Does Gingrich Back Individual Mandate?

Does Gingrich Back Individual Mandate?

By Michael Meulemans, About.com Guide November 25, 2011

Presidential candidate politics got tangled up in health care policy during the recent Republican candidate debate sponsored by CNN on the subject of health care reform, the PPACA, and the individual mandate.

In CNN’s Republican presidential debate last month, when Mitt Romney argued that his Massachusetts reform plan’s central individual health care mandate idea had come from Gingrich. "You did not get that from me," Gingrich thundered in response, before eventually conceding that in the early 1990s he and the conservative Heritage Foundation had backed the idea of a mandate compelling individuals to purchase health insurance.

What Gingrich didn’t say during this dust-up was that the Gingrich Group, a consulting firm the former GOP House speaker founded in 1999, currently promotes a plan that includes an individual mandate.

So what is Gingrich’s health care policy? Now, he says he does not believe in mandates. Ok, positions can evolve over time. But now the think tank Gingrich founded has collected at least $37 million over the past eight years from major health-care companies and industry groups, offering special access to the former House speaker and other perks, according to records and interviews. The Center for Health Transformation, which opened in 2003, brought in dues of as much as $200,000 per year from insurers and other health-care firms, offering some of them "access to Newt Gingrich" and "direct Newt interaction," according to promotional materials.

While there’s nothing illegal, or unethical about that its important nonetheless to remember when analyzing his policies and thinking forward as he makes health care policy if elected to be President of the United States. Surely, it seems if that happens insurance companies would benefit.

In May, Gingrich also criticized Paul Ryan’s Medicare reform plan as "too radical" and a step toward, "right wing social engineering". At the time and since, Gingrich has offered little idea of how he would reduce the deficit. He said it was possible to solve the US’s long-term fiscal deficit without any tax increases but the only cuts he specified were reducing government waste and "not paying crooks".

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

NAIC Statement on MLR Producer Issue

FOR IMMEDIATE RELEASE

STATEMENT FROM NAIC PRESIDENT
SUSAN E. VOSS

The NAIC adopted a resolution urging Congress and the U.S. Department of Health and Human Services (HHS) to use their respective authorities to preserve consumer access to insurance agents and brokers by adjusting the medical loss ratio (MLR) component of the Affordable Care Act.

The impact of the MLR provision on agents and brokers’ ability to serve consumers has been the subject of extensive debate among regulators and there is clearly not unanimous agreement on this issue. However, the resolution follows up on concerns consistently raised by the NAIC since passage of the Affordable Care Act in comments to HHS and letters to Congress. In addition to calling upon Congress to amend the MLR portions of the Affordable Care Act, the resolution specifically asks HHS to take action through its rule-making process to help preserve consumer access to insurance agents and brokers.

The NAIC previously requested that HHS recognize the essential role served by producers and encouraged them to accommodate producer compensation in the MLR rule promulgated. The resolution urges HHS to explore possible options for providing relief.

Throughout the process of implementing provisions of health care reform charged to us by Congress, state regulators have strived to provide our perspective and expertise to federal officials on issues with a direct impact on consumers, even if those issues are potentially divisive and contentious. This resolution reflects that continued commitment.

Click HERE to read the resolution.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

DC Democracy Analysis Bolsters Claims by Those Seeking Ban on Constituent Services Funds

Council Constituent Services Funds: Little Goes for Actual Needs (11/23)

Expenditures

DC Councilmembers are allowed to receive up to $80,000 per year in contributions to their Constituent Services Funds (CSF’s) per year, and may spend up to that amount per year as well for constituent services. Leftover campaign funds may also be contributed without regard to the $80,000 limit. It is a widely held view among District residents that CSF’s are used primarily to pay for urgent individual or family needs such as rental assistance to avoid eviction, utility bills to prevent cutoff, or help with funeral expenses, etc.

The reality is that councilmembers spend very little from their CSF’s to meet these immediate constituent needs. As shown in Table 1, during 2010, for nine (9) councilmembers the amount spent for these needs represented only between 1% and 12% of their total expenditures. The other four members ranged from 25% to 32%. For all members combined, the amounts spent totaled only $48,271, representing 12% of all expenditures from CSF’s for the year.

TABLE 1
COUNCILMEMBER EXPENDITURES ON ACTUAL CONSTITUENT NEEDS (2010)
Councilmember Total Constituent Svcs Expenditures Amount Actually Spent on Constituent Needs1 % Actually Spent on Constituent Needs
Yvette Alexander $49,939 $1,007 2%
Marion Barry $14,463 $3,607 25%
Muriel Bowser $35,713 $2,336 7%
Kwame Brown $7.354 $816 8%
Michael Brown $49,951 $4,793 10%
David Catania $14,932 $1,855 12%
Mary Cheh $34,686 $476 1%
Jack Evans $85,381 $3,286 4%
Jim Graham $48,713 $11,988 25%
Vince Gray $50,508 $14,235 28%
Phil Mendelson $3,751 $455 12%
Harry Thomas, Jr $6,259 $768 12%
Tommy Wells $8,299 $2,649 32%

1Covers immediate constituent needs, mostly to provide rental assistance to avoid eviction, pay electricity bill to avoid service cutoff, and help pay funeral expenses.

Source: DC Office of Campaign Finance (OCF) quarterly reports submitted by councilmembers.

Thus, despite widespread impressions to the contrary, councilmembers spent the vast majority of their constituent services funds for purposes not related to helping constituents with serious, immediate needs.

What then are most constituent services funds spent for? They fall into two broad categories. The first is to assist community organizations and to sponsor or support community events. In 2010, as shown in Table 2, councilmembers spent far more on community organizations and events than on pressing individual and family needs. The amounts spent in this category by councilmembers ranged from 8% to 48% of their total expenditures, with the exception of one member for whom these kinds of expenditures represented 77% of total expenditures.

The other category of expenditures may primarily benefit the councilmember and staff rather constituents. This includes spending on office supplies, computer expenses, printing, local travel and large amounts for catering and refreshments, of which an unknown amount may be for community events. Constituent funds were also used for Council breakfast meetings, for bottled water for their offices, and even to pay for season tickets costing $28,000 to four professional sports teams.

Nine councilmembers spent far more from their constituent services funds on this category of expenditures that they spent on either immediate constituent needs or on community events or organizations, with their expenditures for this category ranging from 40% to 87% of their total CSF expenditures. (See Table 2 for details)

TABLE 2
COUNCILMEMBER EXPENDITURES FOR CONSTITUENT NEEDS AND COMMUNITY EVENTS & ORGANIZATIONS (2010)
Councilmember Total Constituent Svcs Expenditures % Spent on Constituent Needs % Spent on Community Events/Orgs % Spent on Other Kinds of Expenditures1
Yvette Alexander $49,939 2% 11% 87%
Marion Barry $14,463 25% 35% 40%
Muriel Bowser $35,713 7% 14% 79%
Kwame Brown $7,354 11% 8% 81%
Michael Brown $49,951 10% 22% 68%
David Catania $14,932 12% 77% 11%
Mary Cheh $34,686 1% 18% 81%
Jack Evans $85,381 4% 21% 75%
Jim Graham $48,713 25% 20% 55%
Vince Gray $50,508 28% 42% 30%
Phil Mendelson $3,751 12% 48% 40%
Harry Thomas, Jr $6,259 12% 29% 59%
Tommy Wells $8,299 32% 45% 23%

1Includes spending by councilmembers for office supplies, computer expenses, printing, catering & refreshments and local travel; also for breakfast meetings of councilmembers, for Deer Park water and to pay for season tickets to DC professional sports teams.
Note: Catering & refreshments were not broken down and likely include amounts spent in support of community events.

Source: DC Office of Campaign Finance quarterly reports submitted by councilmembers.

Contributions to CSF’s

As noted above, councilmembers are allowed to accept contributions of up to $80,000 per year for their CSF’s, plus leftover campaign contributions. Contributions are limited to $500 per individual or entity.

As can be seen in Table 3, there was great variability among councilmembers in the amounts brought in during the year, ranging from a low of $33 to a high of $81,000. Only four members had contributions in excess of $40,000, while eight brought in less than $15,000. Total contributions to CSF’s were $308,321, and average of $23,717 per member.
The contributions came primarily from those donating the $500 maximum allowed. Many of the $500 maximum donations were from familiar names of individuals and entities that appear prominently in campaign fundraising reports as well. We can only speculate about the motivations behind these contributions. It is worth noting, however, that contributions of $500 over four years ($2,000) vastly exceed the amounts that can be legally contributed to a campaign fund during that time ($500 for ward-level races, $1,000 for at-large races).

TABLE 3
TOTAL CONSTITUENT SERVICES CONTRIBUTIONS TO COUNCILMEMBERS (2010)
Y. Alexander $46,725 J. Evans $81,000
M. Barry $14,000 J. Graham $ 8,461
M. Bowser $50,128 V. Gray $3,142
K. Brown $2,200 P. Mendelson $4,500
M. Brown $57,811 H. Thomas $6,925
D. Catania $ 4,405 T. Wells $ 33
TOTAL $308,321

Source: DC Office of Campaign Finance quarterly reports submitted by councilmembers.

Conclusions

DC for Democracy believes that CSF’s should be eliminated. The quite limited amounts spent on hardship cases handled by these funds—less than $50,000 for all councilmembers’ CSF’s—suggests that there must be a better way to handle them, perhaps in the executive branch through a central office with the ability to access city-wide public and private resources to service them.

We are also concerned that the combination of the nature and sources of contributions, the ability to transfer leftover campaign funds into these accounts, and their use to fund community organizations and events, raise the question whether these funds are being seen as an adjunct to political campaign contributions. There are many legitimate expenditures being made by CSF’s, but our belief is that they should be covered by other means and through budget authorizations. Reducing the limits on contributions and expenditures from $80,000 to $40,000, as Councilmember Muriel Bowser proposes, yet not really narrowing the definition of what CSF’s can be spent for, does not, in our view, address the underlying question of why the CSF’s should be continued.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Cantor praises Obama’s pick for key healthcare post

Cantor praises Obama’s pick for key healthcare post

By Sam Baker – 11/29/11 04:46 PM ET

House Majority Leader Eric Cantor supports President Obama’s nominee for a key healthcare position, The Associated Press reported Tuesday.

The Virginia Republican told the AP that Marilyn Tavenner is “eminently qualified" to lead the agency that oversees Medicare and Medicaid.

The White House announced her nomination last week.

"I would hope to be able to support her," Cantor said. "Obviously, I’m not in the Senate, so I don’t have that vote, but I do think she is qualified. Obviously, she’ll be working for a president with an agenda that’s quite different from mine."

Many stakeholders already thought Tavenner might be able to win Senate confirmation, based largely on the fact that Senate Republicans did not immediately attack her. Support from Cantor, one of Congress’s leading conservative voices, will likely bolster her prospects.

Cantor told the AP that he worked well with Tavenner when she was Virginia’s health secretary.

“I always found her to be extremely professional and understanding of the value of the private sector in health care,” he told the wire service.

Source:
http://thehill.com/blogs/healthwatch/medicare/195989-cantor-praises-obamas-pick-for-key-healthcare-post

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Nine GOP-led states receive new money to implement health law

Nine GOP-led states receive new money to implement health law

By Sam Baker – 11/29/11 02:04 PM ET

Nine Republican governors received grants Tuesday to help implement the core component of President Obama’s healthcare law.

The Health and Human Services Department awarded 13 grants, totaling almost $220 million, for states to build insurance exchanges. The new marketplaces for insurance must be up and running by 2014, and HHS has the power to step in with a federal exchange in any state that doesn’t establish its own.

Planning for exchanges has divided Republican governors and created rifts within state governments. Some have taken a hard line against implementing the law, but others either support the concept of an exchange or want to ensure that the federal government does not take over.

The 13 grants announced Tuesday went to Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee and Vermont.

HHS also said Tuesday that states can apply for, receive and spend grant money even if they don’t have an exchange set up by the healthcare law’s deadline. The department has consistently pushed states hard to set up their own exchanges or to split the responsibilities with the federal government. States that get exchanges grants can use the money to set up parts of an exchange while HHS handles the rest, the department said in new guidance for states.

“States are moving at their own pace to get their exchanges up and running,” HHS Secretary Kathleen Sebelius told reporters.

Source:
http://thehill.com/blogs/healthwatch/health-reform-implementation/195931-9-gop-led-states-receive-new-money-to-implement-health-law

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

States squirm over health exchanges

States squirm over health exchanges

By: Jason Millman
November 28, 2011 11:11 PM EST

For state governments, the coming Supreme Court ruling on health reform isn’t an abstract argument about the U.S. Constitution.

It’s a highly practical question about whether, when and how to proceed with one of the health law’s most important and complicated pieces: setting up health insurance exchanges. Already facing political strife over implementation of health reform, some states are wondering if they should sit tight on exchange decisions until the court rules, probably in June.

Set to open in January 2014, exchanges will offer a marketplace where individuals and small businesses in each state can shop for health coverage. The exchanges, which offer subsidized coverage to lower- and middle-income individuals, will absorb more than half of the law’s projected expansion of health coverage to 32 million people.

Like many of the law’s provisions, the onus falls on states to take on much of the work of setting up the exchanges, with the Department of Health and Human Services running an exchange in states that fail or choose not to create one.

For some conservative states trying to block the law in the Supreme Court, the idea of federal intervention is enough motivation for them to plan ahead for an exchange in case their lawsuit fails. In others, the Supreme Court’s consideration of health reform is a cause for paralysis.

Two Midwestern governors have already declared their states won’t set up an exchange until the Supreme Court decides on the health law. And that idea is growing popular among powerful state legislators vigorously opposed to health reform.

Even without the uncertainty surrounding the Supreme Court, states are already on a tight timeline to get exchanges in working condition. Though the exchanges open in January 2014, HHS must determine by Jan. 1, 2013, whether a state will be ready to run one. The last opportunity for states to receive federal financial assistance for building an exchange is the end of June 2012 — right around the time of the Supreme Court ruling.

Recognizing the heavy lift for states’ exchanges, HHS in September floated ideas for partnership exchange models in which the states would split exchange responsibilities with the feds. But the models were met with grumbles from the states, which found them too restrictive.

Steve Larsen, who oversees exchange development for HHS, said he’s heard from states that are hesitant to do too much ahead of the Supreme Court decision. However, he thinks that states won’t want to fall too far behind if the Supreme Court upholds the law in June.

“If that’s when they start to work on an exchange, they will certainly be challenged to have a state-based exchange in 2014,” Larsen told a conference of Medicaid directors earlier this month.

But it’s an argument that Missouri state Sen. Scott Rupp isn’t buying. Rupp, a Republican who chaired the state’s interim exchange study committee this fall, said Missouri should hold off planning entirely until the Supreme Court has its say. Doubtful that the feds have the resources to set up exchanges in every state that declines, Rupp isn’t worried about the health law’s tight deadlines.

“I think there’s plenty of time,” Rupp said. “We don’t care about the timeline the federal government has laid out. We’re a sovereign state. Just because they throw down a deadline, we don’t have to scramble to hit it.”

In Wisconsin, Frank Lasee, the Republican chairman of the state Senate insurance committee, is looking beyond the Supreme Court decision. Lasee wants to know who wins the 2012 elections before Wisconsin confronts health reform. He recently killed a bill that would have written into state law many of health reform’s insurance provisions, such as banning lifetime and annual limits, preventing discrimination against people with pre-existing conditions and allowing young adults to stay on their parents’ insurance until age 26. The bill wouldn’t have created an exchange, though.

“Exchanges really aren’t required until 2014, so we have plenty of time after November 2012,” Lasee said, even though it would leave the state less than two months until the January 2013 certification.

Just 13 states have passed exchange legislation in the 20 months since health reform became law, and some of those states face further legislative battles to design the exchange. Five governors have taken some form of executive action to continue exchange planning after legislatures balked, with only Rhode Island’s Lincoln Chafee flexing executive muscle to actually establish a functioning exchange. It’s hard to imagine many more governors taking similar action without facing the wrath of state legislators.

Some Democrat-led states are further ahead in the planning process. Maryland and California have had functioning exchange boards in place for months, while Connecticut and Vermont are trying to align their exchanges with new state initiatives that aim for universal coverage.

Some states that have set the Supreme Court decision as a symbolic marker continue their exchange planning. Both Kansas Gov. Sam Brownback and Nebraska Gov. Dave Heineman have ruled out an exchange until after the Supreme Court’s decision, but “just-in-case” policy discussion has not disappeared.

Though Kansas this summer sent back a $31 million grant to build an exchange, an advisory committee continues to meet and a special legislative panel recommended that the legislature continue to pursue a state-run exchange again in January.

Likewise, Nebraska continues to make inroads, recently applying for millions more in federal grants to plan an exchange. Insurance Commissioner Bruce Ramge said the grant would position the state well for designing an exchange, if it comes to that.

“We also continue to have frequent stakeholder meetings with interested parties,” Ramge said.

Exchange planning is even taking place in Gov. Rick Perry’s Texas, which this year approved a “health care compact,” a symbolic agreement among conservative states to take control of federal health programs and reject health care reform. Stakeholders in the state said some legislators are planning for an exchange behind the scenes after receiving a $1 million HHS grant last year.

“I’ve talked to members who are on board,” said Jared Wolfe, executive director for the Texas Association of Health Plans. “They say they get it, an exchange is a good idea, but politically can’t vote on it right now and want to wait until the Supreme Court decides.”

© 2011 POLITICO LLC

Source: http://www.politico.com/news/stories/1111/69253.html

Wash Post: Wal-Mart proposed at D.C.’s Skyland center faces obst acle: Safeway

Lead Washington Post Editorial: A D.C. ethics bill that recognizes the need for serious reform

A D.C. ethics bill that recognizes the need for serious reform

By Editorial, Published: November 28

AS THE DISTRICT’S government has sunk into an ethical malaise, existing agencies have failed to establish or enforce clear rules of conduct. The failure is so abject that it’s time to declare the system beyond repair. That conclusion lies at the heart of a proposal for ethics reform in D.C. government that, while by no means perfect, represents a serious effort in the right direction.

A public roundtable will be held Wednesday on comprehensive ethics legislation drafted by D.C. Council Member Muriel Bowser (D-Ward 4), who heads the committee on government operations. The bill would establish an independent ethics commission that would be split off from the Board of Elections and Ethics. The new body would be given jurisdiction over a toughened code of ethics and would be empowered to conduct investigations and impose penalties. Unlike an earlier proposal considered by the council (which we opposed), this commission would have real teeth.

We admit to some skepticism about creating a government agency to do a job neglected by others. Why not just fix the Office of Campaign Finance or diagnose why the Office of the Inspector General has taken a milquetoast approach to its watchdog role? But given all the scandals that have marred this government, it is clear the city can no longer tinker with its bureaucracy; a clean break is needed. Moreover, in other states and cities, boards with primary jurisdiction over the conduct of public officials, as proposed by Ms. Bowser, have proven effective. The most successful ethics boards do more than react to scandal; they pay attention to training, advising and implementing best practices.

The success of any board would depend on who is appointed and what resources it has. Given the failures of the inspector general and the Office of Campaign Finance, it makes sense to redirect funds from those offices instead of just adding to the cost of government. We would also urge the council to strengthen how board members are selected; instead of allowing the mayor to appoint with the advice of the council, it should create nominating committees similar to those used in selecting judges. The mayor would still appoint but only from a list recruited and vetted by distinguished citizens. We wonder also if there should be more than three members and if three-year terms are long enough to ensure independence.

There are other places Ms. Bowser’s bill can be improved. She would limit constituent service accounts; why not just get rid of these ill-advised slush funds? The council should give itself the power to expel members who flagrantly violate ethics codes. It shouldn’t be possible to hide hearings of ethical violations from the public. Violators should have to pay penalties themselves, without relying on campaign funds.

No one piece of legislation will be able to cure all the ethical issues that have plagued the District. But the Board of Ethics and Government Accountability Establishment and Ethics Reform Act of 2011 would create a mechanism with a chance of making a difference.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Wash Post: District’s holiday speed-camera photos may leave driv ers feeling less jolly

District’s holiday speed-camera photos may leave drivers feeling less jolly

By Ashley Halsey III, Published: November 23

When zipping through the near-vacant streets of the District on Thanksgiving, most drivers give thanks for the lack of traffic. They are less likely to be thankful later when they get a speeding ticket in the mail.

They won’t come from the latest deployment of nine new speed cameras, because until Dec. 21 those are still operating under a grace period — no tickets, just warnings — but the array of cameras already monitoring D.C. streets has gained attention.

AAA cautions its members seeking information on traveling to Washington that the District is a “Strict Enforcement Area” for speeding.

“That’s a modern-day parlance for speed trap,” said AAA’s John B. Townsend II. “By zipping through town this weekend, you’re likely to speed and to get a ticket.”

Critics of the speed cameras and red-light cameras, AAA among them, say they have been deployed to make money. Their defenders, including D.C. Police Chief Cathy L. Lanier, say that if revenue is a byproduct of their efforts to get drivers to slow down, that’s just fine.

Lanier said the District “actually appreciates the AAA designation as a ‘Strict Enforcement Area’ ” because the attention encourages drivers to slow down.

“I find it astounding that AAA Mid-Atlantic would criticize a program that has been successful in reducing traffic deaths,” she said. “Additionally, we constantly receive requests from residents and council members for increased enforcement in their neighborhoods.”

The D.C. camera program issued 533,000 tickets and took in $43.1 million in fiscal 2010. In the first seven months of this fiscal year, it sent out 225,000 speeding and red-light tickets, taking in $30.3 million.

The AAA has ballyhooed a study showing that drivers generally were obeying the speed limit in the District. Done by the Howard University Transportation Research Center, the 2010 study showed that speeds had decreased at 64 percent of 174 locations and increased at 26 percent since 2006. They remained the same at the rest of the sites.

“One would think that traffic safety in the city must be going south with this infusion of new camera sites or that the city’s coffers desperately need replenishing,” said Lon Anderson, another AAA advocate. “So if traffic safety isn’t the issue, we must conclude that the city is more concerned that the $43 million netted last fiscal year in automated speeding enforcement was insufficient. If they are for safety, we applaud the city. But if, perchance, they are for revenue, then shame on them.”

The Insurance Institute for Highway Safety says that speed cameras are being used in 107 jurisdictions nationwide and that 555 places use red-light cameras.

Maryland, Virginia and the District have red-light cameras.

The use of speed cameras is banned by law in Virginia, but they are used in Prince George’s and Montgomery counties. Prince George’s mailed out 30,500 speed camera tickets last month. Montgomery County netted more than $19 million from speed cameras in fiscal 2009, up from $7.5 million two years earlier.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Wash Post Column: A grim diagnosis for our ailing health care system

A grim diagnosis for our ailing health care system

By Robert J. Samuelson, Published: November 27

Even had it succeeded, the supercommittee would have failed. Ultimately, the only way to control federal spending and deficits is to suppress the upward spiral of health costs. These are already the budget’s largest single expense (27 percent in 2010, compared with 20 percent for defense), and their continued rapid growth, combined with the scheduled introduction of Obamacare, will soon bring them to nearly one-third. The supercommittee didn’t have the time or staff to solve a problem as contentious and complex as health care.

It remains urgent. Americans know that expensive medical care is squeezing non-health government programs and, through higher employer insurance costs, take-home pay. But they console themselves that U.S. health care “is the best in the world.” Among experts, this view has long been debated, but a new study from the Organization for Economic Cooperation and Development (OECD) in Paris suggests that the debate is over: It’s not true.

As societies grow wealthier, people want — and can afford — more health care. Still, U.S. health spending (about $7,960 per person in 2009) is in a league of its own. It’s 50 percent higher than Norway’s ($5,352), the next costliest. U.S. spending is more than double Britain’s ($3,487), France’s ($3,978) and the OECD average ($3,233).

Despite this, Americans aren’t notably healthier than people in other advanced countries, the study reports. Life expectancy in the United States (78.2 years) lags behind Japan’s (83 years) and the OECD average (79.5 years). It roughly equals Chile’s and the Czech Republic’s, says Mark Pearson of the OECD. Americans don’t have much to show for their system’s enormous cost, even if the gaps in life expectancy partly reflect differences in lifestyle and diet.

There are some bright spots. Cancer care is one area of superior performance; the five-year survival rate for breast cancer in the United States is 89.3 percent, while the OECD average is 83.5 percent. But the treatment of chronic illnesses such as diabetes and asthma may be worse. The U.S. rate of emergency hospitalization for asthma is three times that in France and six times that in Germany or Italy.

Indeed, by some indicators, Americans get less medical care than do people in other advanced countries. The number of practicing U.S. doctors (2.4 per 1,000 population) is less than the OECD average (3.1 per 1,000), as is the number of annual doctor consultations (3.9 per capita in the United States versus 6.5 for the OECD average).

What propels U.S. health spending upward? The OECD’s answer comes in two parts: steep prices and abundant provision of some expensive services. In 2007, an appendectomy cost $7,962 in the United States, $5,004 in Canada and $2,943 in Germany. A coronary angioplasty cost $14,378 in the United States, compared with $9,296 in Sweden and $7,027 in France. A knee replacement was $14,946 in the United States, $12,424 in France and $9,910 in Canada. Knee replacements in the United States were almost twice as common per 100,000 population as in the rest of the OECD. So were MRI exams and angioplasties.

This is a devastating portrait. At times, the U.S. health care system delivers the worst of both worlds: pay more, get less. Unfortunately, the message isn’t new. America’s fragmented and overspecialized health system maximizes returns to providers — doctors, hospitals, drug companies — but not to society. Fee-for-service reimbursement allows providers to reconcile their ethical duty (more care for patients) and economic self-interest (higher incomes). The more they do, the more they earn. Restraints are few, because patients and providers both resist limits on their choices. Government regulators and private insurers are too weak to control costs.

Countless thousands of conscientious doctors provide most Americans with good care and some with superb care. But the system needs a fundamental overhaul to deliver more value for money. There are essentially two ways to do this.

One is a voucher system that, through tax credits and fixed Medicare premium subsidies, would allow patients to shop for the best health plan. Competition, the theory goes, would force hospitals and doctors to restructure the delivery system; health plans would compete on the basis of price and quality.

The other way is a government-run, single-payer system that would — somehow — include strict budget limits on doctors, hospitals and other providers. Lower administrative costs alone wouldn’t provide enough savings to control overall spending. If open-ended reimbursement survived, so would the existing system.

What’s involved is transforming almost one-fifth of the U.S. economy. The supercommittee couldn’t do that. But it could have proposed legislation to create two teams of experts to design rival plans that would be ready for the next president. One way or another, if we don’t act, we’re surrendering our future to runaway health spending.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

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