SB 1580: Next step in complete government takeover of health care?

by Sen. Jeff Kruse (R-Roseburg)

The legislative Assembly should not be so easily turning over our Constitutional responsibilities to the Governor. And yet in both health care and education that is exactly what we are doing.

SENATE BILL 1580

On February 14, 2012 (Oregon’s birthday) The Senate passed the next version of “health care reform”. I put that in quotes because I am not sure we are getting what is advertised. I tend to get wrapped up in the details of whatever proposal we are dealing with but I thought maybe it is time to step back and talk about some of the basics. Specifically, what is Medicaid?

In the simplest of terms Medicaid is government sponsored and tax payer funded health care for low income people, but our understanding needs to go deeper. Medicaid is a health care rationing system in which the government makes the decisions. Even federal budgets are finite, which means we can’t do all things for all people. The government has three ways to control costs; the number of people covered, the services they get, and the amount providers are paid for those services. But it goes deeper yet.

The services covered are determined at the federal level and for a state to make any adjustment is called a waiver process that is very complicated and can take a great deal of time. The population covered is based on the poverty rate and the state does have some discretion at least until 2014 when the federal mandate will close to double Oregon’s Medicaid population without any state option. The provider reimbursement rate is the most volatile and the one of most concern.

Medicaid funding happens in a number of distinct and separate funding streams, which indeed makes it hard for any sort of coordination of care. When you add to this the fact providers are reimbursed at a level far below actual costs it makes any effort at coordination even more difficult. You will be told this transformation effort will lead to a locally driven coordination model, and if that is true it would be a good thing. But we need to go one step deeper.

We should start with the understanding there are those at both the federal and state level, including our Governor, who would like the complete government takeover of the health care system. (The Governor did say last summer his only regret in the 2011 Legislative Session was he wasn’t able to unionize, or make public employees of health care workers). We also need to understand this would have to happen in phases. I would submit we are well on our way, and it is being driven by provider rates.

In 2011 we “balanced” the budget on 235 million dollars in projected savings from health care transformation. We knew at the time this number was fictitious and was being used to drive an agenda. Now we are being told if we meet some undetermined federal criteria we will get an additional 500 million federal dollars into our Medicaid system. Local communities are scrambling to try and meet these criteria, and I can’t blame them. Providers have been told they will either meet whatever these new requirements are or face a 30% reduction in their rates. This was set up last year to drive the system to a predetermined outcome.

President Obama has been looking for a state to be the first to fully implement his health care plan, and I think he has chosen Oregon and our Governor is a willing participant. You will continue to hear how this is not “Obama Care”, but I am not sure how anyone can say that based on the fact we don’t know what the new federal requirements are. I would also submit there are those in the administration who do know, but are choosing not to tell us.

Simply put, there are still too many unanswered questions about the direction and structure of the system envisioned in this for us to be passing it. The information we did get we received at the 11th hour and was dramatically incomplete. It reminds me of Nancy Pelosi’s statement relative to the federal act when she said they needed to pass it before they read it. The legislative Assembly should not be so easily turning over our Constitutional responsibilities to the Governor. And yet in both health care and education that is exactly what we are doing.

The people deserve better.

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Posted by at 05:00 | Posted in Health Care Reform, Oregon Senate | 65 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Deadbeat

    I want Obamacare as fast as I can get it because then everything is free from his stash.
    I love being able to care for myself on the backs of others.
    Suckers.

  • David Appell

    Sen. Kruse writes, “Medicaid is a health care rationing system in which the government makes the decisions.”
    And private insurance is a health care rationing system in which insurance companies make the decisions. And often that decision is, no, you can’t have care, or even worse, no, we will not sell you insurance.

    So what does Sen. Kruse expect people to do? He doesn’t present any ideas here. It matters, because the system is disintegrating before our eyes. Employer-sponsored coverage has been declining at about 1% per year for at least 10 years now. Longer for some: In 1980 about 65% of high school graduates received employer-sponsored health coverage. Now it’s down to about 33%:
    http://davidappell.blogspot.com/2012/02/some-health-charts-to-make-you-think.html 

    Last week Gallup said that just 44.6% of Americans now get their insurance via an employer, down 4.6 percentage points in just 3 years. Every month, on average, 209,000 people are losing employer-based coverage. Every month, on average, 230,000 more people are uninsured:
    http://www.gallup.com/poll/152621/Fewer-Americans-Employer-Based-Health-Insurance.aspx 

    Countries with single-payer systems have much lower health costs than the US. (And, by the way, Europeans pay *more* out-of-pocket than do Americans.) Health care is not like buying shoes or bread — the free market model fails, because (1) you cannot predict when you will need care, or what care you will need, and (2) you can’t comparison shop. 

    Thus, you need an insurance system. And private insurance systems demand a profit, and a large administrative staff to analyze and deny claims. (*Not* paying for care is, after all, how they make money.) This market failure has been known for some time; the classic paper is by Kenneth Arrow:

    “Uncertainty and the Welfare Economics of Medical Care,” Kenneth J. Arrow, The American Economic Review, Vol. LIII n 5 (Dec 1963)
    http://www.aeaweb.org/aer/top20/53.5.941-973.pdf  

    • JoelinPDX

      Damn, three posts in a row. Do you think someone is just a bit anal.

      • valley person

         I don’t know who is anal, but you are the one who makes a lot of scatacological comments.

        • Rusticones

          What is scatacological about an accepted psychological term as well as a medical reference? 

          • JoelinPDX

            When you’re like VP and go to bed at night and dream about butts, scatology just comes naturally.

          • 3H

             And yet… it is you that scatology seems to come to naturally… which, by your logic, would mean that you dream about….

          • David Appell

            Joel, you’re consistently one of the most childish adults I’ve ever encountered. 

          • JoelinPDX

            To quote you David, “Nah, nah, nah, nah, naaaaah, nah.”

    • Rusticones

      Gee David, i can’t recall where it is written that anybody is owed healthcare at the expense of others? It must spring forth from the feelgood sector of the common sense brain that drives this insane idea that can never be fully funded or efficiently managed.  Since i have no insurance i have no one to blame but myself (personal responsibility) and God forbid i ever become catastrophically ill since i would have to make the decision to pull my plug and not burden others.  You gotta take the hand you’re dealt and do the best with it.  BTW, at the tender age of 60, i have run into very few individuals that have EVER been turned down for medical care!  I’m sure that there are a few, but that’s the way the cookie crumbles.  No, i am not hard hearted, but life is not fair all of the time and sometimes downright sucks.  To your individually responsible good health.

      • David Appell

        Where is it written that you deserve fire protection at the expense of others?

        • Gracie

          You *do* understand, don’t you, that the property taxes we all pay (whether directly through a mortgage on our own homes or through what a landlord pays in by way of those factored into the rent paid to him/her) for the fire and police services. It’s not like fire and police service is provided on a “premium payment for services” model. Please tell me you understand this. If the Federal gov’t can force you to purchase health care, can they then force you to buy something that might violate your conscience? Some want nothing to do with fire arms, but could realistically figure they mighgt be forced to. Some don’t like Planned Parenthood, and could realisticaly expect to see enforced “donations” because some in society

          • David Appell

            Of course I understand what property taxes are paid for. (And the fire department will come put out your car fire, even though you don’t pay property taxes on your car, and even though it might not be in town in which you live and pay taxes.) Police and fire servers are socialized, as are a great many other services in the US. We all have a need for those services, just as we all have a need for health services.

            Many people are forced to pay for government services that violate their conscience, such as a huge and aggressive military, extra taxes to pay for the tax breaks given to religious organizations, bail-outs for corporations who will not accept the jurisdiction of the so-called free market, and a huge number of other things. We all have to accept such compromises in the greater interest. 

            With what we now know about the Catholic church and its widespread tolerance of the sexual abuse of children, the thought that church leaders have a conscience to invoke is rather laughable. If the religious in America showed half as much concern for all their so-called principles, instead of just picking and choosing which they will complain about and which they will ignore, they might have a leg to stand on. But as it is Catholic church leaders seem only to be trying to score points in the culture wars.  

            (And, in fact, polls show a majority of American Catholics supported Obama’s original position on birth control.)

  • Bob Clark

    ObamaCare is basically more addictive federal monies for states swallowing it hard like Oregon.  ObamaCare is fraught with budgeting weaknesses which balloon the federal deficit and debt level.  Among these weaknesses:  That employers will mostly retain their healthcare programs and not dump their employees on the federal health program causing a surge in federal government health care expense.  Then there is the routine yearly reprieval given to medicare and medicaid reimbursement rates when reduced rates were suppose to control the federal government’s cost of these programs.

    ObamaCare is basically a big bloated new entitlement when the country is already tapped out on entitlements.

    Beyond this, ObamaCare tramples on the rights of individuals to find the best health solutions for themselves, as government health exchanges are a facade since the coverage will likely become heavily prescribed by bureaucrats.  Note how folks are being required to buy birth control and other mandated services they can’t possibly use because of their gender, age, and other physical traits.  The collective wisdom embedded in individual transactions is far more efficient at delivering what is exactly needed and demanded by a peoples.  Central planning has been shown time and time again to deliver too much of one thing and way too little of other things.  Ultimately, ObamaCare is price controls and denial of service.  Of course, it appeals to certain citizens who want government to lead them around like a bunch of dumb animals.

    • David Appell

      And yet, employers in Massachusetts have NOT “dumped” their employees onto the state. “The number of people with employer-based coverage rose to 68 percent of the adult population in 2010 from 64.4 percent four years earlier.”
      http://www.thefiscaltimes.com/Blogs/Gooz-News/2012/01/25/The-Health-Care-Story-Romney-Wont-Tell.aspx#page1

      • Rusticones

        My roommate lived in Boston for many years, holding down a sales position with a large east coast music company for many years.  When Romney Care was dictated to the masses of Mass., he could not afford to continue living  in that state and moved to Oregon.  How does that work out for the tax base?

        • David Appell

          Really? Why couldn’t it afford it? The penalty for no insurance was something like $295/yr in the beginning. So he could afford to live in Boston — a very expensive city — and he could afford to move to Oregon, but he couldn’t afford $295/yr? 

          Your claim doesn’t make sense.

    • David Appell

      “ObamaCare tramples on the rights of individuals to find the best health solutions for themselves.”For many people there is no solution, let alone a best one — the (so-called) free market will not sell them insurance at any price due to pre-existing conditions, or at a cost so large it’s impossible to afford. You don’t offer a solution to that problem either, except some vague thoughts you once swallowed about the “wisdom” of “individual transactions.” And you somehow seem to believe such a market failure can’t impact you, or that it’s just everyone else who is losing their employer-based insurance, but you’re immune. So who’s the dumb animal?

      • Ramalama

        David, David, David.

        You mustn’t confuse these people with facts. They operate on a faith-based system where their beliefs are all that matter.

        • Rusticones

          Ding dong!  Faith based health insurance is a reality and at last look, seems to be working out fine for the members. HAHAHAHAHAHAHAHAHAHAHA

  • valley person

    What a bunch of unproductive drivel from Senator Kruse. Typical of Republicans, he doesn’t like so called Obamacare but offers absolutely no alternative. He complains about rationing but I doubt he wants more taxpayer money spent on care to avoid rationing. I long for the days when we had 2 political parties with members who tired to solve problems rather than one party that simply throws its hands up and says “no mas”. 

    • JoelinPDX

      “… he doesn’t like so called Obamacare but offers absolutely no alternative.”

      Of course to Vp “alternative” means some kind of government program never self sufficiency.

      • valley person

         Self sufficiency is a great idea Joel. Should we start with everyone currently on Medicare?

        • Rusticones

          Abso-frickin-lutely!!!!!!!!

        • JoelinPDX

          Wouldn’t bother me a bit VP.

          • David Appell

            Really? So you contract with a private fire department? A private police department? You’ll pay a private arbitrator to enforce your contracts, for your cell phone and lease and mortgage and bank loans? You’ll hire your own security guards so you can walk the street? You’ll buy mercenaries to fight your wars and defend your borders? You’ll pay for private mail delivery? You’ll pay to have your food privately inspected, and you’ll pay for the clinical trials for the medications you take? You’ll pay tolls everywhere you go? You’ll pay a private sewage company to come take your crap away?

            You’ll pay your entire mortgage, instead of expecting the government to write-off part of your interest (i.e. so others will pay it, not you?)

          • valley person

             Don’t make his head explode. It wouldn’t be pretty.

    • Rusticones

      Seems to me that rather than complaining or bashing the other side of the same coin, Jeff was merely explaining the reality of the games being played by D.C. and the financial impact that the state faces.  Lets face it vp, the game is rigged and our money is on the line.  Makes me feel so warm and fuzzy.

  • Chana Cox

    I agree with everything Senator Kruse has said except that a key factor is controlling remuneration to providers.  We know that whatever the rhetoric, funds to providers will not come down.  Every time Congress says it will they change their minds.  They change their minds in part because it is now very difficult to get anyone (without supplemental insurance) to treat Medicaid and Medicare patients.  And the way the remuneration is calculated greatly distorts the efficient allocation of medical services — whether by the government or a private insurance company. 

    The population covered is probably not much of a factor if the plan is (and it seems to be clear this is the plan) that it will be a universal government engineered coverage.  

    What will be rationed is actual medical services.   You may get “free” contraception, but you may not get hip surgery or heart surgery after the age of sixty.  That will keep down medical costs and social security costs because it will bring down life expectancy.  

    • valley person

      “What will be rationed is actual medical services.   You may get “free”
      contraception, but you may not get hip surgery or heart surgery after
      the age of sixty.”

      Except that no one is proposing this sort of rationing. And no one is proposing free contraception. What is being proposed is that contraception be covered within the base cost of the insurance policy rather than treated as an add on.

      What you should consider Chana, is that medical services are presently rationed by who has what insurance policy. What we on the left would prefer is that health care be treated like other public services. We don’t pay insurance so that the police or fire fighters will show up in an emergency do we? Why shouldn’t basic health care be a public service? It would be cheaper and better than the private sector manages to provide.

      •  http://www.webdc.com/pdfs/deathbymedicine.pdf

      • Rusticones

        Hey vp, not just 3 months ago, a family home burnt to the ground because the owner would not pay the rural fire district the yearly fee to cover the costs of fighting fires.  I suggest that some police jurisdictions do not efficiently respond to certain crimes in certain neighborhoods in order to stay within dept. budgets.  This has been verified by conversations with active duty police.  And actually, the taxes (insurance) you pay on your property does amount to insuring that someone,sometime will show up to help you out.

        • valley person

           I’m wondering what your point is.

          • JoelinPDX

            I think he pretty clearly stated his point VP, only a liberal wouldn’t be able to understand it.

            Since you apparently missed it, I’ll reprint it for you:

            “… the taxes (insurance) you pay on your property does amount to insuring that someone,sometime will show up to help you out.”

            See, you were saying that we get fire and police protection for free. Rusticones was pointing out that we indeed don’t get these things for free. Obozo however, just wants to write off health care in his growing federal budget debt.

          • valley person

             Oh. I get it. But no, taxes paid for police and fire SERVICES are not pre-paid insurance, which is why there is a private market for fire insurance AND theft.

            And no, I never said we get any public services for free. We get them in exchange for paying taxes.

            Your last sentence makes no sense.

        • valley person

           Now that Joel has explained your statement, no Rustic, taxes to support police and fire services are not insurance. The dude who failed to pay his taxes to the fire department paid a price in losing his home, but he still could have insured his home against loss due to fire.

          In a very roundabout way, you can make a case that taxes paid for services are a type of social insurance, in that if no one paid anything there would be no one to help out in an emergency. But its a stretch.

    • Gracie

      Oh, it’s about control all right, just not the control they’re publicly talking about,

      Who is John Galt?

  • Health care would include access to knowledge, nutritious foods, and supplements made in facilities that are cleaner and with a far, far, lower death rate than those made by leading pharmaceutical companies.  Real health care is much less expensive than maintaining the arrogant, status quo of the AMA/pharmaceutical/FDA/Monsanto/USDA/Govermental death industries complex.

  • Anonymous

    New window please If the federal gov. did not require medical providers to give free services to any one without regard to insurance and or ability to pay none of this would be an issue.

    • David Appell

      You’re right, it wouldn’t be an issue. But the issue of people dying in the street for want of care *would* be a issue. It’s sad that that is your vision for America.

    • Anonymous

      perhaps mr.appell would prefer the people being killed in the streets. as in greece where the bankrupt government is forced to make cuts in in social liberal policys

      • David Appell

        What makes you think our situation is anything at all like that of Greece? Greece doesn’t even control its own currency and so can’t use monetary policy on their economy. Our currency is the standard of the world. So what is the comparison? 

        • Anonymous

          put down your rose tinted glasses. the fed not the government controls our currency which is being down graded by inflation and government over spending remember the recent down grade in U S credit worthyness  and bankrupcy of the local, county and state governments is a possiblity even being feared by the U S attourney general basicly because laws that require balanced budgets unlike US gov.

          • David Appell

            My God you’re an atrocious writer. Have you ever heard of punctuation? 

            Some inflation is a good thing — it entices people to spend their money instead of hoard it. And that’s good for the economy.

            I can’t really tell what else you’re trying to say. Really, man — learn to write.

          • JoelinPDX

            Funny David, you can’t refute what the guy says so you criticize his writing. This is your buddy the Net David. People take liberties with their writing. Get used to it.

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