News & Opinion

Keep Medicaid expansion plan in Ohio: editorial

 By The Plain Dealer Editorial Board on April 09, 2013 at 7:15 PM, updated April 09, 2013 at 7:24 PM

Ohio House Republicans are acting with gross irresponsibility in rejecting Republican Gov. John Kasich's bid to expand Medicaid coverage for poor Ohioans. Even more perplexing is the lack of vocal opposition from some Cleveland-area GOP lawmakers for a decision that -- if it stands -- will gravely damage Greater Cleveland.

Anti-expansion Republicans portray their position as a matter of principle. But their stance is the poisoned fruit of childish partisanship and craven self-interest: They fear primary-election challenges from other Republicans who think that expanding Medicaid in Ohio represents a form of collusion with President Barack Obama, whom they loathe.

For that seamy reason, the Ohio House's GOP caucus, led by Medina's William Batchelder, would deny adequate medical care to hundreds of thousands of Ohioans (many in Greater Cleveland) and reject billions of dollars from the U.S. Treasury. It's mindless and it's pathetic.

Rejecting Medicaid expansion will damage Ohio from Lake Erie to the Ohio River. It will further imperil community hospitals already squeezed by the cost of caring for uninsured patients. It will especially damage Greater Cleveland, which has some of Ohio's greatest concentrations of poverty -- and a nexus of high-tech biomedical companies, including world-renowned hospitals that help shoulder the costs of caring for the uninsured, a burden Medicaid expansion would lighten.

Medicaid expansion also is a smart economic strategy that will underwrite jobs, keep Ohioans' tax dollars in Ohio, improve the health and productivity of our citizens and reduce state outlays for prison health care.

Among those who would benefit are working Ohioans without health insurance who live at or below 138 percent of the poverty level. These men and women, who play by the rules, are the very Ohioans Republicans claim to respect.

What Ohio House Republicans have really decided is that unpaid emergency room charges -- and all other such unpaid medical costs -- will be paid not with help from taxpayers in all 50 states but instead by jacking up the health-insurance premiums or employer-sponsored health plan costs of Ohioans who do have coverage. If that's fair to Ohio employers, the word "fair" has no meaning at the Statehouse.

The House Finance-Appropriations Committee now will affirm or reject House Republicans' refusal of Medicaid expansion. Among the committee's members are Reps. Marlene Anielski of Independence and Mike Dovilla of Berea, both Republicans. Also with a key voice within the House GOP caucus, although she's not on the committee, is Westlake's Nan Baker.

Baker, Anielski and Dovilla have a clear choice. They can stand with the blind partisanship of some of their GOP colleagues. Or they can stand with Greater Clevelanders by fighting for Medicaid expansion.

Medicaid expansion adds up for Ohio

Medicaid expansion adds up for Ohio families, taxpayers: Evelyn Lundberg Stratton

By Plain Dealer guest columnist on March 16, 2013

As a former Ohio Supreme Court justice busily and happily transitioning into my new work on mental health and veterans' issues, I wasn't paying much attention to the discussion about Medicaid expansion. Like Gov. John Kasich and many others, I had issues with Obamacare. Then a friend asked me to "look at the facts" of Medicaid expansion. That triggered 23 years of judicial training, learning how to put aside personal biases and feeling and judge a matter on evidence alone.

This is what I learned:

Medicaid is health insurance for Ohio's most vulnerable citizens -- those earning up to 138 percent of the federal poverty level, or about $15,856 for an individual and $32,499 for a family of four. About 366,000 Ohioans will be covered by the Medicaid expansion for an estimated total cost of $2.6 billion over the biennium.

That cost will be paid entirely by the federal government through 2016, ratcheting down to 90 percent afterward. Ohio can opt out of the expansion if the rules change later.

Rejecting the federal expansion money would send federal money back to Washington and to other states to pay for their Medicaid expansions. Yet Ohio receives billions of dollars every year from the federal government for roads and bridges, education and research grants, and we don't for one minute consider sending that money back to the federal government. After all, we pay good money to the federal government in the form of taxes, and we deserve to get some of it back. How is Medicaid expansion any different?

Besides, state and local governments, employers and taxpayers already pay for the health care of uninsured Ohioans. Our Department of Rehabilitation and Corrections will save $27 million over the biennium on inpatient hospital costs to prisoners under the expansion. In addition, the community behavioral health system will save approximately $105 million over the biennium on services that shift to Medicaid. For example, of the 8,000 individuals in Lucas County now requiring behavioral health services, 7,000 -- or 88 percent -- would be covered by Medicaid, saving $4.6 million and freeing up much-needed local funding for other county needs.

Today, health care for 1.5 million uninsured Ohioans is borne by Ohio's hospitals, employers and 10 million other taxpayers. Hospitals are required to provide medically necessary care, at no cost, to low-income and uninsured individuals. Hospitals make up their losses by charging others more or eliminating services or programs. As a result, the average privately insured individual pays approximately $1,000 per year for costs incurred by uninsured individuals.

Preventive health care for uninsured individuals is virtually nonexistent. They often wait to seek medical treatment -- hoping the condition resolves itself -- until their situation worsens, requiring care in the emergency department. This is a costly scenario for both the individual and the hospital. In 2010, Ohio hospitals provided $1.1 billion in total charity care and incurred $645 million in bad debt.

The Affordable Care Act reduced reimbursement to hospitals that provide a high volume of care to low-income and uninsured individuals with the expectation that the additional Medicaid funds associated with the expansion would offset the loss. The U.S. Supreme Court ruled that the Medicaid expansion is optional for states, but if a state rejects it, its hospitals will still feel the impact of the reimbursement cuts.

My analysis: Why would we turn down these federal funds and instead use local dollars to pay for needs that already exist? Our federal income-tax dollars will go to other states and we still have to come up with the local dollars.

I have used my health insurance many times, including for surgery that I otherwise would never have been able to afford. But so many people have no such insurance. I am particularly concerned about those with serious mental illnesses. I saw many of them in my courtroom, and I know firsthand the ill effects of a lack of insurance and a poorly funded community behavioral health system.

Individuals who do not get needed physical and behavioral health treatment and their families struggle. Extending Medicaid to Ohio's lowest-income uninsured is the right thing to do for them and for all Ohioans.

Evelyn Lundberg Stratton, a former Ohio Supreme Court justice, is a health care adviser and attorney with Vorys, Sater, Seymour and Pease LLP.

Medicine's Sticker Shock

October 2, 2005
New York Times

In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees - a national health care system that looks less like a tightrope and more like a safety net.
A dozen years after Bill Clinton's health reform efforts were destroyed by the insurance industry's duplicity, it's worth trying again. The health care system is steadily becoming more gummed up in ways that are impossible to hide.

 

One of the bumper stickers attacking the Clinton plan read: "If You Like the Post Office, You'll Love National Health Insurance." That wouldn't work today: the Postal Service runs a system that is manifestly more rational and efficient than our health care system. For starters, imagine a postal system that refused to deliver letters to or from 45 million Americans - except on rare occasions, by ambulance.

 

"This is one of those fleeting opportunities where a catastrophe creates an opportunity to rebuild something better than before," says Dr. Irwin Redlener, president of the Children's Health Fund and associate dean of the Mailman School of Public Health at Columbia University.

 

In a sign of the growing disenchantment with our health system, 13,000 doctors have joined Physicians for a National Health Program, which lobbies for a single-payer government-financed health program.

 

There are four main problems with the existing system. First, it leaves out 45 million uninsured Americans, and their number is rising. Second, it is by far the most expensive in the world, costing 15 percent of our national income, yet our outcomes are awful - U.S. life expectancy is worse than Costa Rica's. Third, our business competitiveness is undermined when, for example, medical expenses add $1,500 to the sticker of each General Motors car. Fourth, our system is catastrophically inefficient: according to a study in The New England Journal of Medicine, health administrative costs are $1,059 per capita in the U.S., and just $307 in Canada.

 

A single-payer system would be most efficient but probably is not politically feasible at the moment. The smart new book "The Health Care Mess" suggests a variety of more gradual approaches that would face less opposition.

 

Whatever the mechanism, all children should be covered. It's a disgrace that we use public funds to save the lives of nonagenarians but not those of 9-year-olds. And kids are a bargain: per capita medical spending is $1,525 for children less than 5, and $9,000 per person aged 65 to 74.

 

A second principle is that we should put less emphasis on curative medicine and more on public health and prevention - everything from preparing for avian flu to encouraging exercise. Sure, we can buy more "left ventricular assist devices," which cost $210,000 per patient installed, or buy Erbitux for colon cancer, at $17,000 per month of treatment. But as a wise new book, "Prescription for a Healthy Nation," argues, you get more bang for the buck when you promote healthier lifestyles - fighting obesity, cigarette smoking and the like.

 

Raising cigarette taxes saved far more American lives, for example, than an army of neurologists ever could. In the same spirit, I'd like to see a French-fry tax. And imagine the health gains if we banned potato chips and soda from schools.

 

Reforming the health system won't be easy. In the real world, poor kids don't see doctors not only because they're uninsured, but also because Mom doesn't have a car, can't easily get time off from work, or doesn't speak English. Those are hard nuts to crack - but one reason to think that we can do better is that much of the world does better.

 

I've been thinking of health care partly because of something that happened when I was on vacation in August. My kids and I were stacking firewood for my parents on the Yamhill, Ore., farm where I grew up, when suddenly the seven-foot stack collapsed - on top of my youngest. She was knocked down and pinned, her face bleeding, under a pile of logs.

 

I had insurance, and a car to get to the emergency room - and in the end the logs (stained with blood) turned out to be in worse shape than my daughter. She's just fine. But that instant was heart-stopping in its terror - and the system routinely does fail such children in need. Isn't it worth fighting one more time for reforms, so that we Americans can get health care every bit as good as Canada's?



Medicine's Sticker Shock

October 2, 2005
New York Times

In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees - a national health care system that looks less like a tightrope and more like a safety net.
A dozen years after Bill Clinton's health reform efforts were destroyed by the insurance industry's duplicity, it's worth trying again. The health care system is steadily becoming more gummed up in ways that are impossible to hide.

 

One of the bumper stickers attacking the Clinton plan read: "If You Like the Post Office, You'll Love National Health Insurance." That wouldn't work today: the Postal Service runs a system that is manifestly more rational and efficient than our health care system. For starters, imagine a postal system that refused to deliver letters to or from 45 million Americans - except on rare occasions, by ambulance.

 

"This is one of those fleeting opportunities where a catastrophe creates an opportunity to rebuild something better than before," says Dr. Irwin Redlener, president of the Children's Health Fund and associate dean of the Mailman School of Public Health at Columbia University.

 

In a sign of the growing disenchantment with our health system, 13,000 doctors have joined Physicians for a National Health Program, which lobbies for a single-payer government-financed health program.

 

There are four main problems with the existing system. First, it leaves out 45 million uninsured Americans, and their number is rising. Second, it is by far the most expensive in the world, costing 15 percent of our national income, yet our outcomes are awful - U.S. life expectancy is worse than Costa Rica's. Third, our business competitiveness is undermined when, for example, medical expenses add $1,500 to the sticker of each General Motors car. Fourth, our system is catastrophically inefficient: according to a study in The New England Journal of Medicine, health administrative costs are $1,059 per capita in the U.S., and just $307 in Canada.

 

A single-payer system would be most efficient but probably is not politically feasible at the moment. The smart new book "The Health Care Mess" suggests a variety of more gradual approaches that would face less opposition.

 

Whatever the mechanism, all children should be covered. It's a disgrace that we use public funds to save the lives of nonagenarians but not those of 9-year-olds. And kids are a bargain: per capita medical spending is $1,525 for children less than 5, and $9,000 per person aged 65 to 74.

 

A second principle is that we should put less emphasis on curative medicine and more on public health and prevention - everything from preparing for avian flu to encouraging exercise. Sure, we can buy more "left ventricular assist devices," which cost $210,000 per patient installed, or buy Erbitux for colon cancer, at $17,000 per month of treatment. But as a wise new book, "Prescription for a Healthy Nation," argues, you get more bang for the buck when you promote healthier lifestyles - fighting obesity, cigarette smoking and the like.

 

Raising cigarette taxes saved far more American lives, for example, than an army of neurologists ever could. In the same spirit, I'd like to see a French-fry tax. And imagine the health gains if we banned potato chips and soda from schools.

 

Reforming the health system won't be easy. In the real world, poor kids don't see doctors not only because they're uninsured, but also because Mom doesn't have a car, can't easily get time off from work, or doesn't speak English. Those are hard nuts to crack - but one reason to think that we can do better is that much of the world does better.

 

I've been thinking of health care partly because of something that happened when I was on vacation in August. My kids and I were stacking firewood for my parents on the Yamhill, Ore., farm where I grew up, when suddenly the seven-foot stack collapsed - on top of my youngest. She was knocked down and pinned, her face bleeding, under a pile of logs.

 

I had insurance, and a car to get to the emergency room - and in the end the logs (stained with blood) turned out to be in worse shape than my daughter. She's just fine. But that instant was heart-stopping in its terror - and the system routinely does fail such children in need. Isn't it worth fighting one more time for reforms, so that we Americans can get health care every bit as good as Canada's?



Health insurance imploding

David Lazarus

San Francisco Chronicle
Wednesday, October 19, 2005

And so the demolition derby that is the U.S. health care system shifts into high gear.
Mighty General Motors, the world's largest automaker and biggest private-sector purchaser of health insurance, said this week that it'll slash its $5.6 billion annual health care spending for workers, retirees and their families by about $1 billion a year.

 

For its part, the United Auto Workers, one of the nation's most powerful unions, is apparently prepared to swallow this hit to organized labor's most sacrosanct benefit to forestall additional job cuts.

 

We have reached a critical turning point in the decline of health care in the United States, one almost certain to expand the already appalling figure of 45 million people lacking health coverage nationwide.

 

"It's not just a breaching of the social contract that's existed between companies and workers," said David Autor, an associate professor of economics at the Massachusetts Institute of Technology. "It's a reflection of how health care costs are out of control.

 

"Hopefully this will be an opportunity for government and companies to rethink how health care is provided," he added. "The old system is clearly breaking down."

 

Since World War II, the old system has been predicated on the notion that employers will bear the primary cost of insuring U.S. workers and their families.

 

That system, as the GM announcement plainly illustrates, is no longer viable in the face of double-digit annual increases in health care costs. Businesses have responded by insisting that workers -- and especially retirees -- shoulder more of the burden of their health coverage.

 

To be sure, GM has been rewarding its more than 750,000 union members, retirees and their dependents with an uncommonly generous benefits package. The company also faces numerous other issues that affect its profitability (or lack thereof; GM reported a staggering $1.6 billion loss for the latest quarter).

 

But health care is undeniably one of the automaker's biggest headaches. GM estimates that health care adds about $1,500 to the cost of every vehicle it sells in North America.

 

The company's chief exec, Rick Wagoner, told employees on Monday that health care is an issue "of great importance for the future of overall U.S. competitiveness."

 

He also all but pleaded with political leaders to do something about the situation.

 

"We would welcome a more proactive role from elected officials at the national and state levels in broad-based strategies to address the U.S. health care crisis," Wagoner said.

 

Helen Darling, president of the National Business Group on Health, a nonprofit organization composed of some of the country's largest employers, told me that more and more companies will follow GM's example and significantly scale back health coverage for workers.

 

For example, Ford and DaimlerChrysler are already negotiating similar concessions from the UAW.

 

"There's no one in the business world who doesn't share the position that the U.S. health care system has a crisis," Darling said. "The issue here isn't General Motors. The issue is the unaffordability of health care."

 

So what do we do about it?

 

I've written repeatedly about how a single-payer health care system could provide universal coverage for all Americans at a long-term cost to taxpayers well below what's now paid annually by employers and workers.

 

Single-payer systems are the norm in virtually all other developed democracies. While far from perfect -- long waits for treatment are a frequent complaint -- such systems ensure that any citizen can receive care from any doctor at any hospital.

 

There are no co-pays or deductibles, no private-sector premiums soaring year after year.

 

"The basic system is quite good," said Steffie Woolhandler, an associate professor of medicine at Harvard University. "We just need to fund it adequately."

 

As it stands, she said about a third of all health care spending in this country is now squandered on bureaucratic overhead. Under a single-payer system, savings from streamlined paperwork alone would be sufficient to provide coverage for all Americans.

 

"The meaning of GM's announcement is that even people working for a powerful company can have their health care cut," Woolhandler said. "Anyone who gets health insurance from an employer or former employer should be worried."

 

The right message: Speaking of the auto industry, senior execs at Delphi, the largest automobile supplier, have said they'll take voluntary pay cuts until the company emerges from bankruptcy.

 

The company's CEO, Robert Miller, will reduce his base salary from $1.5 million to just $1 annually and won't receive any bonuses. Delphi's president, Rodney O'Neal, will take a 20 percent pay cut, and other execs will forgo 10 percent of their salaries.

 

Declared Miller: "Delphi's transformation message must be unambiguous and marked indelibly by the commitment of Delphi's leadership."

 

Compare that with the top brass at PG&E, who last year handed themselves $83 million in bonuses while the San Francisco utility was still mired in Chapter 11 proceedings.

 

"It's become standard to reward executives for sticking around during bankruptcy," said Kirk Hanson, executive director of the Markkula Center for Applied Ethics at Santa Clara University.

 

"Cutting your pay sends a strong message to employees that management understands they're suffering," he said.

 

David Lazarus' column appears Wednesdays, Fridays and Sundays. Send tips or feedback to dlazarus@sfchronicle.com.

 

Dead Woman Working: American Dream Died Long Ago

Published on Friday, August 17, 2012 by Common Dreams

by Donna Smith

It was a slow and torturous death, my American dream. And for millions of others, I am guessing it is the same. Nothing this current round of politicos is planning to do can restore it. Just like there is nothing to being a little bit pregnant, there is nothing anyone can do to breathe life back into what once seemed possible. Now I just hang on waiting to die.

This piece is not about who will or will not be our president or vice president, as after voting in every election since the 1970s, I am pretty sure what I need and want isn’t coming from any of them.

Read more: Dead Woman Working: American Dream Died Long Ago

Diagnosis For America

Jonathan Tasini
October 25, 2005

Jonathan Tasini is president of the Economic Future Group and writes his "Working In America" columns for TomPaine.com on an occasional basis. His blog Working Life chronicles the labor movement and other issues affecting American workers.  

It is a measure of our lowered expectations, fueled by media spin, that people shrugged and seemed to think that it was inevitable that workers for General Motors were destined to have their health care coverage slashed. After all, some seemed to think, at a time when their company is teetering on the edge of oblivion, these “privileged” auto workers had “gold-plated” coverage that almost no other workers in America have.

 

But let’s be clear: The loss of benefits for GM workers was not inevitable. It happened as a result of many years of bipartisan political and economic decisions and the bipartisan lack of political courage to take on dumb ideology and corporate power.


In the minds of the elites, socking workers with a larger share of the costs of health care is just a natural part of the new economic order. As the Wall Street Journal editorial board said about the health care cost-cutting deal between GM and the United Auto Workers, “We hope it’s the beginning of wisdom about the global economy for the American labor movement.” Speaking about UAW president Ron Gettelfinger, Delphi CEO Steve Miller—who took his company into bankruptcy—said,  “He’s going to have to help half a million of workers get used to the idea that globalization has taken away the ability to have someone who mows the lawn or sweeps the floor get $65 an hour.”

At least one thing is refreshing: It exposes as a fraud the liberal and conservative mantra about the wonders of the global economy. Democrats and Republicans alike—from Bill Clinton to George Bush, with a supporting cast of media and academic geniuses—have repeatedly told workers that the global economy will bring great benefits to America, after a period of “adjustment.” To their credit, Steve Miller and the Journal are more honest: The global economy is a tool to drive down living standards, starting with health care. Get with it, folks: Living large is so “old economy.”

So, the first obvious point to make is that employer-provided health care coverage has failed. Workers should never face the choice between sickness and financial ruin simply because the company they work for is going under, poorly managed or because they change jobs. More important, this has become, as I pointed out some months ago, a matter of economic competitiveness for corporations based in the United States: The health care system is dragging down profits.

The second point, then, is that health insurance can never be left to those whose sole motivation is profit. The last time health care was debated, the Clinton administration lost its nerve—or, perhaps, never had any other intention to pursue a system other than one that was destined to perpetuate the existing ideological flaws.  “Hillarycare” was a disaster for the public not because the mismanaged process produced an overly complex system. Rather, the Clintons made a conscious decision to leave health care in the hands of the private insurers — which allowed the HMO industry to grow, if you’ll pardon the expression, like a malignant tumor.

If we had a different philosophy, GM workers’ health care would never change. As Ida Hellander, executive director of Physicians for a National Health Program (PNHP), puts it, “Political will is infinitely harder to muster, especially when Congress is owned by the drug and insurance companies.” PNHP has a very straightforward set of four principles guiding its universal health care proposal, which I think, if properly understood by the public, would send millions of people to the streets demanding immediate change:

·                   Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms’ past record disqualifies them from a central role in managing health care.

·                   The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

·                   Pursuit of corporate profit and personal fortune has no place in caregiving and creates enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing and useless or even harmful medical interventions must be shifted to needed care. 

·                   In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

The economics of a single-payer, universal health care system are unassailable. It would save $300 billion in administration costs. It would be financed partly by the 60 percent of taxes that already go into the health care system via Medicaid, Medicare and payments for public employee coverage. The rest of the financing, over the long term, would be easily done with modest tax increases (by a 7 percent payroll tax and a 2 percent progressive income tax) — and result in better health care for people for less money than people shell out in ever-rising deductibles. With one bold stroke, a single-payer system would do more to help the bottom line of companies than any tax break or so-called “free trade” agreement.

The troubling reality to the arguments I’ve made is that they are not particularly original: The moral and economic need for a universal health care system has been well-known for a very long time. The only question now is: How many companies will have to go belly up and how many more millions of workers will face bankruptcy and illness because we allow ideology—the deification of the so-called free market—to triumph over common sense?

 

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