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.
Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts
Tuesday, April 19, 2011
Sunday, April 17, 2011
Progressive Democrats Almost Silent on Republican Plan to End Medicare
By: Dr. J. P. Hubert
US House Republicans have voted for Congressman Paul Ryan's deficit reduction plan which if passed would end Medicare and Medicaid as we know them. This plan would legislatively enact health care rationing on a level never before seen in this country, certainly not since 1965.
Only wealthy and middle class Americans with private health care plans would receive needed medical care while the poor, elderly, disabled and others would be left to suffer and die.
Where are the progressive Democrats who should be literally screaming from the rooftops about how Republicans are trying to introduce massive class-based health care rationing and even legislatively sanctioned assisted suicide/homicide? When do the Democrats intend to "take off the gloves." This degree of Republican hubris and brashness has not occurred before in my lifetime.
Virtually the entire US House Republican caucus is now on record favoring class-based health care rationing and death by neglect. Who will make the case against them effectively? The moral high-ground rests with those who wish to provide medical care to all Americans not with those who callously voted to deny care to tens of millions of our citizens!
US House Republicans have voted for Congressman Paul Ryan's deficit reduction plan which if passed would end Medicare and Medicaid as we know them. This plan would legislatively enact health care rationing on a level never before seen in this country, certainly not since 1965.
Only wealthy and middle class Americans with private health care plans would receive needed medical care while the poor, elderly, disabled and others would be left to suffer and die.
Where are the progressive Democrats who should be literally screaming from the rooftops about how Republicans are trying to introduce massive class-based health care rationing and even legislatively sanctioned assisted suicide/homicide? When do the Democrats intend to "take off the gloves." This degree of Republican hubris and brashness has not occurred before in my lifetime.
Virtually the entire US House Republican caucus is now on record favoring class-based health care rationing and death by neglect. Who will make the case against them effectively? The moral high-ground rests with those who wish to provide medical care to all Americans not with those who callously voted to deny care to tens of millions of our citizens!
Saturday, April 16, 2011
Legislative Assisted Suicide: House Republicans Embrace Ryan End to Medicare/Medicaid as we Know it
By: Dr. J. P. Hubert
On a party-line vote the Republicans in the US House of Representatives yesterday passed Congressman Paul Ryan's Deficit Reduction Plan which would put an end to Medicare and Medicaid as they now exist.
According to the plan, by 2022, American's would no longer be enrolled in Medicare Part B. Instead, the elderly would be given fixed dollar amounts each year with which to purchase private health insurance coverage--through a kind of voucher program .
Given that elderly patients represent an unacceptable risk pool for insurance companies, the logical outcome is that most senior Americans would be incapable of obtaining health insurance at all. This of course is a radical form of health care rationing or what might better be termed legislative assisted suicide/homicide given the elevated incidence of serious disease among those advanced in age.
All House Democrats and only 4 Republican House members voted against the Ryan measure which is not currently expected to pass the US Senate.
On a party-line vote the Republicans in the US House of Representatives yesterday passed Congressman Paul Ryan's Deficit Reduction Plan which would put an end to Medicare and Medicaid as they now exist.
According to the plan, by 2022, American's would no longer be enrolled in Medicare Part B. Instead, the elderly would be given fixed dollar amounts each year with which to purchase private health insurance coverage--through a kind of voucher program .
Given that elderly patients represent an unacceptable risk pool for insurance companies, the logical outcome is that most senior Americans would be incapable of obtaining health insurance at all. This of course is a radical form of health care rationing or what might better be termed legislative assisted suicide/homicide given the elevated incidence of serious disease among those advanced in age.
All House Democrats and only 4 Republican House members voted against the Ryan measure which is not currently expected to pass the US Senate.
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.
Wednesday, August 19, 2009
Health Care Reform Debate Full of "Noise"
By: Dr. J. P. Hubert
There is a tremendous amount of "noise" currently polluting the national discussion on health care reform. The first commonly misunderstood falsehood is that the system we now have operates according to "free-market" principles. In reality it doesn’t. For example, all Medicare reimbursements whether to doctors or hospitals are limited by the Federal government. Health Care providers are not allowed to charge whatever the market will bear as is the case in a so-called "free-market." Medicare publishes a list of maximally allowable charges that every provider who participates in the Medicare Program must abide by. Not only may "health care providers" not charge whatever they wish for their services, Medicare only reimburses a percentage of the Medicare maximum allowable charge.
For purposes of illustration; if a health care provider (in this example, a surgeon) charges a usual and customary fee of $2000.00 for a given procedure including all post-operative care, and a private insurance company through a negotiated (discount) care contract pays $1500.00 for the same procedure (a 25% discount), Medicare may set the maximum allowable fee--that the provider is allowed to charge--at $1000.00. From that number, Medicare will actually pay only a percentage of $1000.00 for example 80% or $800.00 that is, 40% of the usual and customary fee or a 60% reduction. The only way the provider in question could be paid the $2000.00 is if the patient paid the entire fee personally. However, Medicare does not allow a Medicare patient to pay a non-Medicare approved rate and therefore the patient would have to drop Medicare entirely if he wished to do so. This is extremely uncommon of course. Most patients of Medicare age are enrolled in the Medicare program and would not be willing to drop that coverage in order to pay a health care provider their usual and customary fee.
If on the other hand, such a patient had a supplemental insurance policy to help make up the difference between the Medicare allowed reimbursement of $800.00 and the allowable charge of $1000.00 the supplemental policy would pay a maximum of $200.00 which means the physician would receive a total of $1000.00 or 50% of their usual and customary fee rather than the 40% that Medicare alone would pay. In either case, the amounts are significantly lower than the so-called usual and customary fee which the surgical provider would charge for the same procedure on a non-Medicare patient with full indemnity insurance coverage. However, the supplemental option does not apply if the provider accepts Medicare assignment meaning that the Medicare approved amount of $800.00 must be accepted as payment in full. Should a physician/surgeon, who accepts Medicare assignment attempt to collect the remaining $200.00 from the patient, the consequence could be the physician’s permanent expulsion from the Medicare program. The Medicare system of reimbursement clearly disadvantages the providers who perform complicated lengthy procedures which are quite costly. They have no legitimate way of compensating for the steep reductions in reimbursements. To my knowledge none of the bills pending in Congress attempt to rectify this problem. Certainly none call for increasing long frozen or severely reduced fees for medical and surgical sub-specialists who for over 2 decades have been discriminated against unfairly. Primary care providers have been the primary beneficiaries of any Medicare fee increases.
The situation is even more drastic with respect to Medicaid reimbursement which is so low as to be incompatible with the financial viability of providers who treat a significant percentage of such patients.
Private insurance companies have largely adopted Medicare reimbursement rates as well over the past 2 decades such that very few if any remaining “for-profit” companies/policies pay the so-called "usual and customary" fees which 20 years ago were significantly higher than Medicare allowable rates. Through a variety of discount vehicles including HMO's, PPO's, and various other kinds of negotiated care contracts, the private health care system no longer operates according to free market principles. In fact, as Mr. Cockburn indicated in his piece, private medical practice ceased following a "free-market" model over 40 years ago when third party payers (insurance companies, Medicare and Medicaid) entered the medical market place. The Health Care "product" from that point on instead of involving only medical providers and patients, thereafter became heavily influenced by the wishes, concerns, goals etc. of third party payers. Their goal was to pay as little as possible to providers through heavy discounting of fees while limiting costly treatments and procedures. This was accomplished by eliminating undesirable insured’s and avoiding those with pre-existing conditions all the while continuing to increase insurance premiums at a much greater rate than the annual rise in cost of living. In the private sector these increasing premiums were utilized to help build profits, increase stock price and pay exorbitant salary, bonus and benefits packages to management rather than being used to pay for needed medical care. This has been unconscionable.
It is a complete ruse to argue that health care reform would mean the end of "free-market" economics in medical care. It ended a long time ago. The only question remaining is whether insurance and pharmaceutical companies will be allowed to continue stealing an unconscionable percentage of the total health care dollars available or whether some significant change is to occur whereby the available monies will be spent directly for the benefit of patients. In other words, will the unjust and immoral monopoly that private health care mega-companies currently enjoy be allowed to continue?
In his article Mr. Cockburn was certainly correct in asserting that the insurance companies and the pharmaceutical industry are too powerful at present in their ability to exercise complete control over private health care policy. They of course have been unwilling to release their strangle-hold over the health care system. Unfortunately President Obama has been unwilling to “take-on” these two industries and has essentially folded his cards and admitted defeat without even trying to reign in their power. The Huffington Post reported that in his secret negotiations, Mr. Obama guaranteed the insurance and pharmaceutical industries that any potential health care reform plan would not allow negotiation over drug prices nor prescription drugs to be imported from other countries, essentially insuring that the currently excessive insurance and pharmaceutical corporations’ profits will be maintained. The President gave away the store before even trying to regulate the worst offenders.
Furthermore, it is ludicrous to blame physician health care providers for the enormous rise in health care costs when their reimbursements on an actual and relative basis have dropped year over year for over 2 decades as compared with the cost of living. Their only recourse has been to make up in volume what they have lost in per-case reimbursement. While some physicians have tried to do so, it is neither morally acceptable nor medically safe beyond a minimal degree. There is only a finite amount of time available and beyond a minor increase in volume of patients or procedures complications, errors and adverse outcomes must result at least in part by attempting to rush too many patients through the system per unit time.
Hospitals have largely experienced the same reimbursement reductions which were effected as part of the diagnosis related group (DRG) legislation 2 decades ago. Insurance and pharmaceutical companies on the other hand continued to raise their rates at an incredible double digit percentage year over year. It is obvious that the major problem with regard to the rising cost of health care is the unregulated nature of the private health insurance and pharmaceutical industries which through incredibly effective lobbying efforts have managed to avoid necessary regulation. Unfortunately, the actual providers of medical care i.e. doctors, nurses and hospitals have all experienced drastic cuts.
The second most frequently false health care claim is that reform will lead to rationing of care and bureaucratic control of medical decision making. That is already the case and it is insurance companies and hospitals that are primarily responsible for doing it and to a lesser extent Medicare. Patients and physicians are still united in seeking to provide needed care in most instances while insurance companies and hospitals have a vested interest in not allowing costly, complicated and high-risk procedures and treatments to be done—in the interest of increasing profits. Sadly, this is even true of so-called “not for profit” hospitals.
Stories abound of patients who have had their insurance company deny payment for various reasons despite their procedures having been determined to be medically indicated by multiple medical providers/experts. Most people are aware that they can be dropped by their insurance company at any time and they must absorb the expense of hiring an attorney to contest the suspension of care when they are least able to do so both from a health and economic standpoint. Insurance companies realize this and take full advantage of it in an almost predatory fashion. Moreover, the insurance companies are not in business to provide their insured’s with health care but unfortunately to make as much money in profits as they can by finding reasons to avoid paying for needed care. It is commonplace for patients to receive a denial of benefits letter from the insurance company for reasons which often are totally spurious.
A third false health care claim is that to provide for the entire nation’s health care would simply be too costly. This is a completely phony excuse as it is obvious that the Federal government is willing to spend virtually any amount of money on making war, bailing out the so-called banks “too big to fail” and in artificially propping up certain industries. In all of these, anything but “market forces” are involved. The amount of corporate welfare (monies provided at taxpayer expense for the benefit of favored corporations) that is given out to certain entities is simply astounding (trillions of dollars so far).
To date the combined actual cost of the Iraq and Afghanistan wars has approached one trillion dollars and the long terms costs associate with them is conservatively estimated at a minimum of another trillion dollars. This is an unconscionable sum of money spent for wars which were unwise, immoral and illegal under US and international law. Imagine how much health care could have been provided with 2 trillion dollars! The annual “Defense Budget” of the United States exceeds a trillion dollars if all the hidden costs are added. Moreover, the two Middle East wars have been financed by the continued passing of war supplemental authorization bills above and beyond the Defense Department’s annual budget to which must be added another almost 200 billion dollars annually in war supplemental’s since 2003. That adds up to another 1.2 trillion dollars through 2009.
The truth is that there is more than enough money to provide health care for the entire nation if our priorities are properly ordered. We should end our empire of foreign bases, our presence in Iraq/Afghanistan and re-regulate the finance industry . All “3” represent ongoing financial drains which we are simply incapable of sustaining. They only benefit a minuscule fraction of Americans—those who have managed through over-utilization of our corrupt campaign finance system to buy the US Congress and the Executive branch in order to insure their own personal self interest and ill-gotten gains.
In conclusion, the following is a summary of the major features which must be included in any serious attempt at health care reform.
1.) In order to be meaningful it must address the issue of corrupt insurance and pharmaceutical company practices. If the current system is allowed to persist, the number of Americans without insurance will continue to grow from the current almost 50 million to who knows what number as more and more Americans become incapable of affording their health care premiums.
2.) If the cost of prescription drugs is not drastically lowered in the United States, increasing numbers of patients will be forced to do without them either partially or completely which over time will only increase the cost of medical care.
3.) Equally important is the need to make it illegal to exclude patients from coverage because of pre-existing conditions or because they required costly medical treatments and or procedures both of which are examples of discriminating against patients who have a history significant illness.
4.) The uninsured must be brought into the system if we are to eliminate the high cost of treating them in emergency room settings after they have already become seriously ill. (author's emphasis throughout) This is particularly crucial if the “risk-pool” is to be made large enough to be able to reduce premium rates for groups and individuals.
The two most important problems which must be definitively corrected are the almost 50 million Americans without health care coverage of any kind and the monopoly exercised currently by the insurance and pharmaceutical industries. A failure to resolve these 2 problems will result in higher heath care costs, reduced care and higher taxes that is, a situation worse than the one we face now.
Based on what has transpired to date, I fear that President Obama will allow the insurance and pharmaceutical industries to continue making obscene profits the way the banking industry has--which to date he has been unwilling to re-regulate.
I hope I am wrong. It increasingly appears that the US Congress and Executive branch are controlled by big Pharma, big Banking and the big health insurance companies.
To be continued…
There is a tremendous amount of "noise" currently polluting the national discussion on health care reform. The first commonly misunderstood falsehood is that the system we now have operates according to "free-market" principles. In reality it doesn’t. For example, all Medicare reimbursements whether to doctors or hospitals are limited by the Federal government. Health Care providers are not allowed to charge whatever the market will bear as is the case in a so-called "free-market." Medicare publishes a list of maximally allowable charges that every provider who participates in the Medicare Program must abide by. Not only may "health care providers" not charge whatever they wish for their services, Medicare only reimburses a percentage of the Medicare maximum allowable charge.
For purposes of illustration; if a health care provider (in this example, a surgeon) charges a usual and customary fee of $2000.00 for a given procedure including all post-operative care, and a private insurance company through a negotiated (discount) care contract pays $1500.00 for the same procedure (a 25% discount), Medicare may set the maximum allowable fee--that the provider is allowed to charge--at $1000.00. From that number, Medicare will actually pay only a percentage of $1000.00 for example 80% or $800.00 that is, 40% of the usual and customary fee or a 60% reduction. The only way the provider in question could be paid the $2000.00 is if the patient paid the entire fee personally. However, Medicare does not allow a Medicare patient to pay a non-Medicare approved rate and therefore the patient would have to drop Medicare entirely if he wished to do so. This is extremely uncommon of course. Most patients of Medicare age are enrolled in the Medicare program and would not be willing to drop that coverage in order to pay a health care provider their usual and customary fee.
If on the other hand, such a patient had a supplemental insurance policy to help make up the difference between the Medicare allowed reimbursement of $800.00 and the allowable charge of $1000.00 the supplemental policy would pay a maximum of $200.00 which means the physician would receive a total of $1000.00 or 50% of their usual and customary fee rather than the 40% that Medicare alone would pay. In either case, the amounts are significantly lower than the so-called usual and customary fee which the surgical provider would charge for the same procedure on a non-Medicare patient with full indemnity insurance coverage. However, the supplemental option does not apply if the provider accepts Medicare assignment meaning that the Medicare approved amount of $800.00 must be accepted as payment in full. Should a physician/surgeon, who accepts Medicare assignment attempt to collect the remaining $200.00 from the patient, the consequence could be the physician’s permanent expulsion from the Medicare program. The Medicare system of reimbursement clearly disadvantages the providers who perform complicated lengthy procedures which are quite costly. They have no legitimate way of compensating for the steep reductions in reimbursements. To my knowledge none of the bills pending in Congress attempt to rectify this problem. Certainly none call for increasing long frozen or severely reduced fees for medical and surgical sub-specialists who for over 2 decades have been discriminated against unfairly. Primary care providers have been the primary beneficiaries of any Medicare fee increases.
The situation is even more drastic with respect to Medicaid reimbursement which is so low as to be incompatible with the financial viability of providers who treat a significant percentage of such patients.
Private insurance companies have largely adopted Medicare reimbursement rates as well over the past 2 decades such that very few if any remaining “for-profit” companies/policies pay the so-called "usual and customary" fees which 20 years ago were significantly higher than Medicare allowable rates. Through a variety of discount vehicles including HMO's, PPO's, and various other kinds of negotiated care contracts, the private health care system no longer operates according to free market principles. In fact, as Mr. Cockburn indicated in his piece, private medical practice ceased following a "free-market" model over 40 years ago when third party payers (insurance companies, Medicare and Medicaid) entered the medical market place. The Health Care "product" from that point on instead of involving only medical providers and patients, thereafter became heavily influenced by the wishes, concerns, goals etc. of third party payers. Their goal was to pay as little as possible to providers through heavy discounting of fees while limiting costly treatments and procedures. This was accomplished by eliminating undesirable insured’s and avoiding those with pre-existing conditions all the while continuing to increase insurance premiums at a much greater rate than the annual rise in cost of living. In the private sector these increasing premiums were utilized to help build profits, increase stock price and pay exorbitant salary, bonus and benefits packages to management rather than being used to pay for needed medical care. This has been unconscionable.
It is a complete ruse to argue that health care reform would mean the end of "free-market" economics in medical care. It ended a long time ago. The only question remaining is whether insurance and pharmaceutical companies will be allowed to continue stealing an unconscionable percentage of the total health care dollars available or whether some significant change is to occur whereby the available monies will be spent directly for the benefit of patients. In other words, will the unjust and immoral monopoly that private health care mega-companies currently enjoy be allowed to continue?
In his article Mr. Cockburn was certainly correct in asserting that the insurance companies and the pharmaceutical industry are too powerful at present in their ability to exercise complete control over private health care policy. They of course have been unwilling to release their strangle-hold over the health care system. Unfortunately President Obama has been unwilling to “take-on” these two industries and has essentially folded his cards and admitted defeat without even trying to reign in their power. The Huffington Post reported that in his secret negotiations, Mr. Obama guaranteed the insurance and pharmaceutical industries that any potential health care reform plan would not allow negotiation over drug prices nor prescription drugs to be imported from other countries, essentially insuring that the currently excessive insurance and pharmaceutical corporations’ profits will be maintained. The President gave away the store before even trying to regulate the worst offenders.
Furthermore, it is ludicrous to blame physician health care providers for the enormous rise in health care costs when their reimbursements on an actual and relative basis have dropped year over year for over 2 decades as compared with the cost of living. Their only recourse has been to make up in volume what they have lost in per-case reimbursement. While some physicians have tried to do so, it is neither morally acceptable nor medically safe beyond a minimal degree. There is only a finite amount of time available and beyond a minor increase in volume of patients or procedures complications, errors and adverse outcomes must result at least in part by attempting to rush too many patients through the system per unit time.
Hospitals have largely experienced the same reimbursement reductions which were effected as part of the diagnosis related group (DRG) legislation 2 decades ago. Insurance and pharmaceutical companies on the other hand continued to raise their rates at an incredible double digit percentage year over year. It is obvious that the major problem with regard to the rising cost of health care is the unregulated nature of the private health insurance and pharmaceutical industries which through incredibly effective lobbying efforts have managed to avoid necessary regulation. Unfortunately, the actual providers of medical care i.e. doctors, nurses and hospitals have all experienced drastic cuts.
The second most frequently false health care claim is that reform will lead to rationing of care and bureaucratic control of medical decision making. That is already the case and it is insurance companies and hospitals that are primarily responsible for doing it and to a lesser extent Medicare. Patients and physicians are still united in seeking to provide needed care in most instances while insurance companies and hospitals have a vested interest in not allowing costly, complicated and high-risk procedures and treatments to be done—in the interest of increasing profits. Sadly, this is even true of so-called “not for profit” hospitals.
Stories abound of patients who have had their insurance company deny payment for various reasons despite their procedures having been determined to be medically indicated by multiple medical providers/experts. Most people are aware that they can be dropped by their insurance company at any time and they must absorb the expense of hiring an attorney to contest the suspension of care when they are least able to do so both from a health and economic standpoint. Insurance companies realize this and take full advantage of it in an almost predatory fashion. Moreover, the insurance companies are not in business to provide their insured’s with health care but unfortunately to make as much money in profits as they can by finding reasons to avoid paying for needed care. It is commonplace for patients to receive a denial of benefits letter from the insurance company for reasons which often are totally spurious.
A third false health care claim is that to provide for the entire nation’s health care would simply be too costly. This is a completely phony excuse as it is obvious that the Federal government is willing to spend virtually any amount of money on making war, bailing out the so-called banks “too big to fail” and in artificially propping up certain industries. In all of these, anything but “market forces” are involved. The amount of corporate welfare (monies provided at taxpayer expense for the benefit of favored corporations) that is given out to certain entities is simply astounding (trillions of dollars so far).
To date the combined actual cost of the Iraq and Afghanistan wars has approached one trillion dollars and the long terms costs associate with them is conservatively estimated at a minimum of another trillion dollars. This is an unconscionable sum of money spent for wars which were unwise, immoral and illegal under US and international law. Imagine how much health care could have been provided with 2 trillion dollars! The annual “Defense Budget” of the United States exceeds a trillion dollars if all the hidden costs are added. Moreover, the two Middle East wars have been financed by the continued passing of war supplemental authorization bills above and beyond the Defense Department’s annual budget to which must be added another almost 200 billion dollars annually in war supplemental’s since 2003. That adds up to another 1.2 trillion dollars through 2009.
The truth is that there is more than enough money to provide health care for the entire nation if our priorities are properly ordered. We should end our empire of foreign bases, our presence in Iraq/Afghanistan and re-regulate the finance industry . All “3” represent ongoing financial drains which we are simply incapable of sustaining. They only benefit a minuscule fraction of Americans—those who have managed through over-utilization of our corrupt campaign finance system to buy the US Congress and the Executive branch in order to insure their own personal self interest and ill-gotten gains.
In conclusion, the following is a summary of the major features which must be included in any serious attempt at health care reform.
1.) In order to be meaningful it must address the issue of corrupt insurance and pharmaceutical company practices. If the current system is allowed to persist, the number of Americans without insurance will continue to grow from the current almost 50 million to who knows what number as more and more Americans become incapable of affording their health care premiums.
2.) If the cost of prescription drugs is not drastically lowered in the United States, increasing numbers of patients will be forced to do without them either partially or completely which over time will only increase the cost of medical care.
3.) Equally important is the need to make it illegal to exclude patients from coverage because of pre-existing conditions or because they required costly medical treatments and or procedures both of which are examples of discriminating against patients who have a history significant illness.
4.) The uninsured must be brought into the system if we are to eliminate the high cost of treating them in emergency room settings after they have already become seriously ill. (author's emphasis throughout) This is particularly crucial if the “risk-pool” is to be made large enough to be able to reduce premium rates for groups and individuals.
The two most important problems which must be definitively corrected are the almost 50 million Americans without health care coverage of any kind and the monopoly exercised currently by the insurance and pharmaceutical industries. A failure to resolve these 2 problems will result in higher heath care costs, reduced care and higher taxes that is, a situation worse than the one we face now.
Based on what has transpired to date, I fear that President Obama will allow the insurance and pharmaceutical industries to continue making obscene profits the way the banking industry has--which to date he has been unwilling to re-regulate.
I hope I am wrong. It increasingly appears that the US Congress and Executive branch are controlled by big Pharma, big Banking and the big health insurance companies.
To be continued…
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