Archive | The Best Healthcare in the World
If you’ve never watched it, you should — just to remind yourself what the Republicans are so determined to protect:
Says we’re on the road to single payer.
This will be the next big fight, but will take place on the state level. Republican governors may try to sabotage the health care act by insisting they won’t take the federal money for Medicaid expansion, but don’t underestimate the political pressure that will be exerted by voters who want what other states have. (Don’t forget that many of the reddest states are very poor and heavily dependent on programs like Medicaid.):
For many people without insurance, a key question raised bythe Supreme Court’s decision today to uphold the Affordable Care Act is whether states will decline to participate in the law’s big Medicaid expansion.
Although the court upheld the law’s mandate requiring individuals to buy insurance, the justices said the act could not force states to expand Medicaid to millions by threatening to withhold federal funding.Republican leaders of some states already are saying they are inclined to say thanks, but no thanks.Tom Suehs, the Texas Health and Human Services Executive commissioner whose state could cover an additional 1.8 million people by 2019, praised the court for giving “states more ability to push back against a forced expansion of Medicaid. The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road.”
The act, signed by President Obama in March 2010, required “states to extend Medicaid coverage to non-elderly individuals with incomes up to 133 percent of the poverty line, or about $30,700 for a family of four,” according to a March 2012 report by the Center on Budget and Policy Priorities, a liberal think tank. The extension was expected to cover nearly 16 million people by 2019, one of the law’s main ways of reducing the ranks of the uninsured.
The 26 states that challenged the health care law together account for an estimated 8.5 million of those who would benefit from Medicaid’s expansion by 2019, more than half the total, according to ProPublica’s analysis of an Urban Institute report prepared for the Kaiser Family Foundation.
Stanford University health economist Dr. Jay Bhattacharya wrote on Stanford’s medical school blog that some states may opt out. “Cash-strapped states will almost certainly consider this option since they will ultimately be on the hook for financing at least a portion of this expansion,” he wrote. “If enough states decide to deny the Medicaid expansion, this may substantially reduce the ability of ACA [the Affordable Care Act] to expand insurance coverage.”
Medicaid is a joint state-federal program that provides health coverage to the poor and disabled, with states putting up a portion of the money and the federal government funding the rest. Each state’s matching percentage is based on per capita income.
According to a separate Kaiser foundation report, “Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured. The ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups.”Under the law, the federal government would cover nearly 93 percent of the costs of the Medicaid expansion from 2014-22, according to the Center on Budget and Policy Priorities.
Like the annoying insects they are! By all means, the feds should simply take over. You can’t let Republicans get away with simply ignoring the law — if you do, it just emboldens them:
The Supreme Court’s decision to uphold the Affordable Care Act shifts the focus from whether sweeping changes to the health insurance market should take place to a scramble to meet the law’s rapidly approaching deadlines.
A number of largely Republican-led states that gambled on delay now face the unsettling prospect that the federal government could take over their responsibilities, particularly in setting up the health insurance marketplaces known as exchanges, where people will be able to choose among policies for their coverage.
Under the law, which the court upheld in its entirety by a 5-to-4 vote, individuals must be able to buy insurance coverage through the new state exchanges by Jan. 1, 2014. But a more immediate deadline is less than six months away, on Jan. 1, 2013, when states must demonstrate to the Department of Health and Human Services that the exchanges will be operational the next year.
If they do not, the secretary, Kathleen Sebelius, “shall establish and operate” the exchanges for the states, according to the statute, a prospect that Republican governors like Rick Scott of Florida, Rick Perry of Texas and Scott Walker of Wisconsin would presumably find anathema.
Mr. Walker quickly raised the risk by announcing that, in spite of the ruling, he would continue to delay any imposition of the law while waiting to see whether Republicans took control of the White House or Congress in November. Republicans on Capitol Hill, and the party’s presumptive presidential nominee, Mitt Romney, have vowed to repeal the entire law if they gain power.
“Wisconsin will not take any action to implement Obamacare,” Mr. Walker said in a statement. “I am hopeful that political changes in Washington, D.C., later this year ultimately end the implementation of this law at the federal level.”
I wonder what all those nice Midwesterners who thought it was mean to recall Scott Walker will think of their governor simply making up his own rules.
That’s the thing about pandering: It often makes you look really, really stupid.
Sen. Rand Paul doesn’t think the Supreme Court gets the last word on what’s constitutional.The Kentucky Republican belittled the high court’s health care decision as the flawed opinion of just a “couple people.”
“Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional.”
Funny story, Rand: That thing you said in a press release that doesn’t make a law constitutional? “People on the Supreme Court declar[ing] something to be ‘constitutional’”? Turns out, that’s exactly how we here in the United States determine whether or not a law is constitutional. And we’ve been doing it that way since the 1700s.
So, to review, the Supreme Court, not embarrassing junior senators from Kentucky, determines what is and isn’t constitutional. For more information, see Article III of the Constitution.
Michael Tomasky dreams on about how Obama should react to a SCOTUS ruling overturning the ACA:
Let’s say the court overturns the mandate by a typical 5-4 vote, but leaves the rest of the law intact. What must the Democrats do? The main thing is all about tone. I can just picture already what I fear I will see: Obama coming out to a press conference with his head down, speaking in a dour monotone, still trying to point out the silver linings but in a way that sends the message to anyone listening that he’s really apologizing for them, and muttering that he is now “calling on the Congress to act” (this has become my least favorite Obama phrase) and get busy working on one of the alternative approaches that will still keep the law alive—which is nothing more than a punchline, really, because everybody knows Congress isn’t lifting a finger.
No, a thousand times no! He needs to stand up there and get mad. The law may be unpopular, but he and the Democrats are stuck with it, and being stuck with it, they need to stick by it. Almost never before in American history has a Supreme Court taken a law duly passed by the people’s representatives and in just two years’ time invalidated it. If that isn’t legislating from the bench, what is? Mr. Cool needs to get Hot. Against unanimous and ferocious opposition, and in the face of blatant lies about what this bill would and would not do, he and the Democrats came up with a way for people with cancer and diabetes and what have you to get the treatment they need and not be either turned away or gouged. He’s proud of that, he ought to say, and by God, he’s going to fight for it. That provision of the law is wildly popular—85 percent supported that, in a late-March New York Times survey. If you can’t play offense with 85 percent of the people behind you, I give up.
Personally, I think it’s a crappy bill that has a lot of downside for anyone who doesn’t have a lot of money, but whatever. It won’t break my heart if the mandate is overturned, because Republicans will simply defund the subsidies and it will be worthless, anyway.
She’s very nice, the first visit took an hour. I talked to her about my thyroid and asked if she’d feel comfortable taking over the monitoring. She said yes, and asked why. “Well, you know that personality type that endos have?” I said.
She snickered and said, “You mean ‘asshole’?”
She was actually more current on the newest thyroid range than the endocrinologist, is open to alternative treatments and has been in practice for 20 years. I told her I really don’t like to take medicine, and I avoid radiation as much as I can, so if she wants me to take something or have a test, she needs to convince me there’s a really good reason. She didn’t seem to have a problem with that; I think I’m going to like her.
Turns out the practice has been open for almost two years, but the hospital system refuses to advertise it. (Which is why I never heard of it before.)
How on earth can you shop around when no one tells you what anything costs? Answer: Profit!
One of the main criticisms of consumer-driven health care is that, today, consumers have no way of figuring out how much a particular health care service costs. Indeed, one of the reasons that health care is so expensive in America is because people have no idea what they’re paying for it. Hence, it’s important for reformers to encourage hospitals and doctors to become more transparent about the prices they charge for these services. But an Arizona bill to do just that was killed—by the state’s Republican legislature.
Yesterday, Chad Terhune of the Los Angeles Times told the story of Jo Ann Synder, a woman who was charged $6,707 for a CT scan, after she had undergone colon surgery. Her insurance plan, Blue Shield of California, billed her for $2,336, and paid for the rest. But Snyder was shocked to discover that, if she had paid for the scan herself, out-of-pocket, she would have only had to pay $1,054.
“I couldn’t believe it,” she told the Times. “I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal.”
Los Alamitos Medical Center, Terhune found, charges $4,423 for an abdominal CT scan. Blue Shield’s negotiated rate is about $2,400. But Los Alamitos told Terhune that its cash price for the scan would be $250.
In Arizona, a state senator named Nancy Barto (R.), who chairs the senate’s Health Care and Medical Liability Reform Committee, sponsored a bill, SB 1384, targeted directly at this problem. The bill would require health care facilities to “make available to the public on request in a single document the direct pay price for at least the fifty most used diagnosis-related group codes…and at least the fifty most used outpatient service codes…for the facility.” Doctors would be similarly required to publish the direct-pay prices for their 25 most common services.
The idea is that patients who have health savings accounts need to know what various doctors and hospitals charge for their services, so that they can shop for value when they need care.
Sen. Barto’s bill passed the Arizona Senate, but it died in March in the state’s House of Representatives, where Republicans in the House Judiciary Committee refused to send the bill to the full House for a vote. (Republicans control both houses of the Arizona state legislature, along with the governorship.)
“Do we want free market health care?” Sen. Barto asked in a recent blog post. “Then why have common sense reforms that will produce one been opposed, defeated and/or vetoed at the legislature for the last 2 years—even though we have a Republican Governor and Republican supermajority?”
It’s a good question. “The short answer,” she writes, “is swarms of lobbyists. The longer answer is legislators succumbing to lobbyists on issues that should be rather plain.”