As the Healthcare Reform debate trudges on over 50,000 Americans are expected to die from colorectal cancer. These deaths occur because of the lack of early detection and treatment.
We have heard John Kline (R-MN-02) state 80% of healthcare reform has bi-partisan support … well, Mr. Kline, it’s time for you to weigh in on HR 1189 , The Colorectal Cancer Prevention, Early Detection and Treatment Act Sponsored by Representative Kay Granger (R-TX) and Representative Patrick Kennedy (D-RI). Prominent members of the Republican Study Committee are co-sponsors including Rodney Alexander (LA-5), Joe Barton (TX-06), Brian Bilbray (CA-50), Dan Burton (IN-05), Thaddeous McCotter (MI-11), Mac Thornberry (TX-13) and others … as well as Minnesotans Betty McCollum, Jim Oberstar, and Collin Peterson (all Democrats.)
Today, Mr. Kline heard a person appeal from advocates for this legislation asking for his support.
This is the type of legislation that should be a no-brainer. It’s limited in scope, it’s reasonable in dollar amount, and it requires participation by the states. This is not a give-away … this is not government takeover … in fact it conforms to the Preamble of the U.S. Constitution as it will "promote the general Welfare" of the citizens.
The bill would authorize $50 million in funding for grants to public and nonprofit organizations. The grants would be used to carry out programs that will provide vital colorectal cancer screenings, information and follow-up services to those ages 50-64, with a focus on those most at risk, such as poor, low-income, uninsured, underinsured and racial and ethnic minority men and women.
The investment could result in the savings of $15 billion in Medicare … a hefty payback.
The states would be required to provide 1/3 of the funding to get the federal dollars.
Please call (952-808-1213) or email Mr. Kline today and tell him to co-sponsor this legislation.
Showing posts with label Health Care. Show all posts
Showing posts with label Health Care. Show all posts
Wednesday, March 17, 2010
Sunday, February 28, 2010
MN-02 : Does John Kline Relate to John Q. Public ?
During the Healthcare Summit, orthopedic surgeon John Barrasso (Senate-R-WY) stated “I do believe we have the best health care system in the world” and although the cameras didn’t roll to Mr. Kline, no doubt he agreed with that sentiment.
The key to that statement is “we”.
Who is “we” ?
John Kline has an annual compensation of $176,000 and has a choice of healthcare plans. If he needs surgery, most members of Congress will have it done at National Naval Medical Center in Bethesda Maryland. Nothing but the best health care for some.
Conversely, John Q. Public is limited to his ability to purchase from a health insurance company that will dictate which hospitals and services it will cover. Or, John Q. Public may be fortunate enough to have an employer that “dictates” the insurance program for him. Oh sure, with enough money, you can purchase the best health care in the world in America. Or, as many John Q. Publics do … accepts the “hope and pray plan” --- hope you don’t need medical care and if you do, pray for an early death.
If you have insurance, your premiums are paying for the emergency care for those that don’t … if you don’t have insurance, you’re probably ignoring medical problems.
Let’s return to Senator Barrasso who advocated that “people with catastrophic plans are the people that are best consumers of health care in using the way they use their health care dollars”.
Essentially, “the best health care system in the world” should only be used for catastrophic events.
President Obama then questioned Sen. Barrasso : “I'm just am curious. Would you be satisfied if every member of Congress just had catastrophic care? Do you think we’d be better health care purchasers? I mean, is that a change that we should make?
SENATOR BARRASSO: Yes, I think actually we would. We’d really focus on it. You’d have more, as you say, skin in the game -- and especially if they had a savings account, a health savings account. They could put their money into that --
THE PRESIDENT: Would you feel the same way if --
SENATOR BARRASSO: -- and they’d be spending the money out of that.
THE PRESIDENT: Would you feel the same way if you were making $40,000, or you had -- that was your income? Because that's the reality for a lot of folks. I mean, it is very important for us -- when you say, to listen -- to listen to that farmer that Tom mentioned in Iowa; to listen to the folks that we get letters from -- because the truth of the matter, John, is they’re not premiers of anyplace, they’re not sultans from wherever. They don't fly into Mayo and suddenly decide they’re going to spend a couple million dollars on the absolute, best health care. They’re folks who are left out.
And this notion somehow that for them the system was working and that if they just ate a little better and were better health care consumers they could manage is just not the case. The vast majority of these 27 million people or 30 million people that we're talking about, they work every day. Some of them work two jobs. But if they're working for a small business, they can't get health care. If they are self-employed, they can't get health care.
And you know what, it is a scary proposition for them. And so we can debate whether or not we can afford to help them, but we shouldn’t pretend somehow that they don't need help. I get too many letters saying they need help.”
President Obama understands John Q. Public … he’s making $40,000 and should have good, quality coverage.
Disappointingly, Mr. Kline didn’t seem to listen. Kline issued a press release stating “Key to expanding an affordable health insurance market for smaller employers would be to establish small business health plans. These partnerships would allow small businesses to band together in associations and spread the risk of issuing insurance, thereby lowering the cost of health care for employers and employees. [SNIP]This contrasts with the majority leadership’s plan, which would subject employers to a new federal bureaucracy that will dictate a raft of rules and red tape”
President Obama, summarized how John Q. Public is affected : ” we agree on is the idea that allowing small businesses and individuals who are right now trapped in the individual market and as a consequence have to buy very expensive insurance and effectively oftentimes just go without insurance could be solved if we allowed them to do what members of Congress do, which is be part of a large group. Again, the idea of an exchange is not a government takeover.” [SNIP] “It sounds like we've got some philosophical difference as to whether there should be some minimum benefits in that exchange, some baseline of coverage. Again, there's a baseline of coverage for members of Congress. And the reason we set that up is because we want to make sure that any federal employee who is part of this big pool is getting good, quality coverage -- not perfect coverage, not gold-plated coverage, but adequate coverage. It may be -- and I'd ask my Republican colleagues to look and see, is that an area that can be resolved.”
In essence, the Democrats are pushing “exchanges” while the Mr. Kline and the Republicans want Association Health Plans(AHPs).
So what are some of the differences ?
How about costs … specifically how John Q. Public is treated.
According to a Congressional Budget Office analysis, Kline’s AHPs : “some provisions of the legislation would tend to decrease the premiums paid by all insurance enrollees, while other provisions would tend to increase the premiums paid by less healthy enrollees or would tend to increase the premiums paid by enrollees in some states relative to enrollees in other states.
While Urban Institute evaluation of the House and Senate bills, states “ Health status rating, gender rating,
and rating based upon industry of employment would be prohibited. In this way, the health care risks of workers in small firms would be spread more broadly than they are today in the vast majority of states, shared across all those enrolled in coverage through the insurance exchange in which it participated. Not only would workers in small firms have a choice of insurance plans—a situation extremely unusual for small groups today—but those that have been priced out of the market due to health issues or an older workforce in the past may have affordable access to coverage for the first time.
Actually, the Urban Institute (which is a source that Mr. Kline has cited before) presents a strong case for the Democrat proposal that John Q. Public should like :
-- New insurance market regulations would prohibit preexisting condition exclusion periods.
-- All those enrolling in insurance coverage through the proposed national or state health insurance exchange would have the option of remaining in the exchange, even if they change employers or leave the workforce.
-- Some financial assistance to the low income to cover some of the cost sharing associated with health insurance.
AND, John Q. Public’s employer will also benefit as the administrative costs will be less and there are tax credits to assist small, low to average wage employers contributing to health insurance coverage for their employees.
Of course, Mr. Kline “fears” that small businesses will suffer because of the requirement to offer insurance or pay a penalty. But that fear-mongering is over exaggerated as data from the Census Bureau’s Survey of US Businesses indicate that 87 percent of the over 6 million firms in the US would NOT have a penalty.
This should be a Win-Win … a Win for John Q. Public and a Win for those of us that are incurring higher premiums for the uninsured.
What is the consequences of not doing something ?
Just ask Tom Simmons, president of a small business, who was just informed that his monthly family premium would go up to $1,596 a month from $908, a nearly 76 percent increase. "This industry is getting out of control. It makes me fearful of future years and what could become of things if something doesn't change." Simmons ultimately was able to reduce the increase to about 16 percent, but only after switching to a plan with a higher deductible and other higher out-of-pocket expenses ... surely not what he wanted for himself nor his employees.
Oh, and those Health Savings Accounts that Senator Barrasso was touting are also having significant rate increases. These policies, known as HSAs, were created by the Bush administration in 2003 as way to trim health costs. The policies are supported as a market solution to rising health costs because they require members to pay more of their medical expenses out of pocket to use fewer services. "We were paying out more in claims than we were collecting in premiums," said Aron Ezra, spokesman for Blue Shield adding "We lose membership because fewer people can afford to get it."
John Kline needs to come to the real world … talk to John Q. Public and he will learn that his plans don’t work. While it's good to know that for some that “we have the best health care system in the world”, we are not happy with it.
The key to that statement is “we”.
Who is “we” ?
John Kline has an annual compensation of $176,000 and has a choice of healthcare plans. If he needs surgery, most members of Congress will have it done at National Naval Medical Center in Bethesda Maryland. Nothing but the best health care for some.
Conversely, John Q. Public is limited to his ability to purchase from a health insurance company that will dictate which hospitals and services it will cover. Or, John Q. Public may be fortunate enough to have an employer that “dictates” the insurance program for him. Oh sure, with enough money, you can purchase the best health care in the world in America. Or, as many John Q. Publics do … accepts the “hope and pray plan” --- hope you don’t need medical care and if you do, pray for an early death.
If you have insurance, your premiums are paying for the emergency care for those that don’t … if you don’t have insurance, you’re probably ignoring medical problems.
Let’s return to Senator Barrasso who advocated that “people with catastrophic plans are the people that are best consumers of health care in using the way they use their health care dollars”.
Essentially, “the best health care system in the world” should only be used for catastrophic events.
President Obama then questioned Sen. Barrasso : “I'm just am curious. Would you be satisfied if every member of Congress just had catastrophic care? Do you think we’d be better health care purchasers? I mean, is that a change that we should make?
SENATOR BARRASSO: Yes, I think actually we would. We’d really focus on it. You’d have more, as you say, skin in the game -- and especially if they had a savings account, a health savings account. They could put their money into that --
THE PRESIDENT: Would you feel the same way if --
SENATOR BARRASSO: -- and they’d be spending the money out of that.
THE PRESIDENT: Would you feel the same way if you were making $40,000, or you had -- that was your income? Because that's the reality for a lot of folks. I mean, it is very important for us -- when you say, to listen -- to listen to that farmer that Tom mentioned in Iowa; to listen to the folks that we get letters from -- because the truth of the matter, John, is they’re not premiers of anyplace, they’re not sultans from wherever. They don't fly into Mayo and suddenly decide they’re going to spend a couple million dollars on the absolute, best health care. They’re folks who are left out.
And this notion somehow that for them the system was working and that if they just ate a little better and were better health care consumers they could manage is just not the case. The vast majority of these 27 million people or 30 million people that we're talking about, they work every day. Some of them work two jobs. But if they're working for a small business, they can't get health care. If they are self-employed, they can't get health care.
And you know what, it is a scary proposition for them. And so we can debate whether or not we can afford to help them, but we shouldn’t pretend somehow that they don't need help. I get too many letters saying they need help.”
President Obama understands John Q. Public … he’s making $40,000 and should have good, quality coverage.
Disappointingly, Mr. Kline didn’t seem to listen. Kline issued a press release stating “Key to expanding an affordable health insurance market for smaller employers would be to establish small business health plans. These partnerships would allow small businesses to band together in associations and spread the risk of issuing insurance, thereby lowering the cost of health care for employers and employees. [SNIP]This contrasts with the majority leadership’s plan, which would subject employers to a new federal bureaucracy that will dictate a raft of rules and red tape”
President Obama, summarized how John Q. Public is affected : ” we agree on is the idea that allowing small businesses and individuals who are right now trapped in the individual market and as a consequence have to buy very expensive insurance and effectively oftentimes just go without insurance could be solved if we allowed them to do what members of Congress do, which is be part of a large group. Again, the idea of an exchange is not a government takeover.” [SNIP] “It sounds like we've got some philosophical difference as to whether there should be some minimum benefits in that exchange, some baseline of coverage. Again, there's a baseline of coverage for members of Congress. And the reason we set that up is because we want to make sure that any federal employee who is part of this big pool is getting good, quality coverage -- not perfect coverage, not gold-plated coverage, but adequate coverage. It may be -- and I'd ask my Republican colleagues to look and see, is that an area that can be resolved.”
In essence, the Democrats are pushing “exchanges” while the Mr. Kline and the Republicans want Association Health Plans(AHPs).
So what are some of the differences ?
How about costs … specifically how John Q. Public is treated.
According to a Congressional Budget Office analysis, Kline’s AHPs : “some provisions of the legislation would tend to decrease the premiums paid by all insurance enrollees, while other provisions would tend to increase the premiums paid by less healthy enrollees or would tend to increase the premiums paid by enrollees in some states relative to enrollees in other states.
While Urban Institute evaluation of the House and Senate bills, states “ Health status rating, gender rating,
and rating based upon industry of employment would be prohibited. In this way, the health care risks of workers in small firms would be spread more broadly than they are today in the vast majority of states, shared across all those enrolled in coverage through the insurance exchange in which it participated. Not only would workers in small firms have a choice of insurance plans—a situation extremely unusual for small groups today—but those that have been priced out of the market due to health issues or an older workforce in the past may have affordable access to coverage for the first time.
Actually, the Urban Institute (which is a source that Mr. Kline has cited before) presents a strong case for the Democrat proposal that John Q. Public should like :
-- New insurance market regulations would prohibit preexisting condition exclusion periods.
-- All those enrolling in insurance coverage through the proposed national or state health insurance exchange would have the option of remaining in the exchange, even if they change employers or leave the workforce.
-- Some financial assistance to the low income to cover some of the cost sharing associated with health insurance.
AND, John Q. Public’s employer will also benefit as the administrative costs will be less and there are tax credits to assist small, low to average wage employers contributing to health insurance coverage for their employees.
Of course, Mr. Kline “fears” that small businesses will suffer because of the requirement to offer insurance or pay a penalty. But that fear-mongering is over exaggerated as data from the Census Bureau’s Survey of US Businesses indicate that 87 percent of the over 6 million firms in the US would NOT have a penalty.
This should be a Win-Win … a Win for John Q. Public and a Win for those of us that are incurring higher premiums for the uninsured.
What is the consequences of not doing something ?
Just ask Tom Simmons, president of a small business, who was just informed that his monthly family premium would go up to $1,596 a month from $908, a nearly 76 percent increase. "This industry is getting out of control. It makes me fearful of future years and what could become of things if something doesn't change." Simmons ultimately was able to reduce the increase to about 16 percent, but only after switching to a plan with a higher deductible and other higher out-of-pocket expenses ... surely not what he wanted for himself nor his employees.
Oh, and those Health Savings Accounts that Senator Barrasso was touting are also having significant rate increases. These policies, known as HSAs, were created by the Bush administration in 2003 as way to trim health costs. The policies are supported as a market solution to rising health costs because they require members to pay more of their medical expenses out of pocket to use fewer services. "We were paying out more in claims than we were collecting in premiums," said Aron Ezra, spokesman for Blue Shield adding "We lose membership because fewer people can afford to get it."
John Kline needs to come to the real world … talk to John Q. Public and he will learn that his plans don’t work. While it's good to know that for some that “we have the best health care system in the world”, we are not happy with it.
Thursday, February 25, 2010
MN-02 : Should Kline Blame Bush, Coleman or himself for AHP Failure ?
As the ranking minority member of the House Education and Labor Committee, John Kline had his moment to address the President and other leaders on the solution for Health Care Reform. His recommendation was Association Health Plans (AHPs) for small business owners.
Couple of questions :
1.) What are AHPs and if it’s such a good idea, why hasn’t it been enacted ?
2.) Will it resolve the questions of pre-existing conditions, will it make basic coverage affordable, will it be transferable with employment and will it result in universal participation ?
To the first question. AHPs have existed for decades, both multi-state and intra-state. AHPs would allow for businesses to band together through associations to increase their buying power when negotiating with insurance providers for coverage. By forming AHPs, associations could provide their members with more health insurance options, which in theory would drive down the cost for small business owners and their employees. However because of individual states being able to define what needs to be provided (in other words, mandates), they have declined in use. For example using 2008 data, only eight states mandated that oral surgeries had to be covered in a health insurance policy while 50 states want mammograms covered.
There was some legislation offered during the Clinton years, but it was never passed by both chambers. When Bush became president, it stayed dormant until 2003 when the House with John Kline’s support passed HR 660. The bill would authorize the formation and multi-state operation of federally-certified Association Health Plans. AHPs would be regulated under a single set of federally prescribed rules, and permitted exemptions from costly state regulations that large corporate and union health plans already enjoy under the Employee Retirement Income Security Act. The Senate failed to act … so is Norm Coleman to be blamed? Or President Bush for not pressing harder ? Today, the legislation is HR2607 Small Business Health Fairness Act of 2009 and is awaiting action in the House. Today’s legislation is different than the Bush-era legislation – then the proposal included a federally prescribed rules, but now the current legislation would not have to meet any government-mandated, minimum benefit requirements -- associations would be able to determine which benefits they are willing to pay for.
So why hasn’t it been passed ?
One reason, could be a question of states rights. For example, should Minnesota decide what’s best for Minnesotans or should the Federal Government. AHPs would only have to obtain plan approval in the original state in which it filed. (It also would have to comply with the original state's laws mandating coverage of certain diseases and then all other states would be obligated to accept that approved plan.) This is the same problems that exist if insurance companies are allowed to sell insurance across state lines … insurance companies could seek out the state with the most favorable mandates and make that its complying state … unsuspecting or unknowledgeable purchasers may not find out the limitations of the policy until there is a claim.
Second, the potential impact to the Federal Budget. Although the current legislation has not been reviewed by the Congressional Budget Office, HR 660 was. For a ten year period, it was estimated to cost the government $280 million dollars. Overall it would impact 600,000 people while the CBO also estimates that about 10,000 people would lose coverage in response to rising premiums in the small-group market.
Overall, not much of an impact.
Now, to the second question regarding the real healthcare questions … pre-existing conditions, affordable coverage, transferable with employment and universal participation ? Not much help here.
Kline has offered a solution, that is really a poor choice. Kline has himself to blame since this legislation could have been enacted when Republicans were in control of Congress and the White House. Instead, healthcare expenses continue to escalate, coverage reduced and is now at a crisis stage.
Kline wants Association Health Plans while the Democrats favor Democrats government-based "exchanges" in which small companies can pool together. The House passed a bill that included a federal exchange, while the Senate bill would set up state-based exchanges. Insurers offering plans in the exchanges would have to offer a package meeting minimum standards.
The difference was simply stated in an exchange between Kline and Rob Andrews (D-NJ) concerning who determines when a woman is released from the hospital after a caesarian section. Kline wants the insurance company to decide … Andrews wants the doctor.
Kline's plan has been dormant for good reasons ... exchanges offer a better prospect for America.
Couple of questions :
1.) What are AHPs and if it’s such a good idea, why hasn’t it been enacted ?
2.) Will it resolve the questions of pre-existing conditions, will it make basic coverage affordable, will it be transferable with employment and will it result in universal participation ?
To the first question. AHPs have existed for decades, both multi-state and intra-state. AHPs would allow for businesses to band together through associations to increase their buying power when negotiating with insurance providers for coverage. By forming AHPs, associations could provide their members with more health insurance options, which in theory would drive down the cost for small business owners and their employees. However because of individual states being able to define what needs to be provided (in other words, mandates), they have declined in use. For example using 2008 data, only eight states mandated that oral surgeries had to be covered in a health insurance policy while 50 states want mammograms covered.
There was some legislation offered during the Clinton years, but it was never passed by both chambers. When Bush became president, it stayed dormant until 2003 when the House with John Kline’s support passed HR 660. The bill would authorize the formation and multi-state operation of federally-certified Association Health Plans. AHPs would be regulated under a single set of federally prescribed rules, and permitted exemptions from costly state regulations that large corporate and union health plans already enjoy under the Employee Retirement Income Security Act. The Senate failed to act … so is Norm Coleman to be blamed? Or President Bush for not pressing harder ? Today, the legislation is HR2607 Small Business Health Fairness Act of 2009 and is awaiting action in the House. Today’s legislation is different than the Bush-era legislation – then the proposal included a federally prescribed rules, but now the current legislation would not have to meet any government-mandated, minimum benefit requirements -- associations would be able to determine which benefits they are willing to pay for.
So why hasn’t it been passed ?
One reason, could be a question of states rights. For example, should Minnesota decide what’s best for Minnesotans or should the Federal Government. AHPs would only have to obtain plan approval in the original state in which it filed. (It also would have to comply with the original state's laws mandating coverage of certain diseases and then all other states would be obligated to accept that approved plan.) This is the same problems that exist if insurance companies are allowed to sell insurance across state lines … insurance companies could seek out the state with the most favorable mandates and make that its complying state … unsuspecting or unknowledgeable purchasers may not find out the limitations of the policy until there is a claim.
Second, the potential impact to the Federal Budget. Although the current legislation has not been reviewed by the Congressional Budget Office, HR 660 was. For a ten year period, it was estimated to cost the government $280 million dollars. Overall it would impact 600,000 people while the CBO also estimates that about 10,000 people would lose coverage in response to rising premiums in the small-group market.
Overall, not much of an impact.
Now, to the second question regarding the real healthcare questions … pre-existing conditions, affordable coverage, transferable with employment and universal participation ? Not much help here.
Kline has offered a solution, that is really a poor choice. Kline has himself to blame since this legislation could have been enacted when Republicans were in control of Congress and the White House. Instead, healthcare expenses continue to escalate, coverage reduced and is now at a crisis stage.
Kline wants Association Health Plans while the Democrats favor Democrats government-based "exchanges" in which small companies can pool together. The House passed a bill that included a federal exchange, while the Senate bill would set up state-based exchanges. Insurers offering plans in the exchanges would have to offer a package meeting minimum standards.
The difference was simply stated in an exchange between Kline and Rob Andrews (D-NJ) concerning who determines when a woman is released from the hospital after a caesarian section. Kline wants the insurance company to decide … Andrews wants the doctor.
Kline's plan has been dormant for good reasons ... exchanges offer a better prospect for America.
Thursday, October 01, 2009
MN-01 GOP Blind to NICE
In The Republican Party of Minnesota's First Congressional District blog, Bruce Kaskubar warns about Eye Care in the UK.
I don’t know if Mr. Kaskubar is an ophthalmologist and I do not think that his intention was to scare us, but instead was to express concerns about healthcare legislation – specifically a “rationing board”.
Mr. Kaskubar cites an OpEd that was printed in the Wall Street Journal concerning the National Institute for Health and Clinical Excellence (NICE) – the UK board that promotes "best practices" in medicine.
One might think that if it is printed in the WSJ, that it is current and factually correct, but be warned it can also be misleading and ill-informed.
Mr. Kaskubar accurately cites “In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers."
OK, blindness is scary … but shouldn’t the question be asked : Why did NICE restrict use of these drugs?
On January 2, 2007, Genentech Inc., the manufacturer of Avastin™ (bevacizumab) and Lucentis™ (ranibizumab), informed ophthalmologists that the ongoing SAILOR clinical study revealed a higher incidence of stroke in the 0.5-mg Lucentis™ dose group. When Lucentis™ was initially approved for use, the warning label expressed concerns of the theoretical risk of thromboembolic events with intravitreal inhibitors of VEgf,3 a drug class that also includes Macugen™ and Avastin™.
Ah, that poses an interesting question --- is the risk of a stroke worth preserving the patient’s vision ?
There is also the question of cost. In the US, Lucentis™ runs close to $2,000 per monthly shot (and if the coverage is through Medicare, the co-pay is $400). By contrast, Avastin™ — a close biochemical cousin to Lucentis™ — is priced for use in far larger doses as a cancer treatment, so the tiny amount needed for injections into the eye costs only about $40 a shot. Genentech makes both medicines and has been under pressure for the pricing of Lucentis™ when Avastin™ is apparently effective in treating wet age-related macular degeneration (AMD) … as it is in treating colon, lung and breast cancer.
Those two reasons would seem to be valid justification for NICE to restrict usage while it studies the drug.
In the US, the FDA is involved in the CATT Study which has the primary aim to evaluate the relative safety and efficacy of treatment of subfoveal AMD with both Avastin™ and Lucentis™, determine an appropriate dosing schedule and, to see if there is any clinical difference between the two drugs.
I wonder if the FDA had issued the same ruling as NICE did, would Mr. Kaskubar or the WSJ writer complain that the motivation was due to rationing ?
Incidentally, Mr. Kaskubar and the WSJ writer failed to update the status from NICE’s 2007 instructions. NICE in August 2008 issued a report authorizing the use of Lucentis™ with the UK government paying for the first 14 injections in each eye being treated. If people need more than 14 injections per eye, the manufacturer has agreed to provide the drug at no additional cost.
The obvious question is : What is the price of Lucentis™ in the US versus what it is in the UK ?
Now, I am not an ophthalmologist … and that’s the point … the concept of a second opinion is always beneficial … and NICE seems to be contributing to that goal.
Common folks, like me, rely on the medical community to know what to do … but that may be idyllic.
Governor Tim Pawlenty has complained about direct-to-consumer prescription drug advertising resulting in increased number of patients asking physicians for treatments because they heard about it on TV or a friend told them about it. Additionally, the pharmaceutical industry pays physicians to give “educational” seminars on their products creating a potential conflict of interests. Eli Lilly was fined $1.4 billion dollars in January to settle a lawsuit by the federal government that it illegally promoted drugs while Pfizer paid $2.3 billion fine in September for the same activity. Recently, Schering-Plough offered a variety of psychiatrists around the country up to $1,600 a day and $170,000 total to talk about Saphris, a new psychiatric drug.
Clearly, costs are being impacted ... and that's where the issue should be --- not "rationing".
Let’s not be blind to misleading stories … it is a fact that “rationing” occurs today when insurance companies decide if they will cover a drug or procedure.
Let’s not promote fear.
Mr. Kaskubar is concerned about a “rationing board” but fails to acknowledge that the Obama Administration's proposal for a Council for Comparative Effectiveness Research does not have the same authority as NICE does.
IMO, that is a mistake.
Let’s enact reforms that promote “best practices”. Controlling costs and ensuring best practices can best be achieved when government is involved protecting consumers and patients.
I don’t know if Mr. Kaskubar is an ophthalmologist and I do not think that his intention was to scare us, but instead was to express concerns about healthcare legislation – specifically a “rationing board”.
Mr. Kaskubar cites an OpEd that was printed in the Wall Street Journal concerning the National Institute for Health and Clinical Excellence (NICE) – the UK board that promotes "best practices" in medicine.
One might think that if it is printed in the WSJ, that it is current and factually correct, but be warned it can also be misleading and ill-informed.
Mr. Kaskubar accurately cites “In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers."
OK, blindness is scary … but shouldn’t the question be asked : Why did NICE restrict use of these drugs?
On January 2, 2007, Genentech Inc., the manufacturer of Avastin™ (bevacizumab) and Lucentis™ (ranibizumab), informed ophthalmologists that the ongoing SAILOR clinical study revealed a higher incidence of stroke in the 0.5-mg Lucentis™ dose group. When Lucentis™ was initially approved for use, the warning label expressed concerns of the theoretical risk of thromboembolic events with intravitreal inhibitors of VEgf,3 a drug class that also includes Macugen™ and Avastin™.
Ah, that poses an interesting question --- is the risk of a stroke worth preserving the patient’s vision ?
There is also the question of cost. In the US, Lucentis™ runs close to $2,000 per monthly shot (and if the coverage is through Medicare, the co-pay is $400). By contrast, Avastin™ — a close biochemical cousin to Lucentis™ — is priced for use in far larger doses as a cancer treatment, so the tiny amount needed for injections into the eye costs only about $40 a shot. Genentech makes both medicines and has been under pressure for the pricing of Lucentis™ when Avastin™ is apparently effective in treating wet age-related macular degeneration (AMD) … as it is in treating colon, lung and breast cancer.
Those two reasons would seem to be valid justification for NICE to restrict usage while it studies the drug.
In the US, the FDA is involved in the CATT Study which has the primary aim to evaluate the relative safety and efficacy of treatment of subfoveal AMD with both Avastin™ and Lucentis™, determine an appropriate dosing schedule and, to see if there is any clinical difference between the two drugs.
I wonder if the FDA had issued the same ruling as NICE did, would Mr. Kaskubar or the WSJ writer complain that the motivation was due to rationing ?
Incidentally, Mr. Kaskubar and the WSJ writer failed to update the status from NICE’s 2007 instructions. NICE in August 2008 issued a report authorizing the use of Lucentis™ with the UK government paying for the first 14 injections in each eye being treated. If people need more than 14 injections per eye, the manufacturer has agreed to provide the drug at no additional cost.
The obvious question is : What is the price of Lucentis™ in the US versus what it is in the UK ?
Now, I am not an ophthalmologist … and that’s the point … the concept of a second opinion is always beneficial … and NICE seems to be contributing to that goal.
Common folks, like me, rely on the medical community to know what to do … but that may be idyllic.
Governor Tim Pawlenty has complained about direct-to-consumer prescription drug advertising resulting in increased number of patients asking physicians for treatments because they heard about it on TV or a friend told them about it. Additionally, the pharmaceutical industry pays physicians to give “educational” seminars on their products creating a potential conflict of interests. Eli Lilly was fined $1.4 billion dollars in January to settle a lawsuit by the federal government that it illegally promoted drugs while Pfizer paid $2.3 billion fine in September for the same activity. Recently, Schering-Plough offered a variety of psychiatrists around the country up to $1,600 a day and $170,000 total to talk about Saphris, a new psychiatric drug.
Clearly, costs are being impacted ... and that's where the issue should be --- not "rationing".
Let’s not be blind to misleading stories … it is a fact that “rationing” occurs today when insurance companies decide if they will cover a drug or procedure.
Let’s not promote fear.
Mr. Kaskubar is concerned about a “rationing board” but fails to acknowledge that the Obama Administration's proposal for a Council for Comparative Effectiveness Research does not have the same authority as NICE does.
IMO, that is a mistake.
Let’s enact reforms that promote “best practices”. Controlling costs and ensuring best practices can best be achieved when government is involved protecting consumers and patients.
Sunday, September 21, 2008
MN-01 : Will Davis Use a Mankato Case to Explain His Health Care Concerns ?
When FBI attorney and whistleblower Colleen Rowley announced that she would oppose John Kline for the Second District Congressional seat for the 2006 elections, voters knew that the Global War on Terrorism would be at the center of their campaigns.
When Brian Davis, a physician associated with the Mayo Clinic, announced that he was seeking to represent the First District for the 2008 elections, I thought that health care would be a prime issue.
Health care is not only a concern for voters individually, but its financial impact weighs heavily on businesses that provide employee benefits and on the Federal budget.
Every voter has questions regarding health care coverage and government involvement, but mine include :
-- How do we get to universal participation (Senator David Durenberger in leading the Minnesota Citizens Panel on Health Care Costs has stated that the resolution of the health care crisis is universal participation) ?
-- How to handle high-risk patients that have pre-existing conditions and unable to procure health insurance ?
-- Should Medicare be subject to means testing ?
-- How do we address the shortage of primary care physicians ? (Specialists – in fields like radiology, orthopedic surgery, cardiology, and other tech fields – take home 2 to 3 times the income of primary care physicians, and have more time off.)
-- How do we reduce the $98 billion a year in excess administrative costs as McKinsey and Company noted in their study ?
--- How do we improve effectiveness of personal physicians ? According to Paul Grundy, MD, Director of Health Care Transformation for IBM says a humanistic, patient-centered approach can cuts costs by 30% and improves outcomes by 20%.
-- And the immediate question of how to fund the Medicare trust fund that covers hospital stays that will start running out in 2011 and may be emptied by 2019 ?
Alas, Dr. Davis has not used the health care as a prime issue in his campaign. His website is extremely lacking in details but he did tell KAAL television "I'd like to see a greater transparency in costs so that individuals can become better informed consumers, I'd like to see us have tort reform, the cost of malpractice is driving doctors and hospitals out of business," says Republican candidate Dr. Brian Davis.
It is disappointing that Davis focuses on malpractice rather than the other aspect of health care.
Essentially, Davis is going down the same road that President Bush has traveled in his successful elections. Although Bush and the AMA used tort reform as a campaign issue, a General Accounting Office report indicated that the crisis was overblown. Malpractice rates were impacted by insurers' losses in their investment portfolios, inadequate reserves to pay claims and artificially low rates set during the 1990s when many companies vied to attract policyholders.
The American Medical News reported that 84% of liability companies reported in 2007 rates held steady or dropped while the lowest rates for internists ($3,375), general surgeons ($11,306), and Ob-Gyns ($20.626), are all in Minnesota. Besides Minnesota, states ranking in low tier are our neighbors -- South Dakota, Wisconsin, and Iowa.
That stated, malpractice is a serious problem.
But, is it as big as Dr. Davis implies ?
How many malpractice lawsuits may be settled out of court is not readily available, but last week a Blue Earth County jury found a physician liable.
Excerpts from the Mankato Free Press article : The jury’s unanimous award totaled $975,501. The jury awarded $118,001 for past medical expenses, $137,500 for bodily and mental harm, $420,000 for future damages and mental harm, and $300,000 for loss of future earning capacity.
“This was a horrific injury,” said Michael Djordjevich, the plaintiff’s attorney. During the baby’s delivery, her shoulder was injured. The injury, her lawyers argued, will cause lifelong limitations and significantly reduce future earnings. Djordjevich had shown jurors a radiology report that said measurements of the fetus were “suggestive of a macrosomic fetus.” Macrosomia is a medical term describing a fetus or newborn of excessive weight. He said accepted, published medical standards suggest a C-section be done with macrosomic fetuses.
Djordjevich also showed notes made by the obstetrician prior to the delivery in which she suggested she would order a C-section if the labor did not progress well. Djordjevich, using charts of the progression of the labor, said the obstetrician failed to follow her own plans by not ordering a C-section when the labor did not progress as quickly as it should have.
NOTE : The physician’s and family names were omitted in my excerpt but listed in the MFP story as I do not believe that is relevant to the discussion of medical malpractice.
Now, $975,501 is a lot of money … but is it outlandish ?
The $118,001 for past medical expenses is in line with the current Medicare philosophy of not paying for medical errors or mismanagement. The $300,000 for loss of future earnings amounts to less than $7,500 over a normal 40 year working career … if anything that seems small. The concern is that the shoulder, which was injured during the delivery, will experience lifelong limitations … without knowing the extent of the range of motion, it is quite possible that the child may be limited in career opportunities … such as becoming a physician such as Dr. Davis and thus deprived of earning a salary of $411,780 per year … which is more than what the jury awarded.
This jury members did their job … they listened to the testimony and rendered a verdict. In this case, the system worked ... even if my future health insurance rates eventually reflect this verdict.
Instead of crying for tort reform, Dr. Davis should acknowledge that mistakes are made and that is why malpractice insurance is warranted.
Instead of attacking trial lawyers, he should be promoting efforts to get other states to improve to Minnesota’s performance level. It’s not just blind luck that impacts malpractice insurance rates … it’s also by effective management. For example, Minnesota Medical Insurance Company (MMIC) has sponsored aggressive programs focusing on reducing malpractice risks, patient safety, communication, and quality which has attributed to Minnesota's low malpractice rates.
If patients did not have the remedy of lawsuit, the medical community may not be motivated to improve itself.
In July, I wrote about candidate Dr. Davis Prescription for Health Care.
Now, that Dr. Davis is the officially on the ballot, he should inform voters of his past and current relationship with the medical industry.
#1. Davis’ personal financial disclosure form indicated ownership in a pharmaceutical company. Will Davis sell the stock outright ? Senator and Doctor Bill Frist moved his investments into a blind trust and that did not stop a SEC investigation involving sale of his HCA stock.
#2. As a Co-director of the Prostate Cancer Program at the Mayo Clinic and as Vice President of the American Brachytherapy Society, have you ever been compensated (monies or trips) for educational lecturers, participation in seminars, and/or educational research grants from pharmaceutical companies ? From 1997 through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in Minnesota at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money.
#3. Will Dr. Davis release for public review his complete income tax records so that voters can determine if any compensation recieved as noted in #2 has been properly recorded ? The Schedule D will provide insight into investments in the medical industry.
#4. Lastly, will he support the McCain health care plan which will make employer-provided health care taxable income for employees (resulting in a average tax increase of $2870 in taxes), deregulating the health care insurance industry and potentially eliminating coverage for 20 million citizens ?
Just as Dr. Davis recommends "a greater transparency” so that individuals can become better informed consumers, voters need the same "transparency” to evaluate his candidacy.
Voters need to know if Dr. Davis will represent the AMA and the pharmaceutical and medical industry ... or the citizens of the First District.
When Brian Davis, a physician associated with the Mayo Clinic, announced that he was seeking to represent the First District for the 2008 elections, I thought that health care would be a prime issue.
Health care is not only a concern for voters individually, but its financial impact weighs heavily on businesses that provide employee benefits and on the Federal budget.
Every voter has questions regarding health care coverage and government involvement, but mine include :
-- How do we get to universal participation (Senator David Durenberger in leading the Minnesota Citizens Panel on Health Care Costs has stated that the resolution of the health care crisis is universal participation) ?
-- How to handle high-risk patients that have pre-existing conditions and unable to procure health insurance ?
-- Should Medicare be subject to means testing ?
-- How do we address the shortage of primary care physicians ? (Specialists – in fields like radiology, orthopedic surgery, cardiology, and other tech fields – take home 2 to 3 times the income of primary care physicians, and have more time off.)
-- How do we reduce the $98 billion a year in excess administrative costs as McKinsey and Company noted in their study ?
--- How do we improve effectiveness of personal physicians ? According to Paul Grundy, MD, Director of Health Care Transformation for IBM says a humanistic, patient-centered approach can cuts costs by 30% and improves outcomes by 20%.
-- And the immediate question of how to fund the Medicare trust fund that covers hospital stays that will start running out in 2011 and may be emptied by 2019 ?
Alas, Dr. Davis has not used the health care as a prime issue in his campaign. His website is extremely lacking in details but he did tell KAAL television "I'd like to see a greater transparency in costs so that individuals can become better informed consumers, I'd like to see us have tort reform, the cost of malpractice is driving doctors and hospitals out of business," says Republican candidate Dr. Brian Davis.
It is disappointing that Davis focuses on malpractice rather than the other aspect of health care.
Essentially, Davis is going down the same road that President Bush has traveled in his successful elections. Although Bush and the AMA used tort reform as a campaign issue, a General Accounting Office report indicated that the crisis was overblown. Malpractice rates were impacted by insurers' losses in their investment portfolios, inadequate reserves to pay claims and artificially low rates set during the 1990s when many companies vied to attract policyholders.
The American Medical News reported that 84% of liability companies reported in 2007 rates held steady or dropped while the lowest rates for internists ($3,375), general surgeons ($11,306), and Ob-Gyns ($20.626), are all in Minnesota. Besides Minnesota, states ranking in low tier are our neighbors -- South Dakota, Wisconsin, and Iowa.
That stated, malpractice is a serious problem.
But, is it as big as Dr. Davis implies ?
How many malpractice lawsuits may be settled out of court is not readily available, but last week a Blue Earth County jury found a physician liable.
Excerpts from the Mankato Free Press article : The jury’s unanimous award totaled $975,501. The jury awarded $118,001 for past medical expenses, $137,500 for bodily and mental harm, $420,000 for future damages and mental harm, and $300,000 for loss of future earning capacity.
“This was a horrific injury,” said Michael Djordjevich, the plaintiff’s attorney. During the baby’s delivery, her shoulder was injured. The injury, her lawyers argued, will cause lifelong limitations and significantly reduce future earnings. Djordjevich had shown jurors a radiology report that said measurements of the fetus were “suggestive of a macrosomic fetus.” Macrosomia is a medical term describing a fetus or newborn of excessive weight. He said accepted, published medical standards suggest a C-section be done with macrosomic fetuses.
Djordjevich also showed notes made by the obstetrician prior to the delivery in which she suggested she would order a C-section if the labor did not progress well. Djordjevich, using charts of the progression of the labor, said the obstetrician failed to follow her own plans by not ordering a C-section when the labor did not progress as quickly as it should have.
NOTE : The physician’s and family names were omitted in my excerpt but listed in the MFP story as I do not believe that is relevant to the discussion of medical malpractice.
Now, $975,501 is a lot of money … but is it outlandish ?
The $118,001 for past medical expenses is in line with the current Medicare philosophy of not paying for medical errors or mismanagement. The $300,000 for loss of future earnings amounts to less than $7,500 over a normal 40 year working career … if anything that seems small. The concern is that the shoulder, which was injured during the delivery, will experience lifelong limitations … without knowing the extent of the range of motion, it is quite possible that the child may be limited in career opportunities … such as becoming a physician such as Dr. Davis and thus deprived of earning a salary of $411,780 per year … which is more than what the jury awarded.
This jury members did their job … they listened to the testimony and rendered a verdict. In this case, the system worked ... even if my future health insurance rates eventually reflect this verdict.
Instead of crying for tort reform, Dr. Davis should acknowledge that mistakes are made and that is why malpractice insurance is warranted.
Instead of attacking trial lawyers, he should be promoting efforts to get other states to improve to Minnesota’s performance level. It’s not just blind luck that impacts malpractice insurance rates … it’s also by effective management. For example, Minnesota Medical Insurance Company (MMIC) has sponsored aggressive programs focusing on reducing malpractice risks, patient safety, communication, and quality which has attributed to Minnesota's low malpractice rates.
If patients did not have the remedy of lawsuit, the medical community may not be motivated to improve itself.
In July, I wrote about candidate Dr. Davis Prescription for Health Care.
Now, that Dr. Davis is the officially on the ballot, he should inform voters of his past and current relationship with the medical industry.
#1. Davis’ personal financial disclosure form indicated ownership in a pharmaceutical company. Will Davis sell the stock outright ? Senator and Doctor Bill Frist moved his investments into a blind trust and that did not stop a SEC investigation involving sale of his HCA stock.
#2. As a Co-director of the Prostate Cancer Program at the Mayo Clinic and as Vice President of the American Brachytherapy Society, have you ever been compensated (monies or trips) for educational lecturers, participation in seminars, and/or educational research grants from pharmaceutical companies ? From 1997 through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in Minnesota at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money.
#3. Will Dr. Davis release for public review his complete income tax records so that voters can determine if any compensation recieved as noted in #2 has been properly recorded ? The Schedule D will provide insight into investments in the medical industry.
#4. Lastly, will he support the McCain health care plan which will make employer-provided health care taxable income for employees (resulting in a average tax increase of $2870 in taxes), deregulating the health care insurance industry and potentially eliminating coverage for 20 million citizens ?
Just as Dr. Davis recommends "a greater transparency” so that individuals can become better informed consumers, voters need the same "transparency” to evaluate his candidacy.
Voters need to know if Dr. Davis will represent the AMA and the pharmaceutical and medical industry ... or the citizens of the First District.
Saturday, August 30, 2008
Will MN Republicans Support McCain’s Plan to Tax Health Care Benefits ?
As voters enter the voting booth this November, a recent NYTimes / CBS News poll indicate that the top issue will be jobs and the economy. The most salient point that Barack Obama made during his acceptance speech concerned those issues :
OBAMA: Now, I don't believe that Senator McCain doesn't care what's going on in the lives of Americans; I just think he doesn't know.
Why else would he define middle-class as someone making under $5 million a year? How else could he propose hundreds of billions in tax breaks for big corporations and oil companies, but not one penny of tax relief to more than 100 million Americans?
How else could he offer a health care plan that would actually tax people's benefits, or an education plan that would do nothing to help families pay for college, or a plan that would privatize Social Security and gamble your retirement?
That’s right … under the McCain plan, employer-provided health insurance benefits would be taxed as normal income for individual income tax purposes.
While employers would continue to deduct health insurance coverage costs, employees would pay taxes on the fringe benefit. Currently, the tax code provides an exclusion that allows companies to offer health care benefits to employees free from taxation.
That’s a MAJOR TAX INCREASE that is not being portrayed as such.
In August 2007 the U.S. Census Bureau reported that 59.7% of Americans received employment-based health insurance in 2006. Thus, this would be a major change for those employed by employers who provide health insurance benefits and no impact for those companies that do not.
Your employer may have different rates depending upon group history and policy coverage. For a point of reference, the Kaiser Family Foundation and Health Research and Educational Trust report the annual cost of a family health insurance premium in 2006 was $11,480. Essentially under the McCain plan, your taxable income would increase by that amount … and whatever your tax rate (10% to 35%) would be applied. Although the employer has a rate per employee, the insurance expense is probably a group policy expense, so the impact of adding $11,480 to the average worker’s pay will impact lower wage-earners harder … as well as ethnic breakdown. For example, the median household income in 2006 for White Americans was $50,673 (25% tax bracket) while Hispanics were $37,781 and African-Americans were $31,969. (Source : Income, Poverty, and Health Insurance Coverage in the United States, 2006. Current Population Reports, Consumer Income. August 2007).
Simply, the CEO of the company will have the same additional taxable income --- $11,480 health benefit --- as well as the lowest paid worker.
While burdensome to all but the most affluent families, this level of spending can be deemed excessive.
While this tax increase is substantial to the individual, it would provide the Government with some needed revenue. According to the Committee for a Responsible Federal Budget A Fiscal Voter Guide to the 2008 Election report, this plan to eliminate of the tax exclusion for employer provided health insurance could result in adding $201 billion to $274 billion to the Federal Treasury. (Yep, that’s Billion.)
One could look at this as a necessity to pay for the ongoing Iraq and Afghanistan operations or addressing the “borrowing” from Social Security and Medicare fund for other spending programs. Yet the CRFB report also indicates that McCain’s plans to continue the Bush tax cuts which will cost the government $294 billion, and that McCain plans to reduce the Corporate Income Taxes costing the Treasury another $55 to $68 billion. (Yep, that’s Billion.) MORE on reducing Corporate Income Taxes in a future commentary.
The obvious question is, Why does McCain advocate this change ?
Republicans like Dr. Brian Davis believe that there needs to be more competition and less government intervention in healthcare.
IF employees begin to be taxed for health care benefits, employees may be inclined to want to opt out of insurance. With the rising cost that employers have seen in health care costs, they may likely comply. This could lead to the end of the employer-sponsored health care benefit system. In 2007, some 45.7 million Americans — 15.3 percent of the population — were uninsured so that figure could rise substantially as more people just determine that health care insurance is unaffordable.
That may work out good for employers … and possibly for healthy employees, but for the others that have health problems that would be a problem. The percentage of Americans with insurance through a public program increased from 27.0 percent in 2006 to 27.8 percentage in 2007, primarily as a result of gains in coverage through Medicare and Medicaid. IF the employer-sponsored health care benefit system is effectively terminated, that would cause an increase demands for public programs which may result in scaling back Medicaid benefits and eligibility.
Remember McCain said that Bush made "the right call" in vetoing the SCHIP legislation and has repeatedly voted to cut, eliminate, or restrict health insurance coverage for low income children and pregnant mothers.(source) Congresswoman Michele Bachmann (R-06) and Congressman John Kline (R-02) also voted against SCHIP legislation.
When Norm Coleman, Dr. Brian Davis, Dick Day, John Kline, Erik Paulsen, Barb Davis White, Ed Matthews, Michele Bachmann, or Glenn Menze talk about taxes, be sure to ask them if they support McCain’s efforts to tax health care benefits.
Also, as you watch the Republican National Convention, watch for how often "cutting taxes" is discussed and how many times eliminating the health care tax benefit is mentioned.
Tax fairness should not begin with taxing the health care benefits.
OBAMA: Now, I don't believe that Senator McCain doesn't care what's going on in the lives of Americans; I just think he doesn't know.
Why else would he define middle-class as someone making under $5 million a year? How else could he propose hundreds of billions in tax breaks for big corporations and oil companies, but not one penny of tax relief to more than 100 million Americans?
How else could he offer a health care plan that would actually tax people's benefits, or an education plan that would do nothing to help families pay for college, or a plan that would privatize Social Security and gamble your retirement?
That’s right … under the McCain plan, employer-provided health insurance benefits would be taxed as normal income for individual income tax purposes.
While employers would continue to deduct health insurance coverage costs, employees would pay taxes on the fringe benefit. Currently, the tax code provides an exclusion that allows companies to offer health care benefits to employees free from taxation.
That’s a MAJOR TAX INCREASE that is not being portrayed as such.
In August 2007 the U.S. Census Bureau reported that 59.7% of Americans received employment-based health insurance in 2006. Thus, this would be a major change for those employed by employers who provide health insurance benefits and no impact for those companies that do not.
Your employer may have different rates depending upon group history and policy coverage. For a point of reference, the Kaiser Family Foundation and Health Research and Educational Trust report the annual cost of a family health insurance premium in 2006 was $11,480. Essentially under the McCain plan, your taxable income would increase by that amount … and whatever your tax rate (10% to 35%) would be applied. Although the employer has a rate per employee, the insurance expense is probably a group policy expense, so the impact of adding $11,480 to the average worker’s pay will impact lower wage-earners harder … as well as ethnic breakdown. For example, the median household income in 2006 for White Americans was $50,673 (25% tax bracket) while Hispanics were $37,781 and African-Americans were $31,969. (Source : Income, Poverty, and Health Insurance Coverage in the United States, 2006. Current Population Reports, Consumer Income. August 2007).
Simply, the CEO of the company will have the same additional taxable income --- $11,480 health benefit --- as well as the lowest paid worker.
While burdensome to all but the most affluent families, this level of spending can be deemed excessive.
While this tax increase is substantial to the individual, it would provide the Government with some needed revenue. According to the Committee for a Responsible Federal Budget A Fiscal Voter Guide to the 2008 Election report, this plan to eliminate of the tax exclusion for employer provided health insurance could result in adding $201 billion to $274 billion to the Federal Treasury. (Yep, that’s Billion.)
One could look at this as a necessity to pay for the ongoing Iraq and Afghanistan operations or addressing the “borrowing” from Social Security and Medicare fund for other spending programs. Yet the CRFB report also indicates that McCain’s plans to continue the Bush tax cuts which will cost the government $294 billion, and that McCain plans to reduce the Corporate Income Taxes costing the Treasury another $55 to $68 billion. (Yep, that’s Billion.) MORE on reducing Corporate Income Taxes in a future commentary.
The obvious question is, Why does McCain advocate this change ?
Republicans like Dr. Brian Davis believe that there needs to be more competition and less government intervention in healthcare.
IF employees begin to be taxed for health care benefits, employees may be inclined to want to opt out of insurance. With the rising cost that employers have seen in health care costs, they may likely comply. This could lead to the end of the employer-sponsored health care benefit system. In 2007, some 45.7 million Americans — 15.3 percent of the population — were uninsured so that figure could rise substantially as more people just determine that health care insurance is unaffordable.
That may work out good for employers … and possibly for healthy employees, but for the others that have health problems that would be a problem. The percentage of Americans with insurance through a public program increased from 27.0 percent in 2006 to 27.8 percentage in 2007, primarily as a result of gains in coverage through Medicare and Medicaid. IF the employer-sponsored health care benefit system is effectively terminated, that would cause an increase demands for public programs which may result in scaling back Medicaid benefits and eligibility.
Remember McCain said that Bush made "the right call" in vetoing the SCHIP legislation and has repeatedly voted to cut, eliminate, or restrict health insurance coverage for low income children and pregnant mothers.(source) Congresswoman Michele Bachmann (R-06) and Congressman John Kline (R-02) also voted against SCHIP legislation.
When Norm Coleman, Dr. Brian Davis, Dick Day, John Kline, Erik Paulsen, Barb Davis White, Ed Matthews, Michele Bachmann, or Glenn Menze talk about taxes, be sure to ask them if they support McCain’s efforts to tax health care benefits.
Also, as you watch the Republican National Convention, watch for how often "cutting taxes" is discussed and how many times eliminating the health care tax benefit is mentioned.
Tax fairness should not begin with taxing the health care benefits.
Sunday, March 30, 2008
Most Powerful MN Republican in Congress ? Coleman – No; Kline – No; Bachmann – Maybe
Query : Who will be the most powerful Republican representing Minnesota when the next Congress convenes in January 2009 ?
To answer the question, it’s best to define what is meant by “powerful”. For the purpose of this question, “powerful” is defined by influencing legislation or attracting media attention.
Also, the answer assumes that the three currently serving Republicans will be re-elected; that Jim Ramstad will not seek re-election; and that any new Republicans elected will not be assigned as high ranking members of significant committees.
First, let’s look at the current rankings by Congress.Org : Senator Norm Coleman (#82 out of 100);
Jim Ramstad (#203 out of 435);
Michele Bachmann (#363)
and finally John Kline (#396).
One would think that the Senate would present the most opportunity for power but with the entrenched party seniority system, that has not helped Coleman. Currently, the Senate is technically evenly divided with 49 seats for the Democrats and Republicnas, but the Republicans must defend 23. In addition, five Republicans and no Democrats have announced that they are retiring. Coleman should move up four spots on the ranking based on those retirements ( Larry Craig is rated below Coleman having been disclipined for his “behavior issues”.) Coleman currently has two high profile committees. Coleman is assigned to the Committee on Foreign Relations where he is behind Dick Lugar (IN) while George Voinovich (OH) was elected in 1998 (versus Coleman in 2002). As many Minnesotans know, Coleman is on the Committee on Agriculture whose ranking Republican is Saxby Chambliss (GA) with five other Republicans ranked higher than Coleman’s seniority. Also, as most of us rural areas of Minnesota know, Coleman has been unsuccessful in getting his Republican counterparts to get the 2007 Farm Bill enacted. The latest is another temporary extension until April 18, 2008 of the Paul Wellstone negotiated bill.
Due the Senate’s filibuster rules, unless VOTE 60 is achieved, legislation will remain firmly entrenched in limbo mode.
The House is another story.
Here the number of members that started the session that will not be returning seems to be growing everyday. 22 Republicans have announced their retirements at the end of the session. Another 12 Republicans will not be returning next year for a variety of reasons (seeking a different office, etc.) In contrast, maybe seven House Democrats are not seeking re-election.
The Democrats currently hold a 233 to 198 advantage over the Republicans.
The smart money is that the Democrats will hold the advantage in January 2009.
The interesting question is, who will the Republicans assign to the major committees?
In my opinion, the two most powerful committees are the Ways and Means and Appropriations Committees.
The House Ways and Means Committee is charged with writing tax legislation and bills affecting Social Security, Medicare, and other entitlement programs. Of the 24 Republican members on the Ways and Means Committee in 2006, only nine will return in 2009 — and that’s assuming every GOP panelist wins reelection this November. Jim Ramstad is Minnesota’s voice on the Committee.
The House Appropriations Committee is responsible for writing each of the 13 annual federal spending bills. Six of 29 Republicans are retiring and the ranking Republican, Jerry Lewis, is connected to a federal investigation. No Minnesota Republicans currently serve on the Committee.
John Kline is currently assigned to three committees, most significantly, the House Committee on Education and Labor where he is eleventh in the pecking order.
Michele Bachmann is currently assigned to only the House Committee on Financial Services.
Considering the number of openings on the Ways and Means Committee it would not be surprising for Congresswoman Bachmann to seek a seat. Considering her work on Minnesota’s Taxpayers Bill of Rights and being former federal tax attorney, she would be a logical candidate.
Logical, yet potentially disappointing if you desire any health care reform. While Jim Ramstad was a leading advocate for insurance reform, Bachmann has voted against SCHIP and Mental Health Parity.
Bachmann has become a media darling – making media appearances on Bill Bennett's Morning in America, the Laura Ingraham Show, the O’Reilly Factor, etc. She has also penned commentary on Townhall and initiated legislation such as the Light Bulb Freedom of Choice Act that appeal to a certain group of supporters that are likely to make contributions for her campaign committee. It’s a smart strategy that may return her for another term. Yet, the concern is not only for what may not happen with health care reform, but her ideas on tax policy.
The thought of “Powerful Congresswoman Michele Bachmann” just put shivers down my spine.
Voters in the Sixth and Second District have a choice, do you want Bachmann or Kline assigned to these committees to continue their efforts to neglect Health Care Reform and continue Tax Policies that grow the federal deficit ? This election is not only about who will represent your district but who will be assigned to these important committees.
To answer the question, it’s best to define what is meant by “powerful”. For the purpose of this question, “powerful” is defined by influencing legislation or attracting media attention.
Also, the answer assumes that the three currently serving Republicans will be re-elected; that Jim Ramstad will not seek re-election; and that any new Republicans elected will not be assigned as high ranking members of significant committees.
First, let’s look at the current rankings by Congress.Org : Senator Norm Coleman (#82 out of 100);
Jim Ramstad (#203 out of 435);
Michele Bachmann (#363)
and finally John Kline (#396).
One would think that the Senate would present the most opportunity for power but with the entrenched party seniority system, that has not helped Coleman. Currently, the Senate is technically evenly divided with 49 seats for the Democrats and Republicnas, but the Republicans must defend 23. In addition, five Republicans and no Democrats have announced that they are retiring. Coleman should move up four spots on the ranking based on those retirements ( Larry Craig is rated below Coleman having been disclipined for his “behavior issues”.) Coleman currently has two high profile committees. Coleman is assigned to the Committee on Foreign Relations where he is behind Dick Lugar (IN) while George Voinovich (OH) was elected in 1998 (versus Coleman in 2002). As many Minnesotans know, Coleman is on the Committee on Agriculture whose ranking Republican is Saxby Chambliss (GA) with five other Republicans ranked higher than Coleman’s seniority. Also, as most of us rural areas of Minnesota know, Coleman has been unsuccessful in getting his Republican counterparts to get the 2007 Farm Bill enacted. The latest is another temporary extension until April 18, 2008 of the Paul Wellstone negotiated bill.
Due the Senate’s filibuster rules, unless VOTE 60 is achieved, legislation will remain firmly entrenched in limbo mode.
The House is another story.
Here the number of members that started the session that will not be returning seems to be growing everyday. 22 Republicans have announced their retirements at the end of the session. Another 12 Republicans will not be returning next year for a variety of reasons (seeking a different office, etc.) In contrast, maybe seven House Democrats are not seeking re-election.
The Democrats currently hold a 233 to 198 advantage over the Republicans.
The smart money is that the Democrats will hold the advantage in January 2009.
The interesting question is, who will the Republicans assign to the major committees?
In my opinion, the two most powerful committees are the Ways and Means and Appropriations Committees.
The House Ways and Means Committee is charged with writing tax legislation and bills affecting Social Security, Medicare, and other entitlement programs. Of the 24 Republican members on the Ways and Means Committee in 2006, only nine will return in 2009 — and that’s assuming every GOP panelist wins reelection this November. Jim Ramstad is Minnesota’s voice on the Committee.
The House Appropriations Committee is responsible for writing each of the 13 annual federal spending bills. Six of 29 Republicans are retiring and the ranking Republican, Jerry Lewis, is connected to a federal investigation. No Minnesota Republicans currently serve on the Committee.
John Kline is currently assigned to three committees, most significantly, the House Committee on Education and Labor where he is eleventh in the pecking order.
Michele Bachmann is currently assigned to only the House Committee on Financial Services.
Considering the number of openings on the Ways and Means Committee it would not be surprising for Congresswoman Bachmann to seek a seat. Considering her work on Minnesota’s Taxpayers Bill of Rights and being former federal tax attorney, she would be a logical candidate.
Logical, yet potentially disappointing if you desire any health care reform. While Jim Ramstad was a leading advocate for insurance reform, Bachmann has voted against SCHIP and Mental Health Parity.
Bachmann has become a media darling – making media appearances on Bill Bennett's Morning in America, the Laura Ingraham Show, the O’Reilly Factor, etc. She has also penned commentary on Townhall and initiated legislation such as the Light Bulb Freedom of Choice Act that appeal to a certain group of supporters that are likely to make contributions for her campaign committee. It’s a smart strategy that may return her for another term. Yet, the concern is not only for what may not happen with health care reform, but her ideas on tax policy.
The thought of “Powerful Congresswoman Michele Bachmann” just put shivers down my spine.
Voters in the Sixth and Second District have a choice, do you want Bachmann or Kline assigned to these committees to continue their efforts to neglect Health Care Reform and continue Tax Policies that grow the federal deficit ? This election is not only about who will represent your district but who will be assigned to these important committees.
Thursday, March 01, 2007
Is Norm Coleman going Gutknecht or Wellstone on the Health Care Issue ?
I am an independent voter with no allegiance to any political party. I vote on the issues and the number one issue to me is Health Care. So when Norm Coleman issued a number of press releases in February announcing new proposals that he touts as a “comprehensive rural health legislative agenda”, I am naturally interested.
Coleman states “The quality of your healthcare should not be a reflection your zipcode, and my rural healthcare agenda seeks to efficiently enhance the quality, affordability, and accessibility of healthcare in rural Minnesota.”
His comment sounds more like a campaign speech then an actionable comprehensive solution to the health care problem. His attention to this issue admirable, yet somehow I sense that these are the issues that Paul Wellstone would have been pushing harder and longer than in the year prior to re-election. I thought that based on Coleman complaints about Wellstone's performance, that Coleman would have been pushing these legislative ideas earlier. Coleman said "People should be angry and they should be angry that nothing's been done. The senator's been on the health committee for 12 years and you know I think people are tired of pointing fingers and saying we didn't get it done because of this and because of this."
Well, it's only been four years, but Norm, why has it taken so long for you address this issue ? ? ? Remember, that for the first four years of your term, the Republican Party had both chambers of Congress and the Presidency.
Hence, I ask the question is Coleman, “Gutkencht-ing” the issue ? What is “Gutkencht-ing”?
Simple stated it is when a politician realizes that there is an issue that will appeal to his constituents and that he can talk endlessly, while realizing that the full Congress will not adopt it. I coined the term based former Congressman Gil Gutknecht’s 10/10 Ethanol plan (10 % ethanol by 2010). Gutknecht pandered to rural voters about his proposal, yet failed to get even get a hearing in Subcommittee on Energy and Air Quality. At every farm event, Gutknecht talked ad nauseam about the 10/10 plan while he should have been working his colleagues for legislative action. The 10/10 plan was an attempt to address America’s oil dependence problem, but it was ten years late and by itself would not solve the problem.
Reading the press release, Coleman is offering baby steps that address a portion of the health care problem. In some ways, it mirrors a standard mission statement from an insurance company :
Improve access,
Simplify the health care experience;
Promote quality;
and Make health care more affordable.
The cynic in me makes me wonder how much these proposals were created in concert with some of his political contributors, such as UnitedHealth Group which is the number 2 contributor to his campaign fund.
Health care is an important issue that affects every voter … heck, America spends more on health care than food. But the debate is being controlled by the insurance companies and pharmaceutical/medical device companies, with input from the medical community. The access and influence that those industry lobbyists have on legislation clearly impact politicians (and hence the government) in undertaking action, or inaction.
Last month, McKinsey and Company issued a report on the cost of Health Care in the United States. The analysis attributed some of the cost problems in that we spend $98 billion a year in excess administrative costs ( such as marketing – think of those commercials for Restless Leg Syndrome.) Further, McKinsey estimates excess drug costs to be $66 billion a year. Interestingly, the report estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Thus, if the Healthcare Industry could be squeezed of waste and excess spending, the uninsured problem could be solved. Resolving this issue is critical to all of us, as even Wal-Mart is forming a coalition dubbed "Better Health Care Together," pledged to convene a national summit by the end of May to recruit other leaders from business, labor, government and non-profits with the objective of providing universal health-care coverage for "every person in America.”
Since Coleman is the Ranking Republican on the Permanent Subcommittee on Investigations it would seem logical that he would want to review the claims reported by the McKinsey report.
So, while I applaud Coleman addressing the subject, it is with some skeptism. The most intrigueing legislation is to increase the nursing workforce. There is a simple supply-demand solution to this … provide free education to every person that passes a qualifying enterance exam … if our tax dollars can provide K-12 education, why not provide additional training for selected and needed occupations? On the other hand, his proposal for a hospital in Cass County is an example of earmark spending that if it was for any other state other than his home state would be riducled by fiscal conservatives.
Where will Coleman get the money for funding his legislation? How about CEO compensation … for example former UnitedHealth Group CEO William McGuire received a total compensation of $124.8 million last year. This outlandish amount is enough to fund many Rural Hospitals. Note : McGuire may seem to be a unique example, but consider others in the industry Wellpoint’s CEO Larry Glassrock received $25 million, Aetna’s CEO John Rowe received $22.2 million and Cigna’s CEO Edward Hanway received $13.3 million.
If Coleman is to be successful in taking this from a campaign speech to enacted legislation, we should see co-sponsors signing on and hearings being held. By this summer, if there is no action, then we’ll know it was a hallow effort.
As I recall in his 2002 campaign, a focal point was his little daughter telling us that when he promises Diary Queen, he keeps his promises. Well, Norm were waiting.
REFERENCE :
S.628 : A bill to provide grants for rural health information technology development activities.
S.629 : A bill to amend the Consolidated Farm and Rural Development Act to provide direct and guaranteed loans, loan guarantees, and grants to complete the construction and rehabilitation of rural critical access hospitals.
S.630 : A bill to amend part C of title XVIII of the Social Security Act to provide for a minimum payment rate by Medicare Advantage organizations for services furnished by a critical access hospital and a rural health clinic under the Medicare program.
S.631 : A bill to amend title XVIII of the Social Security Act to provide for coverage of remote patient management services for chronic health care conditions under the Medicare Program.
S.632 : A bill to provide for a hospital in Cass County, Minnesota.
S.633 : A bill to provide assistance to rural schools, hospitals, and communities for the conduct of collaborative efforts to secure a progressive and innovative system to improve access to mental health care for youth, seniors and families.
S.646 : A bill to increase the nursing workforce.
S.716 : A bill to establish a Consortium on the Impact of Technology in Aging Health Services.
Coleman states “The quality of your healthcare should not be a reflection your zipcode, and my rural healthcare agenda seeks to efficiently enhance the quality, affordability, and accessibility of healthcare in rural Minnesota.”
His comment sounds more like a campaign speech then an actionable comprehensive solution to the health care problem. His attention to this issue admirable, yet somehow I sense that these are the issues that Paul Wellstone would have been pushing harder and longer than in the year prior to re-election. I thought that based on Coleman complaints about Wellstone's performance, that Coleman would have been pushing these legislative ideas earlier. Coleman said "People should be angry and they should be angry that nothing's been done. The senator's been on the health committee for 12 years and you know I think people are tired of pointing fingers and saying we didn't get it done because of this and because of this."
Well, it's only been four years, but Norm, why has it taken so long for you address this issue ? ? ? Remember, that for the first four years of your term, the Republican Party had both chambers of Congress and the Presidency.
Hence, I ask the question is Coleman, “Gutkencht-ing” the issue ? What is “Gutkencht-ing”?
Simple stated it is when a politician realizes that there is an issue that will appeal to his constituents and that he can talk endlessly, while realizing that the full Congress will not adopt it. I coined the term based former Congressman Gil Gutknecht’s 10/10 Ethanol plan (10 % ethanol by 2010). Gutknecht pandered to rural voters about his proposal, yet failed to get even get a hearing in Subcommittee on Energy and Air Quality. At every farm event, Gutknecht talked ad nauseam about the 10/10 plan while he should have been working his colleagues for legislative action. The 10/10 plan was an attempt to address America’s oil dependence problem, but it was ten years late and by itself would not solve the problem.
Reading the press release, Coleman is offering baby steps that address a portion of the health care problem. In some ways, it mirrors a standard mission statement from an insurance company :
Improve access,
Simplify the health care experience;
Promote quality;
and Make health care more affordable.
The cynic in me makes me wonder how much these proposals were created in concert with some of his political contributors, such as UnitedHealth Group which is the number 2 contributor to his campaign fund.
Health care is an important issue that affects every voter … heck, America spends more on health care than food. But the debate is being controlled by the insurance companies and pharmaceutical/medical device companies, with input from the medical community. The access and influence that those industry lobbyists have on legislation clearly impact politicians (and hence the government) in undertaking action, or inaction.
Last month, McKinsey and Company issued a report on the cost of Health Care in the United States. The analysis attributed some of the cost problems in that we spend $98 billion a year in excess administrative costs ( such as marketing – think of those commercials for Restless Leg Syndrome.) Further, McKinsey estimates excess drug costs to be $66 billion a year. Interestingly, the report estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Thus, if the Healthcare Industry could be squeezed of waste and excess spending, the uninsured problem could be solved. Resolving this issue is critical to all of us, as even Wal-Mart is forming a coalition dubbed "Better Health Care Together," pledged to convene a national summit by the end of May to recruit other leaders from business, labor, government and non-profits with the objective of providing universal health-care coverage for "every person in America.”
Since Coleman is the Ranking Republican on the Permanent Subcommittee on Investigations it would seem logical that he would want to review the claims reported by the McKinsey report.
So, while I applaud Coleman addressing the subject, it is with some skeptism. The most intrigueing legislation is to increase the nursing workforce. There is a simple supply-demand solution to this … provide free education to every person that passes a qualifying enterance exam … if our tax dollars can provide K-12 education, why not provide additional training for selected and needed occupations? On the other hand, his proposal for a hospital in Cass County is an example of earmark spending that if it was for any other state other than his home state would be riducled by fiscal conservatives.
Where will Coleman get the money for funding his legislation? How about CEO compensation … for example former UnitedHealth Group CEO William McGuire received a total compensation of $124.8 million last year. This outlandish amount is enough to fund many Rural Hospitals. Note : McGuire may seem to be a unique example, but consider others in the industry Wellpoint’s CEO Larry Glassrock received $25 million, Aetna’s CEO John Rowe received $22.2 million and Cigna’s CEO Edward Hanway received $13.3 million.
If Coleman is to be successful in taking this from a campaign speech to enacted legislation, we should see co-sponsors signing on and hearings being held. By this summer, if there is no action, then we’ll know it was a hallow effort.
As I recall in his 2002 campaign, a focal point was his little daughter telling us that when he promises Diary Queen, he keeps his promises. Well, Norm were waiting.
REFERENCE :
S.628 : A bill to provide grants for rural health information technology development activities.
S.629 : A bill to amend the Consolidated Farm and Rural Development Act to provide direct and guaranteed loans, loan guarantees, and grants to complete the construction and rehabilitation of rural critical access hospitals.
S.630 : A bill to amend part C of title XVIII of the Social Security Act to provide for a minimum payment rate by Medicare Advantage organizations for services furnished by a critical access hospital and a rural health clinic under the Medicare program.
S.631 : A bill to amend title XVIII of the Social Security Act to provide for coverage of remote patient management services for chronic health care conditions under the Medicare Program.
S.632 : A bill to provide for a hospital in Cass County, Minnesota.
S.633 : A bill to provide assistance to rural schools, hospitals, and communities for the conduct of collaborative efforts to secure a progressive and innovative system to improve access to mental health care for youth, seniors and families.
S.646 : A bill to increase the nursing workforce.
S.716 : A bill to establish a Consortium on the Impact of Technology in Aging Health Services.
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