Friday, November 6, 2009
Insurance Across State Lines Won't Work
So says me in today's Raleigh News and Observer. Here is the New Yorker article in which Atul Gawande made McAllen, Texas the most famous medical market in America. The folks at Dartmouth have been analyzing 'practice patterns' or variations in medical care for many years. Here is a link to their web site. Buy insurance across state lines is a great political tag line....it just won't work.
Public Option OK?
Jacob Hacker and Diane Archer have an article in The New Republic arguing that the Public Option as written in the current bills might not be as weak as many note. I don't think I am convinced, but they have a reasonable argument.
Thursday, November 5, 2009
CBO score of Boehner Plan
CBO released score of the GOP health reform (Boehner plan). Key facts are these: in 2010, the uninsured rate is 17% of legal residents. After 10 years of the Boehner plan, the uninsured rate is 17% of legal residents. CBO does say 3 million folks insured over these 10 years who otherwise wouldn't be. And bill is estimated to reduce deficit by $68 Billion over 10 years.
House Democratic bill is estimated to reduce deficit by $102 Billion over 10 years and drop uninsured rate of legal residents to 4-5%.
This was not a wise move by Republicans to release this plan....they can't say with a straight face believe the deficit reduction of our bill as scored by the CBO, but not the deficit reduction for your bill as scored by the CBO.
This is the third time this fall that an external factor has fallen into the lap of the Dems/the President and helped reform.
1. The you lie incident during the presidents speech...rallying wavering Dems.
2. The AHIP report released just before Senate Finance Committee vote.
3. This plan released by the Republicans.
House Democratic bill is estimated to reduce deficit by $102 Billion over 10 years and drop uninsured rate of legal residents to 4-5%.
This was not a wise move by Republicans to release this plan....they can't say with a straight face believe the deficit reduction of our bill as scored by the CBO, but not the deficit reduction for your bill as scored by the CBO.
This is the third time this fall that an external factor has fallen into the lap of the Dems/the President and helped reform.
1. The you lie incident during the presidents speech...rallying wavering Dems.
2. The AHIP report released just before Senate Finance Committee vote.
3. This plan released by the Republicans.
Abortion as the hold up....really?
Count me as flabbergasted on this one. Abortion as the stumble on a health reform bill in the House. Really?
I don't say that because I think abortion is not an important issue. I say because I have never met anyone who changed their mind about it (except for politicians who want to run for the Republican nomination for President....but I haven't actually met any of them).
The House is struggling to come up with legislative language to ensure that no federal money would go for abortion, that would line up with what the President said in his speech (no fed funds for abotion under health bill). Activists on both sides are trying to hitch their cause to something that is inevitable....but they are making it less so!
They need to work out a compromise here and move ahead. I would be fine with just saying public option won't pay for abortion....in fact, I would just take it out because it is so weak it doesn't mean much, but that is another story.
Abortion is one of the most contentious societal issue we have....and we aren't going to work it out while we are doing health reform.
As an aside, consider the following facts when thinking about the quest for developing language that would ban the use of federal money from being used for abortion:
*If a single abortion has ever been performed and paid for by employer provided health insurance, then the tax exclusion of employer paid wages means that federal money subsidized this abortion.
*If a single abortion has been performed in a hospital constructed under the Hill-Burton hospital construction Act of 1949, then the federal government subsidized that. Hint: just about every hospital constructed between 1949 and the late 1970s benefitted from Hill-Burton.
*If a hospital or clinic organized as a 501-c-3 corporation (aka non profit) has provided an abortion, then that institution has benefitted from being non profit; they have benefits ranging from likely paying no local property taxes, to not paying state and federal income taxes, etc.
*A physician who performs an abortion and who trained in the United States benefitted from direct Graduate Medical Education subsidies from Medicare to the teaching hospital in which they did their residency and fellowship, and their salary while training was essentially paid by Medicare via indirect Medical Education (IME) payments whereby Medicare pays teaching hospitals more for all care they provide in order to support residency programs and the training of physicians.
etc, etc, etc, etc.
I don't say that because I think abortion is not an important issue. I say because I have never met anyone who changed their mind about it (except for politicians who want to run for the Republican nomination for President....but I haven't actually met any of them).
The House is struggling to come up with legislative language to ensure that no federal money would go for abortion, that would line up with what the President said in his speech (no fed funds for abotion under health bill). Activists on both sides are trying to hitch their cause to something that is inevitable....but they are making it less so!
They need to work out a compromise here and move ahead. I would be fine with just saying public option won't pay for abortion....in fact, I would just take it out because it is so weak it doesn't mean much, but that is another story.
Abortion is one of the most contentious societal issue we have....and we aren't going to work it out while we are doing health reform.
As an aside, consider the following facts when thinking about the quest for developing language that would ban the use of federal money from being used for abortion:
*If a single abortion has ever been performed and paid for by employer provided health insurance, then the tax exclusion of employer paid wages means that federal money subsidized this abortion.
*If a single abortion has been performed in a hospital constructed under the Hill-Burton hospital construction Act of 1949, then the federal government subsidized that. Hint: just about every hospital constructed between 1949 and the late 1970s benefitted from Hill-Burton.
*If a hospital or clinic organized as a 501-c-3 corporation (aka non profit) has provided an abortion, then that institution has benefitted from being non profit; they have benefits ranging from likely paying no local property taxes, to not paying state and federal income taxes, etc.
*A physician who performs an abortion and who trained in the United States benefitted from direct Graduate Medical Education subsidies from Medicare to the teaching hospital in which they did their residency and fellowship, and their salary while training was essentially paid by Medicare via indirect Medical Education (IME) payments whereby Medicare pays teaching hospitals more for all care they provide in order to support residency programs and the training of physicians.
etc, etc, etc, etc.
Tuesday, November 3, 2009
Republican Alternative Plan
Ezra Klein writes about this well in a very straightforward manner. Not a serious plan.
Sunday, November 1, 2009
Bob Creczyn in N and O
BCBS NC CEO Bob Greczyn has an op-ed in today's Raleigh News and Observer. I would like to highlight a quote with which I totally agree (para 3):
".....insurance premiums have to rise in concert with mounting health care costs and increasing demand for the things insurance pays for: hospital stays, drugs, medical devices, and diagnostic testing. [my note: and doctors] Reform that doesn't address these underlying cost drivers will drive costs up, not down."
By far the most effective, and simple policy prescription to address what he notes is repealing the tax exclusion for employer provided health insurance. When employers pay for the premiums of employees, this provides them with tax free income and has systematically lead (for half a century) for persons to have more insurance than they would choose if they purchased insurance with after tax dollars, and therefore understood how much their insurance cost. This is by far the most bipartisan notion that exists in health policy circles.
The link to the right by Jon Gruber outlines the issue. There have been a variety of proposals with this at their heart, including Sen. Burr's Patient's Choice Act, Sen. Wyden and Bennetts reform plan that had bipartisan support before President Obama got elected.
As I have written in the past, the biggest barrier to reducing the rate of health care spending growth is us. And while the high cost insurance tax in the Senate plan is not my ideal solution (see above), it is a de facto capping of the tax exclusion and far preferable to the House bill income tax increase. Here are three suggestions I made along with Frank Hill for how to improve the Senate bill.
".....insurance premiums have to rise in concert with mounting health care costs and increasing demand for the things insurance pays for: hospital stays, drugs, medical devices, and diagnostic testing. [my note: and doctors] Reform that doesn't address these underlying cost drivers will drive costs up, not down."
By far the most effective, and simple policy prescription to address what he notes is repealing the tax exclusion for employer provided health insurance. When employers pay for the premiums of employees, this provides them with tax free income and has systematically lead (for half a century) for persons to have more insurance than they would choose if they purchased insurance with after tax dollars, and therefore understood how much their insurance cost. This is by far the most bipartisan notion that exists in health policy circles.
The link to the right by Jon Gruber outlines the issue. There have been a variety of proposals with this at their heart, including Sen. Burr's Patient's Choice Act, Sen. Wyden and Bennetts reform plan that had bipartisan support before President Obama got elected.
As I have written in the past, the biggest barrier to reducing the rate of health care spending growth is us. And while the high cost insurance tax in the Senate plan is not my ideal solution (see above), it is a de facto capping of the tax exclusion and far preferable to the House bill income tax increase. Here are three suggestions I made along with Frank Hill for how to improve the Senate bill.
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