I heart Chuck Grassley.

I know, I know, I shouldn't say such things about a Republican, but really I can't help myself in this case. Grassley is just so into S-Chip, it makes my heart all aflutter.

Here's why: President Bush apparently got a little misinformation (probably was intentional, who knows) about what the compromise S-Chip bill would do. Someone told Bush the bill would cover children in families with annual incomes of $83,000 (400% of the federal poverty level). However, this is patently untrue. The compromise bill, finalized over the weekend with final text expected today, limits S-Chip enrollment to 300% of the poverty level (maybe 350%, I'm not sure). The $83,000 that Bush refers to in his little rant on Thursday was about New York. NY petitioned to cover children in families at 400% of the poverty level ... and was denied, as Bush should know since his right hand man, HHS Secretary Mike Leavitt, did it.

So Grassley comes out Friday and says flat out, Bush, you don't know what you're talking about. Some highlights of Grassley comments:

• From CongressDaily: Bush's comments indicate a "miserable lack of understanding of what we're doing and even what his own administration has done;"
• From LA Times: Bush's proposal for SCHIP is insufficient "to accomplish what he said he wants to do, and that's cover more kids;"
• From USA Today: "The White House must recognize that bipartisan compromise is necessary" to continue the program; and
• From NY Times: "Drawing lines in the sand at this stage isn't constructive. I wish he'd engage Congress in a bill that he could sign instead of threatening a veto, and I hope he'll still do that."

"Miserable lack of understanding" is my favorite. I think it's just so rare that a Republican comes out and says it. You're wrong, Bush, and you suck (okay, maybe the "you suck" part is just my own personal view).

Runner up for favorite Republican on S-Chip is Orrin Hatch. When asked if he would vote to overturn Bush's veto, Hatch said, "You bet your sweet bippy I will." Aw, shucks, Orrin, you're just too adorable.

I started this post originally on Friday, and obviously more things have happened than my expression of adoration for two senior Republican senators. No, indeed, you may have heard that the compromise bill has been released. Here's the details, ala a Senate Finance Committee press release.

Grassley and Baucus, 1, Stark, 0

To be honest, I almost can't even stand to blog about S-chip anymore, I am so sick of hearing about it. But since it is my life and I love it, and I am a mere 10 days away from seeing SOMETHING actually happen with it, here's yet another post about S-chip.

The House gave in. The "compromise" bill (hopefully) is being released tomorrow and word on the Hill is that Stark lost his oh-so-precious cuts to Medicare Advantage. Baucus and Grassley must be thrilled. Sure, it's not really much of a compromise (considering it is so closely worded to the Senate bill they might not even have to re-vote on it, depending on whether the House can force some concessions). But still. At least it's something. That can pass in the Senate at least -- all bets are off in the House. Today I read that 17 House GOPers have said they will vote in favor of the new bill. Another Republican member (I forget who, but he's working along with Rahm Emanuel) predicted 30. The question becomes: Will it be enough to override a veto? I've heard some mixed predictions -- some say that there's these limited number of Republicans volunteering to support it, while others have said (over and over, I would say), Republican or not, you simply cannot vote against children.

Only 10 days before we find out. I'm going to fucking go into S-Chip withdrawl when this is over.

Let's talk Mayo Clinic

and Hillary, for that matter.

But focusing on the Mayo Clinic for a sec ... The clinic on Friday released 19 recommendations for health care reform. One of their major proposals is to make health insurance more portable. I mentioned this topic in my last post. I simply cannot stress enough how much I support portable health insurance. It doesn't make any sense to have it tied to employers anymore. I mean, hello, people of my generation have extreme ADD when it comes to holding a job. How are we ever supposed to establish a connection with a doctor, which will help us receive better, more coordinated care, if we keep having to change insurance providers every year and a half? New York Times says that one and four change jobs every year ... and I think they might be referring to me, haha.

What really surprised me about the coverage on this was the employer response. According to the Times,

Executives of several large employers who took part in the Mayo discussions agreed that rising medical costs and the aging of the baby boomer generation were pushing the current system toward a crisis. But they said they were not ready to abandon their current health plans for employees.

“We do not believe in relinquishing the employer-sponsored health care system,” said Anthony C. Wisniewski, a Mayo panelist who is executive director of health care policy at the United States Chamber of Commerce.

That's basically all the article says about it, which is kind of annoying because I want to know WHY they don't want to give up health insurance. It would make them totally more profitable. God knows those car makers are itching to drop insurance coverage ... why not businesses in the Chamber of Commerce? Perhaps because a good insurance plan makes a job offer more attractive? Hard to say without a better background in business.

You can read the rest of the recommendations here. Overall, I felt like the recommendations were very thought out .. radical but not so radical it couldn't be done. I'm very hopeful that Hillary will implement some of their recommendations into her reform. The whole quality-cost debate I think is pretty standard, but portability is something I would really like to see implemented.

Now on to discussing my girl Hill's proposal. Since I didn't cover it at work (as I did the Mayo Clinic) this is news to me too. Looking a press release from today on her website, the final prong of her three prong plan includes none other than --- PORTABILITY. (Full disclosure: I love Hillary. I volunteer for her campaign. Which truly demonstrates my love because I hate making cold calls ... but for her, I do it.). She even throws in tax credits. Listen to her: "If you like the plan you have, you can keep it." It's genius. She has some other good things outlined in the press release, so I recommend reading it.

From a different press release (the mainstream media will have more detailed coverage tomorrow ... if I have time I'll post some the main pieces so I am not completely one-sided.):

If you’re one of the tens of million Americans without coverage or if you don’t like the coverage you have, you will have a choice of plans to pick from and that coverage will be affordable. Of course, if you like the plan you have, you can keep it.

• Affordable: Unlike the current health system where insurance premiums send people into bankruptcy, the plan provides tax credits for working families to help them cover their costs. The tax credits will ensure that working families never have to pay more than a limited percentage of their income for health care.
• Available: No discrimination. The insurance companies can’t deny you coverage if you have a pre-existing condition.
• Reliable: It’s portable. If you change or lose your job, you keep your health care.

...If you have a plan you like, you keep it. If you want to change plans or aren’t currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums.

Reading this shit practically makes me giddy. Also, hopefully you caught last week's Newsweek, which had extensive coverage about Hillary and "what kind of decision maker she'd be." It has some good insight into the lessons she's learned from the failed health care reform attempt of 1993/4. Here's a different web exclusive article on health care and Hillary.

For once I'm not going to write about S-Chip

There was an interesting opinion piece by Michael Cannon, director of health policy studies at the Cato Institute, in today's USA Today. Cannon argues that so many of the uninsured have access to insurance ("As many as 20% of the "uninsured" are eligible for government health programs, so in effect they are insured. On top of that, economists Kate Bundorf of Stanford University and Mark Pauly estimate that as many as 75% of the uninsured can afford to buy insurance," he writes), increasing access to health care isn't really the problem we should be focusing on ... cost is.

He writes:

Simply expanding coverage would have little effect on the quality of care, health disparities, or how long we live, nor would it stop free-riders from shifting costs to others. In fact, expanding coverage through government regulation or tax-and-transfer programs would make our problem worse.

He makes a point about the rising cost of premiums, that they aren't

some inevitable result of market forces, but of government programs and tax preferences for employer-controlled insurance. By rewarding employer-controlled coverage — and penalizing plans that stay with you from job to job — the government strips people of their health insurance when they need it most.

He then goes on to support Bush's tax breaks. I'm not completely sure how I feel about that (I know very little about taxes, just that I seem to pay a large proportion of my very small paycheck), but I think Cannon makes a good point that plans that travel should not be penalized, especially since I do think they will be the new way of purchasing health care in the future. Regional purchasing pools are the wave of the future, I'm telling you.

Back to Cannnon ... he ends by saying

If we want to increase access to health care, our first priority must be to contain costs. Nothing would help more than 200 million cost-conscious consumers.

Letting Americans own their health care dollars is the right thing to do. And as it happens, it would also cover a lot of the uninsured.

Cannon makes some very valid points. Cost containment must happen. We as a nation cannot continue to spend as much on health care as we do. And obviously this ties into a couple other areas, such as increasing preventive care and overall health. High insurance and hospital fees are not completely to blame here ... so is obesity and not exercising and smoking and not getting regular check-ups. A change in tax policy is not going to lower costs on its own. We need to have a different view toward health altogether.

Who knew you could do this?

Reporting on S-chip has taught me so much about procedural tactics, it's kind of scary.

This week was no exception. Bush decided on Friday, after business hours, while Congress is in recess, that he is going to make it virtually impossible for any state to enroll children in S-chip if their families earn more than 250% of the federal poverty level. Under his news rules, if states want to insure children in families earning above 250%, they must:

• Enroll 95% of eligible children in families under 200% of the poverty level (This is impossible. No state does it.);
• Ensure that children in families over 250% are uninsured for a year before enrolling them;
• Charge kids in families over 250% premiums and copays at the same rates as private insurance;
• Ensure that the percentage of children enrolled in private insurance plans doesn't drop by more than 2% (to make sure that employees aren't dropping their private insurance left-and-right to run on over to public assistance, the Republicans' anti-Christ); and
• Create mechanisms to ensure that employers don't create policies that encourage employees to switch to public programs.

While it probably goes without saying, I think this new policy is stupid. Yes, I suppose Bush is technically within his rights to create it ... it just seems unnecessarily cruel to set states up for failure, and in turn, children. It really bugs me in its hypocrisies. Bush expects (or maybe he doesn't?) states to now strive for enrolling 95% of all eligible children at 200%, the law's "original intent" or whatever, but under Bush's SCHIP proposal, there wouldn't be enough money to pay for them long-term. What's the point of bringing children into the program, if two years down the line, you are going to have to kick them out when the program runs out of funding? In essence, he basically set up that rule to prevent states from covering children above 250%. Someone never told Bush "honesty is the best policy."

Obviously he can't tell the truth about what he's doing, though. He would sound like an asshole. Which I think perfectly describes what he just did, denying care to children and putting more burdens on states. He is being so incredibly inflexible about everything that is S-chip.

Real reporters' coverage available here and here and here.

Closure of King Harbor Hospital

Friday's announcement that Martin Luther King Jr. Harbor Hospital will close after losing $200 million of federal funding, after it failed a second CMS inspection, highlights yet another problem caused by having high numbers of uninsured residents.

King Harbor is one of the lowest-income areas of L.A., meaning most likely a large number of patients visiting the hospital for care would be uninsured or on Medicaid. Either way, the hospital was probably operating on larger debt than most other hospitals in higher income areas. While I'm sure all the hospital's problems cannot be blamed on funding (I really hate it when government entities blame all problems on inadequate funds -- **cough cough** -- FDA), I think it's safe to say that the hospital would have been able to hire more knowledgeable staff and run the place more efficiently with more funds from the very beginning.

In short, what I'm trying to say is that a vicious cycle exists within our current health care system:

• Uninsured/underinsured residents are less likely to receive care because they can't pay the bills;
• Hospitals that serve large numbers of uninsured/underinsured can't collect enough funds when they're patients can't pay, thus making it difficult to hire competent staff;
• Without competent staff, the hospital can't offer care worth paying for, and might end up the way of King Harbor, and the community loses access to care all over again.

I think that single-payer systems have a lot of problems, but I think in this situation they offer a benefit. When the government is paying for care, and the wealth of the patient is no longer a factor, all patients have a better shot at receiving high quality care. Our system simply reinforces an existing socioeconomic divide. Will there still be a divide under a single-payer system? Of course. There's no way of convincing a doctor to practice at a hospital if he or she is concerned about being shot driving to and from work. Same idea for rural areas. But at least wealth is taken out of the equation.

***

Last week, the Philadelphia Inquirer had a great opinion piece about health as a public good, as opposed to a private good, that I think relates to the problems with King Harbor. Columnist Chris Satullo writes,

Health care is a classic public good that should be supported by a social compact: The healthy should pay into the system to underwrite care for those who need it now, both as a matter of civic morality and self-interest. They need to support the system now so that it'll be there come the inevitable day when they'll need it.

...

The goal shouldn't be for government to supplant the private health-care market, but to tame it. States have tried, but only the feds can really do what's needed: Organize the market rationally so it covers all at a basic level, wastes less, and offers consumers intelligible, workable choices.

For more coverage about King Harbor, see here, here and here.

Now what?

With both the House and the Senate having passed substantially different versions of health care legislation, I'm intrigued to see how the conference committee is going to find some sort of viable solution. Both sides are saying, "here's this provision of our bill that can't change" and they seem completely at odds with each other.

In the House, both Dems and Republicans are saying that the tobacco tax increase can't go above 45 cents. Dems already lost 10 votes because of the tax in the first round, who knows how many more they'd lose if they increased the tax to the Senate level of 61 cents.

Meanwhile, Republican senators do not seem willing to even consider cuts to Medicare Advantage (complete bullshit if you ask me...). But the Senate already has the smaller expansion -- if you were to just collect funds from a 45 cent tax increase, it wouldn't even be enough to fund the $35 billion expansion. So basically senators have to find a completely different, non-controversial source of funding. I hope they're creative, because I'm not sure that exists.

My prediction: $35 billion expansion, with some of the House's Medicare provisions (definitely the reversal of scheduled physicians cuts, to be funded perhaps by the cuts to nursing and inpatient rehabilitation centers?), without the MA cuts. All to be funded with a 45-cent tax increase and "unidentified non-controversial tax" (I've heard that perhaps they could better collect back taxes, and that would get lawmakers the needed money).

What makes it even more tricky is the impending presidential veto. I wish Bush would get off his ideological high horse already. Leavitt is quoted in the NY Times as saying

Congress was jeopardizing health care for millions of needy children by passing bills that “the president will have no choice but to veto.”

Seriously, what an ass. So not only does the conference committee have to come up with something that most of the lawmakers can agree on, it also has to be veto-proof. That, or millions of children go without health insurance. No pressure Congress. No pressure at all.