Tag Archives: healthcare

Easy Way to Fix Obamacare and Cut Deficit

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The easy way to fix Obama’s healthcare bill/law and at the same time cut the federal deficit.  Just sayin’…

by Jonathan Zasloff

One can debate the political pros and cons of President Obama’s proposed budget: Jonathan Chait does an excellent job here debating with — himself!  But in fact there is a quite simple way to reduce federal spending by $47 billion a year as a conservative estimate: that old public health care option.

Such things, however, cannot be discussed in polite company, so let’s just reduce Pell Grants, maternal and child health, and food safety inspections instead.  Whew!  Glad we dodged that bullet.

 

U.S. Healthcare Spending 2009- Sources and Uses

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U.S. Healthcare Spending 2009 – Where It Came From:

U.S. Healthcare Spending 2009 - Sources of Funds

 

 

 

 

 

 

U. S. Healthcare Spending 2009 – Where It Went and How It Was Used

U.S. Healthcare Spending 2009 - How It Was Used and Where It Went

 

 

 

 

 

 

Source and downloadable PDF for the above at http://www.cms.gov/NationalHealthExpendData/downloads/PieChartSourcesExpenditures2009.pdf

Healthcare Act – Unintended Consequences

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So far I’ve largely stayed away from commenting on the lawsuits and Republican/Tea Party attempts to repeal the Affordable Care Act of 2010 that everyone refers to as Obamacare (odd choice of name since it doesn’t set up any government-operated healthcare facilities – it’s mostly about insurance, not care delivery). It seems that there are three sources of opposition to the healthcare reform act. There are those who are opposed to the “mandate”, the requirement that individuals buy healthcare insurance or suffer financial penalties for failing to do so. This is basis it appears of the opposition that has become several lawsuits trying to stop the act. Then second, there are those, primarily many Congressional and Senate Republicans who are simply opposed because Obama proposed it, despite the fact that the program as passed is essentially the same thing that Republican Mitt Romney created in Massachusetts. Finally there are those who opposed to any attempts to find affordable ways in which less privileged Americans can obtain healthcare – they prefer an everyman-for-himself world.  Best as I can tell, these are the folks calling it “socialism” despite the fact the program is best thing to ever happen to privately-owned insurance companies.

This post is relevant to the first opposers, the ones who claim to want affordable insurance to be available for all but oppose the “mandate” on some sort of liberty and constitutional grounds. Now a caveat first.  I am no great fan of the bill as passed. It is far, far from what I would have preferred.  My preference would have been for Medicare eligibility for all,not just seniors – a single payor system with private delivery of care. But, I think those who oppose the mandate, may find, should they win their lawsuits, that they run into that bane of economic policy proposals in the real world: unintended consequences. It seems to me there’s two likely types of unintended consequences that these people will find unpleasant.  First is that should the mandate fail, then the only way to achieve affordable health insurance for even just a majority of Americans is to go to a public-option or single-payor system. The reason is because the healthcare insurance market does not and cannot work successfully without the broad-based coverage that only a mandate, public option, or single-payor can provide. Healthcare insurance, with private insurance companies leading the way, is prone to serious adverse selection problems. Insurance companies only want to insure people who have no claims and only people who need healthcare want to buy coverage until the unexpected happens. It’s the dynamic that caused the nation to have this debate and why every developed nation has some sort of public-option, mandate, or single-payor. The Incidental Economist explains more here and  gives examples of the Massachusetts experience here. So if opponents succeed and get the mandate repealed, they may very well find  that healthcare affordability is more popular than they perceive and the nation may be forced to their even-less liked options: single-payor or public option.  Oops, unintended consequence.

Another possible unintended consequence has to do with a variety of other  laws that most of the mandate-opponent conservatives favor.  Constitutional law scholar Laurence Tribe observes that should the Supreme Court strike down the mandate as unconstitutional, the logic they would have to use would reverse and/or jeopardize a wide range of other federal laws that the court and conservatives have upheld. Such as the ability of the Federal government to “regulate” or prohibit the growing and use of marijuana in one’s own backyard for your own consumption. Through some tortured logic, the same Supreme Court justices that would have rule against the mandate held that growing something for your own use that your state doesn’t prohibit still constitutes “interstate commerce”.  Hmm.  So it the mandate goes, it might create a whole meaning for “medical marijuana”.

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Ok, so apparently 14 or more state Attorneys General, including my state’s AG, Mike Cox, have filed lawsuits to try to stop the recently enacted Healthcare Reform Act.  These AG’s claim to acting in the interests of their citizens to “protect” them against waste, fraud, and so-called unconstitutional mandates by the federal government.  Apparently in their desire to save taxpayers’ money, these same AG’s didn’t do their homework.

Paul J. O’Rourke at OpenSalon notes that the AG’s claim that:

“The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage,” the lawsuit states.

He then proceeds to give the AG’s a history lesson.  It seems our founding fathers, people I presume knew something about the constitution (and the Fed Gov’s power has only gotten wider since) enacted a mandate on private persons for a healthcare insurance scheme back before 1800:

The history lesson

In July, 1798, Congress passed, and President John Adams signed into law “An Act for the Relief of Sick and Disabled Seamen,” authorizing the creation of a marine hospital service, and mandating privately employed sailors to purchase healthcare insurance.

This legislation also created America’s first payroll tax, as a ship’s owner was required to deduct 20 cents from each sailor’s monthly pay and forward those receipts to the service, which in turn provided injured sailors hospital care. Failure to pay or account properly was discouraged by requiring a law violating owner or ship’s captain to pay a 100 dollar fine.

This historical fact demolishes claims of “unprecedented” and “The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty…”

Perhaps these somewhat incompetent attorneys general might wish to amend their lawsuits to conform to the 1798 precedent, and demand that the mandate and fines be linked to implementing a federal single payer healthcare insurance plan.

With conservatives on the Supreme Court that think corporations have been oppressed and denied the ability to “speak”, it’s always possible that strange things happen.  But, frankly, I don’t see how these suits are anything but state Attorneys General wasting taxpayer money in order to promote their own political careers.

BTW: in case you don’t believe O’Rourke, try checking out WikiSource and read the law for yourself.

Healthcare Reform in 2 sentences

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Excerpting from Brad Delong:

we have moved from having by far the worst health care financing system in the OECD to a health care financing system that is merely bad by the standards of the OECD…

…People will wake up one morning and realise that the healthcare bill hasn’t brought socialism to America. And … realise we have not magically solved all our healthcare problems. People should calm down a little. There has been a tendency to exaggerate recently.

Healthcare Reform Explained

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Alter Reiss explains the healthcare bill that just passed in the US:

Some myths about the current healthcare bill explained.
There’s been a lot of talk about this lately, so I figured that I’d clear up a few common misconceptions people seem to have about the recently passed Health Care Reform bill.

Myth 1:
With the passage of HCR, bears will be allowed to roam hospitals, devouring those patients too sick to hide or flee.

Status: FALSE
The ursine provisions of the health care bill remain controversial with the AMA and other organizations, but, basically, all they do is recognize that in some rural areas, particularly in the Dakotas and Alaska, bears have been acting as health care professionals for decades, and puts them into the category of other alternative health professionals, such as acupuncturists, osteopaths, and killer bees. Bear attacks may be available under some health plans, but those treatments are entirely at the discretion of the insurers.

Myth 2:
MRIs are once again to be termed “Nuclear Magnetic Resonance Images”, and once again, a small percentage of those undergoing this procedure will gain super-powers that will allow them to perform great feats, at a cost to their humanity.

Status: FALSE
While this provision was included in earlier versions of the bill, it was dropped in the face of a strong opposition by Senator Keene and others.

Myth 3:
ObamaNaziSocialismAntichristApocolpyseRevalations4:15SicSemperTyranisTaxedEnoguhAlready!

Status: That’s not a myth, that’s a bunch of words, some of which are misspelled.

Myth 4:
A provision of the HCR bill calls to the Lord Above, to send down a dove, with beak as sharp as razors, to cut the throats of them there blokes, what sells bad beer to sailors.

Status: Partially true.
While this language does exist in the current version of the bill, it is unlikely to stand judicial scrutiny, as it will probably be seen as a violation of the separation of church and state. However, this is merely echoing faith-based programs enacted by individual states. The dove attacks on campus area bars selling Rolling Rock to University of West Florida Argonauts, for instance, can only be applauded, as Rolling Rock is swill.

Myth 5:
In order to pay for the mandates of this bill, President Obama has traded the treasury of the United States for a handful of magic beans.

Status: FALSE
Only one government-owned cow was traded for these beans, which have already more than earned back the initial investment. Also, since the treasury of the US currently contains less than negative fourteen trillion dollars, wouldn’t you want to trade it, for just about anything?

Myth 6:
The HCR bill will allow communists control of our vital bodily fluids.

Status: TRUE
Yeah, this one is totally real. But, to be fair, there aren’t that many communists left, and those that there are don’t actually want that many bags full of lymph and phlegm.

For the humor impaired, this is sarcasm.

Healthcare: Do It Because It’s the Right Thing To Do

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The following is important enough to repeat in full from Krugman at Demons And Demonization.

What I want to add is that the opponents of Healthcare Reform claim to be supporters of “liberty” and “free  markets” and claim to be opposed to the “tyranny” of government involvement.  Yet what is very clear (and this story is only one of many examples) is that the current “market” for healthcare insurance does not function as a true market, let alone a free market by any stretch of the imagination.  There is no functioning “market” if participants to contracts can regularly renege, cancel, and deceptively hide their tracks.  The insurance company here  is not engaged in “voluntary, privately-entered contracts in a market”.  They are engaged in predation, deception, and fraud.  Enforcement of contracts is indeed a valid function for government, even for extreme ‘free market’ fundamentalists.  That’s why we need healthcare reform now.

The usual suspects have been attacking Obama for “demonizing” insurance companies; but saying that people do terrible things isn’t demonization if they do, in fact, do terrible things.

And health insurers do, because they have huge financial incentives to act in an inhumane way — most obviously, by revoking coverage when people get sick, using whatever rationale they can devise.

Read this report by Murray Waas on Assurant Health (previously called Fortis), which used a computer algorithm to identify every client with HIV, then systematically revoked coverage on the flimsiest of grounds — and appears to have systematically hidden any paper trail showing how it made its decisions:

The South Carolina Supreme Court, in upholding the jury’s verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court’s finding that Fortis destroyed records to hide the corporation’s misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: “The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents” as well as the “omission” of other records regarding the decision to revoke Mitchell’s insurance, constituted “evidence that Fortis tried to conceal the actions it took in rescinding his policy.”

And what basis did the company use for revoking coverage?

Fortis canceled Mitchell’s health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company’s investigators discovered the note, they ceased further review of Mitchell’s records for evidence to the contrary, including the records containing the doctor’s diagnosis.

Still, this must have been an outlier, a scuzzy company that wasn’t at all typical, right? But in that case, why was the CEO one of the people who testified on behalf of the insurance industry?

On June 16, 2009, the House Energy and Commerce Committee, held a hearing on the practice of rescission by health insurance companies, and among the industry executives who testified was Don Hamm, the CEO and President of Assurant Health.

Hamm insisted before the committee that rescission was a necessary tool for Assurant and other health insurance companies to hold the cost of premiums down for other policyholders. Hamm asserted that rescission was “one of many protections supporting the affordability and viability of individual health insurance in the United States under our present system.”

And as the story points out, the evidence is that the overwhelming majority of rescissions, not just at Assurant but across the board, are, in fact, without justification.

The crucial thing to understand is that depending on how a few Democrats vote sometime soon, stories like this will either cease happening — or continue, and get much worse. The proposed health care reform would end discrimination based on pre-existing conditions, and therefore end the threat of rescission as well.

And to repeat what I and other have repeatedly explained, you need the whole package to make this work. You can’t end discrimination based on medical history unless you require that health as well as sick people have insurance, to broaden the risk pool. And you can’t mandate coverage unless you provide aid to those who otherwise couldn’t afford it.

Right now, we have a system that creates huge incentives for bad, one might say demonic, behavior: Assurant made $150 million by revoking coverage, almost always without cause. We can end all of that — not in some indefinite future, but with a single vote right now.

Just do it.