Health Care Reform: What People Say

The Presidential Quote “If we do nothing, I can almost guarantee you your premiums will double over the next 10 years, because that’s what they did over the last 10 years,” Mr. Obama said. “It will eat into the possibility of you getting a raise on your job because your employer is going to be looking and saying, ‘I can’t afford to give you a raise because my health care costs just went up 10, 20, 30 percent.’ ” (Adam Nagourney and Megan Thee-Brenan, July 29 2009, New York Times) The Major Concerns

In general, Americans are concerned that revamping the health care system would reduce the quality of their care, increase their out-of-pocket health costs and tax bills, and limit their options in choosing doctors, treatments and tests, the latest New York Times/CBS News poll found. The percentage who describe health care costs as a serious threat to the American economy — a central argument made by Mr. Obama — has dropped over the past month. So, now a vigorous advertising and grass-roots effort to shift public opinion is likely in the next month or two. With Congress now almost certain to recess until after Labor Day without floor votes on any specific plan, plentiful advertising and grass-roots effort to shift public opinion is likely in the next month or two. The poll offers hope to both sides. The Poll Findings 1. 69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone. 2. 49 percent said they supported fundamental changes, and 33 percent said the health care system needed to be completely rebuilt. 3. 66 percent of respondents were concerned that they might eventually lose their insurance if the government did not create a new health care system, and 80 percent said they were concerned that the percentage of Americans without health care would continue to rise if Congress did not act. 4. By 55 percent to 26 percent, respondents said Mr. Obama had better ideas about how to change health care than Republicans in Congress did. 5. There is overwhelming support for a bipartisan agreement on health care. 6. 59 percent said that President Obama was making an effort to work with Congressional Republicans, while just 33 percent said Republicans were trying to work with him on the issue.

AND, TO ADD TO THE CONFUSION AND CONTROVERSY, THE POLL FOUND

7. 75 percent of respondents said they were concerned that the cost of their own health care would eventually go up if the government DID NOT create a system of providing health care for all Americans. But in another finding, 77 percent said they were concerned that the cost of health care would go up if the government DID create such a system.

The Desires of the People

So, what do the hundreds of millions of Americans with health care coverage really want to hear? They do not want paying for the last 15 percent to deteriorate their coverage or even be rationed.

First, when Washington does anything of such size (20 percent of the economy) that it directly touches the lives of most Americans, they had better be authentically bipartisan. Otherwise, one party will torpedo the other. The system cannot stay more or less intact with no credible effort is made at cutting costs. The reform must be big and sweeping, not just small incremental progress. (Mike Murphy, political strategist)

"Reducing cost and improving quality are equally important to expanding coverage. When too much of the discussion is focused on extension of coverage and the taxes to pay for it, more people peel off from supporting reform." (Mark Penn, “Microtrends: The Small Forces Behind Tomorrow’s Big Changes.”)

So, any effective campaign for reform must explain (if true) that people with coverage now will experience no change in their ability to have their current plan unless they want change. “No change” is what most people want to hear. And, they want to have this happen without turning the issue into class warfare. Cost, quality and coverage must be addressed as equal concerns.

And, according to Harold Pollack, Professor of Social Service Administration at the University of Chicago adds, new policy must "puncture complacency about an unsustainable status quo." Without effective regulation, people have no real way to know good insurance will remain affordable for them and for their employers.

In addition, the plan must reassure nervous seniors who have been told by some that the President would ration care to finance universal coverage by using deep Medicare cuts.

Do You Support the "Education Begins at Home Act"?

Lawmakers have essentially inserted the “Education Begins at Home Act” – which was introduced in 2008 and again this year by Rep. Danny Davis (D-IL) and Sen. Kit Bond (R-MO) – into the health care bill under the home visitation section. Section 440 of the House bill – Home Visitation Programs for Families with Young Children and Families Expecting Children – would provide grants to states to establish home visitation programs to educate parents on child behavior and parenting skills. The “well-trained and competent staff” will:

"…provide parents with knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains…modeling, consulting, and coaching on parenting practices; [and] skills to interact with their child…"

Many question the role of federal government in such practices. Also, the vaguely-worded program specifics are troublesome. The home visitation provision dictates that the state will “prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment." Concern with the bill is that it will encourage government officials to enter homes and educate and interact in parenting methods that are approved by the Secretary of Health and Human Services.

Does such a bill violate the First Amendment and the Fourth Amendment of the Constitution? What seems like a good idea to expand and improve programs that are already in place, this bill, if it were to become law, opens up the door of every family to government involvement. People don't necessarily believe the law is targeted at low income families or other families that are otherwise considered "at risk" by the government. They, instead, believe this is targeted to everyone including primary caregivers who maybe grandparents, other relatives, foster parents, and noncustodial parents. So, birth parents may not be the only participating parties.

There are privacy concerns because when home visitors come into the home they assess everything about the family: their financial situation, social situation, parenting practices, everything. All of that is put into a database. Questions arise about how agents of the government plan to acquire private medical and financial records to offer the home visiting program.

While the home visitation program is described as “voluntary,” it’s not clear whether it would remain voluntary throughout or just up to the time a parent trainer enters the home. There is no wording in the Education Begins at Home Act requiring parental permission for treatment or ongoing care once the family is enrolled.

Indeed, the states may have an economic incentive to increase enrollments in these home visits and may pressure families to participate in them. Some feel this especially likely because the bill requires states that receive these grants to submit an annual report to the Secretary of HHS which includes the number of families in the home visitation program and retention rate.

Such visitation programs would further increase the federal role in preschool education, and this represents another reason for parents to be concerned about what’s actually in the health care bill. So, many assume that someone coming into homes and telling them how to raise their children strips their personal liberties.

Do bureaucrats know more about parenting than most parents? The government may pressure parents to adopt child rearing methods that are against the family's religious beliefs. Home visitation officials may even threaten families with abuse and neglect investigation if the families do not choose to follow the official parenting education models. Does the good intention of the bill outweigh the possible harm inflicted upon the innocent?

The legislation does not specify whether parents are allowed to decline evaluations, drugs or treatment for their children once they are diagnosed with developmental or mental conditions. There seems to be evidence that state-diagnosed conditions would remain in a child’s permanent medical history. Mental health screening is very subjective no matter what age, especially with very young children.

Proponents of the bill say home visiting has shown to be a strong factor for overall school readiness and serves as key prevention of child abuse, criminal justice, along with improving children’s health, and with linking the child and family with other community based services.

The core components of the Education Begins At Home Act are:

· $400 million over three years to allow states to implement proven home visiting programs of their choosing.

· $50 million over three years to implement home visiting services focused on English Language Learners.

· $50 million over three years to implement home visiting services focused on military bases.

A broad coalition of organizations is working to move this legislation forward. Among them are organizations dealing with child abuse, child advocacy organizations and social workers. Organizations such as the United Way? Advocates for or against this proposed bill should speak out. Now is the time to voice opinion about the proposed program. As part of the costly health care proposal, the "Education Begins At Home" section is open for scrutiny. Weigh in on the issue. Make your voice part of the vocal minority and read more about the proposal for an informed opinion.

What Health Care Reform May Hold For Those Who Have Insurance

World Health Organization's 2000 World Health Report, rated 191 countries' medical systems. The United States placed 37th, behind even Morocco, Cyprus, and Costa Rica. Everyone is curious and deeply concerned about the health care reform bills moving through Congress. Current estimates suggest that it would cost close to $1 trillion over 10 years to extend coverage to tens of millions of uninsured Americans. Though costly, most agree that the reform would do a good job of providing coverage for uninsured Americans, but what about the effect of the reform on the far greater number of people who already have insurance? A recent editorial in the New York Times outlined some answers for the insured. Keep in mind, this is an editorial. Read as much as you can about the bills and decide the direction that benefits most. Labeling and stereotyping does nothing to help alleviate the current problems. Knowledge is the key to solving the health care dilemma of cost versus service. I have outlined some of the major points in the editorial for ease of delivery. Please read the entire article on site. ("Health Care Reform and You," July 25 2009, http://www.nytimes.com/2009/07/26/opinion/26sun1.html?pagewanted=1) 1. Expanding Medicaid would help the poorest of the uninsured. A family of four earning $66,000 to $88,000 would get subsidies to help them buy coverage through new health insurance exchanges, national or state, which would offer a menu of policies from different companies agreeing to provide a specified level of benefits and set premiums at rates more comparable to group rates for big employers than to exorbitant rates charged for individual coverage. 2. A new marketplace, the so-called health insurance exchange would be born. With the creation of so many new subscribers, virtually all major insurers are expected to offer policies through an exchange. 3. All insurance companies would be more tightly regulated. For example, reform would prohibit policies from excluding or charging higher rates to people with pre-existing conditions, bar companies from rescinding policies after people come down with a serious illness, and prohibit insurers from setting annual or lifetime limits on what a policy would pay. 4. In President Obama's proposal, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on proposals. There is strong opposition in the Senate, so it seems likely that some burden would fall on the less wealthy. 5. Healthy young people who might prefer not to buy insurance at all will probably be forced to because of a federal mandate. 6. Less clear is what financial burden middle-income Americans would bear when forced to buy coverage. There are concerns that the subsidies ultimately approved by Congress might not be generous enough. 7. Greater security is the main gain for those enrolled in group coverage. When laid off or leaving a job, those people would no longer be faced with exorbitant costs of individually bought insurance; instead, they could buy new policies through the insurance exchanges at affordable rates. 8. President Obama has also pledged that if people like their current insurance, they can keep it. 9. Coverage for the uninsured should greatly reduce the amount of charity care delivered by hospitals and eliminate the need for the hospitals to shift such costs to patients who have private insurance. It is anticipated in the long run, if reform efforts slow the growth of health care costs, then the increase in insurance costs should ease as well. 10. The bills would alter payment incentives in Medicare to reduce needless re-admissions to hospitals. The bills should promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them and call for pilot programs in Medicare to test the best ways for doctors to manage and coordinate a patient’s total care. 11. People over 65 are already covered by Medicare and would seem to have little to gain. But many of the chronically ill elderly who use lots of drugs could save significant money. 12. Prospective losers are likely to include many people enrolled in the private plans that participate in Medicare, known as Medicare Advantage plans. They are heavily subsidized, and to pay for reform, Congress is likely to reduce or do away with those subsidies. President Obama insisted that benefits won’t be reduced, they’ll simply be delivered in more efficient ways, like better coordination of care, elimination of duplicate tests and reliance on treatments known to work best. 13. The AARP, the main lobby for older Americans, has praised the emerging bills. This might suggests that the great majority of Americans — those with insurance and those without — would benefit from health care reform.