Thursday, February 4, 2010

Rebuttal to “Government Takeover Won't Fix Health Care”

Republican Doc Hastings receiving his instructions from the Republican Caucus, had an op-ed published in Mid-Columbia Voices, Tri-City Herald, January 29, 2010. The following is a rebuttal. RH: Our health care system is in need of reform so that Americans get the care they need when they need it at a price they can afford. This is the one sensible thing Congressman Richard ‘Doc’ Hastings says in his opinion piece.
RH: I'm working to stop bills moving through Washington, D.C., right now because these bills are taking us in exactly the wrong direction. The trillion-dollar government takeover of health care must be scrapped and Congress should start over on reform that is focused on lowering costs.
While Republicans have been doing everything possible to obstruct health care reform this year, we’ve spent enough on Iraq and Afghanistan (about $12 billion per month) to fund the first year of a robust health care reform program and still have enough left over to help families avoid defaulting on their mortgages.
RH: The House of Representatives and the Senate have approved different health care bills. Now, congressional Democrats and the White House are behind closed doors cutting deals and negotiating in secret with special interests to get the votes they need to pass their massive plan for government control of health care.
“Government takeover of health care” is a consistent Republican theme. It’s an attempt to portray health care reform proposals in the House (H.R. 3962) and Senate (H.R. 3590) as the imposition of publicly financed health insurance for all Americans, i.e., a single payer system. Neither of the bills does any such thing.
RH: At its most basic, the bills moving through Congress create a government-run health system that restricts private options and forces Americans to purchase coverage from a government-controlled program. I oppose this $1.3 trillion government takeover of health care. Instead, Congress must fix what doesn't work, find ways to lower costs while maintaining quality, increase choices and protect the doctor-patient relationship.
To repeat, neither the Senate bill (H.R. 3590) nor the House bill (H.R. 3962) “create a government-run health system.” Both bills build on and improve the current system.
RH: First, I want to share some details about what we should do. I support lowering costs by expanding health care choices and tools like health savings accounts that help families save. Individuals should have the same tax benefits that employers receive for purchasing health insurance. Small businesses should be allowed to band together and purchase health insurance at the same rates big corporations can - and these policies should be portable. Americans should have the choice to purchase cheaper prescription drugs from Canada, and lawsuit abuse that drives up costs for everyone must end.
Health savings accounts (HSAs) are a favorite diversion of Republicans. Ask yourself where the money goes that we invest in HSAs. It goes to Wall Street --the very people that took such good care of your 401k and IRA. According to the Kaiser Family Foundation, health care insurance premiums increased by 131% over the last ten years. Where do you think you’re going to earn an average of 13.1% on your HAS?
Furthermore, Hastings throws out a number of Republican proposals without providing any detail about how they would be implemented, what their impact would be, or how they are related to the whole complex of health care components that make up what is a very complex system. Their “solutions" may seem appealing on the surface, but they turn out to be simplistic and unsupported by policy or cost/benefit analysis.
RH: These goals can be achieved without plunging our nation deeper in debt or putting the government between you and your doctor - but that won't happen if the bills written by those who control Congress become law.
What’s plunging this nation into debt is massive, unsustainable Defense spending, $708 billion of the $1.3 trillion 2011 president’s budget. U.S. spending over the last decade is more than the next 45 countries combined.
To date, if you include all the costs of war, including caring for our wounded soldiers and taking care of the families of soldiers killed in action, the U.S. has spent well over a trillion dollars, that’s a million, million dollars, on the war in Iraq since 2001. One estimate, by a Nobel prize-winning economist (Joseph Stiglitz), puts the cost at three trillion dollars, that’s $3,000,000,000,000. This is for a war many think was unwarranted, and for which Republicans under the Bush Administration said we would pay only $50 to $60 billion in total, so it’s somewhat ironic to have Republicans like Hastings complaining about debt.
RH: The misguided proposals in Congress aren't about lowering costs - they're about bigger government and higher spending. As the nonpartisan Congressional Budget Office has stated, these bills will increase the deficit, add to our debt and increase long-term health care costs.
This is just isn’t so. The CBO and the Joint Committee on Taxation estimate that the direct spending and revenue effects of enacting either of the bills would yield a net reduction in federal deficits, $132 billion for the Senate bill and $104 billion for the House bill, over the 2010-2019 period.
RH: According to a report by the Obama administration's Department of Health and Human Services, health care costs would increase under the House-passed bill.
Here again, Hastings is misleading us. The Office of the Actuary for the DHHS Centers for Medicare & Medicaid Services states that according to their estimates the Senate bill (H.R. 3590) would postpone the exhaustion of trust fund assets by nearly 10 years—that is, from 2017 under current law to early 2027 under the proposed legislation. Furthermore, the combination of lower Part A costs and higher tax revenues results in a lower Federal deficit.
As for the House bill, provisions in H.R. 3962 in support of expanding health insurance coverage (including the Medicaid eligibility changes) are estimated to cost about $935 billion through fiscal year 2019. The net savings from the Medicare, Medicaid, growth-trend, CLASS, and immediate reform proposals are estimated to total $529 billion, leaving a net cost for this period of $406 billion before consideration of the increase in Federal income and other tax revenues that would result from the surcharge on high-income individuals and families and other revenue provisions.
The CBO and JCT have estimated that the total net amount of Medicare savings and additional tax and other revenues would offset the cost of the national coverage provisions, resulting in an overall reduction in the Federal deficit through 2019.
RH: Aside from a staggering price tag for a bill that won't lower costs, these proposals would have serious impacts on Tri-City families, farmers, seniors and small businesses.
Yes, the House and Senate health care reform bills would impact Tri-City families, farmers, seniors, and small businesses. Families would be able to buy affordable health insurance that can’t be denied based on pre-existing conditions. Ditto for farmers, involved in one of America’s most dangerous occupations, and generally not covered by an employer. Seniors would be assured of the continued viability of Medicare. And businesses with less than 50 employees would be exempted from most provisions of the bills, plus those that do offer their employees health insurance would receive a tax credit.
RH: The government would decide which health care plans are acceptable. A federal commissioner would determine which benefits are offered and how much is charged. This would force many Americans out of their existing plans and require everyone to sign up for a government-approved health plan or pay a fine. Think about that - Americans would be fined for not participating in a government-approved plan.
Nothing Hastings says in the first part of this paragraph makes a hill of beans – it’s all nonsense and has been refuted many, many times before (remember the “death panels” scare tactic?).

"The biggest issue is the euthanasia part of this" ('Doc' Hastings, September 6, 2009)

It’s the last part of the paragraph that bears scrutiny.
Hastings is unable or unwilling to consider the various health care reform measures in the House and Senate bills in context, i.e., as an interrelated whole. Like the song says, “This I tell you brother. You can’t have one without the other.”
Bills before Congress will preclude insurers from denying coverage for pre-existing conditions. Everyone (except insurers) feels this is necessary. But you can’t do this without requiring that everyone have insurance. Why? Because otherwise no one would buy insurance until they needed care, i.e., had a pre-existing condition.
People can opt not to carry coverage, in which case they’ll pay a tax penalty that amounts to 2 percent of a person’s adjusted income. The penalty may be waived in certain circumstances. The penalty money would be used to defray the costs of the uninsured on the public health system.
Hastings fails to tell us that if a family is now covered through an employer and pays taxes, they are already paying approximately $1,000 dollars every year for the uninsured. They will no longer pay this hidden tax under the health care reform packages being considered in Congress.
Furthermore, the requirement that people have acceptable coverage comes with subsidies that make coverage dramatically more affordable for working people. Millions of people who would otherwise not be able to afford health insurance will now be covered -- something like 31 million people.
RH: Job-creating businesses would face tax increases, fines and mandates - making it harder for them to offer benefits. Tools like health savings accounts and flexible savings plans would be restricted, and $500 million in Medicare cuts would eliminate existing options for seniors.
Hasting has mashed together several things in this paragraph. It makes it tough to determine what he’s referring to in the bills. But let’s take it one step at a time. Employers with more than 50 employees will be expected to offer health benefits. If they don’t, they’ll be expected to pay into a fund to help defray insurance costs. That levels the playing field. It’s a fair and reasonable provision.
The reform bills would permit only prescribed drugs to be paid for out of Health Savings Accounts (HAS), and would increase taxes on disbursements from HSAs not used for qualified medical expenses. Makes sense to me.
I have to laugh when I read Republican objections to health care reform because of its impact on Medicare. Yes, we seniors sometimes forget where we left our eyeglasses, but we don’t forget that under Ronald Reagan, Republicans tried their best to defeat the very bill creating Medicare. Health care reform is endorsed by the AARP. Here’s what it says, “Health reform will help all generations of Americans, saving money and improving care for all ages. Medicare would be a stronger program, with less waste, an improved drug benefit, and better coordination among doctors.” I’ll take their word over that of the Republican Party any day.
As for details, the health care reform bills being debated in the House and Senate both aim to reduce the ballooning costs of Medicare in order to keep the program solvent. They would root out waste, fraud, and abuse. The House health care proposal would reduce projected increases in Medicare payments to some health care providers by more than $500 billion (not $500 million, as Hastings says) over 10 years. Some of that money would be put toward avoiding cuts in payments to doctors so seniors have better access to physicians. The bill would reduce payments to private providers in programs such as Medicare Advantage, which is operated by private insurance companies and bought by seniors to fill gaps in coverage. Some of the savings from Medicare would be used to cover uninsured workers who pay Medicare taxes.
RH: Top-quality hospitals like the Wenatchee Valley Medical Center would be arbitrarily penalized and barred from expanding simply because they are doctor-owned.
Hastings statement that the Wenatchee Valley Medical Center (WVMC) “would be arbitrarily penalized and barred from expanding simply because they are doctor-owned" is erroneous; there’s nothing arbitrary about it.
Many physician-owned hospitals are known as “specialty hospitals.” According to an article in Time Magazine, they tend to sell themselves on the promise of comfort, if not luxury. About half don't have any kind of emergency department and of those that do, more than half have only one bed available. Despite being physician-owned, only about 30% have a doctor on site at all times, and about two-thirds actually tell staff to call 911 in case of an emergency. It's all so entrepreneurial. And profitable. And it's a conflict of interest, e.g., your doctor sending you to a lab he owns for a blood test, an MRI, a CAT Scan, you may not need, and admitting you to a hospital in which he owns shares.
The Senate and House bills would require disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.
Yes, health care reform as currently crafted includes a moratorium on building or expanding physician-owned specialty hospitals, but hospitals with a provider agreement in effect as of February 1, 2010, will be grandfathered-in under the policy provided they meet certain requirements.
WVMC, chartered in 1940, is the only physician-owned hospital of this nature in the State of Washington. It's an important asset to the region. And it just so happens that Maria Cantwell and Patty Murray joined Doc Hastings in a tour of WVMC and held a press conference there in August 2009, and agreed on language to go into the House and Senate bills that would allow WVMC to continue to operate under either bill, although they wouldn’t be able to expand the number of operating rooms, medical procedures, or patient rooms. The CEO of WVMC stated that the two Washington State senators “advocated strongly” for WVMC.
RH: These are all consequences of putting the federal government in charge of deciding how, where and when we get care. This is something I fundamentally oppose. In my experience, putting the federal government in control of a program rarely has the desired effect of making that program cheaper, faster or smoother. It's time to reverse course and work toward reform that increases choices and drives costs down.
I understand the conservative viewpoint that less government is better government and that states should have more say over certain policy matters than the federal government. One can have a reasonable debate concerning where to draw the line. But Hastings isn’t doing that in his remarks. He’s purposely misleading us, and I object to that.
Health reform is a complex matter and getting it right is imperative. The health of Americans and the health of the American economy depend on doing so. I urge all Americans to do their homework. The Kaiser Family Foundation put together a very helpful table comparing the many provisions of the House and Senate bills. Read it. Study. Get informed. And you'll understand how badly Republicans are misrepresenting the nature of these bills.

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