Healthcare Reform: Ain't None of 'Em Pretty, Pick One You Can Live With.

Coffee Brown, University of New Mexico, Talk Radio News
 
 
 At the Alliance for Health Reform briefing, Covering the Uninsured: Options for Reform, Diane Rowland (Kaiser Commission on Medicaid and the Uninsured) said that 15 percent of us are uninsured.
That’s 45 million people out about 298 million. This uninsured figure includes the fact that 81 percent of the uninsured actually have an employed member of the household. These figures are from 2007 and she expects the number to have risen due to the recession.
 Even at 400 percent of the poverty level, 10 percent are not covered.
These rates are not evenly distributed, but tend to be least in the Great Lakes region and progressively worse south and west. The uninsured are about ten times more likely to forego needed medical attention.
Adults without children were the most likely to lack insurance because the eligibility rules are strictest for them even before the recent expansion and extension of SCHIP.
Between 2000 and 2008 the average premium for a family rose from $6,438 to $12,680, with the worker’s share rising from 25 percent to 26.5 percent, for an annual increase of $1,735 per family.
Public support was about two-thirds for healthcare reform both before and after the Wall Street crash, she said.
Ah, but what sort of reform?
Jack Ebeler,  Ebeler Consulting, presented the main alternatives, which he boiled down to tweaking the present system or restructuring it. In the first case, he said, we could go with individual or employer mandates. And/or expand existing public coverage, such as Medicaid, Medicare, and SCHIP. And/or revise regulations affecting private insurance.
The other main approach he described would be to move away from employers, either by going to single payer or by redirecting both responsibility and subsidies away from employers toward individuals.
What we are actually going to get is “mix and match.”
Bradley Herring, PhD, Johns Hopkins Bloomberg School of Public Health, presented some pros and cons of each of the major proposals. There are only four to consider:
Single Payer: HR 676
It would be easy to understand, relatively easy to apply, vs. the others, and would deliver large administrative cost savings. While workers and employers would be glad to be rid of premiums, the increase in taxes, especially for the wealthy, would be substantial.
He described this as a transfer of wealth from the rich to the poor, from the well to the sick, and from the Great Lakes region to the poorer states. He also noted that providers would likely see their incomes fall.
The McCain-Republican vision bets on tax code revisions and a competitive market to control costs and drive enrollment. The downside is basically everything we don’t like now: High risk/high cost individuals are separated from the low-risk/high profit pool. There would also be less consumer protections, less standardization of coverage, and high administrative costs at all levels.
The Obama-Baucus plan adds mandates to the current system and gradually brings public sector insurance into competition with the private sector. Advantage: least change. Disadvantage: least change.
The Wyden-Bennett regulates and subsidizes private markets. This one actually gets more bipartisan support, and the Congressional Budget Office estimates it could break even after only a few years. It was almost no one’s favorite.
And there’s the rub.
Rowland notes that two thirds of the people want healthcare reform. Most of them have a first choice among the four plans, and the status quo is most people’s second choice. Most of those polled would rather keep what we have than accept reforms that are not their first choice.

McCain and Dorgan: What Just Happened?

Coffee Brown, University of New Mexico,Talk Radio News

Faced with more than nine billion dollars in bailout commitments, eight billion in stock losses, six trillion in lost home values, five million jobs lost, and three million foreclosed mortgages in 2008, Sens. Byron Dorgan (D-N.D.) and John McCain (R-Ariz.) want to know what happened?
The McCain Dorgan bill calls for a two-year bipartisan select Senate committee to examine the causes for the current economic crisis. The committee would function independently and would have subpoena power, but would not be conducting a criminal investigation.
“We must understand the causes of the crisis and implement systematic and institutional reforms, quickly and comprehensively,” said McCain.
Select committees are not standing entities, but exist for a specific purpose and duration. This could sometimes be construed to signal that an investigation is being undertaken for suspected wrongdoing. It was made clear by both Dorgan and McCain that this committee’s purpose would be to understand, rather than prosecute, the actions of the financial system leading to and surrounding the meltdown.

When Disaster Strikes, Who’s Minding the Kids?

Coffee Brown, University of New Mexico, Talk Radio News

The president’s National Commission on Children and Disasters met to continue planning for the special needs of children in the worst of times.
Existing standards and guidelines do not account for pediatric differences.
Irwin Redlener, MD, Commissioner, noted that it would be relatively easy to come up with good recommendations, but relatively hard to get them approved by all parties.
Mark Shriver, Chairman, responded, “If disaster hits and your child dies because federal agencies can’t see eye to eye, that’s just unacceptable.”
Several problems illustrate the difficulty: Mandating minimum shelter standards could inhibit emergent, improvised solutions, or impose unrealistic burdens on smaller communities. Often there are no evidence based medical plans, so groups of experts will need to provide consensus opinions. What may strike one person as “comfort measures,” and thus of lower priority, may strike another parent as basic, minimal childcare; Shriver mentioned bathing children in sinks as an example. While victims need shelter from day one, cached supplies may not make to the sites for 72 to 96 hours after the state’s governor makes a request.
An attendee from Columbia University pointed out that the international community has generally had more experience with modern disaster management, and might provide some useful templates, citing the Sphere Project (http://www.sphereproject.org/content/view/146/84/lang,English/) as an example.
Perhaps the most difficult problem for children is recovery. Dr. Redlener said recovery isn’t just infrastructure, it’s young psyches for whom things are not ever going to be “just like before.” He noted that we need to know what works and what doesn’t, that both psychological and material support are needed, and that current regulations are relatively arbitrary and limiting. The goal, he said, is to get these kids back onto a normal or better developmental and educational curve.
Shriver pointed out that when a city rebuilds, it upgrades, why not think that way about recovery for children?
For background on the Commission: http://www.uhhospitals.org/rainbowchildren/tabid/4354/Default.aspx

President’s Budget is All That and a Bag of Chips

Coffee Brown, University of New Mexico, Talk Radio News Service


Senate Majority Leader Harry Reid,(D- Nev.), Sen. Chuck Schumer, (D- N.Y) Sen. Patty Murray, (D-Wash.), and Sen. Dick Durbin, (D- Ill.), presented a favorable Senate Majority response to President Obama’s budget proposal. ($3.5 trillion, according to the Christian Science Monitor)
Reid feels the president’s budget is “in keeping with the message he delivered on Tuesday night, a message of hope, a message that directs his priorities: education, healthcare, and energy. “
“I salute the president on, I think, an excellent budget,” Schumer said.
Murray said, “He’s following up his words by putting into this budget investments that will make our economy stronger, reducing our dependence on oil, investing in healthcare policy, and investing in education.”
“Even more important,” she added, “I appreciate his honesty about the underlying fundamentals of this bill.” She finds criticisms ironic coming from those who did not put the cost of the war into their budget. “We did not get budgets that were honest about the real costs we knew were going to be out there.” This one is, she finished.

But, what about cuts? “We inherited the deepest economic hole that we’ve had since the great depression,” Reid said, adding, “This budget will cut taxes for 95 percent of the American people. Anyone making less than $250,000 will pay no new taxes. We’re giving tax breaks to the people that need them the most, middle class Americans.”
It will cut the deficit in half over the first term, he promised. “We now have adopted the pay-as-you-go program that we had during the Clinton years, and during the Clinton years the deficit was reduced by $600 billion.” There will be $2 trillion in cuts over the next ten years.
Schumer added, “We will have a more active government but, at the same time, a more responsible government that eliminates waste. This budget is aimed at the middle class like a laser. The days are over when Republicans used to give 90 percent of the tax cuts to the very wealthy and say they’re giving tax cuts to everybody.”

Asked if he thought Congress was moving too slowly, Reid said: “In a very short period of time we’ve passed a huge land bill, we’ve passed the Lilly Ledbetter matter, we passed the Children’s Health Insurance Program, the economic recovery package,” and the pace is not slowing.
Schumer added that they are making “Making Work Pay” permanent, continuing tax cuts for families with children, and the job tax credit. “Something I feel very good about, the 2,500 dollar American Opportunity Tax Credit for college…he makes that permanent,” in the form of a tax deduction for tuition.
Schumer went on to say, “I’ve always seen a housing bill (pending reforms to limit foreclosures) as a matter of fairness, now it’s a matter of fairness and urgency.” Critics of this reform, he added, don’t realize how many homes have been lost, “and 99 percent of the time, the bank gets the house and the attendant responsibilities, and have to hope they can sell them to somebody. “We’re trying to give that family a fighting chance to stay in that home.”
Reid said that bankruptcy courts could renegotiate vacation homes, but not primary residences.

Global Meltdown? Every Nation for Itself.

Coffee Brown, University of New Mexico, for Talk Radio News

"Rethinking Global Institutions: Do We Have the International Tools to Fight the Global Economic Crisis?” Well ... no.
The American Enterprise Institute's discussion panel included Brink Lindsey, of the Cato Institute, Marc Busch, a professor in the government department at Georgetown University, and T. N. Srinivasan, from Yale University.
Lindsey said that the global problem is unique within each country, that cultural and political differences would undermine any effort to coordinate monetary strategy, and that this could be a good thing. Allowing each nation to try to muddle though in its own way would reveal which of the competing strategies worked and which did not. If no theory is strong, then Lindsey recommends testing them all empirically. The EuropeanUnion, for example, is testing right now whether a coordinated international economy can weather such a crisis, he said.
All of the board members agreed strongly that no economist understands the complex interplay between parts of the economic system, globally or nationally, even when the individual parts are more or less understood.
Srinivasan opened with an excerpt from John Keynes on the Great Depression, to the effect that we don't really understand all the mechanisms that led to it. Srinivasan pointed out that the proliferation of new financial instruments in the '80s greatly increased the problem. "We don't don't know how it worked when it worked," he said. But, he added, the key to a coordinated effort lies in the common goals; health, education, poverty, and the economy; among nations that differ on almost every other point.
Busch made the case that the present financial institutions, the World Trade Organization, the International Monetary Fund, the United Nations Conference on Trade and Development (UNCTAD), the United Nations Development Programme (UNDP), the International Trade Commission (ITC), and most especially the World bank, have been effective at stabilizing economies, but only at the margins. He took the mediating position that international tools can help, at least a little.