The New York Times
March 7, 2010
Editorial

If Reform Fails

As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation.

Are they really satisfied with the status quo? And is the status quo really sustainable?

Here are some basic facts Americans need to know as Congress decides whether to approve comprehensive reform or continue with what we have:

HOW REFORM WOULD WORK: Let’s be clear, the changes Mr. Obama and Democratic leaders in Congress are proposing are significant. But, despite what the critics charge, this is not a government takeover. And the program is not only fully paid for, it should actually reduce the deficit over the next two decades.

Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.

The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.

46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.

The Congressional Budget Office projects 54 million uninsured people in 2019; the actuary for the federal government’s Centers for Medicare and Medicaid Services projects 57 million.

It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.

The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.

BUT I HAVE INSURANCE: While most Americans have insurance, many pay exorbitant rates because they have no bargaining power with insurers.

That includes many of the tens of millions who buy their own insurance — the unemployed, the self-employed, and those whose employers do not offer insurance. The recently announced plan by Anthem Blue Cross in California to raise annual premiums by 35 to 39 percent for nearly a quarter of its individual subscribers is a chilling harbinger of what is to come if reform fails.

There are another 48 million people who work in relatively small firms that often cannot get the better rates of large-group coverage. All of these groups should be able to get a better deal if they can buy their insurance through new, competitive exchanges.

If current trends continue, the number of underinsured Americans — those who have coverage too skimpy to pay substantial medical bills or protect them from high out-of-pocket spending — will also rise from an estimated 25 million in 2007 to 35 million in 2011, according to the Commonwealth Fund, a respected research organization.

That will increase the risk that this group will forgo needed care and will expose many more of them to potential bankruptcy if they cannot pay huge medical bills. Some 72 million adults currently have medical debt or problems paying their bills even though most of them have insurance. Reform would help them by setting minimum standards of coverage and providing subsidies to tens of millions of low- and middle-income people to help pay their premiums.

BUT I LIKE MY INSURANCE: Most Americans get their insurance through large companies, with large group bargaining power. While they complain about premiums and paperwork, most seem satisfied with their coverage.

For them the real fear is what happens if they lose their jobs or decide to change jobs. Will they be shut out of coverage because of a pre-existing condition or forced to pay high rates to buy their own insurance?

For this group, the real advantage of reform is security. If they get laid off, decide to be self-employed or switch to a smaller employer that offers no insurance, they will still be guaranteed coverage — even if they are a cancer survivor or have heart trouble or any other pre-existing condition. And they will be able to buy insurance on the exchanges.

I’M JUST WORRIED ABOUT COSTS: You should be. The cost of medical care is rising far faster than wages or inflation. And despite all of the talk about reform “bending the curve,” no one is yet sure how to do that.

Many reforms that people instinctively believe should cut costs — computerization of medical records, paying doctors for quality not quantity of services, and prevention programs to promote healthy living and head off costly illnesses — cannot yet be shown to lower costs.

Pending reform legislation, specifically the Senate bill, would launch an array of pilot projects to test reforms in delivering and paying for care. It would also create a special board to accelerate the adoption of anything that seemed to work. That seems a reasonable way to go and a lot better than standing by as costs continue to spiral out of control. The Republicans’ proposals — including their call to cap malpractice awards — would make only a small dent in the problem.

WHAT ABOUT THE DEFICIT?: Republican critics of health care reform have done an especially good job of frightening Americans with their talk of bankrupting the Treasury. The truth of the matter is that the pending reform legislation has been designed to generate enough revenue and savings to more than offset the substantial cost of expanding Medicaid and providing subsidies to the middle class.

The Congressional Budget Office estimated that the Senate bill would reduce deficits over the first 10 years by $132 billion and even more in the second decade.

What critics certainly do not talk about is what happens to the deficit if Medicare costs continue their relentless rise. That is something that should keep Americans up at night.

The pending reforms would cut the growth in Medicare spending per beneficiary in half — from 4 percent a year to 2 percent — by demanding productivity savings from Medicare providers and cutting unjustified subsidies to the private plans in Medicare.

There is some skepticism that Congress will stick to its guns if health care providers say they cannot survive on the reduced rations. But Congress has stood by most previous Medicare cuts (physicians excepted) and should have its spine stiffened by new pay-go rules requiring that any Medicare increases be offset by other savings or taxes.

If reform is defeated, it seems likely that most of the proposed experiments designed to cut costs — first within Medicare and then throughout the rest of the health care system — will die as well. The legislation needs to be passed to establish a structure to force continuing improvement over the years. That is the best chance of restraining soaring medical costs that threaten the solvency of families, businesses and the federal government.

Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

This editorial is a part of a comprehensive examination of the debate over health care reform. You can read all of these editorials at: nytimes.com/edhealthcare2009.


 
 
 
This is why we need newspapers.

It takes a news operation the size of the New York Times to give a reporter like Robert Pear the time he needs to do this kind of reporting:

In House, Many Spoke With One Voice: Lobbyists’
The New York Times
November 15, 2009

As many of you know, the Congressional Record publishes transcripts of every floor debate and vote that takes place in both the Senate and House of Representatives. Every morning at 11, you can go online to http://www.gpoaccess.gov/crecord/  to read a transcript of the previous day’s proceedings. It’s free, searchable and downloadable.  

In addition to taped testimony, speakers are permitted to submit written testimony to clarify or add to their argument. Some do this, or rather, let their staffs do it for them. 

I can only guess, but I imagine Pear was looking for evidence that the unprecedented amount of money spent by health care industries to ward off a negative impact to their business, paid off, at least in terms of The Affordable Health Care for America Act [H.R. 3962].

Not that lobbyist don’t feed members with talking points related to every single bill that comes up for a vote, but this one was special. It spells out policies that will affect one-sixth of the nation’s economy, almost 100 percent of the population, and will direct our access to health care for many years to come.

Remarkably, forty-two House members –- 22 Republicans and 20 Democrats ---gave almost the exact same testimony, in support of their opinion, for OR against. Their thoughts –  and the words that expressed them – were provided at great expense by Genentech, a subsidiary of the Swiss drug giant Roche. 

You may recall Joe Wilson, the little-known Congressman from South Carolina who made his debut as a man who unable to keep his thoughts to himself, the night President Obama spelled out his health care reform message, before a special session of Congress. It seems that Joe sometimes allows others to do his thinking for him:

From the Times:

In separate statements using language suggested by the lobbyists, Representatives Blaine Luetkemeyer of Missouri and Joe Wilson of South Carolina, both Republicans, said: “One of the reasons I have long supported the U.S. biotechnology industry is that it is a homegrown success story that has been an engine of job creation in this country. Unfortunately, many of the largest companies that would seek to enter the biosimilar market have made their money by outsourcing their research to foreign countries like India.”

 
You’re not going to find a story like this on CNN or even CBS. It’s about words, and has no visual appeal. Furthermore, only a word person would spend the time hunting for similarities in text, and checking them against the text sent out by the lobbyists. And, only a newspaper would publish it, because print journalists understand the value and the power of the written word. 
 
 
from  today's The Greenfield (MA) Recorder:

A role in better health
Reforms go beyond cost and care


We’ve heard how health-care reform will or will not work, what it will or will not cost and how it will or will not impact us as individuals. We’ve also heard from people who sincerely believe we should simply leave it alone.

But, few talk about whether reform will improve health, particularly public health.

Considering how much we spend on health insurance, gyms, organic food and vitamins, we should be a very healthy nation. Apparently, there’s room for improvement:

1. We have the highest rate of preventable deaths among (19) industrialized nations.

2. We came in 37th on the World Health Report 2000 for overall health.

3. More than half of U.S. adults are overweight.

4. Almost 2 million a year die in the U.S. from chronic, treatable diseases.

According to Assistant Secretary for Health Howard K. Koh, all five health-care reform bills before Congress contain components that “absolutely” will improve those numbers. Koh was Massachusetts health commissioner from 1997-2003. Today he is America’s top doc, overseeing the U.S. Public Health Service, the CDC, Surgeon General’s office and many related agencies.

Reform will bring quality, affordable care to most Americans, with the operative term “affordable,” since everyone will pay toward their care.

Right now, millions of Americans cannot get coverage at any cost and 14,000 more lose their insurance every day, Koh said in a recent interview. “When Americans go without health insurance, they suffer,” he added.

According to Koh, one in six Americans with employer- sponsored insurance coverage in 2006 lost it by 2008, leaving many children and adults without preventive care, immunizations, basic dental services and prescription medicine. “When sick, (the uninsured) are more likely to experience poorer health outcomes” than the insured.

Insured or not, low-income Americans — including racial and ethnic minorities as well as people living in rural areas — are less likely to receive preventive care than others.

“We are the only advanced democracy that allows this hardship on millions of its people,” according to Koh.

Once insured under reform, there will be little financial reason for anyone to go without basic health care. We will be leveling the field, reducing health disparities, in terms of access to care.

As shocking as it may seem, with reform, millions will have the opportunity to see primary-care physicians — and even dentists — for the first time. Children and adults who previously saw doctors only in emergency rooms will be screened for and, if necessary, treated for chronic diseases. And, they will be called back for check-ups.

“We’re developing a wellness care system that protects health, promotes healthy behaviors and strengthens community prevention,” Koh said.

“A national report recently found that 100,000 lives could be saved each year by investing in five basic preventive services that are available through a doctor’s office,” Koh said. “We can’t eliminate all disease, but … we can reduce chronic disease by ensuring Americans have the care they need to prevent and treat these diseases so that if they do get sick and need care, they have the best possible chance of getting better.”

To accomplish this, the 2009 Recovery Act already has pumped millions into the health-care infrastructure to build work force. Reform measures will expand on that base. Big investments in medical training should boost resources in underserved areas — such as rural New England — which otherwise might not attract enough health-care workers to make reform work.

Of course, reform really begins with each one of us. Whether health-care reform succeeds or fails, individuals will share some responsibility with physicians, hospitals and drug companies.

It won’t be painless, or easy. There are no quick fixes. And, no one will chase us around to “make us” healthy.

If we haven’t already done so, we should start to build our own healthy lives based on knowledge, responsibility and respect. It’s time to make healthy choices, as in “yes” to salads, “no” to cigarettes and binge drinking, etc. We must vaccinate our kids, encourage loved ones to exercise, make sure our young people get enough sleep and our elders are seen by doctors when they need to. We should wash our hands, flu season or not. If sick, stay out of the workplace.

In other words, we need to get our collective act together to start taking proactive responsibility for our health, because the Band-Aid approach to health care is coming to a very expensive end.

But, whatever it takes should be worth the effort, making a big difference in the lives of our children and grandchildren, by making a big difference in public health.

When it comes to closing the gap on health disparities, Koh said, “we should remember that this isn’t a partisan issue. It’s a moral issue.”

_____________________
Greenfield resident Paula Hartman Cohen writes about health care and other issues for The Recorder publications, Harvard Public Health Review, Dartmouth Medicine Magazine, and KevinMD.com, among other media. She blogs at www.birdsonawireblog.com.

 
 
 
Have you wondered why health insurance costs have skyrocketed in recent years?

And, are you inclined to think we need more competition in order to lower costs? If so, you’re probably hoping Congress will see fit to tighten anti-trust regulations in whatever health care reform measures come out of both houses, while the insurance companies are begging for exemptions.

Fact is, the most egregious anti-trust infractions have already occurred, according to the blog Cab Drollery, published by a California attorney.

Blogger Diane lays it all out, citing a Los Angeles Times story that explains how, during the Bush years, more than 400 health insurance mergers occurred under the noses of Justice Dept. watchdogs, who sniffed at only two: 

Health economist James Robinson found in 2003 that three large firms controlled more than 50% of enrollment in almost every state -- and that was before the biggest insurers launched a huge effort to snarf up their chief competitors, a trend exemplified by the 2004 mega-merger of WellPoint Health Networks Inc. and Anthem Inc. By 2008, according to the American Medical Assn., in nearly 90% of the metropolitan areas of the country, a single insurer controlled 30% or more of the market.

Is it merely a coincidence that health premiums have soared over the last decade -- up by 131% for family coverage from 1999 to 2009, according to the Kaiser Family Foundation?

"Competition in the health insurance industry is insufficient," Leemore S. Dafny, a health economist at Northwestern's Kellogg School of Management, told me last week. "It's becoming less competitive over time and it's causing higher premiums than we otherwise would see." [Emphasis added]

See http://cabdrollery.blogspot.com/2009/11/red-herrings-are-not-kipper-snacks.html for the entire enlightening blogpost. 
 
 
We knew all along that reform would not come easy. There are so many issues to consider.

What exactly is fair, and to whom? Can you close coverage gaps without discriminating? 

Here’s something to ponder from Kaiser Health News, a terrific resource for health policy news:  

Fight Erupts Over Health Insurance Rates For Businesses With More Women
From Kaiser Health News

The Pennsylvania home health care company Linda Bettinazzi runs is charged about $6,800 per worker for health insurance – $2,000 more than the national average for single coverage. One reason: nearly every one of her 175 employees is a woman.

Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. But Bettinazzi, the president and CEO of Visiting Nurse Association of Indiana County, believes there's something inherently wrong in charging her company more because it hires a lot of women.

"There's a great sense of unfairness," Bettinazzi says. "I feel angry, and maybe betrayed would be a good word."

Gender rating is the norm today, part of a complex formula of risk factors – including health history and age -- insurers say has been necessary to fairly price policies. But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal.

To read more, go here: http://www.kaiserhealthnews.org/Stories/2009/October/23/gender-discrimination-health-insurance.aspx
 
 
From Kathy in Massachusetts
I appreciate the info you supply about health care reform on your blog.

From Larry in Iowa
What we clearly do not need is a massive piece of costly legislation that masks the symptoms or creates even more, but does nothing to cure the disease.  What we clearly cannot afford is to put off making these decisions another two or five or ten years or more.

From Joan in New Jersey
Good health is NOT a privilege, it is a human RIGHT.  

From Darlene in Arizona
The only weapons we have to fight the obscene funds trying to defeat meaningful reform are our voices. I urge everyone to repeatedly contact their representatives until a bill is passed.

From Karen in California
Affordable access to medical care for ALL persons to guarantee "life" is implied, in my opinion, by our founding fathers. It's past time for the partisan wrangling to be done so that some serious negotiating can begin for crafting legislation that can pass Congress. 

From Kathleen in Texas
I'd settle for creation of ...non-profit insurance coops giving small businesses the benefits of mass-purchasing--so that EVERY WORKER, from the guy who cuts the grass to the local accountant, can afford insurance and not get cut for pre-existing conditions. Big companies get these concessions from insurance companies because of mass purchasing, why not make it possible for the heart of the American work force?

From Kathleen in Texas
Having a response from the Senate Majority Leader's office is encouraging. No one should have to go without medical care because they can't afford it. 

From Cynthia in California
Recently we had a free clinic here, sponsored by Remote Area Medical, and an LA Times columnist described the scene as something from the Third World. I wish people who oppose reform would …become aware of how desperate so many people are.

From Alexandra in Massachusetts
I'm proud to live in a state that decided no one should go without medical care! 

From Jacqui in the UK
The health identity begins inside with an inherent feeling of self, and extends outwards in times of crisis. In the UK this extension is largely met by a NHS for everyone. I wish my friends in the US the same. .

From Sarah in Massachusetts
As the parent of a child with Down Syndrome and as a survivor of life-threatening illness, I can tell you that one of the most frustrating things about our current system is its inequity. An acquaintance and I, who were being treated for the same disease at the same time (and living in the same state), had very different medication options because her HMO was trying to save money instead of her life. She eventually wound up getting the same medication my docs had prescribed in the first place (which they described as the "standard of care" and which worked beautifully for me), but only after she'd gone to the emergency room to treat side-effects from the substandard protocol. I find this intolerable, and I attribute that kind of craziness to being in a profit-motivated health-care system.

From Deputy Director of New Media, Office of Senate Majority Leader Harry Reid
I also wanted to thank your loyal readers for keeping up with this critical topic of health care reform. We need everyone's support!
 
 
Here's an op-ed written for The Washington Post and carried in many newspapers today.


Over 50, out of luck in health care 
10/23/2009 

WASHINGTON - I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath - and it isn't pretty.

Recently, I left my job with the federal government - I was a political appointee, so my tenure was limited - and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51 year old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication, and I have mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "preexisting conditions" - conditions that millions of Americans my age experience - was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

Read the entire op-ed at http://www.gazettenet.com/2009/10/23/over-50-out-luck-health-care
 
 
from today's New York Times:

October 23, 2009
Senate Leader Takes Risk Pushing Public Insurance Plan
By Robert Pear and David M. Herszenhorn

WASHINGTON— In pushing to include a government-run  health insurance plan in the health care bill, the Senate majority leader, Harry Reid, is taking a calculated gamble that the 60 members of his caucus could support the plan if it included a way for states to opt out.

Mr. Reid met with President Obama at the White House Thursday to inform him of his inclination to add the public option to the bill, but did not specifically ask the president to endorse that approach, a Democratic aide said. Mr. Obama asked questions, but did not express a preference at the meeting, a White House official said.

Mr. Reid’s outlook was shaped, in part, by opinion polls showing public support for a government insurance plan, which would compete with private insurers. Speaker Nancy Pelosi said again Thursday that the House would definitely include a public option in its version of the legislation.

Just six weeks ago the public option appeared to be dying, under fierce attack by the insurance industry. A clear majority of Democratic senators favor a government-run plan. But public statements by other senators indicate that the proposal lacks the 60 votes ordinarily needed to secure Senate approval for hotly contested legislation.

Democratic champions of the public plan, like Senator Charles E. Schumer of New York, have urged Mr. Reid to take an aggressive posture, by putting the public plan in the bill and forcing opponents to try to strip it out.

“There is a growing sense that we need to lead on this issue and not wait for it to be offered on the Senate floor,” a senior Democratic aide said. “The idea is that it’s better to show some fight.”

As word of Mr. Reid’s intention spread Thursday, centrist senators from both parties said they had come together in an informal group to resist creation of a uniform nationwide public insurance program.

Leaders of the group, including Senators Ben Nelson, Democrat of Nebraska, and Olympia J. Snowe, Republican of Maine, said they wanted to be sure the bill was not rushed to the floor.

One of the centrists, Senator Mary L. Landrieu, Democrat of Louisiana, said: “I am pressing to get a government-run, taxpayer-supported public option out of the bill. I want to rely on a reformed private marketplace.”

Go to The New York Times for the rest of the story:
http://www.nytimes.com/2009/10/23/health/policy/23health.html?hp

 
 
For those of you confused over where we are in the health care reform progression, there’s an excellent graphic in the New York Times showing the status of health care legislation before Congress. Click here to see it.

Basicially, there are five bills on the table: two in the Senate and three in the House. Each body must merge multiple bills into one, and vote on that single bill.  Then, two houses work to negotiate one bill between themselves. After that, the combined bill must pass both houses. The resulting bill will be sent to the White House and, presumably, signed as law.

In the Friday conference call with Sen. Harry Reid’s office, aides told five or six bloggers (including me) they were hopeful the Senate would pass a bill by Thanksgiving. The president has said he wants legislation on his desk by the end of the year. Whether that’s possible or not remains to be seen.

 
 
 
Four or five bloggers (including this one) had a second opportunity to talk to several aides from Sen. Majority Leader Harry Reid's office this morning. This call and the last gave us a chance to ask questions, pass along some comments from our readers and find out what the next steps are in the legislative process.

Several interesting bits of information came out of this call, including these: 

1.    Your opinions count!

All calls, emails and letters to Senators are tallied and included in daily/weekly reports that members read to learn how many contacts they have received regarding pending legislation, pro or con. These contacts actually affect voting,  according to the aides.

If you want to comment on a Senate bill, they recommend you contact Reid’s office and/or your own senator.

2.    If you’re in favor of a public option (or not), be sure to voice your opinion NOW. Majority Leader Reid is in an interesting position, at the moment. The Senate bill could go either way, when it comes to the public option. It's really up to Reid.  

Here is something very interesting that Sen. Charles Schumer (D-NY) said on The Rachel Maddow Show earlier this week, that's in keeping with what aides told us this morning: