Tuesday, September 15, 2009

Garrison Keillor | Writer, 67, has stroke, lives to write about it

As summer drew to a close Garrison Keillor of Lake Wobegon, Minnesota survived a stroke in St. Paul and lived to write about it. Here's part of what Mr. Keillor wrote in his first column back at Salon.com.
The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture, and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity.

And that is a gift to the man who has been struck by a stroke: our common humanity. It's powerful in a hospital. Instead of a nice linen jacket and cool jeans and black T, you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath," and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin.

Two weeks ago, you were waltzing around feeling young and attractive, and now you are the object of Get Well cards and recipient of bouquets of carnations. Rich or poor, young or old, we all face the injustice of life -- it ends too soon, and statistical probability is no comfort. We are all in the same boat, you and me and ex-Gov. Palin and Rep. Joe Wilson, and wealth and social status do not prevail against disease and injury. And now we must reform our health insurance system so that it reflects our common humanity. It is not decent that people avoid seeking help for want of insurance. It is not decent that people go broke trying to get well. You know it and I know it. Time to fix it.



photo by L-T-L

Monday, September 14, 2009

Health Care Reform | Two Old Friends Chat Each Other Up


A note from an old friend begins...

Hey Jim, since you've gone political on us, a few questions. First, where is your proof for all these claims? Second, where is Obama's "plan" so I can read it? He's never put it in writing. It remains a moving target. Third, all these points are high claims, most of which are being disputed by reputable people and groups, even within Obama's camp (ie. the CBO). I'm sorry, but most of us don't want the government to mess with the world's best heath care. :)


And I respond...
hey; nice to hear from you. I haven't used any numbers that aren't documented in the links from the blog posts in this series on health reform. I'll be happy to dial that in for you if you have trouble finding something.

I ought to have linked this morning's post—sorry; i thought it was more widely available than perhaps it is. You can find the list of essentials here.

The Congressional Budget Office is not in President Obama's camp any more than the Institute of Medicine that produced the 2004 guiding principles was in President Bush's camp. The CBO is chartered specifically to provide economic data to Congress.

My understanding of the CBO health care numbers that seem, as far as I can tell, to be thrown around fairly haphazardly, is that they were requested and delivered in response to first drafts of the health care bill while it was still in committee—multiple committees if I have the story right.

So it's like the first blue sky draft of most any kind of budget: Everyone on the committee puts in everything he or she would like to have and, if it's a good brainstorm, nobody says "we can't afford that" because nobody knows what it costs yet and there are no bad ideas in a first draft.

It's the job of CBO to count costs, not make policy. They put a good faith estimate on what's placed before them and, in many cases—probably most—the sticker price for the gold-plated, handmade, spare not expense first draft of the plan is a splash of cold water in everybody's face. I imagine you've read some film scripts that reflect that process.

Harmonizing a bill that's actually deliverable is what the committees have to do before they put it on the floor of the House or Senate to be further amended and sent yet again to the CBO for cost analysis.

The CBO letter to Congressman Rangel on July 17, 2009 roughly projects the House bill (H.R. 3200) as proposed would produce a reduction of the deficit of about $44BN from 2010-2014 and an increase to the deficit of about $65BN from 2015-2019. These numbers are nothing like the ones thrown around in Knucklehead Nation which I think, generously, must have come from the CBO estimates on the first draft.

So, already, the bill the House is considering is more measured than most of us have been led to believe, and it will be even more realistic before they're done with it.

All this craziness about ObamaCare from the Knuckleheads has been sound and fury signifying nothing but their knuckleheadedness because, as you note, other than what he posted during the campaign (which I don't think many people actually read) he hasn't put a plan in play until now—he is not, after all a legislator and seems to respect the separation of powers to a degree that makes his predecessor look like the socialist dictator his detractors claim the president is.

Putting his plan up now, as chief executive and leader of his party seems about right to me, but I think he's mostly right about this stuff so take that for what it's worth.

...and with this I close: By the end of 2008, the percentage of Americans covered by government-sponsored health insurance plans rose to 29%. Increasingly, I think the "most of us don't want this" refrain depends on getting the right people in the room (or studio) and wording the questions very carefully. In the last decade—much of which was decidedly Republican depending on how you look at it—private health care subscribers grew by one tenth of a percent while public health care subscribers grew by nearly 30%. Assuming a lot of that growth is Boomers, we're not going to see a decline in that shift any time soon.


OK, I'll try to tackle these one at a time. My point in citing the CBO (part of the gov't.) is that it is contrary to Obama's preposterous claim that it won't cost us (the taxpayers) a nickel or add a dime to the deficit.

The Knuckleheads you talk about are, in many cases, disputing Obama's claims and can substantiate their arguments as good or better than Pres. O can. But we're just talking generalities here...

And yes, I'll stand with my comment that the President really has no "Plan". Its not written anywhere and never has been. His speeches have put it in play but its like nailing jello to the wall. Let's see the "Plan" and then lets debate the merits, the solutions and the costs. Wouldn't that be fair?

And the House Plan is so great that every member of Congress is making sure that they are exempt from it!


Well, you didn't cite the CBO, you mentioned it, vaguely and not in a particularly accurate manner. I'll be happy to have you take me to school on what the CBO has said that's more recent or factual or conclusive than the July 17, 2009 letter to Congressman Rangel I linked to above that relates to H.R.3200 as proposed, the only actual health care bill under consideration as far as I know until a) the House does its magic and b) the Senate puts a bill on the table.

No offense intended here, but if you have a case to put forward, please do so. "There are Knuckleheads who disagree" is not a case I can engage.

I couldn't agree more, with your contention that we need to see the president's plan and debate the merits, solutions and costs. That's entirely fair. At the end of the day, of course, the law that's enacted will be legislation harmonized between the House and Senate versions. I think the president is obliged to speak into that process but he's not a lawmaker anymore. American democracy is a beautiful thing...especially when everyone works together.

You're the second person who's mentioned that exemption thing today and I have to admit I'm not familiar with it. I haven't found it in H.R. 3200 (which, not to beat a dead horse, is the only bill under active consideration at present). Can you direct me to something definitive on the subject?


The exemption for Congress has been around since at least the early 90's, as far as I can tell. Here's a couple of links:

here and here.


Jim, thanks for batting this back and forth with me. But I don't want to get lost in the controversies. Can we agree on a few basic points? Would you agree:

1. that we have the best healthcare in the world?
2. that, unfortunately, healthcare insurance seems to cost way too much?
3. that it would really be nice if everyone could afford to have excellent health insurance?

I think that is the basic problem - affordability.


You wrote: "The exemption for Congress has been around since at least the early 90's, as far as I can tell..."

I suppose I hadn’t heard anything about it because it’s a red herring and hasn’t been part of the serious discussion of health care reform.

Here’s a research-based examination of the question from the St. Petersburg Times' Pulitzer Prize-winning Politifact.com.

and

"1. that we have the best healthcare in the world?"

You’d think, wouldn’t you? But the outcomes don’t support that assumption. The most recent evidence based study I know of—published by The Commonwealth Fund in May 2007—compared health care over time in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. US health care ranked sixth. You can download the report here.

and

"2. that, unfortunately, healthcare insurance seems to cost way too much?"

I wouldn’t say it’s unfortunate, I would say it’s contrary to American ideals.

and

"3. that it would really be nice if everyone could afford to have excellent health insurance?"

Yes. And I would add that I think it’s really not nice to stand in the way of that.



photo by Zavosh

Thursday, September 10, 2009

we're number 37!



After days and days of earnest posting, this from Paul Hipp
(with a h/t to Heidi Wagner Turner!).

The President's Plan for Health Reform

Here are the essential features of the health care reform plan President Obama champions:

If You Have Health Insurance,
the President's Plan:


• Ends discrimination against people with pre-existing conditions.
• Limits premium discrimination based on gender and age.
• Prevents insurance companies from dropping coverage when people are sick and need it most.
• Caps out-of-pocket expenses so people don’t go broke when they get sick.
• Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
• Protects Medicare for seniors.
• Eliminates the “donut-hole” gap in coverage for prescription drugs.

If You Don’t Have Insurance, the President's Plan:

• Creates a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices.
• Provides new tax credits to help people buy insurance.
• Provides small businesses tax credits and affordable options for covering employees.
• Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.
• Immediately offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

For All Americans, the President's Plan:

• Won’t add a dime to the deficit and is paid for upfront.
• Requires additional cuts if savings are not realized.
• Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.
• Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.
• Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.
• Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.


photo by artbymags

Tuesday, September 08, 2009

What Sort of Health Care Reform?


In 2004, the Institute of Medicine, one of the congres-
sionally chartered United States National Academies, published the conclusion of its multi-year study of health care in the United States in the form of "a set of guiding principles based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance."

Most of what is in those reports is publicly available, with percentages updated through 2007 or later, so I won't go into detail about those numbers except to say they have tended to become more dire in the five years since publication of the final IOM report, Insuring America's Health: Principles and Recommendations (e.g. the number of excess deaths attributed to uninsurance rose from around 18,000 Americans in 2004 to around 22,000 in 2006—that's about a 20% increase in the number of Americans who died for lack of medical coverage).

Here are a few facts uncovered in the IOM's meticulously evidence-based reporting that I have not found in the discourse this year, followed by the "guiding principles" in the report:

• About four out of five uninsured people in the U.S. are citizens.

• Just over 55% of uninsured Americans are in households with at least one family member who is fully employed. Nearly 14% are in households with two full-time workers.

• The cost of employment-based insurance increased by 260 percent between 1977 and 1998, and the employee’s share increased by 350 percent — while median household incomes only increased by 17 percent (all in constant 1998 dollars)—you know how those costs have accelerated in the new century.

• About 58% of uninsured adults in the reporting period had changed or lost jobs in the previous year—this is well before the job collapse of 2008-09.

• The cost to the U.S. economy in lost productivity from uninsured Americans ran as high as $130 billion a year—nearly twice as much as it would have cost to insure those Americans outright.


The IOM report made the following recommendations in the strongest terms:

1. Health care coverage should be universal—nobody left out.
2. Health care coverage should be continuous—no gaps due to job status.
3. Health care coverage should be affordable to individuals and families—no more medical bankruptcies.
4. The health insurance strategy should be affordable and sustainable for society—weighing all outcomes, costs and savings over time, U.S. health care should benefit the nation, not run it into the ground.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable—what's not to like about better health care?

You can read all this for yourself and I hope you will. The individuals who conducted the studies and analysis and issued the guidelines were a blue-ribbon, nonpartisan committee of genuine experts. As far I can judge, no stakeholders in the future of U.S. health care were left unrepresented with the possible exception of lawyers.

They concluded with the charge:
The Committee calls on the federal government to take action to achieve universal health insurance and to establish an explicit schedule to reach this goal by 2010.

Imagine what the country would be like if everyone had coverage—people would be financially able to have a health problem checked in a timely manner, to obtain preventive and primary care, and to receive necessary, appropriate and effective health services. Families would have security in knowing that they had some protection against medical bills undermining their financial stability. Key community providers and health care institutions could provide care to those who need it without jeopardizing their financial stability.

This picture can become reality, with the right mix of leadership and political will. Unchecked, the costly consequences of the status quo are too large to sustain. It is time for our nation to extend coverage to everyone


Yes, imagine. And then communicate the substance of these recommendations to your U.S. senators and representatives—especially the knuckleheads who act as if they've never heard of the report they commissioned the Institute of Medicine to research and write (I'm looking at you Congressman Bilbray). The health care reform we need calls for the right mix of leadership and political will. This may be one of those instances in which, if the people show the will, the leaders will follow.

But don't mistake this for a political game. "Unchecked," the IOM declares, "the costly consequences of the status quo are too large to sustain (I think the economist on the committee crafted that sentence)."

"It is time for our nation to extend coverage to everyone." Now. How are we going to do it?

Wednesday, September 02, 2009

Health Insurance Reform | Context is Everything Beetlejuice


It doesn't seem that Beetlejuice is in any mood to be reasoned with by the likes of me.

But on the offhand chance you're still reading and thinking, I want to counter his challenge about what's on "page 16" of H.R. 3200, America’s Affordable Health Choices Act of 2009 as proposed.

In a comment, Beetlejuice wrote:
BTW-here's p. 16 which states if you don't re-up your private insurance-you have to take the govt plan.

10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef-
15 fective date of coverage is on or after the first
16 day of Y1.

Indeed, those words are on page 16. If you note the line numbers to the far left you see immediately that what's missing is lines one through nine and 17 through the end of the page (and what comes before and after page 16 for that matter).

The lines he quotes are a subsection beneath the header:
1 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.

Line three sets the agenda for the next several lines:
3 (a) GRANDFATHERED HEALTH INSURANCE COV
4 ERAGE DEFINED

You can go there yourself. What you'll find as you read the offending lines in their context is that the section is explaining the term “Grandfathered Health Insurance Coverage” which means, "individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:" (and that gets us through line nine of page 16).

In general the passage explains that existing coverage is grandfathered into the new system (hence “Protecting the Choice To Keep Current Coverage”) if the coverage is in place before the new system begins. Otherwise it is new coverage, not grandfathered coverage.

New customers can’t be enrolled in grandfathered coverage—because, by definition that would be new coverage, not grandfathered coverage. The exception to this is dependents who may be added to grandfathered coverage

The section goes on to protect those enrolled in grandfathered coverage from reductions in benefits, increases in cost-sharing and what amounts to noncompetitive raises in the rate of premium increases. Strictly speaking, I suppose the passage prohibits increasing benefits and reducing cost-sharing in grandfathered coverage...but I don’t see any clear and present danger of insurers fighting Congress for the right to offer more benefits for less money.

It goes on to say that if your grandfathered coverage does not meet minimum standards for benefits, limits on cost-sharing and no annual or lifetime limits on coverage, with certain exceptions, the plan will have a five year grace period to raise the quality of coverage to meet or exceed that standard of consumer protection or be declared a non-qualifying benefit plan.

The notion that Congress seeks to pass a law protecting citizens from abuse by corporations with a demonstrated willingness to take advantage of their customers in any way the law does not explicitly forbid isn't even a little bit threatening.

I strongly recommend we take the the lines that so frighten Beetlejuice in context, the way they were drafted; the way they were meant. Otherwise we are stuck believing there is a conspiracy afoot at the end of which is Beetlejuice's conception of Ayn Rand's worst nightmare.


photo by shadarington

Tuesday, September 01, 2009

The New Adventures of Knucklehead Senator



Knucklehead Senator says:
At the end of the day, my constituents can rest assured I will have done absolutely nothing to help this great nation address the staggering problems brought on by a failed health care regime. God bless America.

Knucklehead constituents say:
Yay!

— RANTS + REFLECTIONS ON THE COMMON GOOD —

[mostly]