Competing for Better Outcomes and Lower Costs
Victor R. Fuchs
Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it? (Essay 30)
Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it?
Bernard Lown, MD
June 26, 2012
Obama, for the Win!
By CHARLES M. BLOW
Republicans are apoplectic. They’ve lost again.
The Supreme Court ruling on Thursday that largely found President Obama’s signature health care law to be constitutional left them floundering and fuming.
The conservative chief justice, John Roberts Jr., joined the liberal wing of the court in doing so, much to the ire of Republicans.
According to Politico, “Indiana congressman and gubernatorial candidate Mike Pence likened the Supreme Court’s ruling upholding the Democratic health care law to the Sept. 11 terrorist attacks,” during a closed-door House G.O.P. meeting. He later apologized.
Senator Rand Paul, a Republican from Kentucky and the son of former presidential candidate Ron Paul, issued a statement that seemed to suggest that the court doesn’t even have the authority to make the ruling. It read in part: “Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional.”
Did John Roberts Give Mitt Romney A Gift?
By Marcia Angell, M.D.
The Huffington Post, June 29, 2012
The Supreme Court's decision to uphold the Affordable Care Act, aka Obamacare, puts me in mind of the old proverb: Be careful what you wish for. Democrats on a victory lap should watch their step, because John Roberts may have given Mitt Romney a gift. The impact on the health system will be much smaller than the political fallout, because with or without Obamacare, the American health system will continue to unravel -- quickly if Romney is elected, slowly if Obama is re-elected.
First the policy, then the politics:
Obamacare is simply incapable of doing what it is supposed to do -- provide nearly universal care at an affordable and sustainable cost. The problem is that three years ago, in his futile efforts to win over Republicans (remember the embarrassing courtship of Olympia Snowe?), Obama gutted the law before it was even passed. He made the private insurance companies the linchpin of the new system, and promised them millions of additional customers and billions of taxpayer dollars. He also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures. So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.
Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry's trade association, America's Health Insurance Plans, told me privately that that's exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.
In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.
Here's how the unraveling will look:
http://www.pnhp.org/print/news/2012/june/did-john-roberts-give-mitt-romney-a-gift
The Huffington Post, June 29, 2012
The Supreme Court's decision to uphold the Affordable Care Act, aka Obamacare, puts me in mind of the old proverb: Be careful what you wish for. Democrats on a victory lap should watch their step, because John Roberts may have given Mitt Romney a gift. The impact on the health system will be much smaller than the political fallout, because with or without Obamacare, the American health system will continue to unravel -- quickly if Romney is elected, slowly if Obama is re-elected.
First the policy, then the politics:
Obamacare is simply incapable of doing what it is supposed to do -- provide nearly universal care at an affordable and sustainable cost. The problem is that three years ago, in his futile efforts to win over Republicans (remember the embarrassing courtship of Olympia Snowe?), Obama gutted the law before it was even passed. He made the private insurance companies the linchpin of the new system, and promised them millions of additional customers and billions of taxpayer dollars. He also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures. So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.
Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry's trade association, America's Health Insurance Plans, told me privately that that's exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.
In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.
Here's how the unraveling will look:
http://www.pnhp.org/print/news/2012/june/did-john-roberts-give-mitt-romney-a-gift
Next Battleground of Health Care Debate
By ALBERT R. HUNT | BLOOMBERG NEWS
WASHINGTON — Shortly after the U.S. Supreme Court’s historic health care decision, Barack Obama and Mitt Romney appeared before the cameras to offer their spin. Neither took questions.
For weeks, both men had methodically calibrated their response to what was the most eagerly anticipated pre-election high court decision ever. The ruling settles the law, not the politics.
The outcome poses challenges for both presidential contenders. Mr. Obama’s claim that it means the country “can’t refight” the law is a pipe dream. Mr. Romney will be held accountable for his strong inconsistencies on health care and his refusal to offer serious alternatives.
The 5-to-4 decision upholding the central tenet of Obamacare, as Republicans call it, was a better result for the Democrats. If things had gone the other way, Mr. Romney could have credibly charged that Mr. Obama wasted two years on an unconstitutional measure, instead of focusing on the economy.
Yet Chief Justice John G. Roberts Jr., while handing the White House an overall victory, created new problems for Mr. Obama’s re-election, declaring the l
Soda Makers Begin Their Push Against New York Ban
By MICHAEL M. GRYNBAUM
Lobbyists from Coca-Cola and other big soda companies have met with mayoral candidates and City Council members. Canvassers hired by the beverage industry are stopping New Yorkers on the street to solicit signatures on petitions. Facebook and Twitter pages tell readers to “say no to a #sodaban.”
Confronting a high-profile attack on its fizzy products, the American soft-drink industry is beginning an aggressive campaign to fight New York City’s proposed restrictions on large servings of sugary drinks.
Hoping for a debate about freedom, not fatness, the industry has created a coalition called New Yorkers for Beverage Choices to coordinate its public relations efforts in the city. On Thursday, the group introduced its first radio spot, a one-minute advertisement featuring “Noo Yawk”-accented actors proclaiming, “This is about protecting our freedom of choice.”
“This is New York City; no one tells us what neighborhood to live in or what team to root for,” says the narrator, as Yankees and Mets fans shout in the background. “So are we going to let our mayor tell us what size beverage to buy?” Adds one Brooklyn-tinged voice: “It’s unbelievable!”
The charge is being led by the industry’s leading trade group, the Washington-based American Beverage Association, which has retained several powerhouse political consultants for the cause, including the strategists responsible for the “Harry and Louise” television advertisements that helped defeat President Bill Clinton’s health care plan in the 1990s.
Consumer Questions on Health Care Act, and the Answers
By KATIE THOMAS
Q. Now what? The law is upheld, so where does it go from here?
A. Now the scramble to enact the law continues. Unless the law is repealed by Congress, most of the major changes take effect on Jan. 1, 2014. By then, states must have set up health insurance exchanges, where people can buy coverage. Insurers will have to offer policies to anyone who applies, including people with expensive medical conditions. And people who do not qualify for exemptions based on income or religion will be required to have minimum insurance coverage or pay a penalty.
Q. In what way was the Medicaid expansion “limited”? What is the meaning of this portion of the decision?
A. The Supreme Court’s decision means that the Medicaid expansion is now an option for states, not a requirement. If states do not participate, experts have speculated that it could create a subset of people who earn too much to qualify for Medicaid — the exact threshold varies — but not enough to qualify for the tax credits that would help them pay for insurance. States will not have to pick up the added costs of the Medicaid expansion until 2016. After that, the federal government will gradually reduce its contribution until it reaches 90 percent of the costs by 2020.
JOAN VENNOCHI
On health care, it’s Romney vs. Romney
Republicans discredit their own health insurance overhaul with attack on Obama’s plan
Posted June 29, 2012, at 3:14 p.m.
Maine Republicans are assailing President Barack Obama’s health care law by saying it amounts to a tax increase. Not only are they wrong, but it appears their memories are a little selective.Their own health insurance overhaul last year, which they will continue to champion on their campaign trails, included a tax.
If Republicans are going to argue against the Patient Protection and Affordable Care Act, they should first make sure they’re not also delegitimizing their own law.
The Republican argument stems from the fact that five justices agreed on Thursday that the penalty people must pay if they refuse to purchase health insurance is a kind of tax. Because Congress has taxing power, the requirement that virtually all Americans buy insurance is constitutional.
But even though the swing vote came from a conservative — Justice John Roberts Jr. — and even though Maine Republicans last year passed a health insurance reform bill, LD 1333, that included a provision to add a $4 charge to the monthly premium of Mainers with private coverage, some in the GOP argue the health care act is wrong because its legality is based on tax law.
“This massive tax hike will only destroy the American economy as it forces us over the financial cliff,” reads a press release from Gov. Paul LePage’s office issued after the U.S. Supreme Court ruled Thursday that Obama’s health care law is constitutional.
Maine Senate President Kevin Raye, who is running for the U.S. House, called it “an unprecedented coercive new tax.” Olympia Snowe, Maine’s retiring Republican senator, said it will “impose an onerous tax.”
The law, however, is not projected to equate to a tax increase for the vast majority of Mainers or Americans. Most people already have insurance through their employers, Medicaid or Medicare. An Urban Institute study found that of the 26.3 million people currently uninsured, about 70 percent of them qualify for tax credits to help them pay for a qualified plan.
Cranky Uncles, for Better or Worse, Will Lurk in More Exam Rooms
By ABIGAIL ZUGER, M.D.
Money has always played a role in health care, even back in the good old days when Hippocrates charged a drachma or two for a second opinion. Back then it was the coin of the realm that healed the sick, and now, thanks to the upheld individual insurance mandate, it is going to be a little plastic card for all.
So nothing has really changed, right?
Wrong.
Health insurance is more than a cash equivalent. It is cash with strings attached, like a rich uncle with deep pockets but a volatile personality, munificent one minute and stingy the next. This is an uncle who takes you to the doctor but refuses to wait out front with a magazine: He is right there in the exam room with you, commenting on everything. Sometimes he peels the big bills out of his wallet with a smile, and sometimes he scowls, shakes his head and yanks you by the sleeve out the door.
The Price of Health Care
By ROSS DOUTHAT
“IT is not our job,” Chief Justice John Roberts Jr. wrote in Thursday’s health care ruling, “to protect the people from the consequences of their political choices.” He might just as easily have written, “to protect politicians from the consequences of their political choices.” And now, with the Supreme Court parenthesis out of the way, we can get back to finding out exactly what those consequences will be.
For President Obama, the consequences of health care may still be fatal to his re-election hopes. The choice to go all-in on reform was the most important call of the Obama presidency, and from a purely political perspective it has proved the most disastrous one. Thursday’s decision won’t change this reality: Victory at the Supreme Court was obviously preferable to defeat, but the chief justice’s grudging imprimatur is unlikely to make a deeply unpopular piece of legislation suddenly popular instead.
Liberals have persuaded themselves that this unpopularity is largely the product of conservative misinformation and voter ignorance. But it’s really a result of the gulf that opened in 2009 between the public’s priorities and the president’s agenda. By turning from economic crisis management to sweeping social legislation before the crisis had actually abated, Obama made himself look more ideological than practical and more liberal than pragmatic. By continuing to push for the largest possible bill even after the public backlash had elected a Republican senator in Massachusetts, he made himself look wildly out of touch as well.
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