What I'm Reading (1)

Why I Am Pro-Life

By THOMAS L. FRIEDMAN

New York Times  Published: October 27, 2012

You don’t get to call yourself “pro-life” and want to shut down the Environmental Protection Agency, which ensures clean air and clean water, prevents childhood asthma, preserves biodiversity and combats climate change that could disrupt every life on the planet. You don’t get to call yourself “pro-life” and oppose programs like Head Start that provide basic education, health and nutrition for the most disadvantaged children. You can call yourself a “pro-conception-to-birth, indifferent-to-life conservative.” I will never refer to someone who pickets Planned Parenthood but lobbies against common-sense gun laws as “pro-life.”

 http://www.nytimes.com/2012/10/28/opinion/sunday/friedman-why-i-am-pro-life.html?partner=rssnyt&emc=rss&_r=0

 Mitch McConnell and John Boehner’s strategy worked

Washington Post  Posted by Ezra Klein on October 30, 2012 at 12:20 pm

Klein points out that some folks are endorsing Romney on the grounds that Obama doesn’t stand a chance of getting any cooperation whatsoever from Congress.  Needless to say this would be tantamount to rewarding Republicans for flagrant obstructionism and  putting their shot term political interests above the needs of the country.  Democrats could play that game too, in the event Romney wins, but this is, not the type of behavior that any voter would want to reward I would think .  

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/10/30/mitch-mcconnell-and-john-boehners-strategy-worked/

Medicaid on the Ballot

By PAUL KRUGMAN

New York Times   Published: October 28, 2012

If he [Romney] wins, Medicaid — which now covers more than 50 million Americans ………will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost………..So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.

            o   the great majority of Medicaid beneficiaries are in working families.

            o  Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system. According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance.

 http://www.nytimes.com/2012/10/29/opinion/krugman-medicaid-on-the-ballot.html?partner=rssnyt&emc=rss

The Working Poor: Invisible in America - Paperback by David K. Shipler

Paints a grim picture of the lives of the working poor and the huge obstacles that stand in the way of their ability to improve their economic status.  They rely on Medicaid and food stamps, but, as the book makes clear with detailed descriptions of their daily routines, they work long hours, often holding two or more jobs at once.  They hardly fit Romney’s contemptuous description: 

 “47 percent  of the people ……..are dependent upon government, who believe that they are victims, who believe that government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you name it.”

 

Another Romney Whopper

During the first debate, Romney claimed that he could cut personal tax rates without increasing the deficit because the rate cuts would be offset by the elimination of tax expenditures (loopholes).  An analysis by the Tax Policy Center (TPC) indicates that this is, indeed, possible but that Governor Romney failed to mention a couple of minor details – only people earning more than $200,000 a year would see their taxes reduced and the magnitude of the reduction would be greatest for those with the highest income[1].  Now the only cut that Romney has so far been willing to divulge that he would definitely cut Federal funding of the Public Broadcasting System  (thereby reducing the deficit by 1/100 of 1%). 

Since Romney has doggedly refused to release any other details about the “loopholes” that he would eliminate, the TPC has done their analysis following two basic principles:  (1) certain tax breaks were taken off the table based on TPC’s analysis of political realities and  (2) they tried to maximize the benefits to lower income taxpayers by first eliminating tax breaks that most benefited the wealthy[2].  In spite of this effort to make the changes as progressive as possible, the overwhelming share of the tax reductions still wound up going go to the very wealthy.  Peons who earn less than $200,000 a year would actually end up with a tax increase (Figure 3).

The dishonesty and cynicism involved here is simply breathtaking.  One can only hope that such mendacity will not be rewarded with the Presidency. 

A final note:  In dismissing the TPC analysis, Romney glibly allowed as how he could come up with just as many studies supporting his position and cited one study from an “independent, bipartisan, think tank”.  Turns out that the organization he was referring to is the American Enterprise Institute  By this standard, Rush Limbaugh and Bill O’Reilly are raging liberals.

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[1] The full report from the TPC is available at:  http://www.brookings.edu/research/papers/2012/08/01-tax-reform-brown-gale-looney

[2] The main tax breaks that were taken off the table were:

preferential rates on capital gains and dividends;

exclusion of income accrued in qualified retirement savings accounts;

pensions (e.g., Traditional and Roth IRAs, 401k plans, defined benefit pensions);

the step-up basis at death;

The Failure of Our Mainstream News Media

 I recently attended rallies in front of the US Supreme Court to show support for the Affordable Care Act (ACA) otherwise known as Health Care Reform or Obamacare.  I had no illusions that demonstrations would affect the outcome of the Supreme Court hearings, but since the event would be heavily covered by the news media I felt it was important for those who support the law to be as visible as possible.

The experience reinforced my already low opinion of the mainstream news media, particularly the TV news outlets.  First of all, I was astounded to find that virtually all of the news outlets I checked gave the impression that supporters and opponents were there in roughly equal numbers.  Even my beloved NPR gave that impression.  The reality was that supporters of the ACA outnumbered opponents by nearly ten to one as the following photographs clearly show.  The two views show demonstrators on the East and West sides of First Street NW immediately opposite the court.  I have outlined the signs of ACA opponents in red.  All other signs are carried by supporters. 

First Street NW looking east

                                                           First Street NW looking west 

Note: The group circled in yellow are school kids touring the Capital, not demonstrators.  There are no anti-ACA demonstrators

 A Missed Opportunity to Provide Real Information to the Public

The organizers of the pro-ACA demonstration held a news conference that featured real people who related personal experiences in which the ACA had rescued them from the kind of abuses that are now prevalent in our employer-based, for-profit, insurance system.   The stories were compelling and would have provided TV viewers with very clear and compelling examples of how responsible people who have played by the rules have been screwed by the present system and helped by the ACA.  None of this made the evening news even though it took place less than 50 feet away from a mob of 40 TV news cameramen and a handful of carefully coiffed TV reporters twiddling their thumbs while waiting to perform their 30-second sound bites.  Not a single one of them bothered to walk over and listen to the stories even though they had been urged to do so by the organizers. Here are just two of them.

(1) Stacie and Her Twin Daughters

Stacies' twin daughters, now 11, were diagnosed with leukemia when they were four. They both needed stem cell transplants and other cancer treatments. Once the cancer was in remission the twins needed hormone injections in order to grow normally.  Stacie’s husband’s company switched to CIGNA health insurance, and CIGNA refused to cover the hormone shots, which cost $440 each.  The high cost of these medications and related treatment costs forced Stacie and her to file for bankruptcy.  Thanks to the ACA, however, the family was  able to obtain coverage for the girls' treatment under a provision that provides $5 billion to insure families that have been denied coverage for a pre-existing condition. The pre-existing condition exclusion will disappear in 2014 when the ACA becomes fully operative.  In the meantime, the act

                                                               The Twins                          Stacie

the ACA is providing  desperately needed coverage for families like Stacie's.


 (2) Christina

While attending a work-related conference, Christina let two men buy her drinks at a bar in Fort Lauderdale. The next thing she knew, she was lying on a roadside with cuts and bruises that indicated she had been raped. Since she did not know anything about the men who raped her, she was advised by her doctor to take anti-AIDS drugs for 30 days as a preventive measure.  She never developed an HIV infection, but months later, when she lost her health insurance and sought new coverage, she ran into a problem.

The insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication "raised too many health questions". The company told her they might reconsider in three or more years if she could prove that she was still AIDS-free.

                                                

CBO Assessment of Past Demonstrations to Reduce Expenditures

A former colleague of mine at CMS sent the following URL.  It  is a link to the blog of Doug Elmendorf, Director of the Congressional Budget Office, and in this recent post (which caused quite a stir at CMS) Elmendorf supports the statement in my previous post that past demonstrations have failed to show significant savings.  It is important to note that even the demonstrations that succeeded in reducing utilization did not really save money because the payments providers received for extra case management services exceeded the savings resulting from reduced utilization.

http://cboblog.cbo.gov/?p=3158#more-3158

Does the ACA Really Address the Spiraling Cost of Healthcare

The following is my response to a video on the Affordable Care Act (ACA) otherwise known as Obamacare.  The video can be found through a link on Tony Hausner's blog at:

http://tinyurl.com/7tcmuvh

Tony

The video does a good job of presenting the positives of the ACA.  But, as you have heard me say many times before, I find virtually no serious discussion of how we are going to deal with spiraling health care costs.  The video glosses over this and leaves the impression that the ACA will introduce changes that will somehow deal with this issue when, in fact, the only part of the ACA that has any chance of reducing health care costs is the section that calls for the elimination of over-payments to Medicare HMOs.  And these are not a done deal by any stretch of the imagination!  Moreover, the Republicans are busy misrepresenting these cuts by suggesting to beneficiaries that they would threaten their Medicare benefits. 

Unfortunately, all of the talk about improved payment systems that will incentivize quality and cost-effective is just wishful thinking.  CMS has been running demos on payment systems for at least two decades and has yet to come up with anything that works, and don't hold your breath waiting for the Center for Medicare and Medicaid Innovation to come up with anything better.  I continue to track the Center’s activities, and, based on publicly available information plus information gleaned from discussions with former colleagues at CMS, I see no reasons for optimism. 

In my humble opinion, the only way of truly controlling health care costs will require us to abandon our current fragmented health insurance system and replace it with something that looks more like the systems in Europe and Canada.  We presently have Medicare for the disabled and elderly, the VA system for veterans, Tricare for active military and their dependents, and 50 State Medicaid programs.  And that's just the public sector.  In the private sector, we have  the only for-profit insurance system in the world, with hundreds of individual companies and thousands of benefit packages, not to mention 20,000 insurance brokers acting as middle men.  We need to move to a national system with (1) uniform benefits,eligibility, and payment policies, (2) universal participation and pooling of risk, and (3) the ability to monitor utilization and quality at the national level. This does not necessarily mean that government has to run everything.  In Europe, there are lots of examples of systems where insurance is provided by private, non-profit companies.  The big difference is that the companies are not only non-profit, but are tightly regulated by government so that eligibility, benefits and payment policies are uniform.  To the obvious rejoinder that this would not be politically feasible in the US I would reply that Americans should then begin planning for a future in which health care costs take up 40% of GDP.