I Am A Republican … Can We Talk About A Single Payer System?
By David May, M.D.
American College of Cardiology Touch Blog, April 23, 2013
American College of Cardiology Touch Blog, April 23, 2013
I am a Republican. For those who know me that is not a surprise. I live in a red state. I have never voted for a Democratic presidential candidate. I can field strip, clean and reassemble a Remington 12-gauge pump blindfolded. And on top of it, I think we should talk about having a single payer national health care plan. The reason is quite simple. In my view, we already have one; we just don’t take advantage of it.
Firstly, Medicare and the Center for Medicare and Medicaid Services (CMS) are de facto setting all of the rules now. They are a single payer system. When we go to lobby the Hill, we lobby Congress and CMS. Talking to Blue Cross, Aetna, Cigna and United Health care is essentially a waste of time. All the third party payers do is play off the Medicare rules to their advantage and profit. They have higher premiums, pay a somewhat higher benefit and have a significantly higher level of regulation which impedes the care of their customers. This is no longer consumer choice but effectively extortion, a less than hidden shake down in which the “choice” for a family of four is company A at $900 per month or company B at $1100 per month. The payers are simply taking advantage of the system, playing both ends against the middle.
Health Chaos Ahead
By DAVID BROOKS
It was always going to be difficult to implement Obamacare, but even fervent supporters of the law admit that things are going worse than expected.
Implementation got off to a bad start because the Obama administration didn’t want to release unpopular rules before the election. Regulators have been working hard but are clearly overwhelmed, trying to write rules that influence the entire health care sector — an economic unit roughly the size of France. Republicans in Congress have made things much more difficult by refusing to provide enough money for implementation.
By now, everybody involved seems to be in a state of anxiety. Insurance companies are trying to put out new products, but they don’t know what federal parameters they have to meet. Small businesses are angry because the provisions that benefited them have been put on the back burner. Health care systems are highly frustrated. They can’t plan without a road map. Senator Max Baucus, one of the authors of the law, says he sees a “huge train wreck” coming.
I’ve been talking with a bipartisan bunch of health care experts, trying to get a sense of exactly how bad things are. In my conversations with this extremely well-informed group of providers, academics and former government officials, I’d say there is a minority, including some supporters of the law, who think the whole situation is a complete disaster. They predict Obamacare will collapse and do serious damage to the underlying health system.
But the clear majority, including some of the law’s opponents, believe that we’re probably in for a few years of shambolic messiness, during which time everybody will scramble and adjust, and eventually we will settle down to a new normal.
What nobody can predict is how health care chaos will interact with the political system. There’s a good chance that Republicans will be able to use unhappiness with what is already an unpopular law to win back the Senate in 2014. Controlling both houses of Congress, they will be in a good position to alter, though not repeal, the program.
The law’s biggest defenders will then become insurance companies and health care corporations. Having spent billions of dollars adapting to the new system, they are not going to want to see it repealed or replaced.
Fight Club on the Hill
By Dana Milbank,
House conservatives met Wednesday for the latest installment of their “Conversations with Conservatives” luncheon series, but they took their places on the dais without sampling the Chick-fil-A sandwiches and nuggets on offer.These days, House conservatives prefer to eat their own.
Republican leaders had scheduled a vote in the chamber for Wednesday on a plan to help people with preexisting health problems get insurance — part of a broader scheme by Majority Leader Eric Cantor (Va.) to make Republicans appear to care about the little guy. But the conservatives lunching in the Rayburn House Office Building weren’t biting.
One after the other, they vowed to defeat the Republican leaders’ bill, which they said was not much better than President Obama’s health-care reform:
“I’m going to vote no,” said Jim Jordan (Ohio).
“I’m a ‘no’ on expanding Obamacare,” said Tim Huelskamp (Kan.).
“I feel very uncomfortable that we’re moving this bill forward,” said Marlin Stutzman (Ind.).
“I don’t like seeing one big-government Democrat program replaced by a Republican big-government program,” said Trey Radel (Fla.).
The five other men on the dais — Mick Mulvaney (S.C.), Steve Scalise (La.), Justin Amash (Mich.), Ron DeSantis (Fla.) and Raul Labrador (Idaho) — also declared their plans not to back the bill.
The wall of conservative opposition appeared to doom Cantor’s warm-and-fuzzy strategy, and party leaders were looking foolish. At the leadership team’s morning news conference, The Post’s Paul Kane asked Cantor if he had the votes to pass his Helping Sick Americans Now Act.
“Well, listen, this is — that is the whip’s purview,” Cantor replied, shifting the blame to Majority Whip Kevin McCarthy (Calif.).
McCarthy had no good answer, so he quoted a movie line. “The first rule of Fight Club: We don’t talk about Fight Club,” he said.
http://www.washingtonpost.com/opinions/dana-milbank-fight-club-on-the-hill/2013/04/24/4435c4a0-ad2b-11e2-b6fd-ba6f5f26d70e_print.html
House GOP leadership falls on health vote
By Paul Kane,
House Republican leaders suffered a humiliating legislative setback Wednesday when a large faction of GOP lawmakers rebelled against a leadership proposal that had drawn the opposition of powerful outside activists.The mutiny forced House Majority Leader Eric Cantor (Va.) to abruptly pull from the floor legislation to shore up a program that allows people with preexisting health conditions to buy into an insurance pool for high-risk patients before they are able to transition to coverage under President Obama’s health-care law.
The measure is part of Cantor’s effort to rebrand the GOP after defeats in the 2012 presidential and Senate elections, but it quickly found resistance among conservative activists.
The Club for Growth led a contingent of right-leaning groups that urged Republican lawmakers to oppose the bill, casting it as a costly boondoggle that would do nothing to dismantle the health-care law.
“Fiscal conservatives should be squarely focused on repealing Obamacare, not strengthening it by supporting the parts that are politically attractive,” Andy Roth, a vice president of Club for Growth, wrote to lawmakers last week. Heritage Action, the political arm of the the conservative Heritage Foundation, joined in the opposition.
No Democrats supported the bill as it was considered by the House Energy and Commerce Committee because the $3 billion tab would be covered by revoking funding from a different piece of the health-care law. That let GOP leaders know they needed to wrangle almost every vote from their side of the aisle to pass the measure. The failure was reminiscent of flops they have experienced since seizing the majority in 2011.
Cantor pulled the bill after trying to push his rank-and-file members to support it during a closed-door huddle on Wednesday. He argued that “helping the sick people” was a worthy conservative cause. “This is the right thing to do,” Cantor said. “We’re trying to find solutions here.”
http://www.washingtonpost.com/politics/house-gop-leadership-young-guns-near-showdown-on-health-vote/2013/04/24/c0fbfa50-ab90-11e2-b6fd-ba6f5f26d70e_print.html
Tom Harkin’s Political Jockeying
By PHILIP M. BOFFEY
No sooner had Congressional Republicans stopped blocking President Obama’s nominee to head Medicare and Medicaid to emphasize their opposition to the President on totally separate issues than a leading Democratic senator stepped in to do the same thing. This kind of political jockeying unrelated to the merit of the nominee is destructive no matter which party is doing it.
The nominee still left in limbo is Marilyn Tavenner. There is no doubt about her qualifications to do the job, which she has in fact been doing quite well on an acting basis after serving an apprenticeship as principal deputy administrator.
This is actually the second time that Ms. Tavenner has been nominated. After the President first nominated her on Dec. 1, 2011, Senate Democrats chose not to schedule a confirmation vote because they lacked enough support to overcome a likely filibuster by Republicans eager to denigrate health care reform in an election year. So the President re-nominated her and, despite all the partisan rancor over other matters, the Senate Finance Committee supported her by a unanimous voice vote.
Then Senator Tom Harkin, an Iowa Democrat who chairs a key Senate health committee, put a hold on the nomination. At least it was not a secret hold, a pernicious practice that allows senators to block a nominee without revealing who they are or why they are doing it. In this case, Mr. Harkin told reporters what he was doing and why. He raised no issues about her competence; instead he complained that the Administration has been raiding a fund established by the health care reform law to pay for prevention and public health programs, and using the money for other purposes.
Then Senator Tom Harkin, an Iowa Democrat who chairs a key Senate health committee, put a hold on the nomination. At least it was not a secret hold, a pernicious practice that allows senators to block a nominee without revealing who they are or why they are doing it. In this case, Mr. Harkin told reporters what he was doing and why. He raised no issues about her competence; instead he complained that the Administration has been raiding a fund established by the health care reform law to pay for prevention and public health programs, and using the money for other purposes.
Mr. Harkin, who championed creation of the prevention fund, makes a legitimate point: it is easy but shortsighted to meet immediate money needs by sacrificing the future benefits and cost reductions that good prevention and wellness programs would provide. But surely Mr. Harkin can find a better way to make his point than by holding up a nominee who seemed on the brink of bipartisan Senate confirmation.
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