House Passes Bill To Avert Medicare Premium Increase

http://www.cqpolitics.com/wmspage.cfm?parm1=5&docID=cqmidday-000003209910&mp=Most_Viewed
The House passed a bill that would prevent Medicare premiums from rising sharply for about 11 million senior citizens.

The legislation would block a big increase in Medicare Part B premiums for the affected seniors, who account for about 27 percent of those enrolled in the health insurance program for the elderly and disabled.

They are in jeopardy of a steep increase in their monthly premiums because of complexities in federal law and the likelihood that Social Security recipients won’t get a bump in their benefits next year to cover the cost of the premium increase.

“I have 100,000 Social Security recipients in my congressional district [who] will be impacted by the increase in the Medicare Part B premiums next year since this increase is not going to be offset by the normal cost-of- living increase in their Social Security checks,” said Rep. Shelley Berkley , D-Nev. “I think this is a very important way and a very necessary way of helping to keep my seniors who rely on Social Security ... whole.”

Medicare "Maligned"

One casualty in the attacks against expanding health insurance is perhaps the most popular federal program ever created: Medicare. Foes are careful not to say it too directly, but the implication is that the retiree insurance program exemplifies what's wrong with government-run health care. And the daughter of the president who created Medicare is fed up with that argument.

Here's Lynda Bird Johnson Robb in a video message to a retiree group on Medicare, which was signed into law by her father, Lyndon Johnson, in 1965:

Medicare and Masachusetts Myths

Health economists Amy Finkelstein and Robin McKnight examine what happened when the government introduced Medicare into the market.(PDF)

Abstract: We study the impact of the introduction of one of the major pillars of the social insurance system in the United States: the introduction of Medicare in 1965. Our results suggest that, in its first 10 years, the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality. However, we find a substantial reduction in the elderly’s exposure to out of pocket medical expenditure risk. Specifically, we estimate that the introduction of Medicare was associated with a forty percent decline in out of pocket spending for the top quartile of the out of pocket spending distribution. A stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two-fifths of the costs of Medicare. These findings underscore the importance of considering the direct insurance benefits from public health insurance programs, in addition to any indirect benefits from an effect on health.

Massachusetts Health Reform: The Myth of Uncontrollable Costs | Massachusetts Taxpayers Foundation

Despite a public perception that the state's landmark health care reform law has turned out to be unaffordable, a new analysis by the Massachusetts Taxpayers Foundation finds that the cost to taxpayers of achieving near universal coverage has been relatively modest and well within initial projections of how much the state would have to spend to implement reform, in part because many of the newly insured have enrolled in employer-sponsored plans at no public expense.


The Foundation report concludes that state spending on the reform has increased by $350 million between fiscal 2006, the last year before reform, and fiscal 2010 - an average annual increase of only $88 million.


Full Publication (PDF)

Health care insurers often dominate market - Health care- msnbc.com

http://www.msnbc.msn.com/id/32524528/ns/health-health_care
of course

WASHINGTON - One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition — just what private insurers seem to be doing themselves in many parts of the U.S.

Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.

For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system.

Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies.

"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."

Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.

Overhaul supporters tout savings
Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.

A study by the Urban Institute public policy center estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people.

"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan,'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."

Insurers contend their industry is extremely competitive, and a public plan is unnecessary. About 1,300 carriers operate across the country, although many only have a small share of the market in their states.

"You can have a very competitive market and still have companies with a high market share," said Alissa Fox, a top Washington lobbyist for the Blue Cross Blue Shield Association.

Fox points to the federal employee health program, which also covers members of Congress. It offers a total of more than 260 options and 10 nationwide plans. Despite all the choices, about 60 percent of federal workers pick a Blue Cross plan.

"Insurers need to be of a significant size to best serve their customers and make sure that people get the best value," Fox said.

Nonetheless, lawmakers are concerned. Big insurers are getting bigger. Small businesses in particular have fewer and fewer options for getting coverage.

Congressional investigators this year looked at insurers catering to small employers around the country. The Government Accountability Office found that the median — or midpoint — market share of the largest carrier increased to 47 percent in 2008 from 33 percent in 2002.

The basic framework lawmakers are looking at for a health care overhaul would encourage competition, even without a government plan. It calls for setting up a big insurance purchasing pool called an exchange. It would be open, at least initially, to individuals and small businesses. The government would offer subsidies to make premiums more affordable.

Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health.

Offering the option of a public plan would supercharge the competition, supporters say.

Plan could rival giants
Blumberg envisions a plan that pays medical providers more than Medicare, but less than private insurance. Her study estimated it could grow to 47 million members, leaving 161 million with private insurance. Even so, that would make the new public plan one of the largest insurers in the country, rivaling Medicare, Medicaid and big private companies such as Wellpoint and UnitedHealthcare.

It's a scenario that gives pause even to traditional adversaries of the insurance companies.

"The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs."

Snowe, among the few Republican senators still trying to come up with a bipartisan compromise, wants to hold back on creating a public plan for now and give insurers one last chance to show if they can keep costs in check.

That's doesn't go far enough for liberals, who are loath to give the insurance industry tens of millions of new customers supported by taxpayer subsidies.

"It would give the industry a windfall without any countervailing force to require them to lower their costs," said Richard Kirsch, national campaign manager for the advocacy group Health Care for America Now. "The insurance companies could continue to jack up premiums while getting a whole new market."

one last chance, Snowe? that $1M a day in lobbying fees should have been their last chance

What Value do Health Insurance Companies Bring?

Chris Hayes Healthcare Flowchart from nn09

http://www.donkeylicious.com/2009/08/flowchart.html


larger version

In America, Crazy Is a Preexisting Condition - Birthers, Town Hall Hecklers and the Return of Right-Wing Rage

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/14/AR2009081401495.html
Interesting perspective

In Pennsylvania last week, a citizen, burly, crew-cut and trembling with rage, went nose to nose with his baffled senator: "One day God's going to stand before you, and he's going to judge you and the rest of your damned cronies up on the Hill. And then you will get your just deserts." He was accusing Arlen Specter of being too kind to President Obama's proposals to make it easier for people to get health insurance.

In Michigan, meanwhile, the indelible image was of the father who wheeled his handicapped adult son up to Rep. John Dingell and bellowed that "under the Obama health-care plan, which you support, this man would be given no care whatsoever." He pressed his case further on Fox News.

In New Hampshire, outside a building where Obama spoke, cameras trained on the pistol strapped to the leg of libertarian William Kostric. He then explained on CNN why the "tree of liberty must be refreshed from time to time by the blood of tyrants and patriots."

It was interesting to hear a BBC reporter on the radio trying to make sense of it all. He quoted a spokesman for the conservative Americans for Tax Reform: "Either this is a genuine grass-roots response, or there's some secret evil conspirator living in a mountain somewhere orchestrating all this that I've never met." The spokesman was arguing, of course, that it was spontaneous, yet he also proudly owned up to how his group has helped the orchestration, through sample letters to the editor and "a little bit of an ability to put one-pagers together."

The BBC also quoted liberal Illinois Sen. Dick Durbin's explanation: "They want to get a little clip on YouTube of an effort to disrupt a town meeting and to send the congressman running for his car. This is an organized effort . . . you can trace it back to the health insurance industry."

So the birthers, the anti-tax tea-partiers, the town hall hecklers -- these are "either" the genuine grass roots or evil conspirators staging scenes for YouTube? The quiver on the lips of the man pushing the wheelchair, the crazed risk of carrying a pistol around a president -- too heartfelt to be an act. The lockstep strangeness of the mad lies on the protesters' signs -- too uniform to be spontaneous. They are both. If you don't understand that any moment of genuine political change always produces both, you can't understand America, where the crazy tree blooms in every moment of liberal ascendancy, and where elites exploit the crazy for their own narrow interests.

In the early 1950s, Republicans referred to the presidencies of Franklin Roosevelt and Harry Truman as "20 years of treason" and accused the men who led the fight against fascism of deliberately surrendering the free world to communism. Mainline Protestants published a new translation of the Bible in the 1950s that properly rendered the Greek as connoting a more ambiguous theological status for the Virgin Mary; right-wingers attributed that to, yes, the hand of Soviet agents. And Vice President Richard Nixon claimed that the new Republicans arriving in the White House "found in the files a blueprint for socializing America."

When John F. Kennedy entered the White House, his proposals to anchor America's nuclear defense in intercontinental ballistic missiles -- instead of long-range bombers -- and form closer ties with Eastern Bloc outliers such as Yugoslavia were taken as evidence that the young president was secretly disarming the United States. Thousands of delegates from 90 cities packed a National Indignation Convention in Dallas, a 1961 version of today's tea parties; a keynote speaker turned to the master of ceremonies after his introduction and remarked as the audience roared: "Tom Anderson here has turned moderate! All he wants to do is impeach [Supreme Court Chief Justice Earl] Warren. I'm for hanging him!"

Before the "black helicopters" of the 1990s, there were right-wingers claiming access to secret documents from the 1920s proving that the entire concept of a "civil rights movement" had been hatched in the Soviet Union; when the landmark 1964 Civil Rights Act was introduced, one frequently read in the South that it would "enslave" whites. And back before there were Bolsheviks to blame, paranoids didn't lack for subversives -- anti-Catholic conspiracy theorists even had their own powerful political party in the 1840s and '50s.

The instigation is always the familiar litany: expansion of the commonweal to empower new communities, accommodation to internationalism, the heightened influence of cosmopolitans and the persecution complex of conservatives who can't stand losing an argument. My personal favorite? The federal government expanded mental health services in the Kennedy era, and one bill provided for a new facility in Alaska. One of the most widely listened-to right-wing radio programs in the country, hosted by a former FBI agent, had millions of Americans believing it was being built to intern political dissidents, just like in the Soviet Union.

So, crazier then, or crazier now? Actually, the similarities across decades are uncanny. When Adlai Stevenson spoke at a 1963 United Nations Day observance in Dallas, the Indignation forces thronged the hall, sweating and furious, shrieking down the speaker for the television cameras. Then, when Stevenson was walked to his limousine, a grimacing and wild-eyed lady thwacked him with a picket sign. Stevenson was baffled. "What's the matter, madam?" he asked. "What can I do for you?" The woman responded with self-righteous fury: "Well, if you don't know I can't help you."

The various elements -- the liberal earnestly confused when rational dialogue won't hold sway; the anti-liberal rage at a world self-evidently out of joint; and, most of all, their mutual incomprehension -- sound as fresh as yesterday's news. (Internment camps for conservatives? That's the latest theory of tea party favorite Michael Savage.)

The orchestration of incivility happens, too, and it is evil. Liberal power of all sorts induces an organic and crazy-making panic in a considerable number of Americans, while people with no particular susceptibility to existential terror -- powerful elites -- find reason to stoke and exploit that fear. And even the most ideologically fair-minded national media will always be agents of cosmopolitanism: something provincials fear as an outside elite intent on forcing different values down their throats.

That provides an opening for vultures such as Richard Nixon, who, the Watergate investigation discovered, had his aides make sure that seed blossomed for his own purposes. "To the Editor . . . Who in the hell elected these people to stand up and read off their insults to the President of the United States?" read one proposed "grass-roots" letter manufactured by the White House. "When will you people realize that he was elected President and he is entitled to the respect of that office no matter what you people think of him?" went another.

Liberals are right to be vigilant about manufactured outrage, and particularly about how the mainstream media can too easily become that outrage's entry into the political debate. For the tactic represented by those fake Nixon letters was a long-term success. Conservatives have become adept at playing the media for suckers, getting inside the heads of editors and reporters, haunting them with the thought that maybe they are out-of-touch cosmopolitans and that their duty as tribunes of the people's voices means they should treat Obama's creation of "death panels" as just another justiciable political claim. If 1963 were 2009, the woman who assaulted Adlai Stevenson would be getting time on cable news to explain herself. That, not the paranoia itself, makes our present moment uniquely disturbing.

It used to be different. You never heard the late Walter Cronkite taking time on the evening news to "debunk" claims that a proposed mental health clinic in Alaska is actually a dumping ground for right-wing critics of the president's program, or giving the people who made those claims time to explain themselves on the air. The media didn't adjudicate the ever-present underbrush of American paranoia as a set of "conservative claims" to weigh, horse-race-style, against liberal claims. Back then, a more confident media unequivocally labeled the civic outrage represented by such discourse as "extremist" -- out of bounds.

The tree of crazy is an ever-present aspect of America's flora. Only now, it's being watered by misguided he-said-she-said reporting and taking over the forest. Latest word is that the enlightened and mild provision in the draft legislation to help elderly people who want living wills -- the one hysterics turned into the "death panel" canard -- is losing favor, according to the Wall Street Journal, because of "complaints over the provision."

Good thing our leaders weren't so cowardly in 1964, or we would never have passed a civil rights bill -- because of complaints over the provisions in it that would enslave whites.

seems the angry left and the uninsured middle are now stepping up to the plate. Hopefully it's not too late.