Laughter is the cheapest medicine

"The health care bill was introduced yesterday. It's 1,990 pages long and costs $894 billion dollars. Or $2.2 million per word. That makes them the most expensive words to come out of Washington since 'Mission Accomplished.'" — Jimmy Fallon

"I have been thinking about the healthcare problem and how to pay for healthcare. If you took all the money the Republicans have spent trying to stop healthcare and all the money Democrats have spent trying to get healthcare, we could afford healthcare." — Jay Leno 

"If conservatives get to call universal healthcare 'socialized medicine,' I get to call private, for-profit healthcare 'soulless, vampire bastards making money off human pain.'" — Bill Maher 

 "Republican Sen. Olympia Snowe broke ranks with her party and voted for the Democrats' healthcare bill. She's been missing ever since." — Jimmy Fallon

"Not such a great day for the health-care reform. The so-called public option died on the Senate floor today. It could have survived, but apparently, it had a pre-existing condition." — Craig Ferguson

"The big news was the Senate yesterday - the finance committee - rejected the Democrats' health-care plan, the one with the public option. Meanwhile, the Republicans are offering their own health-care plan. It's called, 'Stop Crying and Take an Advil.'" — Jimmy Fallon

"United States Healthcare system: is there a remedy?", by Marina Levkovych.

In a year 2000 The World Health Organization presented its ranking on overall efficiency of world’s healthcare systems. Out of 190 ranks United States ended up on “honorable” 37th place, right next to Costa Rica, Slovenia and Cuba. Although supervision and public finance are not alone the remedy for existing health system “disorder”, world examples show that they both significantly improve the overall efficiency of healthcare.

The above mentioned report consists of numerous pages and measures the efficiency of the system from different perspectives. For example, it recognizes the health system goal in maximizing the health of population, and suggests that it’s performance to be measured in three key factors: health, responsiveness and fairness in finance. Above the 37th “honorable” place is a list of mostly European states such as Italy, Spain, Austria, Norway, Switzerland and Germany. French healthcare completes this list being considered the most competent in the World. It is necessary to note that it is not entirely publicly financed: 76.9% of it comes from public funding leaving the rest for a private sector. What makes it so advanced? The answer lays in what we call socialized medicine and Europeans call Universal coverage. In France every citizen has to have insurance. National healthcare program called Sécurité Sociale (social security) is being funded mostly out of income taxes and payroll. French citizens pay up to 21% of their income towards the health care funds. Employers also contribute to the funds, sometimes up to half of the cost. Government regulates most of the hospital fees. The coverage usually consist of the national plan, the bigger parts regulated by non-profit insurance companies, and supplemented coverage provided by small private insurance companies.  Another pleasant surprise is absence of coverage limit on heavily sick patients. In other words, the sicker you are - the more care you get. “France has made an unusual guarantee”, says Dr. Fabian Calvo, deputy director of France’s National Cancer Institute, ”that every cancer patient can get any drug, including the most expensive and even experimented ones that are still being tested(Healthcare lessons from France)”.

With all due respect to the World Health Organization, one can argue that it’s approach on measuring the efficiency might not be accurate. Victor Rodwin, professor of health policy and management at the Wagner School of Public Service at NYU, says in his interview to New York Times: “A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs. They examined avoidable mortality — that is, deaths whose risk of occurrence would be far lower if the population had access to appropriate health care interventions. In that study, based on data for the year 2000, France was also ranked No. 1, with the lowest rate of avoidable deaths. The United States was last, in 19th place, with the highest rate of avoidable deaths”(Health Care Abroad: France). Here is another easily fixable flaw of the system, which bring us down in charts.

It is easy to see now that many issues of Patient Protection and Affordable Care Act emerged from the concept of Universal coverage. If World Health Organization proved these measures to work, why can’t we try it in United States? Isn’t it better to learn from mistakes of others rather than to make your own? It all depends whether it will fit US economical and social conditions, and all we have to do now is give it some time.

Works cited.

Arnquist, Sarah, and Anne Underwood. "Health Care Abroad: France." nytimes.com. New York Time Media Group. 11 Sept. 2009. Web. 9 Nov. 2012.   

     Brunner, Stephanie. "The French Health Care System." medicalnewstoday.com. MediLexicon, Intl., 8 Jun. 2009. Web. 09 Nov. 2012

"Healthcare lessons from France". Health Care Overhaul: Prescriptions For Change. By Joseph Shapiro. Natl. Public Radio, 11 July 2008. npr.org. Web. 9 Nov. 2012.

WHO (2000). The World Heath Report 2000. Health Systems: improving performance. World Health Organization. who.int. Web. 8 Nov. 2012.

Healthcare Spending Rocketing Out of Control

By Aiya Anvarova

In the recent time of severe economic crisis followed by the sluggish economic recovery that the United States has been going through, it seems that the healthcare issue is not a priority for the country. Thus, many argued that President Barack Obama should have given up the Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare, and focused on the economy. However, in reality escalating healthcare spending has become a significant burden for the U.S. economy which makes it highly problematic to fix the economy without fixing the healthcare system.

In one of his June interviews, Governor Romney cited a book, “The Escape Artists: How Obama’s Team Fumbled the Recovery,” by the liberal journalist Noam Scheiber. In this book, the author put forward the idea that, early in his term, President Obama was deciding whether to focus on the national healthcare law or to devote more of his attention to the economic recovery. According to Scheiber, the President considered healthcare reform as a bigger long-term achievement and his corresponding choice of priorities postponed the U.S. economic recovery. Governor Mitt Romney proceeded with his line of presenting Obamacare as a part of the reason the economy was still sluggish by stating in the first presidential debate that he did not understand how “the President could have come in the office facing 23 million people out of work, rising unemployment and the economic crisis at the kitchen table and spend his energy and passion for two years fighting for Obamacare instead of fighting for jobs for the American people”. Accordingly, the Republican presidential challenger believes that the healthcare issue is not a sound economic issue and should not be on the President’s immediate agenda.

However, even though healthcare may not be a crucial economic issue for many countries in the world, the United States is not one of them as healthcare is one of the major expenditure items in the national budget and a sizable part of the economy. In 2010, the U.S. spent nearly $2.6 trillion on healthcare. This approximated to 17.9% of the country’s GDP, a substantially higher proportion than in any other country in the world. U.S. healthcare spending is now 55% above the average for wealthy countries. With that said, the quality of and access to care in the country is no way consistent with the enormous amount of money the federal government injects into healthcare. In 2011, the number of the uninsured Americans was 48.6 million compared to 37 million in 1980. Also the U.S. lags behind on life expectancy and the quality of preventive treatment. According to the Institute of Medicine, a third of the U.S. healthcare expenditure does not lead to improved health, that is, it is a substantial waste of the federal budget that has to be eliminated.

Healthcare spending is also creating long-term fiscal problems adding significantly to the overall federal debt. Between now and 2050, Medicare and Medicaid spending will rise from 5.5% of GDP to over 12%. In contrast, Social Security is projected to rise from 5% to only 6% of GDP over this period. Consequently, healthcare spending is the primary driver of future growth in government spending. Studies of international medical costs suggest that, compared to other high-income countries such as Canada and Great Britain, the U.S. healthcare system is inefficient, which substantially increases the medical costs both for the individuals and the government. There are a few areas in the U.S. healthcare system, such as overwhelming administrative costs and fee-for-service payment method, where changes have a tangible potential for savings and sustained cost reduction.  

Healthcare spending is nearly a fifth of the U.S. economy and is the largest driver of long-term U.S. debt. The way the healthcare issue is tackled will directly affect the economy in the long run. In general, the issue of healthcare reform is itself a major issue in terms of the economic recovery. In the context of the upcoming presidential election, it is important to understand that the ability and willingness of the next president to take hold of healthcare spending and improve the productivity of the U.S. healthcare system will have a significant impact on the country’s fiscal future and the economy in general.

List of References

Collins, S. R., Guterman, S.,  Nuzum, R.,   Zezza, M. A.,  Garber, T., and Smith, J. (2012, October 2). Health care in the 2012 presidential election: How the Obama and Romney plans stack up. Retrieved from the Commonwealth Fund website: http://www.commonwealthfund.org/

Cutler D. M., and Ly D. (2011, Spring). The (paper) work of medicine: Understanding international medical costs. Journal of Economic Perspectives, 25, 3-25. doi:10.1257/jep.25.2.3

Romney’s new attack: Why did Obama focus on ObamaCare instead of on the economy? (2012, June 6) [Web log post]. Retrieved from http://hotair.com/archives/2012/06/06/romneys-new-attack-why-did-obama-focus-on-obamacare-instead-of-on-the-economy/

Obamacare vs. Romneycare in Massachusetts: Overview.

As an answer to an earlier comment, I decided to write a separate post on what are the differences between Obamacare and original Romney’s healthcare plan in Massachusetts. Below is a summary of a chart taken from diffen.com, that compares several aspects of these two health plans.

	Obamacare	Romneycare
Individual mandate:	Yes	Yes
Penalty for not buying insurance:	Minimum of $695 a year. This penalty will be higher for those with higher incomes, but there are exemptions for people with low incomes and the total fee cannot be more than $2,085 per family.	Minimum of $1,200 a year. Romney now opposes the individual mandate on a federal level, but has supported implementing tax breaks to encourage individuals to purchase insurance.
Employer mandate:	Yes for companies with over 50 employees	Yes for companies with 11 or more employees. However, Romney initially attempted to veto this mandate, and he opposes its use in federal healthcare policy. Romney’s current healthcare plans do not include the employer mandate.
Penalties for employers not providing insurance:	At least $750 per employee for companies with over 50 employees	$295 per employee for companies with over 11 employees
Subsidized insurance:	Yes; for anyone earning up to 400% of poverty level	Yes; for anyone earning up to 300% of poverty level. Free for anyone earning up to 150% of poverty level. Mitt Romney now aims to encourage states to offer subsidies to the poor and to experiment with high-risk pools and insurance buying exchanges to harness the purchasing power of large groups. However, no state would be required to participate.
Young adults:	Children stay on parents' plan until age 26	Children can stay on parents’ plan until age 26 or until they have not been a dependent for 2 years – whichever is sooner.
Benefit limits:	Forbidden on both annual and lifetime basis	Not forbidden, although most MA insurers do not place limits
Retroactive rescinding of coverage:	Forbidden	Forbidden
Pre-existing conditions:	Insurers required to cover	Insurers required to cover, but can limit coverage of certain conditions to 6 months. If he becomes president, Mitt Romney plans to prevent discrimination against individuals with pre-existing conditions, as long as they maintain continuous coverage. However, insurers will be allowed to deny coverage to first-time customers.
Preventative care:	Free	Co-pay, but must be covered without a deductible
Contraception:	Included under free preventative care	Not mentioned
Effective date:	March 23, 2010, Specific provisions phased in through to 2020	April 12, 2006
Funding:	Obamacare is a federal program so its funding comes from new taxes. These include a tax surcharge on medical devices and a tax on "cadillac" health plans i.e. expensive, premium health plans that provide the best coverage. Supporters also cite savings in Medicare expenses to fund Obamacare.	Romneycare depends upon hundreds of millions of dollars in funding from the federal government and so the plan did not raise taxes for Massachusetts residents.

Middle Class Will Suffer Drastically if Obamacare is to Prevail

According to James C. Capretta and Tom Miller over at Economic Policies for the 21st Century, the tax raises due to Obamacare will be astronomical for middle class families over the next few years in order to help a marginal number of people.  Evidently, in return for paying these taxes, the middle class families themselves will actually be receiving worse Medicare benefits than their parents.  Does anyone else see something wrong with this?

Perhaps the candidates have reached a consensus in order to completely eradicate health care for the middle class over the next decade.  Even if that wasn't a mutual agreement between them, they are both definitely paving the path towards achieving that goal.

[Updated] Obamacare and Congressional Health Plans

Attack Ads Hit Republicans for Taxpayer-Funded Insurance

Traditionally, U.S. Representatives and Senators have been provided health insurance through the Federal Employees Health Benefits Program, which is open to all federal workers.  However, this perk is about to end thanks to a provision in Obamacare that requires legislators to be insured through the state health insurance exchanges set up under that law.  This requirement was inserted as an amendment to Obamacare by a Republican Senator, Charles Grassley (Iowa), to force legislators to "live under the same laws [they] pass[] for the rest of the country."  If Obamacare is overturned, as many Republicans favor, Congressional health insurance would revert back to the federally funded system covering all federal employees.

Now, according to the New York Times, Democratic challengers in some Congressional races are accusing the Republican incumbents of hypocritically voting themselves "taxpayer-funded healthcare for life."  The charge stems from criticism of Republican efforts to repeal Obamacare, which would also repeal Senator Grassley's requirement that legislators be insured through the state-based exchanges.

Whether or not the Republicans are acting hypocritically in this situation, the article's discussion of the possible effects of Obamacare on Congressional health insurance helps to illuminate a major problem that haunts the implementation of Obamacare:  uncertainty over what the law actually does.  Here are two possibilities:

1. Legislators lose their federal healthcare benefits and instead must purchase insurance from an exchange with their own money, or
2. Legislators retain federally funded health insurance, but the plan changes from the Federal Employees Health Benefits Program to some private insurance purchased (by the taxpayers) in a state-based exchange.

As to the attack ads arguing that the Republicans are hypocrites, no one can tell yet whether the charges are accurate since the law has yet to be implemented.  Thus, Democrats seem to be premature in calling out Republicans as hypocrites.

As to the wider matter of uncertainty over the effects of Obamacare, this article illustrates the problems that many private companies (large and small*) will be facing in the near future.  Not only is there uncertainty over whether Obamacare will be repealed (in the event of a Romney win), there is also uncertainty over the legal requirements that will come into force in regards to employer-sponsored health plans even if Obamacare remains.

[UPDATE]:  Commenter dpmckay asks what the exact effect of Obamacare will be on small businesses.    According to The Wall Street Journal, the smallest businesses (2-49 employees) will have no requirements and instead will qualify for subsidies if they offer their employees health insurance.  Starting in 2014, businesses with over 50 employees must either provide a health insurance plan to their "full-time" employees (30 hours or more) or pay a penalty (it is unclear whether the penalty is $750 or $2,000).  There is still uncertainty over the exact rules for determining just who counts as a "full-time" employee, as shown by this U.S. Department of Labor FAQ for employers (e.g. regulations are pending).

There are few businesses who employ 50 or more employees and do not offer insurance:  0.2 percent of all firms according to the Healthcare.gov website.  Healthcare.gov also mentions that these firms may be able to find cheaper plans on the state insurance exchanges due to Obamacare, which may offset some of the costs of offering insurance.

*A Personal Note:  Just a few days ago, I was talking with one of the managers of the small company I work for about health insurance.  He made it clear that the company could not make any promises at this time because they still had no idea what would be required under Obamacare.

The [$716 billion] Phantom Menace

$716 billion "cut" from Medicare?

Currently, one of the most popular campaign-trail topics is a scary $716 billion cut from the Medicare budget that will go to help fund Obamacare.  As a New York resident nowhere near the retirement age, I can only imagine the creepy, black-and-white attack ads being run in Florida on this issue.  I can also only hope [in vain, I suspect] that those ads explain the claim better than the candidates are doing in their debates.

Fortunately, Politifact has come to our rescue with some answers on where this $716 billion figure comes from:

1. Obamacare includes cost-saving measures designed to lower the cost of Medicare.  Some of the savings comes from reducing payments to hospitals with high re-admission rates, while some savings comes from cuts in the Medicare Advantage program (supplemental, private insurance).
2. The CBO's analysis of Obamacare found that those measures should lower future costs to Medicare by about $716 billion over the next ten years.

Thus, Medicare's future budget requirements should be lower due to these cost-savings measures.  

Further confusion comes from the fact that these cost-saving measures were included in the Obamacare law. This was done so that the cost of Obamacare would seem lower when the CBO scored the law prior to passage.  In effect, this makes the Medicare cost-savings measures serve as a funding mechanism for the Obamacare programs, which in turn fuels claims that Obama is robbing Medicare to pay for Obamacare.

Healthcare Administrative Costs: Medicare vs. private insurance under Obamacare

A major piece of Obamacare, President Obama’s signature achievement of his first term, was a new requirement that private insurers spend at least 80% of their premium dollars on care, leaving the remaining 20% to cover administrative costs and profit. This requirement was a response to a common criticism of the private health insurance industry: Too many premium dollars going to administrative costs and profit, and not enough going to actual healthcare. Indeed, much has been made recently of the rebate checks that Obamacare forced some private insurance companies to issue to their customers in order to comply with the new requirement. There is, however, one familiar health insurance system that is reported to have extremely low administrative costs: Medicare. This article will compare administrative cost levels among private health insurers and Medicare.

First Presidential Debate Overview: the Healthcare.

The first Presidential debate took place on October 3rd at the University of Denver in Denver, CO.  One of the main issues discussed was the issue of healthcare reform. Although a great amount of time was devoted to this problem, in my opinion, neither of the candidates was able to shed light on the concerns of the American people.

The main topic being the project Obamacare, President Obama started his argument with three main points. The first was that the Affordable Care Act does not concern the people who already have insurance and moreover, it regulates its cost. He also mentions  that under his new program, people with existing policies will be getting rebates if their insurance company spends more than 20% of its profit on infrastructure and CEO bonuses rather than on customers’ benefits. Second, he emphasized that for people who don’t have coverage, the cost to get it would be 18% less than before. Lastly, he notes that this model worked really well in Massachusetts, referring to his opponent’s notion of rejecting something that he himself supported in his own state. Governor Mitt Romney in response agrees that the major task of the reform is to lower the cost of health care, but not through Obamacare. He addresses statistics and finds that ¾ of small business owners will reduce their hiring potential if they will be obligated to provide insurance, which can potentially lead to a job loss in a private sector. “I like the way we did it in Massachusetts," Romney says, but proposes to leave this decision up to the State government. Nevertheless, Governor does not explain why if it works on a State level, it cannot be exercised on a Federal level.

Governor Romney also addresses the problem of Medicare, precisely the $716 billion dollar cut under Affordable Care Act reform. In his opinion, making Medicare a voucher system will give people a choice of insurance, which will create competition, and that will automatically regulate the cost. In response to that President Obama mentions that the goal of any private insurance is to make a profit, which is why Medicare will always cost less. Obama does not give any comment on the $716 billion cut and tries to avoid this subject. It is also necessary to note that the main reason for cuts is a huge federal deficit. Although Governor Romney actively criticized Obamacare, he does not specify how his program will deal with this deficit. Moreover, Congressional Budget Office reports that repealing the health care law would increase the federal deficit by $109 billion over ten years.

Obamacare's Insurance Exchanges: Mixed Feelings from States

WaPo:  Many States Not Willing to Operate Exchanges

According to The Washington Post, many states have fallen behind on planning their health insurance exchanges.  Furthermore, some states are declining to operate exchanges altogether, instead opting for the federal government to run their exchanges for them.  Although the exchanges are legally required to be operating by October 2013, only 13 states and the District of Columbia have formally expressed their intention to operate their own exchanges.  

Health insurance exchanges are a major part of Obamacare (Affordable Care Act).  The exchanges are supposed to include a "one-stop-shop" website for health insurance (akin to Orbitz).  Furthermore, individuals and families will be required to shop on the exchanges if they wish to take advantage of government subsidies for health insurance.