Archive for September, 2009

The President’s Plan and My Comments on It

September 13, 2009

The President’s Plan for Health Reform

“It will provide more security and stability to those who have health insurance.
It will provide insurance to those who don’t. And it will lower the cost of health care
for our families, our businesses, and our government.”

If You Have Health Insurance,
the President’s Plan:

  • Ends discrimination against people with pre-existing conditions.
  • Limits premium discrimination based on gender and age.
  • Prevents insurance companies from dropping coverage when people are sick and need it most.
  • Caps out-of-pocket expenses so people don’t go broke when they get sick.
  • Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
  • Protects Medicare for seniors.
  • Eliminates the “donut-hole” gap in coverage for prescription drugs.

If You Don’t Have Insurance,
the President’s Plan:

  • Creates a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices.
  • Provides new tax credits to help people buy insurance.
  • Provides small businesses tax credits and affordable options for covering employees.
  • Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.
  • Immediately offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

For All Americans,
the President’s Plan:

  • Won’t add a dime to the deficit and is paid for upfront.
  • Requires additional cuts if savings are not realized.
  • Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.
  • Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.
  • Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.
  • Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.

I can only support this plan if the following changes are made:

  • Also limit premium discrimination based on health status, i.e., pre-existing conditions.
  • Replace tax credits for individuals with a sliding-scale, direct assistance to buy health insurance.  Tax credits are helpful only to people who make enough money to pay taxes in excess of the credit.  Furthermore they only provide that help as much as a year after people have had to buy health insurance.
  • The public health insurance option needs to be available immediately to the uninsured, then expanded to be available to everyone.  The fastest, best way to implement it is to modify Medicare, not create a new program.  Co-ops are not acceptable because they do not control costs.
  • If premium discrimination based on health status as above is ended, there is no need for placing people in a high risk pool.  The private insurers should be able to cover them at a reasonable cost.  High-risk pools have the taint of discrimination and people often can’t afford the premiums, the deductibles  or other out-of-pocket costs.
  • Eliminate Medicare Advantage and other subsidies to the private health insurance companies related to Medicare.  They do just fine writing supplemental insurance for Medicare clients.
  • Re adjust Medicare payments so that the same reasonable reimbursement is provided to doctors and hospitals across the country.
  • Eliminate the mandate for individuals to obtain insurance.  If it is available to them at a reasonable price they will take it; we have far more people who want to be insured but can’t get it than we have people who don’t want it at all.  A mandate is meaningless without enforcement and fining people because they can’t afford insurance is repugnant.  We’re supposed to be helping people, not punishing them.
  • Taxes need to be increased on the wealthiest Americans.  If the private insurers are going to continue to take their profits out of the health care system, a portion of that needs to be returned to the system.  Alternatives are taxes on all sales of stock or stock in private insurance companies.  Another alternative is to limit deductions for the wealthiest Americans.  To say “Requires additional cuts if savings are not realized.” is meaningless.  If the savings don’t occur immediately, and they won’t, what are you going to cut, benefits?  Why not immediately tax profits taken outside the health care system?

Mary Bell Lockhart

To President Obama Regarding His Speech on Health Care Assurance

September 12, 2009

President Obama

Your speech was excellent!  And, you have my full support for reform as long as it is real reform, not reform in name only.  I’ll just focus here on my suggested improvements.

You talked about the economic downturn.  Great, but I would suggest making a connection between those economic conditions and health insurance reform.  The fact is that genuine assurance of health care (single-payer) would be the greatest aid to the economy across the board for individuals, businesses small and large, cities, counties, states, organizations and anyone who employs someone or manages tax dollars and elements of the health care system.  It would meet ALL of your goals thoroughly.  I realize that we’re not going to implement single-payer now, but the point remains.  We’re only taking half measures here, and, in absence of single-payer, a national government-run public option is essential.

You implied in your speech that it was only people on the left who favored single-payer.  Not so – fully 75% of people favor at least a government-operated public health assurance option.  A substantial number of those folks have insurance now and a substantial number must be conservative and moderate. Single-payer is not the far left idea you portrayed it to be.  We, the citizens, have been very clear about what we want.

As it stands now, our plan is a boon for the for-profit health insurers who are not in need of financial help.  There are some consumer-friendly changes to be sure.  However, I caution that what is said in speeches be matched by what is in the bills.  For example, I understand that, although we have been repeatedly told that people will not be excluded from coverage due to pre existing conditions, the bills don’t contain that reform.

Your goals are 1) Security and stability for those who have insurance 2) Insurance for those who don’t have it and 3) Holding down costs.  Simply put, you cannot achieve 3) without the government-operated public health assurance option available widely.

Exactly what the public option will be, or even IF it will be, is unclear.  For example, you said that it should compete with the private insurance programs on a level field by being funded primarily by premiums.  That’s fine, but next we were told that people who have private insurance cannot choose the public option.  Thus, the only market in which it can compete is the uninsured market.  That immediately means that it will provide no incentive for private insurers to control premium costs; in other words it won’t be the competition we need.  Simply put, the public option must be available to everyone.  Co-ops just won’t accomplish anything.

Another important aspect of controlling costs is to prevent insurers from charging differential premium rates for people based on pre existing conditions or other characteristics of the person – age, sex, etc.  There is nothing in your plan about this at all.  While insurers may not be able to deny coverage to those with pre existing conditions, what’s to keep them from charging so much that effectively people are still bankrupted for being/getting sick.  So-called “high risk pools” are running the same scam right now.  They are often the functional equivalent of “death panels.”

If you use high-risk pools to help people in immediate need, we will have the very sick over here in one pool and the relatively well over there being covered by private insurance.  Instead, if you make the real, complete reforms of the insurance industry immediately, there’s no reason why they can’t take on those who previously would have been denied by them and dumped into a high risk pool.  After all, isn’t that what the reforms are intended to accomplish?  This can be done day one from your signing of the bill.

Premiums need to be stable within a reasonable range for ALL people. This is NOT the same as car or home insurance where the risk of using benefits can govern the premium prices people pay.  This is health care financing where ASSURANCE of care should be the focus, not financial stability of insurers.  It’s not just catastrophic insurance as car and home insurance are.   Almost everyone will be using the system from day one.  Premium prices thus cannot be based upon the “risk’ of using the benefits.  Otherwise you will be taxing the sick for being sick as we are right now.

And without the public option widely available, there can be no controls on drug costs.  I can understand why that particular can is being kicked down the road, politically, but we should position ourselves so that programs to save drug costs can be pursued in the future. Having a public assurance option large enough to negotiate drug prices is essential.

You said that individuals and small businesses who could not afford health insurance would be given tax credits to help them buy it.  This is economic nonsense.  Tax credits only help people who earn enough to pay taxes greater than the credits.  And they do nothing to help with upfront costs, coming as they do a year later than the person has incurred the costs.  The only effective scheme is to have the government provide direct assistance to buy the insurance on a sliding scale.

The mandate for individuals to obtain insurance coverage is frankly unworkable and political suicide.  The truth is that most people who aren’t covered want to be; they just can’t afford it.  Even young people who see themselves as invulnerable see the rationale for having insurance so that when they do need the care it’s there.  I’ve been told that, under the plans Congress is working on, individuals would be fined $3800 if they didn’t buy the insurance.  Whether it’s $100 or $3800 that should not be a fine, it should instead buy them the insurance they need.  If people can’t afford it, how is a fine going to help that?  The point I’m making is that a mandate is only ethical if there is a sliding scale upfront to help people buy the insurance.  Imagine how angry at us people will be when enforcement of this provision starts.

And how can we justify a mandate to buy insurance if the only source of insurance is the for-profit health insurers?  We will be mandating that people send a significant portion of their health care dollars out of the health care system (into the profits of the insurers).  The health insurers are NOT in need of a bailout and the American people and businesses ARE; this plan runs in the opposite direction of who needs to help whom.  Again it spells doom for the Democrats once people have experienced enforcement of this mandate.  It’s a poison pill.

How we will pay for costs beyond the saving that can be achieved within the system?  The answer should be very simple really:  If the private insurers are going to continue to make their profits, then their taxes need to go up to fund the health care system.  Some of what they are taking out of the health care system needs to be restored to it.  You mentioned the high price of the Bush tax cuts; they need to be undone.  And stick by your idea that deductions should be limited for the very wealthy.

This picture is being needlessly muddled; and too much of it is about preserving the status quo of corporate for-profit insurance dominance.  Single-payer would simplify everything and provide more economic benefit to everyone except big insurance. And it would not disrupt any part of the system that does not critically need disrupting.  Again, what is this really about:  Assuring health care for Americans or preserving the insurance companies profits?  If they could have given us a good system, they should have done it long ago.  The fact that they did not says volumes about how they will behave in the future.

As it stands right now, we’re putting in place some reforms for the existing insurers.  I predict, that, unless the changes I suggested above are made, the opponents of reform will use the individual mandates and the lack of real cost reductions to defeat the Democrats.  Then when the Republicans return to power the reforms placed upon the insurers will be rolled back.  If we’re going to kick some cans down the road, we’d better look down the road first to see what’s there.

By the way, why is no one mentioning that either single-payer health care ASSURANCE or the public option would actually be operated by the private insurers and that private insurers would continue to handle supplemental insurance?  Medicare, Tricare, Medicaid are all operated by private companies under contract to the government, are they not?
Seeing our failure to make these points clear, leads me to believe that someone is just not trying hard enough to give us what more than 75% of Americans have said they want:  a government public option to the for-profit health insurance. Co-ops just won’t cut it, folks.

Kind Regards,

Mary Bell Lockhart/

Think Health Care ASSURANCE, Not Insurance

September 4, 2009

Think of health care ASSURANCE, not insurance. Insurance is when you pay to participate in a risk pool from which you may never need to take a benefit. Homeowner’s and vehicle insurance are good examples. And the payment of different insurance rates can be justified based upon the risk of using benefits, i.e, on your behavior (e.g., driving record), age, or other personal characteristics. It is “catastrophic” coverage, coverage for unplanned, rare events that commonly cost thousands of dollars.

With collective financing of health care, it is virtually guaranteed that those covered have to use benefits from the funding pool regularly from Day One onward. It’s not just catastrophic; a lot of it is preventive. Payments into the system can’t be related to the behavior or nature of the covered person. Everyone must pay the same controlled rate – no differential premiums for sicker or older or younger. It must cover all kinds of health care and medicines. And for those who cannot pay into the system at all or can only pay a limited amount, there must be taxpayer assistance and the taxpayers involved must be the wealthy (you can’t tax the middle and low income folk in order to give it back to them).

This means of paying for health care is incompatible with the profit motive of insurance companies. The profiteers cannot be controlled by regulation because they will always use their money to chisel down regulation. Government is the best performer of services that must be democratic and non-profit, because government is the representative of and beholden to the people. Government excels at ASSURANCE and ASSURANCE of health care is what everyone else now needs, just as our elders did when we implemented Medicare and our children with SCHIP and our low income citizens with Medicaid.

Yet, we have allowed what should be health care ASSURANCE to be forced into the mold of insurance. And thus the capitalists have devised a way to profit from other people’s misery. They have made access to health care a privilege, not a right. They have created an immoral and bankrupt system.

Unless we can implement single-payer health care ASSURANCE, we must have the public option – allowing people who so choose to get their ASSURANCE from the government. Here’s why: Some form of mandates to buy ASSURANCE, either for employers or for individuals, are needed to get everyone covered. And the government cannot ethically mandate purchase if the only option is to buy it from for-profit insurers. Requiring people to pay for-profit insurers is government-sponsored extortion. Furthermore, if the government is paying for the sliding scale assistance for those who cannot pay, taxpayer money goes to private insurers to skim their profits off the top. That would be misdirection of public funds to private, corporate gain. The health insurance industry is NOT in need of a bailout. But you can readily see why they hate the public option. And ALL employers – businesses small and large, cities, counties, states, organizations of all kinds – should love government health care ASSURANCE once they’ve done the math and figured what it actually means for them. And just think how it would benefit our faltering economy!!

Now, are we going to let these ill-informed, prejudiced, anti-government screamers, funded and deployed by the private insurance industry, win this battle? Are we going to allow the rest of us to be abandoned to their chopping block? Or are we going to demand that our government create health care ASSURANCE (ASSURECARE?) for all Americans?