Discussion Topics

Senatorial Staffer

 

 

Recommendations to Think About:

 

The ideas below come from discussions with other citizens who have thought about this problem. They are also, in one form or another, being voiced by millions of citizens around the nation.  The Congress must start listening to the people they are supposed to represent.

Start with the recognition that totally deconstructing and replacing the best healthcare system in the world, one which is satisfactory to the majority of the citizens of this country, is silly if not downright criminal.  Build on the founding principles of individual choice and decision-making. Take a realistic and systematic look at the real issues in health care and insurance and address them rather than reinvent everything on the spur of the moment.  The exceptional “In Search of Excellence” books demonstrate the value of repetitive and incremental experimentation.

 

 

1.      Address real problems of health care delivery and insurance coverage rather than artificial and politically opportune demons.  Not all of the asserted 47M uninsured people are truly uninsurable. Many do not want insurance. Many are not citizens and their care should not be paid for by US tax payers.  Focus on those who truly need assistance.  “Let individuals control their health care dollars, and free them to choose a wide variety of health plans and providers.” (Cato Institute) Exclude individuals from free (Govt) coverage/care (except trauma) who cannot prove they pay taxes and are not otherwise exempt; e.g., seniors, impoverished or disabled.

2.      Improve upon the medical insurance and healthcare systems that most Americans are satisfied with today by use of demonstrated successful approaches such as Health Savings Accounts. Consider all options, such as those under consideration now for member owned and run cooperatives, before resorting to Government control of health care in this country. “Move away from a health care system dominated by employer-provided health insurance” or provide tax and/or cost equity for those not in employer plans. (Cato Institute) Use block grants to the states to leverage the lessons of welfare reform from the 1990s and allow states to try approaches most suited to their populations.  Lessons learned from the various states can them be leveraged around the nation.  (West Virginia’s “Mountain Health Choices (MHC), which began operations in spring 2007” can provide much insight.)

3.      Provide for only limited Government plans.  That part and only that part of health care absolutely needing a payer of last resort should involve Government participation in and sponsorship of medical plans. These would include Medicare (for seniors) or Medicaid (for low income families or individuals.) Such plans might also include higher levels of catastrophic insurance that would be mandatory in the sense that Medicare is now if individuals choose not to have their own catastrophic insurance.  This should be the subject of a healthy pros and cons debate. Also included would be special programs such as for severely disabled or disadvantaged and the earned medical benefits of the VA and Tricare programs that supply unique services to our veterans who have sacrificed for this nation.

4.      Medicare and other “Public Options” should be available only to low income families/individuals until the eligibility ages are reached. Having paid taxes into these programs for many years, Social Security and Medicare benefits must not be denied to those who have paid much into the system and contributed much to the nation over all these years.

5.      Government funded medical care should be available only for U.S. citizens, except in rare and dire circumstances.  Require that individuals receiving these benefits get a national I.D. card that legitimately verifies their citizenship status.  We already have a national various national I.D. cards such as passports and Social Security Cards.  The need is to prevent fraud, falsification and other abuses.  Victims of identity theft already know the problems of securing ID cards.

6.      Require that all individuals who desire coverage and cannot obtain a provider on their own, be afforded coverage by either private insurance or cooperative or a Government-provided health plan on some basis such as shared risk pool. The Government should only be an insurer of last resort.

7.      Make all health plans “NATIONAL” rather than “STATE”.  This will increase competition in the insurance industry and lower costs for all.  Means will be necessary to preclude individual state and industry gaming of the system.  That means is legitimately the province of Government regulation.

8.      Require all medical providers, including doctors and hospitals, publish prices for standard services so that people can exercise their right to choose the medical care that best suits their needs as determined by them and their physician(s) and subject to their available resources and insurance.  Complexity will likely arise in addressing unique needs and services that individuals will have as opposed to standard services.

9.      Implement legal reforms so as to reverse the cost and waste of medical resources driven by untoward malpractice suits.  Mr. Obama talks of wasteful medical procedures.  The waste involved in procedures done simply to protect against malpractice suits is enormous.

10.  Eliminate preconditions or increased risk factors as reasons for denial of healthcare coverage.  Increase maximum coverage to $1.5M per person. Coverage for costs above that level could be integrated into Medicare coverage regardless of age. Recognize, however, that a higher risk pool must perforce accommodate higher premiums to cover the increased risk and this runs counter to the objective of reducing costs.

11.  Decrease waste, fraud, and abuse by increased vigilance of healthcare services.  This can be accomplished using automated cross-checking and other techniques.  Punish violators severely.  Doctors filing false claims such as multiple colonoscopies on a single patient in a single day cost the nation billions of dollars per year per state.  The opportunity for savings here is enormous.

12.  Consider raising the Medicare eligibility age, but recognize that since some 25% of Medicare costs are incurred in the last year of life, that this may not save much at all unless the age is made so high that most people will die before they are covered. That would be a terrible decision for the Government to take.

13.  Do not destroy those things about health care that are working (e.g., higher survival rates for cancer and heart disease than seen in the erstwhile models of single payer systems such as Canada or Britain). Have the Congress join the American people in accepting and participating in the ultimate plan that is developed in the same way that the citizens of this nation, whom they are supposed to represent, are expected to participate.

14.  This is a complex problem with enormous import for the future of individual people and for the future of the nation.  It is imperative that deliberation be thoughtful and complete.  A rush to judgment and a vote without knowledge of what is being voted upon would be a travesty and violation of the sacred trust placed on Congress by the Constitution and the people of this nation.

 

Specific Considerations, Questions and Discussion Points

 

 

Medical: VA/TFL

1.   Promise to people who serve and sacrifice

a.  Active, retiree, survivors

b.  TFL started to rectify loss of lifetime mil med care

2.   Earned Coverage, paid in kind with sacrifice – not new benefit

3.   Concurrent impact of Medicare cuts

4.   What is Senator’s position on medical care for vets, survivors and active duty? What will he want health care bills to say on this issue?

a.  Pres now says he supports Tricare and VA

b.  Previously wanted to make vets responsible for own med care for war injuries – MOAA strong protest and reversal

c.  Hard to find either Medicare or Tricare doctors

d.  What is Senator position on increased Tricare fees

                                 i.      Prior DoD sought x5 increase $460 à $2086

                               ii.      Claim of 260% cost rise since 2000 is misleading – fix readiness probs result of years of pay caps, retirement cuts etc

                              iii.      Projection of continued 2001-09 growth for next decade irresponsible.  TFL in place, no 13.5% pay gap to fix

                            iv.      Does he support Sense of Senate that DoD increases are unfair and should not be pursued?

 

Medical: America’s Affordable Heath Choices Act

1.   Senator supports the proposals in Congress, is that true?

2.   What does Senator see as principal need – cover uninsured or completely revamp the medical system

3.   Why view US System as so bad (CFP-8/10)?

a.  FRG breast cancer mortality 88% higher than US

b.  UK Kidney cancer die 50% faster than US

c.  US 27MRI/M vs CA 6/M

d.  8/10 top drugs American made

e.  8/10 top health care innov past 30 yrs in US

f.     Claude Castonguay – the former health minister public health insurance in Canada –the system is in “crisis”:  “We thought we could resolve the system’s problems by rationing services or injecting massive amounts of money into it.... We are proposing to give a greater role to the private sector so that people can exercise choice.”

g.  The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.

                              i.       “system is imploding, we all agree that things are more precarious than perhaps Canadians realize"

4.   Does the Senator support revamping the Hippocratic Oath and rationing health care as does Ezekiel Emanuel? Look at “Ends of Human Life”?

5.   Will the Senator vote to place Congress under the same plan? Why or why not?

6.   Several Congress people exhibited courage in meeting with constituents in public forum.

a.  Will the Senator agree to meet with citizens in a public forum to discuss his and their views on the plans before Congress?  Why or why not? If not, does the Senator believe he is adequately representing his constituents?

7.      Questions on the AAHCA

a.  Govt run Medicare $38 Trillion unfunded liability (WSJ May09).  How project new program of this magnitude will be successful?

                              i.      Has the Senator read the bill? Will he? If not will he recues himself from the vote?

                            ii.      Why will Health Choices Admin be any better than SSA?

                           iii.      P. 42-43 Health Choices Commissioner to Head Health Choices Administration – new bureaucracy.  Levies national standards: audits and corruption will abound– no state controls – everyone like California?  Bankrupt?

                         iv.      What is Senator’s view on role/authority of the The "Health Choices Commissioner" who will decide health benefits available for individuals – cost vs patient care will drive

b.  Underestimated Medicare cost by orders of magnitude.  Why new program different?

                              i.      Medicare launched in 1965, Part A projected to cost $9 billion by 1990, ended up costing $67 billion.

                            ii.      Medicaid’s special hospitals subsidy added in 1987- supposed to cost $100 million annually, but it already cost $11 billion by 1992.

                           iii.      Medicare’s home care benefit added in 1988 - projected to cost $4 billion in 1993, but ended up costing $10 billion.

                         iv.      Medicare and Medicaid today comprise 36 percent of total US healthcare spending. (Amer Thinker 8/16/09)

                          v.      Medicaid funded roughly 50/50 by federal and state governments. …free benefit to the poor, … no tax associated with it. In 2006, Medicaid spending alone totaled $314 billion.

c.  CBO est of AAHCA $1.5 trillion

                              i.      According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period.

                            ii.      CBO estimates that enacting those provisions would raise deficits by $1,042 billion over the 2010-2019 period.

                           iii.      “ …the figures presented here do not represent a complete cost estimate for the coverage provisions of the legislation. They reflect specifications provided by the committee staff rather than detailed analysis of the legislative language. They do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill’s provisions on other federal programs.

d.  People can keep their current plans and doctors? Why believable?

                              i.      “The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.” All plans must be Govt

                            ii.      80% like their current plans (Rasmussen Poll)

                           iii.       “The Lewin Group estimates that 70 percent of the 172 million persons privately covered might be drawn, or pushed, to the government plan….

                         iv.      Sunset(p16 HR 3200) "The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.”  No program but Govt program in 5 years or less

e.  Rationing of medical services

                              i.      EzekielEmanuel: care reserved for non-disabled, not for those irrevocably non-participating (Hastings Rpt 1996). (“Ends of Life”, “Healthcare Guaranteed”

                            ii.      47M new patients on 800,000 current doctors – impact of exodus from ranks exacerbates

                           iii.      Medicare cuts traditional colonoscopy vice virtual for cost savings vice health considerations

                         iv.      3 young children on Medicaid had corneal ulcers. … potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list. (Zane Pollard, MD)

                          v.      Liability insur gen surgeons 175K-200K+ /yr – unaffordable: 25% more tests to avoid legal action

                         vi.      Added mal prac costs deny health insurance coverage to between 2.4 and 4.3 million people, according to the Department of Health and Human Services. (Amer Thinker 8/16/09)

                       vii.      Where is tort reform and fraud, waste and abuse addressed?

f.     Coverage for illegal immigrants

                              i.      Talk about the 46 million uninsured, the U.S. Census Bureau tells us that 15 percent to 22 percent of those 46 million are illegal aliens

                            ii.      Federation for American Immigration Reform's Director of Special Projects Jack Martin -illegal immigrants cost federal and state governments an estimated $10.7 billion a year in healthcare spending -

                           iii.      Rasmussen poll found that a whopping 80 percent of Americans oppose covering illegal aliens.

                         iv.      Congressman Dean Heller - amendment would have prevented millions of illegal aliens from receiving benefits under AAHCA?  What is Senator’s position – why? 

g.  Costs/Intrusions to business and citizens

                              i.      Page 30: Health Care Advisory Committee to recco benefits and plan levels – political interference?

                            ii.      Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.

                           iii.      Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll

                         iv.      Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.

                          v.      Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in state taxes ahead of time.

                         vi.      $2B “Comparative effectiveness Research Tax” on all private and public option insurance companies (disadvantage private companies?) àQuality of life index

                       vii.      Home visitation pgms for new/young families.  Whose values for age appropriate development?  Take children away from parents? (Sec 440/1904 p 838)

                      viii.      Does Sen support these kinds of costs and intrusions – how justified?

h.   Effect on elderly and infirm

                              i.      $500 B cut in Medicare – Ezekiel Emanuel seeks to eliminate it

                            ii.      Slow medical innovation and reduce costs vs quality healthcare for people?

                           iii.       Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans.

8.      Rush to judgment unwise?

a.  Many impacts: SSA, Medicare, Tricare, private insurance

b.  Need to assess and understand  effects and impacts

c.  Take time to do it right

d.  Only 5% of Stimulus is out after 8 months – Not taking time to read the bill was a breach of trust

 

Other Concerns

1.      Deficits

a.  $1.8 trillion and climbing for FY09

b.  $70B in debt financing in one day

c.  $3.5 trillion FY 10 proposed budget

d.  TARP + Deficit + Budget + medical + Cap N Trade

e.  Stimulus bill ~ $780B

                              i.      MIT: Technology funding in stimulus bill package may fail to stimulate and fail to develop long term technology: not helping, confusing issues, poisoning well for the future

f.     Does Sen believe this is sustainable? Why or why not?

2.      Energy

a.  Heritage Foundation: “national energy tax” could cost the average family "nearly $3,000 per household per year."

b.  Heritage Foundation analysis of Waxman-Markey found unemployment will increase by nearly 2 million in 2012, the first year of the program, and reach nearly 2.5 million in 2035. Total GDP loss by 2035 would be $9.4 trillion.

c.  SAIC: cap and trade result in job losses of between 1.2 million and 1.8 million by 2020, and 3 to 4 million by 2030- roughly the amount of jobs Obama claims will be produced by his economic stimulus package.

d.  Slower growth results in a loss of GDP for the American people of nearly $700 billion per year by 2030, which translates into lost household income of $4,000 to $6,750 per year by then."

e.  MITTR: cheapest way to reduce emissions in long term is capture coal CO2 emission and sequester underground.  Stay with coal, 350 yrs supply

                                    i.      New nuclear produces greatest reduction in fossil fuel use

f.     US Fuel Resources – why not use them (IBD 7/15/09)?

                                    i.      Chukchi Sea northwest of Alaska's landmass - U.S. Geological Survey - 1.6 trillion cubic feet of natural gas, or 30% of the world's supply, and 83 billion barrels of oil, 4% of global conventional resources

                                  ii.      ANWR's frozen tundra contains 10.4 billion barrels of recoverable oil - could supply all the oil needs of Massachusetts for 75 years.

g.  Does Sen support Cap N Trade in light of these analyses? If so why, what basis?

3.      Climate Change

a.  Does Sen believe in Anthropogenic  climate change?

                                    i.      India: no firm link, science dubious at best, better to develop economy and combat poverty and starvation

b.  Twelve-month long drop in world temperatures wipes out a century of warming.

                                    i.      China has its coldest winter in 100 years. Baghdad sees its first snow in all recorded history.

                                  ii.      North America has the most snow cover in 50 years, with places like Wisconsin the highest since record-keeping began.

                                 iii.      Record levels of Antarctic sea ice, record cold in Minnesota, Texas, Florida, Mexico, Australia, Iran, Greece, South   Africa, Greenland, Argentina, Chile

c.  A compiled list of all the sources shows the total amount of cooling ranges from 0.65C up to 0.75C -- a value large enough to wipe out most of the warming recorded over the past 100 years. All in one year's time. For all four sources, it's the single fastest temperature change ever recorded, either up or down

                                    i.      Prof Carter, J. Cook U Aus:”no signif increase in global avg temp …since 1998, despite CO2 incr of 5%”

4.      Second Amendment

a.     Sen. voted for CC reciprocity nationwide. Thank him for that

b.     Heller and Supreme Court

c.     9^th vs 7^th circuit courts – incorporation

d.     Where does the Sen stand` on these questions?

e.     Statistics. Crime down with increased scope of personal protection laws

f.        Higher crime where access to guns restricted: Wash DC, NYC,SF, Moscow, MX