Happy Thanksgiving!
The Single-Payer Alternative
By Nancy Folbre
The New York Times, Economix blog, Nov. 25, 2013
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.
The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, which many policy makers and voters set aside in the putative interests of political pragmatism. Whatever the advantages of a single-payer system such as that currently administered by Medicare, one view held, American voters were unlikely to get behind it.
Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges. Andwhile Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes (other than simple rollback) look complicated, kludgy and costly to administer.
The malfunctioning website has magnified problems inherent in coordinating enrollment across many different companies in many different exchanges in cooperation with many different government agencies. The harmonization challenges are orders of magnitude greater than those faced by a single company or a single state, making streamlining difficult. Improved software can do only so much.
In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.
Lack of clear information about the prices of medical procedures, combined with a proliferation of insurance options whose potential benefits will be strongly affected by unpredictable events (such as being involved in an automobile accident or developing cancer), put consumers in a weak position.
The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage. That fear and aversion has spilled over into the transactions required for many people to benefit from the Affordable Care Act.
By Nancy Folbre
The New York Times, Economix blog, Nov. 25, 2013
The New York Times, Economix blog, Nov. 25, 2013
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.
The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, which many policy makers and voters set aside in the putative interests of political pragmatism. Whatever the advantages of a single-payer system such as that currently administered by Medicare, one view held, American voters were unlikely to get behind it.
Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges. Andwhile Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes (other than simple rollback) look complicated, kludgy and costly to administer.
The malfunctioning website has magnified problems inherent in coordinating enrollment across many different companies in many different exchanges in cooperation with many different government agencies. The harmonization challenges are orders of magnitude greater than those faced by a single company or a single state, making streamlining difficult. Improved software can do only so much.
In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.
Lack of clear information about the prices of medical procedures, combined with a proliferation of insurance options whose potential benefits will be strongly affected by unpredictable events (such as being involved in an automobile accident or developing cancer), put consumers in a weak position.
The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage. That fear and aversion has spilled over into the transactions required for many people to benefit from the Affordable Care Act.
Online Health Law Sign-Up Is Delayed for Small Business
By ROBERT PEAR
WASHINGTON — The Obama administration on Wednesday announced a one-year delay in a major element of the new health care law that would allow small businesses to buy insurance online for their employees through the new federal marketplace.
It was yet another setback for the rollout of the health care law and resulted, in part, from the well-documented problems of the insurance marketplace website. Administration officials said they had to focus on the basic functions of the website, so that individuals could shop for insurance, before offering online enrollment for small businesses. In the meantime, businesses and their employees can apply through brokers.
Many employees of small businesses are uninsured, and the businesses themselves are much less likely than big companies to provide coverage to workers and their families.
The latest delay, coming just as the White House was boasting of major improvements in the health insurance website, HealthCare.gov, opens the door to more complaints about the health care law and could increase pressure to delay other provisions.
“The president bit off more than he can chew with this health care law, and small businesses are now forced to bear the consequences,” said Speaker John A. Boehner of Ohio. “Business owners across the country are already having health care plans for their employees canceled by this law, and now they’re told they won’t have access to the system the president promised them to find different coverage. Instead, they’ll have to resort to a system you’d expect to see in the 1950s.”
It was not the first delay for small businesses. The administration had previously delayed online enrollment for them to the end of this month from Oct. 1.
The date has now been pushed back to November 2014 for coverage that takes effect in January 2015, according to the Health and Human Services Department.
The announcement, just before Thanksgiving, was reminiscent of the way the White House announced, just before the Fourth of July weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.
The marketplace for small businesses — the Small Business Health Options Program, or SHOP exchange — was one of the few provisions of the 2010 law with some Republican support, and it was originally championed by Senator Olympia J. Snowe, Republican of Maine.
John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group that supports the health care law, said, “It’s disappointing that the online portion of the federal small business marketplace through Healthcare.gov will be delayed, and it’s important it get up and running as soon as possible.”
The marketplace, he said, “is still the most important provision in the Affordable Care Act for small businesses.”
Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’
WASHINGTON — The Obama administration on Wednesday announced a one-year delay in a major element of the new health care law that would allow small businesses to buy insurance online for their employees through the new federal marketplace.
It was yet another setback for the rollout of the health care law and resulted, in part, from the well-documented problems of the insurance marketplace website. Administration officials said they had to focus on the basic functions of the website, so that individuals could shop for insurance, before offering online enrollment for small businesses. In the meantime, businesses and their employees can apply through brokers.
Many employees of small businesses are uninsured, and the businesses themselves are much less likely than big companies to provide coverage to workers and their families.
The latest delay, coming just as the White House was boasting of major improvements in the health insurance website, HealthCare.gov, opens the door to more complaints about the health care law and could increase pressure to delay other provisions.
“The president bit off more than he can chew with this health care law, and small businesses are now forced to bear the consequences,” said Speaker John A. Boehner of Ohio. “Business owners across the country are already having health care plans for their employees canceled by this law, and now they’re told they won’t have access to the system the president promised them to find different coverage. Instead, they’ll have to resort to a system you’d expect to see in the 1950s.”
It was not the first delay for small businesses. The administration had previously delayed online enrollment for them to the end of this month from Oct. 1.
The date has now been pushed back to November 2014 for coverage that takes effect in January 2015, according to the Health and Human Services Department.
The announcement, just before Thanksgiving, was reminiscent of the way the White House announced, just before the Fourth of July weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.
The marketplace for small businesses — the Small Business Health Options Program, or SHOP exchange — was one of the few provisions of the 2010 law with some Republican support, and it was originally championed by Senator Olympia J. Snowe, Republican of Maine.
John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group that supports the health care law, said, “It’s disappointing that the online portion of the federal small business marketplace through Healthcare.gov will be delayed, and it’s important it get up and running as soon as possible.”
The marketplace, he said, “is still the most important provision in the Affordable Care Act for small businesses.”
Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’
The Affordable Care Act continues to plow ahead, despite Republican attempts to fight it at every turn. What is unfolding in front of us is nothing short of spectacular. The problems with healthcare.gov are slowly being resolved which is helping more and more people sign up for affordable healthcare, many for the first time in their life. The law provides so much more than that, including standards for even the lowest level plans, protections for young adults 26 and younger, and the elimination of pre-existing plans. Of course, you will not hear the success stories on the news, because those stories are not nearly as sexy as the “Obama Lied” slogan they are so fond of.
The biggest downside of the ACA is the reliance on the private insurance industry. It does not have to be this way, however. There is yet another provision in the Affordable Care Act that can open the door for states to institute their own single-payer healthcare system. Other states have a public option, especially for those below a certain income level, but no state had instituted a true single-payer system. All of this has changed thanks to President Obama and the Affordable Care Act.
Vermont—Home of Ben and Jerry’s, Maple Syrup, Bernie Sanders and the first state to pass marriage equality. Now, Vermont will be known for something that will impact every resident in the state.
The ACA provided states with federal funds to institute a Medicaid expansion. The states chose to expand the program also were able to set up their own state exchanges, which were relatively free from the problems the federal site had. Vermont decided to take it a step further by setting up their very own single payer system.
The slogan of the program: Everybody in, nobody out.
Doctors: New Health Care Plans Raise Red Flags
Physicians groups told Obama administration officials Tuesday that they are worried that new insurance plans under the Affordable Care Act offer only limited networks of providers and low reimbursement rates for doctors, and that could make it difficult for millions of those enrolled to actually get health care.
As the Journal has reported, some health plans don’t include big brand-name health providers in their networks and are slashing how much they’ll pay medical practicesfor treating the newly covered.
Representatives from the major physician lobbying groups raised these issues Tuesday in a White House meeting with health officials includingChris Jennings and Jeanne Lambrewof the White House, and Chiquita Brooks-LaSure of the Centers for Medicare & Medicaid Services.
“Some of the things were not a surprise to them… they’re acutely aware,”Shawn Martin, a top lobbyist for the American Academy of Family Physicians, said after the noon meeting.
Bob Doherty, who represents the American College of Physicians, said that another topic of discussion was the accuracy of the provider lists that consumers see when they try to compare insurance plans. Mr. Doherty said the doctors in his group are worried about facing confused patients starting Jan. 1.
For their part, the administration officials talked about ways that physicians could help patients sign up for coverage. Participants described the meeting as “good dialogue,” but one with no immediate resolutions.
The Vaccination Effect: 100 Million Cases of Contagious Disease Prevented
By STEVE LOHR
Vaccination programs for children have prevented more than 100 million cases of serious contagious disease in the United States since 1924, according to a new studypublished in The New England Journal of Medicine.
The research, led by scientists at the University of Pittsburgh’s graduate school of public health, analyzed public health reports going back to the 19th century. The reports covered 56 diseases, but the article in the journal focused on seven: polio, measles, rubella, mumps, hepatitis A, diphtheria and pertussis, or whooping cough.
Researchers analyzed disease reports before and after the times when vaccines became commercially available. Put simply, the estimates for prevented cases came from the falloff in disease reports after vaccines were licensed and widely available. The researchers projected the number of cases that would have occurred had the pre-vaccination patterns continued as the nation’s population increased.
The journal article is one example of the kind of analysis that can be done when enormous data sets are built and mined. The project, which started in 2009, required assembling 88 million reports of individual cases of disease, much of it from the weekly morbidity reports in the library of the Centers for Disease Control and Prevention. Then the reports had to be converted to digital formats.
Most of the data entry — 200 million keystrokes — was done by Digital Divide Data, a social enterprise that provides jobs and technology training to young people in Cambodia, Laos and Kenya.
Still, data entry was just a start. The information was put into spreadsheets for making tables, but was later sorted and standardized so it could be searched, manipulated and queried on the project’s website.
“Collecting all this data is one thing, but making the data computable is where the big payoff should be,” said Dr. Irene Eckstrand, a program director and science officer for the N.I.H.’s Models of Infectious Disease Agent Study.
The University of Pittsburgh researchers also looked at death rates, but decided against including an estimate in the journal article, largely because death certificate data became more reliable and consistent only in the 1960s, the researchers said.
Where Is the Love?
By NICHOLAS D. KRISTOF
When I’ve written recently about food stamp recipients, the uninsured and prison inmates, I’ve had plenty of pushback from readers.
A reader named Keith reflected a coruscating chorus when he protested: “If kids are going hungry, it is because of the parents not upholding their responsibilities.”
A reader in Washington bluntly suggested taking children from parents and putting them in orphanages.
Jim asked: “Why should I have to subsidize someone else’s child? How about personal responsibility? If you procreate, you provide.”
After a recent column about an uninsured man who delayed seeing a doctor about a condition that turned out to be colon cancer, many readers noted that he is a lifelong smoker and said he had it coming.
“What kind of a lame brain doofus is this guy?” one reader asked. “And like it’s our fault that he couldn’t afford to have himself checked out?”
Such scorn seems widespread, based on the comments I get on my blog and Facebook page — as well as on polling and on government policy. At root, these attitudes reflect a profound lack of empathy.
A Princeton University psychology professor, Susan Fiske, has found that when research subjects hooked up to neuro-imaging machines look at photos of the poor and homeless, their brains often react as if they are seeing things, not people. Her analysis suggests that Americans sometimes react to poverty not with sympathy but with revulsion.
So, on Thanksgiving, maybe we need a conversation about empathy for fellow humans in distress.
Let’s acknowledge one point made by these modern social Darwinists: It’s true that some people in poverty do suffer in part because of irresponsible behavior, from abuse of narcotics to criminality to laziness at school or jobs. But remember also that many of today’s poor are small children who have done nothing wrong.
Some 45 percent of food stamp recipients are children, for example. Do we really think that kids should go hungry if they have criminal parents? Should a little boy not get a curved spine treated properly because his dad is a deadbeat? Should a girl not be able to go to preschool because her mom is an alcoholic?
Successful people tend to see in themselves a simple narrative: You study hard, work long hours, obey the law and create your own good fortune. Well, yes. That often works fine in middle-class families.
But if you’re conceived by a teenage mom who drinks during pregnancy so that you’re born with fetal alcohol effects, the odds are overwhelmingly stacked against you from before birth. You’ll perhaps never get traction.
Right vs. Left in the Midwest
By LAWRENCE R. JACOBS
MINNESOTA and Wisconsin share much more than bone-chilling winters: German and Northern European roots; farming; and, until recently, a populist progressive tradition stretching back a century to Wisconsin’s Fighting Bob La Follette and the birth of Minnesota’s Democratic-Farmer-Labor Party.
But in 2010 these cousin states diverged. By doing so they began a natural experiment that compares the agendas of modern progressivism and the new right. Wisconsin elected Republicans to majorities in the Legislature and selected a bold and vigorous Republican governor, Scott Walker. Minnesotans elected one of the most progressive candidates for governor in the country, Mark Dayton of the Democratic-Farmer-Labor Party.
A month after Mr. Walker’s inauguration in January 2011, he catapulted himself to the front ranks of national conservative leaders with attacks on the collective bargaining rights of Civil Service unions and sharp reductions in taxes and spending. Once Mr. Dayton teamed up with a Democratic Legislature in 2012, Minnesota adopted some of the most progressive policies in the country.
Minnesota raised taxes by $2.1 billion, the largest increase in recent state history. Democrats introduced the fourth highest income tax bracket in the country and targeted the top 1 percent of earners to pay 62 percent of the new taxes, according to the Department of Revenue.
Which side of the experiment — the new right or modern progressivism — has been most effective in increasing jobs and improving business opportunities, not to mention living conditions?
Obviously, firm answers will require more time and more data, but the first round of evidence gives the edge to Minnesota’s model of increased services, higher costs (mostly for the affluent) and reduced payments to entrenched interests like the insurers who cover the Medicaid population.
Three years into Mr. Walker’s term, Wisconsin lags behind Minnesota in job creation and economic growth. As a candidate, Mr. Walker promised to produce 250,000 private-sector jobs in his first term, but a year before the next election that number is less than 90,000. Wisconsin ranks 34th for job growth. Mr. Walker’s defenders blame the higher spending and taxes of his Democratic predecessor for these disappointments, but according to Forbes’s annual list of best states for business, Wisconsin continues to rank in the bottom half.
Stores selling Obamacare policies popping up across California
With enrollment deadlines approaching, California officials, insurers and agents are opening stores in outlets across the state to sign up individuals for Obamacare policies.
By Chad Terhune
5:17 PM PST, November 27, 2013
| advertisement |
As shoppers hunt for holiday bargains this season, they may find something unusual for sale at the mall: Obamacare.
With enrollment deadlines looming, California officials, insurance companies and agents are staking out retail space to sign up thousands of people as part of the Affordable Care Act. These sales tactics reflect how dramatically the healthcare law is changing the insurance industry.
Until recently, most health insurance companies and agents didn't put much time into selling policies to individuals and focused more on catering to employers and large groups in the workplace. But the health insurance mandate and billions of dollars in federal premium subsidies have made individual policies a far more attractive market.
California's health insurance exchange and other government-run marketplaces are rushing to sign up people by Dec. 23, the deadline to have coverage in effect Jan. 1. Open enrollment lasts until March 31.
A state lawmaker and union organizers last week opened a mall store in a predominantly African American area of Los Angeles. In Orange County, insurance agents are signing up dozens of people each week at Laguna Hills Mall, and healthcare giant Kaiser Permanente has rented five retail locations in Northern California to sell exchange policies.
The Covered California exchange has posted solid enrollment since opening Oct. 1, primarily through its website and call centers. It has signed up nearly 80,000 people in private health plans through Nov. 19 and an additional 135,000 people have applied for Medi-Cal, the state's Medicaid program for the poor.
But the exchange estimates that about 80% of people will want in-person help to figure out their insurance options. Rather than set up storefronts itself, Covered California has focused more on training people who then go out to farmers markets and health fairs to promote the exchange and do enrollment.
Some consumer advocates welcome the increased retail exposure, but they worry that stores run by insurers or agents might push certain health plans and leave out other choices on the exchange.
"Having a lot of venues where people are running errands is a good thing," said Betsy Imholz, special projects director at Consumers Union. "But we want to avoid inappropriate steering. There are upsides and downsides to this."
State Sen. Holly Mitchell (D-Los Angeles) said she pushed for a Covered California store at the Baldwin Hills Crenshaw mall because many lower-income people who stand to benefit most from the healthcare law aren't likely to click on a website.
"There are still people who don't have access online," Mitchell said. "We want to bring health insurance to where people are naturally, and the clock is ticking on the enrollment window."
Posted Nov. 28, 2013, at 7:42 a.m.
President Barack Obama’s healthcare law is facing its biggest test this weekend since its disastrous Oct. 1 launch, as Americans find out whether the administration has met a self-imposed deadline to fix its insurance shopping website.
Another major outage of glitch-ridden HealthCare.gov could spell more political trouble for the president, who was forced to apologize for the botched rollout and admit burdening Democratic Party allies in their bids for re-election to Congress in 2014.
If the website does not work on Saturday’s deadline, that could turn off millions of uninsured Americans, especially young and healthy consumers whose participation in the new insurance exchanges are critical for keeping costs in check.
Democratic leaders in Congress might also find it necessary to extend open enrollment beyond the March 31 deadline and delay fines mandated by the law for people who do not have insurance by that date — a prospect that insurers warn would destabilize the market.
Obama officials are confident that this second coming of HealthCare.gov will be much improved from the Oct. 1 debut. Millions of people looked into the website in its first month, but only about 27,000 cleared the gauntlet of technical obstacles to sign up for insurance.
The portal is the gateway for health insurance plans in 36 states under the Patient Protection and Affordable Care Act, commonly called Obamacare, which was passed in 2010. It is intended to move the United States closer to universal care by subsidizing insurance sold by the private sector for less affluent families.
Officials have said that by Saturday the website will be able to load quickly and work accurately for at least 80 percent of users. They have said it will be able to handle 50,000 simultaneous visitors, for a daily total of about 800,000, twice the capacity seen even on Wednesday before a final flurry of hardware and software fixes over the Thanksgiving holiday.
