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Sadness. Frustration. Anger. A lot of embarrassment. Does anybody else have the
same emotions to the Senate's December 20 late-night dance to get
to 60 votes on a critical measure to push health care reform one giant
step closer to fruition? My reaction is not ideology-based as
I truly have a degree of uncertainty as to how America should best proceed.
with ground-breaking social ramifications is best passed with support
from legislators on both sides of the aisles opined CNN's David Gergen.
He is spot on! Unlike the landmark passages of Social Security
and Medicare, the Senate voted right down party lines with plenty of
bitterness and rancor that will not soon dissipate.
this vote looked like a political power play to prevent a significant
political defeat for the Obama administration --. a page directly
out of the Karl Rove playbook. A year ago, one would have expected liberal
Democrats to embrace a significant health care bill. However,
many liberals are upset with the compromise bill that eliminated “public
option” and targeted abortion issues. Dr. Howard Dean was so
disillusioned with the compromises made to get the latest incarnation
of the bill through the Senate that he advocated for the bill's defeat
has many great people who are being let down by a political system that
has become thoroughly corrupted by significant financial interests.
The Senate's latest fiasco is not the exception but the general rule
during the past decade. It is clear that one of the possible solutions
is to restructure the way that political campaigns are financed if our
elected representatives can not start focusing on the “greater good.”
does not address most of the fundamental issues that have helped explode
our health care costs to a staggering 17% of Gross Domestic Product.
It is crystal
clear that focusing on wellness is not stressed nearly enough in the
bill. Instead, the retention of a traditional, premium-based,
fee-for-service model is continued. In the past, the system has
incented non-HMO providers to profit from illness instead of wellness.
For example, it is much more profitable for doctors to be paid for a
gastric bypass surgery than it is to have meaningful programs to help
somebody lose 50 pounds.The
current bill not only does not successfully “bend the curve of health
care costs,” it appears to hardly breathe on the curve.
the Democrats for again caving in to trial lawyers. While there
should be no “free pass” for medical malfeasance, unlimited liability
is very costly and gets passed along to all of us in terms of significantly
increased costs. One study indicated that 25% of all tests requested
by doctors are “defensive” in nature.
the Republicans for protecting the insurance industry. Even if
Howard Dean's claim that 27% of every insurance premium dollar is
not used for benefits is slightly inflated, there does not appear to
be a credible attempt to create new administrative efficiencies.
One of the big arguments for “public option” was that it was intended
to create a more competitive environment that would ultimately help
keep costs down for those not electing the public option. Even
though the Senate jettisoned public option, bear in mind that the House
version did not. There are 60 House Democrats who are on
record as saying any reform without a public option is unacceptable.
The negotiations on a compromise bill ought to produce fireworks!
is not a sufficiently good reason to keep the long-standing link between
employment and insurance availability. The current bill allows
a mechanism for most of the uninsured to get insurance through insurance
exchanges, subsidies and tax credits. For small businesses, the
administrative burden of being involved in the health care promise is
high and, with these proposed changes, unnecessary.
savings touted by the bill are dishonest. This is the second time
in recent years (the government actuary was muzzled during Medicare
Part D deliberations) that unbiased actuarial analysis in the health
arena would have produced widely divergent numbers from the suspect
numbers supplied by Congressional staff. The purported savings
touted by the administration looks at projected revenues and expenses
over the next decade. That sounds reasonable until you realize
that you are comparing 6-7 years of new benefits, which begin
no earlier than 2013, to 10 years of revenue increases.
If a longer period of comparison were selected, the impact of a 3-4
“head start” of increased revenues compared to the start of increased
benefits would rightfully be diminished. This analysis is as misleading
as saying that Social Security is in good actuarial shape just because
current year Social Security taxes exceed current year payouts.
other assumptions in the cost savings that many scoff at. For
example, there is an assumption that there will be hundreds of millions
of reductions in payments to physicians. There are many complications
in effectively being able to enforce such assumed reductions.
For example, primary care physicians who refer “too often” to more
expensive specialists, will have financial consequences. What
bureaucracy will effectively determine what “too often” is?
The dealmakers behind health care reform are reportedly already contemplating
undoing such reductions in future legislation, both as a sop to the
medical community and acknowledgement of the fact that the some of the
proposed bureaucratic watch dogging is an administrative nightmare.
that one of the centerpieces of the bill is coverage for those that
had been excluded due to preexisting conditions. This is a very
high cost group. Is the cost of covering this group and a significant
number of the other 45 million currently uninsured going to be cost
neutral? Undoubtedly not! The idea that a 40% excise tax
on the “Cadillac” portion of benefit coverage (identified as providing
value of at least $23,000 annually for family coverage and $8,500 for
individual coverage) Medicare reductions, and Medicaid reductions will
provide enough offsetting revenues is a pipedream.
ago, an actuarial analysis, commissioned by Blue Cross/Blue Shield,
was completed by Oliver Wyman, Inc. regarding provisions of the Patient
Protection and Affordable Care Act. They concluded that there
would be a 54% increase in premiums, excluding
any potential impact of medical inflation,
five years after implementation.
some efficiencies in administration and vastly increased focus on wellness,
it would have been refreshing for the administration to admit that there
would very likely be some cost increases. Other independent actuarial
analysis indicates that the added cost will be north of a trillion dollars
over the next decade.
trading to get the 58th, 59th and 60th
votes of Senators Lieberman, Sanders and Nelson was embarrassing on
many levels. It is insane that the states of Vermont and Nebraska
would get different Medicaid treatment than any of the other 48 states.
Equally inequitable is how Floridians would be able to keep their Medicare
Advantage coverage while residents of other states cannot. I
wish the deal makers would have had enough pride to do their deal making
in a less brazen manner. Think about the horrible precedent set
for future legislation. A pragmatic legislator will have lots
of incentive to wait until the 12th hour to support a bill
if they can get some local pork as a payoff for a vote. This was
such a travesty that I am embarrassed that I did not put this under
my “Anger” paragraph!
of adequately analyzing and addressing major revenue sources, the bill
targeted some relatively small revenue sources. For example, plastic
surgeons in Hollywood, Boca Raton and Palm Springs were dancing in the
aisles, even if few others are happy about the bill. The proposed
5% tax on cosmetic surgery was axed from the last Senate bill.
Fans of skinny women with unnatural “tops” also applauded.
for plastic surgeons is obviously stronger than tanning salons.
How else to explain why these salons will have to pay a 10% tax for
their services. I wondered if this was a ploy by the Fort Lauderdale
Chamber of Commerce to encourage folks to get their tans the old fashioned
the likes of Carl, Jr. can advertise their triple-decker, double cheese
cholesterol burgers without the burden of any new tax. Nor does
the bill provide any individual disincentive for the obese to keep chowing
away on unhealthy foods. America's health costs, relating
to our obesity epidemic, are very large and need to be addressed.
This bill did not touch this sensitive subject. We tax the heck
out of cigarettes and it would decrease our nation's health bill if
we did the same to certain foods and beverages.
is in a fast changing 21st century global economy and we
are competing at a significant disadvantage. Relatively speaking,
we spend about twice as much as most European countries on health services
and much more than double when compared to the emerging economic powers
in China and India. In addition to all the current bill's warts,
this bill does little to make us more globally competitive.
I proceed? First, it is important to recognize that few, even
amongst Democrats, seem to fully embrace the bills' current
provisions. I am reminded of one of the lyrics from the song that
noted songwriter John D. Loudermilk penned, “Tobacco Road”, a song
made famous by The Nashville Teens during the 1964 British Invasion.
Loudermilk so despised Tobacco Road that he wanted to “blow it up
and start over again.” I would suggest the same course for health
care reform. The best solution, in my opinion, is to build around a
dual foundation of wellness programs and high deductible, catastrophic
coverage for everybody.
P.S. As for Loudermilk, the Durham-born
songwriter would have to admit that North Carolina has prospered and
evolved nicely since he penned “Tobacco Road.”. With thought,
appropriate analysis and a diminishment of political posturing, so too
can health care reform.
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