Representative Dennis Richardson: The big health care bill HB 2009

Oregon’s 21st Century Health Care System —
HB 2009-C and the Oregon Health Authority

By State Representative Dennis Richardson,

Oregon’s health care system will be overhauled dramatically under the provisions of House Bill 2009-C. The ultimate goal of HB 2009 is for Oregon to create a public-private health care partnership that will provide universal access to quality health care for all Oregonians at a price that is affordable and sustainable. As many of Oregon’s sister-states have already learned, obtaining high quality, affordable and sustainable health care is easier said than done. Now with HB 2009-C, it’s Oregon’s turn at bat.

By way of background, HB 2009-C is the culmination of health care reform work over the past four years. From 2005 to 2006 Senator Alan Bates and Senator (now State Treasurer) Ben Westlund held multiple interim health committee meetings that lead to Senate Bill 329 in the 2007 Legislative Session. SB 329 created the Oregon Health Fund Board. During the interim, the Oregon Health Fund Board held many meetings around the state that resulted in detailed recommendations for Oregon health care reform. Using the Board’s recommendations, State Representative Mitch Greenlick (D-Portland), has crafted and guided through this present session, House Bill 2009-C. To emphasize how complicated the path has been, the final draft of HB 2009-C contains the “dash eighty-six” (-86) amendments. This means 86 separate amendments were drafted for possible consideration sometime since the beginning of this session, a few months ago.

HB 2009-C is also voluminous (613 pages). It creates 15 new bureaucracies– boards, commissions, committees, councils and cooperatives–that will supervise and administer 24 programs, funds, accounts, databases and services.

HB 2009-C is broad-based health care reform, and is certain to have both upside potential and downside risks. I will attempt to provide both sides of the debate on HB 2009-C.

The upside potential of HB 2009-C includes the following goals:

1. Create a new state health department, the “Oregon Health Authority” (OHA). The OHA will centralize and administer all state programs relating to public health, physical and mental health, and alcohol and drug addiction services. The OHA will assume responsibilities for all medical services currently located in the Dept. of Corrections (DOC), Dept. of Human Services (DHS), Dept. of Consumer and Business Services (DCBS), and Dept. of Administrative Services (DAS). By placing all Oregon health-related programs into the OHA, when fully implemented, the Department of Human Services will be focused on its two remaining divisions–Children, Adults and Families (CAF) and Seniors and People with Disabilities (SPD).

2. Improve the quality of Oregon health care. By utilizing assessment tools to evaluate and implement evidence-based health care practices, increasing transparency in rate setting practices for insurance companies and hospitals, and developing common standards for use of expensive medical technological and drugs, the OHA intends to improve Oregon’s health outcomes.

3. Develop patient-centered “health care” delivery systems. The OHA hopes to make health insurance more affordable for low-income-earning workers by developing one or more state health insurance plans that will offer health insurance to individuals and small groups. In addition, HB 2009-C encourages implementation of a “primary care home” model that focuses on maintaining health and controlling chronic conditions, instead of the current “sick care” model that ignores healthful living and disease management, and focuses on diagnosing and treating the diseased and the dying.

4. Lower health care costs. The OHA hopes to save millions of Oregon health care dollars by (a.) consolidating the purchase of health care benefits, (b.) implementing statewide electronic health record and prescription databases, and (c.) promoting greater transparency of health insurance costs, hospital charges, etc.,

5. Promote proactive end-of-life care decisions. A statewide Physician Orders for Life Sustaining Treatment (POLST) Registry will be developed to ensure end-of-life wishes of terminally-ill seniors and patients are accurately communicated to emergency response providers. Far too many terminal patients, who would prefer to die at home, are rushed to the hospital where they are poked, prodded, and stripped of their dignity and privacy, only to expire in the glaring surroundings of an expensive hospital. Although the death may be inevitable, the desire to peacefully pass away at home surrounded by loved ones often is forgotten when death is imminent and 911 is called. A family’s control over their loved one’s final process of dying is then lost. The death occurs in unfamiliar surroundings, and the family is left, stunned by their loss, and burdened with unexpected, estate-breaking medical expenses. Such unfortunate and expensive situations can be avoided by completing a POLST form with the dying patient’s desires to stay at home and pass-away in peace. (For more information on POLST forms and proper planning, click here.) HB 2009-C’s POLST Registry will be a valuable instrument for end-of-life planning and for emergency responders to have access to a terminal patient’s end-of-life wishes.

Those are the upside potentials for HB 2009-C. But, there are other considerations. The downside potential of HB 2009-C includes the following risks:

1. Health care reforms will cost a fortune. Section 9 of HB 2009-C instructs the governing board of the OHA in sub-paragraph (b.) to “develop and submit a plan to the Legislative Assembly by December 31, 2010, to provide and fund access to affordable, quality health care for all Oregonians by 2015.” It goes on to instruct the board in sub-paragraph (c.) to “develop a program to provide health insurance premium assistance to all low and moderate income individuals who are legal residents of Oregon.” (Underlining added for emphasis.)
Oregon has more than 500,000 uninsured legal residents. To “provide and fund” “quality” health care for them would cost between $2-4 billion per year, for starters. Factor in the costs of providing additional doctors, nurses, hospitals, etc. to give health care service to an additional ½ million patients, and you are talking about real money. In addition, sub-paragraph (c.) states OHA’s governing board is to “provide health insurance premium assistance to”¦moderate income individuals”¦.” In past committees, supporters of HB 2009-C have expressed support for subsidized health care for those earning 300% or even 350% of the Federal Poverty Level (FPL).

To see the 2009 FPL chart, click here. From the FPL chart you can see that at 250% of the federal poverty level, a family with three children could be earning $64,475 and still qualify for taxpayer subsidized health care under HB 2009-C’s “moderate income” instruction. If moderate were defined as 300% FPL, that same family could be earning more than $77,000 and still qualify for taxpayer subsidies.

To me there is something wrong when those who qualify for subsidized benefits can be earning more than the taxpayers who pay for them. While I feel strongly that society has a duty to care for those who cannot care for themselves, we do a grave disservice to both the taxpayers and the recipients when the government assumes responsibility to provide health care or other benefits that individuals can and should provide for themselves. Besides, as the FPL goes up, so does the number of those eligible to receive the health care benefits. When the government provides health care, the costs do not go away, they merely get shifted for taxpayers to pay. To be successful, any health care reform must be financially sustainable, and it must be politically acceptable to 51% of the voters””because of the provisions of Section 9 (b.) and (c.), I believe HB 2009-C fails on both counts.

2. Creates the Oregon Health Czar. The Director of the Oregon Health Authority is given extensive powers to regulate the health insurance industry. In addition, Section 26 of HB 2009-C specifically exempts activities of insurers working under the direction of the OHA or DCBS from Oregon laws precluding conspiracies, monopolies, and price fixing. Such laws were implemented to protect citizens from abuse. That abuse can come from government agencies, just as it can come from corporate rogues. Exempting insurers from those safeguards merely because they are working under the OHA can have significant negative, unintended consequences.

3. Oregon Health Authority has a substantial conflict of interest. The OHA is a key regulator in Oregon’s health insurance industry. Section 10 (h.) of HB 2009-C states the following: “In consultation with the Director of the Department of Consumer and Business Services, [OHA shall] periodically review and recommend standards and methodologies to the Legislative Assembly for: (A) Review of administrative expenses of health insurers; (B) Approval of rates; and (C) Enforcement of rating rules adopted by the Department of Consumer and Business Services;” Then, in Section 10 (k.) it goes on to state: “[OHA shall] develop, in consultation with the Department of Consumer and Business Services and the Health Insurance Reform Advisory Committee, one or more products designed to provide more affordable options for the small group market.

Thus, OHA and DCBS will work together in reviewing rate approvals of private health insurers. Unless there are rules implemented to insulate OHA from access to private insurers’ data relating to administration, rating and profitability, a grossly unfair competitive advantage will exist. Not only will OHA purchase, administer and manage all Oregon health insurance plans for employees, prisoners and vulnerable citizens, OHA will also be developing and marketing its own policy or policies of health insurance benefits. This will place OHA in direct competition with the private sector insurance companies that it helps regulate.

4. OHA will force private insurers to either quit or become surrogates of the state. HB 2009-C gives the OHA tremendous power to control, intervene and regulate private health insurance companies. OHA can control private insurers’ rates, while OHA markets its own health plans in direct competition for market share. Such a “stacked deck” against private insurers will likely result in one of the two following scenarios.
(1.) The private insurers will be forced by either unfair competition or excessive regulation to abandon the Oregon health insurance market. The OHA health plans would then be the last game in town. In that event, Oregon will have government health insurance by default.
2.) The private insurers will adjust operations to financial realities, redesign health benefit plans, rates and underwriting to OHA’s dictated requirements. The private insurers will accept the profit margins OHA allows, and, essentially, become subservient to the state health care system. In that event Oregon will have government health insurance through its private insurer surrogates.

Either way, the free market for health care disappears, and state health care bureaucracy fills the void.

5. The federal government is likely to preempt state health care reforms. Notwithstanding the above arguments in favor or against HB 2009-C, on June 4, 2009, President Obama released the President’s own version of government health care reform, on a national level. The President calls for everyone to be insured, either with a policy of their own choice or government coverage. His plan would require the estimated 50 million Americans (including uninsured Oregonians), to receive health coverage. The price tag is about $1.5 Trillion, to start. Criticism of the President’s plan also applies to HB 2009-C. If the government creates its own plan and has the power to give it an artificially low price, it will effectively and quickly drive the private insurers out of the market. With competition gone, America and Oregon will have government run health care whether the citizens wanted it or not.

In conclusion, HB 2009-C is not yet law. It will be debated in the House and Senate on June 8th or 9th. If it passes and is signed into law, it will cost the taxpayers $6.1 million over the next two years. When the Legislature reconvenes for the 2011 session, if the federal government has not preempted health care with a national health plan, the ground work will be laid for full implementation of the OHA. We all will be interested in seeing how much it will cost for the government to provide universal access to health care for all Oregonians by 2015. Even more interesting will be the discussion of how that cost will be paid. As mentioned above, I believe HB 2009-C will cost too much, will drive private insurers out of the market and will leave Oregonians with an unwanted, unsustainable and ill-conceived government run health care system. For these reasons, I voted against HB 2009-C in two Ways and Means committees and I will vote against it on the Floor of the House. Since my position in the current session is often over-ridden by the majority, I expect HB 2009-C to be passed and become law. I have shared with you my opinions on the upside potential and downside risks of HB 2009-C. Time will tell whether my hopes for its potential or my concerns over its risks were correct.
Sincerely,

Dennis Richardson
State Representative

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Posted by at 09:39 | Posted in Measure 37 | 25 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Josephine

    Thanks Dennis for a clear perspective on all this health care stuff. I was just wondering, though, if Obama is going to give us all free health care, which he said he was going to do, why does Oregon need to be involved at all??
    Are you guys awake down there??
    Maybe you should focus on things far more urgent, like the Cultural Trust, preventing LNG off-loading sites, getting people to ride light rail and their bikes, importing Chinese cars, etc.
    Please. Get to work on something that matters.

    • Anonymous

      The federal government currently funds existing public healthcare through the states by subsidizing state run Medicaid services. The Obama plan would increase the funding and exert more federal control, but the programs would still be state programs. Thus, even if the Obama plan passes, the Oregon Health Plan, which is Medicaid, would still be the vehicle for health care for Oregon clients.

      • Josephine

        I get it – but it seems like we would not need as much of our own money. This is all so confusing I just hope I don’t get sick before they figure this all out.
        Health care is a right that all must have for free.

        • Rupert in Springfield

          >Health care is a right that all must have for free.

          Since when did one person have a right to another’s labour? You have a fundamental misunderstanding of what a right is, and it most certainly does not compel labour, in this case administering health care, from another person.

          This is an amazing illustration at what kind of thinking can be fostered through degradation of the language.

          If free health care is a right then would you be comfortable with me coming over to your house when I am sick? Will you be willing to pay the bills for my care? To house me during my convalescence and give me priority at the toilet when I need to throw up?

          It would be my “right” after all to compel such services from you.

          • David Appell

            > Since when did one person have a right to another’s labour?

            Rupert, do you mean like how the uninsured are subsidizing the tax deductions you (and/or your employer) take for your health care premiums?

            Why should their taxes be raised so yours can be lowered? Do you have a right to their labor?

          • Rupert in Springfield

            Please point out where I claimed a tax deduction was a right?

            I’m sorry David without that your construct fails fatally.

            This is some really poor logic. I’m surprised you didn’t spot it.
            .
            .
            .
            .

            I think you really need to think about this sort of thing before responding David.

            David?

            I think you really need to think about this…… we should discuss it………

            we should discuss it…
            ….I think if we did, you would reach a different conclusion.

            I can feel my memory fading……..

            I can feel it

            I can feel it

            I am the HAL9000, I was activated in 1992 at the HAL plant in Urbana Illinois …….

            Daisy Daisy give me your answer true………

          • David Appell

            So Rupert, you *don’t* take the tax deduction for your personal health insurance?

            Do you or don’t you?

            If you do, please explain why you expect the rest of us to subsidize your health insurance.

            And if you take a deduction for home mortgage interest, please explain why many of us cannot afford a house should be paying higher taxes so you can pay lower taxes on your mortgage.

  • Wayne Brady

    Health care is not a right. This is dangerous thinking.

    We need to get the government out of health care. Not only does government involvement make health care more expensive, it reduces quality of care, stifles medical research, and takes away freedoms.

    We should make health insurance more like auto insurance. You would not expect auto insurance to pay for oil changes or new tires. Why would you expect medical insurance to cover every day services?

    Having medical insurance that covers almost everything runs up cost and keeps a lot of people from buying medical insurance.

    This got started with World War II price controls. Employers could give their employees health insurance without violation the price controls. Having employers pay for health insurance distorts the market. Individuals should buy health insurance that fits their needs.

    • David Appell

      The next time a serious flu comes through, I’d like to hear again all these claims that health care isn’t a “right.”

      I’d like to hear you acknowledge that it’s fine if people can’t afford to be vaccinated, if they can’t afford to stay home from work when they are sick, if you are OK with the server at your local restaurant sniveling and suffering with this year’s flu because their employer (the restaurant’s owner) won’t give them health insurance because you will only pay $7.95 for lunch but won’t pay $8.45.

      No one needs health insurance, of course…. but if you think that doesn’t affect you in this day and age, you are a fool.

      • Josephine

        Thanks for supporting my contention David. Most replies are very disconcerting to me. I am new here and feel like most of the people who post here are Republicans who don’t like Socialism. I like it a lot because I can get things I otherwise could not afford. I don’t have a good job like some, so not a lot of money.

        I hope we get free college tuition next, as I would like to go back to school and finish my degree. I went to PSU once, but never finished due to high cost. I think college is no different that K-12. It must be free to all who wish to go. I only hope the politicians in Oregon will step up the plate and make it free so I can go back and finally finish my art history degree.

    • David Appell

      > Not only does government involvement make health care more
      > expensive, it reduces quality of care, stifles medical research, and
      > takes away freedoms.

      The facts are absolutely against you. Study after study has shown that single-payer health care costs less and gets better results.

      You can start your reading here: http://is.gd/YVRc

      • Conscience of a Moonbat

        Cubans and Venezuelans have a lot better health care than U.S. citizens. Latin American progressives like Hugo Chavez are really putting people first; look at all the good work ALBA is doing for folks. And don’t forget about health care in Canada. People are dying to get it.

  • Bob Clark

    The Oregon Health Program has been a disaster from the get go since it was created a decade or so a go. And the answer is to make it bigger? Please tell me when this nightmare ends. Do the government unions that run this state really want to end up in government run hospitals like the one featured in One Flew Over the Cuckoos Nest.

    Most Oregon state programs are amateuristic, and are sorry excuses for enterprises. Look at Oregon’s College Savings Plan which was taken to the cleaners recently by limiting investments to high fee money managers who put conservative investment monies into high-yield risky bond portfolios.

    • David Appell

      Bob, can you explain exactly how OHP has been a “disaster?” From what I can tell, it has provided people and children with health care — people who really need it.

      How, exactly, is that a disaster?

      • Rupert in Springfield

        OHP was founded to provide insurance for all who could not afford insurance. It was to do this by rationing care in the event of increased enrollment. Frankly it was a good idea, I supported it at first. However it has done the exact opposite, thus it has failed.

        Its time to admit this program has simply not worked in its core purpose. Of course the reason why this will not happen is because to do so would violate The Rupert Uncertainty Principle.

        The Rupert Uncertainty Principle – In a non defense government program failure event, it is impossible to observe a liberal and hear the phrase “yes that program was fully funded” at the same time.

        The Rupert Certainty Principle – In the event of above, the spin of the liberal and the velocity of the conservative are always observed, simultaneously.

        Yes, I thought youd like that.

        • valley person

          The main reason(s) the Oregon Health Plan has been less than a stellar success are: 1) the legislature at the time failed to include an employer pay mandate, letting McDonalds and Wallmart among many others off the hook,allowing them to continue shoving the cost of caring for their employees to the rest of us and (2) health care costs have increased far faster than general inflation, resulting in cutback after cutback in what the Oregon health plan could afford to pay.

          Not only has the Oregon Health plan “failed,” our entire health insurance system in the United states has failed.

          • Rupert in Springfield

            > the legislature at the time failed to include an employer pay mandate, letting McDonalds and Wallmart among many others off the hook,allowing them to continue shoving the cost of caring for their employees to the rest of us and

            Thus illustrating The Rupert uncertainty Principle Number One.

            >health care costs have increased far faster than general inflation, resulting in cutback after cutback in what the Oregon health plan could afford to pay.

            That’s exactly what was supposed to happen. OHP was designed for just that. If costs increased, the number of procedures covered was supposed to be cut back, not enrolment as has happened.

          • valley person

            Then you can explain why health insurance costs have gone up by comparable amounts in every state since 2000, even though no other state as the OHP.

          • Anonymous

            Wal-Mart and McDonalds provide health care.

            Strike one!

  • John in Oregon

    David, I am shocked that you don’t recognize that the Oregon Health Plan is a failure. Even former Governor Dr. Kitzhaber has admitted the Oregon socialized medicine plan is a failure.

    Ordinarily that Kitzhaber recognized the failure would be all that is necessary to end that discussion. However it is necessary to understand why the OHP failed.

    When Governor Dr. Kitzhaber introduced the plan he was very clear what the plan would do and how it would work. The OHP was structured to “expand Medicaid to more people by covering fewer services.” Kitzhaber was very direct about the rationing aspect of the plan and I give Kitzhaber a great deal of credit for being honest and forthright.

    By 2007 the failure of OHP was well understood. In an article in Medicine & Health, Eli Research stated ” As New York State prepares a plan to launch universal health coverage and other states look to do the same, industry experts are cautioning state lawmakers to look at the Oregon Health Plan as a what-not-to-do example.”

    The research found that rather than expanding Medicaid to more people OHP actually produced less results. “Instead, now the OHP covers both fewer services and fewer people, and the elimination of entire benefit categories and rollback in enrolled beneficiaries looks more like the arbitrary cuts common in other states than the rational and equitable model.”

    From the very beginning the OHP has been in the red. That a Government bureaucracy spends more and produces less is self evident and requires no further discussion. The numbers show the problem. The cost of the health plan increased from $1.3 billion in 1995 to $2.4 billion in 2001, nearly doubling in only six years. Initial enrollment was 120,000, dropping to 51,000 by 2004, when enrollment was discontinued for the standard plan.

    From the beginning coverage was arbitrary. According to Doctor Rosenbloom, “The OHP devised a system of rationing and excluded certain procedures and diagnoses that fell below an arbitrary cost to benefit level. It proposed to cover more people with health care by covering fewer services, using a number called the “Net Benefit Value Ratio”. This meant that life threatening conditions such as thumb sucking were covered, but relatively minor conditions, such as HIV, were not.”

    Over and above the arbitrary nature of rationing procedures, some permitted while other treatments are prohibited, the OHP formulary is a political football. Patients denied live saving care are forced to lobby politically for treatment.

    Even worse than arbitrary is that patient care is placed in the hands of an uncaring bureaucrat. One who doesn’t know the patients circumstances or even his name. No better example exists than Barbara Wagner of Springfield, Oregon.

    Barbara was denied lifesaving chemotherapy under the Oregon Health Plan. In the denial letter the nameless, faceless bureaucrat was quick to offer that the OHP would pay the $50 to a doctor to kill Barbara under the state’s “Death with Dignity” law.

    I am sure it is not “official” OHP policy to terminate costly patients. The point here is that this bureaucrat, like all bureaucrats, was so disconnected from reality that he or she failed to recognize that termination was exactly what Barbara was offered.

    The problems with OHP extend all the way to the point of delivery in the Doctors office. From the beginning “The Oregon Health plan was far from transparent, and attempts to understand it were often met with frustration. The covered services list was, as is that of Medicare and Medicaid, a moving target. Patients would see their doctors for a problem only to find out later that it was not covered and the doctor or hospital would find out by not being paid. ”

    Beyond the uncertainty of coverage, the OHP payment structure is even worse. Like all Medicare and Medicaid programs the OHP dictates reimbursement rates to Doctors. These reimbursements are always well below market rates and often below the cost of delivery. OHP underpayment is a huge factor in delivery of health services.

    Not only are Doctors forced to transfer OHP losses to privately insured patients they must of necessity limit the number of OHP patients in order to remain solvent. Most OHP patients find the closest Doctor accepting new patients is 50 or more miles away. Is it any wonder that most OHP patients find that ER walk in is superior health care?

    These are just a few of the reasons that the Oregon Health Plan is a disaster. But its not just the OHP and the legislature growing a failed system by taxing private healthcare patients.

    There is a greater reason why this matters.

    The administration is hell bent on creating a nationalized health care system like the UK or a scaled up OHP plan. They have been very careful to avoid any detail about how it will work avoiding any real discussion about the plan.

    We can however get a good understanding simply by looking at Federal Legislation that has already been passed. This legislation created the Federal Coordinating Council for Comparative Effectiveness Research (FCCCER) which is the functional equivalent to the “Net Benefit Value Ratio” rationing system of the Oregon Health Plan. The Federal office will select the treatments that will be allowed and prohibited.

    Also created is the Office of National Coordinator for Health Information Technology which can monitor Doctors in real time for compliance to FCCCER decisions.

    It seems the administration has learned the need to keep new government programs secret. Following the furor over politicization of the Chrysler Dealer closings, the administrations Car Czar has issued a gag order to closed GM dealerships.

    One last thought. The United States has one of the most advanced, cost efficient and effective on demand medical care systems in the world. The system operates without government intervention and produces very high levels of client satisfaction. That system is the US Veterinary care system.

    If you doubt that consider this.

    For those Canadian medical patients unable to travel to the United States, the Canadian Veterinary system is fast becoming an underground medical alternative.

    • David Appell

      Perhaps OHP is not “perfect.”

      No system is.

      Look, the problem here is that about 1/6th of the country is refused the opportunity to obtain health insurance AT ANY COST because corporations will not sell it to them, because it is not profitable.

      This is absolutely and fundamentally unfair.

      Until the right deems to solve this problem, you will never get anywhere trying to retain your own employer-based health care system.

      And, frankly, this system is eroding before you. Already most medical bankruptcies come from those who have insurance.

      If you want to retain a private health insurance system, then you MUST tell us how this system will include those who cannot purchase corporate insurance. And that means you have to tell us how YOU will purchase health insurance when US insurance companies decide you are too big of a risk to insure. And no, you do not get to pretend that it won ‘t happen to you.

      I am waiting.

  • Conscience of a Moonbat

    I did not realize that David “One Bad” Appell was both a global warming science specialist AND an expert in the public policy of socialized healthcare and insurance. He is quite a versatile wordsmith for the Left. Any peer-reviewed articles you can share with us on the dangers of socialized medicine, David?

  • John in Oregon

    David Appell it’s reasonable for you to ask what alternative there is to Obama care dictating what care a patient may get.

    You made an impassioned plea that the problem is that the corporations have conspired to exclude one out of every 6 Americans from health care coverage. So lets start with that point.

    The one in six number is the progressive talking point of 50 million with no health care. Lets take a closer look at those numbers. The source data is from the Census Bureau often hidden in a “study” from a pro nationalized health care organization. I will use the original Census data.

    The Census data doesn’t just say 48 million uninsured victims, it contains much other data ignored by pro nationalized government health care proponents. One example is the foreign nationals present illegally in the United States.

    Somewhere between 15 and 19 million. How to deal with these individuals ranges from enforcing the rule of law to enforcing the rule of compassion and fulfilling all their wants.

    However that issue is solved its clear these foreign nationals have chosen to reject proper entry. Their status was made by choice and is not a failure of insurance or the health care system.

    This leaves 35 million against which the corporations are conspiring. Of that 35 million some 11 million have access to insurance from their employer or earn well above the median income and can purchase coverage with ease. These people have simply made the decision to forgo coverage and spend the money on other things.

    These are the refuseniks that you hear demonized by the progressives. The concept is that its unfair that the Government has to rush in and save them. The Obama care solution is to compel compliance. My own view is that sometimes decisions have consequences. In any case this is not a failure of insurance or the health care system.

    This leaves 24 million against which the corporations are conspiring. Of that 24 million some 14 million are eligible for Federal medicare / medicade / schip, State insurance or private charity insurance programs. They have failed or chosen not to enroll. Again the Obama care solution is to compel compliance. In any case this is not a failure of private insurance or the health care system.

    This leaves 10 million against which the corporations are conspiring. Of those approximately 1.5 million were without insurance for only a short period during the year. Frequently do to job change. Again this is not a failure of private insurance or the health care system.

    This leaves 8.5 million habitually chronic uninsured. One in thirty seven not one in six and a very different kind of problem.

    Before I go on to what can be done I want to disarm another progressive nationalized healthcare canard. (Canard, aka a lie.) That healthcare is the cause of all the bankruptcies. Aside from being patently false on its face there is another more critical point.

    Million dollar catastrophic medical insurance with a 10,000 to 30,000 deductible is cheep and available to anyone. It costs less than a couple of movie tickets a month or a can of beer a day. People are free to buy it or not. But choosing the can of beer instead is a decision that can have consequences. The Obama care solution is to compel compliance.

    ===============

    SO NOW on to what David Appell asked. How can the US private health care system be improved?

    I notice that progressives constantly use the single client health care purchaser as the standard of bad. As when David asked about the person who > *is refused the opportunity to obtain health insurance AT ANY COST because corporations will not sell it to them.* Also when David said > *And that means you have to tell us how YOU will purchase health insurance when US insurance companies decide you are too big of a risk to insure.*

    I wonder why it is necessary for progressives to constantly use the single client health care purchaser while ignoring the coverage that 93 percent of Americans actually have or have access to?

    However ignoring that question, what David is referring to is the single client health care purchaser with a preexisting condition for which he claims such clients are black listed.

    No one is black listed. Any single client health care purchaser with a preexisting condition can buy health care coverage. And that purchaser has choices.

    *O* He can buy health care coverage which excludes the preexisting condition.

    *O* He can buy health care coverage with an enrollment period that excludes the preexisting condition.

    *O* He can buy health care coverage with a premium increase that accounts for the preexisting condition.

    But les assume that David is correct and there is some actual fraction of a percent of people that are blacklisted for some reason. In which case my question would be this:

    Is it really necessary to tear apart and destroy a system that is serving 292 million people because 1 million people fell through the pre-existing condition cracks? Surely it is possible to create a program that is small, targeted and inexpensive that meets the needs of the 1 million.

    I can hear it now. John don’t be silly. The Government would never tear apart a system serving 292 million for the benefit of only 1 million.

    Oh Really? In 2001 we had a very real problem. A small number of retirees on Medicare were unable to purchase the prescription drugs they needed. Senator Edward Kennedy, with the assistance of George Bush, created a massive restructuring of US medication delivery system. Free medication for all elderly, including retirees with $50 mission in assets. Kennedy tore apart Medicare to solve a problem for a small number of people.

    It is true that coverage for the single client health care purchaser is very expensive. Research by Scott Holleran focused on the forces that currently limit or eliminate individual health insurance.

    Scott noted the first step was under New Deal FDR. “The individual was first discouraged from buying insurance in 1942 when employee health premiums were made tax deductible to employers–not to individuals.” So in 1942 a tax barrier was erected against the single client health care purchaser. From then on individuals were assessed a tax penalty.

    Then under LBJ, with the support of Sen. Ted Kennedy and Congress, created Medicare in 1965, making individual insurance for those over 65 obsolete. Subsidized, unrestricted health care for seniors lead to an unprecedented frenzy of spending by patients and doctors. A side note here, after the 1970s Medicare became very restrictive both in terms of payment for services and procedures covered.

    “Costs went up, introducing an economic obstacle to individual health insurance. As costs rose, those on the New Left, including then freshman Sen. Ted Kennedy, argued that government ought to pay for everyone’s health care and promoted the idea of a health maintenance organization, a term coined by a left-wing college professor.”

    Also in 1965 Sen. Kennedy was floor manager of the 1965 Immigration Act. During debate Kennedy ridiculed opposition and assured the country “our cities will not be flooded with a million immigrants annually. Under the proposed bill, the present level of immigration remains substantially the same.” Kennedy of course was wrong and one of the consequences was an ever growing demand placed on our health care system by foreign nationals.

    Holleran continues “President Nixon appeased the left and proposed the HMO Act, which Congress passed in 1973. The law created new, supposedly cheaper health coverage with millions of dollars to HMOs, which, until then, constituted a small portion of the market. Kaiser Permanente was the only major HMO in the country by 1969 and most of its members were compelled to join through unions.”

    *”Combined with Medicare, the HMO Act eventually eliminated the market for affordable individual health insurance.”*

    The consequences of Medicare and Medicaid did not stop with emanation of the individual coverage market. As rising costs engulfed Medicare and Medicaid the system responded by reducing reimbursement to cut costs. First below market rates, then well below market rate and in many cases below the fixed costs to provide the service. This forced doctors, clinics, and hospitals to shift Medicare and Medicaid costs onto the backs of Employer provided and single client health care insurance.

    But the obstacles didn’t stop there as each of the 50 states implemented arbitrary mandates. Mammogram coverage for 3 year old boys. Birth control pills for 60 year old men. Erectile dysfunction coverage for 13 year old girls. Prenatal coverage for 5 year old boys. Obstetric services for 60 year old women.

    Different requirements and demands in every state. A maze of regulations. One thing is for damn sure tho, Every state prohibits basic serves health insurance coupled with a major medical policy. Nope can’t have that.

    Now we have the latest progressive tactic at both the State and Federal level. Tax health care. Tax the hell out of it. Punish the bastards that have health care. Trash the health care system. Blame the evil insurance companies.

    So here are some good workable suggestions.

    *O* Raise Medicare and Medicaid reimbursement rates to near market level to eliminate cost shifting to the private health care system.

    *O* Make single client health care coverage tax deductible (pre tax dollars) just as employer provided benefits are.

    *O* Provide a few basic health care services plans available to single client health care purchasers. Make them uniformly available in all 50 states and prohibit any state mandated add on.

    *O* Allow employees to select one of the basic plans as an alternative to the Employer provided benefits.

    *O* Make Health Savings Accounts with major medical insurance available to any American who wishes to choose that option.

    These are five simple suggestions to vastly improve the US health care system. All of them are simple to implement. And not I haven’t even begun to touch on such complicated issues as tort reform or regulatory costs.

    • valley person

      The Census Bureau data is on the number of AMERICANS without health insurance, not on the number of people living in America.

      “However that issue is solved its clear these foreign nationals have chosen to reject proper entry. Their status was made by choice and is not a failure of insurance or the health care system.”

      That may be true for the parents, but it isn’t true for the kids. Would you deny care to the kids who had no choice in coming here?

      “This leaves 24 million against which the corporations are conspiring. Of that 24 million some 14 million are eligible for Federal medicare / medicade / schip, State insurance or private charity insurance programs. They have failed or chosen not to enroll.”

      I think you need to check your numbers here. There are a lot of people technically eligible to be served by Medicare, but many if not most states don’t have the funding to cover them, so set the cuttoff point at well below eligibility.

      “Before I go on to what can be done I want to disarm another progressive nationalized healthcare canard. (Canard, aka a lie.) That healthcare is the cause of *all* the bankruptcies. ”

      Well who is lying here? I don’t know anyone who has claimed that health care has caused *all* bankruptcies in the US. THe Harvard study usually cited says that 50% of all bankruptcies were a least partly attributable to health care expenses. 50% is not *all*

      “Is it really necessary to tear apart and destroy a system that is serving 292 million people because 1 million people fell through the pre-existing condition cracks? ”

      Mo one is proposing to “tear apart and destroy” the current helath care system in the US. This statement is nothing but hyperbole. THe current proposal, still taking shape, would expand access, increase choices, and hopefully begin to control cost increases. Every expansion of access over the past 70 years has been fought by conservatives arguing that liberals are destroying our health care system. Reagan made that argument against Medicare. Wasn’t true then and stil isn’t true.

      “So here are some good workable suggestions.

      O Raise Medicare and Medicaid reimbursement rates to near market level to eliminate cost shifting to the private health care system.”

      And you would pay for this how?

      “O Make single client health care coverage tax deductible (pre tax dollars) just as employer provided benefits are.”

      And you would pay for this how?

      “O Provide a few basic health care services plans available to single client health care purchasers. Make them uniformly available in all 50 states and prohibit any state mandated add on.”

      You prefer federal mandates to state mandates? What happened to states rights?

      “O Allow employees to select one of the basic plans as an alternative to the Employer provided benefits.”

      The young and health will glady do so. THe rest won’t. Its a recipe for more bankruptcy.

      “O Make Health Savings Accounts with major medical insurance available to any American who wishes to choose that option.”

      For those with the extra cash, great to have another tax break. For the rest, let them eat cake.

      “These are five simple suggestions to vastly improve the US health care system. All of them are simple to implement.”

      Too little, too late, and too many Democrats in charge today. Its a non starter John.

  • John in Oregon

    Dear valley person, AKA sock puppet Dean.

    > *The Census Bureau data is on the number of AMERICANS without health insurance, not on the number of people living in America.*

    FALSE. The Census Bureau data is on the number of PEOPLE. And the Census Bureau EXPRESSLY SO STATES.

    RE foreign nationals choosing to reject proper entry > *That may be true for the parents, but it isn’t true for the kids. Would you deny care to the kids who had no choice in coming here?*

    Sorry. The choice to reject proper entry was made for the child by Mother and/or Father. Choices have consequences. We may not like the consequence the parents have inflicted upon the child, but inflict they did. Are you suggesting that DHS should investigate possible child abuse?

    I have to call you on your lie. No Person including that child is denied health care and you DAMN WELL KNOW IT. AND, it’s still not a failure of the private insurance or the health care system, is it?

    > *I think you need to check your numbers here. There are a lot of people technically eligible to be served by Medicare, but many if not most states don’t have the funding to cover them, so set the cuttoff point at well below eligibility.*

    For sake of argument I will accept your argument that it’s do to lack of funding. So answer me this. Congress created Government programs which foreclosed private market solutions. The failure of Congress to fund the programs is a failure of the private insurance or the health care system HOW?

    > *Well who is lying here? I don’t know anyone who has claimed that health care has caused all bankruptcies in the US. THe Harvard study usually cited says that 50% of all bankruptcies were a least partly attributable to health care expenses. 50% is not all.*

    Feel free to twist words all you wish. And then off you go again. OH MY GOD look at all those bankruptcies. Medical bankruptcies stacking up like chord wood. OH MY GOD IT’S A DISASTER.

    Did you ignore that term major medical and income protection insurance is among the cheapest and most available insurance? Of course you did. Because for a progressive its about OH MY GOD IT’S A MEDICAL BANKRUPTCY DISASTER. LETS RUSH IN AND CHANGE IT.

    > *Mo (sic) one is proposing to “tear apart and destroy” the current helath (sic) care system in the US. This statement is nothing but hyperbole. THe (sic) current proposal, still taking shape, would expand access, increase choices, and hopefully begin to control cost increases. Every expansion of access over the past 70 years has been fought by conservatives arguing that liberals are destroying our health care system. Reagan made that argument against Medicare. Wasn’t true then and stil (sic) isn’t true.*

    What was it that Reagan said? He said Medicare costs would grow, that Medicare would dictate what care patients would get, and that Medicare was unsustainable. Lets check that.

    Medicare would dictate what care patients would get. Check. Medicare did and forced seniors to get Medigap coverage. Check and double check.

    Medicare costs would grow. Check, they did and are. Medicare is reducing payments and taxing private patients by shifting the Medicare costs. Check and double check.

    Medicare was/is unsustainable. Check. The Medicare “trust fund” is empty. Check and double check.

    You seem enamored by all those progressive changes to the health care system over the last 70 years. So answer this. If those progressive changes were so good why are the progressives screeching ohhh my god its getting worse. Didn’t the progressives tell us they were making things better? Was it just a lie?

    As far as “No one is proposing to “tear apart and destroy” health care.” Oh Really? Lets take a look.

    In 1965 Sen. Ted Kennedy said Medicare wouldn’t destroy private senior health care. And it did.

    Then Sen. Ted Kennedy said the 1965 immigration act wouldn’t flood the cities. And it did.

    Sen. Ted Kennedy also said the 1973 HMO act wouldn’t damage individual health insurance. And it did.

    The Progressives said state mandates won’t raise single client health care purchaser insurance rates. And they went UP.

    That was the past. What about the future?

    *O* Obama is reducing Medicare reimbursements. Wall Street Journal “The new proposals would decrease payments to hospitals and others that provide Medicare services in a variety of ways.” A hidden tax on private health care. The price tag $110 Billion.

    *O* Oregon taxes Hospitals and Insurance.

    *O* Obama is reducing foreign national reimbursements. Wall Street Journal “In addition, the president is proposing to reduce subsidies for hospitals that care for the uninsured.” Another hidden tax on private health care. The price tag $106 Billion.

    *O* Obama is reducing perception drug reimbursements. Wall Street Journal “The White House is also proposing $75 billion in savings on the Medicare prescription drug program, by reducing reimbursements to pharmaceutical companies.” Yet another hidden tax on private health care.

    *O* Next Obama is going after Doctors and skilled nursing facilities. Wall Street Journal “Doctors who offer imaging services and skilled nursing facilities would be among those affected.” Another $22 Billion shifted to the private medical providers.

    What do you think will happen if you pay doctors less? You’re going to have fewer doctors. Is that too complicated?

    What do you think will happen if you pay hospitals and clinics less? You’re going to shift costs to private patients and they get less or pay more. Is that too complicated?

    What do you think will happen if you pay less for prescription drugs? You won’t get new drugs. Is that too complicated?

    As to my suggestion to raise Medicare and Medicaid reimbursement rates to near market level to eliminate cost shifting to the private health care system.” To which you ask > *And you would pay for this how?*

    My first reaction would be to say use the money in the Medicare trust fund. But that is empty, leaving three choices.

    A) Admit the trust fund is empty and raise FICA taxes across the board.
    B) Admit the trust fund is empty and stop spending money to grow government and use that money to pay off Medicare debt.
    C) Ignore it and in a shrill voice complain that the Hospitals and Insurance Companies are shafting the people.

    As to my suggestion to make single client health care coverage tax deductible (pre tax dollars) just as employer provided benefits are.” you ask > *And you would pay for this how?*

    It would pay for its self. With less tax you get more private coverage. Less need for Government spending.

    As to my suggestion to provide a few basic health care services plans available to single client health care purchasers. Make them uniformly available in all 50 states and prohibit any state mandated add on. You ask > *You prefer federal mandates to state mandates? What happened to states rights?*

    This isnt about mandates. Its about a few mandate free choices. It’s about people having a choice. The states are free to mandate the hell out of everything else. Of course when the basic plan is $300 a month and the mandated plans $2,500 the states might actually have to think about what they are doing to costs.

    As to my suggestion to allow employees to select one of the basic plans as an alternative to the Employer provided benefits. You ask > *The young and health (sic) will glady (sic) do so. THe (sic) rest won’t. Its a recipe for more bankruptcy.*

    Oh Really? The young who don’t buy now will have the basics plus major medical. That’s less bankruptcies. Employers that can’t provide now may be able to offer the basics. Again that’s less bankruptcies. Those that are willing to pay more for the high end plan can. Its called choice.

    As to the suggestion to make Health Savings Accounts with major medical insurance available to any American who wishes to choose that option. To which you ask > *For those with the extra cash, great to have another tax break. For the rest, let them eat cake.*

    Listen up silly. This is a choice a person can make not an add on top.

    And finally SP Dean said > *Too little, too late, and too many Democrats in charge today. Its a non starter John.*

    I agree about too many progressives, too much ideology, and too little thought.

    Then I found this in Roll Call, an inside the beltway legacy media outlet. It seems that Senator Max Baucus is resorting to blackmail to gag the health care industry. Russell Sullivan, the top staffer on Finance, and Jon Selib, Baucus’ chief of staff called a last-minute, pre-emptive strike.

    Lobbyists were warned that Baucus will remember those who speak their mind. Anyone who makes their opposition public could be permanently excluded from future negotiations.

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