I read part of the following article with surprise, guess I was thinking it would just be expanding Medicare and making some changes...or at least along those lines. Maybe I am reading it wrong, maybe it doesn't matter...but just surprised. I think there has to be competition, or no progress will be lasting.
Many people on Medicare now would be uninsurable because of their age and illnesses. I guess, though, if they have another "public option" set up....it would have the policy of allowing anyone to be part of it. I would hope so.
Seems easier to use an existing program and expand and improve on it than forming another one, unless it is NOT going to be a government run option. I find myself thinking about what happens to people left behind in programs that are abandoned for new ones. They will not get the best care or service. They will be "phased out" apparently.
Here is where I read the part about going "beyond" the existing programs.
In televised special, Obama calls for compromise' on health care"There's no perfect unanimity across the table in terms of every single aspect of reform," the president said in remarks after their meeting. "I think everybody here wants to make sure that governors have flexibility, that they have input into how legislation is being shaped on the Hill."
The scope of what Obama, many Democrats and some Republicans want to do is massive, and lawmakers have various ideas about how to get it done.
The most controversial proposal in the emerging debate is to create a so-called public option,beyond Medicaid and Medicare, as an alternative to private insurance. Obama supports that. He has said that would keep private insurers honest and efficient because they'd have to compete.
Of course, after the Sunday shows when
Kathleen Sebelius and
David Axelrod made sure to let us know that they were compromising on this issue, that there would be NO line in the sand...I wonder if any form will be included.
The thought that the public option would be something "beyond" Medicare might be right, as Obama had announced that he would be advocating
313 billion in cuts to Medicare and Medicaid spending.Now that sounds scary. Doctors are worried, and many of us fear they would refuse to take Medicare patients just as many refuse to take Medicaid patients right now.
Obama's thoughts:
Reporting from Washington -- Under pressure to pay for his ambitious reshaping of the nation's healthcare system, President Obama today will outline $313 billion in Medicare and Medicaid spending cuts over the next decade to help cover the cost of expanding coverage to tens of millions of America's uninsured.
Among the proposed policy changes outlined by the president are:
* Reductions in payments to providers to reflect increased efficiencies in the system, which the White House estimates could save $110 billion over the next decade.
* Cuts in federal subsidies to hospitals that treat large populations of uninsured patients, estimated to save $106 billion over the next decade.
If the cuts to payments and subsidies would come naturally with a new health care program helping those without care....that might be feasible. But that is a lot of money that doctors and hospitals will be losing short term. They are concerned. Emergency room treatment is about the only care millions of people with no insurance can get. Cutting those subsidies is making many nervous.
Here is more about the severe cuts to these programs, so it does sound like some in the administration are not thinking of preserving Medicare and Medicaid. It sounds like they will form a new insurance program and get the savings from Medicare and Medicaid.
Obama also proposed cutting payments to hospitals to treat uninsured patients by $106 billion on the assumption those ranks would decline as healthcare reforms phase in.
An additional $75 billion would come from "better pricing of Medicare drugs," Orszag said, adding the White House was in talks with stakeholders over the best way to do that.
The remaining $22 billion in proposed cuts would come from smaller reforms, such as adjusting payment rates for physician imaging services and cutting waste, fraud and abuse.
The new cuts are in addition to a $635 billion "down payment" on healthcare reform that Obama outlined in his budget to Congress earlier this year. About half of that came from cuts in Medicare and Medicaid and the rest from revenue proposals such as cutting tax deductions for families that make over $250,000 a year.
Altogether, the Obama administration is now asking Congress to trim spending on Medicare and Medicaid by more than $600 billion over the next decade, which is more than some Democrats are willing to swallow. Obama eyes more in cuts for health care reformThis sounds like perhaps without talking much about it, that Zeke Emanuel's idea of phasing out Medicare and Medicaid is being considered. Here is more about his ideas. He is very much in close contact with the Chief of Staff and with the president and his financial advisors.
Zeke Emanuel, health care advisor to Obama, wants to phase out Medicare and Medicaid.The Guaranteed Healthcare Access Plan proposes to repair the health care system by giving all Americans a voucher to select a standard benefits package offered by insurance company. In most areas, American will be able to choose between 5 and 8 insurance companies. And the insurance companies will be required to enroll anyone who wants and cannot exclude coverage for pre-existing conditions. The standard benefit package is based on what Congressman and Senators receive, and is more generous than what most Americans currently have through their employers or government program. Americans will also decide if they wanted to buy additional services, say wider selection of doctors and hospitals, more mental health benefits, or coverage for alternative medicines.
The Guaranteed Healthcare Access Plan will be administered by a National Health Board and regional boards modeled on the Federal Reserve System with fiscal, administrative, and political independence to make tough decisions based on the merits, not special interest lobbying. There will also be an Institute for Technology and Outcomes Assessment to assess the effectiveness of new drugs, devices, procedures, and other interventions. It will also assess and make publicly available data on the clinical outcomes of patients in different insurance companies. This will permit comparative shopping based on real quality results.
He says no one will be forced out of Medicare....but no one else will be enrolled.
...but there will be no new enrollees. People who turn 65 will simply stay in the Guaranteed Healthcare Access Plan. The special tax benefits related to employer based coverage will be eliminated and most employers will stop offering health insurance.
Again, my concern is what happens to those left in the Medicare system.
When we talk about a public option being offered alongside private plans, it is misleading not to make clear that they are taking big money from Medicare's present members and cutting payments to doctors and hospitals.
On Meet the Press, David Axelrod made a comment that I am not sure I understood. Yet it too sounds like there is a plan to go outside Medicare and phase it out. He refused to commit to a public option. Here
are his comments.MR. GREGORY: But you're confident about getting that bill with a public plan this year.
MR. AXELROD: I'm confident that we're going to get a healthcare reform bill. I think a public choice will be part of it. I think the public wants to have that option and wants to see that kind of competition, and I think we will, we will have that.
..."R. AXELROD: Well, first of all, I think that if we don't pass healthcare reform it's going to be a catastrophic problem for the country, not just the Democratic Party; for families, businesses and the country itself. Look, we believe strongly in, in a public choice; not one that's subsidized by the government, but one that will embrace the best practices, that will reduce healthcare costs and give people the best quality care. What the president said was illogical were the same people who say that the government is incompetent, the government can't run anything, the government shouldn't be involved in, in anything say, but we can't let that be one of the choices because it'll be an unfair advantage against the, against the insurance companies.
If it's not a government run plan, then it would be a privately run plan...right?
I wonder if they are going to set up a whole new insurance plan, or if they will recontruct or rebuild Medicare. But how will they do that if they keep taking money away from doctors and hospitals?
Will they give them an incentive to keep patients?
I thought it was the Republicans who did not want a public plan run by the government, but now it appears the Democrats don't either.
If you have not read this great post by Daily Kos front pager, David Waldman, it is short clear, and to the point about who has the power to bring forth a bill with real reform in it.
From Congress Matters website:
Who's the gatekeeper on the public option in the Senate? If the HELP committee reports out the bill they've been promising, with a public option included, and the Finance committee doesn't, who reconciles the two and decides which package gets to the floor?
Harry Reid does.
In the FISA Senate battle at the end of 2007, the Intelligence committee and the Judiciary committee reported out different versions of the bill. That case, though, involved a sequential referral of a House bill, and Reid said he was relying on the custom of bringing up the bill that came out of the committee to get the first referral as the base bill, though the option was open to him as Majority Leader to change direction. But it at least made some sense, even if it was obvious that there was a conscious choice to refer the bill to the more receptive of the two committees first.
Health care isn't a referral, though. These are two original Senate bills competing for consideration. The Majority Leader has considerably more flexibility on this. He'll be guided by the chairmen of the committees in this, of course. But you'll learn an awful lot about who stands where if HELP includes a public option, Finance doesn't, and neither does whatever comes to the floor.
It appears that the bill could be stripped of real reform by just a handful of people. I know that is how things have worked for ages, but I was naive enough to think our majority this time mattered.
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