If you take an essential service such as health care and you keep increasing the price of services and health insurance premiums making them unaffordable overtime – what are you left with? You are left with a population of haves and have nots and anarchy (a situation in which there is a total lack of organization or control).

We not only need health care financing and delivery reform but the country desperately needs price controls over medical services/products and health insurance premiums.

Robert Wolf Board Member of the policycenter.org puts this problem is its proper context:

“Yesterday, on the front page of the New York Times, was an article about how drug companies are now upping drug prices aprox 9% this year before there is health care legislation passed. Essentially, the drug companies are making money while it can because it knows there may be change coming down the road.

However, given the past track record of Congress, there is little likely to be done to curb this practice or force price limits in the future. Congress seems to be fully in the corner of the Drug manufacturers and Insurers; simply because they can afford the lobbyists to ensure their interests are placed before the interests of the average citizen of the United States.

In my last article I used the term “GREED” to describe what goes on in the US healthcare system, especially with insurers and drug manufacturers. With this move, raising prices while the consumer price index is actually shrinking by 1.3% a year, is all that is necessary to prove simple unadulterated greed. It was openly discussed in the NY Times article that the reason the drug companies are doing this is because they may not be able to do it in the future. AND “WE THE PEOPLE” ACCEPT THIS?

I am a believer in the free market. However, there are times when the free market breaks down. That I feel is a good trigger for government intervention: when an industry, company or group that delivers a fundamentally necessary service for the society does so but engages in exploitation of that position. Or when consumers, even while attempting to exercise their right to choose, cannot because of patents, monopolies or other impediments to an open competitive market.

At this time I feel that drug companies and manufacturers have crossed that line. It is time for the government to come in and tell these companies how to behave and set price limits. Left to their own devices they do not act appropriately, and that should trigger the government into action.

I won’t be holding my breath on this. If congress actually does act in the best interests of “We the people”, I will be very pleasantly surprised.”

http://www.nytimes.com/2009/11/16/business/16drugprices.html?_r=1&th&emc=th

Drug Makers Raise Prices in Face of Health Care Reform

By DUFF WILSON
Published: November 15, 2009

Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index , which has fallen by 1.3 percent in the last year.

Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years.

“When we have major legislation anticipated, we see a run-up in price increases,” says Stephen W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota . He has analyzed drug pricing for AARP , the advocacy group for seniors that supports the House health care legislation that the drug industry opposes.

A Harvard health economist, Joseph P. Newhouse, said he found a similar pattern of unusual price increases after Congress added drug benefits to Medicare a few years ago, giving tens of millions of older Americans federally subsidized drug insurance. Just as the program was taking effect in 2006, the drug industry raised prices by the widest margin in a half-dozen years.

“They try to maximize their profits,” Mr. Newhouse said.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

“Price adjustments for our products have no connection to health care reform ,” said Ron Rogers, a spokesman for Merck , which raised its prices about 8.9 percent in the last year, according to a stock analyst’s report.

This year’s increases mean the average annual cost for a brand-name prescription drug that is taken daily would be more than $2,000 — $200 higher than last year, Professor Schondelmeyer said.

And this means that the cost of many popular drugs has risen even faster. Merck, for example, now sells daily 10-milligram pills of Singulair, the blockbuster asthma drug, at a wholesale price of $1,330 a year — $147 more than last year. Singulair is now selling at retail, on drugstore.com , for nearly $1,478 a year.

The drug companies “can charge what they want — it’s not fair,” Eric White, the 42-year-old owner of a small jewelry store in Queens, said as he left a pharmacy recently.

Despite having drug insurance, Mr. White says he now pays $110 a month out of pocket for two brand-name allergy medicines, even as he has cut prices in his jewelry store by at least 40 percent to keep customers coming through the door.

He shook his head. “What can I do?” he said. “I need my medicines.”

The drug industry has actively opposed some of the cost-cutting provisions in the House legislation, which passed Nov. 7 and aims to cut drug spending by about $14 billion a year over a decade.

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year — $80 billion over 10 years — from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

“It makes it much easier for the drug companies to pony up the $80 billion because they’ll be making more money,” said Steven D. Findlay, senior health care analyst with the advocacy group Consumers Union .

Name-brand prices have risen even as prices of widely used generic drugs have fallen by about 9 percent in the last year, Professor Schondelmeyer said. But name brands account for 78 percent of total prescription drug spending in this country. And as long as a name-brand drug still has patent protection it faces no price competition from generics.

Ken Johnson, senior vice president of the industry association — the Pharmaceutical Research and Manufacturers of America — criticized the analysis Professor Schondelmeyer had conducted for AARP, saying it was politically motivated.

“In AARP’s skewed view of the world, medicines are always looked at as a cost and never seen as a savings — even though medicines often reduce unnecessary hospitalization, help avoid costly medical procedures and increase productivity through better prevention and management of chronic diseases,” he said.

But Professor Schondelmeyer’s analysis — which found prices for the name-brand drugs most widely used by the Medicare population rising by 9.3 percent in the last year, the fastest rate since 1992 — is in line with the findings of a leading Wall Street analyst, too. The report was released on Monday.

Catherine J. Arnold, a drug industry analyst at Credit Suisse , said her latest study of the nation’s eight biggest pharmaceutical companies showed markedly similar results: list prices rising an average of 8.7 percent in the 12 months ending Sept. 30 — the highest rate of growth since at least 2004.

As does Professor Schondelmeyer, Ms. Arnold based her price calculations on reported wholesale prices and a formula that puts more emphasis on each company’s best-selling drugs.

Ms. Arnold said the prospect of cost containment under health care reform, as well as the tougher business environment, entered into the decisions of manufacturers to raise prices this year.

The industry stands to gain about 30 million customers with drug insurance from the legislation pending in Congress. But the industry also faces the prospect of tougher negotiations from both public and private buyers as the government tries to squeeze savings out of the health system.

“If you’re going to take price increases,” Ms. Arnold said, “here and now might be the place to do that, because the next year and the year after that might be tough.”

Mr. Johnson did not dispute the Credit Suisse study or deny Ms. Arnold’s finding that American drug makers have raised prices at the fastest rate in five years.

He said both studies were incomplete by failing to include rebates that drug makers give distributors. But Ms. Arnold, Professor Schondelmeyer and a 2007 Congressional study of Medicare said the rebates often accrue to the middlemen, not consumers, and higher manufacturer prices lead to higher retail prices.

And the drug industry’s own major consulting firm, IMS Health , has also reported a significant run-up in prices. Back in April, IMS predicted that United States drug sales might actually decline this year.

Billy Tauzin , president of the industry’s trade association, highlighted the gloomy prediction in a June 1 letter to President Obama shortly before striking the deal to cut drug costs by $80 billion. In negotiating the deal, the drug makers argued that they could not afford to give up more than that.

But in October, IMS made an unusual change in the middle of its forecasting cycle, saying it now believed United States sales would grow at least 4.5 percent in 2009 — or $21 billion more than expected six months earlier.

A major reason, IMS said, was higher-than-expected price increases for drugs in the United States.

Here are a few words from a www.policycenter.org Board of Director on U. S. health care financing reform. This brief should be read by everyone in the country.

“Just my two cents”

— Robert Wolf

On Tuesday night this week, I watched a Frontline special on comparing healthcare in the US with a number of other countries. The countries our system was being compared against were Great Brittan, Japan, Germany, Taiwan and Switzerland.

The major difference as I see it between the US system and these other countries are:

1) In most other countries the governments have the wherewithal to tell the insurance companies and doctors what they can charge. The government defines the boundaries as to what can be charged for everything from a doctors office visit to an MRI to prescription drugs.
- In comparison, the US government does not tell Doctors, Insurers, or Drug Companies how much they can charge for goods and services. In actuality, Insurers and Drug Companies write legislation for the government on these sensitive matters. It is as if the Government has gone AWOL on serving the people and capitulated to the Insurers and Drug Companies and have forgotten about we the people and what our goals and needs are.

2) All the countries that were researched in this frontline special have decided that healthcare should not be a pathway to bankruptcy. All these countries ensure that NO CITIZEN WILL GO BROKE BECAUSE OF HEALTH CARE. Theses governments have taken the side of the individual citizen interests over the corporations interests. It is discussed as immoral, unethical and contrary to the goals of the society to allow such a practice of loosing everything because of a health issue.
- In contrast in the US, it seems that it is perfectly appropriate to lose everything because of a health issue. Not only that, but those who are against health care reform feel it is a part of our capitalist system to allow people to loose everything when it comes to a major health care issue. Sort of a “too bad you lucked out”. Is this a hallmark of a “Great Society”? Is it in the best interests of a country to allow its citizens to loose everything over bad luck when it comes to a health issue?

3) Insurers are given limits as to how much they can spend on overhead. This ensures that the money that is given to healthcare insures outside the US is actually used for healthcare.
- In comparison in the US, on average health care insurers spend aprox only 60 cents out of every dollar taken in on healthcare. The rest goes to bonuses for executives, advertising and non healthcare related expenditures. Some of these non-healthcare related expenditures are groups of people trying to find out if some one else can take a portion of responsibility of the claim made. There is a huge bureaucracy based on deferring the cost to someone else. Because of the way other countries have their health care structured this is not an issue and there fore no overhead is spent on it.

The overwhelming problem in the US system is GREED. Too many people are making too much money to make any kind of substantial change. We also need to decide if Healthcare is a right or a privilege? If it is a privilege, then we have the right system: Only those with money are entitled to care. However if we define healthcare as a right (as we have done with Education) then we must find a way to pay for it.
At the very least the US should make it so that no citizen goes bankrupt because of a healthcare issue. The US should also find a way, as the rest of the world has, to stand up to corporations and insurers and tell them what is acceptable in the US. This however, is a shift in paradigm that some citizens will never endorse, and because of this, we will never have meaningful healthcare reform in this country until some major collapse occurs similar to what happened in the banking industry.

Essentially the free market is failing the citizens of the United State when it comes to healthcare. Because of this, it is time for a change.

– Robert Wolf

The Health Care Financing Reform legislation that passed the US House of Representatives over the weekend is not what many of us would have preferred but it is a positive step toward relieving the pain and suffering of millions of our fellow Americans.

The question that baffles me is “What is wrong with the Republican Party?” How can the party of Lincoln try to STOP legislation designed to reduce the suffering and misery of the Uninsured and Underinsured in this country? You know, you have to ask yourself: ‘What is wrong with these people?’ I don’t want to hear that this Bill is “too costly and would end up burdening the nation for decades to come” from the same Republicans that helped President Bush bankrupt the country.

On to the Senate — it is time to Pass Health Care Financing Reform.

http://www.nytimes.com/2009/11/08/health/policy/08health.html?_r=1&th&emc=th

Sweeping Health Care Plan Passes House

By CARL HULSE and ROBERT PEAR
Published: November 7, 2009

WASHINGTON — Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.

After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220 to 215 to approve a plan that would cost $1.1 trillion over 10 years. Democrats said the legislation would provide overdue relief to Americans struggling to buy or hold on to health insurance .

“This is our moment to revolutionize health care in this country,” said Representative George Miller , Democrat of California and one of the chief architects of the bill.

Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion -rights advocates in their ranks.

Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.

Republicans condemned the vote and said they would oppose the measure as it proceeds on its legislative route. “This government takeover has got a long way to go before it gets to the president’s desk, and I’ll continue to fight it tooth and nail at every turn,” said Representative Kevin Brady, Republican of Texas. “Health care is too important to get it wrong.”

On the House floor, Democrats exchanged high-fives and cheered wildly — and Republicans sat quietly — when the tally display showed the 218th and decisive vote, after the leadership spent countless hours in recent days wringing commitments out of House members.

“We did what we promised the American people we would do,” said Representative Steny H. Hoyer , Democrat of Maryland and the majority leader, who also warned, “Much work remains.”

The successful vote came on a day when Mr. Obama traveled to Capitol Hill to make a personal appeal for lawmakers to “answer the call of history” and support the bill.

Only one Republican, Representative Anh Cao of Louisiana, voted for the bill , and 39 Democrats opposed it. The House also defeated the Republicans’ more modest plan, whose authors said it was a more common-sense and fiscally responsible approach.

The Democrats who balked at the measure represent mainly conservative swing districts, signaling that those who could be vulnerable in next year’s midterm elections viewed voting for the measure as politically risky.

“Today’s may be a tough vote, but it was in 1935 when we passed Social Security ,” Representative John Dingell, Democrat of Michigan and the dean of the House, said as the debate drew to a close late Saturday.

Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”

After the vote, Mr. Obama issued a statement praising the House and calling on the Senate to follow suit. “I am absolutely confident it will,” he said, “and I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Senator Harry Reid of Nevada, the majority leader, said he would bring a bill to the floor as soon as possible.

The vote came on the third anniversary of the 2006 Democratic takeover of the House, and the passage moves the bill well beyond the health care overhaul attempted by President Bill Clinton in 1993.

Lawmakers credited Mr. Obama with converting a final few holdouts during his appearance at a closed-door meeting with Democrats just hours before the vote. Democratic officials said that Mr. Obama’s conversation Saturday with Representative Michael H. Michaud, Democrat of Maine, was crucial in winning one final vote.

Many Democrats also credited Speaker Nancy Pelosi for pulling off a victory that proved tougher than many had predicted. “She really threaded the needle on this one,” said Representative Jim McGovern, Democrat of Massachusetts.

A critical turning point was the decision by Ms. Pelosi late Friday night to allow anti-abortion Democrats to try to tighten restrictions on coverage for the procedure under any insurance plan that receives federal money. That concession eased a threat by some Democrats to abandon the bill, but also left Democrats who support abortion rights facing a choice between backing a provision they bitterly opposed or scuttling the bill. The new abortion controls were added to the measure on a vote of 240 to 194 .

Mr. Obama made his rare weekend appearance on Capitol Hill as part of an all-out effort to rally Democrats to support the biggest health care legislation since the creation of Medicare for the elderly four decades ago.

During the private meeting with Democrats in the Cannon Caucus Room, the president acknowledged the political difficulty of supporting major legislation in the face of unanimous Republican opposition and tough criticism from conservatives.

But, those present said, he urged them on, saying, “When I sign this in the Rose Garden, each and every one of you will be able to look back and say, ‘This was my finest moment in politics.’ ”

Republicans said the measure was too costly and would end up burdening the nation for decades to come. Some Democrats expressed the same view in explaining their opposition.

*

“This bill is a wrecking ball to the entire economy,” said Representative Jack Kingston, Republican of Georgia. “We need targeted specific reforms to help people who have fallen through the health care cracks.”

But Democrats said that Republicans were intent on protecting the status quo in health care and that the new Democratic approach would vastly improve the ability of Americans to gain affordable health insurance.

“Now is the chance to fix our health care system and improve the lives of millions of Americans,” Representative Louise M. Slaughter , Democrat of New York and chairwoman of the Rules Committee, said as she opened the daylong proceedings.

The wall of Republican opposition gave Democrats little room to maneuver, and they worked to corral as many party members as they could. But the preliminary approval to clear the way for the debate came on a 242-to-192 vote, suggesting that Democrats had a victory within reach.

The House vote was a significant step in the long-sought Democratic goal of enacting broad changes in the way health care is delivered in the nation. But the Senate has yet to bring its own emerging measure to the floor for debate, and the two chambers will still need to negotiate and approve a final bill in the weeks ahead.

The struggle House Democrats had in lining up the minimum number of votes for the measure was a clear indication of how difficult it would be to get final legislation to the president’s desk.

The House legislation, running almost 2,000 pages , would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression.

Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan . It would also set up a national insurance exchange where people could shop for coverage.

Republicans forced a House vote on their much more modest plan that would expand coverage to just three million of the uninsured. But its authors said it would bring down the costs of private insurance premiums, which they argued was the chief concern of most Americans.

“More taxes, more spending and more government is not the plan for reform the people support,” said Representative Virginia Foxx, Republican of North Carolina and one of the conservatives who relentlessly criticized the Democrats’ plan.

But Democrats said their proposal was long overdue, would relieve the mounting anxiety of Americans struggling to get and retain health insurance, and would ultimately improve the economy by bringing spiraling health care costs under control.

“Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans,” said Representative Peter A. DeFazio of Oregon.

Every Health Insurance/HMO executive, employee and Board of Director Member should be forced to view these three video segments in order for them to understand the type of misery, depression and suffering the Uninsured and lack of adequate health insurance causes common Americans every day. America’s Health Insurance Plans (AHIPs) President and CEO Karen Ignagni should sit in the front row.

http://www.msnbc.msn.com/id/21134540/vp=33487061&#33487061

http://www.msnbc.msn.com/id/21134540/vp=33487061&#33441674

http://www.msnbc.msn.com/id/21134540/vp=33487061&#33422099

A Health Care Reform Home for a Public Option within the Medicare Program. An approach that would provide Universal coverage for the Uninsured and all other individuals/groups that cannot get coverage in the private health insurance market. A brilliant idea.

It would make financial sense to have the Uninsured enrolled in a medical insurance program like Medicare Part E that has proven to have low – 5-7% administrative costs. However, there is a fear that Medicare Part E could
“‘re-brand’ their (Democrats) government takeover of healthcare”.

Why don’t we Stop Fearing Progress and scaring people? I prefer to believe what President Franklin Roosevelt said during the Great Depression “We have nothing to Fear but Fear itself”.

http://thehill.com/homenews/house/64029-medicare-for-everyone

House Dems want Medicare for everyone
By Mike Soraghan – 10/20/09 08:27 PM ET
Say hello to “Medicare Part E” — as in, “Medicare for Everyone.”

House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option.

The strategy could benefit Democrats struggling to bridge the gap between liberals in their party, who want the public option, and centrists, who are worried it would drive private insurers out of business.

While much of the public is foggy on what a public option actually is, people understand Medicare. It also would place the new public option within the rubric of a familiar system rather than something new and unknown.

The idea has bubbled up among House Democrats and leaders in the past week, most prominently in a caucus meeting last Thursday.

Rep. Mike Ross (D-Ark.) spoke out last week in favor of re-branding the public option as Medicare, startling many because he has loudly proclaimed his opposition to a public option.

Rep. Jim Oberstar (D-Minn.), the veteran chairman of the House Transportation Committee, also voiced his support, as did House Majority Whip James Clyburn (D-S.C.).

John Schadl, a spokesman for Oberstar, explained the congressman likes the idea because people are familiar with Medicare.

“One of his concerns is that people don’t know what a public option is. Medicare is a public option,” Schadl said. He said Oberstar started talking about “Medicare for Everyone” during August town hall meetings.

A notable incident last summer demonstrated the popularity of Medicare and the confusion over the public option when a man famously told Rep. Bob Inglis (R-S.C.), “Keep your government hands off my Medicare.”

Speaker Nancy Pelosi (D-Calif.) planned to unveil a proposal to her caucus Tuesday night that would include the public option favored by liberals in the healthcare bill Democrats want to bring to the floor,  according to two House sources.

The plan, called the “robust” option or “Medicare Plus 5” in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November

Some Democrats say there’s no need to rename a legislative concept that’s gained steadily in support since being lambasted as a “government takeover” in August.  A Washington Post-ABC poll published Tuesday showed 57 percent of the public supports the idea — up five points since August — while 40 percent opposes it.

“It keeps polling better and better as a public health insurance option,” said a senior Democratic aide. “I don’t think it’s changing.” Polling experts, however, have documented that many people don’t know what a public option is, and that small changes in language can cause poll results to vary widely. An August poll by Penn, Schoen and Berland Associates showed that only 37 percent of those polled correctly identified the public option from a list of three choices.

“Before this year, few people had ever heard of the term ‘public option,’ ” Ross said last week.

It’s not clear exactly how the new Medicare idea would work. Some want to expand Medicare itself to uninsured people under 65. Others want to simply rename what is now called the public health insurance option.

Oberstar, who supports a “single-payer” system that would be completely run by the government, doesn’t want a Medicare public option to be based on existing Medicare rates because he believe Minnesota is one of the states shortchanged by Medicare reimbursements.

Republicans mocked the idea of re-branding a plan they still consider a government takeover of healthcare.

“It didn’t matter what they called Crystal Pepsi; no one wanted to drink it,” said Michael Steel, spokesman for House Minority Leader John Boehner (R-Ohio). “No matter how the Democrats ‘re-brand’ their government takeover of healthcare, the American people oppose it.”

Republicans also note that Medicare is already $37 trillion in the hole and is projected to go bankrupt by 2018. “Has anyone noticed that Medicare is completely broke?” said Andrew Biggs, a scholar at the American Enterprise Institute who worked in the White House on President George W. Bush’s plan to overhaul Social Security.

The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi  has flatly stated that the House bill will include a public option.

In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn’t advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.

In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.

People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal “Medicare Part E.”

The idea of expanding Medicare while still keeping private insurance was proposed in 2007 by Johns Hopkins University Professors Gerard Anderson and Hugh Waters. They presented a paper at a forum of the Brookings Institution advocating “Medicare Part E(veryone),” and said their proposal would expand Medicare to ensure universal coverage while allowing people to stay on their employers’ health plans.

Health insurers over the past 60 years have been exempt from Federal Anti-Trust regulations thereby allowing them to collude and price-fix
their way to incredible profits at the cost of the patient, provider, consumer and taxpayer.

You know, you have to scratch your head and say to yourself “what was the Congress and Administration thinking when they provided an exemption of this type to the health insurance industry?” Oh that’s right, they weren’t thinking at all. It is time for the Health Insurance/HMO industry to join the 21st Century.

The Health Insurer Anti-Trust Exemption contributes to a dysfunctional and anti-competitive marketplace, artificially inflates premiums and rewards inefficiency and administrative waste. And perhaps the most important reason to remove this exemption – is that the Anti-Trust Exemption encourages health care cost inflation and is the diametrical opposite of cost containment.

REPEAL THE HEALTH INSURER ANTI-TRUST EXEMPTION — NOW.

http://healthplans.hcpro.com/content.cfm?content_id=240662&topic=WS_HLM2_HEP

Obama Takes Aims at Insurance Industry’s Antitrust Exemption

Janice Simmons, for HealthLeaders Media, October 19, 2009

In his weekly address on Saturday, President Obama aimed sharp criticism at the health insurance industry over recent actions related to health reform—and implied he may push for legislation now pending on Capitol Hill to dissolve the industry’s 60-year-old antitrust exemption.

In his remarks, Obama thanked a variety of groups for support of the Senate Finance Committee’s bill, the last healthcare reform measure pending approval by a congressional panel. He specifically cited the work of a “broad and growing coalition of doctors and nurses, workers and businesses, hospitals and even drug companies—folks who represent different parties and perspectives.”

However, “there are still those who would try to kill reform at any cost,” said the president, referring to efforts by the health insurance industry to challenge healthcare reform with a study that said insurance costs would rapidly increase under the Finance Committee plan.

Obama even offered another study—one from the Business Roundtable —as counter to the findings from the health insurance industry. Their report said that annual healthcare costs for employers will rise 166% over the next decade, from $10,743 per employee today to $28,530 by 2019.

“This is the unsustainable path we’re on, and it’s the path the insurers want to keep us on. In fact, the insurance industry is rolling out the big guns and breaking open their massive war chest to marshal their forces for one last fight to save the status quo,” said President Obama, referring to recent studies and advertisement campaigns by the insurance industry in several states challenging changes to the Medicare Advantage program.

Obama went on to say that the insurance industry “is making this last ditch effort to stop reform” as they’re “earning these profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing.”

Last week, the Senate Judiciary Committee held hearings in which Senate Majority Leader Harry Reid (D-NV) testified to repeal health insurance and medical malpractice insurance companies’ antitrust exemption, which is part of the McCarran Ferguson Act.

When asked about that statement on the ABC show “This Week” on Sunday, David Axelrod, a senior adviser to the president, said that is would be it is Congress’s call what to do about the exemption.

“Congress is . . . reviewing that. He (President Obama) said it’s appropriate that they review that . . . We’ll see what Congress does,” Axelrod said. “One of the problems we have is we have a healthcare system now that functions very well for the insurance industry, but not well for the customers.”

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

Normally, I agree with Paul Krugman’s Op-Ed Columns but I have a real disagreement with his most recent piece — “A Hatchet Job So Bad It’s Good”. Mr. Krugman believes that the Health Insurance/HMOs Industry has suddenly gone Dumb & Stupid over health care financing reform.

I do not believe that his assessment is correct. For the most powerful industry in the United States after decades of control over the Political system to suddenly go Stupid is a ridiculous and naïve assumption.

If you really want to find out what the Health Insurance/HMO Industry are up to, pass health care reform legislation that limits the amount of profit that these groups can make from any health insurance product, let’s say “15%”. You will then see the type of control that the Health Insurance/HMOs Industry has over our political system if a cost containment feature like this is introduced.

http://www.nytimes.com/2009/10/16/opinion/16krugman.html?_r=1&th&emc=th

Op-Ed Columnist
A Hatchet Job So Bad It’s Good

By PAUL KRUGMAN
Published: October 15, 2009

In the past, the insurance industry’s power has been a major barrier to health-care reform. Most notably, the industry paid for the infamous “Harry and Louise” ads that helped kill the Clinton plan. But times have changed.

Last weekend, the lobbying organization America’s Health Insurance Plans, or AHIP, released a report attacking the reform plan just passed by the Senate Finance Committee. Some news organizations gave the report prominent, uncritical coverage. But health-care experts quickly, and correctly, dismissed it as a hatchet job. And the end result of AHIP’s blunder may be a better bill than we would otherwise have had.

For 2009, it turns out, is not 1993. Once again, Republicans have tried to kill reform with smears and scare stories. But all they seem to have killed with their cries of “socialism” and warnings about “death panels” is their own credibility. Some form of health-care reform is highly likely to pass.

So it’s a different game than it was 16 years ago. And it’s a game that the insurance industry apparently doesn’t know how to play.

The motivation for the AHIP report seems to have been the decision by the Finance Committee to weaken the penalties for individuals who don’t sign up for insurance, even as it retains regulations requiring that insurers offer the same policies to everyone, regardless of medical history. The industry worries that some people will game the system, remaining uninsured as long as they’re healthy, then signing up when they get sick.

This is, believe it or not, a valid concern. Many health-care economists believe that a strong individual mandate, requiring that almost everyone sign up, will be needed to make health reform work. And the Finance Committee probably did weaken the mandate too much.

But AHIP, apparently unable to help itself, didn’t stop there. Instead, the report threw every anti-reform argument the authors could think of at the wall, hoping that something would stick.

One argument was particularly striking: the claim that attempts to limit Medicare spending would lead to higher insurance premiums. In fact, the report assumes that 100 percent of any reduction in Medicare payments to hospitals will translate into higher costs for patients with private insurance.

The only way to justify this claim is to assume that all hospitals are purely charitable institutions, charging as little as they possibly can. Now, some hospitals may fit this description. But all of them?

What’s more, this argument stands the usual logic of markets on its head: if you believe AHIP’s story, competition raises prices instead of reducing them. And it doesn’t matter where the competition comes from: anyone who gets a better deal, whether it’s Medicare or a private insurer, makes life worse for everyone else. I don’t believe that, and neither should you.

Of course, the report doesn’t mention these implications. The only bad competition it talks about is competition from the government. Specifically, it claims that a public insurance option would be a bad thing — not because it would be inefficient, but because the public plan would negotiate better prices. Isn’t that an argument for, not against, such a plan?

Which brings us to the ways in which AHIP may have done health reform a favor.

As I said, the individual mandate probably should be stronger than it is in the Finance Committee’s bill. But there’s a reason the mandate was weakened: fear that too many people would balk at the cost of insurance, even with the subsidies provided to lower-income individuals and families. So why not address that cost?

Aside from making the subsidies larger, which they should be, there are at least two changes to the legislation that would help limit costs. First, health exchanges — special, regulated markets in which individuals and small businesses can buy insurance — can be made stronger, in effect giving small buyers a better bargaining position. Second, the public option — missing from the Finance Committee’s bill — can be brought back in, giving private insurers some real competition.

The insurance industry won’t like these changes, but that matters less than it did a week ago.

There’s also another point, which House Speaker Nancy Pelosi has stressed. Part of the opposition to a strong individual mandate comes from the sense that Americans will be forced to buy policies from a greedy insurance industry. Giving people, literally, another option — the right to buy into a public plan instead — would defuse that opposition.

Even with stronger exchanges and a public option, health reform would probably increase, not reduce, insurance industry profits. But the insurers wanted it all. The good news is that by overreaching, they may have ensured that they won’t get it.

I cannot believe that the politicians, especially the Democrats, in Washington, DC and the Obama Administration are even considering Health Care Financing Reform Without a Public Option.

First President Obama abandoned the Single Payer Concept as to radical concept and not politically feasible at the present time. Now he wavers on doing what is right and just for the 47 million uninsured and the rest of the 253 million Americans by possibly not including a Public Health Insurance Option in a reform initiative.

THIS TRIGGER GARBAGE IS A REAL PLOY TO KILL FINANCING REFORM AND THE PEOPLE IN MAINE SHOULD VOTE OLYMPIA SNOWE OUT OF OFFICE THE NEXT TIME BECAUSE SHE IS OBVIOUSLY A HEALTH INSURANCE/HMO OPERATIVE.

A trigger will never work in health care financing reform — period. Why? Because it will never be pulled when the public’s focus, enthusiasm and interest in reform has subsided. The politicians and insurers know and understand this fact.

I predict that if the Obama Administration does not have a PUBLIC OPTION in the legislation on health care financing reform, President Obama will never be elected for a SECOND TERM.

http://www.nytimes.com/2009/10/15/health/policy/15public.html?_r=1&th&emc=th

Public Option Is Next Big Hurdle in Health Debate

By SHERYL GAY STOLBERG
Published: October 14, 2009

WASHINGTON — As the White House and Congressional leaders turned in earnest on Wednesday to working out big differences in the five health care bills, perhaps no issue loomed as a greater obstacle than whether to establish a government-run competitor to the insurance industry.

One day after the Senate Finance Committee approved a measure without a “public option ,” the question on Capitol Hill was how President Obama could reconcile the deep divisions within his party on the issue. All eyes were on Senator Olympia J. Snowe , the Maine Republican whose call for a “trigger” that would establish a government plan as a fallback is one of the leading compromise ideas.

Two senior administration officials, speaking on condition of anonymity, said the White House looked favorably on the Snowe plan. But liberal Democrats were maneuvering against it Wednesday, arguing that Ms. Snowe, the lone Republican to vote in favor of the Finance Committee’s bill, was gaining undue influence over the talks.

“It’s one vote, she won’t make the commitment on the final product, and she says she’s got to have the trigger,” said Representative Raúl M. Grijalva , Democrat of Arizona, who is leading an effort in the House to round up votes for a government plan akin to Medicare . “I think the administration has put her in the driver’s seat; it’s very disconcerting.”

Of the many difficult decisions remaining — including how to pay for an overhaul and how many people will be left uninsured — few carry as much political weight for the president as the public option. The plan, which would be for people who do not get health care through their employers, has become a proxy for a larger debate over where Mr. Obama is taking the country.

“What’s going on here is not simply health care and the public option,” said Kenneth M. Duberstein, a chief of staff in the Reagan White House. “In light of the auto bailout, the bank bailout, the stimulus package , the public option fight is a surrogate for how much government is too much.”

With Democrats split, an array of compromises are being floated — including the nonprofit cooperatives in the Finance Committee bill and the latest idea to capture some Democrats’ fancy, leaving the public option to the states. But economists say few would fulfill Mr. Obama’s stated goal of injecting “choice and competition” into the marketplace.

Mr. Obama’s health care adviser, Nancy-Ann DeParle , said she was convinced that Democrats could “find convergence.” She and several other officials, including Rahm Emanuel , the chief of staff, and Peter R. Orszag , the budget director, met Wednesday with Senator Harry Reid of Nevada, the Democratic leader, to discuss merging the Senate’s bills.

Aides say Mr. Obama has reviewed the alternatives to the public option but has not settled on which, if any, he prefers. And some Democrats say a backlash against insurers is creating renewed interest in a public plan. But in private conversations with Ms. Snowe, Mr. Obama has brought up her idea for a trigger that would create a government-run plan in states where at least 5 percent of residents lacked access to affordable care. One senior White House official called the idea “very reasonable.”

As Mr. Obama originally envisioned it, the public option would be a national government plan, offered as part of a menu of plans available to the uninsured. The idea, he has said, was to “keep the private sector honest” and hold down costs by injecting more competition into the system.

Insurers balked, saying it would put them out of business. Conservatives called Mr. Obama a socialist. Ultimately, he dialed back, calling the public option “just a sliver” of his overall plan.

The five bills making their way through Congress — three in the House and two in the Senate — reflect the full range of thinking, and also how far lawmakers are from consensus.

The most robust public plan, favored by liberals and included in two of the House bills, would tie reimbursement rates for health care providers to those paid by Medicare, reducing the nation’s overall health care bill by $110 billion over 10 years, according to estimates the nonpartisan Congressional Budget Office has provided to lawmakers. The third bill contains an idea being pushed by centrist Democrats to negotiate reimbursement rates with providers, saving roughly $25 billion over 10 years, the budget office estimates say.

As House Democratic leaders try to meld those approaches, liberals like Representative Jan Schakowsky, Democrat of Illinois, said they saw support building for the stronger public option because it saves more money. “It’s the best cost-containment measure we can get,” she said.

But centrists like Representative Jim Cooper, Democrat of Tennessee, who teaches health policy at Vanderbilt University , call the Medicare plan unworkable. Mr. Cooper said Medicare reimburses at such low rates that few doctors would sign on for such a plan.

And the idea of tying reimbursement to Medicare is unlikely to pass the Senate. There, the health committee has approved a negotiated-rates public option, while the Finance Committee voted to set aside money to encourage the creation of private insurance cooperatives. The bill bars existing insurance companies from forming co-ops.

The budget office’s analysis of the finance panel’s bill concluded that co-ops would have “very little effect” on the number of insured or on federal costs because “they seem unlikely to establish a significant market presence in many areas of the country.”

Now Mr. Reid must merge the two Senate bills. He has said he likes Ms. Snowe’s trigger proposal — “a pretty doggone good idea,” he called it in a recent conference call with Nevada voters.

But last week a new twist on the public option took hold in the Senate. Senator Thomas R. Carper , Democrat of Delaware, proposed leaving the decision on whether to establish a public plan up to the states. The plan is not fully fleshed out, Mr. Carper said in an interview, saying he simply wanted to “serve as a catalyst to others to think outside the box.”

Senator Charles E. Schumer, Democrat of New York, jumped on the idea; he and Mr. Carper are talking about how to create a national government insurance plan that would let states opt in or out. “All the naysayers weren’t looking at what is happening on the ground,” Mr. Schumer said, “which is that moderate members are open to a public option.”

I agree with David Brooks: “If I were in Congress, I’d figure there’s an 80 percent chance of something like this passing anyway. I might as well get engaged as a provisional supporter to fight to make it better, or at least to fight off the coming onslaught to make it worse.” Now let’s add a public option, even though many of my colleagues would prefer a Single Payer, and move on.

ww.nytimes.com/2009/10/09/opinion/09brooks.html?th&emc=th

Op-Ed Columnist
The Baucus Conundrum

By DAVID BROOKS
NY Time, Published: October 8, 2009

The longer the health care debate goes on, the more I become convinced that the American system needs fundamental reform. We need to transition away from a fee-for-service system to one that directs incentives toward better care, not more procedures. We need to move away from the employer-based system, which is eroding year by year. We need to move toward a more transparent system, in which people see the consequences of their choices.

I’ve also become convinced that the approach championed by Senator Ron Wyden, Democrat of Oregon, is the best vehicle for this sort of change. The Wyden approach — first introduced in a bill with Robert F. Bennett, Republican of Utah, and now pared down to an amendment to the current bills—would combine choice with universal coverage.

People with insurance could stay with their existing health plans. But if they didn’t like the plans their employer offered, they could take the money their employer spends, add whatever they wanted to throw in, and shop for a better option on a regulated exchange. People without insurance would get subsidies to shop at the exchanges.

Americans would have real choices. The vigorous exchanges would reward providers and insurers that are efficient, creative and innovative.

But barring a legislative miracle, the Wyden approach was effectively killed in committee last week. The business and union lobbies worked furiously against it. They want to control their employees’ and members’ benefit packages. Many politicians support it in principle but oppose it in practice. They fear that if they try to fundamentally reform the system, voters will revolt.

So what we are going to get is health insurance reform, not health care reform. We’ll be adjusting and expanding the current system, not essentially changing it.

At this point people like me could throw up our hands and oppose everything. But that’s not what adulthood is about. In the real world, you often don’t get to choose what your options will be. You have to choose from a few bad options. The real health care choice now is between the status quo and the bill primarily authored by Senator Max Baucus, Democrat of Montana, that is emerging from the Senate Finance Committee.

The Baucus bill centralizes power, in contrast to the free choice approach, which decentralizes it. The Baucus approach aims to reduce costs, expand coverage and improve efficiency by empowering regulators to write a better set of rules. It aims to rationalize the current system from the top down.

This approach has many weaknesses. It entrenches a flawed system. It creates greater uniformity and rigidity. It redistributes income from the politically disorganized young to the politically organized old. It squeezes people into a Rube Goldberg complex of bureaucracies based on their income level. It will impose huge costs on people as they rise up the income ladder, distorting the whole economy.

The biggest problem is that it will retard innovation. Top-down systems just don’t innovate well, no matter how many Innovation Centers you put in the Department of Health and Human Services. The bill will retard innovation by using monopoly power to squeeze costs. It will also retard innovation by directing resources toward current care (and current voters) and away from future technologies and future beneficiaries.

But the Baucus bill has some advantages over the status quo as well. It would insure an additional 29 million people, a social benefit critics never grapple with.

It is also more fiscally responsible than any other committee bill. It courageously cuts Medicare benefits by hundreds of billions. It raises taxes on the upper and middle classes in many necessary (and covert) ways. The bill will not really be budget neutral, but the authors have taken fiscal responsibility seriously. They’ve earned that good score from the Congressional Budget Office.

Most impressively, the Baucus bill includes many provisions to make government-run health care more rational. It would bundle payments to hospitals and encourage doctors to work in efficient teams. It would punish hospitals that have to readmit patients. It would create a commission to perpetually squeeze costs. It would improve information technology. It would measure the comparative effectiveness of different treatments. No one knows how much savings would be produced by these changes in payment method, but they could be significant.

If you asked me to compare the Baucus approach with the Wyden approach, the answer is easy. But if you asked me to compare it with the status quo, the answer is hard. The Baucus bill contains hidden bombs that could lead to a rigid bureaucratic system that still doesn’t address the fundamental problems. On the other hand, it contains hidden experiments that could lead to new models that might spread across the system.

If I were in Congress, I’d figure there’s an 80 percent chance of something like this passing anyway. I might as well get engaged as a provisional supporter to fight to make it better, or at least to fight off the coming onslaught to make it worse.

Every politician Republican and Democrat that voted against the the Public Option on the the Senate Finance Committee yesterday MUST be targeted to lose their Senatorial Seat in the next election. Why? Because they are a bunch of incompetent FOOLS.

Let me make this perfectly clear: WITHOUT A PUBLIC OPTION IN THE HEALTH CARE REFORM LEGISLATION — THERE IS NO HEALTH CARE FINANCING REFORM AND WHATEVER COMES OUT OF WASHINGTON IS A WASTE OF SPACE – IT IS THE SAME OLD BS.

http://www.thepolicycenter.org is totally against a Mandate (requiring people to purchase health insurance) without a Public Health Insurance Option. Why? Because it is financial suicide and unconscionable to force people to purchase unaffordable health insurance in a marketplace controlled by the payers without a Option for the Public.

The Senate Finance Committee supports the Co-op concept instead of a Public Option – this is just brilliant – NOT. We have tried the Co-op Concept 36 years ago, remember the HMO Act of 1973 they were federally funded community based Co-op’s and eventually the Insurers turned most of them into For-profit entities and bought them. So much for the Co-op Concept – IT DOESN”T WORK – HELLO, AM I GETTING THROUGH!!!!

thepolicycenter.org urges all of our readers to OPPOSE A FEDERAL MANDATE if a Public Option is not an integral part of any health care financing reform legislation.

The Insurers/HMOs in this country do not merit a Federal Mandate to rob and abuse the American Public without an available Option that they DO NOT CONTROL.

http://www.nytimes.com/2009/09/30/health/policy/30health.html?_r=1&th&emc=th

Senators Reject Pair of Public Option Proposals

Published: September 29, 2009

WASHINGTON — After an intense debate that captured the essence of the national struggle over health care, a pivotal Senate committee on Tuesday rejected two Democratic proposals to create a government insurance plan to compete with private insurers.

The votes, in the Senate Finance Committee, underscored divisions among Democrats and were a setback for President Obama who has endorsed the public plan as a way to “keep insurance companies honest.”

The first proposal, by Senator John D. Rockefeller IV of West Virginia, was rejected 15 to 8, as five Democrats joined all Republicans on the panel in voting no. The second proposal, by Senator Charles E. Schumer of New York, was defeated 13 to 10, with three Democrats voting no.

The votes vindicated the middle-of-the-road approach taken by the committee chairman, Senator Max Baucus Democrat of Montana. Mr. Baucus voted against both proposals which were offered as amendments to his bill to expand coverage and rein in health costs.

“There’s a lot to like about a public option,” Mr. Baucus said, but he asserted that the idea could not get the 60 votes needed to overcome a Republican filibuster on the Senate floor.

Proponents of a public plan said it was needed to compete with private insurers, and they said consumers would benefit from the competition, getting lower prices and better benefits.

Republicans on the committee unanimously opposed the public option, saying it was, in the words of Senator Orrin G. Hatch “a Trojan horse for a single-payer system” in which the government would eventually control most health care.

Mr. Obama has said he wants a public plan, but he has not always insisted on it, and the administration has sent mixed signals about how important it is. In the debate on Tuesday, few senators mentioned the president’s preferences, although several noted that many House Democrats, including Speaker Nancy Pelosi supported the public option.

House Democratic leaders met for several hours on Tuesday to continue the dicey work of melding bills from three committees into a consensus package that could win a House majority.

Mr. Schumer said the public option would hold down costs because it would not have to generate profits, answer to shareholders or incur marketing expenses. His proposal would have required the public plan to negotiate rates with doctors and hospitals rather than setting prices based on Medicare reimbursement rates. Under Mr. Rockefeller’s plan, the payment of doctors and hospitals would have been based on Medicare rates for the first two years.

Mr. Rockefeller said the Congressional Budget Office had estimated that a government insurance plan could slice $50 billion from the cost of Mr. Baucus’s bill, originally put at $774 billion over 10 years. The budget office predicted that eight million people would initially enroll in the public plan — about one-third of those who would seek coverage through new markets, or insurance exchanges.

“The public plan will be optional,” Mr. Rockefeller insisted. “It will be voluntary. It will be affordable to people who are now helpless before their insurance companies.”

But Senator Charles E. Grassley of Iowa, the senior Republican on the committee, said a government insurance plan would have inherent advantages over private insurers. “Government is not a fair competitor,” Mr. Grassley said. “It’s a predator.” He predicted that “a government plan will ultimately force private insurers out of business,” reducing choices for consumers.

Senator John Ensign Republican of Nevada, said he feared that a government plan would prove so popular it could never be uprooted. “Does anybody believe Congress would let this public plan go away once it has a constituency?” Mr. Ensign asked. “No way. Once it’s started, you will never get rid of it. Congress will subsidize it more and more, allow it to grow and grow.”

Besides Mr. Baucus, two Democrats, Senators Kent Conrad of Arkansas, voted against both public option proposals. Two other Democrats, Senators Thomas R. Carper of Delaware and Bill Nelson of Florida, voted against the first amendment, but supported the second.

Mr. Carper said he liked Mr. Schumer’s proposal because it “would establish a level playing field” for competition between private insurers and the government plan.

The votes on Tuesday set the stage for a compromise under which the public plan could be offered in states where people could not find affordable private coverage, Mr. Carper said. He and Senator Olympia J. Snowe Republican of Maine, have proposed such a compromise.

Democrats hope Ms. Snowe will eventually break with her party and support the legislation.

In the House, the Democratic leader, Representative Steny H. Hoyer of Maryland, echoed Mr. Schumer’s argument that the Finance Committee was the least friendly of the forums that would consider a public option.

“The Senate floor may be better, and the conference even better,” Mr. Hoyer said, looking ahead to negotiations where differences between the two chambers might be resolved.

Senator Lincoln, who faces an increasingly competitive race for re-election next year, said she supported efforts to cover the uninsured and to protect consumers by imposing strict new federal rules on insurance companies. But she said Congress could achieve those goals “without creating a purely public new government program, which most Arkansans do not support.”

Mr. Baucus’s bill does not include a public plan, but would set up nonprofit insurance cooperatives as an alternative to private insurers. The Congressional Budget Office has suggested that the cooperatives would have little effect on federal costs.

Mr. Rockefeller and Mr. Schumer were undaunted. “We will keep fighting so the bill that lands on the president’s desk has a good, strong, robust public option,” Mr. Schumer said.