IT'S TIME FOR UNIVERSAL HEALTH CARE

Why are the rich getting richer at the expense of our children and grandchildren? Is this fair?

Pelosi Backs Off Set Rates for Public Option
By ROBERT PEAR

WASHINGTON " Under pressure from moderate-to-conservative members of the House Democratic caucus, Speaker Nancy Pelosi has decided to propose a government-run insurance plan that would negotiate rates with doctors and hospitals, rather than using prices set by the government, aides said Wednesday.

Ms. Pelosi said the public plan, which she prefers to call a “consumer option,” would compete with private insurers. But the speaker was apparently unable to muster the votes needed for the “robust” liberal version of a public plan, which she has repeatedly said would save more money for consumers and the government.

Members of the House Democratic leadership team offered these details of their bill, to be unveiled on Thursday. It would provide coverage to 35 million or 36 million people. The 10-year cost of expanding coverage would be less than the $900 billion ceiling suggested by President Obama. The cost would be offset by new taxes and by cutbacks in Medicare, so the bill would not increase the federal budget deficit in the next 10 years or in the decade after that.

The new bill, like an earlier version, retains a surtax on high-income people, but increases the thresholds. The tax would hit married couples with adjusted gross incomes exceeding $1 million a year and individuals over $500,000 " just three-tenths of 1 percent of all households, Democrats said.

Ms. Pelosi can describe the proposal as a “millionaires’ tax.” The original thresholds were $280,000 for individuals and $350,000 for couples.

The government insurance plan would negotiate rates with doctors and hospitals, as private insurers do. Payments would not be based on Medicare rates, as Ms. Pelosi had wanted. Democrats from rural areas balked at the use of Medicare rates, saying they were so low that hospitals could not survive on them.

House Democratic leaders will hold a rally at the Capitol on Thursday to promote the legislation. They hope to take it to the House floor next week, with a final vote before Veterans Day, Nov. 11.

Scores of lobbyists were “cordially invited” to attend the rally in e-mail messages sent Wednesday by Ms. Pelosi. The Senate majority leader, Harry Reid, Democrat of Nevada, announced Monday that he too had decided to include a government plan, with negotiated rates, in the bill he intends to take to the Senate floor for weeks of debate.

House Democrats do not have firm commitments from enough lawmakers to guarantee passage of their bill at the moment. But their aggressive schedule suggests they are confident they can round up the votes they need.

Speaker Pelosi evidently fell well short of the votes needed for the “robust” public option.

A whip count, prepared Tuesday, shows that 47 House Democrats opposed that approach while 8 more were “leaning no.” That suggests that Ms. Pelosi had lined up, at most, 201 votes of the 218 she would probably need. Ms. Pelosi’s difficulties in securing votes for the most liberal version of a government insurance plan were illustrated by four members of her caucus.

Representative Ike Skelton, Democrat of Missouri, who faces a serious re-election challenge next year, said: “Health insurance reform must not include a public option. While access to health insurance ought to be expanded to reduce costs for everyone, the public option could have the unintended consequence of forcing private health insurance providers out of business.”

Another moderate Democrat, Representative Jim Matheson of Utah, said there were better ways to foster competition. He prefers nonprofit member-run cooperatives, rather than a government plan.

Representatives Kathy Dahlkemper, of western Pennsylvania, and Steve Kagen, from the Green Bay area of Wisconsin, support a public option, but believe the government plan should negotiate rates with health care providers. Aides to the two Democratic lawmakers said Medicare rates in their districts were inadequate.

The new House bill would also impose annual fees on manufacturers of medical devices like heart pacemakers and artificial hips. The fees " in effect, excise taxes " would total $20 billion over 10 years.

House Democrats borrowed this idea from the Senate. Under a bill approved this month by the Senate Finance Committee, the government would try to collect $40 billion in fees over 10 years from makers of medical devices.

The new House bill would expand Medicaid to cover childless adults, parents and others with incomes less than 150 percent of the poverty level, or $33,075 for a family of four. This goes beyond the earlier House bill and a companion measure in the Senate, which would extend Medicaid to people with incomes less than 133 percent of the poverty level ($29,327 for a family of four).

This change saves money. It is less expensive for the federal government to cover low-income people under Medicaid than to provide them with subsidies to buy private insurance.

Cyclo, Thanks. What I find fascinating at this juncture is the simple fact that the majority of Americans want the public option, but democrats are fighting against it. Why?

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE " Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) " Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE"Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS"Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE" Requires health plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE"Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES"Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE" Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING"Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS"Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM"Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES"Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS"Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS " Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

The Unhealthy 'Public Option'

If Medicare were a bank, federal regulators would be closing its doors, selling its operations, and sacking its managers. Thanks to soaring costs, the program is fast running out of money"even though it pays such low fees that many doctors refuse to take Medicare patients. Meanwhile, Medicare fraud costs taxpayers some $60 billion a year, according to a report by CBS's 60 Minutes, making it among the most profitable fields for felons.

That's our experience with government-run health insurance for the elderly. So what do congressional Democrats propose to do? Offer government-run health insurance to everyone else.

Senate Majority Leader Harry Reid capitulated to his party's more liberal elements when he said he will insist that health care legislation include a "public option""a government insurance plan"to bring "meaningful reform to our broken system." But deploying a version of Medicare to repair the status quo is like using a brick to improve a window.

President Obama says it would help consumers by giving private insurers some real competition. But the typical state has 27 companies competing in the small-group health insurance market. If there were insufficient competition, the health insurance sector wouldn't rank 86th among American industries in profitability.

Health care plans average profits of just 3.3 percent. In wireless communications, a vigorously contested market, profits are 11 percent. Does Obama think we need a government cell-phone company to compete with Verizon and AT&T?

The proponents also believe that, like Medicare, a new government plan could be run far more efficiently than private firms. Don't make me laugh. Medicare, keep in mind, is going broke. And its alleged efficiencies are illusory or nontransferable.

Health economists Regina Herzlinger of Harvard and Robert Book of the Heritage Foundation note that on a per-person basis, Medicare has higher administrative costs than private firms. They look smaller only because the average Medicare patient uses more services than the average private insurance patient. "Expressing them as a percentage makes Medicare's administrative costs appear lower because they are spread over a larger base of health care costs," write Book and Herzlinger.

A "public option" might duplicate one of Medicare's means of saving money: limiting reimbursements to doctors and hospitals to far less than what private insurers pay. But 19 health-care organizations that support reform, including the Mayo Clinic, explained the flaw in that approach.

"Under the current Medicare system, a majority of doctors and hospitals that care for Medicare patients are paid substantially less than it costs to treat them," they said in an open letter to Congress. "Many providers are therefore already approaching a point where they can not afford to see Medicare patients." Last year, the government's Medicare Payment Advisory Commission reported that 29 percent of recipients who were looking for a primary care physician had trouble finding one.

Skimpy reimbursements lower Medicare's costs. But if a new government-run plan tries the same trick, it will have trouble attracting providers and therefore patients. If it pays the same rates as private insurers, on the other hand, it will lose that big competitive edge.

Fortunately for disciples of government expansion, the "public option" insurance has other advantages. Obama insists it will have to cover all its costs. Oh, really? When Medicare Part B (which pays doctor bills) was set up in 1966, premiums paid by retirees were supposed to cover 50 percent of its outlays. Instead, Congress limited rate increases so that before long, premiums were covering just 25 percent of the bills, a practice later written into law.

If the Washington-run plan charges too little to pay its expenses, will it raise rates, thus antagonizing what could be a sizable group of voters? Or will Congress cough up the money to keep it going? You know the answer.

In the end, the key to the success of this program, writes Cato Institute analyst Michael Cannon, is that "government possesses both the power to hide its true costs (which keeps its premiums artificially low) and to impose costs on its competitors (which unnecessarily pushes private insurance premiums higher)." Private insurers will be "competing" against a team that gets to write the rules, run the draft and hire the referees.

With those artificial advantages, the public option could eventually become the only option. If that happens, a lot of Americans will be surprised. But I suspect Harry Reid and Barack Obama will not be among them.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) " Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

That's the problem with our government's inability to build in efficiencies in health care; they're part of the problem of higher cost for consumers while they talk about "reducing cost under UHC." If they cut $50 billion from Medicare payments, who's going to pick up the slack?

What happens when a mythbuster gets exposed as a mythmaker? Barack Obama has insisted that people who claim that $500 billion in “savings” from Medicare won’t mean any reduction in benefits. Douglas Elmendorf, director of the Congressional Budget Office, says that simply isn’t true. The cuts to Medicare Advantage, which comprise one-fifth of those savings, means reduced benefits for the 25% of seniors using the program (via Instapundit):

Congress’ chief budget officer on Tuesday contradicted President Barack Obama’s oft-stated claim that seniors wouldn’t see their Medicare benefits cut under a health care overhaul.

The head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, told senators that seniors in Medicare’s managed care plans could see reduced benefits under a bill in the Finance Committee.

The bill would cut payments to the Medicare Advantage plans by more than $100 billion over 10 years.

Elmendorf said the changes “would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans.”

The head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, told senators that seniors in Medicare’s managed care plans could see reduced benefits under a bill in the Finance Committee.

What about this?

Quote:

The head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, told senators that seniors in Medicare’s managed care plans could see reduced benefits under a bill in the Finance Committee.

AARP.org
Budget chief contradicts Obama on Medicare costs


ERICA WERNER

WASHINGTON - Congress' chief budget officer on Tuesday contradicted President Barack Obama's oft-stated claim that seniors wouldn't see their Medicare benefits cut under a health care overhaul.

The head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, told senators that seniors in Medicare's managed care plans could see reduced benefits under a bill in the Finance Committee.

The bill would cut payments to the Medicare Advantage plans by more than $100 billion over 10 years.

Elmendorf said the changes "would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans."

Finance Committee aides emphasized that core Medicare benefits wouldn't be cut because the plans are required to offer the benefits available under traditional Medicare fee-for-service coverage.

Federal subsidies to private Medicare plans average about 14 percent higher than those involved in fee-for-service coverage. The health care bills pending in Congress would reduce or eliminate the difference in part by introducing a competitive bidding system to pay the plans. The private plans cover around 25 percent of Medicare beneficiaries.

The Finance Committee bill along with other health care legislation in Congress would cut around $500 billion in projected Medicare payments to providers over a decade, including around $125 billion from Medicare Advantage.

Obama has pushed the cuts to providers even while repeatedly insisting they won't reduce seniors' benefits. "Nobody is talking about cutting Medicare benefits," Obama said during an online AARP forum in July.

Finance Committee aides emphasized that core Medicare benefits wouldn't be cut because the plans are required to offer the benefits available under traditional Medicare fee-for-service coverage.

You don't give "two shits," but as a senior, I care.