Prediction: No Respite From Bogus “Tort Reform” Claims

Here’s a prediction for 2011 — Republicans in Congress will spend most of this year attempting to repeal or dismantle health care reform.

Access to affordable health care is a huge worry to Americans, including Americans with the deadly lung cancer mesothelioma. The cost of mesothelioma treatment could be ruinous to the uninsured.

Last year’s health care reform law, the Affordable Care Act, should help millions of Americans afford better health care once all the provisions go into effect. But many politicians are determined to dismantle the law before it all goes into effect.

Another prediction is that we’ll continue to hear claims that “tort reform” is the magic bullet that will solve all our health care problems. This is true even though study after study has found that the actual cost of malpractice litigation comes to less than 2 percent of the nation’s health care cost.

We’re told over and over again that the bigger cost of malpractice is “defensive medicine.” Doctors order unnecessary tests and procedures because they fear being sued. And there are studies that appear to back up this claim. A number of surveys have been published in which doctors report that 18  to 28 percent of the tests and procedures they order are purely “defensive.” “Tort reform” advocates use these figures to estimate that “defensive medicine” is costing the U.S. hundreds of billions of dollars.

However, a new study out of the University of Iowa has found that, in state after state, “reforming” malpractice law has no impact on physician “defensive” practices.

“We found that both generalist and specialist physicians fear being sued for malpractice even in states where their risk of being sued is relatively low,” said senior study author David Katz, M.D. “One likely explanation is that physicians’ concerns about malpractice are driven more by their perception that the malpractice tort process is unfair and arbitrary and less by their actual risk of getting sued.”

“The high levels of malpractice concern, even among physicians in relatively low-risk environments, is striking,” Katz said. “One possible explanation is that most physicians do not have the information to accurately access their actual risk of being sued.”

We’ve seen in state after state in which malpractice law is “reformed” that it has no impact on the cost of health care. Although physicians in “reformed” states usually do enjoy lower malpractice insurance premiums, these savings are not passed on to the consumer — the patient — and overall costs of health care continue to skyrocket.

And often, when the old “tort reform” law doesn’t work, state legislatures brilliantly respond by reforming tort even more.

Texas has “reformed” its tort laws so much that emergency room physicians have a near zero chance of being sued. Emily Ramshaw reported in the New York Times that the state’s 2003 tort reform law “made it more difficult for patients to win damages in any health care setting, but especially emergency rooms.”

In order to win a malpractice suit in Texas, patients have to prove an ER doctor acted with “willful and wanton” negligence, meaning a doctor wasn’t just careless but deliberately hurt the patient. Texas attorneys say this is an impossible threshold to meet and have stopped taking cases involving emergency room personnel.

Texas politicians like to brag that Texas malpractice premiums have gone down by 30 percent — which, they say, proves tort reform “works.” However, in the past ten years, patient health insurance premiums in Texas have gone up by almost 92 percent. It works? Heck of a job.

This entry was posted on Monday, January 3rd, 2011 at 9:18 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Poll: Most Americans Don’t Support Health Care Reform Repeal

Many politicians in Washington continue to go through the motions of repealing the health care reform bill that became law last year. I say “go through the motions” because the health insurance industry doesn’t want the law repealed, just tweaked a bit. And it’s hard to imagine that a majority of Congress would ignore what the health insurance industry wants, no matter what they’re telling their constituents.

In the 2010 midterms many politicians ran on the promise of “repeal and replace” and won their elections.  On the other hand, Americans, including those suffering from mesothelioma, seem to want something done about the old system, which has left millions of Americans uninsured while costs spiral out of control.

Politicians who are pushing for repeal of last year’s health reform law claim that’s what the American people want. However, a new poll from the Kaiser Family Foundation/Harvard School of Public Health says otherwise.

The claim that a majority of Americans want repeal is based on polls that show a majority have an unfavorable view of the law, and the new poll shows this, also. However, what the Kaiser/Harvard poll reveals is that a substantial number of people who disapprove of the law want it expanded, not repealed.

The poll found that 43 percent of Americas do want repeal — 23 percent of this group wants the law repealed and replaced with a Republican alternative, and 20 percent want it repealed and not replaced.

However, 28 percent of respondents do not want the law repealed, but expanded. Another 19 percent want it left as it is. That’s 47 percent against repeal, versus 43 percent for repeal.

Of course, 43 percent is a sizable minority. But when pollsters tried to determine exactly what about the law people  don’t like, the picture gets murkier. Many provisions of the bill are popular even among the group that wants repeal.

For example, 85 percent approve of seniors who have fallen into the Medicare “doughnut hole” getting discounted prescription medications; 79 percent approve of subsidies to help lower-income Americans buy insurance; 66 percent approve of regulating insurance companies so that at least 85 percent of premiums are paid out in benefits.

On the other hand, many of the things people say they don’t like about the health care reform law reveal confusion about the law. More than half of those polled seem to believe the bill allows government bureaucrats to dictate what health care they will receive, which is no more true than it was before the bill was passed.  Six in ten Americans think the health care reform law will increase the deficit over the next ten years, but the Congressional Budget Office has said the law will reduce the deficit by $1.3 billion dollars.

The single most unpopular part of the bill is the individual mandate, which goes into effect in 2014. The mandate requires that most Americans obtain health insurance or pay a penalty. But when it’s explained that the mandate is necessary if insurance companies may no longer deny coverage to people with pre-existing conditions, the “favorable” percentage for the mandate goes from 23 percent to 46 percent.

Pro-reform politicians think people will be won over to health care reform once they understand what it is and how it works. The danger is that it will probably take a few years for that to happen, and in the meantime anti-reform politicians will be working to weaken the bill by dismantling the parts the insurance industry doesn’t like. Full repeal is extremely unlikely, however.

This entry was posted on Friday, January 28th, 2011 at 1:08 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Will Health Care Reform Be Repealed?

The 112th Congress of the United States is now in session, with a Republican majority in the House and a very slim Democratic majority in the Senate. And one of the first items on the agenda of many legislators is repealing last year’s Affordable Care Act, also known as the health care reform bill.

A bill titled “Repealing the Job Killing Health Care Law Act” — seriously — was scheduled to be voted on by the House this week, but the vote now has been postponed until next week. This very brief bill does one thing only, which is  cancel every provision of the Affordable Care Act that became law last year.

So does that mean all the seniors who received rebate checks to help cover prescription drug costs in the Medicare Part D “gap” would have to return the money? Yes, apparently so. Further, the new 50% discount on brand-name prescriptions filled in the gap would be yanked away. Medicare co-pays for checkups and preventive services, which were eliminated by last year’s act, would return.

Many provisions of the Affordable Care Act won’t go into effect until 2014. These  includes  the requirement that insurers cannot refuse to insure adults with pre-existing conditions. Nearly all of us have “pre-existing conditions” by the time we reach 50, of course. Our chances of being “pre-conditioned” go up as we age –  mesothelioma, for example, is rarely diagnosed in patients younger than 50.

But a provision that insurance companies cannot deny coverage to children with pre-existing conditions already is in effect. The Republican bill would cancel that.

Thanks to health care reform, young adults can remain on their parents’ employee health benefits until they are 26. According to Marisa Schultz of the Detroit News, in Michigan alone 32,800 young adults now on their parents’ health care plans would lose that coverage.

To the surprise of nay-sayers, tax breaks created by the Affordable Care Act have allowed many small businesses to offer health benefits to employees for the first time. Noam N. Levey writes in the Los Angeles Times that insurance companies have seen a significant increase in customers who work for small businesses.  Repeal health care reform, and hundreds of thousands of working people would lose those new benefits.

The Congressional Budget Office figures that repealing health care reform would add $230 billion to the deficit and result in 32 million fewer people having health insurance by 2021. Such a deal.

Washington watchers say it is highly unlikely the repeal bill will ever become law, if only because the Senate would not approve it and the President would certainly veto it. But since so many House Republicans ran on a promise of repealing “Obamacare,” the repeal effort will go forward anyway.

This entry was posted on Wednesday, January 12th, 2011 at 2:44 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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The So-Called Job Killing Health Reform Bill

The U.S. House of Representatives has passed the “Repealing the Job Killing Health Care Law Act”, which is the name House Republicans gave their bill repealing the health reform act that became law last spring. But is the name of the new House bill honest? Is the new health care reform law really “job killing”?

Andrew Leonard explains how Republicans figured the health reform law they call “Obamacare” would kill jobs:

“The primary evidence for their assertion is based on a line in the CBO analysis of the bill that estimates that the labor supply might drop by one-half of 1 percent as a result of the passage of the ACA. The Republicans multiplied the total number of jobs in the country by half a percent and came up with a total of 650,000 jobs lost”

But the “labor supply” isn’t jobs. The labor supply is the number of employees and people looking for jobs.

According to the CBO, healthcare reform could result in a lower labor supply because workers may voluntarily leave their jobs, secure in the knowledge that they would still have access to healthcare.

In most of the United States, insurance companies can refuse to issue policies to people with pre-existing conditions. Earlier this week, the Secretary of Health and Human Services released a study that said as many as 129 million Americans under the age of 65 have medical conditions that an insurance company could “red flag” as a reason to deny insurance.

Access to health care is a huge worry to Americans, including Americans with the deadly lung cancer mesothelioma. The cost of mesothelioma treatment could be ruinous to the uninsured.

Many of these 129 million people do have insurance today, because they obtained insurance policies while they were healthy. But if they lost their insurance because of, say, a job loss, they may have to wait until 2014 until they can be insured again. Beginning in 2014, a provision in the health care reform law goes into effect that requires insurance companies to insure people with “pre-existing conditions.” But the Republican bill repeals that.

I’ve written previously why I don’t think health care reform will be repealed.  Beside the fact that the insurance industry does not want the act entirely repealed, to become law the Republican bill still has to be passed in the Senate — doubtful — and not vetoed by President Obama — when hell freezes over.

Assuming the law is not repealed and all of its provisions go into effect, most economists say it’s impossible to predict with certainty if the law will have any effect on employment, one way or another. However, economist Steven Pearlstein wrote of health care reform, “Since the immediate impact of the measure will be to allow 30 million more Americans the chance to buy drugs and medical services from doctors, hospitals and pharmaceutical companies, it’s hard to imagine a more effective way to reduce employment in the one sector that is actually adding jobs.”

That’s right; even several months after the passage of the dreaded “Obamacare,” the health care industry is growing far more robustly than the rest of our economy. Go figure.

This entry was posted on Wednesday, January 19th, 2011 at 4:03 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Another Court Decision Against Health Care Reform

The Affordable Care Act that became law last year promises to make health care affordable and accessible for nearly all Americans, including Americans with mesothelioma. However, many people object to the law and want it repealed and replaced with something else. Several states have challenged the act in court, mostly on the basis that mandating that people must purchase health insurance, which the Affordable Care Act stipulates, exceeds the constitutional powers of Congress.

Today a federal judge in Florida ruled that the mandate for individuals to purchase health insurance is unconstitutional. So far, two federal judges have said it is constitutional, and two have said it isn’t. About a dozen other federal judges have dismissed the suits against the Act.

Today’s ruling by Judge Roger Vinson of the Federal District Court in Pensacola, Fla.,goes further than the other “nay” opinion, by Judge Henry Hudson of Virginia. Judge Hudson had ruled that only the individual mandate was unconstitutional, but that the rest of the law could stand. Judge Vinson, on the other hand, struck down the entire Affordable Care Act.

The law will stay in effect until all court challenges are resolved by the Supreme Court, which  probably will take a couple of years.

A few days ago a repeal of the Affordable Care Act was passed in the House. There is little chance such a law would pass in the Senate, however, and in any event it would certainly be vetoed by President Obama. That means it is unlikely the law will be repealed unless it is struck down by the Supreme Court.

Could that happen? Anything is possible. Louis Seidman, a professor of constitutional law at Georgetown University, told Greg Sargent of the Washington Post that it will all come down to the Court’s “swing” voter, Justice Anthony Kennedy. Professor Seidman also found Judge Vinson’s reasoning to be flawed. The constitution’s “necessary and proper clause” provides for the regulation of anything that “has an effect” on interstate markets, Professor Seidman said.

A wrinkle in the repeal effort is that the insurance industry has signaled that it rather likes the individual mandate and doesn’t want it repealed. Insurance companies have been reworking their business models and preparing for millions of new customers. If the Affordable Care Act, or even just the individual mandate, is tossed out by the Court a couple of years from now, health insurance companies could see it as a big setback.

And, of course, the United States would go back to square one in reforming health care.

This entry was posted on Monday, January 31st, 2011 at 6:59 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Why Health Care Reform Won’t Be Repealed

The Republican-sponsored “Repealing the Job Killing Health Care Law Act” will be voted on in the House next week. As explained in the last post, “Will Health Care Reform Be Repealed?,” this bill is intended to nullify the Affordable Care Act health care reform that became law last spring.

Many Americans, including those suffering from mesothelioma, are fed up with being denied coverage for pre-existing conditions, or learning that they’ve exceeding coverage limits. Lifetime coverage limits already have been eliminated by the health care reform law, and beginning in 2014 insurers will no longer be able to deny coverage to people with pre-existing conditions.

In last year’s elections, many Republicans campaigned on repealing health care reform. But now that they are in control of the House, they are hearing from lobbyists that the health insurance industry does not want the Act repealed.

Last year, health insurers tried to derail passage of health care reform bill. But now that it’s become law, and the bean counters and number crunchers have analyzed its effects, they’ve come to realize something startling — the Act will be good for business. This is mostly because, according to the Congressional Budget Office, the Act will allow 32 million Americans to receive health insurance who wouldn’t have it otherwise. And nearly all of those new policies will be written by private insurance companies.

This is not to say they love everything about health care reform. They have a lot of new regulations to deal with, such as the provision that large group plans must spend at least 85% of premium income on benefits, instead of on marketing, paperwork, or profits.

However, now that it’s dawned on the insurance executives that they’re going to get millions of new customers, they aren’t so worried about the regulations. Reporting for The Politico, Sarah Kliff finds insurance companies eagerly preparing for expansion and exploring all the ways they can capitalize in the new health insurance landscape. Sounds like the law might grow some jobs, not kill jobs.

In fact, the one thing that most worries the insurance CEOs is that Congress will leave most of the health care reform bill intact but remove the individual mandate. Without the individual mandate, the health reform law really would be a disaster for insurance companies.

The mandate that everyone must acquire health insurance goes into effect in 2014, and it’s probably the most controversial part of the bill if you exclude the non-existent “death panels.” Many politicians have called the mandate unconstitutional and have sworn to repeal it if they can’t repeal the entire law.

Joseph M. Zubretsky, CEO of Aetna, explained that without the mandate, insurers won’t be able to offer affordable insurance. “The unintended consequence of repealing and replacing part of the legislation is the biggest risk here,” he said. “If guaranteed issue stays but the enforceable mandate disappears, you need another mechanism to make the costs in the risk pool work.”

“Guaranteed issue” is the provision that insurers can no longer refuse to insure someone because of pre-existing conditions. This part of the law also will go into effect in 2014 for everyone. Very simply, without the mandate, young and healthy people will put off buying insurance until they have major medical expenses. And then the insurers’ business model flies out the window.

Zubretsky of Aetna says his company has been talking to Republicans on this issue, and he said he believes they understand the “consequences” of repealing the health care reform bill, in whole or in part.

Those Republican lawmakers probably will put on a good show of trying to repeal health care reform for the folks back home. But with the insurance industry telling them to back off, they won’t try very hard.

This entry was posted on Friday, January 14th, 2011 at 1:38 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Health Care Reform: What’s the Alternative?

The Kaiser/Harvard poll discussed in the last post shows us that about one American in four wants the Affordable Care Act — the health care reform law passed last year — repealed and replaced with a Republican alternative. So, what’s the alternative?

Officially, there isn’t one.  Last spring, when the Affordable Care Act was being debated in Congress, Republican legislators introduced a number of alternative bills and complained their ideas were being ignored. Well, apparently they didn’t think much of their ideas, either, because all of those bills have been abandoned. House Speaker John Boehner said the Republicans have no deadline for drafting an alternative to the Affordable Care Act, but he expects House committees to begin generating ideas.

If affordable health care were a brand-new issue, this all-the-time-in-the-world attitude would be understandable. But rising health care costs, and increasing numbers of uninsured, have been problems for a long time.  Access to affordable health care is a huge worry to Americans, including Americans with the deadly lung cancer mesothelioma. The issue of health care reform has been discussed in every national election going back at least 20 years.

And Republicans don’t have a plan?

Actually, one Republican has a plan. Rep. Paul Ryan of Wisconsin, the new chairman of the House Budget Committee, is considered one of his party’s leading experts in fiscal policy. You might remember that he delivered the Republican rebuttal to the State of the Union speech recently.

Rep. Paul Ryan’s ideas for fixing the health care crisis include putting an end to the Medicare program and replacing it with vouchers. Seniors could apply the vouchers toward purchasing private health insurance policies on the open market, assuming private insurers are willing to insure them. And Ryan’s plan for holding down the cost of his program is to be sure the value of the vouchers lags behind growth in actual health care costs. Seriously.

Rep. Ryan also wants to put an end to the tax exemption for employee benefits. This idea also was floated by Sen. John McCain, when he ran for President in 2008, and several other prominent Republicans. The purpose of ending the exemption — some Republicans will even admit this — is to encourage employee benefit insurance to be phased out, forcing everyone into the private market for health insurance.  And the point of that is to force Americans to confront how much their insurance, and health care, actually cost, so they won’t use it so much. Seriously.

Republicans refer to this as “skin in the game,” meaning that if more of the costs of health care came directly out of people’s pockets, they would make better choices as health care consumers. But purchasing health care is not the same thing as shopping for a toaster, and when people postpone seeing a doctor because of cost it often means their conditions are far more expensive to treat when they finally do seek care.

These ideas are included in what Rep. Ryan calls his “Roadmap for America’s Future.” The “roadmap” goes far beyond just overhauling health care; it also overhauls Social Security and taxes and lots of other stuff in ways that are more “fiscally conservative.” And the Congressional Budget Office says that the “roadmap” will indeed balance the budget — in 2062.  But it would add more than $62 trillion to the national debt before then. Such a deal.

This entry was posted on Sunday, January 30th, 2011 at 3:53 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Health Care Reform Repeal: What Will the Senate Do?

Now that the House has voted to repeal health care reform, what will the Senate do? Or, more specifically, what will Senate Republicans do?

On the health care reform issue, Republicans may have painted themselves into a corner. They’ve spent the past couple of years whipping the base into hysteria over “Obamacare.” They campaigned for re-election on the slogan “repeal and replace,” and now their constituents expect them to deliver.

But then something happened the politicians probably didn’t anticipate. The health insurance industry studied the final bill and decided it wasn’t so bad, after all. In fact, they kind of like it. There are some things in it they want to tweak, certainly, but they don’t want it repealed, and in particular they don’t want the individual mandate to purchase insurance repealed.

And, according to OpenSecrets.com, the insurance/finance/real estate sector contributes much more money to the Republican Party than any other sector of our economy.

So, for the next few months, it’s likely Senate Republicans  in Washington are going to make a great show of repealing health care reform — without actually doing it. And this will mostly be just political theater.

How this could play out — there is talk of using procedural maneuvering to force a vote on the repeal bill in the Senate. Normally a bill is introduced into a committee, and if the committee approves the bill it is voted on by the entire Senate. But since Democrats are a majority on the committees, Republicans have to do an end run around the usual process. For example, they could offer the repeal bill as an amendment to other bills.

However, at some point or another in any procedural maneuver the Republicans will face having to round up 67 votes — two thirds of the Senate — to stop all objections and force a vote. But there are only 47 Republicans in the Senate.

This actually works for Republicans, because this means they can stomp and howl all they like about repealing health care reform, secure in the knowledge it won’t happen. If they actually had the power to repeal health care reform, they’d have to choose between the wrath of constituents and the wrath of the health insurance lobby.

The next question is, how long will they keep this up? That depends on public opinion. Although it could go either way, it’s likely that as time goes on and citizens notice they sky isn’t falling, and that the death panel police haven’t come to collect Grandma, opposition to health care reform could fade away. And if that happens, all but the the most ideologically zealous politicians will quietly let the issue drop.

The demagogues may have spooked the public with stories of “socialized medicine,” but Americans, including those suffering from mesothelioma, are fed up with the old status quo. They are tired of being denied coverage for pre-existing conditions, and with insurance companies that arbitrarily decide what treatments they will pay for and what they won’t.  If the health care reform law is allowed to go completely into effect in 2014, these will be problems of the past.

However, it’s also possible that Republican politicians will try to keep the hysteria going so they can run on repealing “Obamacare” again in 2012. It’s going to be a long couple of years.

This entry was posted on Friday, January 21st, 2011 at 5:14 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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