The Buie Knife

U.S. House Passes Comprehensive Health Care Reform

I haven't yet studied the details of the health care reform legislation passed by the U.S. House, and the devil is always in the details. But on the surface, it's difficult to understand how anyone but insurance company profiteers could disagree with these provisions of the legislation. "Private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies...Businesses with payrolls exceeding $500,000 would (in 2013) be required to offer their workers insurance or pay a fine of as much as 8 percent of payroll. Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income."

Previous:

• At Least 7 Important Questions Remain About the "Public Option" in Health Care

The Real 'Death Panels'

Two 'Good Deaths': The Kennedys, Ted and Eunice, Teach Us How to Die

August 2009 has brought two high-profile deaths from the same family -- Eunice Kennedy Shriver and her brother, Senator Edward Kennedy. Somewhat surprisingly, these two hard-chargers help to teach us what a good death is. Senator Kennedy planned "a good ending for myself," according to The New York Times, as it described his last days. He wrote a letter of confession, summing up his strengths and weaknesses, to Pope Benedict, and received a reply of  blessing from the Pope. Father Patrick Tarrant described Senator Kennedy's last moments, at peace, at home surrounded by loved ones, in this video.

"The last months of my dad's life were not sad or terrifying, but full -- filled with profound experiences, a series of moments more precious than I could have imagined," said Ted Kennedy Jr. "He taught me more about humility, vulnerability and courage than he had taught me in my whole life."

Maria Shriver, in her remarkable eulogy to her mother, described Eunice's last weeks and months: "She who never sat still was forced to confront stillness, and it was hard for her, but she never complained and she never asked for pity. She fought, and she fought, and she fought, right up until her very last breath....As she sat still, she taught me how important that is in one's life. She taught us that real strength can also be found in real vulnerability, and that it's OK -- even important -- to lean on those who love you. Now if you had told me a few years ago that at the end of my mother's life she and I would sit in a room and just be, I would have said you were crazy. If you had told me that at the age of 52, I would finally get up the nerve to crawl into bed with my mother, hold her, and tell her that I love her, I would have said you were nuts. And if you had told me that Mummy and I would write poetry together, I would know for sure you that you'd lost your mind. But all those things really happened, as Mummy learned to let go. At the end of her life, she was strong and vulnerable, she was tired and tireless, determined and also ready to surrender to God."

Related:

• Time.com: The Lessons Ted Kennedy Taught At Death
• Ann Hulbert explores "What Ted Kennedy's end-of-life choices may say about health care reform."

Single-Payer Already Dominates: Competition Is Currently Virtually Non-Existent in Many Health Care Markets As Private Monopolies Post Huge Profits

One of the arguments against a public health insurance option is that private health insurers will not be able to compete with a Medicare-like plan that doesn't have to turn a large profit and can use bulk-rate pricing to lower costs. But the truth is that there is currently virtually no competition for the big health insurance providers in many states, the Associated Press reports. What we have today is a highly profitable ostensibly private monopoly that provides most health insurance coverage. In many markets, there is ALREADY SINGLE PAYER, except it's for-profit and run by private entitites, not the government. The "profit" comes directly from taxpayer subsidies to these private corporations. An Urban Institute study estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people.

"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."

Related:

• At Least 7 Important Questions Remain About the "Public Option" in Health Care
• Nearly 1 in 5 North Carolinians Are Priced Out of Health Insurance

Silly, Bogus, Retro 'Socialism' Charges on Health Care Reform

The charges that Obama is trying to bring "socialism" to the health care marketplace is just silly, retro ignorance. We already have A LOT of socialism in U.S. health care. Overtly, 40% of Americans have "government health insurance," when you count Medicare, the VA, the military, government employees, children's health insurance program, and Medicaid for some of the poor. Then there is all the "uncompensated care" from the uninsured who can't pay. So if you add the 15% uninsured (who will receive care if they get sick, but many of them cannot pay for it), and the 40% who are already in government health insurance, that's 55%. Then consider the $300 billion in tax breaks for private health insurance through employers, and you already have pervasive government involvement in the health care system. I'm not even including the budget for the National Institutes of Health or other agencies.

We're not arguing over "socialism" or government involvement in health care. We're simply considering ways to restructure the system so that it does a better and more efficient job of paying for care that is already given. And ways to make insurance more affordable for small businesses and individuals.

In other words, the "socialism" charge is just silly, retro, not based on the reality of health care today.

Lack of Economical, Comprehensive Health Insurance in U.S. Leads to Medical Tourism, Especially to Turkey

One of the alluring things about going to Turkey is comprehensive health insurance for the family at minimal cost, something that hasn't been available to us recently in the U.S. We're part of a trend. "Americans prefer Turkey for low-cost health services," reports TurkishNY.Com.  USA Today reports on the trend in medical tourism -- Americans going abroad for surgeries and dental care.

Kind of sad, though, that first-world Americans are fleeing to second-world countries for medical care, isn't it?

Why Real Conservatives Must Support Health Care Reform

David Frum, in "What If We (Conservatives) Win the Health Care Fight?" suggests that in the long run, the nation will lose, because the status quo means: "(1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments. We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion."

Andrew Sullivan adds that health care costs are crippling the global competitiveness of U.S. businesses. He believes real conservatives should propose "ending the tax exemption for businesses; medical malpractice reform; an independent body to provide some kind of data on the relative effectiveness of treatments; incentives to reward doctors less for any and all services provided than for health outcomes within clear budgets." Real conservatives "should point out that the current proposals are not tough enough on costs - and criticize Obama for that, not for fantasies like a communist takeover or euthanasia program for special needs kids."

We ALREADY HAVE socialized medicine in this country because we do not let the uninsured die in the streets, Sullivan points out -- it's just not paid for -- and that path is unsustainable:

"If you have guaranteed emergency room care for the uninsured at public expense, you have already effectively socialized medicine. It makes no sense not to bring these people into the insurance system, and to offer less expensive, long-term preventive healthcare. To insist that ideology stand in the way of this piece of compassionate common sense is irresponsible."

Update: "Stormy," a self-described conservative, responds to me and grudgingly supports "socialist" Medicare, or concedes that it is too popular to dismantle; acknowledges that the government needs to purchase health insurance for the poor, and calls for malpractice or tort reform. On those things we can agree. He also calls for the elimination of state and federal government mandates of certain kinds of coverage in order to lower costs. I respond to him. 

Related:

• Without Health Care Reform, U.S. Will Go Bankrupt
• How Government Subsidies Prop Up Private Health Insurance
• Abortion in Health Reform: Common Ground Found
• Yes, ObamaCare Means Huge Expansion of PRIVATE Health Insurance
• House Bill 3200 Improves Affordability of Health Care for People Like Me. Ten Reasons to Support It
• At Least 7 Important Questions Remain About the "Public Option" in Health Care
• 'Act in Haste and Repent in Leisure' on Health Insurance Reform Legislation. Let's Hold Off Passage Until We Understand It
• Obama's Health Insurance Reform Plan Is NOT Single-Payer, Like Canada's and Britain's
• Obama: Health Care Status Quo is the Worst Option
• Switzerland: Model for U.S. Health Reform?
• Unrealistic Expectations for Health Care Reform
• Medical Care Has To Be Rationed; Why Health Care Costs So Much

Without Health Care Reform, U.S. Will Go Bankrupt

It's shocking to me that Republicans are opposing cuts in Medicare, to increase efficiency and reduce waste, given that their own attempts to cut Medicare waste in 2006 ran into Democratic opposition. The same Republicans who cheered when President Bush proposed more than $500 billion in Medicare cuts now say President Obama's Medicare cuts will be "disastrous."

At the same time, former GOP House Majority Leader Dick Armey denounces Medicare as "tyranny," because seniors are forced to participate. 

Both positions are untenable. Must Medicare always be a political football? The cynicism here is blatant.

Democrats want to reduce projected increases in Medicare payments to providers by more than $200 billion over 10 years, in part to pay for health care reform. Medicare spending must be reduced, otherwise the nation will go bankrupt. Cuts Obama proposes, he says, will not affect actual benefits to senior citizens, but instead reduce "overpayments, waste and corporate profits...This is money that is subsidizing folks who don’t need it."

James Kwak, the Baseline Scenario: "The need to reduce growth in Medicare spending stems from the simple fact that otherwise Medicare will blow through the entire Federal budget within the next few decades. Not reducing the Medicare growth rate is not an option. If I were a senior, or expected to be one in the next couple decades, I would very much want health care reform now, because the alternative will be much more draconian cuts to Medicare benefits in the future as the national debt explodes."

E.D. Kain: In 2007, total health care spending was $2.4 trillion dollars.  Per capita, health care costs were an average of $7900.  This number is rising, and total spending is supposed to reach over $4 trillion by 2017, an estimated 20% of GDP.  Premiums on employer-based coverage rose 5% in 2008.

Ross Douthat, NYTimes, "Telling Grandma No": "Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees. That’s supposed to be the Republicans’ job. They should stick to doing it."

The White House has put out a fact sheet on how to reduce waste and increase efficiency in Medicare.

Another way to control costs is to tax cadillac health insurance plans that have no deductibles. "With health care costs increasing at more than twice the general rate of inflation," writes Joe Nation in the San Francisco Chronicle, "any reform that does not adequately address costs will bankrupt both our economy and the U.S. Treasury, and thus ultimately will fail. Health care spending in 2009 will be 17 percent of our gross domestic product, nearly double its level in 1980. Projections suggest it will hit close to 20 percent in 2017. The most significant and simplest policy to control costs - one that has thus far been rejected by President Obama and the Congress - is to tax employer-provided health care benefits. It is not the only step, but it may be the most important one." Fortunately, he says, health care legislation emerging from the Senate may tax employer health-care benefits.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/22/INDR19B11F.DTL#ixzz0P0n9teS7

How Government Subsidies Prop Up Private Health Insurers

In health care, the definitions of "public" and "private" are murky at best. Tax subsidies for private health insurance now total more than $300 billion a year, according to Edward Kleinbard, the top economist for the Joint Tax Committee in Congress.

The debate over "government (public) health insurance" vs. "private health insurance" seems like a false choice to me. The fact is that there is no purely "private health insurance" and "public health insurance," but a blurring of the two. "Private" insurance today receives all kinds of "public" support from government in the form of tax exemptions and subsidies, and "public" insurance has elements of private insurance, in that people pay premiums which are supposed to finance the group plans they are in.

In North Carolina, the state pays a a private, so-called "non-profit," Blue Cross Blue Shield, to administer the health plan for public employees. BCBS has no real competition -- it has an effective monopoly in the state -- and it benefits from government largesse. The executives who run it receive huge salaries and bonuses while subsidized by taxpayers.

The Robert Wood Johnson Foundation a few years ago produced "Tax subsidies for private health insurance: who benefits and what are the implications for new policies?"

Abortion in Health Insurance Reform Legislation: Common Ground Found

Wall Street Journal: "Keeping Health Care Reform Neutral on Abortion." "Lost in the  vitriol about health care is a surprising development: pro-life and pro-choice leaders say they don't intend to use health reform to shift the balance of power in their direction. Many activists on both sides say any big changes to health care should maintain the status quo in the abortion stalemate." Read the whole thing.