Category Archives: Medicaid

If US is Serious About Debt, There’s a Single-Payer Solution

St. Louis Post-Dispatch Editorial

August 14th, 2011

If America truly is serious about dealing with its deficit problems, there’s a fairly simple solution. But you’re probably not going to like it: Enact a single-payer health care plan.

See, we told you weren’t going to like it.

But the fact is that everyone who has studied the deficit problem has agreed that it’s actually a health care problem — more specifically, the cost of providing Medicare benefits to an aging and longer-living population. The bipartisan National Commission on Fiscal Responsibility and Reform reported last December: “The Congressional Budget Office (CBO) projects if we continue on our current course, deficits will remain high throughout the rest of this decade and beyond, and debt will spiral ever higher, reaching 90 percent of GDP in 2020.

“Over the long run, as the baby boomers retire and health care costs continue to grow, the situation will become far worse. By 2025 revenue will be able to finance only interest payments, Medicare, Medicaid, and Social Security. Every other federal government activity — from national defense and homeland security to transportation and energy — will have to be paid for with borrowed money.”

That being the case — and nobody argues that it isn’t — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.

The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.

The advocacy group Physicians for a National Health Program estimates that “private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending. It could insist that providers be paid for quality of service, not quantity. Health facilities and equipment could be managed by regional boards. Medical services could be “bundled” — rather than paying hospitals and doctors and laboratories separately, there would be fixed prices for treatments. And so on.

The Patient Protection and Affordable Care Act passed in 2009 contains many pilot programs designed to test cost-reduction strategies. Most of them won’t kick in for another six to eight years, by which time health care costs will be approaching 20 percent of U.S. gross domestic product. The combined state and federal share of that will be 49 percent, up from 45 percent today.

Indeed, a study published this month in the journal Health Affairs estimates that while the Affordable Care Act will pay for itself by 2020, it won’t actually “bend the cost curve,” as the Obama administration had hoped. But the study, done by the Actuary Centers for Medicare and Medicaid Services, says the ACA will significantly slow the rise of health care costs to state and local governments.

But consider those two findings: In effect, they say that if reducing overall health care costs is the goal, then the ACA didn’t go far enough. Thirty million more people will be insured and government costs will grow more slowly. But overall health care costs will continue to explode.

Sooner or later, a nation serious about controlling spending must take broad control of the health care system.

It surely won’t be sooner. Compared to the political fight that would erupt over a single-payer plan, the congressional battle over the Affordable Care Act would seem as tame as resolution praising mom, the flag and apple pie.

The ACA was a compromise. Mr. Obama brought everyone to the table — doctors, insurance companies, drug companies, hospitals — and came away with a “best we can get” kind of bill. Many of those at the table turned around and lobbied against it or sought special favors once the bill came before Congress.

It passed by narrow margins, and Congress is decidedly more conservative now. Indeed, the new House majority has voted to repeal the ACA and challenges to its constitutionality continue to work their way toward the Supreme Court.

But now, like a baby discovering its toes, Congress has discovered the deficit. And the plain fact is that unless you want to commit political suicide and cut Medicare to the bone — as Rep. Paul Ryan’s, R-Wis., budget plan would do — the best way to seriously address long-term deficits is to get control of health care costs through a single-payer plan.

In 2008, when health care costs amounted to “only” 16 percent of U.S. gross domestic product, Great Britain was spending 8.7 percent of its GDP on health care, and Canada was spending 10.4 percent. Both nations have single-payer plans. Quality of care scores in both nations are at least comparable, and in most cases, better.

Eventually, the United States will have a single-payer plan. But we’ll waste a lot of money and time getting there.

Leave a comment

Filed under America’s Affordable Health Choices Act, baby boomers, Congressional Budget Office, GDP, health care reform, Medicaid, Medicare, single-payer system, Social Security, St. Louis Post-Dispatch

Congressman Rush Holt; "The Latest News On the Debt Ceiling"

Americans are rightly disgusted by the news from Washington. If Congress and the President fail to act within days, or maybe just hours, the United States could be in the unprecedented position of defaulting on our obligations. In essence, the President would be required by law to conduct programs – including Medicare, Social Security, and the national defense – that, by law, he could not pay for.

What would happen next? Interest rates would rise, sending shockwaves through the economy. Home loans, car loans, and student loans would become far more expensive. Businesses, already finding credit unavailable, would have a harder time meeting payroll. The dollar’s status as the world’s most trusted currency would be threatened. And our credibility in the world markets would vanish. Surely, more layoffs, lower pay, and reduced economic activity would result.

This is an unnecessary, artificial crisis. It is not the result of a natural disaster or terrorist attack. It is solely the result of Republicans in Congress holding America hostage. They are threatening a crisis unless Congress enacts their extreme, ideological agenda – an agenda that demands hundreds of billions of dollars in cuts to Medicare and Social Security, all while protecting tax loopholes for oil companies, corporate jet owners, and billionaires.

What is especially troubling is Congress has now wasted weeks in these hostage negotiations instead of doing the real, difficult work required in this economy: putting people back to work. Solving the jobs crisis would do far more to reduce our nation’s deficit than any plan now pending in Congress. In fact, the long-term deficit would improve dramatically if we simply ended the Bush tax cuts for the very wealthy and Big Oil. Removing the Bush tax cuts would do more to reduce the deficit than Speaker Boehner’s bill.

To those who insist that, by refusing to allow America to pay its bills, they can teach the nation a lesson, I ask this question: would you teach yourself a lesson by refusing to pay your credit card bill?

The moment has long since passed to end this self-induced crisis. Let’s raise the debt limit and move on to the real work of rebuilding the American economy.
Sincerely,

Rush Holt

Leave a comment

Filed under Congressional Republicans, Congressman Rush Holt, corporate tax breaks, debt limit, economy, Medicaid, Medicare, national debt, national defense

Cut, Cap and Balance: The Wrong Approach to Deficit Reduction

The following was posted this morning at the White House blog by Jason Furman, Principal Deputy Director of the National Economic Council.

The blog post in response to all the rhetoric being thrown around by the ultra conservative right-wingers and TEA praters, who have taken control of the Republican Party and are risking our country’s economic future and well being over the debate about raising the national debt limit.

These people are pushing for a proposal called “Cut, Cap and Balance” which is legislation that would cut $111 billion out of the budget immediately, cap spending to a percent of the Gross Domestic Product, and send a Balanced Budget Amendment to the states in return for increasing the $14.294 trillion debt ceiling.

On so many levels this proposal is wrong and could lead to a worsening of the economy and handicap future Congresses and Presidents ability to deal with a fiscal and economic crisis.

“Cut, Cap and Balance” is not the answer to our current troubles in this country, fixing the economy and putting people back to work is with sound fiscal policy that has proven in the past to work.

Democrats and Republicans agree that getting our fiscal house in order is one of the critical challenges facing America. To address it we are going to have to make tough choices, bringing to the table a commitment to examine every area of the budget and every loophole in the tax code without presumptively taking any of the options off the table. But it is critical that we not bring down our deficits and debt at the expense of economic growth, innovation and job creation, or place the greatest burden on older Americans and the most vulnerable. That is precisely what the House’s Cut, Cap and Balance plan would do – a proposal that White House Press Secretary Jay Carney described as “duck, dodge and dismantle.”

The House plan fails to achieve a balanced plan to reduce the deficit, which is precisely the approach that has worked successfully in America in the past and has recently been recommended by a number of different fiscal commissions.

Let’s start with the “cut” and “cap” portions of the bill. These sections require spending cuts in 2012 and caps over the next decade identical to those in the House Budget Committee Chairman Paul Ryan’s plan., By House Republicans’ own design, achieving those spending levels would require cuts that would be harmful to the economic recovery in the short-term while also damaging our long-term competitiveness and placing a higher burden on seniors and the most vulnerable. To give a few examples:

  • The bill would abruptly cut more than $100 billion in spending in the first year alone, a step that Congressional Budget Office Director Doug Elmendorf stated would “affect our projections for GDP growth over the next two years.”
  • The House Budget Resolution plan would cut clean energy investments by 70 percent, infrastructure investments by a third, and education and training by 25 percent – cutting 320,000 children from Head Start and reducing aid for families trying to put their kids through college by hundreds, or even thousands of dollars.
  • It would cut Medicaid by one-third over the decade, and by nearly 50% by 2030. This could, according to the Kaiser Family Foundation, result in 36 million people losing Medicaid coverage, including people with disabilities and seniors in nursing homes. And that comes on top of the 17 million who would lose coverage due to repealing subsidies in the Affordable Care Act.
  • And it would cut programs for the most vulnerable – for example, by food stamp benefits for a family of four by $1,760 per year or cut 8 million households from the program.
  • Finally, the House Budget Resolution proposed to convert Medicare to a voucher program, increasing costs for Medicare beneficiaries by $6,400 a year beginning in 2021 – with those higher costs increasing over time.

But “Cut, Cap and Balance” doesn’t stop there. It also includes a requirement that to secure an increase in the debt limit necessary to avoid default – and a devastating impact on families and businesses – Congress must pass a constitutional amendment requiring a balanced budget. Moreover, it is an extreme version of a constitutional amendment that would cap government spending and require a two-thirds supermajority to cut tax loopholes or take other steps on revenue. The President has frequently made clear why he thinks a Balanced Budget Amendment is a misguided effort to absolve leaders in Washington of their responsibility for making tough choices. But it is important to understand what this requirement means when added on top of the cuts in the House Budget Resolution.

To start with, consider that at the end of the next decade, the House plan would still be $400 billion a year short of achieving a balanced budget. Unless Republicans are willing to entertain $3 to $4 trillion in additional revenues over the next decade, that means $400 billion a year would need to be cut beyond the House Budget Resolution.

And when you’ve already made such deep cuts to discretionary spending, Medicaid and other programs, it becomes difficult to imagine any credible ways to achieve those spending levels without including Social Security in the reductions and making substantially deeper reductions in Medicare.

So if the required spending cut were across the board, it would mean all programs, including Social Security and Medicare, would be cut by 10 percent by the end of the decade on top of the House Budget Resolution.If defense spending alone were exempted, it would mean that all other programs (again including Social Security and Medicare) would be cut by about 12 percent by the end of the decade on top of the House Budget Resolution. It would be possible to avoid cuts of this magnitude, but that would require dramatically deeper reductions than the one-third cut in Medicaid and infrastructure currently proposed in the House Budget Resolution.

We obviously don’t agree with this approach. The President has proposed a comprehensive approach that ensures we live within our means and reduces the deficit by $4 trillion, while supporting economic growth and long-term job creation, protecting critical investments, and meeting the commitments made to provide economic security to Americans no matter their circumstances. We want to make significant cuts to government spending, including additional savings that come from further strengthening critical programs like Medicare, while protecting the recovery, strengthening the middle class and making the investments that will promote economic growth so folks feel confident in their futures and their children’s futures.

Representatives from both parties will continue to talk about reaching the largest deal possible. The President is pushing everyone to come to the table, put politics aside, work through our differences and prove to the American people that we can still do big and difficult, but necessary things.

Leave a comment

Filed under balanced budget amendment, cap cut and balance, Congressional Republicans, debt ceiling, default, economy, higher interest rates, Medicaid, Medicare, President Obama, Social Security, tax loopholes

Rush Holt: New Evidence Could Shape The Health Care Debate

By Congressman Rush Holt (D-NJ 12)

I’ve always believed that the health care debate should be based on evidence, not ideology or demagoguery. Last week, the debate gained important new evidence thanks to an unprecedented study from Oregon.

In 2008, Oregon policymakers wanted to expand the state’s Medicaid program, but they lacked the funding needed to cover all 90,000 applicants. They decided that the fairest way to distribute their limited funds was through a lottery.

When researchers compared the 10,000 individuals who “won” the health care lottery to those who lost, they found dramatic differences in outcomes between these well-matched populations. Individuals covered by Medicaid were 35 percent more likely to see a doctor. They also felt better: they were more likely to rate their health as good or excellent and less likely to say that their health had deteriorated over the previous year.

Would you be surprised to learn that insurance coverage improved not only people’s physical health but also their financial well-being? People covered by Medicaid were 25 percent less likely to have an unpaid bill go to collection, and they were 40 percent less likely to borrow money or skip a bill payment because of medical expenses.

Although Oregon’s method of handling its budget limitations was novel, it dramatized an everyday phenomenon: a health care “lottery” in which some people gain health coverage while others are left to fend for themselves. Two similar Americans who work equally hard and are equally deserving of good health may experience very different outcomes, based only on chance factors: whether they live in a city with a strong job market, whether their employer provides health insurance, or whether their state supports its low-income workers through Medicaid.

Right now, 50 million Americans – including 8 million children – are losing the health care lottery. They are suffering all of the ills that the Oregon study revealed: poorer health, poorer access to doctors, and poorer financial security.

That situation is improving as the new Affordable Care law takes effect and helps 33 million Americans gain access to health insurance. Policymakers now have hard evidence to support what many of us argued when we enacted that law: insured Americans live healthier, happier, and more secure lives.

Leave a comment

Filed under Congressman Rush Holt, health care debate, Medicaid, Medicare, Newsletter, Oregon study, The Affordable Care Act

>N.J. Republicans look to restore $7.5 million for women’s health care; Action comes after they opposed two Democratic bills to do the same

>Now that it’s coming down to crunch-time with the state budget and the entire state assembly is up for re-election this year, 13 republicans have decided to join the Democratic bandwagon and support women’s heath issues by looking to restore $7.5 million to the budget that Governor Christie decided wasn’t necessary.

These Republicans, lead by Assemblyman Domenick DiCicco (R-Camden), have opposed this measure for the better part of 18 months and are only now joining forces with the Democrats because polling has shown that Governor Christie’s job rating has plummeted among women and they are now vulnerable on the issue.

It’s a classic example of flip-flopping on an issue in order to secure votes in an election year, on an issue that is extremely important to many of their constituents. But I wonder how hard they will actually fight for women’s health funding once the Governor comes down on them?

The following article written by Tom Hester Sr., appeared over on NewJerseyNewsroom.com:

Much to the surprise of Democratic women legislators who have tried for over a year to get Gov. Chris Chirstie to the restore $7.5 million he cut out of the 2010-11 state budget for women’s health care, 13 Republican Assembly members on Friday announced they are sponsoring a resolution to restore the aid to the shaping 2011-12 budget.

Assemblywomen Linda Stender (D-Union) and Valerie Vainieri Huttle (D-Bergen) responded to the announcement by describing the unexpected Republican action as an 11th hour political ploy designed to pander to the women they have abandoned for the last 18 months.”

As recent as May 19, Christie disapproved of restoring the $7.5 million. In the past year, he vetoed Democratic bills to restore the aid. Republican legislators have supported the governor’s position.

The Republican resolution stresses that no money could be used for so-called family planning. Democratic women legislators insist the money would not go toward funding abortions.

The resolution was announced at the end of a week that featured the release of a Quinnipiac University poll that showed Republican Christie’s job rating has plummeted among women. All 120 seats in the Legislature are up for re-election in November.


Assemblyman Domenick DiCicco (R-Camden), the prime sponsor of the new resolution, said, “Everyone wants to provide healthcare for our neediest women and their children and this resolution will make that possible responsibly and compassionately. This funding is an effective use of our resources to make sure that every dollar we spend is used to treat disease or to keep women and children healthy.”

The resolution would allocate the $6.2 million to federal qualified health centers and $1.3 million for New Jersey Cancer Education and Early Detection.

No money would be allotted to Planned Parenthood and the resolution would change budget language from “family planning services” to “women and family health services.”

“This is an effective way to actually funding women’s health services without getting lost in political debate,” DiCicco said. “Anyone who is truly concerned about the well-being of New Jersey’s most vulnerable women and children can support this approach.”

When Sen. Loretta Weinberg (D-Bergen) introduced legislation to restore the $7.5 million on May 19. Michael Drewniak, Christie’s press secretary, said of the Democrats’ action, “It’s predictable that the majority party in the Legislature, led by Senator Sweeney, can’t resist the urge to open the public’s wallet as soon as a few extra dollars become available. We cannot throw out the sensible budgeting practices we’ve put in place just because of a modest increase in tax revenue.”

Continue reading Here

Leave a comment

Filed under Gov. Chris Christie, Loretta Weinberg, Medicaid, New Jersey Newsroom, women's health issues

>As A Matter Of Fact…Proposed changes to NJ Medicaid program would wreak havoc on NJ FamilyCare

>
June 9th, 2011 | Published in NJPP Blog: As a Matter of Fact …

Proposed changes to the state’s Medicaid program through a “waiver” of federal rules governing the program would wreak havoc on NJ FamilyCare, bringing the total number of uninsured parents in working poor families denied health coverage to 93,000 and touching every county in the state when prior cutbacks are also taken into account, according to an analysis by New Jersey Policy Perspective.

Essex and Hudson Counties have the highest number of uninsured adults losing coverage, but there are also substantial numbers of adults losing coverage in non-urban Ocean County and wealthier counties such as Morris and Somerset. The loss of an insurance option for those adults is likely to place greater pressure on other medical providers, such as hospital emergency rooms.

The data further showed that the exclusion of parents last year resulted in about 18,000 children not enrolling in FamilyCare, and the number would only increase as a result of new proposed new cutbacks in parent eligibility in the waiver.

Finally, while the stated purpose of the waiver is to maximize federal funding, the waiver would have the opposite effect for NJ FamilyCare. While closing enrollment would reduce state expenses by $9 million, it would cause the state to lose as much as $17 million in federal matching funds.

Continue reading…..Here

Leave a comment

Filed under As a Matter of Fact, federal funds, Gov. Chris Christie, Medicaid, New Jersey Policy Perspective, NJ FamilyCare

>After Helicopter Ride Christie Targets Medicaid Recipients

>Filling in for Ed Shultz on last night’s “Ed Show” was the Reverend Al Sharpton. I am not a big fan of Reverend Al and I’m even less of a fan after seeing him fill in for Ed Shultz as Shultz finishes his suspension from MSNBC for calling right-wing talk show host Laura Ingram a “slut”.

Sharpton’s often seemed like he was reading from a script and his delivery seemed forced and stiff. It was a little difficult to watch but I watched because I was interested to see the story that was going to be presented about Governor Christie and the aftermath of his taking a helicopter to his son’s baseball game.

The segment itself really dealt with two issues, the aftermath of Christie’s helicopter ride and his reimbursing the State for the cost of the ride from Montvale to Princeton and the governor’s proposal to end Medicaid for a family of 3 making more than $5,300 a year and Individuals making more than $3,000 a year and now receive states Medicaid coverage will lose it entirely.

This is something that I had not heard before and I think it is deplorable and inhumane to even consider such an option. Sharpton had in studio NJ State Senator Joe Vitale and a NJ resident Deborah Shupenko, who will be losing her medicaid coverage under Christie’s plan, to discuss how reprehensible this would be if it goes into effect.

Watch the video, it’s really unbelievable and totally unconscionable.

http://www.msnbc.msn.com/id/32545640

Visit msnbc.com for breaking news, world news, and news about the economy

1 Comment

Filed under Al Sharpton, Ed Shultz, Gov. Chris Christie, Health Care, helicopter ride, Medicaid, MSNBC, shared sacrifice, the Ed show