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Posts Tagged ‘health care

The Congressional TP is wrong…and it is killing the GOP.

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Is the New Yorker wrong or has the GOP gone GOP Elephant Closes Governmentover the top? I’m of the opinion that the GOP is hurting themselves for a generation if the most hardline members of their base continue this quixotic campaign. There are a lot of things about the ACA that could and should be fixed that would enable better growth in our economy, but the GOP has not offered any alternatives that fixes the problems of coverage, affordability with consumer protections, or bends the medical cost curve that the nation, as a whole, supports. If the nation had, Romney would be president right now.

What the Republican intransigents were willing to deprive of funds, besides the Capitol police, included the following: The Centers for Disease Control, which said that it would have to stop its seasonal flu-prevention program and would “have significantly reduced capacity to respond to outbreak investigations.” The Environmental Protection Agency, which would close down almost entirely, and the Occupational Safety and Health Administration, which would stop most of its inspections. The WIC program, which provides healthy food supplements for millions of pregnant women, new mothers, and babies, and could run on temporary federal funds only through the end of the month. The Food and Drug Administration, which said it “will be unable to support the majority of its food safety, nutrition, and cosmetics activities,” and would have to halt “the majority of the laboratory research necessary to inform public health decision-making.” The National Institutes of Health, which announced that it would not be enrolling any new patients in ongoing studies or clinical trials.

Since Tea Party conservatives dislike the federal government on principle, the derailing of what the federal government does every day doesn’t bother them all that much. What should bother them, deeply, is the anti-democratic nature of the maneuver. To hold up a budget and shut down the government in order to sabotage a law you don’t like is not just nose-thumbing at the government; it’s flouting the will of the people. Obamacare passed both Houses of Congress nearly three years ago. In June, 2012, in an opinion written by Chief Justice John Roberts, the Supreme Court upheld the constitutionality of its fundamental elements. In November, 2012, Obama, who had devoted much of his political capital to the Affordable Care Act—it will likely be his signature legislation—was handily reëlected. And, last week, on the first day that you could sign up for insurance through the new health-care exchanges, 2.8 million people went on the federal government’s enrollment site. Surely that’s evidence that, whatever else Obamacare will prove to be, it is legislation that is fulfilling a real need: that of the fifteen per cent of the American population who are uninsured, as well as of individuals who are paying exorbitant sums for insurance on the open market, all of whom live with the insecurity of being unable to afford health care. In no small part, fixing this problem was what Barack Obama was elected to do.

In the meantime, the diehard opponents of the bill in Congress remain a faction within their own party, whom fellow-Republicans seem determined to identify by more and more outlandish epithets. To Representative Devin Nunes, a Republican from California’s Central Valley, they are “lemmings with suicide vests.” To Senator John McCain, they’re “wacko birds.” (He used the term in March, when Senators Rand Paul and Ted Cruz were filibustering the nomination of John Brennan for C.I.A. director; McCain later apologized, but Cruz, according to a profile in GQ, has embraced “wacko bird.”) To Representative Peter King, of New York, Cruz is the “con man” who knew “this would never work” but somehow “suckered” House Republicans. Cruz, meanwhile, compared those Republicans who were willing to vote on the budget—and let Obamacare proceed—to appeasers of the Nazis.

It’s worth remembering that in the early nineteen-sixties, when another health-care bill was under debate, the rhetoric of the Republicans who opposed it was just as over the top. We didn’t get socialism, as those opponents warned; we got Medicare, which turned out to be a very popular, mostly high-functioning program that saves elderly people from going bankrupt when they get sick. In the end, as the President says, that is the kind of outcome that the extremist Republicans running this budget battle fear the most: that Obamacare will work, and the Democrats will get credit for it. And what the mainstream Republicans fear the most is that voters will blame them for letting the lemmings run the show. If Obama refuses to back down, this could be a moment that will define his legacy—a fight for democracy as much as for Democrats. ♦

According to reports, the Dems already accepted the House budget numbers, which, in reality, are lower than the Ryan budget for the 6 week CR. Six weeks! It’s not like we’re talking about a full year, for heaven’s sake. That, in itself, is a great win for House Republicans. But attaching a defunding or delay in the individual mandate – that only applies to individuals who don’t get health insurance through their company – to the CR was always going to be a loser for the GOP which they should have known. First, most of the ACA funding is not part of the discretionary (aka annual) budget. It’s self-funded like Social Security or Medicare. Second, the Dems would never agree to delay it start up until close to the next election, making the ACA again another election year issue.

Moreover, using the debt ceiling as a negotiating strategy, regardless of how much the deficit is hated, is not acceptable. It’s one thing to decry how on the House or Senate floor how much the country is going into debt when you know the increase will happen anyway, but it’s another to threaten the US economy with default on the nation’s promises of payment. The debt limit and promised payments to our all of our nation’s creditors, whoever they may be, should never, ever be put at risk.

Yes, there is an ongoing disagreement over the size of the federal government. Some are good arguments, such as should the US be the world’s police force or have a huge, expensive national security state that infringes upon the rights of privacy of citizens, but some are bad arguments such as throwing the least able into the trash can of history. Can government work better? Clearly the answer is yes. Our federal government continues as a model of the 19th Century. But *only* Congress can change that antiquated model…and that change will only occur when committee power and fundraising models change.

Regardless, PIMCO’s El-Erian notes, the failure to increase to increase the debt ceiling would lead to a Great Depression worldwide and cause irreparable harm to the US in prestige, authority, and, most of all, to our status as the world’s reserve currency and the special borrowing rates that status implies.

Further, China, in 2011, when Congress last threatened the debt ceiling as a serious negotiating point, entered into talks with other BRIC nations to replace the US dollar as the world’s reserve currency. China, apparently, received a lot of support among those nations. Does anyone in their right minds believe that China will let go of their ability to reduce the status of the US dollar as the world’s reserve currency when it obviously is in their own interest to reduce the influence of the US? Although the Chinese did not say as much publicly, I am quite sure they would like the Renminbi become the world’s reserve currency.

If US voters do not understand the perils on the world stage and to the US economy of the Tea Party strategy, then God help us all.

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Written by Valerie Curl

October 9, 2013 at 9:23 PM

Conservative Health Ideology is Still Wrong…..

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Budget Cuts in 2011 Sign

I object to many of the points in this article published by the American Conservative Magazine…and many of its comments.

According to PEW, I’m a liberal. However, I do not believe in taxing hospitals and providers at extraordinarily (75%!) high levels as the American Conservative article claims all liberals want. Nor do I believe in making all doctors/practitioners state workers. I find these notions shocking and antithetical to our democratic principles. In addition, I do not agree that liberals want someone else to pay for our health care needs. All of my liberal, Democratic friends agree with me on these points. Conservative talking points about what liberals and Democrats is long out of date, thus making them no longer relevant.

I agree that more money should and could be put into health cure research. Curing diseases, as in eliminating them, does bring down cost of health care. However, contrary to what some people posted in the comments section, the fed government via the NIH has provided much of the needed funding for basic research. Health care companies, in general, have reduced their R&D budgets by billions as more me-too drugs and generics hit the market which means the NIH grants become all the more important. I realize this flies in the face of the oxymoronic notion that government cannot do anything right. Would those thinking this way say the same about the DoD and DARPA over the last 30-plus years? Tremendous research is being carried out all across the country by leading research labs and universities as a result of NIH and allied federal research institutes’ funding.

Third, regarding costs. When people talk about how much cheaper it was to get medical care back in the ’50s they fail to note how much medical care has changed since the ’50s. Technologically driven advances drove much of the increased costs. Comparing 1950s medicine to today is like comparing the Model T to today’s automobile. Ain’t gonna work! It’s why a comparison of the 1950s costs to today are totally worthless at best and deceptively ignorant at worst. By the way, health insurance was instituted by companies, as an employee recruitment draw, during WWII. You know, back in the early ‘40s. So, the ‘50s argument about costs is ludicrous on its face as most large companies already offered health insurance to their employees.

The author correctly states in his analysis that hospitals shift cost losses from ERs to all other areas of the hospital. If hospitals failed to do so, they’d go broke rapidly since EMTLA (since Reagan signed the law, hospitals cannot deny treatment to anyone without insurance, regardless of ability to pay cash) is the law for the land. Thus, ERs have become loss leaders even while being necessary as public/community services. But the medical establishment, in conjunction with politicians, has divided up hospital territories upon which, all too often, none shall intervene.

But more to the point is that medical costs are opaque. Even when you ask about costs, most of the time you cannot get an answer. Either the provider refuses to give an answer or says that different insurance negotiating policies provide different pricing so they cannot/will not provide you an answer regarding pricing. In Taiwan, which has a single payer system and a private practitioner system, all prices of all the different providers are printed and posted in every provider’s office so patients can see the prices and can make their decisions accordingly. We don’t have that same transparency here in the US. How can you know you’re getting the best bang for the buck if pricing and comparative quality remain a mystery?

In addition, regardless of emergency needs, how many of us are capable of telling our doctors, “Sorry, I don’t want to do that test you demand I take or take that expensive medicine you prescribe”? Medical care is not like buying shoes or cars, regardless of the libertarian arguments simply because health care consumers – patients – understand they are not medical experts. If the doctor says do x, y, and z, we tend to do it because we believe the doctor is the expert and knows best. And all too often, as I’ve discovered, when you argue with the doctor, he angrily pulls the argument that he’s the professional and you’re not…do it or else! Free financial markets, to work correctly, depend upon access by all to the same information. That doesn’t occur all too often, and most particularly does not occur in the health care market because we’re not all equal experts in health care.

In addition, current regulations preclude the ability of Medicare from negotiating RX prices which means this country subsidizes other countries. We in the US essentially pay higher costs so those other countries can obtain lower prices. As a free market advocate, I object to that subsidy to other countries.

Finally, let me say that I and my liberal friends look forward to the day when health insurance is completely separated from the current employer based system to one that enables a group of like minded individuals to buy insurance on an exchange at market competitive prices. We recognize, as realists, that health insurance is not going away…it’s been around too long and has a huge hold in the mindset of too many people as an appropriate way to spread costs a la all other insurance policies. In addition, many of us liberals hope that once the exchanges are up and working well, a la Reihan Salam, that Medicaid, Medicare and VA outpatient systems can be moved into that singular system similar to Switzerland which spends approximately 11% compared to our almost 18% (17.9% in 2012). Currently, our health care systems are so fragmented that the most needy in those systems cause the highest cost. Moving everyone into the same system spreads the cost across a greater market – which the rest of the insurance market essentially does – to decrease costs for any individual or family.

Further, it should be noted that PPACA, aka Obamacare, does go a long way to fund pilot projects that looks at other health care funding models. Some 27 provisions in the PPACA legislation provide state approved or organizationally approved experimental models. The goal of these 27 provisions is to determine what works to provide the best heath outcomes at the best prices. Many of them are showing such remarkable results that large private companies like Boeing have signed up for.

For the libertarians out there, might I remind you of two things: 1) Friedrich Hayek said he was not a conservative because conservatives look to the past while he looked to the future, and, second, that he believed it was necessary and vital to provide a strong social safety net, including national health care, as societal goods because they promoted social and political stability.

What I believe most conservatives, including many social scientists like Prof. Heidt who claims to lean liberal, get wrong is that modern, post-Clinton Democrats are not adverse to capitalism but rather see the difference between laissez-faire capitalism which never worked for the masses (see Adam Smith, the Irish Famine & British Parliamentary history, early 1900s in the US, Robber Barons, Progressive Movement, TR’s autobiography) and long held Jeffersonian – Jacksonian values of opportunity regardless of the social and economic class into which one was born and regardless of race or ethnicity or wealth. What we liberals don’t demand is equality of outcomes, but rather equity of beginnings, i.e. education.

As a result of our modern belief system, liberals want a medical care delivery system that is fair to all providers while using the best technology and gathered data available to lower delivery system costs including using data from other OECD countries.

Rather than being ideological, we seek pragmatic answers to our modern challenges. Can today’s GOP and its libertarian allies say the same?

Missing 20th Century Republican Roots….

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Regarding the desire of many on the left and among Democrats to see the GOP die, I have very mixed emotions. I remember a very different GOP: one which had lived through the Great Depression and WWII and was firmly committed to fiscal responsibility, rebuilding and renewing the homeland, staying out of foreign military engagements as much as possible, and creating economic growth and security for everyone.

With this ignorant and bombastic GOP, I say keep up the publicity ’cause they’ll continue to lose and maybe lose even more sooner if the current Democratic fundraising push has legs, provided, of course, that the GOP doesn’t rig the electoral game too much more in their favor regardless of what is in the best interests of a constitutional democratic Republic. (FYI, a lot of these sneaky gerrymandering, etc., actions were Cheney’s grand idea. Another reason to hate that rotten old SOB.)

Movement conservative GOP libertarian ideology

Yes, I do want them to lose because they do not represent the GOP I grew up knowing and appreciating for their conservative yet economic moderation, understanding and knowledge of fiscal realities, their desire to rebuild and renew the American physical and economic landscape, and to keep Americans out of more wars. The modern conservative movement, and its many faceted coalition, no longer represent, let along understand, what those earlier Republicans stood for or helped build. Let alone why.

On the other hand, I’d like to see a renewal of a more centrist, post WWII like GOP, aka Eisenhower or Rockefeller Republican party, who were fiscally responsible (as in raised taxes to keep deficits and spending down), did not believe in American Imperialism or being the world’s great cops and liberty bringers, and recognized that the way to create both wealth and a strong functioning society was build the up middle class by providing economically family sustainable jobs and economic opportunity (including quality k-12 and affordable higher education) to anyone who worked hard enough to rise up through the ranks as two of my uncles did within major corporations to senior management ranks.

Those same old-fashioned Republicans, now called RINOs and who have been driven from the party by the Limbaughs, Ericksons, Coulters, and Hannitys of the GOP infotainment media universe, were the ones who also believed in efficient but enforced financial regulations that kept our financial system sound for 50 years. A financial soundness they knew had never happened before in the nation’s history, but at the same time empowered tremendous growth and development of new businesses, quite often through the sharing of financial and information resources of combined government and private enterprise.

Those Republicans had lived through the Great Depression and deeply understood the economic, family, and social harm caused by that speculative financial crash. Even Reagan proudly said he was an FDR Democrat (and a union head) until the ’60s when Democrats went too far left (and yes, Reagan was wrong on Medicare – the best thing the nation could do today economically would be to let go of its obsession with employer provided health care for one of the other OECD models in order to save well over a trillion dollars annually. But many like Reagan believed the AMA denunciations of Medicare way back when).

They, too, had experienced real war, unlike most in the GOP today who either like McCain cannot forget, let alone forgive, leaving Vietnam without winning, or hold to a Cheney-Kristol neo-con belief in American Imperialism that would have been antithetical to the Greatest Generation Republicans who fought WWII. Anyone who had read the dispatches of Ernie Pyle – there’s an out of print book of them and his diaries – quickly understands why Eisenhower kept the US out of more wars. Most of today’s leading GOP pundits and followers hold fast to their guns but have absolutely no knowledge or experience with actual realities of war. I’d bet few of them have ever seen the mid-1950s TV series, “Victory at Sea” that was aired every Sunday morning. They think guns, shooting, et al, are all fun and games kind of like a video game. But Ernie Pyle wrote about the dirty, bloody underside of war. Embedded with Army, he wrote about slogging through the mud, the American GIs (and himself) exhausted and worn out; seeing the bombed, bloody body parts of American GIs he knew spread across the landscape; seeing and feeling death and destruction everywhere as the Army moved north in Italy towards Germany.

My father and mother’s generation had lived through the hell of the Great Depression and WWII. My Dad rode the rails as a teenager, looking for work to send money home to his family and to support himself. My mom’s family lost their home and moved into a cousin’s barn, while my grandfather walked the highways and streets of eastern Washington, selling spices door to door. My dad convinced his mother to lie about his age so he could join the Army and later transferred to the Army Air Corps because he was allergic to horses. He and two other uncles became part of the USAF during WWII. Dad flew missions over Africa. My two other USAF uncles flew missions over Germany. Another uncle was lost when his ship was sunk in the Pacific. That is what Eisenhower knew about war and what today’s neo-cons have never experienced war and do not know…and have never experienced. They never joined up. They have never known the dirt and exhaustion, the horrors of the killing and the ugliness of death.

These prissy gun-toting haters of our social safety net have never experienced the fear, loss and devastation that my parents and grandparents went through. Worse, they don’t care to even learn or even understand. But the Eisenhower and Rockefeller Republicans knew just as Democrats of that era knew. Just as my Republican parents and grandparents knew. They had seen and lived through the worst of deregulation and speculation as well as the real horrors of war. They demanded stability, economic growth and opportunity for a better life than the one in which they had grown into adulthood. They demanded some sense of economic security and the knowledge that the killing was over. They supported reasonable, sound gun laws, as did the NRA in those days, to end the killing of which they had seen far too much.

They supported a social safety net because they knew how easily it was to lose everything they had worked years to achieve to be left with nothing: not homes, not jobs, not businesses, and often without families. They approved of restrictive regulations on Wall St. to prevent another Great Depression, caused by over speculation and gambling. Even the very McKinley-like Lochner SCOTUS eventually finally gave way to public demand for more social equity that put workers on a equal footing with owners and eventually gave way for more new business development and opportunity.

These are the reasons why Reagan was an FDR Democrat until the overreach of Democrats in the ’60s. For all of the GOP’s glorification of Reagan, they have quite literally forgotten, or chosen to ignore, what he had lived through and who he really was. They’ve twisted him into a McKinley laissez-faire hero he never was. In truth, he probably felt closer to a Rockefeller Republican with a great deal of sympathy for 1950s McCarthy-Bircher anti-communistic ideology. There is no where in his record of actions, legislation or speeches in which he preaches a laissez-faire, libertarian ideology. He was a real product of both the Great Depression and World War II…not of the cynical, selfish, ignorant modern movement conservative. I know. I lived in California, as an adult, during his Governorship as well as his Presidency. I watched him and I saw him. He is nothing like what modern conservative claim him to have been. Even his breaking of the Air Traffic Controllers Union was a product of union over reach rather than a hatred of unions. As a union negotiator, he knew and understood the values of unions in protecting the membership’s wages and benefits as opposed to inflating corporate profits at the expense of workers.

So, if and when the GOP returns to its 20th Century, post Great Depression, roots, I will begin to root for it as my parents did. Until then, I will pray – and work towards – for the national and state wide demise of its current incarnation. I believe our nation – and all her people – deserves better than the current GOP.

About That $716 Billion From Medicare….

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2012 Romney-Ryan Republican Candidates

Everyone, not just today’s seniors, need to understand that Obama, through the Affordable Care Act, did not rob Medicare of $716 billion.

First of all, most of that money came from ending a very lucrative subsidy to Medicare Advantage insurance companies.

Here is what happened.

When Medicare Advantage was set up, insurance companies were lured into the program with a guaranteed no-loss, tax-free subsidy. What that meant was that if an insurance provider lost money, the government would pick up the loss and that tax-payer money was given to them tax-free to cover that loss. In other words, these insurance companies could reduce their tax bill by writing off the loss and receive a tax-free handout to cover that loss. A no-loss situation for health insurance companies…and it made them lots and lots of money. It was a pretty good deal: Medicare Advantage insurance companies got to write off any loss and have the government pay for the loss tax-free too.

Think of it this way. Say you make an investment, but it loses money. Naturally, you write off the loss on your taxes which reduces your Adjusted Gross Income and, thus, your tax bill. But then on top of having your tax bill reduced, the government turns around and hands you free of charge whatever amount your investment lost.

Well, that’s exactly the deal Congress made with health insurance companies. It was an absolutely great deal for health care insurance companies but not so much for taxpayers.

I don’t know about anyone else, but I find that deal a waste of taxpayer funds that should have ended. Obama and the Democrats were absolutely correct in ending it. Anyone who supports putting that free subsidy back in place is no fiscal conservative.

Yet, that’s what Romney is now saying should occur. Wrong, wrong, wrong.

Every taxpayer should be incensed by that guaranteed give-away of taxpayer dollars. If taxpayers were incensed by the possibility of helping underwater homeowners – as the original Tea Party was – they should be even more incensed over the deal the Republican held Congress made with insurance companies on Medicare Advantage.

No longer paying for waste, fraud and abuse

The rest of the money comes from tightening up on Medicare fraud enforcement as well as changing how hospitals are paid.

Prior to ACA, hospitals were paid for every readmission, regardless of how poorly those hospitals did their job. ACA now requires hospitals to do a better job of caring for their patients by stopping payments for re-admissions that should not have occurred. Since the Hospital Association agreed with this action, why do so many Republicans now want to continue to pay for poor care and waste? That’s not fiscally conservative, in my view.

At the same time, ACA strengthened the benefit side of Medicare by closing the costly doughnut hole and providing for annual check-ups. Essentially seniors, and all Americans, got a better deal for $716 billion less. That’s fiscally conservative!

So what are Romney and Ryan really saying?

That they want to return to the waste, fraud and abuse in the Medicare system prior to ACA?

Of course not. They don’t believe what they’re currently saying. It’s all campaign spin and garbage. They’d take that same money out of the system but use it differently…to help lower tax rates for the most wealthy. Furthermore, by overturning ACA, they would return the wasteful subsidies to insurance companies as well as end the provision that makes hospitals more accountable for outcomes. Ryan’s plan, which Romney said he would sign into law, makes that absolutely clear.

The next time you hear a Republican, or Romney and Ryan, expound on that $716 Billion, remember you’re being conned.

Written by Valerie Curl

August 23, 2012 at 9:17 AM

Seniors Prefer Ryan’s Medicare Plan?

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The new Washington Post-ABC News Poll show 50% of seniors view Paul Ryan’s Medicare plan favorably.

I’m not sure if they really understand what he proposes or if they just don’t care about making sure their kids and grandkids have the same benefits they have. Are they ignorant of what he really proposes, and which both Romney and House Republicans approved, or are they just selfish? I don’t know.

Paul Ryan's Path to Prosperity What I do know is that Ryan’s plan has been analyzed by dozens of non-partisan groups. All of them say the same thing. Under Ryan’s plan, people now 55 and under will be given a voucher – a premium support payment – based on nominal GDP growth plus .5% pegged to regular inflation. As we all know, health care inflation has been nearly 4 times higher than regular inflation. What that means is that health care delivery costs will rise faster than the value of the voucher. That’s where that $6,0000 number that’s been thrown around comes from. This number may not seem like much, but it gets worse when you look more closely at it. The Center for Economic and Policy Research/ (CEPR) summarized a CBO analysis, saying

In 2022, the projected cost of purchasing a Medicare equivalent plan is equal to 35 percent of the median 65-year-old’s income. By 2050 the cost is projected to rise to 68 percent of the median 65-year-old’s income…[The projected payment to buy a Medicare equivalent policy] would be equal to 200 percent of the income of the median 85-year-old.

What Ryan does is sift the costs for seniors’ health care expenses from the government to seniors. Yes, it will reduce the budget deficit because health care spending is huge, but his Medicare plan does not save any money in the health care delivery system, i.e. health care providers and suppliers. It does nothing to bend the cost curve, apart from expecting seniors to become more rational buyers of health care.

In other words, he’s telling future seniors to shop around more, or to tell doctors they won’t get that test the doctor wants done, or to question their doctor’s judgement. Good luck with that!

But that is not all. Ryan also sets up Medicare exchanges – exactly the same type of exchanges that the GOP rails against as part of the Affordable Care Act – from which seniors can review and pick their private insurance. Overall, that’s fine. Having been a shopper of private health insurance, I approve of exchanges where people can review different plans (apples to apples comparisons) and choose one that best suits their needs; but as we know, seniors oftentimes don’t choose the best plan for themselves, and evidence suggests from recent studies that some seniors are often misled on costs and benefits so that they ending up paying far more than they would under traditional Medicare.

As we all know, too, a private insurance market currently exists under the Medicare umbrella. It’s called Medicare Advantage. However, what too many don’t know is that Medicare Advantage costs the Medicare program 14% more than traditional Medicare for a variety of reasons. One of the biggest reasons for this differential is because of traditional Medicare’ size: the program’s size enables it to use its massive buying power to lower costs far more than a variety of private insurance companies can. In addition, Medicare’s administration costs are much lower, around 3% compared to 20% to 30% for Medicare Advantage.

So, here’s the point: health care, especially for seniors, costs all of us far too much. We all agree on that point. Currently, the U.S. spends 17% of GDP on health care while other developed countries spend between 3% to 11%. So, I’m not saying Medicare should not be reformed, but I believe any reforms must be targeted at reducing the overall costs inherent in the delivery system rather than just shifting ever increasing costs to seniors.

If current seniors believe this is a good deal for their kids and grandkids, then I have to wonder what they’re thinking. As a senior myself, if his plan were put in place next year, I’d be flat broke in a decade or so, rather than lasting 20 some years. Every dime I saved for 30 years for my retirement would be gone, forcing me to move in with my kids. Is that the scenario 50% of seniors today want for their kids?

The Effects of Ryan’s Medicare and Medicaid Plan

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Wendell Potter, senior analyst for the Center for Public Integrity and former head of public relations at CIGNA, joined Eliot Spitzer to analyze Paul Ryan’s plan to restructure Medicare and to put states in charge of Medicaid.

GOP VP nominee Paul Ryan

“You almost would be taking us back to the days before we had Medicare to start with,” Potter says of Ryan’s plan to replace Medicare benefits with vouchers that are pegged to the rate of inflation. “Over the past 10 years, health insurance premiums for people in the private insurance market have increased 113 percent — this is by the Kaiser Family Foundation, which tracks this. And that’s far and away more than inflation.”

Watch the interview to hear what this former health insurance company executive has to say about Ryan’s (and now Romney’s) health care plan.

How An American Conservative Lost Her Fear of Universal Health Care

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I came across an except of this post by an American very conservative woman who moved to Canada with her family. I think the entire post is worth reading and passing along to others, especially to conservatives who fear a national health care system. The author makes a number of points, backed up by data and personal experience, that should appeal to economic and social conservatives alike. Hers’ is a powerful story that should be read by everyone.

I’ve chosen not to edit the post for length as I believe the entire post is relevant to our national discussion on health care as well as its economic and freedom costs to families, individuals, businesses and the government.

When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I Doctor's Office found out that we were going to be covered by Canada’s Universal Health Care, I was somewhat disgusted. This meant we couldn’t choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom.

When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted. So imagine my surprise when I discovered that Midwives were not only covered by the Universal health care, they were encouraged! Even for hospital births. In Canada, Midwives and Dr’s were both respected, and often worked together.

I went to my first Midwife appointment and sat in the waiting room looking at the wall of informational pamphlets. I never went to the Dr growing up, we didn’t have health insurance, and my parents preferred a conservative naturopathic doctor anyways. And the doctor I had used for my first 2 births was also a conservative Christian. So I had never seen information on birth control and STDs. One of the pamphlets read “Pregnant Unexpectedly?” so I picked it up, wondering what it would say. The pamphlet talked about adoption, parenthood, or abortion. It went through the basics of what each option would entail and ended by saying that these choices were up to you. I was horrified that they included abortion on the list of options, and fact that the pamphlet was so balanced instead of “pro-life.”

During my appointment that day, the midwife asked her initial round of questions including whether or not I had desired to become pregnant in the first place. Looking back I am not surprised she asked that, I was depressed at the time, (even though I did not list that on my medical chart) and very vocal about my views on birth control (it wasn’t OK, ever.) No wonder she felt like she should ask if I was happy to be having this baby. But I was angry about the whole thing. In my mind, freedom was being violated, my rights were being decided for me by the evils of Universal Health Care.

Fast forward a little past the Canadian births of my third and fourth babies. I had better prenatal care than I had ever had in the States. I came in regularly for appointments to check on my health and my babies’ health throughout my pregnancy, and I never had to worry about how much a test cost or how much the blood draw fee was. I didn’t have to skip my ultrasound because of the expense. With my pregnancies in the States, I had limited my checkups to only a handful to keep costs down. When I went in to get the shot I needed because of my negative blood type, in Canada it was covered. In fact I got the recommended 2 doses instead of the more risky 1 dose because I didn’t have to worry about the expense. I had a wide array of options and flexibility when it came to my birth, and care providers that were more concerned with my health and the health of my baby than how much money they might make based on my birth, or what might impact their reputation best. When health care is universal, doctors are free to recommend and provide the best care for every patient instead of basing their care on what each patient can afford.

I found out that religious rights were still respected. The Catholic hospital in the area did not provide abortions, and they were not required too. I had an amazing medically safe birth, and excellent post-natal care with midwives who had to be trained, certified and approved by the medical system.

I started to feel differently about Universal government mandated and regulated Health care. I realized how many times my family had avoided hospital care because of our lack of coverage. When I mentioned to Canadians that I had been in a car accident as a teen and hadn’t gone into the hospital, they were shocked! Here, you always went to the hospital, just in case. And the back pain I had endured ever since would have been investigated and cared for with whatever X-rays, Physiotherapy or even Surgery that was needed, which would have been at no cost to me. In our particular province, even chiropractic care was provided after a car accident by the provincial care insurance.When I asked for prayers for my little brother who had been burned in an accident, they were all puzzled why the story did not include immediately rushing him to the hospital. When they asked me to clarify and I explained that many people in the States are not insured and they try to put off medical care unless absolutely needed, they literally could not comprehend such a thing.

I started to wonder why I had been so opposed to government mandated Universal Health care. Almost every western country in the world has Universal Insurance of some kind, except the USA. Here in Canada, everyone was covered. If they worked full-time, if they worked part-time, or if they were homeless and lived on the street, they were all entitled to the same level of care if they had a medical need. People actually went in for routine check-ups and caught many of their illnesses early, before they were too advanced to treat. People were free to quit a job they hated, or even start their own business without fear of losing their medical coverage. In fact, the only real complaint I heard about the Universal Health Care from the Canadians themselves, was that sometimes there could be a wait time before a particular medical service could be provided. But even that didn’t seem to be that bad to me, in the States most people had to wait for medical care, or even be denied based on their coverage. Depending on where one lived and how rural the area was, one’s access to care could be limited, and that was regardless of what country one lived in. The only people guaranteed immediate and full service in the USA, were those with the best (and most expensive) health coverage or wads of cash they could blow. In Canada, the wait times were usually short, and applied to everyone regardless of wealth. If you were discontent with the wait time (and had the money to cover it) you could always travel out of the country to someplace where you could demand a particular service for a price. Personally, I never experienced excessive wait times, I was accepted for maternity care within a few days or weeks, I was able to find a family care provider nearby easily and quickly, and when a child needed to be brought in for a health concern I was always able to get an appointment within that week.

The only concern I was left with was the fact that abortion was covered by the Universal Health Care, and I still believed that was wrong. But as I lived there, I began to discover I had been misled in that understanding as well. Abortion wasn’t pushed as the only option by virtue of it being covered. It was just one of the options, same as it was in the USA. In fact, the percentage rates of abortion are far lower in Canada than they are in the USA, where abortion is often not covered by insurance and can be much harder to get. In 2008 Canada had an abortion rate of 15.2 per 1000 women (In other countries with government health care that number is even lower), and the USA had an abortion rate of 20.8 abortions per 1000 women.

And suddenly I could see why that was the case. With Universal coverage, a mother pregnant unexpectedly would still have health care for her pregnancy and birth even if she was unemployed, had to quit her job, or lost her job. If she was informed that she had a special needs baby on the way, she could rest assured knowing in Canada her child’s health care needs would be covered. Whether your child needs therapy, medicines, a caregiver, a wheelchair, or repeated surgeries, it would be covered by the health care system. Here, you never heard of parents joining the army just so their child’s “pre-existing” health care needs could be covered. In fact, when a special needs person becomes an adult in Canada, they are eligible for a personal care assistant covered by the government. We saw far more developmentally or physically disabled persons out and about in Canada, than I ever see here in the USA. They would be getting their groceries at the store, doing their business at the bank, and even working job, all with their personal care assistant alongside them, encouraging them and helping them when they needed it. When my sister came up to visit, she even commented on how visible special needs people were when the lady smiling and waving while clearing tables at the Taco Bell with her caregiver clearly had Downs Syndrome.

I also discovered that the Canadian government looked out for its families in other ways. The country mandates one year of paid maternity leave, meaning a woman having a baby gets an entire year after the birth of her baby to recover and parent her new baby full-time, while still receiving 55% of her salary and her job back at the end of that year. Either parent can use the leave, so some split it, with one parent staying at home for 6 months and the other staying at home for 6 months. I could hardly believe my ears when I first heard it. In America, women routinely had to return to work after 6 weeks leave, many times unpaid. Many American women lost their jobs when becoming pregnant or having a baby. I knew people who had to go back to work 2 weeks after giving birth just to hang onto their job and continue making enough money to pay the bills. Also every child in Canada gets a monthly cash tax benefit. The wealthier families can put theirs into a savings account to pay for college someday (which also costs far less money in Canada by the way), the not so wealthy can use theirs to buy that car seat or even groceries. In the province we lived in, we also received a monthly day care supplement check for every child under school age. I made more money being a stay at home mom in Canada than I do in the States working a part-time close to a minimum wage job. And none of the things I listed here are considered “welfare” they are available to every Canadian regardless of income. For those with lower incomes than we had there are other supports in place as well.

If a woman gets pregnant unexpectedly in America, she has to worry about how she will get her own prenatal care, medical care for her child, whether or not she will be able to keep her job and how she will pay for daycare for her child so she can continue to support her family. In Canada those problems are eliminated or at least reduced. Where do you think a woman is more likely to feel supported in her decision to keep her baby, and therefore reduce abortions?

Since all of these benefits are available to everyone, I never heard Canadians talking about capping their incomes to remain lower income and not lose their government provided health coverage. Older people in Canada don’t have to clean out their assets to qualify for some Medicare or Social Security programs, I knew older people who went in for procedure after procedure, and we never heard about dwindling resources, kids paying for their parents medical expenses, or being forced to use up life insurance or funeral savings in order to get the health care they needed. I heard of inheritances being left even amongst the middle classes. Something I had only heard about in wealthy families in the USA.

And lest you think that the Canada system is draining the government resources, their budget is very close to balanced every year. They’ve had these programs for decades. Last year Canada’s national debt was 586 billion dollars, the USA has 15.5 trillion dollars in national debt. Canada has about one 10th the population of the US, so even accounting for size, the USA is almost 3 times more indebted. And lest you think that taxes are astronomical, our median income taxes each year were only slightly higher than they had been in the States, and we still got a large chunk of it back each year at tax time.

In the end, I don’t see Universal health care as an evil thing anymore.
Comparing the two systems, which one better values the life of each person?

Which system is truly more family friendly?

This young woman’s advocacy provides a powerful message of the blessings that Universal Health Care provides to families, businesses and the country. In a later post, she writes:

First of all, when I describe myself as a die-hard republican, believe me I was. For my first election in 2004 I voted for Bush, and a few weeks before moving to Canada I voted for McCain. I believed that abortion was always wrong in every case, I believed that “gay marriage” was wrong, I believed that welfare programs were unnecessary because if every woman just got married to one man and he supported her and her kids there would never be a need for welfare, I believed that Christian rights and privacy were being violated by the government on a regular basis, and I believed that public schools were bad scary places. 4 years later, I am no longer a Republican.

I remember being on a mommy chat board during my first and second pregnancies and someone started a thread on costs of prenatal care and childbirth. I mentioned that my uninsured home births had cost between six and seven thousand dollars each and felt proud that my costs were so low compared to many people who spoke of struggling to pay bills even higher than mine which their insurance did not cover, such as for anesthesia and hospital stays. Others were uninsured because they were self-employed, or had to pay over thousand dollars a month for their private health insurance. People in Australia and Europe chimed in, shocked that anyone had to pay for anything. I felt sorry for them, I had been taught to not listen to anyone else who was not like me, I believed that those people were part of an evil system that they had no control over. In other words, I believed the lies I had been told rather than the stories of people who actually lived every day with Universal Health Care.

I was afraid of Universal Health Care, because I knew nothing else but what I had been told by religious propaganda and conservative think tanks. They repeatedly spread the idea that Universal Health Care took away all choice. I was told that people were assigned doctors, and were not free to choose a different doctor. I was told that older people were denied health care and left to die because they were not a priority to the national interest. I was also told that abortion was pushed heavily on any woman who had an unwanted pregnancy or women who were pregnant with a child with disabilities. I was told that people with disabilities would be eliminated by government encouraged abortions or possibly even killed at birth (they wouldn’t want those people on the federal dole since they would “waste money” and “drain the system.”) Universal Health Care was often tied in my mind to places like China with their one child policy, places where the choice to have a large family would not be tolerated.

When I moved to Canada at the age of 23, and was forced to experience Universal Health Care and found that it was actually a good thing for pretty much every person I came in contact with, I began to question what else I had been told could be misinformation. Even the very conservative people I came in contact with in Canada were happy with their Universal Health Care. In Canada large secluded religious sects had all their health care needs met by the government and had no problem with that. The stuff I had been fed was purely propaganda. There was no cap on how many children you could have, no older people left to die, no forced abortions or elimination of special needs people. Even when Canadians complained about wait times and talked of maybe running to the states to get a service faster, after finding out that it would cost them tens of thousands of dollars out of pocket, most chose to wait instead. (And yes I am aware that optical and dental care are not covered, I wear glasses myself. And since I wasn’t spending years paying off emergency room visits or the leftover costs of my children’s births, I could actually afford to take my kids in for dental care every 6 months.) The system wasn’t perfect, but it was a decided improvement on what I had observed and experienced in the USA.

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