"In an effort to deny more than 30 million uninsured Americans health care coverage, 26 states have filed legal action against the Affordable Care Act which passed last year. But Republican demagoguery costs money and âthe [lawsuit's] cost the states have split so far amounts to $46,000.â But Florida Republican Attorney General Pam Bondi has âaid less than $6,000â³ for its lawsuit. Why? Because an anti-health care lobbying group is picking up the 26-state tab"
While dubbing itself âthe Voice of Small Business,â NFIB has spent the past two years âyoking itself to the GOPâ while simultaneously âjeopardizing billions of dollars in credit, tax benefits and other federal subsidiesâ at the expense of small businesses. Affiliated with both the U.S. Chamber of Commerce and the GOP âsince the Reagan era,â NFIB âis run mostly by and for Republicansâ and spent 93 percent of its campaign contributions on GOP candidates. It is no wonder, then, that NFIB is happy to pay to secure the top GOP priority and equally âdelightedâ to see the pay off.
A [Massachusetts] official may have gone off-script last week, but what he had to say is an important contribution to the stateâs ongoing debate over reining in health care costs.
Terry Dougherty, director of MassHealth, the stateâs Medicaid program, was addressing a budget hearing in Boston Friday, State House News Service reports. He noted a little-known fact that runs counter to the widespread assumption that government is more wasteful than the private sector.
MassHealth, which insures nearly 1.3 million Massachusetts residents, spends just 1.5 percent of its $10 billion budget on administration, Dougherty said, while private insurers spend about 9.5 percent of their revenue on administration.
âI like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,â Dougherty said. Under a single payer system â like MassHealth or Medicare â the government pays health care providers directly, instead of an insurance company.
Unlike private insurance companies, Dougherty said later, at MassHealth âWe donât build big buildings. We donât have high salaries. We donât have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth â¦ who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.â
"U.S. District Judge Gladys Kessler didn't just endorse the constitutional legitimacy of the Patient Protection and Affordable Care Act on Tuesday evening. She used her 64-page ruling to answer some of the most basic criticisms of the new federal health care law. And she was as blunt in its defense as two of her colleagues on the federal trial bench, in Florida and Virginia, have been in striking down the contentious measure."
In a footnote, Judge Kessler wrote: "To put it less analytically, and less charitably, those who choose -- and Plaintiffs have made such a deliberate choice -- not to purchase health insurance will benefit greatly when they become ill, as they surely will, from the free health care which must be provided by emergency rooms and hospitals to the sick and dying who show up on their doorstep. In short, those who choose not to purchase health insurance will ultimately get a 'free ride' on the backs of those Americans who have made responsible choices to provide for the illness we all must face at some point in our lives."
By playing the "free ride" card, and by suggesting that those who do not purchase health insurance are making irresponsible choices that eventually harm others, Judge Kessler is reminding her readers that the dense legal issues involved in all of these cases have as their backdrop the nation's colossal health-care mess. The quote is a very pointed and unusual expression of official frustration (no wonder it's in a footnote) and it speaks not to the lawyers and the judges who will ultimately determine the fate of the new law, or to the politicians who created it in the first place, but to all the Americans out there who refuse to buy health insurance in the name of federalism and the 10th Amendment.
Then, later in her ruling, as if her initial point were not clear enough, Judge Kessler wrote: "It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not 'acting,' especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality."
Here we have a direct shot across the bow of the good ship Vinson, as in U.S. District Judge Roger Vinson, the Reagan appointee who last month tossed out the health-care law in its entirety. At the time, Judge Vinson wrote (PDF): "If Congress can penalize a passive individual for failing to engage in commerce, the enumeration of powers in the Constitution would have been in vain for it would be 'difficult to perceive any limitation on federal power.' and we would have a Constitution in name only. Surely this is not what the Founding Fathers could have intended"
Expanded Medicare for All - Single Payer, would have been so much easier - and cheaper....
"A federal judge on Tuesday threw out a lawsuit claiming that President Barack Obama's requirement that all Americans have health insurance violates the religious freedom of those who rely on God to protect them.
U.S. District Judge Gladys Kessler in Washington dismissed a lawsuit filed by the American Center for Law and Justice, a Christian legal group founded by evangelist Pat Robertson, on behalf of five Americans who can afford health insurance but have chosen for years not to buy it."
Susan Martin: Besides being a commentator, you are a medical doctor who criticized health care reform as a â2,000-page bill that will generate tens of thousands of pages of regulations.â Isnât that a great argument for the simplicity of Canadian-style universal health care?
Charles Krauthammer: It is. But it seems to me there are two choices. We have the best medical care in world but it is the most expensive and we waste a lot. What you need to do is reduce the complexity and inefficiency. If we canât get it right, weâre eventually going to a single-payer system. At least it doesnât have this incredible, absurd complexity of ObamaCare. Itâs the worst of the worst. It has the complexity of our (present) system and doesnât give the universal coverage of single payer.
Itâs not that we donât understand the efficiency and effectiveness of single payer; we clearly do. The opposition has been primarily from those who, on an ideological basis, oppose any role of government in health care, other than as a safety net for the indigent. But even their icon of liberty, Friedrich Hayek, stated in his classic, The Road to Serfdom, âNor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.â
The logic for single payer is there, and there is no longer any reason to perpetuate the ideological divide. The conservatives need to revisit Friedrich Hayek, and the liberals need to review again the tenets of social justice, perhaps beginning with Article 25 of The Universal Declaration of Human Rights. Once we get our respective camps in order, we should find that we have a common meeting ground.
Peter Shumlin, the newly elected governor of Vermont, has a plan for health-care reform: Rather than repeal it, he wants to supercharge it. His state will set up an exchange, and then, as soon as possible, apply for a waiver that allows it to turn the program into a single-payer system. You can read a summary of the plan here(Word file). I spoke with Shumlin this morning, and a lightly edited transcript of our conversation follows.
Ezra Klein: The report(PDF) prepared by Dr. William Hsiao offered three options for Vermont: single payer, a strong public option and a form of private-public single payer. My understanding is that you're backing the third option. What separates it from a traditional single-payer system?
Peter Shumlin: Single payer means something different to everyone. The way I define it is that health care is a right and not a privilege. It follows the individual and not the employer. And itâs publicly financed. The only difference between single-payer one and single-payer three in Hsiao's report is that in single-payer three, the actual adjudication of payment is contracted to an existing insurance entity. So the state doesn't have to set up a new bureaucracy to run it. His modeling suggests thatâd be more economical. It's a minute difference.
EK: And why go to a single-payer system at all?
PS: In Vermont, this is all about cost containment. There are 625,000 people in Vermont. We were spending $2.5 billion on health care a decade ago. Now weâre above $5 billion. And we project weâll be spending a billion dollars more in 2014. This is where everyone has failed in health-care reform. And this will go after three of our main drivers of costs.
First, Vermont spends 8 cents on every dollar on administrative costs, just chasing the money around. Thatâs a huge waste of money. Second, weâll use technology to conquer waste. You'll get a Vermont medical card, and everyoneâs medical records will be on that card, so youâll go into a doctorâs office and theyâll know what the last doctor did to you. That helps avoid duplication of services. And the last piece, the most challenging, is remaking the payment system so providers are paid for making you healthy, not for doing the most procedures.
EK: Single-payer systems often lose on the ballot and in the legislature. No state has successfully managed to pass one into law, much less implement it. And the objection that usually stands in the way of these projects is that I'm happy with my health-care insurance, and I don't trust the government to create something new and put me into it. How do you answer that?
PS: I suspect Iâm the only politician in America who won an election in this last cycle with TV ads saying I was going to try to pass the first single-payer system in America. This election was a confirmation of my judgment that Vermonters are tired of enriching pharmaceutical companies and insurers and medical equipment makers at the expense of their family members. The reality in Vermont is that there are not very many Vermonters who are happy with the current system. Weâre losing our rural providers. Our small hospitals are struggling. And Vermonters are lowering their coverage and paying more and more for it.
EK: How will the funding work? Right now, a lot of money comes from employers. What happens to their share?
PS: Where health care has failed is in designing a cost containment mechanism that works. Thatâs the really hard part of our job. So Iâm asking us to spend the next 12 months designing the tools for cost containment. Once we do, we'll figure out how to structure the way we pay for it.
EK: One of the things you asked of Dr. Hsiao was to preserve provider incomes. How can you do that while cutting costs? At some point, doesn't lower spending also mean fewer doctors or hospitals or lower incomes?
PS: The reason Vermont has the opportunity to be the lab for a different kind of change is that we donât have a lot of high-paid physicians in Vermont. We have a lot of low-paid physicians. We have rural providers whoâre making less than they did when they graduated from medical school. Our cost driver is not that we have a lot of physicians running around in Mercedes-Benzes. Itâs waste in the system.
EK: How will this interact with other systems? Let's say I have Kaiser Permanente. I come to Vermont and break my leg. What happens?
PS: Nothing different than what happens right now. Youâd go to one of our providers' offices, and theyâd bill Kaiser for that one. No different than if you break a leg in France or Switzerland. Radical as this seems to Americans, the rest of the world has figured this out and gotten it right. We keep getting it wrong, and weâre paying for it.
The Affordable Care Act puts states in the driver's seat because they often understand their health needs better than anyone else - and that is why it is so frustrating to hear opponents of reform falsely attack the law as "nationalized health care."
The truth is that states aren't just participating in implementation of the law; they're leading it.
Health insurance shoppers are considering a new version of an old discount strategy that can be summed up in three words: Hold the Mayo.
Bloomington-based HealthPartners last year started marketing health plans that feature a network of hospitals and doctors that doesn't include the Mayo Clinic. In exchange for not having access with low co-payments to the iconic Rochester, Minn., clinic, subscribers pay lower premiums when they select a HealthPartners plan with Mayo as an out-of-network option.
Last year, Eagan-based Blue Cross and Blue Shield of Minnesota also started emphasizing health insurance products for individuals in which Mayo isn't in the network of providers.
Mayo has been celebrated nationally for providing high-quality and low-cost health care, but health insurance brokers say the local reputation is different as far as cost goes.
"Mayo is cheap only compared to other national care centers, but in general is a higher-cost center when compared to its Minnesota peers," said Christopher Schneeman, a health insurance broker with SevenHills Benefit Partners in St. Paul.
House Republicans have pledged to repeal and/or defund the health care law. Rep. Michele Bachmann (R-MN) even adopted the effort as her sole âmotivation in life.â But, for at least 16 GOP lawmakers, the reality of the partyâs position is coming home to roost. These Republicans, âmany of whom were swept into office fueled by tea party anger over the health care law,â are now facing the same expensive, unforgiving health insurance market as middle-class Americans the GOP wantonly abandoned
GOP lawmakers have struggled to explain why they deserve government-subsidized health care while ordinary Americans donât. Rep. Aaron Schock (R-IL) said he accepted federal health care because he was âactually loweringâ premiums for older lawmakers. When asked whether heâd turn down taxpayer benefits, Rep. Bill Posey (R-FL) actually said, âI donât know. Am I a federal employee?â And Rep. Michael Grimm (R-NY) offered a more blunt â and revealing â response: âWhat am I not supposed to have health care?â¦God forbid I get into an accident and canât afford the operation. That can happen to anyone.â
The U.S. House of Representatives is likely to vote to block funding for President Barack Obama's signature healthcare overhaul when it takes up a budget plan next week, House Republican Leader Eric Cantor said on Tuesday.
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