Single Payer, Period
David Himmelstein and Steffie Woolhandler are professors at the City University School of Public Health at Hunter College and visiting professors at Harvard Medical School. They are co-founders ofPhysicians for a National Health Program.
The Department of Health and Human Services' breathless report touts the 53 choices and low premiums available through the new health insurance exchanges. But citizens of other developed nations would laugh at this definition of choice, and the rosy rate quotes hide nasty news for those who aren’t forever young.
Citizens of other developed nations would laugh at this definition of choice, and the rosy rate quotes hide nasty news for those who aren’t forever young.
As The Times reported, the lower than expected rates reflect many insurers’ decisions to pare down their provider networks for plans offered through the exchanges. You may have a choice of insurer, but little choice of doctor or hospital. So in Los Angeles, low cost means you’re not welcome at the top ranked hospitals: Cedars Sinai and U.C.L.A.
In the past the uninsured and Medicaid patients traveled in medical steerage – or not at all; private insurance guaranteed a place in first class care. Much of health law's new private coverage looks a lot like a Medicaid H.M.O. – coverage that restricts and segregates lower-income patients from the affluent. Top-class care is increasingly reserved for the well-to-do.
Canadians or the French or Germans have little or no choice of who pays their medical bills. But they can choose any hospital and any doctor. And they’re not socked with the enormous uncovered bills that will still afflict insured Americans. Elsewhere, insurance pretty much covers what you need.
Doing Nothing Wasn’t an Option
Robert Reich, the secretary of labor in the Clinton administration, is Chancellor's professor of public policy at the University of California, Berkeley. He is featured in the new film, "Inequality for All."
It's not perfect. I would have preferred a single-payer system, or at least one in which people had an option to buy into Medicare. And I'm sure there will be some glitches as the federal government rolls out new insurance markets in 36 states starting next week. Anything this large and ambitious will need fine-tuning. That was the case with Social Security after it was introduced in 1935, and Medicare in 1965.
The Affordable Care Act isn't perfect, but it's worth trying.
But the Affordable Care Act -- now the law of the land -- is a step in the right direction. Doing nothing wasn't an option: ours is the most expensive and complex health care system in the world that delivers poorer results and leaves a larger portion of the population without care than that of any other advanced nation. One benefit already apparent even before the law implemented: health care cost increases are beginning to slow in anticipation of it. That means savings for almost every American already insured.
We'll learn a lot more in coming months and years. And as with Social Security and Medicare, what needs fixing can be fixed. If it turns out we don't like it at all, we can repeal it -- the same way we occasionally repeal other laws, through an orderly process of legislating.
When up is down and down is up: the political paradoxes of Obamacare
Let me see if I’ve got this right:
The most implacable foes of Obamacare are alienating their allies and may inflict grave political damage on their own cause.
The most enthusiastic supporters of Obamacare are increasingly suspicious that some of its provisions may inflict serious economic harm on them.
The chief justice of the Supreme Court, whose vote “saved” Obamacare, may have fatally undermined one of its key provisions.
Some key Republican office holders, all of whom opposed Obamacare, may be in the process of salvaging it.
Most of the headlines these days around Obamacare — officially called the Affordable Care Act — focus on the political infighting that’s broken out on the right. With Texas Sen. Ted Cruz and Utah Sen. Mike Lee leading the charge, the most militant opponents of President Barack Obama's historic health care law are threatening to shut down the government, and perhaps trigger a disastrous default on the national debt, in a clearly futile effort to defund the law. This effort has led not only fellow GOP senators like John McCain and Tom Coburn to distance themselves, it has also drawn the scorn of the Wall Street Journal editorial page, usually an enthusiastic advocate of confrontation tactics. (Noting the political reality of a Democratic president and Senate, the Journal called the Cruz-Lee tactic a “charge into fixed bayonets.”)
This intraparty warfare, however, is only one part of the confusion Obamacare has triggered.
Analysis: Benefit firms create tremors for insurers in U.S. healthcare shakeup
By Caroline Humer and Lewis Krauskopf
NEW YORK (Reuters) - American companies are sending shockwaves through the healthcare industry by moving a rapidly growing number of employees onto privately run online exchanges for their medical coverage.
In a business already bracing for major change because of President Barack Obama's healthcare reforms, the decisions are threatening to shift more power in the market to the benefit consulting firms opening many of the exchanges.
Health insurance companies and pharmacy benefit managers who have traditionally had a more direct relationship with the employers could lose out to the nascent marketplaces.
"It's important to the insurance companies to sell through the private exchanges to maintain their biggest customers," said Mike Nugent, managing director of the healthcare practice at business consulting firm Navigant Consulting.
He said that if the pharmacy benefit managers and others "do not deliver the savings, they will not get paid and that will be the ripple effect."
The exchanges received their biggest boost yet when Aon Plc insurance broker said on Wednesday it signed up 18 companies to participate in its Aon Hewitt Corporate Health Exchange, including the country's largest drug store operator Walgreen Co, resulting in coverage for an estimated 600,000 people next year.
The announcement drove up the shares of Aon and other benefits consulting firms, such as Towers Watson and Marsh & McLennan, which owns Mercer, one of the largest consulting firms in the world.
All three have easily outpaced the broader market in the past year, with Towers Watson shares up 79 percent and Aon up 42 percent. Among the biggest stock losers were Catamaran Corp, which has had a pharmacy benefit deal with Walgreen.
Corporations are hoping the move to the private exchanges will keep healthcare spending in check and force employees to manage more of their own healthcare costs. Companies still directly pay a portion of the premium and deduct premium payments from employee wages for the difference between the employer contribution and the cost of a plan, but employees can choose a plan from a menu of low to high cost offerings.
http://www.reuters.com/article/2013/09/21/us-usa-healthcare-exchanges-analysis-idUSBRE98J0W620130921
Obamacare: It's Better Than You Think
Monday, 23 September 2013 10:31By Dean Baker, Truthout | News Analysis
In just one week the main part of Obamacare will begin to kick in. This is the state level exchanges that will allow the uninsured to be covered. Beginning on October 1, people will be able to sign up to get insurance in their state regardless of their health.
Most people signing up on the exchanges will qualify for subsidies based on their income and family size. This means that the cost of insurance will be less than the advertised price.
This is good news. It means that tens of millions of people who are uninsured now will likely be insured in the next year or two as a result of the Affordable Care Act (ACA). However this is actually the less important aspect of the program. The more important part is that those of us who now have insurance will have real health care insurance for the first time.
Most of the insured get covered through their job. This creates an obvious problem. If they develop a chronic illness, they may be unable to keep their job. Once they are no longer employed, workers will be left trying to buy insurance in the individual market.
Insurers don't want to insure people who are sick. If a person with a chronic health condition applies for insurance in the individual market, they would be facing premiums of tens of thousands of dollars a year, making it unaffordable for all but the very wealthy.
This situation will end with the start of the exchanges. Workers who lose their job because of an illness will still be able to find affordable insurance. This will provide a huge element of security that is currently lacking. In effect, most workers will have true health insurance for the first time.
Workers of all ages will benefit from this transformation of the insurance market but it will be especially important for older workers in poor health. There are a large number of older workers who struggle to stay employed despite bad health, because this is the only way that they will be able to afford insurance until they are old enough to qualify for Medicare.
Many of these people will now find insurance to be affordable with the subsidies on the exchanges even if they do not work. Some critics of Obamacare have argued that it will undermine incentives to work. In the case of older workers in poor health they are right, and this will be good.
There is much real basis for criticism of the ACA. Private insurers are the sole providers of insurance. Not only are we not getting universal Medicare, we did not even get a public option, the right to purchase a Medicare-type plan that would compete with private insurers.
The drug companies and medical equipment suppliers both end up as winners under Obamacare. They will be able to secure even greater profits from their government provided patent monopolies since the ACA does little to rein in costs.
As a result, we will still be paying close to twice as much for drugs and medical devices as people in other wealthy countries.
As a result, we will still be paying close to twice as much for drugs and medical devices as people in other wealthy countries.
This is a guaranteed recipe for bad health care since the enormous profits provided by these patent monopolies give drug companies an incentive to push their drugs even when they may be harmful.
And we will still be paying twice as much for our doctors as people in other wealthy countries. These failures on cost controls will add hundreds of billions of dollars to the cost of health care each year.
The fact that so many states refused to go along with the expansion of Medicaid will leave millions of working poor uncovered. Undocumented workers were explicitly prohibited from being covered through the exchanges. And the plan will effectively penalize many workers who get insurance through union sponsored plans, since they will not be eligible for subsidies through the exchanges.
These are serious complaints about the inadequacy of Obamacare which will have to be addressed in the years ahead. But none of these problems changes the fact that the ACA is an enormous step forward. Most of the country will now have real security in their access to health care. The agenda now has to be to extend this security to the rest of the country and to squeeze the parasites out of the health care system.
http://www.truth-out.org/news/item/19002-obamacare-its-better-than-you-think
6:41 PM PDT, September 25, 2013
WASHINGTON — Even when he was done talking in the Senate, Sen. Ted Cruz wasn't really done.
After holding the floor for 21 hours and 19 minutes, the Texas Republican talked just a bit longer outside the chamber, talking to reporters about, well, talking.
He said he hoped the public would carry his message of opposition to President Obama's healthcare law and pressure Republicans to support his drive to prevent federal spending on it.
"At this point, the debate is in the hands of the American people," said Cruz, who even in the halls of the Capitol sounded as if he were still speaking in the chamber. "At this point, I think I have spoken long enough."
But he hadn't. Within the hour, he was on Rush Limbaugh's afternoon radio talk show.
And when Limbaugh asked whether he would stay for another segment, Cruz replied, "I'm here as long as you like."
The overnight talkfest was not technically a filibuster because Cruz used time allotted for the debate; he did not delay any Senate business. But it was still the fourth-longest streak in the so-called world's greatest deliberative body. Sen. Strom Thurmond of South Carolina set the record in 1957 at 24 hours and 18 minutes, when the longtime Republican was still a Democrat. Next was Alfonse M. D'Amato (R-N.Y.) at 23 hours and 30 minutes in 1986 and Wayne Morse (I-Ore.) at 22 hours and 26 minutes in 1953.
Cruz also bested Sen. Rand Paul's filibuster by more than eight hours. The Kentucky Republican spoke for 12 hours and 52 minutes in March to denounce U.S. drone policy, electrifying his libertarian base and raising his national profile as a potential GOP presidential contender. Cruz, also a White House aspirant, may likewise benefit.
The freshman senator's office had received nearly 3,000 phone calls through late Tuesday, mostly supportive. He also sparked significant response on Twitter by using the hashtag #makeDClisten.
Cruz began his speech Tuesday afternoon when he entered the Senate chamber with just a binder, wearing black tennis shoes rather than his usual "argument boots." He placed his wristwatch on his desk to track the time and announced he would talk "until I am no longer able to stand."
That moment never came. Cruz quit only when he was forced to yield the floor for a scheduled vote.
http://www.latimes.com/nation/la-na-cruz-speech-20130926,0,5904067,print.story
When you’re being forced to endure another rabid Sen. Ted Cruz (R-Tex.) soliloquy on Obamacare’s threat to human freedom, it’s easy to forget how absurd our health-care debate seems to the rest of the civilized world. That’s why it’s bracing to check in with red-blooded, high testosterone capitalists north of the border in Canada — business leaders who love Canada’s single-payer system (a regime far to the “left” of Obamacare) and see it as perfectly consistent with free market capitalism.
Take David Beatty, a 70-year-old Toronto native who ran food processing giant Weston Foods and a holding company called the Gardiner Group during a career that has included service on more than 30 corporate boards and a recent appointment to the Order of Canada, one of the nation’s highest honors. By temperament and demeanor, Beatty is the kind of tough-minded, suffer-no-fools wealth creator who conservatives typically cheer.
On Tuesday, September 24, President Obama joined former President Clinton to talk about the October 1 implementation of the Affordable Care Act. Following is a White House transcript of their talk, edited here for length:
PRESIDENT CLINTON: . . . let's talk a little about the health care law, because we're about to begin on October 1st open enrollment for six months. And I'd like to give you a chance, first of all, to tell them why - when you took office, we were teetering on the brink of a depression. You had to avert it. You had to start the recovery again. Why in the midst of all this grief did you also take on this complex issue? Many people were saying, why doesn't he just focus on the economy and leave this alone? So tell us why you did it.
PRESIDENT OBAMA: Well, first of all, I think it's important to remember that health care is the economy. A massive part of our economy. And so the idea that somehow we can separate out the two is a fallacy.
Second of all, the effort for us to deal with a multifaceted health care crisis has been going on for decades. And the person who just introduced us, as well as you, early in your presidency, had as much to do with helping to shape the conversation as anybody.
The fact is that we have been, up until recently, the only advanced industrialized nation on Earth that permits large numbers of its people to languish without health insurance. Not only is there the cruelty of people who are unable to get health insurance having to use the emergency room as their doctor or their health service, but - we're also more efficient than anybody else and so when we talk about, for example, our deficit - you know this better than anybody - the reason that we have not only current deficits but also projected long-term deficits - the structural deficit that we have is primarily based on the fact that we have a hugely inefficient, wildly expensive health care system that does not produce better outcomes.
And if we spent the same amount of money on health care that Canada or France or Great Britain did, or Japan, or any other industrialized country, with the same outcomes or better outcomes, that essentially would remove our structural deficit, which would then free up dollars for us to invest in early-childhood education and infrastructure and medical research and all the other things that can make sure that we're competitive and growing rapidly over the long term.
So my view when I came into office was we've got an immediate crisis - we've got to get the economy growing. But what we also have to do is to start tackling some of these structural problems that had been building up for years. And one of the biggest structural problems was health care. It's what accounts for our deficit. It's what accounts for our debt. It causes pain and misery to millions of people all across the country. It is a huge burden on our businesses.
7:11 PM PDT, September 26, 2013
WASHINGTON — For years, President Obama's healthcare law has been praised, excoriated, legally challenged, upheld as constitutional and debated some more.
Now, with its online insurance marketplaces days from opening for business, the White House is focused on a task that many of the law's supporters complain is overdue: explaining it.
On Thursday, the president debuted a healthcare primer in a speech meant to convince young, uninsured Americans that they will find insurance coverage to suit their budgets.
The speech was laced with political jabs at congressional Republicans who want to gut or delay the program, but mostly it was a direct plea to Americans to give the new virtual marketplace a try when the six-month enrollment period opens Tuesday.
"This is real simple," Obama told the crowd at a community college in Largo, Md. "It's a website where you can compare and purchase affordable health insurance plans side by side, the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Amazon."
"You've got new choices," he said. "You've got new competition because insurers want your business, and that means you will have cheaper prices."
The administration has faced considerable criticism from fellow Democrats for not selling the Affordable Care Act, as the law is called, in the 3 1/2 years since Obama signed it into law. White House officials have countered that until the benefits became clear to consumers through the online system, such efforts would have been futile.
A few glitches in that system are popping up. Small businesses in almost three dozen states will have to use paper forms to sign up until November because that part of the online system isn't ready to go.
Republican critics noted the irony of what was supposed to be a cutting-edge digital operation resorting to snail mail and, as one GOP staffer scoffed in an email, "facsimile machines!"
But advisors to the president are hoping that the shopping experience of comparing plans, with subsidies and lower premiums available for many users, will win people over.
Obama and his White House have their work cut out for them. Polls show that uninsured Americans, the primary target for the law's new marketplaces, are wary. A Pew Research survey conducted last week found that the uninsured were as likely to disapprove of the law as they were to approve of it, with about one-third of those without insurance saying they thought the law would have a negative effect on them. Only half of the uninsured surveyed knew that the law offered subsidies.
http://www.latimes.com/nation/la-na-obama-healthcare-20130927,0,199087,print.story
WASHINGTON –€” Congressional Republicans have become a party of grievances in search of a strategy.
With polls showing many Americans still skeptical of the law known as "Obamacare," the president went back to the basics of explaining how nearly 50 million uninsured Americans will be able to buy coverage in new government-run exchanges while mocking Republicans for trying to block its implementation. "The closer we get, the more desperate they get," Obama argued.
"The Republican party has just spun itself up around this issue," Obama said. "And the fact is the Republicans' biggest fear at this point is not that Affordable Care Act will fail. What they're worried about is it's going to succeed."
http://www.pressherald.com/news/Obama-mocks-GOP-for-crazy-Obamacare-predictions-.html
More Sway for F.D.A. Is Object of New Bill
By SABRINA TAVERNISE
A bipartisan committee of lawmakers from the Senate and the House reached a compromise on Wednesday on legislation that would give the Food and Drug Administration greater control over compounding pharmacies. But analysts said it was still unclear whether the law would actually make drugs safer.
Lawmakers said the bill’s primary function was to help prevent another national health disaster like the meningitis outbreak last year that was traced to a large Massachusetts-based compounding pharmacy, a company that mixes specialty medicine. More than 60 people died and more than 700 were sickened after receiving injections of a contaminated steroid made by the pharmacy, the New England Compounding Company.
The F.D.A. has argued repeatedly that it has limited authority over compounders, which are now regulated by state boards of pharmacy, even though many ship drugs across state lines.
The bill’s authors argued that it would give the agency broader powers by placing some compounding pharmacies in a separate category that would require them to behave much like traditional drug manufacturers: to alert the authorities when something goes wrong with their products, to register with the F.D.A. and to allow agency officials into their facilities for inspection, much as traditional drug manufacturers do.
But the language of a statement issued late on Wednesday by the bill’s authors implied that companies would not be required to be part of the new category, leaving the option open to those compounding facilities “who wish” to join.
If being part of the new group is optional, that means there will be a reliance on the market to drive demand for products made under the stricter standards, said Allan Coukell, a drug policy expert at the Pew Charitable Trusts.
“It will be incumbent on the purchaser — the physician, clinic or hospital — to opt for drugs from F.D.A.-regulated facilities,” he said.
Easing Doctor Burnout With Mindfulness
By PAULINE W. CHEN, M.D.
According to the nurse’s note, the patient had received a clean bill of health from his regular doctor only a few days before, so I was surprised to see his request for a second opinion. He stared intently at my name badge as I walked into the room, then nodded his head at each syllable of my name as I introduced myself.
Shifting his gaze upward to my face, he said, “I’m here, Doc, to make sure I don’t have anything serious. I’m not sure my regular doctor was listening to everything I was trying to tell him.”
I smiled. To hide my embarrassment.
I had walked into the exam room to listen to this patient; but my mind was a few steps behind, as I struggled with thoughts about the colleague who’d just snapped at me over the phone because she was in no mood to get another new consult, my mounting piles of unfinished paperwork, and the young patient with widespread cancer whom I’d seen earlier in the day. Thoughts about my new patient jumbled in the mix, too, but they came into focus only after I had pushed away the fears that I might have neglected to order a key test on my last patient, that I’d forgotten to call another patient and that I was already running behind schedule.
That relentless inner conversation came to mind this past week when I read two studies on physician burnout and mindfulness in the current issue of The Annals of Family Medicine.
Research over the last few years has revealed that unrelenting job pressures cause two-thirds of fully trained doctors to experience the emotional, mental and physical exhaustion characteristic of burnout. Health care workers who are burned out are at higher risk for substance abuse, lying, cheating and even suicide. They tend to make more errors and lose their sense of empathy for others. And they are more prone to leave clinical practice.
Unfortunately, relatively little is known about treating burnout. But promising research points to mindfulness, the ability to be fully present and attentive in the moment, as a possible remedy. A few small studies indicate that mindfulness training courses can help doctors become more focused, more empathetic and less emotionally exhausted.
Time is short for GOP to stop Obamacare, avoid government shutdown
Republicans seek a strategy to fund the government but not the healthcare law before a possible shutdown. Sen. Ted Cruz's long speech leaves them less time.
By Lisa Mascaro6:41 PM PDT, September 25, 2013
| advertisement |
WASHINGTON — The collapse of a GOP strategy to halt President Obama's healthcare law has Republican leaders scrambling to find other ways to dismantle it as part of legislation needed to fund the government in a few days or trigger a shutdown.
Time is not on their side: Sen. Ted Cruz (R-Texas) has monopolized the floor in his lonely filibuster-like campaign to kill the Affordable Care Act. Patience among Republicans for the renegade senator's go-it-alone strategy is waning as money for routine government operations is set to run out by Oct. 1.
Republicans huddled again Wednesday after a rare 100 to 0 vote in the Senate to end the first round of debate over a bill that would fund the government but not the healthcare law. Cruz, who had just completed one of the longest speeches in Senate history, urged Republicans to oppose an upcoming motion as part of his effort to stall the bill. He did not attend the strategy session.
"All I know is how it ends: We don't defund Obamacare," said Sen. John McCain (R-Ariz.) as he emerged from the private lunch. "Seen this movie before."
Republicans are in the minority in the Senate, and Democrats have the votes to protect the president's signature law.
With that endgame understood, Republican leaders want Cruz to wrap up his moment in the limelight so that they can quickly dispatch the legislation back to the House. That would give Speaker John A. Boehner (R-Ohio) ample time to attach amendments that would curtail, but not kill, Obamacare.
A do-over could have better results, Republicans argued, if the GOP-led House attached a provision that would be difficult for some Senate Democrats to oppose. Among those being considered: a repeal of the new tax on medical device manufacturers that some Democrats dislike, or a delay of the mandate that all Americans carry health insurance or pay a fine in 2014.
"My own view is it would be to the advantage of our colleagues in the House, who are in the majority, to shorten the process," said Senate Republican Minority Leader Mitch McConnell of Kentucky, who has distanced himself from Cruz's strategy. "If the House doesn't get what we send over there until Monday, they're in a pretty tough spot."
But that strategy could leave lawmakers in the same stalemate if Senate Democrats remain unified in protecting the Affordable Care Act, as they appear inclined to do.
Sen. Amy Klobuchar (D-Minn.), who has led efforts to halt the medical device tax, said linking the measures "is not the strategy we're pushing for this time. We see this as part of a bigger budget deal or as part of some more rational changes to the healthcare bill."
Ted Cruz's Senate talkathon is over, but he's still talking
The Texas Republican, who held the floor for 21 hours and 19 minutes, says he hopes his message of opposition to Obamacare will resonate with the public.
By Michael A. Memoli
5:21 PM PDT, September 25, 2013
| advertisement |
WASHINGTON — Even when he was done talking in the Senate, Sen. Ted Cruz wasn't really done.
After holding the floor for 21 hours and 19 minutes, the Texas Republican talked just a bit longer outside the chamber, talking to reporters about, well, talking.
He said he hoped the public would carry his message of opposition to President Obama's healthcare law and pressure Republicans to support his drive to prevent federal spending on it.
"At this point, the debate is in the hands of the American people," said Cruz, who even in the halls of the Capitol sounded as if he were still speaking in the chamber. "At this point, I think I have spoken long enough."
But he hadn't. Within the hour, he was on Rush Limbaugh's afternoon radio talk show.
And when Limbaugh asked whether he would stay for another segment, Cruz replied, "I'm here as long as you like."
The overnight talkfest was not technically a filibuster because Cruz used time allotted for the debate; he did not delay any Senate business. But it was still the fourth-longest streak in the so-called world's greatest deliberative body. Sen. Strom Thurmond of South Carolina set the record in 1957 at 24 hours and 18 minutes, when the longtime Republican was still a Democrat. Next was Alfonse M. D'Amato (R-N.Y.) at 23 hours and 30 minutes in 1986 and Wayne Morse (I-Ore.) at 22 hours and 26 minutes in 1953.
Cruz also bested Sen. Rand Paul's filibuster by more than eight hours. The Kentucky Republican spoke for 12 hours and 52 minutes in March to denounce U.S. drone policy, electrifying his libertarian base and raising his national profile as a potential GOP presidential contender. Cruz, also a White House aspirant, may likewise benefit.
The freshman senator's office had received nearly 3,000 phone calls through late Tuesday, mostly supportive. He also sparked significant response on Twitter by using the hashtag #makeDClisten.
Cruz began his speech Tuesday afternoon when he entered the Senate chamber with just a binder, wearing black tennis shoes rather than his usual "argument boots." He placed his wristwatch on his desk to track the time and announced he would talk "until I am no longer able to stand."
That moment never came. Cruz quit only when he was forced to yield the floor for a scheduled vote.
http://www.latimes.com/nation/la-na-cruz-speech-20130926,0,5904067,print.story
Canadians don’t understand Ted Cruz’s health-care battle
Take David Beatty, a 70-year-old Toronto native who ran food processing giant Weston Foods and a holding company called the Gardiner Group during a career that has included service on more than 30 corporate boards and a recent appointment to the Order of Canada, one of the nation’s highest honors. By temperament and demeanor, Beatty is the kind of tough-minded, suffer-no-fools wealth creator who conservatives typically cheer.
Yet over breakfast in Toronto not long ago, Beatty told me how baffled he and Canadian business colleagues are when they listen to the U.S. health-care debate. He cherishes Canada’s single-payer system for its quality and cost-effectiveness (Canada boasts much lower costs per person than the United States). And don’t get him started on the system’s administrative simplicity — you just show your card at the point of service, and that’s it. Though he’s a well-to-do man who can pay for whatever care he wants, Beatty told me he’s relied on the system just as ordinary Canadians do, including for a recent knee replacement operation. The one time he went outside the system was to pay extra for a physical therapist closer to his home than the one to which he’d been assigned.
President Obama & Former President Clinton on the Affordable Care Act - Free Press Online - Rockland, ME
On Tuesday, September 24, President Obama joined former President Clinton to talk about the October 1 implementation of the Affordable Care Act. Following is a White House transcript of their talk, edited here for length:
PRESIDENT CLINTON: . . . let's talk a little about the health care law, because we're about to begin on October 1st open enrollment for six months. And I'd like to give you a chance, first of all, to tell them why - when you took office, we were teetering on the brink of a depression. You had to avert it. You had to start the recovery again. Why in the midst of all this grief did you also take on this complex issue? Many people were saying, why doesn't he just focus on the economy and leave this alone? So tell us why you did it.
PRESIDENT OBAMA: Well, first of all, I think it's important to remember that health care is the economy. A massive part of our economy. And so the idea that somehow we can separate out the two is a fallacy.
Second of all, the effort for us to deal with a multifaceted health care crisis has been going on for decades. And the person who just introduced us, as well as you, early in your presidency, had as much to do with helping to shape the conversation as anybody.
The fact is that we have been, up until recently, the only advanced industrialized nation on Earth that permits large numbers of its people to languish without health insurance. Not only is there the cruelty of people who are unable to get health insurance having to use the emergency room as their doctor or their health service, but - we're also more efficient than anybody else and so when we talk about, for example, our deficit - you know this better than anybody - the reason that we have not only current deficits but also projected long-term deficits - the structural deficit that we have is primarily based on the fact that we have a hugely inefficient, wildly expensive health care system that does not produce better outcomes.
And if we spent the same amount of money on health care that Canada or France or Great Britain did, or Japan, or any other industrialized country, with the same outcomes or better outcomes, that essentially would remove our structural deficit, which would then free up dollars for us to invest in early-childhood education and infrastructure and medical research and all the other things that can make sure that we're competitive and growing rapidly over the long term.
So my view when I came into office was we've got an immediate crisis - we've got to get the economy growing. But what we also have to do is to start tackling some of these structural problems that had been building up for years. And one of the biggest structural problems was health care. It's what accounts for our deficit. It's what accounts for our debt. It causes pain and misery to millions of people all across the country. It is a huge burden on our businesses.
A Health Care Fight That Punishes Federal Workers
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
One can think of the Affordable Care Act as a highly complex patch on the even more complex and fragmented health insurance system.
Thinking of it that way helps explain why even people who have no ideological dog in the hunt have such difficulty getting their mind around this complex legislation, especially from a worm’s-eye view. It does not help that Americans are bombarded daily with misleading information about the act.
Viewing the law from a distance, one discerns two main objectives:
1. To facilitate easier and affordable access to health insurance to Americans who do not now have health insurance (and that latter phrase warrants emphasis).
2. To help reorganize the delivery of health care in the United States to enhance its cost-effectiveness by lowering the cost of producing a given level or quality of care or by enhancing the quality of care for a given cost, or both.
To the best of my knowledge, nowhere in its many pages does the law, either in its spirit or its wording, suggest that employers who currently sponsor health insurance for their employees and who make contributions to the premiums for that coverage are expressly forbidden to do so come Jan. 1.
And yet, seemingly serious adults seem to believe that this is exactly what Section 1312(d)(3)(D)of the law dictates. Among them are the editors of The Wall Street Journal, Michael Cannonof the Libertarian Cato Institute and Robert Moffitt, Edmund Haislmaier and Joseph Morris of the Heritage Foundation.
These longstanding critics of the Affordable Care Act assert that its Section 1312(d)(3)(D) expressly forbids the federal government from sponsoring health insurance for members of Congress and their staffs; they accuse the Office of Personnel Management of the Obama administration of breaking the law by exempting the targeted federal employers from the supposed prohibition.Writing on the opinion page of The Wall Street Journal, for example, former Secretary of Education William Bennett and Christopher Beach speak of “The Hypocrisy of Congress’s Gold-Plated Health Care.”
My State Needs Obamacare. Now.
By STEVE BESHEAR
FRANKFORT, Ky. — SUNDAY morning news programs identify Kentucky as the red state with two high-profile Republican senators who claim their rhetoric represents an electorate that gave President Obama only about a third of its presidential vote in 2012.
So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act?
Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget.
It’s no coincidence that numerous governors — not just Democrats like me but also Republicans like Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — see the Affordable Care Act not as a referendum on President Obama but as a tool for historic change.
That is especially true in Kentucky, a state where residents’ collective health has long been horrendous. The state ranks among the worst, if not the worst, in almost every major health category, including smoking, cancer deaths, preventable hospitalizations, premature death, heart disease and diabetes.
We’re making progress, but incremental improvements are not enough. We need big solutions with the potential for transformational change.
The Affordable Care Act is one of those solutions.
For the first time, we will make affordable health insurance available to every single citizen in the state. Right now, 640,000 people in Kentucky are uninsured. That’s almost one in six Kentuckians.
Lack of health coverage puts their health and financial security at risk.
They roll the dice and pray they don’t get sick. They choose between food and medicine. They ignore checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away.
Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked.
For Kentucky as a whole, the negative impact is similar but larger — jacked-up costs, decreased worker productivity, lower quality of life, depressed school attendance and a poor image.
The Affordable Care Act will address these weaknesses.
Years after signing it into law, Obama explains Obamacare to public
Obama and his aides call on uninsured Americans to buy coverage under the healthcare law. Online insurance marketplaces will open Tuesday.
By Christi Parsons and Kathleen Hennessey7:11 PM PDT, September 26, 2013
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WASHINGTON — For years, President Obama's healthcare law has been praised, excoriated, legally challenged, upheld as constitutional and debated some more.
Now, with its online insurance marketplaces days from opening for business, the White House is focused on a task that many of the law's supporters complain is overdue: explaining it.
On Thursday, the president debuted a healthcare primer in a speech meant to convince young, uninsured Americans that they will find insurance coverage to suit their budgets.
The speech was laced with political jabs at congressional Republicans who want to gut or delay the program, but mostly it was a direct plea to Americans to give the new virtual marketplace a try when the six-month enrollment period opens Tuesday.
"This is real simple," Obama told the crowd at a community college in Largo, Md. "It's a website where you can compare and purchase affordable health insurance plans side by side, the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Amazon."
"You've got new choices," he said. "You've got new competition because insurers want your business, and that means you will have cheaper prices."
The administration has faced considerable criticism from fellow Democrats for not selling the Affordable Care Act, as the law is called, in the 3 1/2 years since Obama signed it into law. White House officials have countered that until the benefits became clear to consumers through the online system, such efforts would have been futile.
A few glitches in that system are popping up. Small businesses in almost three dozen states will have to use paper forms to sign up until November because that part of the online system isn't ready to go.
Republican critics noted the irony of what was supposed to be a cutting-edge digital operation resorting to snail mail and, as one GOP staffer scoffed in an email, "facsimile machines!"
But advisors to the president are hoping that the shopping experience of comparing plans, with subsidies and lower premiums available for many users, will win people over.
Obama and his White House have their work cut out for them. Polls show that uninsured Americans, the primary target for the law's new marketplaces, are wary. A Pew Research survey conducted last week found that the uninsured were as likely to disapprove of the law as they were to approve of it, with about one-third of those without insurance saying they thought the law would have a negative effect on them. Only half of the uninsured surveyed knew that the law offered subsidies.
http://www.latimes.com/nation/la-na-obama-healthcare-20130927,0,199087,print.story
Looking to block Obamacare, Republicans in search of a strategy
By DAN BALZ The Washington Post
WASHINGTON –€” Congressional Republicans have become a party of grievances in search of a strategy.
Their first grievance is with President Obama's Affordable Care Act, the single most unifying issue for a party that has been showing signs of divisions all year. Rank-and-file Republicans, especially those who are aligned with the tea party, hate the new health-care law. Their anger has welled up to force GOP leaders to respond with ever-riskier strategies to delay, defund or in some other way disrupt the imminent implementation of the act.
Their second is with Obama himself, and his steadfast resistance to negotiate with them on any aspect of the health-care law. The president may unilaterally decide to delay this or that aspect of the law, as he did again on Thursday with a small portion of the implementation plan. But he doesn't want Republicans to touch it. Each time he makes a change, his unwillingness to engage only infuriates Republicans more.
The antagonism between Obama and the Republicans was on full display on Thursday. House GOP leaders went before the cameras to offer their latest ideas on funding the government, defunding or delaying Obamacare and dealing with the day next month when the government runs out of borrowing authority.
Suddenly it seemed like the summer of 2011 on steroids. House Speaker John Boehner, R-Ohio, and others seemed to up the ante again in their quest to stop Obamacare and to force the president to yield. Not only did they continue on a path that could lead to a partial shutdown of the government next week, they also signaled that they are ready for another confrontation in mid-October over the debt ceiling, with a list of demands for the president.
An hour or so later, Obama answered at an appearance at Prince George's Community College in Largo, Md.. Rather than trying to tamp down on partisan rhetoric or lower temperatures, Obama did the opposite, repeatedly waiving red flags at the Republicans.
Their second is with Obama himself, and his steadfast resistance to negotiate with them on any aspect of the health-care law. The president may unilaterally decide to delay this or that aspect of the law, as he did again on Thursday with a small portion of the implementation plan. But he doesn't want Republicans to touch it. Each time he makes a change, his unwillingness to engage only infuriates Republicans more.
The antagonism between Obama and the Republicans was on full display on Thursday. House GOP leaders went before the cameras to offer their latest ideas on funding the government, defunding or delaying Obamacare and dealing with the day next month when the government runs out of borrowing authority.
Suddenly it seemed like the summer of 2011 on steroids. House Speaker John Boehner, R-Ohio, and others seemed to up the ante again in their quest to stop Obamacare and to force the president to yield. Not only did they continue on a path that could lead to a partial shutdown of the government next week, they also signaled that they are ready for another confrontation in mid-October over the debt ceiling, with a list of demands for the president.
An hour or so later, Obama answered at an appearance at Prince George's Community College in Largo, Md.. Rather than trying to tamp down on partisan rhetoric or lower temperatures, Obama did the opposite, repeatedly waiving red flags at the Republicans.
Obama mocks GOP for 'crazy' Obamacare predictions
Yesterday at 1:53 PM'What they're worried about is it's going to succeed.'
By Darlene Superville / The Associated Press
LARGO, Md. — With just five days to go before Americans can begin signing up for health care under his signature law, President Barack Obama on Thursday ridiculed Republican opponents for "crazy" doomsday predictions of the impact and forecast that even those who didn't vote for him are going to enroll.
"The Republican party has just spun itself up around this issue," Obama said. "And the fact is the Republicans' biggest fear at this point is not that Affordable Care Act will fail. What they're worried about is it's going to succeed."
http://www.pressherald.com/news/Obama-mocks-GOP-for-crazy-Obamacare-predictions-.html
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