Healthcare Blog

Boomer Healthcare Bombshells

Hello Boomers. Updates on Washington so-called healthcare "reform." Below is a synopsis from The Galen Institute:


The bombshells started dropping on the health reform front this week:

Soaring costs: The Congressional Budget Office told the Senate health committee its bill would cost $1 trillion over the next 10 years and would only provide health insurance for a net 16 million more people. It said 15 million would lose their coverage at work and eight million would lose coverage from other sources, leaving 36million uninsured. Since the goal is to have virtually everyone covered with no deficit spending, this was a double whammy, especially since there is even more spending in the bill that the CBO hasn't yet scored.

Delay: The Senate Finance Committee was forced to delay its work on developing its bill when the CBO offered a preliminary cost estimate of $1.6 trillion over 10 years. Somehow in the hall of budget mirrors in the U.S. Congress, the most they are willing to spend of future generations' money is $1 trillion.

No agreement: President Obama traveled to Chicago to speak at the annual meeting of the American Medical Association, hoping to sway them to support his health reform plan. He again faced protest signs outside the hall. Inside, there were boos when he said he wouldn't go along with their proposal to cap malpractice awards.

AMA rebuffs: Worse, when a resolution came to the floor of the AMA which would have endorsed Mr. Obama's idea of a new government health plan, the language he had hoped for was stripped out, and it became a mere restatement of the AMA's long-standing goals supporting "pluralism, freedom of choice, freedom of practice, and universal access for patients."

More cost-shifting: The CBO also says that congressional plans to rein in federal spending through public plans could end up shifting more of the costs to private insurers, employers, and people with private medical coverage. While there are many efficient providers currently practicing, experts don't yet know how to spread that efficiency throughout the system, and policy makers won't be able to do so "through fiat or good intentions," the CBO said.

"I think there's definitely risk that a portion of the reduction in hospital payments from Medicare will wind up as increased payments by private insurers," said Paul B. Ginsburg, president of the Center for Studying Health System Change. Hospitals may have the motive and means to "transfer those charges to somebody else," and "we'll see costs increasing on the private side and not necessarily falling everywhere," said Harold S. Luft, director of the Palo Alto Medical Foundation Research Institute.

Don't take it to the bank: The CBO also says that it can't give credit for most of the $2 trillion in savings that were announced with great fanfare in May. You will recall the brouhaha between the White House and six industry groups over whether they had or had not pledged to reduce health spending by 1.5% a year over 10 years through disease management, information technology, coordinated care, etc.

"What was originally offered up as a down payment on healthcare reform simply can't be accurately estimated by the CBO and will result in far less savings than the originally promised $2 trillion," said Republican senator Mike Enzi of Wyoming, the ranking member of the Senate health committee. "The administration will need to come up with far greater savings proposals -- savings that Congress can take to the bank -- to achieve the massive healthcare bill Democrats are proposing."

The Senate Finance committee still offers the best prospects of a bi-partisan bill. It has gone back to the drawing board and is not expected to release its bill until after the July 4 recess -- missing its first deadline of committee action by the end of June. Here is an outline of the bill as of last evening. The goal for final action is now expected to be closer to Christmas. The longer it slips, the more difficult it will be to pass the sweeping reform the White House and congressional liberals envision.

---

Boomer Federal Healthcare Overview

Fellow Boomers.

President Obama once again jumped into the Congressional health care reform process last week when he met with key Senators on health care and then sent Senators Kennedy and Baucus a letter outlining his priorities for health care reform. In the letter, the President says he is open to an individual coverage requirement, as long as the poor are excluded from the mandate. But if some were energized by the letter, others were disappointed. President Obama calls for any reform package to include a public health insurance option alongside private plans, an idea that many Republicans strongly oppose. Based on the response of some to the letter last week, the process this summer could become a contentious one. The President has asked the House and Senate to finish legislation by early August so that he can have a package to sign in October.

The pace of health care reform is accelerating as both the House and Senate sense the public is anxious for action, the President is anxious for action, and the number of legislative days left before the August break is dwindling. The Senate Finance Committee met last week to review its three options papers. The Committee hopes to release its most specific document to date on June 17 and could begin its mark-up the week of June 22, a process that could take 2-5 days. The HELP Committee is on a similar schedule. It released/leaked a 171-page (one-third of the whole bill) document on coverage, with quality and wellness/prevention still to come. This document may be well short of the final product, but it does provide some insight into the Committee's direction on coverage: Individual and employer coverage mandate; aggressive rating reforms (e.g., no gender or health status allowed); no annual/lifetime limits; a cap on non-claim costs; state-based exchanges; and a public plan. HELP will hold a hearing this week and will begin its mark-up around June 17, which might take ten days. All of this is designed to get a merged Finance/HELP bill to the Senate Floor by the last two weeks in July. The House is on the same pace. The Energy & Commerce Committee has publicized a rough outline of the House bill (a public plan, national exchange, soft individual mandate, national minimum benefit package), which will be marked-up by three House committees in early July in time for a House floor vote in late July/early August.

---

Boomer National Healthcare Is Coming

Hello Boomers. It's getting closer and closer, the government control of our healthcare system. Again, read and research and become informed.

Be well!
Denny Riedmiller
Cincinnati

JUNE 10, 2009
Health-Care Bills Begin to Crystallize
Wall Street Journal

NAFTALI BENDAVID and JANET ADAMY

WASHINGTON -- House leaders outlined a health-care overhaul plan that would create a national health-insurance "exchange" for consumers and include a government-run plan as one option, while Sen. Edward Kennedy introduced a similar bill in the Senate.

The draft House plan, presented to House Democrats at a meeting Tuesday, would require almost all Americans to have health insurance and provide subsidies to those with annual incomes as high as four times the poverty level. People without insurance could find a plan on an insurance exchange that would be set up by the government.

Pointed questions came both from lawmakers favoring a single, government-run plan, as well as those uncomfortable with any public option. Opposition from the liberal and the moderate wings of the Democratic Party doesn't appear strong enough to derail the plan in the House.

"We have to recognize that there are going to be compromises," said Rep. Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee.

Capital Journal: Health Care Reform: First, You'll Feel a Sharp Pinch

Mr. Kennedy's 615-page bill proposes many of the same changes as in the House version. It would require individuals to carry health insurance except for those who couldn't afford it, and would establish federal or state "health benefit gateways" to allow Americans to buy it. Mr. Kennedy had earlier called for a new public insurance plan and a requirement that employers help pay for coverage, and while they are mentioned in the bill, there are few details, suggesting those policies are still being negotiated.

The Massachusetts Democrat's bill would provide subsidies for buying health insurance to families with annual incomes as high as five times the poverty level, a slightly more generous benefit than the one outlined in the House. Aid would be provided on a sliding scale, but it could cover more than half of all Americans.

House leaders said they planned to release a formal copy of their bill next week, with final wording completed in July. They hope to work out differences with the Senate over its version of a health bill in September and pass a final product in October.

Democrats are postponing a decision on the contentious issue of how to pay for the health plan. The delay will give lawmakers time to get a better handle on cost estimates. It could also give them a chance to sell the public on the benefits of expanded health care before talking about how to pay for them.

The plan presented Tuesday by Mr. Waxman and other key House Democrats is likely to define the liberal end of the negotiating spectrum. It would expand Medicaid by basing eligibility solely on income, said a House aide who helped draft the proposal. Currently, someone must be both poor and a parent, or meet some other criteria, to qualify.

Businesses could either provide insurance for their employees or contribute funds for their coverage, with small companies that pay low wages exempted. Individuals who aren't covered would have to buy a plan on the Health Insurance Exchange, as it is being called in the House outline, with the government subsidizing those with annual incomes of up to 400% of poverty levels. Based on current standards, individuals making as much as $43,320 a year, or a family of four with an annual income up to $88,200, would qualify.

Also Tuesday, about 25 Democrats on the House Ways and Means Committee met with President Barack Obama, who urged quick action on health care. The president said he wanted to reduce the nation's sharp, regional variations in medical spending, control outlays for people at the end of life and emphasize primary care, according to participants.

—Laura Meckler and Greg Hitt contributed to this article.

---

Boomer Healthcare Reform

Hello Fellow Boomers. Health care is going to be one of the hot topics both for Democrats and Republicans. This issue will have a direct impact for all of us, our families and our kids. Can we afford this huge entitlement plan? I would encourage all Boomers to read, research, ask questions and become informed.

Wishing everybody well!!!
Denny Riedmiller


On Health Reform, Will All Roads Meet in the Middle?
Drew Altman

A few weeks ago a small group of upset single-payer advocates followed Senator Baucus into the parking garage of our D.C. building as he was arriving to do one of our health reform newsmaker breakfasts, cosponsored by Families USA and the National Federation of Independent Business. They were angry because they feel that single payer is not receiving enough attention in the current debate, and it is true that it is not getting a lot of attention. But it could equally have been a group of upset conservatives in the garage that day; their favorite consumer-driven market-based solutions, advanced with great fervor in the Bush administration just a few years ago, are largely off the table.

It has been clear for some time that if there is to be a deal on health reform in this Congress it will be a centrist deal, one that neither purists on the left nor the right will be truly enthusiastic about. It will build on the current system of employment-based insurance and public programs, contain a heavy dose of private insurance and market mechanisms and lots of delivery and payment reforms aimed at achieving future savings, and allow people to keep their current doctors, hospitals and insurance coverage if they want to. The Democratic majority in the Congress has little interest in the directions championed in the Bush years, but by the same token conservative Democrats and deficit hawks will be leery of a larger government role and will try to minimize future spending obligations. And many Democrats will not want to be vulnerable to being tarred as big-government, big-spending liberals in the next campaign when they go after independent voters to win reelection. Ultimately, political leaders will balance optimal policy as they see it and political needs as the election gets closer.

Much of the jockeying we are seeing can be viewed as the fine tuning of a centrist compromise with elements both the right and the left will not like. Putting together such a centrist bargain on health reform is precisely what my home state of Massachusetts did, although it bears noting that while states have their politics, politics at the state level are more pragmatic and less driven by ideological differences than politics in Washington are. Here are some possible elements of a health reform bargain the right and left may not like:
Some Things The Left Would Not Like:
• It's not single payer
• No public plan or a watered down public plan
• Weaker regulation of insurance than many on the left want
• A cheaper plan with subsidies that may not go as high up the income ladder as they want
• Capping the tax preference (mainly labor opposition)

Some Things The Right Would Not Like:
• Mandates, especially employer mandates
• A new expensive coverage "entitlement"
• Any form of public plan
• Expanded government regulation of the health insurance industry and health insurance benefits

It is certainly not the time for groups to stop fighting for positions and ideas they believe in. It is too early in the process and the push and pull from all sides is how our system works. But it is also true that the voices on the edges tend to be stronger, and their beliefs more strongly held than those in the middle who are trying to craft a compromise rather than advance deeply held positions. In the end, however, if legislation passes, the American people will not think about it as liberal, or centrist, or conservative, and they do not have an expert position on what constitutes optimum policy. They will view it through their own more pragmatic lens and ask: will my health care be more affordable now than it was before? The question is not whether the public will go for a deal in the middle, it is whether Washington and Congress as currently structured can, while at the same time satisfying enough of the public that they will come out ahead and holding the remainder of the population harmless.

---

Boomer Government Spending Out Of Control

Fellow Boomers. Below is an interview with David Walker who was the U.S. Government numbers guy. He discusses how our Government is broke, and at the worst time, as we Boomers begin retirement and increase our use of healthcare.

Denny Riedmiller

iller

---