Impeding changes to our Health Care system

[xoxoxoBruce]

The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

WSJ

$1.4 million a day, that they admit to. I don't see a chance for the public being a winner in this fight. However, if the little guy really wants to, this is an opportunity to track his/her elected representative's actions, and get involved with the political process during their next election cycle. Kick the bastards out, that are working against your interests.

That said, it won't happen. Joe Average will grouse and bitch about Congress, then quickly turn his attention to who will be the next American Idol on his HD, wide screen, Wallymart TV. Smug in the belief the American system is best, because it's of the people*, by the people*, and for the people*.


* At least the ones with the money and power... or the gumption to get off their fat ass and do something about it.

[TheMercenary]

Originally Posted by Redux

There is a reason why most of the insurance industry lobbying money is working as hard as it is against comprehensive reform.

And, even under the Swiss model you prefer, the government subsidizes consumers when the costs exceed a government set percentage of income. Someone always has to pay.

IMO, greater competition (like the proposed exchange), along with standardized federal regulations (like those I listed above), are still is the best way to lower costs and/or ensure a basic level of service.

I am open to other ideas, but all I hear are complaints and misrepresentations of the proposals on the table, and not solutions.

I suggested earlier how I would pay for it (increasing FICA taxes on high income wage earners). The other proposals most under consideration also are targeted to the top 1-5% of taxpayers.

Any model in which the insurance companies come out ahead at the expense of all other elements is not a solution. And so far I have seen nothing proposed by Congress which does not do that very thing. Every proposal on the table has elements of minor reform of the insurance process while giving them a HUGE increase in profit.

Originally Posted by TheMercenary

Any model in which the insurance companies come out ahead at the expense of all other elements is not a solution. And so far I have seen nothing proposed by Congress which does not do that very thing. Every proposal on the table has elements of minor reform of the insurance process while giving them a HUGE increase in profit.

I dont think ending exclusions on pre-existing conditions, requiring caps on total out-of-pocket expenses, eliminating cost-sharing (no co-pays or deductibles) for preventive care, mandating a required level of basic benefits are minor reforms.

Of course insurance companies will "come out ahead" if an additional 30+ million people, mostly employees in small businesses currently w/o insurance, will have access to affordable health care through new programs like the health insurance exchange. The point is to force the companies to make it more affordable through a competitive bid process and requiring insurance companies to meet specific costs and benefit provisions in order to participate in the exchange.

How else would you propose providing coverage to those millions?

Or for those 200+ million with employer-based insurance, how else do you rein in the spiraling costs and/or provide greater choice of that private provider system?

The only other solution is even greater federal regulation of the insurance industry or to do away with insurance companies completely.

[TheMercenary]

Originally Posted by Redux

I dont think ending exclusions on pre-existing conditions, requiring caps on total out-of-pocket expenses, eliminating cost-sharing (no co-pays or deductibles) for preventive care, mandating a required level of basic benefits are minor reforms.

They are if you are trading profits to the insurance industry for them at the expense of all the other elements of the medical system who will have to take cuts or pay more for others to get the benefit and funnel profits to the insurance industry.

Of course insurance companies will "come out ahead" if an additional 30+ million people, mostly employees in small businesses currently w/o insurance, will have access to affordable health care through new programs like the health insurance exchange. The point it to make it affordable by forcing greater competition.

Which is why it really is not reform.

How else would you propose providing coverage to those millions?

Everyone pays the same percent of their income to get the benefit. And or a user tax on goods and services akin to the VAT in the UK.

Or for those w/insurance, how else do you rein in the spiraling costs and/or provide greater choice of the current employer-based, private provider system.

Much more comprehensive reform than that proposed by any plan being offered by Congress who is merely pandering to the insurance industry while they try to sell a bandaid to the American public. I promise this will have significant unintended consequences which will be difficult to recover from.

The only other solution is even greater federal regulation of the insurance industry or to do away with insurance companies completely.

Both of those options are quite good.

[TheMercenary]

One of the first casualties as Insurance companies begin to cost shift.

WASHINGTON–More than 660,000 seniors next year will lose the private Medicare plans they now have because some insurers are dropping coverage in response to tougher federal requirements.

Most of those beneficiaries are enrolled in a type of Medicare Advantage plan called Private Fee for Service, where enrollment has surged from about 820,000 three years ago to more than 2.44 million today. PFFS enrollees, unlike those under other Medicare Advantage plans, can see any doctor they like as long as he or she accepts payments through their plan. Medicare Advantage plans are subsidized by the federal government and run by insurance companies; most operate with networks of providers.

President Barack Obama and Democrats in Congress have proposed more than $100 billion in payment cuts to private Medicare plans over 10 years to help pay for expanding coverage to the uninsured. They argue that the private insurers are overpaid -- Advantage plans cost the government 14% more on average per beneficiary than traditional Medicare -- and the cuts will help control Medicare costs.

"Today's announcement demonstrates the real impact that policy changes can have on the health security of seniors in Medicare Advantage," said Karen Ignagni, president and chief executive of America's Health Insurance Plans, the trade association for insurers. The proposed payment cuts "will put the entire program at risk and cause seniors to face even higher premiums, further reductions in benefits and fewer health-care choices."

http://online.wsj.com/article/SB125443003194657369.html

[TheMercenary]

Another change is that everyone's premiums are going to go up. My premiums went up $300 a month last year. This year they have gone up another $300. And my new employer REQUIRES every employe to take their insurance option, it is mandatory. This is in anticipation of the Obamanation Healthcare Reform.

Originally Posted by TheMercenary

They are if you are trading profits to the insurance industry for them at the expense of all the other elements of the medical system who will have to take cuts or pay more for others to get the benefit and funnel profits to the insurance industry.

Which is why it really is not reform.

Everyone pays the same percent of their income to get the benefit. And or a user tax on goods and services akin to the VAT in the UK.

Nothing you suggested reduces the spiraling costs without heavy subsidy.

You want everyone paying the same percent of their income to get benefits, but you also want the working poor and middle class to pay a greater percent of their income through a vat tax.

It sounds like you want to do away the entire employer based system and the insurance industry.

IMO, that is no reform, that is blowing up the system completely. And then you support greater federal regulations?

I dont get your plan at all.

[TheMercenary]

Originally Posted by Redux

Nothing you suggested reduces the spiraling costs without heavy subsidy.

We don't need subsidy, we need across the board reform of the industry. Take a look at the reform in Mass and see how it is on the verge of epic failure.

You want everyone paying the same percent of their income to get benefits, but you also want the working poor and middle class to pay a greater percent of their income through a vat tax.

Absolutely. It is the only way the program will survive the long term. Any other change will be reversed the next time there is a switch in power in Congress. And that may not be as far off as people think.

[TheMercenary]

By now, it should be obvious to everyone that the Massachusetts model was the president’s health reform endgame all along. As articulated last week in his speech to the nation, Obama’s proposal appears to replicate the Massachusetts plan, sans public option. And yet few in the media have taken a good look at the Massachusetts model, and its many shortcomings. With Congress back in session and legislation on the way, now is the time to do so.

The Massachusetts model includes an individual mandate that requires people to carry insurance. The state helps people who can’t afford a policy pay for one. Those with incomes up to 300 percent of the federal poverty level ($66,150 for a family of four and $32,496 for an individual) receive full or partial subsidies. If someone doesn’t qualify for a subsidy, they must purchase insurance on their own. If they want to, they can use the state’s shopping service, called the Connector. Those deemed able to afford a policy must pay a tax penalty if they don’t buy one.

Massachusetts embarked on its reform efforts with several advantages. The state’s number of uninsured residents was lower than most states, and a large percentage of employers offered coverage and still do. Boasting a tradition of strong insurance regulation, the state already required insurers to cover sick people. The state’s Medicaid waiver was up for renewal, and politicians persuaded the federal government to recast the waiver and expand coverage to more poor people.

But recent Census Bureau statistics show that, in 2008, some 352,000 Massachusetts residents did not have coverage, even though the law requires that they do. That’s about 5.5 percent of the state’s population; up from the 2.6 percent who were uninsured in the years after reform took effect. These numbers caused Dr. Steffie Woolhandler, a professor at the Harvard Medical School (and unabashed single-payer advocate), to remark: “Today’s numbers show that plans that require people to buy private insurance don’t work. Obama’s plan to replicate Massachusetts’ reform nationally risks failure on a massive scale.”

continues:
http://www.cjr.org/campaign_desk/hea...from_mas_5.php

[TheMercenary]

Meanwhile, few of the near-poor uninsured seem able to afford even the newly subsidized policies, and the federal funds providing the bulk of the subsidies are set to expire in 2008. The unsubsidized coverage mandated for middle-income individuals (most of whom have incomes between $30,000 and $50,000) offers a bitter choice between unaffordable premiums (at least $7,200 for comprehensive coverage for a single 56-year-old) or plans so skimpy (e.g., a $2,000 per person deductible with 20% coinsurance for hospital care after that) that they hardly qualify as insurance. The religious coalition that was key to passage of the legislation has already called for a delay in enforcement of the individual mandate, fearing that it will place unbearable financial stress on many of the uninsured. In sum, neither government, nor employers, nor the uninsured themselves have pockets deep enough to sustain coverage expansion in the face of rising costs.

http://econlog.econlib.org/archives/...setts_h_1.html

[TheMercenary]

PNHP's study found that the state's 2006 reforms, instead of reducing costs, have been more expensive. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.

Many low-income residents who used to receive free care now face co-payments, premiums and deductibles under the new system - financial burdens that prevent many from receiving necessary medical treatment, the study said. Since the state's reforms passed, premiums under the state insurance program have increased 9.4 percent. The study found that a middle-income person on the cheapest available state plan could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

"We are facing a healthcare crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits - all at the expense of American consumers," said Sidney Wolfe, MD, director of Public Citizen's health research group. "Massachusetts' failed attempt at reform is little more than a repeat of experiments that haven't worked in other states. To repeat that model on a national scale would be nothing short of Einstein's definition of insanity."

http://www.healthcarefinancenews.com...system-failure

[TheMercenary]

A very good, highly footnoted, review of the Mass system by Cato.

http://www.cato.org/pubs/bp/bp112.pdf

Personally, I dont find articles from two libertarian sites (cato and econlib) and an insurance industry site (health care finance news) to be objective or convincing.

Nor is the personal mandate, as established in Massachusetts, set in stone in the current proposals.

But thats just me.

[TheMercenary]

Originally Posted by Redux

Personally, I dont find articles from two libertarian sites (cato and econlib) to be objective or convincing.

They are far more objective than the BS we are being fed from the White House or spouted by Demoncrats or Republickins who both have agendas to complete.

Nor is the personal mandate, as established in Massachusetts, set in stone in the current proposals.

Not set in stone but certainly a halmark of the plans currently before both houses.

[classicman]

Whats good for the rest of the nation apparently isn't good for Nevada. WTF is this and why isn't anyone outraged?

Changes to a health care reform bill in the U.S. Senate increased to $2.3 billion the extra money that would assist low-income residents in Nevada.

That is the word from Sen. Harry Reid, D-Nev., who sought changes to a proposal from Sen. Max Baucus, D-Mont. The changes would provide more health care help for Nevadans without dipping into the state's budget at least temporarily.

Nevada would be one of four states to be reimbursed 100 percent by the federal government over five years for the cost of increasing the number of people eligible for Medicaid.

After five years, the federal government would pay 82.3 percent of the cost to provide care to the newly eligible people. Nevada would pay 17.7 percent, said sources who worked on the legislation.

"I promised the people of Nevada that I wouldn't support any health insurance reform proposal that wasn't good for our state, and I meant it," Reid said in a statement.

An earlier version of the bill would have required states to increase the percentage rate they pay for Medicaid. Reid said that was unacceptable and sought changes to shield Nevada from such an increase.

link

Why is it fair for all the other states to pay and not his??? This is the kind of BS that really pisses me off. Basically they are either adding to the cost of the program or taking money from other states. Either way it seems very wrong.