Do doctors have too much sway over Medicare payouts?
By Editorial Board, Published: July 24
REPORTERS PETER Whoriskey and Dan Keating have opened Post readers’ eyes to the fact that Medicare paysfor physician services — a $69.6 billion item in 2012 — according to an arcane and little-known price list, over which doctors themselves exercise considerable and less-than-totally-transparent influence.
Known as the Relative Value Update, the process consists of a 31-member committee of the American Medical Association (AMA) recommending what Medicare should pay for some 10,000 procedures — with the fees based in part on how long it takes to complete each one. This time-and-motion study often fails to take full account of changing technology and other factors affecting physician productivity, so anomalies result: For example, Medicare pays for a 15-minute colonoscopy as if it took 75 minutes.
Mental Health Cuts in Utah Leave Patients Adrift
By JACK HEALY
SALT LAKE CITY — H. Rachelle Graham, who has spent the last 15 years in hospitals and in therapy battling depression’s chokehold, was finishing up an exercise session at Utah’s largest mental health provider when she got the news that she would no longer be treated there.
Citing budget cuts, the nonprofit agency, Valley Mental Health, was removing Ms. Graham and some 2,200 other people from its roster and transferring them to other providers, a change that mental health advocates said was striking in its size and sweep, even in these austere times.
“It was devastating,” Ms. Graham said.
Officials with Valley Mental Health emphasized that no one would be left without mental health coverage. All of the 2,200 patients will be able to receive similar services from a network of clinics, counselors and treatment centers across Salt Lake County, the most populous in Utah.
Still, the changes have shaken providers and recipients of mental health care in Utah while testing the resilience of its safety net as hundreds of Medicaid patients try to find new psychiatrists and counselors and wonder who will fill their next prescription. Some patients said they felt whipsawed by the shift, and were reluctant to part with counselors or support groups they had known for a decade or more.
“There’s a level of anxiety hanging over everyone,” said Rebecca Glathar, executive director of the Utah office of the National Alliance on Mental Illness.
The tremors at Valley Mental Health come as politicians at the Republican-led Statehouse confront broader questions about what level of care Utah should provide to its poor residents. Utah still has not decided whether to accept the Medicaid expansion offered under President Obama’s health care law, and officials here are steeped in a debate pitting this conservative state’s reflexive distaste for bigger government against calls to extend care to more needy Utahans.
Gov. Gary R. Herbert, a Republican, has asked a group of politicians and health care officials to look at the state’s Medicaid options, including an idea to steer people eligible for the Medicaid expansion into private health insurance.
Advocates said Utah had long struggled to meet the needs of its people with mental illness, especially poorer residents and people living in rural corners of the state. A 2012 report by the state’s Division of Substance Abuse and Mental Health found that only 31 percent of those in need were receiving mental health care. In part, it blamed lingering stigmas against mental illness, a view echoed by people in treatment.
“Utah still has this old-fashioned view of mental illness,” Ms. Graham said. “Like, you just need to pray, or snap out of it.”
Don’t Shift Payments by Medicare, Panel Says
By ROBERT PEAR
WASHINGTON — Adjusting Medicare payments to reward doctors and hospitals in regions that provide high-quality care at low cost would be a bad idea, the National Academy of Sciences said Wednesday.
After a three-year study, the academy’s Institute of Medicine rebuffed arguments by members of Congress from states like Minnesota and Iowa who say Medicare has shortchanged their health care providers for decades.
Congress should not create a “value index” to funnel Medicare money to areas that provide high-quality services at relatively low cost, the academy said.
The 19-member panel said such an index would be unfair because it would “reward inefficient providers in low-cost regions and punish more efficient providers in high-cost regions.”
President Obama has said the nation could save huge sums if all doctors and hospitals were as efficient as those in lower-cost states like Iowa, Minnesota, Washington and Wisconsin. But the academy said a regional value index made no sense because spending for doctors and hospitals in a single region often varied as much as spending for providers in different regions.
In its report, the group debunked some widely held beliefs about geographic variations in health spending. It found that the 10 local areas with the lowest Medicare spending per beneficiary — after adjusting for local wages and prices and the health of patients — were all in New York, California and Oregon. The areas included Rochester, Sacramento, Buffalo and the Bronx.
The panel found that the 10 areas with the highest Medicare spending per beneficiary were all in Florida, Texas and Louisiana. They included Miami; McAllen, Tex.; Houston; Baton Rouge, La.; and Fort Lauderdale, Fla.
“Areas that are high spenders in Medicare are not necessarily high spenders in the commercial insurance market,” the panel said.
Drug Companies Promise More Data Transparency
By KATIE THOMAS
Representatives of the world’s biggest pharmaceutical companies pledged on Wednesday to release detailed data about their drugs to outside researchers, a move that was applauded by some but also seen as an effort to head off more extensive disclosure requirements that are under review in Europe.
The announcement, made jointly by the two major pharmaceutical trade groups in the United States and Europe, signals a shift for the industry, which in the past has resisted calls to systematically share its data. The proposal was unanimously approved by member companies and is to take effect on Jan. 1. It would apply to all new drugs and all new uses for existing drugs, whether approved in the United States or the European Union.
“Quite frankly, we recognize that there are a lot of skeptics, but this is the right thing to do and the right time to do it,” said John J. Castellani, chief executive of the Pharmaceutical Research and Manufacturers of America, also known as PhRMA, which developed the guidelines with its overseas counterpart, the European Federation of Pharmaceutical Industries and Associations. Members of the two groups collectively represent about 80 percent of the world’s pharmaceutical research, Mr. Castellani said.
“What they are doing would have been thought to be inconceivable even a short time ago,” said Dr. Harlan M. Krumholz, a cardiologist at Yale who recently oversaw an outside review of a treatment by the device maker Medtronic. “If these companies truly fulfill these promises, then they will have made an important contribution to science and the common good.” But he said their efforts would need to be monitored.
Proponents say doctors and patients need independent information — not just that provided by manufacturers — about the risks and benefits of drugs.
But as recently as February, PhRMA issued a statement criticizing proponents of data sharing, saying that releasing what’s known as “patient-level” clinical data would be irresponsible and encourage second-guessing of regulatory agencies, “which would be disastrous for patients.” Both industry groups have opposed a plan by the European Medicines Agency, which oversees approvals in Europe, to make trial data public whenever a drug is approved. A similar effort to require such data disclosure is under way in the European Parliament. On Monday, the British newspaper The Guardian reported on a leaked e-mailthat detailed plans by the two trade groups to enlist the help of patient groups to try to kill the efforts in Europe.
Kaiser's rising premiums spark employer backlash
State bill would force HMO to reveal details on rates, spending
By Chad Terhune
5:51 PM PDT, July 24, 2013
The Oakland company's unique HMO model kept a lid on costs, and big employers flocked to enroll their workers to the point that Kaiser has become the largest health plan in California, grabbing more than 40% of the market.
Now, some of Kaiser's biggest customers are complaining that the company is no longer a bargain and, even worse, standing in the way of controlling healthcare costs. Critics say the company is so entrenched in the workplace that it refuses to negotiate rates or to fully explain why its premiums keep rising.
Kaiser rejects the criticism and says it remains a great value for employers and patients, offering superior care at rates that are often 10% below its rivals. It considers the mounting backlash a direct attack on the way it does business.
Employer frustration has flared up in recent weeks as officials in the city of Los Angeles, San Francisco and at the California Public Employees' Retirement System bristled at Kaiser's latest rate hikes.
At CalPERS, the nation's third-largest healthcare buyer, Kaiser's premiums have shot up 65% since 2007. In comparison, Blue Shield of California's HMO rates have risen 50% and premiums for an Anthem Blue Cross preferred-provider plan have increased 43% for the same period.
For the city of Los Angeles, Kaiser's premiums for a family have increased 34% in the last five years to $1,306 a month. Anthem Blue Cross charges the city 10% less, or $1,176 a month, for a family PPO plan.
"We are held hostage to Kaiser," said Miguel Santana, the city's top budget official and administrative officer. Like many workers, Santana is a satisfied customer himself, and three of his children were delivered at Kaiser hospitals.
But as an employer, he said that "Kaiser takes us for granted, and the frustrating thing is they are not willing to have a discussion about their increases."
Many of Kaiser's critics are rallying around state Senate legislation, SB 746, that would require the company to disclose more details on how it calculates rates and spends money. Some powerful interests are supporting the bill, including AARP, big labor unions and the Safeway grocery chain, while other health insurers and business groups have joined Kaiser in opposition.
Kaiser is different from most insurers because it runs 37 hospitals across the country, owns hundreds of medical clinics and has 17,000 doctors on salary. It collects an upfront premium from customers to cover all of their care and has an incentive to keep patients healthy as opposed to the conventional fee-for-service model that can produce wasteful spending.
http://www.latimes.com/business/la-fi-kaiser-cost-backlash-20130725,0,1170631,print.story
Republican Health Care Panic
By PAUL KRUGMAN
Leading Republicans appear to be nerving themselves up for another round of attempted fiscal blackmail. With the end of the fiscal year looming, they aren’t offering the kinds of compromises that might produce a deal and avoid a government shutdown; instead, they’re drafting extremist legislation — bills that would, for example, cut clean-water grants by 83 percent — that has no chance of becoming law. Furthermore, they’re threatening, once again, to block any rise in the debt ceiling, a move that would damage the U.S. economy and possibly provoke a world financial crisis.
Yet even as Republican politicians seem ready to go on the offensive, there’s a palpable sense of anxiety, even despair, among conservative pundits and analysts. Better-informed people on the right seem, finally, to be facing up to a horrible truth: Health care reform, President Obama’s signature policy achievement, is probably going to work.
And the good news about Obamacare is, I’d argue, what’s driving the Republican Party’s intensified extremism. Successful health reform wouldn’t just be a victory for a president conservatives loathe, it would be an object demonstration of the falseness of right-wing ideology. So Republicans are being driven into a last, desperate effort to head this thing off at the pass.
Some background: Although you’d never know it from all the fulminations, with prominent Republicans routinely comparing Obamacare to slavery, the Affordable Care Act is based on three simple ideas. First, all Americans should have access to affordable insurance, even if they have pre-existing medical problems. Second, people should be induced or required to buy insurance even if they’re currently healthy, so that the risk pool remains reasonably favorable. Third, to prevent the insurance “mandate” from being too onerous, there should be subsidies to hold premiums down as a share of income.
Is such a system workable? For a while, Republicans convinced themselves that it was doomed to failure, and that they could profit politically from the inevitable “train wreck.” But a system along exactly these lines has been operating in Massachusetts since 2006, where it was introduced by a Republican governor. What was his name? Mitt Somethingorother? And no trains have been wrecked so far.
The question is whether the Massachusetts success story can be replicated in other states, especially big states like California and New York with large numbers of uninsured residents. The answer to this question depends, in the first place, on whether insurance companies are willing to offer coverage at reasonable rates. And the answer, so far, is a clear “yes.” In California, insurers came in with bids running significantly below expectations; in New York, it appears that premiums will be cut roughly in half.
Anthem insurance plan with MaineHealth wins key approval
Posted July 25, 2013, at 1:27 p.m.
AUGUSTA, Maine — A state regulator has greenlighted a key component of a new health insurance product that would be sold next year under a controversial deal between insurer Anthem and MaineHealth.
The Maine Bureau of Insurance issued a decision Thursday that largely approved one piece of the health plans, the proposed network of doctors and hospitals that would serve consumers who buy the policies. The plans would be sold next year on Maine’s health insurance exchange under the Affordable Care Act.
The network was the subject of a public hearing in late June at which health providers excluded from the network raised concerns that patients may have to travel farther for care and find new doctors.
The bureau approved the provider network but listed 14 conditions, including that Anthem submit more information about how the plans would affect access to health care based on where consumers live, contract with additional specialists in some areas, and report on consumers’ future experience with the plans.
The plans need more approvals before they can be sold on Maine’s insurance exchange. The state insurance bureau will issue a broader report by the end of July detailing whether the plans comply with the federal health reform law. That report also will include one other carrier that plans to offer health insurance on Maine’s exchange, the nonprofit Maine Community Health Options.
The next report also will shed light on how much the plans will cost and what benefits they’ll include.
The federal government will have the final say about whether plans meet standards to be sold on the exchange.
The insurance exchanges are a key component of the health reform law, the federal Affordable Care Act, which aims to widen health coverage to 30 million people.The exchanges will operate as online markets where consumers and small businesses can shop for coverage beginning in October 2013. The plans would take effect in January 2014.
Plans sold on the exchanges will be available to individuals who buy their own insurance, small businesses and the uninsured. Most workers who have health insurance through a large employer aren’t eligible to shop for plans on the exchange and wouldn’t be affected by the Anthem-MaineHealth deal.
About 257,000 Mainers are expected to be eligible to shop for insurance on Maine’s exchange, which will be run by the federal government.
The Anthem-MaineHealth plans include 32 of Maine’s 38 hospitals, but exclude Central Maine Healthcare, which operates Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital, as well as Parkview Adventist Medical Center in Brunswick, York Hospital, and Portland’s Mercy Hospital.
Anthem-MaineHealth network approved – with conditions
Posted: July 25Updated: Today at 12:14 AM
A rival health network blasts the partnership as a 'backroom deal' that discriminates against central and western Maine.
Anthem Blue Cross and Blue Shield won a key approval Thursday from the state Bureau of Insurance for the insurer's plan to partner with MaineHealth on the new health insurance exchange.
The proposed Anthem-MaineHealth pact would include 32 of the state's 38 hospitals, and would exclude the three hospitals owned by Central Maine Healthcare of Lewiston, as well as Parkview Adventist in Brunswick, York Hospital in York and Mercy Hospital in Portland.
http://www.pressherald.com/news/maine-Anthems-network-approved-affordable-care.html?pagenum=full
Medical tourism: Maine man one of many patients heading overseas for cheaper surgery
Posted July 25, 2013, at 3:12 p.m.
Jeff Wheeler has always wanted to travel to Southeast Asia. He also happens to need shoulder surgery.
Next week, he’ll cross both items of his to-do list with a trip to Thailand. His itinerary concludes with a stint in a Bangkok hospital.
Wheeler, who lives on Westport Island, a small Lincoln County community in Sheepscot Bay, will pay roughly $9,000 for his shoulder replacement overseas, about 80 percent less than he would shell out in the United States.
He’ll also get to take in the sights after a preliminary CT scan in Bangkok, traveling to Vietnam to explore Hanoi, Da Nang and the tunnels of Cu Chi, an immense network of underground tunnels in Ho Chi Minh City, before heading to the Cambodian temple Angkor Wat.
After his travels, he’ll return to Thailand to have his left shoulder replaced. A work injury and wear and tear have left his shoulder painful, he said.
“Might as well have a look around while I’m there, I like to travel,” Wheeler said.
Wheeler is among a few hundred thousand Americans expected to travel overseas this year in search of affordable medical care, from nose jobs to root canals to joint replacements. Fueled by rising health care costs in the U.S., “medical tourism” can open the door to high-quality treatments at steep discounts, often a fraction of the cost at home.
The growing industry caters primarily to the uninsured and people with insufficient insurance, or plans that don’t cover certain elective procedures or carry painfully high deductibles.
Wheeler, a 59-year-old retired boilermaker, has some health insurance, but still expects to pay far less out of pocket for his surgery by traveling overseas. One Massachusetts hospital quoted him about $130,000 for the procedure, he said.
Big corporations move their “operations” of a different sort overseas, so why not individuals, Wheeler figures.
“It’s a global market,” he said. “I think a lot of people in the U.S. are a little bit xenophobic or they have some fears about going [overseas]. But I think eventually these fears will fade as they know more and more and they hear about savings.”
Wheeler booked his three-week trip through a Calabasas, Calif., company called Planet Hospital that vetted his doctors and the hospital along with assisting with his travel arrangements. Since its founding in 2002, the company has served 6,000 clients, most of them uninsured, said Geoff Moss, Planet Hospital’s vice president of corporate affairs and business development.
“If they need that life-changing procedure and they can’t afford to do it in the United States, they contact us,” he said.
Many of the doctors the company works with were trained and board certified in the U.S., later lured back to their home countries by the promise of tax incentives, Moss said.
“Just because you’re traveling completely across the world doesn’t mean that you’re sacrificing the quality of medical care that you’re receiving,” he said.
Thousands training to enroll the uninsured for Obamacare
Posted July 26, 2013, at 7:52 a.m.
LOS ANGELES — Nahla Kayali is a foot soldier for Obamacare.
She is among the first wave of 2,000 community organizers in California getting trained to persuade more than 1 million uninsured people in the state to sign up for subsidized health coverage under President Barack Obama’s reform law.
Kayali and her cohorts begin their mission next month, armed with flyers, pamphlets and a small army of volunteers who speak 13 languages.
“We’re getting consumers and small businesses the tools to enroll, and trying to eliminate the barriers to enrolling,” said Kayali, 55, who runs a non-profit that provides social services to Arab Christians and Muslims in Orange County, just south of Los Angeles. “We’re going to break down the stigma — any barrier, whether it’s a language barrier or a cultural barrier.”
Among U.S. states, California will have the largest force deployed in a massive national outreach effort costing hundreds of millions of dollars. These thousands of foot soldiers will have to promote the Patient Protection and Affordable Care Act in the face of widespread political opposition and public skepticism.
Their work is key to the success of the new law in its first year, when the Obama administration seeks to enroll as many as 7 million people, including 2.7 million young and healthy people who are cheaper to insure, for 2014.
Oregon and Vermont have already begun training their enrollment advisers, while Connecticut and Washington are just starting up and other states, including Illinois and New York, will commence later this summer.
The playbook for these ambassadors focuses on two main points: First, tell people how they will benefit from Obamacare; second, stay away from divisive political talk.
“There is a major effort … to try to educate Americans,” said Michael Sparer, head of American health policy and management at Columbia University’s Mailman School of Public Health. “There are extraordinary levels of confusion over what the Affordable Care Act, or Obamacare, does and does not do.”
Opponents of the health reform law have criticized the public funds spent on mobilizing tens of thousands of people like Kayali into what they say is a highly politicized campaign. Michael Cannon, director of health policy studies at the libertarian Cato Institute, says it may not work despite the expense.
“They’re trying to sell millions of people something that they’ve already shown they don’t want and they’re trying to do it in a very confused and politically polarized atmosphere,” he said. “They don’t realize what they’ve got themselves into.”
Forgiving loans to ease Maine’s primary care shortage
Posted July 25, 2013, at 3:44 p.m.
As we attempt to rein in this country’s skyrocketing health care costs, part of the focus is — rightly — on encouraging more people to sign up with primary care providers and receive preventive care rather than showing up at the emergency room for more costly treatment.
But Maine faces a provider shortage. Each of the state’s 16 counties has regions designated as “federally underserved,” meaning there is less than one primary care physician for every 3,500 patients. And if the Maine Legislature passes a Medicaid expansion bill when it reconvenes in January, about 50,000 more Mainers will have insurance and could be looking for primary care providers.
So how can this state ensure it has enough providers to care for all Maine patients?
One way for Maine to attract and retain new primary care providers is by extending loan repayment programs for nurse practitioners.
Nurse practitioners can legally practice independently, order lab tests and write prescriptions. Their education, while requiring an advanced master’s or doctorate degree, tends to cost significantly less than medical school, thereby allowing them to pay off their school loans faster.
Maine is an aging state, meaning more patients are going to need more medical attention. But new medical school graduates with more than $100,000 in debt — and a looming reality of tens of thousands of dollars in costs annually to pay for malpractice insurance — are finding themselves drawn to more lucrative specialties in other states, leaving a void in the number of providers here in Maine. We have more patients and fewer physicians.
How can we deal with this problem? First we need to help ensure that all Mainers have access to primary care, so we can prevent costly hospital admissions and emergency room visits. Nurse practitioners, with a focus on prevention and health promotion, can safely and cost-effectively fill this gap.
Nurse practitioners have either a master’s or doctoral degree, in addition to a four-year bachelor’s degree. The Institute of Medicine estimates that three to 12 nurse practitioners can be educated for the same cost of one physician.
Treat health care as a social need, not a commodity
By Elizabeth R. Rosenthal, M.D.
The Journal News (Westchester, N.Y.), July 25, 2013
The 48th birthday of Medicare on Tuesday reminds us that the birth of the Affordable Care Act has not and will not fix our broken health-care system.
Health care is simply unaffordable for too many of us. In October, the last phase of the reform act known as “Obamacare” will begin with the opening of the health-care exchanges (now known as “the marketplace”). Here many more people will be able to buy more affordable health insurance.
However, by continuing to rely on our for-profit, market-based system, we are wasting billions of dollars on inflated administrative costs. These dollars should instead be going to pay for actual health care.
We need to follow Medicare’s lead — with greatly reduced administrative costs — and treat health care as a social need instead of as a commodity, as an opportunity for profit-making.
Original Medicare, born July 30, 1965, brought affordable health care to the elderly, lifting most of them out of poverty. It has been working well for 48 years and is one of the most popular government programs. In recent years, efforts have been made to privatize it: The Part D drug program and the Medicare Advantage plans are both private. This has led to higher costs.
Although original Medicare’s costs are rising, they are rising more slowly than overall health-care costs. Lowering the costs to government by shifting more of the costs onto patients (e.g., through higher deductibles) does nothing to lower the total health-care expenditure. Even with the arrival of the Affordable Care Act’s insurance exchange, 2,000 New Yorkers will die each year for lack of health care.
We can do better. New York can adopt a publicly funded, privately delivered single-payer plan for all New Yorkers. We can pass the New York Health Bill (A5389/S2078) that provides such a plan. This will save New York billions of dollars and lift the burden from municipalities and companies of providing health care for their workers.
http://www.pnhp.org/print/news/2013/july/treat-health-care-as-a-social-need-not-a-commodity
The Journal News (Westchester, N.Y.), July 25, 2013
The 48th birthday of Medicare on Tuesday reminds us that the birth of the Affordable Care Act has not and will not fix our broken health-care system.
Health care is simply unaffordable for too many of us. In October, the last phase of the reform act known as “Obamacare” will begin with the opening of the health-care exchanges (now known as “the marketplace”). Here many more people will be able to buy more affordable health insurance.
However, by continuing to rely on our for-profit, market-based system, we are wasting billions of dollars on inflated administrative costs. These dollars should instead be going to pay for actual health care.
We need to follow Medicare’s lead — with greatly reduced administrative costs — and treat health care as a social need instead of as a commodity, as an opportunity for profit-making.
Original Medicare, born July 30, 1965, brought affordable health care to the elderly, lifting most of them out of poverty. It has been working well for 48 years and is one of the most popular government programs. In recent years, efforts have been made to privatize it: The Part D drug program and the Medicare Advantage plans are both private. This has led to higher costs.
Although original Medicare’s costs are rising, they are rising more slowly than overall health-care costs. Lowering the costs to government by shifting more of the costs onto patients (e.g., through higher deductibles) does nothing to lower the total health-care expenditure. Even with the arrival of the Affordable Care Act’s insurance exchange, 2,000 New Yorkers will die each year for lack of health care.
We can do better. New York can adopt a publicly funded, privately delivered single-payer plan for all New Yorkers. We can pass the New York Health Bill (A5389/S2078) that provides such a plan. This will save New York billions of dollars and lift the burden from municipalities and companies of providing health care for their workers.
http://www.pnhp.org/print/news/2013/july/treat-health-care-as-a-social-need-not-a-commodity
Plan ignores 'free market' failure of health care costs
By Christopher Stack, M.D.
Indianapolis Star, Letters, July 23, 2013
Abdul-Hakim Shabazz (“We Need a Single Payer — You,” July 10) says he wants an adult discussion about U.S. health care and then presents a simplistic position on the issue: Get the government out. He proposes we return to our nation's pre-World War II state when people bought individual insurance policies. He facetiously calls this a “single-payer plan” when in fact it is the diametrical opposite of a publicly financed, nonprofit plan that assures everyone high-quality care.
Shabazz’ proposal is no surprise, given he is a self-proclaimed “free-market conservative, social-libertarian political pundit.” But it shows a remarkable lack of understanding of the economics of health care and the private sector's miserable failure to control costs over the last 60 years.
The basic principles of the free market (transparency, price competition, open access, informed consumers, etc.) do not and cannot exist in health care. Every other industrialized nation has already figured that out. Shabazz ignores the fact that Big Insurance is not about to give up its near-monopoly power, which it uses to keep out competitors and increase its bottom line. His proposal is completely unrealistic.
Indianapolis Star, Letters, July 23, 2013
Abdul-Hakim Shabazz (“We Need a Single Payer — You,” July 10) says he wants an adult discussion about U.S. health care and then presents a simplistic position on the issue: Get the government out. He proposes we return to our nation's pre-World War II state when people bought individual insurance policies. He facetiously calls this a “single-payer plan” when in fact it is the diametrical opposite of a publicly financed, nonprofit plan that assures everyone high-quality care.
Shabazz’ proposal is no surprise, given he is a self-proclaimed “free-market conservative, social-libertarian political pundit.” But it shows a remarkable lack of understanding of the economics of health care and the private sector's miserable failure to control costs over the last 60 years.
The basic principles of the free market (transparency, price competition, open access, informed consumers, etc.) do not and cannot exist in health care. Every other industrialized nation has already figured that out. Shabazz ignores the fact that Big Insurance is not about to give up its near-monopoly power, which it uses to keep out competitors and increase its bottom line. His proposal is completely unrealistic.
Obama aides, supporters huddle to agree on Obamacare message
While President Obama was on the road talking about the economy this week, top aides and supporters were huddling for a major strategy session to coordinate a new, more aggressive message on Obamacare.
Meeting Wednesday at Democratic National Committee headquarters over an Obamacare message testing poll taken by the Service Employees International Union, they hashed out a simple strategy, but one they agreed needs to quickly become unanimous among them and other Obama supporters. Republicans are winning the rhetorical and political argument because they're the only ones keeping focus on the parts of the law they feel are vulnerable. There's an opportunity to neutralize their argument by fitting the opposition into the broader message of Republican obstructionism and partisanship, and casting the GOP as hurting their constituents by making a concerted effort to make the law fail.
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GOP feuds over Obamacare tactics
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| A brewing Republican versus Republican fight over whether to use a government funding measure to choke off Obamacare is splitting the party ahead of this fall’s budget battles. A growing number of Republicans are rejecting calls from leading conservatives, including Sens. Marco Rubio, Ted Cruz and Rand Paul, to defund the president’s health care law in the resolution to keep the government running past Sept. 30. The rift exposes an emerging divide over how the GOP can best achieve its No. 1 goal — to repeal Obamacare — while highlighting the spreading fears that Republicans would lose a public relations war if the dispute leads to a government shutdown in the fall. The debate is happening behind closed doors and over Senate lunches, as well as during a frank meeting Wednesday with House leaders in Speaker John Boehner’s suite where fresh concerns were aired about the party’s strategy. On Thursday, the dispute began to spill into public view, most notably when three Senate Republicans — including Minority Whip John Cornyn — withdrew their signatures from a conservative letter demanding defunding Obamacare as a condition for supporting the government funding measure. (PHOTOS: 25 unforgettable Obamacare quotes) Sen. Richard Burr (R-N.C.) called the push to defund the law through the continuing resolution the “dumbest idea” he had ever heard. “Defunding the Affordable Care Act is not achievable by shutting down the federal government,” Burr said. “At some point, you’re going to open the federal government back up, and Barack Obama is going to be president.” http://dyn.politico.com/printstory.cfm?uuid=61FDA2E4-5547-4075-9D49-C96A77919854 |
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