http://www.huffingtonpost.com/marcia-angell-md/is-the-house-health-care_b_350190.html?view=screen
Is the House Health Care Bill Better than Nothing?
Marcia Angell, M.D.
Physician, Author, Senior Lecturer, Harvard Medical School
Huffington Post:: November 8, 2009
Well, the House health reform bill -- known to Republicans as the Government
Takeover -- finally passed after one of Congress's longer, less enlightening
debates. Two stalwarts of the single-payer movement split their votes; John
Conyers voted for it; Dennis Kucinich against. Kucinich was right.
Conservative rhetoric notwithstanding, the House bill is not a "government
takeover." I wish it were. Instead, it enshrines and subsidizes the
"takeover" by the investor-owned insurance industry that occurred after the
failure of the Clinton reform effort in 1994. To be sure, the bill has a few
good provisions (expansion of Medicaid, for example), but they are marginal.
It also provides for some regulation of the industry (no denial of coverage
because of pre-existing conditions, for example), but since it doesn't
regulate premiums, the industry can respond to any regulation that threatens
its profits by simply raising its rates. The bill also does very little to
curb the perverse incentives that lead doctors to over-treat the
well-insured. And quite apart from its content, the bill is so complicated
and convoluted that it would take a staggering apparatus to administer it
and try to enforce its regulations.
What does the insurance industry get out of it? Tens of millions of new
customers, courtesy of the mandate and taxpayer subsidies. And not just any
kind of customer, but the youngest, healthiest customers -- those least
likely to use their insurance. The bill permits insurers to charge twice as
much for older people as for younger ones. So older under-65's will be more
likely to go without insurance, even if they have to pay fines. That's OK
with the industry, since these would be among their sickest customers.
(Shouldn't age be considered a pre-existing condition?)
Insurers also won't have to cover those younger people most likely to get
sick, because they will tend to use the public option (which is not an
"option" at all, but a program projected to cover only 6 million uninsured
Americans). So instead of the public option providing competition for the
insurance industry, as originally envisioned, it's been turned into a
dumping ground for a small number of people whom private insurers would
rather not have to cover anyway.
If a similar bill emerges from the Senate and the reconciliation process,
and is ultimately passed, what will happen?
First, health costs will continue to skyrocket, even faster than they are
now, as taxpayer dollars are pumped into the private sector. The response of
payers -- government and employers -- will be to shrink benefits and
increase deductibles and co-payments. Yes, more people will have insurance,
but it will cover less and less, and be more expensive to use.
But, you say, the Congressional Budget Office has said the House bill will
be a little better than budget-neutral over ten years. That may be, although
the assumptions are arguable. Note, though, that the CBO is not concerned
with total health costs, only with costs to the government. And it is
particularly concerned with Medicare, the biggest contributor to federal
deficits. The House bill would take money out of Medicare, and divert it to
the private sector and, to some extent, to Medicaid. The remaining costs of
the legislation would be paid for by taxes on the wealthy. But although the
bill might pay for itself, it does nothing to solve the problem of runaway
inflation in the system as a whole. It's a shell game in which money is
moved from one part of our fragmented system to another.
Here is my program for real reform:
Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This
should be an expansion of traditional Medicare, not a new program.
Gradually, over several years, drop the age decade by decade, until everyone
is covered by Medicare. Costs: Obviously, this would increase Medicare
costs, but it would help decrease costs to the health system as a whole,
because Medicare is so much more efficient (overhead of about 3% vs. 20% for
private insurance). And it's a better program, because it ensures that
everyone has access to a uniform package of benefits.
Recommendation #2: Increase Medicare fees for primary care doctors and
reduce them for procedure-oriented specialists. Specialists such as
cardiologists and gastroenterologists are now excessively rewarded for doing
tests and procedures, many of which, in the opinion of experts, are not
medically indicated. Not surprisingly, we have too many specialists, and
they perform too many tests and procedures. Costs: This would greatly reduce
costs to Medicare, and the reform would almost certainly be adopted
throughout the wider health system.
Recommendation #3: Medicare should monitor doctors' practice patterns for
evidence of excess, and gradually reduce fees of doctors who habitually
order significantly more tests and procedures than the average for the
specialty. Costs: Again, this would greatly reduce costs, and probably be
widely adopted.
Recommendation #4: Provide generous subsidies to medical students entering
primary care, with higher subsidies for those who practice in underserved
areas of the country for at least two years. Costs: This initial, rather
modest investment in ending our shortage of primary care doctors would have
long-term benefits, in terms of both costs and quality of care.
Recommendation #5: Repeal the provision of the Medicare drug benefit that
prohibits Medicare from negotiating with drug companies for lower prices.
(The House bill calls for this.) That prohibition has been a bonanza for the
pharmaceutical industry. For negotiations to be meaningful, there must be a
list (formulary) of drugs deemed cost-effective. This is how the Veterans
Affairs System obtains some of the lowest drug prices of any insurer in the
country. Costs: If Medicare paid the same prices as the Veterans Affairs
System, its expenditures on brand-name drugs would be a small fraction of
what they are now.
Is the House bill better than nothing? I don't think so. It simply throws
more money into a dysfunctional and unsustainable system, with only a few
improvements at the edges, and it augments the central role of the
investor-owned insurance industry. The danger is that as costs continue to
rise and coverage becomes less comprehensive, people will conclude that
we've tried health reform and it didn't work. But the real problem will be
that we didn't really try it. I would rather see us do nothing now, and have
a better chance of trying again later and then doing it right.
***
Is the House Health Care Bill Better than Nothing?
Marcia Angell, M.D.
Physician, Author, Senior Lecturer, Harvard Medical School
Huffington Post:: November 8, 2009
Well, the House health reform bill -- known to Republicans as the Government
Takeover -- finally passed after one of Congress's longer, less enlightening
debates. Two stalwarts of the single-payer movement split their votes; John
Conyers voted for it; Dennis Kucinich against. Kucinich was right.
Conservative rhetoric notwithstanding, the House bill is not a "government
takeover." I wish it were. Instead, it enshrines and subsidizes the
"takeover" by the investor-owned insurance industry that occurred after the
failure of the Clinton reform effort in 1994. To be sure, the bill has a few
good provisions (expansion of Medicaid, for example), but they are marginal.
It also provides for some regulation of the industry (no denial of coverage
because of pre-existing conditions, for example), but since it doesn't
regulate premiums, the industry can respond to any regulation that threatens
its profits by simply raising its rates. The bill also does very little to
curb the perverse incentives that lead doctors to over-treat the
well-insured. And quite apart from its content, the bill is so complicated
and convoluted that it would take a staggering apparatus to administer it
and try to enforce its regulations.
What does the insurance industry get out of it? Tens of millions of new
customers, courtesy of the mandate and taxpayer subsidies. And not just any
kind of customer, but the youngest, healthiest customers -- those least
likely to use their insurance. The bill permits insurers to charge twice as
much for older people as for younger ones. So older under-65's will be more
likely to go without insurance, even if they have to pay fines. That's OK
with the industry, since these would be among their sickest customers.
(Shouldn't age be considered a pre-existing condition?)
Insurers also won't have to cover those younger people most likely to get
sick, because they will tend to use the public option (which is not an
"option" at all, but a program projected to cover only 6 million uninsured
Americans). So instead of the public option providing competition for the
insurance industry, as originally envisioned, it's been turned into a
dumping ground for a small number of people whom private insurers would
rather not have to cover anyway.
If a similar bill emerges from the Senate and the reconciliation process,
and is ultimately passed, what will happen?
First, health costs will continue to skyrocket, even faster than they are
now, as taxpayer dollars are pumped into the private sector. The response of
payers -- government and employers -- will be to shrink benefits and
increase deductibles and co-payments. Yes, more people will have insurance,
but it will cover less and less, and be more expensive to use.
But, you say, the Congressional Budget Office has said the House bill will
be a little better than budget-neutral over ten years. That may be, although
the assumptions are arguable. Note, though, that the CBO is not concerned
with total health costs, only with costs to the government. And it is
particularly concerned with Medicare, the biggest contributor to federal
deficits. The House bill would take money out of Medicare, and divert it to
the private sector and, to some extent, to Medicaid. The remaining costs of
the legislation would be paid for by taxes on the wealthy. But although the
bill might pay for itself, it does nothing to solve the problem of runaway
inflation in the system as a whole. It's a shell game in which money is
moved from one part of our fragmented system to another.
Here is my program for real reform:
Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This
should be an expansion of traditional Medicare, not a new program.
Gradually, over several years, drop the age decade by decade, until everyone
is covered by Medicare. Costs: Obviously, this would increase Medicare
costs, but it would help decrease costs to the health system as a whole,
because Medicare is so much more efficient (overhead of about 3% vs. 20% for
private insurance). And it's a better program, because it ensures that
everyone has access to a uniform package of benefits.
Recommendation #2: Increase Medicare fees for primary care doctors and
reduce them for procedure-oriented specialists. Specialists such as
cardiologists and gastroenterologists are now excessively rewarded for doing
tests and procedures, many of which, in the opinion of experts, are not
medically indicated. Not surprisingly, we have too many specialists, and
they perform too many tests and procedures. Costs: This would greatly reduce
costs to Medicare, and the reform would almost certainly be adopted
throughout the wider health system.
Recommendation #3: Medicare should monitor doctors' practice patterns for
evidence of excess, and gradually reduce fees of doctors who habitually
order significantly more tests and procedures than the average for the
specialty. Costs: Again, this would greatly reduce costs, and probably be
widely adopted.
Recommendation #4: Provide generous subsidies to medical students entering
primary care, with higher subsidies for those who practice in underserved
areas of the country for at least two years. Costs: This initial, rather
modest investment in ending our shortage of primary care doctors would have
long-term benefits, in terms of both costs and quality of care.
Recommendation #5: Repeal the provision of the Medicare drug benefit that
prohibits Medicare from negotiating with drug companies for lower prices.
(The House bill calls for this.) That prohibition has been a bonanza for the
pharmaceutical industry. For negotiations to be meaningful, there must be a
list (formulary) of drugs deemed cost-effective. This is how the Veterans
Affairs System obtains some of the lowest drug prices of any insurer in the
country. Costs: If Medicare paid the same prices as the Veterans Affairs
System, its expenditures on brand-name drugs would be a small fraction of
what they are now.
Is the House bill better than nothing? I don't think so. It simply throws
more money into a dysfunctional and unsustainable system, with only a few
improvements at the edges, and it augments the central role of the
investor-owned insurance industry. The danger is that as costs continue to
rise and coverage becomes less comprehensive, people will conclude that
we've tried health reform and it didn't work. But the real problem will be
that we didn't really try it. I would rather see us do nothing now, and have
a better chance of trying again later and then doing it right.
***
http://www.politico.com/news/stories/1109/29351.html
In the House, lawmakers who were forced over the weekend to accept the compromise made clear Monday that they wouldn't do it again. Forty-one members — enough to stall passage — told Pelosi that they would oppose a conference report that goes any further than current law in restricting abortion rights.
In the House, lawmakers who were forced over the weekend to accept the compromise made clear Monday that they wouldn't do it again. Forty-one members — enough to stall passage — told Pelosi that they would oppose a conference report that goes any further than current law in restricting abortion rights.
Nancy Keenan, president of NARAL Pro-Choice America, told POLITICO on Monday that the group "is not going to stand for a bill that has this kind of language in it."
Asked if NARAL would oppose a final health care bill with the so-called Stupak amendment, Keenan said she was operating on the premise that it will not include the restrictive language but that NARAL would work against the overall bill if it did.
"Absolutely," she said. "We are prepared to stop at nothing."
***
From: Linda Sutton
Subject: [PDLA]: Names To Live In Infamy:
Subject: [PDLA]: Names To Live In Infamy:
STUPAK, ELLSWORTH, KAPTUR, DAHLKEMPER, LIPINSKI
http://www.dailykos.com/story/2009/11/9/20526/7738?mode=edit
INCUMBENT POLITICIANS TO ADD TO YOUR "REMEMBRANCE" LIST
In the wee hours this weekend, four Democrats participated in the ultimate
in deal-making.
Bringing forward the anti-abortion issue to take away a woman's right to
choose, Stupak, Ellsworth, Kaptur and Kahlkemper joined with Republicans,
Pitts and Smith, to add kerosene to an already extremely disappointing bill
that has now been kicked over to the Senate where the MEGA bought-outs will
now start taking their shots.
Our former vice presidential candidate, who was kept in his committee chair
position for some as-yet-unexplained-reason after LEAVING the DEMOCRATIC
PARTY and running as an independent, is vowing he'll single-handedly kill
the bill. Yea Joe! Way to go! Show Reid how much he screwed up by trying to
keep you "in the caucus" with Democrats. But wait, Lieberman's wife's on the
payroll of WHICH insurance and pharmaceutical companies? And she makes how
many millions?
Here's the link to the actual amendment language:
http://www.house.gov/apps/list/speech/mi01_stupak/morenews/20091107amendment.html
http://www.dailykos.com/story/2009/11/9/20526/7738?mode=edit
INCUMBENT POLITICIANS TO ADD TO YOUR "REMEMBRANCE" LIST
In the wee hours this weekend, four Democrats participated in the ultimate
in deal-making.
Bringing forward the anti-abortion issue to take away a woman's right to
choose, Stupak, Ellsworth, Kaptur and Kahlkemper joined with Republicans,
Pitts and Smith, to add kerosene to an already extremely disappointing bill
that has now been kicked over to the Senate where the MEGA bought-outs will
now start taking their shots.
Our former vice presidential candidate, who was kept in his committee chair
position for some as-yet-unexplained-reason after LEAVING the DEMOCRATIC
PARTY and running as an independent, is vowing he'll single-handedly kill
the bill. Yea Joe! Way to go! Show Reid how much he screwed up by trying to
keep you "in the caucus" with Democrats. But wait, Lieberman's wife's on the
payroll of WHICH insurance and pharmaceutical companies? And she makes how
many millions?
Here's the link to the actual amendment language:
http://www.house.gov/apps/list/speech/mi01_stupak/morenews/20091107amendment.html
Bart Stupak, a DEMOCRAT in NAME, was the lead author of this amendment that was inserted into this health care bill that narrowly made it out of theHouse very late Saturday night. His numbers, so you can let him know whatyou think:202-225-4735 (his media person is Michelle Begnoche if you wish to use aname)
Others named on the amendment that you can add to your "remembrance" list:
Brad Ellsworth/Indiana DEMOCRAT Toll Free: (866) 567-0227 http://www.ellsworth.house.gov/ A proud "BLUE DOG." When do we start bringing out the pots & pans and start banging them? Stop wondering about where the independents have gone and consider why a huge segment of the Democrats who voted in '08 are now in hiding. Witness the recent election losses.
Joe Pitts/Pennsylvania (Lancaster, Phila western suburbs), Republican,202-225-2411 http://www.house.gov/pitts/who then voted NO on the final healthcare bill--no surprise
Christopher Smith/NJ (Whiting-Hamilton), Republican, 202-225-3765 http://chrissmith.house.gov/ who then voted NO on the final healthcare bill--typically what we expect
Marcy Kaptur, DEMOCRAT http://www.kaptur.house.gov/ According to herToledo office, "No federal funds for abortion" has always been one of herCORE POSITIONS. So those of you who had a little white hat on her headbecause of recent other positions and press conferences (hey, remember heron Moyers even?) need to temper any joy. Tel: (202) 225-4146 Fax: (202)225-7711(800)964-4699|(419) 259-7500
Kathleen Dahlkemper/Erie, Pennsylvania, DEMOCRAT, a first-termer this year..So, anyone wanting to claim it's better to have a Democrat in this districtthan the long time Republican? Is there a difference here? What about aprogressive challenge to her in the next primary? http://www.dahlkemper.house.gov/ Phone: (814) 456-2038 Fax: (814) 454-0163 Phone: (202) 225-5406 http://www.meadvilletribune.com/local/local_story_312220244.html"We wanted to make sure that any federally subsidized plans would not pay for abortion," said Dahlkemper....and from another Erie Times article: "Despite the Democratic Party'sstrong abortion-rights platform, Dahlkemper wasn't afraid to call herself a"whole life" candidate who opposes abortion and supports programs to helpwomen in need."
Dan Lipinski/ 3rd District (w of Chicago), Illinois DEMOCRAT http://www.lipinski.house.gov/> (202) 225 - 5701, (866) 822 - 5701"After a painstaking review of its details, and after I succeeded in adding to it restrictions that will prevent taxpayer funding of abortion, I voted today to move the health care reform bill forward."
These are our very real obstacles to meaningful change.
###--Linda SuttonPDLA Co-ChairLos Angeles, CA
What difference does it make to the dead, the orphans and the homeless,whether the mad destruction is wrought under the name of totalitarianism orthe holy name of liberty or democracy?
Mahatma Gandhi, "Non-Violence in Peace and War"
--Linda SuttonLos Angeles, CA 818-992-5187cell 818-419-7560 when NOTat home number
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