“I want to apologize to you that the website is not working as well as it should,” Ms. Tavenner said, in remarks addressed to the public during testimony before the House Ways Means Committee.
Ms. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said that “nearly 700,000 applications have been submitted to the federal and state marketplaces” in the last four weeks.
But she repeatedly refused to say how many of those people had actually enrolled in health insurance plans since the federal and state marketplaces, or exchanges, opened on Oct. 1.
“That number will not be available until mid-November,” Ms. Tavenner said. “We expect the initial number to be small.”
The chairman of the Ways and Means Committee, Representative Dave Camp, Republican of Michigan, said that at least 146,000 Michigan residents had recently received notices that their current insurance policies would be canceled because the coverage did not meet requirements of the new health care law.
“In fact,” Mr. Camp said, “based on what little information the administration has disclosed, it turns out that more people have received cancellation notices for their health care plans this month than have enrolled in the exchanges.”
Ms. Tavenner said that existing insurance policies were, in many cases, inferior to the new policies they could get. In compliance with the health care law, she said, new policies will provide more benefits and pay a larger share of medical costs than many existing policies.
Representative Kevin Brady, Republican of Texas, asked Ms. Tavenner what she would tell people who were losing their current insurance but could not get coverage on the balky federal website.
“My constituents are frightened,” Mr. Brady said. “They are being forced out of health care plans they like. The clock is ticking. The federal website is broken. Their health care isn’t a glitch.”
WASHINGTON — After focusing for weeks on the technical failures of President Obama’s
health insurance website, Republicans on Tuesday broadened their criticism of the
health care law, pointing to Americans whose health plans have been terminated because they do not meet the law’s new coverage requirements.
The rising concern about canceled health coverage has provided Republicans a more tangible line of attack on the law and its most appealing promise for the vast majority of Americans who have insurance: that it would lower their costs, or at least hold them harmless. Baffled consumers are producing real letters from insurance companies that directly contradict Mr. Obama’s oft-repeated reassurances that if people like the insurance they have, they will be able to keep it.
“My constituents are frightened,” Representative Kevin Brady, Republican of Texas, told
Marilyn Tavenner, the official whose department oversaw the creation of Mr. Obama’s health insurance marketplace, at a House Ways and Means Committee hearing Tuesday. “They are being forced out of health care plans they like. The clock is ticking. The federal website is broken. Their health care isn’t a glitch.”
In the weeks since the health marketplaces opened, insurance companies have begun sending notices to hundreds of thousands of Americans in the individual insurance market informing them that their existing plans will soon be canceled. In many of those cases, the insured have been offered new plans, often with better coverage but also at higher prices.
The cancellation notices are proving to be a political gift to Republicans, who were increasingly concerned that their narrowly focused criticism of the problem-plagued
HealthCare.gov could lead to a dead end, once the website’s issues are addressed. Already they found themselves being pressed to join a Democratic push to fix the problems, not gut the law.
“There’s a little bit of a danger that if we’re just focused on the obvious ineptitude of the web designers and of the system breakdown — I wouldn’t call it a glitch, I’d call it a breakdown — we’re forgetting the bigger picture here,” said Senator Rob Portman, Republican of Ohio. “Once people do get on they’ll find out they’ll be paying more, not less, and won’t be able to keep what they have.”
Senator Tom Coburn, Republican of Oklahoma, called the website criticism “overblown.”
“They’ll fix the problems with the website. I think they won’t fix the problems with the bill,” he said.
Democrats pushed back on the Republican attacks, pointing to problems in the early days of the prescription drug plan Republicans passed in 2003, known as
Medicare Part D. Most Democrats opposed that law strenuously, but, they said, once it went into effect, they helped constituents enroll and worked for its success.
“Despite Democrats’ opposition to Part D 10 years ago, we committed to making the best of the program,” said Representative Bill Pascrell Jr., Democrat of New Jersey, rising from his seat at the Ways and Means hearing to excoriate Republicans.
In contrast, with the president’s health care law, Republicans “want this to fail. They want chaos,” said Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate. “Their credibility is not that strong.”
Two Kinds of Hospital Patients: Admitted, and Not
Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was
on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring with a policy popularly known as the “two-midnight rule.” When a physician expects a patient’s stay to include at least two midnights, that person is an inpatient whose care is covered under Medicare Part A, which pays for hospitals. If it doesn’t last two midnights, Medicare expects the person to be an outpatient, and Part B, which pays for doctors, takes over.
It’s rare to have hospital and nursing home administrators, physicians and patient advocates all agreeing about a Medicare policy, but in this case “there’s unanimity of dislike,” said
Carol Levine, director of the Families and Health Care Project of the United Hospital Fund. Despite
protests, the rule took effect on Oct. 1, but Medicare agreed to delay penalties for 90 days.
Meanwhile, administrators at the Johns Hopkins Hospital in Baltimore have taken to calling the policy the Cinderella Rule, said Amy Deutschendorf, senior director of clinical resource management: “If you cross two midnights, you’re an inpatient. If not, you’re a pumpkin.”
Sebelius Apologizes for Health Site’s Malfunctions
WASHINGTON — Kathleen Sebelius, the secretary of health and human services, apologized Wednesday for the frustration that millions of Americans have experienced while trying to shop for insurance on the HealthCare.gov website, even as she defended the problem-plagued rollout of President Obama’s health care law and tried to explain the cancellation of hundreds of thousands of individual insurance policies.
Ms. Sebelius, fighting for her political life at a hearing of the House Energy and Commerce Committee, said she was “as frustrated and angry as anyone with the flawed launch of HealthCare.gov.”
Ms. Sebelius said she was ultimately responsible for “this debacle,” including the website’s problems. But she said that a government contractor, Verizon’s Terremark unit, was responsible for outages that disrupted the website on Sunday and again on Tuesday.
Representative Fred Upton, Republican of Michigan and chairman of the committee, said: “Over the months leading up to the Oct. 1 launch, the secretary and her colleagues repeatedly looked us in the eye and testified that everything was on track. Despite the numerous red flags and lack of testing, they assured us that all systems were a go. But something happened along the way. Either those officials did not know how bad the situation was, or they did not disclose it.”
Moreover, Mr. Upton said: “There are millions of Americans coast to coast who no doubt believed the president’s repeated promise that if they liked their plan, they’d be able to keep it. They are now receiving termination notices.”
Ms. Sebelius said the cancellation of some individual policies was a justifiable byproduct of the 2010 health care law. These policies will be replaced, she said, with new policies that provide better benefits and more consumer protections, often at similar or lower prices.
People in the individual market have never had consumer protections, Ms. Sebelius said, adding, “They can be locked out, priced out, dumped out.”
However, in recent weeks, many consumers have received cancellation notices offering new policies at prices much higher than what they have been paying.
Ms. Sebelius minimized the significance of recent changes in individual insurance policies, which have shocked many consumers.
“In the individual market, plans change every year,” she said, adding, “This market has always been the Wild West.”
WASHINGTON — President Obama, on a symbolic trip to Boston’s Faneuil Hall Wednesday, will highlight the Bay State’s success at expanding insurance coverage and its status as a national model as he seeks to stem the political damage caused by the rocky rollout of his national plan.
Obama is expected to highlight the bipartisan nature of the Massachusetts overhaul and emphasize that it took many months to sign up residents, according to the White House. He will speak in the same room where former governor Mitt Romney, a Republican, signed the groundbreaking law in 2006 with the late senator Edward M. Kennedy, a Democrat, looking on.
Even as the White House planned that defensive strategy, the administration was forced Tuesday to deflect the latest round of complaints about the health plan debut — this time that hundreds of thousands of Americans are receiving notices canceling coverage, mostly of bare-bones, individual health plans that do not meet new minimum standards.
Republicans in Congress cited the cancellations to contend that Obama broke his own promise in 2009 that Americans under his law could keep their existing insurance, if they liked it. The president’s promise ultimately did not square with the fine print of the 2010 act, which prohibits insurance plans that offer patchy, weak benefits beginning in 2014.
In Boston, Obama Will Point to a Health Law’s Success
WASHINGTON — President Obama will travel to Boston on Wednesday to promote the success of the Massachusetts health care program on which the Affordable Care Act was based, while Mr. Obama’s top health official faces an intense grilling on Capitol Hill about the national law’s troubled rollout.
In a speech at historic Faneuil Hall, where the president’s one-time rival for the White House, Mitt Romney, signed the state’s health program into law in 2006, Mr. Obama is expected to argue that the similarities between the two laws should give the public confidence that the problems plaguing the Affordable Care Act will eventually fade.
“The bottom line is it ramped up to success,” Jonathan Gruber, a professor at the Massachusetts Institute of Technology, said of the state program. Mr. Gruber, who advised both Mr. Romney, the Massachusetts governor at the time, and Mr. Obama on the health care laws, spoke to reporters on Tuesday evening during a White House conference call.
“We’ve covered two-thirds of our uninsured citizens. We’ve lowered premiums in the individual market. And we have a widely popular law, with about two-thirds public support for our law,” Mr. Gruber said of the Massachusetts law. “That same kind of outcome will happen at the national level, but it will take time. We need to be patient and measure the outcomes in months and years, not days and weeks.”
Lawmakers from both parties have expressed little interest in being patient in the wake of the malfunctioning HealthCare.gov website, which has only partially worked since opening for customers on Oct. 1.
Kathleen Sebelius, the secretary of health and human services, testified Wednesday morning at a hearing of the House Energy and Commerce Committee on the website’s problems. She faced tough questions about who was responsible for the failure of the website and broader criticisms from Republicans about the impact of the Affordable Care Act on the marketplace for insurance in the country.
Brendan Buck, a spokesman for Speaker John A. Boehner, said in a statement Tuesday night that “every which way you look at it, Obamacare has proven to be a train wreck – with problems that run far beyond its AOL-era website. A law that was delivered through a pack of fictitious promises can’t be saved by another misleading speech.”
The President Wants You to Get Rich on Obamacare
Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the “21” Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: “Washington to Wall Street”). Today’s discussion centered on the most significant change in decades to the nation’s health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.
During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses — insurance companies, for instance, and hospital chains — have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law. According to Thomson Reuters, private equity investment, usually the lifeblood for entrepreneurialism, has dropped by an astonishing 65 percent in the health care sector this year.
Scully has been trying to assuage these worries, but the nervous questions keep coming at him. Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. “No way,” Scully said. “Way more — way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.” Another asked if Scully was worried about Congressional repeal. “It’s just not going to happen,” he said. “Don’t pay attention to Rush Limbaugh.” When Scully finally began his speech, he noted that the prevailing narrative among Republicans — assuming that many in the room were, like him, Republican — was incorrect. “It’s not a government takeover of medicine,” he told the crowd. “It’s the privatization of health care.” In fact, Obamacare, he said, was largely based on past Republican initiatives. “If you took George H. W. Bush’s health plan and removed the label, you’d think it was Obamacare.”
The Father Who Fought for Lorenzo’s Oil
By BARRON H. LERNER, M.D.
Augusto Odone surely was one of the best fathers of all time. Along with his wife, Michaela, Mr. Odone defied and then amazed the medical profession when he devised an apparent treatment for his son Lorenzo’s incurable neurological disease. The treatment was called “Lorenzo’s Oil.”
Mr. Odone
died last week, but he left an indelible mark on the world of disease activism, setting a gold standard for what patients and their families might achieve with determination, good luck and the media. But Mr. Odone himself preferred to be remembered as a loving parent.
I had the opportunity to meet Mr. Odone — and Lorenzo — when researching a book on famous patients. He was an unlikely activist. An Italian-born economist working for the World Bank, Mr. Odone, Michaela and 5-year-old Lorenzo had moved from Africa to the suburbs of Washington in the summer of 1983. With his thick Italian accent and Old World charm, Augusto stood out among his neighbors. Michaela, who hailed from Yonkers, was an editor. Lorenzo, a precocious boy who spoke three languages, started kindergarten that fall.
Yet rather than thriving, Lorenzo experienced numerous problems, having temper tantrums, slurring his words and even falling on two occasions. Doctors initially suspected a difficult adjustment to a new country and school. But Lorenzo grew progressively sicker. When a neurologist finally made the diagnosis, in April 1984, the news was terrible:
adrenoleukodystrophy, or ALD, a genetic disorder of young boys in which the myelin that protects the nerves of the brain and spinal cord becomes progressively damaged. Lorenzo, doctors said, would gradually lose his ability to see, hear, eat and walk. Death would soon follow.
The crestfallen Odones did what they could. They took Lorenzo to Baltimore to see the world’s top ALD specialist, Dr. Hugo Moser. Dr. Moser entered Lorenzo in a clinical trial of a special diet to try to lower the elevated level of very-long-chain fatty acids in the blood of affected boys. But it did not work.
It was here that the Odones went from ordinary to extraordinary parents. Refusing to believe that there was nothing else to be done, they became fixtures at the nearby library of the National Institutes of Health in Bethesda, Md. Among the things the Odones discovered was that scientists across the globe who were working on ALD and other so-called demyelinating diseases had never actually attended a conference together. Not only did the Odones arrange this, in October 1984, but they began to study ALD themselves, asking probing questions of the scientists, generating hypotheses about the cause of the disease and beginning to develop possible therapies. When asked why he and Michaela did this, Mr. Odone, in typically modest fashion, said “We love this kid, and we don’t want to lose him.”
OCTOBER 25, 2013, 12:01 AM
The Midterm Grade for HealthCare.gov
By UWE E. REINHARDT
The best place to start is President Obama’s remarks in the Rose Garden of the White House on Monday.
Shortly before the president’s appearance, White House officials
let it be known that the “president will directly address the technical problems with HealthCare.gov – troubles he and his team find unacceptable.” But in that Rose Garden appearance, the president did not explain what the technical problems with HealthCare.gov were, though he did
acknowledge their existence and stated “there is no excuse” for them.
He then promised that in a techno-surge he would recruit the best information technology talent in the country to come to the rescue and fix the problems. It made me wonder why the A-team, as the White House now calls it, was not enlisted in the first place.
President Obama taught constitutional law at the University of Chicago Law School. How would he have graded a student’s performance on, say, a term paper or test that the professor viewed as “unacceptable,” especially when there was “no excuse” for the paper’s deficiencies?
One would hope that the grade would have been F, even under modern grade inflation. I certainly would affix that grade to such inexcusably deficient work.
But who exactly should be assigned the F for the troubled rollout of HealthCare.gov?
At the Rose Garden ceremony,
President Obama noted, “There’s no sugar coating it, the Web site has been too slow, people are getting stuck during the application process, and I think it’s fair to say that nobody is more frustrated by that than I am.”
That makes it sound as if the president was surprised and then angered by the poor performance of HealthCare.gov. Indeed, in
a television interview Tuesday with Dr. Sanjay Gupta on CNN, the secretary of health and human services, Kathleen Sebelius, appears to suggest as much, even though HealthCare.gov is reported to have crashed days before the start on Oct. 1 when
only 100 people tried to register simultaneously.
The Power of the Individual Mandate
By CASEY B. MULLIGAN
If and when the Affordable Care Act is executed as planned, it will leave few members of working families uninsured.
About 31 million members of nonpoor working families are without health insurance (according to my calculations from the Census Bureau’s current population survey). An important reason they do not have private health insurance coverage is that, in one way or another, they find it too expensive. Their employer may offer health insurance, but they decline coverage because the premiums are too much.
If their employer doesn’t offer insurance, the uninsured workers are, judging from their behavior, unwilling to switch to an employer that does offer health insurance in exchange for lower cash pay (of course, finding such an employer may not be easy and may require a move across state lines, but that’s my point: getting private insurance is costly).
The Affordable Care Act has at least two provisions to make insurance cheaper to workers who have so far been uninsured, compared with what employer insurance would have cost them in previous years, and these will take effect in the next couple of years (or whenever the federal government gets its systems running, whichever comes later).
The first provision is the “individual mandate penalty” for being uninsured, which will eventually reach the greater of 2.5 percent of husband-and-wife income, or $695 per uninsured family member (up to three, with uninsured children counting half, and the $695 indexed to inflation). Undocumented immigrants are not liable for the penalty.
The penalty effectively makes insurance cheaper because people can avoid it by getting insurance. In effect, all nonpoor legal residents pay the penalty, but people who purchase health insurance get their penalty applied toward their health insurance premiums.
The law’s premium assistance tax credits are another provision that makes insurance cheaper, at least for uninsured nonpoor people living in households below 400 percent of the federal poverty line.
These two provisions are a potent combination — and might be reinforced by the prospect of Internal Revenue Service enforcement of fines due.
The Uproar Over Insurance ‘Cancellation’ Letters
By DAVID FIRESTONE
Kathleen Sebelius, the Health and Human Services secretary, took a lot of grief this morning from Republicans on the House Energy and Commerce Committee who were outraged that some people’s individual insurance policies had been “cancelled” because of health care reform.
Some of the rants bordered on the comical. Cory Gardner, Republican of Colorado, brandished his “cancellation” letter and demanded that Ms. Sebelius nullify the health law for all residents of his congressional district.
Most lawmakers mentioned President Obama’s unfortunate blanket statement that all Americans would be allowed to keep their insurance policies if they liked them. He failed to make an exception for inadequate policies that don’t meet the new minimum standards.
But in between lashings, Ms. Sebelius managed to make an important point. Yes, some people will be forced to upgrade their policies, she said. But that’s preferable to the status quo before the passage of the Affordable Care Act, when insurers could cancel policies on a whim.
“The individual market in Kansas and anywhere in the country has never had consumer protections,” she testified at the hearing. “People are on their own. They could be locked out, priced out, dumped out. And that happened each and every day. So this will finally provide the kind of protections that we all enjoy in our health care plans.”
A true cancellation is when someone gets a letter saying that she’s losing her insurance and cannot renew. That was common practice in the individual market for people with expensive conditions. Under the new law, no one will ever get a letter like that again. They cannot be turned down for insurance.
The so-called cancellation letters waved around at yesterday’s hearing were simply notices that policies would have to be upgraded or changed. Some of those old policies were so full of holes that they didn’t include hospitalization, or maternity care, or coverage of other serious conditions.
Republicans were apparently furious that government would dare intrude on an insurance company’s freedom to offer a terrible product to desperate people.
Memo raises security concerns about government health website
Posted: 6:32 AM
Updated: 3:00 PM
The nation’s top health official tells lawmakers ‘I’m responsible’ for the problems with the launch of Healthcare.gov.
By Ricardo Alonso-zaldivar And Laurie Kellman The Associated Press
WASHINGTON – Defending President Barack Obama’s much-maligned health care overhaul in Congress, his top health official was confronted Wednesday with a government memo raising new security concerns about the trouble-prone website that consumers are using to enroll.The document, obtained by The Associated Press, shows that administration officials at the Centers for Medicare and Medicaid Services were concerned that a lack of testing posed a potentially “high” security risk for the HealthCare.gov website serving 36 states. It was granted a temporary security certificate so it could operate.
Security issues are a new concern for the troubled HealthCare.gov website. If they cannot be resolved, they could prove to be more serious than the long list of technical problems the administration is trying to address.
You accepted a risk on behalf of every user ... that put their personal financial information at risk,” Rep. Mike Rogers, R-Mich., told Health and Human Services Secretary Kathleen Sebelius during questioning before the House Energy and Commerce Committee. “Amazon would never do this. ProFlowers would never do this. Kayak would never do this. This is completely an unacceptable level of security.”
Sebelius countered that the system is secure, even though the site has a temporary certificate, known in government parlance as an “authority to operate.” Sebelius said a permanent certificate will only be issued once all security issues are addressed.
Added spokeswoman Joanne Peters: “When consumers fill out their online ... applications, they can trust that the information they’re providing is protected by stringent security standards and that the technology underlying the application process has been tested and is secure. Security testing happens on an ongoing basis using industry best practices.”
Patient advocates dispute the accuracy of apparent declines in missed rides, saying the data omit patients who have simply given up
AUGUSTA — After a 2½-hour presentation of data and bureaucratic jargon Tuesday, Daniel Donovan gave lawmakers the statistic that he believes matters most about MaineCare’s new rides program.
Donovan, executive director of the Aroostook Regional Transportation System, said his organization provided 9,762 rides to low-income patients in September.
In September of last year, the number was 16,192.
Donovan asked where more than 6,400 rides went, and what happened to the people who needed them.
In the hearing before the Legislature’s Health and Human Services Committee, state officials acknowledged for the first time that they are exploring contingency plans to use if they cancel contracts with the companies the state hired to run the program, which has left thousands of poor and disabled Mainers without rides to and from medical appointments.
Still, as the third month of the new system ends, many questions about the widespread, chronic problems have yet to be answered by lawmakers or the Department of Health and Human Services, which awarded contracts worth more than $40 million to three brokers that arrange rides statewide.
The contractors told the committee that there has been marked improvement since they started on Aug. 1. Stefanie Nadeau, director of MaineCare Services for the DHHS, acknowledged progress but said the agency is also looking into alternative plans.
“There are significant number of missed rides that continue to occur,” Nadeau told the committee, saying the failure rate is between 0.5 percent and 1.5 percent.
Transportation providers and health care advocates said that rate doesn’t tell the complete story.
Here’s how GOP Obamacare hypocrisy backfires
GOP base doesn't understand right wants to turn Medicare, Social Security and more into a very similar programBy Michael LindSalon, Oct. 28, 2013
The smartest thing yet written about the botched rollout of the Affordable Care Act’s federal exchange program is
a post by Mike Konczal of the Roosevelt Institute at his “Rortybomb” blog at Next New Deal. Konczal makes two points, each of which deserves careful pondering.
The first point is that to some degree the problems with the website have been caused by the overly complicated design of Obamacare itself. Instead of being a simple, universal program like Social Security or Medicare, the Affordable Care Act system is designed as if to illustrate
Steven Teles’ notion of “kludgeocracy” or needless, counterproductive complexity in public policy. By using means-testing to vary subsidies among individuals and by trying to match individuals with private insurance companies, the ACA requires far more information about people who try to sign up than do simpler public programs like Social Security and Medicare. If Congress had passed Medicare for All, the left’s preferred simple, universal alternative to the kludgeocratic ACA mess, signing up would have been a lot easier and the potential for website snafus correspondingly less.
Konczal’s second point is even more important — the worst features of Obamacare are the very features that conservatives want to impose on all federal social policy: means-testing, a major role for the states, and subsidies to private providers instead of direct public provision of health or retirement benefits. This is not surprising, because Obamacare’s models are right-wing models — the Heritage Foundation’s healthcare plan in the 1990s and Mitt Romney’s “Romneycare” in Massachusetts.
This point is worth dwelling on.
Conservatives want all social insurance to look like Obamacare. The radical right would like to replace Social Security with an Obamacare-like system, in which mandates or incentives pressure Americans to steer money into tax-favored savings accounts like 401(k)s and to purchase annuities at retirement, with means-tested subsidies to help the poor make their private purchases. And most conservative and libertarian plans for healthcare for the elderly involve replacing Medicare with a totally new system designed along the lines of Obamacare, with similar mandates or incentives to compel the elderly to buy private health insurance from for-profit corporations.
If you don’t like Obamacare, you should really, really hate the proposed conservative alternatives to Social Security and Medicare. Konczal writes:
"Conservatives in particular think this website has broad implications for liberalism as a philosophical and political project. I think it does, but for the exact opposite reasons: it highlights the problems inherent in the move to a neoliberal form of governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism. This point is floating out there, and it turns out to be a major problem for conservatives as well, so let’s make it clear and explicit here."
Building on
an insightful discussion of public policy by means of subsidies or “coupons” published by the New America Foundation’s Next Social Contract initiative, Konczal contrasts the indirect, market-based, state-based neoliberal/conservative approach to social insurance that inspired Obamacare with the kind of universal federal social insurance preferred by liberals in the tradition of FDR and LBJ:
http://www.pnhp.org/print/news/2013/october/here’s-how-gop-obamacare-hypocrisy-backfires
Is competition really good for health care?
There’s little evidence to support the model, this author postulates
By Leigh Dolin, M.D.
The Lund Report (Portland, Ore.), Oct. 28, 2013
Competition is supposed to be good for health care. Only with competition, it is said, will we get the highest quality health care at the lowest cost. But is this true? Where’s the evidence?
In the 1990’s capitated managed care was supposed to prove the benefits of competition. Insurance companies would compete with each other to keep people healthy and by keeping them healthy, they would make money. But unfortunately, the bottom line of the insurance companies was not the health of its customers, but profit. They competed with each other to avoid caring for the sickest patients and to deny coverage for treating illness.
And now we have the Affordable Care Act -- Obamacare -- which is based on the same principles of competition. To be sure, there are some benefits to Obamacare. More people will have access to health insurance and coverage can’t be denied for preexisting conditions. But once again, the insurance companies are in charge, and we know what their ultimate goal is.
In pursuit of profit maximization, they expend enormous amounts of money on bloated salaries for their executives and on advertising to lure customers from each other. Moda (the insurance company previously known as ODS -- how much was spent to have someone think up that more appealing name?) paid $40 million for the naming rights to the Rose Garden. How much medical care could that have paid for? How much was added to the monthly premiums of its customers so that the Rose Garden could be called the Moda Center?
The bronze and silver policies that most people will select under Obamacare have enormous deductibles so that people are discouraged from seeking routine medical care and from getting the companies to provide something in return for the premiums. And the companies will continue their efforts to avoid caring for the sickest patients and to deny coverage whenever possible. The “choice” in the “health care marketplace” is limited to policies of companies whose bottom line is not patient care, but profit. (The “not for profit” companies have the same bottom line as those that are “for profit” -- they just have to call it something else.)
The other reason for health website chaos
By David Freudberg
The Huffington Post, Oct. 28, 2013
Advocates of a single-payer health system have long touted what they see as its cost-saving advantages. In light of the recent Obamacare rollout, they would be justified in citing another benefit as well: simplified sign-up.
An easy shorthand for single-payer is Medicare for All. The concept is to take a health coverage system that is highly popular and generally works well and just expand it. Without reinventing the wheel, simply lift the age restriction for Medicare eligibility.
Instead of covering only seniors, single-payer champions urge allowing everyone to be covered by a federal system -- the way health care is provided in basically every other industrialized nation.
For example, in Canada's single-payer system, you select your own doctor (and if unsatisfied, you pick a new one). There are some limitations on what services a patient can get when, but they're apparently not seen as too drastic: A Gallup Poll showed a majority of Canadians to be "satisfied" or "very satisfied" with their system.
And for Americans, of course, there are limits to coverage from private insurers as well. Just ask anyone who has recently braved healthcare.gov and studied the fine print of competing private policies offered on the new exchanges. Or anyone who has had the unpleasant experience of being denied medical care by an American insurer.
I'm not sure which is more incomprehensible: the ham-handed launch of registration for the Affordable Care Act (ACA) or the system's mind-numbing complexity. But the two are related.
Romneycare returns
By: Kyle Cheney and Jonathan Allen
October 30, 2013 05:00 AM EDT
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President Barack Obama wants Americans to believe this about his health care law: It’s just like Mitt’s.
After all, the White House used the 2006 Massachusetts health program signed into law by Republican Mitt Romney as its blueprint for the national model. And in case anyone missed the message last year during the presidential campaign, Obama will repeat it again Wednesday.
He’ll speak at Faneuil Hall, the 269-year-old downtown Boston marketplace that has taken on hallowed status in state legislative lore after Romney signed his law with Democratic Sen. Ted Kennedy by his side.
There is more than symbolism here. Obama’s advisers insist that participation in Obamacare, though slowed by a botched website rollout, will ultimately match the late-breaking arc of Romneycare. And Obama will make the argument that Democrats and Republicans should put politics aside to implement the Affordable Care Act just as they broke party lines on the Massachusetts law.
(PHOTOS: 10 Sebelius quotes about the Obamacare website)
Obama and his aides have long used Romney’s program in the political arena both as a weapon and a shield. During debate over Obamacare in Congress, and now more recently, it’s been used to show that Obama is open to Republican-backed solutions. On the campaign trail last year, he and his aides used it to bludgeon Romney. David Plouffe, Obama’s former adviser, called Romney “the godfather” of Obamacare on “Meet the Press” in 2012.
But for all the Boston ballyhoo, the two laws simply aren’t the same — a fact acknowledged by some in the White House — and there’s no chance that national Republicans will beat their swords into stethoscopes to help diagnose and solve problems in the implementation of Obamacare. Still, Obama’s needs greater cooperation from Republican governors and state legislatures to make the law work, and his public appeal for bipartisanship could stoke constituents to pressure elected Republicans to get on board.
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