As ACA deadline looms, Maine doctors show support for single-payer health care
Affordable Care Act, health policy
With March 31 fast approaching as the deadline to buy health insurance under the Affordable Care act, the state’s largest physicians group has released new survey results showing Maine doctors favor a very different kind of health reform.
The survey of Maine Medical Association members shows nearly two-thirds of doctors prefer a single-payer health care system.
Conducted in January and completed by more than 450 respondents, the survey asked:
“When considering the topic of health care reform, would you prefer to make improvements to the current public/private system or a single-payer system such as a “Medicare for all” approach?
Nearly 65 percent of doctors preferred the single-payer option, a jump from about 52 percent in a 2008 MMA survey asking the same question.
Single-payer health systems cover everyone under a publicly funded insurance plan run by a single entity, often the government. All hospitals, doctors, and other health providers bill that entity for their services.
Supporters of the “Medicare for all” approach advocate expanding that government program to cover all Americans, not just those over age 65 and people with disabilities.
The Affordable Care Act, on the other hand, is built on the existing system, with some people covered through government programs such as Medicare and Medicaid and most others through private insurance offered through their jobs. The law drastically reforms one, relatively small part of the existing system — private insurance for people who don’t get coverage through work or government programs. These are the people health advocates want to sign up for coverage through Heathcare.gov by March 31, the last day of open enrollment.
(In Maine, about 34,000 people carried individual health coverage before the ACA, compared to 223,000 with coverage through an employer, roughly 500,000 with public health insurance, and 133,000 with no insurance.)
In the MMA survey, doctors’ answers varied depending on their speciality, practice size and ownership structure. Primary care providers and psychiatrists were more likely to favor a single-payer approach, as were doctors from larger practices (serving between 1,000 and 2,000 patients). Radiologists and anesthesiologists, on the other hand, preferred reforming the existing system. Respondents from practices wholly owned by physicians, rather than hospitals, also were less likely to prefer the single-payer option.
The survey found no difference in responses based on age or geographic location.
Most of the respondents were doctors, while 15 percent were medical students. In all, they represent about 13 percent of MMA’s membership. The survey was conducted by Crescendo Consulting Group in Portland as part of a grant awarded to MMA by the Maine Health Access Foundation.
While the survey showed strong support for a single-payer system, MMA’s official position on health reform is support for universal coverage for all Mainers through a combination of public and private health plans.
With March 31 fast approaching as the deadline to buy health insurance under the Affordable Care act, the state’s largest physicians group has released new survey results showing Maine doctors favor a very different kind of health reform.
The survey of Maine Medical Association members shows nearly two-thirds of doctors prefer a single-payer health care system.
Conducted in January and completed by more than 450 respondents, the survey asked:
“When considering the topic of health care reform, would you prefer to make improvements to the current public/private system or a single-payer system such as a “Medicare for all” approach?
Nearly 65 percent of doctors preferred the single-payer option, a jump from about 52 percent in a 2008 MMA survey asking the same question.
Single-payer health systems cover everyone under a publicly funded insurance plan run by a single entity, often the government. All hospitals, doctors, and other health providers bill that entity for their services.
Supporters of the “Medicare for all” approach advocate expanding that government program to cover all Americans, not just those over age 65 and people with disabilities.
The Affordable Care Act, on the other hand, is built on the existing system, with some people covered through government programs such as Medicare and Medicaid and most others through private insurance offered through their jobs. The law drastically reforms one, relatively small part of the existing system — private insurance for people who don’t get coverage through work or government programs. These are the people health advocates want to sign up for coverage through Heathcare.gov by March 31, the last day of open enrollment.
(In Maine, about 34,000 people carried individual health coverage before the ACA, compared to 223,000 with coverage through an employer, roughly 500,000 with public health insurance, and 133,000 with no insurance.)
In the MMA survey, doctors’ answers varied depending on their speciality, practice size and ownership structure. Primary care providers and psychiatrists were more likely to favor a single-payer approach, as were doctors from larger practices (serving between 1,000 and 2,000 patients). Radiologists and anesthesiologists, on the other hand, preferred reforming the existing system. Respondents from practices wholly owned by physicians, rather than hospitals, also were less likely to prefer the single-payer option.
The survey found no difference in responses based on age or geographic location.
Most of the respondents were doctors, while 15 percent were medical students. In all, they represent about 13 percent of MMA’s membership. The survey was conducted by Crescendo Consulting Group in Portland as part of a grant awarded to MMA by the Maine Health Access Foundation.
While the survey showed strong support for a single-payer system, MMA’s official position on health reform is support for universal coverage for all Mainers through a combination of public and private health plans.
Watch an expert teach a smug U.S. senator about Canadian healthcare
By Michael Hiltzik
The Los Angeles Times, March 12, 2014 A U.S. politician's I-don't-need-no-stinkin'-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it's practiced in Canada and several other countries.
The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes -- for far less money than the U.S. spends. To explain this, Sen. Bernie Sanders (I-Vt.) asked seven experts to testify before his subcommittee on primary health and aging.
Those interested in how the U.S. matches up should watch the whole 90-minute session. (The official subcommittee hearing record is available.)
By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. The exchange, in which Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her, starts at about the 1:08:15 mark.
(The reference to "Premier Williams" is to Newfoundland Premier Danny Williams, whose decision to have a heart valve procedure in Miami, near where he owns a condo, rather than Canada, is widely viewed in Canada as a rich man's failure to investigate the care available to him closer to home.)
Here's a lightly edited transcript of the key moments, which start with Burr asking Martin about the observation in her written testimony that wait times for elective surgery in single-payer systems will lengthen as doctors move out of the public system:
BURR: Why are doctors exiting the public system in Canada?
MARTIN: Thank you for your question, Senator. If I didn’t express myself in a way to make myself understood, I apologize. There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.
What I did say was that the solution to the wait time challenge that we have in Canada -- we do have a difficult time with waits for elective medical procedures -- does not lie in moving away from our single-payer system toward a multipayer system. And that’s borne out by the experience of Australia. So Australia used to have a single-tier system and did in the 1990s move toward a multiple-payer system where private insurance was permitted. And a very well-known study by Duckett, et al., tracked what took place in terms of wait times in Australia as the multipayer system was put in place.
And what they found was in those areas of Australia where private insurance was being taken up and utilized, waits in the public system became longer.
BURR: What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?
MARTIN: It’s actually interesting, because in fact the people who are the pioneers of that particular surgery, which Premier Williams had, and have the best health outcomes in the world for that surgery, are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.
So what I say is that sometimes people have a perception, and I believe that actually this is fueled in part by media discourse, that going to where you pay more for something, that that necessarily makes it better, but it’s not actually borne out by the evidence on outcomes from that cardiac surgery or any other.
(The ultimate zinger came at the end of the exchange, when Burr thought he had Martin down for the count about wait times in Canada, and she neatly put the difference between the Canadian and U.S. systems in perspective.)
BURR: On average, how many Canadian patients on a waiting list die each year? Do you know?
MARTIN: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.
By Michael Hiltzik
The Los Angeles Times, March 12, 2014 A U.S. politician's I-don't-need-no-stinkin'-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it's practiced in Canada and several other countries.
The Los Angeles Times, March 12, 2014 A U.S. politician's I-don't-need-no-stinkin'-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it's practiced in Canada and several other countries.
The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes -- for far less money than the U.S. spends. To explain this, Sen. Bernie Sanders (I-Vt.) asked seven experts to testify before his subcommittee on primary health and aging.
Those interested in how the U.S. matches up should watch the whole 90-minute session. (The official subcommittee hearing record is available.)
By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. The exchange, in which Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her, starts at about the 1:08:15 mark.
(The reference to "Premier Williams" is to Newfoundland Premier Danny Williams, whose decision to have a heart valve procedure in Miami, near where he owns a condo, rather than Canada, is widely viewed in Canada as a rich man's failure to investigate the care available to him closer to home.)
Here's a lightly edited transcript of the key moments, which start with Burr asking Martin about the observation in her written testimony that wait times for elective surgery in single-payer systems will lengthen as doctors move out of the public system:
BURR: Why are doctors exiting the public system in Canada?
MARTIN: Thank you for your question, Senator. If I didn’t express myself in a way to make myself understood, I apologize. There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.
What I did say was that the solution to the wait time challenge that we have in Canada -- we do have a difficult time with waits for elective medical procedures -- does not lie in moving away from our single-payer system toward a multipayer system. And that’s borne out by the experience of Australia. So Australia used to have a single-tier system and did in the 1990s move toward a multiple-payer system where private insurance was permitted. And a very well-known study by Duckett, et al., tracked what took place in terms of wait times in Australia as the multipayer system was put in place.
And what they found was in those areas of Australia where private insurance was being taken up and utilized, waits in the public system became longer.
BURR: What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?
MARTIN: It’s actually interesting, because in fact the people who are the pioneers of that particular surgery, which Premier Williams had, and have the best health outcomes in the world for that surgery, are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.
So what I say is that sometimes people have a perception, and I believe that actually this is fueled in part by media discourse, that going to where you pay more for something, that that necessarily makes it better, but it’s not actually borne out by the evidence on outcomes from that cardiac surgery or any other.
(The ultimate zinger came at the end of the exchange, when Burr thought he had Martin down for the count about wait times in Canada, and she neatly put the difference between the Canadian and U.S. systems in perspective.)
BURR: On average, how many Canadian patients on a waiting list die each year? Do you know?
MARTIN: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.
It’s Time for Democrats to Embrace Obamacare
Posted by John Cassidy
Paul Begala is right. “Democrats shouldn’t try to spin this loss,” Begala, a veteran political consultant, tweeted after it became clear that the Republicans had won a keenly contested special election for a vacant seat in Florida’s 13th District, which runs through Pinellas County, on the Gulf Coast. “We have to redouble our efforts for 2014. Too much at stake. #noexcuses.” The Democratic contender, Alex Sink, a former gubernatorial candidate, had experience and strong name recognition; the Republican, David Jolly, was a little-known former lobbyist. Despite the endorsement of Begala’s former boss Bill Clinton and other leading Democrats, Sink came in second—largely because her opponent, with the aid of well-financed Republican groups, portrayed her as a poster child for the Affordable Care Act.
The G.O.P. campaign was straightforward and unrelenting. In one campaign ad (cited by Alex Isenstadt, of Politico), Jolly said, simply, “She supports Obamacare. I don’t. I’m David Jolly, and I approve this message because Pinellas needs someone to look out for our interests.” Another ad claimed that Sink’s loyalty was to President Obama and Nancy Pelosi rather than to Florida, adding, “Why else would she continue to support Obamacare?”
As Yahoo’s Chris Moody noted, the election wasn’t a bellwether contest—special elections rarely are—but a test of each party’s messaging as the mid-term elections approach. Faced with the G.O.P. barrage, Sink tried to change the subject from the Affordable Care Act to protecting Medicare and Social Security from Republican privatization efforts, which she said Jolly supported. (In a dispatch from the district entitled “Obamacare’s Ground Zero,” David Weigel, of Slate, provided a good account of Sink’s troubles.) When pressed, as she was frequently, she equivocated, saying that she supported parts of the health-care reforms, such as forcing insurers to enroll people with preëxisting conditions, but that she also believed it needed fixing in ways that she couldn’t readily specify.
Trying to pussyfoot around Obamacare was an awkward strategy, and, evidently, it didn’t work. If other Democrats are to avoid meeting Sink’s fate in November, they need something more convincing to say about the Affordable Care Act than “mend it, don’t end it,” which is now their default position. But what could that be?
Here’s a heretical idea. Rather than parsing the individual elements of the law, and trying to persuade voters on an à la carte basis, what about raising the stakes and defending the reform in its entirety as a historic effort to provide affordable health-care coverage to tens of millions of hard-working Americans who otherwise couldn’t afford it? Instead of shying away from the populist and redistributionist essence of the reform, which the White House and many Democrats in Congress have been doing since the start, it’s time to embrace it.
What would that mean? It would involve reaching out to the Democratic Party’s core voters—lower-income people, minorities, highly educated liberals—and portraying Obamacare as the fulfillment of the great human-rights project that began in the nineteen-thirties, under Franklin D. Roosevelt, and was expanded during the nineteen-sixties, under Lyndon Johnson. That message wouldn’t merely be more honest; it would be more effective in getting Democratic voters to turn out in November, which is essential if the Party isn’t to suffer a repeat of 2010.
To be sure, Social Security and Medicare aren’t often described as human-rights reforms, but, make no mistake, that’s what they were. They were based on the notion that elderly Americans, regardless of race, income, or creed, have a right to avoid destitution and be treated for their illnesses. Similarly, the premise of the Affordable Care Act is that Americans of all ages, regardless of their incomes and personal histories, have a right to receive medical treatment. You don’t see Republicans campaigning against the public retirement programs—not openly, anyway. Despite the widespread belief that voters don’t like big government, G.O.P. candidates know, to their cost, that Social Security and Medicare are sacrosanct. Over time, universal health coverage will probably come to be seen in the same way. But it might not happen unless the architects of Obamacare stand up for it more vigorously.
http://www.newyorker.com/online/blogs/johncassidy/2014/03/its-time-for-democrats-to-embrace-obamacare.html?printable=true¤tPage=all#ixzz2vr9vCSfZ
Posted by John Cassidy
Paul Begala is right. “Democrats shouldn’t try to spin this loss,” Begala, a veteran political consultant, tweeted after it became clear that the Republicans had won a keenly contested special election for a vacant seat in Florida’s 13th District, which runs through Pinellas County, on the Gulf Coast. “We have to redouble our efforts for 2014. Too much at stake. #noexcuses.” The Democratic contender, Alex Sink, a former gubernatorial candidate, had experience and strong name recognition; the Republican, David Jolly, was a little-known former lobbyist. Despite the endorsement of Begala’s former boss Bill Clinton and other leading Democrats, Sink came in second—largely because her opponent, with the aid of well-financed Republican groups, portrayed her as a poster child for the Affordable Care Act.
http://www.newyorker.com/online/blogs/johncassidy/2014/03/its-time-for-democrats-to-embrace-obamacare.html?printable=true¤tPage=all#ixzz2vr9vCSfZ
The G.O.P. campaign was straightforward and unrelenting. In one campaign ad (cited by Alex Isenstadt, of Politico), Jolly said, simply, “She supports Obamacare. I don’t. I’m David Jolly, and I approve this message because Pinellas needs someone to look out for our interests.” Another ad claimed that Sink’s loyalty was to President Obama and Nancy Pelosi rather than to Florida, adding, “Why else would she continue to support Obamacare?”
As Yahoo’s Chris Moody noted, the election wasn’t a bellwether contest—special elections rarely are—but a test of each party’s messaging as the mid-term elections approach. Faced with the G.O.P. barrage, Sink tried to change the subject from the Affordable Care Act to protecting Medicare and Social Security from Republican privatization efforts, which she said Jolly supported. (In a dispatch from the district entitled “Obamacare’s Ground Zero,” David Weigel, of Slate, provided a good account of Sink’s troubles.) When pressed, as she was frequently, she equivocated, saying that she supported parts of the health-care reforms, such as forcing insurers to enroll people with preëxisting conditions, but that she also believed it needed fixing in ways that she couldn’t readily specify.
Trying to pussyfoot around Obamacare was an awkward strategy, and, evidently, it didn’t work. If other Democrats are to avoid meeting Sink’s fate in November, they need something more convincing to say about the Affordable Care Act than “mend it, don’t end it,” which is now their default position. But what could that be?
Here’s a heretical idea. Rather than parsing the individual elements of the law, and trying to persuade voters on an à la carte basis, what about raising the stakes and defending the reform in its entirety as a historic effort to provide affordable health-care coverage to tens of millions of hard-working Americans who otherwise couldn’t afford it? Instead of shying away from the populist and redistributionist essence of the reform, which the White House and many Democrats in Congress have been doing since the start, it’s time to embrace it.
What would that mean? It would involve reaching out to the Democratic Party’s core voters—lower-income people, minorities, highly educated liberals—and portraying Obamacare as the fulfillment of the great human-rights project that began in the nineteen-thirties, under Franklin D. Roosevelt, and was expanded during the nineteen-sixties, under Lyndon Johnson. That message wouldn’t merely be more honest; it would be more effective in getting Democratic voters to turn out in November, which is essential if the Party isn’t to suffer a repeat of 2010.
To be sure, Social Security and Medicare aren’t often described as human-rights reforms, but, make no mistake, that’s what they were. They were based on the notion that elderly Americans, regardless of race, income, or creed, have a right to avoid destitution and be treated for their illnesses. Similarly, the premise of the Affordable Care Act is that Americans of all ages, regardless of their incomes and personal histories, have a right to receive medical treatment. You don’t see Republicans campaigning against the public retirement programs—not openly, anyway. Despite the widespread belief that voters don’t like big government, G.O.P. candidates know, to their cost, that Social Security and Medicare are sacrosanct. Over time, universal health coverage will probably come to be seen in the same way. But it might not happen unless the architects of Obamacare stand up for it more vigorously.
As Yahoo’s Chris Moody noted, the election wasn’t a bellwether contest—special elections rarely are—but a test of each party’s messaging as the mid-term elections approach. Faced with the G.O.P. barrage, Sink tried to change the subject from the Affordable Care Act to protecting Medicare and Social Security from Republican privatization efforts, which she said Jolly supported. (In a dispatch from the district entitled “Obamacare’s Ground Zero,” David Weigel, of Slate, provided a good account of Sink’s troubles.) When pressed, as she was frequently, she equivocated, saying that she supported parts of the health-care reforms, such as forcing insurers to enroll people with preëxisting conditions, but that she also believed it needed fixing in ways that she couldn’t readily specify.
Trying to pussyfoot around Obamacare was an awkward strategy, and, evidently, it didn’t work. If other Democrats are to avoid meeting Sink’s fate in November, they need something more convincing to say about the Affordable Care Act than “mend it, don’t end it,” which is now their default position. But what could that be?
Here’s a heretical idea. Rather than parsing the individual elements of the law, and trying to persuade voters on an à la carte basis, what about raising the stakes and defending the reform in its entirety as a historic effort to provide affordable health-care coverage to tens of millions of hard-working Americans who otherwise couldn’t afford it? Instead of shying away from the populist and redistributionist essence of the reform, which the White House and many Democrats in Congress have been doing since the start, it’s time to embrace it.
What would that mean? It would involve reaching out to the Democratic Party’s core voters—lower-income people, minorities, highly educated liberals—and portraying Obamacare as the fulfillment of the great human-rights project that began in the nineteen-thirties, under Franklin D. Roosevelt, and was expanded during the nineteen-sixties, under Lyndon Johnson. That message wouldn’t merely be more honest; it would be more effective in getting Democratic voters to turn out in November, which is essential if the Party isn’t to suffer a repeat of 2010.
To be sure, Social Security and Medicare aren’t often described as human-rights reforms, but, make no mistake, that’s what they were. They were based on the notion that elderly Americans, regardless of race, income, or creed, have a right to avoid destitution and be treated for their illnesses. Similarly, the premise of the Affordable Care Act is that Americans of all ages, regardless of their incomes and personal histories, have a right to receive medical treatment. You don’t see Republicans campaigning against the public retirement programs—not openly, anyway. Despite the widespread belief that voters don’t like big government, G.O.P. candidates know, to their cost, that Social Security and Medicare are sacrosanct. Over time, universal health coverage will probably come to be seen in the same way. But it might not happen unless the architects of Obamacare stand up for it more vigorously.
http://www.newyorker.com/online/blogs/johncassidy/2014/03/its-time-for-democrats-to-embrace-obamacare.html?printable=true¤tPage=all#ixzz2vr9vCSfZ
Emergency Rooms Are No Place for the Elderly
By PAULINE W. CHEN, M.D.
The elderly man lived alone in an apartment complex not far from the hospital. A younger neighbor, who’d watched him hobble down the building’s stairwell for nearly a week, insisted on taking him to the emergency room. Doctors there immediately diagnosed an infection in his painful toe and prescribed antibiotics for him to take at home.
But they also advised the man to be sure to take his diabetes medicine, since the infection could elevate his blood sugar to dangerous levels. And as the surgical consultant, I urged him to keep his foot up, check the toe once a day and come to our vascular surgery clinic in a week to make sure the infection was clearing up. He needed close follow-up to prevent serious complications, even the loss of his foot.
“Of course, if things get worse before the week’s up,” I said, raising my voice to be heard over the clatter beyond the makeshift curtain walls of the E.R. examining room, “come back here right away.”
Under the glaring fluorescent lights, there was no mistaking the blank look that passed over the man’s face. He was overwhelmed.
But so was the emergency room.
None of the staff members had been trained in coordinating the complex outpatient care this elderly patient needed. None knew of a way for the emergency department to check on him a day or so after discharge to ensure his care was proceeding as planned. And when a social worker from another department agreed to pitch in with outpatient care, the emergency room doctors and nurses became alarmed rather than relieved, because arranging such follow-up could take several hours. With patients spilling out of the waiting room and into the hallways, they were under pressure to either admit or discharge patients as quickly as possible.
An older nurse finally pulled me aside. “Just admit him,” she whispered. “It’ll cost more, but it’s the only way you’ll be sure he’s getting the right care.”
Health Mandate Won’t Be Delayed, Sebelius Says
By ROBERT PEAR
WASHINGTON — Kathleen Sebelius, the secretary of health and human services, said Wednesday that the Obama administration would not extend the deadline for people to sign up for health insurance or delay the requirement for most Americans to have coverage.
And she declined to say whether the administration was still committed to its original goal of enrolling seven million people in private coverage through federal and state exchanges by March 31.
Testifying before the House Ways and Means Committee, Ms. Sebelius said categorically that the administration would not delay the “individual mandate,” under which most Americans must have insurance or pay a tax penalty. In addition, she said that officials would not extend the six-month open enrollment period, scheduled to end on March 31.
Ms. Sebelius reported Tuesday that 4.2 million people had selected health plans through the federal and state exchanges from October through February.
Better health through good choices
By George F. Will, Published: March 12
In September 1958, a future columnist, then 17, was unpacking as a college freshman when upperclassmen hired by tobacco companies knocked on his dormitory door, distributing free mini-packs of cigarettes. He and many other aspiring sophisticates became smokers. Nearly six years later — 50 years ago: Jan. 11, 1964 — when the surgeon general published the report declaring tobacco carcinogenic, more than 40 percent of U.S. adults smoked. Today, when smoking is considered declasse rather than sophisticated, fewer than one-fifth do.
In 1971, a New York couple decided their Bon Vivant brand vichyssoise tasted strange so they put aside their bowls, too late. Within hours he was dead and she was paralyzed from botulism poisoning. And within a month Bon Vivant was bankrupt, proof of the power of health-related information to change Americans’ behavior.
These two excursions into the sociology of health are occasioned by the remarkable recent report of a 43 percent reduction in the obesity rate among children ages 2 to 5. In 2004, about 14 percent of those children were obese; in 2012, about 8 percent were. The New York Times, which showed sound news judgment in making this the lead story on its front page, reported that the result of the large federal survey was “a welcome surprise to researchers.”
It was welcome because obesity begins early — people obese from age 3 to 5 are five times more likely than others to be overweight or obese as adults, when being so makes people more susceptible to cancer, heart disease and stroke. It was a surprise because no one knows why the rate dropped.
A reasonable surmise, however, is that one cause is the cumulative effect of talk about sensible eating and exercising. Certainly one lesson of the past 50 years is that one of the most cost-effective things government does is disseminate public health information concerning behaviors as disparate as smoking and using seat belts.
Mark Twain said humans are the only animals that blush — or need to. Leon Kass, a University of Chicago professor emeritus now at the American Enterprise Institute, has written that humans are the only animals that do not “instinctively eat the right foods (when available) and act in such a way as to maintain their naturally given state of health and vigor. Other animals do not overeat, under-sleep, knowingly ingest toxic substances, or permit their bodies to fall into disuse through sloth, watching television and riding in automobiles, transacting business, or writing articles about health.”
There may be no such thing as an unmixed blessing, and there was a cost even to the conquest of polio. Americans, whose national DNA disposes them to anticipate progress to be a product of technology, interpreted the Salk vaccine as establishing what can be called the “polio paradigm.” It is the mistaken idea that large improvements in public health result primarily from new medicines.
Medicaid expansion vote has real-life impact for low-income Mainers
Democrats and health care advocates say coverage should be free for the state’s poorest residents.
For the most financially destitute Mainers, the Senate debate and vote Wednesday that dimmed the prospects for Medicaid expansion was more than a political and ideological battle. It likely put health insurance out of reach for them this year.
“I’m left out in the cold,” said Gail MacLean, 64, a farmer from Gray.
Some opponents of expanded Medicaid – called MaineCare in Maine – have argued that low-income Mainers should instead buy their own insurance at subsidized prices offered through the Affordable Care Act. But, under the law known as Obamacare, Mainers such as MacLean who earn less than 100 percent of the federal poverty level – about $12,000 per year for a single adult – don’t qualify for those subsidies.
Mainers who are slightly above the 100 percent income threshold qualify for subsidies that can drive down premiums to less than $20 per month. And additional cost-sharing subsidies are available to help them pay for deductibles and other health care costs.
However, those below the poverty level are left to pay hundreds of dollars per month for insurance – often more than half of annual income.
The reason: When the Affordable Care Act was passed in 2010, Medicaid expansion was mandatory and Americans like MacLean had to be covered. But a U.S. Supreme Court ruling in 2012 permitted states to opt out of the expansion, and so far Maine and about 20 other states have spurned it.
Maine lawmakers endorse Medicaid expansion, but LePage veto looms
In a critical vote, the state Senate backs a compromise 22-13 but falls just shy of a veto-proof majority, threatening to relegate the issue to campaign fodder.
By Steve Mistler smistler@pressherald.com
Staff Writer
Staff Writer
AUGUSTA — Democrats’ hopes of extending Medicaid health insurance to more than 60,000 low-income and uninsured Mainers dimmed Wednesday after a three-hour debate and potentially decisive vote in the state Senate.
Senators voted 22-13 to pass a compromise bill co-sponsored by two Republican senators. However, supporters fell two votes short of the two-thirds majority – 24 votes – that eventually will be needed to override a certain veto by Gov. Paul LePage.
The prolonged debate showed that positions have hardened among Republicans who are backing the governor’s high-profile bid to defeat the proposal as he heads into his re-election campaign. The outcome also will shape the Democrats’ attempts to retain their majorities in the Legislature in November and unseat LePage.
Although Democrats hoped that a veto-proof margin in the Senate would create momentum for upcoming votes in the House, some party members have already shifted their rhetoric to the campaign by promising an electoral reckoning for Republicans who don’t support the bill.
Banners declaring “We’ll remember in November” were carried in the State House on Wednesday by activists from the Maine People’s Alliance, a liberal activist group that supports Democratic candidates with voter drive efforts.
The bill to expand MaineCare, the state’s Medicaid program, would provide health care coverage for 60,000 to 70,000 people who earn as much as 138 percent of the federal poverty level – just over $15,856 a year for an individual. Maine would be the 27th state to expand Medicaid using federal subsidies available through the Affordable Care Act.
With the expansion now in doubt, so is the prospect that Maine hospitals will receive an economic benefit from extension of insurance to people who now receive free “charity care.”
Maine officials in document-shredding case want testimony kept secret
It would be a first for the Government Oversight Committee. Lawyers for DHHS say state officials could be more open during private hearings.
AUGUSTA — State officials who have been subpoenaed by a legislative committee to explain the destruction of public documents justifying $4.7 million in public health grants could give their testimony in an unprecedented private hearing.
Attorneys defending the Department of Health and Human Services and the Center for Disease Control and Prevention against a lawsuit asked the Government Oversight Committee last week to interview the five subpoenaed officials, including CDC Director Sheila Pinette, in a closed-door meeting. The five officials are scheduled to appear before the committee Friday.
The request for privacy is the first in the five-year history of the oversight committee, which reviews state programs and agencies for inefficiencies or suspicion of mismanagement of public funds or duties. The request puts the 12-member panel in the position of choosing between transparency and the possibility that it could learn more about the case if the officials testify privately.
Sen. Emily Cain, D-Orono, the committee’s Senate chair, said the request contradicts the duty of the committee.
“This entire investigation and the fundamental goal of the Government Oversight Committee is to increase transparency and trust in government,” Cain said. “I’m concerned that if we do this we will be adding to the secrecy around this issue.”
The committee originally intended to take testimony in public. If it agrees to the private session, it will be limited in the amount of information it can share with the public.
The committee subpoenaed the five officials last month after the Legislature’s investigative arm determined that supervisors in the CDC ordered staff members to destroy grant documents and found “strong indications” that supervisors manipulated selection criteria for the Healthy Maine Partnerships program. The probe by the Office of Program Evaluation and Accountability stalled because of the missing documents and inconsistent stories from CDC officials.
HHS Seeks $600 Million For Health Law Enrollment Efforts
TOPICS: HEALTH REFORM, POLITICS
KHN Staff Writer
MAR 05, 2014
Just in case Congress doesn’t pass President Barack Obama’s fiscal 2015budget plan, officials at the Department of Health and Human Services say they have other options for finding the money they need to implement the health care law.
The law is expected to generate $1.2 billion in user fees—including those on health insurers who participate in its online marketplaces, or exchanges. The administration’s budget requests an additional $600 million to help run the federal marketplace, call centers and other outreach efforts, said Ellen Murray, assistant HHS secretary for financial resources.
If Congress doesn’t agree, she said, the secretary’s office has the authority to transfer funds from existing accounts, or to tap the agency’s non-recurring expense fund, which allows the agency to take money from expired accounts and use it for information technology and other capital investments.
“We would be looking at all those resources, as we are doing this year,” Murray said at a news briefing Tuesday about the budget. “But our expectation and hope is that Congress will provide the dollars we need.”
Funding for the federal exchange has been a trouble spot before. The health law provided funding for states to run their own exchanges, but because of strong Republican opposition to the law, more than half the states opted to let the federal government do that job instead. The law did not have adequate funding for such a large effort, and HHS officials have taken the money from other accounts.
Congressional Republicans, who have tried to defund all or part of the health law, balked before at adding money for the health law and are highly unlikely to approve an administration request for additional implementation funding. In addition, in December the House and Senate Budget Committee chairs, Rep. Paul Ryan, R-Wis., and Sen. Patty Murray, D-Wash., agreed to a budget deal that set federal government spending caps for fiscal 2015 and rolled back some of the automatic spending cuts known as “sequestration.”
Ryan and House Republicans are widely expected to put forth and pass a fiscal 2015 budget plan to outline the party’s spending priorities before midterm elections this fall where they are fighting to win control of the Senate and maintain or increase their majority in the House. Murray has said she is not pursuing a budget resolution this spring. “This budget year is settled and it wouldn’t be productive to relitigate it so soon after our two-year deal,” she said.
More dependency or opportunity: What’s at stake in Maine’s Medicaid expansion debate
By Kenneth Fredette, Special to the BDN
Posted March 11, 2014, at 1:36 p.m.
After all Maine’s budget and economy have been through at the hands of Medicaid over the years, it is shocking that Democratic politicians would propose a new, record expansion of the state’s medical welfare program under Obamacare.
Their proposal comes just months after finally paying off our state’s massive debt to its hospitals — debt racked up by the very program they want to expand. It comes just as we’re trying to patch an$80 million hole in the state budget caused by — you guessed it — the very program they want to expand.
Recently, I read the transcripts of the debate that took place on the floor of the Maine House of Representatives back in 2001 when Maine passed its last major expansion of Medicaid.
It struck me how every single one of the promises that proponents of expansion made back then have failed to be realized today.
Free care provided by hospitals has gone up, not down. ER usage has not declined among those covered. Maine’s rate of uninsured has stayed the same. Health care costs have continued to skyrocket.
Today, liberal politicians are making the same promises all over again. How many times do we have to try the same old, failed welfare policies before we realize that they don’t work?
Some Mainers have had to learn the hard way. I grew up poor in Washington County. I know firsthand the perils of poverty, and I know firsthand how to overcome it. Welfare dependency is not the way.
The welfare expansion proposal entails covering 70,000 able-bodied adults of working age at a massive cost to Maine state taxpayers.
Democrats are saying that this time, Medicaid expansion will be different. Actually, in one important respect, it is. There is an alternative from the federal government for the people who would be eligible for expanded Medicaid.
Most of them are already eligible for low-deductible plans on the exchange for $10, $7, or even $1.50 per month.
That’s a pack of cigarettes. It’s a Netflix membership. It’s an energy drink. It’s coverage provided by the feds that actually does not come out of the state’s coffers, and studies show that private insurance leads to better health outcomes than Medicaid.
In fact, about 4,500 Mainers who would be eligible for Medicaid if we expand have already signed up for the exchange, according to the state Bureau of Insurance. By pushing Medicaid expansion, liberal politicians are telling them, “We don’t want you to have superior private insurance; we don’t want you to chip in just a few bucks for your health. We want you on welfare.”
That’s the wrong message to send in a state that ranks second in the nation for welfare spending.
Republicans have raised the alarm many times about our broken welfare system. For example, we introduced a bill to create a tiered welfare system that removes incentives for people to turn down jobs, promotions, raises and more hours for fear of losing benefits. Democrats killed that idea twice.
But right now we actually have an opportunity to create an incentive for low-income people to earn more. Those who earn at or above the poverty level (about $11,500), up to 400 percent of the poverty level, are eligible for subsidies on the exchange. Some of those who would be eligible for expansion fall under that threshold and don’t qualify for subsidies. As one insurance agent found, however, many of them are already looking for ways to earn a little more to qualify for the plans.
Don’t get me wrong. Like most Americans, I agree that Obamacare taken as a whole is bad for our economy and our health care system. Let’s not make it worse for Maine by expanding Medicaid. The existence of the exchange is just one major reason why we don’t need to.
Making private insurance more affordable was the reason why Gov. Paul LePage and Republican lawmakers overhauled Maine’s insurance regulations in 2011, leading to premium drops of up to 70 percent in the individual market, eight times as many northern Maine businesses seeing rate decreases, and more young people getting covered. That reform shook things up, gave us great results and stabilized the health insurance market in Maine.
I can think of no better contrast of our competing visions for Maine’s future than the Medicaid expansion debate. Liberals want policies that bring us more welfare, debt, deficits, dependency and broken promises. Conservatives want to reform welfare, strengthen the private sector and encourage work and personal achievement.
Liberals have had their way in Maine for most of the past few decades, but with a fresh approach to government, our state’s best days can lie ahead of us.
State Rep. Ken Fredette of Newport is the Republican leader in the Maine House of Representatives.
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