Spring is in the air and a (not so) young man’s thoughts turn to Obamacare

(Excerpted from Nature’s Way by Randy California, Spirit, The Twelve Dreams of Doctor Sardonicus, 1970)

It’s nature’s way of telling you soon we’ll freeze
It’s nature’s way of telling you dyin’ trees
It’s nature’s way of receiving you, it’s nature’s way of retrieving you
It’s nature’s way of telling you something’s wrong

The “soon we’ll freeze” line changed to summer breeze as the group, and others, moved away from the claims of the major media of the time that we were headed toward a period of cooling. Climate change skeptics often cite the “1970’s scientists expected an ice age” pseudo-fact as proof scientists don’t know what they are talking about. But a review of the era suggests that 7 peer-review journal articles supported cooling and 42 suggested warming. There’s more about this debate here. However the media picked up on the “next ice age” threat and pushed that concept out into the public consciousness.

In the America of the 1970s most people were open to the idea that we were poisoning the planet, the environmental movement blossomed and change was forced by law. Aerosol sourced CFCs were banned in the late 1970s in response to measured decreases in ozone in the atmosphere. Ozone is responsible for most of the absorption of UVB radiation making sunlight (a little) safer to skin. The EPA was established in 1970 under Republican President Nixon’s watch. EPA’s first press release noted that they had “…a broad responsibility for research, standard-setting, monitoring and enforcement with regard to five environmental hazards; air and water pollution, solid waste disposal, radiation, and pesticides.” In fact, Nixon (no wide-eyed liberal, btw) said, “the 1970s absolutely must be the years when America pays its debt to the past by reclaiming the purity of its air, its water, and its living environment.”

So how did the EPA become the arch-enemy of the modern conservative movement? It’s pretty simple, the businesses that are affected by EPA rules think that their profits come first, over health and environmental concerns, and they prefer to spend their money on PR and politicians. In late 2009 and 2010, for example, the energy sector spent over 1/2 billion dollars to defeat the The American Clean Energy and Security Act of 2009. That bill would have required electric utilities to meet 20% of their electricity demand through renewable energy sources and energy efficiency by 2020 and while mandating that power plants clean up their carbon emissions it included subsidies to do so and protections for consumers (so that it wouldn’t have been used as an excuse to hike rates sky-high). It passed the House (that was before the 112th do-nothingest-ever Congress) but didn’t find the needed 60 votes in the Senate.

And that leads us to my segue to the week’s Supreme Court hearing of the constitutionality of the mandate in the Patient Protection and Affordable Care Act. (The common theme–ding ding ding– is business pumping millions to affect public opinion and political votes.) The commercial healthcare industry (including insurance, MD groups, hospital groups, etc.) has spent $4.9 billion in lobbying between 1998 and 2011. In the run-up to passage of the ACA bill, the Center for Responsive Politics research showed that $1.06 billion was spent in 2009 and 2010 on lobbying. The lobbying came from 1,251 organizations and 3,154 individual lobbyists. The passed version of the bill shows they got what they paid for–a bill that is essentially a sweetheart deal for insurance companies stripped of a public option and many surtaxes. So why do they continue to fight it? The answer is easy, they want to fill the Congress with anti-Obamacare politicians who can then proceed to strip out the consumer protections leaving only the new and presumably healthier customers intact.

Is the bill reform? Some characteristics of reform:

  • Defeating the insurers worst traits: seeking higher profits by cherry-picking the insured base and excluding those with pre-existing conditions, denying claims, using annual and lifetime limits to ration care and limit costs.
  • Shifting focus to less expensive preventive care.
  • Creating a mechanism where market forces can lead to lower prices.
  • Improved access to healthcare or to insurance for healthcare, more Americans covered and able to affordably seek primary and specialty medical care.
  • Move Medicare and Medicaid “pay for procedures” toward “pay for outcomes” reducing the incentives for high utilization and high costs.

The ACA’s provisions for the first bullet included policy ideas referred to as community rating and guaranteed issue. The bill established state-run health insurance exchanges where individual policies will be sold that prohibit insurers from charging differential premiums based on health status (known as community rating) and require them to offer coverage to all people wishing to purchase it (known as guaranteed issue). This is pretty much what employer-based insurance offers today so it only affects the 20% of the market on individual policies.

Chronic diseases are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending. And, they are often preventable. So the ACA has provisions wherein depending on age and gender, Medicare or private insurance must offer at no cost:

  • Blood pressure, diabetes, and cholesterol tests
  • Many cancer screenings, including mammograms and colonoscopies
  • Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use
  • Routine vaccinations against diseases such as measles, polio, or meningitis
  • Flu and pneumonia shots
  • Counseling, screening, and vaccines to ensure healthy pregnancies
  • Regular well-baby and well-child visits, from birth to age 21

Costs were to be controlled through the strategic applications of government healthcare spending as discovered by HHS reporting. The health insurance exchanges are intended to offer 3 levels of plans that will be differentiated only by physician and hospital network and cost. The keystone was the debated and debatable individual mandate. In a guaranteed issue world many people would only seek insurance when they got sick, shifting the costs of their care onto others in the risk pool. By forcing everyone in, from young and healthy to boomers not yet on Medicare, the distribution of those costs would be much wider having much less impact.

The individual mandate, with a penalty of just $625 per year (1/4 of the cost of a pack per day cigarette habit), can’t be extricated from the community rating and guarantee issue laws without it forcing prices up.

Should health insurance be for-profit at all? Considering that we pay twice as much per capita as any other developed country and still have 50 million uninsured, I’d say that it doesn’t make sense to have 30% of the spending go to marketing and advertising, underwriting, claims litigation, investor rewards, and insane CEO compensation (commonly $10 to $20 million per year.)

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Ex-Cigna executive and today’s health insurance whistleblower Wendell Potter  has said, “The higher up that ladder I climbed the more I could see what these companies do to meet Wall Street’s profit expectations. And most of the big insurance companies are now for-profit companies. They cancel people’s health insurance when they get sick. They refuse to sell coverage to people who need coverage. They price policies so high that small businesses can no longer afford care. They are spending less and less of our premium dollars on our health care and more and more to reward shareholders and senior executives.”

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From a David Axelrod fundraising email:

P.S. — Can you imagine if the opposition called Social Security “Roosevelt Security”? Or if Medicare was “LBJ-Care”? Seriously, have these guys ever heard of the long view?

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Last Laff:

He miss-stepped in two ways. First, if he would have said he was wrong instead of that his choice of words was wrong he could have moved past it, even without suspensions like Ed Schultz and Don Imus got. His “contrition” didn’t come until advertisers began bailing. Second, he thought it was still 2009 when Michael Steele called him an “entertainer” with an “incendiary” talk show and had to fall over himself with an apology and acknowledge him as a “national conservative leader.”

Then, the “entertainer” label raised his ire, now it’s the main excuse for his behavior.

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