Health Care -- Affordable And Accessible For All

December 12, 2008

by Faiz Shakir, Amanda Terkel, Satyam Khanna, Matt Corley, Benjamin Armbruster, Ali Frick, Ryan Powers, and Igor Volsky

HEALTH CARE

Affordable And Accessible For All

Yesterday, President-elect Obama nominated former South Dakota senator Tom Daschle to head the Department of Health and Human Services and the White House Office of Health Reform. Obama also appointed Center for American Progress Senior Fellow Jeanne Lambrew as deputy director of the new White House health office. As the Politico's Mike Allen reported, the new White House health office "will be like a special-projects arm of the White House" designed to achieve "significant changes" in health care reform. "The time has come -- this year, in this new Administration -- to modernize our health care system for the twenty-first century; to reduce costs for families and businesses; and to finally provide affordable, accessible health care for every American," Obama said at the press conference announcing the appointments. Linking the health care crisis to the current economic downturn, Obama suggested that without addressing the skyrocketing costs of health care and reforming the fragmented system, America cannot solve its economic problems. "This has to be intimately woven into our overall economic recovery plan. It's not something that can be put off because we are in an emergency. This is part of the emergency," Obama explained. To address this challenge, Obama proposes a new system in which every player in the health-care arena -- the government, employers, doctors and hospitals, insurers, and individuals --helps support a rational and sustainable structure. He has promised to expand access to care, lower health care costs, and improve care quality.

EXPAND AFFORDABLE COVERAGE: By extending coverage to all, Obama can achieve efficiencies, end cost shifting, and rationalize financing mechanisms. To insure the 45.7 million Americans living without health insurance and the more than 25 million Americans who are underinsured, Obama will build on the major existing sources of health coverage such as the employer based system and public insurance programs like Medicaid and State's Children's Health Insurance Program (SCHIP). Obama's plan offers Americans the choice of staying with their employer-based coverage and enrolling in Medicaid or SCHIP -- if eligible -- or buying affordable insurance through a new national insurance pool. Insurance companies will be required to cover all Americans "regardless of their health status or history" and charge "fair and stable premiums." Private insurance companies participating in the pool will have to compete on quality and efficiency with a new public plan and offer comprehensive benefits "including preventive, maternity and mental health care." Americans who can't afford coverage will receive new tax credits to help make coverage more affordable and ensure that families don't spend more than a certain percentage of income on health insurance premiums. Small businesses will be eligible for a new Small Business Health Tax Credit that will "provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees." Obama will also expand eligibility for Medicaid and SCHIP to ensure that "these programs continue to serve their critical safety net function" of providing affordable coverage to working Americans.

LOWER COSTS: At yesterday's press conference, Obama argued that the costs of America's health care system are unsustainable. Without lowering costs, "we can't insure everyone under the current system without bankrupting the government or bankrupting businesses or states," he said. Indeed, as Center for American Progress Senior Fellow James Kvaal pointed out, while "high health care costs put many American businesses at a disadvantage to their foreign competitors and lead to lower wages and fewer jobs," "ever-rising health care costs are threatening to drive an unsustainable explosion in the national debt." To lower America's health care costs and build an economically sustainable health care system, Obama proposes developing better information about which treatments and procedures work best. Currently, "most health research focuses on determining whether a particular medicine or treatment is safe and works." A federal investment in clinical effectiveness and cost effectiveness that compares different treatments and medical technologies would "enable patients, providers, and payers to make sensible health care choices." Obama's plan calls for establishing an "independent institute to guide reviews and research on comparative effectiveness" to provide unbiased information to doctors and patients." Refocusing America's health care system on prevention rather than treatment will also contain costs. More than 75 percent of America's health care dollars are spent on managing chronic diseases, and Obama will require federally funded health plans to cover preventive services such as cancer screenings and smoking cessation classes. Obama also calls for empowering employers and local communities in their efforts to implement workplace wellness programs and community-based preventive interventions. While it is difficult to quantify the possible savings from expanded prevention efforts, experts estimate that just ensuring that every child receives every routine vaccination could reduce direct and indirect health care costs by up to $40 billion.

IMPROVE QUALITY: While investments in disease prevention, health promotion, and comparative effectiveness research will improve health outcomes and secure better value for the health care dollar, investing in health information technology (HIT) will improve health quality. Obama has promised to invest $50 billion over the next five years "to move the U.S. health care system to broad adoption of standards-based" HIT, "including electronic health records." While estimates vary and real-life experience is limited, one group of researchers found that implementing HIT would result in mean annual savings of $40 billion over a 15-year period. Moreover, Obama seeks to improve quality by investing in coordinated care. Health providers will be encouraged to put in place care management programs and implement the medical home model to improve coordination and integration. The payment system will also be reformed. Currently, public and private insurers are paid based "on the volume of services provided, rather than the quality or effectiveness of care." Consequently, while some patients receive excellent care, America wastes as much as $700 billion a year on tests and treatments that cannot be shown to improve health. Obama's plan aligns reimbursement with "provision of high quality health care," rewards providers who achieve certain performance thresholds, and incentivizes prescription of only the most effective treatments and medicines.

TORTURE -- TOP BUSH OFFICIALS SIGNED OFF ON TORTURE: A new bipartisan report from the Senate Armed Services Committee states that approval of torture at Guantanamo and Abu Ghraib came from the very highest levels of government. Prisoner abuse "was not simply the result of a few soldiers acting on their own" but came from former Defense Secretary Rumsfeld and other top officials, who "conveyed the message that physical pressures and degradation were appropriate treatment for detainees." Newsweek reports that the administration approved waterboarding on suspected al Qaeda detainees after receiving reports from government psychologists that it was "100 percent effective" in breaking military personnel. In contrast, former interrogator Matthew Alexander recently stated, "When I was in Iraq, the few times that I saw people use harsh methods, it was always counterproductive." The report concludes that the use of waterboarding "damaged our ability to collect accurate intelligence that could save lives, strengthened the hand of our enemies and compromised our moral authority."

CONGRESS -- HOUSE GOP GIVES SCANDAL-RIDDEN DON YOUNG'S COMMITTEE SEAT TO SCANDAL-RIDDEN DOC HASTINGS: In a memo to the House GOP this week, Minority Leader John Boehner (R-OH) lauded the election of Joseph Cao, who defeated the corrupt Rep. William Jefferson (D-LA). Boehner wrote, "In the two years ahead, House Republicans will demonstrate our commitment to reform by holding ourselves to the highest possible ethical standard." This week, Boehner seemed to be following through with the pledge, telling embattled Rep. Don Young (R-AK) that he could no longer support him as ranking Republican on the Natural Resources Committee, leading to Young's resignation from the post. But Boehner's promise is already imploding. The AP reports that a panel of top House leaders picked former Jack Abramoff associate Rep. Doc Hastings (R-WA) yesterday to replace Young as ranking member of the committee. Indeed, Abramoff once boasted of having an "excellent relationship" with Hastings, who received $14,000 from Abramoff's firm, Preston Gates, including $1,000 from Abramoff himself. Additionally, after taking control of the Ethics Committee, Hastings reportedly fired two staff lawyers involved in unanimous decisions to admonish Tom DeLay for improper fundraising. Hastings also contacted fired U.S. Attorney John McKay and attempted to improperly pressure him in an ongoing investigation.

ETHICS -- NASA ADMINISTRATOR MUZZLES EMPLOYEES FROM SPEAKING OPENLY WITH OBAMA AGENCY REVIEW TEAM: According to a report in the Orlando Sentinel, "NASA administrator Mike Griffin is not cooperating with President-elect Obama's transition team, [and] is obstructing its efforts to get information." He has gone after agency review leader Lori Garver, who once served as an associate administrator at NASA, calling her "not qualified" to judge his rocket programs. After a "heated 40-minute conversation" between the two last week, a "red-faced" Griffin allegedly demanded to speak directly to Obama. The Sentinel also reported that Griffin has been muzzling NASA employees from speaking openly with Obama's review staffers, "scripting" them "on what they can tell the transition team." He has also reportedly "warned" aerospace executives not to criticize his pet project -- NASA's "delayed and over-budget" moon rocket program. In an e-mail to NASA employees, Griffin denounced the article, writing, "This report, largely supported by anonymous sources and hearsay, is simply wrong. ... We are fully cooperating with transition team members."

Republican senators blocked a $15 billion bailout to General Motors and Chrysler late last night, after insisting that autoworkers accept "steep cuts in pay and benefits" next year. Reacting to the news, "[s]tocks tumbled around the world and the dollar slumped...threatening to deepen the global recession."

At a closed-door GOP lunch Wednesday, Vice President Cheney reportedly warned that it will be "Herbert Hoover" time if an auto bailout failed to pass, according to a senator familiar with the remarks. "A Cheney spokeswoman would neither confirm nor deny the vice president's remarks."

General Motors is hiring bankruptcy counsel "to prepare for a filing if Congress does not authorize $14 billion in emergency federal loans." GM and Chrysler's "only chance of survival" might hinge on the possibility that funds may be tapped from the $700 billion Wall Street bailout package.

The Swedish government is preparing a $3.5 billion bailout for Saab and Volvo. The plan consists of credit guarantees and rescue loans. "The government plan will now be presented to parliament for approval." More »

Yesterday, the Bush administration finalized rules that will accelerate drilling projects and power plant construction. The Interior Department eliminated "35-year-old regulations in the Endangered Species Act that required an independent scientific review of proposed federal projects to determine whether they imperil protected plants and animals."

The Bush administration issued new rules yesterday for the H-2A guest worker program that "it said would lessen the bureaucratic burden on employers seeking to hire foreign farm workers." Critics of the rule change argued that that changes would "depress wages and working conditions."

More Americans "believe in the devil, hell and angels" than believe in evolution, a new Harris poll finds. Forty-seven percent of Americans said they believe in evolution, while 40 percent said they believe in "creationism." Additionally, 73 percent believe in heaven, and 59 percent believe the devil exists.

Senate Republicans, including Sens. Arlen Specter (R-PA), Chuck Grassley (R-IA), and Jon Kyl (R-AZ), are trying delay confirmation hearings for attorney general nominee Eric Holder. Yesterday on the Senate floor, Grassley said, "Public reports have just emerged that in 2004, the Governor of Illinois hired or sought to hire Mr. Holder."

President-elect Obama plans to include billions of dollars of health care spending in his stimulus proposal, aiming to expand the State Children's Health Program and extend COBRA benefits, among other provisions. Obama explained yesterday that the health care crisis "is part of the [economic] emergency" and thus demands immediate attention.

And finally: John McCain does his Blagojevich impersonation. The senator opened his Letterman appearance last night by joking, "I don't want to talk about the BLEEPING campaign, understand? [Laughter] If you think I'm gonna go back to that BLEEPING situation, then -- then BLEEP you."

"Drivers clocked 9 billion fewer miles on the nation's roads in October even while gas prices were dropping, suggesting the downturn in driving that began a year ago is attributable to changing habits, not just energy costs."

THINK PROGRESS: Glenn Beck: "I was the most well-researched show" on CNN.

WONK ROOM: Conservative "no-bailout alternative" for Detroit amounts to union-busting.

YGLESIAS: A better model for standardized testing.

VET VOICE: Blackwater blurs the line between itself and the military.

CALIFORNIA: State regulators yesterday adopted the nation's first comprehensive plan to slash greenhouse gases.

ILLINOIS: Illinois General Assembly will hold a special session Monday to consider whether to revoke Gov. Rod Blagojevich's (D) power to appoint a senator and or to begin impeachment proceedings.

INDIANA: Gov. Mitch Daniels (R) freezes pay for state workers due to a budget crisis.

"[Democrats] turn on a dime on their former heroes and they will in this case."
-- Right-wing blogger Michelle Malkin, 12/11/08, on Chicago U.S. Attorney Patrick Fitzgerald

VERSUS

"“I don't think there is any thought whatsoever of changing the U.S. Attorney in Chicago with these very, very troubling and important times."
-- Sen. Charles Schumer (D-NY), 12/10/08

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