As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don´t agree. Today, I´m going to step over that line.
The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they´ve given up any pretense of being the loyal opposition. They´ve become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.
There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I´ve made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.
Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.
The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.
There is still a vigorous debate as to whether one of the insurance options offered through those exchanges would be a government-run insurance company of some sort. There are now less-than-even odds that such a public option will survive in the Senate, while even House leaders have agreed that the public plan won´t be able to piggy-back on Medicare. So the probability that a public-run insurance plan is about to drive every private insurer out of business -- the Republican nightmare scenario -- is approximately zero.
By now, you´ve probably also heard that health reform will cost taxpayers at least a trillion dollars. Another lie.
First of all, that´s not a trillion every year, as most people assume -- it´s a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.
Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year.
The Republican lies about the economics of health reform are also heavily laced with hypocrisy.
While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.
When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn´t, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly.
Government negotiation on drug prices? The end of medical innovation as we know it, according to the GOP´s Dr. No. Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing.
Can there be anyone more two-faced than the Republican leaders who in one breath rail against the evils of government-run health care and in another propose a government-subsidized high-risk pool for people with chronic illness, government-subsidized community health centers for the uninsured, and opening up Medicare to people at age 55?
Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.
If health reform is to be anyone´s Waterloo, let it be theirs.
Steven Pearlstein can be reached at pearlsteins@washpost.com.
Seniors Benefit from a Reformed System
Seniors, especially those with Medicare, will benefit from an improved system that will not change access to their providers of choice. You will have better patient service, better quality, and better coordination of your care.
More specifically, new health information technology available under a reformed system will bring the use of medical information up-to-speed with your clinician´s ability to diagnosis and treat you. For example, you will not have to fill out your information by hand every time you see your doctor or someone you are referred to. You will be able to make an appointment over the Internet or by phone. Your doctor will be able to confirm the visit with you and even remind you that the visit is scheduled. Any laboratory test or X-rays will be available to you, your doctor or any clinicians you approve to help manage your care 24/7.
Your doctor and her staff will have more time to spend with you because they have less paperwork to fill out by hand. Your doctor will be able to ensure you got your flu shot after a review of your electronic record that shows that your lung doctor gave it to you three weeks ago. Your laboratory tests and X-ray results ordered by the lung doctor are available for your doctor to review. She, therefore, does not need to repeat these tests, saving you valuable time and the health system money. Your prescriptions are ordered by computer and all you have to do is drive by the pharmacy to pick them up on your way home. By the way, the pharmaceutical ordering system is safer because the pharmacist did not have to decipher your doctor´s handwriting.
As a primary care doctor, your physician is paid a little bit more for coordinating your care and is able to spend more time with you trying to resolve that nagging backache on this visit instead of making a second appointment. More time saved. She also has access to new scientific breakthroughs, which helps her better manage your lung problem thanks to the new medical effectiveness research the administration and Congress approved. In addition, your costs are lower because you are no longer paying as much for prescription drugs.
Same physician, better service, improved care coordination, enhanced safety and quality, and lower prescription drug costs. Seniors will benefit.
By Georges Benjamin | August 11, 2009; 5:23 AM ET
It may be the longest chain e-mail we´ve ever received. A page-by-page analysis of the House health care bill argues that reform will end the health care system as we know it: "Page 29: Admission: your health care will be rationed! ... Page 42: The ´Health Choices Commissioner´ will decide health benefits for you. You will have no choice. ... Page 50: All non-US citizens, illegal or not, will be provided with free health care services."
Most of what the e-mail says is wrong. In fact, it´s a clearinghouse of bad information circulating around the Web about proposed health care changes, so we thought it would be helpful to address a bunch of its claims.
To check this e-mail, we read the health care bill ourselves. Yes, it´s over 1,000 pages long, but that´s not as long as you might think: The document has large margins, so the text only takes up about one third of each page.
We also read the bill´s legislative summary, a report published by the House that explains the bill in greater detail.
Finally, we consulted with Jennifer Tolbert, an independent health care analyst at the Kaiser Family Foundation, a nonpartisan foundation that studies health care reform. Tolbert has read and analyzed all the major health proposals, including those of the Republicans, and the foundation provides point-by-point analyses of the plans on its Web site.
We´re hardened, battle-scarred fact-checkers, so false claims in e-mails don´t really surprise us anymore. But we sent Tolbert a copy of the latest from our in-box, and she was none too pleased.
"It´s awful," she said. "It´s flat-out, blatant lies. It´s unbelievable to me how they can claim to reference the legislation and then make claims that are blatantly false."
The claim that the bill provides free health care for illegal immigrants is particularly egregious, Tolbert said. "No one´s provided with free health care. That´s ridiculous," she said.
We looked for promises of free health care for immigrants and found nothing. So we´ve rated this claim Pants on Fire!
Another claim that´s Pants on Fire! is the following: "Page 42: The ´Health Choices Commissioner´ will decide health benefits for you. You will have no choice. None."
To explain this one, we will start with an explanation of the overall bill, which was unveiled July 14, 2009. The bill envisions that everyone will be required to have health insurance. People who get health insurance through work satisfy this requirement right off the bat.
People who don´t get insurance through work or other groups will go to the health care exchange; it´s designed to help people who have to go off on their own to buy health insurance, and for small businesses with few employees. The reason for the exchange is that the government wants to regulate insurers to make sure that health plans clearly explain what they offer, can´t refuse people for pre-existing conditions, and must offer basic levels of service.
"This is designed to protect consumers from plans that have outrageous cost-sharing or really limited benefits," Tolbert said. "It´s to ensure that they´re actually getting coverage and not a junk policy."
A key point here is that employer-provided insurance is already subject to this kind of regulation. Employer-provided insurance has to meet certain requirements to win its tax-exempt status.
That´s why, if you get insurance through work, you´re not asked about pre-existing conditions, and you pay the same rate as all of your fellow co-workers.
The bill says that a Health Choices commissioner will run the exchange, and that he or she will make sure that insurers are offering basic benefits and adhering to the regulations. Individuals then choose their own plan from offerings on the exchange. The health commissioner does not "decide health benefits for you." To the extent that insurance plans have to meet basic requirements, those instructions are ultimately coming from Congress. The commissioner executes the rules.
One of the few claims from the e-mail that is truthful is the statement that "All private healthcare plans must conform to government rules to participate in a Healthcare Exchange." This was confirmed by our reading of the legislation, and Tolbert agreed with the statement as well. The legislation intends to more closely regulate health insurance, so it requires plans to follow the rules if they want to sell insurance through the exchange. We rated the statement True .
The e-mail includes almost 50 claims about the health care bill in its original form. (The bill is still in Congress, so it´s expected to change as members negotiate for votes.) We´ve ruled on the first 15 claims below. We wanted to publish our initial findings promptly, and we´re still deciding whether we should proceed with checking all the claims after finding so many problems with the first batch. We´ll make our decision based on reader feedback, so e-mail us your thoughts at truthometer@politifact.com or message us via Twitter @politifact .
The e-mail begins, "Subject: A few highlights from the first 500 pages of the Healthcare bill in congress. Contact your Representatives and let them know how you feel about this. We, as a country, cannot afford another 1000 page bill to go through congress without being read. Another 500 pages to go. I have highlighted a few of the items that are down right unconstitutional." Below are the e-mail´s assertions, followed by our findings.
• Page 22: Mandates audits of all employers that self-insure! False: Section 113 of the bill requires the Health Choices commissioner to conduct a study to make sure health reform does not unintentionally create incentives for businesses to self-insure or create adverse selection in the risk pools of insured plans. There is no mandated audit.
• Page 29: Admission: your health care will be rationed! False: Section 122 outlines broad categories of benefits that must be included in an essential benefits package. It prohibits cost-sharing for preventive care and limits annual out-of-pocket spending to $5,000 for an individual and $10,000 for a family, indexed for inflation. It says nothing about rationing or limiting treatment.
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process) Barely True: Section 123 establishes a Health Benefits Advisory Committee that makes recommendations on what types of health insurance coverage will be defined as basic, enhanced or premium. The committee will be chaired by the surgeon general, with members appointed by the president, the comptroller general, and representatives of federal agencies. This committee makes recommendations on insurance regulations, so in that sense it does set standards for benefits. But it does not make decisions about treatments for individuals.
• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None. Pants on Fire!: Section 142 outlines the duties of the Health Choices commissioner, who is charged with regulating insurers. The commissioner should seek insurers to offer different types of insurance, including basic, enhanced and premium. Individuals will be able to choose among competing insurers who are regulated via the exchange.
• Page 50: All non-US citizens, illegal or not, will be provided with free health care services. Pants on Fire! Section 152 includes a generic nondiscrimination clause, which says insurers may not discriminate with regard to "personal characteristics extraneous to the provision of high quality health care or related services." It says nothing about "non-US citizens" or immigrants, legal or otherwise. In fact, the legislation specifically states that undocumented aliens will not be eligible for credits to help them buy health insurance, in Section 246 on page 143.
• Page 58: Every person will be issued a National ID Healthcard. Barely True: Section 163 sets out goals for electronic health records. It says one goal should be real-time confirmation of which services a person qualifies for and how much they will have to pay. That could be achieved by machine-readable beneficiary cards, according to the legislative language. But the legislation does not require the cards.
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer. Barely True: Section 163 sets out goals for electronic health records. One of the goals is to include features that "enable electronic funds transfers, in order to allow automated reconciliation" between payment and billing. The legislative summary says the intent in the section is "to adopt standards for typical transactions" between insurance companies and health care providers. The legislation generically describes typical electronic banking transactions and does not outline any special access privileges.
• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN) . Pants on Fire! Section 164 creates a temporary reinsurance program to help employers or employee associations pay for coverage for workers ages 55 to 64. It does not mention labor unions or community organizer groups, though presumably they could qualify for subsidies like any other employee association that previously offered health insurance. The section´s point, however, is to offer subsidies to employer-based insurance programs, not unions or community organizers.
• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange. True. Private health care plans must conform to government rules to participate in the exchange, and this page begins an explanation of exchange rules. However, the requirement that insurance companies must conform to is also presented much earlier in the bill. We spotted an earlier reference on page 15, Section 101.
• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans) . Mostly True. Section 203 sets rules saying that plans must offer basic plans before they can offer plans with extra benefits. These extra benefits are defined as enhanced plans and premium plans. (The unstated assumption here is that enhanced and premium plans will be more profitable for the insurance companies.) But this isn´t the page number that requires health plans to participate in the exchange. Technically speaking, private insurance plans are not required to participate. Rather, only insurance sold on the exchange will satisfy the mandate that people have health insurance. In effect, private health plans that want to sell to individuals will have to sell through the exchange, under the terms of the bill.
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens. Half True. Section 204 outlines more regulations for health insurance plans in the exchange. One of the requirements is that they provide "culturally and linguistically appropriate communication and health services." Another part of the bill mentions that this includes "effective methods for communicating in plain language." There is no mention of citizenship status.
• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan. False. Section 205 says the Health Choices commissioner is charged with publicizing the options on the health care exchange. The legislation says the commissioner "may work with other appropriate entities to facilitate the dissemination of information." The bill does not mention ACORN or Americorps. The bill also says that the commissioner must publicize the "Exchange-participating health benefits plan options," which would include private insurance plans.
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. False. This page describes people who would qualify for Medicaid, a government insurance program for people with very low incomes. It says that individuals will be automatically enrolled in Medicaid only if they have "not elected to enroll in an Exchange-participating health benefits plan." So the auto-enrollment only happens if they have not chosen another plan.
• Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed. Barely True. Section 223 discusses how the government will pay doctors under the public option health insurance; they will pay 5 percent more than Medicare pays. It´s true that this section does not set out any sort of judicial review, but it specifically states that health care providers do not have to accept patients under the public option. The bill also says that the Health Choices commissioner has the authority "to correct for payments that are excessive or deficient," taking into account "amounts paid for similar health care providers and services under other Exchange-participating health benefits plans." There may be a broader case to be made that the government can outcompete private insurers through the public option, but this section of the plan doesn´t have to do with lawsuits or judicial review.
• Page 127: The AMA sold doctors out: the government will set wages. Barely True. Section 225 discusses payments for physicians who choose to accept the public option insurance. Again, there may be a broader case to be made that the government can outcompete private insurers through the public option, but this section of the plan only applies to payments to doctors for patients who are part of the public option. The government does not set wages for doctors because doctors are free to decline to see the patients.
Finally, a few words about the e-mail´s origins. It appears that someone out there based it on the work of Peter Fleckenstein, who publishes commentary on the Twitter messaging service under the name Fleckman . (Some of the e-mails we receive credit him, but many do not.) Fleckenstein strongly opposes the Democratic health plan and labels most of his posts #tcot , which stands for "top conservatives on Twitter." Fleckenstein has also posted the analysis at his blog, Common Sense from a Common Man . Many of the e-mails we received have made changes to Fleckenstein´s original tweets, and the e-mail we´ve checked here has made changes as well.
Right now the fate of health care reform seems to rest in the hands of relatively conservative Democrats — mainly members of the Blue Dog Coalition, created in 1995. And you might be tempted to say that President Obama needs to give those Democrats what they want.
Fred R. Conrad/The New York Times
Paul Krugman
To grasp the problem, you need to understand the outline of the proposed reform (all of the Democratic plans on the table agree on the essentials.)
Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.
By regulation I mean the nationwide imposition of rules that would prevent insurance companies from denying coverage based on your medical history, or dropping your coverage when you get sick. This would stop insurers from gaming the system by covering only healthy people.
On the other side, individuals would also be prevented from gaming the system: Americans would be required to buy insurance even if they’re currently healthy, rather than signing up only when they need care. And all but the smallest businesses would be required either to provide their employees with insurance, or to pay fees that help cover the cost of subsidies — subsidies that would make insurance affordable for lower-income American families.
Finally, there would be a public option: a government-run insurance plan competing with private insurers, which would help hold down costs.
The subsidy portion of health reform would cost around a trillion dollars over the next decade. In all the plans currently on the table, this expense would be offset with a combination of cost savings elsewhere and additional taxes, so that there would be no overall effect on the federal deficit.
So what are the objections of the Blue Dogs?
Well, they talk a lot about fiscal responsibility, which basically boils down to worrying about the cost of those subsidies. And it’s tempting to stop right there, and cry foul. After all, where were those concerns about fiscal responsibility back in 2001, when most conservative Democrats voted enthusiastically for that year’s big Bush tax cut — a tax cut that added $1.35 trillion to the deficit?
But it’s actually much worse than that — because even as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost.
There has been a lot of publicity about Blue Dog opposition to the public option, and rightly so: a plan without a public option to hold down insurance premiums would cost taxpayers more than a plan with such an option.
But Blue Dogs have also been complaining about the employer mandate, which is even more at odds with their supposed concern about spending. The Congressional Budget Office has already weighed in on this issue: without an employer mandate, health care reform would be undermined as many companies dropped their existing insurance plans, forcing workers to seek federal aid — and causing the cost of subsidies to balloon. It makes no sense at all to complain about the cost of subsidies and at the same time oppose an employer mandate.
So what do the Blue Dogs want?
Maybe they’re just being complete hypocrites. It’s worth remembering the history of one of the Blue Dog Coalition’s founders: former Representative Billy Tauzin of Louisiana. Mr. Tauzin switched to the Republicans soon after the group’s creation; eight years later he pushed through the 2003 Medicare Modernization Act, a deeply irresponsible bill that included huge giveaways to drug and insurance companies. And then he left Congress to become, yes, the lavishly paid president of PhRMA, the pharmaceutical industry lobby.
One interpretation, then, is that the Blue Dogs are basically following in Mr. Tauzin’s footsteps: if their position is incoherent, it’s because they’re nothing but corporate tools, defending special interests. And as the Center for Responsive Politics pointed out in a recent report, drug and insurance companies have lately been pouring money into Blue Dog coffers.
But I guess I’m not quite that cynical. After all, today’s Blue Dogs are politicians who didn’t go the Tauzin route — they didn’t switch parties even when the G.O.P. seemed to hold all the cards and pundits were declaring the Republican majority permanent. So these are Democrats who, despite their relative conservatism, have shown some commitment to their party and its values.
Now, however, they face their moment of truth. For they can’t extract major concessions on the shape of health care reform without dooming the whole project: knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it.
Is that what the Blue Dogs really want to see happen? We’ll soon find out.
