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Tuesday, June 20, 2017


The GOP is still trying to sell the lame canard that "ObamaCare" was written and passed "in secret" by Democrats with no Republican input. That's simply not true. I followed every draft of the legislation as it wound its way through Congress. See my 2009 post "Public Optional."

It passed with no GOP votes, yes, but it did contain 147 GOP amendments, and had been the subject of many hours of hearings spanning a year.
"You're going to have such great health care, at a tiny fraction of the cost—and it's going to be so easy.” - Donald Trump, Oct 2016 rally in Florida
apropos of the federal health policy debate, see my prior post Rationing by "Price."
Just got my Miraca Life Sciences bill stemming from a recent local dermatology visit biopsy for a chronic arms and torso rash I've had for about 30 years. The "Billed Charges" total came to $1,565.00. Medicare paid $439.39. Part-B "Patient Amount due" was $112.11 (I paid it immediately). Were Trump HHS Secretary Tom Price to get his "balance billing" way, I'd be on the hook for an additional $1,013.40.
See also my prior posts on "An American Sickness." Buy her book. Also, stay up with the #ShowMeTheBill hashtag activity here.

Worth re-posting a quick graph I did a little while back.

The core question remains one of how we pay for health care equitably.


Just Google "H.R. 1628." 132 pages in my PDF download. 36 allusions to the administrative/regulatory discretion of "the Secretary" (HHS Secretary Tom Price -- e.g., "as the Secretary shall determine..." " determined by the Secretary"). The words "quality," "improvement," and "affordability" are nowhere to be found. "Subsidy"? How about "SEC. 131. REPEAL OF COST-SHARING SUBSIDY." (pg. 59)

Hmmm... "Sec. 117. Permitting States to apply a work requirement for nondisabled, non-elderly, nonpregnant adults under Medicaid."

Wonkistan will be busy today with reactions. News reports of protests and arrests outside Senator Mitch McConnell's office.
"FEHB" is not cited in the bill. FEHB is the program that gives members of Congress a 70% taxpayer subsidy on their health care premiums.

Click to enlarge.

Again, see my prior posts reviewing An American Sickness.

Let's see, the usual stuff: "A third to half of health care is wasteful, unnecessary, and even harmful, blah, blah, blah..." Not to summarily discount all of that widely repeated assertion, but we are not gonna Lean Process QI our way to macro expenditure reductions getting even close to that. Similarly with respect to more accurate dx's and more efficacious tx's. Health care will likely remain a vexingly expensive endeavor. I first addressed this stuff in 2009:
Some reform advocates have long argued that we can indeed [1] extend health care coverage to all citizens, with [2] significantly increased quality of care, while at the same time [3] significantly reducing the national (and individual) cost. A trifecta "Win-Win-Win." Others find the very notion preposterous on its face. In the summer of 2009, this policy battle is now joined in full fury.
BTW, per this post, I should add that I don't buy the claim that everyone in the space is "losing money."

Our politics are divided. They have been for a long time. And while I know that division makes it difficult to listen to Americans with whom we disagree, that’s what we need to do today.

I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party. Still, I hope that our Senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on health care or any other issue, must be something more than simply undoing something that Democrats did.

We didn’t fight for the Affordable Care Act for more than a year in the public square for any personal or political gain – we fought for it because we knew it would save lives, prevent financial misery, and ultimately set this country we love on a better, healthier course.

Nor did we fight for it alone. Thousands upon thousands of Americans, including Republicans, threw themselves into that collective effort, not for political reasons, but for intensely personal ones – a sick child, a parent lost to cancer, the memory of medical bills that threatened to derail their dreams.

And you made a difference. For the first time, more than ninety percent of Americans know the security of health insurance. Health care costs, while still rising, have been rising at the slowest pace in fifty years. Women can’t be charged more for their insurance, young adults can stay on their parents’ plan until they turn 26, contraceptive care and preventive care are now free. Paying more, or being denied insurance altogether due to a preexisting condition – we made that a thing of the past.
We did these things together. So many of you made that change possible.

At the same time, I was careful to say again and again that while the Affordable Care Act represented a significant step forward for America, it was not perfect, nor could it be the end of our efforts – and that if Republicans could put together a plan that is demonstrably better than the improvements we made to our health care system, that covers as many people at less cost, I would gladly and publicly support it.

That remains true. So I still hope that there are enough Republicans in Congress who remember that public service is not about sport or notching a political win, that there’s a reason we all chose to serve in the first place, and that hopefully, it’s to make people’s lives better, not worse.

But right now, after eight years, the legislation rushed through the House and the Senate without public hearings or debate would do the opposite. It would raise costs, reduce coverage, roll back protections, and ruin Medicaid as we know it. That’s not my opinion, but rather the conclusion of all objective analyses, from the nonpartisan Congressional Budget Office, which found that 23 million Americans would lose insurance, to America’s doctors, nurses, and hospitals on the front lines of our health care system.

The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Those with private insurance will experience higher premiums and higher deductibles, with lower tax credits to help working families cover the costs, even as their plans might no longer cover pregnancy, mental health care, or expensive prescriptions. Discrimination based on pre-existing conditions could become the norm again. Millions of families will lose coverage entirely.

Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

I hope our Senators ask themselves – what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid? What will happen if you have a medical emergency when insurance companies are once again allowed to exclude the benefits you need, send you unlimited bills, or set unaffordable deductibles? What impossible choices will working parents be forced to make if their child’s cancer treatment costs them more than their life savings?

To put the American people through that pain – while giving billionaires and corporations a massive tax cut in return – that’s tough to fathom. But it’s what’s at stake right now. So it remains my fervent hope that we step back and try to deliver on what the American people need.

That might take some time and compromise between Democrats and Republicans. But I believe that’s what people want to see. I believe it would demonstrate the kind of leadership that appeals to Americans across party lines. And I believe that it’s possible – if you are willing to make a difference again. If you’re willing to call your members of Congress. If you are willing to visit their offices. If you are willing to speak out, let them and the country know, in very real terms, what this means for you and your family.

After all, this debate has always been about something bigger than politics. It’s about the character of our country – who we are, and who we aspire to be. And that’s always worth fighting for.

More to come...

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