More Myths of Obamacare
If only I'd checked with you first, Times readers, I could have expanded my list of fallacies about the Affordable Care Act. Thanks to your comments and emails on my column, I've noted a few more enduring myths that seem worthy of debunking. See below.
But first, let me field a bit of incoming flak.
An astute reader took issue with my statement that the law will "deliver 30 million new customers to the private insurance industry." In fact, some of those 30 million will be poor enough to qualify for Medicaid, and will not end up in the private market. How many? Because the same Supreme Court case that approved the mandate also allowed states to opt out of expanded Medicaid, it's impossible to say. Estimates were that if the states had to participate, roughly half of the 30 million would qualify for Medicaid, but under the Supreme Court ruling the number is likely to be far fewer. (We're publishing a correction on the 30 million.) But my point stands that the law, although it imposes new rules on insurers, is not a "federal takeover" of health insurance. For better or worse, it preserves our private insurance industry and requires that millions of additional customers buy their products.
On the "job-killer" front, I heard from a number of small businessmen who insisted the new law would prevent them from hiring more workers if it increased their payroll to more than 50 employees. Under Obamacare, companies with more than 50 workers are obliged to provide health insurance or pay an annual fine of $2,000 per excess worker beyond the first 30-roughly a dollar per hour for a full-time employee. I appreciate the visceral reluctance to take on additional costs and paperwork, and can imagine marginal cases where a small company would decide it's not worthwhile to grow. But I'm skeptical that many savvy businessmen would turn down a good opportunity to expand simply to avoid offering workers health insurance. If the value of the new business is greater than the employer's share of an insurance plan or a fine, you go for it, right? That's called capitalism.
Govs’ health care questions crucial to moving on Obamacare
Overhauling the United States health care system will be complicated and take time. It will rightfully involve feedback and questions from the states and assistance and flexibility from the federal government.
But having questions about the law should not deter states from cooperating with the implementation of the Affordable Care Act. Questions should be part of the process, not an excuse to wait until the next election with the hope of overturning the law then.
The Republican Governors Association sent a letter to the Obama administration last week seeking answers to many questions about the Medicaid expansion provision of the law and the required health insurance exchanges, which act as an online marketplace for people to shop for private insurance plans.
The letter was beneficial in the sense that it opened discussion about realistic concerns, instead of relying on common rhetoric about the law making Americans less free. Governors asked the federal government to explain how long-term funding of health care exchanges will be sustained and wanted to know the deadline by which states have to say whether they will participate in the Medicaid expansion.
The Republican governors asked what regulations will have to be reopened for public comment in regard to the health care exchanges. Also, when will the federal government provide guidance about health benefits required under the exchanges? How will the states be reimbursed through Medicaid for medical services provided to undocumented aliens?
I’m Sorry. Really. I Mean It.
Hello. This is David Farmer.
The recent remarks by Gov. Paul LePage have created a lot of clarity and confusion and at least one (more) parody.
In my column last week, I intended to make fun of the fact that LePage compared federal workers to the Gestapo, murderous Nazi secret police.
Instead, one word halted the conversation: Gazpacho.
Study: Medicare Beneficiaries Receive Higher Quality, More Affordable Care
A study from the Commonwealth Fund found that adults receiving health care through Medicare receive higher quality care than those who have insurance through their employers or purchase their own coverage.
The report concluded that Medicare beneficiaries are both the most satisfied with their insurance, and also the least likely to have problems paying medical bills. Fifty-eight percent of adults with individual insurance report spending 10 percent or more of their income on medical costs, compared to only 29 percent of adults with medicaid. Similarly, the study found that “only 13 percent of Medicare beneficiaries were unable to pay for basic necessities such as food or rent or used up all their savings to cover medical bills, compared to 27 percent of adults with employer-based insurance and 33 percent with individual insurance.”
Questioning Surgery for Early Prostate Cancer
By TARA PARKER-POPEA new study shows that prostate cancer surgery, which often leaves men impotent or incontinent, does not appear to save the lives of men with early-stage disease, who account for most cases, and many of these men would do just as well to choose no treatment at all.
The findings were based on the largest-ever clinical trial comparing surgical removal of the prostate with a strategy known as "watchful waiting." They add to growing concerns that prostate cancer detection and treatment efforts over the past 25 years, particularly in the United States, have been woefully misguided, rendering millions of men impotent, incontinent and saddled with fear about a disease that was unlikely ever to kill them in the first place. About 100,000 to 120,000 radical prostatectomy surgeries are performed in the United States each year.
"I think this is game-changing," said Dr. Leonard Marks, a professor of urology at the University of California, Los Angeles, who was not involved in the study. "What this study does is call attention to the fact that there are a lot of prostate cancers that are diagnosed today that are not dangerous."
Even so, the research, published Wednesday in The New England Journal of Medicine and paid for by the Department of Veterans Affairs, the National Cancer Institute and the Agency for Healthcare Research and Quality, is unlikely to settle the debate about the best course of care for men with prostate cancer.
An editorial accompanying the report argued that the study of 731 men, while important, is still too small to draw definitive conclusions about the relative benefits of radical prostatectomy. In addition, slightly more men who did not undergo surgery developed bone metastases over the course of the 15-year study. There was no statistical difference in risk of death from prostate cancer or any cause among men who were randomly assigned to surgery or to an observation group. There was also a suggestion that men with very high scores on a prostate cancer screening test were more likely to benefit from surgery.
Texas Counties Fear Residents Will Pay the Price of Perry’s Medicaid Rebuff
By MANNY FERNANDEZ
HOUSTON — Gov. Rick Perry’s decision on July 9 to refuse two key provisions of the federal health care law — the expansion of Medicaid and the creation of a state insurance exchange — is already being fiercely debated by lawmakers in Austin. But the real impact of the move will be felt far from the Texas Capitol, in the chambers of the commissioners who oversee the state’s counties.
In Texas, the burden of paying for the health care of the uninsured falls largely on county residents, whose property taxes help support so-called safety-net hospitals like Ben Taub General Hospital in Houston and University Medical Center of El Paso. Last fiscal year, taxpayers in Houston’s Harris County supplied $504 million and those in El Paso County $54 million to maintain and operate the public hospital districts that treated uninsured Texans in the two counties.
Several local leaders, health policy analysts and officials at urban hospitals across the state said Mr. Perry’s decision to reject billions of federal dollars that Texas would receive in a Medicaid expansion would hurt county taxpayers and the hospitals they support, forcing them to continue to pick up much of the tab for treatment of the uninsured.
Last year, the El Paso County Hospital District, which includes University Medical Center, asked county commissioners to raise property taxes to make up for cuts to Medicaid passed by the State Legislature and to address the growing number of uninsured patients. The commissioners, including Daniel R. Haggerty, the lone Republican, approved the tax increase, the first the county had authorized for the hospital district in 22 years. The average increase for homeowners was about $13 a year.
“I understand the governor is probably trying to make a political move here,” Mr. Haggerty said. “He hasn’t got a clue as to what our situation is and what our problems are. He’s saying, ‘You guys figure it out.’ That’s fine. I understand how it works.”
http://www.nytimes.com/2012/07/18/us/texas-counties-fear-cost-of-medicaid-rebuff.html?_r=1&ref=health&pagewanted=print
Businesses Will Push Perry to Rethink Medicaid Expansion
Nurses Union Will Keep Fighting for Medicare for All
By Rose Ann DeMoro
The Nation, July 17, 2012
Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter’s appeal to single payer advocates to “bury the hatchet,” recently published in The Nation, is both misdirected and shortsighted.
Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.
But there are some gaping holes in this thinking.
First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don’t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.
Second, let’s not have illusions about the history of the ACA.
Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.
So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It's one reason so many people vote against their own interests.
http://www.pnhp.org/print/news/2012/july/nurses-union-will-keep-fighting-for-medicare-for-all
The Nation, July 17, 2012
Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter’s appeal to single payer advocates to “bury the hatchet,” recently published in The Nation, is both misdirected and shortsighted.
Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.
But there are some gaping holes in this thinking.
First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don’t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.
Second, let’s not have illusions about the history of the ACA.
Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.
So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It's one reason so many people vote against their own interests.
http://www.pnhp.org/print/news/2012/july/nurses-union-will-keep-fighting-for-medicare-for-all
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