Over the weekend, I watched Twitter as drops of information about the debt ceiling leaked out bit by bit. There was a deal. No deal. Well, maybe a deal. The deal would require Congress to wait until a Balanced Budget Amendment passed in the states before it acted. Well, no it actually didn't include that. Medicare was on the chopping block. Well, not cuts to members, only cuts to physicians and other providers. What's an ordinary person to think?
There was plenty of humiliation to go around. Speaker Boehner didn't return the president's phone calls. Speaker Boehner couldn't rally his own party to support his deal. Majority Leader Reid couldn't get Republicans to talk to him. Sen. McConnell would only talk to Biden not Reid, and his unfortunate facial expressions left us with the impression that he had a serious digestive problem. The classic picture was Boehner in the House elevator letting out a long groan as the doors closed. He was not the only one groaning.
Pundits made the worst cliché pronouncements. Everything was a "crisis"; there was lots of "kicking the can down the road." TV time had to be filled and fill it they did. Those smart folks who spent the weekend outside, barbecuing or swimming, were the wise ones. We all knew it would come down to the last moment, but oh, was it painful to watch those last agonizing hours.
Now that the debt ceiling will be raised and we can pay our bills (for a while at least), we are left to wonder -- what will it really mean for some of the programs we care about? The predictions have ranged from death to resurrection for Medicare and Medicaid. But somewhere in this pile of doo-doo there may be a few ponies. The details of the debt ceiling "deal" require that some programs be kept off the table in the negotiations of the "super committee." Those programs include Medicaid (remember almost half of Medicaid goes to nursing home care and the rest to health benefits for the disabled, poor women and children, and the elderly), Social Security, military salaries, and veterans' benefits. Cuts to Medicare cannot affect "benefits" (although the committee can raise eligibility age and potentially copayments), only payments to providers. The military and Homeland Security are not exempt as they have been in the past.
While there is some protection for the programs that serve our most vulnerable citizens, it is hard to claim that these are victories we should cheer about. Some of the key aspects of the health reform law may be affected negatively by the need to make these deep budget cuts. Funding for the subsidies that will allow people of limited income to get health insurance in 2014 may be severely constrained. The new Independent Payment Advisory Board (IPAB), which has been under fire for some time, may be eliminated, leaving decisions about how to contain costs in Medicare to the politicians -- the same politicians that have proven themselves unable to do that very thing up to this point. While many of the health reform law's provisions are already being implemented (e.g. closing of the donut hole in prescription drug coverage for seniors, allowing young adults to stay on their parents' plan until 26, tax credits for small business to help them provide coverage, the establishment of state-based exchanges, demonstration programs to cut costs and maintain quality in Medicare -- to name a few things), the full roll out of the law very much depends on who wins what in 2012. If the Republicans keep the House, win the Senate and the Presidency, the ACA will most definitely be repealed.
Meanwhile? There is no Republican plan to fix health care, other than Rep. Ryan's proposal to give seniors some money and toss them into the health insurance marketplace to find coverage. Oh yes, and more "personal responsibility" for health care, translated as shifting costs to us and requiring us to try to figure out which doctor or hospital is cheaper and better, when that is almost impossible to do with the information we currently have. The trifecta of Republican options remains the same: 1) personal responsibility 2) malpractice reform and 3) selling insurance across state lines. Have these solutions brought down health care costs? Not so much.
I am generally a pretty optimistic person. If you read my blogs, you know that I try to find something positive in almost every aspect of health reform, even though many of you have tried to disavow me of that optimism and have accused me of pollyanism or worse! Still, I have found plenty of ponies in the last several years -- the bookstore owner who was able to give her employees coverage because of the tax credit; the family whose son had cancer but could keep him on their insurance plan while he underwent chemotherapy; the savings for seniors from the closing of the donut hole for prescription drugs; the state programs for people who are uninsurable.
What I tell my family and friends now is the following: 1) This is not the worst deal ever. There are some wins for health care programs and some small potential for meaningful tax reform. 2) If you care about keeping Medicare and Social Security solvent you need to speak out and organize, but also be willing to be flexible about what changes to those programs will keep them solvent and 3) While you may not think that the president negotiated as well as he could have, we don't really know all the details and the background of what went down. I do think it could have been worse and so do many others.
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Are you satisfied with the deficit reduction/debt ceiling deal in Congress?
Through me you pass into the city of woe:
Through me you pass into eternal pain:
Through me among the people lost for aye.
Justice the founder of my fabric moved:
behind me was the was the power divine,
Supremest wisdom and primeval love.
Before me things create were none, save things
Eternal, and eternal I endure.
All hope abandon ye who enter here.
Try googling "the People's Budget" released by the Dems in early April.
Jeffrey Sachs describes the People’s Budget:
Like Ryan’s plan, the People’s Budget would cut the budget deficit to zero by 2021, but would do so in an efficient and fair way. It would close the budget deficit by raising tax rates on the rich and giant corporations, while also curbing military spending and wrestling health care costs under control, partly by introducing a public option. By raising tax revenues to 22.3 percent of GDP by 2021, the People’s Budget closes the budget deficit while protecting the poor and promoting needed investments in education, health care, roads, power, energy, and the environment in order to raise America’s long-term competitiveness. The People’s Budget thereby achieves what Ryan and Obama do not: the combination of fairness, efficiency, and budget balance.""
http://www.flixya.com/blog/2519148/Republicans-Refudiate-Health-Care
the drug industry will take your favorite supplements off the market, patent them, and sell them back to you—by doctor’s prescription only—for 10 or 100 (or even more) times what you’re paying now?
For example: Lovaza (omega-3-acid ethyl esters), is the only FDA-approved semi-synthetic omega-3 fish oil, though a second drug, Epanova, is in Phase III of its drug trials. To keep the FDA approval cost down, it is supposedly only approved for the treatment of very high triglycerides. But doctors prescribe it for many reasons, and it is the only fish oil that Medicare and Medicaid and the Veterans Administration is allowed to reimburse. This is wonderfully profitable monopoly for the drug company producing it. Lovaza costs $6.75 per day, over $200 per month. A high-potency natural fish oil supplement with the same EPA and DHA amounts may cost less than 50¢ per day, or $15 per month.
http://www.physicianspractice.com/blog/content/article/1462168/1917846
However, there several states with Democratic Governors and legislatures that can put public options on their state's insurance exchange going online in 2014. These don't have to just be for "uninsurables" or have waiting lists. If they are open to everyone, younger, healthier consumers will flee overpriced for-profit insurance, requiring for-profit insurers to lower their premiums and change their business models to stay in business. Everybody wins.
Progressives need to become as affective and dynamic at the state level as conservatives have been.
Vermont is even going for single-payer.
One thing that will keep prescription costs high is they won't even tell you over the phone what a prescription will cost so you can't shop around by calling different places for prices.
Oh and the hospital visit cost me $45 in total and that was because I was a tourist, otherwise I was told it would have been half.
Decreasing Medicaid reimbursements for MDs will clearly impact the ability to create health insurance exchanges, which is key to expanding health care coverage in 2014. At present, there are not enough primary care MDs to provide that care. Reducing Medicaid reimbursement to physicians, which can charitably called paltry at best, will act as a strong incentive to opt out of health insurance exchanges. My initial optimism for health care reform is melting quickly in the face of the hot tea party that we have experienced.
We spend twice as much as any other country for worse outcomes, and that includes countries who have systems that deliver healthcare in a manner fairly similar to ours (eg; Germany, where the main difference is not how health care is delivered but rather that there is universal coverage). The problem is not that we aren't spending enough, and the solution isn't a single-payer nationalized system. People need to get involved in and responsible for their own health, they need to be informed of how much money is available, how much the medical care they are receiving costs, and how their lifestyle decisions are affecting that cost. And providers need to come down out of the ivory towers and join the real world of ordinary people. American providers and facilities are wildly overqualified and overpriced ... yes there will always be the anecdotal "miracle cure" ... how about looking at how many people DIDN'T get treated for lack of money thanks to that metaphorical diving catch in the outfield.
America needs to get real about healthcare.
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