The Conservative Case for Obamacare
By J. D. KLEINKE
Washington
IF Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.
This fundamental ideological paradox, drowned out by partisan shouting since before the plan’s passage in 2010, explains why Obamacare has only lukewarm support from many liberals, who wanted a real, not imagined, “government takeover of health care.” It explains why Republicans have been unable since its passage to come up with anything better. And it explains why the law is nearly identical in design to the legislation Mr. Romney passed in Massachusetts while governor.
The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s. The president’s program extends the current health care system — mostly employer-based coverage, administered by commercial health insurers, with care delivered by fee-for-service doctors and hospitals — by removing the biggest obstacles to that system’s functioning like a competitive marketplace.
Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.
Cut we must
Posted Sept. 17, 2012, at 3:25 p.m.
The Maine Hospital Association warned last week that automatic Medicare cuts will cost the state $21 million next year and nearly 3,000 jobs.
This is the result of the robotlike sequestration process Congress came up with last year. That scheme was designed to be so frightening and so repugnant to both sides that it would force Democrats and Republicans to compromise on a more rational, less harmful plan.
As it turned out, Republicans and Democrats disliked each other even more than they disliked the nightmare of sequestration and the plan failed. True story.
Everyone who’s anyone now says sequestration was a stupid idea in the first place and will cripple the economy if enacted. Yet, here we are, with the stupid plan as our only plan.
The hope now is that with the election out of the way Congress can act swiftly to avert a crisis. Everyone who has faith in that happening, raise their hand.
Yeah, didn’t think so.
Maine’s hospitals are clearly hoping for that miracle. They not only face the sequestration cuts, but Affordable Care Act cuts and Medicaid cuts imposed by the Republican Legislature.
But even if sequestration isn’t the answer — and it’s clearly not a good one — hospitals had better be about the job of cutting expenses over the next decade.
Medicare is unsustainable, and you don’t have to be a hospital CFO to understand that. It is the elephant in the room when politicians try talking about the deficit.
Bluntly, we spend too much on health care and, by a lot of measures, we do not get our money’s worth.
The Psych Approach
By DAVID BROOKS
In the 1990s, Vincent Felitti and Robert Anda conducted a study on adverse childhood experiences. They asked 17,000 mostly white, mostly upscale patients enrolled in a Kaiser H.M.O. to describe whether they had experienced any of 10 categories of childhood trauma. They asked them if they had been abused, if their parents had divorced, if family members had been incarcerated or declared mentally ill. Then they gave them what came to be known as ACE scores, depending on how many of the 10 experiences they had endured.
The link between childhood trauma and adult outcomes was striking. People with an ACE score of 4 were seven times more likely to be alcoholics as adults than people with an ACE score of 0. They were six times more likely to have had sex before age 15, twice as likely to be diagnosed with cancer, four times as likely to suffer emphysema. People with an ACE score above 6 were 30 times more likely to have attempted suicide.
Later research suggested that only 3 percent of students with an ACE score of 0 had learning or behavioral problems in school. Among students with an ACE score of 4 or higher, 51 percent had those problems.
In Paul Tough’s essential book, “How Children Succeed,” he describes what’s going on. Childhood stress can have long lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and do many of the other things that contribute to a happy life.
Tough interviewed a young lady named Monisha, who was pulled out of class by a social worker, taken to a strange foster home and forbidden from seeing her father for months. “I remember the first day like it was yesterday. Every detail. I still have dreams about it. I feel like I’m going to be damaged forever.”
Health Care: Reform law supported in MaineA poll finds a majority like Obamacare and oppose its repeal, which diverges from U.S. survey results.Mainers are much more supportive of President Obama's health care reform law than most Americans are, according to the latest statewide poll by Critical Insights Asked whether the Affordable Care Act, also known as Obama- care, will be good or bad for the country, 47 percent said good and 38 percent said bad. That is the opposite view of Americans in general, who say the law will be bad, 51 percent to 37 percent, according to a Rasmussen poll during the same week in mid-September. The same is true when voters are asked if they support repeal of the law. In Maine, voters said they oppose repeal 55 percent to 39 percent, according to the Critical Insights poll. Nationwide, voters support repeal 53 percent to 43 percent. The 2010 Affordable Care Act includes a sweeping set of reforms aimed at reducing the number of uninsured Americans. A core piece of the law, and the most controversial, is a requirement that most uninsured Americans buy health insurance through government-run exchanges starting in 2014. The exchanges will provide subsidies to help qualified people pay for the coverage http://www.pressherald.com/politics/health-care-reform-law-supported-in-maine_2012-09-30.html |
Spiritual side of health care
By Ahmed Kutty, M.D.
Kearney (Neb.) Hub, Letters, Aug. 24, 2012
On Aug. 15 at the dedication of the new west wing and the Cope Heart Center at Good Samaritan Hospital, Bishop William Dendinger of Grand Island paid tribute to the late Cardinal Joseph Bernardin, who held a strong belief that the sacred dimension of the healing professions was just as vital as its scientific foundations.
In November 1996, the cardinal passed away after battling advanced pancreatic cancer, which brought him into direct and personal experience of pain and suffering. While very satisfied with the care he received at Chicago’s Loyola University MedCenter, Bernardin spoke out with anguish and passion regarding the plight of 45 million fellow Americans who were uninsured and often did not receive needed and timely medical care simply because the cost of coverage was unaffordable.
The Affordable Care Act of 2009 (Obamacare), while addressing some of the major flaws in our current dysfunctional system, has a long road to travel before a publicly funded health care financing mechanism is in place, providing necessary, appropriate and evidence-based medical care, both preventive and curative, to all citizens of this country. Achieving universal Medicare (Improved Medicare for All) will take a sustained, hard and bitter fight before the powers that be will concede it.
If we, the people, carry on the struggle for the cause that was very dear to his heart, the cardinal could not have wished for a worthier tribute
http://www.pnhp.org/print/news/2012/september/spiritual-side-of-health-care
Kearney (Neb.) Hub, Letters, Aug. 24, 2012
On Aug. 15 at the dedication of the new west wing and the Cope Heart Center at Good Samaritan Hospital, Bishop William Dendinger of Grand Island paid tribute to the late Cardinal Joseph Bernardin, who held a strong belief that the sacred dimension of the healing professions was just as vital as its scientific foundations.
In November 1996, the cardinal passed away after battling advanced pancreatic cancer, which brought him into direct and personal experience of pain and suffering. While very satisfied with the care he received at Chicago’s Loyola University MedCenter, Bernardin spoke out with anguish and passion regarding the plight of 45 million fellow Americans who were uninsured and often did not receive needed and timely medical care simply because the cost of coverage was unaffordable.
The Affordable Care Act of 2009 (Obamacare), while addressing some of the major flaws in our current dysfunctional system, has a long road to travel before a publicly funded health care financing mechanism is in place, providing necessary, appropriate and evidence-based medical care, both preventive and curative, to all citizens of this country. Achieving universal Medicare (Improved Medicare for All) will take a sustained, hard and bitter fight before the powers that be will concede it.
If we, the people, carry on the struggle for the cause that was very dear to his heart, the cardinal could not have wished for a worthier tribute
http://www.pnhp.org/print/news/2012/september/spiritual-side-of-health-care
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