RNC Survey (Part 2)

[See my previous post for an explanation of where these survey questions came from.... -JG]

Question #4: Do you believe it is right for the federal government to use age and life expectancy as criteria for determining access to health care?
Yes
No
Undecided
Um, we do that now, by limiting Medicare access to only people over 65. And since access and affordability go hand-in-hand, those people have access. The rest of us are on our own. Is that right?

Question #5: Estimates show that the Democrats’ plan could cost more than $1.7 trillion dollars. Do you believe that America can afford this added debt when the deficit has already reached record levels?
Yes
No
Undecided
First of all, the CBO report just came out that the latest bill is $1 trillion, not $1.7. Second of all, just because something costs $X that doesn't mean that it automatically creates $X of "added debt." (Well, I guess unless you belong to a group who believes that the government should never raise revenue and should borrow money for everything. Hmm, that does sound kind of familiar. I think their group's name starts with an "R.") In fact, the bill is designed with revenue streams to pay for itself. Third of all, I wonder who we have to thank for the deficit having "already reached record levels." I think their group's name also starts with an "R."

Question #6: If you have private insurance, please rate your level of satisfaction with your coverage.
Excellent
Good
Satisfactory
Unsatisfactory
N/A
This is one of those genuinely complex issues. "If you have private insurance," then yes, you may be relatively happy with it. But as I pointed out in an earlier post on this blog, people with Medicare are happy with that, too (maybe happier than you). And if you're one of the people that has to answer "N/A" to this question, well, you're in trouble.

Some reading on health care reform options

Here's a selection of commentary from Robert Reich, Dean Baker, and others from the NYT:

http://roomfordebate.blogs.nytimes.com/2009/07/20/should-the-rich-pay-for-the-uninsured/


And if you haven't seen it, here's Walter Brasch on Prescribing Cake for the Health Care Crisis:

http://www.opednews.com/articles/Prescribing-Cake-to-Cure-t-by-Brasch-090720-273.html

My reading is that the final bill will "pay" for reform in one of two ways: either by taxing excessive health care benefits or by some kind of surtax on superearners (over $500,000 per year or so). The latter option seems to be preferred right now, but it's going to be a long process. Dean Baker's anaylsis--that the projected health care reform deficit amounts to .15% of GDP while the military operations in Iraq/Afghanistan is 1%--puts the issue in proper perspective. But, of course, we still haven't gotten at the problems with long-term Medicare and Medicaid (which are much more difficult than the long-term problems with Social Security). But let's tackle one mountain at a time, shall we?

RNC Survey (Part 1)

I somehow ended up on a mailing list for the Republican National Committee (RNC) and so I get regular email updates from their chairman, Michael Steele. Usually, I don't read the emails, but this week they invited everyone to take a "Future of American Healthcare Survey." This poll is mostly an excuse to get you to click on a link where they can ask you to donate $$. (And to be fair, I've gotten plenty of the same type of surveys from the Democratic Party, and I find them kind of annoying as well.)

However, it bothers me (though I guess it doesn't surprise me) how each question is carefully phrased to deliver a talking point, and most questions don't actually give you the option of answering in a way that would oppose that talking point. I thought it might be a useful exercise to go through the poll and discuss each point. I hope that others will add their comments. Here are the first 3 questions (there were 12 total).

"Future of American Health Care Survey" by the RNC
Question #1: Do you believe that the state of America’s health care system is in crisis?
Yes
No
Undecided

There's some good, recent (June '09) Pew Research Polling data on this general issue here. My sense is that most people recognize there's a problem with the current system that affects them or someone they know. At the same time, people who can afford good coverage are probably afraid of what "change" might mean. Still, even among Republicans, I think everyone senses that healthcare is getting unsustainably expensive--for everybody--and something has to be done about that. I bet they'll get a lot of "Yes"'s on this question.

Question #2. What is your biggest concern regarding health care in America as it is today?
Cost
Quality
Availability
Other: ___
I expect this is an easy question for someone without insurance: they would choose "availability," while those with insurance will probably choose something else. I expect there will be a lot of people choosing "Cost" here. And I don't see anything wrong with that.

Question #3. Do you believe that your health care decisions should be made by you and your doctor, and not government bureaucrats in Washington, D.C.?
Yes
No
Undecided
Dear RNC: I would love for my health care decisions to be made by me and my doctor. And if I had unlimited cash to spend, then decisions would always be made by me & whatever doctor I wanted. But when a third party (of any kind) is paying our bill, they get a say, too. And that third party is either going to be a private insurance company or a public entity. (Or a very rich uncle.) So this question should really ask whether decisions should be made by a private or public entity. I think, at the very least, you would get different answers to your question.

Surprise! Medicare Ranks High in Consumer Satisfaction

CSCC is considering partnering with a local university to co-sponsor a poll of the PA-10 District about healthcare reform and a "public option" for health insurance. The results, regardless of what they show, would be published for all to see and shared with our local lawmakers.

This article from the National Journal Online is definitely worth reading, and may be important in informing the type of poll we want to do. It shows two important things:

• When asked if they support "having the government create a new health insurance plan to compete with private health insurance plans," 62% of Americans supported that. Describing the plan as "government administered" and "similar to Medicare" resulted in even more positive reactions: 67% and 72% support in two other polls.
• Even more encouraging is the data from the Dept. of Health & Human Service's CAHPS survey which gauges consumer satisfaction with their current health insurance. 51-60% of people who have government insurance (Medicare or Medicaid) give their health plan a 9 or 10 rating (out of 10), whereas only 40% of people with private insurance do. What's driving this difference is that Medicare patients perceive they have better access to care, with 70% saying they "always" get access to needed care (vs. only 51% of those with private insurance).

I think the people arguing that "Americans are afraid of government-run health insurance" don't want us to look at this type of information. So take a look. And if you favor a public option, make sure your representatives know it.

PA Healthcare Statistics

(This is taken from HealthReform.gov, with just a little editing by me, but I thought this was an appropriate forum for repeating the information. Hopefully, some of these facts may be useful to people when writing Carney, Casey and Specter to keep the pressure on them for meaningful healthcare reform.

The two items that I put in bold below highlight why having a public option is such a critical component. The issue is that the free market is not offering consumers a wide array of marketplace choices; two companies basically control the insurance market in PA. Instituting a public option that would be available everywhere would break that stranglehold and lead to real choice and competition.)

-JG)

PENNSYLVANIANS CAN’T AFFORD THE STATUS QUO

• Roughly 7.9 million people in Pennsylvania get health insurance on the job[1], where family premiums average $13,646, about the annual earning of a full-time minimum wage job.[2]
• Since 2000 alone, average family premiums have increased by 103 percent in Pennsylvania.[3]
• Household budgets are strained by high costs: 19 percent of middle-income Pennsylvania families spend more than 10 percent of their income on health care.[4]
• High costs block access to care: 10 percent of people in Pennsylvania report not visiting a doctor due to high costs.[5]
• Pennsylvania businesses and families shoulder a hidden health tax of roughly $900 per year on premiums as a direct result of subsidizing the costs of the uninsured.[6]

AFFORDABLE HEALTH COVERAGE IS INCREASINGLY OUT OF REACH IN PENNSYLVANIA

• 10 percent of people in Pennsylvania are uninsured, and 65 percent of them are in families with at least one full-time worker.[7]
• The percent of Pennsylvanians with employer coverage is declining: from 71 to 64 percent between 2000 and 2007.[8]
• Much of the decline is among workers in small businesses. While small businesses make up 71 percent of Pennsylvania businesses[9], only 51 percent of them offered health coverage benefits in 2006 -- down 7 percent since 2000.[10]
• Choice of health insurance is limited in Pennsylvania. Highmark and Independence Blue Cross alone constitute 72 percent of the health insurance market share in Pennsylvania.[11]
• Choice is even more limited for people with pre-existing conditions. In Pennsylvania, premiums can vary based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.

PENNSYLVANIANS NEED HIGHER QUALITY, GREATER VALUE, AND MORE PREVENTATIVE CARE

• The overall quality of care in Pennsylvania is rated as “Average.”[12]
• Preventative measures that could keep Pennsylvanians healthier and out of the hospital are deficient, leading to problems across the age spectrum: 15 percent of children in Pennsylvania are obese[13], 21% of women over the age of 50 in Pennsylvania have not received a mammogram in the past two years, 37% of men over the age of 50 in Pennsylvania have never had a colorectal cancer screening.[14]

The need for reform in Pennsylvania and across the country is clear. Pennsylvania families simply can’t afford the status quo and deserve better.

References:

1. U.S. Census Bureau, Current Population Survey. HIA-4 Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2007, 2007.
2. Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table X.D.Projected 2009 premiums based on Centers for Medicare and Medicaid Services, "National Health Expenditure Data," available at http://www.cms.hhs.gov/nationalhealthexpenddata/.
3. Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2000, Table II.D.1.Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table X.D.Projected 2009 premiums based on Centers for Medicare and Medicaid Services, "National Health Expenditure Data," available at http://www.cms.hhs.gov/nationalhealthexpenddata/.
4. Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006.
5. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.
6. Furnas, B., Harbage, P. (2009). "The Cost Shift from the Uninsured." Center for American Progress.
7. U.S. Census Bureau, Current Population Survey. Annual Social and Economic Supplements, March 2007 and 2008.
8. U.S. Census Bureau, Current Population Survey. HIA-4 Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2007, 2007.
9. Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table II.A.1a.
10. Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2001, 2006, Table II.A.2.
11. Health Care for America Now. (2009). "Premiums Soaring in Consolidated Health Insurance Market." Health Care for America Now.
12. Agency for Health Care Research and Quality. 2007 State Snapshots. Available http://statesnapshots.ahrq.gov/snaps07/index.jsp.
13. Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child and Adolescent Health.
14. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.

Tell Carney "No" to Healthcare Trigger

(This message originated from Moveon.Org, but Joe & I thought it was worth repeating here. I have edited it a tiny bit. -JG)

The Huffington Post is reporting that the Blue Dog Coaltion says it will "only support the public health care option as a fallback measure that would be triggered sometime down the road." If you're following the current healthcare reform debate, you know that a "trigger" means the creation of a public health insurance option would be delayed for years until certain criteria were met. This is a bad idea, and threatens to undermine any real "reform" by ensuring that it "may happen someday, but not now."

President Obama and 73% of Americans think every American should have a choice between keeping their insurance or opting into a quality public health insurance plan. But the concern is that the Blue Dog Coalition and Rep. Carney seem to be siding instead with Republicans and the insurance industry over the voters.

Please call Rep. Carney, and tell him: "We need a public health insurance option immediately. The 'trigger' plan is unacceptable."

The public health insurance option would allow you to keep your current insurance, if you like, or switch to a public health insurance plan. In the absence of "single-payor" reform, it's the key to lowering costs and making sure all of us have guaranteed access to health care. But some Blue Dogs, like Newt Gingrich said the other day, seem to be more concerned that "a public option stacks the deck" against insurance companies than actually being concerned about Americans' healthcare. Don't be fooled: The trigger proposal is an attempt to defeat the public health insurance option. It would delay a public health insurance option for years. But we know there's already a crisis: high costs, millions of uninsured, and a lack of choice for all of us. We cannot afford to wait. Please call right now.

Sources:
1. "Blue Dogs Backsliding on Health Care," Huffington Post, June 8, 2009 http://www.moveon.org/r?r=51485&id=16350-8030410-ioKh3xx&t=4
2. Ibid.
3. "Fixing Health Care Does Not Require a 'Bi-Partisan' Bill—It Does Require a Public Health Insurance Option," Huffington Post, June 8, 2009 http://www.moveon.org/r?r=51486&id=16350-8030410-ioKh3xx&t=5
4. "Blue Dogs Backsliding On Health Care," Huffington Post, June 8, 2009 http://www.moveon.org/r?r=51485&id=16350-8030410-ioKh3xx&t=6

A Unifying Issue: Save PA's Parks

I don't for a moment believe that the state will close R. B. Winter State Park. I do think it's a sign of dysfunctional politics in this state that DCNR put it on a list for possible closure and that the Daily Item put the story on the top of page 1. The park reportedly gets 140,000 visits per year and is a very important recreational destination for the entire region. If any issue could unify citizens across the political spectrum (with the possible exception of a certain branch of libertarians) it's this one.

Given the looming budget problems, we are sure to see more political posturing and testing. The knee-jerk response is to say, "Hey, don't touch my park." A more political savvy response is to ask our politicians why they are forcing DCNR to make such radical proposals that alarm the public. Where are the political leaders to talk to us about what options are available and to plan for the future?

For example, we might start talking about some of these ideas: instituting user fees, changing the way some of the less-used state parks are managed, cutting some park services, figuring out how to raise donations in support of the park system (is there a state park endowment?). We might also reprioritize some new spending to maintain what we have. But the idea that it's a good idea to close an important place for low-cost family entertainment in the midst of recession, a park that is our legacy from past generations--that's just asinine, and everybody knows it.