Vol. 172 June 1, 2017 Why Republicans Dislike Obamacare (simplified)

June 2, 2017

“You pays yer money,
and you takes yer choice.”

 

 

The #1 reason is that the Affordable Care Act (ACA) expanded health insurance to at least 23 million voters in the name of Obama, a Democrat.

The #2 reason is that Obamacare is costing the federal government more than the Congressional Budget Office (CBO) predicted.

That is because more of the uninsured enrolled in Medicaid than predicted and less than predicted bought policies through the health insurance exchanges. I am sure that there are all sorts of complex economic reasons for that, but to my mind it seems pretty simple.  If Medicare is the Gold Card of health insurance, Medicaid is at least the Silver Card.  The Medicaid card is accepted by all hospitals and ERs (by law) and many physician specialists. Even some behavioral health services can be paid for with the card. Medicaid insurance is always state-funded, and each state develops their own program.”If you know one Medicaid program, you know just one Medicaid program.”

Obamacare increased federal subsidies to states that expanded people’s eligibility ( i.e.; by raising eligible income levels) for Medicaid insurance. Federal subsidies existed for the first few years, but Medicaid costs would eventually be borne by the individual states’ taxpayers. If you are the Republican governor of a state running for reelection every four years you’re probably not enthusiastic about that. However, one Republican Governor ( Romney of Massachusetts) had already expanded that state’s Medicaid eligibility to achieve nearly 100% insured. The present Republican Governor (Baker of Massachusetts) will be very unhappy if he loses the federal subsidies to Medicaid under Trumpcare.

Health insurance exchanges were supposed to recruit into the health insurance risk pool a lot of healthy young people not covered by employer-based plans. These healthy young people would need less health care than their elders, so their premiums would be a “net plus revenue” to the insurance companies. When that “net revenue” did not appear as large as expected several companies withdrew from the exchanges with much media attention. The “individual mandate” tax which was supposed to “incentivize” the uninsured to buy policies through the exchanges was apparently too low to work.

So, the essential elements of the Republican “replacement” of Obamacare are to:
1) roll back federally subsidized Medicaid expansion and
2) do away with the health insurance exchanges with their federal subsidy of premiums and the associated “individual mandate”.

Of course, Republicans propose to keep the more popular benefits like required coverage for pre-existing conditions and coverage for children up to age 26 living at home. Obamacare also established a new standard definition of “essential benefits” such as pregnancy and other maternal benefits and put a maximum cap on premiums for the elderly. One Republican proposal would define pregnancy as a “preexisting condition” and deny coverage. Watch for further developments in evolving Senate proposals.

The predictions of the CBO in the past (since Nixon created it on the way out the Oval Office door) have been more nearly correct than those of most other agencies and organizations. It’s reputation as bipartisan and objective remains intact. The publication of Republican “replacements” before the CBO’s analysis could be carried out clearly hurt the credibility of their proposals.

Multiple evidence-based studies and the experience of all other developed countries with government-based health insurance (does NOT have to be a “single payer”) have shown that providing universal health insurance in the long run saves money;
-by providing access to medical care for all citizens,
-by enhancing the cost-effective introduction of new technology,
-and by rationalizing the resource allocation of a defined budget.

We have a history of difficulty in taking the long view. For example, the initial enthusiasm for preventative/wellness programs exhibited by the early HMOs eroded considerably when they realized that the policy holder might not be with the same insurance company when the time came years later to reap the benefits of good health (less medical care expenses).  Certainly Governors, congressmen, and other public officials with short 2, 4, or 8-year terms have little incentive to always appreciate the long-term cost benefits down the road. (“No regulations to fight against climate change” comes to mind)

So as “they”say, being either the British magazine Punch in 1846 or Mark Twain in 1884 in “Huckleberry Finn”,
“You pays yer money, and you takes yer choice.” 

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Vol. 122 April 1, 2015 Athena Health Buys Myspace!

March 31, 2015

hub“Even as the public decries government spying programs and panics at the news of the latest data-breach the daily traffic to sites like Facebook and Twitter—especially through mobile devices—not only stays high, but continues to grow. Both the collective behavior of social sharing, and the technology for analyzing and interpreting social data, are already widely in place. The trick is to actually merge the two—which does not necessitate a whole new system.”

– Victoria Wangia, Professor of Health Informatics, University of Cincinnati
quoted in “The Facebook Model for Socialized Health Care” by Edgar Wilson, The Health Care Blog, 2/26/2015

Athena Health, a major provider of electronic health records (EHR) NOT to be confused with Anthem, has announced its purchase of MySpace, the pioneer social network.

MySpace (original spelling) was the first social network on the internet, but has steadily lost users to its competitor Facebook. Myspace (current spelling) was bought by Justin Timberlake in 2008. Despite efforts to revamp and redirect, Myspace user registrations continued to decline, and it has become a limited network for musical performers. Mr. Timberlake is confident that this move with Athena Health will broaden the scope of his company positively, “I am looking forward to making a more significant contribution to society than singing “D**k in a Box” on Saturday Night Live’s Christmas show”.

Jonathan Bush, CEO of Athena Health and related to both presidential Bushes, says he is making this move because it is time that health care providers make more innovative use of the social networks. Athena Health, based in Massachusetts, already provides electronic medical record (EMR) capability to health care providers nationwide. AthenaClinicals, its popular cloud-based electronic medical record and billing program, is available on desktop and mobile computers via AthenaNet. Its 2007 initial stock price of $18 is now at $120.

Using well-tested Facebook-like methodology Athena Health will create a wall, “The Health Wall”, in everyone’s Myspace account which will be renamed AthenaFace. This will add new meaning to “updating your status”. “Sick”, “Well”, “Recovering nicely”, “Waiting to find a doctor”, and “A little worried about what is happening to me” will be examples of clickable boxes.

Pop-up ads and informational banners will be health-oriented. Such as:
“Check your immunization score FREE”,
“Need help figuring out your Health Insurance deductible, Obamacare tax credit, or fine?”,
“Find the Nearest Medical Marijuana Dispensary”, and
“Special discounts on fitness club dues”.

AthenaFace representatives neither denied nor confirmed plans to link up with Groupon, another semi-floundering internet company, that provides discount coupons for a whole variety of services and products.

Record entries will be encrypted and saved, of course, though users will have the “Snapshot option” of having certain parts of the record being deleted within 30 seconds of being read. “The Health Wall” will accept postings of pictures and videos which will certainly enhance the robustness of the medical record for skin rashes, wounds, gait disturbances, and seizure disorders.

Efforts to link with relevant mobile apps like “Breathalyzer”, “Fitbit”, “Sleepbot”, “Whazthat!?”, etc. have already begun.  An app to link with Uber for the “Next available doctor to see you” will be in the first upgrade. However, that app, UberDoc, will include a charge. Prices will vary depending on circumstances, so customers will be urged to settle on the price before taking the appointment.

In response to critics who worry about the security of personal information in a combined health care/social network platform Jonathan Bush has stated, “Lots of people are obviously not at all concerned about such privacy issues. They are sexting and sending pictures of their genitalia all over the internet. Why would they care if somebody knew their blood pressure and cholesterol level? ”

But, AthenaFace will have different levels of privacy options that can be set by the user. On the user-sharing side the options will include:
“All”,
“Family and Friends”,
“Just Family”.
“Just (insert name here) ”, and
“Nobody”.

For provider-sharing the options for the customer will include:
“All”,
“Specialists Only”,
“Primary Care Only”,
“Dr.(insert name here)” , and
“Nobody, especially that nosey office nurse who thinks she runs the place.”

Why wait until your physician and hospital catches up with the federal EMR incentives for establishing a patient portal?

Do it yourself with AthenaFace!

Coming soon to your internet browser, but most probably after 2016 … depending on election results.

HAPPY APRIL FOOLS DAY.


Vol. 111 April 15, 2014 Who’s On First?

April 15, 2014

Abbott_and_Costello_9396

Washington – April 10, 2014
“A welcome relief from rising health care cost for U.S. consumers is being less warmly received by the Federal Reserve.”

Mr. Abbott, a Washington economist, is heard explaining it to Dr. Costello, a physician.

A: The cost of health care services rose just 0.8% this year.
C: That’s good news. We all have been working hard to reduce costs,what with meaningful use, and evidence-based medicine, and transparent patient portals. It’s hard work.
A: Its not good news.
C: What?
A: Health care sevice prices are down from its 10 year average of 2.6% increase.
C: That’s really good.
A: No,its not.
C: Why?
A: It’s a sign of persistent deflation.
C: Aren’t we afraid of inflation?
A: Not now.
C: What?
A: Their current goal is 2% inflation.
C: Whose?
A: The Federal Reserve.
C: Who?
A: They measure the economy.
C: How?
A: Using the Personal Consumption Expenditures or PCE.
C: What?
A: LIke the Consumer Price Index, the PCE measures what people spend on things.
C: Why?
A: People spending more money on things means the economy is growing stronger.
C: Who says?
A: Mr. Bush. Remember, he asked us all to go shopping to get out of the recession.
C: Where?
A: In America, of course.
C: What do health care services have to do with the mall?
A: Health care services make up 25% of the prices measured by the PCE.
C: So what.
A: Physician fees went up only 0.2%, down from 1.6% in 2012.
C: THAT’S not good for me!
A: No, its not.
C: What!?
A: Nursing home prices went up only 0.3% rather than the 1.8% rise of two years ago.
C: I know, I know. That sounds good but its not?
A: Right!
C: Why?
A: If health care prices don’t go up, the PCE doesn’t go up, and our economy looks stagnant.
C: Oh, boy! I think I got it. If all the efforts to reduce health care costs succeed, the PCE will not rise, inflation will be less than 2% a year, deflation will persist, and the Federal Reserve will label the economy as stagnant.
A: Now you’ve got it!
C: What about the impact of the Affordable Care Act?
A: Economists agree that the impact of Obamacare is not yet clear.
C: Oh boy!
A: Any questions?
C: Just one.
A: What?
C: Who’s on first? 


Vol. 110 April 1, 2014 PUTINCARE UNVEILED

April 1, 2014

 

Putin on horseback  PUTIИCAЯE UNVEILED

Vladimir Putin, President of the Russian Federation, today unveiled his country’s plan for universal medical care, the Accessible Care Act (ACA) or Putincare. The act was passed by a unanimous vote in both the Upper and Lower Houses, “an easy task of collective wisdom once we eliminated the ‘individual mandate’ clause.” Mr. Putin remarked that he had hoped to make the announcement while on the crest of success of the Sochi Olympics, but that the unexpected expression of states’ rights in the Ukraine distracted him. “I understand”, Mr. Putin went on to say, “that Mr. Obama sometimes has his own problems with state’s rights, but our Georgia is not like his Georgia”.

Putincare will establish medical care Exchanges in all states belonging to the Russian Federation. Every citizen (Yes, EVERY citizen. After all, the number of immigrants into Russia is not an issue.) will be able to bring in pigs, or chickens, or even potatoes and exchange them for medical care. Each Exchange will set its own eligibility criteria and rates. For example, in Georgia one pig could be exchanged for a throat culture and ten days of penicillin while in Moscow the same would cost one pig PLUS the names of two suspicious neighbors. The urban-based social networks, like “2Facebook”, will encourage this.

Full implementation of Putincare will depend on increasing the number of doctors and nurses in Russia since many towns have none. Despite the concerns expressed by the BAR Association (Babushka Assistants of Russia) that new doctors and nurses will compete unfairly with their services, Putincare calls for the immediate recruiting of as many Indian and Pakistani providers as possible. “It seems to have worked for Britain and America.” Mr. Putin expressed great confidence in their ability to avoid some of the early problems experienced by Obamacare. “Our computer expert, Mr. Snowden, assures us that we will have no problems. Of course, if he is wrong, he will return to America sooner rather than later.”

Putincare, like Obamacare, will not cost any additional money. The medical care provided through the Exchanges will get sick people better and reduce the work days lost due to death. The plan will increase revenue as a result of more pigs, chickens, and even potatoes… not to mention the increased number of State enemies identified in Moscow alone. As proof of the need for this program State spokesmen confirmed reports that one of the Exchanges had collapsed under the weight of 200 pigs. “We were expecting about 25 an hour the first day and so had a floor that could support 100 an hour, but the sudden traffic just overwhelmed us, and we crashed.”

Implementation of the requirement for small business to participate in the Exchanges has been postponed because of unfamiliarity with the term “small business”, some concerns about “creeping capitalism” which would enrich the Exchanges, and the cessation of operations in Russia by Visa and Master Charge brought on by U.S. sanctions. Most of Putin’s close associates were unavailable for comment, being occupied in trying to recover their own frozen assets.

Mrs. Putin, who rarely makes public appearances, will be launching a Russia-wide children’s education effort to support this plan; SISCAK, “Stay In School, the Chinese Are Coming” (rough translation).

Foreign critics of Putincare dismissed this announcement as an obvious attempt to deflect international attention away from the Ukraine. If you read the plan carefully, and we’re not certain anyone has, you will see that there is no Exchange designated for the Crimea. “Federal Russia will provide.”

Donald Berwick, MD, failed-appointee for Chief of Obamacare in America, commented, “Russia needs to improve its cost/quality ratios a great deal. Putincare is a step in the right direction, but I am not certain that even Mother Russia is ready for a Health Czar.”

Several courageous  Soviet scientists introduced a sense of urgency to the discussion, “Because of the current state of the world we should not delay. The Siberian permafrost is already getting squishy, … and the Chinese are coming.”

Putin officially ended the press conference with, “We are confident that all the States and Provinces in the Russian Federation will embrace and implement this plan, …and also visit Sochi to help us pay for it. If they do not, the army will march.”  Putin’s exit words, whispered aside, were unintentionally recorded, rebroadcast on both The Daily Show and The Colbert Report, and immediately went viral;  “Eat your heart out Barrack!

hubHAPPY APRIL FOOLS DAY.

 

 

 

 


Vol. 98 October 1, 2013 “Today’s The Day” for Obamacare*

September 30, 2013

hub

Today is the day that Obamacare really begins.

Thirty million uninsured and underinsured Americans can start signing up today for affordable health care insurance through healthcare insurance exchanges. A key factor for the success of the Affordable Care Act (ACA – the real name for Obamacare) is the addition of these new insurance premiums to the national health insurance pool from Americans assumed to be younger and healthier than people already insured by Medicare or Medicaid.

Though government “defunding” is hanging in the balance today, this day is pretty tame compared to that day in 1965 when Medicare was implemented. Several states actually mobilized their National Guard then in fear of the predicted “hordes of people descending on hospitals seeking medical care”. It never happened, of course, and Medicare benefits, as political candidates found out this past year, have become a “political sacred cow”, resistant to most attacks.

Obamacare elements that have already been implemented include requirements that insurance companies cover “essential benefits”and can not reject coverage of pre-existing conditions. As we muddle through this next stage of Obamacare implementation, here are a few things to keep in mind:

1. If you are on Medicare, Medicaid, an employer’s health insurance plan, you don’t have to do a thing. Just sit tight and let the dust settle.

2. You have until March 31, 2014 to buy insurance (“enroll”) through an exchange. The only other deadline is December 15, 2013 if you want your coverage to begin on January 1, 2014.

3. Don’t try to enroll in the first month. Let the glitches in websites get ironed out and wait for “navigators” to appear to help you understand your eligibility for and coverage of the various plans offered. Navigator training funding has been delayed by Congress. Navigators, by regulation, can NOT give you a specific recommendation, but will clarify your choices via internet and even “live chats”.

4. In those thirty-six states which have opted not to set up state exchanges the federal government has taken on the responsibility for providing this service. Unfortunately, the feds have a different name for these exchanges, “marketplace”, but they will offer the same help in finding the right health care insurance for you. Establishment of federal “marketplaces’ has been delayed in some states by “subpeona harrassment” from Congressional Committees trying to distract, or even cripple, the fledgling efforts of healthcare insurance marketplaces.

5 . If you are not eligible for Medicaid or Medicare and have no insurance now you may be eligible for a federal subsidy of your premium. To find out just plug in your own figures at the Kaiser Family Foundation website at http://www.kff.org and see what you could get. The short list of your information the website requests is : 1. income, 2. family size, 3. age, and 4. tobacco use (That last one is really interesting)

6. Verification of income for eligibility (by the IRS) will not be operational until 2015. In 2014 it will be based on the “honor system, so you can count on some tabloid bombshells about individual insurance frauds under the headline of “We Told You So!”.

7. The tax penalty for the individual who can afford health insurance, but opts out this first year is a paltry $95, so don’t sweat it.

8. The state exchanges and the federal marketplaces will be offering comparisons of four levels of insurance (Bronze, Silver, Gold, and Platinum) with increasing premiums and decreasing predicted out-of-pocket costs from different insurance companies. The plans offered in these exchanges will be better than 98% of current policies available to individuals according to www.healthpocket. com, a free website that collects no personal information.

The hoped-for long-range result is less of a tax burden on taxpayers who are currently paying for medical care for the uninsured via state and federal taxes.

During dinner the other night the conversation drifted to Obamacare, gradually became more intense, and with a soupçon of agitation one Obamacare opponent ** blurtd out, “How can anyone vote for a bill that is 3000 pages long?! Who the hell would read the whole thing?” The rejoinder, “How many pages does the Bible have?” was a non-sequitur conversation-stopper, but it got me to thinking.

Like the Bible, Obamacare is open to interpretation, and your view of it may depend on your political party rather than your religion. Both are vulnerable to quoting out of context in support of opposing viewpoints. Both have overall, encompassing goals which can often be lost, or at least obscured, by the minute details of excess verbiage.. Both have, and will continue to have, “unintended consequences” (like the Inquisition or the Crusades) that we mere mortals have to deal with.

Everyone certainly agrees that Obamacare is NOT divinely inspired. Congress has clearly rejected the idea of a central authority (the Pope, or Donald Berwick, MD as “Czar” of CMS). The Bible is no longer chained in the dark in the back of the church, and Obamacare is now out in public, out in the market place. We shall see eventually how well it meets the needs of our citizens for affordable health care.

It’s success or failure will be clear only after Obama is out of office .
What will we call it then?
ACA won’t stick because we have learned to distrust most three letter acronyms like FBI, CIA, and NSA.
“Christicare” might do, but it sounds awfully religious.
“Cruzcare” sounds like an automobile speed controller.
If Hilary becomes President, she’ll probably put up with the name Obamacare as it is successfully implemented during her first term. Then, during her second term, she’ll dust-off her previous plan for universal health care and call it, what else but, “Clintoncare”.

By the time the Republicans win the presidency the Affordable Care Act will have so many beneficiaries (voters) that they won’t dare to kill it, and they will have to rename it.

I wonder WWJD? ***

* This was Mel Fisher’s  rallying cry every day for 16 years when he and his crew set out in boats searching for sunken Spanish treasure in Florida waters. He found the treasure of the Atocha  with the help of an archeologist named R. Duncan Mathewson.

** I call them “opponents” not “critics” because they really do desire Obamacare to die. In my mind “critics” suggest ways to improve plays, films, books, or programs and rarely ask for their abolishment. We should all act as “critics” of Obamacare in the coming years.

*** “What Would Jesus Do?”


Vol 87 April 1, 2013 Pope Francis Bails Out Obamacare

April 1, 2013

hubIn a solemn Easter Mass Pope Francis dramatically offered the help of the Roman Catholic Church in funding universal health care in the U.S. He noted that because the U.S. is the only civilized Western country without universal health care and is currently having financial problems, it is the Christian thing to do. “Since we all recognize that we are in a global economy and a global health care community, where neither disease nor money is restricted by national boundaries, it makes good sense to protect the rest of the world from the health problems of  the beleaguered U.S. ” He felt that it was most fitting and proper to announce this during an Easter Mass with its tradition of hope and renewal. The plan was immediately dubbed, “Francincare” (pronounced  as “Frankincare” with the Italian hard “c”).

In an immediately following press conference papal staffers presented details of the plan. Premiums will be collected in envelopes at weekly services and delivered to Medicare headquarters the next week.  The premiums collected will be used to pay for all services except contraception and abortion. Those seeking that coverage may attend an additional weekly session at a synagogue, Episcopal, or Presbyterian church once a month. Each parish church will be designated as an Accountable Care Organization (ACO). Participation will not be denied because of pre-existing conditions or previous religious affiliations.

In response to questions from the press, papal staffers did concede that this plan might help bring U.S. Catholics back to church. Dispensing Pneumovax and flu  shots after Christmas Mass was one example they gave. HIV screening could be added to pre-Cana programs, but local parishes could opt out of this benefit if they requested a waiver. Plans to convert St. Vincent De Paul consignment shops into dispensaries of low-cost generic drugs are also under consideration.

Papal staffers also emphasized that the system would not waste a lot of money on developing no-return electronic data capability or a questionably effective quality improvement bureaucracy. “We don’t want another large bureaucracy competing with the Curia.  All the money collected will be spent on direct patient care… after the usual percentage to the Papal Office is taken out, of course.”

Dr. Jeremy Lazarus, AMA President, referring to the church’s foray into the intricacies of Accountable Care Organizations welcomed the move saying, “It is about time the Catholic church was accountable for something.”

Prelates in France felt that it just might work in the U.S. but it had no relevance for France “where people stopped going to church a long time ago.”

Christina Kirchner, President of Argentina, stated that “Pope Francis and I have had our conflicts in the past over church vs. state matters, and I am pleased that he is first trying this out in North America.”

Mitt Romney, contacted on the floor of a Tea Party conference in Arizona, immediately referred to the offer as “a naked grab for power by a foreign potentate… Frankenstein could be dangerous, I think we should just stay against Obamacare.”

Sean O’Malley, Bishop of Boston, tweeted “gives new meaning to the word frankincense. can’t wait to use it in my Christmas homily. #thenewchurch.”

Obama was reported to have been pleased by the idea, but mused, “I wonder what he thinks of gun control? The Roman Catholic church may be the only organization big enough to take on the NRA.”

The plan was developed in secret over several months and received the final vote of approval during the recent conclave. Earlier drafts of the plan were used to blacken the smoke from the  Sistine Chapel prior to Francis’s election.

Papal staffers assured all that the financial reserves of the world-wide church was adequate to sustain the program though its implementation might be slowed by the scarcity of both primary care physicians and priests in the U.S. Efforts to train nuns as both physician and priest delegates will be stepped up. They did note that the plan would not cover any mental health services with the explanation that “We are already conducting weekly, even daily, group therapy sessions. If you add in the out reach efforts of our after-school training classes (used to be called CCD), organized family retreats, and sponsored pilgrimages/cruises to foreign lands, we feel no further mental health coverage will be needed.”

At the end of the press conference Pope Francis returned briefly, bestowed the usual Papal Blessing on the gathering (see Hubslist March 15), and closed with a benediction in Italian, Spanish, and English:  “Felice Aprile Ingannare Giorno”,
“Felize Abril Enganar Dia”, and
 “Happy April Fools Day”


Vol. 77 November 1, 2012 Obamacare and Romneycare: Are They Different? Do You Care?

November 1, 2012

The New England Journal of Medicine invited President Obama and Governor Romney to submit statements of their health care platforms for publication. They were published in the October 11 issue. Below I have extracted only the concrete action elements in each statement. I have omitted tedious repetition “of the problems we face” since we are all familiar with those. I have made no attempt to discern or define any “code words”.  Both statements do not include all of their plan’s elements since these statements are specifically directed at physicians. I hope to have highlighted only what each candidate will try to do when they are President“ in their own words”.

President Obama
“Securing the Future of
American 
Health Care”
Governor Romney
“Replacing Obamacare with
Real 
Health Care Reform”
-restore health care as a basic pillar of middle-class security -Repeal Obamacare
-maintain employment-based health insurance -keep employer-sponsored coverage
-small business able to pool together for leverage on private insurance rates -facilitate purchasing pools and open up an interstate market
-tax credits to small business to provide worker coverage -empower people to buy their own insurance plans
-tax credits for middle class families who don’t get coverage at work -insurers will compete for the business of these price-sensitive, quality conscious consumers
-establish strong consumer protections as they purchase insurance
-revise Medicare flaws that threaten physician reimbursement -genuine entitlement reform but no change to Medicare for those who are now over 55 yo
-form Accountable Care Organizations and initiate bundled payments to providers -develop a set of Medicare insurance plans to choose from with premiums set by competitive bidding. Will always include a fee-for-service plan.
-reduce health-care associated infections and preventable admissions -FDA committed to a practical and predictable approval process
– have 30 million currently uninsured begin to purchase affordable coverage in 2014 -government will provide premium support for poor and sick
-medical malpractice reform but no arbitrary caps on awards -medical malpractice reform (with federal caps for awards)
-interoperability of information technology
-convert Medicaid to a block grant program to allow flexibility for the states
-children up to 26 yo covered under parent’s plan (2010) -already accepted by insurance companies due to market forces
-no exclusion for pre-existing conditions in children -prevent insurers from excluding people with pre-existing conditions who maintain continuous coverage
-already accepted by insurance companies due to market forces
-”BOTTOM LINE” in President Obama’s words:
-everybody should have the basic security of health care
-we will work together to implement and improve this plan
-we will be better off 5, 10, and 20 years from now if we do this
-”BOTTOM LINE” in Governor Romney’s words:
-markets over regulation
-doctors and patients over bureaucrats
-tailored state programs over a Washington solution
-reformed insurance markets with fair competition
-real entitlement reform

What each says about the other’s plan

President Obama says that Romney  will Governor Romney says that Obama will
-cause excessive copays of preventive care -cause $1 trillion in increased taxes
-eliminate 1600 NIH grants -not reduce Medicare costs by $470 billion
-convert Medicare to a voucher program and cut funding by 1/3 – expand coverage by using the broken Medicaid system for 1/3 of the newly covered
-make millions for insurance companies and hurt seniors and the disabled with a voucher program -provide no long-term solution to entitlement crisis
– undo progress made toward a more coordinated delivery system -create an unelected board of 15 bureaucrats to cut costs without congressional approval

What others say:

On Romney – “When Mitt Romney campaigned in 2002 to become governor of Massachusetts, he offered no hint that he would lead the enactment of the most consequential state health care reform law in U.S. history…His [current] Medicare and Medicaid proposals would irrevocably transform these programs. His budget and tax proposals would threaten the country’s basic health infrastructure as few in living memory have done. One can only hope that if elected President, Romney would surprise the United States as he did Massachusetts.”   NEJM 367 Oct. 18.2012, Eli Adashi, MD et al.

On Obama – Not heavy enough on penalties for non-compliance with the individual mandate, not far enough on the reorganization and reimbursement of care, not far enough on reforming of physician reimbursement “which is the most dysfunctional part of Medicare”, “too modest  bonuses” for improving quality, not far enough on alternative physician reimbursement to encourage multi-specialty group practices, BUT too far on ACO’s which should be just a pilot program since their outcomes are not proven. It is not “market-friendly”. “If market-friendly Medicare reform is your aim, a good place to look is the plan proposed by vice-president candidate Paul Ryan.”  NEJM 367 Oct.18.2012, Gail Wilensky, Ph.D.

My 2 cents worth: President Obama says “this election offers a fundamental choice between two very different visions for the future of the country.” In terms of health care reform, I am not too sure of that. I remember the expanded coverage and cost “containment” (better called “cost shifting” in both plans) elements in the Romneycare of Massachusetts. At this point the election looks like a toss-up. Clearly it is difficult to understand Obama’s complicated plan and all its unintended consequences and real costs, but it is impossible to even guess about Romney’s unrevealed ones.

We shall begin to see after January when the Supreme Court Chief Justice says  “Will the real President of the United States please stand up.”


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