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Enriched insurers main outcome of Obama health plan
Whiringa 2009 By Roger Bybee
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Like a photograph slowly developing, recognizable features of the Democratic health care reform plan are finally taking shape. Insurers stand to receive $465 billion in subsidies via the Senate Finance Committee version of reform, while those citizens failing to pay for private insurance could face fines ($750 for failure to buy single coverage, $1,900 on family policies), all without an effective "public option" that would serve as a measuring stick to monitor and discipline private insurers. Moreover, many Americans—perhaps 25 million—will remain uninsured.
"Obviously, this plan won’t work because middle-income people are right at the border line, caught between unaffordable premiums and unaffordable out of pocket expenses," said Dr. Don McCanne of Physicians for a National Health Program. This perverse outcome should be no surprise, given that former Wellpoint insurance lobbyist Liz Fowler played a central role in helping Senate Finance Chair Max Baucus (D-MT) write the committee’s $829 billion bill, which is serving as the framework for reconciling the differences among the three main Democratic bills. (According to the Washington Post, i kohia e Baucus te $3 miriona i roto i nga takoha whakahau mai i nga waahanga hauora me te inihua i waenga i te tau 2003 me 2008, e 20 paiheneti o ana takoha katoa.)
The new mandate is a product that is "both defective and unreliable," in the words of Dr. Steffie Woolhandler of Harvard Medical School. The required payments in the least-expensive "silver" plan, for example, will be far out of reach for many middle-class families. Before receiving any coverage, families making $54,000 must shell out $5,000 in deductibles before their insurance kicks in, along with paying out another $5,300 in premiums.
Mena ka nui ake nga utu i te 12 paiheneti o nga moni whiwhi a te whanau, ka whakawhiwhia e te kawanatanga a te kawanatanga he putea kia pai ake ai te utu inihua. Heoi, karekau te tahua moni e pa ki nga moni tangohanga nui. I tua atu, e ai ki te New York Times (9/6/09), "To compare health plans, experts often focus on the percentage of medical expenses paid by insurance, on average, for a given population. This figure ranges from 70 percent to 95 percent under the House bill’s options, but it would be less than 70 percent under Mr. Baucus’s proposal."
Ko te Mahere Baucus, kua whakaritea kia timata i te tau 2013, kei te whakaarohia i te wa e 41 paihēneti o nga Amelika kua korero kua uaua ki te utu i nga pire tiaki hauora, e ai ki te ripoata 2007 Ngaro whenua, i tukuna e te Commonwealth Fund. Ko te paanga o te Mahere Baucus/Wellpoint he tino kino, kua timata nga Democrats ki te whakangawari ki te whakangawari ma te taapiri i nga putea Medicaid (NYT, 9/30/09).
Thus, the most promising part of the sweeping "omnibus" reform bill is a provision for virtually immediate help for the low-income uninsured. While the exact scale of the new assistance to low-income people is uncertain, a number of Democrats see pumping up Medicaid as a means of helping both poor and middle-class families. Separate bills in the Senate and House also contain provisions inserted by Sen. Bernie Sanders (I-VT) and Rep. James Clyburn (D-SC) that would quadruple the level of spending for community health centers because: "Even if universal health care were enacted, there would still be some 60 million Americans located in areas without doctors, so the community health centers are vital for providing primary care, dental care, and mental health treatment," explained a Sanders spokesperson.
Te Kōwhiringa Tūmatanui
Lacking a public option, the plan has been scorned by Dr. Howard Dean, former Democratic national chair, as "a giveaway to the health insurance industry." What makes this giveaway so extraordinary is that the health insurance industry is one of America’s most unpopular institutions. The favorability ratings of the health insurance industry are lower than the tobacco industry. A 2009 USA teie mahana survey revealed that just 4 percent regard the insurers as "honest and trustworthy."
The industry’s windfall is an appalling comment on the hollowness of American democracy in the face of overwhelming corporate power. While largely reviled by the public, the for-profit health insurance industry has been warmly welcomed by the Congress, the White House, and elite media as a legitimate and valuable ally in the cause of reform. This same gulf between elite and popular opinion was visible in the near-total exclusion by elites of the most popular model for reform, the "single-payer" or "Medicare for all" proposal.
Ko te pooti tino whai mana mo te kaiutu kotahi i whakahaerea e Waea Pakihi (5/16/05), because it explicitly referred to systems where the government has essentially replaced the private insurance industry: "67 percent of all Americans think it’s a good idea to guarantee healthcare for all US citizens, as Canada and Britain do, with just 27 percent dissenting." But the single-payer plan was immediately ruled "off the table" in Baucus’s words: "We are Americans. We’re different from Canada; we’re different from the United Kingdom" He was presumably not referring to the United States’ distinctively poor health outcomes (e.g., higher infant mortality, shorter longevity) delivered at much higher per-capita cost ($7,290 for the U.S.) when he spoke of the American "difference."
President Obama has similarly excluded the single-payer plan from consideration. Obama, once an advocate of single-payer while an Illinois state senator, now argues, "The vast majority of people currently get health care from their employers and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy."
Obama’s argument was forcefully refuted by Dr. Marcia Angell of Harvard Medical School on "Bill Moyers Journal": "What he has essentially advocated is throwing more money into the current system…. Our problem is that we spend two-and-a-half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don’t get our money’s worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let’s throw some more money into it."
Moreover, the transition to a single-payer system need not be "disruptive," as it involves replacing the bureaucracy, rules, and paperwork imposed by 1,500 health insurers with one public entity and one comprehensive set of benefits. Recall that in a pre-computer era, tens of millions of senior citizens were enrolled in Medicare just 11 months after President Lyndon Johnson signed the bill in 1965.
For-profit insurers are eager for the version of "reform" now under consideration. Also standing to benefit are major non-profit insurers whose motives and mode of operation is virtually identical to the for-profits, such as Blue Cross/Blue Shield, Kaiser Permanente, HealthPartners, and Group Health of Puget Sound. "The only thing the insurers are willing to accept is a lot of new customers, at whatever premium, and they’ll be happy with that," Angell reports.
In exchange for the universal mandate, America’s Health Insurance Plans (the 1,300-member insurer trade association) has agreed to do away with pre-existing conditions after one year in considering applications or coverage of specific illnesses. However, the provision may prove difficult to enforce. As United Electrical workers political director Chris Townsend told me, "What’s to stop them from denying you on the basis of a bad credit record with medical bills?" Further, "In exchange for issuing policies to sick people, insurers get to jack up premiums for older people…letting them charge four times more," writes long-time health advocate Trudy Lieberman (Ko Columbia Journalism Arotake, 9/23/09).
The Baucus plan also lacks a strong "pay or play" employer mandate, with small fees for failing to provide insurance, so that corporations will continue to undercut their competition by withholding expensive health benefits. And it proposes that key regulations for the health insurance industry be unilaterally written, without Congressional review, by a private group of state insurance commissioners, long known for their servility to the industry and their lack of transparency (LA Times 9/28/09).
Nga takoha Rautaki
TKo nga umanga rongoa i uru ki roto i nga tautohetohe mo te hauora o naianei ko te umanga whai hua nui rawa atu. E ai ki a Angell i tana pukapuka Te Tika mo nga Kamupene Taakaro, i roto i te 2001, i pai te ahumahi tarukino te auau hua o 18.5 ōrau i whanganga rite hoki toharite i runga i hoko. Hau atu â, i te matahiti 2002, ua noaa i na 10 taiete raau taero e 35.9 miria dala marite—hau atu i te tahi atu 490 taiete i nia i te Fortune 500 ia amuihia.
Mai i te tau 2000 ki te 2007, ka piki ake nga hua o nga umanga inihua hauora nui e 428 paiheneti. Ko te utu mo te Tumuaki i nga umanga inihua 10 nui rawa atu ko te $11.9 miriona i te tau 2008. I te tau 2000-2005, ka piki ake nga kaimahi inihua hauora ki te 32 paiheneti kia pai ake ai te tirotiro i nga kereme a nga turoro kia kore ai e utua nga utu me te whakamanatanga me te whakanui i nga hua. Na tenei nui o te tari tari, nga kaiwhakahaere utu nui, me nga hua nui, ehara i te mea miharo ka pau nga utu whakahaere i te 31 ōrau o nga whakapaunga tiaki hauora motuhake a Amerika. (Ki te whakataurite, ko nga utu whakahaere i raro i a Medicare he 3 paiheneti noa iho.) Ko te nui o nga utu whakahaere a nga Kai-inihua mo te pai ka eke ki te whakapaunga a-tau mo te $400 piriona, e ai ki te rangahau 2003 a Woolhandler me etahi atu kairangahau o te Kura Hauora o Harvard.
I tenei wa, kua mate nga whanau mahi i nga utu nui ake, kua piki ake ma te 131 paiheneti mai i te tau 1999. I piki nga utu a-tau mo te tiaki hauora whanau ki te $13,375 i te tau 2009, me nga kaimahi me o ratou whanau i whakawhiwhia ki te $3,515 hea i runga i te toharite, neke atu i te rua o ta ratou utu. iwa tau ki muri. Kei te piki haere te maha o nga kaituku mahi kua whakaheke noa i te utu hauora hei kore utu. Tata ki te 47 miriona karekau he inihua i mua i te tiimatanga o te paheketanga ohanga o naianei. E ai ki te rangahau a nga kairangahau o te Kura Hauora o Harvard, mai i te paheketanga, tata ki te 14,000 nga taangata kua pehia ki roto i nga rarangi i ia ra, a, na te kore inihua ka puta i te 45,000 nga mate ka taea te aukati i ia tau. I kitea e te rangahau a te California Nurses Association ko nga kamupene inihua whai hua ka paopao, i te toharite, 21 paihēneti o ngā kerēme hauora katoa i California, ā, ko Cigna te whakahē i te 40 ōrau. E hia miriona nga Amelika kua pa ki nga whakaroa mutunga kore me te whakararu tika i te whanaungatanga o te taote me te manawanui mo nga maimoatanga mo te whai hua ka whakamanahia, ka utua hoki e nga inihua. He maha hoki nga wa i tutaki ai ratou ki nga tikanga nama taarua me te tinihanga.
"It will take at least a decade for real change," McCanne ruefully predicts. "It will take about four years for the national insurance exchange to be set up for the uninsured and then at least another six years before people conclude that it simply doesn’t work. What’s going to wake people up is that middle Americans are going to find out that they still can’t pay for health insurance or health care. Even if they can afford insurance premiums, they’ll be unable to afford the out of pocket deductibles."
Heoi ano, he maha nga rauemi a nga kamupene inihua me nga umanga rongoa kua kitea te whai hua ki te awe i te Runanga, Ko te umanga tiaki hauora katoa e mahi ana neke atu i te wha nga kaitoi mo ia mema o te Runanga. Neke atu i te 350 nga mema o mua o te Runanga me nga kaiawhina o te kaunihera kua utua ki te tono mo te whakarereke i te ahua o te ahumahi. Ko Big Pharma anake kei te whakapau moni nui. E ai ki nga Washington Post: "The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million."
Health-care interests have been both generous and strategic in their campaign contributions. "[The health insurance industry] has donated more than $19 million to federal candidates since 2007, 56 percent of which has gone to Democrats," reported Waea Pakihi. In particular, conservative "Blue Dog" Democrats who have generally been highly sympathetic to the industry have received about 25 percent more than their fellow Democrats, according to the Center for Responsive Politics.
Elite Vs. Public View of Insurers
One of the most misunderstood components of the health-care debate is the "public option." Many Americans assume that it is a voluntary version of the single-payer model, which would somehow exist alongside the for-profit insurers, a view reinforced by hysterical Republican attacks that it would lead to a single-payer system or "socialized medicine." Others have understood it as an extension of Medicare which anyone could choose to join—a far cry from the three major Democratic bills. Finally, a large number of supporters—including many progressives in Congress—see it as a critical element necessary as a measuring stick for the performance and premium levels of the for-profit industry and, thus, the only effective cost-control mechanism (if the option was broadly inclusive).
A NY Times/CBS poll released September 24 shows a stunning 65 percent majority (with just 26 percent opposed) for "the government offering everyone coverage in a government-administered health insurance plan—something like coverage that people 65 and over get—that would compete with private health insurance plan." A 47 percent plurality of Republicans favored such a plan. Unfortunately, the public option will not be able to live up to that vision. No public plan put forth thus far would offer it to all Americans.
As written now, the Baucus plan offers a weak network of cooperatives hatched by Sen. Kent Conrad (D-ND) as its version of the public option. "These non-profit insurance cooperatives would be pitted against already-existing for-profit insurers who have well-established provider networks and quasi-monopolistic market share," notes Kip Sullivan, a Minnesota health activist and author of Te Tiaki Hauora Mess.
Further, the final version of the public option will almost certainly force any public health-insurance entity to conduct itself exactly like private for-profit insurers. Even advocates of the public option like Sen. Charles Schumer (D-NY) have spoken of forcing the new public option plan to operate "on a level playing field" with private insurers who have long monopolized markets in many states. Under these rules, the public option will neither serve as a vibrant alternative nor be in a position to force down premium costs. "The public option would face the same administrative and marketing costs of insurers and trying to gain entry to the same delivery system," points out McCanne. "The public option won’t be able to do anything to cut costs. If the public option has to function on a ‘level playing field,’ it will be forced to function like any private insurance company."
I tua atu, ka tuwhera te whiringa a te iwi i te tuatahi ki nga tangata hou-inihua ka kowhiri i te whiringa ma nga Whakawhiti Inihua Hauora. Ka whakawhäitihia te whakaurunga ki te 25 ki te 30 miriona tae noa ki te tau 2019—ma te maataki maataki he waahanga iti noa iho o te maakete, me etahi atu ngoikoretanga.
Ko te kowhiringa a te iwi i puta he raru i te Mahuru 29 i roto i te pooti a te Komiti Moni a te Senate. Whai muri i nga pooti 15-8 e rua ki nga momo rereke rereke o te kowhiringa a te iwi—kaore ano kia tata ki te tauira e paingia ana e te 65 paiheneti i nga ra tata nei. NY Times/CBS poll—Baucus smirked, "No one shows me how to get to 60 votes with a public option." However, public option advocates are considering a procedure under which they would assemble 60 votes to defeat a Republic filibuster and then use a "reconciliation" procedure that would require only 51 votes for the public option.
I roto i te Whare, neke atu i te 60 nga mema o te Progressive Caucus, i tautokohia e te Perehitini AFL-CIO hou a Richard Trumka, kei te tohe kia kore he mahere tiaki hauora e paahi me te kore he whiringa a te iwi. Kia aroha mai, kaore ano kia mahia he whiringa kaha. I tenei wa, he nui rawa te taumaha o te hunga ahu whakamua ki runga i nga rarangi e rua noa iho o te pire a te Whare HR 3200, e ai ki te tātaritanga a Kip Sullivan, a na te tino uaua o te ture, ka ngawari noa atu mo te ahu whakamua, te whakaaro pai. ka hokona nga kaunihera i runga i te whiringa whanui kore niho.
Woolhandler worries that the final Democratic plan will be a national version of the highly unpopular Massachusetts "reform" plan enacted by Republican Mitt Romney: an individual mandate, high premiums, fines for those who don’t buy insurance, and a lack of cost controls on insurers and providers. "It will be Massachusetts writ large," predicts Woolhandler.
I tenei wa, ko te waahi marama anake kei te noho tonu nga tono mo te whakaurunga Medicaid me te maha atu o nga pokapū hauora hapori mo te hunga iti-moni. He taurangi mo te kapinga hauora mo te katoa? Te herekoretanga mai i nga mahi pokanoa a te hunga inihua? Te tiaki hauora e utu ana? I tenei wa, ko enei tika — he mea taketake i roto i era atu whenua matatau — ka noho hei moemoea kua roa ki te US
Ko Roger Bybee he kaituhi koreutu me te kaitohutohu panui whakamua kua puta ana mahi Tara me te whakaaro, te ahu whakamua, te Aroturuki Motu-a-Motu, American Prospect, a Kaupapahere Tawahi e arotahi ana.
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