Right now, you and I pay for health care, as evidenced by the growing mountains of medical bankruptcies in this country. Health care costs are heaped on consumers and on their employers, while insurance companies profit.

Under reform, this burden would be more fairly distributed. Consumers would still pay for health care, but government would help them shoulder the burden. That’s not enough, however. Insurance companies would have to compete with a public health insurance option, driving down costs. And lastly, employers would have to continue chipping in.

At least that’s how it should be. However, business right-wing groups like the Chamber of Commerce are against this “employer mandate,” claiming, like everything they disagree with, that the provision would destroy business. (Some employers, like Wal-Mart interestingly, disagree.)

Employers do help pay for health care now, as most people get their health care through work with at least some help from their employer. Asking employers to share the responsibility for providing health care to their workers would strengthen the employer based health care system, a system business defends as necessary for attracting talent. Employer responsibility provisions would also ensure people get not just health care, but good health care by requiring employers to meet a minimum standard for health benefits.

Of course, employers could choose not to offer health care, and that’s their right. But if they do, they should not get off Scot free. It’s only fair to ask employers, who share in the fruits of a healthy workforce, to help pay to keep that workforce healthy. If employers don’t want to provide health benefits, they should pay the government to provide benefits for them.

This is how the “pay-or-play” provisions in health reform should work, and it is how they do work in the House health reform bill, HR 3200 [pdf]. Jacob Hacker, one of the fathers of the health reform plans promoted by President Obama and others, feels these pay-or-play provisions are a necessary part of reform. For moral reasons, I agree.

Of course, it helps that this idea is not only fair, but popular. In Kaiser’s August health care tracking poll [pdf], 68% of people thought a pay-or-play requirement was a good idea:

Employers should have to help pay for health coverage, just like consumers and government, and the American people agree.

Too bad Senator Max Baucus doesn’t. His bill, released yesterday, has no measures to hold employers responsible. To make things worse, it has a “free rider” provision that would discriminate against the hiring of older workers, poor and minority workers, workers with children, and unmarried workers.

Sounds like reform that works for business better than it does for you, right?

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This year, Szakos was informed that Anthem was going to increase the premiums on Virginia Organizing Project’s health plan by 14.1%. Around the same time, the Virginia Organizing Project received an email from Anthem:

We strongly support reform that builds a strong, sustainable private-sector health care system – and strongly oppose creating a government-run health plan. We are urging our elected officials in Washington to take bipartisan action that will accomplish that. We are educating policymakers in Washington and working with our trade associations to encourage Congress to build on the current system and not disrupt the quality, affordable coverage on which our members depend….

As our elected officials debate health care, they need to hear directly from you.

Szakos immediately had some questions for Anthem. Chief among them, why is Anthem using its resources to lobby against health care reform with a public health insurance option while at the same time increasing rates by 14.1%?

Szakos, along with three other Virginia Organizing Project board members, went down to Anthem’s offices in Richmond, VA to ask. He left in handcuffs. Watch the video:

Szakos, a customer, couldn’t get an answer from Anthem. There was no justification for raising rates on one hand, and spending money lobbying against health care reform on the other. And instead of trying to offer Szakos an explanation, they had him arrested.

As Szakos said in the video, this is about greed and force. There is no good explanation for these rate increases, and there is no justification for Anthem to spend money it collects in premiums from customers suffering under its “health care” plans on lobbying against reform that would help these very same people. The only thing motivating Anthem – and all insurance companies – is greed. And they get and keep their money by force.

If the insurance companies win, you lose, and if you protest, you’ll be arrested. That’s health care in this country right now, but it cannot be our future. Reform must work for you, not the industry, and that means no more denying care for pre-existing conditions, coverage you can afford, and the choice of a public health insurance option to increase competition and keep these greedy corporations honest.

Anything less is a win for the industry and a loss for you.

Szakos’s trial is scheduled for September 22nd. Szakos’s legal defense team has subpoenaed Anthem’s CEO C. Burke King and director of public relations Scott Golden to appear in court on Tuesday to explain themselves. Stay tuned for more…

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Baucus Offers Health Plan but Lacks G.O.P. Support – New York Times

The chairman of the Senate Finance Committee on Wednesday unveiled his long-awaited plan to remake the nation’s health care system and insure millions of Americans. But he did not win support from a single Republican despite tailoring his proposal to be less costly and to extend the reach of government less than other health bills moving through Congress.

Baucus health care bill gets lukewarm reception – USA Today

A long-awaited plan to revamp health care got a tepid response from lawmakers Wednesday, underscoring the challenge President Obama confronts as his top priority enters a critical new phase.

All sides go on attack as senator issues health plan – Boston Globe

Max Baucus, chairman of the Senate Finance Committee, released his long-awaited health care proposal yesterday without the bipartisan support he had sought over months of painstaking negotiations, only to see it attacked from every corner of the political spectrum.

Guarded Optimism Among Insurers, but Some Health Sectors Remain Skeptical – New York Times

In an important victory for the insurance industry, Senator Max Baucus’s legislative proposal does not call for a government-run health plan that would directly compete with private insurers. Insurance stocks rose on that news Wednesday.

Chasm In Congress Over How Much Individuals Should Pay For Health Care – Kaiser Health News

How much can people afford to pay for health care?

New A.F.L.-C.I.O. Leader Calls for Public Option – New York Times

In his speech accepting the presidency of the A.F.L.-C.I.O on Wednesday, Richard L. Trumka dove headfirst into the health care debate.

Ganging up on Baucus: Senator’s plan garners bipartisan grumbles - The Hill

Sen. Max Baucus (D-Mont.) finally introduced his much-anticipated healthcare reform bill Wednesday — and was rewarded with a chorus of disapproval from both the left and the right.

Michelle Obama turns to health care – Politico

Pushing for health care reform didn’t turn out so well for the last first lady in a Democratic White House.

Vacant Senate Seat Triggers Flip-Flop – Wall Street Journal

The Democrat-controlled legislature in Massachusetts is poised to pass a bill in coming days giving Democratic Gov. Deval Patrick authority to appoint an interim senator to succeed the late Edward M. Kennedy, strengthening the party’s U.S. Senate majority and bolstering prospects for passage of a health-care overhaul.

Firms Split From NFIB On Public Option – CongressDaily

A network of small-business owners, saying that their interests have been misrepresented by K Street, are holding out hope for the inclusion of a public insurance option in the healthcare overhaul, even as the nation’s top business …

Subsidies in Baucus Health Reform Plan Would Fall Short of What Is Needed for Many People to Afford Health Care – CBPP

The difficulty Congress is encountering in finding ways to finance health reform legislation is placing in jeopardy the adequacy of the legislation’s subsidies to help low- and moderate-income people afford health coverage and out-of-pocket costs. The plan unveiled today by Senate Finance Committee Chair Max Baucus, reflecting deliberations by a group of the Committee’s Senators, would provide more limited subsidies to help people purchase coverage than the Senate HELP Committee bill or the House bill. The Baucus plan could leave many people who are eligible for subsidies facing fairly steep insurance premiums and cost-sharing charges that they could have difficulty affording.

OPINION

The Baucus Health Care Plan: Who Will Vote for THIS? – Change.org

You’ve heard endlessly about how you need 60 votes to pass anything in the Senate. (It’s the number of votes required to end a filibuster.) You’ve even heard the number 60 used to justify why the Senate Finance Committee is jettisoning something as popular as the public option from their bill. As Sen. Kent Conrad said again and again on TV, there are “not 60 votes in the U.S. Senate” to pass a public option. But given the reaction to Sen. Max Baucus’ bill, crafted in secret with a bipartisan “gang of six” including Mr. Conrad, the magic number is not 60. It’s 12.

The Only Good News About Senate Finance Bill? It Won’t Pass - Mike Lux

I have written several times of the media’s fixation with the bill that comes out of the Senate Finance Committee on health care. It’s finally starting to move now, creaking its way up the track like a half-dead carcass. Traditional media will act like whatever is in the Senate Finance bill will be the bill, that the deal is done. Not even close, folks.

There Are Enough Votes For *A* Triggerless Public Option – Chris Bowers

In our email petitioning Harry Reid earlier today, I claimed “we have the votes to pass a public option in health care reform.” This is a statement I stand by, as long as the emphasis is on a triggerless public option, rather than on any of the triggerless public options that currently passed through Congressional committees.

Conrad Praises Baucus Bill Which Contains Co-Ops He Proposed After Meeting With UnitedHealth Group - Think Progress

After months of legislative deliberation aimed at forging a bipartisan health care bill that began by ejecting single-payer advocates from his hearing room, Senate Finance Committee Chairman Max Baucus (D-MT) unveiled his committee’s health care bill today with zero Republican support. Baucus’s bill — which former Cigna executive Wendell Potter has referred to as “an absolute gift” to the health insurance industry — includes no public option, an individual insurance mandate, and the creation of health care co-ops.

How Does Baucus Protection Stack Up? - Jon Cohn

One of the big questions about the Baucus proposal is affordability–that is, what protection it provides and at what cost. The best answer I’ve seen, so far, comes from Nicholas Beaudrot. He had the good sense to compare the provisions of the Baucus bill to those now available in Massahcusetts, under its newly reformed system. Better still, he put the results on a chart.

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To help amplify the president’s message, the Office of Health Reform at HHS also published a report detailing how health reform can help young adults, Young Americans and Health Insurance Reform: Giving Young Americans the Security and Stability They Need . Young adults make up nearly one-third of the uninsured population, and nearly one in four are paying off medical debt. Frightening statistics — especially for soon-to-be college graduates who may soon find themselves among the ranks of the uninsured.

In his speech, Obama described health care as "the struggle of this generation," and outlined the many ways health reform will benefit young Americans:

• Young adults will be able to stay on their families’ health insurance policies as dependants until the age of 26
• Young adults who are not covered at work will be able to buy quality, affordable coverage fthrough the new health insurance exchange
• Many people will be able to get certain preventive care services for free, and the health care system will invest more in wellness and prevention.
• Small businesses will get a tax credit to help them cover their employees
• Insurance companies will have to limit what young adults would have to pay in out-of-pocket expenses, co-pays, and deductibles.
• There will be limits on how much insurance companies can spend on administrative costs

Young adults have much to gain from proposed reforms, but they will also be asked to contribute their fair share to reform. Shailagh Murray of the Washington Post explains:

A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

Young Invincibles — a term used to describe these young adults who willingly forgo insurance because of their good health — is also a campaign "committed to making sure young people are heard in the debate about the future of our country." Their site contains hundreds of stories from young adults across the nation explaining why health reform matters to their generation.

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As policymakers put the final touches on health care legislation that would expand coverage to millions of Americans, it is important that they ask themselves, "Coverage for what?"

Two new reports from the Georgetown University Health Policy Institute and the Kaiser Family Foundation tackle this question head on, looking at health coverage for children and individuals with special needs. Both groups require specialized care. The reports analyzed how insurance coverage differs between a benchmark private plan and public programs. Read the full reports, respectively, here and here.

Their key findings, from last week’s discussion, Matching Health Benefit Packages to Health Needs: Key Issues to Consider in Health Reform, are interesting:

Individuals with Special Needs and Health Care Reform:

• The medical needs of individuals with special needs are diverse, complex, specialized and life-long
• Medicaid offers comprehensive coverage with little or no cost-sharing
• The typical private plan falls short in providing necessary long-term services and support for individuals with disabilities and chronic conditions

Children and Health Care Reform:

• Children have unique health care needs (e.g. vision, dental, hearing) that are often limited or excluded from private plans. Appropriate health care can help children avoid preventable and serious conditions as well as promote nutrition and physical activity.
• Even families with relatively healthy children will face high medical bills under a typical private insurance plan
• Children with special needs face coverage gaps and high medical bills under private coverage; often families will put off children’s preventive care
• Medicaid fully covers children’s acute care and long-term needs with limited or zero cost sharing

While private plans offer generous benefits for acute problems, the public plans are better able to accommodate individuals with long-term conditions, children and low-income families/individuals. Yet while benefit packages in Medicaid may be more comprehensive, funding issues can create significant barriers to care.

Clearly one size does not fit all in health care. Which is why we are pleased that reform proposals in Congress place such an emphasis on creating more options for Americans to get the health care coverage they need.

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Eby is a family physician and the medical director of a nonprofit health care system that serves Alaska Native people in Anchorage and far flung remote communities, some accessible only by air.

He has learned that a diagnosis and a pill don’t necessarily make a patient well. And he has helped organize Southcentral Foundation (SCF), the tribal-owned system that has attracted notice nationally for its innovation and ability to find a better way to deliver quality health care

Before the makeover, he wrote:

The system misunderstood the core product as being tests, diagnosis, pills and procedures. When individuals sought health care services, providers would take their signs and symptoms, perform a physical examination, and produce a differential diagnosis. Then providers would do what health care does really well: order a bunch of tests. That would lead to a definitive diagnosis, which would then result in pills being prescribed, procedures and tests being ordered, and perhaps some advice being delivered. When the visit was done, the provider thought the work was done.  

 

 

 

 

 But really, that isn’t the model that works best for chronic illness, long-term conditions, prevention and wellness. 

The customer decides whether to pick up the medicine the provider prescribes, whether to take it as prescribed, whether to share it with a neighbor, whether to split it in half so it lasts longer, whether to stop taking it in a few days, whether to exercise, what to eat, whether to drink too much, whether to smoke… All of these things are determined by the customer and not always in the provider’s presence.

 

 

 

 

SCF, which runs outpatient centers focusing on primary care and jointly operates a 150-bed hospital with the Alaska Native Tribal Health Consortium, regards patients as both its owners and its customers. SCF focuses on community and primary care (broadly defined). The consortium is responsible for more specialized inpatient care.

The clinics provide about 400,00 outpatient visits a year, integrating primary care, behavioral health, and, when appropriate, traditional healing and complementary medicine such as acupuncture. For complex historical and economic reasons, they have to do it efficiently. As Eby explained, they have no choice.

SCF isn’t a purely safety net hospital, but it has a safety-net component. Many customers are educated, health-literate and insured. They could seek care outside the tribal system, and, before the SCF makeover about a decade ago, they did. But now they choose to get their care there.

But Eby and the other providers also see poverty, unemployment, and a fair amount of dislocation and family disruption as people transition from a rural subsistence lifestyle to an urban, cash-based environment. "It’s fair to say that our population has higher than the general community’s averages of risk factors," Eby said. Health care, therefore, must include getting a handle on stresses, smoking, alcoholism, nutrition.

The patient mix means there is also a payment mix — Medicare, Medicaid, private insurers, and a payment from the federal government based on the tribal status. The federal money gives SCF some flexibilty and room to innovate — but it also never keeps up with the rising cost of care, Eby said. "We have to become smarter about how we design and deliver services every year," said Eby, who has been there nearly 20 years.

"In our system, every bit of outpatient care is delivered through an integrated primary care team," he said. The team has access to "immediately available advice and support" from cardiologists or other specialists but they are "truly consultants, and not primary care givers." Specialists do see the patients, of course, when needed, but at about one-fourth the rate elsewhere. And when a patient (or customer) does need to see, for instance, the cardiologist, he or she is seen that day or soon after. No weeks of waiting. It’s fast and convenient — the specialists are right across the street, and next spring they will move into the primary care building.

When patients need something, they call their care team — not via a clerk at a front desk.The team assesses whether they need to come in, and can usually arrange an appointment that day. The team includes primary care provider, a case manager, two medical assistants, and there’s one behavioralist for every three teams. 

Because the team works so closely, they pack as much of the routine annual care into a visit. For instance, if a child comes in with an ear infection, the team will make sure they do the appropriate preventive care, immunization, screening and wellness services at the same time. That way there’s no need for a special "well-child visit" (unless the child never gets sick enough to need the doctor in between scheduled checkups). A woman who comes in with a sprained ankle may also get caught up on her routine OB/GYN care. If a 45-year-old man comes in for the first time in five years, and he’s happy and healthy other than, say, an ingrown toenail, he’ll get the relevant routine checks and maybe a tetanus shot. But if he’s not so happy and healthy, he may get some help with diet and exercise, smoking cessation, lowering his risk for things like diabetes and heart disease.

It is all holistic — and scientific. They measure outcomes — both through standard HEDIS measures and patient satisfaction surveys. Eby lists successes:

• Hospital days per 1,000 people have dropped by more than half
• They have 40 percent fewer inpatient admissions
• Emergency room visits have plummeted
• Specialty visits dropped by 60 percent
• Diabetes is being better controlled
• They have high immunization rates
• They have high rates of screening for colorectal cancer and depression

In part two of this post, Eby shares his "to do" list — What problems have not yet been solved, what they are doing about it — and how health reform can help.

Photo copyright Southcentral Foundation

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Robb, who reached Medicare eligibility age herself this year, recalled the achievements of  Presidents Roosevelt, Truman, Kennedy and Johnson — "Social Security, Medicare, Medicaid and more."

She recalled the day her father signed Medicare into law — and gave the first Medicare card to former President Harry Truman.

Now it’s time, she said, to complete "the unfinished business of our generation."

"Reject the falsehoods," she said.  Pass health reform.

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