Will Obamacare raise the price of your pizza?
By Aaron E. Carroll, Special to CNN
New Maine insurer to get $62 million loan for co-op program
The nonprofit, consumer-oriented Maine Community Health Options would fill a niche created by the Affordable Care Act.
PORTLAND — A new nonprofit health insurer for Maine will receive $62.1 million in financing from the federal government to help it start offering affordable insurance options to individuals and small businesses in 2014.
Maine Community Health Options will receive the loan money from the federal Centers for Medicare and Medicaid Services. Of the total, $7.1 million is to develop a subscriber-run plan and $55 million is to meet the plan's reserve requirements.
Congress has appropriated $3.4 billion in loans to establish such insurers.
Maine Community Health Options is a new type of private insurer -- a consumer-operated and consumer-oriented plan -- that was created by the federal Affordable Care Act.
The co-ops are a substitute for the government-run public option that was discarded in the final version of the health care overhaul.
The details are still being developed. The goal is to establish co-ops in time to begin enrolling subscribers in October 2013. Coverage will begin Jan. 1, 2014.
Can Maine cut Medicaid? Depends on how broadly you read the Supreme Court ruling
By Matthew Stone, BDN Staff
Posted Aug. 10, 2012, at 4:51 p.m.
AUGUSTA, Maine — As the federal government reviews Maine’s request to make about $20 million in cuts to its Medicaid program, the debate is still brewing over whether Gov. Paul LePage’s administration has the legal authority to make those cuts.
And the side you take largely revolves around one question: How far-reaching is the Supreme Court’s June ruling that largely upheld the Obama administration’s health care reform law?
Not very, for those who think the Medicaid cuts are illegal.
Maine Equal Justice Partners, an organization that provides legal aid to low-income residents, rekindled the debate on Thursday when it sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius urging her to reject the LePage administration’s request to cut coverage for about 36,000 residents.
At issue is the court decision’s effect on the “maintenance of effort” requirements of the Affordable Care Act, which largely prohibited states from scaling back existing Medicaid services in advance of the law’s 2014 Medicaid expansion.
“We believe the Supreme Court decision had very limited holding, and it was specifically to the enforcement mechanism of the Medicaid expansion,” said Sara Gagne-Holmes, the group’s executive director. “We didn’t believe it impacted maintenance of effort. These cuts would be contrary to the federal law.”
While the Supreme Court in June largely upheld the health care law as constitutional, the court ruled it unconstitutional for the federal government to withhold funds for existing Medicaid services as a way to enforce the Medicaid expansion.
The LePage administration read that part of the ruling more broadly and took it as a sign it could make cuts to its existing Medicaid program through a routine process — an amendment to Maine’s Medicaid State Plan. Attorney General William Schneider said earlier this month that the maintenance of effort requirements are “part and parcel of the Medicaid expansion that was struck down.”
Ambiguity in Health Law Could Make Family Coverage Too Costly for Many
By ROBERT PEAR
WASHINGTON — The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular.
Under rules proposed by the service, some working-class families would be unable to afford family coverage offered by their employers, and yet they would not qualify for subsidies provided by the law.
The fight revolves around how to define “affordable” under provisions of the law that are ambiguous. The definition could have huge practical consequences, affecting who gets help from the government in buying health insurance.
Under the law, most Americans will be required to have health insurance starting in 2014. Low- and middle-income people can get tax credits and other subsidies to help pay their premiums, unless they have access to affordable coverage from an employer.
The law specifies that employer-sponsored insurance is not affordable if a worker’s share of the premium is more than 9.5 percent of the worker’s household income. The I.R.S. says this calculation should be based solely on the cost of individual coverage for the employee, what the worker would pay for “self-only coverage.”
Critics say the administration should also take account of the costs of covering a spouse and children because family coverage typically costs much more.
In 2011, according to an annual survey by the Kaiser Family Foundation, premiums for employer-sponsored health insurance averaged $5,430 a year for single coverage and $15,070 for family coverage. The employee’s share of the premium averaged $920 for individual coverage and more than four times as much, $4,130, for family coverage.
Under the I.R.S. proposal, such costs would be deemed affordable for a family making $35,000 a year, even though the family would have to spend 12 percent of its income for full coverage under the employer’s plan.
The debate over the meaning of affordable pits the Obama administration against its usual allies. Many people who support the new law said the proposed rules could leave millions of people in the lower middle class uninsured and frustrate the intent of Congress, which was to expand coverage.
Understanding the Ryan plan
By Matt Miller, Published: August 12
The striking thing about Paul Ryan’s ascent is the gulf between his proposals and the way the media have characterized them. Since Mitt Romney named Ryan to the ticket on Saturday, the news has been filled with talk of the “ fiscal conservative ” (NPR) “ intent on erasing deficits ” (New York Times) who has become “ the intellectual heart of the Republican Party’s movement to slash deficits” ( The Post). All of this is demonstrably false. Ryan’s con has succeeded largely because Democrats haven’t sensed the political salience of assailing his plans from the right ; instead, they’ve chosen to slam only Ryan’s regressive priorities and Medicare scheme.
This strategic error allows the presumption that Ryan, and thus Romney, are the true apostles of fiscal responsibility in this race, a value important to the voters who will decide November’s outcome. But the con has worked in part because budgets make journalists’ eyes glaze over, and once the phony Ryan meme took hold two years ago it became hard to dislodge.
Now that Ryan is on the ticket, however, the stakes are too high not to expose the fraud. In that spirit (and at the risk of taxing readers who’ve heard my Ryan fetishes before), I offer one wonk’s guide to what every citizen should know about Ryan’s plans. Otherwise, like the talented Mr. Ripley, Ryan will continue to get away with (fiscal) murder.
Ryan is not a “fiscal conservative.” A fiscal conservative pays for the government he wants. Ryan never has. His early “Roadmap for America’s Future” didn’t balance the budget until the 2060s and added $60 trillion to the national debt. Ryan’s revised plan, passed by the House in 2011, wouldn’t reach balance until the 2030s while adding $14 trillion in debt. It adds $6 trillion in debt over the next decade alone — yet Republicans had the chutzpah to say they wouldn’t raise the debt limit! (I remain mystified why President Obama never hammered home this reckless contradiction by insisting that the GOP “raise the debt ceiling just by the amount it would take to accommodate the debt in Paul Ryan’s budget.”)
To Isaiah
Donald M. Berwick, MD, MPP
JAMA. 2012;307(24):2597-2599. doi:10.1001/jama.2012.6911
Thank you for letting me share this glorious day with you and your loved ones. Feel good. Feel proud. You’ve earned it.
In preparation for today, I asked your dean of students what she thinks is on your mind. So, she asked you. The word you used—many of you—was this one: Worried. You're worried about the constant change around you, uncertain about the future of medicine and dentistry. Worried about whether you can make a decent living. You’ve boarded a boat, and you don't know where it's going.
I can reassure you. You’ve made a good choice—a spectacularly good choice. The career you’ve chosen is going to give you many moments of poetry. My favorite is the moment when the door closes—the click of the catch that leaves you and the patient together in the privacy—the sanctity—of the helping relationship. Doors will open too. You’ll find ways to contribute to progress that you cannot possibly anticipate now, any more than I could have dreamed of standing here when I was sitting where you are 40 years ago.
But look, I won't lie; I’m worried too. I went to Washington to lead the Centers for Medicare & Medicaid Services, full of hope for our nation's long-overdue journey toward making health care a human right here, at last. In lots of ways, I wasn't disappointed. I often saw good government and the grandeur of democracy—both alive, even if not at the moment entirely well.
But, like you, I also found much that I could not control—a context torn apart by antagonisms—too many people in leadership, from whom we ought to be able to expect more, willing to bend the truth and rewrite facts for their own convenience. I heard irresponsible, cruel, baseless rhetoric about death panels silence mature, compassionate, scientific inquiry into the care we all need and want in the last stages of our lives. I heard meaningless, cynical accusations about rationing repeated over and over again by the same people who then unsheathed their knives to cut Medicaid. I watched fear grow on both sides of the political aisle—fear of authentic questions, fear of reasoned debate, and fear of tomorrow morning's headlines—fear that stifled the respectful, civil, shared inquiry upon which the health of democracy depends.
And so, HSDM and HMS Class of 2012, I’m worried too. I too wonder where this boat is going.
There is a way to get our bearings. When you're in a fog, get a compass. I have one—and you do too. We got our compass the day we decided to be healers. Our compass is a question, and it will point us true north: How will it help the patient?
This patient has a name. It is “Isaiah.” He once lived. He was my patient. I dedicate this lecture to him
http://www.pnhp.org/print/news/2012/august/to-isaiah
JAMA. 2012;307(24):2597-2599. doi:10.1001/jama.2012.6911
Thank you for letting me share this glorious day with you and your loved ones. Feel good. Feel proud. You’ve earned it.
In preparation for today, I asked your dean of students what she thinks is on your mind. So, she asked you. The word you used—many of you—was this one: Worried. You're worried about the constant change around you, uncertain about the future of medicine and dentistry. Worried about whether you can make a decent living. You’ve boarded a boat, and you don't know where it's going.
I can reassure you. You’ve made a good choice—a spectacularly good choice. The career you’ve chosen is going to give you many moments of poetry. My favorite is the moment when the door closes—the click of the catch that leaves you and the patient together in the privacy—the sanctity—of the helping relationship. Doors will open too. You’ll find ways to contribute to progress that you cannot possibly anticipate now, any more than I could have dreamed of standing here when I was sitting where you are 40 years ago.
But look, I won't lie; I’m worried too. I went to Washington to lead the Centers for Medicare & Medicaid Services, full of hope for our nation's long-overdue journey toward making health care a human right here, at last. In lots of ways, I wasn't disappointed. I often saw good government and the grandeur of democracy—both alive, even if not at the moment entirely well.
But, like you, I also found much that I could not control—a context torn apart by antagonisms—too many people in leadership, from whom we ought to be able to expect more, willing to bend the truth and rewrite facts for their own convenience. I heard irresponsible, cruel, baseless rhetoric about death panels silence mature, compassionate, scientific inquiry into the care we all need and want in the last stages of our lives. I heard meaningless, cynical accusations about rationing repeated over and over again by the same people who then unsheathed their knives to cut Medicaid. I watched fear grow on both sides of the political aisle—fear of authentic questions, fear of reasoned debate, and fear of tomorrow morning's headlines—fear that stifled the respectful, civil, shared inquiry upon which the health of democracy depends.
And so, HSDM and HMS Class of 2012, I’m worried too. I too wonder where this boat is going.
There is a way to get our bearings. When you're in a fog, get a compass. I have one—and you do too. We got our compass the day we decided to be healers. Our compass is a question, and it will point us true north: How will it help the patient?
This patient has a name. It is “Isaiah.” He once lived. He was my patient. I dedicate this lecture to him
http://www.pnhp.org/print/news/2012/august/to-isaiah
Health care cost -- Myth versus reality
By Ethan Parke
Vtdigger (Montpelier, Vt.), Aug. 9, 2012
Single payer critics warn that Vermont should not go forward with Green Mountain Care because there are too many unknowns. But one thing is certain — if we do nothing, health care expenditures in Vermont (from all sources) are expected to reach $10 billion a year by the year 2020. That’s a back-breaking $16,000 per person, which could very well doom our economy.
A single-payer system would empower Vermont, as a commonwealth of citizens, to take charge of its own health care spending. One accountable entity, subject to public oversight and control, would administer the flow of dollars from all sources to health care providers, eliminating the excessive profits and administrative waste that plague our current system.
Yet the single payer naysayers claim that doctors will leave the state, and infer that costs can be controlled only at the expense of health care quality. This has not been the case in other countries, which have a single-payer system with plenty of doctors, but which spend less than we do, and have higher indicators of health.
So where exactly is the fat in our current system? What can be cut without sacrificing quality? These are important questions that the Green Mountain Care Board would do well to examine in detail. The board must correctly identify the root causes of health care inflation in order to make the right decisions as we move toward a single payer.
Along the way, the board should be careful to avoid misconceptions. A prize-winning Michigan journalist, Julie Mack, recently wrote an article debunking the myths that opponents of health care reform recite as reasons why we must live with the world’s highest health care costs. See her article here.
The five false assumptions are (1) we have the best care in the world; (2) we don’t ration care as other countries do; (3) we have bad habits and are therefore less healthy than people elsewhere; (4) our medical malpractice lawsuits are out of control; and (5) the U.S. government is a free spender on health care.
Mack showed that all five of these assertions are contradicted by statistical evidence. She based her conclusions on a 2011 report by the Organization for Economic Cooperation, and from other reliable sources, such as the nonpartisan Congressional Budget Office. Mack then went on to list the real reasons for high health care costs, roughly in order of magnitude. If she is correct, these are the things the Green Mountain Care Board should focus on fixing:
First, U.S. health care providers charge much more than providers in other developed countries. For instance, in 2007 an appendectomy in the U.S. was billed at an average of $7,962. In Canada the charge was $5,004, and in Germany $2,943. An MRI in the U.S. averaged $1,009, while the same test was $304 in Canada, and only $187 in Britain. The same disparity was true for pharmaceuticals. In the U.S. we simply pay much more per product or per service, than people in other developed countries.
http://www.pnhp.org/print/news/2012/august/health-care-cost-myth-versus-reality
MarketWatch, The Wall Street Journal, Aug. 9, 2012
PORT TOWNSEND, Wash. (MarketWatch) — It’s a relief to see hard facts finally emerging on this side of the border about Canada’s single-payer health-care system.
For years I’ve heard Canada’s popular medicare (the Canadian term for universal health care) system slagged by lies, distortions, and outright ignorance on U.S. radio talk shows and other American popular media (where do people GET this stuff?). And for years, I’ve tried to set the record straight in my online and newspaper columns, having lived in Canada and actually having used their system. My son and his family are now covered by it in Vancouver.
Also, for years I’ve heard from Canadians, in Comments under my pieces and in email, thanking me for trying to set the record straight. They overwhelmingly like their medical delivery system, which turned 50 just last month.
I’ve also heard Canadian talk-show callers upset and incredulous about the nonsense being circulated south of the border about their single-payer medical system, which is still evolving as Ottawa pays less and the provinces pay more of growing health-care costs.
Anyone who wants a strong, honest defense of the Canadian system should keep a copy handy (and print out, as I have) a well-written piece — a touchstone, actually — in the latest online edition of the journal of the U.S.’ large and powerful AARP.
The well-researched, fact-based AARP article is written by an American, Aaron E. Carroll, M.D., and is titled “5 Myths About Canada’s Health Care System.” Its subhead:
“The truth may surprise you.” It just might, my fellow Americans.
To separate fact from polarizing talk-show nonsense, Carroll, the director of the Center for Health Policy and Professional Research in Indianapolis, examined the major myths about the Canadian and U.S. systems, myths I hear repeatedly voiced on U.S. talk shows of all political stripes.
The first myth Carroll takes on is the oft-heard one about Canadians supposedly “flocking” to the U.S. to get medical care. An eye-popping pie chart, generated by peer-reviewed journal “Health Affairs,” shows only a tiny sliver of Canadians heading south for care — less than 1%.
Even more telling here is a “Health Affairs” survey of U.S. hospitals near the Canadian border, where you’d expect all these “care-deprived” Canucks to go first. A vast majority saw fewer than one Canadian a month. Bigger hospitals, even those rated by U.S. News & World Report as “America’s Best,” also saw very few Canadians, in either emergency or elective care. And these are exactly the hospitals where you’d expect to well-off Canadians to go.
(I love the metaphorical title of the Health Affairs study, “Phantoms in the Snow: Canadians’ Use of Health Care Services in the U.S.”)
The second myth, about Canadian doctors supposedly taking U.S. jobs, is also debunked by Carroll’s research and facts, which show high Canadian physician satisfaction in Canada and fewer Canadian doctors heading south to practice — less than 0.5% of all Canadian MD’s in the most recent findings.
(Charts and graphs from hard data, something many MarketWatch readers appreciate. Carroll’s well-researched article is loaded with them).
The third myth concerns how Canadians ration health care in specific areas. Every Western nation rations medical care out of necessity. As we’ve mentioned here before, Americans have chosen (so far, anyway) to ration medical care by income.
One favorite argument, heard on the floor of Congress and elsewhere, is that Canada denies hip replacements to older people. Absolutely not true, Carroll documents. Older Canadians get a ton of hip replacements. He can’t resist adding this wry note in the AARP piece:
“Know who pays for care for older people in the U.S.? Medicare. A single-payer system.”
The fourth myth is that Canadians have far longer wait times for medical treatment because of its system. This is one I hear all the time. Carroll says this is true, BUT...there’s a good reason:
http://www.pnhp.org/print/news/2012/august/myths-about-canada-us-health-care-debunked
Vtdigger (Montpelier, Vt.), Aug. 9, 2012
Single payer critics warn that Vermont should not go forward with Green Mountain Care because there are too many unknowns. But one thing is certain — if we do nothing, health care expenditures in Vermont (from all sources) are expected to reach $10 billion a year by the year 2020. That’s a back-breaking $16,000 per person, which could very well doom our economy.
A single-payer system would empower Vermont, as a commonwealth of citizens, to take charge of its own health care spending. One accountable entity, subject to public oversight and control, would administer the flow of dollars from all sources to health care providers, eliminating the excessive profits and administrative waste that plague our current system.
Yet the single payer naysayers claim that doctors will leave the state, and infer that costs can be controlled only at the expense of health care quality. This has not been the case in other countries, which have a single-payer system with plenty of doctors, but which spend less than we do, and have higher indicators of health.
So where exactly is the fat in our current system? What can be cut without sacrificing quality? These are important questions that the Green Mountain Care Board would do well to examine in detail. The board must correctly identify the root causes of health care inflation in order to make the right decisions as we move toward a single payer.
Along the way, the board should be careful to avoid misconceptions. A prize-winning Michigan journalist, Julie Mack, recently wrote an article debunking the myths that opponents of health care reform recite as reasons why we must live with the world’s highest health care costs. See her article here.
The five false assumptions are (1) we have the best care in the world; (2) we don’t ration care as other countries do; (3) we have bad habits and are therefore less healthy than people elsewhere; (4) our medical malpractice lawsuits are out of control; and (5) the U.S. government is a free spender on health care.
Mack showed that all five of these assertions are contradicted by statistical evidence. She based her conclusions on a 2011 report by the Organization for Economic Cooperation, and from other reliable sources, such as the nonpartisan Congressional Budget Office. Mack then went on to list the real reasons for high health care costs, roughly in order of magnitude. If she is correct, these are the things the Green Mountain Care Board should focus on fixing:
First, U.S. health care providers charge much more than providers in other developed countries. For instance, in 2007 an appendectomy in the U.S. was billed at an average of $7,962. In Canada the charge was $5,004, and in Germany $2,943. An MRI in the U.S. averaged $1,009, while the same test was $304 in Canada, and only $187 in Britain. The same disparity was true for pharmaceuticals. In the U.S. we simply pay much more per product or per service, than people in other developed countries.
http://www.pnhp.org/print/news/2012/august/health-care-cost-myth-versus-reality
Myths about Canada, U.S. health care debunked
Canadians aren’t flocking to U.S. for medical care
By Bill MannMarketWatch, The Wall Street Journal, Aug. 9, 2012
PORT TOWNSEND, Wash. (MarketWatch) — It’s a relief to see hard facts finally emerging on this side of the border about Canada’s single-payer health-care system.
For years I’ve heard Canada’s popular medicare (the Canadian term for universal health care) system slagged by lies, distortions, and outright ignorance on U.S. radio talk shows and other American popular media (where do people GET this stuff?). And for years, I’ve tried to set the record straight in my online and newspaper columns, having lived in Canada and actually having used their system. My son and his family are now covered by it in Vancouver.
Also, for years I’ve heard from Canadians, in Comments under my pieces and in email, thanking me for trying to set the record straight. They overwhelmingly like their medical delivery system, which turned 50 just last month.
I’ve also heard Canadian talk-show callers upset and incredulous about the nonsense being circulated south of the border about their single-payer medical system, which is still evolving as Ottawa pays less and the provinces pay more of growing health-care costs.
Anyone who wants a strong, honest defense of the Canadian system should keep a copy handy (and print out, as I have) a well-written piece — a touchstone, actually — in the latest online edition of the journal of the U.S.’ large and powerful AARP.
The well-researched, fact-based AARP article is written by an American, Aaron E. Carroll, M.D., and is titled “5 Myths About Canada’s Health Care System.” Its subhead:
“The truth may surprise you.” It just might, my fellow Americans.
To separate fact from polarizing talk-show nonsense, Carroll, the director of the Center for Health Policy and Professional Research in Indianapolis, examined the major myths about the Canadian and U.S. systems, myths I hear repeatedly voiced on U.S. talk shows of all political stripes.
The first myth Carroll takes on is the oft-heard one about Canadians supposedly “flocking” to the U.S. to get medical care. An eye-popping pie chart, generated by peer-reviewed journal “Health Affairs,” shows only a tiny sliver of Canadians heading south for care — less than 1%.
Even more telling here is a “Health Affairs” survey of U.S. hospitals near the Canadian border, where you’d expect all these “care-deprived” Canucks to go first. A vast majority saw fewer than one Canadian a month. Bigger hospitals, even those rated by U.S. News & World Report as “America’s Best,” also saw very few Canadians, in either emergency or elective care. And these are exactly the hospitals where you’d expect to well-off Canadians to go.
(I love the metaphorical title of the Health Affairs study, “Phantoms in the Snow: Canadians’ Use of Health Care Services in the U.S.”)
The second myth, about Canadian doctors supposedly taking U.S. jobs, is also debunked by Carroll’s research and facts, which show high Canadian physician satisfaction in Canada and fewer Canadian doctors heading south to practice — less than 0.5% of all Canadian MD’s in the most recent findings.
(Charts and graphs from hard data, something many MarketWatch readers appreciate. Carroll’s well-researched article is loaded with them).
The third myth concerns how Canadians ration health care in specific areas. Every Western nation rations medical care out of necessity. As we’ve mentioned here before, Americans have chosen (so far, anyway) to ration medical care by income.
One favorite argument, heard on the floor of Congress and elsewhere, is that Canada denies hip replacements to older people. Absolutely not true, Carroll documents. Older Canadians get a ton of hip replacements. He can’t resist adding this wry note in the AARP piece:
“Know who pays for care for older people in the U.S.? Medicare. A single-payer system.”
The fourth myth is that Canadians have far longer wait times for medical treatment because of its system. This is one I hear all the time. Carroll says this is true, BUT...there’s a good reason:
http://www.pnhp.org/print/news/2012/august/myths-about-canada-us-health-care-debunked
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