Health Plan: Ask 'What,' Not 'When'
By Marie Cocco
Truthdig: July 22, 2009
It's not yet time to say that the political debate over this year's
effort at health insurance reform has reached its low, since we're sure to
hear more hyperbolic charges about socialized medicine, meddlesome
government bureaucrats that might replace meddlesome corporate
bureaucrats-and how we shouldn't tax the rich because after all, they create
jobs!
Any sentient person might wonder where all these jobs are, and why this
upper-crust, job-creation engine should be spared a tax surcharge to finance
insurance coverage for those who do not now have it. But that would be a
digression.
What we apparently are supposed to be talking about is when health
legislation should be passed-before the August congressional break? Just
after that? Never?
Now that it's gripped the imaginations of politicians and the media, the
politics of the calendar has overtaken the plain truth that Congress already
is moving-barely moving, and not necessarily to a triumphal finish-toward
expanding coverage, reordering convoluted medical payment systems that breed
inefficiency and raise costs, and cleaning up some messes in Medicare
created when the Republicans controlled Congress and gave away billions to
drug makers and the insurance industry.
Maybe this isn't a very encouraging beginning. But making a truly fresh
start would require the political courage to acknowledge that the
workplace-based, private insurance system is too far gone to save with a
hodgepodge of fixes. It would force us to acknowledge that to get the
definitive cost controls politicians say they want, we would need cost
controllers-those worrisome government bureaucrats-to impose rules that
consumers, medical providers and the private insurance industry have failed
to deliver through market "magic."
I know, this is all too logical amid the inversion of logic that drives
the health care debate. Still, Congress is managing a start. And despite
whatever distortions you may hear, the House bill now moving through a
series of committees is the best of this year's starts.
It would expand coverage, according to the Congressional Budget Office,
so that 97 percent of adults (not counting illegal immigrants) would have
insurance. It would create a public plan as one option for individuals to
purchase. And just to set the record straight, this is the clearest path to
the culture change needed to upend the payment schemes that now contribute
to ever-higher costs.
The nonpartisan Commonwealth Fund, a health care think tank, studied
three options for new plans and found that by far the most effective
mechanism to drive costs down-with savings for the federal government,
consumers and employers alike-was the creation of a public plan that would
pay medical providers at the same rates that Medicare pays. A middle-ground
option along these lines, creation of a public benefit plan that pays
doctors and hospitals somewhat more than Medicare, is included in the House
proposal.
Meanwhile, though political ire is directed at the proposed surtax on
high-income Americans that would finance much of the House bill, this is the
only provision in any bill we've yet seen that effectively states the
obvious: There has to be a clear source of revenue to finance all of this.
The surtax is transparent. We know who would pay it and how much it
would raise (about $544 billion over 10 years, according to official
estimates). It doesn't need a slew of adjustments and exceptions, such as
those now contemplated in the Senate for taxing workers who benefit from
high-cost health insurance premiums. Any tax on these benefits would require
political compromises to account for vast regional differences in premium
costs, and, for example, generally higher premiums paid by employees in
small firms or those dominated by older workers.
Though the surtax may well be jettisoned, there are unequivocally
necessary parts of the House bill that must remain. Chief among them is
elimination of overpayments to insurance industry managed-care plans that
serve Medicare patients. Taxpayers now spend 13 percent more per patient in
these HMOs than they do for a patient enrolled in regular (yes,
government-run!) Medicare. Another must-have is a provision to force drug
makers to reinstate discounts for Medicare patients who are poor enough to
qualify for prescriptions under Medicaid-a rebate that was in place until
the Medicare drug benefit legislation, laden with gifts to the
pharmaceutical industry, was implemented.
You can call these nagging details. But surely they're more significant
than whether a bill passes next month, or the month after, or even by
Christmas.
Marie Cocco's e-mail address is mariecocco(at)washpost.com.
© 2009, Washington Post Writers Group
***
From: The RAIN Newsletter (24-7-9) %
http://mdn.mainichi.jp/mdnnews/international/news/20090723p2a00m0na011000c.html
52 percent of U.S. soldiers wounded in Iraq, Afghanistan diagnosed with TBI
Mainichi Daily News Japan July 24, 2009
WASHINGTON -- Some 52 percent of soldiers severely injured in Iraq and
Afghanistan who have come to the U.S. Army's largest hospital for treatment
have been diagnosed with traumatic brain injuries (TBI), an internal study
has found.
The results of the study, carried out by Defense and Veterans Brain Injury
Center (DVBIC) at Walter Reed Army Medical Center, also showed a steep
increase -- from 33 percent -- in TBI cases since the end of 2008.
Diagnoses of TBI are rising steadily as arrangements for TBI checks improve,
while at the same time improvised explosive device (IED) attacks -- the
primary cause of TBI -- in Afghanistan are intensifying, with 46 U.S.
soldiers killed by the homemade bombs so far this year. Casualties from
these attacks flow into Walter Reed, which provides treatment to badly
wounded soldiers unavailable anywhere else.
According to DVBIC at Walter Reed, since January 2003 -- just before the
beginning of the Iraq War -- 52 percent of soldiers wounded in Iraq and
Afghanistan by bombs and treated at the hospital have been diagnosed with
TBI. According to figures uncovered by the Mainichi, this would mean the
number of diagnosed TBI cases has risen to well over 10,000 since the end of
2008, when the figure stood around 9,100. Furthermore, in more than 90
percent of those diagnosed with TBI, the patient had no visible head
injuries.
On the battlefield, TBI is caused by the supersonic shockwave produced by an
explosion -- often from an IED -- which damages or destroys brain cells. A
soldier caught in the blast may not even know he or she has been injured.
The U.S. Department of Defense began conducting cognitive ability tests on
all military personnel to be deployed to Iraq or Afghanistan in November
2007. The servicemen and women who took the tests began returning from their
combat tours early this year, allowing for greater chances of discovering a
TBI and probably leading to the increased numbers of diagnosed cases.
The Department of Defense estimated in March this year that the final tally
of TBI cases would reach 10 to 20 percent of all personnel deployed to Iraqi
and Afghani battlefields.
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