Congressman Faso and the proposed American Health Care Act

Congressman Faso

Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to other pieces of legislation frequently calling for comprehensive knowledge of the topic to even begin understanding its implications. 

The site also spends a lot of time bad-mouthing Obamacare. I get it. Republicans don’t like Obamacare. The question is how will they improve upon it??

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1 Our Situation

Our Situation button

For some time I have been thinking, writing, and gathering information, not necessarily in any good order, about our situation here in the US. For more than a decade I have thought that we are in a protracted crisis.

This crisis can be felt at the personal, family, local and national level in all areas of life. Some of the sources are systemic to technological change and the global dynamics of capitalism. Some find their roots in fundamental failures in humans – racism, sexism, religion, etc. Some flow from our political system, some from our economy.

The focus of this work has been to try to identify what this crisis is about within the US context, to describe it, without any real notion of even suggesting solutions.

Where Did This List Come From and Is There an Order?

I first started this list two or three years ago while we were still in the deepest part of the Great Recession. Most of the early entries related to the political system and economic inequality. As I have returned to it I have broadened the coverage of social and political topics. Most recently I have added ones that relate to the mythology underlying our approaches to life in the US.

Here is my current list of topics:

  • Underperforming, expensive healthcare system
  • Political system controlled by big money, private and corporate
  • Distorted role of corporations
  • Quasi-religious faith in “free market” capitalism
  • Race, sex, ethnicity, klans….
  • Myth of social mobility
  • National and State Political Systems Designed to Be Anti-democratic and Dysfunctional
  • 30+ year stagnation of income
  • Disappearance of living wage jobs
  • The rich are at their feeding troughs
  • Expensive, underperforming K-12 educational system
  • Expensive, underperforming higher ed system
  • Web access and infrastructure
  • Homelessness and poverty
  • Bloated, dysfunctional global military and empire
  • Our longest war – the war on drugs
  • Criminal justice system – aka the judicial-incarceration gulag
  • Persistent income disparities
  • Super rich vs. everyone else
  • Intrusion by organized religion into government and politics
  • Energy policy focused on consumption instead of efficiency

 

The Health Care Debate Is About The Wrong Issues

The rhetoric about our health care system continues to center around market religions of one sort or another. For all of the blathering about “Obamacare” taking us over the edge into the territory of socialized medicine, it remains, like it’s progenitor dreamed up by Romney while governor of Massachusetts, a market focused policy. Even now Massachusetts is struggling to come up with policies to restrain the growth of costs to the rate of inflation plus 1%. At the national level it will be years before Obamacare can begin such considerations in real terms.

What is missing is a willingness by the political system to engage the undeniable truths about our health care system. Continue reading

The Future of Healthcare??

I don’t generally pause long over the editorials in the NY Times. This morning’s caught my eye. As a recent state resident I watched the debate closely and supported the single payer approach. Since then the results have been interesting and as noted in the Time’s editorial generally good.

Here us the editorial:

Health Reform in Massachusetts
Last Updated: 11:18 PM EDT

Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.

Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.

There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.

Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.

The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.