Head-in-the-sand ‘solution’ is killing GOP

By Jack Bernard
DesMoinesRegister.com, July 16, 2012
We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare.
Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare.
It is our baby, ugly or not.
It is the height of hypocrisy for us now to criticize our own idea unless we have something better to replace it. And, the replacement needs to be comprehensive, not just a series of unacceptable statements and proposals based on doing away with traditional Medicare by turning it into a voucher program and gutting Medicaid by making it into a block grant.
Using vouchers for Medicare just dumps the cost problem into the lap of the powerless patient, rather than the federal government that has clout, making the cost escalation problem worse. The block grants for Medicaid idea just shifts the cost issue onto the states rather than the federal government, which once again solves nothing and only makes things worse.
States will just cut services and people from their Medicaid roles, creating more uninsured. Don’t Iowa hospitals serve enough uninsured in their emergency rooms now?
This gets us to what we as Republicans should do: throw out our rule book and be innovative. People my age will remember how we Republicans were 100 percent against recognizing China before Richard Nixon, the anti-communist crusader, came out for it. We must do the same with health care.
There is only one way to control health care costs and insure universal access — and that is by first admitting that the U.S. system has failed and then adopting ideas that have been proven to work elsewhere. We should take a look at how health care is financed and delivered in other developed nations with lower cost and better morbidity and mortality rates.
A Commonwealth Fund study was issued in May 2012 which did just that for 13 countries. The bottom line is that we spend 17.4 percent of our gross national product on health care, far more than other developed nations, which averaged 9.5 percent. Our per-capita spending was $7,960 versus $3,182 for the group as a whole.
Why? One key factor is prices. For example, U.S. pricing on the 30 most commonly prescribed brand name drugs is one-third higher than Canada and double France, both of which have a form of Universal Medicare.
From looking at the international data, if we Republicans really want to dump the Affordable Care Act, the way to go is Medicare for all. Studies show that the nations with universal health care have better overall health care outcomes than we do, not worse.
And, according to the respected Physicians for a National Health Program, www.pnhp.org, yearly savings generated under Medicare for all would be $400 billion. That would go a long way towards paying for universal coverage, versus the Affordable Care Act, which will increase systemic costs because it relies on private insurance.
The canard about waiting times to see doctors is just a tactic to scare the public. If you need a knee replacement for a knee that has been going bad for years, waiting a little longer for an operation should not be a major issue for the patient. Despite the scare tactics, no one who needs immediate care in Canada is ever left to sit in a line. In any case, there should be no waiting lists at all here. Canada spends just $4,363 per capita on health care versus our $7,960.
If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs. When it was implemented and turned out to be widely accepted, as was Medicare in the 1960s, we would be the party the public would look to for the future.
Of course, there is an alternative. We can stick our heads in the sand and push for infeasible actions. That approach is killing us regarding immigration and will work just as well for health care.
(JACK BERNARD of Monticello, Ga., is a retired health care executive who worked extensively with Iowa health care providers, including Iowa Health System. He now is a member of the Jasper County (Ga.) Board of Commissioners and Jasper County Board of Health. Contact: bernard_jack@hotmail.com)
http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/

This article should be distributed widely. Although it is written by a Republican, targeting his fellow Republicans, if his party can understand this message, then the Democrats and others who bailed on Medicare for all should be able to understand it as well.

By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty
The Commonwealth Fund, July 2012

Abstract

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

From the Conclusion

When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf

Comment: 

By Don McCanne, MD

Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That’s not acceptable.

The authors of this Commonwealth Fund report note how the Affordable Care Act “will correct much of the inequity in the U.S. system.” But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That’s not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty
The Commonwealth Fund, July 2012
Abstract
An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.
From the Conclusion
When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf

Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That’s not acceptable.
The authors of this Commonwealth Fund report note how the Affordable Care Act “will correct much of the inequity in the U.S. system.” But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That’s not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012

I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.

I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.

As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.

http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Comment: 

By Don McCanne, MD

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.

Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.

Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012
I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.
I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.
As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.
http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.
Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.
Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

By Anna Sommers, Ellyn R. Boukus, Emily Carrier
Center for Studying Health System Change, July 2012

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.

Misconceptions

Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.

Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.

http://www.hschange.com/CONTENT/1302/

Comment: 

By Don McCanne, MD

In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.

Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.

With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.

We can do a much better job of getting our priorities straight through a single payer national health program.

Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

By Anna Sommers, Ellyn R. Boukus, Emily Carrier
Center for Studying Health System Change, July 2012
Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.
Misconceptions
Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.
Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.
http://www.hschange.com/CONTENT/1302/

In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.
Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.
With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.
We can do a much better job of getting our priorities straight through a single payer national health program.