At long last, the Senate is poised to begin voting today on a measure to repeal and/or alter portions of the Affordable Care Act.
Much remains in flux regarding process and the substance of what will be voted on. According to multiple media sources today, Senate leaders latest strategy is to hold a vote on a narrower piece of legislation than those circulated in recent weeks.
The substance of such a measure—if indeed, it exists and is submitted for a vote—is unclear as of this posting. But it reportedly could contain just a repeal of the ACA’s individual and employer mandates and a few of the law’s taxes, such as the one on medical device companies.
This narrow, or “skinny,” bill would not have any provisions pertaining to Medicaid.
The idea, apparently, is to pass this initial piece of the puzzle—to get things going—and then to take up the larger and more controversial issues that have so deeply divided the Republican caucus.Continue reading…
John McCain would reform the American health care system by providing big tax incentives for it to transition from being employer-based to one built on a system of individual responsibility. He would do this by eliminating the longtime personal tax exemption on employer-provided health insurance and replacing it with a $2,500 individual, and $5,000 family, tax credit for those who have health insurance.
It’s too bad this idea will likely recede from the national health policy debate whether John McCain wins or loses the presidency. Even if he wins, the Democratic majorities in Congress will be so large there is little chance we will be able to move away from the traditional employer health insurance base in the next few years. All you have to do is look at the way Obama and all of the Democratic candidates for the Senate and House have railed against McCain’s plans to "tax your health benefits" to see how Democrats have willingly painted themselves into a political corner that makes this idea a non-starter in the new Congress.
As I have said before on this blog, I have been largely disappointed in the McCain health plan. He started out with a bold new approach but never closed the loop on so many key elements in his plan. For example, he leaves those with pre-existing conditions to the fate of state-based risk pools–a place no one would ever vote themselves into.
If Senator John McCain becomes U.S. president he plans to give each American family $5,000 to pay for health insurance premium costs in the individual market. Individuals would get $2,500 for the same use.
How does McCain propose to pay for this? In part, by revoking the tax deductibility of workers’ health benefits and by making cuts to Medicare and Medicaid. Even with these provisions, however, The Tax Policy Center estimates McCain’s plan will run an estimated $1.3 trillion short in funding over the next ten years.
In McCain’s “Health Care Action” television ad, he says, “The problem with health care in America is not the quality of health care, it’s the availability and the affordability. And that has to do with the dramatic increase in the cost of health care.”
The International Association of Firefighters (IAFF) recently launched a campaign in support of Senator Obama for president — and an attack on Senator McCain’s health care plan.
The commercial features four firefighters. "Our job is to risk our lives to protect you, and your loved ones. We’re proud of that," one of the firefighters say. "Like you, we need our health care for our families," adds another firefighter.
The IAFF, based in Washington D.C., is a labor union representing approximately 292,000 full-time firefighters and paramedics in the United States and Canada. The commercial will air on local cable networks in New Hampshire, parts of North Carolina, Orlando, St. Louis, parts of Ohio and parts of Virginia.
The New England Journal of Medicine and Harvard University teamed up to bring you this compelling, hour-long nail-biter of Gail Wilensky and David Cutler discussing their respective candidates’ health plans.
I wonder if the NEJM has had to buy more bandwith to support the flood of viewers?
In all seriousness, I think it’s great the NEJM is sponsoring this type
of dialogue. It probably won’t reach many people, but it might reach
and influence those who have the potential to influence others — legislative staffers,
journalists, doctors and health care leaders.
There have been calls recently for more serious coverage of the candidates’ health care issues. We need a mix of coverage. This kind of wonky dialogue and the kind that ordinary folks read and watch — yes that 800-word explainer story with a few pithy quotes.
This election is different than any other on the issue of health care because both candidates are giving us serious blueprints to reorganize America’s health care system and those blueprints are very very different.
As voters, you have a huge and critically important choice on health care.
There are dozens of details upon which they differ and for those I would point you to my comprehensive posts on the McCain Health Care Plan and the Obama Health Care Plan.
But to understand their big idea differences, I would point you to our pension system to better understand where McCain and Obama are going on health care. Back in the 1960s and 1970s, it was common for workers to have what is called a defined benefit pension plan.The worker got a promise from the employer that when retirement came he’d get a certain monthly benefit — often about 60 percent of his final average earnings. That might be $2,000 a month — every month for the rest of his life. Therefore, a defined benefit.
Republican vice-presidential candidate Sarah Palin has very little on her health care
policy resume from her short time in office as Alaska’s Governor but what she does have fits right in with Senator McCain’s strategy to use the market more effectively in bringing down America’s health care costs and improving access to the system.
Her health care efforts have focused on two things in Alaska:
- Eliminating the 1970s era strategy of requiring providers to file Certificate of Need (CON) applications before being able to build more health care facilities.
- Providing consumers with more information.
What do we do with people who are uninsurable because they have a pre-existing medical condition?
That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.
One of the solutions being discussed–by McCain among others–is to use state-based risk pools. Under McCain’s plan heavily dependent on an individual platform, people who don’t have employer-based coverage and healthy enough to qualify for individual health insurance could get a private mainstream plan and people who do not qualify for a standard individual plan could buy into a state-run high risk pool for the uninsurable.
John McCain is now the presumptive Republican nominee for president. As a result, what he thinks about health care policy will be out front in the presidential campaign this fall.
McCain’s thinking couldn’t be more different from Democrat Barack Obama.McCain very rightly points to health care costs as the biggest health care issue. "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode," he has said.
Therefore, his focus is on the health care costs that make health insurance so expensive that many individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor and long-term solvency for senior benefits.
He also reminds us that costs can’t be improved without dealing with quality in tandem.
Barack Obama’s health reform proposal includes creating a center for comparative effectiveness research.
John McCain also has expressed support for this research.
And the American College of Physicians would like patients and doctors to use comparative effectiveness information when making health decisions.
What the heck are they talking about?
Policymakers, pundits and journalists have begun throwing around the term “comparative effectiveness” as if people know what it means.
I haven’t seen a formal survey, but I’m confident that the general public does not understand the concept behind this jargon nor the reasons why a national center might be needed to compare different medical treatments and procedures to find out what is most effective for different patients.
The first step to helping people understand these issues is to stop using the term comparative effectiveness. Using insider terms like this will ensure the public never engages in the issue and never buys into it. And public buy-in is important — crucial actually — says Gail Wilensky, the term’s mother of sorts.