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Dems want health care for all no matter the cost

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With little fanfare, Vermont is preparing to become the first state to implement a single-payer, government-run health-care system. The Vermont plan, if implemented, would abolish private health insurance in the state and replace it with a taxpayer-funded system under which the state government directly pays doctors and hospitals.

Of course the state is having a bit of trouble figuring out how to pay for the programs estimated $2 billion price tag, considering that the entire state governments operating budget is currently just $2.7 billion. Currently under consideration is an increase in the state sales tax from 6.9% to 29%.

At the same time, opponents of ObamaCare have often suggested the massive health-care program is really a stalking horse for such a government-run system. ObamaCares fans have sometimes suggested the same. Senate Majority Leader Harry Reid (D-Nev.) has said that the health-care law is as step in the right direction toward abolishing private health insurance.

But a single-payer system or at least government-run health care may already be a reality in far more ways than most Americans realize.

Already the government directly pays for more than half of every dollar spent on health care in this country. This compares to just 13 cents directly paid by the individual purchasing or consuming the health care. (Virtually all of the remaining 37% is paid for through insurance, much of which is also subsidized, directly or indirectly, by the government).

In fact, consumers in many countries that we associate with socialized medicine, such as France, actually pay more out of pocket for their health care than do Americans.

Medicare is the single biggest government health care program. At a cost of $612 billion this year, the massive insurance program for seniors alone accounts for one-fifth of all US health care spending. Medicaid pays an additional 15%. Altogether, there are at least a dozen government programs to provide or pay for health care.

In 2012, nearly 41% of New Yorkers receive health care through one or another government program, Medicaid in particular. According to the Kaiser Family Foundation, roughly 23% of New Yorkers are on Medicaid. By comparison, just 15% of Connecticut residents and 12% of New Jerseyans are on Medicaid.

Medicare is the second-largest health-care payer in New York, providing coverage for 12% of residents, slightly below the 14% in Connecticut and New Jersey.

But Medicares influence extends well beyond the number of enrollees. Because the program is the 800-pound gorilla in terms of paying for health care, it establishes the standards that private insurers use to set reimbursement rates for doctors and hospitals. Thus, directly or indirectly, the government is already involved in setting health-care prices.

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Dems want health care for all no matter the cost

Peter Orszag: Burwell's big chance to control health care costs

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In the past several months, health care costs outside Medicare may have accelerated, even as Medicare spending growth remains remarkably low. This is why Sylvia Mathews Burwell (who is a friend of mine) has the opportunity to be a transformational secretary of Health and Human Services.

If over the next three years she can take the bold steps needed to reinforce better value in health care, she will drastically alter prospects for everything from the federal budget to state and local priorities (including education) and the take-home pay of Americas workers.

After several years of very slow growth, total health care spending picked up in the fourth quarter of 2013, data from the Bureau of Economic Analysis show. This has led some commentators to declare an end to the era of slower health-cost increases, which has lasted for the past several years. Yet Medicare spending growth is still low, even through last month. Indeed, in the first half of this fiscal year, nominal Medicare spending was only 0.6 percent higher than in the corresponding period a year earlier.

The combined acceleration in total health care spending (which should be expected to pick up as the economy continues to recover) and continued low growth in Medicare highlights why leadership is needed from Health and Human Services. If the secretary provides a clear glide path for shifting away from fee-for-service payments, then low health-cost increases will be much more likely.

Perhaps the most important thing Burwell could do is to declare a specific goal for payment reform I favor aiming to have 75 percent of Medicare costs paid in some way other than fee-for-service by 2020 and then lay out a timetable for how to get there. Such clarity is crucial because health care providers already anticipate a shift toward value-based payment mechanisms and are poised to respond, but the timing is unclear, as is exactly which new payment model will prevail. This ambiguity impedes strategic planning and action.

With a better sense of how they will be paid for value rather than quantity, providers could do much to limit cost growth as demonstrated by the results from the many new payment systems (such as the Alternative Quality Contract in Massachusetts) currently being tested. Lower cost growth, in turn, would have multiple benefits, as a series of papers presented at the Brookings Institution recently illustrates.

Two of these reports examined what would happen if health care costs grow at the same rate as income per person, or 2.5 percentage points faster. Economists Alan Auerbach of Berkeley and William Gale and Benjamin Harris of Brookings found that, under the lower-growth scenario, stabilizing the federal debt between now and 2040 would require tax and spending changes amounting to 1.3 percent of gross domestic product a challenge, but a manageable one.

Under the higher health-spending scenario, in contrast, immediate tax increases or spending cuts equal to a whopping 4 percent of GDP would be needed to stabilize debt as a share of the economy through 2040. Over longer periods, the differences are even greater; under the more rapid spending scenario, no plausible traditional tax increases or spending reductions would be sufficient to stabilize our fiscal trajectory.

As for state and local governments, the low-growth scenario is unlikely to pose particularly difficult decisions, Donald Boyd, a fellow at the Rockefeller Institute of Government, found. But high growth would impose severe stress: Over the next two decades, state and local governments would have to either cut all nonhealth spending by 20 percent or increase taxes to a level 20 percent higher than they have been in 70 years, as a share of GDP.

Clearly, much is riding on whether we can improve value and maintain low cost growth in health care. Sylvia Burwell, an inspired choice to be the next secretary of Health and Human Services, has the opportunity to boldly lead the system toward a brighter future in which our dollars buy better health care, not just more of it.

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Peter Orszag: Burwell's big chance to control health care costs

Rising to the Challenge: Bending the Cost Curve in Health Care and Education – Video

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Rising to the Challenge: Bending the Cost Curve in Health Care and Education
Join us for our April Fuqua Faculty Conversation as Ronnie Chatterji, Associate Professor of Strategy, presents: Rising to the Challenge: Bending the Cost Cu...

By: FuquaSchOfBusiness

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Rising to the Challenge: Bending the Cost Curve in Health Care and Education - Video

Clinton sought GOP support for health care

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Washington President Bill Clintons advisers estimated early in his term that passing a health care overhaul would require a delicate balance of Democratic and Republican support, needing at least eight moderate Republicans in the Senate and 15 or more in the House to win approval, according to documents released Friday.

New records released from the Clinton White House show how the presidents team tried to build support for the ill-fated legislation, led by former first lady Hillary Rodham Clinton, in setting up a schedule to achieve passage before the 1994 midterm elections. Democrats were routed in the election after the overhaul failed. They lost control of both the House and Senate.

A strategy memo from 1993 argued the plan would require support from enough conservative Democrats and moderate Republicans without alienating too many liberal Democrats. But the bill never cleared a House committee.

The complexity of our bill undermines our chances for success but without complexity, success is impossible, the unsigned memo said.

The documents were among about 7,500 pages of records released through the Clinton Presidential Library in Little Rock, Ark., on Friday, covering a wide range of topics including the former first ladys work on health care, the administrations promotion of the North American Free Trade Agreement and the 1995 Oklahoma City bombing.

The records are being closely scrutinized as former Secretary of State Hillary Rodham Clinton considers a second presidential campaign in 2016.

The documents show parallels between the Clinton era and the current White House under President Barack Obama. Obamas health care overhaul is expected to be a major deciding point in the 2014 midterm elections and Republicans have assailed the White House for approving the 2010 legislation without a single GOP vote.

Preparing for an August 1994 news conference, Clinton discussed the teetering health care overhaul at length. A lot of them want to know they can keep their own plan if they like it, the president told his aides. That point would be heard again, years later.

At the start of the enrollment period for the Obamacare plan, the government website for new signups was riddled with technical problems. A spate of private policy cancellations forced Obama to recant his pledge that all Americans who liked their health insurance plans could simply keep them.

In 1993, Clintons team aimed to put together a diverse coalition in Congress to overhaul health care. The winning congressional majority for health care reform depends on holding almost all liberal and moderate Democrats, winning a significant number of conservative Democrats and attracting 8-10 moderate Republicans in the Senate (assuming we need 60 votes) and 15-20 in the House, the memo said.

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Clinton sought GOP support for health care

Health care site flagged in Heartbleed review – NBC40.net

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By JULIE PACE AP White House Correspondent

WASHINGTON (AP) - People who have accounts on the enrollment website for President Barack Obama's signature health care law are being told to change their passwords following an administration-wide review of the government's vulnerability to the confounding Heartbleed Internet security flaw.

Senior administration officials said there is no indication that the HealthCare.gov site has been compromised and the action is being taken out of an abundance of caution. The government's Heartbleed review is ongoing, the officials said, and users of other websites may also be told to change their passwords in the coming days, including those with accounts on the popular WhiteHouse.gov petitions page.

The Heartbleed programming flaw has caused major security concerns across the Internet and affected a widely used encryption technology that was designed to protect online accounts. Major Internet services have been working to insulate themselves against the problem and are also recommending that users change their website passwords.

Officials said the administration was prioritizing its analysis of websites with heavy traffic and the most sensitive user information. A message that will be posted on the health care website starting Saturday reads: "While there's no indication that any personal information has ever been at risk, we have taken steps to address Heartbleed issues and reset consumers' passwords out of an abundance of caution."

The health care website became a prime target for critics of the Obamacare law last fall when the opening of the insurance enrollment period revealed widespread flaws in the online system. Critics have also raised concerns about potential security vulnerabilities on a site where users input large amounts of personal data.

The website troubles were largely fixed during the second month of enrollment and sign-ups ultimately surpassed initial expectations. Obama announced this week that about 8 million people had enrolled in the insurance plans.

The full extent of the damage caused by the Heartbleed is unknown. The security hole exists on a vast number of the Internet's Web servers and went undetected for more than two years. Although it's conceivable that the flaw was never discovered by hackers, it's difficult to tell.

The White House has said the federal government was not aware of the Heartbleed vulnerability until it was made public in a private sector cybersecurity report earlier this month. The federal government relies on the encryption technology that is impacted - OpenSSL - to protect the privacy of users of government websites and other online services.

The Homeland Security Department has been leading the review of the government's potential vulnerabilities. The Internal Revenue Service, a widely used website with massive amounts of personal data on Americans, has already said it was not impacted by Heartbleed.

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Health care site flagged in Heartbleed review - NBC40.net


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