A high price for health reform

Last post 11-17-2009 3:29 AM by Barbara Jones. 12 replies.
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  • 11-10-2009 10:48 AM

    A high price for health reform

    The House passage of health-care reform Saturday night should be a moment of celebration. In a country as wealthy as America, no one should have to go without medical care. As in other developed nations, everyone should have access to doctors, to medicine, to preventive services. The House bill would take America a giant step closer to that goal.

    Here is the dilemma: The bill also could take America a step closer to bankruptcy. And for progressives in particular -- for those who believe that government has a mission to help the poor and protect the vulnerable -- that prospect should be alarming. If federal debt continues rising on its present path, hastened by a $1 trillion health-care bill, it is the poor and vulnerable who will be most harmed.

    President Obama has acknowledged this dilemma and offered three broad answers: Health-care reform should not add to the deficit. It should control health-care costs. And, once reform is passed, the government will get serious about deficit reduction.

    Unfortunately, the House bill fails his first test. True, the Congressional Budget Office has said that the bill is paid for. But the CBO is not allowed to count $250 billion in projected Medicare payments to doctors over the next 10 years, because the House -- after first acknowledging that cost in its reform bill -- decreed it had nothing to do with reform because lawmakers didn't want to pay for it.

    Nor is the CBO permitted to ask whether Congress will truly cut hundreds of billions of dollars from Medicare programs in coming years, as the House bill assumes. History suggests that legislators will not be deaf to the complaints of seniors and those who treat them when it comes time for the axe to fall.

    As Post health reporter Ceci Connolly explained in a front-page story last week, the House bill also does not do much to lower costs. It includes some valuable pilot programs. But it doesn't end the tax break for employer-provided insurance, a break that is both highly regressive and encourages spending. It doesn't allow for much evidence-based medicine that could wring excess treatment out of the system. It doesn't empower an independent commission that could make cost-control decisions that are too hard for Congress. It doesn't target the cost of malpractice litigation and defensive medicine.

     
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    Obama's third answer is welcome, but can he succeed? If he could not or chose not to raise revenue more substantially or reduce entitlement benefits while pleasing the Democratic faithful with universal health care, why would he fare better when he has no goodies left to offer?

    The root difficulty is Obama's insistence that the nation can afford a large new social program without raising taxes on anyone who earns less than $250,000 per year.

    Under his plan, according to a CBO analysis, the government will be spending 24.5 percent of gross domestic product -- the total value of the national economy -- by 2019 while raising only 19 percent in revenue: a huge, unsustainable gap.

    In the kind of fiscal crisis that might ensue, as progressive budget expert Robert Greenstein said recently, "the risk is high that the people with the least political power in this country could bear a disproportionate share of the burden even though, by and large, they're lower on the income scale." The government would spend more and more on interest payments while likely stinting on college scholarships, inner-city schools, and, above all, aid to the poor and near-poor here and abroad.

    Expanded access to health care has rightly been a goal for decades. No civilized nation should allow sick people to go untreated. Yet neither should a civilized nation saddle its coming generations with a lower standard of living, a likely effect of U.S. profligacy if unchecked. No civilized nation should leave its government too bankrupt to help the poor.

    Is there a way out of this dilemma? Cling to a hope that, as the bill winds through the Senate and conference, Obama puts his clout behind the progressive ideals of thrift and cost containment as well as universal access.

    fredhiatt@washpost.com

     

  • 11-11-2009 12:12 AM In reply to

    Re: A high price for health reform

    InnaD  I think the author of the article has been badly misinformed.  I read the entire CBO analysis and they said that without the healthcare reform the healthcare would continue to grow at a rate that was unsustainable and would continue to increase the deficit but that with healthcare reform and medicare spending was the major thing considered that the rate of increase would drop from 8% a year to 6 % and would be sustainable if the healthcare reform was passed.

     I copied a part of the CBO report below which dealt with medicare spending and everything was allowed to be counted as far as I could tell. 

    Based on the extrapolation

    described above, CBO expects that Medicare spending under the bill would

    increase at an average annual rate of roughly 6 percent during the next two

    decades—well below the roughly 8 percent annual growth rate of the past

    two decades, despite a growing number of Medicare beneficiaries as the

    baby-boom generation retires.6

    The long-term budgetary impact of H.R. 3962 could be quite different if

    those provisions generating savings were ultimately changed or not fully

    implemented. If those changes arose from future legislation, CBO would

    estimate their costs when that legislation was being considered by the

    Congress.

  • 11-11-2009 12:52 PM In reply to

    Re: A high price for health reform

    I just wish I could understand the bill myself and didn't have to listen to what other people and government organizations like CBO say about it. lol

  • 11-11-2009 1:05 PM In reply to

    Re: A high price for health reform

    So I'm trying to read the bill again, *sigh*, and even the first sentence I don't like - To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. WHAT OTHER PURPOSES?
  • 11-11-2009 10:48 PM In reply to

    Re: A high price for health reform

      The CBO is not really an arm of the government like congress,  it is not politicians, but people hired from the private sector, republican, democrat, and independents that majored in economy in colleges,  to do the analysis and budget projections, and they work with the tax Policy Center which also is not a government organization  in order to make their projections. That is why Congress gets stumped by them on both sides of the aisle when the CBO gives their analysis, because most of the time it is far different than what Congress thinks it should be.

    There are several analysis on several different healthcare bills so you have to make sure you are reading the right one.

    For the latest bill,  I googled CBO analysis for healthcare bill passed by the house.   I will get you a link when I get the chance, and maybe we could discuss some of the things I don't understand either.

    I know some of the other purposes include a 500 billion cut in medicare spending by restructuring,  funding cuts to hopitals with high rates of no pay emergency room patients which will encourage them to take more insured and less illegals and uninsured patients except for dire emergency cases.   A lot of people don't like this, and I don't blame them, because some of  the high HSE hospitals may not  make it without the fundinng, but something has to be done because the current system just costs more than what can be paid for.

    There is an accredited non-partisan independent site,  I came across once that gives a summary of the CBO analysis that is much easier to read and understand than the CBO wordings. I will see if I can find that also, when I get a chance.

     

  • 11-12-2009 12:26 PM In reply to

    Re: A high price for health reform

    In my humble opinion, we need health reform but can't pay for it. Therefore, we don't get it !

    The govt. can defecit finance till we're totally broke. You and I Barb have to pay as we go or risk the repo man.

  • 11-12-2009 3:35 PM In reply to

    Re: A high price for health reform

     SamWham  , it seems the main problem here is being overlooked,  

    Without healthcare reform we are facing more debt because the current system is more expensive than what CAN be paid for.

    One of the most important aspects of healthcare reform is to bring the costs down so that it will be sustainable.

    I would say we can not afford NOT to have healthcare reform.

  • 11-13-2009 10:27 AM In reply to

    Re: A high price for health reform

    People need to be pushed into making healthier choices, living healthier lifestyles. It's not difficult to stay healthy. It shouldn't be expensive either. To me it's simple. We have insurance only for emergencies or if we'll have more kids. I just don't think it's fair that we should pay for everybody who doesn't care about their health until it's too late.

  • 11-13-2009 11:42 AM In reply to

    Re: A high price for health reform

    I agree InnaD,  the problem is we are already paying for it and far too high a price, I am all for paying less myself.

    And it isn't for just those that don't try to live healthy lifestyles, accidents happen, broken bones, etc., and even some of the healthiest people do get sick.

    The way the system is now we will continue to pay more and more, reform is badly needed to cut the cost.

    I know where people are coming from on anything that is connected to any kind of tax increase,  the tax cuts under Reagan and then Bush were hard fought for and nobody wants to reverse those.    The problem is that these tax cuts were not paid for and only contributed to large deficit growths, did not promote sufficient job growth. wages remained stagnate and cost of living increased considerably and sales declined accordingly, and our economy tanked.

    And now we have an ever increasing problem with healthcare which is the most serious contributor to the deficit problem and has to be addressed.  We have lower and middle income workers who just don't have the income to meet increasing healthcare costs, and we have Ceo's, company owners,  and politicians who make thousands more every single day than workers do in whole year. 

     We have three options, make things worse than what they are, let things slide and continue to worsen on their own, or deal with the most expensive problem which is healthcare, and in order to deal with it some money has to come where there is money.

     

  • 11-14-2009 7:18 PM In reply to

    Re: A high price for health reform

    Barbara, I don't know how much you trust the doctors, big pharma, etc. but I don't. Most of the doctors are in it for the money, others just don't know better. Once people start the medication they have to continue with it all their lives, which destroys their organs one by one. They don't cure the diseases, they only treat the symptoms for a little while. And we shouldn't be paying for it, we should be looking for the alternative treatments.

    There's a good movie about it, "first do no harm", everybody should watch it. It's about a boy who had epilepsy, how drugs after drugs were making him sicker and sicker and how his mother's love won in the end. It's based on a true story.

  • 11-15-2009 3:16 AM In reply to

    Re: A high price for health reform

    I agree with you,  I have been thru it myself where medication caused more problems and did not help at all.   As a result of my own experience I would only take prescription medication as a last resort.  But then I also had to have surgery that saved my life so a person just has to use common sense and try alternative methods and if they work they are much better off, but if they don't then they need to be able to go to the doctor

    Because doctors are needed sometimes no matter how healthy a lifestyle people live like when accidents happen that result in broken bones, or serious auto accidents, serious heart disease, or other serious genetic diseases and all alternative methods tried have not been successful.  My husband also hates pills and going to a doctor  has had chronic asthma since childhood has tried numerous alternative methods with no success, and has to depend on an inhaler to be able to breath and  there are many other things that doctors are needed for. 

    My mother-in-law is an amazing woman whose life is being prolonged and have allowed her to continue to be mobile and not bedridden thru dialysis and blood transfusions and weekly shots that cost 600 dollars a shot due to terminal illnesses. It is temporary, but the extra time is precious for all of us.

    But everybody has to follow their own beliefs and what they think is best, and I don't fault anyone for doing that.

      For me I do think healthcare reform is badly needed.    I don't like everything about the healthcare reform being proposed, but I like it better than maintaining the status quo and doing nothing, and I like it better then the alternative proposal.

    Even without the CBO analysis that showed the alternative proposal would be really bad for consumers but a great boon for insurance companies,   just the fact that the republicans had eight years to pass some of the things they have proposed and did not even try convinces me that they had their chance and have no intentions of trying to improve conditions for consumers.

  • 11-16-2009 10:14 AM In reply to

    Re: A high price for health reform

    What I don't like is when the governmet pretty much says that the only way to get better is through medical doctors and hospitals. It's just not true. They should be telling people to take better care of themselves first. That will cut on the healthcare costs dramatically, imho.

    Another thing I don't like is that the governmet approves harmful additives in our foods (as long as their listed with ingredients) and pushes people into taking vaccines with dangerous preservatives. I think that needs to be addressed before government takes over the health insurance.

  • 11-17-2009 3:29 AM In reply to

    Re: A high price for health reform

     Actually InnaD one of the major parts of the healthcare proposal is to promote healthy living styles and preventative practices thru diet, exercise, etc etc. 

     And it is not a government takeover of health insurance that is being proposed. 

      Insurance companies would continue to operate independently of the government and would just be required to meet some standards that they are currently not required to do,  and they will also have the opportunity IF they choose and qualify to offer insurance thru a public option exchange consisting of a pool of private insurance companies which will be offered to the public by the government.

     The alternative is higher and higher insurance premiums, increasing numbers of uninsured, more and more people being denied coverage despite paying insurance premiums,  and a ever increasing cost to the deficit, so if it doesn't pass this time eventually it will pass, only it will cost a whole lot more.  And the longer it is put off the more likely it is due to more support from people needing healthcare that instead of a public option consisting of private insurance companies we would go to universal healthcare.

     I think you are confusing the government with private corporations on the food issue,  the government sets regulations and restrictions on what is allowed in our food and the private corporations, farmers, pharmaceutical companies, major food corps, etc are constantly lobbying and fighting the restrictions to be allowed to put what they want to in our drugs and food. Without the FDA restrictions and regulations it would be a great deal worse than it is now.

     On the vaccinations, well we had serious epidemics in this country of deadly and highly contagious diseases before vaccinations became the norm,  polio, small pox, tuberculosis, diptheria, these diseases were dreaded by everyone in this country.  When the memory of the epidemics was still strong people did not have to be encouraged to take the vaccinations because they were just glad to get them. 

      Now that the vaccinations have stamped out these diseases for so many years, people are fearing the vaccinations more than they do the diseases.  But when we have more epidemics again in the future from people refusing the vaccinations then that will change again.

     The American citizens that are elected to represent us, the medical associations, CDC, etc etc., natually fear that if vaccinations are discontinued that we will once again have serious epidemics that hit whole areas and cause massive deaths, and they could be even worse due to mutations than what was faced in the past.  And of course they don't want the diseases becoming epidemics again in order for people to be once again asking for the vaccinations instead of fighting against them.

     

     

    The history of the rise and fall of smallpox is a success story for "modern" medicine and public health. Even though the disease has been eradicated, the threat of its return has once again brought it to the forefront of public controversy.

    The origin of smallpox is uncertain, but it is believed to have originated in Africa and then spread to India and China thousands of years ago. The first recorded smallpox epidemic was in 1350 BC during the Egyptian-Hittite war. Smallpox reached Europe between the 5th and 7th centuries and was present in major European cities by the 18th century. Epidemics occurred in the North American colonies in the 17th and 18th centuries. At one time smallpox was a significant disease in every country throughout the world except Australia and a few isolated islands. Millions of people died in Europe and Mexico as a result of widespread smallpox epidemics.

    The fall of smallpox began with the realization that survivors of the disease were immune for the rest of their lives. This led to the practice of variolation - a process of exposing a healthy person to infected material from a person with smallpox in the hopes of producing a mild disease that provided immunity from further infection. The first written account of variolation describes a Buddhist nun practicing around 1022 to 1063 AD. She would grind up scabs taken from a person infected with smallpox into a powder, and then blow it into the nostrils of a non-immune person. By the 1700's, this method of variolation was common practice in China, India, and Turkey. In the late 1700's European physicians used this and other methods of variolation, but reported "devastating" results in some cases. Overall, 2% to 3% of people who were variolated died of smallpox, but this practice decreased the total number of smallpox fatalities by 10-fold.

    The next step towards the eradication of smallpox occurred with the observation by English physician, Edward Jenner, that milkmaids who developed cowpox, a less serious disease, did not develop the deadly smallpox. In 1796, Jenner took the fluid from a cowpox pustule on a dairymaid's hand and inoculated an 8-year-old boy. Six weeks later, he exposed the boy to smallpox, and the boy did not develop any symptoms. Jenner coined the term "vaccine" from the word "vaca" which means "cow" in Latin. His work was initially criticized, but soon was rapidly accepted and adopted. By 1800 about 100,000 people had been vaccinated worldwide.

    The "modern" vaccine that was licensed by the FDA was taken from a weak strain of virus called the New York City Board of Health strain. It was produced by Wyeth Laboratories and licensed under the name Dryvax. The last outbreak of smallpox in the United States occurred in Texas in 1949 with 8 cases and 1 death. Even though most of North America, Western Europe, Australia, and New Zealand were free of smallpox by this time, other countries such as Africa and India continued to suffer from epidemics.

    In 1967 the World Health Organization (WHO) started a worldwide campaign to eradicate smallpox. This goal was accomplished in 10 years due in a large part to massive vaccination efforts. The last endemic case of smallpox occurred in Somalia in 1977. On May 8, 1980, the World Health Assembly declared the world free of smallpox.

    The United States stopped vaccinating the general population in 1972, but continued to vaccinate military personnel. It was recommended that vaccination of military personnel stop in 1986, and vaccination was officially stopped in military recruits in 1990.

     

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