Serious reservations about the Kennedy bill

[eridani]

From the NYT summary--

Under the Kennedy bill, individuals would be subject to financial penalties if they did not have health insurance.

Under the bill, the federal government would make grants to the states to establish insurance marketplaces or exchanges. Those entities, known as health benefit gateways, would disseminate information about premiums and benefits and would help people enroll.

This sounds exactly like the utter failure that is the Massachusetts system. I mean failure for sick people of course. Quite a few of the healthy majority are happy with the delusion of "coverage," about which they know nothing, not having ever been expensively sick.

Dr. Rachel Nardin's PNHP testimony--

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7000 before expenses before the insurance pays a single medical bill. It is not surprising that many of the state's uninsured have declined such coverage.

....

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. She told us “Under Free Care I saw doctors at Mass. General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization. Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well.” Now that she's “insured,” Kathryn's medical expenses consume almost one-quarter of her take home pay, and she wonders whether she'll be able to continue taking her life saving medications.

From the PNHP analysis of aobut 2 years ago--
http://www.pnhp.org/news/2007/september/health_reform_failur.php

And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don’t buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

From Public Citizen Health Letter
Public Hospitals and Community Clinics Suffering Under Massachusetts Health Care Reform

Statement of Steffie Woolhandler, MD., Associate Professor of Medicine, Harvard Research Group and Co-Founder, Physicians for a National Health Program

Many remain uninsured in Massachusetts and access to health care continues to be a problem statewide; for many residents it has actually worsened. This is particularly disgraceful given the surge in spending for the reform effort, which has run hundreds of millions of dollars over its original budget. The reform cost $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009.

These high costs have already triggered a new crisis in our state. Last fall Gov. Deval Patrick announced massive cuts to safety net providers including public hospitals and community clinics. As a result, these providers have reduced the care available to the state's remaining uninsured, as well as to others who rely on them for services in short supply in the private sector. These safety net services, which often lose money for hospitals even when patients have good insurance, include emergency care, chronic mental health care and primary care. The public hospital where I work is busier than ever, but has just announced that it will close six community clinics, and about half of its inpatient psychiatry beds—despite critical shortages of primary care and psychiatric services. Most of our poor patients, who previously received completely free care, are now forced to pay upfront co-payments prior to receiving care.

Meanwhile, the reform further encouraged the overuse of expensive, high-technology care. Little known provisions in the bill increased payments for specialty care while cutting reimbursement for primary care. This has further tilted health spending toward expensive, high-tech care and away from the primary and preventive care that is the sine qua non of quality efficient health care.

By requiring that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Patients were forced to help foot the bill for private insurer's high overhead—three to four times higher than Medicare's administrative costs. Moreover, the agency that administers the new law (the "Connector") adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies. And for hospitals and doctors, the new reform has added new administrative burdens and costs.

In contrast, a single payer system of non-profit national health insurance could save $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state's uninsured residents and to improve coverage for those who now have insurance with large co-payments and deductibles, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a wealthy state with the most favorable circumstances. We started out with high levels of medical spending and low rates of uninsurance. Yet even under these near-ideal conditions the reform is failing. It would be a grave mistake to use Massachusetts' reform as a model for the nation.

[Hannah Bell]

1. "subject to financial penalties" = how the poor get poorer.

[sandnsea]

2. Obama opposes mandates

So that's something else we can add to tomorrow's agenda. Real public option, open enrollment, no trigger, no mandates.

[Lasher]

9. Not anymore.

He opposed individual mandate during the presidential campaign. Now he's going along with it.

Obama Open to a Mandate on Health Insurance

President Obama said Wednesday that he was receptive to Congressional proposals that would require Americans to have health insurance and oblige employers to share in the cost. But he said there should be exemptions for people who cannot afford insurance and for small businesses in general.

Mr. Obama set forth his views in a letter to the chairmen of the two Senate committees writing health care legislation, Max Baucus of Montana and Edward M. Kennedy of Massachusetts, both Democrats.

The president said he was open to proposals for “shared responsibility — making every American responsible for having health insurance coverage, and asking that employers share in the cost.”

He did not use the terms “individual mandate” and “employer mandate,” which suggest a degree of coercion that Democrats try to avoid implying. Still, the letter provides the fullest statement of Mr. Obama’s views on proposals at the heart of legislation to cover all Americans, his top domestic priority.

http://www.nytimes.com/2009/06/04/health/policy/04health.html?hp

To help pay for the poor uninsured he wants to take up to $300 billion out of Medicare & Medicaid over the next decade. I don't like that at all. Medicare (parts A & B) and Medicaid are single payer programs and he wants to take money out of that to help support this new utopia for insurance companies? And what about the GOP scheme to tax medical benefits? He's not said where he stands on that.

I'm trying to keep an open mind about this but I've been thinking it might be best if this health care reform never comes to pass.

[sandnsea]

3. Expands Medicaid to 150% of poverty

The poorest will get FREE health care.

"Mr. Kennedy’s bill would also expand Medicaid to cover uninsured people with incomes up to 150 percent of the poverty level ($16,245 for an individual and $33,075 for a family of four). That could open Medicaid to millions of people who do not now qualify."

[eridani]

4. That just continues the ghettoization and marginalization of the poor and the sick.

Medicaid now only covers about 70% of treatment costs, and for that reason few doctors will take Medicaid patients. And Medicaid funding is getting cut all the time.

There is absolutely no way to permanently take care of everybody in a sustainable way until the dollars wasted on private insurance are diverted to the care of actual sick people.

[sandnsea]

5. Canada, France, Germany,

most country's single payer systems cover about 70%, Canada's doesn't cover prescription drugs.

How many nonprofit hospitals in your town or 100 mile radius, how many for profit? There's 1 for-profit hospital within 100 miles of me, which was a nonprofit until 2003. The other 4 are all nonprofit. Why isn't their health care cheaper? An office visit is $200, a specialist is $400 plus.

[eridani]

6. That's because they lose money on the Medicaid people

Under single payer, global budgeting can control costs.

[sandnsea]

7. Canada, France, Germany,

They pay 70%. Are they losing money?

I think anybody who has been on Medicaid and regular insurance would choose the Medicaid every time.

The public plan will also only pay doctors Medicare plus 10%, a single payer plan would do something similar. So why isn't that enough cost conrol?

[eridani]

14. It's how the cost control is done

Currently, our version of cost control is like controlling the movements of a herd of cattle by hiring a bunch of cowboys with individual sets of reins to each cow. Single payer, with global capital and operating budgeting, is analogous to controlling them by putting a fence around them and letting them wander freely within. Much cheaper to do it that way.

[grillo7]

8. This is a troubling scenario...

is that really the direction of the Kennedy bill? How does the "public option" Obama has mentioned factor into this draft?

[stray cat]

10. Even a single payer option is going to makes things worse for some and better for others

There is no free fully covered option for all of the US

[eridani]

15. In the case of "worse", people can just buy extra bells and whistles from private insurers

Forcing everyone to subsidize criminal profit taking is a whole nother ball of wax.

[Wednesdays]

11. K&R

:kick:

[kath]

12. Kick and Mega-Rec.

Thanks, eridani

[femrap]

13. WASF nt

[JCMach1]

16. My medicare insurance payment back home each month is 4x what I pay

for PRIVATE health insurance here in the UAE that covers me here AND back in the U.S.

The system in the U.S. is completely broken and needs to be pulled-out by the roots.

[leftstreet]

17. Triple our wages - and we'll buy your f**king insurance

This is just getting ridiculous

Are they hoping we'll get so disgusted we'll be relieved if they do nothing?

[ProgressIn2008]

18. Surely you're not suggesting that the little people will be screwed?

Who could have guessed?

Good post, thanks.

[dreamnightwind]

19. not affordable!

Wow, we make well over what would be the threshhold for assistance, but there's no way we could afford that, we're not even breaking even now! They've got to be joking...