The Lewin Group
October 8, 2008
McCain and Obama Health Care Proposals: Cost and Coverage Compared
In this study, The Lewin Group estimated the cost and coverage impacts (for 2010-2019) of the health reform proposals introduced by Senators McCain and Obama. Our key findings are that the McCain proposal would reduce the number of uninsured from a projected number of 48.9 million people in 2010 by 21.1 million people if fully implemented in that year. The Obama plan would reduce the number of uninsured by 26.6 million people. The McCain proposal would result in a net increase in federal spending (i.e., net of offsets) of $2.05 trillion over the 2010 through 2019 period compared with a net federal cost of $1.17 trillion under the Obama plan over this same ten-year period.
The Candidates' Proposals
The McCain proposal would expand coverage through private insurance and decrease regulation of health insurance markets. His plan would provide a refundable tax credit of $2,500 for single filers and $5,000 for families that have private health insurance from an employer or as an individual in the non-group market. Insurers would be permitted to sell insurance across state lines, thus sidestepping state minimum benefit and insurance rating regulations.
The McCain proposal would establish federally subsidized high-risk pools called the Guaranteed Access Program (GAP) to cover those denied coverage due to health status. The Campaign indicates that half of the losses under the GAP would be paid with an assessment on private insurance with the federal government providing the remaining half.
The Obama proposal would expand coverage through public and private insurance and increase federal regulation of insurance markets. His proposal would expand Medicaid eligibility to include all very low-income adults and would provide premium subsidies for people with low to moderate incomes. Insurers would be prohibited from denying coverage or setting insurance premiums on the basis of health status. Also, the Obama plan would provide small employers with a tax credit for the purchase of insurance and would create a federally subsidized reinsurance program to cover "catastrophic health" expenses in employer plans.
Senator Obama's plan would also create a "National Exchange" offering a selection of private health insurance options comparable to those now offered to members of Congress and federal workers. The exchange would be open to individuals, the self-employed and small employers. In addition, the Obama proposal would create a new publicly-operated insurance program called the "National Plan" that would be available as an alternative to private coverage in the National Exchange.
Unlike the McCain plan, the Obama proposal would establish a minimum standard of covered benefits.
http://www.lewin.com/dyn/healthpolicies
Comment (again, from Don McCanne) : The release of this report from The Lewin Group has provoked a debate on whether it accurately reflects the numbers of individuals that would gain coverage under the McCain and Obama proposals respectively. Although this debate is legitimate, it misses the most important point. We don't really care how many people nominally have health insurance; we want to know whether or not people are protected from financial hardship should they need health care.
The McCain proposal aims to make premiums for private health plans affordable by deregulating the market. Premiums can be kept low by (1) creating a market of underinsurance products (limited benefits and greater cost sharing, especially through high deductibles), and by (2) insuring only low risk individuals who can pass medical underwriting standards.
The Lewin report makes the assumption that when the McCain plan is fully implemented in 2010 the number of individuals with private employer coverage will decrease from 157 million to 148 million. That level of decrease might be true at the beginning of the program, but incentives are likely to cause a further dramatic decline in employer-sponsored coverage. If an individual can obtain a very inexpensive plan in a deregulated market, and the government is going to provide a $2500/$5000 tax credit, why would an employer want to continue to offer an expensive comprehensive plan, and why would an employee pass up a pay increase offered by the employer for those who decline coverage?
Once a large number of healthy employees move into the individual market, the employer-sponsored plans will be subject to adverse selection. The spiraling costs of premiums will cause employers to terminate their plans, especially since a President McCain's proposal would have opened up the individual market to plans with affordable premiums, albeit underinsurance plans.
Since the deregulated market insures only healthy individuals, the individuals who actually need health will have to look elsewhere for coverage. Sen. McCain understands this, and that is why he has proposed the Guaranteed Access Program (GAP) to insure these individuals with greater needs.
This is where there is a problem with defining the success of a reform proposal by the numbers of insured individuals. The very large number of individuals purchasing underinsurance plans are healthy, but most of the spending is on the smaller group with needs that will be forced to obtain coverage under GAP. The Lewin Group estimates that of those with chronic health conditions who are currently uninsured, only 24 percent would be covered by the McCain proposal. These are people who most desperately need coverage, yet three-fourths of them would remain uninsured.
How does McCain propose to pay the high costs of those who do make it into GAP? Half would be paid by federal subsidies (taxes), but the other half would be paid by assessments on individual private insurance plans. Suddenly the cheap premiums for these underinsurance products aren't so cheap anymore since half of the excess costs of the high-risk pools are moved back into the underinsurance pools. What will happen to the enrollment rates for these underinsurance products when the premiums are jacked back up to unaffordable levels?
When people tell you that the McCain plan is almost as good as the Obama plan in reducing the number of uninsured, you now have a response. The McCain proposal provides nominal coverage with uninsurance plans for those who are healthy, but it doesn't pay the bills for those who actually need health care.
Friday, October 10, 2008
Friday, October 3, 2008
sunset on our chance for reform in health care
From the great Don Mccanne - his comments not mine - CJH
The Vice-Presidential Debate
October 2, 2008
Sarah Palin: (in her closing statement) It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don't pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we're going to find ourselves SPENDING OUR SUNSET YEARS TELLING OUR CHILDREN AND OUR CHILDREN'S CHILDREN ABOUT A TIME IN AMERICA, BACK IN THE DAY, WHEN MEN AND WOMEN WERE FREE.
Video and transcript:
http://elections.nytimes.com/2008/president/debates/vice-presidential-debate.html
And...
Ronald Reagan Speaks Out Against Socialized Medicine LP recording, 1961, Woman's Auxiliary of the AMA
Ronald Reagan: Write those letters now. Call your friends, and tell them to write them. If you don't, this program (King-Anderson version of Medicare) I promise you will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don't do this, and if I don't do it, one of these days, you and I are going to SPEND OUR SUNSET YEARS TELLING OUR CHILDREN, AND OUR CHILDREN'S CHILDREN, WHAT IT WAS ONCE LIKE IN AMERICA WHEN MEN WERE FREE.
WHAM campaign (Women Help American Medicine):
http://www.larrydewitt.net/Essays/Reagan.htm
mp3 audio of "Ronald Reagan Speaks Out Against Socialized Medicine"
http://blogfiles.wfmu.org/KF/reagan1.mp3
Comment: If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.
Obama and Biden support a greater government role in ensuring that more individuals have affordable health care and health care coverage.
McCain and Palin support freedom and individual responsibility in accessing health care and health care coverage. If you need health care, well designed public policies can work for all of us, but private policies can work only for those with the financial means to obtain adequate coverage.
For her closing statement, the McCain/Palin advisors selected the most notorious attack on a government role in health care, deceptively cloaked in the rhetoric of freedom. That should tell you something.
The Vice-Presidential Debate
October 2, 2008
Sarah Palin: (in her closing statement) It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don't pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we're going to find ourselves SPENDING OUR SUNSET YEARS TELLING OUR CHILDREN AND OUR CHILDREN'S CHILDREN ABOUT A TIME IN AMERICA, BACK IN THE DAY, WHEN MEN AND WOMEN WERE FREE.
Video and transcript:
http://elections.nytimes.com/2008/president/debates/vice-presidential-debate.html
And...
Ronald Reagan Speaks Out Against Socialized Medicine LP recording, 1961, Woman's Auxiliary of the AMA
Ronald Reagan: Write those letters now. Call your friends, and tell them to write them. If you don't, this program (King-Anderson version of Medicare) I promise you will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don't do this, and if I don't do it, one of these days, you and I are going to SPEND OUR SUNSET YEARS TELLING OUR CHILDREN, AND OUR CHILDREN'S CHILDREN, WHAT IT WAS ONCE LIKE IN AMERICA WHEN MEN WERE FREE.
WHAM campaign (Women Help American Medicine):
http://www.larrydewitt.net/Essays/Reagan.htm
mp3 audio of "Ronald Reagan Speaks Out Against Socialized Medicine"
http://blogfiles.wfmu.org/KF/reagan1.mp3
Comment: If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.
Obama and Biden support a greater government role in ensuring that more individuals have affordable health care and health care coverage.
McCain and Palin support freedom and individual responsibility in accessing health care and health care coverage. If you need health care, well designed public policies can work for all of us, but private policies can work only for those with the financial means to obtain adequate coverage.
For her closing statement, the McCain/Palin advisors selected the most notorious attack on a government role in health care, deceptively cloaked in the rhetoric of freedom. That should tell you something.
Thursday, September 4, 2008
Dynamed Update
Consumption Of Nuts, Corn, Popcorn And Berries Not Associated With Increased Risk For Diverticular Disease
Dynamed is site primarily for physicians with an evidence based PDA medical text. The site is http://www.ebscohost.com/dynamed/
Consumption of nuts, corn, popcorn, and berries were not associated with an increased risk for diverticular disease in a prospective cohort study (Health Professionals Follow-up Study). Men aged 40-75 years without diverticulosis (or its complications), cancer, or inflammatory bowel disease at baseline (n = 47,228) answered self-administered questionnaires. They were followed every 2 years for medical information and every 4 years for dietary information for 18 years. Comparing men with intake at least twice weekly vs. intake less than once monthly, the risk for diverticulitis was reduced for popcorn and possibly for nuts. There were no associations with corn consumption or with berry consumption (strawberries and blueberries). None of these food groups were associated with diverticular bleeding (JAMA 2008 Aug 27;300(8):907). This study does not establish the safety or risk of specific foods in patients with known diverticulosis, but the presumption is that many participants had unknown diverticulosis and did not appear harmed by ingestion of nuts, corn, popcorn or berries. For more information, see the Diverticulitis or Diverticular bleeding topics in DynaMed.
Dynamed is site primarily for physicians with an evidence based PDA medical text. The site is http://www.ebscohost.com/dynamed/
Consumption of nuts, corn, popcorn, and berries were not associated with an increased risk for diverticular disease in a prospective cohort study (Health Professionals Follow-up Study). Men aged 40-75 years without diverticulosis (or its complications), cancer, or inflammatory bowel disease at baseline (n = 47,228) answered self-administered questionnaires. They were followed every 2 years for medical information and every 4 years for dietary information for 18 years. Comparing men with intake at least twice weekly vs. intake less than once monthly, the risk for diverticulitis was reduced for popcorn and possibly for nuts. There were no associations with corn consumption or with berry consumption (strawberries and blueberries). None of these food groups were associated with diverticular bleeding (JAMA 2008 Aug 27;300(8):907). This study does not establish the safety or risk of specific foods in patients with known diverticulosis, but the presumption is that many participants had unknown diverticulosis and did not appear harmed by ingestion of nuts, corn, popcorn or berries. For more information, see the Diverticulitis or Diverticular bleeding topics in DynaMed.
The Republican Convention
I really hated what i saw at the democratic convention last night. It was mean spirited and little. I have followed the factcheck.org website from the Annenberg School to give me some balance on polical posturing. Everything said at the Democratic Convention was not 100% correct either, but here is just a quick copy of what they had to say about Fred Thompsons speech. I will look for their comments about Sarah Palin's speech tomorrow. I am really saddened and angry that as an example for all women she is reduced to being an attack dog with lipstick.
Here is the www.factcheck.org summary:
Joe Lieberman and his former Senate colleague Fred Thompson both made misleading claims about Obama in their prime time GOP convention speeches on Tuesday. We've heard two of them before – many times.
Lieberman said Obama hadn't "reached across party lines" to accomplish "anything significant," though Obama has teamed with GOP Sens. Tom Coburn and Richard Lugar to pass laws enhancing government transparency and curtailing the proliferation of nuclear and conventional weapons.
Thompson repeated misleading claims about Obama's tax program, saying it would bring "one of the largest tax increases in American history." But as increases go, Obama's package is hardly a history-maker. It would raise taxes for families with incomes above $250,000. Most people would see a cut.
Lieberman also accused Obama of "voting to cut off funding for our American troops on the battlefield." But Obama's only vote against a war-funding bill came after Bush vetoed a version of the bill Obama had supported – and McCain urged the veto.
Here is the www.factcheck.org summary:
Joe Lieberman and his former Senate colleague Fred Thompson both made misleading claims about Obama in their prime time GOP convention speeches on Tuesday. We've heard two of them before – many times.
Lieberman said Obama hadn't "reached across party lines" to accomplish "anything significant," though Obama has teamed with GOP Sens. Tom Coburn and Richard Lugar to pass laws enhancing government transparency and curtailing the proliferation of nuclear and conventional weapons.
Thompson repeated misleading claims about Obama's tax program, saying it would bring "one of the largest tax increases in American history." But as increases go, Obama's package is hardly a history-maker. It would raise taxes for families with incomes above $250,000. Most people would see a cut.
Lieberman also accused Obama of "voting to cut off funding for our American troops on the battlefield." But Obama's only vote against a war-funding bill came after Bush vetoed a version of the bill Obama had supported – and McCain urged the veto.
Wednesday, August 27, 2008
From Don McCanne's email - health coverage for children
From time to time I am just going to copy Don McCannes email listing to this blog. Don doesnt blog but should, you can get his daily email at the PNHP website.
Los Angeles Times August 24, 2008
Thousands of California children are in danger of losing health insurance
By Jordan Rau
California's promising strides toward extending medical coverage to all its children, a longtime goal of Gov. Arnold Schwarzenegger and one advocates believed was in reach by decade's end, has stalled -- and thousands of kids are in danger of losing insurance.
...legislative budget negotiators this year have decided to increase premiums for the state's Healthy Families program (SCHIP), which pays for medical care for more than 850,000 children of low-income workers who are above the federal poverty line. The state estimates that the parents of 19,000 children will end up dropping out of the program by July...
Lawmakers also have decided to require the parents of 3.4 million Californians who are below the federal poverty line to renew their Medi-Cal health coverage every six months. The Schwarzenegger administration expects that rule will pare Medi-Cal rolls by about 196,000 children over the next two years.
The changes to subsidized or free health programs come as private health initiatives that pay for the care of children are running out of money, causing them to limit the number they cover. These privately run initiatives exist in 30 counties, arranging medical care for children who are not legal residents or whose families earn slightly more than the threshold for public programs. Enrollment in the initiatives has dropped by 8,000 in the last two years, to 80,000, according to Wendy Lazarus, co-president of the Children's Partnership, a nonprofit advocacy group.
http://www.latimes.com/news/local/la-me-kidshealth24-2008aug24,0,4590020,full.story
Comment: The good news in yesterday's Census Bureau release was that increased enrollment in government health programs more than offset the decline in private insurance coverage, especially for children. Nationally, there were 512,000 fewer uninsured children in 2007 than there were in 2006, primarily because of increased Medicaid and SCHIP enrollment.
Only one year later, over 200,000 children in California alone are projected to lose their coverage.
Think about that.
If SCHIP and Medicaid expansion represent the successes of incrementalism, then how do you define failure?
Try this one. Failure is the perpetuation of policies that do not ensure that everyone is automatically included, for life, in a program that enables affordable access to all necessary health care.
Success would be easy - merely adopt a single payer national health program. So why are we so fixated on perpetuating failure?
Los Angeles Times August 24, 2008
Thousands of California children are in danger of losing health insurance
By Jordan Rau
California's promising strides toward extending medical coverage to all its children, a longtime goal of Gov. Arnold Schwarzenegger and one advocates believed was in reach by decade's end, has stalled -- and thousands of kids are in danger of losing insurance.
...legislative budget negotiators this year have decided to increase premiums for the state's Healthy Families program (SCHIP), which pays for medical care for more than 850,000 children of low-income workers who are above the federal poverty line. The state estimates that the parents of 19,000 children will end up dropping out of the program by July...
Lawmakers also have decided to require the parents of 3.4 million Californians who are below the federal poverty line to renew their Medi-Cal health coverage every six months. The Schwarzenegger administration expects that rule will pare Medi-Cal rolls by about 196,000 children over the next two years.
The changes to subsidized or free health programs come as private health initiatives that pay for the care of children are running out of money, causing them to limit the number they cover. These privately run initiatives exist in 30 counties, arranging medical care for children who are not legal residents or whose families earn slightly more than the threshold for public programs. Enrollment in the initiatives has dropped by 8,000 in the last two years, to 80,000, according to Wendy Lazarus, co-president of the Children's Partnership, a nonprofit advocacy group.
http://www.latimes.com/news/local/la-me-kidshealth24-2008aug24,0,4590020,full.story
Comment: The good news in yesterday's Census Bureau release was that increased enrollment in government health programs more than offset the decline in private insurance coverage, especially for children. Nationally, there were 512,000 fewer uninsured children in 2007 than there were in 2006, primarily because of increased Medicaid and SCHIP enrollment.
Only one year later, over 200,000 children in California alone are projected to lose their coverage.
Think about that.
If SCHIP and Medicaid expansion represent the successes of incrementalism, then how do you define failure?
Try this one. Failure is the perpetuation of policies that do not ensure that everyone is automatically included, for life, in a program that enables affordable access to all necessary health care.
Success would be easy - merely adopt a single payer national health program. So why are we so fixated on perpetuating failure?
Sunday, August 24, 2008
Free Medical Advice
Thats what having a doctor in the family means! Ask me questions, ask me opinions! I will look things up if I don't know. I will refer you to an article or a website. Remember this information is made with good intentions but is not meant to replace your doctor's advice, ie., I am giving advice but am not pretending to be your doctor, ie., don"t sue me over this!
Saturday, August 23, 2008
Smoking - an evidence based analysis of the national data
A study from the Journal of the National Cancer Institute puts some perspective on smoking. I had been discussing this with patients and my numbers are pretty accurate with what this article concludes. CIGARETTES ROB 5 TO 10 YEARS FROM THE LIFE OF SMOKERS. Thats the conclusion. Its an average, not all smokers will die 5 - 10 years sooner than non-smokers but on the whole, smokers die that much sooner and for every smoker that lives to the ripe old age of 90 (about 10 years longer than normal) there is a smoker that dies at 50 (twenty years sooner - 10 to balance the 90 year old and 10 because the average is lower!). So maybe some smokers live a long life but most on average die 5 to 10 years sooner. What would you give to live 5 or 10 years longer if you found out you were dying. Would you give up smoking then?
Friday, August 22, 2008
health care - why the election counts
Believe This
there is a huge difference between these candidates in terms of health care reform. Obama will try to institute some real reform. I dont know if he can do it, because fighting the entrenched interests of the insurance industry and the pharmaceutical industry will be really hard (but I dont believe its impossible).
McCain doesnt understand health care delivery, anyone who thinks competition will keep health care costs down, doesnt understand health care delivery. Competition is the idea behind health savings accounts, and while this sounds good in theory, the average person cant make a decision about what a reasonable price for healthcare delivery IS! It just doesnt work. I dont think there has ever been a study to show that it increased access, improved quality and held cost down, of even accomplished one of those things.
So for people who care about health care for everyone, even basic coverage, the democrats should have a shot at it.
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