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The toughest job in America

Today, the loneliest job in American isn’t being the Maytag repair man. And the hardest job in America isn’t necessarily the Presidency. It’s being a state governor.

Take Pennsylvania (the state I call my home). Governor Ed Rendell sought the position with an explicit goal of expanding health insurance to uninsured Pennsylvanians. After two years in the job, Rendell is facing declining tax revenues, increasing costs. Rendell is already facing a $281 million deficit in this fiscal year, which could increase to over $1 billion. A detailed analysis of this story was published by PR Newswire, "Pennsylvania’s Loss of Employer Health Coverage Outstripping National Average."

The Kaiser Commission on Medicaid and the Uninsured has been studying other state initiatives targeting covering the uninsured. The Commission has found that in California, Illinois and New Mexico, for example, have been unable to broaden health insurance access to citizens without it.

That’s because, as Diane Rowland, the Executive Director of the Commission said, "Health reform … is easier when economic times are good and more difficult to accomplish and more difficult to sustain when the economy goes down."

Jane’s Hot Points: The U.S. Census Bureau found that the level of uninsured in the U.S. actually fell by 1.5 million between 2006 and 2007. Where did most of those uninsured people find insurance? Through growth in public programs funded by public (read: taxpayer) sources: Medicaid and Medicare, and in military programs including the VA and TRICARE.

The Kaiser Commission on Medicaid and the Uninsured issued a paper on The Decline in the Uninsured in 2007: Why Did It Happen? which speaks to this statistic in great detail.

The point is that the economic growth enjoyed in 2006-7 will not occur in 2008-9, and based on what macroeconomic forecasts are saying, into 2010.

Growing unemployment and the decline in the U.S. economy will inevitably result in an increase in the number of uninsured Americans.

The Commission expects this number of uninsured Americans will be no fewer than two million in 2008, and more if unemployment exceeds 6.1%.

Will these uninsured citizens, living throughout the 50 states, find a health insurance haven through public programs? Probably not. That’s because Governor Rendell and his colleagues in the National Governors Association will have less money to spend on Medicaid and children’s health (S-CHIP) programs compared to 2006-7.

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buying penny stocksstock trading for beginnersGRGary LevinDeron S. Recent comment authors
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buying penny stocks
Guest

Your idea makes way to much sense. Plus, it doesn’t put any money in the pockets of special interest groups. Ooops, that’s why they won’t do it.

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Guest

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GR
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GR

Yes America is different, and the so called “low income”
make up a larger portion of our population. More people will put themselves in this category if it means getting something for “free”, this could lead to the collapse of our health care system – like with our low income housing loans.
Interesting article…
http://www.healthplan.9f.com

Peter
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Peter

Deron, I’m from Canada and there it’s the doctors that make the medical decisions with their patients, not some government board. The government controls the money though because they pay for the system through taxes, so everyone operates under a strict health budget. The doctors negotiate their reimbursments and prices are controlled. There are some downsides, if you want to call it that, they don’t have an MRI on every street corner so access is controlled that way, but there is very little over utilization. There have been waiting periods for some surgeries but in an emergency there is no… Read more »

Deron S.
Guest

Peter – As always, you make some good points and good analogies. I’m just concerned about the “new reality” you mentioned. I’m having visions of a Big Brother scenario where someone is closely watching over patients, physicians, and everyone else in the system with a ruler in their hand. I’m definitely not against some additional oversight because we’ve allowed the players in the system (not just health insurers) to develop a selfish attitiude and they’ve lost any sense of a system level focus. Single-payer goes well beyond that. Is that where we’re headed? Are we going to continue screwing up… Read more »

Peter
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Peter

Deron, we shouldn’t let the costs to unwind the insurance industry be a hurdle to fixing the system with single-pay. The longer the present system is allowed to stand the harder it will be. Surely we haven’t let the unwind costs of gutting our manufacturing sector and shipping jobs overseas stand in our way of lower prices at Walmart. It seems appropriate that when another industry (health insurance) becomes obsolete and unable to adapt, it too should suffer the same fate. There will be employee “dislocations” and some people will have to find new careers, but there will be experienced… Read more »

Deron S.
Guest

Peter – I appreciate the fact that you were willing to elaborate and I think a little constructive debate is a good thing. I might be be sold on single-payer if someone could provide proof beyond a shadow of a doubt that single-payer is the #1 reason other countries spend less on healthcare than we do. What if other countries are more socially responsible than we are? Less greedy? Healthier? I guess what I’m saying is, we have some serious societal issues needing addressed if we’re going to have an optimally functioning healthcare system. How do you stop 14 year… Read more »

Peter
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Peter

If you think PA has a problem, how about Massachusetts.
A $1.4 Billion deficit.
http://www.bostonherald.com/news/politics/view.bg?&articleid=1125838&format=&page=1&listingType=MA2004#articleFull

Peter
Guest
Peter

Deron, how much it will cost who? The providers or the patients? For the country probably about half of what the present system costs us now, if other single-pay countries are any indication. How long will it take, how can I answer that? How about 5 years, is that an ok target? You can do some research on Taiwan and their health system. They looked at every other system in the world, including ours, and chose single-pay. “Simplistc” really? as if you think I expect us to wave the magic single-pay wand. You’re new to this blog so you don’t… Read more »

Deron S.
Guest

Peter – No offense, but your approach is simplistic and it appears that you do not fully appreciate the complexity of the problem we face. There are major cost drivers, such as an increasing prevalence of chronic conditions, that you never seem to mention. Single-payer is a shallow fix that will not produce sustainable results on it’s own. In fact, it will be a distraction that will delay our addressing those more serious health issues and cost drivers. Do you have any idea how much it will cost, and how long it will take to implement single-payer?

Peter
Guest
Peter

Deron, that won’t happen from inside the healthcare industry. It will come from a single-pay system imposing health budgets that force the health industry to cut costs. That will mean getting higher efficiency and less utilization, but it will also mean income cuts to providers. Waiting for the industry to make the first move while just reducing or eliminating access to people lossing their jobs is not even a path to solving this. Do you think just trying to cover present programs with increasing patient loads is increasing access?

Gary Levin
Guest

Jane,
How does this news affect Sarah Palin’s candidacy for VP?

Deron S.
Guest

Jane – As a fellow PA resident, I see where you’re coming from. However, the struggling economy is yet another reason why we should attack the uninsured issue by addressing the high costs that lead many of them to become uninsured, as opposed to incurring greater deficits by increasing access to a struggling system.

Peter
Guest
Peter

I guess we’re seeing that a national policy of low wages, lost manufacturing, large pools of poor people, widening income disparities, a culture of unhealthy lifestyles and an overall economy based on debt is catching up with us. My state of NC is also bracing for higher deficits and lower tax receipts. Here the political scapegoat so far in local and state elections is our population of illegal immigrants that Republicans have found a convenient group to attack, but forgetting that it’s their own ideology that got us here. It’s like the person who sets fire to your house from… Read more »