Universal health care and economic freedom go hand-in-hand
By David Callahan
Demos, June 19, 2013
One of the most pernicious myths of the past half century is that guaranteeing health care for all Americans would strike a mortal blow against this country's system of free enterprise.
That claim has been made endlessly in the context of the Affordable Care Act, and Obamacare critics are now ramping up their predictions of doom as implementation of the law grows near.
But as Robert Frank explained this weekend in the New York Times, the lived experience of other countries like Sweden with national health care systems doesn't bear out the fears.
In fact, you don't need to take the word of a progressive economist like Frank on this point. The Heritage Foundation's research indicates the same thing.
Consider Heritage's "Index of Economic Freedom," which measures how friendly countries are to business, investors, and property rights.
The countries that rank the highest on the list are: Hong Kong, Singapore, Australia, New Zealand, Switzerland, Canada, Chile, Mauritius, Denmark, and the United States.
Of those ten countries, nearly every one has a universal health care system or mandates that individuals pay into medical savings accounts. Australia and Canada both have single-payer systems. Denmark's system is pretty much government controlled. Switzerland's system is similar in many ways to Obamacare. Among the top twenty nations on the list are Ireland, the U.K., Germany, Sweden, and Finland -- other countries that also have universal health care systems.
There are some good reasons why such systems might go hand-in-hand with economic freedom. For one thing, as Robert Frank noted, these systems help keep down healthcare costs: "The United States spends more than $8,000 a person per year on health care, well more than twice what Sweden spends. Yet health outcomes are far better in Sweden along virtually every dimension."
Lower health care costs mean that business and individuals can channel more money into productive uses that foster a vibrant and globally competitive market economy.
http://www.pnhp.org/print/news/2013/june/universal-health-care-and-economic-freedom-go-hand-in-hand
Universal health care and economic freedom go hand-in-hand
By David Callahan
Demos, June 19, 2013
One of the most pernicious myths of the past half century is that guaranteeing health care for all Americans would strike a mortal blow against this country's system of free enterprise.
That claim has been made endlessly in the context of the Affordable Care Act, and Obamacare critics are now ramping up their predictions of doom as implementation of the law grows near.
But as Robert Frank explained this weekend in the New York Times, the lived experience of other countries like Sweden with national health care systems doesn't bear out the fears.
In fact, you don't need to take the word of a progressive economist like Frank on this point. The Heritage Foundation's research indicates the same thing.
Consider Heritage's "Index of Economic Freedom," which measures how friendly countries are to business, investors, and property rights.
The countries that rank the highest on the list are: Hong Kong, Singapore, Australia, New Zealand, Switzerland, Canada, Chile, Mauritius, Denmark, and the United States.
Of those ten countries, nearly every one has a universal health care system or mandates that individuals pay into medical savings accounts. Australia and Canada both have single-payer systems. Denmark's system is pretty much government controlled. Switzerland's system is similar in many ways to Obamacare. Among the top twenty nations on the list are Ireland, the U.K., Germany, Sweden, and Finland -- other countries that also have universal health care systems.
There are some good reasons why such systems might go hand-in-hand with economic freedom. For one thing, as Robert Frank noted, these systems help keep down healthcare costs: "The United States spends more than $8,000 a person per year on health care, well more than twice what Sweden spends. Yet health outcomes are far better in Sweden along virtually every dimension."
Lower health care costs mean that business and individuals can channel more money into productive uses that foster a vibrant and globally competitive market economy.
http://www.pnhp.org/print/news/2013/june/universal-health-care-and-economic-freedom-go-hand-in-hand
Demos, June 19, 2013
One of the most pernicious myths of the past half century is that guaranteeing health care for all Americans would strike a mortal blow against this country's system of free enterprise.
That claim has been made endlessly in the context of the Affordable Care Act, and Obamacare critics are now ramping up their predictions of doom as implementation of the law grows near.
But as Robert Frank explained this weekend in the New York Times, the lived experience of other countries like Sweden with national health care systems doesn't bear out the fears.
In fact, you don't need to take the word of a progressive economist like Frank on this point. The Heritage Foundation's research indicates the same thing.
Consider Heritage's "Index of Economic Freedom," which measures how friendly countries are to business, investors, and property rights.
The countries that rank the highest on the list are: Hong Kong, Singapore, Australia, New Zealand, Switzerland, Canada, Chile, Mauritius, Denmark, and the United States.
Of those ten countries, nearly every one has a universal health care system or mandates that individuals pay into medical savings accounts. Australia and Canada both have single-payer systems. Denmark's system is pretty much government controlled. Switzerland's system is similar in many ways to Obamacare. Among the top twenty nations on the list are Ireland, the U.K., Germany, Sweden, and Finland -- other countries that also have universal health care systems.
There are some good reasons why such systems might go hand-in-hand with economic freedom. For one thing, as Robert Frank noted, these systems help keep down healthcare costs: "The United States spends more than $8,000 a person per year on health care, well more than twice what Sweden spends. Yet health outcomes are far better in Sweden along virtually every dimension."
Lower health care costs mean that business and individuals can channel more money into productive uses that foster a vibrant and globally competitive market economy.
http://www.pnhp.org/print/news/2013/june/universal-health-care-and-economic-freedom-go-hand-in-hand
Weiner Wants City to Test Single-Payer Health Care
By NINA BERNSTEIN
Vowing to “make New York City the single-payer laboratory in the country” if he is elected mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create aMedicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act.
Mr. Weiner, a Democrat who championed a Medicare-for-all style of health care as a congressman, said his plan could curb the rise of $15.5 billion in city spending on health care and save money for raises for teachers and other workers, mainly by using the city’s muscle to reduce the profits or the role of private insurance companies.
In return, he proposed that 300,000 city workers and 300,000 retirees who now pay nothing toward their insurance premiums should pay 10 percent — 25 percent if they smoke. An estimated 500,000 undocumented immigrants would also be expected to buy in to the city’s insurance coverage, he said, describing it as a more cost-effective way to care for those whose treatment in emergency rooms and city hospitals already falls to taxpayers.
“This isn’t about who manages health care; this is about who manages the money in health care,” Mr. Weiner said, flicking through slides showing that city spending on workers’ health benefits was projected to rise by 40 percent from 2014 to 2017 under the current arrangement. Under an entrenched system partly codified in law, he said, a single private insurance company, Emblem, handles 95 percent of the coverage for the city’s workers, and a state board approves annual raises in the rates it charges.
Of insurance companies, he said, “Their job is to take in as much money as they can and pay out as little as they can.” The complexity and delays of private insurance processing are no accident, he added: “They make money on the float.”
Depending on the recommendations of a government task force he would create under a deputy mayor of health care innovation, he said, city coverage might still be placed in the hands of a different insurance company under a more competitive scheme, or the city might outsource just the administration to an insurer, as Medicare does while keeping overhead as low as 1.3 percent. A third option he listed would be for the city “to take the whole thing in-house.”
Medicaid expansion remains reasonable, right despite defeat by minority
Posted June 20, 2013, at 12:44 p.m.
There are reasonable women and men left in the Maine House and Senate, apparently just not enough. In a destructive decision for Maine on Wednesday night, the House fell a few votes short of the two-thirds support needed to override Gov. Paul LePage’s veto of legislation that would have expanded Medicaid.
Expanding health insurance under the Affordable Care Act to some of Maine’s poorest residents was the reasonable thing to do. It was reasonable economically, with one nonpartisan report from the Kaiser Family Foundation estimating Maine would spend $570 million, or 3.8 percent, less on the state’s Medicaid program if it expanded access, while the federal share would increase $3.1 billion, or 11.4 percent. The foundation also predicted the influx of money would boost jobs and economic activity.
It was reasonable politically. The legislation to cover about 50,000 adults without children making $20,628 for a two-person household, and prevent about 25,000 parents and childless adults from losing their Medicaid coverage next year, had support from Democrats, Republicans and independents. A poll by the Maine People’s Resource Center showed 58.1 percent of respondents definitely support expansion, mirroring national support levels.
Medicaid expansion was a reasonable move to improve people’s health and even save lives. Research shows that the uninsured are less likely to seek preventive care, such as prostate screenings or pap smears, increasing the likelihood of preventable diseases. The ill health of the uninsured affects everyone. They still seek medical help, often when a condition has worsened and become more expensive to treat, and hospitals must provide care. The cost is passed on to those who hold insurance.
Medicaid expansion was reasonable because it would have evened out the continuum of health insurance assistance. Without it, there will be a major coverage gap. Maine people with incomes near and below poverty will not be eligible for subsidies to buy insurance through the new health insurance exchange when it opens this fall. That means the very poorest will not receive help to pay for insurance, while those who earn more will receive assistance.
Medicaid expansion was not only reasonable but right. Without it, tens of thousands of Maine residents will continue to put off checkups, be forced to pay out of pocket for emergency care or pass on costs to hospitals and premium holders, or go without prescription medication. Insurance should be there when people need it, no matter how much they earn. Everyone gets sick.
Expanding Maine Medicaid — a fact-finding mission
Posted June 20, 2013, at 11:21 a.m.
In the debate about whether to expand Maine Medicaid to cover 50,000 largely uninsured Mainers making less than $11,500-$15,000 annually, it’s worth comparing some of the rhetoric to some of the facts. The cool breeze of reality might blow away some of the smoke and reveal a path to compromise and better health care for 50,000 of our friends in need.
Rhetoric: Per Gov. Paul Lepage, getting Medicaid insurance from government encourages people not to get private health insurance on their own.
Fact: It’s the only way to get health insurance — and therefore the only way to get ongoing health care — for most of those 50,000 Mainers. The majority work for employers who do not provide insurance (less than half of Maine employers provide it), so would have to buy health insurance themselves. An insurance policy for a healthy adult in Maine is about $5,000 annually, $12,000 or more for a family of four. Those costs are prior to out-of-pocket expenses, which easily could add $1,000 to the annual health care bills for that family, and much more if anyone gets really sick.
Who can pay for rent, food, transportation, and other essentials, and still have $5,000 to spend on health insurance, on a $15,000 salary? I don’t know the exact answer, but bet it’s just about nobody. What couple making 130 percent of the federal poverty level — about $20,000 annually — can afford $10,000 for health insurance for both? I bet it’s the same answer.
That means for most of the 50,000 fellow Mainers who would be covered if Maine expanded Medicaid insurance coverage as recently proposed by the majority of the Maine Legislature, the choice is not between Maine Medicaid and private health insurance; it’s between Medicaid and no health insurance at all. For many of those friends of ours, that means a choice between working and making too much to get Medicaid insurance, or not working so you can afford to take care of your illnesses, or between health care and food, etc.
Fact: That’s not a real choice.
Rhetoric: Maine state government cannot afford to expand Medicaid.
California Pushes for Immigrant Health
By JENNIFER MEDINA
LOS ANGELES — When Congress passed President Obama’s health care overhaul, a critical compromise provision was that immigrants living in the United States illegally would not be allowed access to publicly subsidized health insurance. Even now, as lawmakers in Washington are debating an overhaul of immigration laws, leaders from both parties are arguing that no federal money should be spent on health care for immigrants on their way to obtaining citizenship.
But not in California, where there are an estimated 2.6 million illegal immigrants. Here, public health officials, elected representatives and advocacy groups are going in the opposite direction, trying to cobble together ways to provide preventive care for such immigrants, who are expected to make up the largest share of the remaining uninsured once the state’s expanded Medicaid program takes full effect.
By many measures, California, with roughly seven million people currently uninsured, more than any other state, is taking the lead in aggressively rolling out changes before January, when most Americans will be required by law to have medical coverage or pay a penalty, the so-called universal mandate. While other states are resisting efforts to expand Medicaid, California has already begun public campaigns to encourage more residents to enroll in subsidized health plans.
But in counties with large immigrant populations like Los Angeles, officials say that not including immigrants in coverage, regardless of their legal status, will only cost local government more in the long run. So they are lobbying state and federal officials to find ways to pay for preventive health care, rather than rely on emergency rooms to care for them.
The push shows how dramatically the debate around immigration has shifted in California, which approved a state ballot initiative 20 years ago that prohibited illegal immigrants from receiving any kind of public benefit, including health care. Now, public opinion polls show that the vast majority of the state’s residents approve granting illegal immigrants a path to citizenship, though they are opposed to offering them the same benefits for public services as legal residents.
Sunday Dialogue: Will Training More Doctors Improve Health Care?
Some readers say a better allocation of resources or healthier lifestyles are the answer.
To the Editor:
With the expansion of coverage under the Affordable Care Act set to take effect next year, the United States is facing an alarming physician shortage. We don’t have enough physicians to treat insured patients right now. What happens when there are an estimated 30 million more insured patients in 2014?
The American Association of Medical Colleges estimates that by 2015, the shortage of doctors across all specialties will quadruple, to more than 60,000. By 2025, that number will reach a staggering 130,000. Last year there were 45,266 medical school applicants competing for 19,517 seats. Thousands of qualified people every year can’t get into medical school. This will be partly addressed by plans to open new medical schools and expand existing ones.
But there’s a bigger problem. After graduating from medical school, a newly minted doctor must complete a three-to-seven-year residency before practicing independently. These residency positions are largely federally funded, and while medical school enrollment has been slowly increasing, the number of residencies has been capped since the 1997 Balanced Budget Act.
A bill recently introduced in Congress would increase the number of residency training programs by 15,000 over five years. And while I applaud this proposal, it’s estimated that it will supply not even half of the physicians necessary to address our shortage. We need to do more.
Here’s one idea: Foreign-trained physicians usually must complete a residency here before they are licensed to practice independently. We ought to allow them to quickly prove their competence, sit for the boards and start taking care of patients.
I am pleased that 30 million Americans will soon have health insurance for the first time. But health insurance is pretty useless if you can’t find a doctor to treat you and your family.
ALEX BUSKO
Miami, June 17, 2013
Miami, June 17, 2013
The writer is about to begin medical school at the University of Miami.
Readers React
I found Mr. Busko’s argument interesting, but flawed for several reasons:
Obamacare exchange in Maine among those that could miss deadline
Posted June 20, 2013, at 11:05 a.m.
New health insurance exchanges being set up by the federal government in more than 30 states under President Barack Obama’s 2010 health care overhaul could miss an Oct. 1 deadline for open enrollment, a government report said on Wednesday.
The launch of the exchanges, or marketplaces, which are expected to provide federally subsidized health coverage for 7 million people in 2014 and 22 million by 2016, could determine whether Obama’s signature domestic policy achievement succeeds. The administration will operate exchanges in 34 states, while the remainder operate their own markets.
The report by the nonpartisan Government Accountability Office said U.S. officials have missed deadlines and remain behind schedule on key parts including those that involve consumer eligibility for federal subsidies, the certification of health plans to be sold on the exchanges and the hiring and training of special “navigators” to guide people through the enrollment process.
GAO found that states have also failed to complete many of the tasks assigned for implementation and that the administration has conducted only initial testing of the computerized system that will link the exchanges with states and federal agencies including the Internal Revenue Service.
A separate GAO report found that the exchanges for small businesses that are also being created under the Patient Protection and Affordable Care Act are behind schedule, with about 44 percent of the key activities targeted for completion by March 31.
But in both cases, the government watchdog agency said much progress had been made in completing major tasks necessary for implementation, including establishing the regulatory framework for reform.
The Department of Health and Human Services (HHS) has also completed contingency plans and is prepared to carry out additional exchange functions that individual states may prove unable to assume, according to GAO.
“Whether these efforts will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” the GAO report concluded.
While interim deadlines that have been missed up to now may not affect implementation, the agency added, “additional missed deadlines closer to the start of enrollment could do so.”
Federal officials, led by U.S. Health and Human Services Secretary Kathleen Sebelius, have vowed repeatedly that the federal exchanges set up under the health care law, also known as “Obamacare,” will be ready on time in states that have chosen not to implement their own marketplaces, often because of political opposition from Republican governors and legislators.
The administration reiterated that stance in response to the report, telling the GAO authors that “HHS is extremely confident that on October 1 the (federal) marketplace will open on schedule and millions of Americans will have access to affordable quality health insurance.”
Republicans, who want the law repealed and have blocked new federal funding for the implementation effort, said the GAO report confirmed a picture of an administration ill-prepared for implementation more than three years after Obama signed health care reform into law.
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