Instead of contemplating a health care Quote of the Day today, let’s take a moment to consider what each of us might do to harness the energy behind the forces that would destroy social solidarity, and bring us all together in efforts to heal our social problems such as our sick health care system that leaves so many suffering and dying.

Blue Shield of California seeks rate hikes of as much as 59% for individuals

By Duke Helfand
Los Angeles Times
January 5, 2011

Another big California health insurer has stunned individual policyholders with huge rate increases — this time it’s Blue Shield of California seeking cumulative hikes of as much as 59% for tens of thousands of customers March 1.

In all, Blue Shield said, 193,000 policyholders would see increases averaging 30% to 35%, the result of three separate rate hikes since October.

Nearly 1 in 4 of the affected customers will see cumulative increases of more than 50% over five months.

http://www.latimes.com/health/healthcare/la-fi-insure-rates-20110106,0,6975599.story

And…

Statement of HHS Secretary Kathleen Sebelius on Blue Shield of California’s proposed rate increase

U.S. Department of Health and Human Services
January 6, 2011

“The people of California have a right to be concerned when they see this kind of rate increase month after month. We have reached out to California Insurance Commissioner Dave Jones and know he is doing everything in his power to help consumers. We stand ready to assist him and the people of California in any way that we can.”

http://www.hhs.gov/news/press/2011pres/01/20110106b.html

And…

Statement by Blue Shield of California

Blue Shield of California
January 6, 2011

The rate increases reported today cover a period of more than one year and have almost nothing to do with the federal health reform law. These rates reflect trends that were building long before health reform. Our individual market medical costs are rising rapidly due to higher provider prices, increased utilization, and the fact that healthier people are dropping coverage during a bad economy. Health reform will help slow down this trend by expanding coverage, which will keep healthier people in the system, and through quality and cost containment initiatives such as the Independent Payment Advisory Board, Center for Medicare and Medicaid Innovation, Patient-Centered Outcomes Research Institute and other incentives for prevention and coordinated health care.

Even with these rate increases, Blue Shield of California expects to lose tens of millions of dollars on its individual healthcare business in both 2010 and 2011. These new rates meet the federal requirement that 80 percent of premiums are spent on healthcare expenses.

https://www.blueshieldca.com/bsc/newsroom/pr/statement_rates_010611.jhtml

Last year California’s for-profit Anthem Blue Cross, a division of WellPoint, enraged everyone when they attempted to raise premiums as much as 39 percent. In contrast, Blue Shield of California is a non-profit insurer attempting to compete in a market in which the rules are established by investor-owned insurers, yet they are now calling for premium increases as high as 59 percent. As a provider or a patient, it is difficult to tell the California Blues apart.

That said, the brief statement released by Blue Shield of California explains the reasons for the increases: higher provider prices, increased utilization, and a decline in enrollment in a bad economy resulting in spiraling premiums due to adverse selection. In spite of these premium increases, Blue Shield expects to lose tens of millions of dollars on its individual health plans.

These premium increases are intolerable, but is Blue Shield really to blame? Keep in mind that the average working family of four now uses over $18,000 worth of medical care (Milliman Medical Index), and Blue Shield is trying to sell a product that covers those costs plus its own administrative expenses. With insurer administrative costs at 20 percent for the individual market, that’s about $22,500 that the premium would have to be. To lower the premium, costs are shifted directly to the family through deductibles, co-payments, coinsurance, and paring of benefits, but how much in direct costs can the family bear when median household income is about $50,000?

Blue Shield is facing an impossible situation. They cannot create a product that has both affordable premiums and adequate protection against out-of-pocket medical expenses.

That is why the Patient Protection and Affordable Care Act provides income-indexed subsidies for both premiums and cost sharing, but applying simple math to these subsidies will demonstrate that they are inadequate for the majority of low- and moderate-income families who have health care needs.

If we were to increase the subsidies to a level where they would be adequate, then you would be paying more than an improved Medicare for all would cost since the subsidies would have to pay not only for health care but for all of the administrative excesses of our fragmented system composed of a multitude of private and public plans. If taxpayers are going to pay the bill, we might as well pay the one that is a bargain.

The administrative team at Blue Shield of California is composed of fine people. We should thank them for their dedicated service and offer them job retraining to serve in our expanded and improved Medicare program. For the investors and administrative team at Anthem Blue Cross, we should show them the door.

Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades

Anne Martin, David Lassman, Lekha Whittle, Aaron Catlin and the National Health Expenditure Accounts Team
Health Affairs
January 2011

In 2009, US health care spending grew 4.0 percent — a historically low rate of annual increase — to $2.5 trillion, or $8,086 per person. Despite the slower growth, the share of the gross domestic product devoted to health spending increased to 17.6 percent in 2009 from 16.6 percent in 2008. The growth rate of health spending continued to outpace the growth of the overall economy, which experienced its largest drop since 1938. The recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. The recession also placed increased burdens on households, businesses, and governments, which meant that fewer financial resources were available to pay for health care. Declining federal revenues and strong growth in federal health spending increased the health spending share of total federal revenue from 37.6 percent in 2008 to 54.2 percent in 2009.

http://content.healthaffairs.org/content/30/1/11.full#aff-5

How much are we spending on health care?

For 2009:

National health expenditures: $2.5 trillion

Percent of GDP: 17.6%

Spending per person: $8,086

Although the title of this article and the news reports stemming from it tout the fact that this is the slowest increase in health care spending in five decades, the 4.0 percent increase is well in excess of inflation and remarkably high considering that it occurred during the Great Recession.

Perhaps the most impressive number that demonstrates this increased spending on a background of the recession is the percent of federal revenues that were directed to federal health spending. Federal revenues decreased 18.2 percent while federal health spending increased 17.9 percent. Thus the federal revenues directed to federal health spending increased from 37.6 percent in 2008 to 54.2 percent in 2009. Over half of the recession-impacted federal revenues were spent on federal health programs!

These numbers demonstrate that even a severe recession was unable to reduce the increase in health care spending to anywhere near the rate of inflation nor the growth in GDP (gross domestic product).

Since the cost containment measures in the Patient Protection and Affordable Care Act (PPACA) are so weak, there is little hope for truly significant relief from escalating costs in the foreseeable future. Yet just the administrative savings alone of a single payer system would be much more effective, and there is no reason that an improved Medicare covering everyone couldn’t adopt some of the modest but beneficial cost-saving measures of PPACA so long as they have no detrimental policy impacts.

Instead of repealing PPACA, we need to retain the beneficial measures, but then replace the flawed financing component with one that will work – an improved Medicare for all.

The following text contains the written testimony of Dr. Anne Scheetz that she presented to the Illinois House Special Committee on Medicaid Reform on Jan. 3, 2011, in Springfield, Ill.

Thank you for allowing me to address your committee on behalf of the Illinois chapter of Physicians for a National Health Program and the Illinois Single-Payer Coalition.

As I have listened to the proceedings of the University of Illinois Institute of Government and Public Affairs State Summit 2010, “Reforming Medicaid in Illinois: Managing Service Delivery and Controlling Costs,” and to those House and Senate special committee hearings that I have been able to attend, I have heard several recurring themes, among them, restoring public trust in government by eliminating fraud and abuse in the Medicaid system; controlling costs; and obtaining good value for taxpayer money.

Committee members have been assured that by privatizing Medicaid, that is, by turning over taxpayer money to private insurance companies, and forcing Medicaid recipients into HMOs, they can control Medicaid costs while improving recipients’ quality of care.

The Illinois chapter of Physicians for a National Health Program and the Illinois Single-Payer Coalition oppose forcing patients into HMOs. We work for a health care system in which every person has access to all necessary care without financial barriers and with complete choice of hospitals, physicians, and other providers. We note that the only health care system capable of controlling costs is, paradoxically, one in which everyone has access to care, because only a universal system is able to reduce the bureaucracy that consumes at least 30 percent of our health care dollars.

In regard to proposals for forcing people into Medicaid HMOs, we note that evidence from the Medicare program contradicts the assurances about cost and value that the committees have received.

Medicare was enacted in 1965 as a public program under which nearly all persons in the United States over age 65 were entitled to receive certain health care services on a fee-for-service basis. Beginning in 1972 there have been multiple forays into partial privatization. Currently, Medicare recipients are allowed to choose between the public program and private HMOs called Medicare Advantage Plans (MAPs). Insurance companies offering qualified MAPs receive capitated payments and assume full risk for covered services for their enrollees.

I will review briefly the results of partial privatization in terms of value, cost control, fraud and abuse, and public trust.

A report released by the U.S. House of Representatives Committee on Energy and Commerce on December 9, 2009, found the following: Traditional Medicare spends 1.5 percent of revenues on medical care and over 98 percent on health care. By contrast, the average MAP insurer spent 15 percent of premium revenue on profits, marketing, and other corporate expenses, and some insurers spent less than 75 percent on medical care in at least some years. MAPs spent nearly 10 times as much as traditional Medicare on administrative expenses per beneficiary. MAPs that spent less than 85 percent of revenues on medical care paid their executives over $1.2 billion, and one company that spent 83 percent of revenues on medical care spent $3.1 million for two executive retreats in Hawaii. In summary, the House report found that MAPs shift taxpayer money away from medical care into administrative overhead and wasteful executive benefits.

Dr. John Geyman in his 2006 book “Shredding the Social Contract: The Privatization of Medicare” provides further analysis of the effects of MAPs on beneficiaries’ health and on Medicare spending (pp. 103-106). MAPs received on average 13 percent more than the cost of traditional Medicare per patient. Medicare beneficiaries enrolled in MAPs were hospitalized at the rate of 66 percent of those in traditional Medicare during their MAP period of enrollment; but those who disenrolled from MAPs were hospitalized, during the first year after disenrollment, at 180 percent of the rate of traditional Medicare patients. Fifty-four percent of chronically ill Medicare patients in HMOs had declines in physical health during a four-year period compared to 28 percent in traditional fee-for-service Medicare. These are only some of the damning pieces of evidence listed in Dr. Geyman’s book; all were derived from articles published in Health Affairs and in top peer-reviewed medical journals. Furthermore, Medicare private plans engaged in both legal and illegal practices in order to enroll healthier beneficiaries and avoid sicker ones, despite their high level of payment (Geyman, pp. 69-70). Finally, between 1999 and 2002, about one-third of MAP enrollees lost their plans when insurance companies pulled out of certain markets due to low profitability or inability to enroll sufficient providers in their networks (p. 76).

A 2010 study by The Medicare Rights Center (www.medicarerights.org) provides a beneficiary perspective on disenrollment from MAPs. Voluntary disenrollment occurred because of provider access problems for such services as cancer specialists, home health, and rehabilitation; misinformation and marketing abuse, including enrolling customers without their consent; coverage problems; cost sharing that was higher than expected; and data systems problems. Although the practice is illegal, some patients were disenrolled involuntarily when they received a diagnosis of cancer, through plans claiming that premiums had not been paid and refusing to rescind disenrollment even when proof of payment was presented.

To summarize, partial privatization of Medicare has resulted in the opposite of cost control, increased value, and elimination of fraud and abuse. Instead, privatized Medicare as compared with traditional public Medicare has resulted in the following: increased per beneficiary cost to Medicare; increased beneficiary out of pocket costs; higher overhead; disruption of continuity of care; decreased choice of providers; denial of services; and poorer health outcomes. Furthermore, insurance companies break the law and waste taxpayer money.

Privatized Medicaid, as I have heard it presented during these hearings, will be different in some respects from privatized Medicare. For instance, recipients who cannot access the providers and other services they need, such as cancer care and rehabilitation, will not be able to switch to a public program. We do not know what will happen to these patients, but we can anticipate that their needs will not be met. On the other hand, we can anticipate that insurance companies will demand that the state pay them enough to ensure their profitability, regardless of the loss to patients and to taxpayers; if they do not get the profits they want they will withdraw, in itself an expensive process for the Medicaid program and for patients and providers. We can expect multiple disruptions of continuity of care. We can expect the insurance companies to engage in illegal practices. We can expect poorer health outcomes among Medicaid recipients.

At the same time that Physicians for a National Health Program and the Illinois Single-Payer Coalition foresee these problems for Medicaid recipients, we acknowledge that every person in the contemporary U.S. health care system faces the risk of denial of services, disruptions of care, and financial devastation in the event of serious illness. Thus, we work for true reform of the entire U.S. health care system in the form of Expanded and Improved Medicare for All. We urge all of you to support H.B. 311, the Illinois single-payer bill, when it is reintroduced during the next legislative session.

Thank you.

Financial disclosures: none. I receive no reimbursement, including for expenses, for my work for PNHP and ISPC.

Anne Scheetz, M.D., F.A.C.P., is board certified in internal medicine with added qualifications in geriatric medicine. She resides in Chicago.

Outlook negative for insurers: Moody’s

By Melanie Evans
ModernHealthcare.com
January 4, 2011

Health insurers’ outlook continues to be negative as the sector faces new regulations, heightened political pressure and a weak economy, which are expected to squeeze earnings, one major ratings agency said.

Moody’s Investors Service said in a report that insurance provisions of the Patient Protection and Affordable Care Act that go into effect this year could limit insurers’ income. Analysts described 2011 “as a transition year” for insurers as companies grapple with new medical-loss ratio regulations, which require 85% of large group premiums and 80% of small group and individual premiums to be spent on patient care.

Flat Medicare Advantage reimbursement levels for 2011, to be followed by cuts next year, could squeeze insurers’ margins, the report said. Insurers have moved to diversify to increase revenue and income not affected by changes under the reform law, analysts said. The sector also faces greater oversight and political pressure regarding insurers’ premium increases.

Insurers also face threats to enrollment from the economy, according to the report. The weak job market and possible further layoffs in the public sector this year could leave more households without employment, the source of health insurance for many, the report said. Struggling employers and households may not be willing or able to pay for care even as providers seek pay increases to increase revenue.

http://www.modernhealthcare.com/article/20110104/NEWS/301049965/-1#

And…

US Healthcare Insurers: Outlook Remains Negative

Moody’s Investor Service
December 29, 2010

…Despite better than expected results in 2010, Moody’s has maintained its negative outlook for the U.S. healthcare insurance sector due to regulatory, political, and economic threats that combine to place downward pressure on future earnings. Our expectations for 2011 for the sector as a whole include lower earnings, flat-to-low membership growth, and strategies increasingly focused on diversification. The negative sector outlook represents our view of credit conditions facing health insurers over the next 12 to 18 months; it provides a framework against which to consider issuer-specific ratings and research. 1. Regulatory Issues ¡ The healthcare reform law passed in early 2010, has already imposed a number of challenges for health insurers. During 2010, most changes required insurers to provide additional benefits while allowing them to adjust premiums appropriately. However, in 2011, two key provisions of the law — minimum medical loss ratio (MLR) regulations and changes to Medicare Advantage…

The remainder of this 9 page report can be purchased for $550.00 at this link:
http://moodys.alacra.com/research/moodys-global-credit-research—PBC_129845

We hear much about the private health insurance industry from Health and Human Services (HHS) and from America’s Health Insurance Plans (AHIP) and the private insurers themselves. This report is of interest because it provides a perspective on for-profit health insurers from a consulting firm for investors.

Although the regulatory changes that the insurance industry faces as a result of the Patient Protection and Affordable Care Act bring bad news to investors, in a sense this is good news for patients because some of the greed has been squeezed out of the system. Moody’s seems to be an expert on greed since they charge $550.00 for a 9 page report that apparently only tells us what we already knew. (I must confess that I made an exception in not reading the full report that was used as the source of today’s quote since I couldn’t bring myself to pay that fee.)

We could have had better news. The savings that is good news for patients is only minuscule when you consider the much larger amount that we could have saved by changing to a single payer national health program – an improved Medicare for all.

Cuomo Targeting Medicaid Spending

By Jacob Gershman
The Wall Street Journal
January 4, 2011

Gov. Andrew Cuomo is aiming to reduce the state’s Medicaid spending by billions of dollars, exceeding the size of cuts to the program proposed in past years, according to individuals with knowledge of his budget.

The Cuomo administration is considering a cut of about $2.1 billion out of the state’s projected spending on Medicaid in the upcoming fiscal year. With federal matching funds, the cut comes to more than $4 billion.

http://online.wsj.com/article/SB10001424052748704111504576060280154691892.html

And…

Brown to propose broad list of budget cuts

By Kevin Yamamura
The Sacramento Bee
January 3, 2011

(Gov. Jerry Brown) will propose Medi-Cal (Medicaid) savings by requiring patients to provide co-payments for services, limiting doctor visits and reducing rates paid to health providers. In Healthy Families (CHIP), which provides subsidized care for low-income children, he wants participants to pay more in premiums and co-payments while eliminating vision care.

“These would be shocking cuts if we hadn’t seen them before, but we have seen them before,” said Anthony Wright, executive director of Health Access California. “This is what’s left to cut outside of the wholesale dismantling of core programs. These are bad cuts that will impact millions of Californians.”

http://www.sacbee.com/2011/01/03/3295079/brown-to-propose-broad-list-of.html

A substantial increase in eligibility qualification for the Medicaid program is a crucial measure in the Patient Protection and Affordable Care Act (PPACA), designed to decrease the numbers of Americans without insurance coverage. Now the newly-elected Democratic governors of the two most populous states in the nation intend to sharply reduce funding of their Medicaid programs. What does this say about the wisdom of the PPACA policy of using Medicaid to expand coverage?

Gov. Brown’s proposal to impose financial penalties for accessing care, placing caps on doctor visits, and further slashing payments in this already critically underfunded program can only be disastrous for the low-income patients enrolled.

Once again, this is not change we can believe in. We desperately need an improved Medicare that covers everyone.

Coupons for Patients, but Higher Bills for Insurers

By Andrew Pollack
The New York Times
January 1, 2011

With drug prices rising and many people out of work, pharmaceutical companies are increasingly helping patients with their co-payments.

Drug companies say the plans help some patients afford medicines that they otherwise could not.

But health insurers and some consumer groups say that in many cases, the coupons are just marketing gimmicks that are leading to an overall increase in health care costs. That is because they circumvent the system of higher co-pays on costlier drugs that insurers use to encourage consumers to use less expensive products.

Any shift to brand-name drugs can have a big impact on health care costs.

At District Council 37, a union representing public employees in New York City, 59 percent of claims for statins in the year ended in June 2009 were for brand-name products that cost the plan $17.3 million. The other 41 percent of claims were for generic statins, which cost only $179,000. A year ago, the health plan eliminated the co-pay on generic statins to encourage more use of them.

For very expensive drugs, co-pay assistance is almost de rigueur, because in some cases co-payments can be up to 20 percent of the price of the drug. Novartis’s new pill for multiple sclerosis, Gilenya, costs $48,000 a year, compared with $30,000 to $40,000 for rival drugs, which are injected. Novartis is offering to cover the entire co-pay, up to $800 a month, which is 20 percent of the drug’s monthly cost.

Jazz Pharmaceuticals has quadrupled the price of its narcolepsy drug Xyrem, to about $30,000 a year, over the last five years, according to a recent report from the securities firm Jefferies & Company. To cushion patients, the company recently increased its co-pay assistance to as much as $1,200 a month.

Drug companies cannot offer co-payment assistance for patients in federal programs like Medicare because such offers are considered an inducement to use a drug and in violation of anti-kickback laws. Some companies have responded by contributing to, or even helping to set up, charitable foundations that can provide co-payment assistance legally.

Executives at insurers and pharmacy benefit management companies say they would like to counter the cards and coupons but are not sure exactly how to do so. One problem is that the information they receive from pharmacies does not specify whether the co-pay was made by the patient or by the drug company.

“The payer doesn’t know, and the P.B.M. doesn’t know,” said F. Everett Neville, chief trade relations officer at Express Scripts, a pharmacy benefits manager. “We have no ability to stop it and no ability to prohibit it.”

http://www.nytimes.com/2011/01/02/business/02coupon.html?_r=1&pagewanted=all

Should a health care system be designed to ensure that patients receive appropriate medications that they should have to relieve symptoms or cure disease? Of course. Yet co-payments (a dollar amount) and coinsurance (a percentage of the cost) impose on the patient financial barriers to the medications – barriers which frequently are not surmounted, and thereby may result in impaired health outcomes.

With our fragmented system of financing health care those seeking greater profits will always find another way to achieve their goals. In this instance, the pharmaceutical manufacturers have found a way to reduce or eliminate these financial barriers to their products.

In providing cost-sharing assistance to the patient, the manufacturers are not specifically removing barriers to the most appropriate products, but rather are removing barriers to their most profitable products, irrespective of whether or not they are the best choice. Since these are more expensive products, that increases the drug costs of the private insurers. Those of us paying premiums to private insurers that cover drugs are paying for these excess costs.

These practices do not require collusion with the physicians and pharmacists since their marketing practices are effective in creating a demand for their products regardless of the appropriateness.

Note that these pharmaceutical industry subsidies of co-payments and coinsurance are illegal in federal programs such as Medicare because they are the equivalent of kickbacks. If we had a Medicare program that covered everyone and eliminated the private intermediaries such as the insurers and pharmacy benefit managers, then these kickbacks wouldn’t exist. Drugs would be prescribed based strictly on appropriateness, and would be priced to provide fair profits for the pharmaceutical firms and fair costs for Medicare.

Deficit Hypocrisy

Editorial
The New York Times
December 29, 2010

On Dec. 22, just before they left town for the holidays, House Republican leaders released new budget rules that they intend to adopt when they assume the majority in January and will set the stage for even more budget-busting tax cuts.

The new Republican rules will gut pay-as-you-go because they require offsets only for entitlement increases, not for tax cuts.

It gets worse. The new rules mandate that entitlement-spending increases be offset by spending cuts only — and actually bar the House from raising taxes to pay for such spending.

Even worse, they direct the leader of the House Budget Committee to ignore several costs when computing the budget impact of future actions.

For example, the cost to make the Bush-era tax cuts permanent would be ignored, as would the fiscal effects of repealing the health reform law. At the same time, the new rules bar the renewal of aid for low-income working families — extended temporarily in the recent tax-cut deal — unless it is fully paid for.

http://www.nytimes.com/2010/12/30/opinion/30thu1.html

Rules draft (33 pages):
http://rules-republicans.house.gov/Media/PDF/112-Hres5-CP_xml.pdf

Although long, the new Republican rules for the House of Representatives read somewhat like those jokes that are circulated around the Internet. When the fact sinks in that this is no joke but that these rules are very real, the inhumanity implicit in these new rules induces a feeling of despair.

Think of what these rules do for public funding of health care under the Patient Protection and Affordable Care Act. Because health insurance is too expensive and out-of-pocket costs are also unaffordable, government subsidies are necessary, but those called for in the act are inadequate. Many people who will need health care will face financial hardship unless the subsidies are increased.

Under the Republican rules, increases in these subsidies cannot be paid for by increasing taxes. Only reductions in other programs can be used. This is not unlike the prohibited act of cannibalizing one military vehicle to get another one up and running, when both vehicles are essential. Just as we have a responsibility to pay our taxes, our government has a responsibility to ensure that appropriate publicly-financed services will be there when needed, whether it’s maintaining our military vehicles, supporting transportation services in major snowstorms, or ensuring that everyone always has access to affordable health care.

Although the Republicans display a decidedly uncaring attitude toward the financing of important public services shared by most of us, they have an almost sacred devotion to protecting higher-income individuals from the need to pay their equitable share of the taxes to fund those services.

Any increases in spending for the public good must be offset by reductions in other services that would then no longer be available for the public good. Yet, under the new Republican rules, any tax reductions which would accrue primarily to the benefit of the wealthy do not have to be offset at all. Instead, those deficits are added to our debt burden and the debt burden passed on to our progeny.

Is the tax burden in the United States so great that we must sacrifice our public services while burdening ourselves with more debt simply to provide tax relief for the wealthy? The following chart provides that answer. The United States has one of the lowest tax burdens of all nations. The Republicans are catering to the rich at a great cost to the rest of us. What is really tragic is that it seems that, rather than electing representatives who care, the American voters would rather attend tea parties.

If the following OECD chart was not transmitted in this message, it can be accessed by scanning down to Chart A at this link:
http://www.oecd.org/document/35/0,3343,en_2649_37427_46661795_1_1_1_3742…

Total tax ratio as percentage of GDP, 2008

Insurers Bid for State Medicaid Plans

By Avery Johnson
The Wall Street Journal
December 29, 2010

Health insurers are preparing to capitalize on $40 billion of new opportunities to run privately managed Medicaid plans for the states, which would position insurers to benefit from the health overhaul’s expansion of Medicaid in 2014.

Medicaid is one of health insurers’ few bright spots, as their margins are pressed by regulatory crackdowns on premiums in their traditional policies. Gail Boudreaux, UnitedHealth’s executive vice president, told investors last month that: “The Medicaid space is a significant long-term growth opportunity for us. It’s a big market that’s getting even bigger.”

Budget crises mean cash-strapped states are more willing than ever to outsource their programs to private companies.

http://online.wsj.com/article/SB10001424052748704259704576033943934403286.html

When you hear that the nation’s largest (in revenue) investor-owned insurer is looking at taxpayer-financed Medicaid as “a significant long-term growth opportunity,” be afraid. Be very afraid.

Two Views of Health Law

Letters, The New York Times
December 27, 2010

To the Editor:

Re “In Health Law, Old Arguments Get New Airing,” by David Leonhardt (Economic Scene, front page, Dec. 15):

It is interesting to compare Ronald Reagan’s argument opposing Medicare as “socialized medicine,” a program that would take away the freedom of “our children and our children’s children,” with the words of one of his heroes.

In 1944 Winston Churchill, while still prime minister, said that “our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Humphrey Taylor
New York, Dec. 15, 2010

The writer is chairman of the Harris Poll.

http://www.nytimes.com/2010/12/28/opinion/lweb28health.html

“In Health Law, Old Arguments Get New Airing,” by David Leonhardt:
http://www.nytimes.com/2010/12/15/business/economy/15leonhardt.html

And…

Actually, Reagan Wasn’t So Proud of That 1965 Medicare Speech

By David Weigel
The Washington Independent
August 21, 2009

In the last month, there’s been a rediscovery of Ronald Reagan’s 1965 recording “Ronald Reagan Speaks Out Against Socialized Medicine.” Something that’s largely been forgotten, though, was that a much more famous Reagan quote — his “There you go again” dismissal of President Jimmy Carter in the 1980 presidential debates–came when Reagan denied that he really meant this, or that he was “opposing the principle of providing care for” seniors in 1965.

http://washingtonindependent.com/56004/actually-reagan-wasnt-so-proud-of-that-1965-medicare-speech

Winston Churchill represented the view of most conservative politicians in recent history when he said that “everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Even Ronald Reagan tried to erase his personal history of opposing Medicare by stating during the debate with President Carter, “I happened to favor the other piece of legislation and thought that it would be better for the senior citizens and provide better care than the one that was finally passed.”

So what has happened? Why are conservative politicians in the United States implicitly paying homage to the Chicago school of economics when their policies result in tens of millions of Americans being denied equal opportunities to benefit from the best and most up-to-date medical services that Winston Churchill spoke of? Does the faith in the abstraction of free market ideology really trump the actual health and welfare of the citizenry?

It would be too much of a stretch to classify this as a folie en masse. However the feigned obliviousness toward the unmet needs of fellow citizens can hardly be interpreted as anything other than heartless neglect driven by greed.

The conservatives and their moderate co-conspirators have updated Russell Long’s famous quotation: Don’t tax you, don’t tax me, and above all don’t even consider taxing that rich man behind the tree even if it means destroying social justice and common decency along with it.