Expert Jonathan Gruber and health care reform.

It seems that Jonathan Gruber an economist specialising in health care has been helping out and has a contract with Health and Human Services. Gruber has given advice to both Democrats and Republicans but is closely associated with Democrats now. He wrote an op ed for the Washington Post without disclosing the contract he held. As Perelman points out Gruber thinks everything has been tried but of course this excludes a single payer system. This oversight no doubt qualifies him to be a career expert in health economics in the United States. Health Care in the US is really Health Insurance Company care.


This is from Michael Perelman's blog.

Off the Table or Under the Table: Economics vs. Health Care


Apparently, the Obama folks are following the Bush precedent, paying Johathan Gruber, a health care economist, under the table — at least he seems to have done nothing to let it be known — to influence the health care debate

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http://emptywheel.firedoglake.com/2010/01/08/gruber-did-not-disclose-conflict-to-the-wapo/

I posted two brief mentions about Jonathan Gruber and health care, without realizing that he had a $392,600 contract with Health and Human Services that had not yet been made public.

First, last November, I posted the following comment in response to a New York Times article about Health Care, alluding to single payer being “off the table.”:

Jonathan Gruber is a health economist from MIT — an expert, no doubt. David Leonhardt quotes his favorable comment on the Senate health care bill: “I can’t think of a thing to try that they didn’t try.”
Leonhardt, apparently, never bothered to ask him about single payer, which was off the table.

A year before, prior to the contract, I posted:

I’m just looking over the August NBER digest. It covers five NBER articles, of which three may be mildly interesting. The first has the scary title, Public Insurance Expansions Crowd Out Private Health Insurance by Jonathan Gruber and Kosali Simon. We learn that: For every 100 children who are enrolled in public insurance, 60 children lose private insurance.” Thank God that George Bush had the courage to stand up to the radicals and threatened to veto an expansion of child health coverage. Otherwise, they might lose their private insurance.

http://www.nber.org/digest/aug07/w12858.html

Jane Hamsher has a piece showing how effectively the White House and the Democrats use Gruber’s expertise to support their own mangling of health care reform.

http://www.huffingtonpost.com/jane-hamsher/how-the-white-house-used_b_421549.html

Glenn Greenwald has a piece, the second part of which compares this arrangement to what Bush did with Armstrong Williams and Maggie Gallagher and the CNN generals.

http://www.salon.com/news/opinion/glenn_greenwald/2010/01/15/sunstein/index.html

US Home Care Patients Worry over Possible Cuts.

Since the details of how cuts will be made in Medicare remain unclear patients are bound to worry if the passage of the bill will impact negatively on their care in spite of reassurances from the Obama administration. It is hard to believe that large cuts can be made without impacting the care that is given. Because of this many may think of the bills as not real reforms at all but simply changes that may impact negatively on their own personal care. This is from the NYTimes.


December 5, 2009
Home Care Patients Worry Over Possible Cuts
By ROBERT PEAR
CARIBOU, Me. — Dozing in a big lift chair, propped up by pillows in the living room of her modest home here, Bertha G. Milliard greeted the nurse who had come to check her condition and review the medications she takes for chronic pain, heart failure, stroke and dementia.

Ms. Milliard, 94, said those visits had been highly effective in keeping her out of the hospital. But the home care she receives could be altered under legislation passed by the House and pending on the Senate floor as Congress returned to work this week.

As they are across the nation, Medicare patients and nurses in this town in northern Maine are anxiously following the Congressional debate because its outcome could affect Medicare’s popular home health benefit in a big way. The legislation would reduce Medicare spending on home health services, a lifeline for homebound Medicare beneficiaries, which keeps them out of hospitals and nursing homes.

Under the bills, more than 30 million Americans would gain health coverage. The cost would be offset by new taxes and fees and by cutbacks in Medicare payments to health care providers.

The impact of the legislation on Medicare beneficiaries has been a pervasive theme in the first week of Senate debate, which is scheduled to continue through the weekend.

Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?

Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says.

The House bill would slice $55 billion over 10 years from projected Medicare spending on home health services, while the Senate bill would take $43 billion.

Democratic leaders in the House and Senate justify the proposed cuts in nearly identical terms. “These payment reductions will not adversely affect access to care,” but will bring payments in line with costs, the House Ways and Means Committee said. The Senate Finance Committee said the changes would encourage home care workers to be more productive.

The proposed cuts appear to be at odds with other provisions of the giant health care bills. A major goal of those bills is to reduce the readmission of Medicare patients to hospitals. Medicare patients say that is exactly what home care does.

“It helps me be independent,” said Mildred A. Carkin, 77, of Patten, Me., as a visiting nurse changed the dressing on a gaping wound in her right leg, a complication of knee replacement surgery. “It’s cheaper to care for us at home than to stick us in a nursing home or even a hospital.”

Delmer A. Wilcox, 89, of Caribou, lives alone, is losing his vision, uses a walker and has chronic diseases of the lungs, heart and kidneys. He said his condition would deteriorate quickly without the regular visits he received from Visiting Nurses of Aroostook, a unit of Eastern Maine Home Care.

The Aroostook County home care agency, which lost $190,000 on total revenues of $1.9 million in the year that ended Sept. 30, estimates that it would lose an additional $313,000 in the first year of the House bill and $237,000 under the Senate bill.

The prospect of such cuts has alarmed patients and home care workers. “We would have to consider shrinking the area we serve or discontinuing some services,” said Lisa Harvey-McPherson, who supervises the Aroostook agency as president of Eastern Maine Home Care.

“Our staff are scared,” Ms. Harvey-McPherson said, “but it’s our patients who will pay the price if Congress makes the cuts in home care.”

The four agencies under the umbrella of Eastern Maine Home Care cover a huge geographic area. Its nurses aim to see five patients a day, and they drive an average of 25 miles between patients, traversing potato fields and forests of spruce, birch and maple trees — and a few bear, moose and lynx. In winter, they may need a snowmobile, or even cross-country skis, to reach patients in remote areas.

President Obama has said that the savings in Medicare would be achieved by eliminating “waste and inefficiency” and that “nobody is talking about reducing Medicare benefits.” Moreover, he said, health care providers stand to benefit because they would gain tens of millions of new paying customers.

Home care executives question the arithmetic.

“No family or individual should ever go without health care coverage,” Ms. Harvey-McPherson said, as she drove up to a patient’s home here. “But an increase in the number of people with insurance would not necessarily help our agency because we depend so heavily on caring for seniors, with 80 to 90 percent of our home care revenue coming from Medicare.”

The impact on Medicare is a major concern for Maine’s senators, Susan Collins and Olympia J. Snowe, both Republicans being courted by the White House. Ms. Collins, a longtime champion of home care, has indicated she will resist the proposed cuts.

“Deep cuts to home health care would be completely counterproductive to our efforts to control overall health care costs,” Ms. Collins said. “Home care and hospice have consistently proven to be cost-effective and compassionate alternatives to institutional care.”

Private insurance companies often follow Medicare’s lead. So cuts in home-care payments could also jeopardize home care for privately insured patients like Christopher M. Hayes, a 35-year-old police officer in Presque Isle, Me. His left leg was crushed when he was struck by a car while jogging. He is learning to walk again with the help of a physical therapist.

In trying to slow the growth of Medicare, Democrats in Congress assume that health care providers can increase their productivity at the same pace as the overall economy.

But Saundra Scott-Adams, executive vice president of Eastern Maine Home Care, said: “That’s a joke for home health care. We provide one-on-one care.”

Her doubts are shared by Richard S. Foster, chief actuary of the federal Centers for Medicare and Medicaid Services. Mr. Foster said the health care industry was “very labor-intensive” and could probably not match the productivity gains of the overall economy.

While nurses can monitor some patients with electronic telecommunications devices, they said they still needed to provide hands-on care to many.

Phillip H. Moran, a 65-year-old diabetic in Houlton, Me., lost his right leg several years ago. His kidneys are failing. Without regular visits from a home health nurse, Mr. Moran said, he would be in danger of losing his other leg because of complications from diabetes. As a double amputee, he would be more likely to go into a nursing home.

“The nurses’ visits are really important,” Mr. Moran said. “If they are cut, it could cost people their lives.”

Kucinich: Why I voted NO on the healthcare bill.

There is much attention paid to those on the right who are voting against the health care bill that recently passed through the US house but little to those such as Kucinich who also voted against it because it has compromised too much. As Kucinich points out health care provder stocks are happy about the reform bill, a sign that they are not being hurt no matter what happens to the US taxpayer and general public.


http://www.commondreams.org/view/2009/11/08-0
Why I Voted NO

by Dennis Kucinich

We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system.

Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.

But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies - a bailout under a blue cross.

By incurring only a new requirement to cover pre-existing conditions, a weakened public option, and a few other important but limited concessions, the health insurance companies are getting quite a deal. The Center for American Progress' blog, Think Progress, states, 'since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.' Similarly, healthcare stocks rallied when Senator Max Baucus introduced a bill without a public option. Bloomberg reports that Curtis Lane, a prominent health industry investor, predicted a few weeks ago that 'money will start flowing in again' to health insurance stocks after passage of the legislation. Investors.com last month reported that pharmacy benefit managers share prices are hitting all-time highs, with the only industry worry that the Administration would reverse its decision not to negotiate Medicare Part D drug prices, leaving in place a Bush Administration policy.

During the debate, when the interests of insurance companies would have been effectively challenged, that challenge was turned back. The 'robust public option' which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million. An amendment which would have protected the rights of states to pursue single-payer health care was stripped from the bill at the request of the Administration. Looking ahead, we cringe at the prospect of even greater favors for insurance companies.

Recent rises in unemployment indicate a widening separation between the finance economy and the real economy. The finance economy considers the health of Wall Street, rising corporate profits, and banks' hoarding of cash, much of it from taxpayers, as sign of an economic recovery. However in the real economy - in which most Americans live - the recession is not over. Rising unemployment, business failures, bankruptcies and foreclosures are still hammering Main Street.

This health care bill continues the redistribution of wealth to Wall Street at the expense of America's manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.

Notwithstanding the fate of H.R. 3962, America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system, which is good for the American people and good for America's businesses, with of course the notable exceptions being insurance and pharmaceuticals.

Rodberg: Is there any way out for Obama on health care reform?

Rodberg gives an incisive critique of health care reform plan that is now being considered. Actually a combined plan is being forged behind closed doors but no doubt it will contain much of what Rodberg is critiquing. Rodberg recommends a much simpler plan such as extending Medicare to arrive at something that is understanbable to the public and does not make things worse at least! From this site.


Is There Any Way Out for Obama?By Leonard Rodberg
Progressives worry that, if Obama's health reform plan (hereafter called the "Plan") fails to pass, a latter-day right-wing Gingrich movement will take over the Congress in 2010 and the White House in 2012. What I have not heard, but what I am increasingly coming to believe, is that, if the Plan passes in any of its current forms, things will go just as badly for him! Why is that?The general reason is that the Plan is a DOG. It is a terrible, complex plan that will accomplish almost nothing. Relatively few people will benefit from it, while everyone who has to use health care will continue to experience the mess that is, and will continue to be, the American health care system. And, because of the new requirements built into the Plan, health care finance will become even more complex and confusing.More specifically:1. The large majority of people, who receive their insurance from their employer, will see no benefit whatsoever from the Plan. Most will, in fact, find their premiums rising as new requirements imposed by the Plan (e.g., the elimination of lifetime limits) raise the cost of insurance. And, of course, to their undoubted surprise, most of them will not have access to the public option, even if there is one.2. Most provisions of the Plan will not become effective until 2013. This gives four years for Republicans to criticize the Plan, including (1) its use of cuts in Medicare reimbursements and Medicare Advantage premiums as principal sources of funding, (2) its lack of any real or believable mechanism for containing costs, and (3) its bureaucratic complexity.3. The taxes on high-cost insurance plans, the other principal source of funding, will cause those who now have good insurance (called, pejoratively, "Cadillac" plans) to find these plans heavily taxed and their employers given a strong incentive to cut back on their benefits. Instead of reducing underinsurance, this part of the Plan will increase it! (And the rest of the plan does little about underinsurance at all.)4. During the four years of waiting for the Plan to take effect, costs will continue to rise. By the time the Plan takes effect, costs are likely to be at least 25% greater than now. Even more people will find insurance and health care unaffordable. People will ask "What was health reform about?" The disillusionment will be great.5. The complexity of the plan, including (1) federal rules regarding what kinds of employer-based insurance plans are "qualified," (2) new income tax forms that will be needed to implement the individual mandate, and (3) the process of determining income eligibility for everyone, will all lend themselves to criticism and even ridicule.Is there a way out? Not, in my view, as long as Obama sticks with this worthless and unworkable Plan. Only if we were to adopt a much simpler plan that would benefit everyone -- a Medicare for All plan -- would he be seen as actually addressing the problem and really offering a workable solution. Short of that, he, and all of us, are in real trouble.(Leonard Rodberg, Ph.D. is Professor and Chair, Urban Studies Department, Queens College/CUNY.

Ralph Nader on U.S. Health Care Reform.

This is a hard hitting article that brings up issues that are not emphasized in many reports. The fact that Obama had a series of meetings with drug and health insurance bigwigs is a sure sign that any reform will try to ensure that their interests are not hurt. Obama did get some cost concessions which he trumpeted briefly as a big victory but as the article shows these promises were not made free and without the interests getting a great deal in return. But kowtowing to the big boys has not helped him that much. It shows him as weak and ripe to be attacked to give even more. Obama did not even bother to talk to any of the prominent single payer advocates. They do not count, or rather Obama probably figures they can be counted on to support whatever weak compromise he is able to push through legislatively.
The single payer system was never really considered by Obama, the great pragmatist. Now it seems that even though a majority of Americans actually support a public alternative it may be dropped to try to bring a few Republicans and blue dog Democrats on board. However, this could be the last straw for progressives. I even noticed that some progressive economists have the same worry expressed at many town halls that reform will involve cutting back on Medicare services to seniors as some scare ads by right wing opponents of reform have claimed.
It may be that Obama will not only face a right wing campaign against his reforms but also a growing revolt on the left who will block his compromise. Once again health care reform in the U.S. may not happen at all. For those who are well off or have good plans through their workplace this will be just fine. For the rest they can line up at free clinics as they are now in California. A group that formerly brought health care to far off locales with virtually non-existent health care services are now finding that they are needed at home in their own country.


"Now Make Me Do It"
by Ralph Nader
Never much of a fighter against abusive corporate power, Barack Obama is making it increasingly clear that right from his start as President, he wanted health insurance reform that received the approval of the giant drug and health insurance industries.
Earlier this year he started inviting top bosses of these companies for intimate confabs in the White House. Business Week magazine, which proclaimed recently that "The Health Insurers Have Already Won" reported that the CEO of UnitedHealth, Stephen J. Hemsley, met with the President half a dozen times.
These are the vendors. They and their campaign slush funds cannot be ignored in the power struggle over the legislation percolating in the Congress. One public result of these meetings was that the drug industry promised $80 billion in savings over ten years and the health insurance moguls promised $150 billion over the same decade. Mr. Obama trumpeted these declarations without indicating how these savings would be guaranteed, how the drug companies could navigate the antitrust laws and what was given to the health care industry by the White House in return.
We have now learned that one Obama promise was to continue the prohibition on Uncle Sam from bargaining for volume discounts on drugs that you the taxpayer have been paying for in the drug benefit program enacted in 2003.
Unknown is whether the health insurance companies were also promised continuation of Medicare Advantage with its 14% added taxpayer subsidy to induce the elderly to make the move out of public Medicare. Also unknown is whether the Medicare public option that Mr. Obama formerly espoused but since has wavered on has been put on the concession table.
The whole secret process is seedy and demonstrates cruel disregard for the millions of American who, whether in dire need of medical services or not, voted in "change we can believe in."
By stark contrast, President Obama has never invited to the White House the leading consumer-patient champions in this country who favor full Medicare and free choice of physician and hospital-often called "a single payer" system. Open to the corporate barons who have failed decade after decade to deliver what patients need, the White House door is closed to the likes of Dr. Quentin Young-a founder of the Physicians for a National Health Program and an old Chicago friend of Obama's, Dr. Sidney Wolfe, who heads Public Citizen's Health Research Group, Drs. Marcia Angell, Stephanie Woolhandler, and David Himmelstein, who are nationally known and accomplished single payer advocates or Rose Ann DeMoro, executive director of the fast-growing California Nurses Association.
Mr. Obama even tried to exclude any advocate of a single payer system-previously favored by Obama and still favored by a majority of the American people, doctors and nurses-from his roundtable meetings convened to receive the views of different constituencies.
"Make me do it" was the advice of Franklin Delano Roosevelt to reformers when faced with legislation he desired but did not have the votes for in Congress. Mr. Obama is not exerting that plea for people power. Were he to do that, he would be encouraging daily public hearings in the Senate and the House on the bureaucratic waste, greed, overbilling, collusion, and fraud that many in the corporate world have inflicted with their costly, pay or die health care industry.
Such publicized hearings would keep him on the offensive. It would arouse the public and focus energies on the main problem-the corporatization of medicine. This commercialism has left tens of millions of people without health insurance, caused 20,000 fatalities a year, and cost Americans twice or more per capita than have full Medicare systems in western countries, which have better health outcomes than the U.S.
Further indication of Obama's corporate dealings is that he never identified himself with a specific bill with a House and Senate number that he could rally the people around. No wonder people are confused, frustrated and angry. President Obama did not stand for an unambiguous proposal.
He thereby emboldened both the cash and carry Blue dog Democrats to rebel and the Republican yahoos to launch their lies and distortions via Rush Limbaugh and similar trash media.
Obama is about to make his biggest mistake to date by favoring the bipartisan deal his assistants are working out with Blue Dog Senator Max Baucus and his Republican counterparts on the Senate Finance Committee. This proposal has no public option, no consumer protections or restraints on the mayhem and skyrocketing charges of the so-called health care industry.
Already the less corporate-indentured bills being reported from the House Committee by Rep. Henry Waxman (D-CA) and his allies are getting short-shrift from a White House that clearly views the forthcoming Baucus-Grassley "compromise" as the "more practical" go-to legislation.
There is reliable word that the AFL-CIO will endorse whatever Obama approves, with the exceptions of the California Nurses Association and the Sheet Metal Workers' union. The latter, through their president, Michael J. Sullivan, announced in late July that it was suspending all future campaign contributions to any candidate for Congress or the Presidency.
Already over sixty progressive members of the House, headed by Congresswoman Lynn Woolsey (D-CA) have declared opposition to these unacceptable compromises moving forward in both the House and the Senate.
So is gridlock around the corner? Will there be a health insurance reform of any stripe signed into law this year? It depends on the alliances that settle for the lowest corporate denominators being blocked by the unyielding principled stands of the progressives who want something that puts patients above the failed profiteering vendors.
The guess here is that Obama will sign anything which squirms through a cowardly Congress that cannot give to the American people in 2009 the health care system Congress stopped President Harry Truman from establishing in 1950.
It is up to the people of our country to "make him do it" whether this year or next. A mere one million immediate calls to members of Congress by one million assertive citizens will start sobering up these legislators who think they can get away with another sale of our public trust.
The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org. The rest is up to you, the majority, who want to put the people first.
Ralph Nader is a consumer advocate, lawyer, and author.