A Monday Tuesday Health Care Mashup (9/8/09)

September 8, 2009

Medicalinsurance1(Update: AAARRGGHH! My bad on the day – still unconsciously trying to hang onto summer, I guess.)

(One day, I won’t be posting on this topic any more – by the way, posting may be questionable for part of this week…don’t know exactly when yet.)

Dem U.S. House Rep Anthony Weiner tells us the following over at The Hill (here)…

The truth is that the United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veterans Administration, the Department of Defense and the Bureau of Indian Affairs.

Understanding that these single-payer health programs are already a major part of our overall health care system should help us visualize what an actual public plan would look like. These institutions also provide health care to millions of satisfied customers in every community who would heartily agree that the government can build and run programs that work quite well.

Medicare also provides us with a case study in the hypocrisy of our Republican friends who have built their party on a 44-year record of undermining this popular program. And now their Chairman sees no irony in ripping “government run” healthcare while publishing an op-ed opposing changes to Medicare.

If Medicare has been such a success, why not extend it? Why not have single-payer plans for 55 year olds? Why not have one for young citizens who just left their parents or college coverage?

As I read this, I realize that Weiner is the one who should be I charge of “message control” for the White House on this issue (and in the matter of single payer, I give you the following from Dr. David Himmelstein of Harvard Medical School here in the New York Times)…

Q: A major goal of health care reform is to cover the uninsured. But does covering more people necessarily mean that medical bankruptcies will decline?

A: No. Our most recent study found that nearly two-thirds of Americans who declared bankruptcy cited illness or medical bills as a significant cause (PDF) of their bankruptcies. And of the medically bankrupt, three-quarters of that group had insurance, at least when they first got sick.


Q: Would any of the plans under discussion on Capitol Hill reduce the rate of medical bankruptcies?

A: Only the single-payer plan sponsored by Representative John Conyers and Senator Bernie Sanders. The others pretty clearly do little or nothing for medical bankruptcy.

Q: How would a single-payer system reduce medical bankruptcies?

A: A single-payer system, such as the one proposed by my colleagues and myself, not only covers everyone, but also eliminates co-pays, deductibles and virtually all uncovered medical bills. Both the Sanders and Conyers bills would work that way. That’s how it works in Canada. Every Canadian has coverage with zero co-pays and zero deductibles. As a result, when they get sick, they’re not forced to pay for care. It’s the coincidence of bills coming when you’re least able to pay them that creates the problem.

Q: We’re hearing a lot of criticism of the national health care system in Canada. What is the rate of medical bankruptcy there?

A: Colleagues in Canada tell us that medical bills per se almost never cause bankruptcies in that country. The relatively small number of medical bankruptcies seems to be among people who suffer a sharp drop in income because of illness. Canada does not have a full disability and joblessness safety net. We’re planning a study with Canadian colleagues now to study this formally.

And in the same “Prescriptions” blog of the New York Times where I found the Q&A with Dr. Himmelstein, I found this post from Katharine Q. Seelye today, which tells us the following…

“What does all this talk of health care reform mean to me?”

That may sound like a line from one of those vintage “Saturday Night Live” monologues by Al Franken, but this is 2009, and the question is a serious one, posed by AARP in a mailing that will arrive in almost nine million homes this week.

The mailer is part of a broader campaign by AARP to reassure its 40 million members that the organization is committed to protecting their Medicare benefits.

(By the way, am I the only one who thought it was a real reach by Seelye to mention Franken here, given that she could’ve mentioned a whole range of other former cast members who people would remember? But I guess Franken is an easily target for Seelye’s particularly facile brand of punditry.)

But it’s a funny thing; the print version of the story contained the following paragraph (this was omitted for the online version)…

AARP lost more than 50,000 members this summer as a result of the perception that it had taken a partisan position in favor of Democratic health care legislation, which many feared posed a threat to the current level of Medicare coverage.


Fortunately, Media Matters brings us the “reality” point of view here (and as we know, reality has a well-known liberal bias)…

Between July 1 and mid-August, AARP nationally lost about 60,000 members. But during that same period, spokesman Drew Nannis said, it brought in 1.8 million new members.

I’ll breathlessly await another Times Correction in the print version of the paper tomorrow.

And finally, Joe Klein of Time tells us the following (here)…

If conservatives seem ridiculously hyperbolic about what the public option does and does not do–it does not, for example, increase costs (it could decrease them) or mean a government takeover of health care–some progressives have been a bit confused about what a public option might actually accomplish. Here’s Ezra Klein, who has established himself as a real voice of sanity in this debate, on what a public option actually might accomplish–and what it won’t.

I give J. Klein credit for linking to E. Klein here, but J. merely provides the link to E.’s blog and not the particular post in question; I’ll assume it’s this one.

(And by the way, J. provides two reasons for not liking the public option: 1) It sets up unfair competition with private insurers, and 2) “the right-wing smear campaign has succeeded and moderate Democrats, and a few stray Republicans, who might otherwise vote for health care reform won’t do so.”)

I won’t dignify the second supposed reason with a response, but how J. can believe that the public option sets up “unfair competition” after reading what E. says in his post, namely the following, is a real head-scratcher…

The strongest public plan on offer is in the bill being considered by the House of Representatives. This plan is limited to the health insurance exchanges, which are in turn limited to employers with fewer than 20 workers. So that’s the first point: The vast majority of Americans would be ineligible for the public plan, even if they wanted it. The CBO estimates that by 2019, the public plan would have a likely enrollment of 10 million Americans — and that estimate (pdf) imagines a world in which the exchanges are opened to businesses with 50 or fewer employees, which is to say, it’s more favorable than the actual bill.

The end result is that the public plan is unlikely to have a very large customer base, which means it will be unable to use market share to bargain prices far lower than private insurers. That might not matter if the plan could attach itself to the rates that Medicare uses. In the first draft of the House bill, the plan could do that, at least for its first three or four years of existence, after which point it was cut loose from Medicare. But the deal Henry Waxman cut with the Blue Dogs erased that advantage, and now the public plan, even in the House bill, is on its own. That is to say, the plan has neither Medicare bargaining power nor the sort of customer base that gave Medicare its bargaining power.

Ezra emphasizes, though, that he most definitely supports a public plan in spite of what he states above; even if it emerges in an imperfect form, its mere presence would ensure a built-in mechanism to “level the playing field” to a greater degree than what we have right now.

And by the way, here and here are two more instances of corporate media wankery on this issue (pay no attention to the propagandists “behind the curtain,” my fellow prisoners).

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