I say this,
not just because the poorly written, poorly managed and poorly structured bill
is a farce, but because it has now been revealed that an amendment to that Bill
from Reps Collins and Faso from Upstate New York was approved by the Speaker to
be quickly and quietly allowed into the re-written bill that was then to be presented
and passed by a voice vote in the House.
Why?
It’s not that it is so unusual; it’s very
simple really. It is such a transparent
sham because the amendment, although it might eventually benefit other states, was
at that moment aimed at “benefiting” just New York State. It’s somewhat like certain amendments to the
Tax Code – it only benefits one group.
Here’s what RollCall.com had to say about it:
“The
proposal by upstate Republicans Collins and Faso would prevent New
York counties from shouldering the cost of Medicaid, leaving the responsibility
to the state alone, New
York media outlets reported. Collins argued that it would reduce the
property tax burden for New Yorkers. ‘Year after year, Albany’s leadership
relies on counties to foot the bill for New York State’s out-of-control
Medicaid costs,’ Collins said in a statement. ‘Enough is enough’.”
Collins and Faso introduced the amendment with the
support of (Republican) Reps. Elise Stefanik, Tom Reed and Claudia Tenney. The amendment was crucial to getting Faso and
Collins’ upstate New York Republican colleagues to support the GOP plan to
replace the 2010 health care law signed by former President Barack Obama.”
As Politico
reports: “New York State’s Medicaid program is paid for with county, state and
federal dollars. The counties pay roughly 13 percent of the total Medicaid
budget. Their contribution is capped so the percentage decreases every year.
Collins’ amendment, which excludes large municipalities such as New York City,
would bar federal reimbursements for state Medicaid funds raised from local
governments, shifting roughly $2.3 billion in Medicaid spending from the
counties to the state. ‘Considering Rep.
Tenney’s history as a staunch advocate for the taxpayer, this is a great
opportunity for her to advocate for real property tax relief for the 22nd
District,’ her spokeswoman, Hannah Andrews, said in an email.”
As much as
those upstate Republicans want this amendment to be their ticket to being able
to cover themselves when they (finally) get to cast an affirmative vote for the
American Health Care Act, this is a political deal that benefits no one other
than them. They believe firmly that it
gives them enough support from conservative Republicans in their districts to
enable them to vote YES on AHCA without losing their districts to Democrats in
2018. In fact, Rep. Claudia Tenney of
the 22nd District had even declared that she had been leaning to
voting “No” on the AHCA, but with this amendment would change her vote to a
“Yes.” Thank you, congresswoman, for
telling us exactly what this is – a backroom deal to save your SEAT.
However, the
firestorm from congressional and NY state Democrats may not be to their advantage. Gov. Andrew Cuomo has called them out for
forcing the State to come up with an additional $2.3 billion to cover the effects
of the amendment plus all the $8 billion it will cost the State if the AHCA is
passed. The DCCC has targeted all of their
upstate districts for the 2018 election, declaring: “The House Republican
repeal bill is an especially bad deal for New Yorkers, and this backroom
amendment is nothing more than politicians putting lipstick on a pig.” Last, but hardly least, it is not clear that
the bill as amended will survive an eventual vote in the House. If it does, the amendment itself may not be
able to be considered by the Senate unless it meets that body’s stricter rules
on what can be passed in the Senate by 51 votes rather than 60 votes.
Having given
this nod to partisan politics, let us get to the real meat of the healthcare
problem.
Have you
stopped to consider what a mess we are going through just to maintain a health care system flawed by the free market, private payer myth. Think about it.
- Out of 36 developed countries, the USA healthcare system ranks last
in terms of the overall efficiency and positive outcomes
- The ACA was the first major reform
that became the law of the land since the introduction of Medicare and Medicaid
under LBJ; but the compromises that were necessary to get ACA passed took
their toll and the obstructionist Republicans gutted important provisions
before it started and after it became law. The most glaring omission that now is
apparent is the lack of a public option that would compete with private
plans forcing private insurance companies to offer more competitive plans
- The ACA has made great strides in covering previously
uncovered or poorly insured citizens, extending Medicaid to millions,
reforming nefarious practices of insurance companies to restrict sicker
people from obtaining or maintaining coverage if they had a pre-existing condition
or got very sick; lowering the percentage of premium increase, and
requiring certain benefits be in all policies. However, the resistance of insurance
companies to this “interference of the federal government’ into ‘their
business’ along with the continuous repeal efforts of the Right-wing
Republicans, has resulted in a system that is being sabotaged instead
of enhanced.
- There are flaws in the ACA, of course –
for example: restrictions on private plans are too lenient (as demanded by
those insurance companies before the bill passed; consumer protection has
been almost stripped clean; co-pays and deductibles have not been
controlled; and a provision to reimburse insurance companies for early
losses was denied funding by Republicans in 2014.
- Replacement bills – including the latest AHCA --
have been offered by Republicans, but their offerings are so flawed and lacking in substance that
it is tragic and laughable at the same time. As I have said – they know how to
obstruct and lie, but they can’t govern because their limited government
ideology, and their inability to handle reality and truth, prevent them
from doing so.
- The projected loss of insurance for 14 million people by the end of 2019 is a disaster waiting to happen.
So, let us
come back to basics. What are we trying
to achieve? What is the purpose we want
to accomplish? What outcomes are we
looking to see happen? Is removing a tax
burden from local counties any kind of solution to lack of affordable health
care? Is the abandonment to the states
of what must be a federal program – Medicaid – is this the way to ensure equal health
care and treatment across our whole land for elderly in long-term care
facilities, for persons with developmental or acquired disabilities, for
children in poverty?
Instead of
treating healthcare as a set of problems to be solved, we are seeing the
politicization of healthcare as something to be manipulated for the gain of
drug and insurance conglomerates, small businesses, certain religious
denominations, political careers, law firms, lobbying firms, and a host of
small and large affiliated businesses, including health care professionals and
entities. Strangely enough, people who need
health care, including in need of insurance to help them obtain it, are the
last to be considered in this imperative need to reform our measurably-flawed
healthcare system.
So – you ask
– what are the basics? We certainly need
to search for some, which is more than the radical Republicans have ever done! How about we start with the purpose of the
Affordable Health Care Act. Contrary to
what I believe should be Title I of every ACT in Congress, Title I of
the ACA does not spell out the purpose(s) and outcome(s) of the entire
Act. However, the various Titles do
spell out some purposes and here they are, thanks to Obamacarefacts.com:
- Quality, affordable health care
for all Americans
- Improving the quality and
efficiency of health care
- Preventing chronic disease and
improving public health
- Improving access to
innovative medical therapies
- Community living
assistance services and supports
- Work Force Development and Training
Obamacarefacts.com
does provide its own version of a purpose statement, when it says:
“The Affordable Care Act’s main focus is
on providing more Americans with access to affordable health insurance,
improving the quality of health care and health insurance, regulating the
health insurance industry, and reducing health care spending in the US.”
Let’s look
next at some of the purposes of a comprehensive health care reform of the
recent past to see if any are relevant for our present-day dilemma.
- Provide health insurance to those who cannot
afford it by helping them through subsidies.
- Those who meet certain qualifications can buy insurance on an exchange
- Help businesses offer health insurance to their employees due to tax credits and more affordable health insurance.
- Reduce insurance costs and provide better quality affordable health care to more people.
- Tax penalty for those who choose not to purchase health insurance
SURPRISE – these are the aims behind the RomneyCare plan in Massachusetts! Some of these suggestions came directly from
the conservative Heritage Foundation.
2)
Let’s take a brief look at a Single-Payer Plan introduced
earlier this year into the House by Rep. John Conyers (D) of Michigan:
Expanded & Improved
Medicare for All Act
Summary: H.R.676 — 115th Congress (2017-2018). Introduced in House (01/24/2017)
- Provide all individuals residing in the United States and U.S.
territories with free health care that
includes all medically necessary care, such as primary care and
prevention, dietary and nutritional therapies, prescription drugs, emergency
care, long-term care, mental health services, dental services, and vision
care.
- Only public or nonprofit institutions may participate.
- Patients may choose from participating physicians and institutions.
- Health insurers may not sell health insurance that duplicates the
benefits provided under this bill, but may sell
benefits that are not medically necessary, such as cosmetic surgery
benefits.
- The bill
sets forth methods to pay institutional providers and health professionals
for services.
- The program is funded by:
(1) existing sources of government revenues,
(2) increasing personal income taxes on the
top 5% of income earners,
(3) progressive excise tax on
payroll and self-employment income,
(4) a tax on unearned income, and
(5) a
tax on stock and bond transactions.
(6) Amounts
that would have been appropriated for federal public health care programs,
including Medicare and Medicaid, are transferred and appropriated to carry out
this bill.
- The program
must give employment transition benefits and assure priority in retraining
and job placement to individuals whose jobs are eliminated due to reduced
clerical and administrative work under this bill.
- The
Department of Health and Human Services must create a confidential
electronic patient record system.
- The bill establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
IF the GOP ever means to deal seriously and
professionally with healthcare reform, and the savings that can accrue from such, they must
consider a public option single-payer plan with other common-sense provisions
that appear in the above plans. However,
if the GOP chooses to remain in a dark place where healthcare is considered something
one must earn or merit or take as is (‘junk’ coverage level) because they
believe not everyone has the RIGHT of being adequately cared for by
professionals or fully covered by insurance -- then they must be met with total
resistance and eventual electoral defeat.
Like education, healthcare is enormous enough in its implications to
demand a bipartisan effort, expert advice, thorough debate and abundant appropriations
that do not skimp on equality, justice and strength of provisions for
enrollees.
So, let us turn finally to what a group of health
professionals say is an adequate single-payer plan for all Americans. (This constitutes a summary of a Post that
occurred on October 23, 2011 on this site – I encourage you to read it for more
detail on each of the following provisions)
What would be some of the savings
from a single-payer health care system? It is estimated by the Physicians for a National
Health Program (PNHP) that “the reason we spend more and get less than the rest
of the world is because we have a patchwork system of for-profit payers.
Private insurers necessarily waste health dollars on things that have nothing
to do with care: overhead, underwriting, billing, sales and marketing
departments as well as huge profits and exorbitant executive pay. Doctors and
hospitals must maintain costly administrative staffs to deal with the
bureaucracy. Combined, this needless
administration consumes one-third (31 percent) of Americans’ health dollars.
Single-payer financing is the only way
to recapture this wasted money. The potential savings on paperwork - more than
$400 billion per year - are enough to provide comprehensive coverage to everyone
without paying any more than we already do.
“The ten largest health insurance companies
insured roughly 118 million Americans in 2008. Compensation figures suggest
that these 10 companies paid over $300 million dollars to their executives in
2009. While this is only a crude estimate, it serves to define a ballpark
figure for overall executive compensation: hundreds of millions of dollars, at
minimum. This is all money paid for by health insurance premiums that buys
little or no health care. Some might call it a money pit for health care
dollars.
While
Cigna paid their CEO over $14 million to oversee the health coverage of 11.9
million people, Medicare's head, the administrator of the Centers for Medicare
and Medicaid Services (CMS) makes around $140,000 a year overseeing the health
insurance coverage of 40 million people.
Second, Hospital procedures have grown more
costly and doctor's fees have also risen.
PNHP intends that National Health Insurance (NHI) would pay each
hospital a monthly lump sum -a global budget - to cover operating
expenses. This amount would be negotiated yearly based on past
expenditures, fiscal and clinical performance, projected changes in levels of
services, wages and input costs, and proposed innovations. Hospitals
would not be allowed to bill for services covered by NHI, but equally important
could not use any of their operating budget for expansion, profit, excessive
executive incomes, marketing, or major capital purposes. Privately-owned
hospitals would be converted to non-profits and their owners would be
compensated for past investment. This “global budgeting” would virtually
eliminate billing, freeing substantial savings for enhanced clinical
care. Prohibiting use of operating funds for capital improvements would
eliminate the primary financial incentive for excess interventions and services
as well as its opposite (skimping on care) since neither strategy could result
in institutional gain.
Third, the PHNP says NHI would include
three payment options for physicians and other practitioners:
fee-for-service; salaried positions in institutions; salaried positions within
group practices or HMOs. Privately-funded HMOs and group practices would
also be converted to non-profits. Only institutions that deliver care
could receive NHI payments, thus excluding many HMOs and groups that currently
sub-contract services but don’t maintain clinical facilities.
The three
proposed payment options uncouple physician payment and other operating costs
from capital purchases. Global negotiated budgets for institutional
providers would eliminate billing costs; at the same time providing a stable
and predictable financial support. It could also stimulate development of
community prevention programs (e.g. smoking cessation).
Fourth, NHI will cover disabled Americans
of all ages for all necessary nursing home and home care. According to
PNHP, a “local public agency in each community would determine eligibility and
coordinate care. Each agency would receive a single budgetary allotment
to cover the full array of long term care services in its district. The
agency would contract with long-term care (not-for-profit) providers for the
full range of needed services, eliminating the perverse incentives in the
current system that often pays for expensive institutional care but not the
home-based services that most patients would prefer.” The program would
encourage home and community-based services by supporting the 7 million unpaid
caregivers that provide 70% of the care, and by supporting the expanded
training of geriatric physicians, nurses and social workers who would assume
leadership of this system.
Finally, NHI would pay for all medically
necessary prescription drugs and medical supplies, based on a national
formulary, established and updated by an expert panel. The most important
provision of this would be the negotiation by NHI with the drug and equipment
manufacturers, based on costs (excluding extras like advertising and lobbying
costs), resulting in very substantial savings which is not happening under the
current multiple private-payer system.
Of course,
this single-payer system will not solve all problems; i.e. improvements in
environmental and occupational health will not automatically follow; need for
improvements in quality will remain; medical school problems of high tuition
and lack of minority representation will continue; some physicians will still
succumb to temptations to enhance their earnings by encouraging unneeded
services. However, a framework for addressing such problems will be in
place.
However, it’s better than the
alternatives, especially better than the multiple private-payer debacle;
defined contribution schemes with lower-paid employees forced into skimpy
plans; tax supplements and vouchers; turning Medicaid over to states.
An article
under the heading of the PNHP concludes: “Incremental changes cannot solve these
problems; further reliance on market-based strategies will exacerbate
them. What needs to be changed is the system itself.”
This change
to a new system of health care insurance and delivery is still one of the most
important steps we could take to save money and thus affect the national
budget, to give relief to businesses, to cover all citizens with health insurance,
and to literally bring relief to the pocket-books of millions thereby restoring
confidence in our healthcare system and increasing the likelihood of better
research and innovation than we have seen in a long time.”
Single-payer
is the clear choice for reform of healthcare.
TrumpCare is not a choice -- it is a death sentence!
