No more public option? Senate Dems reach tentative compromise

Both the Associated Press and the New York Times are reporting Democrats have dropped the public option in the tentative deal.  Updated at 9:54 p.m., the New York Times reports:

“The Senate majority leader, Harry Reid of Nevada, said on Tuesday night that he had reached “a broad agreement” among a group of 10 Democrats who have been working to resolve the dispute over a proposed government-run insurance plan that has posed perhaps the biggest obstacle to major health care legislation.”

1. In sacrificing the government-run health care program, Democrats have tentatively settled on a private insurance arrangement modeled after the Federal Employee Health Benefits Program. It would be supervised by the Office of Personnel Management, the federal agency that oversees the system from which lawmakers purchase coverage.

2. The option to purchase Medicare would also be extended to those uninsured between age 55 and 64 (instead of over 65).

All information was provided by  anonymous sources because they were not authorized to discuss the tentative deal publicly.

Why the for-profit model is to blame: Interview with Dr. Rachel Adler

In the words of Winston Churchill, “America will always do the right thing, but only after failing at everything else.” According to Dr. Rachel Adler, associate professor sociology and anthropology, health care is no exception to this assertion. “Our health system in the U.S. is definitely problematic,” she explained. “From my perspective, the for-profit model is at odds with the human rights foundations of what health care should be.”

As part of the Global Public Health course taught this semester, Adler says she and her students examined the pros and cons of health care systems worldwide. Though each is different, the basic principles remain the same and shed light on some of the inadequacies of the U.S. system. First and foremost, she says our view of health care as a privilege and not a basic human right is fundamentally flawed. Referencing a documentary about foreign systems, Alder described how in other capitalist countries that have successfully re-conceptualized health care (Germany, Japan, Taiwon, Great Britain), average citizens think it is inconceivable that a person might get sick and be unable to afford a visit to the doctor. “It was so interesting to look at how other countries thought of it as scandalous to think that that could happen whereas in our country we have millions and millions of people for whom that is their reality every single day,” she said.

A common thread in the design of universal health care systems is that these are financed through tax revenue, with each citizen paying the same amount (Great Britain, for example). Though Adler admits that high taxes for health care most likely would not fly in the U.S., she hopes we can still take a few cues from the other principles governing foreign systems. Most importantly, she advocates the non-profit model.

“Right now, the profit-hungry insurance companies are running the show,” explained Adler. “It is not really in their best interest to pay sick people, because if they pay sick people it is less profit for them. Philosophically, the system is at odds with the goal of providing health care.” Non-profit organizations, on the other hand, are designed so that rather than funneling profit into billion dollar CEO salaries, it goes right back into the company. Thus, it is a matter of maintaining the enterprise rather than obtaining unlimited profits and Adler says that when motive is removed, there is a lot of money to play with, “it can go into extending coverage to those who deserve to be insured or those who have lost their insurance.”

Regarding the House bill, Adler says she is fully in favor of the oft-disputed “public option.” In her opinion, extending Medicare-like coverage to everyone while changing the way money is distributed (shift to non-profit), could reduce costs and improve care. Based on discussions I’ve had with students here at the College, my general impression is that some people are paranoid about the prospect of “big government” health care, complete with long waits and bureaucrats mandating what care you can and can not receive.

Adler, however, pointed out the fact that insurance companies are currently doing those very things. “Insurance companies run the show, telling physicians what they can and cannot do, what tests they will and will not pay for and which hospitals patients can and cannot go to,” she said. “All the things people are afraid big government will do.” To drive home her point, she gave the examples of the postal service and Amtrak as two nationalized, government-owned corporations (socialist even!) that people do not seem to have a problem with not view as radical.

So, what does Adler say about Christie and the future of health care reform? It’s probably not a good thing. Throughout the campaign, Corzine accused Christie of supporting “swiss cheese plans” (limited coverage) that would cut out funding for mammograms and autism consultations. “From a public health perspective, those prevention and screening mechanisms are a necessity,” said Adler. “If you talk about Cadillac plan being someone paying a little extra luxurious perks in the system, like the option of a private hospital room or fancy meal plans, that is fine, but when you are talking about mammograms and basic stuff, no way! Everyone needs to have access to that.”

Moreover, Christie has stated he is not in favor of the public option and if a provision is added to the Senate bill allowing states to opt out, New Jersey may be left behind in the health care overhaul. Looking on the bright side, Adler says if that happens, at least our state will be able to see the great results in other states that opted in and hopefully enact change, better late than never.

Regardless of whether reform passes the Senate, Adler is confident something will happen soon because of the momentum the issue has garnered across the nation. “People need to look beyond themselves and find some compassion,” Adler said. “In the end, lack of health care is bad for our country, bad for public health and bad for the kids, who have no choice in the matter. Something has to change, it just can’t go on like this.”

Let’s talk doughnut holes (in Medicare drug coverage)

The voices of the 39 million people aged 65 and older in the United States may be some of the most influential in shaping the future of the health care overhaul. As lawmakers emphasize how the proposed House plan would close the “doughnut hole” in Medicare coverage, the powerful voting bloc has gradually swayed in favor of the bill, so much so that the AARP (American Association of Retired Persons) formally declared its support last month.

Medicare is the federal health plan for seniors over age 65. Its prescription drug benefit plan (Medicare Part D), in which 27.07 million Americans are enrolled according to the Centers for Medicare and Medicaid Services, was  launched in 2006. The oft-mentioned “doughnut hole” refers to the gap in coverage between the initial coverage limit and and the catastrophic coverage threshold. After surpassing the initial limit,the beneficiary is financially responsible for the cost of prescription drugs until reaching the threshold.

It was designed to reduce the overall cost of the program but often forces a disproportionate burden on those with chronic illnesses. It is estimated 3.4 million seniors, and 32% of beneficiaries in New Jersey alone, fall into the hole yearly.

The House bill would close the gap gradually until it is eliminated in 2022.

“Five Myths About Health Care Around the World”

“Five Myths About Health Care Around the World”

Washington Post Article, 8/23/09

In anticipation of the soon-to-be posted interview with Dr. Rachel Adler, associate professor of anthropology and instructor for the Global Public Health course, I thought it would be interesting to share this article on five top myths about foreign health care systems and the oft-made claim that they are all socialist systems.

Some key points in the author’s argument:

1. Almost all Americans over the age of 65 sign up for Medicare (government insurance) whereas in Germany, Switzerland and the Netherlands, seniors often remain with private plans for life.

2. Although those notorious waiting lists do exist (for non-emergency care and elective surgeries), studies by the Commonwealth Fund indicate many nations — Germany, Britain, Austria — outperform the United States for measures like appointment waits and elective surgeries.

3. Private sector, for-profit health insurance system is less cost-effective than other payment systems. The United States systems spends 20 cents of every dollar on non-medical related costs (paperwork and marketing, for instance).

Take Japan, the “world champion at controlling medical costs,” a nation in which the average citizen visits the doctors 15 times a year, triple the U.S. rate, quality of life is high, life expectancy is greater than in U.S. BUT where our nation spends more than $7,000 on each individual annually, Japan spends a mere $3,400.

4. The myth that America has the “finest health care” in the world.

Overseas, cost-control drives innovation, falsifying the belief that the U.S. dominates groundbreaking medical research as the result of its for-profit system. Let’s look at Japan, once again. The identical MRI neck region scan that costs $1,500 in the U.S. is $98 in Japan, and these labs are still making a profit.

5. Let’s make health insurance “nice”

Foreign health insurance companies MUST accept all applications and are prevented from canceling as long as you pay the premiums (though everyone is mandated to buy insurance).

We are the only nation that has yet to agree on one model for health-care delivery and finance, ours is a mixture of other nations blended in to a “costly, confusing bureaucratic mess.”

With our remarkable medical assets: top-notch education, advanced hospitals and world-class research, we should not have tens of millions without insurance coverage. Let’s take a cue from all the other industrialized nations and work our way up to the label of providing the finest health care.

Thoughts of a Future Doctor

Rahool Davé, sophomore philosophy major and seven-year medical student, shares his thoughts on health care reform, malpractice insurance, global systems and Chris Christie.

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Health Care– spelled out in the cards

What does Christie say about health care reform?

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Affordable Health Care for America Act (H.R. 3962)

1,990 pages, 19 pounds and $1.055  trillion over the next ten years. The statistics of the Affordable Health Care for America Act passed by the House Saturday (November 7) are admittedly intimidating but so too is the fact that in a nation as wealthy and advanced as ours, millions of Americans are without health insurance.

According to U.S. Census numbers, nationwide the number of uninsured increased from 39.8 million in 2001 to 46.3 million in 2008. In New Jersey alone, the number has increased from 1.1 million in 2001 to 1.2 million in 2008, with the percent of non-elderly adults without insurance rising from 16% to 17.9%. Furthermore, insurance problems can cross income brackets, for an additional 119,000 people from high-income households are now uninsured.

According to the Committee on Energy and Commerce website, key components of the legislation, approved by vote of 220 to 215, which will cover 96% of American by 2015 and reduce the deficit by tens of billions over the next decade, are as follows:

Increasing choice and competition. The bill will protect and improve consumers’ choices.

• If people like their current plans, they will be able to keep them.
• Those not currently covered by employers and small businesses can purchase coverage through a new Health Insurance Exchange.  Consumers are able to choose from a variety of  affordable, quality health care options, including private plans, health co-ops, and a new public health insurance option.
• Public health insurance: Participation is completely voluntary; creates an alternative on the market and will help lower premiums for all plans because the private market will have to compete on a level playing field for the first time.
• Competition leads to better coverage and care, with patients and doctors acting as decision-makers rather than insurance bureaucrats.

Giving Americans peace of mind. Provides portable, secure health care coverage.

• Every American who receives coverage through the Exchange will have a plan that includes comprehensive and quality health care benefits.
• Eliminates discrimination (either through increases in premiums or denials of care) by insurance companies on the basis of a pre-existing condition, race, age or gender. According to U.S. Census statistics, 8% of people in New Jersey have diabetes and 28% have high blood pressure, both are considered “pre-existing conditions” that may be cause for losing insurance.

Improving quality of care for every American. The legislation will ensure that Americans of all ages, from young children to retirees, have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.

• Guarantees that every child will have health care coverage that includes dental, hearing, and vision benefits.
• Provides better preventive and wellness care. Every health care plan offered through the Exchange and by employers, after a grace period, will cover preventive care at no cost to the patient.
• Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.
• Strengthens Medicare and Medicaid and closes the Medicare Part D “donut hole” so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

Ensuring shared responsibility. The bill will ensure that individuals, employers, and the federal government share responsibility for a quality and affordable health care system.

• Employers can continue offering coverage to workers, and those with payrolls over $500,000 who choose not to offer coverage will contribute a fee of up to eight percent of payroll.
• All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income.  Individuals facing difficulties can apply for hardship waivers from the penalty.
• The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families, to make premiums affordable and reduce cost-sharing.

Protecting consumers and reducing waste, fraud, and abuse. The legislation will put the interests of consumers first, protect them from insurer discrimination and mistreatment, and reduce waste, fraud and abuse.

• Provides transparency in plans in the Health Exchange so that consumers have clear, complete information, in plain English, to select the plan that best meets their needs.
• Establishes consumer advocacy offices as part of the Exchange to protect consumers, answer questions, and assist with any problems related to their plans.
• Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all benefit from a streamlined, less confusing, more consumer-friendly system.
• Increases funding of efforts to reduce waste, fraud and abuse; and creates enhanced oversight of Medicare and Medicaid programs.

Reducing the deficit and ensuring the solvency of Medicare and Medicaid. The legislation will be entirely paid for – it will not add a dime to the deficit and will actually reduce the deficit over at least the next two decades. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive quality health care benefits for years to come.

• Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and through revenue generated from placing a surcharge on the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other revenue measures.
• CBO estimates the bill will reduce the deficit by $30 billion over ten years, not counting the additional deficit reduction generated by the CLASS Act.
• Extends the life of the Medicare trust fund by 5 years.
• Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually.

GOP Counters with Health Plan of its Own

Health / Health Care Policy

G.O.P. Counters With a Health Plan of Its Own

By ROBERT PEAR and DAVID M. HERSZENHORN

Published: November 4, 2009

The bill would reward states for reducing the number of uninsured and limit malpractice awards. It has no chance of passing.

Obama Plan in Four Minutes

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