Monday, August 24, 2009

Parsing the NY Times on Health Care

One of my sisters graciously forwarded two articles from Sunday's NY Times, and here's my take on these:

The article entitled "A Basis is Seen for Some Health Plan Fears Among the Elderly" ( certainly illustrates that fears among the elderly are a great deal more than "not entirely irrational" as the author puts it. Let's begin with "Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient"....right on, but begging the question, by the way, of any thought that the government can be more efficient than either.

The article says that "the House version of the legislation [and doesn't having different versions cause questions about trial balloons and the lack of seriousness in drawing up the legislation?] would help older Americans with their drug costs." Now wasn't this done under the Bush general satisfaction????

One, apparently pro- Obama plan individual is quoted saying the elderly are responding to "fear of the unknown." Of course, such fear on questions of their health care would not seem unfounded, but the article goes on to diss the elderly, "62 percent [of those over 45] said they were confused by the debate in Washington, compared with 43 percent of those under 65." I'd suggest that the 57% of those under 65, or most of them, have not followed the debate and know nothing beyond platitudes of the discussion, in other words they know not enough to be confused.

Finally, what do doctors think: "In effect Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries. Many doctors are dubious." And..."Cardiologists will be especially hard hit...'Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients,' said Dr. John C. Lewin, chief executive of the American College of Cardiology."

Please bear in mind that the people who are proposing this massive change in an existing system with which most people are happy (note polls) have never run anything in their lives. How can they, honestly, make the claims they do to produce a successful, if volcanic, change in something as vital as American's health care?

The second article on the San Francisco public health plan ("A Public Option that Works" is interesting, and I am not opposed to differing plans being tried locally or within states. However, this article leaves many questions unanswered and fails to mention that the San Francisco plan is being challenged before the U.S. Supreme Court (The court will decide on Oct. 5 whether or not to review the case)...but the suit, which is supported by the U.S. Chamber of Commerce and the National Association of Manufacturers, gives an indication that the response of the business world is not as approving as the opinion piece indicates. According to the San Francisco Chronicle ( July 20), "More than 80 percent of the $200 million annual cost will come from state and local taxes and payment from patients, based on their incomes. The restaurant association's lawsuit challenges the city's authority to require large and midsize companies [over 19 employees] to pay the rest of the bill."

The Times' authors offer a 4 percent surcharge instituted at 25 percent of restaurants as a mitigating factor... acknowledging also that costs are passed on to employees in the form of lower or delayed pay raises. This does seem regressive to me, as would the restaurant association's desire to pay for the plan through a quarter percent increase in the sales tax.

Under the San Francisco plan, employers with between 19 and 100 employees must add $1.85 per hour cost per employee for "pay or play" ($1.23 for those with over 100 employees). This is a substantial employment cost, and despite the assurances of the authors (offered without statistical backup) that employment in San Francisco has not suffered, it is a cost that would make most small business owners shudder.

There's nothing in this article that informs on satisfaction with the plan among users. It has the advantage that a national plan would not have of not affecting the health care of those satisfied with their current coverage (about 87% of Americans, I believe). The article mentions that Massachusetts has a public health plan without offering any details, and this is as well since the Massachusetts plan is rapidly heading for insolvency.

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