TUESDAY, JULY 3, 2012
The Game’s Not Over, and It May Not Even Be The Real Game
by Brian Klepper
Like most health law watchers, I was surprised by the recent Supreme Court decision. I'm sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle.
I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the law with some constraints. Here's the comment from SCOTUS (Supreme Court of the United States) Blog:
Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial - and most controversial - feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don't. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.
Wooing Swing Voters, Both Parties Wary of Overemphasizing Health Care
By JONATHAN WEISMAN
LEESBURG, Va. — George Allen, a former Republican senator campaigning to get his old job back, did not seem eager to discuss health care on Tuesday as he buzzed through this town’s historic district. The economy, energy production, even a rash of Lyme disease at a local college were quicker to get him talking as he glad-handed voters.
But some of the most avid Republicans he ran into on King Street were determined to complain about the Supreme Court decision last week upholding President Obama’s health care law — and pull Mr. Allen off message.
“The health care bill was a total disaster,” said Dr. Ralph Swiger, 55, a dental surgeon having lunch at Leesburg Restaurant. “What the Supreme Court did, I’m so upset about it. Everybody is.”
The experience pointed to the problem that both parties face after one of the most consequential Supreme Court decisions in memory: their core voters are energized, either by rage or elation, but the independents who are likely to decide the 2012 elections may be ready to move on.
Dr. Swiger said the health care decision made him weep for his country. But to win his Senate campaign over Tim Kaine, a popular former governor, Mr. Allen needs to reach less partisan voters like Joshua Schwanborg, 43, the proprietor of China King restaurant. He was far more concerned about the rates charged by the Australian highway firm that runs the toll road to Washington.
Too Quiet, Again, on Health Care
Nearly two dozen Pennsylvania residents, interviewed recently by Abby Goodnough of The Times, said they were opposed to President Obama’s health care reform law. Though almost all of them would benefit from it, they expressed fears about a loss of control over their health care that is nowhere in the law.
There are two reasons for this situation, which is repeated around the country. Business groups allied with Republicans have spent $235 million on television ads attacking the law with false accusations, with the vigorous aid of Mitt Romney and his campaign. Meanwhile, Democrats and the Obama campaign have been amazingly reluctant to speak up for the president’s biggest accomplishment and tell voters what’s in it.
The president has not even capitalized on his victory in the Supreme Court last week over his opponents’ attempt to dismantle the law on constitutional grounds. He listed some of its benefits in a low-key East Room speech after the ruling, and the campaign has sent out several direct-mail fliers on the subject to women. But the campaign has broadcast no television ads about health care, except for one in Spanish. Jack Lew, the White House chief of staff, said on “Fox News Sunday” that it was time “for the divisive debate on health care to stop,” suggesting Democrats want to move on.
Mr. Lew might consider going to a swing state and turning on the television because the debate isn’t going to stop. Republicans are happy to continue it with obvious propaganda like “Obamacare is the largest tax increase in U.S. history.” Countering this attack and, more important, building a foundation of support for a vastly important social change, will require the president and other Democrats to spend more time and more money explaining the law’s benefits, and pointing out that Republicans have no useful ideas to replace it.
In Rwanda, Health Care Coverage That Eludes the U.S.
By TINA ROSENBERGLast week's Supreme Court decision upholding of the constitutionality of President Obama's health care law moves the United States closer to the goal of health coverage for all. All otherdeveloped countries have it. But so do some developing nations - Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.
The point is not that Americans should envy Rwanda's health system - far from it. But Rwanda's experience illustrates the value of universal health insurance. "Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years," said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.
It couldn't have happened without health insurance.
Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president. Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.
But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled - although the fact that it is now only $550 a year tells you how destitute Rwanda was.
Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 - in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. "Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all," said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.
Will Maine opt out of Medicaid expansion?
Some GOP governors intend to forgo the federal money, but LePage indicates the complex decision won't be made until after the fall election.
The U.S. Supreme Court's landmark decision last week to uphold the federal health care law affirmed the legality of President Obama's signature legislative achievement.
But an unanticipated aspect of the ruling has created uncertainty for states like Maine, which must decide whether to participate in the law's expansion of health insurance for low-income residents.
States didn't have much choice before the court decision. Expansion of Medicaid, known asMaineCare in Maine, was mandated in the Affordable Care Act as a way to increase coverage for 17 million low-income Americans, including an estimated 37,000 uninsured Mainers. States that didn't comply with the law's 2014 deadline to increase coverage faced losing all Medicaid funds.
Cigna to repay Mainers $2.6 million
The health insurer failed to meet an Affordable Care Act requirement that it spend 85 percent of premiums on medical care.
Cigna must pay $2.6 million in rebates to nearly 10,600 health insurance consumers in Maine because it failed to meet a federal requirement to spend 85 percent of the premiums it collected last year on medical care.
Connecticut-based Cigna is the only health insurer operating in Maine that must pay rebates, which will average $463 per family, according to the U.S. Department of Health and Human Services.
A provision in the federal Affordable Care Act requires insurers to spend certain amounts on medical care, with a minority of their spending allocated to administrative expenses such as salaries and marketing.
The challenge of the Affordable Care Act for Mainers
Posted July 03, 2012, at 11:42 p.m.
In the United States we spend approximately $8,000 per person per year on health care but rank 15th in the world for overall health. The country that ranks No. 1 spends less than half of what we do per person. Are you and I getting our money’s worth? Will the Affordable Care Act help us?
The Supreme Court’s decision presents Mainers with a remarkable opportunity. The
court endorsed a full set of new benefits — free preventative care, lower-cost Medicare prescriptions, the path to universal coverage and much more. Furthermore, everyone who has a personal physician and a good insurance program will be able to keep them.
Over time we can do this without increasing the cost of medical care.
Starting in 2014, the Affordable Care Act will pay Maine to expand MaineCare, our version of Medicaid, which we created years ago to provide health coverage for people with low incomes. The feds will pay 100 percent of the cost for three years, 95 percent for two more and then permanently 90 percent of the cost of this expanded network. The act opens doors for more Mainers to have dependable and secure medical care with minimal cost to us.
Even though the Supreme Court removed the legal uncertainties surrounding the Affordable Care Act, Maine’s work is just beginning. The act’s opponents lost the legal battle but their concerns are real and need to be addressed. At their heart is a fundamental moral question: Is health care a right or a privilege? We are going to have to publicly discuss and answer this question, as well as many practical questions: Can we afford the Affordable Care Act? Can we not afford the Affordable Care Act? Is health care better delivered by for-profit insurance companies, such as Aetna and Cigna with their 22 percent to 33 percent overhead, or government programs such as Medicare, with its 3 percent overhead? What are the alternatives?
Maine’s role as national leader in student health at risk
Posted July 03, 2012, at 10:56 p.m.
Having a personal connection to Maine, I have always appreciated the state for its virtues, including its independent political streak. As campaign staff for Rep. Tom Allen and one of his first legislative assistants, I learned to appreciate that Mainers value principle over politics. Allen always had support back home for his efforts to bridge the partisan gap in Washington.
In the end, common sense prevails in Maine, and the public good outweighs that of a select few. For that reason, the state is a policy leader in areas such as education and public health.
That’s also why it is so unfortunate that Maine’s role as a national leader in community-focused health is at risk. This year’s budget bill cut $9.2 million from the Fund for a Healthy Maine. Within that, nearly $3 million was cut from a Fund for a Healthy Maine program called Coordinated School Health. That’s about half the program’s budget. To implement these cuts, the Department of Health and Human Services chose to eliminate all of Maine’s school health coordinator positions. That’s almost 30 jobs in a down economy and difficult job market.
This funding — and the school health coordinators as well — supported one of the country’s best models, putting Maine on the map as a national leader in advocating for student health. However, that success likely will become history if funding is not restored.
Translating the insurance industry's feel-good rhetoric
By Wendell Potter
iWatch News, July 2, 2012
Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.
That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.
Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.
“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”
Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”
Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”
Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”
http://www.pnhp.org/print/news/2012/july/translating-the-insurance-industrys-feel-good-rhetoric
iWatch News, July 2, 2012
Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.
That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.
Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.
“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”
Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”
Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”
Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”
http://www.pnhp.org/print/news/2012/july/translating-the-insurance-industrys-feel-good-rhetoric
The Downside of Liberty
By KURT ANDERSEN
THIS spring I was on a panel at the Woodstock Writers Festival. An audience member asked a question: Why had the revolution dreamed up in the late 1960s mostly been won on the social and cultural fronts — women’s rights, gay rights, black president, ecology, sex, drugs, rock ’n’ roll — but lost in the economic realm, with old-school free-market ideas gaining traction all the time?
There was a long pause. People shrugged and sighed. I had an epiphany, which I offered, bumming out everybody in the room.
What has happened politically, economically, culturally and socially since the sea change of the late ’60s isn’t contradictory or incongruous. It’s all of a piece. For hippies and bohemians as for businesspeople and investors, extreme individualism has been triumphant. Selfishness won.
From the beginning, the American idea embodied a tension between radical individualism and the demands of the commonweal. The document we’re celebrating today says in its second line that axiomatic human rights include “Life, Liberty and the pursuit of Happiness” — individualism in a nutshell. But the Declaration’s author was not a greed-is-good guy: “Self-love,” Jefferson wrote to a friend 38 years after the Declaration, “is no part of morality. Indeed it is exactly its counterpart. It is the sole antagonist of virtue leading us constantly by our propensities to self-gratification in violation of our moral duties to others.”
Curbing the cost of health care
By Fareed Zakaria,
Many liberals believe that the Affordable Care Act — Obamacare — is unpopular only because most Americans don’t understand it. There is some truth to this: Studies show that the core provisions of the bill are more popular than the bill itself. But there’s also a reason, rooted in reality, why many Americans worry about Obamacare — its cost.
Most Americans have health care. What they worry about is the cost of insuring 20 million to 30 million more people. Unless the meteoric rise of health-care costs is slowed, a big expansion of coverage might well remain unpopular, no matter how it is explained.
Republican alternatives to Obamacare, such as Rep. Paul Ryan’s plan, don’t bother with expanding coverage, which is a mistake because they leave in place a broken insurance model in which people can freeload. But most do have a strategy to control costs — get consumers to pay for more of their health care. The basic idea is intuitively appealing. Markets produce efficiencies; they presumably would do the same thing in health care.
But the situation on the ground suggests that markets work imperfectly in this realm. A new study conducted by the pharmaceutical company Novartis and McKinsey and Co. shows a stunning difference among countries with regard to health-care efficiency.
Taxpayer-paid health care not just for politicians
Seriously, whenever someone is against the Affordable Health Care Act, I ask them what type of health care they have, and invariably they have good coverage. It's like, "I have it, too bad for everyone else, I don't want to share." Just look at all these politicians who are against it; they have incredible coverage – and who pays for that? We do – the U.S. taxpayer! It's good enough for them but not for the rest of us.
Health care should not be about making a profit from someone who is sick and sending people into bankruptcy. When people go to the ER as their only source of medical care and don't have insurance, we all pay for that through our insurance rates.
Maine needs to get moving on a health insurance exchange
Posted July 04, 2012, at 4:39 p.m.
If you are uninsured, or you’re a business owner wanting to compare health insurance plans, in the future you might rely on a health insurance exchange. The online exchange is where you’ll be able to see what private health plans are most suitable for you, find out whether you’re eligible for tax credits and, finally, enroll in a plan.
Simple, right?
But Maine doesn’t yet have an exchange, and it doesn’t appear to have a strategy for building one, even though President Barack Obama’s Affordable Care Act has been ruled constitutional. If the state doesn’t set one up soon, or partner with the federal government to build one, the federal government will do it for Maine.
And it appears more and more likely that the federal government will take the lead. Gov. Paul LePage said recently he will wait to make a decision on the exchange until after he gets answers to implementation questions and until after the November elections, which would be near to the deadline to create one. That’s unfortunate because it makes the most sense for the state to have a say in developing the exchange. We would rather see LePage direct state legislators to return for a special session as soon as possible to approve one.
Maine knows better than the federal government how to reach out to Mainers and educate them about an exchange. Maine knows better the needs of its small businesses. Maine should be the one to choose which plans are offered through the exchange and what the required benefits are. If there isn’t enough time for Maine to help develop a well-thought-out exchange now, it would be good for LePage to announce that he would like to create a state-based one in the coming years.
It would be understandably difficult for some legislators now to work on an exchange when they opposed the health care law. But the benefit to Mainers should come before pride or ideology. If the federal government is going to require an exchange, it’s only to Maine’s advantage to have a hand in it.
No comments:
Post a Comment