While the health care reform effort itself lies on the operating table in critical condition, Democrats and Republicans are going through the motions of trying to be bipartisan, since that seems to be what the voters want.

Actually, as we reported in the January 13th Bucks Voices update and previously, it’s not clear what the voters want. Many want very contradictory things: unlimited health care and no additional taxes or higher premiums to pay for it, an end to preexisting conditions limits but no requirement to have continuous coverage, high quality care but no collection and distribution of comparative effectiveness research to doctors, government out of their medical care but keep its hands off “their” Medicare, preventing Medicare from bankrupting the federal budget but no premium increases or cuts to Medicare to achieve this, understandable health care benefits but no government regulations to require standards on covered benefits, disclosure, communications, etc., etc. The fact that voters show much ignorance over the proposed bills and contradictory wants about reform, suggests that if the Democrats can get a bill passed and then explained to the public, public opinion about it could turn around quickly.

On January 25 the AP reported on a Robert Wood Johnson Foundation survey taken between Nov. 28 and Dec. 20 which showed increased anxiety that the reforms would make things worse off than doing nothing. The facts of course say that doing nothing is by far the worst that could happen. (See the following AP story published on the msnbc site on Feb. 14: click here).While still reflecting a minority of respondents, the survey showed an increase in concerns over reforms in these areas, compared to a similar poll done last September:

− 33% said they believed their access to care would be worse if a health care overhaul occurred, a jump from 25 percent in the poll released last month. Thirteen percent said they thought they would have better access to care in a remade system, about the same as last month.

− 30.5% said their personal finances would be worse under a health care overhaul, compared to 24.5 percent last month. Eleven and a half percent said their personal finances would improve, compared to 14 percent last month.

− 35% said the country’s access to health care would be worse under a health care overhaul, compared to 30 percent last month. Around 38 percent said it would be better, around the same as last month.

− 42% said the country’s finances would suffer under a health care overhaul, compared with 34.6 percent last month. Thirty percent said matters would improve financially, compared to 32 percent last month.

It’s clear from these results that many people don’t understand (or don’t believe) that both the House and Senate bills would provide a huge expansions of cost subsidies to individuals and small employers, greatly expanded Medicaid coverage, guaranteed coverage from insurance carriers, greater competition through regulated insurance exchanges, better prescription and prevention benefits to at least the 75% of seniors under regular Medicare coverage, and many initiatives to improve quality and control long term costs.

President Obama has agreed to one last bipartisan effort by hosting a health care summit on Feb. 25. The invitation list includes House and Senate leadership, and the chairmen and ranking members of relevant committees. The House and Senate leaders, Pelosi, Reid, Boehner and McConnell to each choose another four members and one staffer specializing in health care policy to attend the meeting. C-Span junkies note: the meeting starts at 10:00 a.m. and will be broadcast live on TV.

Democrats claim they are trying to resolve the key differences between the bills already passed in the House and Senate and then post the “new” proposal on a website. They’ve asked the Republicans to do the same. However, not much progress seems to be occurring. According to the February 16^th New York Times:

“…the White House hinted on Tuesday that President Obama might post his own bill on the Internet before the bipartisan health care summit he is planning for Blair House next week…

During a news conference last week, Mr. Obama said he envisioned posting a merged House-Senate bill that would address his goals of controlling costs and expanding coverage…

But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. “Stay tuned,” Mr. Gibbs said.” (click here)

At the meeting, the President will moderate a discussion through four major topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.

Republicans are trying to figure out what they might gain or lose as a party before deciding if they should commit to the meeting, despite the claims that they were always willing to work on a bipartisan solution (so long as it meant merely their own baby steps approach). If they accept the offer, they would have to make the agonizing decision of actually committing to specific proposals that could be also criticized by the experts, media pundits, and the public.

Many Republicans of course are speaking out against participating, at least not until the Democrats agree to “start over” with a blank slate. As reported on msnbc on Feb. 8:

“If we are to reach a bipartisan consensus, the White House can start by shelving the current health spending bill,” said Senate Minority Leader Mitch McConnell, R-KY

But House Majority Leader Steny Hoyer, D-Md., said his earlier efforts to reach out to Republicans “did not result in any serious follow through to work together in a bipartisan fashion.” (click here).

According to New York Times editorial writer, Ross Douthat, on Feb 15 (click here), there is not much incentive to compromise. “…both sides believe they’re on the verge of a comprehensive victory. The Republicans are convinced they’re inches away from killing off a fundamentally misguided piece of legislation, and the White House believes it’s still this close to passing the centerpiece of its domestic agenda. In that environment, all the incentives favor posturing and finger-pointing, rather than serious negotiation.”

Further, as Douthat points out, the two sides define bipartisanship and compromise differently. If the Democrats want to pass A through F major health reform elements, the Republicans want to do A and B. So the Democrats see compromise and doing A through perhaps D. But the Republicans see it as doing just the A and B things that “all sides can agree on.” We’ll leave it to you to decide which approach sound like compromise or meeting the other side half way.

Many of course argue that the Democrats, by chucking the single payer idea and later, even emasculating the public option in the House bill and scrapping it in the Senate bill altogether, have already compromised significantly. Douthat, a conservative, spouts the usual criticisms about the Democrats’ overly regulatory solution, but also notes that the Republicans have to come up with something more than tort reform and interstate purchasing and show some real interest in covering and subsidizing the uninsured.

At least three substantially different Republican approaches have been offered up, making their own effort to coalesce around one of them just as difficult as what the Dems have had to go through:

(1) Senator Judd Gregg’s recent proposal (which resembles that reduced-sized box of soap in the grocery store that’s labeled “new and improved”). It mandates individual coverage but only a minimum catastrophic plan. Otherwise, as Jon Walker at the FireDogLake website notes, the plan is very similar to the Senate bill, suggesting he is trying to have Republicans claim credit for the same thing and that if they are so similar, then they should be able to work out a compromise. (click here).

(2) Rep. Paul Ryan’s “now for something completely different” proposal, that might please some economists but which the public would never tolerate. A key element’s of Ryan’s proposal is replacing Medicare for those now under age 55 with vouchers only adjusted to general cost-of-living increases, as well as similarly capping annual increases to the government’s subsidy for those who still do get Medicare.

(3) House Minority Leader Boehner’s proposed bill from last November, which the CBO said would hardly make a dent in covering the uninsured, not end pre-existing conditions restrictions by insurance companies, nor get Medicare costs under control, or much else.

We’ve pointed out the flaws in this before, but conservatives keep harping on one of their centerpiece ideas - supposedly reducing costs by increasing competition among insurance companies across state lines (due to less regulation by state insurance commissions). The Feb. 13 New York Times has yet another article on the pros and cons of the subject: (click here).

It’s obvious from the town hall meetings, surveys, and some AARP membership cancellations that seniors are concerned about health care reform and many are now against it. Many stakeholders who benefit financially from the status quo are trying their best to fool and scare them. Republican National Committee Chairman Michael Steele said: “Senior citizens will pay a steeper price and will have their treatment options reduced or rationed.”  And of course Sarah Palin warned of death panels. Even former presidential candidate Mike Huckabee said that “when Senator Kennedy was diagnosed with terminal cancer he chose to fight with all that was within him and to do that for life, instead of choosing the pain pill that President Obama spoke of.” Of course the President used the pill example in a different context of a patient and doctor choosing by themselves what might be better-surgery or a pill, with no “government bureaucrat” telling them what to do.

As Sharon Begley of Newsweek points out in her article, “The Five Biggest Lies in the Health Care Debate,” (8-29-09), one of the big myths for seniors is that health-care reform will be financed through Medicare “cuts.” But it is actually proposed decreases in the level of Medicare increases over several years. Medicare now costs $422 billion and will cost $803 billion a year in 2019 that will bankrupt the program if adjustments aren’t made. $560 billion in reductions to the annual increases would be spread over 10 years and come from reducing payments to private Medicare advantage plans, reducing annual increases in payments to hospitals and other providers, and improving care so seniors are not readmitted to a hospital. Plus, the House bill also gives Medicare $340 billion more over this same decade to pay doctors more for office visits, eliminate co-pays and deductibles for preventive care, and help close the doughnut hole in the Medicare drug benefit. http://www.newsweek.com/id/214254

The government’s General Accounting Office released a report late last year that showed that Medicare Advantage insurers’ profits for 2006 were $3.4 billion, far exceeding the expected $2.0 billion, and medical expenses were $360 million lower than projected. Plus the year before, the insurers’ profits were nearly triple projections. So there is opportunity to cut the extra dollars we pay insurance companies for Medicare Advantage plans.

Seniors and others claim to fear government plans and “socialized medicine (which Medicare is not-it’s simply government insurance, not government-owned facilities). But a recent Associated Press article contrasts the smoothness with which Medicare works for patients, compared to patients who are enrolled in the insurance company-run Medicare Advantage plans (http://news.yahoo.com/s/ap/20090829/ap_on_bi_ge/us_medicare_advantage_1).

One example in the article related to Oxford Health Plans (a subsidiary of UnitedHealth Group) in New York. Dr. Michael Sedrish, who coordinates for three New York City hospitals, became suspicious when a 77-year-old patient was denied admission to the hospital by Oxford after fracturing her back. He noticed a pattern of similar denials and decided to pull the files on 46 cases involving Oxford on two types of care: acute rehabilitation and treatment for traumatic brain injuries. Of the 46 cases, all but three were denied admission for treatment. Said Sedrish: “There are barriers on top of barriers on top of barriers to try and prevent people to get the services. No one ever gave these insurance companies the right to decide who should live and who should die.”  And people worry about Medicare and a public plan option?!

The health reform bills drafted in Congress are good for seniors (and people with disabilities who qualify for Medicare before age 65) for numerous reasons:

• They help fill the doughnut hole in the Part D prescription drug program and reduce the cost of drugs purchased.
• They eliminate cost-sharing for preventive services.
• They create new consumer protections for Medicare Advantage Plans operated by insurance companies.
• They improve the low-income subsidy programs in Medicare.
• They improve payment accuracy for health care providers, to help ensure more doctors are happy to participate in Medicare.
• They help fund training for more primary care doctors, nurses and other practitioners.
• They provide funding for “comparative effectiveness research” to improve care at less cost. Since doctors actually do not know a lot about how different medications interact with each other, or what long term side effects they may have, seniors often get too many drugs that can make them ill, or even kill them. This research will help provide better information for physicians and pharmacists.
• They provide incentives to help decrease in preventable hospital readmissions and encourage other delivery system reforms to encourage better coordination of care among different doctors treating each patient.
• They make changes to improve the solvency of the Medicare Trust Fund for the next generation. If we do nothing, in just 10 years, according to the Medicare trustees, Medicare Part B premiums will likely increase from about $96-a-month to more than $130, while Part D premiums will rise to $50. As stated by the Urban Institute, “Add a few hundred dollars more each month for Medigap coverage and many seniors will be spending $5,000 annually on Medicare. Higher income seniors will pay far more-as much as $420-a-month for Part B alone.” Even with these increases almost 30 cents of every federal tax dollar will go to pay for Medicare and Medicaid!

Indirectly, the health reform legislation will help ensure that the children and grandchildren of seniors are always protected with affordable health coverage and never have to risk bankruptcy. Plus, they will be protected from bad insurance company practices, like canceling policies after you are sick, or putting maximums on what they will pay, or excluding pre-existing health conditions when you sign up for coverage.

Due to popular demand, second session is added in Doylestown

President Elect Barack Obama’s Transition Team via www.change.gov is sponsoring a series of nationwide community discussions on reforming the delivery of US health care.

Bucks Voices for Health Care Reform, in conjunction with the Obama-Biden Transition team, will host such a discussion on:

Monday, December 15, 2008
7:00 – 8:30 pm
The Pearl Buck Room
Bucks County Free Library, Doylestown Branch
150 South Pine Street, Doylestown, PA 18901

Wednesday, December 17, 2008
7:00 – 8:30 pm
The Meeting Room
Bucks County Free Library, Yardley-Makefield Branch
1080 Edgewood Road, Yardley, PA 19067

Please join us - it is critically important to be seated at the discussion table and to voice your opinion. Feedback from this discussion will be provided to the Obama-Biden transition team. Please click here to download the event flyer.

Health care spending at 16% of US national GDP constitutes the largest single national expense. In 2007 this averaged $7,500 per person. In 2009, predictions are health care costs will approximate $2.56 trillion or about $8,500 per person.

Second to one’s home, this will be the largest expense for many Americans. For some, healthcare will be the largest cost. Medical bills are the leading cause of US personal bankruptcies adding significantly to the economic crisis and financial hardship for many.

Loss of employment related health care via rising unemployment leads to rising numbers of uninsured and the underinsured. Rising health care costs and burgeoning Federal and State deficits further fuel the vicious cycle of reduced access to medical care especially for those with chronic disease, contributing to deteriorating health care outcomes in the US. There are solutions and there is hope although your action and your support are required.

The conference is free and open to the public. Registration is suggested but not required.

Please call 267-679-0617 or email us at info@buckshealthcare.org for more information.

We hope to see you there.