Poll: U.S. Split On Socialized Medicine

[Zeno Swijtink]

It will be very hard for any president to lead a campaign for health care reform. Which candidate is the best positioned to lead such a battle against powerful economic interests with the greatest chance of success?

****
https://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=57513&sid=5&fid=1

The California collapse
Published: January 31, 2008 04:39AM

Oregon and a handful of other states trying to navigate the choppy seas of comprehensive health care reform felt their sails go slack on Tuesday when a promising bipartisan effort in California unexpectedly sank.

The surprising failure of California’s ambitious $14.9 billion plan stunned health care reform advocates throughout the nation and brought into sharp focus the myriad obstacles facing any state hoping to effect more than incremental health care improvements.

The highest hurdle, as always, is the staggering amount of money a state needs to extend decent health care to all — or even most — of its citizens. But even if money to pay for such plans were no object, threats to the profits of major stakeholders in the existing system offer incentive enough for ferocious opposition. The heavy hitters in the health care industry have enormous political clout.

All eyes were on California’s far-reaching legislative proposal to overhaul a health care system burdened by 5.1 million uninsured residents. But a yearlong effort on the part of Republican Gov. Arnold Schwarzenegger and Democratic California Assembly Speaker Fabian Nuñez collapsed when the state Senate Health Committee voted 7-1 to kill the bill.

The bill would have covered about 70 percent of the state’s uninsured residents through a combination of subsidies and mandates. All California residents would have been required to buy health insurance, and insurers would have been prohibited from denying coverage to almost all applicants, including those with pre-existing health problems. The plan required employers to contribute to workers’ health benefits or pay into a state fund.

The largest nail in the plan’s coffin came from California’s staggering $14.5 billion budget deficit, which already has prompted Schwarzenegger to propose $2.9 billion in health care cuts over the next 18 months.

“It doesn’t matter if there are these good things in the bill if there isn’t the money to pay for them,” said Sen. Sheila Kuehl, D-Santa Monica. “We can’t simply say to the people of California, ‘Go buy insurance.’?”

Voicing a fear that would sound familiar to Oregonians who watched their groundbreaking Oregon Health Plan suffer huge cuts due to state budget shortfalls, California senators said Schwarzenegger’s proposal was too risky in the current economic environment. The misgivings were bolstered by a report last week from the California Legislature’s nonpartisan fiscal analyst, who said the plan would run out of money in five years unless all of its assumptions worked perfectly.

Fallout from California undoubtedly will land in Oregon, where a health care reform effort launched in the last legislative session is just getting under way. Even if Oregon escapes the worst of the economic downturn gathering momentum elsewhere in the nation, earlier revenue forecasts certainly will be revised downward.

That would affect funding assumptions and revenue needs built into the Healthy Oregon Act, which aims to provide health insurance to every Oregonian.

The implosion of the carefully negotiated California plan demonstrates that the forces working against comprehensive health care reform are even more powerful at the state level than they are in Congress. Their power is multiplied in individual states, because every state health care system is inextricably linked to national corporations and federal health care programs.

While states can make progress, and Oregon is among the states that have pioneered innovative approaches, comprehensive health care reform must be addressed at the federal level.

Of all the issues driving debate in the 2008 presidential campaign, the candidate who offers the strongest commitment to national health care reform will present voters with a persuasive argument for election.

[Tars]

The U.S. Gov't has a "single payer" universal health plan covering employees. This is the health plan that congresspeople enjoy (but which the huge majority of their constituents lack).

As your CA & OR examples point out, any universal health plan is a huge, fractious, tremendously daunting project. It reminds me of the similar problem getting alternative fuels going - there has to be a big initial investment in the infrastructure before the larger operation can start rolling effectively. Any universal health plan requires that the administrative part become operational before the coverage can become anything remotely like "universal"

I don't know how the next president will deal with the huge problem. I have a suggestion though: Disengage from Iraq as expeditiously as possible. It's sucking this nation's lifeblood in more ways than one.

Instead of investing in war, invest similar levels of funds in rebuilding the infrastructure of the U.S. - transportation mediums, sustainable power generation, improved water supplies, etc. This project has been estimated to take more than ten years, cost hundreds of billions, and employ millions. But it would also start paying for itself more and more as it progresses.

Make these rebuilding programs "public works programs", administered under the federal gov't as with the similar programs in the mid 20th century. Since all of these workers would be government employees, they would become eligible for government-funded health care. The numbers of people enrolling into that health system would bring the administrative cost of their health care down to what is currently used by the government's current healthcare system - about 7-8% of its gross budget. This is far below the estimated 20-25% administrative cost of corporate HMOs.

While all those people are improving our infrastructure, helping our society to operate more efficiently and safely, they'll simultaneously be creating the health care system system that we will eventually have anyway, a universal, government administered single-payer health system.
OK, what's next? https://www.rpriddle.com/smile/wink.gif

[Zeno Swijtink]

https://www.capitolweekly.net/article.php?xid=wvanx2pnrdc8z8

Postmortem analysis of health care bill
By Anthony York (published Thursday, January 31, 2008)
Who killed health care and why?

That was the question circulating around the Capitol this week in the wake of the Senate Health Committee’s vote killing the compromise bill brokered by Speaker Fabian Núñez and Gov. Arnold Schwarzenegger.


Most senators cited fiscal concerns in their decision not to support the bill. But it was clear Tuesday that neither the speaker nor the governor truly believed that the fiscal analysis was the true reason health care failed in the Senate.

In fact, both Núñez and Schwarzenegger seemed to indicate that the LAO report was being used as political cover for senators who voted against the bill.

“We have to find out what is the reason and why it did not pass,” Schwarzenegger said. “Not what has been given to the public, but what is the real reason … In acting, we call it the sub-layers, the different colors underneath.”


“I can tell you as a Democrat, I’ve looked at LAO reports,” said Núñez. “What we like to do is we pick the stuff we like, that’s advantageous to us, and the things that are not, we sort of ignore and brush aside.”

A spokeswoman for Senate leader Don Perata reiterated that the health care bill died under the weight of the state’s fiscal problems. “Our sole motivation is the governor’s budget and our deficit,” said Perata spokeswoman Alicia Trost. “Everything we care about as Democrats and human beings is at risk. Our first priority is figuring out how to not lay off hundreds of teachers and not kick 165,000 kids off of Medi-Cal, and then we can talk about doing other things.”

Núñez said he did not want to “point fingers at any one person” over his bill’s demise. But there was plenty of blame in the subtext. He took issue with Perata’s analysis that the health care bill was not truly bipartisan, and he took some shots at the way Sheila Kuehl, the chairwoman of the committee that killed the bill, conducted her committee hearing.

“I don’t know that (the bill) was given the type of balance and objectivity that I would have given it in a hearing. There’s clearly now a different vetting that we’re going to have to go through.”

“If you’re going to have disagreements, they ought to be over the facts,” said Núñez. “We did not have a hearing, not for one minute, on the facts of this bill. That debate was not about the facts.”

So, who do the speaker and governor think did kill health care? The list of potential culprits range from the California Nurses Association on the left to Blue Cross and tobacco companies, who were trying to protect their economic interests.

And while nobody cited concerns for the insurance industry or tobacco companies in their vote Monday, one of Schwarzenegger’s health care experts, Daniel Zingale, indicated those powerful interests were largely responsible for the bill’s demise. “There’s nothing new about a panel of legislators voting down health care reform under intense lobbying from special interests — tobacco, Blue Cross, whoever else was active over there,” Zingale said. “That’s familiar.”

*“The coalition against this bill was clear across the political spectrum,” said Mark Ridley-Thomas, the lone senator to vote for the bill in the Health Committee on Monday.

Schwarzenegger led a formal wake for his health care proposal at a Capitol news conference this week. But as stakeholders and interest groups lick their wounds after the Senate defeat, many are already trying to figure out what’s next.

Schwarzenegger lamented the failure of Perata to seize “this golden opportunity” to put a health care proposal before voters in November. Health care reform has a poor track record with California voters. But backers of the bill were optimistic that a contested presidential election with a motivated Democratic Party base provided a once-in-a-generation opportunity to get a health care deal approved by voters.

“It’s pretty obvious why we all felt November was so important,” said Zingale.

Schwarzenegger said he had not had time to sit down with Núñez and other health care leaders to discuss a strategy. And, he noted, Perata “has not even called me” to discuss how to proceed from here.

One possibility may be to extend health insurance coverage to California’s 760,000 uninsured children. Groups like the California Endowment and Children Now have been focused on securing health coverage for children, regardless of what happened to the comprehensive health care proposal.

AB1 by Assemblyman John Laird, D-Santa Cruz, would set the framework for extending children’s health coverage. It would expand the state’s Healthy Families program to cover all children at or below three times the federal poverty level. And it would offer a way for families above that income threshold to buy in to the program.

Sen. Darrell Steinberg, D-Sacramento, has introduced a bill identical to Laird’s AB1 in the Senate. Steinberg, who abstained on AB1X1, said the defeat of the bill puts pressure on the Senate to take some action on health care this year.

“I think it is very important that the Senate articulate alternatives,” said Steinberg. “The lead alternatives are children’s health care, transparency, and beginning to phase in coverage for uninsured adults.”

AB1 has passed both the Senate and Assembly and is currently being held at the Assembly desk.

Like the speaker’s health care plan, Laird’s AB1 does not have a funding source. And a spokesman for Núñez said that if the Senate balked at the cost of the speaker’s health care proposal in these lean budget times, there was no reason to believe the Senate would be any more forthcoming in its support of Laird’s measure, or one like it.

“It’s still a problem of money,” said Núñez spokesman Steve Maviglio. “The Senate made it clear. They said we have to take care of our existing budget problem first.”

“If you are able to keep intact the hospital fee tax and a tobacco tax, we not only could cover 800,000* children, but we could begin making progress on the issue of uninsured adults,” Steinberg said.

Trost said that after the budget mess is ironed out, the Senate “would be happy to look at all kinds of things.”

[Kathleen Shaffer]

After focusing on health care this year which culminated in the local Health Care Forum here in Sebastopol, this is a huge disappointment. California could have been the leader for the country. There are certain state legislators, including Democrats, who did not take the needs of Californians into account, and were not going to support a health care bill in any form.

I am convinced that should Clinton wind up in the White House, she will not bring about reform. Whatever she does, it will be what the insurance companies allow, and then she will be 2 for 2 on her health care efforts.

Kathleen Shaffer






It will be very hard for any president to lead a campaign for health care reform. Which candidate is the best positioned to lead such a battle against powerful economic interests with the greatest chance of success?

****
https://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=57513&sid=5&fid=1

The California collapse
Published: January 31, 2008 04:39AM

Oregon and a handful of other states trying to navigate the choppy seas of comprehensive health care reform felt their sails go slack on Tuesday when a promising bipartisan effort in California unexpectedly sank.

The surprising failure of California’s ambitious $14.9 billion plan stunned health care reform advocates throughout the nation and brought into sharp focus the myriad obstacles facing any state hoping to effect more than incremental health care improvements.

The highest hurdle, as always, is the staggering amount of money a state needs to extend decent health care to all — or even most — of its citizens. But even if money to pay for such plans were no object, threats to the profits of major stakeholders in the existing system offer incentive enough for ferocious opposition. The heavy hitters in the health care industry have enormous political clout.

All eyes were on California’s far-reaching legislative proposal to overhaul a health care system burdened by 5.1 million uninsured residents. But a yearlong effort on the part of Republican Gov. Arnold Schwarzenegger and Democratic California Assembly Speaker Fabian Nuñez collapsed when the state Senate Health Committee voted 7-1 to kill the bill.

The bill would have covered about 70 percent of the state’s uninsured residents through a combination of subsidies and mandates. All California residents would have been required to buy health insurance, and insurers would have been prohibited from denying coverage to almost all applicants, including those with pre-existing health problems. The plan required employers to contribute to workers’ health benefits or pay into a state fund.

The largest nail in the plan’s coffin came from California’s staggering $14.5 billion budget deficit, which already has prompted Schwarzenegger to propose $2.9 billion in health care cuts over the next 18 months.

“It doesn’t matter if there are these good things in the bill if there isn’t the money to pay for them,” said Sen. Sheila Kuehl, D-Santa Monica. “We can’t simply say to the people of California, ‘Go buy insurance.’?”

Voicing a fear that would sound familiar to Oregonians who watched their groundbreaking Oregon Health Plan suffer huge cuts due to state budget shortfalls, California senators said Schwarzenegger’s proposal was too risky in the current economic environment. The misgivings were bolstered by a report last week from the California Legislature’s nonpartisan fiscal analyst, who said the plan would run out of money in five years unless all of its assumptions worked perfectly.

Fallout from California undoubtedly will land in Oregon, where a health care reform effort launched in the last legislative session is just getting under way. Even if Oregon escapes the worst of the economic downturn gathering momentum elsewhere in the nation, earlier revenue forecasts certainly will be revised downward.

That would affect funding assumptions and revenue needs built into the Healthy Oregon Act, which aims to provide health insurance to every Oregonian.

The implosion of the carefully negotiated California plan demonstrates that the forces working against comprehensive health care reform are even more powerful at the state level than they are in Congress. Their power is multiplied in individual states, because every state health care system is inextricably linked to national corporations and federal health care programs.

While states can make progress, and Oregon is among the states that have pioneered innovative approaches, comprehensive health care reform must be addressed at the federal level.

Of all the issues driving debate in the 2008 presidential campaign, the candidate who offers the strongest commitment to national health care reform will present voters with a persuasive argument for election.

[Zeno Swijtink]

I am convinced that should Clinton wind up in the White House, she will not bring about reform. Whatever she does, it will be what the insurance companies allow, and then she will be 2 for 2 on her health care efforts.

Kathleen Shaffer

A contrary point of view from Krugman: "If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.."

****
https://www.nytimes.com/2008/02/04/opinion/04krugman.html

February 4, 2008
OP-ED COLUMNIST
Clinton, Obama, Insurance

By PAUL KRUGMAN
The principal policy division between Hillary Clinton and Barack Obama involves health care. It’s a division that can seem technical and obscure — and I’ve read many assertions that only the most wonkish care about the fine print of their proposals.

But as I’ve tried to explain in previous columns, there really is a big difference between the candidates’ approaches. And new research, just released, confirms what I’ve been saying: the difference between the plans could well be the difference between achieving universal health coverage — a key progressive goal — and falling far short.

Specifically, new estimates say that a plan resembling Mrs. Clinton’s would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama’s — at only slightly higher cost.

Let’s talk about how the plans compare.

Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.

And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll.

An Obama-type plan would also face the problem of healthy people who decide to take their chances or don’t sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up — but it’s not clear how this would work.

So the Obama plan would leave more people uninsured than the Clinton plan. How big is the difference?

To answer this question you need to make a detailed analysis of health care decisions. That’s what Jonathan Gruber of M.I.T., one of America’s leading health care economists, does in a new paper.

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

As with any economic analysis, Mr. Gruber’s results are only as good as his model. But they’re consistent with the results of other analyses, such as a 2003 study, commissioned by the Robert Wood Johnson Foundation, that compared health reform plans and found that mandates made a big difference both to success in covering the uninsured and to cost-effectiveness.

And that’s why many health care experts like Mr. Gruber strongly support mandates.

Now, some might argue that none of this matters, because the legislation presidents actually manage to get enacted often bears little resemblance to their campaign proposals. And there is, indeed, no guarantee that Mrs. Clinton would, if elected, be able to pass anything like her current health care plan.

But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

[Zeno Swijtink]

"About 6.6 million Californians lack health insurance, more than 20 percent of the state's population."

****
https://www.washingtonpost.com/wp-dyn/content/article/2008/01/30/AR2008013003298_pf.html
Health-Care Reform to Shift Focus
CHRISTOPHER LEE, Staff Writer - Washington Post


The demise of California's attempt at comprehensive health-care reform this week means that advocates of overhauling the health-care system will turn their focus back to Washington, several experts said yesterday, as an increasingly tough budget climate raises new questions about whether states can go it alone.

When the plan championed by Gov. Arnold Schwarzenegger (R) and state Assembly Speaker Fabian Nunez (D) went down to defeat in a legislative committee, so did hopes that successful reform in such a populous, influential state would bolster efforts elsewhere to cover more of the nation's 47 million uninsured.

While California is unique in some respects -- it has a diverse electorate, a high number of uninsured and a history of occasional budget crises -- experts said some of the same economic forces at work there threaten to slow or swamp similar proposals in other states. The slumping economy diminishes states' tax revenue at the same time that spending demands increase as more people seek help from programs such as Medicaid, which serves the poor. And, unlike the federal government, state governments have to balance their budgets every year.

"The failure of California's plan pushes the focus about expanding coverage even more strongly towards Washington," said Paul B. Ginsburg of the Center for Studying Health System Change, a nonpartisan policy-research group. "I've never believed that states would be able to go very far on their own because of their fiscal limitations. A state in an average year could be able to afford something, but once they get into a recession, they get into fiscal trouble."

Karen Davis of the Commonwealth Fund, a nonprofit research institution, said federal leadership is crucial because California and some other states' plans depend, in part, on expanding Medicaid and other public programs to cover uninsured children who currently do not qualify. But the Bush administration has been unwilling to sign off on most such expansions. "The lack of federal support for state innovations has proved to be a major hurdle to reform," Davis said.

California's proposal, borrowing elements from a similar plan that passed in Massachusetts in 2006, would have required most residents to obtain private health insurance and would have called for new charges on businesses, hospitals and cigarettes to help fund it.

It drew opposition from Republicans who saw it as too onerous on business and from Democrats, including advocates of a single-payer system, who said it would impose a financial burden on working people and yet bring too little benefit. But the crowning blow came from the gaping $14 billion hole in California's budget, which made many supporters and opponents doubtful that the state could afford the program's $14 billion cost.

Schwarzenegger and Nunez have vowed not to give up. About 6.6 million Californians lack health insurance, more than 20 percent of the state's population.

So far, Massachusetts -- which began with an estimated 400,000 to 600,000 uninsured people, less than 10 percent of its population -- is the furthest along among states trying to expand coverage.

Since July, Massachusetts has required almost all residents to obtain health insurance or face a penalty of as much as $912, exempting only those deemed unable to afford coverage. More than 300,000 people had signed up for coverage as of Jan. 1, according to the Commonwealth Health Insurance Connector Authority, the new state entity implementing the law. But the program's long-term cost remains a concern, with state budget experts projecting a shortfall of as much as $147 million this fiscal year.

"We've been extremely successful in enrolling people in health plans, but there is still an awful lot of work to do," said Dick Powers, a spokesman for the authority.

Despite the sagging economy and the collapse of the California effort, other states are still trying. In recent years, Vermont and Maine approved legislation intended to expand coverage to the uninsured, and Illinois and Wisconsin made it a priority to cover more children. Late last year, Maryland expanded Medicaid coverage for single adults and approved new subsidies for small businesses. Other states that are developing plans and may consider them in legislation this year include Colorado, Iowa, Missouri, New Mexico and Washington, according to the National Conference of State Legislatures (NCSL).

"They are likely to take a look at what happened in California and tweak something that they may already have in the works, but I wouldn't see those states as changing a basic direction or abandoning what momentum they already have," said Richard Cauchi, health program director at the NCSL. "States, to be honest, look inward primarily. They are not necessarily trying to be the national trendsetter. They are looking to create a law that will work within their own boundaries."

[Zeno Swijtink]

France Best, US Worst in Preventable Death Ranking
WILL DUNHAM - Reuters

https://www.reuters.com/article/latestCrisis/idUSN07651650

WASHINGTON -- France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.

Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did.

They called such deaths an important way to gauge the performance of a country's health care system.

Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.

"I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.

In establishing their rankings, the researchers considered deaths before age 75 from numerous causes, including heart disease, stroke, certain cancers, diabetes, certain bacterial infections and complications of common surgical procedures.

Such deaths accounted for 23 percent of overall deaths in men and 32 percent of deaths in women, the researchers said.

France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said.

After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.

PREVIOUS RANKINGS

The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings.

All the countries made progress in reducing preventable deaths from these earlier rankings, the researchers said. These types of deaths dropped by an average of 16 percent for the nations in the study, but the U.S. decline was only 4 percent.

The research was backed by the Commonwealth Fund, a private New York-based health policy foundation.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," Commonwealth Fund Senior Vice President Cathy Schoen said.

"The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference," Schoen added in a statement.

[Zeno Swijtink]

https://www.nytimes.com/2008/01/04/washington/04health.html

January 4, 2008
U.S. Curtailing Bids to Expand Medicaid Rolls
By ROBERT PEAR

WASHINGTON — The Bush administration is imposing restrictions on the ability of states to expand eligibility for Medicaid, in an effort to prevent them from offering coverage to families of modest incomes who, the administration argues, may have access to private health insurance.

The restrictions mirror those the administration placed on the State Children’s Health Insurance Program in August after states tried to broaden eligibility for it as well.

Until now, states had generally been free to set their own Medicaid eligibility criteria, and the Bush administration had not openly declared that it would apply the August directive to Medicaid. State officials in Louisiana, Ohio and Oklahoma said they had discovered the administration’s intent in negotiations with the federal government over the last few weeks.

The federal government has leverage over states, because it pays a large share of the costs for Medicaid and the State Children’s Health Insurance Program, and states have to comply with federal standards to get federal money. The insurance program was created for children whose families have too much income to qualify for Medicaid but not enough to buy private insurance.

On Dec. 20, the Bush administration rejected a proposal by Ohio to expand its Medicaid program to cover 35,000 more children. Ohio now offers Medicaid to children with family incomes up to twice the poverty level, or about $41,000 a year for a family of four. The state had proposed increasing the limit to three times the poverty level, to about $62,000.

“Federal officials told us that they would apply the criteria set forth in the Aug. 17 letter to our proposal for expansion of Medicaid,” said Cristal A. Thomas, the Ohio Medicaid director.

Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, confirmed that account.

“To be consistent and logical, you have to apply the criteria to Medicaid and CHIP,” Mr. Smith said in an interview.

The same concern, about the substitution of government health care for private insurance, is present under both programs, he said, and states will not be allowed to “sidestep the Aug. 17 policy directive” by expanding Medicaid.

Jeff Nelligan, a spokesman for the Medicaid agency, said Ohio officials “were trying to get around the Aug. 17 policy directive.” Under that policy, states had to enroll 95 percent of eligible children below 200 percent of the federal poverty level before they could expand their programs, a criterion that many state health officials said would be impossible to meet.

Tony Fratto, a spokesman for President Bush, defended the administration’s stance.

“We want states to focus on enrolling their neediest population before they consider expanding Medicaid and CHIP to middle-income families,” Mr. Fratto said. “This policy demonstrates the president’s compassion. He wants to direct scarce tax dollars to those with the greatest needs.”

Administration officials say government health programs start to “crowd out” private insurance when they cover families with incomes from 250 percent to 300 percent of the poverty level — about $51,600 to $62,000 for a family of four.

Some state officials complained about both the substance of the Medicaid policy and the way it was adopted.

“The Aug. 17 letter is a CHIP policy, not a Medicaid policy,” said Mike Fogarty, chief executive of the Oklahoma Health Care Authority. “But it’s being applied in a much broader way. We are seeing many more roadblocks.”

The Oklahoma Legislature voted in May to cover 42,000 more children under Medicaid by increasing the income limit to 300 percent of the poverty level, from 185 percent. “In recent weeks,” Mr. Fogarty said, “we got a very clear signal from federal officials that we would not be allowed to go beyond 250 percent of the poverty level.”

Louisiana officials reported a similar experience. “We found that we have much less flexibility to make changes in Medicaid than we thought,” said J. Ruth Kennedy, deputy director of the state’s Medicaid program.

The new federal policy reflects a significant shift. In the first four years of the Bush administration, Tommy G. Thompson, the secretary of health and human services, often boasted that he had approved record numbers of waivers, allowing states to decide who got what benefits under Medicaid and the child health program.

“Our goal is to give governors the flexibility they need to expand insurance coverage to more Americans,” Mr. Thompson said in 2001.

The child health program complements Medicaid. Income limits vary from state to state and tend to cluster from 133 percent to 185 percent of the poverty level for Medicaid, with states allowed to go 50 percentage points higher for the child health program.

Mr. Bush has been engaged in a yearlong battle with Congress over the child health program. In his budget request last February, Mr. Bush said he wanted to return the program to its “original objective” of covering children with family incomes less than twice the poverty level. He asked Congress to cut payments to states that covered children at higher income levels.

The Democratic-controlled Congress showed no interest in Mr. Bush’s proposal. But the administration has tried to achieve a similar objective unilaterally, with the letter to state health officials.

Under the new policy, states must meet certain conditions if they want to cover children with family incomes above 250 percent of the poverty level. For example, a child who had private coverage in the past must be uninsured for at least one year before being enrolled in a state child health program.

In June, the Louisiana Legislature unanimously approved a bill to expand eligibility for the State Children’s Health Insurance Program by raising the income limit to 300 percent of the poverty level, from 200 percent.

But Ms. Kennedy, the Louisiana official, said, “After receiving the Aug. 17 letter, we had to change course.”

Louisiana is now seeking permission to increase its income limit to 250 percent of the poverty level. And it has had difficulty getting federal approval.

In correspondence with the Louisiana Department of Health and Hospitals, federal officials have suggested that the state does not have enough money to pay its share of the costs.

In addition, federal officials challenged Louisiana to explain why it did not want to enforce the one-year waiting period for children who had lost private health insurance because of a parent’s death or the failure of a business where a parent was employed. In such cases, the state replied, the loss of coverage is involuntary, and the waiting period would “penalize children and families for circumstances beyond their control.”

In Wisconsin, Gov. James E. Doyle, a Democrat, and the State Legislature also wanted to expand eligibility for the children’s health program by increasing the income limit to 300 percent of the poverty level, from 200 percent. The federal government approved the proposal after Wisconsin scaled it back to 250 percent. Coverage for children above that level is to be financed entirely with state money.

“Federal officials made clear that they would not approve our proposal if we went to 300 percent of the poverty level,” said Jason Helgerson, the Medicaid director in Wisconsin.

[Zeno Swijtink]

Blue Cross Halts Letters Amid Furor
LISA GIRION and JORDAN RAU, Staff Writers - Los Angeles Times
https://www.latimes.com/business/la-fi-bluecross13feb13,0,4778416.story

Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients' insurance coverage.

In a statement issued about 6 p.m., the state's largest for-profit insurer said, "Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern.

"As a result, we are discontinuing the dissemination of this letter going forward."

The announcement came after blistering rebukes Tuesday by physicians, patients, privacy experts and officials including Gov. Arnold Schwarzenegger and Sen. Hillary Clinton (D-N.Y.) after The Times disclosed the practice.

The letter had been sharply criticized Monday by the California Medical Assn., and Tuesday night its president, Richard Frankenstein, said: "This letter was part of Blue Cross' pattern of unfairly canceling policies when people need coverage most. We're relieved that Blue Cross is ending this particular tactic but continue to have serious concerns about this company's practices looking forward."

Earlier in the day, Shannon Troughton, a spokeswoman for Blue Cross parent WellPoint Inc., said the company had been sending as many as 1,000 letters a month for years and had received no complaints.

Blue Cross sent physicians copies of insurance applications filled out by new patients, along with the letter advising them the company had a right to drop members who failed to disclose "material medical history." That could include "preexisting pregnancies."

The letter asked physicians to "immediately" report any discrepancies between their patients' medical condition and the information in the applications.

Other major insurers in California said Tuesday that they had not asked physicians to do anything like what Blue Cross was seeking.

Schwarzenegger sharply criticized the practice, which he described as akin to telling physicians to "rat out the patients and to give the patients' medical history to the insurance company so they have a reason to cancel the policy."

The governor said the practice should be banned.

"That is outrageous," he said, and "one more reason why it is so important to have comprehensive healthcare reform."

Democratic presidential contender Clinton said the Blue Cross effort was another "example of how insurance companies spend tens of billions of dollars a year figuring out how to avoid covering people with health insurance."

California insurers, including Blue Cross, are under fire for issuing individual policies without checking applications and then canceling them after patients get sick. The practice, known in the industry as rescission, is under scrutiny by state regulators, lawmakers and the courts.

In scores of lawsuits, patients contend that the insurers dropped them over honest mistakes and minor inconsistencies on applications that they allege are purposely confusing. People ailing with cancer or other diseases often are unable to get new coverage once their insurance has been rescinded, and they may go without treatment. Swamped with medical debt, people have lost homes and businesses.

Insurers say the cancellations are an important weapon against fraud and occur rarely.

Several physicians and medical groups said they were troubled by the letters. Robert Margolis, a physician and the chief executive of one of the state's largest medical groups, described the letters as "an obnoxious intrusion" on the relationship between physicians and patients.

"Asking us to be the application police is inappropriate," said Margolis, who heads HealthCare Partners Medical Group in Los Angeles.

Troughton said the company believed the letters complied with state and federal privacy and health practice laws. She said Blue Cross "highly values the trust of its members and understands the personal relationship members have with their physicians."

But, she said, "it is our responsibility to assure that all members' records are accurate and up to date both for the benefit of our members and the providers in our HMO network."

Sending applications to physicians for review is an important tool, Troughton said, to "ensure that it mirrors what is reflected in the physician's notes for that member."

But privacy experts said that may violate privacy laws.

"They don't have a right to contact someone that you hired and you employed to take care of your health and to release data about you without your permission," said Deborah Peel, a Texas physician who founded Patient Privacy Rights, a nonprofit advocacy organization. "What's the point of paying for insurance if they are going to look for every reason to deny what you think you paid for, which is access to services to help you?"

Jamie Court, president of the Foundation for Taxpayer and Consumer Rights, said information exchange also might violate state laws aimed at ensuring that physicians do not allow financial considerations to interfere with medical judgments.

"The real issue here is the doctor acting as a double agent," Court said.

Other large health insurers, including UnitedHealth Group Inc. -- which operates PacifiCare in California -- Blue Shield of California and Health Net Inc., said Tuesday that they did ask doctors to look for or alert them to possible preexisting medical conditions.

Margita Thompson, a spokeswoman for Health Net, said the company asks physicians for medical records when it suspects patients may have omitted preexisting conditions on applications.

"But the doctor is not asked to review the records at all," she said. "And we do not send the doctor a copy of the application for his review."

[Zeno Swijtink]

https://www.cbsnews.com/stories/2008/02/14/health/webmd/main3832537.shtml

Poll: U.S. Split On Socialized Medicine
WebMD


A new poll shows that U.S. voters are divided on the issue of socialized medicine, which is a single-payer, government-run health care system.

The poll comes from the Harvard School of Public Health and Harris Interactive. More than 2,000 people took part in the poll, conducted by phone in January and February.

First, people were asked how well they understood the term "socialized medicine."

About two-thirds - 67% - said they understand the term "very well" or "somewhat well." Thirty percent said they don't understand the term very well or at all. The rest said they didn't know or didn't answer that question.

What Is Socialized Medicine?

People also had different expectations of socialized medicine.

Participants who said they understood socialized medicine "very well," "somewhat well," or "not very well" listened to three statements and noted those they thought applied to socialized medicine.

The poll shows that 79% thought that in a socialized medicine system, the government makes sure everyone has health insurance, 73% thought the government would pay most of the cost of health insurance, and 32% said they think it means that the government tells doctors what to do.

Better or Worse?

Next, people who claimed to understand socialized medicine "very well," "somewhat well," or "not very well" were asked if they thought socialized medicine would make the U.S. health care system better or worse.

The results: 45% said they thought it would improve health care, 39% said they thought it would worsen health care, 4% said they thought it wouldn't make much difference, and 12% didn't know or didn't answer.

But those figures take on another dimension when politics comes into play.

Partisan Split

Among Democrats, 70% said they thought socialized medicine would improve U.S. health care. And 70% of Republicans said they thought it would worsen health care.

As for independents, 43% said they thought socialized medicine would improve U.S. health care, 38% said it would worsen health care, 5% said it wouldn't make much difference, and 14% didn't know or didn't answer.

Lastly, participants heard a list of presidential candidates' names and indicated whether they thought that person, if elected, would propose socialized medicine. They didn't have to pick just one candidate.

Hillary Clinton led the list of candidates that participants expected to propose socialized medicine as president; 69% said they thought she would do so. Next came Barack Obama (57%), Mike Huckabee (19%), and John McCain (15%).

John McCain topped the list of candidates that participants didn't expect to propose socialized medicine; 62% said they didn't expect such a proposal from McCain, followed Mike Huckabee (52%), Barack Obama (26%), and Hillary Clinton (21%).

None of those candidates has proposed socialized medicine programs as part of their campaign platform.

[Tars]

A new poll shows that U.S. voters are divided on the issue of socialized medicine, which is a single-payer, government-run health care system.

Thanks for the interesting post, Zeno. I wonder if there'd've been a significant difference in the results if the poll had used the term "univeral healthcare" instead of "socialized medicine". The latter term was generated by the GOP foes-of-Hillary during the '90's. Its intent apparently, was to cast her as a uber-liberuhl, trying to turn the U.S. into a communist state. Though the term "socialized medicine" may have lost some of its emotional charge for many since then, for many others whose support universal healthcare would need to become fact, it still smacks of a liberal comm-symp-one-world-government plot.

[Valley Oak]

I very strongly support universal health care. It's one of Rodham's strongest points as a candidate and one of Obama's weakest.

We should have had free health care in the states no later than the sixties. It is loooooooooooooong overdue. (By the way, we are by far the wealthiest country in the world, amazing!)

Edward

[wohlii]

How could we be the wealthiest country having a deficit going into the trillions???? Being 50% owned by the Chinese, etc., etc.