Kerry in the Boston Globe “If Congress Won’t Fix Healthcare"...

[kerrygoddess]

John Kerry: “If Congress Won’t Fix Healthcare, Then Americans Will Fix Congress”
July 31st, 2006 @ 12:58 am

John Kerry will deliver a speech today at noon at Faneuil Hall in Boston on healthcare. The speech will lay out Kerry’s comprehensive healthcare plan, a plan that Congress and the current administration had better get on board with, because American’s are wise to the fact that the healthcare crisis has “gotten worse” under the Bush administration and the Republican leadership.

It’s time for a new direction, it’s time we start “Getting moving on healthcare,” because we’re “stuck with a 20th- century healthcare system that just doesn’t work for a 21st- century economy.”

The truth is, the healthcare crisis “affects all of us.” Not just the single mothers struggling on a limited a income, not just the elderly on Medicare, now waking up to the fact that the Bush administration lied about the Medicare Drug Plan. We’re all in this boat togther. This healthcare crisis directly effects the economy. It directly affects the bottomline for businesses, big and small. It directly affect the health of all of our children — “It matters if the kid down the block isn’t immunized.”

It’s time to make healthcare an issue at the polls this fall. “Americans have a choice,” John Kerry says in an OP/ED in the Boston Globe today, “If Congress won’t fix healthcare, then Americans will fix Congress.”

MORE & LINKS - http://blog.thedemocraticdaily.com/?p=3757

[ProSense]

1. In response, the RNC touts Bush's prescription drug plan

and the Mass. plan.

The Republican National Committee, which typically responds to political criticism of the president, said Kerry's critique ignored the prescription drug program enacted by the Bush administration.

"It's unfortunate that John Kerry's bitterness over losing the election clouds his ability to recognize the president's prescription drug plan is providing millions of seniors with more affordable medicine," said RNC spokeswoman Tracey Schmitt.

Whatever his criticism, Kerry faces the reality that the governor of his home state _ Republican Mitt Romney, himself a potential 2008 presidential candidate _ has not only talked about but enacted a sweeping health care overhaul designed to bring universal coverage to Massachusetts.

Last week, Michael Leavitt, secretary of the federal Department of Health and Human services, called Romney's program "a model" for the nation.

http://www.washingtonpost.com/wp-dyn/content/article/2006/07/31/AR2006073100270.html

[ProSense]

2. Don't copy Massachusetts' reform

I'm sure the Repubs will start clamoring about the disaster in disguise:

Friday, April 28, 2006

Don't copy Massachusetts' reform

RICK J. CARLSON
GUEST COLUMNIST

The most fateful decisions about health care in the United States were both made more than 40 years ago.

The first, to run health care financing through employers, arose in the run-up to World War II and locked us into a bedeviling third-party reimbursement model for services, making health care that rare product that divorces payment from use.

The second decision, made 20 years later with the enactment of Medicare and Medicaid, wrapped public payment around medicine, as practiced, shielding the delivery system from anyone looking over its shoulder. We made this deal: Go along with Medicare and Medicaid, and we'll pay you what you want for whatever you do.

Both decisions demonstrate that U.S. health care policy is always about the business, and not the outcomes, of health care, as if the delivery system was its product, rather than the medicine it delivered. This is a fatal flaw: It is medicine that should be the focus of reform, and only derivatively the system that delivers it.

Our vaunted medicine has become the product our delivery system can sell at appreciable profit. In spite of its salutary objectives, if the Massachusetts model is replicated -- reforming only the ways money for care is raised and used -- it will doom us to many more years of spiraling costs and poor health.

Over the past 10 years we have poured $15 trillion into health care. Two-thirds of that was by the U.S. Treasury through payments for services, administration, research and tax and indirect subsidies. The Treasury is the primary source of operating capital for our health care system and U.S. business is the second. The public has no expectation of repayment except in improved health. Business, on top of that, invests expecting to get a productive and healthy work force in return.

more...

http://seattlepi.nwsource.com/opinion/268285_healthcare28.html

Limited options
By Robert Kuttner | April 8, 2006

WITH THE new health plan that Governor Mitt Romney promises to sign into law, advocates of universal health coverage feel they finally have their nose under the tent. The question remains, however: Is this the right tent?

Romney severely limited options, with three dubious assumptions. First, he insisted that basic health insurance could be bought for $2,400 a year. As any employer or individual who actually buys insurance knows, minimally decent coverage costs about $4,000 for an individual and double that for a family. The rhetoric about basic ''Chevrolet policies" versus ''Lexus policies" is blarney. Any policy that costs only $2,400 has astronomical out-of-pocket payments. It simply shifts medical costs to individuals.

Romney's second premise, shared by Senate President Robert E. Travaglini, was that ''market reforms" could liberate hundreds of millions of wasted dollars to redirect to coverage. The health bill, which creates a ''connector" to restructure insurance markets, will test that assumption. But as long as private insurers remain dominant to take their cut -- for profit, marketing, the costs of cherry-picking healthy customers, second-guessing doctors, and spewing paperwork -- the savings of market reform will remain modest. True market-reform would be single-payer coverage like Medicare, which is far more efficient than anything private insurers offer.

The final dubious assumption is that health insurance is like auto insurance; government should just make everyone buy it. But you can get basic auto insurance for well under a thousand dollars. While there are an estimated 50,000 affluent people in the Commonwealth who could afford medical coverage but choose instead to play Russian roulette with their health, the majority of the uninsured and under-insured don't have decent insurance because their employer doesn't offer it and they can't afford to buy it. (How do you pay $8,000 for insurance on a $30,000 income?)

The real free-riders are not improvident low-income individuals who fail to buy insurance that they can't afford, but negligent employers who let responsible businesses and taxpayers pick up the costs.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/08/limited_options

Massachusetts Health Care Reform Falls Short
By Rand Wilson and John Horgan
http://labornotes.org/index.shtml
from Labor Notes, #328, July 2006

Frustrated by the lack of action on health care reform at the national level, activists are working for state-level reforms that could be models for a future, more sympathetic federal government.

Massachusetts recently gained national prominence when a reform bill was signed into law. Unfortunately, the “breakthrough” solution that has been trumpeted as reaching near universal coverage is a false promise.

Like most states, Massachusetts has a serious health care crisis. The number of uninsured is rising (state estimates are as high as 750,000 people), costs are the highest in the country, and bargaining for contracts is often stalemated over employers’ cost shifting demands.

Snip...

BACKROOM DEALING
Behind closed doors with top legislative leaders, the reform coalition’s leaders crafted a plan. It did make some modest gains by undoing cuts in state Medicaid programs that benefit the poorest people. And the largest pool of uninsured people—low-wage, often part-timer or temporaries —will be eligible for subsidized insurance plans.

However, the combination of an individual and employer mandate to achieve these gains has dangerous consequences. Under the legislation, employers with more than 10 workers who do not make a “fair and reasonable” contribution toward employee health insurance will only be required to contribute a fee of up to $295—per year.

http://www.pnhp.org/news/2006/july/massachusetts_health.php

Lobbyists took in $7.5m on health bill - Industry boosts spending by third
By Scott Helman
Boston Globe
April 5, 2006

Lobbyists for hospitals, insurance companies, and other major players in the healthcare industry were paid at least $7.5 million in 2005 as the Legislature took up a major healthcare bill, records show.

Big spenders include Eli Lilly and Co., the pharmaceutical giant, which spent $299,000; Massachusetts Hospital Association, which spent $263,000; Massachusetts Association of Health Plans, which spent $208,000; and Partners HealthCare System, which spent $206,000, according to public records on lobbying activity filed with the secretary of state's office.

The amount spent on healthcare lobbying in 2005 is up more than a third over 2004 and far outstrips what was spent on another industry -- gambling and casinos -- at the heart of an intense slot machine debate playing out on Beacon Hill. Supporters and opponents of expanding gambling paid about $871,000 in 2005.

Spending on healthcare in 2005 also exceeded by far the $3.5 million in lobbying money devoted last year to utilities and telecommunications issues.

Not all the spending was aimed specifically at influencing the major healthcare bill, but observers say much of it was. Secretary of State William F. Galvin said the increased spending represents a significant increase and is "reflective of a certain culture that these large institutions are used to seeking their will through hiring people of influence."

"They made sure they were taken care of," Galvin said, adding that lobbying by large institutions is not necessarily wrong so long as the public also benefits. "I don't know the answer to that yet."

http://www.calnurses.org/media-center/in-the-news/2006/april/page.jsp?itemID=27623094

Amid cheers for healthcare, fears for funding abound
http://www.boston.com/yourlife/health/other/articles/2006/04/06/amid_cheers_for_healthcare_fears_for_funding_abound


Overwhelming support from RW groups is a clue:

http://www.heritage.org/Press/Events/ev012606b.cfm

[wisteria]

3. Another Repub calling another Repub's plan a model for the nation-

a good reason why we shouldn't take this comment seriously.
Anyway, aren't there major flaws in the Mass plan?

[ProSense]

4. A lot!

See the articles about the Mass. health plan in the post: Don't copy Massachusetts' reform.

[Mass]

6. Interesting - Two remarks.

As you noted, the MA plan is not a great plan. It is better than the status quo, but has a lot of problems.

The MA plan is NOT a Romney plan. It is supported by the MA House and Senate without which nothing would have been done. Kennedy and Kerry also participated in the elaboration of the plan which would not exist without the Dems.

However, as the articles you posted both note, it is not the way to go. Single payer would be the way to go, but very few people would offer it.

Also, it is interesting that the comment concerning the MA plan is offered by Glen Johnson as an editorial comment, and not by the RNC.

[Mass]

5. Congress cannot fix healthcare. Congress can fix health insurance,

but for that, they need to recognize the problem and be ready to offend insurance companies by creating a single payer system that is the only thing that can reduce costs.

Hopefully, Kerry will offer something that will actually improve the system, even if it does not go where it should really be. His proposals for 2004 were probably the best that can be done while letting health insurance into the hands of private companies.

I still stand with Kennedy "Medicare for All". It is by far the best proposal I have seen to this day coming from a US senator.

The two articles on the Mass. system are excellent, both by presenting the problem and what the Mass. solution does not offer.

[kerrygoddess]

7. Medicare is not the answer

Kennedy Medicare for all is good a start but it's not the answer. The Medicare system in it's current form does not work and speaking as someone who has been recipient of healthcare through Medicare in MA and CA - it sucks.

It's not just health insusrance that needs fixing - a lot of healthcare in general needs fixing - that is what JK is saying in his speech.

[ProSense]

8. Speech transcript posted

here:

Health Care for All Americans

Fact Sheet:

HEALTH CARE REFORM THAT LOWERS COSTS, IMPROVES QUALITY AND EXPANDS COVERAGE TO ALL AMERICANS JOHN KERRY’S HEALTH CARE PRINCIPLES:

• We need a health care system that ensures quality, affordable health care for every American man, woman, and child. And it’s our moral responsibility to help those who need it most.
• We’re stuck with a twentieth century health care system that just doesn’t work for a twenty first century economy. The traditional employer-based health care system can no longer meet all our needs. Costs are too high and businesses overseas are operating on a whole different playing field.
• A one-size-fits-all program just won’t work in America. People want and deserve more options and more choices – ones they can actually afford.
• Health care in America works, just not for enough people. We don’t need to scrap the entire system and replace it with something new and unknown. John Kerry wants to build on what’s already working and make it work for everybody.
• We must strengthen what works now, reward what’s right, and fix what’s wrong.
• We must not add bureaucracy – we must slash it.
• We must invest in American ingenuity to modernize our systems, improve quality and lower costs.

JOHN KERRY’S HEALTH CARE PLAN:
• Gives every American access to the same type of health care plan that Members of Congress get today and providing tax credits to make it affordable for the middle class, small businesses, near retirees, and people between jobs.
• Lower costs for employers and employees: The federal government will reimburse a percentage of the highest cost cases if employers include disease management and health promotion benefits in their employee health plans and implement ‘evidenced-based’ practices – those that are proven to provide the best care, including preventative care – to help make care more affordable. Right now the most expensive 0.4% of insurance claims account for 20% of all health care costs. Direct financial relief to employers and their workers will bring down premiums for everyone.
• Covers ALL children. We could cover every child in America next year with federal-state coverage expansions. John Kerry’s plan will provide health care coverage for every child in America. KidsFirst will cover all children up to three times the poverty level, through age 21.
• Improves quality and contains costs of health care overall through better care coordination, physician payment incentives, implementing ‘evidence-based’ practices, and investing in health information technology, such as electronic medical records.
• Experts agree Kerry’s plan will cover all Americans. A mandate will go into effect in 2012 to cover any remaining uninsured.
• Kerry’s health plan is paid for by repealing the Bush tax cuts for those earning over $200,000.

HEALTH CARE FACTS:
• There are 11 million uninsured children and 35 million uninsured adults in America.
• Since President Bush took office, the number of uninsured Americans has grown by six million and premiums are up 73%.
• Health care for a family of four now costs more than a minimum wage worker earns in a year.
• Health care affects the competitiveness of American companies in the global marketplace. For example, General Motors pays $1500 in health care costs on every vehicle they manufacture. Toyota pays only $500.
• African Americans, Hispanics, Native Americans, and Asians and Pacific Islanders comprise only one-third of the population but account for half of the nation’s uninsured, though they are just as likely as whites to belong to working families.
• America ranks 37th in overall performance of our health system. Cyprus, Morocco and Costa Rica outrank us.

http://www.johnkerry.com/features/health/facts.html

[ProSense]

9. People are not considering the current drawback with single-payer:

Consensus!

One of the problems is going to be finding consensus on financing single-payer, which will require a 5% tax increase for top 5% of income earners:

Proposed Funding For USNHI Program:

Maintaining current federal and state funding of existing health care programs. A modest payroll tax on all employers of 3.3%. A 5% health tax on the top 5% of income earners. A small tax on stock and bond transfers. Closing corporate tax loop-holes, repealing the Bush tax cut.

http://www.house.gov/conyers/news_hr676_2.htm

Good luck with passing that anytime soon.

Also, single-payer isn't synonymous with universal health care:

Krugman and Wells are persuasive—it's not a hard sell—about the nightmarish complexity and administrative costs of the current fragmented system. But they don't do much more than simply assert that a single, government-run insurance program would be more efficient. Even the most competitive industry can seem wasteful and inefficient when described on paper. Dozens of computer companies making hundreds of different, incompatible models, millions spent on advertising: Wouldn't a single, government-run computer agency producing a few standard models be more efficient? No, it wouldn't. Krugman and Wells duck the issue of rationing—saving money by simply not providing effective treatments that cost too much. They say let's try single-payer first. So, I say let's try some more modest reforms before plunging into single-payer.

Snip...

What's different about health insurance is the opposite: Much of it isn't insurance at all but a subsidy. The value of the subsidy is the difference between what the individual pays and what the insurance would cost in the free market. If people were buying health care or insurance with their own money, they might or might not spend too much—whatever "too much" is—but no one else would need to care if they did.

A subsidy has to take from someone and give to someone else. Everybody can't subsidize everybody. Or, to put it another way, society cannot give the average citizen better health care than the average citizen would choose to buy on his or her own. And this is what people want. Krugman and Wells believe that the average citizen will be sated by whatever bonus comes out of single-payer efficiencies. In this day of $100,000-a-year pills, I doubt it.

Even though we don't do it, most Americans surely think we ought to guarantee decent health care to everyone. In fact, most would probably be uncomfortable saying it's OK to have anything less than equal health care for everybody. Should a poor child die because her family can't afford a medicine that an insured, middle-class parent can pick up at the drugstore? Current government programs don't protect poor people very well against the cost of becoming sick. They do much better at protecting sick people against the risk of becoming poor. People who can afford insurance ought to protect themselves against a catastrophic health expense. But subsidizing this insurance for them is not only unnecessary, it is futile and unfair. No one is better able to afford health care for people of average means or above than they are themselves.

Krugman and Wells say that private insurance is flawed by "adverse selection": Insurance companies will avoid riskier customers. Only a single payer (that is, an insurance monopoly) can insure everybody and spread the risk. But anyone is insurable at some price—a price that reflects the cost they are likely to impose on the insurer. Adverse selection is only a problem to the extent that insurance is not really insurance, but rather a subsidy.

If you're not as hopeful as Krugman and Wells about being able to avoid rationing, you face the question: Should people be allowed to opt out of rationing if they can afford it? That is, if the system (private or single-payer) won't pay for the $100,000 pill, should you be able to pay for it yourself? Fear that this would not be allowed helped to kill the Clinton health-care reform 13 years ago. But explicitly granting some people life and health while denying these things to others is hard, even though this disparity has existed throughout history and is probably unavoidable. In fact, a serious defect of single-payer is that it makes all sorts of unbearable trade-offs explicit government policy, rather than obscuring them in complexities.

more...

http://www.slate.com/id/2138174

[Mass]

10. True, but you have posted the problems that what the Massachusetts bill

has (and it is not that far from what Kerry is proposing).

The problem is that, if people are not ready to lead and start a discussion of these issues, it will never happen and we will continue to say it will never happen.

The remark between universal healthcare and single payer is true, but there is a lot more chance to have an universal healthcare system that is meaningful with single payer system than without (see once again the MA bill.

[ProSense]

11. The case for Kerry's plan

plan is clear. While single-payer pushers mis-characterize the plan as favoring the insurance companies, the right denounces it as a government plan, but it's an excellent, workable, passable (will not be easy, but should be) plan.

First assessments from the right (when it was first introduced):

http://www.nationalreview.com/comment/cannon200407280009.asp


Now a former Clinton admin official:

The Impact of Sen. John Kerry’s Health Care Proposalon Health Care Costs
http://www.sph.emory.edu/hpm/thorpe/nobugthorpe2.pdf

Here is his bio:

KENNETH E. THORPE, Ph.D., Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality. He was the Vanselow Professor of Health Policy and Director, Institute for Health Services Research at Tulane University. He was previously Professor of Health Policy and Administration at the University of North Carolina at Chapel Hill; an Associate Professor and Director of the Program on Health Care Financing and Insurance at the Harvard University School of Public Health and Assistant Professor of Public Policy and Public Health at Columbia University. Dr. Thorpe has also held Visiting Faculty positions at Pepperdine University and Duke University. Professor Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. In this capacity, he coordinated all financial estimates and program impacts of President Clinton’s health care reform proposals for the White House. He also directed the administration’s estimation efforts in dealing with Congressional health care reform proposals during the 103 rd and 104 th sessions of Congress.

As an academic, he has testified before several committees in the U.S. Senate and House on health care reform and insurance issues. In 1991, Professor Thorpe was awarded the Young Investigator Award presented to the most promising health services researcher in the country under age 40 by the Association for Health Services Research. He also received the Hettleman Award for academic and scholarly research at the University of North Carolina and was provided an “Up and Comers” award by Modern Healthcare.

Dr. Thorpe has authored and co-authored over 85 articles, book chapters and books and is a frequent national presenter on issues of health care financing, insurance and health care reform at health care conferences, television and the media. He has worked with several groups (including the American College of Physicians, American Hospital Association, National Coalition on Health Care, Blue Cross and Blue Shield Association, Service Employees International Union, and the United Hospital Fund) and policymakers (including Senators Wellstone, Corzine, Bingaman, Snowe, Clinton, Obama and Kennedy) to develop and evaluate alternative approaches for providing health insurance to the uninsured. He serves as a reviewer on several health care journals.

Dr. Thorpe is a frequent commenter on health care issues in the print media and television. He has appeared on Nightline with Ted Koppel, NBC News with Tom Brokow, ABC World News Tonight with Peter Jennings, CNN, CNBC and Newshour with Jim Lehrer.

Professor Thorpe received his Ph.D. from the Rand Graduate School, an M.A. from Duke University and his B.A. from the University of Michigan.

http://www.sph.emory.edu/hpm/thorpe.php

Also noted that KG's thread is on DU's home page. Cool!