The hidden issue of health care

When I checked a few minutes ago, of the few dozen people who answered the question posed in this morning’s Five at 8, 83% said they knew little to nothing about the specifics of the health care debate taking place in Washington.

How could that be? Because it’s happening in Washington where process is most important.

Example. Read this article from the Associated Press. I’ll wait right here.

Welcome back. Did you notice something about the article? There wasn’t a single word about what’s in the legislation or what the major points of contention are. Not one word. There is a reference to the Blue Dogs — conservative Democrats — being concerned about “tax increases and the impact on rural health care and small businesses.” That’s it. So what’s in the House bill that specifically has them concerned?

It’s no wonder that talk shows — which boil legislation down to small talking points, some of which are occasionally in context and accurate — steer the political debate.

But what if you want to be informed about the specific issues?

For the most part, it’s piecemeal. Pick an editorial here or there, read a blog and piece it together.

Here are a few salient points.

Des Moines Register editorial


Democrats propose increasing taxes on the wealthiest Americans – about 2 million taxpayers – to help pay for reform. The surtax would be imposed on families earning more than $350,000 a year and individuals earning more than $280,000 a year. The tax rate would range from 1 percent to 5.4 percent.

The New York Times provided separate views of this proposal in a blog post here. “Should the Rich Pay for the Uninsured?” Included were these details.

Doctors’ reimbursements:


The baseline budget calls for large cuts over the next decade in doctors’ reimbursements under Medicare. Congress has always voted to waive these cuts. The health care reform bill will make this waiver permanent at a cost of more than $200 billion. It is disingenuous to get outraged over this expense, since we always knew that Congress would not allow the baseline cuts to go into effect.

Capping health insurance premiums:


Senator Max Baucus, chairman of the Senate Finance Committee, wants to cap the tax exclusion to put a lid on inflationary health insurance and restore fairness to the tax code. Workers could still keep their health insurance at work, but they would have a new incentive to stay under an annual cap of, say, $15,000 for a family policy.The company could still deduct any amount it spends on insurance, but employees would be motivated to stay under the cap.

Maggie Mahar, who writes the Health Beat blog for the Century Foundation, says misinformation is growing. She took apart a Wall Street Journal editorial which, she says, are full of falsehoods. She provides a few more details of what’s actually in the bill.


The House bill actually protects and increases employer-sponsored insurance. According to official CBO numbers, 2 million more people would be covered under employer-sponsored insurance than is projected to be the case today – 164 million compared to 162 under current law.

But the best analysis of what’s in the House bill — which is H.R. 3200, by the way — may be the Congressional Budget Office:


The legislation would establish a mandate to have health insurance, expand eligibility for Medicaid, and establish new health insurance exchanges through which some people could purchase subsidized coverage. The options available in the insurance exchange would include private health insurance plans as well as a public plan that would be administered by the Secretary of Health and Human Services. The specifications would also require payments of penalties by uninsured individuals, firms that did not provide qualified health insurance, and other firms whose employees would receive subsidized coverage through the exchanges. The plan would also provide tax credits to small employers that contribute toward the cost of health insurance for their workers.

… and …


Changes to the Medicare Part D program… would establish a new prescription drug rebate program for some people who are eligible for both Medicaid and Medicare, while expanding drug coverage to beneficiaries that are currently subject to a gap in coverage (often referred to as the Part D “doughnut hole”), saving $30 billion over the 2010-2019 period.

A read of the actual bill shows a few other provisions:

>> A grant to train more nurses, and to provide more diversity in the nursing profession.

>> Health clinics in schools

>> Low-interest student loans for primary care students.

>> Home visitation programs for families expecting children.

>> Optional Medicaid coverage for low-income HIV individuals.

It’s not a perfect way to get up to speed on the actual issue of health care, but it’s better than what we’ve had so far.

As for the politics of the debate, which are getting the lion’s share of coverage, a guest on this morning’s Midmorning program succinctly told us all we needed to know about that:


“Every dollar in the health care system is someone’s income.”

It was good listening.

  • Elizabeth T

    Sen. Baucus’ “fairness” in the tax code is a disingenuous way of stating “flat tax”. There is nothing inherently “fair” about making me pay more money than you. I think it is just and ought to be that way. But it’s not “fair”. Your kid gets my taxes to pay for her school; your grandmother gets my taxes to pay for her Medicare; MN-DOT gets my taxes to pay for the highway you use, even though I don’t use it. It ain’t fair, and we already live in a society based on socialism.

    Every time I hear (almost) anyone opine on health care, they demonstrate an appalling lack of understanding of the economics of public health.

    I have never heard someone reject the idea of universal health care who was denied coverage under the current system.

  • Bob Collins

    Good post, Elizabeth. However, one of the reasons some people consider fairness is that you benefit, too. For instance, you may not drive on a highway, but the chances are pretty good the goods you buy came that way. Or the taxes that a local industry pays (that might benefit you in some way), came because highways were able to get their product to market.

    Schools, the argument goes, creates a more educated people. Are we better off being an intelligent society or a stupid one? So do we benefit by educating someone else’s kid?

    There’s a general feeling that whatever we have in our lives right now, we have solely on the basis of ourselves, when someone actually helped us at some point.

    But the debates are always framed in whether something personally and directly benefits us personally as opposed to whether there is a benefit to us communally.

    I like living in Minnesota. I think it’s a smart state, a healthy state, an invigorating state. I have no interest in living in Mississippi, however, which I consider to be exactly the opposite. Theoretically, I suppose, it wouldn’t matter. I’m still me wherever I live. And yet it does.

  • Ruth E. Ulvog

    I believe conversation and dialogue about Health Care Reform are needed and good. However, I have seen or heard absolutely **nothing** mentioned about Complementary and Alternative Medicine (CAM). There seems to be nothing about Complementary and Alternative Medicine in any of the plans. This is what really scares me.

    At this point, it is obvious that any legislation will be extremely biased in favor of hospitals, the American Medical Association (AMA), the insurance companies, Big Business, the mega-conglomerate pharmaceutical companies (known collectively as Big PhARMA), the Food and Drug Administration (FDA), the Center for Disease Control (CDC), the National Institutes of Health (NIH), and the World Health Organization (WHO).

    What ever happened to Freedom of Choice? Where, oh, where is our freedom to choose the kinds of care, diagnostic and treatment protocols we desire and know will work for us without making us sicker, more dependent upon prescription drugs manufactured for that purpose as well as lining the pockets of stakeholders, both corporate administration as well as shareholders in the Pharmaceutical Industry (Big PhARMA)?

    All I hear, see and read about is Big PhARMA, prescription drugs, hospitals and allopathic medicine; sometimes called **Western Medicine.** The all-powerful American Medical Association (AMA) is in collusion with the pharmaceutical conglomerates (Big PhARMA) giving everyday citizens virtually no choice: **It’s my way or the highway.** What now passes for *medicine* has become a *one-size-fits-all* big business; health care no longer has the interest of the patient as the top priority.

    Any real change in Health Care Reform Legislation must legitimize and offer coverage for such Complementary and Alternative Medicine fields including but not limited to non-traditional diagnostic and treatment protocols administered and or prescribed by Medical Doctors, Doctors of Chiropractic, Kinesiology, Accupuncture, Osteopathy, Homeopathy, Naturopathy, and Midwifery.

    Doctors and other health care professionals who dare break ranks with their organizations’ *party line* or who dare even suggest there are alternatives to the *cut, poison and burn* triumvirate that is at the heart of Western Medicine’s *best standard practices,* are black-listed, forced to recant and or retract such statements or are expelled from the organization, outright.

    Agencies and entities of the government whose mission it is to protect the citizenry have long since forgotten that mission, and are instead protecting Big PhARMA, multi-national food-processing conglomerates, Big Agribusiness, and Big Chemical Companies whose lobbyists have paid untold billions in order to get their way and or product approved; despite questions and or concerns about public health and or safety. Money has become an idol and a god.

    Individual people no longer seem to matter. The health and safety of the public is no longer paramount; the Almighty Dollar is. Let the pockets of the powerful become lined with more and deeper layers of the Almighty Dollar and the public be damned.

    When will the United States Senate and the United States House of Representatives stand up for those on Main Street who elected them to office instead of the armies of company Lobbyists?

    SHAME on we, the public for having elected people to office who cow-tow to Lobbyists; and SHAME on these people for becoming so spineless and corrupt.

    ~~Ruth E. Ulvog (REU)

  • Paul

    As a result of the Great Stupid (period of time starting at the end of the 70s, when Americans forgot what government is supposed to do and how to pay for it amongst many other colossal failures of intellect) Americans are literally incapable of imagining how any public system let alone health insurance would work. Apparently social security and unemployment checks are the product of wizardry since the government can’t possibly collect money and pay it out without causing irreparable damage to the economy.

    As for transparency, well it just wouldn’t do for Americans to actually witness the extent to which industry lobbyists have captured our elected officials. The myth of democracy is useful after all.

  • Elizabeth T

    Bob… regarding fairness…

    I realize I benefit when my taxes are spent on you. I was perhaps not clear in this … I approve of this. I benefit from your child being educated. It’s not “fair” in the sense of dollar-equity. It is the best course for Society if all of our children received a good education. But it is not an inherently equitable system to produce that.

    people try to paint “fair” in politics as equitable: everyone has an equal share/burden of something: a = b = c.

    “fair” in my world is the eventual calculation of short term and long term benefits and costs. I pay less taxes in the long run if your child gets good neo-natal care. That is fair, and in fact is beneficial to me compared to the status quo.

    We either accept that all of our lives are inter-twined, and that we need to financially support each other (read: universal health care completely dissociated from work) – or else we need to just admit that we don’t care about anyone else and are going to go it alone. Because those are the only two honest options.