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US Health Care System

US Health Care Costs

Project: US Health Care System
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American Medical Association logo.American Medical Association logo. [Source: American Medical Association]The American Medical Association (AMA), in conjunction with many Congressional Republicans and some Democrats, attempts to beat back attempts to create a new government-run program to provide medical care for the elderly, to be called “Medicare.” The AMA and its political allies have fought the idea of a government-provided health care program for senior citizens since 1945, when then-President Harry Truman first suggested universal health care for all Americans.
Minimal 'Eldercare' Considered Too Much - Currently, a modest health care program for senior citizens, called “Eldercare,” is the only government coverage American seniors have. It is based on a compromise proposal written by conservative Democratic Senator Robert Kerr (D-OK) and Representative Wilbur Mills (D-AR) and signed into law by President Dwight Eisenhower. Eldercare provides government benefits only for senior citizens who can demonstrate economic need, and states that choose not to participate in the program can opt out entirely. However, the AMA considers even this truncated program far too invasive, and fiercely opposes the more sweeping “Medicare” proposal, called King-Anderson after its main authors, Senator Clinton Anderson (D-NM) and Representative Cecil King (D-CA). The legislation is mired in Congressional committees. [Time, 2/19/1965; Larry DeWitt, 9/2004]
WHAM - The opposition to King-Anderson is led by the Women’s Auxilary of the AMA, which is given the task of coordinating the WHAM program—Women Help American Medicine. WHAM is directly dedicated to defeating the King-Anderson bill in Congress, “a bill which would provide a system of socialized medicine for our senior citizens and seriously curtail the quality of medical care in the United States.” The public campaign consists of the usual rallies and advertisements, most funded by corporate lobbyists working for the AMA and other health care firms. WHAM accuses King-Anderson proponents of being “socialists” and warns of federal bureaucrats violently invading “the privacy of the examination room.” WHAM coordinates an extensive grassroots effort under the rubric of “Operation Hometown,” enlisting local medical societies to speak out against King-Anderson, and providing pamphlets, reprints of press releases and articles, and talking points to local physicians.
Operation Coffeecup - Operation Coffeecup is a less visible, but just as important, element of the WHAM campaign. It centers around a series of “coffee klatches,” or “impromptu” get-togethers in kitchens and living rooms across America, hosted by WHAM members. WHAM members are told to downplay the significance of the events. One instruction tells them to portray the events as nothing more than “spontaneous” neighborhood get-togethers: “Drop a note—just say ‘Come for coffee at 10 a.m. on Wednesday. I want to play the Ronald Reagan record for you.’” The attendees are shown how to write equally “spontaneous” letters to members of Congress opposing the King-Anderson bill. The letters are carefully constructed to give the appearance of real, unsolicited missives written by concerned Americans, not the product of an orchestrated lobbying effort. Each WHAM member uses a 10-point checklist to ensure that the letters cover the points needed to make the argument against King-Anderson, and are not full of boilerplate, obviously copied-over material. The program is deliberately kept quiet, for fear that the media will portray it as an attempt to manipulate public opinion.
Reagan on Vinyl - The centerpiece of the Operation Coffeecup material is a vinyl LP entitled Ronald Reagan Speaks Out Against Socialized Medicine (see 1962). The album is a 19-minute recording featuring an 11-minute address by Reagan, followed by an eight-minute follow-up by an announcer. WHAM members are assured that Reagan’s work for the organization is unpaid and voluntary, though they are not told that his father is a top AMA executive. Instead, they are told Reagan is motivated entirely by his sincere political convictions. The hope is that Reagan’s message will inspire legions of housewives to write letters demanding that King-Anderson be defeated. The AMA claims that Operation Coffeecup prompts a “legion” of responses. [Larry DeWitt, 9/2004]
Exposed - In June 1962, investigative reporter Drew Pearson exposes Operation Coffeecup in his newspaper column. Pearson writes: “Ronald Reagan of Hollywood has pitted his mellifluous voice against President Kennedy in the battle for medical aid for the elderly. As a result it looks as if the old folks would lose out. He has caused such a deluge of mail to swamp Congress that congressmen want to postpone action on the medical bill until 1962. What they don’t know, of course, is that Ron Reagan is behind the mail; also that the American Medical Association is paying for it.… Reagan is the handsome TV star for General Electric.… Just how this background qualifies him as an expert on medical care for the elderly remains a mystery. Nevertheless, thanks to a deal with the AMA, and the acquiescence of General Electric, Ronald may be able to outinfluence the president of the United States with Congress.” [Larry DeWitt, 9/2004; TPMDC, 8/25/2009]

Entity Tags: American Medical Association, Cecil King, Clinton Anderson, Operation Coffeecup, Drew Pearson, Women’s Auxilary of the AMA, Operation Hometown, Ronald Reagan, Women Help American Medicine, Medicare

Timeline Tags: Domestic Propaganda

Category Tags: History of US Health Care System, US Health Care Costs, US Health Care Polls, Medicare

In an op-ed, the New York Times calls the idea that the US has “the best health care system in the world,” as recently stated by President Bush, or provides “the best medical care in the world,” as recently stated by former New York City Mayor Rudolph Giulani, a “delusion.” “That may be true at many top medical centers,” the Times writes. “But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.” The Times notes that in 2000, the World Health Organization (WHO) ranked the health care systems of 191 nations. France and Italy were first and second; the US came in 37th. The Times notes a more recent study by “the highly regarded Commonwealth Fund,” which “has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data”; the latest Commonwealth Fund study put the US last among six highly developed nations (see May 15, 2007). “Other comparative studies also put the United States in a relatively bad light,” the Times notes.
Lack of Universal Coverage - Unlike every other major industrialized nation, the US does not provide universal health coverage. In the US, some 45 million people have no health insurance whatsoever, and millions more suffer with poor coverage. The Times writes, “Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.”
Lack of Access - While citizens of foreign nations often face longer waits before they can see specialists or undergo elective surgery than do Americans in comparable situations, “[t]he real barriers here are the costs facing low-income people without insurance or with skimpy coverage.” However, “even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.”
Unfair Disparities - The dichotomy between the care provided to economically well-off Americans and their more economically challenged fellows is worse than in any other industrialized nation. “Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.”
Unhealthy Living - The US ranks last among 23 nations in its infant mortality rate—more American children die in infancy than in 22 other countries. “But the problem is much broader,” the Times continues. “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.”
Varying Quality - The Commonwealth Fund study notes that the US ranks first in providing the correct care for a given condition, and does very well in providing preventative care to its citizens. But it does much worse in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting the needs and preferences of patients. Overall, the quality of health care in the US is the lowest among the six nations profiled by the study.
Varying Survival Rates - US citizens live longer than their foreign counterparts with breast cancer, and second-longest with cervical cancer and childhood leukemia. But US citizens rank last or next-to-last in life expectancy for patients with kidney transplants, liver transplants, colorectal cancer, circulatory diseases, respiratory diseases, diabetes, bronchitis, asthma, and emphysema.
Poor Patient Satisfaction - Only 40 percent of Americans are satisfied with the nation’s health care system. Of 17 countries surveyed, the US comes in 14th. The US ranks first in negative public perceptions, with a third of Americans calling for a system-wide revamp of American health care.
Poor Use of Information Technology - American health care providers are years behind their foreign counterparts in their use of information technology, electronic medical records, electronic prescriptions, and more. “This makes it harder to coordinate care, spot errors, and adhere to standard clinical guidelines,” the Times writes.
Conclusion - “With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has ‘the best health care system in the world’ and turn instead to fixing its very real defects,” the Times concludes. “The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally.… The world’s most powerful economy should be able to provide a health care system that really is the best.” [New York Times, 8/12/2007]

Entity Tags: Commonwealth Fund, Rudolph (“Rudy”) Giuliani, World Health Organization, George W. Bush, New York Times

Category Tags: Other health care systems, US Health Care Costs, US Health Care Problems

During the year, a number of states enact over 77 laws and other measures that affect reproductive rights, a sharp upturn from the 33 enacted in 2008. Some of these laws protect and enhance reproductive rights (see 2009), others restrict them. Some of the restrictive laws are as follows:
bullet Arizona adopts what the Guttmacher Institute calls “a massive omnibus measure that essentially revamps abortion policy in the state,” requiring in-person counseling, long waiting periods before a woman can legally seek an abortion, and new restrictions on minors seeking abortions; the measure restricts the performance of abortion procedures to physicians only and grants providers new rights to refuse to participate in abortion-related services. The new measure is shepherded through the state legislature by Governor Jan Brewer (R-AZ), a strong opponent of abortion rights. Many of the new measures are not in effect due to legal challenges. Eighteen other states attempt to enact measures relating to parental involvement in attempts by minors to seek abortions, but fail.
bullet Arizona, Kansas, North Dakota, and Ohio adopt laws requiring abortion providers to post signs informing women that they cannot be coerced into having abortions, and encouraging their clients to contact authorities or clinic staff if they feel they have been subjected to such pressure.
bullet Arizona and Arkansas adopt measures restricting so-called “partial-birth abortions” similar to a federal ban upheld by the Supreme Court in 2007 (see April 17, 2007). In all, 17 states have such restrictions. Utah tightens the availability of such late-term abortions in its laws. A measure that would have entirely banned “partial-birth abortions” and restricted other such procedures was vetoed in Kansas.
bullet Iowa, Maryland, and Minnesota continue existing prohibitions on public funding for abortion.
bullet Kansas and Nebraska enact laws requiring that women seeking abortions after 19 weeks’ gestation be given information on the availability of ultrasound procedures. In all, 16 states now have similar requirements on the books.
bullet Massachusetts, Michigan, Montana, and Washington enact substantial cuts in family planning programs.
bullet North Dakota enacts a law requiring women seeking abortions to be told that the procedure will “terminate the life of a whole, separate, and unique human being.” Similar provisions were enacted by the Kansas legislature, but vetoed by Governor Mark Parkinson (D-KS).
bullet Oklahoma enacts laws banning abortions for purposes of “sex selection,” and institutes what the Guttmacher Institute calls “intrusive abortion reporting requirements” that will result in making private information about women seeking abortions public (see November 1, 2009).
bullet Utah requires women seeking abortions to be provided with information on the purported ability of a fetus to feel pain, information many medical providers consider false. The state also institutes an “Abortion Litigation Trust Account” to cover the cost of defending the state against legal challenges filed against its anti-abortion laws.
bullet Tennessee joins six other states in restricting access to contraceptive services.
bullet Virginia authorizes the sale of license plates with the “Choose Life” slogan, and earmarks profits from the sale of those plates to fund “crisis pregnancy centers” (see April 2006) across the state. Twenty-one states now offer such license plates. [Guttmacher Institute, 1/2010]

Entity Tags: Mark Parkinson, Guttmacher Institute, Jan Brewer

Category Tags: Abortion controversy & violence, US Health Care Costs, US Health Care Problems

The California Nurses Association (CNA) releases the results of a study which found “a national single-payer style health care reform system would provide a major stimulus for the US economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the US economy.” The study was conducted by the Institute for Health & Socio-Economic Policy (IHSP), a “non-profit policy and research group” that is “the exclusive research arm of the California Nurses Association/National Nurses Organizing Committee.” In addition to the growth in jobs and revenues generated by covering the 47 million Americans who were uninsured as of 2006, the study also found that universal coverage “could be achieved for $63 billion beyond the current $2.1 trillion in direct health care spending,” according to the press release for the study, which also notes that this figure is “six times less than the federal bailout for CitiGroup, and less than half the federal bailout for AIG.” [CalNurses.org, 1/14/2009]

Entity Tags: Institute for Health & Socio-Economic Policy, California Nurses Association

Category Tags: Health Care Cost, Studies-Academic, History of US Health Care System, Obama Health Care Reform, Other health care systems, US Health Care Costs, US Health Care Problems

The US spends more than any other nation in the world on health care, but ranks only 50th among 224 nations in life expectancy, according to the 2009 CIA World Factbook. Experts say that this fact could raise serious questions in the debate over health care reform. Americans have an average life span of 78.1 years; the populations of 49 other nations live longer, on average. Japan is first in life expectancy, at 83 years; Australia, Iceland, Italy, San Marino, Switzerland, Andorra, Canada, and France round out the top 10 countries. Other countries, such as Sweden, Norway, Denmark, Singapore, Greece, Spain, and Portugal also do better than the US in life expectancy. The bottom 10 nations are, in reverse order, Sierra Leone, Afghanistan, Zimbabwe, Lesotho, Zambia, Chad, Uganda, Swaziland, Mozambique, and Guinea-Bissau, with life spans ranging from averages of 41 to 48 years. Some experts note that the US is the only developed nation to have a virtually completely privatized health care system. “What we are able to find in the industrialized world is that life expectancy will be influenced in a beneficial manner to the extent that health care expenditure is publicly financed,” says public health professor Harvey Brenner. “The higher the government expenditure on health care, the lower will be the mortality rate.” A study from the University of Chicago shows that a single-payer system—government-run health care—may be associated with higher life expectancy. The governments of such nations as Norway, Sweden, Denmark, Australia, and Canada have government-run health care, and their citizens have some of the longest life spans in the world. The author of the study, Bianca Frogner, writes: “Inevitably the conversation about reforming our health care system focuses on the question of what are we getting for our money and how are others doing with their health care dollars. Life expectancy, along with mortality and morbidity rates, are fairly straightforward numbers to rely on.” Other comparisons show that Scandinavian and other European countries have lower birth mortality numbers than the US, though babies born with abnormally low birth weights tend to fare better in the US system than in the Scandinavian systems. [CNN, 6/11/2009]

Entity Tags: University of Chicago, Bianca Frogner, Harvey Brenner

Category Tags: Other health care systems, US Health Care Costs

In an interview with NPR, Michael Steele, the chairman of the Republican National Committee (RNC), finds it difficult to both support Medicare and attack government-run health care. Steele is interviewed by Steve Inskeep, and tells him that government-run health care is never a good option, but simultaneously demands that health care reformers protect Medicare and retain its funding.
Says Democrats Want to Cut Medicare, Then Advocates Cutting Medicare - Steele calls Medicare “a valuable program” that is “the last line of opportunity” for elderly Americans to receive health care. He accuses Democrats of wanting to “raid” the program to fund health care reform, and says accusations that he wants to cut Medicare spending is “a wonderful interpretation by the left” that he wants to reduce such funding. However, in response to the next question, Steele says he supports cutting Medicare spending; Inskeep asks, “[Y]ou would be in favor of certain Medicare cuts?” and Steele says: “Absolutely. You want to maximize the efficiencies of the program. I mean, anyone who’s in the program would want you to do that, and certainly those who manage it want you to that.”
Protecting and Attacking Medicare Simultaneously - Inskeep pins Steele down on the dichotomy by noting that he has previously written about the need to protect Medicare while attacking the idea of President Obama’s “plan for a government-run health care system.” Inskeep observes, “You’re aware that Medicare is a government-run health care program,” and Steele retorts: “Yeah, look how it’s run. And that’s my point. Take Medicare and make it writ large across the country, because here we’re now—how many times have we been to the precipice of bankruptcy for a government-run health care program?” In the following exchange, Steele, according to Think Progress reporter Amanda Terkel, “tie[s] himself into knots”:
bullet Inskeep: “It sounds like you don’t like Medicare very much at all.”
bullet Steele: “No, I’m not saying that. No, Medicare…”
bullet Inskeep: “… But you write in this [Washington Post] op-ed that you want to protect Medicare because it’s politically popular. People like Medicare.”
bullet Steele: “No, no, no, no, no. Please, don’t…”
bullet Inskeep: “That’s why you’re writing to protect Medicare.”
bullet Steele: “Well, people may like Medicare, and liking a program and having it run efficiently is sometimes two different things. And the reality of it is simply this: I’m not saying I like or dislike Medicare.… My only point is that, okay, Medicare is what it is. It’s not going anywhere. So let’s focus on fixing it so that we don’t every three, five, 10 years have discussions about bankruptcy and running out of money.”
'You're Doing a Wonderful Little Dance' - Inskeep continues to drill into Steele’s support for Medicare and his simultaneous opposition to government-run health care, leading Steele to note, “I want to protect something that’s already in place and make it run better and run efficiently for the senior citizens that are in that system does not mean that I want to automatically support, you know, nationalizing or creating a similar system for everybody else in the country who currently isn’t on Medicare.” When Steele says the government could regulate the private industry to make sure that private insurers don’t make decisions for citizens’ health care based on profit, Inskeep asks: “Wait a minute, wait, wait. You would trust the government to look into that?” After a brief, spluttering exchange, Steele says, “I’m talking about those who—well, who regulates the insurance markets?” Inskeep notes, “That would be the government, I believe.” Steele then accuses Inskeep of trying to manipulate the conversation: “Well, and so it—wait a minute, hold up. You know, you’re doing a wonderful little dance here and you’re trying to be cute, but the reality of this is very simple. I’m not saying the government doesn’t have a role to play. I’ve never said that. The government does have a role to play. The government has a very limited role to play.”
Insists that 'No One's Trying to Scare' Americans about Reform - Towards the end of the interview, Inskeep asks whether it is difficult to explain health care to Americans in a way that “doesn’t just kind of scare people with soundbites.” Steele replies: “No one’s trying to scare people with soundbites. I have not done that, and I don’t know any leaders in the House and the Senate that have done that.” [National Public Radio, 8/27/2009; Think Progress, 8/27/2009] Steele has called the Democrats’ health care reform plan “socialism” and accused Congressional Democrats of being in a “cabal” to enact government-controlled health care over the objections of the American populace (see July 20, 2009). And his RNC has sent out a survey suggesting that the Democrats’ reform proposal would discriminate against Republicans (see August 27, 2009).

Entity Tags: Steve Inskeep, Michael Steele, Medicare, Republican National Committee

Category Tags: Obama Health Care Reform, US Health Care Costs, Medicare

Newsweek publishes an extensive article detailing what it calls “the five biggest lies in the health care debate.” Despite the title, the article actually debunks seven.
bullet The government will have electronic access to your bank accounts and steal citizens’ money (see (July 30, 2009) and After). The bill passed by the House Ways and Means Committee indeed calls for electronic fund transfers, but only from insurers to doctors and other providers. Patients are not involved in such transactions.
bullet You’ll have no choice in what health benefits you receive. This story seems to originate from a blog, Flecks of Life, which features a picture of President Obama made up as the Joker from the Batman films. The House bill provides for a “health care exchange,” including a list of private insurers and a single government plan, allowing people without health insurance to choose from the list. The government will prevent insurers from refusing clients with “preexisting conditions,” and require them to offer at least minimum coverage. However, Newsweek observes, “The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.”
bullet No chemo for older Medicare patients. Newsweek calls this a “vicious” rumor coming from the so-called “deather” camp (see November 23, 2008, January 27, 2009, February 9, 2009, February 11, 2009, February 18, 2009, May 13, 2009, June 24, 2009, June 25, 2009, July 10, 2009, July 16, 2009, July 17, 2009, July 21, 2009, July 23, 2009, July 23, 2009, July 23, 2009, July 23-24, 2009, July 24, 2009, July 28, 2009, July 28, 2009, July 28, 2009, July 31, 2009 - August 12, 2009, August 6, 2009, August 7, 2009, August 10, 2009, August 10, 2009, Shortly Before August 10, 2009, August 11, 2009, August 11, 2009, August 12, 2009, August 12, 2009, August 12, 2009, August 13, 2009, August 12-13, 2009, August 13, 2009, August 15, 2009, August 18, 2009, and August 23-24, 2009). The claim is that Medicare will refuse cancer patients over 70 years of age anything other than end-of-life counseling, including chemotherapy and other life-extending treatments. The claim, Newsweek says, “has zero basis in fact. It’s just a vicious form of the rationing scare.”
bullet [H]ealth-care reform will be financed through $500 billion in Medicare cuts. Again, nothing in the House bill or anything being considered in the Senate exists to back this claim. There are proposed decreases to increases in future Medicare funding, essentially reducing Medicare expenditures from the forecast of $803 billion by 2019. $560 billion would be removed from future Medicare increases over the next 10 years, and would not come from funds slated to provide actual care to seniors. And the House bill proposes increasing Medicare funding by $340 billion over the next 10 years. According to Medicare expert Tricia Newman of the Kaiser Family Foundation, the money would pay for office visits, eliminate copays and deductibles, and close the so-called “donut hole” in Medicare drug benefits.
bullet Illegal immigrants will get free health insurance. While a 1986 law allows illegal immigrants to receive free emergency care through emergency room clinics like everyone else in America, the House bill does not give anyone free health care. Illegal immigrants will not be eligible for subsidies to buy health insurance. In July, the House defeated a Republican-sponsored amendment to require anyone enrolling in a public plan or seeking subsidies to purchase health insurance to provide proof of citizenship. After the amemdment was defeated, Representative Steve King (R-IA) began spreading the false claims that since proof of citizenship would not be mandated, illegal immigrants would indeed be able to obtain government-funded health insurance. Newsweek writes: “Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can’t prove a negative, but experts say that Medicare—the closest thing to the proposals in the House bill—has no such problem.”
bullet Death panels will decide who lives. So-called “death panels” form the heart of the “deather” claims that the government would mandate “end of life counseling sessions” that would encourage elderly and seriously ill patients to allow themselves to die. Newsweek calls the claim a “lie” that “springs from a provision in the House bill to have Medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the House bill expands Medicare coverage, but without forcing anyone into end-of-life counseling.”
bullet The government will set doctors’ wages. This is another claim that seems to have originated on the Flecks of Life blog. Like the earlier claim, it is false. The House bill, according to Newsweek, “says that physicians who choose to accept patients in the public insurance plan would receive five percent more than Medicare pays for a given service, [but] doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna.” Amitabh Chandra of Harvard University says, “Nobody is saying we want the doctors working for the government; that’s completely false.” [Newsweek, 8/29/2009]

Entity Tags: Obama administration, Barack Obama, House Ways and Means Committee, Amitabh Chandra, Medicare, Tricia Newman, Steve King, Newsweek

Timeline Tags: Domestic Propaganda

Category Tags: Obama Health Care Reform, US Health Care Costs, Medicare

A poll by the nonpartisan Consumers Union finds that many Americans are having so much difficulty affording their medical care that they routinely put off doctors’ visits, forego medical tests, forego medical procedures, skip filling prescriptions, and take expired medications to save money and limit expenses. According to the poll, 51 percent of Americans have “faced difficult health care choices in the past year,” and 25 percent cannot afford their medical bills or their medications. Another poll, by Ipsos and McClatchy News, finds that 53 percent of Americans favor a public health insurance plan “to make sure all Americans have access to quality health care,” and 42 percent believe that sufficient changes could occur without a public plan. The Consumers Union poll finds that 28 percent of Americans have either endured cutbacks in their medical coverage or lost their coverage entirely in 2008 alone, with the trend widespread among differing income groups. Around 66 percent of respondents who make below $50,000 a year say they have cut back on their health care due to costs. [Consumers Union, 10/5/2009; McClatchy News, 10/7/2009]

Entity Tags: Ipsos, McClatchy News, Consumers Union

Category Tags: US Health Care Costs

America’s Health Insurance Plans (AHIP), the health insurance industry’s largest lobbying organization, releases a study that claims the Democrats’ health care reform initiative would send health insurance costs sharply upward. The study is released the day before the Senate Finance Committee votes on its version of the reform proposal. [The Week, 10/12/2009] AHIP says it intends to circulate the study among lawmakers on Capitol Hill and use it as the basis for new advertisements attacking the health care reform proposals. [Washington Post, 10/12/2009] NBC Washington calls the study “a surgical strike against Democrats’ best hope for passing health reform,” specifically targeting the Finance Committee’s legislative efforts, which it calls the “Baucus bill” for committee chairman Max Baucus (D-MT). Until now, AHIP has operated largely behind the scenes to delay or terminate Congressional efforts to reform US health care; the study marks its most public and overt effort to influence the discussion. According to the study, which was carried out by accounting and services firm PriceWaterhouseCoopers (PWC) and paid for by AHIP, the average cost increase would be $1,700 per family per year by 2013. “[T]he cumulative increases in the cost of a typical family policy… will be approximately $20,700 more than it would be under the current system,” the report claims. “[T]he cost of coverage for both single and family policies in the individual, small group, large group, and self-funded insurance markets” will rise dramatically. AHIP official Karen Ignagni says private insurers would almost certainly pass cost increases to consumers for a number of reasons, including her claim that too many people with pre-existing conditions would sign up for insurance. “The report makes clear that several major provisions in the current legislative proposal will cause health care costs to increase far faster and higher than they would under the current system,” she writes. Baucus calls the study “seriously flawed.” A spokesman for the Finance Committee, Scott Mulhauser, says: “Now that health care reform grows ever closer, these health insurers are breaking out the same, tired playbook of deception to prevent millions of Americans from getting the affordable, accessible care they need. It’s a health insurance company hatchet job, plain and simple.” [America's Health Insurance Plans, 10/11/2009; NBC Washington, 10/12/2009; Washington Post, 10/12/2009] An analysis of the committee’s proposal by the Congressional Budget Office (CBO) shows that while some people’s premiums would go up, the subsidies to be provided by the government would make health insurance considerably less expensive for most consumers. According to the CBO, premiums under the government “exchange” option proposed in the Baucus bill would cost consumers $14,400 per year in 2016, while the average private insurer would charge their customers $21,300 by 2016. [Think Progress, 10/12/2009] Nancy-Anne DeParle, director of the White House Office of Health Reform, says PWC is not the firm to have carried out such a study. “Those guys specialize in tax shelters,” she says. “Clearly this is not their area of expertise.” [Washington Post, 10/12/2009] Almost immediately after the study’s release, critics begin attacking it, calling it deeply flawed and an “industry hit job” (see October 11-12, 2009). And PWC itself will back away from the study’s central claims (see October 12, 2009).

Entity Tags: Scott Mulhauser, Max Baucus, Karen Ignagni, Nancy-Anne DeParle, Senate Finance Committee, Congressional Budget Office, PriceWaterhouseCoopers, America’s Health Insurance Plans

Category Tags: Obama Health Care Reform, US Health Care Costs

Within minutes of the release of a new study by health insurance lobbying firm America’s Health Insurance Plans (AHIP) that claims health care reform would drastically raise costs to American families (see October 11, 2009), critics from different sides of the political divide dispute the study’s accuracy and question its impartiality.
White House: Study Ignores Key Elements of Reform - White House assistant press secretary Reid Cherlin says the study “conveniently ignores critical policies that will lower costs for those who have insurance, expand coverage, and provide affordable health insurance options to millions of Americans who are priced out of today’s health insurance market or are locked out by unfair insurance company practices.” [MSNBC, 10/12/2009]
'Blowback' from Study Possible - White House and Senate officials say that the insurance industry may suffer “blowback” over the report. Democrats may well close ranks behind either the Senate Finance Committee (SFC) bill or another version of the legislation, and liberal lawmakers may go after the insurance companies, maybe by proposing a cap on premiums or solidifying support for the government insurance plan. “They have opened themselves up,” says a senior Senate Democratic aide. “It is an incredibly stupid strategic blunder. If you are going to fire a shot like this, you fire a good shot.” Former industry executive Wendell Potter, who has become an industry whistleblower (see July 10, 2009), says AHIP is responding to critical analyses from Wall Street that the legislation will hurt private insurers. “Karen [AHIP official Karen Ignagni] had no alternative because the CEOs were so determined to do something to try to sway the committee to back off the reductions,” he says. “She didn’t have an alternative. They are obviously doing this on the eve of the vote in the Senate Finance Committee, hoping enough members of the committee would be concerned, to restore it. I think the strategy will backfire.” [Politico, 10/12/2009]
Economist: Study Fundamentally Flawed - MIT economist Jonathan Gruber analyzes the PWC study and concludes that it is fundamentally flawed. He writes: “The nonpartisan analysis based on information from the CBO [Congressional Budget Office] shows clearly that for those facing purchase in the non-group market, the SFC bill will deliver savings ranging from several hundred dollars for the youngest consumers to over $8,500 for families. This is in addition to all the other benefits that this legislation will deliver to those consumers—in particular the guarantee, unavailable in most states, that prices would not be raised or the policy revoked if they became ill.” On MSNBC, Gruber notes: “If the report had came out and said, ‘look we need stronger penalties, or premiums will go up,’ that’s a very valid point to make. But what the report says is that it went too far. It said with the current structure, premiums will be much higher than they are today. And that’s just wrong. I mean, the nonpartisan Congressional Budget Office has came out and said that for this bill, premiums in the exchange will be lower than they are in the none group market today. So they just drew the wrong comparison.” [Massachusetts Institute of Technology, 10/12/2009; Think Progress, 10/13/2009]
Democrats: Proof that Industry Needs Further Regulation - Representative Anthony Weiner (D-NY) says, “[T]he health insurance lobby today fired the most important salvo in weeks for the public option,” and adds that the study proves the industry needs further regulations imposed on it by Congress: “If you have the health care industry complaining that we’re going to raise costs because of these changes, it is them putting us on notice that we haven’t put enough cost containment in the bill. You know, the health care industry themselves is putting out a whole report saying that. That should be a tell to the [Senate Finance Committee] that you know what, maybe it’s time for them to go back and revisit the public option. In a strange way, and look, obviously they didn’t mean this, the health insurance lobby today fired the most important salvo in weeks for the public option, because they have said, as clear as day, left to their own devices, according to their own number crunchers, they’re going to raise rates 111 percent.” [Think Progress, 10/12/2009] Senator John D. Rockefeller (D-WV) charges the insurance industry with releasing a false study for political purposes. “The misleading and harmful claims made by the profit-driven insurance companies are politicking for corporate gain at its worst,” he says. “Their recent statements only further highlight that our focus here in Congress must be on the inclusion of a public health insurance option in the marketplace to protect families and put more money back in their wallets by creating greater competition and driving down costs.” [Politico, 10/12/2009]
Washington Post: 'Industry Hit Job' - The Washington Post’s Ezra Klein calls the report “deceptive” and “a predictable industry hit job,” and notes that the study was produced by accounting and services firm PriceWaterhouseCoopers (PWC), which in the 1990s was commissioned by the tobacco industry to do a study on the economic catastrophe that would result from taxing tobacco products. That study was found to be unreliable, and, perhaps not surprisingly, made all of its errors in favor of the tobacco industry. Klein writes that the same effect can be observed in this report on health care. He concludes: “But if the [study] doesn’t offer much in the way of trustworthy policy analysis, it is an interesting looking at the changing politics of the issue. In short, the insurance industry is getting scared. After many months of quiet constructiveness, they’re launching a broadside on the week of the Senate Finance Committee’s vote. The White House, which had a pleasant meeting with the industry’s leadership last week, was shocked by the report, and so too was the Senate Finance Committee. The era of cooperation seems to be over, and they weren’t given much advance warning. But the report might have another impact, too: The evident anger and fear of the insurance industry might do a bit to reassure liberals that this plan is worth supporting, after all.” [Washington Post, 10/12/2009]
New Republic: 'Questionable Assumptions' - The New Republic’s Jonathan Cohn chastizes PriceWaterhouse for deliberately, and explictly, choosing to believe that all the new factors included in the study will raise costs, when other analyses show that many of those factors will actually drive costs down. Cohn writes that the study is based on a plethora of “strange [and] questionable assumptions.” [New Republic, 10/11/2009]
Progressive Columnist: 'This Is News?' - Progressive columnist Josh Marshall wrote before the study was released: “Let me get this right. The big news tomorrow is that ‘America’s Health Insurance Plans’ (AHIP, aka the health insurance lobby) has commissioned a study by PriceWaterHouseCoopers that comes to the conclusion that the Senate Finance Committee bill is a bad, bad thing and would lead to health care costs going up even faster than they are under the current system. This is news?” [Talking Points Memo, 10/12/2009]
Washington Times: Defending the Study, Attacking the CBO - The conservative Washington Times defends the study as essentially accurate, and instead attacks the Congressional Budget Office, whose own figures differ dramatically from the PWC study. The Times editorial board calls the CBO’s estimates “fanciful” and “grandly overoptimistic,” and accuses the Democrats of adding opportunities for consumers to “game the system”—“It’s a mystery how the CBO can make its evaluation without once mentioning that individuals easily will be able to go without insurance while they are healthy and then buy insurance after they get sick.” The entire proposal allows Democrats to “avoid electoral accountability over the urgent health care needs of the people they say they’re trying to help but won’t.” [Washington Times, 10/12/2009]
AHIP Defends Study - Ignagni defends the study and says the lobbying firm did not release it to undermine the Finance Committee’s attempt to craft an acceptable reform bill. She says the industry’s main concern is getting everyone involved in health care to work together to bring costs down. There is a strong need, she says, to “encourage all the other stakeholders to participate in a broader effort so that they can too lend a hand and get costs under control in a much more effective way than we would.… We don’t see comprehensive cost control in any legislation.” [MSNBC, 10/12/2009]
PWC Backs Off from Study - Late in the evening, PWC issues a statement noting that the study only examined “a small slice” of the health care reform initiative, and saying that if other provisions in the reform package succeed in lowering costs, then the estimates of cost increases claimed in the study would be inaccurate (see October 12, 2009).

Entity Tags: America’s Health Insurance Plans, Anthony D. Weiner, Jonathan Gruber, Congressional Budget Office, Ezra Klein, Jonathan Cohn, Wendell Potter, John D. Rockefeller, PriceWaterhouseCoopers, Karen Ignagni, Washington Times, Obama administration, Joshua Micah Marshall, Reid Cherlin, Senate Finance Committee

Category Tags: Obama Health Care Reform, US Health Care Costs

PriceWaterhouseCoopers (PWC), the services and accounting firm that recently released a controversial study funded by the health care insurance lobbying firm America’s Health Insurance Plans (AHIP—see October 11, 2009 and October 11-12, 2009), backs away from claims that the report is comprehensive. Politico’s Chris Frates writes that the statement “basically sa[ys], ‘Hey, we weren’t paid to evaluate the effects of the entire bill, but rather a small slice of it.’ The statement only seems to reinforce critics’ view that the report is skewed precisely because it doesn’t take into account the totality of reform.” PWC’s statement concludes, “If other provisions in health care reform are successful in lowering costs over the long term, those improvements would offset some of the impacts we have estimated.” Frates explains, “In other words, PWC is saying if reform’s cost containment measures work, their estimate could be wrong.” [Politico, 10/13/2009]

Entity Tags: PriceWaterhouseCoopers, America’s Health Insurance Plans, Chris Frates

Category Tags: Obama Health Care Reform, US Health Care Costs

Senator Charles Grassley (R-IA), one of the key Republicans in the health care debate (see August 12, 2009 and August 19, 2009), now says that any attempt by Congress to incorporate the so-called “individual mandate” might be unconstitutional. An individual mandate provision, under consideration by Grassley’s Finance Committee, would require Americans to purchase some form of health insurance. “[T]his is the first time in the 225-year history of our country that we have forced you as a constituent, any of our constituents, to buy a product,” he says. “You know, you’ve been free to buy or not buy. But now for the first time you’re going to have to buy health insurance. If you don’t buy it, IRS is going to tax a family $1,500.” Asked, “[I]s that constitutional, forcing somebody to buy it and punishing them through the IRS if they don’t?” Grassley replies: “I’m not a lawyer, but let me tell you, I’ve listened to some lawyers speak on this. And you know, it’s a relatively new issue. I don’t think we’ve ever had this issue before of having to buy something. And a lot of constitutional lawyers, saying it is unconstitutional or at least in violation of the 10th Amendment. Now maybe states can do this, but can the federal government? So, I have my doubts.” Progressive news and advocacy Web site Think Progress notes that in June 2009, Grassley said “there isn’t anything wrong with” mandates and that he believed there was “a bipartisan consensus to have individual mandates.” The site also notes that the US Constitution provides for the federal government’s right to enact wide-ranging regulatory programs, a power generally upheld by the Supreme Court. [NewsMax, 10/14/2009; Think Progress, 10/15/2009]

Entity Tags: Charles Grassley, Senate Finance Committee, Think Progress (.org)

Category Tags: Obama Health Care Reform, US Health Care Costs

Frances Kissling.Frances Kissling. [Source: University of Pennsylvania]Frances Kissling, the former head of pro-choice organization Catholics for a Free Choice, writes that the pro-choice movement made a grievous mistake in not successfully opposing the so-called “Hyde Amendment,” which since 1976 has denied federal funding for abortions in most instances (see September 30, 1976). Kissling is spurred to write in part by President Obama’s recent characterization of the Hyde Amendment as an “American tradition.” She writes: “It seems that pro-choice legislators, following the president’s lead, now explicitly consider that throwing women who cannot afford to pay for their own abortions under the bus is a reasonable compromise between those who favor and those who oppose legal abortion and a sensible concession to those who think abortion is immoral. The compromise is the logical outcome of one of Roe’s essential weaknesses: the fact that the constitutional right to abortion was based on the principle of privacy rather than non-discrimination. A private right, even a fundamental one, did not, according to the Supreme Court, require the state to pay for its implementation.” Kissling notes that in the years when Hyde was under consideration, the nascent pro-choice movement, in a decision “[b]ased substantially on the advice of direct-mail and political consultants,” decided to let Hyde go through without serious opposition, and focused instead on the “less real” threat of an anti-abortion constitutional amendment. Kissling writes: “The advice was clear and classist. It accepted the racism that lay buried in middle class hostility to poor women, ‘welfare queens,’ and the ‘sexually promiscuous’—all those who might be expected to look to Medicaid to pay for abortions—whom the rest of us should not support.” In hindsight, Kissling writes: “[n]ot concentrating on overturning Hyde was arguably the worst decision the mainstream choice movement made.… [T]he largely unchallenged Hyde Amendment emboldened anti-abortion groups to pick off powerless constituencies one at a time.” Instead of working to restore federal funding for abortions for women unable to pay for their own procedures, the pro-choice movement has, Kissling writes, taken on far more unpopular issues such as so-called “partial-birth” abortions (see April 1996 and November 5, 2003), but has never mounted a clear and unified challenge to Hyde. Kissling calls on the pro-choice movement to mount just such a challenge, and to continue to do so until Hyde is overturned. [Women's Media Center, 1/3/2010]

Entity Tags: Frances Kissling, Barack Obama

Category Tags: Abortion controversy & violence, US Health Care Costs, US Health Care Problems, Medicaid

Five men, including several conservative religious leaders, testified before a House committee on female contraception issues. No women were allowed to testify. The Senate later blocks a bill restricting contraception from passing.Five men, including several conservative religious leaders, testified before a House committee on female contraception issues. No women were allowed to testify. The Senate later blocks a bill restricting contraception from passing. [Source: Twitter / London Daily Mail]The Senate votes down the controversial “Blunt amendment” 51-48, on a nearly party-line vote. The amendment, offered by Senator Roy Blunt (R-MO) as a rider to a routine highway bill and co-sponsored by Senate Minority Leader Mitch McConnell (R-KY) and 22 other senators, would have allowed health care providers to refuse to pay for contraception and other health care procedures on religious or moral grounds. If the amendment had passed, health insurance plans and employers could refuse to provide or pay for coverage of “specific items or services” if the coverage would be “contrary to the religious beliefs or moral convictions of the sponsor, issuer, or other entity offering the plan.” Blunt and the bill’s supporters characterize the legislation as an attempt to restore religious freedoms taken away by the Obama administration’s “government health care takeover,” in Blunt’s words; opponents say the bill is an attack on women’s rights and an effort to ban contraception. Blunt said during the debate of the bill: “This amendment does not mention any procedure of any kind. The word ‘contraception’ is not in there because it’s not about a specific procedure. It’s about a faith principle that the First Amendment guarantees.” McConnell says the bill is an attempt to fight for “religious liberty,” which he and others say is under attack by the White House and Congressional Democrats. The Obama administration’s health care policy requires organizations to cover the cost of contraception, but does not require religious establishments to cover the cost. Employees of religious establishments can still obtain contraception from the health care insurance company. Mitt Romney (R-MA), a Republican presidential candidate, first stated his opposition to the bill, then quickly reversed course and said he was for it. The only Senate Republican to vote against the bill is Olympia Snowe (R-ME), widely considered a moderate Republican; three conservative Democrats vote for the bill. Senator Marco Rubio (R-FL), considered a strong candidate to run as the Republican vice-presidential nominee in the 2012 elections, says the Senate’s refusal to pass the bill is “a setback for religious freedoms in America.” Senator Charles Schumer (D-NY) calls the bill a straightforward effort to ban contraception. Senator Kirsten Gillibrand (D-NY) wrote in a recent op-ed, “Instead of coming together to fix our economy and strengthen the middle class, the Senate is considering a measure so extreme that it would allow any employer—religious or secular—to deny their employees coverage of any preventive service, including contraception, mammograms—anything the employer deems unfit to be covered.” Senator Patty Murray (D-MA) says, “The Senate will not allow women’s health care choices to be taken away from them.” Senator Barbara Mikulski (D-MD) says Republicans are attacking women’s health care as part of “a systematic war against women.” Secretary of Health and Human Services Kathleen Sebelius had asked the Senate to reject the proposal, saying, “The Obama administration believes that decisions about medical care should be made by a woman and her doctor, not a woman and her boss.” Dr. Hal C. Lawrence of the American Congress of Obstetricians and Gynecologists came out against the amendment, saying contraception “improves and saves babies’ lives, improves maternal health, and can be life-saving for women with serious medical problems.” The American Cancer Society released a statement opposing the amendment, saying it would allow employers to deny coverage of life-saving preventive services like mammograms and smoking cessation programs based on “undefined religious beliefs or moral convictions.” [New York Times, 3/1/2012; The State, 3/1/2012; The Week, 3/2/2012] After the bill is voted down, conservative talk show host Rush Limbaugh vilifies Georgetown University law student Sandra Fluke, who was not allowed to testify before a House committee meeting debating the bill [Think Progress, 2/16/2012] , calling her a “slut” and a “prostitute” for advocating the free availability of contraception (see February 29, 2012). Fluke gave her testimony before a panel of House Democrats and posted it on YouTube, where she discussed the needs of young women who use birth control and other contraceptives for medical needs such as cancer prevention. Specifically, she cites the example of a friend who needed, and was unable to obtain, birth control pills to manage polycystic ovarian syndrome. [Think Progress, 2/16/2012] Democrats and others criticized committee chairman Darrell Issa (R-CA) for only allowing men to testify before the House Oversight Committee on the topic of female contraception. It was Issa’s decision to bar Fluke from testifying before the committee. House Minority Leader Nancy Pelosi (D-CA) said at the time: “The Republican leadership of this Congress thinks it’s appropriate to have a hearing on women’s health and purposely exclude women from the panel. I may at some point be moved to explain biology to my colleagues.” Issa only allowed committee Democrats to name one witness; they named Fluke, whom Issa barred from testifying as she was “unqualified” to speak. [Daily Mail, 2/17/2012]

Entity Tags: Kirsten Gillibrand, Kathleen Sebelius, Darrell E. Issa, Charles Schumer, Barbara Mikulski, American Cancer Society, Willard Mitt Romney, US Senate, Rush Limbaugh, Hal C. Lawrence, Olympia Snowe, Obama administration, Nancy Pelosi, Patty Murray, Mitch McConnell, Roy Blunt, Marco Rubio, Sandra Fluke

Timeline Tags: Domestic Propaganda, 2012 Elections

Category Tags: Abortion controversy & violence, Obama Health Care Reform, US Health Care Costs, US Health Care Problems

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