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Sunday, April 20, 2014

Health Care Reform Articles - April 20, 2014

Life and death and Obamacare

byJoan McCarterFollowThis is what Republicans have to answer for. This is what Republicans want to repeal. Meet Elizabeth Hand, a writer from Maine, who from January 1, 2001 until this February spent at least $60,000 in insurance premiums and medical costs for herself and two dependent children on a relatively cheap premium plan, with exceedingly high deductibles. She and her kids are on the whole pretty healthy, minus asthma and seasonal depression and for that they are among the lucky ones. But that was all that Hand took care of—the things already diagnosed. She relied on free clinics and health fairs for immunizations and basic screenings, and that was it.
Her health insurance premiums for herself and her one still dependent child went up to  $466.35 this year, with a $15,000 deductible. So in February, she called the 800 number for HealthCare.gov. She found out she could get a plan with a $1,500 deductible for $51.56, and "started to cry." But that's not the remarkable part of the story, the life and death part. That started the next weekend when she saw an old friend at a party, and found out that the friend had had colon cancer. Hand is 57, and because her previous insurance wouldn't pay for it, had never had a colonoscopy. She got the name of her friend's doctor, and made her screening appointment.
A few Mondays ago, I finally had my colonoscopy.  No, the prep wasn't fun, although the gallon of stuff I had to drink actually tasted pretty good (drinking it with a straw helps).  During the procedure, a large polyp was removed. Or so I was told: I don't remember a thing. Afterward I went home and slept.  Late the following afternoon, the doctor called.
"You were very, very lucky," he said.  He sounded somber, and went on to explain that the kind of precancerous polyp he'd removed, and the place where he'd found it, were both indicative of a highly aggressive form of colon cancer. […
http://www.dailykos.com/story/2014/04/17/1292751/-Life-and-death-and-Obamacare?detail=email#


Health Care Spending’s Recent Surge Stirs Unease

By 
WASHINGTON — It’s back.
For years, because of structural changes in the health care delivery system and the deep economic downturn, the health care “cost curve” — as economists and policy makers call it — had bent. Health spending was growing no faster than spending on other goods or services, an anomaly in 50 years of government accounts.
But perhaps no longer. A surge of insurance enrollment related to rising employment and President Obama’s health care law has likely meant a surge of spending on health care, leaving policy experts wondering whether the government and private businesses can control spending as the economy gets stronger and millions more Americans gain coverage.
“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, said in a statement.
The news comes as President Obama promotes the success of the Affordable Care Act in covering more Americans at less cost than anticipated.
“Under this law, real Medicare costs per person have nearly stopped growing,” Mr. Obama said at a news conference on Thursday as he announced that eight million people had signed up for insurance coverage through the law’s exchanges.
“Those savings add up to more money that families can spend at businesses, more money that businesses can spend hiring new workers,” he said, adding that the government’s budget scorekeeper “now says that the Affordable Care Act will be cheaper than recently projected.”
But some health care experts and economists said that an expanded use of the health system might start to have the opposite effect. Americans feeling more economically confident might demand more procedures from doctors and hospitals. Insurers paying more money for those procedures might, in time, increase premiums, cutting into wage gains. The government might end up spending more on the health law than current projections imply.
“We knew this was coming,” said Douglas Holtz-Eakin, a former head of the Congressional Budget Office and a prominent Republican economist, of rising spending because of the coverage expansion and improving economy. “The question now is whether we can hold spending down.”

Democrats Confront Vexing Politics Over the Health Care Law

By 
ATLANTA — When Franklin D. Roosevelt established Social Security, he created generations of loyal Democrats. When Lyndon B. Johnson signed Medicare into law, he built on that legacy, particularly with older Americans. And when George W. Bush instituted a new prescription drug benefit for Medicare, it helped reclaim elderly voters for Republicans.
But President Obama’s Affordable Care Act, the $1.4 trillion effort to extend health insurance to all Americans, is challenging the traditional calculus about government benefits and political impact.
Even as Mr. Obama announced that eight million Americans had enrolled in the program and urged Democrats to embrace the law, those in his party are running from it rather than on it, while Republicans are prospering by demanding its repeal.
The reasons are complex and layered in the early assessments, but say much about the nation’s political polarization, its shifting fault lines of class and race, and a diminished faith in government.
Democrats could ultimately see some political benefit from the law.  But in this midterm election, they are confronting a vexing reality: Many of those helped by the health care law — notably young people and minorities — are the least likely to cast votes that could preserve it, even though millions have gained health insurance and millions more will benefit from some of its popular provisions.
“The angry opponents are more mobilized than the beneficiaries,” said David Axelrod, the longtime adviser to Mr. Obama.
Young adults and minorities tend to vote in midterms at lower rates than older and white voters. And a poll by the Pew Research Center and USA Today found that more Republicans than Democrats will be influenced by a candidate’s stance on the health law.
http://www.nytimes.com/2014/04/20/us/politics/democrats-confront-vexing-politics-over-the-health-care-law.html

Obamacare Bashing or Bust

 Thursday, President Obama delivered a compendium of positive news about the Affordable Care Act:
■ Eight million people have signed up for private health insurance.
■ Thirty-five percent of those signing up are under 35 years old.
■ The Congressional Budget Office now estimates that the cost of the law will be $100 billion lower than expected and will significantly shrink the deficit over the next 10 years.
“This thing is working,” the president said. But it rang more as a lamentation than a proclamation. The health care law is a staggering achievement by this president and the Democrats and is likely to be viewed by history as such, but Republican opposition to it has been so vociferous and unrelenting that the president has been hard pressed to find a message that can overcome it.
Republicans repeat the same complaints, regardless of their veracity: Obamacare is bad for the economy and bad for Americans; it’s an unwelcome expansion of government by an overreaching president; it’s failing and will never work.
http://www.nytimes.com/2014/04/19/opinion/blow-obamacare-bashing-or-bust.html?action=click&contentCollection=Opinion&region=Footer&module=MoreInSection&pgtype=article


BDN’s logic on Medicaid expansion ignores history

By Jonathan McKane, Special to the BDN
Posted April 19, 2014, at 5:39 a.m.
Logic didn’t prevail, according to the Bangor Daily News editorial of April 12. In the BDN’s opinion, a logical conclusion to the 126th Legislature would have been a massive expansion of our MaineCare program.
But the BDN must have a different kind of logic — one that ignores history, facts and reasoned common sense.
For those of us who look at the whole picture — not just emotional anecdotes and false promises, the Maine Medicaid expansion issue really isn’t that complicated.
Essentially the question before the governor and the Maine Legislature was: Can the Maine people afford another massive welfare expansion?
The obvious and common sense answer is: No. Regardless of what promises are being made, Maine people, their children and grandchildren can’t afford to expand this welfare program any further than we already have.
Here’s why:
Maine’s Medicaid program, known here as MaineCare, is the third largest Medicaid program in the country measured as a percentage of the state’s population it enrolls.
It is our state’s largest single program, eating up one quarter of the biennial budget and starving all other programs, departments and spending (including programs for the most needy). It is the reason we have budget shortfalls every year and why we must resort to budget balancing gimmicks such as borrowing from the next fiscal year, borrowing from highway funds, bonding for what should be budgeted expenses and constantly raising taxes and fees. Ultimately, MaineCare is the reason our taxes are so high.
Our enormous MaineCare budget is the reason we can’t spend enough on our roads or on education, why there is never enough in the “rainy day fund” and why Maine accumulated so much debt. All of this puts a strain on Maine families, businesses and individuals and ultimately takes a heavy toll on our economy.
And yet even with this history of budget and economic misery due to our already expanded MaineCare program, we continue to hear the siren song of expanding this program once again, as though it were “logical.”
The promises are enticing and familiar — Maine’s uninsured rate will drop, there will be less charity care, fewer emergency room visits, and it will ultimately save the state money. And besides, most of it is paid for by the feds.
Sadly, this is not the reality. Our past MaineCare expansion and Medicaid expansions in other states have proven it.
Expanding Medicaid does not reduce the number of uninsured, it does not reduce charity care, and emergency room use actually goes up. In addition, a recent column in the Wall Street Journalshows that Medicaid coverage may be worse for participants than no coverage at all.

Single-payer health care system needed for consumer fairness

By Rosalind L. Murray
The Palm Beach Post, April 17, 2014
So much has been said about the Affordable Care Act — both bad and good. Most people, unless you are a professional, will have a difficult time fully understanding your insurance policy. Consumers (and politicians) say that no one should come between them and their doctor. However, unless a consumer pays out of pocket — there has always been someone between them and their doctor: the insurance company. It was that way before the Affordable Care Act, and it remains that way now.
As a result of being born with a congenital birth defect, I am an amputee who has worn a prosthetic since the age of 2. I have always been very active — which has been a lifesaver for me. Without that, I am at risk of high blood pressure, diabetes and obesity. I teach spinning, aerobics, Pilates and Silver Sneakers (fitness program), and hope I serve as a source of inspiration and willpower.
However, life is full of surprises — not all of them good. You see, I have employee-sponsored health insurance, yet my policy states that “(neither) wear and tear, nor theft, nor destruction, nor bio-mechanical reasons” is worthy of a new replacement device. These are policy constraints that I was not aware of, and I had assistance signing up. In other words, the only reasons that an active adult needs a replacement leg are excluded. I am speechless. I thought I was covered because the pre-existing condition clause was no longer included in insurance policies.
We all need insurance navigators because it’s difficult. Some states have made even the process of educating consumers about insurance more difficult. Most of us don’t even know which questions to ask. We know that our employers do their best to provide coverage for the average person. I used to think I was unique, but more and more people use prosthetic devices these days. A new leg costs between $50,000-$75,000, which can send families into bankruptcy.


2013 Comparative Price Report
International Federation of Health Plans
The International Federation of Health Plans was founded in 1968 by a small group of health plan industry leaders. It is now the leading global network in the industry, with more than one hundred member companies from twenty-five countries.
Federation member plans meet regularly to share information about health care financing and health care delivery in their home countries.
2013 Survey Overview
In response to interest from member plans, this year’s survey includes pricing for several specialty prescription drugs, along with prices for other prescription drugs and a variety of medical procedures. Prices for each country are submitted by participating federation member plans, and are drawn from public or commercial sectors as follows:
  • Prices for the United States are calculated from a database with over 100 million claims that reflect prices negotiated and paid between thousands of providers and almost a hundred commercial health plans
  • Prices for Australia, Argentina, and Spain are from the private sector, with data provided by one private health plan in each country
  • Prices for Canada and Netherlands are from the public sector, with data provided by one private health plan in each country
  • Medical procedure prices for Switzerland, England and New Zealand are from the private sector; prescription drug prices
    are based on public sector prices. Prices are provided by one private health plan in each country
    Comparisons across different countries are complicated by differences in sectors, fee schedules, and systems. In addition, a single plan’s prices may not be representative of prices paid by other plans in that market.

    http://static.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013%20iFHP%20FINAL%204%2014%2014.pdf

    Could an Unknown Civil Libertarian Unseat Susan Collins?

    By John Nichols, The Nation
    19 April 14

    Shenna Bellows can’t match the millions of her opponent. But she’s dialing for activists, not dollars.

    he woman who could be the future of progressive politics in America is sitting at the back table of an Indian restaurant in Portland, Maine. It’s early evening, she’s got a list of names, and she’s wearing out her cellphone. US Senate candidate Shenna Bellows doesn’t do downtime. While she waits for a meeting, the upstart Democrat makes the calls she says will upset an entrenched Republican incumbent. These aren’t the kinds of calls most candidates make: to big donors in distant cities with agendas even more distant from the concerns of the people she hopes to represent. Bellows is calling the people: nurses and teachers, lobster-boat captains and farmers, students and union activists. And she’s asking them to counter not just big money but a broken politics that values party labels and personalities more than ideals and movements.
    Bellows knows she can’t match the millions her opponent, three-term Senator Susan Collins, has banked—or the millions that wealthy donors are ready to spend in Maine and other states to make Mitch McConnell the Senate’s next majority leader. The Democrat is satisfied if the Mainers she calls give $5. That’s because Bellows isn’t really dialing for dollars. She’s dialing for activists. “We had over 200 volunteers gathering signatures in Maine to put me on the ballot. They were talking to friends and family members about who I am and what our campaign represents,” she explains. “We then invited the signature-gatherers to speak on my behalf at Democratic caucuses. So we had 100 volunteers speak at 150 different caucuses across the state. This is the movement that we are building: a movement for social justice, environmental justice and economic justice. And it’s working.”
    Bellows began her run against Collins—who despite her “moderate” label has drifted with her party to the right on economic and social issues—as an off-the-radar challenger. The 39-year-old former head of the Maine ACLU had no money, little name recognition, and a set of principles and positions that sometimes put her at odds with top Democrats. Bellows runs left on healthcare (she’s for single-payer) and climate change (don’t get her started on the Keystone pipeline), yet she makes common cause with libertarians on marijuana legalization and privacy rights. She speaks comfortably of building coalitions with independent-minded Tea Party activists against cronyism and corruption. Bellows believes in pushing political boundaries, and in Maine—with its history of electing independent governors and senators—it seems to be working. The challenger turned heads when, with those $5 donations from working-class Mainers, she outraised Collins in the last quarter of 2013. Even skeptics have begun to note the ease with which this first-time candidate—the daughter of a carpenter and a nurse, whose home had no electricity during much of her childhood—makes connections with disenfranchised and disengaged voters. Bellows has gained endorsements from the Progressive Change Campaign Committee (which calls her “the Elizabeth Warren of civil liberties”), Democracy for America, MoveOn and, belatedly, at the end of March, the Democratic Senatorial Campaign Committee.
    http://readersupportednews.org/news-section2/318-66/23215-could-an-unknown-civil-libertarian-unseat-susan-collins

    House Calls Are Making a Comeback

    By 

    A relic from the medical past — the house call — is returning to favor as part of some hospitals’ palliative care programs, which are sending teams of physicians, nurses, social workers, chaplains and other workers to patients’ homes after they are discharged. The goal is twofold: to provide better treatment and to cut costs.
    Walter Park, 68, of San Francisco says house calls prevented an expensive return visit to the hospital, where he initially stayed for seven weeks after a heart attack in 2012.
    After his discharge, palliative care specialists from the University of California, San Francisco, were among those who visited his home to monitor his physical and emotional health. He got help with tasks as varied as household chores and organizing the 20 pills he takes daily for his heart and other conditions.
    Confusion continues to exist over what palliative care is and whom it is for. Broadly, it is meant to ease symptoms and pain, and focus on quality of life for severely ill patients, who can choose between continuing or halting traditional medical treatment.
    Palliative care also occurs in hospitals, but an added emphasis on home care has been a selling point. A vast majority of patients would rather be at home than in a hospital anyway, said Dr. R. Sean Morrison, co-director of the new Patty and Jay Baker National Palliative Care Center at Mount Sinai Hospital in New York and director of the National Palliative Care Research Center.
    Home care is generally cheaper than hospital care, and for more than a decade, government programs such as Medicare and Medicaid have worked to create incentives for hospitals to switch to less-expensive treatment. Recently, under the Affordable Care Act, Medicare has begun to penalize hospitals when, under certain conditions, patients are readmitted within 30 days after discharge.
    Some insurers, including Medicare, pay for house calls by doctors and nurses specializing in advanced care. In cases where insurance does not cover this type of palliative care, hospitals are financing it themselves, sometimes with grants.
    http://www.nytimes.com/2014/04/20/business/house-calls-are-making-a-comeback.html?hpw&rref=health

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