Friday, July 26, 2013

For Bioethicist With Ailing Spouse, End-Of-Life Issues Hit Home

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Margaret Battin's husband, Brooke Hopkins, was left quadriplegic after he collided with an oncoming bicycle while cycling down a hill in Salt Lake City.

Courtesy of The New York Times

Margaret Battin's husband, Brooke Hopkins, was left quadriplegic after he collided with an oncoming bicycle while cycling down a hill in Salt Lake City.

Courtesy of The New York Times

After writing books and essays about end-of-life issues, and advocating for the right to die, bioethicist Margaret Battin is wrestling with the issue in her own family. Her husband, Brooke Hopkins, an English professor at the University of Utah, where she also teaches, broke his neck in a bicycle accident in 2008, leaving him with quadriplegia and dependent on life support technology. In order to breathe, he requires a ventilator some of the time and a diaphragmatic pacer all the time. He receives his nutrition through a feeding tube.

Hopkins' living will gives him the right to decline this technology, and although he's chosen to keep living, there have been times he's told his wife he wants to die, and she's had to decide how literally to interpret his words.

In her academic life, Battin has also had to reflect on the positions she's taken in the past to see if she still believes in them. She and her husband are in their early 70s. She's a distinguished professor of philosophy and still teaches full time. When Hopkins is doing well, and not suffering from one of the many infections that have plagued him since the accident, he's able to do some teaching from his home, talk with friends who come to visit, go in his wheelchair on walks with his wife and even occasionally get taken to a concert or museum.

Battin and Hopkins were profiled in the cover story of last Sunday's New York Times Magazine. Battin tells Fresh Air's Terry Gross about what happened right after the accident, and the responsibility of deciding if someone is genuine in their wish to die.

Interview Highlights

On whether, post-accident, she and her husband discussed if he wanted to live or die

"It's odd ... that we didn't have that conversation. At least, I don't recall that conversation. I think it's because in those early days you are so intent on survival. He had had quite a respiratory infection at the time of the accident, which he had gotten campaigning during the 2008 election just prior to that. So the probability of him even surviving the accident, or the immediate period afterward, wasn't particularly good. Our efforts, his and mine, and everybody else's were focused on survival: Can he pull through these respiratory problems? Once those were a little more stabilized and he was able to communicate, there's a whole new phenomenon, and that's the ... enormous expression of love and affection and ... concern from family members, friends, people you haven't seen for ... five years, this overwhelming involving and concern by other people. ...

"So your sense of whether you want to continue or not ... your circumstances are so altered, and altered by this phenomenon that doesn't occur for most people in their ordinary lives; you don't have all of your entire family and your entire range of friends all showering you with love all at once. That's quite heady in a way. It's quite wonderful. ... You might even say it's sublime and it's extraordinary. That made a huge amount of difference at the beginning. ...

"At the beginning we had been told that the paralysis, initial paralysis, would last five to six weeks anyway, and only after that would you have some sense of realistic prognosis. So, while you worry about it, you ... knew that there was no point in thinking about it until after this period. Would he be able to get up and walk away eventually? Well, maybe. That's the kind of thing you can't tell. ... So such a choice would've been premature. Also, walking isn't the only thing in the world. So one begins to recognize that one will begin thinking about how to adapt to a very changed situation."

On the responsibility of deciding if someone is genuine in their wish to die

"I think you have to take it seriously. That doesn't mean that because he says, 'I want to die right now,' that you have to marshal action about it. ...

Author Interviews Discworld's Terry Pratchett On Death And Deciding Remembrances Assisted Suicide Advocate Uses Law To End His Life Health When Prolonging Death Seems Worse Than Death

"It's not easy, I can tell you that. It doesn't diminish in any way my belief that people � my belief and firmly considered position that people ought to be able, ought to be legally protected, legally empowered to control the character of their own deaths. That is, I do favor legalization of Death with Dignity laws, but that doesn't mean that these decisions are always easy. There [are] some differences. Brooke is not terminally ill, in any standard sense, although his life in certain ways is precarious, his survival. I'm not a physician, I don't pretend to be, so under the Death with Dignity laws it would be the physician that made the determination of whether ceding to this request was appropriate or not. ... If a physician under these laws were to receive a request from a patient and had any doubts about competency, they would be expected to request a psychological or psychiatric consult."

On her husband's accident hitting so close to her academic expertise

"To have it become so real, that someone you love � and love a lot, deeply � would be enmeshed in the same ... very kind of choice you had been thinking about academically for so long is an extraordinary experience. In one way, it's a healthy experience as it forces me to rethink everything. And even doing that, and even given the acute agony of being so close to something that is so difficult, it doesn't change my basic position that people should be recognized to have the right to not only live their lives in ways of their own choosing, providing of course that they don't harm others ... be the architects of their own lives, but that includes the very ... ends of their lives. You shouldn't have to lose those rights just at the end, especially since the very end makes the greatest amount of difference to some people, and also to some of their loved ones around them."

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Wednesday, July 24, 2013

Obama Turns To Comedians To Promote Health Coverage

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Obama Turns To Comedians To Promote Health Coverage

More From Shots - Health News HealthFemale Genital Mutilation On The Decline, But Still Too Common Health CareObama Turns To Comedians To Promote Health CoverageHealth CareTime To Get Out Of The High-Risk Health Insurance Pool? HealthUnusual Tick-Borne Virus Lurks In Missouri's Woods

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Tuesday, July 23, 2013

State Laws Limiting Abortion May Face Challenges On 20-Week Limit

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Saturday, July 20, 2013

White House Muddles Obamacare Messaging — Again

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Friday, July 19, 2013

White House Muddles Obamacare Messaging — Again

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For A Long And Healthy Life, It Matters Where You Live

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Wednesday, July 17, 2013

Pause in Honor of Medicare

At this time of year I usually start thinking about the passage of Medicare in July of 1965. How in the world did President Johnson decide to take on Congress to approve such a huge program for seniors? To sum it up, it was just the right thing to do. Why?

A personal story may help. In 1965 I was chief medical resident at Albany Hospital under Professor Richard Beebe. He allowed us to moonlight. I worked in Ravena in the practice of Drs. Mosher and LeFevre. Our elderly patients often had no money for their office visits or medicines. Sometimes they might leave a chicken on Mrs. Mosher’s back door. These folks were forced to rely on charity but had no real access to quality care. It just wasn’t right.

After Medicare was implemented in 1966, there were changes in medicine. Medicare Part A paid for hospital stays and also paid medical residents a better wage. Part B reimbursed outpatient care at 80 cents on the dollar and physicians flourished.

Later on, the disabled and those with kidney failure and ALS were covered as was Hospice care. Why? It was the right thing to do.

Some conservatives have always hated this government program for the elderly along with the program for the poor, Medicaid, that was enacted at the same time. They say that government should not be responsible for any health care. And even now they would privatize Medicare by turning it over to insurance companies through vouchers. You and I, through our Congress and our President, have so far beaten back these efforts. Why did we organize to fight for Medicare? Because it was the right thing to do.

And so, as July 30 approaches, it is proper that we pause to remember the signing of the Medicare Act, which took place at the Truman Library in Independence, Mo., on that day. Here is what Lyndon Johnson said: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

We honor Presidents Truman, Kennedy and Johnson and their staffs for their foresight and work that sustains our grandparents, parents, children, and generations yet unborn. Harry Truman proposed a national health plan in 1945. John Kennedy had health care on his agenda when he was assassinated in 1963. Lyndon Johnson carried their causes to fruition. And we will celebrate this historic achievement with a Medicare 48th birthday party at noon in West Capitol Park in Albany on Wednesday, July 31. Join us! It’s the right thing to do.

Then we will continue the struggle to improve and expand Medicare for all, as a right. We will do this to obey the ethics of all faiths that instruct us to “love your neighbor as yourself.” It’s the right thing to do.

Dr. Richard Propp lives in Albany and is chair of Capital District Alliance for Universal Healthcare, which he co-founded.

Thursday, July 11, 2013

Catholics Split Again On Coverage For Birth Control

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How Oregon Is Getting 'Frequent Fliers' Out Of The ER

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Wednesday, July 10, 2013

A Busy ER Doctor Slows Down To Help Patients Cope With Adversity

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Tuesday, July 9, 2013

Insurance Pitch To Young Adults Started In Fenway Park

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Saturday, July 6, 2013

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Friday, July 5, 2013

A Busy ER Doctor Slows Down To Help Patients Cope With Adversity

More From Shots - Health News Health CareA Busy ER Doctor Slows Down To Help Patients Cope With AdversityHealthGut Bacteria We Pick Up As Kids Stick With Us For DecadesHealthScientists Grow A Simple, Human Liver In A Petri DishHealthA Surge In Painkiller Overdoses Among Women

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Thursday, July 4, 2013

Idaho AFL-CIO endorses HR 676, National Single Payer Health Care

From UnionsForSinglePayer.org –

Rian Van Leuven, President of the Idaho State AFL-CIO, announced that on June 12, 2013, the delegates to the 55th Annual Idaho State AFL-CIO Convention passed a resolution to publicly endorse and support H.R. 676, Single Payer Healthcare.

Further the resolution states “That the Idaho State AFL-CIO will develop working relationships with community organizations in Idaho which advocate for single-payer healthcare and Medicaid expansion.”

Louis Schlickman, MD, an Idaho physician who practices in Meridian and is Co Chair of the Physicians for a National Health Program state chapter, showed the movie Escape Fire and made a single payer presentation to the convention prior to the passage of the resolution.

After the resolution for HR 676 was passed by the Idaho State AFL-CIO Convention, Dr. Schlickman stated that, �Collectively we are all realizing that unions in general can play a huge role in helping others, not just union workers, see the merit in a single payer financing system of care.�

Dr. Schlickman observed that union members �have seen how one unexpected illness or injury leads to significant catastrophes of health and income status. And most important, they understand the issue of solidarity.�

Idaho is the 43rd State AFL-CIO Federation to endorse HR 676, which was introduced into the 113th Congress by Representative John Conyers (D MI). The bill is subtitled Expanded and Improved Medicare for All.

Wednesday, July 3, 2013

Canadians pay taxes for universal healthcare, and now they’re richer than us

I�ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.

Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.

Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.

Since the Legislature has now refused to override the governor�s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.

Some opponents of expansion claim that they don�t trust the feds to keep their word (even though it�s now written into law) and that we won�t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.

This fight could be avoided, and is just a symptom of a more fundamental underlying disease � the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into �risk categories.�

This phenomenon was made worse by PL 90, the �pro-competition� health insurance reform law passed by the Republican legislature in 2011. Now we�re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.

Many conservatives still characterize Medicaid as �welfare,� and many think of it as such. Presumably other types of health care coverage have been �earned� (think veterans and the military, highly paid executives, union members and congressional staff). We resent our tax dollars going to �freeloaders.� Until the slicing and dicing is ended, the finger pointing, blame shifting and their attendant political wars will continue.

In sharp contrast, our Canadian neighbors feel much differently. Asked if they resent their tax dollars being spent to provide health care to those who can�t afford it on their own, they say they can�t think of a better way to spend them. �Isn�t that what democracy is all about?� I�ve heard Canadian physicians say, �Our universal health care is the highest expression of Canadians caring for each other.�

Here in Maine, the response tends to be much different. Canadians seem to think health care is a human right. We don�t � yet.

If everybody was in the same health care system in the U.S., as is the norm in most wealthy nations, we would be having a much different and more civil conversation than what we are now witnessing in Augusta. No other wealthy country relies on the exorbitantly expensive and divisive practice of insurance underwriting to finance their health care system. They finance their publicly administered systems through broad-based taxes or a simplified system of tax-like, highly regulated premiums. Participation is mandatory and universal.

Taxation gets a bad rap in the U.S. and consequently is politically radioactive. Yet it is the most efficient, most enforceable and fairest way to finance a universal health care system.

In her excellent New Yorker essay called �Tax Time,� Jill LePore points out that taxes are what we pay for civilized society, for modernity and for prosperity. Taxes insure domestic tranquility, provide for the common defense, promote the general welfare, and take some of the edge off of extreme poverty. Taxes protect property and the environment, make business possible and pay for roads, schools, bridges, police, teachers, doctors, nursing homes and medicine.

Oliver Wendell Holmes once said, �Taxes are what we pay for a civilized society.� The wealthy pay more because they have benefited more.

Canada�s tax-financed health care system covers everybody, gets better results, costs about two-thirds of what ours does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.

What�s not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

Canadians pay taxes for universal healthcare, and now they’re richer than us

I�ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.

Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.

Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.

Since the Legislature has now refused to override the governor�s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.

Some opponents of expansion claim that they don�t trust the feds to keep their word (even though it�s now written into law) and that we won�t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.

This fight could be avoided, and is just a symptom of a more fundamental underlying disease � the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into �risk categories.�

This phenomenon was made worse by PL 90, the �pro-competition� health insurance reform law passed by the Republican legislature in 2011. Now we�re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.

Many conservatives still characterize Medicaid as �welfare,� and many think of it as such. Presumably other types of health care coverage have been �earned� (think veterans and the military, highly paid executives, union members and congressional staff). We resent our tax dollars going to �freeloaders.� Until the slicing and dicing is ended, the finger pointing, blame shifting and their attendant political wars will continue.

In sharp contrast, our Canadian neighbors feel much differently. Asked if they resent their tax dollars being spent to provide health care to those who can�t afford it on their own, they say they can�t think of a better way to spend them. �Isn�t that what democracy is all about?� I�ve heard Canadian physicians say, �Our universal health care is the highest expression of Canadians caring for each other.�

Here in Maine, the response tends to be much different. Canadians seem to think health care is a human right. We don�t � yet.

If everybody was in the same health care system in the U.S., as is the norm in most wealthy nations, we would be having a much different and more civil conversation than what we are now witnessing in Augusta. No other wealthy country relies on the exorbitantly expensive and divisive practice of insurance underwriting to finance their health care system. They finance their publicly administered systems through broad-based taxes or a simplified system of tax-like, highly regulated premiums. Participation is mandatory and universal.

Taxation gets a bad rap in the U.S. and consequently is politically radioactive. Yet it is the most efficient, most enforceable and fairest way to finance a universal health care system.

In her excellent New Yorker essay called �Tax Time,� Jill LePore points out that taxes are what we pay for civilized society, for modernity and for prosperity. Taxes insure domestic tranquility, provide for the common defense, promote the general welfare, and take some of the edge off of extreme poverty. Taxes protect property and the environment, make business possible and pay for roads, schools, bridges, police, teachers, doctors, nursing homes and medicine.

Oliver Wendell Holmes once said, �Taxes are what we pay for a civilized society.� The wealthy pay more because they have benefited more.

Canada�s tax-financed health care system covers everybody, gets better results, costs about two-thirds of what ours does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.

What�s not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

Tuesday, July 2, 2013

You Ask, We Answer: Demystifying The Affordable Care Act

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