We've blogged a lot about how health reform fight moves to the state. But it continues in Congress as well. In particular, California's two Senators are continuing the fight for rate review.
Senator Feinstein had called on WellPoint/Anthem Blue Cross to drop plans for the rate hike on Californians (one that has been delayed pending an independent investigation for the California Department of Insurance) most recently during a speech on the floor of the U.S. Senate last Friday:
The Health Insurance Rate Authority Act of 2010, authored by Senator Feinstein and co-sponsored by Senator Boxer, would give the U.S. Secretary of Health and Human Services the authority to review and reject unfair premium rate increases in states where Insurance Commissioners do not have the authority or capability to do so. This is especially key for states like California, which do not have rate review, and important for the period between now and 2014, before the exchanges are functional and can use their negotiating power.
This bill is something that Senator Feinstein is looking to move, so stay tuned...
For me and many others, the blog was a go-to source for both the latest update on process and good analysis on substance. As someone who had literally written the book on the health care crisis in America, Jonathan Cohn provided both the knowledge of complicated health policy wonkery, and the savvy of a reporter to decipher and explain the political process--but without the corrosive cynicism so often employed in his profession. He's also just a nice person, with good values and a sense of fairness, even to those with whom he disagrees.
As he describes in his farewell post, his reporting also performed an important function at the magazine The New Republic, exorcising the past mistake of publishing the discredited Betsy McCaughey's false yet devastating attack on the Clinton health reform proposal in 1993. The New Republic's productive role in the past year's health reform debate provided a kind of karmic balance.
I was honored that Jonathan asked me to contribute to the new blog he was starting up a year and a half ago. Beyond this and other blogs that focused on California policy and politics, I appreciated having a forum to weigh in on the federal fight. In my couple-dozen contributions, I tried to speak from experience, and provide a perspective of a Californian, of a veteran of previous reform fights, of an organizer not inside the Beltway echo chamber. I hope I was successful.
I actually am sad that The Treatment won't continue. I know from experience that a blog can be very demanding time-wise, and there's no doubt that with the law's passage, there may be a drop-off in interest.... But there's a lot of work is just beginning, at the Department of Health and Human Services; in 50 state Capitols; at state regulators; in the courts; and in the communities around the country. Here at the Health Access Blog, we'll continue to try to cover some of this here in California, but we have our own time and staff constraints as well.
Until then, thanks to Jonathan for his dogged work and reporting, and his virtual hospitality for my work. Here's a compilation of my TNR reports from how the health care debate was playing out in California:
We've long had issues with Anthem Blue Cross of California--both their practices and policy positions. That's why we launched http://www.sickofbluecross.com/, to document these issues and collect stories of aggrieved Californians.
Anthem Blue Cross of California has gotten lots of attention in the past few days, due to its controversial increases of up to 39% for their customers in the individual insurance market, as first reported by Duke Helfand of the Los Angeles Times, who has followed up with reporting the fallout.
* President Obama cited--multiple times!--these rate increases on California consumers as one reason why he is continuing to pursue comprehensive health reform.
* Insurance Commissioner Steve Poizner is investigating the increases, according to the Sacramento Bee. It's indicative of how little oversight California currently places on these rates that the Insurance Commissioner is going to contract with an outside actuary to see if Anthem Blue Cross is complying with existing law.
* California's two Senators have weighed in as well, urging action and review at the state level. As the San Francisco Chronicle reports, Senator Boxer urged state Attorney General Jerry Brown to investigate the proposed rate increases and Feinstein asked state Sen. President Pro-Tem Darrell Steinberg, D-Sacramento, to introduce legislation to regulate rates.
* Assemblyman Dave Jones, the chair of the Assembly Health Committee and someone who has long carried a bill on rate regulation, is holding his own hearing on health insurance rates on February 23rd.
* Others, like Jonathan Cohn at the New Republic, have refuted Anthem's explanations on the large increases, and explained why this situation would be prevented--or at least ameliorated--under health reform.
All of these government officials are right to question the premium spikes by California's largest insurer. While we know health costs grow at a rate higher than inflation, they are not growin anywhere near 20%, 30%, or 39% in the past year. However good it is to have this scrutiny now, the point is we need this oversight on a regular basis, and that's why we need health reform.
Anthem has been a longstanding opponent of health reform. Just a few months ago, Anthem Blue Cross was sending anti-health reform messages to their customers. Their new notices--about their premium increases--is the strongest message to date about why we urgently need health reform.
Consumers who buy coverage as individuals have no bargaining power, and are at the mercy of the big insurance companies. The benefits of health reform is to provide consumers with the power of group purchasing, so we all can get better rates for health coverage. Health reform would also put in place rate review, so insurers would have to justify their rate increases much more than they do now in California.
Health Access California will continue to host www.sickofbluecross.com, that contains more background of Anthem Blue Cross of California's anti-consumer record, and is collecting stories of people's experience with the insurer.
Republican legislators are viewing President Obama's invitation to the White House with skepticism. I don't doubt the President's sincerity in wanting to take into consideration and even adopt their best ideas. As frustrating as that may be to some of his supporters, he is a consensus builder and organizer, and that is who he is.
But that doesn't mean the Republicans shouldn't be worried. Because I don't think the President is going to give up on his proposals. And because the Congressional Republican leadership doesn't have a comprehensive solution to the health care crisis. The spotlight that the President has put on alternative reforms has shown them to be ineffective, but ones that provide less security and stability, not more.
Change can be scary, especially when there's an entire political party feeding that fear and mistrust. Consumers don't like the status quo, but it can be seen to be comforting compared to the unknown. If it's a fight between a complex reform with both benefits and burdens (and any reform of health care is going to be complex) with the status quo, the status quo has a distinct advantage.
President Obama wants to make this a fight between the change you want, versus the change you don't. Reformers make the point--correctly--that the status quo isn't an option, since the current health system is unravelling.
FYI, I'll be on a panel at the Insure the Uninsured Project conference this Wednesday, February 10th, in Sacramento. Should be an interesting conference, with the mix of anticipation and uncertainty around reform right now.
This past year's health reform debate went through major holidays, so it isn't a surprise that news is made on the secular holiday of Super Sunday.
In an interview with Katie Couric before the Super Bowl, they talked health care:
Politico has the story. The White House will host a meeting on February 25th, televised, with both Democratic and Republican leaders of Congress to discuss their best ideas on health reform. It's not an attempt to start over, the White House says, but to incorporate the best thoughts a final agreement. It'll be one more proof that the President has tried to pursue a bipartisan course, only to face solid opposition.
When we get health reform, Speaker Nancy Pelosi of California will be a major reason. The New Republic's Joanthan Cohn commented that she "has been nothing short of heroic over the past week" on keeping health reform alive as legislators remembers that despite a special election in a specific state, the need and urgency and political imperative of passing health reform has fundamentally not changed.
As reported by Carolyn Lochhead of the San Francisco Chronicle, Pelosi had strong words today keeping the momentum up. She said that while some parts of health care reform may be done piecemeal, but "That doesn't mean that is a substitute for doing comprehensive. It means we will move on many fronts, any front we can."
"We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn't work, we will parachute in. But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit."
The only other path, short of complete abdication, is a drastically scaled back, unrecognizable proposal that would reopen all sorts of difficult conversations, and may provide some help to specific folks but no one would call it close to health reform.
This week, many of us will be in Washington, DC, and may have additional insights into what is going on. As always, we'll have reports on health reform and the California budget, from DC and Sacramento.
Back in DC, legislative leaders from both the House and Senate have been in long negotiations at the White House for over five hours. There's a rumor that President Obama has urged them to stay in until the framework of a bicameral health reform deal is agreed to.
Fingers crossed on our Congressional leaders coming to a good and equitable resolution. Many of my thoughts on federal health reform have found a forum on Cohn's blog at The New Republic, called The Treatment. I have appreciated having the platform on national health policy issues (and the editing), and have now posted there 20 times in the past year. Here are the posts, many of which are still very relevant to the current debate:
Two years ago, as part of his health reform proposal, ABx1 1, the Governor was willing to raise the revenues to expand the same Medicaid program to the same population, and was willing to raise the revenues to do it, with a 50% of the cost paid for by the federal government.
The current health reforms will expand the same Medicaid program to the same population with the federal government paying for 100% of the expansion population for the first several years, and over 80% from the eighth year on. Much of that small cost to the state--much smaller than what the Governor projects--would be offset by savings elsewhere.
This isn't apples and oranges. The comparison isn't even apples and apples. We are talking about the very same apple.
To be clear: we support and prefer the House health reform proposal that would provide even more assistance to states, by having the federal government pick up over 90% of the cost of the newly eligible population in the eighth year on. That would be a productive means of advocacy for the Governor, rather than attacking the overall health reform package that would provide a new infusion of billions of dollars in needed subsidies to California families, small businesses, and yes, the state of California.
While vacationing in Hawaii, conservative radio talk show host Rush Limbaugh had chest pains and as a result had a stay at the Queens Medical Center--which is the hospital where Barack Obama was born (as was my wife as well.) But that's not the only irony.
At a press conference talking about his stay, he made comments which were widely interpreted to take a dig at efforts to reform the health care system, saying he was availed of "the best health care the world has to offer." Limbaugh continued, "Based on what happened here to me, I don’t think there’s one thing wrong with the American health care system. It is working just fine, just dandy.”
My post takes a look at some of the new research about the Hawaii Pre-Paid Health Care Act of 1974, and its central requirement for employers to provide health coverage to their workers: it shows positive results in improving access with no measurable impact on jobs. If Rush Limbaugh is endorsing an employer mandate, the House and Senate leadership may want to take another look at beefing up its requirements.
One lesson from Hawaii beyond Limbaugh's visit and unintended endorsement of reform I want to spotlight:
* Beyond the level of the assessment, the structure of the employer assessment is key, so there aren't broad loopholes that allow employers to avoid any contribution whatsoever. In this regard, the Senate's complicated "free rider" provision needs to be fixed. The House version has a simple test of whether an employer is providing adequate coverage, and the assessment for those that don't is a percentage of payroll, based on a sliding scale capped at 8%. The Senate is more convoluted, and the most problematic part is that employers could avoid much of the penalty by shifting workers to part-time status.
As Elise Gould and Ken Jacobs writing for the Economic Policy Institute indicate, "Studies of Hawaii’s health insurance mandate have found that the state has a disproportionate number of employees working slightly under 20 hours a week, the number of hours at which that requirement becomes effective. The 30-hour cut-off in the Senate Finance bill is more likely to encourage reductions in work time, since it is easier to restructure work to fewer than 30 hours a week than to fewer than 20 hours a week." As the researchers note, work shifts in this range are common in the restaurant, retail, and nursing home industries--the very ones that are less likely to provide coverage and leave their workers uninsured. The experience from Hawaii is strong evidence that the final employer responsibility provisions should be closer to the House than the Senate.
This issue of the structure of an employer requirement---and especially how to cover and pay for part-time workers---was a crucial unresolved issue in the California debate around health reform in 2007. The House bill gets this right--and better than what we had in the final Schwarzenegger-Nunez negotiated bill, partially because we didn't have the constraints of ERISA. The Senate version, however, needs to be fixed in order for it to work as intended.
For those who stopped paying attention since the Senate passed its version of health reform on Christmas Eve, here's some links of articles to catch up:
On the process from here, the likelihood in that the House and Senate do not go into a formal conference--which would simply let the Republican opposition put up more procedural roadblocks. Instead, the House and Senate leadership would hold informal negotiations, and they would amend an existing bill to be a final compromise to then get the two final floor votes--the 218 votes in the House and the 60 votes in the Senate. Jon Cohn at The New Republic has more about this game of "ping pong," and David Dayen of FireDogLake (formerly of Calitics) has a detailed report and quotes from CA Representative and House Energy and Commerce Chairman Henry Waxman.
As we start the Senate debate on health reform, some key items about the health reform that passed the House of Representatives:
Politico's Jonathan Allen and Patrick O'Connor has the scoop on some of the behind-the-scenes back-and-forth around the House of Representatives, which highlights at least three California Representatives, starting with Representative Dennis Cardoza. The article points out an interesting footnote, that the last two Democratic votes for the bill were Californians, Rep. Maxine Waters (who waited to be the deciding vote #218) and afterwards, Rep. Loretta Sanchez.
Health Access supports H.R.3962, as we wrote in our letter supporting the health reform measure. Our letter does mention areas that we agree, and areas where it could improve. What it doesn't mention is the anti-abortion Stupak amendment, which was added on the day of the vote. It's an overreach, going beyond extending the current federal prohibition against federal funding of abortions, to impact any private health plans offered in the exchange.
The amendment is bad in its policy, but also in its politics. The House bill was a very good bill, in most cases better than in Senate counterpart. But the Stupak amendment is a major exception to that rule, and this makes it harder to rally aggressive support for the other House provisions.
There are other issues with the House bill that need to be worked out in a conference committee. Lisa Girion at the Los Angeles Times has an important story about how provisions in health reform might undermine state-based consumer protections. Health Access, which sponsored many of those HMO patients' rights in the past two decades, is working with Senators and members of Congress to point out the issues, so that national health reform serves as a floor, not a ceiling, for consumer protections. Luckily, as the article indicates, some of our members of Congress, from Susan Davis to Jackie Speier to John Garamendi, were heavily involved in the state passage or implementation of those protections, and so have a base of knowledge and passion on this issue.
Those who oppose an employer requirement, and health reform in general, have been making wild claims about the supposed negative impact. To fact-check these claims, here's a guest commentary by Ken Jacobs, Chair of the UC-Berkeley Center for Labor Research and Education:
Over the last few months, we have heard any number of outrageous claims about the potential impacts of the proposed health care bills (death panels, end to private insurance, etc.). Still, the claim made by Republican speaker after speaker during Saturdays House debate that the bill would result in a loss of 5.5 million jobs stands out. They even go so far as to say (see House Republican Leader John Boehner’s website), that the research was based on a methodology developed by Dr. Christina Romer, Chair of the Council of Economic Advisors, and Jared Bernstein, the Vice President’s Chief Economist. What’s going on here?
The Economic Policies Institute’s Josh Bevans pointed me to Politifact, which does a good job of debunking the claim. It turns out that the number comes from Republican staff of the House Weighs and Means Committee.
They started with an estimated tax increase on employers from the play or pay provision of $300 billion. It is not clear where this number comes from; the CBO estimate is $163 billion over ten years. They treat that number as though it is a direct reduction in GDP for a single year, thereby increasing the projected impact tenfold. To get the total impact on GDP they use a multiplier from a 2007 paper by Christina Romer which explicitly states that the analysis in the paper pertains to tax increases or cuts that change the total spending in the economy. This would be the case, for example, for a tax increase to fund the deficit where there is no corresponding increase in government spending, or for a tax cut to stimulate the economy that was not balanced by a reduction in spending. The paper is very clear that the analysis would not apply to a social insurance program where the increased tax is balanced by an equal increase in output—as with the healthcare act. Finally, the minority committee staff applied a ratio of changes in GDP to job losses or gains from the stimulus analysis by Romer and Bernstein to reach a number of lost jobs.
So to reiterate—they: * use a methodology that is clearly inappropriate for the case at hand * start with a cost to employers that is nearly double that of the CBO projections * inexplicably multiply the results by ten.
Then they claim that the analysis was done with a methodology from the Counsel of Economic Advisors—one Congressman actually directly attributed the estimates to the CEA—even as it directly contradicts what Romer wrote in the paper they cite. Amazing.
So, what does the academic literature tell us about pay or play provisions and job losses? Studies on Hawaii and San Francisco, which both have employer requirements, have found no measurable impacts on employment. Most economists believe that for workers above the minimum wage the costs of health insurance are passed on to workers over time in the form of lower compensation. The impact of a health requirement of the size under consideration would be equivalent to a modest increase in the minimum wage. Drawing on the minimum wage and health mandate literature, Philip Cryan found that the job impacts of an employer requirement of 8 percent of payroll, with no exemptions or subsidies for small businesses, would be in the range of 166,000 jobs lost to 55,000 jobs gained.
This is before taking into account the many positive impacts of health reform on jobs, small businesses and the economy as a whole. The biggest “job-killer” would be a failure to act.
Today was a major day of action for health reform, with well over 100,000 calls made to Congress, and events around the country. This included several cities in California, from an overnight vigil in front of the federal building in Sacramento, to a "Rolling Caravan for Health Care Reform" in Los Angeles. Below, pictured with HCAN organizers Mari Lopez of the California Partnership and Nancy Gomez of Health Access California, is the flatbed truck that circulated through LA with over 150+ people at various stops, with the theme "The Clock is Ticking." Other events were all over the place, from San Diego to Modesto.
Another fellow "judge" on the Truman panel with myself is erstwhile Californian and health policy consultant Peter Harbage, who has an important post on the need to not just make coverage affordable and accessible, but administratively simply, if not automatic. He's right: the recent conversation on penalties from the individual mandate is missing the point: after all, people overwhelmingly want coverage. (Even with auto insurance, the coverage required is for the person you may run into, not yourself.) The key is removing the barriers for people to get coverage in the first place.
One of the benefits of living in these times is that information flows so freely. As a nation, we really cannot be hoodwinked unless we choose to.
Those who want to expand their fact-based understanding of the need for health care reform can find a number of reliable, unbiased news sites to visit online, such as the Washington, D.C.,-based independent Kaiser Health News and California Healthline, an aggregate site produced by the California HealthCare Foundation.
And then, there's the bookshelf as well. I recently picked up a copy of longtime Washington Post reporter T.R. Reid's "The Healing of America: a Global Quest for Better, Cheaper, and Fairer Health Care." (I know, I know...it's not exactly the blogosphere, but it is bound in an old-fashioned way with 277 pages -- and oh soportable!)
Published in 2009 by The Penguin Press, the book offers a refreshing bird's-eye view of what the world has to offer in terms of health care delivery systems. Reid's travels and reportage pivot around his search for treatment of a bum shoulder; he'd badly injured his right shoulder decades ago, and the effectiveness of the initial fix -- surgery and steel screws --has long since worn off, leaving him with pain and stiffness (albiet not disability) and in search of quality, affordable care.
From India to Japan, from France to Taipei, from Britain to Canada and beyond, Reid roams the continents, checking out his options.
That's after starting in the United States, where his visit to "a brilliant American orthopedist" results in a proposed surgical intervention that Reid says reflects the (flawed) "high-tech ethos of American contemporary medicine."
In other words, a solution that involves what seems like the most complicated, space-aged, super-techno, state-of-the-art, expensive, over-the-top procedure possible. The author writes:
"This operation -- it is known as total shoulder arthroplasty, Procedure No. 080.81 on the National Center for Health Statistics' roster of 'clinical modifications' -- would require the orthopedist to take a surgical saw, cut off the shoulder joint that God gave me, and replace it with a man-made contraption of silicon and titanium. This new arthroplastic joint would be hammered into my upper arm and then cemented to my clavicle.... I had serious reservations about Procedure No. 080.81. The saws and hammers and glue made the procedure sound rather drastic. It would cost tens of thousands of dollars (like most major medical procedures in the United States, the exact price was veiled in mystery). The best prognosis I could get was that the operation might or might not give me more shoulder movement...A certain skepticism crept into my soul about this high-tech medical intervention. I departed my American surgeon's office and took my aching shoulder to other doctors, doctors all over the globe. Over the next year or so, I had my blood pressure and temperature taken in ten different languages...."
Reid admits the shoulder wasn't really all that bad, but his condition did provide a way in the door to medical offices worldwide. His thesis? "We can bring about fundamental change by borrowing ideas from foreign models of health care."
He pooh-poohs the notion that anybody who dares say that other countries could offer lessons to America is unpatriotic or anti-American.... "The real patriot, the person who genuinely loves his country, or college, or company, is the person who recognizes its problems and tries to fix them. Often, the best way to solve a problem is to study what other colleges, companies, or countries have done."
And why not? Take Japan, for one. Japan has the oldest population in the world, and the Japanese go to the doctor on average 14 times per year, compared to an average of 5 times for an American. The U.S. average expenditure per capita is $7,000 on health care; Japan spends about $3,000.
Surely, we can still learn a lot from other nations older and more experienced than ours. Reid's book provides plenty of mind-expanding experiences and ideas in a fairly breezy voice, neither leaden with policy nor politics.
A New York Times online book review concludes with the line: "Evidently, when it comes to health care, America is exceptional only in that it’s a rich country with a poor country’s approach to taking care of people."
The quiz is important in reminding us not just to look at the bills, but the condition of the current status quo in health care.
At TNR's The Treatment, I joined many much-more disinguished experts in ranking of the Baucus bill. Under the "Truman score" Jon Cohn developed, the Baucus bill got a 6.1 out of 10. In such a life and death issues, my comparison isn't a batting average but a driving test--and 61% is a failing grade in most circumstances. Jon Cohn promises an evaluation of the status quo, which I imagine will get even worse marks. It reminds us why we health reform is so necessary.
Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.
For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.
President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.
My post goes on (and on!) to rebut the range of attacks on the number of 46.5 million uninsured that was recently updated by the U.S. Census Bureau last week. It's a bad sign for the debate when we are arguing about basic facts. But it also shows that health reform opponents don't even have a good sense of the actual problem--much less how H.R.3200 and other health reforms will solve it.
Health reform was in the air, and the subject of a (8am!) panel on the subject, moderated by Tom David from Tides, and with Crystal Hayling, President & CEO, Blue Shield of California Foundation, and coming from DC, Roger Hickey, Founder & Co-Director, Campaign for America's Future.
Sacbee.com held a liveblog regarding the President's health reform speech. Here are excerpts by myself and my fellow panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis, who also writes a weekly column for The Bee; and Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. It hopefully has some real-time insights into the speech...
4:59 Linda Gonzales/sacbee.com: Thanks to Anthony and Marge for joining us. Would you two share a little information about your organizations as we get started? 5:00 Marge Ginsburg, Center for Healthcare Decisions: Center for Helathcare Decisions is a non-profit, non-partisan organization that seeks the public's voice in complex healthcare issues. We often focus on areas where there are no easy answers! 5:02 AnthonyWright: Health Access California is the statewide health care consumer advocacy coalition, working for the goal of quality, affordable health care for all. Our website is www.health-access.org. For more info on health reform, visit our daily blog at blog.health-access.org, or follow us on Facebook or Twitter, at @healthaccess. 5:04 AnthonyWright: It's poignant to see Hillary Clinton coming in as a Cabinet Secretary, given her past effort at health reform 5:07 [Comment From Tyler] My child turns 1 soon and will not be eligible for mediCal due to my income. I also was recently married and my new wife is not covered. I have insurance options through my work, but it is not affordable for me to add two dependants to my health coverage at this time. Do I have any options currently besides paying more than I can afford? 5:11 AnthonyWright: Tyler: There are very limited options now. The point of health reform is to increase those options, by expanding coverage at work, through Medicaid and other safety-net programs, and to provided subsidies and help if you have to buy coverage as an individual. 5:12 [Comment From maria] Why are people so afraid of the public option? I understand people are afraid it would eliminate the private insurance companies but if they are so great why would people ditch them? I seem to hear people complaining that they would want to keep their current insurance isn't that the meaning of the "option" part of the public option. I just don't understand the fear behind the public option. If they are afraid of reduced quality of care I would love to tell them my mom has medicare and I buy into a high deductible health plan for myself and my mom has it so much better than me. 5:12 AnthonyWright: Tyler: If you need care or coverage, we have some resources at a nonprofit website we run, at www.hospitalbillhelp.org to help people with big hospital bills, or those who seek care but are uninsured or underinsured. 5:14 [Comment From Tyler] Thanks, Anthony. 5:14 Marge Ginsburg: I think there is unwarranted but pervasive fear of 'big government'...I think it will take a long time for many people to recognize the role the govdrnment has in healthcare today. 5:15 AnthonyWright: Maria: The public health insurance option typically gets 60-75% approval ratings. It's a very American concept to have a public option, whether in our university system, our television stations, our mail delivery, or in other parts of American life. 5:16 AnthonyWright: Here we go... 5:17 [Comment From maria] well that is good to hear! I often keep hearing people against the idea I never knew the approval rating for it was so high. Thanks so much! 5:18 Dr. Michael Wilkes: Good evening everyone. Dr. Wilkes here! 5:19 [Comment From lite_speed] To date, I have experienced the healthcare systems in 3 countries where I have lived and worked for extended periods. The US, by far, is the most expensive. People here fear a govt bureaucrat will somehow make healthcare decisions for them. I am more afraid of an insurance company bureaucrat making that decision and being incented financially to deny coverage. 5:20 AnthonyWright: Actually, he's not going to end the health reform conversation. Even if we pass major health reform, we will need to continue to need to adapt and move forward. But we need to get started. The conversation won't end with the passsage of a bill. 5:22 AnthonyWright: The key point: *It can happen to anyone* 5:23 Marge Ginsburg: It's good to see the Pres. return to why we are tying to tackle this problem in the first place! 5:23 AnthonyWright: Thank you, lite_speed. I think President Obama is making your point about the concern with the current system, including with the current insurance market. 5:26 AnthonyWright: It's not just a slogan: The status quo isn't an option. It's deteriorating. 5:29 AnthonyWright: Minimize disruption, but reform. As @consumersunion is livetweeting: Obama: #healthreform = Build on what works, and fix what doesn't. 5:30 AnthonyWright: Obama is now going through the consumer protections in the bill. When Gov. Schwarzenegger tried health reform in 2007, stopping the denial of pre-existing conditions was his most consistent applause line. It's working for Obama as well. 5:31 Dr. Michael Wilkes: This concept of pre-exisiting condition is crucial as it unfair and will resonate with all Americans. 5:31 AnthonyWright: The protections against "junk" insurance, capping out-of-pocket costs, is huge. "No one should go broke because they get sick."--880,000 Facebook users made that their FB status on last Thursday. 5:33 AnthonyWright: Californians are more likely to be uninsured than residents of all but three other states. That's why it is so critical for our state. 5:33 Dr. Michael Wilkes: Quality is key. Transportability is crucial. Empowerment of the consumer is crucial. Choice is key. 5:34 AnthonyWright: NEW IDEA: low-cost coverage for those denied for pre-existing conditions during the transition 5:34 Marge Ginsburg: These are definitely the messages that people are looking for! 5:35 Dr. Michael Wilkes: Key to see him try to tie this to Republicans! There is credit all around and it is key to let America see this problem is recognized by all. 5:35 AnthonyWright: California's high-risk pool for those denied with pre-existing conditions now has a waiting list. It's very sad. 5:36 AnthonyWright: Laughter at the details "to be ironed out." 5:37 Marge Ginsburg: People hate mandates...but they also hate irresponsible behavior. It's a real balance. 5:41 AnthonyWright: Obama references Wendell Potter. Insurers are rewarded for denying coverage. 5:41 AnthonyWright: I don't want to put them out of business. I want to hold them accountable. 5:42 Dr. Michael Wilkes: Cherry picking is a concept that is essential understand. It implies that insurance companies choose healthy, young people wo are less likely to get sick. It also implies the similar but opposite concept of "dumping". Dumping is the process of trying to get rid of those most like to cost money (elderly, pre-existing conditions, etc.) 5:42 AnthonyWright: Obama defends the public insurance option, says what it is and what it won't be. 5:45 AnthonyWright: Did a member of Congress really yell out "liar" to the President? We've lost some decorum here... 5:46 Dr. Michael Wilkes: Yes, this issue has become very divisive. 5:46 Marge Ginsburg: Providing a choice: magic words! 5:46 Dr. Michael Wilkes: Appealing to fiscal conservatives... 5:47 AnthonyWright: New Idea: Promises spending cuts if the savings aren't realized. (And let's be clear, a lot of the preventative savings aren't being scored) 5:47 Dr. Michael Wilkes: Wow... The President is also stepping into it with digs against the Bush administration. In my opinion, not a wise step. 5:47 AnthonyWright: Obama talks directly to seniors. 5:48 brogonzo:#hc09 Obama is reaching across the aisle to offer olive branches to some, and blacken the eyes of the irresponsible 5:50 AnthonyWright: Just saw CA Sac-area Congressman Tom McClintock not applauding 5:50 AnthonyWright: Obama: I will protect Medicare. 5:52 AnthonyWright: New Idea: Embraces fee on certain insurance policies that is in the Baucus plan 5:52 AnthonyWright: New idea: Obama embraces medical malpractice reform, gets standing O from both sides. Not a "silver bullet." Patient safety first. 5:53 Dr. Michael Wilkes: Malpractice is absolutely essential to improve quality, but it needs to be kept in check to avoid this defensive medicine. 5:53 amorporchoco: Liking the trend towards the center - not sure how the finances balance out, but I do know something needs to change. #hc09 5:53 AnthonyWright: Obama: move forward on malpractice proposals by Bush Admin 5:54 AnthonyWright: $900 million cost: My concern is that it won't provide the help that people need to actually make coverage affordable. 5:54 elleabis:#hc09 malpractice reform is necessary also 5:54 thanasipetridis: He’s making a lot of people happy so far... #hc09 5:55 Dr. Michael Wilkes: elleabis: Reform needs to happen, but MP can't be eliminated as it is an important check on the system. Sure it also has incentives that drive to higher costs and those need to be addressed. 5:56 AnthonyWright: I am also tweeting at @healthaccess. 5:56 AnthonyWright: Important tribute to Ted Kennedy. Panning to Vicky Kennedy, sons. 5:58 AnthonyWright: He's right: this is more than health care. It's about the character of our country. That's why the debate. 5:58 AnthonyWright: Wow. He is going right to the core of the issue. 5:59 Marge Ginsburg: People really do believe that the character of our country is at stake -- it's a message we need to remind them sometimes! 6:00 AnthonyWright: What does it mean to be an American? He is recognizing that the debate is really not about health policy... 6:01 AnthonyWright: "Govt cannot and should not solve every problem... the danger of too much govt is matched by the perils of too little. " 6:02 AnthonyWright: This is Professor Obama, talking to us like adults. 6:03 Marge Ginsburg: And this is what he is particualry skilled at. 6:03 AnthonyWright: "We did not come to fear the future. We came here to shape it." 6:04 Linda Gonzales/sacbee.com: The president's speech has concluded. What did you think? 6:04 AnthonyWright: He didn't go for obvious pandering... 6:05 Dr. Michael Wilkes: Did he succeed in laying out an effective blueprint? Do you now know what his plan will entail? 6:05 Marge Ginsburg: I think he hit a home run...this is an emotional issue, not just a political one. 6:06 AnthonyWright: About five new details, and clarifications about what the President supports. 6:06 Dr. Michael Wilkes: I like the high risk pool, insurance company fees, individual mandate, public option... but the devil is still in the details. Of course he missed a few important areas, although they may opted for simplicity. 6:06 AnthonyWright: He didn't disavow the left, but he focused on the middle, 6:07 Marge Ginsburg: He had no choice but to focus on the middle...that's where most people are. 6:08 Linda Gonzales/sacbee.com: Can anyone speak to the cost of health care under reform plans? 6:08 Linda Gonzales/sacbee.com: The Republican response being televised now is keying on the price of health care, saying costs will rise. 6:08 AnthonyWright: The Republican response is just using talking points that have little reference to the actual bill... 6:10 AnthonyWright: Costs are $900 billion, paid for by savings from the system, employer & individuyal premiums, etc... 6:10 AnthonyWright: The idea to buy insurance across state lines is just a way to eviscerate state consumer protections. If an insurer denied you care, do you want to go to the Delware or Alabama Dept of Insurance? 6:12 [Comment From lite_speed] In a single payer system you would not be denied care. i am surprised that Americans are not embracing that single point. 6:12 AnthonyWright: The R response wasn't truthful. Wouldn't improve the Medicare program? I think seniors in the "donut hole" who have trouble buying Rx drugs would disagree. 6:13 AnthonyWright: KCRA-Sacramento is running a "Prescription for Change" special. I'll be commenting later in the hour. 6:14 AnthonyWright: The President made key points how people would benefit. People get coverage through 1 of 3 ways: through employers, safety-net programs, and buying it as individuals. 6:14 Linda Gonzales/sacbee.com: Dr. Wilkes, along with Shannon Brownlee of the New America Foundation, wrote a column for today's Bee. You can read it here: http://www.sacbee.com/opinion/story/2168499.html 6:14 Dr. Michael Wilkes: In closing the President could have mentioned more about the system being badly broken (besides malpractice). The system isn’t honest with patients, it doesn’t allow doctors or patients the information they need to make choices, it pushes for more treatment instead of better care, it allows pharmaceutical companies to push drugs and advertise treatments for diseases that don’t exist or that aren’t effective treatments. It is all about incentives pushing the system in the wrong direction. We need to re-align incentives for hospitals, doctors, pharmaceutical companies and consumers... 6:15 AnthonyWright: For those with employer-based coverage, it provides stability and security, setting some minimum standards--much like the minimum wage for pay. It would also provide help to small biz. 6:16 Marge Ginsburg: I suspect if he talked too much about improving how healthcare is delivered, it might worry people about gov't intrusion into the doctor-pt. relationship. 6:16 AnthonyWright: For those with Medicaid & Medicare, it would improve & expand coverage: fill the donut hole, increase reimbursement rates, etc. 6:18 AnthonyWright: For those who buy coverage as individual, it would provide new consumer protections, subsidies, and an exchange to buy coverage, including a public health insurance option. 6:18 Linda Gonzales/sacbee.com: Thank you again to our three panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis. Dr. Wilkes also writes a weekly column for The Bee. Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. Anthony Wright, executive director of Health Access California in Sacramento.
While there's been a lot of concern in federal health reform about the public health insurance option, I am more concerned with the possible scaling back of affordability subsidies. Partially because of concern for the size of the number, and partially because some don't want to have to raise the needed revenues, there is talk in the Senate and even in the White House about to make the bill cost less, from about $1 trillion over 10 years to about $700 million.
The cost of the bill is for the subsidies and assistance to low- and moderate-income families to afford health coverage. Do they do enough? Former LA Times Sacramento reporter Jordan Rau at Kaiser Health News reports on this issue with some real examples, no doubt informed by his experience reporting on the California attempt at health reform in 2007-8, as that was the core issue here: what is affordable?
However appealing it sounds, scaling the cost of the bill back is to make low- and moderate-income families pay more in premiums and/or out-of-pocket costs, or get less in terms of benefits. For many, it will still be an improvement over the current status quo, where people struggle to makes ends meet, or simply go uninsured and fully exposed to medical debt and bankruptcy. But as Ezra Klein at the Washington Post indicates, if the bill is scaled back too much, the reform collapses.
Affordability was the issue in *the* key issue in the California debate, it is *the* issue now.
It looks like Anthem Blue Cross of California is willing to be the bad guy again in the national debate. As Ben Smith in Politico writes and excerpts, they have sent a mass E-mail to their subscribers, making false charges and repeating scare tactics about health reform proposals.
With a 33 million customer list, insurance giant Wellpoint is now actively fueling the misinformation campaign against health insurance reform and America’s Affordable Health Choices Act. In a recent email to customers, California insurer Anthem Blue Cross, a Wellpoint subsidiary, attacked the bill on key fronts.
Myth: The House bill will cause “tens of millions of Americans to lose their private coverage and end up in a government-run plan…”
Fact: Actually, according to non-partisan Congressional Budget Office (CBO), private insurance coverage will expand by 16 million under reform. And under the House bill, no one can ever be forced onto the public health insurance option. The only way someone would be in the public plan is as a result of their own individual choice...
Myth: The House bill will limit “customers' choices of the products they can purchase and how they can purchase health coverage…"
Fact: The heart of the House bill is actually to create MORE choice and MORE options – and to help more Americans afford those options. If you have a private insurance plan now, the House bill:
* provides competition to help make your plan more affordable,
* ends the insurance company practices of discrimination based on age, pre-existing condition, or a newly discovered illness,
* ends copays for preventive care, caps what you pay out-of-pocket, but eliminates yearly or lifetime cost caps on what insurance companies pay, and
* requires a minimum set of benefits to help protect you from the fine print in a flimsy plan.
If you need to purchase health insurance, the bill creates an Insurance Exchange, providing one-stop shopping where you can compare and find the best and most affordable plan for you. All those using the Insurance Exchange will have a range of choices – various private plans, and the public plan.
Myth: The House bill will increase the “premiums of those with private coverage by imposing new mandates and coverage requirements.”
Fact: The House bill promotes competition—designed to make your private insurance premiums more affordable—and offers affordability credits to those who need them. The bill’s minimum benefit requirements (the so-called “coverage requirements” under attack) are modest (less than the average benefit offered today), will NOT lead to increased premiums, and are designed to protect Americans from insurance company whims and fine print.
Furthermore, the bill contains numerous provisions to lower your costs, with caps on what you pay but not what insurers cover, no copays for your preventive care, and ending discrimination against you for getting sick or having a pre-existing condition...
For more health insurance reform myth busting, please click here.
Changing the channel and the health reform debate..
Saturday, August 29, 2009
Are the tea party protest fading? Health Access staffers and allies have been to many Congressional town halls in the last few weeks. Despite the media narrative, my sense is that after the first week of August, health reform supporters have matched and often outnumbered opponents. In some areas, like the town halls of Rep. Diane Watson or of Rep. Judy Chu, they don't show up with any visible presence at all. The "tea party"activists have called protests against Representative Henry Waxman, Senator Dianne Feinstein, and others, yet the number of health reform supporters have outnumbered the opponents by 5 to 1.
Has the opposition already peaked? While focused more on environmental issues, the Sacramento "tea party" rally had a significant turnout on Friday, but fell it well short of the 10,000 people advertised, and also was significantly less than the turnout earlier at a previous protest in April. Maybe the reason was that this time, it didn't feature a Fox News star, Neil Cavuto, as a headliner.
Fox News certainly has played a role in organizing the opposition. But even the mainstream media has promoted bad behavior, focusing on the tactics of disruption rather than the substance of the debate.
The town halls have been more like Fox's reality show programming than their baseball coverage, by focusing and encouraging outrageous behavior. The town hall coverage has been like if Fox focused on the fights in the stands rather than the game on the field. Fox does show most of the people in the stands, the cheers and jeers, and the signs supporting or opposing a certain team. But if someone runs onto the field, the camera turns away, not to encourage people from doing the same and ruining the event for everyone.
Beyond Joe Buck and Joe Millionaire, the Fox network provides another model for a way out of August into the fall season—American Idol. It starts with large casting calls--frankly bigger than any of the protests opposing reform. It goes on to give 15 minutes of fame to the most outrageous, most outlandish of performers. (This could include protest from the British representative--perhaps Simon Cowell could have tweeted #WeLoveTheNHS). But as we go into the fall, quality of voice matters. Popular support matters.
As health reformers, we need talk to our friends and neighbors. The novelty acts fall away as we concentrate on some key voices, even if we’ve heard the words before. And hopefully like health reform, a winner passes through the final gauntlet—maybe not everyone’s top choice, but one that is deserving.
There are 47 million Americans without health insurance, and we all pay for their health care through our taxes and in increased insurance premiums. How do we cover them at a cost that doesn't break the U.S. treasury?
There are at least 12 million Americans who have "pre-existing conditions," allowing insurance companies to deny coverage or put them in a costly high-risk pool with high deductibles and limited coverage. This must be fixed because this is one of the most unfair parts of the current system. The concept of pre-existing conditions was developed by insurance companies to pad their profits by limiting their payouts. Insurance is based on spreading risk among a broad pool of people. But if the insurance companies only have to cover healthy people, why have insurance at all? People with health problems must be covered at a fair cost.
Millions of Americans are stuck in their jobs because they fear losing their health insurance if they go to another job. We must find a way to allow workers to move from job to job without worrying about whether they'll have health coverage.
We must make an investment in preventative care to limit the overall cost of health care. That will improve the quality of life of individuals and be a wise financial decision in the long run by treating illness before they require costly hospital care. There must be incentives for Americans to lead healthy lives, including maintaining a healthy weight and stopping smoking.
We must rein in the escalating costs of health care in a way that does not compromise care. That can be done in many ways through efficiencies such as improving the wasteful and duplicative billing and insurance claims system.
It's time to step back and look at ways to improve the nation's health care system for everyone. But right now the debate is being seen through a political lens, and that is a losing proposition.
Access to quality health care at an affordable price should not be a political issue.
The Central Valley will have a key role to play before health reform is done.