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Post by Bluestocking on Oct 8, 2007 17:51:12 GMT -6
I have some friends who are doctors who led me to this site, www.pnhp.org/. I also read a book, Critical Condition, that mentioned this site too. (I suppose these comments should have been posted under Healthcare and Medical.)
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Post by nomad943 on Oct 8, 2007 19:19:50 GMT -6
Thanks again for the linkage ... Yeah, I hear you about this thread being misplaced; and to think I am the one who started it, I thought I was in the right area at the time but must have gotten sidetracked..... DOOHHHH ... Maybe someone with admin powers could move it
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Post by nomad943 on Oct 9, 2007 7:41:00 GMT -6
Thanks for the move UC. Sorry for messing up the board like that. Anyhow, after reviewing the info presented here, I now feel a bit better about my understanding of the health care issue in general and I can now fit that comfortably into my understanding of todays political climate. I AM STILL LIBERAL. <Thank god, I had become concerned> IMO opinion anyone who wastes one keystroke promoting anything other than universal single payer health care is just confusing the issue and that likely for the purpose of defeating its enaction. In the same way that conservatives bemoan the lack of actual conservatism in anything proposed by supposed "conservatives", it should be obvious to all that we liberals face the exact same situation. When loyalty to party causes one to go against ones own ideology its time to step back and question. Question authority and do it WITH AUTHORITY>
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Post by proletariat on Oct 9, 2007 15:34:30 GMT -6
Also, I see touted quite regularly on leftist blogs a concept called "single payer" health care systems as in contrast to what we have now or what is being proposed. You seem to be knowledgeable on this subject, so excuse my french but ..... what the hell is that all about? Single payer is largely a response to watered down universal coverage. The Dems love to bring out their plans which tout universal coverage, but are nothing of the sort. Single payer gets at we are all in one pools so the costs are shared / less. In order to support thousands of private plans you need a good size bureaucracy. The idea is if everyone was covered much of this bureaucracy could go towards health care. The marketeers will tell you with socialized health care you will get bureaucracy and rationing. That is really not accurate, there is plenty of rationing in private insurance, its called profit. As far the bureaucracy most single payer countries have a fraction of one that we do. One more important thing about single payer. Currently Medicare, Medicaid, Cal-Care, Badger Care, no insurance etc only cover part of the costs. This is made up through higher premiums in HMO's and private insurance. I lean more towards a single payer on the state level. This would most likely take the form of taxation. The implementation would be through HMO like non-profit organizations. It is essential to keep private organizations out because profit=rationing.
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Post by blueneck on Oct 9, 2007 19:59:43 GMT -6
HMO's and insurance companies already decide who gets and what treatments, and what doctors you can go to.
Left to its own devices the "free" market has not controlled costs in medicine, quite the opposite -costs have escalated by some estimates as much as 78% since Hillarycare I
Health care does not fit a free market model - if you are desparately ill - are you going to sjhop around for which doctor is 5 bucks cheaper? this is the fatal flaw of the rights "private" account style plan
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Post by unlawflcombatnt on Oct 10, 2007 1:11:41 GMT -6
Update: 10/10/07 1PM Pacific TimeHMO's and insurance companies already decide who gets and what treatments, and what doctors you can go to. Left to its own devices the "free" market has not controlled costs in medicine, quite the opposite -costs have escalated by some estimates as much as 78% since Hillarycare I Health care does not fit a free market model - if you are desparately ill - are you going to shop around for which doctor is 5 bucks cheaper?If you're using Medicare, Medicaid, Medi-Cal, or any private health insurance-- there is no such thing as 'a doctor who is 5 bucks cheaper'. Doctors are paid the exactly the same by Medicare for the same level of office visit, and for the same procedure. There is a set rate for any geographical area for each level of care for an office visit. The same is true for Medi-Cal and Medicaid. A private insurer pays every doctor exactly the same for the same treatment. Private insurers' physician reimbursements are directly tied to Medicare reimbursements. A doctor can bill $100, $200, or a $1000 for a treatment Medicare allows $100 for. He'll get paid no more when billing $100 than he will if he bills $1,000. If he's a "participating" provider, Medicare will pay him $80 regardless. And if he's a participating provider, he can only balance bill for the remaining $20. It doesn't matter whether he initially billed for $100, $500, or $1,000. Medicare will only allow $100, and they will only pay $80. And the doctor is forbidden from balance billing any more than $20. These fixed reimbursements are something many are not aware of. Medicare imposes strict price controls. Medicare determines exactly how much the doctor gets paid, and exactly how much he can balance bill the patient for. By proxy, Medicare effectively puts price controls on private insurance as well. Private insurance pays a fixed rate for procedures which they determine, not what the doctor bills for. They also determine exactly how much a doctor can balance bill the patient for. But private insurers go one step further. They make it mandatory that the physician's office demands a co-pay from the patient. Physicians are required to ask for a co-pay-- by the insurance company. Usually, they are not allowed to waive the co-pay. Waiving the co-pay violates the insurance company's rules, and may cause the physician to be dropped from the plan. And again, private insurance reimbursements are based on Medicare reimbursements. They may be more, or they may be less than Medicare. But insurance reimbursements rise and fall with Medicare reimbursement rates. And they are based on some fraction of Medicare reimbursement rates. As such, Medicare basically fixes prices for ALL medical procedures, even those in the private sector. Doctors do not get paid what they charge-- they get paid what Medicare allows, or what the insurer allows. The only way a doctor gets paid more (or less) is if the patient has no insurance, and pays in cash. Even here, there are restrictions. It is illegal for a doctor to charge cash patients less than insurance-covered patients. A doctor cannot offer a better better price to a cash-paying patient than he does for an insurance-covered patient. Just know that when a doctor's office requests a co-payment, it's required by the insurance company, not the doctor's office. Insurance companies mandate co-pays because it reduces office visits and procedures. If an office visit requires no co-payment, in effect it becomes a "free" visit as far as the patient is concerned. If a service is free to the consumer (the patient), consumer "demand" for the service will be higher. Patients will demand more medical care if it costs them nothing. And the insurance company will pay out more for the increased number of doctors' visits. Thus, insurance companies mandate that doctors' collect co-payments for each office visit. It reduces the number of office visits patients make, and reduces the insurance company's number of pay-outs for office visits. Thus, mandatory co-payment collection for doctors' visits reduces the insurance company's total costs--both by reducing the amount paid for each individual visit, as well as the total number of individual visits. This is not necessarily a criticism of co-pays per se. It's simply an explanation of the underlying motivation, and who it is that determines co-pays. Insurance companies love to blame physicians for increasing medical costs. But in reality, the facts don't support this claim at all. Medicare determines physician reimbursements. Insurance companies base their reimbursements on those set by Medicare. Medicare reimbursements are less than they were 3 years ago. And that's in current dollars, not inflation-adjusted real dollars. In inflation-adjusted real dollars, Medicare reimbursements are much less than they were 3 years ago. And again, private insurance reimbursements are based on rates set by Medicare. The increasing cost of health care has absolutely nothing to do with physician reimbursement "increases", since reimbursements are decreasing--especially if measured in real dollars. The increased costs are going exclusively to increased profits, management compensation, and stockholder dividends. The malpractice cost myth also needs to be debunked. Only physicians (and health care professionals) are liable for malpractice. Physicians cannot pass malpractice costs on to patients or insurers, since their fees are set by Medicare. Rising malpractice premiums and claims do not increase health care costs for patients or insurers. Malpractice costs are born exclusively by physicians. Malpractice premiums and lawsuits reduce only a physician's net income. But they have no bearing on fixed the reimbursements allowed by Medicare or private insurers. It's a complete lie to claim that excessive malpractice litigation increases the cost to the public of medical care. It increases the cost only to physicians, who have no mechanism of passing that cost on to insurers or patients. Physician fees are fixed. But health insurance and malpractice premiums are not.
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Post by proletariat on Oct 10, 2007 5:07:46 GMT -6
If you're using Medicare, Medicaid, Medi-Cal, or any private health insurance-- there is no such thing as 'a doctor who is 5 bucks cheaper'. Doctors are paid the exactly the same by Medicare for the same level of office visit, and for the same procedure. There is a set rate for any geographical area for each level of care for an office visit. While this is true, at least in my state, HMO's and private insurance are able to recoup their costs via non-Medicaid, Medicare customers. I would imagine at least part of the 20% a year health care inflation is about this cost deferment. This was why Wal-Mart not paying for insurance became a big deal. They encouraged employees to go on Medicare which taxpayers funded, and a good chunk was deferred to others insurance costs. In the end programs like SCHIPS are probably more expensive than universal, single payer health care. They incorporate pages of rules of who qualifies in which bureaucracy is needed, only pay partially for the cost of health care, and allow HMO's to defer the additional costs on to other customers.
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Post by graybeard on Oct 10, 2007 10:40:43 GMT -6
What would the ideal medical plan for the US look like? Corporations that now provide medical coverage for their employees would reap a huge windfall if we go to a single payer system. How could we recapture that? My former co. is self-insured for medical, with it being administered by Blue Cross and other companies.
GB
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Post by Bluestocking on Oct 10, 2007 12:09:33 GMT -6
The following is the new Republican proposal for SCHIP. This is how they solve our healthcare problems. www.cbpp.org/10-10-07health.htm The bill that Bush vetoed and misstated www.cbpp.org/7-16-07health.htm. Originally the proposal was to remove the overpayments to Medicare Advantage (private) plans which CBO and MedPAC estimated to total $54 billion over 5 years and $149 billion over 10 years. www.cbpp.org/5-10-07health.htmWho do you think Bush and the Republicans want to help?
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Post by nomad943 on Oct 10, 2007 14:25:22 GMT -6
Ah back to this schip push. I found this video refreshing. It is being touted as a "watch the NJ governor slap down GOP thug" video; but proponents better be careful where they play it because it would be a wake up call more than a tear jerker to many ... like realy, you have already been doing that for 9 + years and you have the gaul to ask for even more? Universal single payer healthcare good. Disjointed, disparity filled, regressivly funded and regionaly unequal plans need to be disbanded not expanded.
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Post by nomad943 on Oct 10, 2007 14:56:38 GMT -6
Grayneard ... Where do you come up with the logic
"Corporations that now provide medical coverage for their employees would reap a huge windfall if we go to a single payer system."
From what I read the only effect on corporations would be that the ones who currently give there employees little or nothing would be penalized by losing the unfair competative advantage that they now have over companies that exhibit some social consiounce. How is this bad? Single payer would be a great big plow leveling the playing field for all and reducing all this disparity that has been and continues to be built into the system.
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Post by graybeard on Oct 11, 2007 20:31:37 GMT -6
Be careful how you address me...
You are looking at the other side of the same coin. Probably the only companies left who have generous health plans are highly profitable, and single payer would be a windfall for them.
GB
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Post by nomad943 on Oct 12, 2007 6:24:06 GMT -6
Graybeard; Sorry about that. Being cheap, I ordered some reading glass replacements on line and am still waiting for them to arrive three weeks later. Leaves me a tad blind so I tend to fall victim to the occasional typo Any-hoo ... The proposal that was posted here claimed that ALL businesses would be assessed a 7% payroll tax to fund the plan, along with individuals paying an additional 2% tax (on top of current medi tax). To me that sounds fair. All benefit and all pay. Companies that actually have benefits today would likely come out even to slightly ahead, and the corporate scum they compete with would have to pay something which currently they avoid altogether .... and for us people, the 2% tax is far less than what is pulled from our checks now without mentioning the copays ... I like it ... which is why it will never happen. Look at the Romney plan in Massachusetts. Insurance .. Buy it or pay fines, its the law! Great plan. Romney's only contribution to the plan was to line item veto the part about businesses having to participate in the payment for it and of course the "liberal" legislature passed it anyway just so they could say that they were addressing the issue. Another bad bill that will make things worse and exempt business from any social obligation. All I ask is that business participate, if you try to balance the weight of the world on them alone they wont be able to compete in our new world order and jobs are a plus for most of us.
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Post by Bluestocking on Oct 13, 2007 21:24:44 GMT -6
Bush said he could not support the SCHIP bill because it would lead to government run healthcare for all. I found this article by Tom Daschle Politics and a Pragmatic Paradigm for Health Reform, Part 1. www.hfma.org/hfmaviews/PermaLink,guid,523b7511-9faf-43b4-b0fe-34c65af6fd4b.aspx I loved this paragraph the shows the Bush hypocrisy. The next myth is that the cure is worse than the disease. We are seeing this play out on SCHIP. SCHIP is one of the most popular, bipartisan health programs we have. Yet we are hearing from the president--who gets the best care in the world at Bethesda Naval Medical Center, by government funded-physicians, in a government-built building, and on government-owned machines--that we should not support government-run health care. He also lays out the very real reason why reform is so hard. Second, there are special interests. Unlike Social Security or other programs, there is a layer of “intermediaries”: health insurers and providers of care. One person’s savings is another’s salary--or profit. And in terms of political clout, the health industry is second to none. Between 1998 and 2006, pharma and other health product companies spent over a billion dollars on lobbying--twice as much as the oil and gas industry. Not surprisingly, insurers, including health insurers, were number two in spending on lobbyists. These special interests have also created and funded patient front groups, using “human shields” to protect payments and profits. No other industry has done this as well.
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Post by Bluestocking on Oct 13, 2007 21:29:09 GMT -6
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Post by Bluestocking on Oct 13, 2007 21:33:29 GMT -6
Here's the article, link doesn't work
Tuesday, October 02, 2007 Politics and a Pragmatic Paradigm for Health Reform, Part 1 Senator Tom Daschle
In 1991, the political landscape was changed by a teacher from Pennsylvania who ran--and won--by saying, if every prisoner has a lawyer, every American should have a doctor. I remember being one of the sitting senators who made presentations to Senator-elect Harris Wofford in the hopes that he would work with us on our plan. The excitement was palpable--and optimism was high. I don’t think a freshman senator has gotten that kind of attention from his colleagues since. And it helped set the stage for the presidential election and debate over health reform in 1993 and 1994.
Health care is back again--and it just might be that it is back stronger than before. It is present in full force in the presidential campaign, with all the Democratic candidates, and some Republicans, offering comprehensive reform plans. All the major newspapers have run front-page stories on the politics of health care. The central domestic policy fight in Washington is between Congress and the White House over the State Children’s Health Insurance Program (SCHIP). And poll after poll tells us that health care is typically second in importance only to Iraq for the American public, regardless of their party affiliation.
The Cusp of Change?
But as a veteran of the 1994 battle and a student of previous efforts’ lessons, I view these facts as only suggestive, not conclusive, that we are on the cusp of health reform. A sober political analysis must answer two questions: Are the circumstances any different now than during previous attempts, and are we ready to accept the pragmatic over the perfect solution?
Beginning with the “good news,” some circumstances are now more propitious for reform. On one level this is a bad news-good news story. That is to say, the problems with the system are so bad, the failings of the current administration so monumental, and the thirsting for leadership is so large that there is increased attention to the issue.
That’s bad--but potentially good news.
Unlike the early 1990s, when recession and job insecurity drove concern, today the problem is less about job loss and low-income people. It is increasingly a concern among the educated, middle-income, older, and insured population. It is exacerbated by the chronic disease epidemic that is crippling the nation. And so many people have seen someone they know struggle with the system that everyone fears they are not immune from an underperforming system.
High costs and complexity are driving business leaders’ frustration, which is leading to new levels of mobilization in that community. According to a McKinsey analysis, healthcare costs will exceed profits at Fortune 500 companies by next year, and over the past seven years, we’ve seen wages go up 24 percent, while healthcare premiums have gone up 98 percent. Costs were a problem in the 1990s too, but today legacy costs are new--and crippling.
These costs are undercutting competitiveness, a fact not lost on business leaders. This is why we are seeing maverick CEOs like Howard Shultz of Starbucks and James Sinegal of CostCo buck Wall Street and push not only for generous benefits for their employees but also for comprehensive reform of the system. And that’s why we are seeing coalitions like Wal-Mart/SEIU in “Better Health Care Together” and Safeway and the Business Roundtable demanding comprehensive reform.
At the same time, the media have democratized. The Internet has led to media reporting and political organizing that magnifies possibilities for reform. The 24-hour news cycle, challenged by blogs and other forms of communication, can catalyze anger and pressure for action. At a recent gathering of college students, I was told that healthcare reform is the civil rights fight of that generation--and the new media offer the possibility of virtual rallies analogous to the marches of the 1960s that involve millions more Americans in the debate.
Last, we are in a very unique political situation. About 70 percent of the country is convinced we are on the wrong track. For the first time in 80 years, there is no incumbency, legacy, or trail of policy inertia in the presidential campaign. And the foreign policy failures of the current administration may create a demand for a domestic policy success.
Challenges to Reform
Yet these new positive indicators must confront deep, perennial challenges to health reform.
First is the complexity of health care. Seeking health care is not like buying a car; classic economic theory need not apply. There is an imbalance of knowledge. Clearly, our health professionals are highly trained, and we typically trust them to do the right thing. Yet we have seen that supply can determine demand, most recently with the explosion of sophisticated imaging and tests that may not always be needed. And health care is literally a matter of life or death, making it difficult on the demand side to distinguish what is necessary from what is interesting or optional or, even, a long shot.
This difficulty is made worse by layer after layer of complexity. In the federal system alone, consider the differences in benefits and payments a South Dakotan in a program such as Medicare can expect from a South Dakotan in the Indian Health Service from a South Dakotan in the Veterans Health Administration--and then consider how you answer concerns about each as you walk through a parade on the Fourth of July.
Second, there are special interests. Unlike Social Security or other programs, there is a layer of “intermediaries”: health insurers and providers of care. One person’s savings is another’s salary--or profit. And in terms of political clout, the health industry is second to none. Between 1998 and 2006, pharma and other health product companies spent over a billion dollars on lobbying--twice as much as the oil and gas industry. Not surprisingly, insurers, including health insurers, were number two in spending on lobbyists. These special interests have also created and funded patient front groups, using “human shields” to protect payments and profits. No other industry has done this as well.
Third, we struggle with some myths. Because fear can trump hope, defenders of the status quo oversell what we have now and warn about unforeseen dangers lurking around the corner of reform. Let me give you three of the myths that drive the politics of health care.
One myth is that we have the best health care in the world. You’re familiar with the statistics. Think what would happen to the chairman of the U.S. Olympic Committee if the United States comes in 37th place in the next summer Olympics. Well, that’s where we rank in life expectancy. It is a national shame that on Pine Ridge Indian Reservation in South Dakota life expectancy is 47 years--about 10 years more than in Botswana, where one in three adults has HIV.
The next myth is that the cure is worse than the disease. We are seeing this play out on SCHIP. SCHIP is one of the most popular, bipartisan health programs we have. Yet we are hearing from the president--who gets the best care in the world at Bethesda Naval Medical Center, by government funded-physicians, in a government-built building, and on government-owned machines--that we should not support government-run health care.
And perhaps the most misleading myth is that we can’t afford reform. The most common question asked of all the presidential candidates is, how are you going to pay for reform? Cynics suggest that even the most modest plans are the nose under the tent of a more generous and more expensive solution. Yet at $2 trillion per year and 16 percent of gross domestic product, I fear we can’t afford the status quo.
These myths are easy to exploit. Sometimes it is by special interests whose motivation is crass: that status quo means dollars and cents to them. Other times, it is for political gain. Bill Kristol and Newt Gingrich saw the defeat of health reform in 1994 as a political victory. The same seems to be happening with SCHIP: A sinking White House wants to drag down Congress with it. How else can you explain the awkward attempt to pin ideological concerns on a program that represents a true, bipartisan compromise?
Part 2 of this piece--How to Fix a Broken System--will be posted tomorrow.
Sen. Tom Daschle completed 26 years of public service in January 2005, having represented South Dakota for eight years in the U.S. House of Representatives (1978-86) and 18 years in the U.S. Senate (1986-2005). He served as Minority Leader of the Senate from 1994 to 2001 and from 2003 to 2005, and Majority Leader from 2001 to 2003. Today, Daschle is an adviser to the law firm of Alston & Bird, Washington, D.C., and is a Distinguished Fellow at the Center for American Progress, Washington, D.C.
posted on 10/2/2007 7:59:29 AM (CST) Permalink Wednesday, October 03, 2007 Politics and a Pragmatic Paradigm for Health Reform, Part 2 Senator Tom Daschle
(Read Part 1 of this piece.)
How to Fix a Broken System
So our challenge is to overcome ideology with a new pragmatic paradigm for reform. To be sure, there is an important role for vision and ideology in our system. It grounds incremental actions and serves as a compass toward the vision of an ideal healthcare system. But this is not an academic debate: Millions of Americans have suffered; thousands have died due to purely preventable public policy choices while we criticize good plans that are not good enough.
I believe that the way forward is to embrace pragmatism, in both the substance and approach to reforming the health system.
Starting with policy, we have three serious problems in the system: unacceptable access, quality, and costs. Each could be addressed by building on what works.
Although we have 47 million uninsured and growing, we have roughly 250 million insured through some type of health insurance. We can ensure access for all by extending public and private group health insurance to all Americans.
Although we have medical errors that result in nearly 100,000 unnecessary deaths a year, we have some of the best minds and best practices in the world scattered throughout the nation. We need to promote best practices through propagating them, paying for them, and ultimately demanding them.
And although we have the most expensive healthcare system in the world, most experts believe that we can significantly reduce costs without affecting health through:
Promoting research on what works and what doesn’t Prioritizing prevention Harnessing the potential of IT Reducing administrative costs through simplifications Such solutions are not perfect, but neither are they radical. They can move toward the ideal system without invoking the fears and partisanship that have been barriers in the past.
There is a difference between a concession and structural compromises. Building support and coalitions to pass legislation requires concessions, even though experts and the press love to hate them. For example, I’m open to some compromise on medical malpractice, some way to keep the drug industry at bay, and other policies that build a larger and stronger coalition. The plain truth is that no major legislation has been enacted without such “gives,” and we need to be tolerant of such policies.
We also must look to new models. In 1991, I first proposed the creation of a federal health board to govern the healthcare system the same way the Federal Reserve Bank governs our banking system and monetary policy. Like the Fed, the Fed Health would be a board composed of independent experts. Its main job would be to develop the standards and structure for a health system that ensures accessible, affordable, and high-quality care. It would, for example, develop model benefits, rules for insurers, and best practices for clinicians. These would apply to federal health programs and contractors and serve as a model for private insurers.
Congress and the White House would relinquish some of their health policy decisions to it. For example, a shift to a more effective drug or service could be accomplished without an act of Congress or White House political support. Delegation of power rightly raises concerns. But imagine the outcomes if Congress revoked the Fed's power to set interest rates and instead took it upon itself to enact them each quarter. It would be a disaster, similar to the consequences of our mismanaged health system.
Last, we need leadership on this issue.
In the SCHIP debate, even with a lame duck president who is verifiably the weakest and least popular in modern history, you are seeing the negative power of the White House. With his veto threats and refusal to engage in a negotiation toward a solution, we may well see millions of children in this country go without health insurance.
I hope with the next president you will see the positive power of the White House to create and act on a sense of urgency on this matter and to forge a consensus for where we go. The power of the White House is unmatched in this regard. But we should also not fool ourselves that there is any one magic bullet here. We could have as many health reform plans as there are Americans, and each would score better on one dimension than another. Yet each of us insisting on our own plan not only fails to advance reform, but could even set it back.
Leadership also means going on the offensive. Advocates for reform cannot wait for the next Harry and Louise ad--they must pre-empt it. They cannot assume that the public recognizes the liabilities of the other side’s proposal--they have to educate the public, for example, about the emptiness of health savings accounts. And we cannot limit the options available for us to act--which is why I am becoming an advocate for using the reconciliation process in Congress to enact healthcare reform. Acting swiftly and in the early--and strongest--days of the next presidency will be the best way to not get caught in the stasis of the status quo.
More than anything, we need to finally put good ahead of perfect. Congress should fulfill its commitment financially to covering all low-income, uninsured and put its money behind this commitment. If it does not take this opportunity, we will be back here debating this issue again in 20 years, still bedeviled by a broken system that is not giving us what we pay for.
Sen. Tom Daschle completed 26 years of public service in January 2005, having represented South Dakota for eight years in the U.S. House of Representatives (1978-86) and 18 years in the U.S. Senate (1986-2005). He served as Minority Leader of the Senate from 1994 to 2001 and from 2003 to 2005, and Majority Leader from 2001 to 2003. Today, Daschle is an adviser to the law firm of Alston & Bird, Washington, D.C., and a Distinguished Fellow at the Center for American Progress, Washington, D.C.
This piece will be published in print in the November issue of hfm magazine.
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Post by nomad943 on Oct 14, 2007 9:35:46 GMT -6
SCHIP is one of the most popular, bipartisan health programs we have. Of course it is popular. Its PURE PORK dressed up in some starving children. Who could oppose helping poor children with health security. So lets set aside a pile of cash and take care of them. Problem comes when the pile of cash gets chewed up insuring middle class kids and adults in states worthy of political payback so that the money is all used up without ever having helped the aforementioned poor kids. So do they fix the problem and help the kids ... no, they just pile on more money. What I want to know and what no one seems to mention about this BIPARTISAN bill ... is what was the "business tax cut" that was amended onto the bill in order to get some GOP support for this previously straight party line vote.... no one seems to know why this is now BIPARTISAN ...
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Post by Bluestocking on Oct 17, 2007 10:13:29 GMT -6
President Bush had a press conference today and again spouted his rhetoric about insuring "poor children first". The following article shows how this administration is trying to do the opposite.
I am also tired of hearing that this bill will allow income level of $82,000. This is mis-stated and misrepresented as this administration is fond of doing. Under SCHIP each state can cover children up to 200% above the poverty level. (around 42,000/yr for a family of 4) the states under the current rules, before this legislation, could already request of the federal government to increase the percent above the poverty level and if they went over I believe 300% they would face some consequences. I believe this new legislation is a fair bill from what I have read although I still would like to see it remove the overpayments to Medicare Advantage (private) plans which amount to $54 billion over 5 years in comparison to $35 billion over 5 yr. for SCHIP. Who do you want to pay for?
Here's the article: POOR CHILDREN FIRST — OR LAST? Watch What the Administration is Doing, Not What It Is Saying by Robert Greenstein
The Bush administration has recently argued that the President favors providing health insurance to “poor children first” and vetoed bipartisan children’s health legislation because it violates this principle. On “This Week” on October 7, Health and Human Services Secretary Mike Leavitt stated: “The President’s position can be summarized in three words: poor children first.”[1]
But is the Administration’s claim about the bipartisan legislation accurate? Does the bill, in fact, put middle-income children ahead of poor ones? And do the Administration’s actions and policies put poor children first?
The facts show this claim to be a large distortion. In fact, the truth is almost precisely the opposite of what the Administration claims.
The vetoed bipartisan legislation is specifically designed to put poor children ahead of everyone else, and the Congressional Budget Office’s analysis of it shows that it would achieve this goal, and
Recent Administration policies that have received little media attention would actually make it harder to reach poor children and likely cause more of them to be uninsured.
This brief analysis explores each of these points.
The “poor children first” phrase appears to reflect polling data more than Administration policy proposals. The Wall Street Journal reported last week that research by Republican pollster David Winston found poll numbers strongly favoring the legislation could be driven downward when respondents were told that policymakers who opposed the bill did so because they sought to cover “poor kids first” and that the legislation thwarts this goal.[2]
The Bipartisan Children’s Health Legislation
The legislation is designed to give priority to poor uninsured children over all others.
The bill provides fiscal incentives to states to cover uninsured children who are already eligible for public health insurance programs — and provides the largest incentives for covering the poor and near-poor children who are eligible for Medicaid, rather than the modestly better-off children who are eligible for SCHIP. In most states, children age 6 to 18 must have incomes below the poverty line to qualify for Medicaid, while children age one to 6 must have incomes below 133 percent of the poverty line.[3]
The bill also provides fiscal incentives to states to cover children who have incomes too high to qualify for Medicaid but who qualify for SCHIP under their state’s current SCHIP eligibility criteria, but these fiscal incentives would be smaller.
The bill does not provide fiscal incentives to states for enrolling children with income above their state’s current SCHIP income limit.
And if a state sought in the future to raise its SCHIP income limit above 300 percent of the poverty line, the state would (1) receive no incentive payments for enrolling eligible children in this income range and (2) have its federal SCHIP matching rate reduced with respect to these children, if the state were allowed to cover these children at all. (The state would eventually have to meet a number of new criteria to be allowed to raise its income eligibility level or to continue to cover children in this income range.)
In short, claims that the bill favors middle-class over poor children are undeniably false. Senator Charles Grassley, the senior Republican on the Senate Finance Committee and a key author of the bipartisan legislation, recently said on the Senate floor that some charges made by the legislation’s opponents are intellectually dishonest. His label applies to this charge.
Moreover, the CBO analysis of the bill finds that of the 3.8 million otherwise uninsured children who would gain coverage under it by 2012, some 1.7 million are children who are eligible for Medicaid but are uninsured. Most of these children live below the poverty line. Another 1.5 million are children who are eligible for SCHIP under their state’s current eligibility criteria but are uninsured. CBO estimates that only 600,000 (or less than 16 percent) of the 3.8 million children are children with incomes above their state’s current SCHIP income limits. Similarly, according to estimates by the Urban Institute, more than 75 percent of the uninsured children who would gain coverage under the bill have incomes below 200 percent of the poverty line.[4]
The Administration’s Medicaid and SCHIP Policies
What would the Administration’s policy proposals do instead? Rather than provide coverage to 3.8 million otherwise uninsured children by 2012, as the bipartisan legislation would do, the Administration’s proposals would actually reduce the number of children enrolled in SCHIP or Medicaid — including, most likely, the number of poor children enrolled in Medicaid.
As CBO has reported, the President’s budget fails to request enough money for SCHIP simply to continue insuring the number of children that the program covers today. Less well known is that the Administration is pursuing policies through the regulatory process that would adversely affect Medicaid coverage of poor children.
On August 31, the Administration issued proposed regulations that would make it harder to reach and enroll eligible poor children in Medicaid. Several million poor or near-poor children are uninsured despite their eligibility for Medicaid. Since most of these children attend school, federal rules have long allowed state Medicaid programs to contract with school districts to help find and enroll them. Specifically, many states contract for a portion of the time of the school nurse or other appropriate school personnel to identify poor, uninsured children and help them enroll. The Administration’s proposed regulations would outlaw such contracts, cutting off all federal Medicaid matching funds for them. (The proposed regulations would still allow contracts with private corporations to find and enroll children, but not contracts with schools.)[5]
On August 13, the Administration issued another proposed rule that would adversely affect poor children. It would cut off Medicaid funding for various health services that children and parents with mental illness or other serious disabilities need to stay out of institutions and improve their ability to function.[6]
These rules would make it harder to reach and enroll poor children, and for those who are enrolled, reduce the health services they can obtain. To prevent these children from being harmed, the bipartisan legislation would place a moratorium (through the end of May) on the Administration’s ability to issue final rules to implement these policy changes.
Nevertheless, the White House insists that it is the defender of poor children and that the vetoed legislation is their enemy.
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Post by nomad943 on Oct 17, 2007 19:40:32 GMT -6
Not to seem rude, but you must be experiencing tunnel vision. I personaly linked a video where the governor of NewJersey stated very clearly that his state has had a waiver for the past 9 years to cover up to 350% over poverty due to that states " high cost of living". Thats 74,000$. New York is 400% now. This is before the proposed "expansion" takes effect. Wonder why the funding bucket ran dry before the actual poor kids got coverage? Isnt this political pork passing at its best? Am I somehow supposed to believe the fed should be doling out support at 350% to New Jersey and only at 200% to Massachusetts or Pennsylvania. I live in Mass and I would personaly like to slap my glorious senators for shortchanging their constituants by peddling this crap. If 400% is good enough for NewYorkers (and by the by you can still buy a nice home in the capital region for about 65,000) than its good enough for all of us. I'm sure the cost of living in California is dirt cheap too. This type of floating floor is pure crap and a politicians dream.
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Post by Bluestocking on Oct 18, 2007 8:31:51 GMT -6
The video proves my point that the $82,000 is rhetoric. That provision to increase the percent above poverty level has probably always been there. This program is 10 years old and by Corzine admission that they have had a waiver for 9 years shows that the President saying this [u]new[/u][/b] legislation would allow them to cover people making up to $82,000 is false. If you also listen to Corzine he talks about the misrepresentations and that only about 3% of all covered in his state fall into that 300-350% level. You and I don't know the circumstances of why these people are covered under this program but could it be that they are uninsured because they were denied insurance or that the cost is so prohibitive because of a pre existing condition. My other point is that we will never get a perfect program because our system won't allow it. We would never get everyone or enough people, to agree because of misrepresentations, to what we really need - universal healthcare not insurance. My other point is that what I have read in several places also says that the new legislation tightens up the guidelines making the states cover the poorest first:
And if a state sought in the future to raise its SCHIP income limit above 300 percent of the poverty line, the state would (1) receive no incentive payments for enrolling eligible children in this income range and (2) have its federal SCHIP matching rate reduced with respect to these children, if the state were allowed to cover these children at all. (The state would eventually have to meet a number of new criteria to be allowed to raise its income eligibility level or to continue to cover children in this income range.)
Moreover, the CBO analysis of the bill finds that of the 3.8 million otherwise uninsured children who would gain coverage under it by 2012, some 1.7 million are children who are eligible for Medicaid but are uninsured. Most of these children live below the poverty line. Another 1.5 million are children who are eligible for SCHIP under their state’s current eligibility criteria but are uninsured. CBO estimates that only 600,000 (or less than 16 percent) of the 3.8 million children are children with incomes above their state’s current SCHIP income limits. Similarly, according to estimates by the Urban Institute, more than 75 percent of the uninsured children who would gain coverage under the bill have incomes below 200 percent of the poverty line.[5]
Most of what I have read says that the states do a good job of administering this program for the poor and uninsured and when this president starts with his mantras - the surge is working, the poor first - I look to see what is behind it. In fact the president's proposal won't even cover the ones in the program. Sorry about my tunnel vision I only seem to be attracting you to my postings.
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Post by nomad943 on Oct 18, 2007 12:58:10 GMT -6
It is a good topic and one I enjoy airing out. Lets hope that the powers that be choose to utilize the interest that has been aroused, as an opportunity to push for some real fundemental change and not just create another murky mess to use as a political football. We shall see.
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