Category: Health care

Implement and Improve the Affordable Care Act (ACA)

Implement and Improve the Affordable Care Act (ACA)

Posted on by Jack

Now that the election is over and Democrats remain in control of the Senate and President Obama occupies the Whitehouse, it should be clear to everyone that repeal of the Affordable Care Act (ACA) is extremely unlikely and House Republicans can stop wasting their time with this repeal and replace nonsense for at least the next 4 years.

There are many good things about the law. Or at least I think it is good that insurance companies cannot exclude people who they think will be expensive because of preexisting conditions. I think it is good that they cannot cap the benefits someone who gets seriously sick can receive. But I do not believe the law is perfect.

There are also a good number of things that do not seem like great ideas. And people will differ in opinions as to what those are. For example, many oppose the individual mandate to have health insurance. Others may think the free rider provision for employers is not such a great idea.

You can disagree with some provisions of the law without disliking all of it.

But the ACA is law and there is almost no chance of that changing. I see lots of good things but there are also problems, or at least provisions that some people see as problems. Unless you are happy with all of it, actively encourage your Representatives, Senators, and President to improve the ACA.

More disingenuous crap from Mitt Romney on medicare this time

More disingenuous crap from Mitt Romney on medicare this time

Posted on by Jack

I do like the term “disingenuous crap” to describe many of Mitt’s apparent positions. This time he is talking about Medicare.

I suppose it is meant to scare seniors who don’t think it through. Be Scared, very scared. Not so much about Obama’s cuts to Medicare as Mitt would like. But just think about the Medicare cuts in the Ryan/Romney budget.

Read the NPR story on his latest dubious and baffling claim. Is he really that that confused or is he trying to confuse us?

Mitt Romney is now the candidate of big change or big flip-flop

Mitt Romney is now the candidate of big change or big flip-flop

Posted on by Jack

So Mitt Romney is now the candidate of big change. Sounds very 2008 when President Obama was a candidate of hope and change.

I guess the difference is that I liked some of President Obama’s changes. I think it is good that health insurers can’t turn down people with pre-existing medical conditions. And it is good that insurers cannot cap your coverage if you have some really big claims. It seems good that insurers cannot find a reason to deny coverage if you are sick. There will be problems with health care reform and we need to elect people who will modify the reform to get it right.

I like that the economy is not falling apart and we are not losing hundreds of thousands of jobs each month as we did in the year before Obama took office. It seems the Presidents Bush and Obama (and Congress) took the right steps in late 2008 and 2009 to reverse the trend. Certainly things could be much better and I think they probably would be if Republicans in congress did not block many of President Obama’s efforts. But I see nothing to indicate Governor Romney would do any better.

I like that Obama seems to have a thoughtful foreign policy.

But Governor Romney is also known for his changes or flip-flops. I am surprised he wants to remind voters about that.

Science Debate

Science Debate

Posted on by Jack

No doubt science is important. Very important. It help us understand our world and beyond. It guides us in many ways as we find our way to live in the world. It is the basis of industrial advances. It is an important part of a healthy economy. Scientific advances are also important to our health. The ways in which science impacts our lives are almost too numerous to count.

Yet science does not seem to play a large part in political debates. The presidential candidates barely mention science and certainly not in any way that approaches its importance to our society. I’m not aware of any elected political office where the candidates discuss science.

But the presidential candidates (President Barack Obama and Governor Mitt Romney) participated in an online science forum ( http://www.sciencedebate.org/ ) in which they answered a series of science questions.

The questions were submitted to and answered by the candidates. So it wasn’t really a debate but it is the start of a discussion and the hope is that candidates might be moved to address these important scientific questions in a debate.

So if you would like to know what the candidates are thinking about science, be sure to check out http://www.sciencedebate.org/.

A false savings by repeal of Obamacare

A false savings by repeal of Obamacare

Posted on by Jack

I have many disagreements with Mitt Romney’s tax and budget plans and here is one that may surprise a few people who think his promises are all about saving money. On his website, he lists several savings. Among them-

Repeal Obamacare, which would save $95 billion in 2016

The House recently passed a bill that did just that. Or at least it would do so if it also passed the Senate and was not vetoed. Seems a bit unlikely now but there next year there is sure to be a different Congress and maybe a new President. But my point was that the House did pass this bill, HR 6079, which would repeal Obamacare and the Congressional Budget Office (CBO) looked at the fiscal consequences.

In a “Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act”, the CBO did a 10 year estimate of spending and revenue which would result if that legislation became law.

Sure enough there were big saving there but the government was forgoing even more revenue. The bottom line is a net loss to the government of 109 billion dollars. Since this is just an estimate a reasonable guess is that the average cost is about 10 or 11 billion dollars per year. This could just be added to the deficit or we could just add this to Mitt Romney’s tax plan.

I’m sure this figure does vary from year to year as different parts of Obamacare are implemented but since the average appears to actually be net loss to the government Governor Romney should explain why he thinks this action will save 95 billion dollars in 2016. And he might want to mention what he thinks will happen in all those other years.

Pro-life and Anti-Choice: VP abortion debate

Pro-life and Anti-Choice: VP abortion debate

Posted on by Jack

Abortion is a issue on which Americans disagree. One side believes it should be legal. The other believes it should be illegal.

In last night’s Vice Presidential Debate, Vice President Biden and Representative Ryan pretty much expressed positions on opposite sides of this issue. The quotes below are from NPR which has the video and transcript online. Those interested in the whole exchange can find it there.

Representative Ryan:

“That’s why — those are the reasons why I’m pro-life.

Now, I understand this is a difficult issue. And I respect people who don’t agree with me on this. But the policy of a Romney administration will be to oppose abortion with the exceptions for rape, incest and life of the mother.”

Of course if you think about, it Rep. Ryan is saying that he respects people who disagree but the favors a law that would force them to comply with his belief. Or more accurately, they must comply with Gov. Romney’s belief because Rep. Ryan doesn’t believe in exceptions but does defer to the top of the ticket

Vice President Biden:

“With regard to — with regard to abortion, I accept my church’s position on abortion as a — what we call de fide (doctrine ?). Life begins at conception. That’s the church’s judgment. I accept it in my personal life.

But I refuse to impose it on equally devout Christians and Muslims and Jews and — I just refuse to impose that on others, unlike my friend here, the congressman.”

I am with Joe Biden on this one. I don’t think I should impose my beliefs on others. I think it is a difficult decision but I would rather see individuals involved decide rather than the government.

I can understand why some people will have positions very different, even opposite, from my positions. But I think there is a lack of consistency in taking positions that highlight individual free choice for most aspects of life but take the anti-choice position in others.

Then there is a practical issue. Abortions will occur whether legal or not. Would it not be better to have them occur in plain sight where they will be safer?

Protect the kids or why people do dumb things

Protect the kids or why people do dumb things

Posted on by Jack

Last year I read a good book, The Panic Virus: A True Story of Medicine, Science, and Fear by Seth Mnookin.

But for some reason I did not review it on my book review site. But here is a review of this and some related books from New Scientist. I don’t recall why I didn’t write a review but Mnookin’s book came back to mind when I saw Parade magazine this weekend.

Seth Mnookin wrote an article “Why So Many Parents Are Delaying or Skipping Vaccines” which covered some of the ground he covered so well in his book but the emphasis was clearly on the problems parents cause for both their children and other children when they do not vaccinate their children as recommended. [Update: The link went bad. Looks like Parade reorganized the site. The new link is given.]

Study after study has show vaccination to be safe, yet many are hesitant. How can people ignore the evidence and do a dumb thing ? I am not calling people dumb. Even smart people can do dumb things.

Health Insurance Exchanges on Obamacare and Republican Medicare

Health Insurance Exchanges on Obamacare and Republican Medicare

Posted on by Jack

I do not understand why Paul Ryan, Romney-Ryan ticket, and perhaps Republicans in general seem to believe that having health insurance on exchanges for Medicare will somehow bring down healthcare costs though the magic of the marketplace. But having health insurance on exchanges in Obamacare will not also drive down health care costs.

I hope this is one on many mysteries that will be explained in the next few days or maybe months.

Yesterday (August 1, 2012) a date that shall live in infamy

Yesterday (August 1, 2012) a date that shall live in infamy

Posted on by Jack

According to Rep. Mike Kelly (R-Pa.), yesterday (August 1, 2012) was a date that shall live in infamy. What terrible thing happened that made it comparable to the great loss of life on September 11, 2001 and December 7, 1941 ?

Why it was the implementation of a provision of the Affordable Care Act (Obamacare) ? Now most folks won’t think this is as terrible as the terrorist attacks of September 11, 2001 or the attack on Pearl Harbor that got us into World War 2 but at least 1 republican representative thinks so.

What was this dastardly provision that is so terrible? It is the provision of preventive health services to women( avert your eyes for the rest of this sentence if you are squeamish) which includes contraception. Surely a terrible thing and a good reason for this date to live in infamy.

Here is the story of CBS News which includes a video of the Congressman. Here is an annoucement from Kathleen Sebelius, Secretary of Health and Human Services in case you are interested what this provision is actually about.

As I mentioned before this is a complicated issue but “date that shall live in infamy” is a bit over the top.

Do we improve the healthcare law or repeal and replace?

Do we improve the healthcare law or repeal and replace?

Posted on by Jack

Now that the healthcare law or the Affordable Care Act (ACA) has been upheld by the Supreme Court, the ball is once again in the hands of Congress.

Should we improve the law? Many people support aspects of the law but may oppose others. Perhaps they should encourage Congressmen to try for improvements. I will use the term Congressmen to include women just because “Congress persons” sounds awkward and I cannot think of a good inclusive term (Comments to suggest alternatives, anyone?) Maybe even replace those Congressmen who are not interested in improving the current healthcare law.

There are those who like the idea of repeal and replace. They would reject the law because there are parts they disagree with and trust Congress to replace it with something better. Not a very bright idea, in my opinion.

There are those who just want to repeal the law. Are they really happy with the current system? Do they think it is a good idea that many are uninsured, we have the most expensive system in the world, and certainly far from the best results? Not a good value in my opinion but then I don’t own an insurance company.

Conflict between Religious Freedom and Healthcare (Affordable Care Act aka ObamaCare)

Conflict between Religious Freedom and Healthcare (Affordable Care Act aka ObamaCare)

Posted on by Jack

Recently there has been quite a bit in the news about conflict between Religious Freedom and Healthcare. Specifically, the mandate for employers to provide health insurance meeting standards and the freedom of religious organizations to refuse what they feel in morally objectionable. To be even more specific, the administration believes contraceptive services should be included in all health plans but the Catholic Church believes contraception is morally objectionable and that they should be forced to provide such is an issue of religious freedom.

The administration is tasked with outlining minimum standards for health insurance policies under Affordable Care Act (aka ObamaCare). The administration has decided all policies should cover contraception with an exception for religious institutions such as churches and other houses of worship but the Catholic Church does not want to provide such coverage to employees of its many charitable organizations. The Obama administration has proposed a compromise which is still unacceptable to many.

Although it is often presented as a simple fight between religious freedom and a woman’s right to contraception, it is much more than that. Opens up a whole bunch of questions worth thinking about.

Should the exemption to health care requirements be limited to established churches alone?

What about church-related organizations?

Should any employer because of his or her church be exempt for providing some aspects of health insurance to employees?

Does a church need to be of any particular size before its members are allowed to object to the health care law on religious grounds?

How about employer with religious objections not based on any church?

What if the employer objects to more than contraception? Say the objection is to transfusions, surgery, chemotherapy, diseases related to various lifestyle factors, etc.

If an employer has objection to providing insurance or certain parts of insurance should that employer provide the employee with an allowance comparable to what the employer would pay for a policy they are willing to provide?

Since this is so complicated, should we just skip the employer mandate and move toward a single payer system or individual policies?

do we need to destroy medicare in order to save it

do we need to destroy medicare in order to save it

Posted on by Jack

No doubt Medicare has a problem. We are told the funds available are not enough to pay the benefits promised. So do we need to destroy Medicare (as it is) in order to save it?

Can we reduce costs without impacting benefits? You occasionally read about really big frauds being found. Do we need to do more about preventing those or at least minimizing damage? Private insurers seem less subject to this type of fraud. What is their secret? Can we make the medical system more efficient and less coslty.

If the American people think we should keep Medicare benefits, do we need to find a better funding mechanism? Obviously paying a small percentage of your salary while working and getting heath care benefits for life after 65 is not a viable model in itself. Do we want to supplement this from general revenues or add another dedicated tax. Increasing the taxes on gasoline consumption or adding a carbon tax seems appropriate. We need to decrease our dependence on oil and other carbon producing eneny sources so a tax seems logical to me.

Do we want to decrease benefits? That is the other possible solution. I don’t agree with Rep. Ryan’s plan but at least it has moved us a bit more toward a discussion on this.

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities

Posted on by Jack

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities.

Plan B alternative to the individual mandate for health insurance

Plan B alternative to the individual mandate for health insurance

Posted on by Jack

Last month I wrote about Plan B or finding an alternative to the individual mandate for health insurance . Several have been proposed but I’d like to point out a recent NY Times opinion piece by Ross Douthat which says in part:

The mandate is a harder puzzle, since it works in tandem with the requirement — popular enough to have many Republican supporters — that insurers cease denying coverage to customers with pre-existing conditions. If you repealed the mandate without repealing that requirement, people could simply wait until they were sick to buy insurance, driving everyone’s prices up.

But Republicans could propose dealing with the same problem in a less coercive way. One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.

Several other ideas for conservative reforms of the health care reform known as ObamaCare are discussed and the article is worth reading but this seemed directly relevant to my thoughts on finding alternatives to the individual mandate for health insurance.