Health Care
Feb. 20, 2011
Anderson Ind. Mail
First of 3 in a series.
"Health Care Still Ailing"

"In a recent letter to the editor, a reader asked how much elected officials paid for their health benefits, specifically what portion of their coverage that we, the taxpayers, fund.

The writer was a government retiree who appreciates the health-care coverage he has and can feel the pain (if you’ll pardon the pun) of those who aren’t so fortunate.

It was an interesting question, especially in light of the efforts of U.S Sen. Lindsey Graham and Gov. Nikki Haley to enable South Carolina to opt out of the health-care reform (the Patient Protection and Affordable Care Act) that President Barack Obama signed into law last year.

“At a Statehouse news conference, Graham and Haley took turns blasting the law as an expensive federal takeover of the nation’s health-care system,” according to a report in The State newspaper.
Many South Carolinians are already dependent upon the federal government for health-care coverage, according to the Kaiser Family Foundation, which reports that 17 percent of our residents are covered by Medicare. Even residents living comfortably are still recipients of Medicare. They don’t have a choice. If one has adequate coverage before reaching age 65, that coverage becomes secondary and Medicare pays the bulk of expenses for care. (Perhaps that might help explain its financial problems.)

Another 18 percent of South Carolinians are covered by Medicaid, the program administered by states that is designed to help the poor and disabled.

And despite the legitimate need to cut costs in Medicaid, we must remember that when we cut the program at the state level, we also cut revenues to support it. Medicaid carries a 3-to-1 federal match.

That’s one reason there’s been such a struggle to apply any brakes to Medicaid. That, and the fact that in South Carolina, where the average income is third from the bottom of the 50 states, Medicaid provides care to people who would do without.

So we are left with about 65 percent of our residents who are either covered by an employer, buy their own insurance — or do without. Many of the last group are young and have the disease we all have when young: “It won’t happen to me” syndrome. Others are called the “working poor.” They have jobs but don’t make enough to buy private health insurance or work for an employer who can’t — or won’t — provide employees with insurance. It’s isn’t cheap, especially for the small-business owner.
Graham’s stand with Haley to push for South Carolina to opt out of health-care reform isn’t just talk. Earlier this month, Graham, along with Sen. John Barrasso, R-Wyo., introduced legislation allowing states to do just that. While the legislation was specific in citing three mandates that states would not have to follow — individuals must purchase insurance, employers must provide insurance and an expansion of Medicaid — such a move would dismantle the health-care law, some provisions of which have already gone into effect. Graham knows that. He said at the time that it would “force Congress to start over on health-care reform,” according to a report in the Greenville News.

That means we will spend another two years (or more) creating a “new” healthcare plan that will likely not pass muster in Graham’s own body, the still Democratic-controlled Senate, and certainly not in the White House. What will happen in 2012, when Graham and others expect health care to be an election issue? It depends on what happens in 2011. Until there is a viable alternative, Graham and Haley are just part of another exercise in futility, posturing that is designed more to placate critics of health-care reform and make political points rather than to truly deal with the health-care problems in our state — and in our nation — one of which is the underlying cost of treatment and medications.

We don’t know the governor well, but we are accustomed to less rhetoric and more substance from Graham.

Our health-care system is ailing and the cure is both painful and not to be delayed any longer."
Feb. 21, 2011
Anderson Ind. Mail
Second of 3 in a series.
What will Republicans offer the American people if the party’s efforts to repeal health-care reform are successful?

“Replacing ‘Obamacare’ is not something we can do overnight,” Rep. Fred Upton, R-Mich., told the Washington Post. “It may take some time. But mark my words, we will get it done.” So far, however, all that has been accomplished (at least for the record) is the drafting of a resolution containing “broad, long-held GOP health-care goals” but no specifics — and the directing of four House committees to develop proposals.

The truth is, according to Fox News, the only plan the GOP has right now is to deny funding for the current plan. In a Feb. 8 story headlined “Republicans plan to choke off funding for health-care law,” the network reported that some House Republicans were eyeing the annual spending bill to pay for government operations as a way to “strip the health-care law of any dollars, thus depriving healthcare operations of any money.” Now that’s productive. In 2009, during long-overdue discussions of health care in the United States, the GOP created H.R. 5424, “Reform Americans Can Afford,” in response to the Democrats’ proposal that became the Patient Protection and Affordable Care Act. In our research, we found numerous references to the 2009 plan and its provisions, some portions of which made it into the final legislation signed into law last year.

The GOP proposal calls for the end to “junk lawsuits” through medical liability reforms. South Carolina has already reformed its medical malpractice lawsuit system, said John Ruoff, program director for the advocacy group South Carolina Fair Share.

Ruoff told the Associated Press that South Carolina stands to create jobs with the federal health-care law because more federal matching funds will be available for the state. Opting out would mean the state gives up $10.9 billion that would go to doctors, hospitals and other healthcare businesses.
The 2009 GOP proposal gives small businesses the power to pool to offer health insurance at lower prices, like corporations and labor unions do. (That’s also a part of existing law. The Patient Protection and Affordable Care Act (PPAC) created a pre-existing condition insurance plan to offer subsidized premiums to people who have been uninsured for at least six months and have yet-to-be-defined medical problems, according to, an independent site that researches consumer insurance issues.)

H.R. 5424 allows Americans to buy insurance across state lines, increasing competition. This last provision is a questionable benefit, according to the Congressional Budget Office, which looked at a bill along those lines in 2005. That legislation, reports the CBO, “would reduce the price of individual health-insurance coverage for people expected to have relatively low health-care costs while increasing the price of coverage for those expected to have relatively high health-care costs.” The consensus by the CBO was that the legislation “wouldn’t change the number of uninsured.”

H.R. 5424 “promotes prevention and wellness by giving employers greater flexibility to financially reward employees who adopt and maintain healthier lifestyles.” Thousands of companies already do that. In fact, $200 million for small businesses to implement workplace wellness programs is in existing healthcare reform.

And while 2010’s PPAC addresses insurers’ practices, such as cancellation for frivolous reasons, the GOP plan addresses only one instance: if the insured has sloppy paperwork. The plan’s other “plus” is “rewarding innovation by providing incentive payments to states that reduce premiums and the number of uninsured — without expanding government entitlement programs or creating new ones.”
If any state comes up with an idea that effective, we should all sign on — and fast –– and chip in for the reward.

The main objection to the health-care reform law and what has provoked lawsuits by more than 25 states, including South Carolina, to declare it unconstitutional are the individual and business mandates. And we’ll admit we can understand how that would rankle. But the truth, according to Frank Knapp, chief executive officer of the South Carolina Small Business Chamber of Commerce, is that at least 96 percent of the businesses in South Carolina have fewer than 50 employees and wouldn’t be required to comply.

And here’s another truth, a tough one: Without some mandate, something that would encourage the majority of Americans to have health-care coverage, reform will only work for a few.

As consumers, we are frequently trading up or trading down. New cell phones, faster computers, better clothes and cars, all dependent upon our fiscal situation at any point in time. What’s to stop us from doing the same thing with health-care coverage?

Too many people would simply wait until they are sick to get insurance, if insurers aren’t allowed to legally discriminate (as they are today), and in all fairness to the industry, the pool of only healthy people paying regular and longterm premiums with few claims wouldn’t be large enough to maintain a healthy business.

Do we care if insurance companies are healthy? We should. Without them — or a fully funded government-sponsored insurance plan for every American — a lot of us would be out of luck.
And out of money, especially if a catastrophic illness hits."
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Feb. 22, 2011
Anderson Ind. Mail
Third in a series

Does the dog wag the tail or does the tail wag the dog? As we’ve written over the last two days, the debate over health-care reform still rages, despite the 2010 enactment of the Patient Protection and Affordable Care Act. Republicans are frank about efforts to repeal PPAC and S.C. Gov. Nikki Haley and U.S. Sen. Lindsey Graham are bonding over seeking permission for South Carolina to opt out of the law.

But the costs of health-care coverage can’t be properly explained without considering the cost of health care, regardless of one’s coverage status.

In April 2009, as the debate in Congress over health care was really heating up, Megan McArdle, business and economics editor for The Atlantic, gave her top three reasons for the cost of health care:
We pay more for our medical services. Although the pharmaceutical industry is a contributor, McArdle claims the real concern is wages. “Our medical personnel cost vastly more than their counterparts abroad in almost every category,” she wrote.

We consume more services. Americans get private rooms in hospitals instead of cheaper open wards. Staffing is high (a claim that recent visitors to a hospital might dismiss, if they had a bad experience with receiving attention when they believed they needed it.) But McArdle is correct that there are more tests than at any time in medical history. “We use an expensive machine rather than watchful waiting,” she writes.

But is that responsible medical care, to wait and see, when numerous tests and machines are readily available? It depends upon the ailment and if there is an emergency involved.

No one wants to delay care in the latter instance and doctors are more likely to err on the side of caution, sometimes, in part, for the reason that some opponents to health-care reform via PPAC cite as the main source of higher costs: litigation and malpractice insurance.

There are inefficiencies. “I don’t mean ‘compared to other systems’ (because) every system has some illogic that costs it money and makes patients worse off,” McArdle said. She notes that Medicare pays for procedures, not wellness, “even though the nation’s largest health-care provider is specifically designed for old people.” There are, as a result, fewer physicians who specialize in the health care of the elderly, because it’s not a specialty that pays particularly well.

(There are, however, more provisions for preventative care in the new law and there have been improvements in insurance coverage, paying for mammograms and other tests that can detect –– and help lessen treatment costs and severity of –– some diseases.)

Also, the argument that those without insurance drive up the costs for the rest of us can’t be discounted, although McArdle said that there is not much evidence that lack of insurance is the primary reason people visit an emergency room. Yet she goes on to report that about 24 percent of all ER visits for people without insurance were for non-urgent purposes.

Looking at our own insurance, we find that emergency room visits are discouraged unless it is a “life-threatening” case. But can the layperson judge what is life threatening and what is not? Most of the time, like some doctors, an individual will err on the side of caution and pay the penalty (the bill) later.
We believe, however, that there is another cause for the high cost of health care: our own apparent inability to follow a doctor’s instructions. We don’t take medication on time or as directed, and our conditions don’t improve or stabilize. We don’t exercise or eat properly, then wonder why our resistance is down and we get sick. We continue to practice habits that we know are contradictory to a healthy lifestyle and we don’t practice preventative care as thoroughly as is wise.

We’re particularly bad at watching our diet in the South, as numerous studies (and a recent editorial) explain. According to a United Health Foundation study, South Carolina was 45th of the 50 states in the number of residents classified as obese and No. 46 in cases of “premature death.”

And that final ranking reminds us of another reason heath-care costs are so high: We all want to live as long as we can. It’s only natural to want those to be healthy years. And we aren’t afraid to pay for it (or have our insurance pay for it) when we’re able. It’s almost like an out-ofcontrol real estate boom. Costs keep rising because of what the market will bear.

Then there are medication costs. After expensive research and development, pharmaceutical companies are reluctant to offer generic versions of popular drugs — the ones that some of us go rushing to our doctor wanting prescriptions for — and many insurers discourage anything but generics through their coverage options that pay so little for the name brand.

We’ll talk one more day on this subject, because we’ve had difficulty answering our reader’s original question: How much do Graham and Haley pay for health-care coverage?

While Graham’s office was very cooperative Friday in answering our query, we didn’t have that quick a response from Haley’s office. The response to our original inquiry on Friday came after a second request on Monday morning: that as it was a state holiday, the information was not available.

In the interest of fairness –– and the complete story –– we hope to have more information in our Wednesday edition.

Until then — stay well. It’s good for you — and your wallet.

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Feb. 23, 2011
Anderson Ind. Mail
Forth in a series

What do they pay?

U.S. Sen. Lindsey Graham’s office didn’t hesitate to give us information on what the senator has available under the Federal Employees Health Benefits program, as well as a website address with additional — and detailed — information. Rank-and-file senators and representatives earn $174,000 per year. A position in leadership is more lucrative, with the Speaker of the House the top earner at $223,500. Any member of Congress, should he or she choose, is offered a choice of the same insurance plans as any other federal employee.

For an individual, insurance costs about $1,000 per month, with a $30 co-pay for doctors’ visits and a $20 co-pay for prescriptions (generic), according to Graham’s office. The senator pays 25 percent of that monthly cost, with taxpayers picking up the cost for the rest.

FEHB offers 10 plans from which employees can choose. According to an analysis by the Los Angeles Times, 85 percent of private employers nationwide offer one plan. The rest give employees a choice of two or three plans, with costs corresponding to that choice. A lower deductible, for example, carries a higher cost. Some prescription drug coverage does not kick in until a deductible is met.

Because there are thousands of potential customers and thus great bargaining power, insurers in the federal plan cannot deny coverage to workers with pre-existing conditions. If a worker changes jobs, even to another federal department (theoretically a “new employer,” as salary might be paid under a different department of the budget), the insurance goes with the worker. There are no coverage limits under the federal insurance plan. Starting to sound familiar? It should. Those are some of the changes brought about for the rest of us through the Patient Protection and Care Act of 2010, the same act that some members of Congress have vowed to repeal.
To the average American worker, even if he or she is among the estimated 70 percent who are insured and would be financially devastated otherwise by a catastrophic illness, coverage under the federal plan is more than generous. For those plans, the American taxpayers spent about $15 billion last year to insure 8.5 million federal workers — including our men and women in Congress. We don’t begrudge them (or their state-level colleagues) their coverage. We all want healthy public servants. It simply supports our contention that if elected officials were under the average American’s plan — or among the nation’s estimated 46 million people who have no insurance at all — their views on the cost and scope of health care might be vastly different. While Graham’s office was, as always, helpful and prompt, we didn’t get the same cooperation from the office of S.C. Gov. Nikki Haley.

Our first attempt was made Friday, Feb. 18, in an e-mail to Haley’s press secretary, Rob Godfrey. The response (on Monday, Feb. 21) was that, as it was a state holiday, the information was not available. Our response asked for the information at the earliest opportunity and if Godfrey could at least confirm if the governor participates in the state plan.

That response, verbatim: “For attribution to Rob Godfrey, Haley press secretary: ‘The governor, like every other state employee who so chooses, is covered by the state health plan and contributes to it out of every paycheck — no different than those who work at the Anderson Independent being covered by insurance offered by their employer.”

Well, not exactly, for obvious reasons. Taxpayers don’t pay any portion of our premiums and we’re not advocating opting South Carolina out of needed healthcare reform.

We talked with a state employee, married, with two school-aged children (like the governor), whose payment is $294.58 per month, with an additional $21.34 for dental coverage (taxpayers fund the rest, around 70 percent of the total cost). There is a $10 co-pay per doctor’s visit and a $10 co-pay per prescription. For that same family, a web search on the cost of obtaining private coverage produced 10 plans with monthly costs ranging from $219.79 (with doctors’ visits not covered and a $10,000 deductible; no drug card) to $569.63 (no charge for office visits after meeting a $5,000 deductible; no drug card).

A little more food for thought. According to a Tuesday report in the Charlotte Observer: “Seventeen new Republican lawmakers, almost a fifth of the large House GOP freshman class, have rejected federal medical coverage for themselves and their families to highlight their opposition to President Barack Obama’s showcase health-insurance law.”

Also on the record as opposing the law but signed up for FEHB are South Carolina’s four newest congressmen: U.S. Reps. Mick Mulvaney, Tim Scott, Trey Gowdy and Jeff Duncan. All four voted last month to repeal what they call “Obamacare” and what we would call a welcome change. “I am paying for the same health insurance plan that thousands of other federal employees get,” Mulvaney told a McClatchey Washington Bureau reporter. “That has nothing to do with opposing ObamaCare — which is a massive health-insurance takeover.”

Norman Ornstein, an analyst with the conservative American Enterprise Institute in Washington, refers to the stance of Mulvaney and others as hypocrisy, opposing “the federal takeover of health care” while accepting federal medical benefits.

Mulvaney said that his coverage now is more expensive than it was when he was a member of the South Carolina General Assembly. Both plans, however, are more generous than the average South Carolinian can afford or even has available for consideration.

And his costs are supplemented by taxpayers — some of whom have no healthcare coverage of their own.

There has been no end of misleading emails and statements
concerning the Health Care Reform bills in Congress.
Finally, in the Anderson Independent Mail newspaper
was an editorial that addresses the situation perfectly!

"Pols tied to polls are highly questionable
Wednesday, March 03, 2010
By Reg Henry, Pittsburgh Post-Gazette
If you happened to see the health care summit that President Barack Obama hosted the other day -- I admit it was a bit of an effort, so perhaps intruders came into your house and tied you to a chair in front of the TV -- you saw the Republicans insist with great certainty that Americans don't want health care legislation.

Being closer to the Almighty than most of us, Republicans do have a knack for speaking with almost divine assurance on many subjects, as in Dick Cheney's famous declaration on Iraq, "We will, in fact, be greeted as liberators."

In fact, it may be that the Republicans are correct about Americans not liking the current health care bills. I don't know and, as I will explain later, I don't care.

But as Rep. Henry Waxman, a Democrat from California who supports health care reform, observed at the summit: "Now, I hear people all day say, 'Mr. President, the public doesn't want your plan.' Well, if I heard the kind of rhetoric over and over again that I've heard from some of the Republicans, I wouldn't want your plan either."

(By the way, Mr. Waxman is the rarest of politicians -- he is bald and has a mustache, a type of fellow always to be trusted, a view of course not influenced by my own baldness and mustache. As it is, my mustache is a sly one and can't be trusted to stay out of the soup.)

Whether Americans have been influenced by the propaganda barrage of unfactual facts, as Mr. Waxman suggests, I don't know. But speaking as an American, albeit a naturalized one, I do know that I was not consulted on what Americans think about health care reform. I am thinking that you probably weren't either.

True, we were consulted in November 2008 in the presidential election when we decisively gave our opinion on health care and other issues, but nobody has asked most of us since.

So how can the Republicans say with such certainty that Americans don't like the health care legislation? Well, they hear from their constituents. And as they tend to represent conservative districts, they doubtless hear a lot from voters who want them to resist the government-controlled death panels of their fevered dreams.

Yet what these GOP politicians believe is mostly rooted in public opinion polls. It is polling that allowed Republican Sen. John Barrasso of Wyoming to say at the summit that "only one in three people in America support what is being proposed here."

While I haven't met the other two, even if this is true, I could argue that the answer all depends on how the question was asked. However, I won't. My response is to pose another question: So what?

As far as I am concerned, people can differ on health care reform but they should be unanimous in support of the principle that a government -- any government -- shouldn't be run according to the shifting findings of public opinion polls. It is an odd thing now for the conservative party to suggest otherwise.

Where in the Constitution does it call for public opinion polls to decide the great issues of the day? Will we the poll-driven people come to accept that a government of the polls, by the polls and for the polls shall not perish from the earth?

What if the Continental Congress had been influenced by opinion polls when Gen. George Washington was holed up at Valley Forge in the terrible winter of 1777-78?

What if the pollsters had asked: Do you have confidence in a commander with wooden teeth? Should government-subsidized shoes be given to the troops? Do you support the free market in patriotic war profiteering? (I know, I know, George Washington's teeth weren't really wooden -- that was merely the death panel rumor of the time.)

If polling had existed back then, bowlers and wicket keepers would now be reporting in advance of the new cricket season. So don't tell me, Congressman Republican, what Americans believe about health care reform.

Nobody asked me and a great many others except back in 2008. Public opinion polls are informative but they should not be determinative -- that's the place of elections. And the way to win elections is to gain the respect of the voters by acting on principle.

If Democrats fall into the Republican trap of being cowed by public opinion polls, we may yet get President Palin in 2013 governing in the style now favored by her party, watching the winds of Gallup turn the old weather vane -- the one with the bronze moose. Shame then on all of us.

Reg Henry: or 412-263-1668. Read his blog "Reg on Wry" at More articles by this author

Read more:"

However, in the same Anderson paper, same day was this political cartoon!:

Good review of Norway and US Health Care Systems from the Viking Magazine, may 2009: