Limits Placed on Immigrants in Health Care Law
By ROBERT PEAR
WASHINGTON — The White House has ruled that young immigrants who will be allowed to stay in the United States as part of a new federal policy will not be eligible for health insurance coverage under President Obama’s health care overhaul.
The decision — disclosed last month, to little notice — has infuriated many advocates for Hispanic Americans and immigrants. They say the restrictions are at odds with Mr. Obama’s recent praise of the young immigrants.
In June, the president announced that hundreds of thousands of illegal immigrants who came to the United States as children, attended school here and met other requirements would be allowed to remain in the country without fear of deportation.
Immigrants granted such relief would ordinarily meet the definition of “lawfully present” residents, making them eligible for government subsidies to buy private insurance, a central part of the new health care law. But the administration issued a rule in late August that specifically excluded the young immigrants from the definition of “lawfully present.”
At the same time, in a letter to state health officials, the administration said that young immigrants granted a reprieve from deportation “shall not be eligible” for Medicaid or the Children’s Health Insurance Program. Administration officials said they viewed the immigration initiative and health coverage as separate matters.
Kathleen Sebelius, the secretary of health and human services, said in the Federal Register that the reasons offered for the immigration initiative “do not pertain to eligibility for Medicaid,” the children’s health program or federal subsidies for buying private health insurance.
Regulating U.S. Health Care
Regarding “Après Rahm, le déluge” (Views, Sept. 15): David Brooks mistakenly implies that health care is exceedingly expensive and wasteful in the United States because of too much government control over the provision of health care. The facts do not support this claim. Health care in the United States is expensive and compares poorly in terms of life expectancy and child mortality rates with West European countries, Canada, Australia and Japan in large part because of a lack of effective government regulation of the health care industry. Private insurers in America spend huge sums of money on advertising and bureaucratic administrative costs that do not improve health. The high profits they earn are not reinvested adequately in the public interest. Overall, the most effective health care systems combine strict government regulation in the form of quality standards and cost containment with private competition between health care insurers, as in countries such as Germany. Moreover, it is the lack of effective government regulation of health care in the United States that allowed — until the passage of the Affordable Care Act — gross injustices such as health care insurers discriminating against the sick, disabled and individuals with pre-existing conditions by denying them access to health care.
Noam Schimmel, LONDON
Grappling With Details Of Medicare Proposals
By RONI CARYN RABIN
When Claire Celsi's father-in-law died in July, the one thing her mother-in-law did not have to worry about was the $300,000 hospital bill. Medicare covered most of it.
But election-year proposals to transform Medicare into a so-called premium-support program, as proposed by Mitt Romney, the Republican presidential nominee, are making Ms. Celsi anxious about the health costs she may face in retirement. People age 55 and older would see no changes to their Medicare benefits under these plans.
But at 46, Ms. Celsi is well into her working life. She has contributed to Medicare and has been counting on it.
"I'm 46; my husband is 52. At this stage of our lives, it's already too late to start building up an emergency medical fund that's big enough to pay for all the extra expenses we'd incur," Ms. Celsi said. "I looked at that hospital bill and thought, what if that was me and I didn't have Medicare? What would I do?"
Many health care consumers are wondering the same. But answers to their questions are hard to come by: The proposals keep changing, and some are short on details. No one is certain what health care costs will be in the coming years.
Still, it's clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. "All scenarios will require seniors to pay more," said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, "is a fantasy."
Under the current Republican plan, seniors would buy medical coverage from private insurers or from traditional Medicare, which would compete with private plans. Medicare beneficiaries would receive fixed amounts from the government to help pay the premiums. The amounts would vary with the recipient's income.
The strategy has been supported by conservatives in Congress since the early 1980s, and it has become a central issue in the presidential campaign. The restructuring would affect some of the most vulnerable Americans: the elderly, nearly half of whom live on less than $22,000 a year, and who already spend 16 to 22 percent of their income on health care. Many have dementia and other complex medical problems.
Proponents say that calling such a system a "voucher plan," as many critics have, is misleading.
In ‘Obesity Paradox,’ Thinner May Mean Sicker
By HARRIET BROWN
A few years ago, Mercedes Carnethon, a diabetes researcher at the Feinberg School of Medicine at Northwestern University, found herself pondering a conundrum. Obesity is the primary risk factor for Type 2 diabetes, yet sizable numbers of normal-weight people also develop the disease. Why?
In research conducted to answer that question, Dr. Carnethon discovered something even more puzzling: Diabetes patients of normal weight are twice as likely to die as those who are overweight or obese. That finding makes diabetes the latest example of a medical phenomenon that mystifies scientists. They call it the obesity paradox.
In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease.
Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans, was one of the first researchers to document the obesity paradox, among patients with heart failure in 2002. He spent more than a year trying to get a journal to publish his findings.
“People thought there was something wrong with the data,” he recalled. “They said, ‘If obesity is bad for heart disease, how could this possibly be true?’ ”
But there were hints everywhere. One study found that heavier dialysis patients had a lower chance of dying than those whose were of normal weight or underweight. Overweight patients with coronary disease fared better than those who were thinner in another study; mild to severe obesity posed no additional mortality risks.
In 2007, a study of 11,000 Canadians over more than a decade found that those who were overweight had the lowest chance of dying from any cause.
Maine Voices: Maine health law enables employers to join forces for better care
The first member-owned US. insurance company uses proven strategies to raise quality and cut costs.
By ARTHUR BATSON III
PORTLAND – The Portland Press Herald published an editorial Sept. 10 titled "Maine health law better for insurers than patients." The editorial blasted Maine's health care reform law, Public Law 90, while pointing to Arkansas as a model for its work in addressing root health care cost drivers.
The editorial described Arkansas' attempt to shift from a fee-for-service payment model; to center care on primary care physicians, who play the role of "quarterback" in care management; and to hold providers responsible for the quality of the services they provide.
These are all things happening today in Maine, thanks to PL 90.
One provision of PL 90 enabled the creation of MaineSense, the nation's first health insurance association captive: a member-owned insurance company that does not offer policies to the public.
MaineSense was created by employers tired of paying the tab for an expensive and inefficient health care system with no ability to guarantee quality and value for their employees.
More than half of Maine adults will be obese by 2030, report projects
Posted Sept. 18, 2012, at 10:09 a.m.
More than half of all adults in the state will be obese by 2030 if Mainers continue packing on the pounds at current rates, according to a national report released Tuesday.
The adult obesity rate in Maine is on course to reach 55.2 percent in 20 years, according to the annual “F as in Fat” report by the Trust for America’s Health and the Robert Wood Johnson Foundation. The report predicts that every state in the nation will have an obesity rate topping 44 percent by 2030, with Mississippi tipping the scales at 66.7 percent and Colorado at the thinner end with 44.8 percent of all adults labeled obese.
Adults are considered obese if their body mass index, a body fat calculation based on individual weight and height, totals 30 or higher.
The report’s projections aren’t surprising given the prevalence of obesity in Maine and across the country, but serve as a call to action, said Tina Pettingill, executive director of the Maine Public Health Association.
“It’s devastating,” she said. “It will devastate our economy and the people of Maine. We have to do something about this.”
Today, Maine is tied with North Dakota at 25th in the nation with an adult obesity rate of 27.8 percent, according to 2011 data from the U.S. Centers for Disease Control and Prevention. In 1995, 14.3 percent of Mainers were obese.
Over the next 20 years, obesity is on track to contribute to 192,680 new cases of Type 2 diabetes, 462,648 new cases of coronary heart disease and stroke, 405,204 new cases of hypertension, 248,703 new cases of arthritis, and 65,041 new cases of obesity-related cancer in Maine, the report found.
The analysis was commissioned by the Trust for America’s Health and the Robert Wood Johnson Foundation and conducted by the National Heart Forum. Its projections are based on a peer-reviewed model published last year in the medical journal “The Lancet” and an annual phone survey conducted by the U.S. CDC and state health departments.
Urgent Care Centers Are Booming, Which Worries Some Doctors
http://www.kaiserhealthnews.org/Stories/2012/September/18/urgent-care-centers.aspx
The Guardian (U.K.), Sept. 12, 2012
“Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong.”
Surprisingly, those are the words of Friedrich Hayek, straight out of “The Road to Serfdom.” And I’m not pulling them out of context: Hayek firmly believed that the government should organize comprehensive systems of social insurance, including health care; should protect citizens against poverty and should ensure, for everyone, “the certainty of a given minimum of sustenance for all.”
With vice-presidential candidate Paul Ryan claiming that his ideas are inspired by Hayek and even handing out copies of “The Road to Serfdom” “to bring new staffers up to speed” – following the earlier highjacking of Hayek by Glenn Beck and Rush Limbaugh – it’s time for some intellectual honesty.
Others have usefully begun to discuss the tension between Paul Ryan’s politics and Hayek’s thought, as well as the internal tensions between Hayek and Ryan’s other guru, Ayn Rand. But here, for a moment, let’s go back to the primary text, open our University of Chicago Press definitive edition of “The Road to Serfdom” and honestly read it in relation to the American health care debate.
By way of background, Hayek was adamant that the central economic function of government is to organize and administer markets in such a way as to promote and protect competition. His central focus was on the neutrality of government rules – or what he called (on page 117), “the Rule of Law, in the sense of the rule of formal law, the absence of legal privileges of particular people designated by authority” – not the elimination of government rules.
“The liberal argument is in favor of making the best possible use of the forces of competition as a means of coordinating human efforts, not an argument for leaving things just as they are.” (p. 85)
Hayek emphasized that it is a pure and simple – and highly misleading – mischaracterization of his own thought, and of liberal economic theory, to suggest that government should do nothing. “In no system that could be rationally defended would the state just do nothing,” he stressed in “The Road to Serfdom” (p. 88).
In this sense, Hayek firmly believed that the notion of a “free market” is an illusion:
http://www.pnhp.org/print/news/2012/september/how-paul-ryan-enslaves-friedrich-hayek’s-‘the-road-to-serfdom’
How Paul Ryan enslaves Friedrich Hayek’s ‘The Road to Serfdom’
The Republican VP nominee claims Hayek as hero. Did he miss the libertarian economist’s advocacy of universal health care?
By Bernard HarcourtThe Guardian (U.K.), Sept. 12, 2012
“Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong.”
Surprisingly, those are the words of Friedrich Hayek, straight out of “The Road to Serfdom.” And I’m not pulling them out of context: Hayek firmly believed that the government should organize comprehensive systems of social insurance, including health care; should protect citizens against poverty and should ensure, for everyone, “the certainty of a given minimum of sustenance for all.”
With vice-presidential candidate Paul Ryan claiming that his ideas are inspired by Hayek and even handing out copies of “The Road to Serfdom” “to bring new staffers up to speed” – following the earlier highjacking of Hayek by Glenn Beck and Rush Limbaugh – it’s time for some intellectual honesty.
Others have usefully begun to discuss the tension between Paul Ryan’s politics and Hayek’s thought, as well as the internal tensions between Hayek and Ryan’s other guru, Ayn Rand. But here, for a moment, let’s go back to the primary text, open our University of Chicago Press definitive edition of “The Road to Serfdom” and honestly read it in relation to the American health care debate.
By way of background, Hayek was adamant that the central economic function of government is to organize and administer markets in such a way as to promote and protect competition. His central focus was on the neutrality of government rules – or what he called (on page 117), “the Rule of Law, in the sense of the rule of formal law, the absence of legal privileges of particular people designated by authority” – not the elimination of government rules.
“The liberal argument is in favor of making the best possible use of the forces of competition as a means of coordinating human efforts, not an argument for leaving things just as they are.” (p. 85)
Hayek emphasized that it is a pure and simple – and highly misleading – mischaracterization of his own thought, and of liberal economic theory, to suggest that government should do nothing. “In no system that could be rationally defended would the state just do nothing,” he stressed in “The Road to Serfdom” (p. 88).
In this sense, Hayek firmly believed that the notion of a “free market” is an illusion:
http://www.pnhp.org/print/news/2012/september/how-paul-ryan-enslaves-friedrich-hayek’s-‘the-road-to-serfdom’
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