Consumer Directed Healthcare

By LAURIE KELLMAN, Associated Press Writer, Yahoo! News

WASHINGTON – For Democrats determined to get a health care bill, Sen. Roland Burris is like the house guest who couldn’t be refused, won’t soon be leaving and poses a plausible threat of ruining holiday dinner.

Suddenly, he can no longer be ignored.

The Illinois Democrat, appointed by disgraced former Gov. Rod Blagojevich, says he’ll only vote for a bill to provide health care to millions more Americans as long as it allows the government to sell insurance in competition with private insurers.

And he says he won’t compromise.

“I would not support a bill that does not have a public option,” Burris, 72, said in a recent interview with The Associated Press. “That position will not change.”

Those words caught the attention of the very Democratic leaders who tried to keep Burris out of the Senate, suggested he resign and have shunned him in unprecedented fashion. Burris is not the only Democrat to insist on creation of a government-run health plan. But he is the one who has the least to lose by defying President Barack Obama and the Democrats who once turned him out in the cold rain.

It was early January and Blagojevich had appointed Burris, a former Illinois attorney general, to Obama’s former Senate seat — defying Democrats in Washington who had wanted someone without a tainted patron and with a better chance of winning election in 2010.

What happened next was a procession of ugly images, from Burris’ rain-swept news conference after Democrats turned him away from a swearing-in to Illinois Rep. Bobby Rush daring Democrats to block an accomplished lawyer who would be the chamber’s only black.

Bitterly, the Democrats seated Burris. But when it came out that Burris had admitted what he had denied under oath — that he’d unsuccessfully tried to raise money for Blagojevich — Majority Whip Richard Durbin, D-Ill., suggested that Burris resign. He refused.

A Senate ethics committee probe is pending into Burris’ statements. Democratic leaders, meanwhile, refused to support any effort by Burris to seek a full term, and he will leave the Senate in 2011.

Meanwhile, his relationship with the rest of his caucus has settled into one of mutual, if chilly, benefit.

It works this way: Burris stays mum about any bitterness he may feel about his reception, and he gets Obama’s Senate seat for two years. Democrats seat him, don’t speak of him and can count on his loyal vote at a time when all 58 Democrats and two independents must vote together to prevent Republican filibusters.

They’ve never needed 60 votes like they do on the yet-to-be-finalized health care bill. A disciplined grin shows that Burris knows it.

No, he says, he will not vote for any version of a government-run plan circulating in the Senate, other than the full-blown one from the Senate Health, Education, Labor and Pensions Committee.

He won’t vote, for example, for Republican Sen. Olympia Snowe’s idea to use the threat of a public option to force insurers to lower premiums by certain deadlines. He hasn’t seen the details of another idea, proposed by Sen. Tom Carper, D-Del., that would allow each state to decide whether to offer public coverage to compete with private insurers. The health committee’s proposal, he says, must be in the final bill to earn his vote.

“Yeah, that’s the one,” Burris said.

By definition, all 100 senators are relevant because any one can block Senate business unless there are 60 votes to override the objection. But Burris’ stated position on the public option means that Democrats can no longer take his vote for granted.

It’s too early to tell whether the public option, or some version of it, ends up in the final compromise between a committee of House and Senate lawmakers. First, each chamber must pass its version of a health care bill. House Democrats are insisting on the government-run plan; but in the Senate, the public option is less popular in both parties.

Every Democratic vote is important. And yet, Democratic leaders aren’t talking about Burris.

Instead, they’re talking confidently about having the votes for the biggest policy overhaul in a generation, a signature issue for Obama and the Democratic Party.

Finance Committee Chairman Max Baucus, D-Mont., said Burris’ demand alone makes him no different than other senators seeking this or that in the bill.

“I will do what I can to address the thises and thats,” Baucus said. “But my strong feeling is in the end, the need for health care reform is to get 60 votes (and) is going to trump the concerns that some might have.”

For his part, Burris says he’s just representing the wishes of his state. And he’s relentlessly loyal to the arrangement. His only acknowledgment of being treated differently than others is a reference to the “distractions” that marked his first weeks in office.

Ask him whether he feels badly treated by the leaders, and he’ll answer with a question:

“By whose standard?”

Go a couple more rounds, and he’ll elaborate, generally.

“I feel that I’ve had great opportunities here,” Burris said. “I feel like anytime I had a question that needed answered, anytime I needed something, there was certainly assistance there.”

Does he feel respected and listened-to? Burris pauses and looks puzzled.

“Yes. I’m a senator from Illinois representing 13 million people. I’m one of 100, and I speak on the floor, I preside over the Senate, I co-sponsor legislation,” he says. “I’m very busy, I’m very challenged, and I have one problem.”

He grins.

“I enjoy what I’m doing.”

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By: Jennifer Newell
Published: Thursday, 15 October 2009 ~ HealthNews

It is complicated. Listening to a singular pundit or TV channel for news about health care reform may only provide talking points, and attempting to put together the entire debate and its current status leaves most people confused and frustrated. The ins and outs of health care reform are undoubtedly complicated, especially as hundreds of pages of legislation filled with political-speak will likely dictate the future of health care in America. But the issues at stake are rather simple, and though the debates rage on, a basic understanding of the core of health care reform is necessary for the public to stay aware and involved in the process.

Health care reform became an issue partially because the public demanded it. Not only are there more than 46 million Americans currently without any type of health insurance, another 25 million people are underinsured. And recent economic woes have sent hundreds of thousands more into the category of uninsured as unemployment numbers rise. Another contributing factor to the underinsured and uninsured is medical costs that continue to rise; Health Affairs reported that $2.4 trillion was spent in 2007, which is 52 percent more than any other nation in the world. Add to those numbers the fact that of the 1.5 million Americans that are likely to declare bankruptcy in 2009, more than 60 percent of them result from medical bills, per a 2009 study by the American Journal of Medicine. Thus, the need for action increases by leaps and bounds.

When President Barack Obama campaigned for the office he currently holds, he spoke of the need for health care reform on a consistent basis. And just over one month after taking the oath of office, he reiterated his focus on the health care crisis that “cannot wait.” By June of 2009, he brought the issue to Congress as a must-do item on the agenda, and he urged the idea of a government-sponsored health insurance plan, similar to Medicare and now known as the “public option,” to compete with the private insurance companies now dominating the market, along with the mandatory removal of preexisting conditions as a reason for refusal of any health care.

While some Democrats in Congress embraced the plan, others were skeptical of implementing a public option, and Republicans blatantly rejected the idea, fearing low quality care and the strain that might cause private insurance companies to be put out of business. The debates then began in the hall of Congress but quickly disintegrated to divisive jabs when erroneous information spread that illegal immigrants would be covered under the public option, that death panels would be instituted to rid society of some of its sick or elderly members, and that people would not be able to keep their current insurance coverage if they chose to do so. Some of the public became fearful that the public option would create a socialist form of medical care in the United States, and many in Congress fell in line with those fears, standing back from support of any drastic changes to the current system.

Another stumbling block for potential agreement on the issue of reform is the ability of the government to find ways to pay for it. Numerous ideas have been introduced, including cutting excess from Medicare, and while those continue to be debated, the general consensus remains that any health care reform package should provide a viable alternative to increasing the U.S. government’s current deficit.

It should also be noted that a great majority of the members of Congress have or continue to accept large campaign donations from private insurance companies and their executives, making it more difficult to stand for changes that those companies staunchly oppose. Senators and Representatives who have chosen to support drastic health care reform have likely done so at the risk of losing campaign contributions and possibly future elections, if they accepted said monies in the first place.

The latest development in the ongoing saga of Congress’ attempt to address health care reform involves a bill introduced to the Senate on September 16, 2009, by Senator Max Baucus (D-MT). America’s Healthy Future Act proposes a 10-year overhaul of the health care system that would cost roughly $829 billion, though the Congressional Budget Office’s study revealed it would not only be paid for by taxes on expensive and comprehensive health plans and reductions in Medicare Advantage spending, but it would reduce the deficit by $81 billion over the next decade.

The meat of the bill proposes the creation of health insurance cooperatives (co-ops), which are non-for-profit insurance groups controlled by consumers to compete with private insurance companies. However, this is different from the aforementioned public option in that it would not be regulated by the government (after its initial launch and sponsorship by federal funding). Along with the co-op initiative, the Baucus bill proposes an individual mandate that will require every American to buy some form of insurance or pay a penalty, with those living three times below the poverty level eligible to receive subsidies to aid in their purchases.

Baucus prepared his bill to come before the Senate Finance Committee on October 13 for a vote, but on October 12, a lobby representing a group of insurance companies released a previously-commissioned study by PricewaterhouseCoopers that warned of insurance premiums rising drastically should the Baucus bill eventually be passed into law. It was speculated that the news was released to deter members of the committee from passing the bill, though it seemed to effect none of the votes either way.

The October 13 hearing was held as scheduled, and the Baucus bill passed by a vote of 14 to 9, split directly down the line with Democrats voting for it and Republicans voting against it with one sole exception when Olympia Snowe (R-ME) crossed party lines to cast her vote in favor of the bill.

Where does that leave health care reform?

Many steps remain in the process. Changes to the Baucus bill are inevitable, as it must be combined with the previously-passed Health Committee bill that provided for a public option. Ultimately, the bill that comes before the Senate must win at least 60 votes to pass and avoid the possibility of a Republican filibuster, and Congressional aides estimate that the meetings to merge the bills and finding consensus between House and Senate proposals will require a minimum of several weeks, according to CNN.

Therefore, Americans must wait. While constituents can contact their representatives in Congress to express their opinions, they must then wait as the fate of their health care coverage is debated on Capitol Hill. The goal is to pass some form of health care before the end of the 2009 calendar year, but what kind of reform eventually passes remains to be seen.

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Mississippi, Other Southern States Do Poorly as Midwest, New England Provide Best Care
By Susan Donaldson James
Oct. 8, 2009—

Vermont leads the nation in the delivery of its health care, while Mississippi is rated the worst, according to a non-partisan study that compares all 50 states and the District of Columbia.

Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators of health care.

At the bottom were Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas.

The Commonwealth Fund Commission’s “Scorecard on Health System Performance,” which was released today, rated the states on access, quality, costs and health outcomes in a follow up to their 2007 report.

Overall, the states which did best on the Commonwealth scorecard were in New England and the upper Midwest, and the worst states were in the South.

Vermont, with only 640,000 residents, has nearly universal health care coverage with 93 percent insured. Its innovative “Blue Print for Health” focuses on prevention of chronic diseases.

Click Here to Compare Health Care Quality State By State
http://www.commonwealthfund.org/Charts-and-Maps/State-Scorecard-2009.aspx

“We’re small. There are 19 cities larger than the state of Vermont,” said Susan Besio, director for health care reform and Medicaid for Vermont.

“But I believe there is something unique about Vermont in terms of its culture,” she told ABCNews.com. “We want to take care of each other and we are a healthy state.”

In Mississippi, however, about 20 percent are uninsured despite having some of the highest rates of hypertension, diabetes and asthma.

According to the report, only 35.7 percent of adults 50 or over in Mississippi receive recommended screening and preventive care.

“When you compare Mississippi on almost any socio-economic profile, we are a struggling population that has a large percentage of low-income individuals, high unemployment rates, low rate of education,” said Robert Pugh, director of the Mississippi Primary Health Care Association.

The scorecard “paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs,” according to co-author Cathy Schoen, who is senior vice president of the commission.

“Where you live matters for access, quality of care and whether you live a long and healthy life,” she told ABCNews.com. “These wide and persistent gaps among states highlight the need for national reforms and federal action to support states.”

For example, 32 percent of working-age adults in Texas are uninsured, compared to only 7 percent in Massachusetts in the most recent survey.

“It’s very hard to have a high performing health care system and hospitals that do well for everyone if you have a high rate of uninsured in the state,” said Schoen.

In 1999-00, there were only two states with 23 percent or more of adults uninsured. But by 2007-2008 there were nine.

Children fared much better, due in large part to the Children’s Health Insurance Program (CHIP) under Medicaid. The number of states with 16 percent or more of children uninsured dropped from nine to three during the same time period.

Other findings of the report were that in a, costs rose and quality improved in areas where outcomes were reported to the public.

Vermont’s ‘Blue Print For Health’ A Model
The Green Mountain state was cited for its model “Blue Print” program. Launched by Republican Gov. Jim Douglas, it covers everything from teaching children healthy eating to helping seniors stay in their homes rather than going to costly nursing homes.

“You betcha, I feel good about the reforms we put in place,” Douglas told ABCNews.com. “It’s centered on quality and containing costs. Care shouldn’t start in the emergency room.”

All Vermonters are encouraged to have yearly exams and adults are notified when they are due for check-ups.

Douglas talks to children about “getting off the couch” and set an example just this week by joining elementary students on a walk to school.

With the second oldest population in the nation, Vermont subsizes care for seniors and the disabled to defray the costs of home care. Nursing home beds were reduced by 200 last year.

In one pilot program, electronic medical records can avert expensive tests like MRIs and x-rays. One emergency room doctor seeing a woman with stomach pains discovered in her online medication history that she had not filled her prescription for ulcer medicine.

“It takes time and so a lot of the fruits come from years of work and planning and cooperation,” said Douglas.

Health Care Affects a State’s Economy
But Mississippi, with the highest infant mortality and low birth rates in the nation, makes access to these Medicaid programs more difficult, according to Roy Mitchell, director of the Mississippi Health Advocacy Program (MHAP).

“I am not at all surprised we were 51st on the list,” he told ABCNews.com. “We are last on several health indicators. Our policy makers work hard at being last.”

Despite one of the highest matches of federal to state dollars in Medicaid funding, the state mandates “face-to-face” eligibility, requiring all new applicants and those reapplying for benefits to come in for an interview.

“As a direct result, 65,000 children have fallen off the rolls,” Mitchell said.

“Mississippi does virtually no outreach at all. They don’t publish where these face to face stations are and what times,” he said. “It’s a bureaucratic maze even to find out where to go. And when they get there they don’t have a certain document.”

Of those, about 77 percent would be eligible, he said. “It’s touted as fraud prevention.”

These disparities between the highest and lowest ranked states could be alleviated with national reform, according to Commonwealth.

The report emphasizes the need for insurance reform that rewards good outcomes, payment reform with an emphasis on prevention and advanced information systems that travel with the patient from physician to physician, saving time, money and preventing errors.

“What the scorecard is showing is that we have a system under stress, no matter where we live,” said co-author Schoen. “The costs are rising more than people’s incomes. We need to act.”

Schoen said she has hope for reform. “There is real leadership and people are taking reform seriously.”
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