We are told by supporters of health care reform bills in the Democrat-controlled Congress that they will save us money in the long run and contain skyrocketing health care costs. But the CBO has projected that the most comprehensive proposal yet, America's Affordable Health Choices Act of 2009 (H.R.3200 in the House), will add to the federal deficit by $239 billion over 10 years. So the Administration and most Democrats find themselves on the defensive over these costs as Republicans have a field day in proclaiming the risks of even higher deficits than we already are facing. As Rep. John Boehner (R-OH and Republican leader in the House of Representatives) says:
"Americans want a better plan to lower costs and improve the quality of health care. --It's not just about health care, it's also about out-of-control government spending that's piling debt on our kids and grandkids"
That gives the fiscally conservative Blue Dog Democrats, in the middle of the battle over health care reform, powerful clout in cutting costs of the various bills working their way through Congress.
Increasing red ink haunts future projections for federal and state budgets for years to come, whether we are considering Medicare, Medicare, or the public's capacity to afford rising health care costs. The proposals currently in Congressional committees all call for expansion of Medicaid, which beleaguered states are already pushing back on. In past years, states have shared the costs of Medicaid with the federal government about equally. Now, 48 of the 50 states are having such budget shortfalls that the federal share of Medicaid's expansion is likely to be 93 percent. (Nichols, J. Dire states. The Nation. 289:5, August 17-24, 2009:3-4) The annual costs of Medicaid are now $340 billion, and the CBO projects them to increase to $430 over the next ten years. (Krauss, C. Trickle-down costs: states fear the bills in health care overhaul. New York Times. August 7, 2009: B1)
So how is the political battle actually playing out? If fiscal conservatism were the dominant factor in the debate, we should have a bill coming out of Congress that will be deficit-neutral at worse, and actually save money at best. But none of the bills we are yet hearing about will accomplish either of those goals. H.R. 3200 will cost about $1 trillion more over ten years. And as we saw in the last post (link to blog # 26), it won't result in containment of either insurance or health care costs. The only proposal in Congress that could meet goals of fiscal conservatives (of either party) is the Conyers bill in the House (H.R. 676), a single-payer Medicare-for-All bill. But so far it has been kept off the table by supposedly fiscal conservatives in both the Senate and House, even including the Obama Administration.
So why this incredible disconnect among our elected representatives shaping the future of one-sixth of our economy and future health care of all 310 million of us? The answer, of course, is all about money, corporate power and influence. For industrial stakeholders in our for-profit health care system, our costs are their income, CEO compensation and returns to investors. It really does come down to Wall Street vs. Main Street. More than 3,000 lobbyists (a 6:1 ratio to members of Congress) have descended on Washington, D.C. to lobby for stakeholder interests among industry and providers. They range from the insurance, drug, medical device, and medical equipment industries to hospitals, nursing homes and professional groups within organized medicine. In each case their agenda is to preserve and grow their revenues under the cloak of "reform".
Absent from the negotiating table is the public interest. Instead of long-term containment of health care costs for patients and their families, employers and taxpayers, the battle is being fought to extend future profits of the medical-industrial complex. Corporate money and lobbying clout ($1.4 million a day) is focused on limiting the interference of government in the health care market and avoiding price controls while calling for increased government subsidies (of private insurance through employer and individual mandates and of public programs such as Medicare and Medicaid). And at the same time, supposed fiscal conservatives are distorting the debate through their disinformation campaign against a "government takeover", "socialized medicine" and threats to "choice" -- a blatantly cynical and dishonest approach.
If the public interest is to be served by any health care reform to be enacted this year, we need an informed public to rise up and force our legislators to do the right things to actually rein in the costs of health insurance and care. A weak and small public option won't do the job. Here are some of the things that will:
• Force a favorable vote on the floor of the House this Fall on H.R. 676, the United States National Health Insurance Act, a single-payer bill for all Americans; an amendment to H.R. 3200 will be introduced by Rep. Anthony Weiner (D-N.Y.) in September that would replace the private insurance industry with such a program.
• Require Congress to enact an independent federal agency for Comparative Effectiveness Research, with authority to guide coverage and reimbursement policies.
• If a single-payer program is not possible this year (as it will inevitably be!), hold members of Congress accountable for their votes on efforts to eliminate
overpayments to private Medicare plans (not over years, but now); require that all insurance plans cover a high percentage of benefit costs; allow a public option to vigorously compete with private insurers, including setting its premiums well below private premiums and capping premium increases; and allow the government to negotiate the prices of drugs and medical devices.
When the Congress re-convenes this Fall, we the public will have an opportunity to force our legislators to be accountable to us. We need to get H.R. 676 on the table, scored by the CBO on its merits, and brought to votes in Congress on the basis of its real provisions, not the disinformation and scare tactics of self-serving stakeholders in the open market of health care.
Fiscal conservatism could and should bring together a landslide vote by
Republicans and Democrats, including the Blue Dogs, to pass H.R. 676, the only fiscally conservative option before us. The battle IS over money, but it's OUR money, including that of future generations of Americans, that should take priority over the special interests that profit from our higher costs.
John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008. With permission of the publisher, Common Courage Press
Buy John Geyman's Books at: http://www.commoncouragepress.com
Julie Farby: Hey Kids, It's Comedy Hour With Barney And Rush!
Barney Frank doesn't like being interrupted. And he certainly doesn't like having his town hall discussion disrupted by a seemingly normal looking woman who's actually bat crazy.
Health Care Reform News - The New York Times
What you need to know about health care reform - CNN.com
Rioting against health care reform - Paul Krugman Blog - NYTimes.com
https://www.madashelldoctorstour.com/Mad_as_Hell_Video.html
These Oregon physicians are in the process of organizing a caravan designed to inform the public about the benefits of the single-payer option. At last count they will be stopping in approximately 23 states, on their way to demonstrate in Washington. They need volunteers and our support. Please spread the word.
The current debate adds to the fragmentation. Complex formulary of insurance and funding only makes the healthcare system more cumbersome and inefficient, adding further irrationalities and alien motivations within the system. And good patient care is lost in the shuffle.
It is the front-line of medical care (physicians, nurses and allied medical professionals) that will make-or-break the new comprehensive healthcare. The old medical adage of "captain of the ship" is an important principle, even in the 21st century; and the one who should be held responsible to "bend the cost-curve."
Short-term, significant savings (i.e no additional dollars needed) can be achieved through reforming payments to insurance and drug companies; as well as providers (doctors and hospitals) by using "Best Practice" paradigms. For more info write to glawrenc@mvnhealth.com
Since grocery, drug, mass-market merchandisers and manufacturers earn $83 billion a year in Private Label sales each year, there is no reason why Private Label Medical Insurance Plan would not work. Manufacturers currently run both private label and branded products simultaneously in drug stores and make big profits doing it, and the consumer benefits because it has more affordable choices.
Before implementing such a program nationwide, the government should test market the program to ensure its effectiveness. The risk of loosing your doctor by switching to a private label program would be the same as when your employer changed insurers. To those concerned that private label would encourage employers to drop health care insurance, I say you are going to loose it any way, so why not have a back up plan in place.
The only draw back I see is that I do not trust either business or the government to regulate the program because of our government’s ties to its big business sponsors. However, this type of activity is already going on under the current health care insurance system.
HR676 - Medicare for All.
It will deflate the townhall "keep government away from my Medicare" protests. The Republicans won't dare trash it, not with most of their core supporters being beneficiaries. The lack of details about the widely supported public option have made it easy to misinform constituents and incite fear. Everyone knows about Medicare, at least the basics of what it costs and what the benefits are.
Almost every argument used against reform can be used as support for HR676. You said HR3200 was too expensive? Then you must support HR676 since it makes the most financial sense. You foment fear at the idea of "government" making life-and-death decisions for people? Ask any of the millions of Medicare beneficiaries if they've felt any pressure to sign a "Do not resuscitate" order.
By accident or design, the best antidote to the current "debate" over HR3200 is HR676!
The public health insurance option is the heart of health care reform and right now it's under serious attack.
Even some members of the administration are pushing President Obama to give in to conservatives and drop it: one senior White House adviser told The Washington Post, "I don't understand how [the public option] has become the measure of whether what we achieve is health-care reform."1
This unnamed source apparently doesn't understand that the public option is the key to lowering health care costs and expanding coverage.
But there is a group of progressives in Washington who DO understand. Sixty House Democrats have signed a written pledge to not vote for health care reform unless it includes a robust public option.2 That's more than enough to block a bill without the public option.
These representatives are already facing pressure to back down, but if we stand strong with them, we'll send a clear signal that the heart of reform can't be compromised away. Can you make a contribution to the progressives in Congress who are standing tall for the public option? Clicking the link below will take you to ActBlue, where you can donate.
http://www.moveon.org/r?r=51789&id=16918-9193653-lMdAxQx&t=3
“In a press release issued earlier this week (mid-July), we announced that the Commonwealth Care program has experienced an annualized premium trend of 4.7 percent since program inception through the fiscal year ending June 2010. This compares to private market trends on the order of 8 to 10 percent during the time period. This significantly lower trend for Commonwealth Care translates to a savings in excess of $100 million for the taxpayers of the Commonwealth.”
“How have we achieved such effective cost containment? Several reasons:
• The Connector has developed and applied innovative competitive bidding strategies that have incentivized participating managed care plans to compete on value.
• The managed care plans themselves have worked to aggressively manage underlying medical cost trend.
• The 181,000 members of Commonwealth Care are price-shopping effectively.
Consistent with the theme of "shared responsibility" that has been the hallmark of Massachusetts health reform since implementation began: everyone involved deserves credit for this fantastic achievement!”