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March 28, 2011 / Political Fluency

Silly Kathy – Final

It’s definitely a happy problem when you delay posting because your favorite team just made the Final Four and you attended their most exciting game when they vanquished the number 1 team in the nation.

Let’s finish off calling out the propaganda of one, Kathleen Sebelius – Health and Human Services Secretary.

Ultimately, we know that the biggest factor driving up premiums is the soaring cost of care. So, as part of the health care law, we have invested in preventive care, and innovative programs aimed at slowing that growth of premiums. By testing and implementing new ideas to coordinate care, improve patient safety, and reduce waste, fraud and abuse, the law will create additional savings for decades to come. Analysts predict that by 2019, these efforts could save an additional $2,000 for a family policy for employer-based coverage.

Is this for real? The argument has been made that the emphasis on preventive care – gaining great popularity and usage because of the rapid growth of Health Maintenance Organizations (HMO’s) in the 1990’s – is one of the main reasons health care costs so much. It certainly is a reason the system is so strained. Patients go to the doctors and facilities to get every sniffle and superficial pain checked out because it merely costs them a copay each visit. While this has changed in the past few years, the mentality of patients to go to receive care from providers when they do not actually need it is ingrained in the American population.

The “testing and implementing new ideas to coordinate care, improve patient safety, and reduce waste, fraud and abuse” could have and should have been done within the existing Medicaid and Medicare government programs. If that was successful, then we could implement those programs more robustly in the private sector. The majority of waste, fraud, and abuse within the health care system happens within Medicaid and Medicare because they are using tax dollars as payment. There is much less fraud perpetuated on private insurers because insurers only have premium dollars to be converted into provider payments. As a result, insurance carriers are much more incentivized to identify and stop fraud and waste.

We also know that individuals and small businesses have often had to pay significantly more for health insurance than big businesses, which can use their size to negotiate lower premiums. But in 2014, individuals and small businesses will be able to pool their purchasing power through new state-based health insurance exchanges to bring down their rates. Millions of people will be eligible for tax credits, based on need, to help them afford health coverage.

Bold is my emphasis to set up the next point.

President Barack Obama has made clear that his administration is willing to work with anyone to improve the law and fix what needs fixing. That’s why, after hearing from governors, providers and patients, the president recently announced his support for legislation that allows states to pursue innovative alternatives to the law, provided they can achieve the same results as the Affordable Care Act — including relief from skyrocketing costs.

Well actually the President’s willingness to work with the states to pursue alternatives to the health care law are twofold. The main reason is Obama needs to look moderate during the 2012 campaign beginning in just a few months. A secondary reason is that the governorships and statehouses tilted to a large Republican majority just like the federal House elections did in November of 2010. There are many states not only challenging this law in federal courts, but they are also proposing legislation to block the exchanges from being built in their state.

Many of the challenges of the new health care law by Republicans revolve around the individual mandate whereby every individual in the country needs to have some form of health coverage from January 1, 2014 onwards or else pay a $700 fine to the government. The law depends on this provision to not only incentivize those who can afford coverage to buy it, but to also increase the number of healthy people that have coverage (expanding the risk pool). This controversial provision will ultimately be decided by the Supreme Court. If the individual mandate is struck down, then the law is in serious jeopardy of being effective at all.

The law also depends on the state-based exchanges to help expand access to coverage tot hese individuals and small employers so they can avoid the fines for not having health coverage. But there are Republican majorities and governors who are delaying the building of the state-based exchanges in order to score political points with the voters as being against this unpopular law and to frustrate the Democratic opponents. They can’t say that explicitly so that is the subtext of genuine criticisms including lack of funding for building the exchanges and a desire for clarification of the implementation of certain provisions of the law by the courts and the HHS Secretary that was busy writing an Op-Ed instead of giving much-needed direction on the law.


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