I don't know whether the commenter is correct that passage of the Affordable Care Act was responsible for strategic actions taken by Texas health insurers to raise rates or make unavailable maternity benefits (2 sides of the same coin). Was the decision by insurers to raise their rates for individuals seeking maternity benefits as part of their insurance package solely due to health care reform or was it a response to actuarial experience (increases in the range of 10-15% have not been unusual in the health insurance business in many states, even before health reform), to the extraordinarily high costs of Texas health care (as documented in 2010 journal articles and federal government discussions), was it a business strategy to mobilize public opinion against health reform, or was it a non-publicized highly selective business or political strategy?
I don't know. Do any of my readers have other insights?
Showing posts with label Health Reform. Show all posts
Showing posts with label Health Reform. Show all posts
Monday, November 15, 2010
Sunday, October 17, 2010
If the Republicans Repeal Health Reform -- Then What?
As I have reported, and one of my sons mentioned to me in this morning's phone call, I have plowed my way through 906 single-spaced pages of the Patient Protection and Affordable Care Act ("ACA") which President Obama signed last March. I have read numerous blogs (including those of the Director of the Congressional Budget Office which, being written for Congress people and their staffs, are written clearly) some of which demonstrate complete unfamiliarity with the actual text and meaning of the ACA. I am convinced that many public statements about the ACA reflect uninformed for personal-profit political positions more than hard time-consuming actual work to understand and think about the act.
A disclaimer - I have my biases. As a physician specialist, I took care of very sick people, never turned anyone away because of insurance status or lack of it, and have no respect for those that do. I have a large family which has seen more than "its share" of sickness and disease and death and my family has been significantly impacted by our severe recession. I have been the Chief of Staff of a large mid-city hospital, now closed and abandoned, and have seen what economists call "dislocation" and the rest of us call bankruptcy in health care. I have seen excellence and incompetency in health care and the systems which deliver it. I was a member of Stanford University's clinical faculty, providing one morning a week of unpaid time for thirteen years, taking care of veterans with blood diseases at the Palo Alto VA hospital and teaching medical students, residents and hematology fellows. As a member of a powerful well-financed state hospital industry board, I have seen political and economic jousting within and outside the hospital industry. When I practiced health law, among others, I represented a large medical group and was heavily involved in the analysis and negotiating of managed care contracts as well as contracts among physicians and their practice entities.
Bottom line - if health reform is repealed we will be worse off. The good outweighs the rest.
The ACA will provide access to insurance for Americans who have lost employment and their families' health insurance and don't have enough money to buy Cobra extended coverage. The ACA outlaws insurance company abuses and will provide health insurance and care to our kids and grandchildren. The ACA will provide incentives to employers to sign their workers up for insurance, insurance which cannot be rescinded or be subjected to unreasonable annual coverage limits or lifetime limits. The ACA will expand Medicare coverage for Part D beneficiaries although there will be a modest increase in premiums over the next ten years and it will even help seniors to stay out of nursing homes, or if in nursing homes, have better quality of care (Also see the Elder Justice Act within the ACA at pages 664 and following) The ACA will improve access to care in rural and underserved areas and the care of the poor. It will train doctors, nurses and others in the health professions without burying them and their families in debt. It incorporates an "Elder Justice Act" which may safeguard seniors against some of the terrible things that I saw happen to my older patients. It has strengthened protections against fraud and abuse. And, it encourages advances in medical inventions, products and care which moves us into a new generation of health services.
The projections are that it will save about $14 billion dollars each year for the next 10 years and thus control the rise of premiums and out-of-pocket expenses that each of us experiences each year. And interestingly, it will make it possible - through support of America's families and children - to grow our workforce so that in coming there will be young working people able to fill the jobs that America offers and help America's businesses.
My study indicates that health reform is good for families, good for working-people and those who would work if they could find work, good for America's supply of doctors, nurses and health care workers, good long term for large and small business and less costly than the alternative - no health care reform.
A disclaimer - I have my biases. As a physician specialist, I took care of very sick people, never turned anyone away because of insurance status or lack of it, and have no respect for those that do. I have a large family which has seen more than "its share" of sickness and disease and death and my family has been significantly impacted by our severe recession. I have been the Chief of Staff of a large mid-city hospital, now closed and abandoned, and have seen what economists call "dislocation" and the rest of us call bankruptcy in health care. I have seen excellence and incompetency in health care and the systems which deliver it. I was a member of Stanford University's clinical faculty, providing one morning a week of unpaid time for thirteen years, taking care of veterans with blood diseases at the Palo Alto VA hospital and teaching medical students, residents and hematology fellows. As a member of a powerful well-financed state hospital industry board, I have seen political and economic jousting within and outside the hospital industry. When I practiced health law, among others, I represented a large medical group and was heavily involved in the analysis and negotiating of managed care contracts as well as contracts among physicians and their practice entities.
Bottom line - if health reform is repealed we will be worse off. The good outweighs the rest.
The ACA will provide access to insurance for Americans who have lost employment and their families' health insurance and don't have enough money to buy Cobra extended coverage. The ACA outlaws insurance company abuses and will provide health insurance and care to our kids and grandchildren. The ACA will provide incentives to employers to sign their workers up for insurance, insurance which cannot be rescinded or be subjected to unreasonable annual coverage limits or lifetime limits. The ACA will expand Medicare coverage for Part D beneficiaries although there will be a modest increase in premiums over the next ten years and it will even help seniors to stay out of nursing homes, or if in nursing homes, have better quality of care (Also see the Elder Justice Act within the ACA at pages 664 and following) The ACA will improve access to care in rural and underserved areas and the care of the poor. It will train doctors, nurses and others in the health professions without burying them and their families in debt. It incorporates an "Elder Justice Act" which may safeguard seniors against some of the terrible things that I saw happen to my older patients. It has strengthened protections against fraud and abuse. And, it encourages advances in medical inventions, products and care which moves us into a new generation of health services.
The projections are that it will save about $14 billion dollars each year for the next 10 years and thus control the rise of premiums and out-of-pocket expenses that each of us experiences each year. And interestingly, it will make it possible - through support of America's families and children - to grow our workforce so that in coming there will be young working people able to fill the jobs that America offers and help America's businesses.
My study indicates that health reform is good for families, good for working-people and those who would work if they could find work, good for America's supply of doctors, nurses and health care workers, good long term for large and small business and less costly than the alternative - no health care reform.
Sunday, March 21, 2010
Thursday's Lunch
I met with the Thursday doctors' lunch group on March 18, 2010, and found a significant level of apprehension, questioning and mistrust concerning health reform.The first issue was the lack of information on how the ever-changing contents of the reform proposal would affect the practice and economics of physicians. Physicians noted that an ever-increasing number of doctors in our community is moving to concierge practices or refusing new Medicare patients (they had long-ago stopped taking MediCal [Medicaid] because they felt that it was a path to financial ruin). One doctor had called the American Medical Association and found that they were uninformed about new developments in health reform and he related that only the promise of elimination of the 21.5% cut in Medicare payment kept the AMA supporting reform. None of the physicians was trusting of the alliance between the government and health insurers because of their long experience with both. All in all, this group of physicians seemed depressed over their futures.
Wednesday, March 3, 2010
Reform, Not Minimalism "Where's The Beef?"
I spent lots of time on National Health Lawyers Association activities in Washington, DC during Ronald Reagan's administration and remember the awesome power and control that President Reagan exercised through the House-Senate conference committee process. It would be hard for the current generation of Republicans to deny their Reagan heritage and cry foul should President Obama emulate Reagan's example with respect to reforming our health system.
But if Obama is going to use his presidential authority and legislative majorities to get the job done, it should be for major health care reform, not the minimalist program spelled-out in today's communique from the White House (Click Title for "Where's The Beef"):
"On Wed, Mar 3, 2010 at 11:45 AM, President Barack Obama wrote:
"Friend --
"Last Thursday's first-of-its-kind summit capped off a debate that has lasted nearly a year. Every idea has now been put on the table. Every argument has been made. Both parties agree that the status quo is unacceptable and gets more dire each day. Today, I want to state as clearly and forcefully as I know how: Now is the time to make a decision about the future of health care in America.
"The final proposal I've put forward draws on the best ideas from all sides, including several put forward by Republicans at last week's summit. It will put Americans in charge of their own health care, ensuring that neither government nor insurance company bureaucrats can ration, deny, or put out of financial reach the care our families need and deserve.
"I strongly believe that Congress now owes the American people a final vote on health care reform. Reform has already passed the House with bipartisan support and the Senate with a super-majority of sixty votes. Now it deserves the same kind of up-or-down vote that has been routinely used and has passed such landmark measures as welfare reform and both Bush tax cuts.
"Earlier today, I asked leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And now, I'm asking you, the members of the Organizing for America community, to raise your voice and do the same.
"The final march for reform has begun, and your participation is crucial. Please commit to join with me to take reform across the finish line.
"Essentially, my proposal would change three things about the current health care system:
"First, it would protect all Americans from the worst practices of insurance companies. Never again will the mother with breast cancer have her coverage revoked, see her premiums arbitrarily raised, or be forced to live in fear that a pre-existing condition will bar her from future coverage.
"Second, my proposal would give individuals and small businesses the same choice of private health insurance that members of Congress get for themselves. And my proposal says that if you still can't afford the insurance in this new marketplace, we will offer you tax credits based on your income -- tax credits that add up to the largest middle class tax cut for health care in history.
"Finally, my proposal would bring down the cost of health care for everyone -- families, businesses, and the federal government -- and bring down our deficit by as much as $1 trillion over the next two decades. These savings mean businesses small and large will finally be freed up to create jobs and increase wages. With costs currently skyrocketing, reform is vital to remaining economically strong in the years and decades to come.
"In the few crucial weeks ahead, you can help make sure this proposal becomes law. Please sign up to join the Organizing for America campaign in the final march for reform:
http://my.barackobama.com/commit
"When I talked about change on the campaign, this is what I was talking about: coming together to solve a huge problem that has been troubling America for 100 years and standing up to the special interests to deliver a brighter, smarter future for generations to come.
"I look forward to signing this historic reform into law. And when I do, it will be because your organizing played an essential role in making change possible.
"Thank you,
President Barack Obama"
MY OPINION
America needs reform which will provide: (1) efficient basic accessible, ethical, scientifically appropriate, health care, pharmaceutical product and health insurance coverage for every citizen in America; (2) a health care work force including physicians, nurses and other personnel, which is adequate in number, well-educated, highly competent, and incentivized to provide appropriate high quality health services; (3) a system, including but not limited to, a federal independent agency provider, which provides economically sound medically necessary, scientifically well-founded, and appropriate health services 24 hours a day, 7 days a week, 365 days per year; (4) appropriate incentives for high level mathematical and scientific student and post-graduate training; (5) a respected and appropriately supported system of national public health services which will coordinate and manage health care emergencies including epidemics, national disasters, bio-terrorism episodes, nuclear disasters and other events; (6) national licensing of health care providers; (7) support for local, national and internationally based health care fraud detection, prosecution and punishment; (7) continued support for scientific research; (8) appropriate quality, professional and financial standards for all institutional providers of health services including hospitals, outpatient facilities, research institutions dealing directly with patients; (9) independent objective public health education; and (10) encouragement and support of the development of enforceable ethical standards related to health care, health-related information, and products which purport to effect health care.
But if Obama is going to use his presidential authority and legislative majorities to get the job done, it should be for major health care reform, not the minimalist program spelled-out in today's communique from the White House (Click Title for "Where's The Beef"):
"On Wed, Mar 3, 2010 at 11:45 AM, President Barack Obama
"Friend --
"Last Thursday's first-of-its-kind summit capped off a debate that has lasted nearly a year. Every idea has now been put on the table. Every argument has been made. Both parties agree that the status quo is unacceptable and gets more dire each day. Today, I want to state as clearly and forcefully as I know how: Now is the time to make a decision about the future of health care in America.
"The final proposal I've put forward draws on the best ideas from all sides, including several put forward by Republicans at last week's summit. It will put Americans in charge of their own health care, ensuring that neither government nor insurance company bureaucrats can ration, deny, or put out of financial reach the care our families need and deserve.
"I strongly believe that Congress now owes the American people a final vote on health care reform. Reform has already passed the House with bipartisan support and the Senate with a super-majority of sixty votes. Now it deserves the same kind of up-or-down vote that has been routinely used and has passed such landmark measures as welfare reform and both Bush tax cuts.
"Earlier today, I asked leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And now, I'm asking you, the members of the Organizing for America community, to raise your voice and do the same.
"The final march for reform has begun, and your participation is crucial. Please commit to join with me to take reform across the finish line.
"Essentially, my proposal would change three things about the current health care system:
"First, it would protect all Americans from the worst practices of insurance companies. Never again will the mother with breast cancer have her coverage revoked, see her premiums arbitrarily raised, or be forced to live in fear that a pre-existing condition will bar her from future coverage.
"Second, my proposal would give individuals and small businesses the same choice of private health insurance that members of Congress get for themselves. And my proposal says that if you still can't afford the insurance in this new marketplace, we will offer you tax credits based on your income -- tax credits that add up to the largest middle class tax cut for health care in history.
"Finally, my proposal would bring down the cost of health care for everyone -- families, businesses, and the federal government -- and bring down our deficit by as much as $1 trillion over the next two decades. These savings mean businesses small and large will finally be freed up to create jobs and increase wages. With costs currently skyrocketing, reform is vital to remaining economically strong in the years and decades to come.
"In the few crucial weeks ahead, you can help make sure this proposal becomes law. Please sign up to join the Organizing for America campaign in the final march for reform:
http://my.barackobama.com/commit
"When I talked about change on the campaign, this is what I was talking about: coming together to solve a huge problem that has been troubling America for 100 years and standing up to the special interests to deliver a brighter, smarter future for generations to come.
"I look forward to signing this historic reform into law. And when I do, it will be because your organizing played an essential role in making change possible.
"Thank you,
President Barack Obama"
MY OPINION
America needs reform which will provide: (1) efficient basic accessible, ethical, scientifically appropriate, health care, pharmaceutical product and health insurance coverage for every citizen in America; (2) a health care work force including physicians, nurses and other personnel, which is adequate in number, well-educated, highly competent, and incentivized to provide appropriate high quality health services; (3) a system, including but not limited to, a federal independent agency provider, which provides economically sound medically necessary, scientifically well-founded, and appropriate health services 24 hours a day, 7 days a week, 365 days per year; (4) appropriate incentives for high level mathematical and scientific student and post-graduate training; (5) a respected and appropriately supported system of national public health services which will coordinate and manage health care emergencies including epidemics, national disasters, bio-terrorism episodes, nuclear disasters and other events; (6) national licensing of health care providers; (7) support for local, national and internationally based health care fraud detection, prosecution and punishment; (7) continued support for scientific research; (8) appropriate quality, professional and financial standards for all institutional providers of health services including hospitals, outpatient facilities, research institutions dealing directly with patients; (9) independent objective public health education; and (10) encouragement and support of the development of enforceable ethical standards related to health care, health-related information, and products which purport to effect health care.
Monday, November 2, 2009
Keep Your Eyes On The Ball
During the Reagan era, as a board member of the National Health Lawyers Association (which subsequently morphed into the American Health Lawyers Assocation) I learned of the enormous power vested in House-Senate conference committees, where proposed legislation may be rewritten and the vote for the rewritten, often very different bill than that originally passed by the house or senate, is straight up and down.
Instead of getting excited about the political hoopla surrounding health reform, I suggest my readers keep their eyes on the ultimate conference committee and its rewrite of health reform. That's where deals will be made, the decisions hammered out, and health reform will either be gutted or given the muscle that it needs to work. Take a look at Ezra Klein/Jim Horney's analysis of conference committee functions for insight into this legislative powerhouse.
Instead of getting excited about the political hoopla surrounding health reform, I suggest my readers keep their eyes on the ultimate conference committee and its rewrite of health reform. That's where deals will be made, the decisions hammered out, and health reform will either be gutted or given the muscle that it needs to work. Take a look at Ezra Klein/Jim Horney's analysis of conference committee functions for insight into this legislative powerhouse.
Monday, October 5, 2009
Critical Political Effectiveness
A few days ago, my wife and I visited the Lyndon B. Johnson museum and Library at Austin'sUniversity of Texas campus. We saw a detailed history of Johnson's life and political activities from childhood to death. What struck us was the thoroughness of his apprenticeship and life's training as a political figure and campaigner, his long-hours of work (often from 4 A.M. to midnight), his extraordinary Congressional career which earned him respect, and political chips, from Representatives and Senators on both sides of the aisles, and his principles concerning civil rights which dated to his early career as a teacher in a Texas Mexican-American primary school.
When Lee Harvey Oswald murdered President Kennedy, Vice President Johnson had the energy, talent, politcal experience, credibility, focus, commitment and contacts to become an extraordinary President, actively involved in passage of revolutionary civil rights and health care reforms, including the establishment of Medicare. However, his commitment to continuing the Vietnamese war eroded public support and led to his decision not to seek reelection.
In my opinion, President Obama lacks a number of the presidential qualities of President Johnson. Obama's decision to flee Washington to pursue the illusion of a Chicago Olympics, rather than to provide needed leadership to ineffective Harry Reid in the Senate battle over health care reform, demonstrates a lack of focus and a failure of staff to work with him to set an appropriate agenda. Obama abandoned the appearance of serious comitment to health care reform to chase after international games. Like the Olympics, his actions suggest amateurism.
When Lee Harvey Oswald murdered President Kennedy, Vice President Johnson had the energy, talent, politcal experience, credibility, focus, commitment and contacts to become an extraordinary President, actively involved in passage of revolutionary civil rights and health care reforms, including the establishment of Medicare. However, his commitment to continuing the Vietnamese war eroded public support and led to his decision not to seek reelection.
In my opinion, President Obama lacks a number of the presidential qualities of President Johnson. Obama's decision to flee Washington to pursue the illusion of a Chicago Olympics, rather than to provide needed leadership to ineffective Harry Reid in the Senate battle over health care reform, demonstrates a lack of focus and a failure of staff to work with him to set an appropriate agenda. Obama abandoned the appearance of serious comitment to health care reform to chase after international games. Like the Olympics, his actions suggest amateurism.
Thursday, September 3, 2009
Kathleen Sebelius Secretary, HHS: Reform To Help Older & Senior Women
Strengthening the Health Insurance System: How Health Insurance Reform Will Help America’s Older and Senior Women
Executive Summary
While all Americans shoulder the burden of rising health care costs and increasingly inadequate health insurance, the 17 million older women (ages 55-64) and 21 million senior women (ages 65 and older) in America have unique situations and health care needs that make them particularly susceptible to rising costs – at a time in their lives when access to affordable health care is increasingly important. Health insurance reform will remove these hurdles to ensure that older and senior women, along with all other Americans, get the quality, affordable health care they deserve.Link To Report: http://www.healthreform.gov/reports/seniorwomen/index.html
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