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The Healthy, the Wealthy, the Poor

Posted: 07/06/2012 1:21 pm

If a free society cannot help the many who are poor, it cannot save the few who are rich. ~ John F. Kennedy, Inaugural Address

Not all of the states' reactions to the recent health care decision by the U.S. Supreme Court are an embarrassment. Only a select few. Some States, like Oregon, welcomed it.

In 2008 Oregon embarked on a program to provide health care to some of its residents who live in poverty. It did not have enough money to cover all its impoverished residents so it set up a lottery system and folks who entered it got a chance to win health insurance coverage. Unlike lotteries at charity events, this lottery didn't cost a thing to enter. The only requirement to participate in the lottery was that the entrant be poor and not have health insurance. The lottery was an instant success.

In 2008, 89,284 people entered the lottery and the lucky winners received that which those who live in other wealthy, industrialized nations get without entering a lottery-health insurance. Once the lottery had taken place its effects on those won was studied to determine the costs and benefits of the coverage. The study disclosed that 25 percent of the winners were less likely to be burdened by unpaid medical bills and 40% percent less likely to find that paying medical bills forced them to skip paying other significant obligations. Those who won were more likely to have a family doctor they visited regularly and enjoyed better overall health than those who did not have insurance.

Notwithstanding the success of the lottery many residents remained uninsured and Oregon is happy to abandon the lottery in favor of having all its residents obtain insurance. Bruce Goldberg, the Oregon Health Authority director, is not worried about the additional cost to the state. He said the Supreme Court decision is "very good news for the 600,000 Oregonians who do not have health care coverage... Under the Affordable Care Act, the health care lottery for low-income Oregonians goes away and everyone wins. That is good for them, good for their families, and good for Oregon. They will have better health care and more financial security..." If governors of some of the other states cared about the health of their citizens they would study the results of the lottery and might even decide to permit their Medicaid rolls to expand. They haven't and they don't.

A spokesman for South Carolina's Gov. Nikki R. Haley, said: "We're not going to shove more South Carolinians [600,000 poor people without insurance] into a broken system that further ties our hands when we know the best way to find South Carolina solutions... is through the flexibility that block grants provide." Since there are no block grants available, if South Carolina fails to take advantage of the ability to expand eligibility, 600,000 poor South Carolinians will remain uninsured.

Governor David Heineman of Nebraska explains his opposition to expanding Medicaid eligibility explaining that if it is expanded it will affect state aid to education even though the federal government will pay all the cost of the increased costs of expanding Medicaid until 2017 and by gradually decreasing amounts until 2020 when states will have to assume 10% of the cost with the federal government paying the remaining 90%. Another Governor who is unambiguous in his response is Florida's governor, Rick Scott.

Governor Scott has said that: "Florida will opt out of spending approximately $1.89 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program." Explaining his decision the governor said: "Floridians are interested in jobs and economic growth, a quality education for their children and keeping the cost of living low. Neither of these provisions (Medicaid expansion and insurance exchanges) will achieve those goals, and since Florida is legally allowed to opt out, that's the right decision for our citizens." Twenty percent of Florida's residents lack health insurance. Mr. Scott is not among them. The state provides health insurance for him. If Florida took advantage of the expansion 1 million residents would get coverage.

Health insurance seems like a luxury only to those who have it, people like Governors Haley, Heineman and Scott. Since they refuse to take advantage of Medicaid expansion the law permits and largely funds, to help their impoverished citizens, perhaps they would consider starting a lottery. Oregon did it cover in an impartial manner as many people as limited funds would permit. The recalcitrant governors could do it to give the impression that they were doing something positive for their poor citizens even though they were doing far less than the law permits. Watching to see who won the lottery and, therefore, obtained health insurance, could be a source of amusement for observers who already have insurance and would give the uninsured but hopeful poor a distraction to take their minds of the other hardships poverty forces them to endure. Kind of like Hunger Games.

Christopher Brauchli can be emailed at brauchli.56@post.harvard.edu. For political commentary see his web page at http://humanraceandothersports.com

 
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10:29 AM on 07/09/2012
The GOP claims to be a "Christian" party. They want to create a "Christian" nation, and re-establish prayers in public schools.

Very well.

Let's remember that Jesus spent most of his ministry healing the sick. Never once did he ask about health insurance. Jesus even healed the blind man at the pool of Siloam, even though the blind man had "pre-existing" conditions, namely the "sins of his father." Never once did Jesus denounce gays although he had no respect for religious authorities, and even less respect for the rich. ("It's harder for a rich man to enter the Kingdom of Heaven than for a camel to pass through a needle's eye.")

That's the Gospel truth. (Read about it yourself.)

So all these Republican have absolutely NO business claiming they are Christians. Rather than following the Gospel of Jesus, they are worshipping the Golden Idol of Greed.
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Nomccain
03:09 PM on 07/08/2012
I can't ever recall the Republicans ever doing anything for middle income or poor Americans. They've always been partial to the big money interests, corporations, and greedy and the corrupt. That hasn't changed, and in fact, it's more evident and transparent today than ever before. Their disdain for the health care reform bill as well as their cowardice in ever addressing rising health care costs shows clearly how much they're owned by the giant health insurance companies and their spin off industries. If you ever want universal health care, which all other industrialized nations now have, then you should know that you will never get it with Republicans in power. It's just that simple so remember health care, social security, medicaid, and womens rights when you enter that voting booth in November. If they win, we'll lose all these programs and surrender again to big money.
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Barry O Bama
10:06 AM on 07/08/2012
If republicans don't want Obamacare, what do they want?
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Allene Stucki
02:05 PM on 07/08/2012
Obamacare is just same-old same-old, with a lot of additional enrollees - a recipe for national bankruptcy. We need a whole new system, a national health service such as Britain operates.

Once you establish health care as an entitlement, regardless of ability to pay, you either need to get for-profit OUT of the system or watch the country go broke as the health care budget doubles.
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Barry O Bama
05:45 PM on 07/08/2012
Obamacare solved the heath care crisis in America and will be the most successful and popular successful social program in history.
07:42 PM on 07/08/2012
Great achievements happen in steps. The ACA is but a step -- albeit a very large step. The president is open to making changes. If the right would concentrate more on changes that wouldl improve the law instead of trying to repeal it, we might have something that we all can be proud of.
cdianek
An antibiotic-resistant micro-bio
02:29 PM on 07/08/2012
For people to die as quickly and quietly as possible. Quickly so as not to cost too much money, quietly so as not to cause too much discord.
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Barry O Bama
05:54 PM on 07/08/2012
the republican leadership desperately want credit for obamacare. Can you imagine how popular a program will be that solves the heath care crisis without burdening the working class to pay for it.
08:17 AM on 07/08/2012
Winners and loser in the Obamacare game. The wealth will be fine as they can afford to pay for what they want and will go to the head of the line. 40 Million uninsured will be put in line with the midlle class. The middle clas will have to pay higher premiuns to pay for the unfund poor and illegals. Medicade and medicare will see a cut in doctor and hosiptal pay for treating them, 305 drop. Emergency rooms will be filled with the old as doctors will not see any new medicare patients. Rationing will be the first price control. There will be waiting list for treatment for many illness. The rich can pay the will not wait. I worked my and pay a lot to make sure my son had the best insurance I could get. I cut out other thing to pay for it. Now I will have to pay 40% for all I gave up to get what I have. I will have to drop the coverage because I cannot cut anymore to keep it. Losers are the working middle class and the old. The winners are the people not willing to work and the rich.
12:11 PM on 07/08/2012
This law actually helps people like you, please study it! First, we already pay for the uninsured and there will be fewer of them once the PPACA is fully implemented. Eventually, that means premiums could be lower. More importantly to you, you will never have to pay 40% for coverage. If your family earns less than $88,000 per year (for a family of four), the government will subsidize your premiums - you can not pay more than 8% of your income. And if you have an insurance plan now that you are happy with, just keep it!
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PrometheanSalvation
Bringing fire to cleanse the land.
09:54 AM on 07/09/2012
You are truly, deeply, misinformed. 'illegals' will not be covered, and premiums will go down, not up. Your son is one of many sons in this country; they should all be able to see a doctor.
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Josh Crawford
Just the facts, man!
04:12 AM on 07/08/2012
A "Hunger Games" like scenario is the ideal option for many of these so called "conservatives". They think they would come out on top, but that's just as silly as the 20% of people who think they are in the top 1% of income earners. Ain't gonna happen!!!
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innerpuppie
The truth is an absolute defense...
05:00 PM on 07/07/2012
I get so ticked off that people who HAVE insurance are making the decisions for those who DON'T have insurance. No skin off their teeth if they withhold the medical care - they already have some of the best in the Nation.
08:50 AM on 07/08/2012
you can have all the insurance you want ....why do I have to pay for mine and yours though
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Barry O Bama
10:11 AM on 07/08/2012
why does the working class shoulder the free ride the rich get under the tax code? obacare evens out the playing field.
09:05 AM on 07/08/2012
BINGO!!
03:27 PM on 07/07/2012
The free market will not lower the cost of healthcare. They will transfer cost from the gov. To the individual. Guess many who do not recieve the free cadilac plans of the elite will die.
The taxpayer is just not paying for non citizens and others they deam unworthy. But if the elite do not pay, they also pick up the tab for those who can afford to pay.
02:31 PM on 07/07/2012
Was the system broken, yes. Did the ACA fix it, no. Why do I say that. Prior to the ACA health care costs were out of control and many had no coverage, half of those were in the country illegally. Medical care was a per procedure reimbursement system, with most doctors especially those in teaching centers doing a large number of unnecessary tests and procedures. Compounding the problem is defensive medicine, with a serious need for malpractice reform, Germany has no malpractice suits allowed. The ACA addressed none of that. In fact the promised executive order never materialized, and the increased load and decreased pay means even more attempts to increase income use to increased costs. The Medicaid system reimburses at less than 10% of the cost. Most doctors do not accept Medicaid. The ACA includes rationing of care, and will decrease access. It should be scrapped, keep insurance for children with no age limit. Improve free market access, allow marketing across state lines. Keep admin costs to 20% and that includes the govt programs. Pay true RBRVBS amounts. Eliminate malpractice and set up treatment protocols (this will save 50% or $2 trillion a year). Then if a tax is needed to fund minimal policy access for others, enact one, and have the balls to call it one.
08:15 PM on 07/08/2012
I would call your statement very naive. We have two parties with different philosophies on how to handle the heath care crisis we are facing today -- not to mention that within the parties there is a lack of agreement on this topic. Passing a health care law that encompasses everything you advocate was and still is, albeit not much because of ACA, nearly impossible. This should be viewed as a process. If this law falls significantly short of its stated objectives then changes will no doubt be made -- the people will demand it. Right now the noise coming from the right is just that noise. The truth is none of us knows what is going to happen tomorrow. Will our premiums or taxes go up -- maybe but by how much? I don't know and neither do you.
01:19 AM on 07/09/2012
Actually, you need to read the bill. There is not just one tax, there are 5 or more. So yes, your taxes are guaranteed to go up. You cannot add 34 million people to the Medicaid rolls and not think there will be an increase in cost. That is naive. I am sure you are aware that certain cancers will not be treated if the patient is over 70. One section of the bill deals with palliative versus curative. If something extends life, based on actuarial tables, it is covered. Many items that just improve quality of life, are not. That includes Bypass surgery in patients over 60. Obama promised malpractice reform by executive order. He never did it. No one can stop him, he just chose to honor his promise to the trial lawyers not to do it, remember he is a lawyer himself.  Every country with socialized medicine has limitations, if not complete banning of malpractice suits. Without it, the costs of defensive medicine will bankrupt the system. The bill needs to be repealed, and redone piecemeal, or we need to pony up the $10 trillion to completely convert to socialized medicine.
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Gestas
Mountain Man
01:59 PM on 07/07/2012
Health Insurance for the Wealthy...How about Fire Insurance for the wealthy..This week we learned that the reason some houses in Colorado stood untouched and the houses on both sides burned to the ground, is that some of the high end houses were being protected by Private Fire Fighters, working for the Insurance Companies.
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innerpuppie
The truth is an absolute defense...
05:01 PM on 07/07/2012
Deplorable.
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Allene Stucki
05:40 PM on 07/08/2012
What exactly is "deplorable" about insurance companies protecting their investment? Would you have been happier ft those homes had burned also, raising insurance rates even more? How stupid is that?
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Josh Crawford
Just the facts, man!
04:14 AM on 07/08/2012
If it was private fire fighters working for a private insurer above and beyond what the "regular" fire department was doing, I'm not sure I see the problem.
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Martha Rayburn
03:30 PM on 07/08/2012
The problem is that the money spent on the private firefighters for the wealthy could have been paid in taxes so firefighters who fight for the public could be paid more and more firefighters added so there were enough to protect everyone's homes. Unless you have enough money to pay for private firefighters, I'm not sure why you would object to that. Otherwise, it could be your house that burns to the ground next.
12:38 PM on 07/07/2012
Shameful.
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07:25 AM on 07/07/2012
About these governors,

South Carolina's Governor Nikki R. Haley opposes the Affordable Care Act. So far South Caroloina has spent $223,784,079 of federal funds made available through the Affordable Care Act.

Nebraska's Governor David Heineman opposes the Affordable Care Act. So far Nebraska has spent $70,598,757 of federal funds made available through the Affordable Care Act.

Florida's Governor Rick Scott opposes the Affordable Care Act. So far Florida has spent $341,759,269 of federal funds made available through the Affordable Care Act.

Lune
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richard in obihiro
translator
12:27 AM on 07/08/2012
They spent it on what?
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11:18 AM on 07/08/2012
richard in obihiro,

Health care.

Lune
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DocJoseph
A bleeding heart will heal; a cold heart will not
07:56 PM on 07/06/2012
The costs for augmenting the Medicaid coverage is miniscule for the States averaging about 3% of the total expenses for the first 5 years. Moreover, the savings for hospitals and communities would be tremendous.

Rick Scott's calculation is not a monetary calculation, but a political one.

Or should I say miscalculation.
07:01 PM on 07/06/2012
"Floridians are interested in jobs and economic growth, a quality education for their children and keeping the cost of living low."
Being healthy (proactively healthy via preventative medicine) in order to accomplish these goals is not a consideration.
05:06 PM on 07/06/2012
I guess like many others I have not, since the ACA was proposed, gleaned any indication of what the GOP vision might be for health care in America after decades of a broken system. I am forced to conclude there is none. It just can't be that a nation as great and rich as the USA lacks a national vision for a uniquely important service as the health of its citizenry. It's seems haphazard and it's every man for himself so far until Obama's vision for an AFFORDABLE AND INCLUSIVE system that's congruent to the ideals of 'AMERICA" AMERICA"
FORWARD!!! OBAMA 2012.
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Martha Rayburn
03:33 PM on 07/08/2012
If we get a republican president, you can rest assured that some time in the future they will propose a bill very much like the ACA and proclaim it the greatest thing since white bread.
07:48 PM on 07/08/2012
Are you saying that the vision is the same but they won't admit it? Anyway it's wheat bread for me.