Tag: Health Care Reform

We Need a Liberal Immigration Policy to Support Health Care Reform

May 25, 2011• 2

By DAVID E. WILLIAMS

Over the last decade, the United States has intentionally made itself less attractive to immigrants, forgetting that immigration has been a huge driver of the country’s economic success. In a recent article (America needs a 21st century immigration policy), leading entrepreneurs, executives and investors including Steve Case and Sheryl Sandberg said:

To some, the link between immigration reform and economic growth may be surprising. To America’s most innovative industries, it is a link we know is fundamental.

The global economy means companies that drive U.S. job creation and economic growth are in a worldwide competition for talent. While other countries are aggressively creating policies and incentives to attract a highly educated workforce, America has stagnated. Once a magnet for the world’s top minds, America now faces a “reverse brain drain” and is no longer the first choice for many entrepreneurs creating new companies and jobs.

America needs a pro-growth immigration system that works for U.S. workers and employers in today’s global economy. And we need it now.Continue reading…

Vermont Chooses Single-Payer: Who Else Has an Appetite for Experimentation?

Apr 29, 2011• 28

By JONATHAN HALVORSON

This past Monday, the Vermont Senate passed a Single-Payer bill. The House had already passed a similar bill and the governor is friendly to the legislation, so all that stands between Vermont and a single-payer law are a few formalities. At the moment, though, Vermont is alone in taking advantage of the Affordable Care Act to achieve universal coverage without private insurers. In fact, it isn’t clear that any other states are taking serious steps even toward a public option.

Massachusetts isn’t going there: it is doubling-down on its eponymous model that relies on private health plans, and seems hell bent on showing the nation that this model can work. The state just boasted that capitation rates will actually go down in 2012, allowing the program to grow enrollment without additional funding. It’s not difficult to imagine the feeling of responsibility weighing on administrators and Democratic officials there as they work to pull the levers of payment reform to reign in Partners HealthCare and other misbehavers.Continue reading…

Bureaucrats vs. Entrepreneurs

Apr 19, 2011• 17

By JOHN GOODMAN

I used to think the biggest obstacle to getting agreement about health care reform was ideology (socialism vs. capitalism). Then I decided it was sociology (engineers vs. economists). I now am inclined to believe it is psychology (bureaucrats vs. entrepreneurs).

I came to this realization after reading through a long list of comments to a Health Alert I posted the other day about a health care entrepreneur (more on that below).

The entrepreneurial approach is the way we are trying to solve big problems in many other fields. Take the Ansari X Prize, established by citizen-astronaut Anousheh Ansari and her husband, Amir. They awarded $10 million to the first group to build a privately-funded spacecraft capable of carrying three people 100 kilometers above the earth’s surface twice within two weeks. Interestingly, 26 teams from seven nations spent more than $100 million competing to win the prize.Continue reading…

The Massachusetts Mistake

Apr 10, 2011• 17

By ROGER COLLIER

A year after the passage of health care reform, fewer than half of Americans support it, a similar percentage believe that it has already been found unconstitutional or soon will be, health care costs are continuing to rise far faster than the CPI, and the Republican Party has seized on the issue as a sure election winner.

The Obama administration and congressional Democrats, now thoroughly on the defensive, are clearly surprised at the public and political reaction. But should they be? This post—on the reliance on Massachusetts as a model—is the first of three that will look at some of the miscalculations—and sheer bad luck—that have helped to undermine reform. When Governor Mitt Romney signed Massachusetts’ reform bill into law in 2006, it was widely regarded as a bipartisan political triumph, and one that was supported by the public and by most of the state’s insurers and providers. Massachusetts would be the first state to require virtually all legal residents to have coverage (with tax penalties imposed on those not complying), while providing subsidies for lower-income individuals not eligible for government programs, as well as to implement a state-administered brokerage function (the Connector) to allow competitive selection of health plans. By the fall of 2008, as congressional efforts to design national health care reform moved into overdrive with the election of Barack Obama, the Massachusetts legislation was widely regarded as a success. Public reactions were generally positive, the numbers of uninsured had fallen, and there had been no dramatic increase in costs. It was scarcely surprising that the Massachusetts model emerged from the field of competing proposals as the favorite of most Democratic lawmakers.

Unfortunately, the elected officials in Washington DC failed to recognize that Massachusetts was an exceptional state in terms of health care. Even before the state’s reform bill was enacted, the percentage of uninsured was very low. It was also a socially very liberal state, far more likely than most to support reform efforts (in fact, Massachusetts had passed, but then revoked, a slightly different version of health care reform a dozen years earlier). And, of course, the economy was still in its boom period when the new law was passed. Massachusetts had other advantages that would not transfer to national reform. As a small state, with only a small percentage of the population likely to be directly affected by reform, implementation could be much faster—less than a year for most provisions of the state’s new law. Continue reading…

Does the GOP Have a Health Plan?

Mar 31, 2011• 17

By JOHN GOODMAN

The Republicans have no plan to insure the uninsured.

How do I know that? A New York Times editorial told me. So did Ezra Klein, writing in The Washington Post. Matt Miller, also writing in the Post, went further. “I’m willing to repeal ObamaCare,” he wrote, provided the Republicans can “cover the same number of uninsured” and “do it at a lower cost.”

So why don’t the Republicans have a plan? That’s easy. “They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do,” wrote Paul Krugman in The New York Times. The Times’ own editorial said the same thing.

All this has caused me to suffer a bout of severe depression. But, wait a minute. Wasn’t health care the biggest issue in the last presidential election? And…how memory fades…didn’t the Obama campaign spend millions of dollars…promoting his own plan?…no, that’s not right…

Ah, now I remember. The Obama campaign spent tens of millions of dollars on TV commercials attacking the John McCain health plan! It spent more money than has ever been spent for or against any policy proposal in the history of American politics.

The McCain plan, for all those suffering from collective amnesia, proposed to replace all existing health care tax and spending subsidies with a universal health grant, structured like a refundable tax credit. The Patients’ Choice Act version of the idea is sponsored by Tom Coburn (R-OK) and Paul Ryan (R-WI). It promises $2,300 (individual) or $5,700 (family) to everyone who isn’t enrolled in a government health plan.

So what was candidate Obama’s problem with that? Did he object that the plan wasn’t generous enough? Too few regulations? No, none of that. The Obama TV ads focused like a laser on raw self-interest. McCain’s health plan, the ads said, will cause your withholding taxes to go up (without mentioning the offsetting credit that would cause them to go down).Continue reading…

Centrists Back Health Care Reform

Jan 19, 2011• 11

By MERRILL GOOZNER

The tone on Capitol Hill during Tuesday’s debate was more civil, the partisan rhetoric less harsh than previous exchanges on the House floor. But there’s little doubt that the Republican-led House will vote later today to repeal President Obama’s signature health care reform law.

That largely symbolic vote – there’s almost no likelihood the Democratic Senate will follow, nor would the president sign the bill – signals the start of a two-year campaign by newly empowered Republicans in the House to undermine the new law. Proponents of “repeal and replace” will next turn to eliminating the most unpopular elements of the law—including the individual mandate – and to cutting off funding for implementation.

But the administration won a powerful set of centrist allies on Tuesday as it scrambled to set in motion reforms that it believes will be popular with the American people once its key provisions go into effect. The new law, signed by Obama last March, is designed to provide about 32 million previously-uninsured Americans with coverage either through Medicaid or subsidized private insurance sold through state-based insurance exchanges. The total cost of the program of about $900 billion will be paid for by a combination of tax increases and slower growth in Medicare spending. The law also places consumer-friendly restrictions on insurance carriers, funds Medicare pilot models in alternative care delivery, and creates a government-run long-term care insurance program.

Ghosts of Health Reform Past

Jan 10, 2011• 3

By DAVID DRANOVE, PhD

I have not blogged for several weeks, mainly because I have been making sense of the curious events that transpired over the Christmas holiday. If you a regular reader of my blog, you know that I have had some harsh things to say about health reform. To criticize a law that brings joy to so many people, it must make me seem like a scrooge. But I really thought that most of the legislation was humbug. And then, in the days leading up to Christmas, I had a series of strange dreams that changed everything. I must tell you about them.

In my first dream, I was visited by a shriveled up old man who seemed to have already passed through death’s door.

I shuddered to see him. “Who are you? What do you want with me?” There was no response. He came closer and closer. I tried to move away but I was paralyzed with fear. Suddenly, he reached out and took me by his cold, clammy hand. As he held me tight we seemed to fly through space and time. Just as suddenly I seemed to be back in the real world. Only I wasn’t in my bedroom; instead I found myself in a conference room in a dreary office building. There was one window and if you craned your neck you could just make out the U.S. Capitol. Everyone attending the meeting wore the same uniform – gray dress slacks and powder blue dress shirts. But what I noticed most of all about their attire was that they all had pocket protectors filled with mechanical pens and pencils.

Then it occurred to me that I recognized a lot of those in attendance. I had seen them at healthcare conferences talking about the latest government initiatives to hold down healthcare spending. And here they were, hard at work. I listened closely and could hear them going on and on about diagnostic codes and relative values, and making exceptions for this drug and that hospital. They talked for hour after hour; it was becoming so excruciatingly boring that I begged my guide to leave. I wanted to go home. He refused and insisted that I listen carefully, for there were lessons to be learned. “Who are you,” I asked my guide again. “Why am I here?”

How the Republican Assault on Health Care Could Backfire On Them

Jan 7, 2011• 6

By ROBERT REICH

When it comes to health care, Republicans should be careful what they wish for.

Their upcoming vote to repeal the health-care law will be largely symbolic — they don’t have the votes to override President Obama’s certain veto. The real thing happens later, when they try to strip the Department of Health and Human Services of money needed to implement the law’s requirement that all Americans buy health insurance. This could easily precipitate a showdown with the White House—and a government shutdown later this year.

On its face it’s a smart strategy for the GOP. The individual mandate is the lynchpin of the heath-care law because it spreads the risks. Without the participation of younger or healthier people, private insurers won’t be able to take on older or sicker customers with pre-existing medical conditions, or maintain coverage indefinitely for people who become seriously ill. The result would be to unravel the health-care law, which presumably is what many Republicans seek.

At the same time, the mandate is the least popular aspect of the law. According to a December 9-12 ABC/Washington Post survey, 60% of the public opposes the individual mandate. While they want help with their health-care bills, and over 60% want to prevent insurers from dropping coverage when customers become seriously ill, most Americans simply don’t like the idea of government requiring them to buy something. It not only offends libertarian sensibilities, but it also worries some moderates and liberals who fear private insurers will charge too much because of insufficient competition in the industry.

Health Problem Quantified

Jan 7, 2011• 11

By JOHN GOODMAN, PhD

We now know how many people have the problem most often cited as the reason for last years’ health overhaul legislation. Answer: 8,000

No, that’s not a misprint. Out of 310 million Americans, only 8,000 people have the problem given as the principal reason for spending almost $1 trillion, creating more than 150 regulatory agencies and causing perhaps 150 million or more people to change the coverage they now have.

Alert readers will remember the White House summer of 2009 invitation to all Americans to send in their horror stories describing health insurance industry abuses. Although the complaints were many, the vast majority were about pre-existing condition limitations. Then, on the eve of the ObamaCare vote, every member of Congress who appeared on television to defend the legislation was able to cite by name an individual or family in his or her state or Congressional district with a heart wrenching story.

Gone was any interest in “universal coverage” or “insuring the uninsured” or “helping poor people get health care.” The case for change was focused almost exclusively on protecting the middle class from miserly insurance companies.

A Bipartisan Agreement on Health Care Was Possible in 2009

Jan 1, 2011• 6

By ROBERT LASZEWSKI

Readers of this blog have often heard me say that a bipartisan agreement on a health care bill was possible in 2009–driven from the Senate Finance Committee. I have continually made the point that the two sides were much closer than is commonly believed–or partisans are willing to concede.

Every time I post this, the overwhelming reaction is that I am wrong–with one side inevitably blaming the other for a lack of good faith in the discussions.

Bara Vaida had an interview in Friday’s Kaiser Health News with Mark Hayes, who was the lead Republican health staffer on Senate Finance at the time and had a “clear view” of the negotiations.

Here are the key excerpts:

Q: [Vaida] Key Democrats, including Senate Majority Leader Harry Reid, D-Nev., recently said their biggest regret was allowing the Senate Finance Committee leaders, your former boss Sen. Grassley and committee chair Max Baucus, D-Mont., to spend so much time trying to forge a bipartisan compromise on health care. What do you think about that criticism?

A: [Hayes] We really devised much of the health care framework even before the Gang of Six Senate (Finance Committee) leaders started meeting. In the summer of 2008, Sens. Grassley and Baucus held a summit and we were chugging along with planning our roundtables and it is my understanding that the leadership was frustrated with us that we were moving too quickly and they wanted us to slow down. We got agreement on 80 percent of the framework even before the Gang of Six started meeting to take on the remaining 20 percent. People were naturally impatient but the complexity of the job, connecting the dots and making the model work is a huge challenge so those who pushed for it to be done quickly were watching the clock and likely didn’t have a full appreciation for the issues we were attempting to resolve. The idea that the health care law could be done quickly and be done right is like saying you can go to the moon on the first try.