Head-in-the-sand 'solution' is killing GOP
By Jack Bernard
Des Moines Register, July 16, 2012
We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare.
Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare.
It is our baby, ugly or not.
It is the height of hypocrisy for us now to criticize our own idea unless we have something better to replace it. And, the replacement needs to be comprehensive, not just a series of unacceptable statements and proposals based on doing away with traditional Medicare by turning it into a voucher program and gutting Medicaid by making it into a block grant.
Using vouchers for Medicare just dumps the cost problem into the lap of the powerless patient, rather than the federal government that has clout, making the cost escalation problem worse. The block grants for Medicaid idea just shifts the cost issue onto the states rather than the federal government, which once again solves nothing and only makes things worse.
States will just cut services and people from their Medicaid roles, creating more uninsured. Don’t Iowa hospitals serve enough uninsured in their emergency rooms now?
This gets us to what we as Republicans should do: throw out our rule book and be innovative. People my age will remember how we Republicans were 100 percent against recognizing China before Richard Nixon, the anti-communist crusader, came out for it. We must do the same with health care.
http://www.pnhp.org/print/news/2012/july/head-in-the-sand-solution-is-killing-gop
Des Moines Register, July 16, 2012
We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare.
Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare.
It is our baby, ugly or not.
It is the height of hypocrisy for us now to criticize our own idea unless we have something better to replace it. And, the replacement needs to be comprehensive, not just a series of unacceptable statements and proposals based on doing away with traditional Medicare by turning it into a voucher program and gutting Medicaid by making it into a block grant.
Using vouchers for Medicare just dumps the cost problem into the lap of the powerless patient, rather than the federal government that has clout, making the cost escalation problem worse. The block grants for Medicaid idea just shifts the cost issue onto the states rather than the federal government, which once again solves nothing and only makes things worse.
States will just cut services and people from their Medicaid roles, creating more uninsured. Don’t Iowa hospitals serve enough uninsured in their emergency rooms now?
This gets us to what we as Republicans should do: throw out our rule book and be innovative. People my age will remember how we Republicans were 100 percent against recognizing China before Richard Nixon, the anti-communist crusader, came out for it. We must do the same with health care.
http://www.pnhp.org/print/news/2012/july/head-in-the-sand-solution-is-killing-gop
Our View: Cost control the next arena for health care
Now that the individual mandate debate is done, let's look at programs like MaineHealth's.
The Supreme Court's decision upholding most of the Affordable Care Act has generated so much argument it's easy to forget that the court was only looking at a small part of the law.
Most of the debate has been over whether the federal government can mandate that individuals buy health insurance, and while near universal coverage is an important aspect of the law, it does not on its own make health care affordable. It was the rapid inflation of health costs and insurance premiums that created the current crisis, with tens of millions of Americans with no health insurance, and cost control is the cure.http://www.pressherald.com/opinion/cost-control-the-next-arena-for-health-care_2012-07-17.html
Governors divided over Medicaid expansion
Posted July 15, 2012, at 6:41 p.m.
WILLIAMSBURG, Va. — America’s governors have long used their semi-annual gatherings to lock arms in opposition to dreaded unfunded federal mandates and emphasize a pragmatic approach to problem-solving in stark contrast to a hyper-partisan, even dysfunctional Washington.
But the makings of a real divide loomed over the summer meeting of the National Governors Association here, as state leaders grappled with the fallout of the Supreme Court ruling that granted unexpected leeway with regard to a key component of President Barack Obama’s landmark health law: whether to accept billions of federal dollars in return for expanding coverage for the poor through Medicaid.
Against the backdrop of a heated presidential race, some Republicans who had hoped the entire law would be struck down gained an opportunity to neuter it at home when the court invalidated part of the measure dealing with Medicaid.
“I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government,” Texas Gov. Rick Perry said earlier this week in a statement joining “the growing chorus of governors who reject the Obamacare power grab.”
Democrats eager to champion the law saw a partisan effort to undermine the president who signed it.
“The bottom line is that Republican governors are running around this country literally willing to cut off their nose to spite their state,” said Connecticut Gov. Dannel Malloy, a first-term Democrat.
But a greater number of governors on both sides approached the unexpected ruling with caution, largely out of concern for the long-term effect on state budgets that had been stretched to the brink by the economic downturn.
Fee-For-Service is Not the Problem
By Stephen Kemble, M.D.
OpEd News, July 14, 2012
There is a widespread assumption among health policy experts that the key problem with runaway health care costs is unnecessary care driven by the incentive to over-treat that is inherent in fee-for-service payment of doctors. Therefore, the argument goes, we need to improve financial incentives for care coordination and reorganize doctors into "Accountable Care Organizations," forcing primary care, specialist physicians, and hospitals into shared financial arrangements that shift at least some insurance risks onto providers, countering the fee-for-service incentive to over-treat.
While there are certainly some doctors providing unnecessary procedures due to fee-for-service financial incentives, it is extremely unlikely that this is the root of our health care cost problem. The argument that fee-for-service incentives are the driver of excess health care cost is based on a fundamental misdiagnosis of the reasons for unsustainable cost escalation in U.S. health care.
If one attempts to quantify the sources of excess U.S. health spending by looking at actual evidence, it is apparent that exorbitant and unnecessary administrative costs are the biggest driver (around 20-25 percent of National Health Expenditures[1,2]), followed by unnecessary care due to over-treatment[3,4](perhaps 10 percent of NHE, of which only a fraction is attributable to fee-for-service incentives), and expensive complications of under-treatment due to lack of access (perhaps 5-10 percent of NHE, plus a lot of suffering and death that does not show up in health spending figures). About half of over-treatment is due to unreasonable demands for care by patients, most of which is actually driven by providers (direct-to-consumer advertising for drugs, ads by hospitals, and by the recommendations of doctors.) Malpractice costs and defensive medicine are only a few percent at most.[5]
There is a problem with lack of coordination of care for certain patients, but the far bigger problem is inadequate access to necessary care. There is a nation-wide shortage of doctors in primary care and also in many specialties. This is compounded by the problems of un-insurance and under-insurance, and the refusal of many doctors to accept patients with insurance plans that are onerous, pay low fees, or both. Care coordination is meaningless without access.
http://www.pnhp.org/print/news/2012/july/fee-for-service-is-not-the-problem
OpEd News, July 14, 2012
There is a widespread assumption among health policy experts that the key problem with runaway health care costs is unnecessary care driven by the incentive to over-treat that is inherent in fee-for-service payment of doctors. Therefore, the argument goes, we need to improve financial incentives for care coordination and reorganize doctors into "Accountable Care Organizations," forcing primary care, specialist physicians, and hospitals into shared financial arrangements that shift at least some insurance risks onto providers, countering the fee-for-service incentive to over-treat.
While there are certainly some doctors providing unnecessary procedures due to fee-for-service financial incentives, it is extremely unlikely that this is the root of our health care cost problem. The argument that fee-for-service incentives are the driver of excess health care cost is based on a fundamental misdiagnosis of the reasons for unsustainable cost escalation in U.S. health care.
If one attempts to quantify the sources of excess U.S. health spending by looking at actual evidence, it is apparent that exorbitant and unnecessary administrative costs are the biggest driver (around 20-25 percent of National Health Expenditures[1,2]), followed by unnecessary care due to over-treatment[3,4](perhaps 10 percent of NHE, of which only a fraction is attributable to fee-for-service incentives), and expensive complications of under-treatment due to lack of access (perhaps 5-10 percent of NHE, plus a lot of suffering and death that does not show up in health spending figures). About half of over-treatment is due to unreasonable demands for care by patients, most of which is actually driven by providers (direct-to-consumer advertising for drugs, ads by hospitals, and by the recommendations of doctors.) Malpractice costs and defensive medicine are only a few percent at most.[5]
There is a problem with lack of coordination of care for certain patients, but the far bigger problem is inadequate access to necessary care. There is a nation-wide shortage of doctors in primary care and also in many specialties. This is compounded by the problems of un-insurance and under-insurance, and the refusal of many doctors to accept patients with insurance plans that are onerous, pay low fees, or both. Care coordination is meaningless without access.
http://www.pnhp.org/print/news/2012/july/fee-for-service-is-not-the-problem
Obamacare opponents madder and more isolatedPosted on
Say you’re part of a family of four with an annual income of $40,000 and no health insurance. Now you’re eligible for an annual $10,000 subsidy to buy insurance, with no co-pays for preventive care. And you can shop for your insurance on a website set up by your state.
Or you’re a senior on Medicare who now has free checkups. More of your prescription drug costs are covered, and by 2020 the “donut hole” will be closed.
Perhaps you’re planning on opening a small business and want health care coverage. Because you had cancer, now in remission for nearly 10 years, you’ve been afraid to leave your job, which has insurance. Now insurance companies can’t turn you away, and if the cancer returns, there will be no lifetime limit on health benefits. Starting out with a few employees, your new business can get tax credits to buy them health insurance.
The Affordable Care Act has these provisions, and these details matter.
States saying no to ‘Obamacare’ could see downside
Posted July 17, 2012, at 8:31 p.m.
WASHINGTON — For Gov. Rick Perry, saying “no” to the federal health care law could also mean turning away up to 1.3 million Texans, nearly half the uninsured people who could be newly eligible for coverage in his state.
Gov. Chris Christie not only would be saying “no” to President Barack Obama, but to as many as 245,000 uninsured New Jersey residents as well.
The Supreme Court’s recent ruling gave governors new flexibility to reject what some Republicans deride as “Obamacare.” But there’s a downside, too.
States that reject the law’s Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new “doughnut hole” — a reference to a Medicare gap faced by seniors.
Medicaid is a giant federal-state health insurance program for the poor, now mostly covering children, mothers and disabled people. The expansion in Obama’s health care overhaul was originally expected to add roughly 15 million uninsured low-income people, mainly adults without children, who currently are not eligible in most states. Washington would pick up the entire cost for the first three years, with the federal share then dropping to 90 percent. The Medicaid expansion accounts for about half the total number of uninsured people projected to get coverage under the law.
If every state were to reject that Medicaid expansion — as the Supreme Court ruling now allows — some low-income people would still be picked up by other coverage provisions meant to help the middle class.
But nearly 11.5 million uninsured people below the federal poverty line would be left behind in a new coverage gap, according to recent estimates from the Urban Institute. That brings to mind the infamous “doughnut hole” in the Medicare prescription drug benefit, in which seniors with high drug costs find themselves paying out of pocket much of the year.
Those who fall into the new gap would neither qualify for Medicaid in their states under current rules nor be eligible for subsidized private insurance in new state marketplaces that Obama’s law calls exchanges.
Low-income children and mothers would continue to have insurance through Medicaid. Then, starting in 2014, millions of people over the poverty line would have subsidized private coverage through the new exchanges. “And then this group in the middle has nothing,” said Matt Salo, executive director of the National Association of Medicaid Directors. His organization takes no position on what states should do.
Things only get trickier from there.
http://bangordailynews.com/2012/07/17/health/states-saying-no-to-obamacare-could-see-downside/print/
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