There is one certainty in the era of the new federal health law — nothing in U.S. health policy will ever be the same.
Every week events take place — regulations are issued, grants are awarded and provisions, such as the 1099 reporting requirement that raised revenue to pay for the measure, face congressional challenges. Each development marks one more step in the continuing transformation of the health system — changes now put in motion by the sweeping overhaul. In this vein, President Barack Obama’s surprise signal last week to governors that he was willing to give states some extra flexibility in implementing the law is particularly noteworthy because it offers a useful window into the health law’s evolving politics and the future bargaining that will likely take place.
The health care community is discovering to its shock and dismay that it’s not simply traditional Republican conservatives who have taken control of the House of Representatives, it’s a new group of cynics.
Conservatives, like liberals, have a more-or-less coherent set of ideas. They use political power to push preferred policies, whether related to health care, housing or a hundred other possible issues. William F. Buckley Jr., one of the fathers of modern American conservatism, “had a way of … making conservatism a holistic view of life not narrowed to the playing fields of ideology alone,” as one admirer put it.
By now, everyone has seen the young Google executive, Wael Ghonim – credited with starting the Egyptian revolution via Facebook – proclaiming his willingness to die for the cause. I predict he will not only become an Egyptian national hero, but that one day he will be nominated for the Nobel Peace Prize.
But, where, oh where, is the Wael Ghonim of health care? Who is out there that will proclaim that they will fight to the death (or even fight to a bit of discomfort) for the cause of health reform. I don’t know anyone – right, left or center- that, when speaking honestly and in private, will say that the US health delivery “system” is working for the American people – you remember those folks, the ones we hear about so often during hotly contested political campaigns.
First published 2/9/11 on Health Policy and Marketplace Review
Word is that House Republicans will attach an amendment to the latest federal spending bill that will cut-off funding for the health care bill.
The last Congress never finalized a budget for the current fiscal year—the feds have been operating under a series of continuing resolutions. The most recent one will expire on March 4th. If another resolution is not agreed to, much of the government has to shutdown.
Last week, before a lower federal judge in Florida declared the Affordable Care Act unconstitutional, another relatively obscure government figure generated news about health care reform. It was Richard Foster, the chief actuary at the federal agency that runs Medicare and Medicaid.
During a Capitol Hill hearing, Foster was asked to judge claims that the health law would “hold down costs.” Foster said he thought the claim was “false … more than true.” Critics of the overhaul seized on his comments as proof that they have been right — and proponents have been wrong — about the law’s fiscal impact.
The health reform debate, they say, is between those who would use government regulation to try to control growth of health care spending and those who would rely on cost-conscious consumers operating in a competitive market place. The right way to reform health care, they say, is not government regulation but rather by shifting to a defined-contribution system in which people would bear the full marginal costs of insurance they buy. Medicare beneficiaries and Medicaid recipients should be given vouchers for the purchase of health insurance. Employers should do the same with private employees. The recently enacted health reform legislation, they say, extends fee-for-service medicine. For that reason, it should be replaced.
Originally published 1/11/11 on Kaiser Health News
The Congressional Budget Office’s budgetary scoring of the health reform law has returned as a subject of debate. At issue is whether health reform will really reduce the deficit by $143 billion through 2019 as the CBO predicted last year. It’s a legitimate question, but focusing on it misses the most important message conveyed by CBO estimates
Republicans in the House, who are intent to repeal the new health law, contend that eliminating it wouldn’t really increase the deficit. It’s an argument that makes sense if one is willing to reject the CBO’s deficit-reducing score of the law, and many are. There are good reasons to be skeptical that the law will in fact reduce the deficit.
Now that I’m trying to fill this site with an interesting and varied diet of serious health care materials, I’ve taken, among other approaches, to trolling for videos and news stories that do what they do well. The Web is overflowing with hare-brained I-Hate-and I-Love ObamaCare videos by people who don’t have enough knowledge or insight to know what they’re talking about, but every once in a while I come across something that’s fun and worth 3 minutes at a time. I present two modest examples below. Just for the weekend.
1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform.
It’s no secret that early generations of Social Security beneficiaries got more out of the system than they paid into it. Beneficiaries in the 1940s and 1950s paid very low Social Security taxes for only a few years, then retired and received benefits for the rest of their lives. Until recently, in fact, almost all generations of retirees fared rather well. After all, the combined employer and employee tax rate for Old Age, Survivors, and Disability insurance, or OASDI, was kept low relative to benefits that would later be received. That combined rate equaled only 3.0 percent of earnings in 1950 and 6.0 percent in 1960, and it didn’t rise to its still-inadequate level of 12.4 percent until the late 1980s. Since most of these revenues weren’t saved, the increased OASDI tax rate supported ever-rising transfers to beneficiaries.
Just over one-half of U.S. employers plan to maintain their health plans in 2014 even if health insurance exchanges (HIEs) offer competitive priced health plans for individual employee health coverage, according to a survey of 1,400 employers by Willis and Diamond Management & Technology Consultants. 1 in 3 employers is not sure whether they’ll maintain their own health plan or shift employees toward an HIE.
Originally Published 11/22/10 here on Kaiser Health News
What if a Republican governor and a Republican legislature had the ability to implement their version of health insurance reform and the federal government would have to pay for it? It’s a great idea. And I’m thrilled to say that a bi-partisan bill has already been introduced in the Senate by Ron Wyden, D-Ore., and Scott Brown, R-Mass., that would help facilitate exactly this end.