We're just about at the stage at which the health care debate starts crowding out practically every other domestic policy. That, at least, was the impression one got watching the White House this afternoon.Aravosis: Not the freaking pointPresident Barack Obama says changes to the nation's health systems are necessary and the window for overhaul will close when Congress breaks for summer vacation.
Obama met with lawmakers Tuesday at the White House. He told reporters at the start of the meeting that it makes no sense to add people to a broken system, so he wants to see costs controlled.
Obama says he wants broad action before Congress leaves for an August recess. He says this is a make-or-break moment for his priority.
This comes shortly after a report from The Hill which said Democratic leaders on both ends of Pennsylvania Avenue "are shoving aside issues that divide their party to clear the deck for healthcare reform, which is likely to dominate the rest of the legislative year."
It also coincides with a new administration report that emphasizes the reform effort in the context of economic and fiscal concerns.
Slowing the growth in health-care spending from 6 percent a year to 4.5 percent would have enormous benefits for the nation's economy, creating as many as 500,000 jobs a year and increasing annual income for the average family of four by $2,600 over the next decade, President Obama's chief economic advisers said in a report released today.
In the report, the Council of Economic Advisers concludes that cutting costs while extending coverage to the 46 million people who lack health insurance would also dramatically improve the federal budget outlook, remove "unnecessary barriers" to job mobility and increase the nation's overall economic well-being by "roughly" $100 billion a year.
Now all we need is an ambitious, comprehensive reform package with a public option to make these savings happen. Piece of cake.
From CNNMoney:Perhaps the most controversial proposal tied to health care reform, Obama backs public insurance plans as an alternative to commercial plans, intended to offer coverage to those who currently can't afford insurance.Wrong wrong wrong. Unless Congress can figure out how to force companies like Blue Cross to give us coverage that doesn't cost an arm and a leg, that doesn't go up in cost 25% a year, that doesn't cap prescription benefits at $1500 a year (and never increase), that doesn't set lifetime limits on your coverage (meaning, if you get really sick, you die) - unless all of that happens, then the public plan is about much more than helping the poor. It's about helping all of us who can't get comprehensive insurance at a decent price - nay, at any price.
Aravosis: Blue Cross' response to the recession? Increase rates 29%
My friend Nick got a little surprise in his mailbox today from Blue Cross Blue Shield. A 29% increase in his health insurance rates.
Just received my " shakedown package " in the mail today from the crooks at Blue Shield of California.
Yeah, I chuckle when I read Blue Cross complaining about the high cost of expensive new drugs. My coverage under Blue Cross has always provided only $1500 a year in prescription drug benefits, that's it, for 12 years now - no increase in coverage, always $1500 (even though my rates have nearly tripled). It doesn't matter if the drug is $50 a bottle or $50 million a pill. All Blue Cross is going to pay is $1500 a year and then they cut me off. So explain to me how the expensive price of new drugs is "forcing" them to increase the price of their plans when, actually, the money they spend on my prescriptions is going down each year in real dollars (and I have the best self-employed plan Blue Cross offers)?
Effective 7-1-09 (2 months before my birthday)
A 29% increase from my current rate!
No claims in 7 years - no chronic conditions - healthy!
A 29% yearly increase during the worst economy in 70 years?!
Their" reasons ":Why is my rate changing?
Their option for only a 6% increase is to move to a plan (' Vital Shield Plus 2900 ') with LESS COVERAGE ALMOST ACROSS THE BOARD, a $400 higher yearly deductible, and a $3 million lifetime cap. The deductible is now $2900 in the new plan (which I'll have to go to in order to afford having ongoing coverage).
Rates are changing due to rising costs across the healthcare industry. Major drivers include hospital upgrades, new technologies, and expensive new drugs. Other factors include an aging population and higher costs for inpatient and out patient care. To learn more....blah, blah, blah
Until we get Single Payer we are truly and totally fucked!
These people are liars and thieves out to make a fast buck off of our misery. The federal government should be regulating companies like Blue Cross in the same way they're now overseeing GM and Wall Street. Once Blue Cross has to submit its books to the feds and to Congress, then maybe we'd see a little more corporate responsibility from one of the worst insurance companies in the business.
Benen: TRIGGER TROUBLE...
One can convincingly argue that the media have a hand in perpetuating the conservative caricature, but the Republican Party has contributed to the distortion by pandering to its less rational elements. Still fresh in our minds is the last presidential election -- a strange season that might be attributed to GOP desperation if not for a prior history in times of political prosperity.
Two words: Terri Schiavo. During that 2005 Operation Rescue debacle -- complete with death vigils and lamentations -- Bill Frist, then the Senate majority leader and a practicing physician, lent credibility to the circus performers by diagnosing Schiavo's condition via video and challenging other medical opinion that she was in a persistent vegetative state.
And let's not forget how the GOP handled the 2004 U.S. Senate race in Illinois against one Barack Obama. They inserted their own African American, none other than Alan Keyes. That worked out well.
We should never shoot the messenger, it should go without saying. But until the Republicans marginalize those who belong in the margins, they won't be attracting many new recruits. And the messengers will continue to obscure the message.
- Joe Sudbay (DC) adds:
Yesterday, Obama had a meeting with Democratic Senators to talk about health care reform. I'm getting a little worried. Democratic Senators really have the capacity to screw this up. They get lost in their own little world up there on Capitol Hill. Keep an eye on Senator Max Baucus (D-MT). He's the chair of the Senate Finance Committee. Right now, seems like he's more obsessed with bi-partisanship than good policy.
- digby: Supporting The Public Plan
I was talking to Darcy Burner yesterday, who filled me in on the exciting work she's doing as the new head of the American Progressive Caucus Policy Foundation (APCPF), which is:
a nonpartisan 501(c)(3) organization whose mission is to bring together the collective wisdom of progressives inside and outside of Congress to promote
Check out the web site for more info. It's a much needed pathway for progressive thought and action from many different perspectives to come together and work in new ways.
* peace and global security,
* energy independence,
* environmental sustainability,
* human rights,
* civil liberties and
* the health and economic well-being of us all.
We will serve as a communications, fact finding, research and education center for progressive leaders and other public policy-makers, issue advocates, the media, and the general public inside and outside of Congress.
Darcy mentioned to me that this week is an important moment in the health care debate, in which it might be helpful for members of the netroots to weigh in with a little positive reinforcement to the progressive caucus, which has been holding the leadership's feet to the fire on the public plan option. Everyone pretty much agrees that if that goes down, health care reform will be a meaningless shell game.
I was somewhat surprised frankly (in a good way)to hear the the progressives caucus had pulled together on this one and was actually wielding some clout. They represent over 70 m4mbers of congress, which is a bigt bloc of votes. if they can stick together on the public plan, it will happen.
I think it's pretty clear that netroots types are all more than willing to meet our responsibility to push and criticize and basically be a thorn in the sides of politicians to "make them do it." But it's also important to let them know that we appreciate it when they follow through.
If you have time today or tomorrow to give a progressive caucus rep a call or send an email it would be helpful. They need to know that the public is paying attention and that we have their backs as this debate kicks into high gear. The health care industry is working overtime to whittle away at meaningful health care reform, most especially the public plan which scares them to death. These self-identified progressives are the people who will hold the line and ensure that they do not get their way.
If one of these House members is your Congressional Representative, all the better. But contact one or more of them even if they aren't. They need to know that people other than lobbyists and big donors are engaged and informed on this and that weknow what's at stake with the public plan.
Write or Call Your Congressional Progressive Caucus Member and tell them you appreciate that they are holding the line on the public plan.
*I posted this yesterday over at Ourfuture.org.
Update: There's more to this story developing in the Senate as we speak. Mike Lux writes:The insurance lobby has had multiple tactics for stopping the public option idea, which they despise because they know if regular folks have choice to go to a public option, insurance companies won't have the same ability to treat their customers like garbage when they get sick. The first tactic was just to try to kill the public option outright, and the good news is that they appear to have failed at that. This so-called trigger proposal is the second tactic: the idea is to write a "trigger" that will allow for a public option only under certain conditions, but write the legislation so that those conditions would never get met in the real world. It's a classic DC tactic, right up there with calling for a commission to study something. Olympia Snowe is carrying the insurance industry water on their trigger proposal, proposing triggers that would only get tripped in some fairyland none of us have ever visited.
The great thing for the insurance companies in a tactic like this is that it gives "centrist" Senators (centrist in Washington, DC usually means those who have taken massive amounts of campaign contributions from the affected industry) an excuse to help the insurance industry while looking like they are open to the public option that their constituents have been demanding.
Barack Obama and Democrats in Congress have gotten some good things done so far, and are building real momentum in getting us moving in the right direction on health care. But if conservative Democrats force the adoption of the trigger, it will destroy Democratic unity and doom health care reform, because progressives will start attacking Democrats rather than insurance companies. We really are at a critical moment.
The only committee seriously considering the trigger turkey is the Senate Finance Committee, whose members average several hundred thousand a piece in insurance industry contributions. If you care about getting true health care reform, now is the time to make your voice heard: call the Senate Finance Committee members and tell them "NO to a trigger."
So, thanks to progressives in the House, it looks like they haven't been able to kill the public option. But they are now working overtime in the Senate to get this trigger mechanism in place to essentially --- kill the public option.
Anyone who thinks these people are partners in health reform needs to stop smoking the good stuff.
Yglesias: Christina Romer on the Health Tax Exclusion
Council of Economic Advisers Chair Christina Romer did an interesting interview with Ezra Klein mostly focused (naturally) on the recent CEA report on health care. But I thought this dancing around the issue of the exclusion of employer-provided health benefits from taxation was probably the most interesting part:
Ezra Klein: You talked a lot in the report about the inefficiencies in the system. One of the sections — the second, if I remember — talks about price sensitivity and the way consumers don’t see the true cost of health care, and thus don’t have the full incentive to press down on the system. You also have a great graph on the fifth page showing the bite that health care takes out of compensation, but most workers don’t know about that connection. For all that you don’t mention the employer tax exclusion anywhere, which most economists I’ve spoken with over the years to seem to think is the key driver behind consumer insulation. Any thoughts on that?
Christina Romer: I have to tell you it’s there in a crucial footnote! [Laughs] You can’t say it’s not in the report!
It is something that a lot of health-care economists say provides an incentive to do expensive things. We heard Senator Baucus say today he wants it on the table. It’s not something the president has supported, and certainly the way it was done in the campaign, taking it off for everybody, that’s a bad idea. But at the event I was at today, David Cutler and Mark McClellan made the point that there are things in-between. Cap it for a Cadillac plan, for instance.
EK: Do you think there’s openness to these midpoint compromises? Capping it for plans, or at a certain level of income?
I’m trying not to prejudge the legislative process.
During the campaign, John McCain basically proposed just doing away with this tax break and replacing it with a little hocus pocus that would have left most families high and dry in the medium-term. The Obama campaign went after that with some very hard hits. Consequently if, as seems likely, the legislative process winds up involving some curbing of the tax exclusion you’re going to see charges of hypocrisy and flip-floppery.
So part of what’s happening here is an effort to start laying the groundwork for distinguishing between the Senate may want to do in terms of financing comprehensive health care reform and what McCain proposed during the campaign. In this section, Romer is pointing to the possibility of curbing the tax preference without necessarily hitting people of modest means enjoying average health plans. I would say, however, that the biggest difference is in terms of what the tax hike would be paying for. Neither the HELP Committee nor the Finance Committee is proposing to unravel the employer-based health insurance system and then just kind of hope for the best, à la McCaincare.
Instead, the idea is to construct a much firmer system that will ensure the available of affordable health care for everyone at all times and they pay for that in part by curbing the tax exclusion. That makes all the difference in the world. In general, higher taxes are undesirable, but when they’re used to finance something worthwhile that’s fine.
Ezra Klein: News Break: How the White House Hopes to Control Health Care Costs
You've heard the line that "entitlement reform is health reform." Yesterday, at a meeting between Barack Obama and Senate Democrats from the Finance and HELP committees, that line grew up and graduated into something altogether sturdier: A policy. Senate sources confirm that the president argued in favor of a genuinely major Medicare reform -- a reform that could make Medicare the nation's most important laboratory for health care reforms.
You probably haven't heard of MedPAC. Most people haven't. It stands for The Medicare Payment Advisory Commission and it's an independent congressional agency formed in 1997 to advise the Congress on matters relating to Medicare. The commission is staffed by experts who are appointed for three-year terms, and its existence is due to a simple insight: Medicare payment policy is too technical for the Congress. There aren't five senators with an informed opinion on the "equipment use standard" for imaging machines, much less 50, and much less 100.
Every year, MedPAC releases a "report to the Congress on Medicare payment policy." The report contains acres of analysis (this year's "assessing payment adequacy and updating payments in fee-for-service Medicare" was particularly thrilling) and a final chapter on recommendations. The recommendations tend to be smart, aggressive, reforms. The sort of reforms experts agree are needed, but interest groups effortlessly stymie. The recommendations don't, in other words, matter. None of it does, really. The report sits on a shelf.
But what if it didn't? What if MedPAC had power?
That's what the White House wants. There are, I'm told, two policies under consideration. The first is a version of Senator Jay Rockefeller's MedPAC Reform Act. This legislation would move MedPAC into the executive branch. The commissioners would be approved by Congress and appointed for six-year terms. Beyond that, it would largely be an autonomous agency, able to set Medicare payment rates, conduct trial programs, and fund policy initiatives.
The theory is that it would act as a Federal Reserve for Medicare. "Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare," said Rockefeller. "Congress should leave the reimbursement rules to the independent health care experts.”
That's the plan Obama spoke of favorably in yesterday's meeting. But what hasn't been reported is that senior administration officials are also considering another variant: This plan would package MedPAC's yearly recommendation and fast track them through Congress for a simple, up-or-down vote. No filibuster. No changes to the package of recommendations. Health reform, under this scenario, would become a yearly legislative project.
And that's how some in the White House would prefer it. The health system changes too quickly for Congress to address through massive, infrequent, efforts at total reform. New technologies and new care structures create new problems. A health care reform package signed in 2009 might miss some real deficiencies, or real opportunities, that present themselves in 2012. A health reform process that recognizes that fact is a health reform process that is continual, rather than episodic.
But the reason health reform is so infrequent is that it's structurally difficult. Small tweaks are too technically complex for Congress to easily conduct and so are dominated by lobbyists. Large reforms attract broad interest but are impeded by polarization and the threat of the filibuster. The MedPAC changes under discussion are, in other words, nothing less than a new process for health care cost reforms. They empower experts who won't be intimidated by the intricacy of the issues and sidestep the filibuster's ability to halt change in its tracks.
MedPAC, of course, is restricted to Medicare. But there's little doubt that where Medicare leads, the health care industry follows. Private insurers frequently set their prices in relation to Medicare's payment rates. Hospitals are sufficiently dependent on Medicare that a reform instituted by the entitlement program becomes a de facto change for the whole institution, and thus all patients. A process that empowers Medicare to aggressively and fluidly reform itself would end up dramatically changing the face of American health care in general.
Thus far, we've heard a lot of talk about cost control. But this is the first time, at least to my mind, that we've seen anything that actually looks able to deliver on controlling costs. To flip the old line, this is where health care reform becomes entitlements reform.
Benen: ACROSS THE BORDER....
A conservative project called "Patients United Now" started running a television ad last week, featuring a Canadian woman who said she came to the United States to be treated for brain cancer, because in Canada, she would have had to wait six months to see a specialist. The point of the ad is to condemn Canada's system, and by extension, attack the health care reform effort underway in Washington.
After all, if Canadians are coming to the U.S. for care, then the status quo in the U.S. must be pretty good, right?
There are, of course, more than a few problems with the argument, not the least of which is the fact that the Democratic approach to reform bears no resemblance to the Canadian system. But if we're taking the argument at face value, what does it say about our system when people in the U.S. travel to Mexico for care?
Nearly a million Californians, perhaps hundreds of thousands more, cross the border to Mexico every year because they cannot afford the rising cost of health care in the United States, according to UCLA researchers.
The study by the school's Center for Health Policy Research, published Tuesday in the journal Medical Care, affirms what has long been suspected -- that the untamable cost of medicine is forcing many, particularly Latino immigrants, to look outside California for medical and dental care. As casualties from the recession rise and as budget-strapped government programs eliminate health services, more people are expected to head south to fill prescriptions, get teeth fixed or undergo care for chronic illnesses.
According to the study, at least 952,000 California adults -- 488,000 of them described by the study as Mexican immigrants and about a quarter as non-Latino whites -- head south annually for their medical, dental and prescription services.
The number seeking care in Mexico may actually be much larger, because findings are based on 2001 data from the California Health Interview Survey and do not take into account today's higher rates of unemployment and the increasing rate of the medically uninsured.
Gil Ojeda, executive director of the California Program on Access to Care, which is housed at UC Berkeley's School of Public Health, added, "We suspect the number has grown by leaps and bounds."
Inheritance tax is money that is paid on the value of the property you own. There is a nil rate band and can be assessed when you send in your inheritance tax return. The nil band rates can affect your capital gains tax.
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