By the St. Louis Dispatch Editorial Board | Posted: Wednesday, August 10, 2011 12:00 am
If America truly is serious about dealing with its deficit problems, there's a fairly simple solution. But you're probably not going to like it: Enact a single-payer health care plan.
See, we told you weren't going to like it.
But the fact is that everyone who has studied the deficit problem has agreed that it's actually a health care problem — more specifically, the cost of providing Medicare benefits to an aging and longer-living population. The bipartisan National Commission on Fiscal Responsibility and Reform reported last December: "The Congressional Budget Office (CBO) projects if we continue on our current course, deficits will remain high throughout the rest of this decade and beyond, and debt will spiral ever higher, reaching 90 percent of GDP in 2020.
"Over the long run, as the baby boomers retire and health care costs continue to grow, the situation will become far worse. By 2025 revenue will be able to finance only interest payments, Medicare, Medicaid, and Social Security. Every other federal government activity — from national defense and homeland security to transportation and energy — will have to be paid for with borrowed money."
That being the case — and nobody argues that it isn't — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.
The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.
The advocacy group Physicians for a National Health Program estimates that "private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."
Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending. It could insist that providers be paid for quality of service, not quantity. Health facilities and equipment could be managed by regional boards. Medical services could be "bundled" — rather than paying hospitals and doctors and laboratories separately, there would be fixed prices for treatments. And so on.
The Patient Protection and Affordable Care Act passed in 2009 contains many pilot programs designed to test cost-reduction strategies. Most of them won't kick in for another six to eight years, by which time health care costs will be approaching 20 percent of U.S. gross domestic product. The combined state and federal share of that will be 49 percent, up from 45 percent today.
Indeed, a study published this month in the journal Health Affairs estimates that while the Affordable Care Act will pay for itself by 2020, it won't actually "bend the cost curve," as the Obama administration had hoped. But the study, done by the Actuary Centers for Medicare and Medicaid Services, says the ACA will significantly slow the rise of health care costs to state and local governments.
But consider those two findings: In effect, they say that if reducing overall health care costs is the goal, then the ACA didn't go far enough. Thirty million more people will be insured and government costs will grow more slowly. But overall health care costs will continue to explode.
Sooner or later, a nation serious about controlling spending must take broad control of the health care system.
It surely won't be sooner. Compared to the political fight that would erupt over a single-payer plan, the congressional battle over the Affordable Care Act would seem as tame as resolution praising mom, the flag and apple pie.
The ACA was a compromise. Mr. Obama brought everyone to the table — doctors, insurance companies, drug companies, hospitals — and came away with a "best we can get" kind of bill. Many of those at the table turned around and lobbied against it or sought special favors once the bill came before Congress.
It passed by narrow margins, and Congress is decidedly more conservative now. Indeed, the new House majority has voted to repeal the ACA and challenges to its constitutionality continue to work their way toward the Supreme Court.
But now, like a baby discovering its toes, Congress has discovered the deficit. And the plain fact is that unless you want to commit political suicide and cut Medicare to the bone — as Rep. Paul Ryan's, R-Wis., budget plan would do — the best way to seriously address long-term deficits is to get control of health care costs through a single-payer plan.
In 2008, when health care costs amounted to "only" 16 percent of U.S. gross domestic product, Great Britain was spending 8.7 percent of its GDP on health care, and Canada was spending 10.4 percent. Both nations have single-payer plans. Quality of care scores in both nations are at least comparable, and in most cases, better.
Eventually, the United States will have a single-payer plan. But we'll waste a lot of money and time getting there.
Rep. Hayes, I write you this open letter in response to your Circleville Herald column of 10 August “Health Care Close to Home”. I sincerely invite you to spend a shift or two with me in the emergency department to see and feel face to face the desperation of the tens of thousands of down-home Ohioans without access to healthcare. These are not slackers or persons who just wish to freeload on your tax dollars, they are our neighbors and friends, the barber who cuts your hair, the server who waits on you, the clerk in the that large store. Often they are working two jobs trying to make ends meet, while cutting back on their own medicines to save for kid’s school supplies. Come and feel the pain of real persons suffering and dying in your district having been abandoned by profitable insurance companies, whose profit margins are at record levels (“Health Insurers Make Record Profits as Many Postpone Care” New York Times 14 May 2011).
Like you, I too have problems with the Patient Protection and Affordable Care Act (PPACA), called “Obamacare” by detractors when “Romneycare” is in fact more accurate, as the PPACA is modeled after Massachusetts healthcare reform signed by Republican governor Mitt Romney in 2006. I have problems with the PPACA not because of your concern that it is a government program controlled by inaccessible far-away elected representatives, but because it keeps in place private health insurance companies controlled by even more inaccessible, often dishonest, and even farther away corporate boardrooms that I can’t even un-elect.
Dishonest a strong word? The Associated Press article of 27 July “Insurers Allegedly Provided Inaccurate Medical-Loss Ratios” notes several Florida insurance companies took advantage of lax oversight under Governor Rick Scott, falsely claiming they spent funds on children’s Medicaid when in fact they pocketed the cash. Florida Governor Rick Scott, a tea party favorite, presided as CEO of the Hospital Corporation of America/Columbia Healthcare when his company was fined one of the largest penalties ever levied by the federal government for insurance fraud. Rep. Hayes, your column implies that the PPACA removes local choices that “are best handled by the people closest to home who know the situation best.” Ask your constituents how much honest close-to-home help they received from their health insurance company.
Rep. Hayes, Ohioans health is at risk not because of too much government, but too little. We the people have failed to demand that our elected representatives appropriately oversee and regulate Wall Street traded health insurance giants that increase their bottom line by not keeping their word on the promise they offer: financial security in the face of illness. Wendell Potter, former Cigna public relations officer turned whistleblower and author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans” warns “One of the secrets to achieving these [record profits] is what the insurers euphemistically call ‘medical management’. That often translates into denied claims and denied coverage for doctor-ordered care. The fewer claims they pay and the more procedures they refuse to pay for, the more money is left over for investors to put in their pockets… … It’s to the insurer’s advantage for it to be complicated and confusing and hard to deal with insurance companies. They profit as a result of the confusion.” Private for-profit health insurance companies, these are the real death panels.
Rep. Hayes, for the sake of all Ohioans I urge you to support HB 287 the “Ohio Health Security Act” introduced by Reps. Bob Hagan and Mike Foley. HB 287 would move Ohio closer to a single payer model, shown throughout the industrialized world to be the most cost-effective and compassionate. Vermont has just passed single payer—no one in Vermont will die for lack of health insurance. The prestigious New England Journal of Medicine, September 2009, published “Health Insurance and Mortality in U.S. Adults” estimating that 45,000 Americans die yearly from lack of health insurance; this does not include those who die as a result of denied claims. Some of these deaths are your constituents.
Rep. Hayes, until we reach single payer you can save the lives of many Ohioans by reining in the worst of health insurance company abuses by supporting the PPACA. Under these reforms no Ohioan can be denied insurance for pre-existing conditions, no neighbor of ours will find their insurance taken away when their care threatens company profits. Arbitrary denials of claims by insurers will, for the first time, be subject to appeal, as will premium increases. Insurers will be forced to spend at least 80-85% of all premiums collected on direct patient care. Under the Patient Protection and Affordable Care Act more Ohioans will live, certainly the best “down home” neighborly gift we can give.
Brad Cotton, member Physicians for a National Health Program
Published: Thursday, November 10, 2011, 5:15 AM Updated: Thursday, November 10, 2011, 8:02 AM
"In the short term, not a lot," said Matt Albers, a health care lawyer with the Cleveland office of Vorys, Sater, Seymour and Pease who has studied the amendment but did not take a position during the debate on the issue.
Supporters of Issue 3 cheered it as a repudiation of President Barack Obama's health care policy.
But experts like Albers agree that the issue will have no impact on the legal tussle in federal courts over the new federal health care law, although it will prevent Ohio from enacting its own Massachusetts-style law.
Beyond that, there's plenty of disagreement over whether the broadly worded amendment will invite lawsuits, lead to confusion and interfere with the state's powers to protect public health and regulate the medical and insurance industries.
Denny Recker, the legislative chair for the Ohio Association of Health Underwriters, said the amendment "creates as many questions as it answers" but does not alter deadlines for Ohio that are "looming very quickly" under the new federal law.
On Tuesday, a District of Columbia federal appeals court became the latest to uphold the Affordable Care Act, which opponents refer to as Obamacare. The court ruled that the law's requirement that most Americans get health insurance is constitutional.
Federal judges in two states have found the law unconstitutional while three others have upheld it. Most legal experts expect the law to eventually land in front of the U.S. Supreme Court.
"Issue 3 will have no ability to forestall the federal legislation if it passes muster," Albers said. "It's really sort of an internal state decision not to go forward with a state-level mandated health insurance program."
In other words, voters have tied the hands of Ohio lawmakers looking to move the state to a Massachusetts-style system -- a remote possibility now with a Republican-dominated legislature.
Other legal experts who opposed the legislation, such as Case Western Reserve University law professor Max Mehlman, see troubling consequences. The amendment bans new health care mandates passed after March 19, 2010, which has the effect of freezing laws or rules made before that date.
Mehlman says that jeopardizes more recent changes to state law such as restrictions on late-term abortions signed into law recently by Gov. John Kasich. Under the amendment, no law could prohibit the purchase of health care except in cases to deter fraud or wrongdoing.
So could getting an abortion be considered the purchase of health care?
Kellie Copeland, head of the Ohio chapter of the National Abortion Rights Action League, said her group is studying the amendment to see if it could be used to overturn the recent restrictions.
"We are absolutely looking at it," Copeland said. "We believe that the late-term abortion ban poses a danger to Ohio women because it doesn't have adequate health exceptions, and this may provide an opportunity to go after it."
Maurice Thompson, head of the 1851 Center for Constitutional Law and the author of Issue 3, said state lawmakers probably will end up enacting legislation saying abortion doesn't fit the definition of health care to head off such a suit.
"I think there will be clamor with the abortion issue to make it clear," Thompson said. "Somebody on the left could very well decide to run it up the flagpole."
Other future medical regulations could be affected, such as new immunizations the state health department wants to mandate or new ways the state medical board might want to regulate the doctor-patient relationship, according to Mehlman.
"My hope is that people would not challenge actions that would be clearly in the public benefit, but libertarians could certainly sue to stop new vaccination programs if they wished," Mehlman said.
Thompson said the state health department would still hold broad powers to protect the public health but would be barred from imposing immunization mandates that weren't absolutely necessary.
Albers said the amendment's broad language makes it certain to be batted around by the courts in a number of different cases.
"It's open to significant amounts of interpretation, so it's difficult to say what the long-term impact will be," he said.
© 2011 cleveland.com. All rights reserved.
By Sarah Kliff, Washington Post
Published: November 23
President Obama’s top Medicare official has resigned in the face of Republican pledges to block his confirmation in the Senate.
Center for Medicare and Medicaid Services Administrator Donald M. Berwick notified colleagues Wednesday that he will step down Dec. 2, nearly a month before the expiration of his recess appointment.
The White House will nominate Marilyn Tavenner, Medicare’s deputy administrator, as his replacement.
“Don Berwick did outstanding work at CMS,” White House deputy press secretary Jamie Smith said Wednesday. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people.”
Obama nominated Berwick to run Medicare in April 2010. In July 2010, with no confirmation hearing scheduled, the president appointed him to the job while Congress was in recess. As a recess appointment, Berwick’s term was to expire Dec. 31. Earlier this year, 42 Republican senators signed a letter pledging to block his confirmation, effectively ending any chance of him serving beyond 2011.
“It was a mistake to recess-appoint him,” said Sen. John Barrasso (R-Wyo.), who has been a vocal Berwick critic. “He was the wrong person for the job, and I think it was wrong of the president to make an end run around Congress.”
A Harvard-educated pediatrician, Berwick won accolades and the endorsements of major health-care groups for his academic work, which focused on reducing the cost of care while improving quality and patient experience.
Republicans, however, seized on remarks he made praising Britain’s National Health Service as an “example” for the United States to follow. Many accused him of supporting the “rationing” of services, a claim Berwick has rejected.
“Every bone in my body, as a physician, even as a person, is to get everything [patients] want and need and to help them at every step,” he told The Washington Post in an interview this summer. “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia .?.?. and they are telling me I'm rationing? They haven’t met me.”
In his 18-month tenure, Berwick oversaw the rollout of crucial health reform regulations that stand to reshape both the private insurance market and the Medicare program. His agency drafted rules for the new health insurance marketplaces, called exchanges, where Americans will be able to compare and buy health insurance plans in 2014.
Berwick also weathered an aggressive backlash to his draft rules for Accountable Care Organizations, a pilot program that is meant to move Medicare away from paying doctors for the volume of services they provide and toward reimbursements based on quality of care. Medical groups reacted much more positively to the final regulations for that program.
Republicans have responded cautiously to the White House’s nomination of Tavenner, a former nurse and hospital administrator who has served in the Obama administration since February 2010. She was Virginia’s secretary of health and human resources under then-Gov. Tim Kaine (D).
In announcing her nomination, the White House highlighted Tavenner’s nearly 35-year health-care career, “including almost 20 years in nursing, 3 years as a hospital CEO and 10 years in various senior executive level positions for Hospital Corporation of America.”
Sen. Orrin Hatch (R-Utah), ranking member of the Senate Finance Committee, said, “Republicans on the Finance Committee look forward to examining her record and gaining an understanding of her views of Medicare, Medicaid and the president’s health law.”
Senator Bernie Sanders of Vermont held a town hall meeting on August 29th and was asked by one of his constituents from the Healthcare is a Human Right Campaign what as Vermonters those who are supporting that movement can do about the amount of money that is going to flood into their state and how to stand against it and stop it. Bernie explained just how powerful the interests are that they are fighting against and how the recent Supreme Court decision to allow massive amounts of money to be poured into campaigns has made that worse. He also explained that if Vermont leads the country in trying to prove that a single payer, Medicare for all system can work, they are going to be deluged with special interest money trying to fight it. See the video.
Rick Ungar, Contributor
I cover the public health care policy beat
Forbes, 1/17/2011 @ 9:08PM |211,388 views
The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court.
The pleadings, in part, read -
The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage.
State of Florida, et al. vs. HHS
It turns out, the Founding Fathers would beg to disagree.
In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.
Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution.
And when the Bill came to the desk of President John Adams for signature, I think it’s safe to assume that the man in that chair had a pretty good grasp on what the framers had in mind.
Here’s how it happened.
During the early years of our union, the nation’s leaders realized that foreign trade would be essential to the young country’s ability to create a viable economy. To make it work, they relied on the nation’s private merchant ships – and the sailors that made them go – to be the instruments of this trade.
The problem was that a merchant mariner’s job was a difficult and dangerous undertaking in those days. Sailors were constantly hurting themselves, picking up weird tropical diseases, etc.
The troublesome reductions in manpower caused by back strains, twisted ankles and strange diseases often left a ship’s captain without enough sailors to get underway – a problem both bad for business and a strain on the nation’s economy.
But those were the days when members of Congress still used their collective heads to solve problems – not create them.
Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade, Congress and the President resolved to do something about it.
Enter “An Act for The Relief of Sick and Disabled Seamen”.
I encourage you to read the law as, in those days, legislation was short, to the point and fairly easy to understand.
The law did a number of fascinating things.
First, it created the Marine Hospital Service, a series of hospitals built and operated by the federal government to treat injured and ailing privately employed sailors. This government provided healthcare service was to be paid for by a mandatory tax on the maritime sailors (a little more than 1% of a sailor’s wages), the same to be withheld from a sailor’s pay and turned over to the government by the ship’s owner. The payment of this tax for health care was not optional. If a sailor wanted to work, he had to pay up.
This is pretty much how it works today in the European nations that conduct socialized medical programs for its citizens – although 1% of wages doesn’t quite cut it any longer.
The law was not only the first time the United States created a socialized medical program (The Marine Hospital Service) but was also the first to mandate that privately employed citizens be legally required to make payments to pay for health care services. Upon passage of the law, ships were no longer permitted to sail in and out of our ports if the health care tax had not been collected by the ship owners and paid over to the government – thus the creation of the first payroll tax in our nation’s history.
When a sick or injured sailor needed medical assistance, the government would confirm that his payments had been collected and turned over by his employer and would then give the sailor a voucher entitling him to admission to the hospital where he would be treated for whatever ailed him.
While a few of the healthcare facilities accepting the government voucher were privately operated, the majority of the treatment was given out at the federal maritime hospitals that were built and operated by the government in the nation’s largest ports.
As the nation grew and expanded, the system was also expanded to cover sailors working the private vessels sailing the Mississippi and Ohio rivers.
The program eventually became the Public Health Service, a government operated health service that exists to this day under the supervision of the Surgeon General.
So much for the claim that “The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty….”
As for Congress’ understanding of the limits of the Constitution at the time the Act was passed, it is worth noting that Thomas Jefferson was the President of the Senate during the 5th Congress while Jonathan Dayton, the youngest man to sign the United States Constitution, was the Speaker of the House.
While I’m sure a number of readers are scratching their heads in the effort to find the distinction between the circumstances of 1798 and today, I think you’ll find it difficult.
Yes, the law at that time required only merchant sailors to purchase health care coverage. Thus, one could argue that nobody was forcing anyone to become a merchant sailor and, therefore, they were not required to purchase health care coverage unless they chose to pursue a career at sea.
However, this is no different than what we are looking at today.
Each of us has the option to turn down employment that would require us to purchase private health insurance under the health care reform law.
Would that be practical? Of course not – just as it would have been impractical for a man seeking employment as a merchant sailor in 1798 to turn down a job on a ship because he would be required by law to purchase health care coverage.
What’s more, a constitutional challenge to the legality of mandated health care cannot exist based on the number of people who are required to purchase the coverage – it must necessarily be based on whether any American can be so required.
Clearly, the nation’s founders serving in the 5th Congress, and there were many of them, believed that mandated health insurance coverage was permitted within the limits established by our Constitution.
The moral to the story is that the political right-wing has to stop pretending they have the blessings of the Founding Fathers as their excuse to oppose whatever this president has to offer.
History makes it abundantly clear that they do not.
UPDATE: January 21- Given the conversation and controversy this piece has engendered, Greg Sargent over at The Washington Post put the piece to the test. You might be interested in what Greg discovered in his article, “Newsflash: Founders favored government run health care.”
Contact Rick at firstname.lastname@example.org
John Nichols, The Nation, March 27, 2012
It would seem that the majority on the US Supreme Court is conflicted about how to respond to the healthcare reform currently known as "Obamacare."
CNN's legal correspondent Jeffrey Toobin listened to the high court's deliberations this week and concluded that "this was a train wreck for the Obama administration. This law looks like it's going to be struck down."
Not so fast, suggests the Wall Street Journal, which like most media pins the outcome on Justice Anthony "Swing" Kennedy. "Justice Kennedy's early comment that the government carried a 'heavy burden of justification' showed considerable sympathy for the challengers," observed the Journal Tuesday. "But toward the end, one of his questions suggested that people who don’t carry health insurance are still engaged in the healthcare market—which is the central pillar of the government's case."
It's all so confusing. Or maybe not.
It is obvious enough that the barely cloaked political partisans who dominate the court would like very much to whack the Democratic president by declaring that critical components of his Patent Protection and Affordable Care Act—or, to borrow Vice President Biden's technical terminology: Barack Obama's "BFD"—are unconstitutional.
By the same token, the justices know that their conservative movement's paymasters in the insurance and healthcare industries, and on Wall Street, are actually looking foward to the day when the government requires Americans to purchase insurance from for-profit insurance companies, and when Washington steps in as the guarantor of payments to those companies (and to for-profit healthcare concerns) on behalf of low-income Americans.
Tough call, indeed.
It is usually smart when such conflicts arise to bet on the corporate crowd, as they really do call most of the shots.
But on the outside chance that the court goes rogue—as some analysts are suggesting after two days of hearings on the plan that was approved by Congress and signed into law by the president—is that the end of healthcare reform?
Frankly, it could be the beginning.
It is not like a decision by the Supreme Court to scrap all or part of the current plan is going to make the crisis facing America's dysfunctional healthcare "system" go away. In all likelihood, it would cause the crisis to become even more of, well, a crisis.
By the same token, allowing the Obama plan to go forward in its current form—without the protection that would have been afforded by a public option—is not going to solve nearly as many of the plan's problems as its more starry-eyed proponents might imagine. Indeed, one of the selling points for the Obama plan when progressives were gritting their teeth and deciding to support what was clearly a compromise was the understanding that the Patiet Protection and Affordable Care Act was a beginning, not an end.
The end has always, and should always, be the single-payer "Medicare for All" plan that would provide quality care for all Americans—as a right—and cut costs by eliminating the profiteers.
So how, amid all the legal wrangling of the moment, should real reformers think about things?
“Whether the Court overturns part or all of the law, or the Affordable Care Act remains fully intact, we will not have universal coverage, medical bills will still push too many Americans into bankruptcy or prompt them to self-ration care, and insurance companies will continue to have a choke hold on our health,” says Deborah Burger, RN, a co-president of the 170,000-member National Nurses United union.
NNU, a union that represents frontline healthcare providers—and that has taken then lead when it comes to real reform—offers a savvy response to the hyperbole that's coming from in and around the Supreme Court chambers this week:
Despite its name the Affordable Care Act has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar. Nurses now routinely see patients who have postponed needed care, even when it might be life saving, because of the high co-pays and deductibles.
Delayed dental care illustrates the problem. A February Pew Center report noted a 16 percent jump in the number of Americans heading to emergency rooms for routine dental problems, at a cost of 10 times more than preventive care with fewer treatment options than a dentist's office.
Premiums have jumped 50 percent on average the past seven years, according to a Commonwealth Fund report last November, with more than six in 10 Americans now living in states where their premiums consume a fifth or more of median earnings.
Medical bills for years have been the leading cause of personal bankruptcy. Increasingly they ruin people’s credit as well. Another Commonwealth Fund report earlier this month found that 30 million Americans were contacted by collection agencies in 2010 because of medical bills.
Fifty million still have no health coverage. Another 29 million are under insured with massive holes in their health plans, up 80 percent since 2003, according to the journal Health Affairs.
The percentage of adults with no health insurance at 17.3 percent in the third quarter of 2011 was the highest on record, up from 14.4 percent just three years earlier, Gallup reported.
On quality, the U.S. continues to lag far behind other nations. Two breathtaking examples:
More than 80 percent of U.S. counties trail life expectancy rates of nations with the best life expectancies, the University of Washington found last June. Some U.S. counties are more than 50 years behind their international counterparts.
The U.S. ranks just 41st in the world in death rates for child bearing women, and it has been getting worse, according to the World Health Organization. The average mortality rate within 42 days of childbirth has doubled in two decades, partly due cuts in federal spending for maternal and child health programs the past seven years.
Our economic meltdown has exacerbated the crisis. For the past year, nurses have seen a spike in health woes associated with job loss, high medical bills, poor nutrition and other economic factors. These include stress-induced heart ailments in younger patients, hypertension, anxiety and “gut” disorders.
“More handouts to the private insurers and other healthcare corporations will not improve these dreadful statistics,” says Burger. “The choke hold on our health by the same Wall Street types who tanked our economy is exactly what has caused the falling health barometers on access, quality, and cost.”
"The consequences of the denial of care en masse—now and in the future, with or without the ACA—could not be more ominous, explains NNU co-president Jean Ross." Only more comprehensive reform, Medicare for Life, for all Americans, will finally produce real healthcare security for our country."
New York Times
June 28, 2012
Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama
By ADAM LIPTAK
WASHINGTON — The Supreme Court on Thursday upheld President Obama’s health care overhaul law, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The vote was 5 to 4, with Chief Justice John G. Roberts Jr. joining the court’s four more liberal members.
The decision was a victory for Mr. Obama and Congressional Democrats, affirming the central legislative achievement of Mr. Obama’s presidency.
“The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice Roberts wrote in the majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
At the same time, the court rejected the argument that the administration had pressed most vigorously in support of the law, that its individual mandate was justified by Congress’s power to regulate interstate commerce. The vote was again 5 to 4, but in this instance Chief Justice Roberts and the court’s four more conservative members were in agreement.
The court also substantially limited the law’s expansion of Medicaid, the joint federal-state program that provides health care to poor and disabled people. Seven justices agreed that Congress had exceeded its constitutional authority by coercing states into participating in the expansion by threatening them with the loss of existing federal payments.
Justice Anthony M. Kennedy, who had been thought to be the administration’s best hope to provide a fifth vote to uphold the law, joined three more conservative members in an unusual jointly written dissent that said the court should have struck down the entire law. The majority’s approach, he said from the bench, “amounts to a vast judicial overreaching.”
The court’s ruling was the most significant federalism decision since the New Deal and the most closely watched case since Bush v. Gore in 2000. It was a crucial milestone for the law, the Patient Protection and Affordable Care Act of 2010, allowing almost all — and perhaps, in the end, all — of its far-reaching changes to roll forward.
Mr. Obama welcomed the court’s decision on the health care law, which has inspired fierce protests, legal challenges and vows of repeal since it was passed. “Whatever the politics, today’s decision was a victory for people all over this country whose lives are more secure because of this law,” he said at the White House.
Republicans, though, used the occasion to attack it again.
“Obamacare was bad policy yesterday; it’s bad policy today,” Mitt Romney, the presumptive Republican presidential nominee, said in remarks near the Capitol. “Obamacare was bad law yesterday; it’s bad law today.” He, like Congressional Republicans, renewed his pledge to undo the law.
The historic decision, coming after three days of lively oral arguments in March and in the midst of a presidential campaign, drew intense attention across the nation. Outside the court, more than 1,000 people gathered — packing the sidewalk, playing music, chanting slogans — and a loud cheer went up as word spread that the law had been largely upheld. Chants of “Yes we can!” rang out, but the ruling also provoked disappointment among Tea Party supporters.
In Loudoun County, Va., Angela Laws, 58, the owner of a cleaning service, said she and her fiancé were relieved at the news. “We laughed, and we shouted with joy and hugged each other,” she said, explaining that she had been unable to get insurance because of her diabetes and back problems until a provision in the health care law went into effect.
After months of uncertainty about the law’s fate, the court’s ruling provides some clarity — and perhaps an alert — to states, insurers, employers and consumers about what they are required to do by 2014, when much of the law comes into force.
The Obama administration had argued that the mandate was necessary because it allowed other provisions of the law to function: those overhauling the way insurance is sold and those preventing sick people from being denied or charged extra for insurance. The mandate’s supporters had said it was necessary to ensure that not only sick people but also healthy individuals would sign up for coverage, keeping insurance premiums more affordable.
Conservatives took comfort from two parts of the decision: the new limits it placed on federal regulation of commerce and on the conditions the federal government may impose on money it gives the states.
Five justices accepted the argument that had been at the heart of the challenges brought by 26 states and other plaintiffs: that the federal government is not permitted to force individuals not engaged in commercial activities to buy services they do not want. That was a stunning victory for a theory pressed by a small band of conservative and libertarian lawyers. Most members of the legal academy view the theory as misguided,if not frivolous.
“To an economist, perhaps, there is no difference between activity and inactivity; both have measurable economic effects on commerce,” Chief Justice Roberts wrote. “But the distinction between doing something and doing nothing would not have been lost on the framers, who were practical statesmen, not metaphysical philosophers.”
Justice Ruth Bader Ginsburg, in an opinion joined by Justices Stephen G. Breyer, Sonia Sotomayor and Elena Kagan, dissented on this point, calling the view “stunningly retrogressive.” She wondered why Chief Justice Roberts had seen fit to address it at all in light of his vote to uphold the mandate under the tax power.
Akhil Reed Amar, a Yale law professor and a champion of the health care law, said that it was “important to look at the dark cloud behind the silver lining.”
“Federal power has more restrictions on it,” he said, referring to the new limits on regulating commerce. “Going forward, there may even be laws on the books that have to be re-examined.”
The restrictions placed on the Medicaid expansion may also have significant ripple effects. A splintered group of justices effectively revised the law to allow states to choose between participating in the expansion while receiving additional payments or forgoing the expansion and retaining the existing payments. The law had called for an all-or-nothing choice.
The expansion had been designed to provide coverage to 17 million Americans. While some states have indicated that they will participate in the expansion, others may be resistant, leaving more people outside the safety net than the Obama administration had intended.
Although the decision did not turn on it, the back-and-forth between Justice Ginsburg’s opinion for the four liberals and the joint opinion by the four conservatives — Justice Kennedy and Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — revisited the by-now-familiar arguments. Broccoli made a dozen appearances.
“Although an individual might buy a car or a crown of broccoli one day, there is no certainty she will ever do so,” Justice Ginsburg wrote. “And if she eventually wants a car or has a craving for broccoli, she will be obliged to pay at the counter before receiving the vehicle or nourishment. She will get no free ride or food, at the expense of another consumer forced to pay an inflated price.”
The conservative dissenters responded that “one day the failure of some of the public to purchase American cars may endanger the existence of domestic automobile manufacturers; or the failure of some to eat broccoli may be found to deprive them of a newly discovered cancer-fighting chemical which only that food contains, producing health care costs that are a burden on the rest of us.”
All of the justices agreed that their review of the health care law was not barred by the Anti-Injunction Act, which allows suits over some sorts of taxes only after they become due. That could have delayed the health care challenge to 2015. The conservative dissenters said that the majority could not have it both ways by calling the mandate a tax for some purposes but not others.
“That carries verbal wizardry too far, deep into the forbidden land of sophists,” they said.
As a general matter, Chief Justice Roberts wrote that the decision in the case, National Federation of Independent Business v. Sebelius, No. 11-393, offered no endorsement of the law’s wisdom.
Some decisions, the chief justice said, “are entrusted to our nation’s elected leaders, who can be thrown out of office if the people disagree with them.”
Justice Ginsburg, speaking to a crowded courtroom that sat rapt for the better part of an hour, drew a different conclusion.
“In the end,” she said, “the Affordable Care Act survives largely unscathed.”
Reporting was contributed by John H. Cushman Jr., Robert Pear, John Schwartz, Ethan Bronner and Sabrina Tavernise.
July 4, 2012
Michael Moore, ACA, and the Single Payer Solution
By Chuck Pennacchio
Michael Moore's SiCKO reunion visit, coupled with Single Payer state-based convention, show the way to transform the Affordable Care Act's enabling provisions into Medicare for All.
Filmmaker and citizen activist Michael Moore (SiCKO, Bowling for Columbine, Roger and Me, Capitalism: A Love Story) graced Philadelphia last Saturday for a five-year reunion of SiCKO's release, the third-highest grossing documentary ever that revealed the tragedy of under-insurance in the United States. Also assembled were seven of the film's health insurance industry victims (including our own Donna Smith), and two industry whistle-blowers who continue to expose the medical-industrial-complex's profit-first methods of maximum money-making.
In addition to the emotional sagas of PREVENTABLE suffering that continue to this day - 9/11 rescue worker with oxygen tank, parentless teen, widowed spouse, morphing cancers, running battles with insurance companies, medical bankruptcies - Wendell Potter (author of "Deadly Spin") shared his crisis-of-conscience journey to 'industry whistle-blower,' beginning with his former company, CIGNA, assigning him, stealthily, to sneak-preview "SiCKO" in Sacramento and plan the public relations attacks on the movie.
Michael Moore then used story, movie-making insights, and outrage over right-wing bullying and Obama-enabling to illustrate, on the one hand, SiCKO's educational and motivational benefit and, on the other hand, the watered-down Affordable Care Act that the Supreme Court validated last week. At the same time, Michael (and Wendell) chastised single payer activists inclined to look past the significance of corporatist Chief Justice Roberts siding with the Court's more liberal members, and permitting ACA's implementation (minus the force of withholding Medicaid funding for states that refuse to accept ACA minimal health standards).
During a pre-event reception at Healthcare-NOW's William Way Center auditorium, the 300-person public event at Plays and Players Theater (sans air-conditioning on a sticky night!) near Rittenhouse Square, and the day following at our 22-member, 'One Payer States' all-day conference, speaker after speaker, discussant after discussant, emphasized the opportunity presented by ACA's continuing implementation. We need to celebrate (Moore), exploit (Michael Lighty, CA Nurses), understand our challenges, challengers, and potential allies (Brigitte Marti, Dr Carol Ritter, Mark Dudzic, Pennacchio), strategize (Potter), and organize (Francesca Lo Basso, Smith).
Specifically, our best opportunity for translating ACA passage and SCOTUS ruling into universal healthcare isembedded in the national legislation itself. That is, ACA contains provisions for state-based healthcare innovation and funding waivers (can you say "Single Payer six times straight"...six times?), already endorsed by President Obama, embraced by numerous Republicans at all levels of government, and led by Independent Senator Bernie Sanders (VT) and Democratic Representative Jim McDermott (WA) in the United States Congress.
So now it's on us, to build on the week's and weekend's successes, energy, inspiration, and more, to turn ACA into state-based Improved Medicare for All as the next step to achieving true, universal single payer healthcare for each and every person in America. Every body in, no body out.
Onward to the Proven Single Payer Solution.
Chuck Pennacchio, PhD
Co-Founder, One Payer States Network
Submitter’s Website: www.healthcare4allpa.org
Chuck Pennacchio, PhD, Executive Director, Healthcare for All Pennsylvania, and History Program Director, The University of the Arts in Philadelphia. BA in history and political science from University of California, and MA and PhD in diplomatic history from University of Colorado. Organizer of 40 years on issues of healthcare, environment, economic justice, war and peace. Former aide to Senators Alan Cranston (CA), Tom Harkin (IA), Tim Wirth (CO), Paul Simon (IL), and Military Personnel Caseworker to Congressman Ronald V. Dellums. Pennsylvania candidate for US Senate in 2006.
By Bill Moyers, Moyers & Company
04 Aug 12
BILL MOYERS: I read a news story this week that sent me on a nostalgic trip down memory lane. This past Monday, July 30th was the 47th anniversary of Medicare, and to celebrate it, the "Raging Grannies," as they’re known, gathered outside the county office building in Rochester, New York to protest rumored cuts to their Medicare coverage.
RAGING GRANNIES: This old grey granny now needs a test or two -
BILL MOYERS: They praised Medicare in song as "the best deal we have in the country," and even called for expanding it Medicare into universal health care for everyone.
It seems the Republican Speaker of the House, John Boehner, was coming up from Washington to raise funds for Republican congressional candidate Maggie Brooks. The "Raging Grannies" wanted to make certain Ms. Brooks didn’t sign on to the GOP budget which includes cuts to Medicare.
For myself, the "Raging Grannies" channeled a familiar voice, the Texas twang of my boss back in 1965, Lyndon Baines Johnson. I was a White House assistant at the time and had been working with the President and others on the team trying to get Medicare through Congress. Even with overwhelming Democratic majorities in the House and Senate, it was one tough fight. Others had tried before us.
In his 1948 State of the Union message, President Harry Truman said:
HARRY TRUMAN: This great Nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.
BILL MOYERS: But every time Harry Truman proposed legislation to do just that, Congress refused to budge. In the 1960s, John F. Kennedy took up the cause:
JOHN F. KENNEDY: Our working men and women, instead of being forced to ask for help from public charity, once they are old and ill, should start contributing now to their own retirement health program through the Social Security System…
BILL MOYERS: But his proposal failed in the Senate by just two votes.
On the other side, actor Ronald Reagan, still in private life, had signed on as the American Medical Association’s hired spokesman in their campaign against Medicare. Doctors’ wives organized thousands of small meetings in homes around the country, where guests listened to a phonograph record of Reagan deploring the evils of "socialized medicine":
RONALD REAGAN: Behind it will come other Federal programs that will invade every area of freedom as we have known it in this country […] until one day, as Norman Thomas said […] you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.
BILL MOYERS: But now, it was Lyndon Johnson’s turn. Tragically thrust into the White House by Kennedy’s assassination, LBJ, the son of Franklin Roosevelt’s New Deal and Harry Truman’s Fair Deal, vowed to finish what they had started. He pushed us relentlessly to get it done. Here he is talking to his Vice President, Hubert Humphrey, in early March of 1965:
LYNDON JOHNSON: They are bogged down. The House had nothing this week, all -damn week. Now that’s where you and Moyers and Larry O’Brien have got to find something for them. And the Senate had nothing […] so we just wasted three weeks […] Now we are here in the first week in March, and we have just got to get these things passed […] I want that program carried. And I’ll put every Cabinet officer behind you. I’ll put every banker behind you. I’ll put every organization we got behind you […] I’ll put the labor unions behind you."
BILL MOYERS: About all he had left was the White House kitchen sink, and pretty soon he threw that behind us, too.
Later that March he called me to talk about a retroactive increase in Social Security payments that we were supporting. I had argued for it as a stimulus to the economy. LBJ said okay, but reminded me that social security and Medicare were about a lot more than economics:
LYNDON JOHNSON: My inclination would be […] that it ought to be retroactive as far back as you can get it […] because none of them ever get enough. That they are entitled to it. That that's an obligation of ours. It's just like your mother writing you and saying she wants $20, and I'd always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that's a much better reason and a much better cause and I think it can be defended on a hell of a lot better basis […] We do know that it affects the economy […] But that's not the basis to go to the Hill, or the justification. We've just got to say that by God you can't treat grandma this way. She's entitled to it and we promised it to her.
BILL MOYERS: LBJ kept that promise. He pushed and drove and cajoled and traded, until Congress finally said yes. And so it was that 47 years ago, we traveled to Independence, Missouri, the hometown of Harry Truman, and there with the former president at his side, LBJ signed Medicare into law. Turning to Truman, whom he called "the real daddy of Medicare, " Johnson signed him up as its first beneficiary. Harry Truman was 81.
All this was high drama, touched with history, sentimentality, politics, and compromise. A whole lot of compromise. The bill wasn’t all LBJ wanted. It was, in fact, deeply flawed. There were too few cost controls, as some principled conservatives warned, who were then rudely ignored. Co-pays and deductibles remain a problem. And we didn’t anticipate the impact of new technology, or the impact of a burgeoning population.
In fact, even as he signed the bill we still weren’t sure what all was in it. As LBJ himself once told me, never watch hogs slaughtered before breakfast and never, never, never show young children how legislation gets enacted.
But Lyndon Johnson had warned: "We will face a new challenge and that will be what to do within our economy to adjust ourselves to a life span and a work span for the average man or woman of 100 years."
That longevity, and the cost, are what we must now reckon with. As the historian Robert Dallek has written, Medicare and Medicaid, the similar program for the very poor, "…did not solve the problem of care at reasonable cost for all Americans", but "the benefits to the elderly and the indigent…are indisputable." And there’s no going back, current efforts notwithstanding. A new study in the journal Health Affairs finds that Medicare beneficiaries age 65 and older are more satisfied with their health insurance, have better access to care, and are less likely to have problems paying medical bills than working-age adults who get insurance through employers or purchase coverage on their own.
So sing on, Raging Grannies, sing on. The surest way to save so popular and efficient a health care system is to make it available to everyone.
RAGING GRANNIES: Everybody in and nobody out, single-payer Medicare for all.