Reasons To Be Concerned About Our Prescription Medications...

From yesterday's New York Times...

NEW DELHI — India, the second-largest exporter of over-the-counter and prescription drugs to the United States, is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines. Dr. Margaret A. Hamburg, the commissioner of the United States Food and Drug Administration, arrived in India this week to express her growing unease with the safety of Indian medicines because of “recent lapses in quality at a handful of pharmaceutical firms.” India’s pharmaceutical industry supplies 40 percent of over-the-counter and generic prescription drugs consumed in the United States, so the increased scrutiny could have profound implications for American consumers. F.D.A. investigators are blitzing Indian drug plants, financing the inspections with some of the roughly $300 million in annual fees from generic drug makers collected as part of a 2012 law requiring increased scrutiny of overseas plants. The agency inspected 160 Indian drug plants last year, three times as many as in 2009. The increased scrutiny has led to a flood of new penalties, including half of the warning letters the agency issued last year to drug makers.

Generic medication make up roughly 69 percent of all prescriptions dispensed in the United States. As the situation in India is currently in a flux and Indian companies scramble to try and save their businesses, we may see a large percent of generic production shifting to China, which allows for even less oversight.

A fascinating story that may effect most of us, its certainly worth a read...

Click here to read the full article...

Sources:

http://www.nytimes.com/2014/02/15/world/asia/medicines-made-in-india-set-off-safety-worries.html?_r=2

http://www.tevagenerics.com/default.aspx?pageid=3425

How is healthcare handled around the world? A look at various countries starting with the United States...

This week's Healthcare Triage starts a series of episodes focusing on how various countries deliver healthcare to their people. There are many different ways around the world ranging from our mostly private system here in the States to Canada's single payer and the United Kingdom's fully Socialist system. This series looks at other ways countries deliver healthcare to its citizens. Dr. Carroll packs a ton of great information into about seven minutes, so pay attention!

First up, the United States:

Question: Does Making People Pay More Out of Pocket for Reduce Health Care Spending? Answer: Yes, but...

 Starting in 1971 and concluding in 1986, the RAND Corporation conducted the largest study ever done on health insurance in the United States. Its findings were landmark and serious. The study basically looked at 4 groups of people, divided by how much out of pocket each group would pay for their health care.

Would the people that paid less or nothing for their health care spend more than those who paid more? A popular idea then and now is that if you make people pay more for their healthcare, they will use less of it, thereby lowering total healthcare spending in the country.

The findings have not produced a universally held interpretation of the study. Dr. Aaron Carroll, in this week's Healthcare Triage, discusses the study and why some savings from higher out of pocket expenses aren't necessarily without consequences. At times, serious consequences...




Sources:

http://www.rand.org/health/projects/hie.html

Who's Really To Blame for Rising Health Care Costs?

Josh Moon from the Montgomery Advertiser writes:

Let me break some bad news: You’re being played

 A small number of people with their own self interests in mind are running a con game on you concerning the health care reform. They’ve convinced you — and it wasn’t hard to convince some of you — that Obama’s goal is to limit your health care choices, redistribute your wealth and control your lives.

Moon lays out in clear and concise fashion where the blame is better placed for increasing health insurance premiums. Rather than understand (more importantly accepting) that insurance companies have been increasing our rates for over a decade while the "free market" did its magic, too many people are quick to point the finger at President Obama's Affordable Care Act. Which is ironic because for the first time in memory the insurance companies now have limits to how much they can increase the premiums on health care plans. They also have to justify their increases. They also have to spend a minimum of .85 of every premium dollar on actual health care (as opposed to marketing, advertising, executive compensation, etc) or refund people some of their money.

Two things strike me as headshakers in this ongoing debate. The irrational refusal to accept that the free market hasn't served us well enough and that the ACA isn't to blame for everything that is wrong in the world of health insurance today.

Moon makes his case in less than two pages, give it a read here...


Source: http://www.montgomeryadvertiser.com/article/20131020/NEWS01/310200036/Josh-Moon-s-Just-Saying-Who-s-really-blame-rising-health-care-costs-?fb_action_ids=10200793236018749&fb_action_types=og.recommends&fb_ref=artsharetop&fb_source=other_multiline&action_object_map=%7B%2210200793236018749%22%3A343759305761441%7D&action_type_map=%7B%2210200793236018749%22%3A%22og.recommends%22%7D&action_ref_map=%7B%2210200793236018749%22%3A%22artsharetop%22%7D&nclick_check=1

How Obamacare will effect 8 different lives...

The Obamacare equation: How eight lives would be effected by the health law...

The Washington Post's Sarah Kliff and others have posted a terrific article on how the Affordable Care Act will effect eight different people, all in different situations. They provide a concise summary of the person's situation, their current medical needs and concerns and provide an example of what both a moderate and a cheap health insurance plan would cost them. The eight people ran the gamut from eagerly awaiting the state exchanges to open on October 1st, to a case where the individual will choose to pay the fine rather than sign up for coverage.

Kliff is becoming one of the heavy hitters when it comes to health reform coverage. In my opinion, she does extraordinary work.

Read the entire article by clicking on the link below...

The Obamacare equation: How eight lives would be effected by the health law....

Source:

http://www.washingtonpost.com/wp-srv/special/national/health-care-profiles/

Still Unsure on Why Health Care is So Expensive in the US, Watch This...

New York bestselling author John Green has put out a short but well done video on why we pay so much more than other countries do for health care. Nothing really new here, but the material is put together in a very easy to swallow and entertaining fashion. (H/T to A. Carroll, TIE for this treat...)



Learn more about John Green here...

Source: http://johngreenbooks.com/

What About College Kids & the Affordable Care Act? Some Answers...

NPR has a short but informative audio piece on the issue of College students and the Affordable Care Act. Are they required to obtain insurance? What sort of penalty will they face if they don't? How will it be collected?

Listen to the Q&A right here:




Source: http://www.npr.org/blogs/health/2013/08/19/207902395/you-ask-we-answer-more-of-your-questions-about-the-affordable-care-act

Paul Krugman on the Crow that Conservatives Will Likely Have to Eat...

New York Times economist and columnist Paul Krugman weighs in with a direct, no nonsense column aimed directly at those Conservatives who have painted the Affordable Care Act as a failed, catastrophe of a Law.

Krugman writes:

Is there an illegitimate way? Well, the G.O.P. can try blackmail, either by threatening to shut down the government or, an even more extreme tactic, threatening not to raise the debt limit, which would force the United States government into default and risk financial chaos. And Republicans did somewhat successfully blackmail President Obama back in 2011.

However, that was then. They faced a president on the ropes after a stinging defeat in the midterm election, not a president triumphantly re-elected. Furthermore, even in 2011 Mr. Obama wouldn’t give ground on the essentials of health care reform, the signature achievement of his presidency. There’s no way he would undermine the reform at this late date.

Read the entire column here, its well worth it...

Source: http://www.nytimes.com/2013/08/19/opinion/krugman-one-reform-indivisible.html?ref=opinion&wpisrc=nl_wonk_b&_r=0

This Week's Ridiculous Weekly GOP Address on Healthcare...

Senator Mike Enzi, (R) Wyoming, says in this week's GOP weekly address that we should scrap the Affordable Care Act because of its partisan construction. I'm not going to shred Mr. Enzi's premise because I'm tired of arguing with people who actually believe President Obama and the Democrats shoved the ACA up the Republican Party's ass and they weren't invited to participate. They were, they said no to almost everything. So, the Dems moved on, and voila! The ACA was born.

Mr. Enzi wants to stop the ACA in its tracks permanently and start anew in smaller steps on health care reform. “We need to focus on common sense, step-by-step reforms, that protect Americans’ access to the care they need, from the doctor they choose, at a lower cost. Providing Americans with access to high quality, affordable health care is something both Democrats and Republicans should be able to agree upon."

The problem is, that healthcare doesn't work like other things. Its not a typical free market entity, plus the pieces are intertwined, out of necessity. Want to kill the individual mandate? OK, but then kiss the pre-existing condition coverage goodbye as well because if you can't promise the insurance companies that everyone is in the boat, then you'll have adverse selection which means only sick people buying insurance which leads to the dreaded "death spiral." The insurance companies can't survive with such a business model, so such a move would clearly be anti-business.

Sen. Enzi, like so many of his fellow Republicans loves to drone on about "we need to focus on common sense, step by step reforms,.." Short on specifics, aren't we? Sure access to care, choosing a Doctor, paying less are all nice ideas, but they won't just happen. Every move effects multiple parts of the health care industry. You can say you want to improve access but there are ramifications. The uninsured in the country are too often the worst risk pool to be found. That's going to cost a TON of money for the insurance companies to cover them, which they won't unless they get something in return. Like a mandate where now everybody healthy, young and well as the sick and older people can pool their premium dollars together to absorb the expenses of the sickest.

Choosing your own doctor isn't that tough of a hurdle to navigate. But, sometimes when insurance companies are up against it, they might elect to work with physician group B versus physician group A, for economic reasons. So, if you have United Healthcare, but they decide to not renew the contract with the practice your favorite doctor works with...you have a choice. Pay out of pocket or find a new doctor. This isn't a new phenomenon, certainly not unique to the age of the ACA. Its been going on for years.

"Paying less" An admirable goal, but how, Mr. Enzi? If we're paying less for our healthcare, that means somebody is making less as well, and that's not a very popular idea. How do you sell that, sir? Again, it sounds great, but who's going to take less for their services?

These remarks from Sen. Enzi are, for all practical purposes, useless in advancing and improving health care in this country. Its a grand waste of our time and his. Its an insult to the people who are seriously trying to improve a dysfunctional healthcare delivery system. It is ridiculous to pine for these things aloud but be willing to do virtually nothing to realistically address the issue. Please stop wasting our time.

You can watch his full remarks below:

More Favorable Data on Health Insurance Premiums Coming In....

A new analysis done by Avalere Health suggests that consumer's costs for health insurance may indeed be dropping via the new exchanges. Looking at data available from nine states, (CA, CO, CT, OH, OR, RI, VT and WA)  where the average cost for Silver Plans was (in some cases) running 20-25% lower than the CBO expected. This is big news on two fronts. First, its a smaller than expected cost out of pocket for many consumers, secondly, the Federal Government will use the second lowest premium to set its subsidy rates, which will effect thousands of people.

Nothing reverses the trend and expectation that younger healthy people will likely pay more for their health insurance going forward. If its any solace to this market, they'll be purchasing far better and comprehensive coverage than what their money bought them before. Subsidies still apply to this group based on income, so it may be a bit of a wash in the end.

The state insurance exchanges are expected to go live sometime in October, 2013....

Sources:

http://www.avalerehealth.net/

http://www.avalerehealth.net/news/spotlight/20130619_Avalere_Exchange_Rate_Analysis.pdf

The Best Defense of the Medical Device Tax I've Seen....

Michael Hiltzik of the Los Angeles Times has written what is the best and clearest defense of the Affordable Care Act's "medical device tax."

One of the ACA's primary funding sources, the MDT has come under bi-partisan fire and the Senate voted last March to repeal it, 79-20, with 33 Democrats voting for repeal. While the vote was mostly symbolic, its shows how many Democrats have decided that it would be ok to defund this part of Obamacare and let the chips fall where they may. Most assuredly, such votes are in response to localized political pressure.

Hiltzik does a good job at breaking down the arguments in favor of repeal and describes the effect on the overall impact of the ACA should the MDT be removed.

Read the column here: 

Source:

http://www.latimes.com/business/la-fi-hiltzik-20130522,0,1622096.column

"I thought Obamacare was going to lower my health insurance premiums???"

"I thought Obamacare was going to lower my health insurance premiums???"

Well, maybe...

According to Kathleen Sebelius, Secretary of Health & Human resources, she says we'll see some of both.

From Sarah Kliff in Wonkblog (3/29/13)...

“Women are going to see some lower costs, some men are going to see some higher costs,” Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday. “It’s sort of a one to one shift … some of the older customers may see a slight decline, and some of the younger ones are going to see a slight increase.”

As some of the skimpier health care plans are beefed up to meet new federal guidelines, some younger people, may see rates rise. Others, like some women and older Americans, may see rates fall due to new restrictions on how insurance companies can set prices, specifically regarding age or gender. 

Added to the overall question of out of pocket expenses for healthcare is the impact of the subsidies, which take effect in 2014. 

The Affordable Care Act isn't some magic thing that lowers everybody's premiums and gives more of everything to everyone. Its most effective about increasing access to the uninsured, which is just one of the "three legs" of a health care system. The other two legs are quality and cost. The ACA does have components that attempt to address those two legs, but they pale in comparison to the access improvements. 

Its also important to remember that health insurance premiums have been increasing since the 1990's. They would likely continue to increase with or without the ACA ever being enacted. 

Going forward, the ACA restricts health insurance companies from setting their rates based on pre-existing conditions, health status or gender which have resulted in years of increased premiums and many people being unable to purchase health insurance. Now, insurers are only permitted to consider single person vs. family plan, geographic area, age (with limits) and smoker or non smoker (again, with limits.) 

We know that without the ACA, our premiums would've likely continued to increase. Now, for many, those increases may not be as severe.  Also keep in mind, that millions of Americans will now have access to private health insurance, which the government will help pay for if they can't afford it. If the ACA had included a Public Option, we might be seeing lower prices as one of the effects of a public option would have been to pull the market price down by offering a insurance product that didn't have to return earnings/profits to its shareholders, didn't have to allow for high administrative costs and certainly no allowance for exorbitant CEO salaries. The Urban league says it this way: 

The arguments around the public plan too often ignore what we believe is the central reason for including a public plan as a component of reform: that health insurance markets today, by and large, are simply not competitive. And as such, these markets are not providing the benefits one would expect from competition, including efficient operations and consequent control over health care costs. We believe that the concentration in the insurance and hospital industries that has taken place over the past several years has been a significant contributor to this problem. The role of the government plan is to counter the adverse impacts of market concentration and, in doing so, slow the growth in health care costs.

Conservative Democrats are directly responsible for the lack of a public option, but there was zero support for it from virtually any Republicans either. The CBO estimated that a public option could've saved 100 Billion dollars over ten years, but despite that, it wasn't enough to bring even fiscal conservatives on board.

The next few years are going to be bumpy. The exchanges aren't going to function smoothly at first. There are gaps in coverage for too many Americans who make too much to qualify for subsidies but can't afford their premiums. We know there's going to be problems, but then we will also see problems we haven't anticipated. In time, they will get worked out. All large social programs including Social Security, Medicare and Medicaid have had major growing pains. You can also count on many conservatives, conservative leaning media outlets like Fox News and RW talk radio, blogs, etc.  to put those mistakes, errors and screw-ups front and center for all to see on a 24/7 basis. It won't help a damn thing except to possibly motivate the government to throw everything they can at making it as smooth a rollout as possible. I predict it won't be good enough and we'll all get sick of hearing how badly its going. 



Sources: 

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/29/how-will-obamacare-hit-premiums-lets-break-down-the-numbers/

http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/

http://healthreform.kff.org/Subsidycalculator.aspx#incomeAgeTables

http://www.kff.org/healthreform/upload/8328.pdf

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/22/whatever-happened-to-the-public-option/

Dr. Aaron Carroll on Stand Up with Pete Dominick (Audio)

Pete Dominick, host of Stand Up with Pete Dominick on Sirius XM radio Indy Channel, interviews Dr. Aaron Carroll, from the Indiana University School of Medicine. Dr. Carroll is a frequent guest on the program where he discusses various issues within health policy.

In this interview Dr. Carroll discusses the care at the Veterans Administration, why reforming Medicare and Medicaid is hard, why the transition to an improved way of handling medical information is coming along slowly and takes a few questions from listeners...

Click here to listen to it. It runs about 33 minutes in length...




Source:

http://theincidentaleconomist.com/wordpress/wp-content/uploads/2013/03/03-20-13_DrAaronCarroll.mp3

Interesting Conversation with Dr. Aaron Carroll....

If you've been following health care reform you probably already know who Dr. Aaron Carroll is. Carroll is a pediatrician and an expert on health care reform. He is also an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine. He is also the director of the Center for Health Policy and Professionalism Research. He earned a BA in chemistry from Amherst College, an MD from the University of Pennsylvania School of Medicine, and an MS in health services from the University of Washington, where he was also a Robert Wood Johnson Clinical Scholar.

He also blogs at the Incidental Economist website...

Recently he and Harold Pollack recorded a conversation about health policy and what the next year holds for the Affordable Care Act's continued implementation. The thirty minute conversation is split into two halves. Its fast moving and covers a good bit of ground. I found it very enjoyable. 

Click on the link below to watch it...

"How I became a health policy wonk, my favorite policy charts and what's ahead for health reform..."

Abortion rates falling faster than normal...

According to the Centers for Disease Control (CDC) the abortion rates in the US fell faster in 2009 than in any of the ten years prior. Research tells us that the use of contraception has played a major role in this decrease. As improvements (IUD, implants and "morning after pills") to available contraceptive options has spread, more and more women are availing themselves of them.

(Click here for the CDC Study)

According to the AP, "U.S. abortions fell 5 percent during the recession and its aftermath in the biggest one-year decrease in at least a decade, perhaps because women are more careful to use birth control when times are tough, researchers say.

The decline, detailed on Wednesday by the Centers for Disease Control and Prevention, came in 2009, the most recent year for which statistics are available. Both the number of abortions and the abortion rate dropped by the same percentage." 

Reasonable people can agree that the use of contraceptives is a highly personal one. No one really disputes that. The main question arises when federal insurance guidelines mandate that employers make contraceptives available to their employees. Mostly, this causes issues for faith based employers. The Obama Administration has granted waivers to all Churches and other related businesses including many (mostly Catholic) Universities and Hospitals. In these cases, the burden falls upon the insurance company itself to provide these services.

In the run up to the election, we heard a great deal from politicians about women's health issues. Some of it was absolutely incredible to hear. Crazy talk about rape victims and their previously unknown powers of preventing pregnancy. And worse. It boggles the mind why some politicians felt that voicing such opinions would help their election chances. In several instances, these candidates who couldn't control their vocal urges, paid the price and lost.

I'm the husband of my wife, a father of three daughters and the brother of two sisters. I want them ALL to have as many options available to them as possible for their personal health issues. I know that this is getting awfully scientific and stuff for some, but if we agree that fewer abortions are better than more abortions, can we finally get some sensible talk about contraception from some of our conservative leaders?

The use of contraceptives prevents abortions. That is fact.

Source:

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6108a1.htm?s_cid=ss6108a1_w

http://hosted.ap.org/dynamic/stories/U/US_MED_ABORTION_DECLINE?SITE=AZPHG&SECTION=HOME&TEMPLATE=DEFAULT

http://www.nytimes.com/2012/08/20/us/politics/todd-akin-provokes-ire-with-legitimate-rape-comment.html?_r=0

http://www.thedailybeast.com/articles/2012/08/20/rep-todd-akin-7-more-crazy-rape-statements.html

http://thinkprogress.org/health/2012/11/07/1155211/rape-gaffes-lose-elections/

Fact Checking the 2nd Presidential Debate/Ten Websites to Review...

After every Presidential debate, various fact-checkers get to work immediately to separate fact from fiction from both participants. Reasonable Conversation has compiled a list of ten different factchecks from around the internet to provide a convenient "one-stop" place for your perusal.

The good folks at Politfact.com were hot on the trail of truth after last night's second presidential debate between President Barack Obama and challenger Mitt Romney. They've posted updated evaluations of claims made by both men on several different topics: Jobs, Energy, Taxes/Spending, Healthcare, Immigration, Foreign Policy and Education. Its a mixed bag of results showing that both men took liberties with the truth as they saw fit.

Not to be outdone, Factcheck.org has also posted their version of fact checking last evening's debate, covering many of the same issues. Here's the overview from their piece posted earlier this morning:

The second Obama-Romney debate was heated, confrontational and full of claims that sometimes didn’t match the facts.

• Obama challenged Romney to “get the transcript” when Romney questioned the president’s claim to have spoken of an “act of terror” the day after the slaying of four Americans in Libya. The president indeed referred to “acts of terror” that day, but then refrained from using such terms for weeks.
• Obama claimed Romney once called Arizona’s “papers, please” immigration law a “model” for the nation. He didn’t. Romney said that of an earlier Arizona law requiring employers to check the immigration status of employees.
• Obama falsely claimed Romney once referred to wind-power jobs as “imaginary.” Not true. Romney actually spoke of “an imaginary world” where “windmills and solar panels could power the economy.”
• Romney said repeatedly he won’t cut taxes for the wealthy, a switch from his position during the GOP primaries, when he said the top 1 percent would be among those to benefit.
• Romney said “a recent study has shown” that taxes “will” rise on the middle class by $4,000 as a result of federal debt increases since Obama took office. Not true. That’s just one possible way debt service could be financed.
• Romney claimed 580,000 women have lost jobs under Obama. The true figure is closer to 93,000.
• Romney claimed the automakers’ bankruptcy that Obama implemented was “precisely what I recommend.” Romney did favor a bankruptcy followed by federal loan guarantees, but not the direct federal aid that Obama insists was essential.
• Romney said he would keep Pell Grants for low-income college students “growing.” That’s a change. Both Romney and his running mate, Ryan, have previously said they’d limit eligibility.

Both candidates repeated false or misleading claims they have made, and we have rebutted, many times before. Obama repeated his claim that he wouldn’t put tax rates for affluent families higher than they were under Bill Clinton. Actually, he’s already signed two new taxes that will also fall on those same high-income persons. And Romney accused Obama of saying “no” to the Keystone XL pipeline. Actually, no final decision has been made, and the company says it expects to win approval and start construction early next year.

Click here to read FactCheck's full article...

Other publications providing factchecking of the debate include The Washington Post, The New York Times, The Washington Times, Fox News offers a factcheck on President Obama's claim he called the events in Libya "terrorism" in the days following the death of four Americans. The Chicago Tribune, CBS News, Bloomberg and Politico also weigh in.

" Grateful for health insurance" Must reading from our friends at the Incidental Economist...

In the never ending battle to better understand this health care system of ours, and what has and might be done to improve it, there have been a great many articles, essays, papers which I've found tough to read. Largely self-taught, I've come to rely upon a handful of trusted, high quality websites for the accurate information that I seek. Sometimes the reading is arduous, technical and intimidating. I'm not complaining, mind you. I don't think this is the type subject matter that lends itself to a simplistic approach. Its complicated stuff, and its slow going quite often to correctly understand what the very bright and knowledgeable people who do this for a living are trying to say. 


One such resource I use daily is called the Incidental Economist. They describe themselves in part as, "This is a blog (mostly) about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it. All blog authors have professional expertise in an area relevant to the health care system. We are researchers and professors in health economics, law, or health services. By avocation and as bloggers we’re actively trying to understand our health care system and make it better. Our goal is to help you understand it too, and to empower you with research-validated information so you can be a more informed observer of or participant in the ongoing debate over how to reform our system."


This morning I read a piece by the founder of TIE, Austin Frakt, which blew me away. Austin is a health economist at Boston University, with an educational background in Physics and Engineering who earned his PhD in statistical and applied mathematics. Read the rest of Frakt's bio here... 


He's a serious guy.


Today's offering from Frakt was possibly the most personal thing he's shared with his blog's readers. He talked about how the concept of having a thing called health insurance has effected him. Not in an academic or wonkish way, but in a human way. The way a husband, a father, a friend would feel about it. There are no charts, no graphs, no formula to digest. Mostly, the concept that people can come together as a community and solve a problem that as individuals they won't or can't solve by themselves. 


I thank Austin for his permission to share his words from this morning with the Reasonable Conversation family. Here they are, as they appeared on his blog: 

Grateful for health insurance

I could not have known this would happen at the time, but since the passage of the Affordable Care Act, health insurance has played a large role in the lives of some family and friends. Last year a colleague was diagnosed with cancer. He’s insured through work. Earlier this year, a family member with a serious medical condition requiring many surgeries, was caught — perhaps saved — by Medicaid. Recently the five-year-old daughter of friends was diagnosed with leukemia. They’re insured, I suspect through a non-group plan.

All of these people and their families now face high medical costs for care, or would if they were not insured. I doubt all of them would receive the same level of care without coverage. All of these people live in Massachusetts. That fact may not be decisive in their insurance status, but it could be, and it certainly is for many others. These people are not so different from me or my children. They are not so different from millions of others in other states with weaker safety nets and a culture less committed to health insurance as a basic necessity. Massachusetts is unique in that it has a coverage mandate.

I live in Massachusetts. For its safety net, its culture of coverage, its mandate, and its expensive and, yes, wasteful health system, I pay more in taxes. I pay more in premiums. What would otherwise be my wages are helping to care for my sick family members, friends, their loved ones, and many others I don’t even know. Next year they might be paying for me.

I’m grateful for it. I assure you, I would not voluntarily put aside thousands of dollars to help pay for the care of my friends. I’d likely not do it for anyone outside my nuclear family. I certainly would not do it for strangers. This is not because I’m callous or greedy. It’s because I probably wouldn’t think of it. Even if I did, I might not want to dwell on such unpleasant thoughts. Thankfully, I don’t have to.

Our society, or at least the one we have crafted in Massachusetts, in its messy, political, imperfect way, has already thought it through. Through decades of struggle, thought, and effort, policymakers have cobbled together a way for me to care for those I love and those just as deserving that I don’t (but someday might!) — and for them to care for me — without each of us having to think it through on our own. Even though we’d each like access to what would otherwise be health care too expensive to afford in the moment, we would likely not provide enough privately to make that possible. I certainly would not trust that my neighbors would pay for all of my chemo with their retirement savings if and when the time comes.

We have solved a collective action problem. It’s called insurance. Of course it could take many other forms — and many of those would be just fine, if different. Certainly we could reorganize the health system it funds to be more efficient. And we should! But at least we have done something, in Massachusetts, that solves a problem I’d not have solved on my own. Now more than ever, I’m grateful for it.

Austin Frakt

------------------------------------------------------------------------------------------------------------------------

Sometimes its healthy to step away from the micro-level stuff and get a view from thirty thousand feet or so. Frakt shows us that while people may disagree on the details of how we fundamentally care for each other as a community, there is an "everyman" aspect to this. We all have friends who with or without insurance, have faced intensely difficult times related to health issues. To appreciate that a community can, sometimes, find a way to assist these people, is very human, I think. 

(You can follow The Incidental Economist here and I strongly encourage you do to do so. Bookmark them. Make them a part of your daily reading. Tell your friends about them. Frakt, Dr. Aaron Carroll and the rest of TIE team provide fresh topical content on a daily basis. They welcome comments and respond to readers emails and questions. You WILL learn more about health policy, how things work and why things are the way they are if you do so.)

Sources: 

http://theincidentaleconomist.com/

http://theincidentaleconomist.com/about/about-austin/

Supreme Court Finds Affordable Care Act Constitutional...

Shortly before 10:00am, my inbox and facebook page began to percolate as we approached zero hour for the much awaited Supreme Court decision on President Obama's Affordable Care Act. By 10:15am, I was several songs into my first performance of the day. I had my phone sitting on the edge of my mixer and every time I'd look over at it, the number of emails and facebook messages were growing quickly.

During a brief pause, I opened up my twitter feed and saw the headlines. "Obamacare Stands", "Obamacare Constitutional", etc... I finished up my hour, packed up and headed for the car trying to read through all the tweets that had come in.

My initial reaction was relief. Surprised relief.

I knew what awaited me on facebook and in emails. I knew one group would be very happy this had passed, but express this pleasure via some barbs aimed at the Right. Another group would find this decision impossible to accept and take out some of their frustration on the Left. What I knew I'd hear too little of was the better health access for all the uninsured adults and children that will benefit from this.

Its so easy to view this as a game. Its not. Health insurance plays a big part in terms of living a healthy, capable life. Having about 45-50 million uninsured people in our Country is unacceptable. We're the only industrialized Country in the Western Hemisphere that doesn't provide access to good quality, affordable healthcare for all of our citizens. For a lesser Country, that might work, but not for the richest Country in the world. It just doesn't.

Some feel their liberty and freedom were reduced because of the Court's decision today. I'm not sure what was taken away from anyone. You may not like the Individual Mandate, but in reality, it effects a fairly small number of us. If you currently have insurance, which most of us do, it doesn't effect you. If you're over 65, you're eligible for Medicare, so it doesn't effect you. If you earn below the Federal Poverty Line, there's Medicaid, so it doesn't effect you. By getting the free-riders into the pool with the rest of us, over time our premiums should drop.

Since President Reagan signed the Federal Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to provide medical services to those needing it with no regard to financial status. We don't let people die on the sidewalk. Hospitals try and collect for their services from patients with no health insurance but often, they are dealing with people who don't have the means to pay these size bills.

Let's suppose a hospitalization for an uninsured accident victim adds up $85,000. With no savings, a payment agreement of $100.00 a month would take 850 months or 70.83 years to pay off. That's crazy. So, typically the hospitals charge a large amount of the uncollectable monies back to Medicaid, which is the guarantor of the Federal Government. That was the deal Reagan made with the hospital industry. You treat everyone who needs it no matter what and if we have to, we'll step in with the bill. You know where the money comes, of course, to pay for these type situations, yes? From tax dollars that people like you and I pay to the government. Is this really the best way to spend our money? No. The mandate helps on that front as well...


The mandate forces all those who don't have insurance, yet can afford it to buy insurance (on the free market) for just such accidents. This way the amount of hospital bills we wind up having to pay gets reduced dramatically with the bulk of the costs being passed onto the health insurance companies. Don't feel too bad for the insurance companies, they are picking up over 30 million new customers. Paying customers...


You don't have to like it, but understand its not reaching into your pocket and ripping out your kids college funds or your retirement. Its a policy that was founded by the republicans during the Clinton presidency. The Heritage Foundation was heavily involved. Prominent Conservatives were on board. If it was "the right thing to do" back in the 1990's, how in the world is it the end of liberty twenty years later? Its not. 


Beyond the mandate, the rest of the Affordable Care Act polls strongly among most Americans. Kids staying on parents plans until 26, free preventive services, donut hole reduction for seniors, no lifetime caps or maximums anymore, etc. The bulk of the ACA (the exchanges) kicks in 2014. This won't cover everyone, but its a big improvement.


Its also not perfect. The mandate penalty for the first year is only $95, the donut hole isn't closed totally for several years, its not very aggressive on costs or quality, etc. Politically its been a heavy lift for this Administration and reaching for even more wasn't practical. We have a long way to go before our health care costs as a percent of GDP are in line with other industrialized countries. We have a long way to go before our outcomes compare favorably with other industrialized countries. We have a long way to go before our coverage compares favorably with other industrialized countries. But today's ruling keeps us on the path towards improving our nation's healthcare delivery system, which is something we simply must do. The previous path was fiscally unsustainable. Doing nothing wasn't an option...

3 Minute Cartoon Explains Supreme Court / Health Care Hearings...(Part 2)

From CommonHealth:

Cartoon summarizing what the Supreme Court was going to listen to oral arguments on today:

Can we still reform health insurance without a mandate? Yes, but...

Ok, so it wasn't the best day for President Obama's health care plan yesterday, was it? Not really. The Government's defense of the individual mandate wasn't exactly impressive and many now think the chances of the Supreme Court overturning the Affordable Care Act are larger now than they were Tuesday morning.

There's a long, long way to go before the SCOTUS renders a decision and all the speculation from all sides about what will happen is just that. Speculation. Everybody needs to take a deep breath, relax, chill, chillax, etc. From following the coverage closely my take is that too much is being made of the questioning by some Judges yesterday. There has been tough questioning before, in lower Courts, that ultimately ruled in favor of the mandate being Constitutional. The so-called "experts" say the chances of the mandate took a hit yesterday, but nothing close to a death blow.

Further, I've heard several SCOTUS experts explain that while the oral arguments occurring this week make for compelling courtroom drama, they often have a rather small part to play in the ultimate decision by each of the Court's Judges. More powerful are the dozen's of briefs filed both pro/con toward the health care law. Many are repetitive but both sides of the case have been laid out, in fine detail for these judges. THAT is where the bulk of the individual decisions likely comes from.
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I found this article by Jonathan Cohn, author of "SICK", very interesting and timely. It takes a hard look at one state, New Jersey, that tried to reform its health care sector without an individual mandate back in the 1990's. After a promising start, cracks began to show in the reform. Big ones. Participation in regulated plans dropped dramatically and the kind of person that remained was unfavorable. Healthy people left the plan, leaving the sicker ones, which drove premiums up between 48% and 155%, depending on the particular plan involved. The average age of the participants went from 41.9 to 48.4 in just five years. Older. Sicker. More expensive.

Give it a read...


Reform With No Mandate? Ask New Jersey About That...
By Jonathon Cohn/March 21, 2012

On Monday, when the Supreme Court hears arguments about whether the Affordable Care Act is constitutional, the justices will also contemplate a policy issue: Is it possible to reform the private insurance market, making affordable coverage available to all, without an individual mandate?

The Obama administration has told the court that if it invalidates the mandate it should also invalidate two key insurance reforms that would prevent discrimination because of preexisting conditions. On this, the administration has a somewhat unusual ally: The insurance industry. Although insurers have fought many parts of the health law, they have long favored the establishment of a mandate, which requires almost everyone who can afford it to buy health insurance or pay a fee. Without it, they say, the reformed market cannot function. (Critics point out that a mandate would also help insurers generate more business.)

Legally, the administration's argument is as potent as it is risky. The Constitution says that the federal government may do whatever is "necessary and proper" to carry out its other functions. The Supreme Court historically has interpreted that power broadly. If insurance market reform really is more prone to failure without a mandate, that fact alone could, in the eyes of the justices, make the law constitutional.

But is the administration's claim correct? For some clues, the justices could examine what happened in New Jersey, a state that tried to reform its insurance markets without a mandate -- and failed pretty miserably.

To continue, please click here...



Sources:

http://www.supremecourt.gov/docket/PPAACA.aspx

http://www.tnr.com/blog/jonathan-cohn/101948/supreme-court-mandate-new-jersey-insurance-reform