Editor's NOTE:
The timely piece below was written by an Orthopedic Surgeon who has authored a book for the Acton Institute entitled; A Prescription for Health Care Reform. Unfortunately, one must spend 6 dollars plus shipping to read it.
In my opinion, books on public policy are best presented as so-called "white papers" free of charge. Presumably, Dr. Condit's views as represented in this piece reflect those in his book.
Based on what he has written in this essay, I encourage Dr. Condit to make copies of his book available on-line for free.
--Dr. J. P. Hubert
by: Donald P. Condit MD, MBA
Acton Institute
April 6, 2011
Remember Mary Poppins singing, “A spoonful of sugar helps the medicine go down in the most delightful way”?
If so, be concerned, because you or your parents are probably on Medicare – or will be soon -- and last week the Department of Health and Human Services (HHS) proposed regulations for Accountable Care Organizations (ACOs).
The sugar-coated rhetoric in this announcement from HHS cannot disguise the bad medicine in this part of this part of the Affordable Care Act, which intends to bureaucratically cut as much as $960 million in Medicare spending over three years. This Obam-Care prescription threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity. (Editor: the greatest beneficiary is clearly the private health insurance industry)
Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.
Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs. Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times . The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. (Editor: in my personal experience they usually do) Medical care providers will receive incentives for controlling spending, and penalties if they do not. "No one can serve two masters” (Matthew 6:24). Not even physicians.
The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that, “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.” Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)
The principle of subsidiarity (Editor: according to Wikipedia, an organizing principle that matters ought to be handled by the smallest, lowest or least centralized competent authority or in this context the Roman Catholic Church teaching that decisions should be made by those closest to the people they affect) guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction. It increases bureaucratic power and responsibility. This is not the antidote needed to reform health care in the United States. The complexity, cost, and confusion of implementing these ACO regulations defy comprehension. We can only hope ACOs will follow “just say no” HMOs into the historical ash heap of misguided health policy.
There is no question that significant – and scarce -- health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending -- the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward:
While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community. (32)”
The patient must be the focal point of concern. They, or their surrogate, with the help of their physician, need to become informed. They must also participate in the expense of their care, which will better allocate resources for the community than would more distant bureaucratic panels or regulation.
Furthermore:
A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (57). [Editor: this is another reference to The Ethical and Religious Directives by the United States Conference of Catholic Bishops in which the author is citing paragraph #57 of that document. Readers should be aware that debate exists even among Roman Catholic Moral Theologians/Philosophers about the definition of the words "disproportionate" and "benefit" in this loaded moral context. The editor has written on this subject in a piece for Catholic Online entitled: "Fr. Richard McBrien and Others Mislead Catholic Public: Allege Schiavo Feeding Tube Removal OK"]
Enabling all patients, with and without means, to “proportionally” participate in the cost of their care will better allocate scarce health care resources than further sugar-coated, and non-delightful, misguided administrative policies.
By the way, if you didn’t recognize the Mary Poppins song, that’s OK. Worry instead about your grandparents for now, and consider how your generation will counter-reform ObamaCare in the future.
[Editor: Comments are kindly invited.]
Showing posts with label Health Care Crisis. Show all posts
Showing posts with label Health Care Crisis. Show all posts
Wednesday, April 20, 2011
Tuesday, April 19, 2011
Health Care Spending in the Light of Wisdom and Justice
Editor's NOTE:
The following opinion piece by a reader of this blog--is presented in way of adding to our understanding of the current debate in Congress with respect to altering Medicare and Medicaid.
The pespective presented by Dr. Gibbons is fairly consistent with Traditional Roman Catholic Moral Theology and is worthy of consideration. My comments follow his piece.
--Dr. J. P. Hubert
Health Care Spending in the Light of Wisdom and Justice
By: Joel Clarke Gibbons
Logistic Research & Trading Co.
Saint Joseph, Michigan.
We have to get a few basic points in order before we are ready to weigh the pros and cons of the Republican plan, or of any plan, to change Medicare and Medicaid. I offer the following in the cause of reason and balance on this topic.
Justice:
Justice demands that we accord to every person what is his or her due. That precept -- or more exactly, that definition -- covers justice in all its manifestations; between individuals, in what is called commutative or transactional justice, it defines the just claims of one party against another. It also covers claims that a person makes on his community or society, which we call distributive justice. The issue of public funding of medical treatments through programs like Medicare and Medicaid is distributive in nature, raising the question of which claims a person can legitimately make on his/her fellow citizens. He does not have the right to bankrupt them.
No person has a just claim which – if it was honored across the board for all the people – would simply break the bank. That certainly applies to claims which everyone might raise, like free food for all, but it also applies to claims which many persons would register for themselves, but which if they were available to all would find enough claimants to break the bank. So while not everyone would like to have a heart transplant, if even a fraction of citizens wanted that treatment and if as a result to public Treasury would be so drained as to force grave limitations on its other expenditures, then that is not a just claim.
No person has a just claim – a commutative right – to escape the consequences of his own folly. We nonetheless tend toward charity which softens this rule. The citizens have moreover a just expectation of charity on our part. But they do not have the right to repeated folly. St. Paul made that clear when he reminded the Thessalonians of the rule he had enforced, that whoever would not work, should not eat (II Thessalonians 3: 10). This probably applies in some ways to how the person cares for his or her own body, but I won't go there. With regard to the economics, the citizen does not have the right to spend all his money on the good life, and expect the Treasury to pay his medical bills. The community is entitled to demand that the citizens make provisions for their own needs, and in this case, that requires them to buy some sort of insurance, or alternatively to have the personal wherewithal to pay their own bills.
We have a moral duty both to save for future needs, to the extent possible, and to develop and employ our talents to provide for us and for those who depend on is, and we do not have a just claim to be absolved of this duty. This duty follows directly from the Seventh Commandment, which enjoins us not to live by theft, because the choice to be dependent on the community, to expect to be supported by others or by the State are in fact a kind of theft.
We often say that distributive justice endows everyone with a right of sorts to an equal chance. In many areas that is the case. It endows us, for instance, with a right to basic education at public expense but of course it does not endow anyone with a right to learn as much as everyone else. How much we gain from education is governed also by our unequal endowments and by our unequal attention to the work of learning. Life however is filled with unequal opportunities right at the start. Unequal outcomes moreover quickly become unequal opportunities too. If I am unable for reasons good or bad to exploit my equal opportunity to learn nuclear physics, I will be very disadvantaged in the competition for university faculty positions. Thus the opportunity/outcome test is not nearly as revealing in practice as we had hoped it would be. Nonetheless the idea is a good one and comes down to this. It is unjust to defend inequality in opportunity – to defend artificial barriers – but it is not unjust to accept inequalities as they arise. We should always look for ways to lower barriers of inequality, both as a matter of charity and of justice, no matter what has caused them, but we accept that they are all around us no matter what we do.
In the matter of equal opportunity as it applies to medicine, it is imperative to weigh the costs and benefits of various treatments. As a very clear example, no one should have to suffer broken limbs without treatment. It is simply too easy to set them, or even to repair them surgically; this technology is widely known and available and the benefit far outweighs the cost. Even in this case however, we do not lose sight of the requirement that any particular course of treatment reasonably accomplish the purpose. There is no cost-benefit analysis that would deny that treatment, except in the most desperately poor society.
Now we move up the line to cost, invasiveness, frequency, and prognosis. As we do that, we keep track of the cost in the aggregate to the society. At some point, well above setting broken bones but almost surely before we get to the triple heart-lung-liver transplant, we run out of money and we run out of medical logic too. Cost in this, as in most cases is defined not in the absolute sense but in the economists' sense: the value of other kinds of outlays begins to swamp the value of another surgery.
At that point – and I do not mean in any way to suggest that this is easily done or that it is something we do once and for all – the just claims on society are exhausted. Everyone has a claim – depending on the wealth of the community – to basic medical care, understanding that the standard of “basic” is fundamentally economic in the sense that it hinges on the trade off between more care and more highways and other demands on the Treasury. In no sense do I vote for descriptively “basic” – i.e. minimal – care. On the contrary, we want to be as generous as possible, especially since I myself might come down with one of those really expensive needs. But there has to be a cutoff.
As a matter of justice, no person should be denied any kind of medical treatment that he or she is prepared to pay for out of his own pocket, or to pay for from the voluntary donations of other citizens. If there is some kind of treatment that costs a billion dollars, only billionaires will have it. Well, let that be a reminder of just how nice it is to be a billionaire, although realistically speaking no one would want to suffer from whatever might require such a treatment. In justice we cannot out of envy prevent anyone from treating himself – in effect – nor can we hold him hostage to exorbitant claims to pay for our medical care. From time to time the proposition is advanced that equality of access implies that access be identical for all persons. That would be a manifest perversion of justice.
Distributive justice is sometimes framed as an exception to transactional justice, but that is never correct. In reality, there is only one kind of justice. The Lord God created society for the benefit of the people, and thus they have just claims on it. Society has duties under the moral law. The most obvious of these duties is to secure for us the demands of transactional justice: to defend our rights to life, liberty, and the pursuit of happiness when they are infringed by our neighbors, which is to say that in practice, the guarantee of transactional justice is itself an example of distributive justice. Of equal merit however are the just claims that we have on the society; and in rich societies like ours, those claims can be defined in very generous terms. These are the claims of fairness and of fellowship, and of concern for our neighbors and for the solidarity of the community.
Justice always ensures to the poor an adequate living and to the infirm the care and solicitude of the community. The claims we have individually on the community are of course only the reflection of claims it has on us, and while we are entitled to grumble, we must in justice submit and pay our taxes and do whatever else is needed and right. This is never an engine for extortion and jealousy, because that would pit communal justice against the rights of the person. It is for that reason that the claims of the citizen for public support must be weighed on a scale of reason, and in light of all the demands on the Treasury.
Wisdom:
So what does this say about changing Medicare? It says that the cost of Medicare is in principle limited, as is everything else in life, and that the society has duties both to respond to just claims against it, and to deny unjust claims on its generosity. At this time, medicine has undergone such revolutionary change, carrying with it extraordinary benefits and costs that it is exceedingly difficult to know where to draw the line. At what point do claims cease to be fair and just, and become exploitative? Justice demands that we collectively put our heads together in an honest attempt to discern where this very elusive line is hiding. It implies also that attempts to uncover the line and to calibrate it in practical and financial terms cannot be and should not be thought of in moralistic terms alone. The moral demand of justice itself sets us to the task of finding the answers.
Wisdom is the virtue that leads us to find the best course of action under all kinds of particular circumstances. It serves justice, because justice really is blind. Justice doesn’t know what works medically from what doesn’t work, and that “working” and “not working” are not simple, blanket judgements but are specific to each case. Justice doesn’t know either medicine or the technical details of any of the myriad other goods that press their demands on the Treasury. It is for wisdom to inform justice, and in that sense we concede that justice is not sufficient, but there is no escape from it.
___________________________________________________
Dr. J. P. Hubert's Comments:
I am largely in agreement with Dr. Gibbons. Some additions and commentary follow:
Justice is only one criterion/virtue by which to consider the question of whether to change Medicare, Medicaid or any other federally funded government program—in the light of reason. As Dr. Gibbon's suggests, other criteria are important as well, for example, 1) societal expectations based upon accepted practices people have come to rely upon, 2) the precepts of the common morality which flow from the Natural Moral Law e.g. (do good, avoid evil, treat your neighbor fairly and so forth) 3) available resources, 4) best practices based upon documented outcomes in the case of health care and 5) comparative cost analyses of US vs.: other developed nation’s health care costs among others.
With regard to the issue of what to do about those procedures that are controversial, extremely expensive or demanded by the patient: it is important to note that medical recommendations must be made only after applying stringent criteria which include a consideration of alternative therapies as well as expected outcomes when performed in settings capable of “best practices.”
It is not appropriate to deny care simply because it is very expensive and high-tech., but it must be demonstrably shown to be a better choice than any other alternative and associated with reasonable morbidity/morality. The “cut-off” is not simply based on economics but must also be based upon stringent medical/surgical criteria in order to avoid unnecessary morbidity/mortality and waste.
A critical issue in this debate is the fact that the private health insurance industry has a virtual monopoly over American Health Care which was reflected in the ommision of an effective "Public Option" from the bill passed and signed by President Obama last year. Similarly, the pharmaceutical industry lobby is so strong that the federal government has not been allowed to negotiate over the price of drugs. Finally, the entire financial reimbursement scheme should be addressed as well. These are all defects which must be fixed if we are to solve our health care problems and reduce the budget deficit and national debt.
This is a very complex topic, one which would require an extended essay to “flesh-out.” We encourage comments.
The following opinion piece by a reader of this blog--is presented in way of adding to our understanding of the current debate in Congress with respect to altering Medicare and Medicaid.
The pespective presented by Dr. Gibbons is fairly consistent with Traditional Roman Catholic Moral Theology and is worthy of consideration. My comments follow his piece.
--Dr. J. P. Hubert
Health Care Spending in the Light of Wisdom and Justice
By: Joel Clarke Gibbons
Logistic Research & Trading Co.
Saint Joseph, Michigan.
We have to get a few basic points in order before we are ready to weigh the pros and cons of the Republican plan, or of any plan, to change Medicare and Medicaid. I offer the following in the cause of reason and balance on this topic.
Justice:
Justice demands that we accord to every person what is his or her due. That precept -- or more exactly, that definition -- covers justice in all its manifestations; between individuals, in what is called commutative or transactional justice, it defines the just claims of one party against another. It also covers claims that a person makes on his community or society, which we call distributive justice. The issue of public funding of medical treatments through programs like Medicare and Medicaid is distributive in nature, raising the question of which claims a person can legitimately make on his/her fellow citizens. He does not have the right to bankrupt them.
No person has a just claim which – if it was honored across the board for all the people – would simply break the bank. That certainly applies to claims which everyone might raise, like free food for all, but it also applies to claims which many persons would register for themselves, but which if they were available to all would find enough claimants to break the bank. So while not everyone would like to have a heart transplant, if even a fraction of citizens wanted that treatment and if as a result to public Treasury would be so drained as to force grave limitations on its other expenditures, then that is not a just claim.
No person has a just claim – a commutative right – to escape the consequences of his own folly. We nonetheless tend toward charity which softens this rule. The citizens have moreover a just expectation of charity on our part. But they do not have the right to repeated folly. St. Paul made that clear when he reminded the Thessalonians of the rule he had enforced, that whoever would not work, should not eat (II Thessalonians 3: 10). This probably applies in some ways to how the person cares for his or her own body, but I won't go there. With regard to the economics, the citizen does not have the right to spend all his money on the good life, and expect the Treasury to pay his medical bills. The community is entitled to demand that the citizens make provisions for their own needs, and in this case, that requires them to buy some sort of insurance, or alternatively to have the personal wherewithal to pay their own bills.
We have a moral duty both to save for future needs, to the extent possible, and to develop and employ our talents to provide for us and for those who depend on is, and we do not have a just claim to be absolved of this duty. This duty follows directly from the Seventh Commandment, which enjoins us not to live by theft, because the choice to be dependent on the community, to expect to be supported by others or by the State are in fact a kind of theft.
We often say that distributive justice endows everyone with a right of sorts to an equal chance. In many areas that is the case. It endows us, for instance, with a right to basic education at public expense but of course it does not endow anyone with a right to learn as much as everyone else. How much we gain from education is governed also by our unequal endowments and by our unequal attention to the work of learning. Life however is filled with unequal opportunities right at the start. Unequal outcomes moreover quickly become unequal opportunities too. If I am unable for reasons good or bad to exploit my equal opportunity to learn nuclear physics, I will be very disadvantaged in the competition for university faculty positions. Thus the opportunity/outcome test is not nearly as revealing in practice as we had hoped it would be. Nonetheless the idea is a good one and comes down to this. It is unjust to defend inequality in opportunity – to defend artificial barriers – but it is not unjust to accept inequalities as they arise. We should always look for ways to lower barriers of inequality, both as a matter of charity and of justice, no matter what has caused them, but we accept that they are all around us no matter what we do.
In the matter of equal opportunity as it applies to medicine, it is imperative to weigh the costs and benefits of various treatments. As a very clear example, no one should have to suffer broken limbs without treatment. It is simply too easy to set them, or even to repair them surgically; this technology is widely known and available and the benefit far outweighs the cost. Even in this case however, we do not lose sight of the requirement that any particular course of treatment reasonably accomplish the purpose. There is no cost-benefit analysis that would deny that treatment, except in the most desperately poor society.
Now we move up the line to cost, invasiveness, frequency, and prognosis. As we do that, we keep track of the cost in the aggregate to the society. At some point, well above setting broken bones but almost surely before we get to the triple heart-lung-liver transplant, we run out of money and we run out of medical logic too. Cost in this, as in most cases is defined not in the absolute sense but in the economists' sense: the value of other kinds of outlays begins to swamp the value of another surgery.
At that point – and I do not mean in any way to suggest that this is easily done or that it is something we do once and for all – the just claims on society are exhausted. Everyone has a claim – depending on the wealth of the community – to basic medical care, understanding that the standard of “basic” is fundamentally economic in the sense that it hinges on the trade off between more care and more highways and other demands on the Treasury. In no sense do I vote for descriptively “basic” – i.e. minimal – care. On the contrary, we want to be as generous as possible, especially since I myself might come down with one of those really expensive needs. But there has to be a cutoff.
As a matter of justice, no person should be denied any kind of medical treatment that he or she is prepared to pay for out of his own pocket, or to pay for from the voluntary donations of other citizens. If there is some kind of treatment that costs a billion dollars, only billionaires will have it. Well, let that be a reminder of just how nice it is to be a billionaire, although realistically speaking no one would want to suffer from whatever might require such a treatment. In justice we cannot out of envy prevent anyone from treating himself – in effect – nor can we hold him hostage to exorbitant claims to pay for our medical care. From time to time the proposition is advanced that equality of access implies that access be identical for all persons. That would be a manifest perversion of justice.
Distributive justice is sometimes framed as an exception to transactional justice, but that is never correct. In reality, there is only one kind of justice. The Lord God created society for the benefit of the people, and thus they have just claims on it. Society has duties under the moral law. The most obvious of these duties is to secure for us the demands of transactional justice: to defend our rights to life, liberty, and the pursuit of happiness when they are infringed by our neighbors, which is to say that in practice, the guarantee of transactional justice is itself an example of distributive justice. Of equal merit however are the just claims that we have on the society; and in rich societies like ours, those claims can be defined in very generous terms. These are the claims of fairness and of fellowship, and of concern for our neighbors and for the solidarity of the community.
Justice always ensures to the poor an adequate living and to the infirm the care and solicitude of the community. The claims we have individually on the community are of course only the reflection of claims it has on us, and while we are entitled to grumble, we must in justice submit and pay our taxes and do whatever else is needed and right. This is never an engine for extortion and jealousy, because that would pit communal justice against the rights of the person. It is for that reason that the claims of the citizen for public support must be weighed on a scale of reason, and in light of all the demands on the Treasury.
Wisdom:
So what does this say about changing Medicare? It says that the cost of Medicare is in principle limited, as is everything else in life, and that the society has duties both to respond to just claims against it, and to deny unjust claims on its generosity. At this time, medicine has undergone such revolutionary change, carrying with it extraordinary benefits and costs that it is exceedingly difficult to know where to draw the line. At what point do claims cease to be fair and just, and become exploitative? Justice demands that we collectively put our heads together in an honest attempt to discern where this very elusive line is hiding. It implies also that attempts to uncover the line and to calibrate it in practical and financial terms cannot be and should not be thought of in moralistic terms alone. The moral demand of justice itself sets us to the task of finding the answers.
Wisdom is the virtue that leads us to find the best course of action under all kinds of particular circumstances. It serves justice, because justice really is blind. Justice doesn’t know what works medically from what doesn’t work, and that “working” and “not working” are not simple, blanket judgements but are specific to each case. Justice doesn’t know either medicine or the technical details of any of the myriad other goods that press their demands on the Treasury. It is for wisdom to inform justice, and in that sense we concede that justice is not sufficient, but there is no escape from it.
___________________________________________________
Dr. J. P. Hubert's Comments:
I am largely in agreement with Dr. Gibbons. Some additions and commentary follow:
Justice is only one criterion/virtue by which to consider the question of whether to change Medicare, Medicaid or any other federally funded government program—in the light of reason. As Dr. Gibbon's suggests, other criteria are important as well, for example, 1) societal expectations based upon accepted practices people have come to rely upon, 2) the precepts of the common morality which flow from the Natural Moral Law e.g. (do good, avoid evil, treat your neighbor fairly and so forth) 3) available resources, 4) best practices based upon documented outcomes in the case of health care and 5) comparative cost analyses of US vs.: other developed nation’s health care costs among others.
With regard to the issue of what to do about those procedures that are controversial, extremely expensive or demanded by the patient: it is important to note that medical recommendations must be made only after applying stringent criteria which include a consideration of alternative therapies as well as expected outcomes when performed in settings capable of “best practices.”
It is not appropriate to deny care simply because it is very expensive and high-tech., but it must be demonstrably shown to be a better choice than any other alternative and associated with reasonable morbidity/morality. The “cut-off” is not simply based on economics but must also be based upon stringent medical/surgical criteria in order to avoid unnecessary morbidity/mortality and waste.
A critical issue in this debate is the fact that the private health insurance industry has a virtual monopoly over American Health Care which was reflected in the ommision of an effective "Public Option" from the bill passed and signed by President Obama last year. Similarly, the pharmaceutical industry lobby is so strong that the federal government has not been allowed to negotiate over the price of drugs. Finally, the entire financial reimbursement scheme should be addressed as well. These are all defects which must be fixed if we are to solve our health care problems and reduce the budget deficit and national debt.
This is a very complex topic, one which would require an extended essay to “flesh-out.” We encourage comments.
Saturday, December 19, 2009
White House as Helpless Victim on Healthcare
By Glenn Greenwald
December 16, 2009 "Salon" -- Of all the posts I wrote this year, the one that produced the most vociferious email backlash -- easily -- was this one from August, which examined substantial evidence showing that, contrary to Obama's occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it. From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House -- hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama's campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN). Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn't pass it. The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party -- rather than the GOP -- will continue to be the prime recipient of industry largesse.
As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this -- the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional "centrists." Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:
Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.
"This bill appears to be legislation that the president wanted in the first place, so I don't think focusing it on Lieberman really hits the truth," said Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."
Let's repeat that: "This bill appears to be legislation that the president wanted in the first place." Indeed it does. There are rational, practical reasons why that might be so. If you're interested in preserving and expanding political power, then, all other things being equal, it's better to have the pharmaceutical and health insurance industry on your side than opposed to you. Or perhaps they calculated from the start that this was the best bill they could get. The wisdom of that rationale can be debated, but depicting Obama as the impotent progressive victim here of recalcitrant, corrupt centrists is really too much to bear.
Yet numerous Obama defenders -- such as Matt Yglesias, Ezra Klein and Steve Benen -- have been insisting that there is just nothing the White House could have done and all of this shows that our political system is tragically "ungovernable." After all, Congress is a separate branch of government, Obama doesn't have a vote, and 60 votes are needed to do anything. How is it his fault if centrist Senators won't support what he wants to do? Apparently, this is the type of conversation we're to believe takes place in the Oval Office:
The President: I really want a public option and Medicare buy-in. What can we do to get it?
Rahm Emanuel: Unfortunately, nothing. We can just sit by and hope, but you're not in Congress any more and you don't have a vote. They're a separate branch of government and we have to respect that.
The President: So we have no role to play in what the Democratic Congress does?
Emanuel: No. Members of Congress make up their own minds and there's just nothing we can do to influence or pressure them.
The President: Gosh, that's too bad. Let's just keep our fingers crossed and see what happens then.
In an ideal world, Congress would be -- and should be -- an autonomous branch of government, exercising judgment independent of the White House's influence, but that's not the world we live in. Does anyone actually believe that Rahm Emanuel (who built his career on industry support for the Party and jamming "centrist" bills through Congress with the support of Blue Dogs) and Barack Obama (who attached himself to Joe Lieberman when arriving in the Senate, repeatedly proved himself receptive to "centrist" compromises, had a campaign funded by corporate interests, and is now the leader of a vast funding and political infrastructure) were the helpless victims of those same forces? Engineering these sorts of "centrist," industry-serving compromises has been the modus operandi of both Obama and, especially, Emanuel.
Indeed, we've seen before what the White House can do -- and does do -- when they actually care about pressuring members of Congress to support something they genuinely want passed. When FDL and other liberal blogs led an effort to defeat Obama's war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):
The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won't get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday. "We're not going to help you. You'll never hear from us again," Woolsey said the White House is telling freshmen.
That's what the White House can do when they actually care about pressuring someone to vote the way they want. Why didn't they do any of that to the "centrists" who were supposedly obstructing what they wanted on health care? Why didn't they tell Blanche Lincoln -- in a desperate fight for her political life -- that she would "never hear from them again," and would lose DNC and other Democratic institutional support, if she filibustered the public option? Why haven't they threatened to remove Joe Lieberman's cherished Homeland Security Chairmanship if he's been sabotaging the President's agenda? Why hasn't the President been rhetorically pressuring Senators to support the public option and Medicare buy-in, or taking any of the other steps outlined here by Adam Green? There's no guarantee that it would have worked -- Obama is not omnipotent and he can't always control Congressional outcomes -- but the lack of any such efforts is extremely telling about what the White House really wanted here.
Independent of the reasonable debate over whether this bill is a marginal improvement over the status quo, there are truly horrible elements to it. Two of the most popular provisions (both of which, not coincidentally, were highly adverse to industry interests) -- the public option and Medicare expansion -- are stripped out (a new Washington Post/ABC poll out today shows that the public favors expansion of Medicare to age 55 by a 30-point margin). What remains is a politically distastrous and highly coercive "mandate" gift to the health insurance industry, described perfectly by Digby:
Obama can say that you're getting a lot, but also saying that it "covers everyone," as if there's a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don't get it from their employer. I guess you can call that progressive, but that doesn't make it so. In fact, mandating that all people pay money to a private interest isn't even conservative, free market or otherwise. It's some kind of weird corporatism that's very hard to square with the common good philosophy that Democrats supposedly espouse.
Nobody's "getting covered" here. After all, people are already "free" to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won't make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn't or didn't want to write. Indeed, it actually looks like the worst caricature of liberals: taking people's money against their will, saying it's for their own good --- and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don't miss the money as much when they never see it.
In essence, this re-inforces all of the worst dynamics of Washington. The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls. Progressive opinion-makers, as always, signaled that they can and should be ignored (don't worry about us -- we're announcing in advance that we'll support whatever you feed us no matter how little it contains of what we want and will never exercise raw political power to get what we want; make sure those other people are happy but ignore us). Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress. And highly unpopular, industry-serving legislation is passed off as "centrist," the noblest Beltway value.
Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm. But the idea that the White House did what it could to ensure the inclusion of progressive provisions -- or that they were powerless to do anything about it -- is absurd on its face. Whatever else is true, the overwhelming evidence points to exactly what Sen. Feingold said yesterday: "This bill appears to be legislation that the president wanted in the first place." (editor's emphasis throughout)
December 16, 2009 "Salon" -- Of all the posts I wrote this year, the one that produced the most vociferious email backlash -- easily -- was this one from August, which examined substantial evidence showing that, contrary to Obama's occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it. From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House -- hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama's campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN). Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn't pass it. The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party -- rather than the GOP -- will continue to be the prime recipient of industry largesse.
As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this -- the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional "centrists." Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:
Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.
"This bill appears to be legislation that the president wanted in the first place, so I don't think focusing it on Lieberman really hits the truth," said Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."
Let's repeat that: "This bill appears to be legislation that the president wanted in the first place." Indeed it does. There are rational, practical reasons why that might be so. If you're interested in preserving and expanding political power, then, all other things being equal, it's better to have the pharmaceutical and health insurance industry on your side than opposed to you. Or perhaps they calculated from the start that this was the best bill they could get. The wisdom of that rationale can be debated, but depicting Obama as the impotent progressive victim here of recalcitrant, corrupt centrists is really too much to bear.
Yet numerous Obama defenders -- such as Matt Yglesias, Ezra Klein and Steve Benen -- have been insisting that there is just nothing the White House could have done and all of this shows that our political system is tragically "ungovernable." After all, Congress is a separate branch of government, Obama doesn't have a vote, and 60 votes are needed to do anything. How is it his fault if centrist Senators won't support what he wants to do? Apparently, this is the type of conversation we're to believe takes place in the Oval Office:
The President: I really want a public option and Medicare buy-in. What can we do to get it?
Rahm Emanuel: Unfortunately, nothing. We can just sit by and hope, but you're not in Congress any more and you don't have a vote. They're a separate branch of government and we have to respect that.
The President: So we have no role to play in what the Democratic Congress does?
Emanuel: No. Members of Congress make up their own minds and there's just nothing we can do to influence or pressure them.
The President: Gosh, that's too bad. Let's just keep our fingers crossed and see what happens then.
In an ideal world, Congress would be -- and should be -- an autonomous branch of government, exercising judgment independent of the White House's influence, but that's not the world we live in. Does anyone actually believe that Rahm Emanuel (who built his career on industry support for the Party and jamming "centrist" bills through Congress with the support of Blue Dogs) and Barack Obama (who attached himself to Joe Lieberman when arriving in the Senate, repeatedly proved himself receptive to "centrist" compromises, had a campaign funded by corporate interests, and is now the leader of a vast funding and political infrastructure) were the helpless victims of those same forces? Engineering these sorts of "centrist," industry-serving compromises has been the modus operandi of both Obama and, especially, Emanuel.
Indeed, we've seen before what the White House can do -- and does do -- when they actually care about pressuring members of Congress to support something they genuinely want passed. When FDL and other liberal blogs led an effort to defeat Obama's war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):
The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won't get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday. "We're not going to help you. You'll never hear from us again," Woolsey said the White House is telling freshmen.
That's what the White House can do when they actually care about pressuring someone to vote the way they want. Why didn't they do any of that to the "centrists" who were supposedly obstructing what they wanted on health care? Why didn't they tell Blanche Lincoln -- in a desperate fight for her political life -- that she would "never hear from them again," and would lose DNC and other Democratic institutional support, if she filibustered the public option? Why haven't they threatened to remove Joe Lieberman's cherished Homeland Security Chairmanship if he's been sabotaging the President's agenda? Why hasn't the President been rhetorically pressuring Senators to support the public option and Medicare buy-in, or taking any of the other steps outlined here by Adam Green? There's no guarantee that it would have worked -- Obama is not omnipotent and he can't always control Congressional outcomes -- but the lack of any such efforts is extremely telling about what the White House really wanted here.
Independent of the reasonable debate over whether this bill is a marginal improvement over the status quo, there are truly horrible elements to it. Two of the most popular provisions (both of which, not coincidentally, were highly adverse to industry interests) -- the public option and Medicare expansion -- are stripped out (a new Washington Post/ABC poll out today shows that the public favors expansion of Medicare to age 55 by a 30-point margin). What remains is a politically distastrous and highly coercive "mandate" gift to the health insurance industry, described perfectly by Digby:
Obama can say that you're getting a lot, but also saying that it "covers everyone," as if there's a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don't get it from their employer. I guess you can call that progressive, but that doesn't make it so. In fact, mandating that all people pay money to a private interest isn't even conservative, free market or otherwise. It's some kind of weird corporatism that's very hard to square with the common good philosophy that Democrats supposedly espouse.
Nobody's "getting covered" here. After all, people are already "free" to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won't make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn't or didn't want to write. Indeed, it actually looks like the worst caricature of liberals: taking people's money against their will, saying it's for their own good --- and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don't miss the money as much when they never see it.
In essence, this re-inforces all of the worst dynamics of Washington. The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls. Progressive opinion-makers, as always, signaled that they can and should be ignored (don't worry about us -- we're announcing in advance that we'll support whatever you feed us no matter how little it contains of what we want and will never exercise raw political power to get what we want; make sure those other people are happy but ignore us). Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress. And highly unpopular, industry-serving legislation is passed off as "centrist," the noblest Beltway value.
Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm. But the idea that the White House did what it could to ensure the inclusion of progressive provisions -- or that they were powerless to do anything about it -- is absurd on its face. Whatever else is true, the overwhelming evidence points to exactly what Sen. Feingold said yesterday: "This bill appears to be legislation that the president wanted in the first place." (editor's emphasis throughout)
Monday, November 30, 2009
Medicare in Crisis: The Devastating Impacts of a Corporate Health Care Bill
Editor's NOTE:
I share Mr. Cooke's concerns re: the competing Senate and House Health Care bills. Both appear more or less to be reform "in name only" which benefit health insurance companies at the expense of the Middle class and working poor. Medicaid rates of reimbursement are already unconscionably low and Medicare reimbursement rates have either been frozen or have failed to keep pace with inflation for over a decade.
As a retired physician and surgeon who has worked in the nightmare that is "for-profit" health care, I favor universal single payer coverage for all Americans. If health insurance companies were eliminated entirely, provider's could be paid reasonable rates of reimbursement for services including increases tied to the rate of inflation (for more see THIS...) Given the fact that Congress is currently "owned" by elite special interests, such an option appears extremely unlikely any time soon. While the current situation is deplorable, I fear the passage of a health insurance industry "reform" bill in the current climate--would be far worse.
--Dr. J. P. Hubert
By Shamus Cooke
Global Research,
November 27, 2009
Wading through the endless debate over health care has exhausted the patience of most Americans — the zigzags, obscure language, and long-winded discussion is inherently repulsive.
But now the dust is starting to settle, and the Congressional vision for health care in the U.S. is emerging. Instead of being “progressive,” it will amount to a massive, corporate-inspired attack on American workers, the elderly, and the poor.
After months of confusion and delay, Congress has shipwrecked the popular energy over health care onto the jagged rock of corporate interests. More spectacularly, health care “reform” is being used as an opportunity to greatly advance corporate influence over social spheres long-dedicated to the working-class — seemingly harmless provisions carry with them enormous implications.
These devils hide in the details of the competing health care bills in Congress; both contain debilitating right-wing policies hidden within a progressive shell. Obama is indeed acting as the agent of change, to the great benefit of the U.S. corporate elite.
And although the final bill has yet to be crafted, there exists general agreements as to what the end version will look like. Americans will be forced to buy shoddy corporate insurance with no limit to the cost, no guarantee of quality, with large premiums and other tricks to further gouge consumers. If a public option emerges in the final bill — by no means a guarantee — it will be shrunken enough to insure very few people (2 percent of the U.S. population).
But it gets worse. How this health care “reform” will be paid for has implications that dwarf the above atrocities.
For example, the Democrats were determined to pass a health care bill that “will not add one cent to the deficit.” And they have succeeded: the House and Senate health care bills both plan to reduce the deficit by over $100 billion. But a second-grader could do the math here: more service does not equal less cost — a truism that dominates the for-profit health care industry.
So how does the government plan to save billions of dollars as they “help” millions of people?
The two biggest cost saving schemes are the most damaging. The first is the enormous attack on Medicare. Since its inception, the corporate elite wanted this program struck down. Now they have their man for the job — a Republican could never get away with such obvious treachery.
The Congressional Budget Office estimates that the Senate version of health care would cut $404 billion from Medicare and Medicaid; the house version would cut $570 billion. The final cut could be much more. Obama made the ridiculous claim that only “wasteful” parts of Medicare would be cut. The truth is far different.
One way that both Congressional health care bills will gut Medicare is referred to as “forced productivity gains” — cost saving measures essentially; trimming the fat.
What are these savings? The most mentioned device — by politicians and media alike — is the reduction of “wasteful tests” and procedures that doctors routinely perform, an idea that the health care mega-corporations love. It will save them billions, while having catastrophic effects on the health care of millions of people.
For example, the recent announcement that women will now be persuaded to cut back on screenings for breast cancer and cervical cancer have caused an uproar nationwide: people are correctly making the connection behind Congress’ “forced productivity gains” and the new “recommendations” that will be used by insurance companies to justify cutting these services, both of which will boost profits. The general agreement behind rationing health care in this way will be an attack on not only Medicare, but serve as the backbone of any health care bill passed, negatively effecting everyone unable to afford luxury health care.
Another piece of Medicare that’s being trimmed is Medicare Advantage, a favorite program of the elderly because of its comprehensive services. Premiums for this program are already rising drastically in anticipation of the health care bill’s passage, considered by Congress to be “wasteful.” Without this program, Medicare will be greatly devalued and be more appropriately named: “band-aides for seniors.”
Finally, The Senate health care bill attacks Medicare by reducing payments to doctors by 25 percent. If doctors receive such a drastic reduction in pay, they will simply refuse to see Medicare or Medicaid patients; people will thus be insured only on paper. The newly insured Medicaid patients under any new congressional bill will be sorely disappointed.
Once Medicare is undermined in the above ways, the corporate sponsored right-wing will make a very convincing argument that “Medicare doesn’t work”, leading to future cuts that will further destroy the program.
The second hidden disaster in financing a congressional health care bill is the tax on so-called “gold-plated” or “Cadillac” health insurance policies that some employers offer their workers. This tax is supposedly meant to apply to the health care policies that “elite” employees receive.
And while there should exist no complaints about taxing corporations, the motives behind this particular tax are intentionally deceiving. As it turns out, many, if not most workers in unions will be included in this tax, which, under the Senate version, will include any plan worth more than $8,000 for individuals and $21,000 for families. Hardly elite, considering the still-soaring costs for health care.
If this provision were to pass — and it’s very popular in Congress — the immediate reaction would be very predictable: employers would immediately drop their health care plans, forcing workers into the now-forced purchasing of inadequate health care. This is why unions oppose such a plan. California Democrat Pete Stark agrees: “Employers and insurers will reduce their benefits to avoid paying the proposed tax.”
Workers fortunate to have union contracts will be heavily pressured to concede their plans, which in the past they’ve sacrificed wage-increases to keep. Ultimately, employers will have a new excuse not to provide health care to workers.
Obama again used his superb intelligence to totally obscure the issue in support of the tax:
“I do think that giving a disincentive to insurance companies to offer Cadillac plans that don’t make people healthier is part of the way that we’re going to bring down health care costs for everybody over the long term.” Translation: he supports taxing the health care of union workers.
Overall, a compromise bill between the Senate and House versions will create utter disaster for the working-class. It will not signal a progressive “step in the right direction,” as many liberals claim. At minimum, it will be a step backward, though more likely such a bill will be an enormous regression, to a time where health care was the exclusive privilege of the wealthy.
The right-wing attacks on “Obamacare” — along with the media’s lack of questioning — have shielded the Democrats from any serious debate about the above questions, including many other concerns unmentioned here.
The trash legislation that Congress is producing is the direct consequence of the Democratic Party being dominated by giant corporations — in this case the health care industry. The two-party system is the political system of the corporate elite, who switch party affiliations when they find it convenient; many of them throw equal money at both parties.
A crucial prop in this broken political system needs to be removed and organized under its own strength. If the unions took their support from the Democrats, organized their members and resources into a new political party, and aggressively pushed reforms that benefited the majority of working-class Americans, U.S. democracy would be tremendously strengthened. Medicare could not only be saved, but expanded to everyone from birth to death and be considered a fundamental human right.
I share Mr. Cooke's concerns re: the competing Senate and House Health Care bills. Both appear more or less to be reform "in name only" which benefit health insurance companies at the expense of the Middle class and working poor. Medicaid rates of reimbursement are already unconscionably low and Medicare reimbursement rates have either been frozen or have failed to keep pace with inflation for over a decade.
As a retired physician and surgeon who has worked in the nightmare that is "for-profit" health care, I favor universal single payer coverage for all Americans. If health insurance companies were eliminated entirely, provider's could be paid reasonable rates of reimbursement for services including increases tied to the rate of inflation (for more see THIS...) Given the fact that Congress is currently "owned" by elite special interests, such an option appears extremely unlikely any time soon. While the current situation is deplorable, I fear the passage of a health insurance industry "reform" bill in the current climate--would be far worse.
--Dr. J. P. Hubert
By Shamus Cooke
Global Research,
November 27, 2009
Wading through the endless debate over health care has exhausted the patience of most Americans — the zigzags, obscure language, and long-winded discussion is inherently repulsive.
But now the dust is starting to settle, and the Congressional vision for health care in the U.S. is emerging. Instead of being “progressive,” it will amount to a massive, corporate-inspired attack on American workers, the elderly, and the poor.
After months of confusion and delay, Congress has shipwrecked the popular energy over health care onto the jagged rock of corporate interests. More spectacularly, health care “reform” is being used as an opportunity to greatly advance corporate influence over social spheres long-dedicated to the working-class — seemingly harmless provisions carry with them enormous implications.
These devils hide in the details of the competing health care bills in Congress; both contain debilitating right-wing policies hidden within a progressive shell. Obama is indeed acting as the agent of change, to the great benefit of the U.S. corporate elite.
And although the final bill has yet to be crafted, there exists general agreements as to what the end version will look like. Americans will be forced to buy shoddy corporate insurance with no limit to the cost, no guarantee of quality, with large premiums and other tricks to further gouge consumers. If a public option emerges in the final bill — by no means a guarantee — it will be shrunken enough to insure very few people (2 percent of the U.S. population).
But it gets worse. How this health care “reform” will be paid for has implications that dwarf the above atrocities.
For example, the Democrats were determined to pass a health care bill that “will not add one cent to the deficit.” And they have succeeded: the House and Senate health care bills both plan to reduce the deficit by over $100 billion. But a second-grader could do the math here: more service does not equal less cost — a truism that dominates the for-profit health care industry.
So how does the government plan to save billions of dollars as they “help” millions of people?
The two biggest cost saving schemes are the most damaging. The first is the enormous attack on Medicare. Since its inception, the corporate elite wanted this program struck down. Now they have their man for the job — a Republican could never get away with such obvious treachery.
The Congressional Budget Office estimates that the Senate version of health care would cut $404 billion from Medicare and Medicaid; the house version would cut $570 billion. The final cut could be much more. Obama made the ridiculous claim that only “wasteful” parts of Medicare would be cut. The truth is far different.
One way that both Congressional health care bills will gut Medicare is referred to as “forced productivity gains” — cost saving measures essentially; trimming the fat.
What are these savings? The most mentioned device — by politicians and media alike — is the reduction of “wasteful tests” and procedures that doctors routinely perform, an idea that the health care mega-corporations love. It will save them billions, while having catastrophic effects on the health care of millions of people.
For example, the recent announcement that women will now be persuaded to cut back on screenings for breast cancer and cervical cancer have caused an uproar nationwide: people are correctly making the connection behind Congress’ “forced productivity gains” and the new “recommendations” that will be used by insurance companies to justify cutting these services, both of which will boost profits. The general agreement behind rationing health care in this way will be an attack on not only Medicare, but serve as the backbone of any health care bill passed, negatively effecting everyone unable to afford luxury health care.
Another piece of Medicare that’s being trimmed is Medicare Advantage, a favorite program of the elderly because of its comprehensive services. Premiums for this program are already rising drastically in anticipation of the health care bill’s passage, considered by Congress to be “wasteful.” Without this program, Medicare will be greatly devalued and be more appropriately named: “band-aides for seniors.”
Finally, The Senate health care bill attacks Medicare by reducing payments to doctors by 25 percent. If doctors receive such a drastic reduction in pay, they will simply refuse to see Medicare or Medicaid patients; people will thus be insured only on paper. The newly insured Medicaid patients under any new congressional bill will be sorely disappointed.
Once Medicare is undermined in the above ways, the corporate sponsored right-wing will make a very convincing argument that “Medicare doesn’t work”, leading to future cuts that will further destroy the program.
The second hidden disaster in financing a congressional health care bill is the tax on so-called “gold-plated” or “Cadillac” health insurance policies that some employers offer their workers. This tax is supposedly meant to apply to the health care policies that “elite” employees receive.
And while there should exist no complaints about taxing corporations, the motives behind this particular tax are intentionally deceiving. As it turns out, many, if not most workers in unions will be included in this tax, which, under the Senate version, will include any plan worth more than $8,000 for individuals and $21,000 for families. Hardly elite, considering the still-soaring costs for health care.
If this provision were to pass — and it’s very popular in Congress — the immediate reaction would be very predictable: employers would immediately drop their health care plans, forcing workers into the now-forced purchasing of inadequate health care. This is why unions oppose such a plan. California Democrat Pete Stark agrees: “Employers and insurers will reduce their benefits to avoid paying the proposed tax.”
Workers fortunate to have union contracts will be heavily pressured to concede their plans, which in the past they’ve sacrificed wage-increases to keep. Ultimately, employers will have a new excuse not to provide health care to workers.
Obama again used his superb intelligence to totally obscure the issue in support of the tax:
“I do think that giving a disincentive to insurance companies to offer Cadillac plans that don’t make people healthier is part of the way that we’re going to bring down health care costs for everybody over the long term.” Translation: he supports taxing the health care of union workers.
Overall, a compromise bill between the Senate and House versions will create utter disaster for the working-class. It will not signal a progressive “step in the right direction,” as many liberals claim. At minimum, it will be a step backward, though more likely such a bill will be an enormous regression, to a time where health care was the exclusive privilege of the wealthy.
The right-wing attacks on “Obamacare” — along with the media’s lack of questioning — have shielded the Democrats from any serious debate about the above questions, including many other concerns unmentioned here.
The trash legislation that Congress is producing is the direct consequence of the Democratic Party being dominated by giant corporations — in this case the health care industry. The two-party system is the political system of the corporate elite, who switch party affiliations when they find it convenient; many of them throw equal money at both parties.
A crucial prop in this broken political system needs to be removed and organized under its own strength. If the unions took their support from the Democrats, organized their members and resources into a new political party, and aggressively pushed reforms that benefited the majority of working-class Americans, U.S. democracy would be tremendously strengthened. Medicare could not only be saved, but expanded to everyone from birth to death and be considered a fundamental human right.
Saturday, November 8, 2008
U.S Gap Between Rich and Poor Widening!
By Bob Kendall
October 31, 2008 "Information Clearinghouse" -- "PC" -- Now that the U.S.A. has discovered that only Mexico and Turkey had poverty rates higher than the 30-country study by the Organization for Economic Cooperation and Development, what if anything will be done to help the U.S. poor obtain health care?
Politicians, during campaigns, loudly proclaim "The U.S.A. is the greatest nation on earth and the richest."
With the largest, almost incomprehensible national debt in the world, exceeding all prior national debts combined since the U.S. was founded, recent political rants have avoided claiming the U.S.A. to be the richest nation in the world! However, the persistent claim to greatness has been much used in the current election campaigns (rest assured).
Mary Reynolds-Gilmore of Northport, N.Y. in her October 24 Letter to the Editors of the New York Times hit the problem of U.S. health care precisely, stating:
"The problem is cost and access. We will never be first until all Americans have basic health care, health and malpractice executives stop pocketing such a high percentage of our premiums, and we institute a system of medical-specialist juries to control the malpractice frenzy. More money for evidence-based research is not the answer."
Stanley R. Bermann of Santa Fe, New Mexico had this to say in his letter of the same day to the Times:
"What needs to happen is that we have a universal health care program for all Americans. Nothing else will do!
"No American should have to suffer medically and then suffer financially."
Bruce Leff of Baltimore, also writing the same day in the Times, is an Associate Professor of Medicine at John Hopkins University School of Medicine. He explains succinctly:
"The evidence base for most interventions in medicine is lacking, especially so in the area of how to deliver quality care to the most costly patients, the elderly with multiple chronic conditions.
"Improvements in the evidence will be ineffective if they come in the absence of health care payment reform that obliterates the perverse incentives that favor specialty care and glitzy idolatry over diligent primary care and care coordination.
"A vast overhaul of medical education must be aligned with any reforms to achieve success."
This professor's opinion reflects a recent survey of students entering the schools of medicine at U.S. universities, where only 2% wanted to become primary care physicians. The reason? Because the specialty fields of medicine pay much more.
John McCain's much vaunted health care plan is almost amusing if it wasn't so absurd. The Republican health care plan allows a $5,000 tax consideration for health insurance. With almost all health insurance policies $12,000 top $15,000 a year, that doesn't help very much. But even worse is the accompanying nonsense of having to pay taxes on any health insurance coverage supplied by one's place of employment.
After hearing for years the boast about the U.S.A. being the richest nation in the world, possibly the recent survey of 30 nations by the Economic Cooperation and Development study, placing the U.S. above only Mexico and Turkey will bring us down to earth.
Arnold S. Cohen, president of Partnership for the Homeless in New York City in his October 23 letter to the Times touches base with reality:
"During these fragile and uncertain economic times, we'll certainly be seeing thousands upon thousands more people teetering on the precipice, falling into homelessness.
"Just think back to the days of the 2001 economic slump when homelessness in New York City dramatically increased.
"By the fall of 2003, more than 16,000 children were living in homeless shelters.
"The shrinking economy will undoubtedly mean less public financing for critical services and fewer jobs for our neighbors in need. But deep budget cuts -- which may appear on their face prudent -- have historically proved to be fiscally unwise.
"It only manages to push people further into poverty and homelessness, costing taxpayers millions more."
While 45 million Americans lack health care coverage, this Republican-led administration goes on spending $10 billion a month in Iraq. Meanwhile on the business front, U.S. CEO's have the highest salaries in the world!
October 31, 2008 "Information Clearinghouse" -- "PC" -- Now that the U.S.A. has discovered that only Mexico and Turkey had poverty rates higher than the 30-country study by the Organization for Economic Cooperation and Development, what if anything will be done to help the U.S. poor obtain health care?
Politicians, during campaigns, loudly proclaim "The U.S.A. is the greatest nation on earth and the richest."
With the largest, almost incomprehensible national debt in the world, exceeding all prior national debts combined since the U.S. was founded, recent political rants have avoided claiming the U.S.A. to be the richest nation in the world! However, the persistent claim to greatness has been much used in the current election campaigns (rest assured).
Mary Reynolds-Gilmore of Northport, N.Y. in her October 24 Letter to the Editors of the New York Times hit the problem of U.S. health care precisely, stating:
"The problem is cost and access. We will never be first until all Americans have basic health care, health and malpractice executives stop pocketing such a high percentage of our premiums, and we institute a system of medical-specialist juries to control the malpractice frenzy. More money for evidence-based research is not the answer."
Stanley R. Bermann of Santa Fe, New Mexico had this to say in his letter of the same day to the Times:
"What needs to happen is that we have a universal health care program for all Americans. Nothing else will do!
"No American should have to suffer medically and then suffer financially."
Bruce Leff of Baltimore, also writing the same day in the Times, is an Associate Professor of Medicine at John Hopkins University School of Medicine. He explains succinctly:
"The evidence base for most interventions in medicine is lacking, especially so in the area of how to deliver quality care to the most costly patients, the elderly with multiple chronic conditions.
"Improvements in the evidence will be ineffective if they come in the absence of health care payment reform that obliterates the perverse incentives that favor specialty care and glitzy idolatry over diligent primary care and care coordination.
"A vast overhaul of medical education must be aligned with any reforms to achieve success."
This professor's opinion reflects a recent survey of students entering the schools of medicine at U.S. universities, where only 2% wanted to become primary care physicians. The reason? Because the specialty fields of medicine pay much more.
John McCain's much vaunted health care plan is almost amusing if it wasn't so absurd. The Republican health care plan allows a $5,000 tax consideration for health insurance. With almost all health insurance policies $12,000 top $15,000 a year, that doesn't help very much. But even worse is the accompanying nonsense of having to pay taxes on any health insurance coverage supplied by one's place of employment.
After hearing for years the boast about the U.S.A. being the richest nation in the world, possibly the recent survey of 30 nations by the Economic Cooperation and Development study, placing the U.S. above only Mexico and Turkey will bring us down to earth.
Arnold S. Cohen, president of Partnership for the Homeless in New York City in his October 23 letter to the Times touches base with reality:
"During these fragile and uncertain economic times, we'll certainly be seeing thousands upon thousands more people teetering on the precipice, falling into homelessness.
"Just think back to the days of the 2001 economic slump when homelessness in New York City dramatically increased.
"By the fall of 2003, more than 16,000 children were living in homeless shelters.
"The shrinking economy will undoubtedly mean less public financing for critical services and fewer jobs for our neighbors in need. But deep budget cuts -- which may appear on their face prudent -- have historically proved to be fiscally unwise.
"It only manages to push people further into poverty and homelessness, costing taxpayers millions more."
While 45 million Americans lack health care coverage, this Republican-led administration goes on spending $10 billion a month in Iraq. Meanwhile on the business front, U.S. CEO's have the highest salaries in the world!
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