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Those vulnerable Democrats whose votes for health care reform were predicated on the conceit that it would not add to the nation’s bloated deficit have today found themselves in a precarious position, as a new report by federal regulators indicated the health care remake will add $311* billion to the national deficit over the next ten years.

A report released Thursday by economic experts at the Department of Health and Human Services (DHHS) found the new legislation would add 34 million uninsured Americans to the coverage rolls, but at a significant cost — one that neither the president nor his party anticipated as they approach the midterm elections.

“We estimate that overall national health expenditures under the health reform act would increase by a total of $311 billion (0.9 percent) during the calendar years 2010-2019,” the report, authored by the chief actuary for the Centers for Medicare and Medicaid Services, read. “Although several provisions would help to reduce health care volts growth, their impact would be more than offset through 2019 by the higher health expenditures resulting from coverage expansions.”

The memeorandum also warned the spending hike associated with the legislation may be understated, since the cuts in Medicare may be untenable and impractical.

President Barack Obama insisted the nation’s economic recovery and health care system were inextricably linked, and not reforming the latter could further depress the former. We could not afford not to reform the health care industry, the White House said at numerous junctions in the year-long debate.

“Make no mistake: The cost of our health care is a threat to our economy,” he told the American Medical Association. “It’s an escalating burden on our families and business. It’s a ticking time bomb for the federal budget. And it’s unsustainable for the United States of America.”

Per The American Spectator’s Phil Klein:

But for all the talk over the past year about “bending the cost curve down,” CMS, the agency that is tasked with tracking national health care expenditures, has now projected that the new law will actually bend the cost curve in the opposite direction. That is, up.

Not surprisingly, CMS notes that, “Numerous studies have demonstrated that individuals and families with health insurance use more health services than others-similar persons without insurance.” Thus, expanding coverage will mean greater usage of health care services.

Those House Democrats most vulnerable by their votes include Representatives Brad Ellsworth, Kendrick Meek, John Boccieri, Charlie Wilson, Suzanne Kosmas, Melissa Bean, Joe Sestak, Bill Owens and Chris Carney, all of whom contended, at one point or another over the course of the health care debate, that the legislation would not further saddle the federal government with unnecessary and additional expenses.

Their unfortunate colleagues in the upper chamber, via the Weekly Standard’s Daniel Halper, include Senators Michael Bennet, Barbara Boxer, Russ Feingold, Kirsten Gillibrand, Paul Hodes, Blance Lincoln, Patty Murray, Harry Reid and Arlen Specter.

Suffice it to say: Virtually every Democrat is on the chopping block this cycle.

*The CMS report said spending would increase by $311 billion, not $331 billion, and the post has been updated to reflect that.

…continued

Alexander was technically correct when he said premiums would go up "for millions." CBO figured that 32 million persons would fall into the nongroup market by 2016, should the Senate bill become law. What he didn’t mention is that they would make up only 17 percent of workers covered by private insurance. And he didn’t mention these costs would go up because benefits would improve in the nongroup market.
The senator was correct when he cited "mandates" as one cause for the increase – but that’s not the only reason premiums go up. The bill would require plans to have a standard level of benefits. However, most of those buying their own coverage would receive subsidies that would prompt them to buy more expensive plans than they normally would. CBO said "the average insurance policy in this market would cover a substantially larger share of enrollees’ costs for health care (on average) and a slightly wider range of benefits." People would basically use money from the government to buy themselves a nicer plan than they would if they were only using their own money. CBO said well over half of those buying individual policies — 57 percent — would get government subsidies "that would reduce their costs well below the premiums that would be charged for such policies under current law."

But Obama also misled when he claimed that the costs for "families" would go down by 14 to 20 percent "for the same type of coverage as they’re currently receiving." For one thing, he was referring only to policies purchased directly by individuals — not to all families. And as we’ve seen, the bill generally would require more generous coverage than is currently provided, at higher cost. Overall, premiums in the individual market would go up, not down. Some in the nongroup market might choose to keep their current policy, with no changes. The legislation would permit that for a few years. But CBO said those "grandfathered" policies probably would not see a substantial change in their premium costs, relative to current law.

One last point: Alexander said “taxes” would also cause premium costs to go up – but that’s not really the case, according to CBO. Paradoxically, CBO predicts that the Senate bill’s excise tax on high-cost health plans would actually bring premium costs down. That’s because the tax would induce employers and employees to choose lower-cost plans with less coverage, to avoid being hit by the tax. CBO said the average premium for those affected by the tax would be 9 percent to 12 percent lower. The bill also includes some taxes on medical device manufacturers and drug importers; CBO found those taxes would have a less than 1 percent effect on premium costs.

Medicaid Naysayers?
Sen. Alexander noted that Obama’s proposal, like the Senate-passed bill, relies to a great extent on Medicaid — which he said "none of us would want to be a part of because 50 percent of doctors won’t see new patients." That claim was echoed by GOP Sen. Charles Grassley of Iowa, who said "Doctors don’t take Medicaid."
But according to a 2008 survey of 4,700 physicians by the Center for Studying Health System Change, nationwide only 28 percent of physicians won’t accept any new patients who are insured by Medicaid. HSC, which is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research Inc., also found that 19.2 percent accept some new Medicaid patients, while 53 percent accept most or all of them.

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Democrat Mark Critz, running to succeed the late Rep. John Murtha (D-Pa.), is branding himself as an opponent of health care legislation in his latest ad – a sign that the legislation is a tough sell even in working-class blue-collar Democratic confines.

Responding to an NRCC advertisement accusing him of backing health care reform, Critz says: “That ad’s not true. I opposed the health care bill, and I’m pro-life and pro-gun. That’s not liberal.”

Critz didn’t take a public position on the health care legislation during the Democratic nomination process, and declined to answer a survey from The Hill newspaper in March whether he would support the bill. 

Critz’s campaign spokesman told POLITICO last week that he opposed certain aspects of the health care legislation, but would not support its repeal.

Critz is facing Republican businessman Tim Burns in the May 18 special election. Burns has been running against House Speaker Nancy Pelosi and the administration’s domestic agenda.

Democrats hold a significant registration edge in the southwestern Pennsylvania district, but Obama is not viewed favorably there. John McCain narrowly won the district with 49 percent, after John Kerry and Al Gore carried it the previous two presidential elections.

Not long ago Speaker of the House Nancy Pelosi declared health care to be a right. By this she meant: Whether a person has the means to pay for medical services or not, he is nonetheless entitled to them. As appealing as that idea might seem, let's consider its logic. Let's say one of our neighbors (we'll name him “Tom”) suffers from diabetes and he has no means to pay a doctor for treatment or a pharmacy for his insulin. Does Tom have a “right” to “Dr. Dick's” services and a prescription from “Harry's Pharmacy”? And, if those services are not provided without charge, should Tom be able to call for criminal sanctions against Dick and Harry for violating his right to health care?

But if Tom can force Dick and Harry to serve him without pay, then in what way does that arrangement differ from slavery? However, let's suppose (instead of Tom's being able to force Dick and Harry to provide services without pay) Congress were to use its power of taxation to take money from Peter and it gave that money to Tom so he could pay “Paul's Clinic” for his health care. Is taking Peter's money to pay Paul any different morally than Tom's forcing Dick and Harry to work without compensation?

Of course there would be one important tactical difference — concealment. Given America's shameful history of slavery, we would be immediately (and rightly) outraged if one person directly and visibly forced another person to serve him without compensation. But using the tax system to stealthily accomplish the same end (transferring the earnings of one person to another) stirs no such outrage.

Genuine rights do not confer the power to steal from others. That means the exercise of my right (whether freedom of speech, or religion, or press, or the right to bear arms) does not impinge on the rights of others, nor impose on them an obligation to provide me with the means to exercise my right. For example, my right to own firearms cannot be understood to mean that other citizens must surrender their weapons or provide me a 45 auto. But (employing the logic of Ms Pelosi's definition of health-care rights) my right of free speech should require the government to force others to provide me with an auditorium, television studio or radio station. My right to travel freely should require the government to force others to provide me with a vehicle, gasoline, airfare and hotel accommodations.

By Nancy Pelosi's definition of so-called this “right to health care” (the guarantee that I will never be denied any good or service that is medically indicated, whether I can afford it or not), the government must diminish someone else's rights, namely their rights to their own earnings. Of course the reason such a “right to health care” necessitates theft from my fellow citizen is simply that the government has no resources of its own.

It would be very generous of President Obama to open his wallet to pay for my medical needs, but sadly Mr Obama is neither independently wealthy nor quite so altruistic. The only stash of money that President Obama has with which to pay for my “right to health care” belongs to someone else — someone who actually earned that money. Yet apparently Congress (like most little children) still believes in Santa Claus. Sadly the Jolly Old Elf always turns out to be those same old grumps who must eventually cough up the payment for all the goodies we so carelessly broke on Christmas afternoon. For government to give one person a dollar, it must first confiscate that dollar from some other person.

But there's more than a mere tactical difference between Ms Pelosi's so-called “right to health care” and the old-time institution of slavery. Ms Pelosi's “right to health care” has a great strategic advantage over Antebellum Slavery — advancing the cause of slavery far beyond the confines of a darkly hued minority. This newly discovered “right to health care” modifies the very meaning of “rights”, insidiously changing a “right” from something given by God to something rationed by government. It is the essence of tyranny for the government to define rights as something it alone gives. After all, didn't Adolf Hitler himself claim that Germans had the absolute right to “Freiheit und Brot” (freedom and bread) just before he proceeded to ration out both to the German people?

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WASHINGTON — Uh-oh. The cantankerous, polarizing and deeply confusing debate about health care is likely to get even worse.

Just when I thought the controversy was cooling a bit — no longer burning white-hot and charring everything in sight — I came across a statement by U.S. Rep. Roy Blunt, head of the GOP Health Care Task Force, who expressed skepticism about government efforts to guarantee health insurance for adults “who’ve done nothing to care for themselves.” Blunt doesn’t mind a law to prevent insurers from banning children with pre-existing conditions, but adults are another matter.

Blunt’s remarks echoed recent policy manifestos by Newt Gingrich, possible GOP presidential candidate, and Sen. Jim DeMint, the South Carolina Republican who pronounced health care reform President Obama’s “Waterloo.” Both Gingrich and DeMint have issued statements that frame each person’s health as a matter of “personal responsibility.”

Their pronouncements illuminate the odd conversations I had recently with spokespersons for the American Cancer Society, who were eager to point out that “women shouldn’t be blamed for their breast cancer.” I had called to ask about research suggesting that 25 to 30 percent of breast cancer cases could be avoided if women changed their lifestyles — eating less, exercising more and drinking less alcohol.

As a middle-aged woman who dreads the disease more than almost any other, I was heartened by that news, delighted to know I can at least alter my chances. Shouldn’t the cancer society tout that more widely?

Well, not if a common-sense campaign to enlighten women about the risks of added weight and alcohol consumption allows Blount and other health-care-reform critics to paint breast-cancer patients as victims of their own irresponsibility. Patient advocates who work to ameliorate any number of chronic ailments — from hypertension to diabetes — worry about an emphasis on personal responsibility that sounds like, “It’s your fault you’re sick!”

Yet — and here’s where the matter gets tricky — a nation with a massive health care tab does need to have a conversation about health and “personal responsibility.” There is little doubt that lifestyle factors contribute to obesity, heart disease and various cancers, from malignant breast tumors to melanomas.

On its face, Gingrich’s observation — “I think you want to re-establish that the individual has a big responsibility for their own health, because otherwise you can’t deal with diabetes and obesity and things that are chronic conditions” — offers little for argument. Nor is there anything unseemly in DeMint’s statement: “As we look at the health care of our nation, we’ve got to look at our own health care and the health care of family –– what we can do to lower the cost of health care just by taking care of ourselves.”

However, access to health care boosts personal responsibility, encouraging those with high blood pressure, for example, to get check-ups and medication before out-of-control hypertension leads to kidney failure and expensive dialysis. Gingrich and DeMint remain vehemently opposed to the recent expansion of health insurance, each vowing to continue to battle it as if he were Napoleon Bonaparte facing the Duke of Wellington. Their declarations of “personal responsibility,” then, sound more like an excuse to do nothing to help people take better care of themselves.

Neither Gingrich nor DeMint is known for cooling down the temperatures of over-heated controversies. And that’s what the discussion needs — calm, dispassionate and authoritative voices.

At some point, public health agencies will have to mount a persuasive campaign to get Americans to change their habits: eat less, exercise more, wear sunscreen. When that happens, the country as a whole will get healthier (although individual results won’t be guaranteed) and, with any luck, health care costs will at least level off.

That campaign will bring undoubtedly bring its own controversy because it will require government to marshal its resources and, against the wishes of libertarians, attempt to change personal behavior. Sorry to bring you the news, but the health care craziness will continue for awhile.

Across the nation, Democratic members of Congress defended their support for health care reform to constituents during the Easter recess. But while many Democrats in more conservative districts stuck their necks out by voting for the historic bill, Rep. Jerrold Nadler is defending the legislation to liberal Upper West Side voters who believe it didn’t go far enough.

“It’s a fundamentally conservative bill,” Nadler said to his constituents at the April 6 Community Board 7 meeting. “But from the rhetoric today, it’s a left wing, government takeover. I wish it were in some ways.”

Nadler, a prominent House liberal and supporter of a single-payer health care system, lamented some of the bill’s provisions, such as the strict anti-abortion rights language (which he said tempted him to vote against it) and the lack of a public option, the government-run health care program that will compete with private insurers.

“We didn’t get it in the end because the president didn’t support it,” Nadler said.

Nadler spoke about fighting against other provisions included in health care reform, such as the “Cadillac” tax on high-cost insurance plans. He told the crowd that he opposed the tax that is going into effect in 2018, and that Congress has eight years to repeal it.

But after explaining his gripes and criticisms, he dove into the details of reform: how people will be covered, how the plan is financed and how it will affect businesses.

Regarding benefits, Nadler said he was pleased that coverage will no longer be dropped for pre-existing conditions, and that women will not be charged higher premiums for insurance.

“We’re solving a lot of the problems,” he said.

Despite his misgivings about the bill, the most important aspect of reform is that it “saves 40,000 lives a year.”

“How can you vote against it?” Nadler asked. “Everything else is secondary.”

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By Peter Shapiro for fightbacknews.org –

Passage of President Obama’s health care reform in late March made for great political theater. Here was House Speaker Nancy Pelosi, skillfully maneuvering the bill through Congress after many had given it up for lost. Here was House minority leader and Republican point man John Boehner, reduced to ranting about ‘Armageddon’ and predicting the end of civilization as we know it if the bill passed. Here were Republican legislators egging on the mob of teabaggers who massed outside the Capitol, hurling racist and homophobic slurs at Representatives John Lewis and Barney Frank as they went inside.

I’ll admit the scene worked on my emotions. The Republicans’ tactics were ugly and cynical and I was happy to see them fail.

Now that the dust has settled, however, a hard look at the legislation that prompted all the fuss suggests that, far from ‘fixing our broken health care system,’ it merely reproduces some of its worst features.

The bill does nothing to lessen the grip of the private insurance industry on our health care system. It won’t bring exploding health care costs under control. It does little to change the shameful disparities in access to treatment in a society that treats medical care as a commodity to be bought and sold, rather than as something all of us need and deserve.

What it will do is require everybody to buy health insurance, with federal subsidies for those who can’t afford the premiums on their own. The price tag of these subsidies is $447 billion over the next ten years. That’s money that could have gone to pay directly for medical treatment but which will, instead, wind up in the pockets of the insurance industry – one more corporate bailout at taxpayers’ expense.

To help pay for it, public hospitals that treat the uninsured will have their federal funding slashed by $36 billion. Eight years down the road, union health plans and other job-based health insurance will be slapped with a 40% ‘excise tax.’ Protests from organized labor succeeded in getting this tax modified somewhat, but not eliminated from the bill.

The bill does expand eligibility for Medicaid, the federal health care program for the poor. And it is supposed to make it harder for insurance companies to deny legitimate claims or refuse to cover ‘high-risk’ patients. Insurance industry lobbyists, who actually helped draft the bill, swallowed these reforms in part because they’ll get 30 million new customers out of the deal, and in part because over the years the industry has proved adept at evading every government attempt at regulation.

Physicians for a National Health Program, which has led the fight for a single payer system comparable to what other developed countries have, likens the bill to morphine for a cancer patient. It lessens the pain for a while, but it doesn’t stop the cancer from spreading. Health care in the U.S. costs twice as much as in most other countries, mainly because the administrative costs of maintaining a private insurance system soak up nearly one in every three dollars we spend on it. And a big chunk of that money goes to buy politicians. The health care industry spent a record $266.8 million last year making sure nothing got into the bill that would seriously threaten its profits.

I’ve heard some interesting arguments over whether we’re better or worse off with this law on the books, but it’s really beside the point. The battle for universal, equal access to care still lies ahead, and it won’t be won until those of us who are victimized by the health care system have more political clout than those who profit from it.

The law’s shortcomings will provide ample organizing opportunities in the fight for true reform. Here are a few:

1. Medicaid. It’s financed with matching state and federal funds, and while the federal government may have the money to pay for expanded eligibility, most states don’t. Oregon, where I live, already has a very liberal program of health care for the poor, but the state is so strapped for cash that it actually has to hold a lottery to determine which eligible people get benefits. And because an underfunded Medicaid program compensates doctors so poorly, many doctors are already reluctant to take Medicaid patients. The new law promises to make it easier for poor people to get care; we should be prepared to hold politicians’ feet to the flames if it doesn’t happen.

2. Rate hikes. Since everyone will now be required to buy insurance or pay a fine, insurers are likely to take advantage of their captive market by jacking premiums up even more. There should be organized, angry protests every time it happens.

3. Underinsurance. Before the law passed, a woman with ‘pre-existing’ breast cancer was apt to be refused coverage. Now she can’t be denied coverage – but she may find that her new policy won’t pay for the extra round of chemotherapy or surgery she needs. Nothing in the law spells out what benefits must be offered for insurance plans to qualify for the government-run ‘health insurance exchanges’ that will be set up in 2014. The requirement that everybody buy insurance will mean a proliferation of cut-rate policies that are of no use when you most need them. When policies like that go on the market, we should read the fine print and expose them for what they are.

4. Inadequate regulation. Supporters of the new law boast that it outlaws ‘rescissions,’ the practice of canceling a policy as soon as a policyholder files a claim. But rescissions were already illegal! State regulators simply didn’t enforce the law. We need to keep a close eye on them and demand that they do their job.

5. Employer mandates. “If you like the coverage you have, you can keep it,” says Obama. But it’s really your boss’s decision, not yours. The penalties for employers who cancel their coverage are too small to discourage them from canceling or cutting back on increasingly costly employee benefits. Unions can expect continued brutal fights over health insurance at contract time. Whenever it happens, they shouldn’t hesitate to point out that health benefits shouldn’t even be on the bargaining table – the government should be picking up the tab for everybody, regardless of where they work or how much they make. Only by advocating for health care for all can unions win public sympathy when their own coverage is under attack.

6. Penalizing the uninsured. A lot of people who can’t afford to buy coverage, even with federal subsidies, will get stuck with stiff fines for remaining uninsured. They need to become organized and visible and demand relief.

7. Discrimination. Denying coverage to immigrants is a particularly ugly and pointless feature of the new law. Preventing sick people from going to the doctor doesn’t ‘secure our borders’ or discourage people from coming here, as anti-immigrant propagandists claim. It just means more needless and untreated illness and more pressure on overburdened hospital emergency rooms. Full access to health care is a key component in the battle for immigrant rights.

8. Federal deficits. As costs keep rising, subsidizing insurance premiums will inevitably add to an already huge federal deficit. There will be intense pressure to cut necessary social programs, including Medicare, to pay for it. In defending those programs, we should be prepared to raise the issue of single payer – pointing out that a universal government-funded health care system would save the taxpayers billions and make those cuts unnecessary.

It’s common for politicians like President Obama to say they support single payer ‘on principle’ but don’t consider it ‘realistic.’ The truth is that it’s the only realistic solution. Nothing else will solve our health care crisis. We have to keep the heat on until we get it.

Peter Shapiro co-chairs the Health Care Committee of Portland Jobs with Justice.

The Otago and Southland District Health Boards are proposing
changes to the mental health needs assessment service,
potentially affecting 11 full-time equivalent jobs.

Mental health needs assessment is carried out by a mix of
community and district health board providers, but the boards
propose tendering the service to one provider.

A decision is expected later this month, after the boards
consider feedback from the sector.

Eleven equivalent full-time positions in Otago and Southland
in the DHB and community sector could be affected by the
change.

Mental health and community services group manager Elaine
Chisnall said the change would provide a single consistent
service across the two regions and it was too early to say
whether jobs would go.

The move would eliminate confusion about mental health needs
assessment in Otago and Southland, where there were five and
two “points of contact” respectively.

“There will be one service that has knowledge of and an
understanding of all services and resources available to
support people with a mental health need in the community,”
Mrs Chisnall said.

A decision had been expected this week, but was delayed to
allow more time to examine the feedback, she said.

If adopted, the tender process would start on April 23, with
implementation in June.

The move was not designed to cut costs; it was in line with
the Ministry of Health's push to make health services
available in the community.

It was also a response to last year's Deloitte report, which
said the DHBs had overpriced their mental health services.

The report highlighted the troubled relationship between
boards and community health providers.

The move coincides with a proposal to tender the mental
health outpatient group provided at Dunedin Hospital.

A decision on that is expected later this month.

Otago Mental Health NGO Group chairman Donald Shand released
to the Otago Daily Times feedback the group had sent the
boards.

It warned the boards risked the “potential loss” of Miramare,
a high-quality Otago needs assessment service which would
have to tender like any other service.

Miramare has 592 service users and 4.5 of the 11 full-time
equivalent staff.

“You will be well aware of the competence and community
connectedness of the Miramare team and such capability is
hard earned and difficult to replicate.”

The group suggested the boards name Miramare the preferred
provider.

The sector was wary of tender processes due to past
experience, which did not always deliver the best result,
especially when it was not clear what the boards wanted.

The group was concerned the proposal was too “cautious” and
did not go far enough to increase resources in the community
for mental health services.

“Our considered view is that the biggest single risk to
improved provision is DHB management reluctance to create a
future in which the majority of mental health services are
provided outside of hospital and clinical settings.”

Miramare manager Kerry Hand said already, one staff member
had resigned because of job uncertainty.

He cautiously welcomed the tender process, which made it
possible for community organisations to play a greater role
in the health sector, in which they were undervalued.

Mike McAlevey, of the Otago Mental Health Support Trust, who
submitted feedback on behalf of mental-health-service
consumers and their families, said feelings were mixed about
the value of a single service.

Concerns were raised about the shortness of the
implementation time-frame, the lack of choice in having one
provider, the effects on staff morale of job uncertainty, and
fear the move was cost-cutting.

Potential benefits were less red tape, having one properly
resourced service, and more consistency.

eileen.goodwin@odt.co.nz

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