Jun 28, 2012

SCOTUS OPINION on Obamacare- Read it here!

Here is the C-span link to the Supreme Court opinion on the ACA.
Who would have thought that logic (i.e., a mandate that is enforced as a tax is a tax! and Medicaid is a voluntary program, that States can opt out of in pieces) would prevail?

Is this another switch in time that saved nine?  Or the opposite?  Only time will tell.  My relief tells me exactly where my own opinions lie.

Jun 24, 2012

What's the best outcome of SCOTUS on Obamacare?

Here we are, on the possible eve of the supreme court's decision on the constitutionality of the Affordable Care Act (ACA).  I've been grappling with what I want to see as the outcome, from the standpoint of what's good for the health care system, what's good for Obama's reelection, for the Democrats in Congress, and finally, for the crowd of  people who deeply believe that a single-payer health care system (a la Medicare) is best for the entire country.  To clarify, when I think about what's good for the health care system, I have in mind the ultimate effects on cost, quality and equality of access...those three competing objectives of public policies governing the delivery of health care.
What's good for Obama's re-election?  I believe the best thing for Obama politically speaking  is to have the whole bill nullified (except for the Medicare provisions, which nobody is talking about anyway).  That would wipe out the state-level exchanges, the insurance mandate (of course), and all the Medicaid provisions that expand access to Medicaid to all individuals and families with incomes less than 133% of the Federal poverty line (about $14K for individuals;  and $31K for a family of four).  I can't imagine how striking down the insurance mandate could leave in tact the ban on insurers discriminating on the basis of pre-existing conditions, or even the requirement to cover the under-26 crowd (even though some major insurers say they will keep that one.)
I think it would be good for voters to go back to square zero on health care.  It would take the fire out of the conservatives' righteously(?) indignant bellies over the mandate, while leaving the rest of the country to mull the alternatives.
What's good for the Democrats in Congress?  Re-election wise, see above.  Ideologically wise?  What ideology?  Dollars (theirs)  is what matters to them.
What's good for the Single-payer ideologues?  This is a no-brainer.  The mandate goes, the Medicaid provisions stay.  Most Americans do not realize that the Medicaid provisions, in addition to expanding eligibility, require Medicaid to pay for physician services at Medicare rates..  We hear a lot about how Medicare fees are low compared with private rates, but Medicaid fees are 30% lower than that!  And, to top it all off, the Federal government will pick up the entire tab for the health care costs of the new eligibles.  (Yes, yes, that's for 2 years, after which the Federal % drops to 90% and the Medicaid fee schedule rule drops, but who believes that the doctors won't have the clout to extend the fee schedule, just as they have managed to keep fees from plunging under Medicare's law by one-year extensions?)
Bottom line:  an extension of the Medicare-like single-payer system to a greater part of the population, and a gradual acclimation of the public to the idea that universal coverage can only come from a single-payer system.
What's good for the Health Care System?   At this point, I am rooting for a complete nullification, though  I am aware it's a long-shot.  That's because I don't believe in a single-payer system. So, what I mean is that if the mandate is going to be shot down, then I hope they shoot down Medicaid, too. That way, in having to start from scratch, perhaps Congress will put all the people into exchanges, which will treat the lower-income folks with the same respect they treat others. And, instead of  "exchanges," it should be "exchange."   I believe in a regulated market place (much like the Federal Employees Health care system) that offers competing plans meeting minimum coverage requirements.  The exchanges sounded like a good idea, but they are implemented at the state level, which doesn't allow much ability to pool risks, especially in smaller states.  (The state-level exchanges came from the Senate and its nefarious (Demorcatic) leadership, while the (Democratic) House bill had a national exchange system that would have guaranteed a large pool of enrollees.)
At this point, it would be worthwhile to go back to ground zero and let the nefarious Republican leadership deal with the consequences of its political intransigence and the public with another failure of our country to make access to health insurance (and therefore decent access to health care) a right.
What do you think?

Jun 19, 2012

Vitamin D supplementation reduces mortality in the elderly

A meta-analysis from 8 large randomized clinical trials, involving more than 70,000 elderly people, found that  Vitamin D supplementation decreased mortality over 3 years by 7 percent.  That's huge.