Washington state Sen. Karen Keiser (D), chairwoman of her legislature's powerful health committee, this week introduced the nation's most far-reaching universal health care proposal. Her legislation is the American West's version of a parallel Wisconsin initiative, and the replication suggests this model may begin building the universal health care system our country wants.
Employers and employees pay a modest [state] payroll tax in exchange for full medical benefits, with no premiums. Save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade. States to "pool all existing health care expenditures and then replace the middlemen with one publicly controlled, not-for-profit system." This "will save private-insuring employers almost $700 million a year. Create 13,000 new jobs." Can provide "property tax relief." Also "reduces out-of-pocket copayments and increases the number of mandated medical services covered."
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Digging In the Right Place
http://www.alternet.org/healthwellness/74256There's a memorable moment in "Raiders of the Lost Ark" when Indiana Jones sees a rival's archaeological excavation and realizes the buried treasure is somewhere else.
"They're digging in the wrong place!" he exclaims.
The line could explain why our national elections leave us feeling empty. By expecting so much so fast from Washington D.C., we are digging for "change" in the wrong place.
Think about it: The White House can only be won by raising truckloads of cash from moneyed interests looking to preserve the status quo. Likewise, the U.S. Senate's filibuster rules allow 41 lawmakers, representing just 11 percent of the population, to stop anything. These are institutions designed to prevent change, not embrace it.
Thankfully, the same cannot be said for the so-called "laboratories of democracy" -- state legislatures. Amid pundits' breathless analyses of Hillary Clinton's tear ducts, these arenas quietly opened throughout America this month. And from beneath the rubble of celebrity-obsessed campaign journalism and the ruins of national political gridlock, change is being exhumed in two bellwether states.
In a move making health care lobbyists quiver, Washington state Sen. Karen Keiser (D), chairwoman of her legislature's powerful health committee, this week introduced the nation's most far-reaching universal health care proposal. Her legislation is the American West's version of a parallel Wisconsin initiative, and the replication suggests this model may begin building the universal health care system our country wants.
The plan is simple: Employers and employees pay a modest payroll tax in exchange for full medical benefits, with no premiums. Patients never lose coverage and pick the doctors they prefer. And for the spendthrifts, here's the best part: According to an analysis of the Wisconsin proposal by the nonpartisan Lewin Group, the plan would save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade.
Seem too good to be true? That's because you're used to being bilked by an insurance industry that drives up premiums, drives down benefits and gives executives like former UnitedHealth CEO William McGuire $1.6 billion worth of stock options in one year. Eliminating that greed is precisely how the Washington state and Wisconsin proposals simultaneously save money and cover everyone.
Unlike the much-touted Massachusetts law forcing citizens to buy insurance from the private profiteers, the Washington and Wisconsin models pool all existing health care expenditures and then replace the middlemen with one publicly controlled, not-for-profit system. That structure attacks problems beyond the immorality of allowing 18,000 Americans to die each year because they lack health coverage.
For businesses faced with crushing health care costs, the Lewin Group predicts the plan will save private-insuring employers almost $700 million a year. For politicians looking to provide economic stimulus in the face of a recession, the nonpartisan Families USA estimates the proposal's investments will create 13,000 new jobs. Even tax reformers have something to like, as Wisconsin's version directs much of the system's savings into property tax relief.
The Royalist Right is distraught about the plan. When an initial draft passed the Wisconsin Senate last year, the Wall Street Journal's editorial board attacked it on the grounds that it "reduces out-of-pocket copayments" and "increases the number of mandated medical services covered" for patients. Wow. Sounds just awful.
The paper then criticized it as a tax increase and labeled it "government-run" -- as if patients are better served by paying even bigger premium increases to corporate CEOs whose paychecks grow with each coverage denial.
The screed showed how little conservative elites care, not just for the uninsured, but for the working-class wing of the Republican Party -- the roughly 40 percent of GOP voters who, according to the Pew Research Center, tell pollsters they "favor universal health coverage, even if it means higher taxes." These voters are part of a new transpartisan consensus -- one that believes the words of the hero we remember this week. "Of all the forms of inequality," Dr. Martin Luther King Jr. said, "injustice in health care is the most shocking and inhumane."
Those desiring "real change" should applaud these Washington and Wisconsin leaders confronting that injustice. Unlike the nearsighted nabobs of national politics and the adversaries of Indiana Jones, these state legislators are digging in the right place.
See more stories tagged with: healthcare, campaign finance, election08
David Sirota is a bestselling author whose newest book, "The Uprising," will be released in June of 2008. He is a fellow at the Campaign for America's Future and a board member of the Progressive States Network -- both nonpartisan organizations. His blog is at www.credoaction.com/sirota.
1 comments:
In 1990 third parties paid 77 cents of each dollar of medical expense. Because patients pay an average of only 23 cents on each dollar of medical expense, there is only a weak linkage between any consumer's use of medical resources and the payments made by that consumer. When the direct linkage between use of medical facilities and payment is broken, medical consumers lose their incentive to economize on their use of medical resources.
• The first, and by far the largest excess cost, is due to the current overuse of medical resources by patients. Overuse is the rational response of consumers who do not have to pay the entire cost of the medical services they use. The causes of those excess costs are Medicaid, Medicare, and tax laws that provide incentives for individuals to have their employers purchase their medical care in the form of private health insurance.
• The second category of excess cost consists of administrative and paperwork costs that are unnecessary for the provision of health care, but that have come into existence because of the current patchwork of third-party payers and their attempts to control their increasing costs by closely monitoring the behavior of doctors and patients. Even worse is the fact that those cost-containment activities do not seem to have contained costs very well.
• The third excess cost is associated with the fear of malpractice suits. Administering medically unnecessary tests and procedures helps to insulate doctors and hospitals from the potential wrath of patients or their families when inevitable accidents occur in medical treatment or when treatments just do not work.
The combination of an increase in medical knowledge and the differential payment for specialists as compared to general practitioners led to an increase in medical specialization. The increasing costs of both college and medical school education, with the mounting debt on the part of medical school graduates, further supported decisions to specialize.
By the 1960s, it became apparent that having tied health insurance to employment left two very large groups of people without access to our increasingly expensive healthcare system: the retired and the unemployed. In 1965, with the passage of the Medicare and Medicaid Acts, these persons now had the financial resources to demand and pay for health services. This increase in numbers of potential patients, accompanied by the decision of the federal government to have Medicare and Medicaid Programs retain all the biases of employer-sponsored health insurance, contributed to the rapid escalation of health care costs as more and more people sought the services of the increasingly specialized doctors.
More people living longer with more chronic diseases, almost all of them controlled to some extent by medicines, increases the number of prescriptions that are written each month. For example, a patient with high blood pressure and diabetes may easily use $485 worth of prescription medications each month. If you add to that blood-sugar testing materials, syringes, the need for regular medical monitoring, and periodic flare-ups that may require hospitalization, you begin to understand how the increase in the elderly population, and in the number of years that they are living, impact on healthcare costs.
While those who are more than 65 years old represent 12 percent of the population, they consume 25 percent of all prescription medications.
The decreasing proportion of total costs paid by the federal government, as a result of the Balanced Budget Act, continues to put pressure on the private sector.
Take New York State, where regulations and taxes impose a particularly heavy burden on private insurance costs. New York State subsidizes the cost of graduate medical education at the state’s big teaching hospitals by levying a tax on private insurance policies. In New York City, that tax comes to about $400 per policy—a gift to the hospitals. The state also levies an 8.18 percent tax on hospital bills to subsidize charity care in hospitals. (Health insurers must also pay their own separate taxes, including a special assessment to subsidize the operations of the state’s insurance department.)
More onerous still, New York, often responding to political pressure from special interests, piles on regulations that force businesses to offer specific treatments, at added cost. Several years ago, for example, the state began requiring all policies to pay for expensive treatments for infertile couples—hardly a life-threatening condition. But the fertility mandate is just one of 35 such regulations in the state. Together with the health-care taxes, they enlarge the cost of private insurance in New York by some 15 to 20 percent, a huge additional bill in a state where the average cost of family insurance is over $10,000 a year.
Simply expanding coverage would have little effect on the quality of care, health disparities, or how long we live, nor would it stop free-riders from shifting costs to others. In fact, expanding coverage through government regulation or tax-and-transfer programs would make our problem worse.
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