outcome'-based payment founded upon IT system may be enough to save more than 50 billions per year (500 / decade), both 'improving quality' and removing the unnecessary procedures (as pay is dependent on patient's outcome). Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the disinformation.
Unlike private market, this public option includes large-scale investments, these large investments still does not get the fair score, instead seem to become a source of acute conflict, even so, this common sense-based program needs to develop further as early detection goes beyond monetary value.
In short, with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs change and should join together to complete this reform , as promised, if not, the runaway premium only has itself to blame. Job-based coverage (indirect payment), mandate code, and ample capital might be favorable to the private market. And It can be said that fair competition starts with fair market value.
Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.
Thank You !
Posted by: hsr0601 | August 11, 2009 3:03 AM
Part 1.
Problems :
1. No systematic, expansive Prevention & Wellness Program.
According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end
reporting health tips about prevention. Rather, all of the excellent health systems seem to have one feature in common, a expansive, systematic preventative program
requiring immense investments.
I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
This might offer us one clue of why all of the free states have public insurance policy in place.
Surprisingly enough, the system today is designed around treating patients once they become sick. As far as I'm concerned, the congress affected by the special interests
has turned down the budget request for prevention program in Medicare & Medicaid, which are the most expensive parts of the health program. Let's imagine the astronomical
costs and invaluable lives following the levee breach.
2. A pay for each service / volume compensation, & No E-Medical Record.
As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the
recipients, and this 700 billion dollars a year can cover a lot of uninsured people, in return, it could lessen the tragic, prohibitive ER cares.
Medical errors ( No e-Medical Record ) & lawsuits, more profits motive, and indirect payments from employers etc would account for it.
Supposedly, 'a pay for each service / volume' compensation seems to leave the medical institutes unequipped with the essential IT system. To understand its importance, If
we imagine the cost difference between the previous and current system in financial institutes, the magnitude of cost-savings and the mess in health care system can
be easily explained.
3. Premium Inflation.
This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.
Insurance premiums have nothing to do with the law of demand & supply and the free / fair market concept.
Basically, as demand diminishes, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, cherry-picking, rationing, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, as all of
us know. Thereby they could be cited as an objective for anti-trust or anti-corruption. If the public plan sets the same rate of the insurers, it will be another headache.
Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they are free from the sponsors.
And the spoiled menu, 'Takeover and Rationing Cliche' is still marching for bankruptcy, as opposed to its motto.
4. 'Work or Break' health system with no brake or safety system.
Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system.
The rising mental stress or illness & 'keep eating habit' , which are the epicenter of a number of different diseases,might be traced
to this insecure system and exorbitant premiums.
Part 2.
The Public Plan:
1. Thankfully, the health care reform bill currently before Congress makes several key investments including more primary care doctors in preventive care, and those pieces
of the public plan must be maintained .
2. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM, and it will help doctors focus on their patients.
3. The 'innovative' idea of a 'pay for value / outcome' pack will allow for Quality and affordability
. If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
procedures.
Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the
disinformation.
4. The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably decrease the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. The creative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.
6. This New 'Payment Reform' could accelerate the progress in medical science, in return, it will save more cash.
And this idea will be able to bring 'competition' to the private market, as a result, it can contribute to mitigating premium inflation.
7. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of revenue-neutral.
(Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos).
8. Through clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and recommendations from clinic that is optimized for each person.
The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the information patients provide.
9. In case the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the insecure system and
exorbitant premiums may bend the curve surprisingly.
10. Clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' lie ahead, these will lead to economic recovery.
Part 3.
Conclusion ;
1. The last thing to expect is rallying for premium inflation, JUST SAYING NO.
2. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.
3. With the Prevention & Wellness Program as a stable levee in place, the promising pay for value/ outcome reimbursement reform based on IT system could clear the way for revenue-neutral. Some say the installation of IT network will take time, but once this new outcome-based payment system is implemented, the hospitals reluctant to adopt it will most likely rush to introduce it.
4. The final hurdle looks like a scoring issue surrounding the savings on Prevention & Wellness Program, but I'd like to say
health clubs and media reports on prevention tips must be maintained.
5. People would be entitled to various services whether you are employed, unemployed or self-employed, homeless or housed, young or old, chronically ill or mentally ill, moving from job to job or from town to town or from state to state.
Thank You !
Posted by: hsr0601 | August 11, 2009 3:05 AM