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Background on Health Care


HMOs & MANAGED CARE

  • Comprehensive national health care reform died in Congress in 1994 (after a report by a commission run by Hillary Clinton).
  • 16% of Americans (42 million people) have no health insurance (and hence must pay for health services in full, or receive hospital charity).
  • 14% of Americans receive some form of public health care or health insurance (70% have private health insurance).
  • 20% of Americans are members of Health Maintenance Organizations (HMOs). NATIONAL HEALTHCARE
  • Opponents (usually conservatives or libertarians) say that "HillaryCare" and other national healthcare initiatives are a government takeover of one of the largest industries in the economy.
  • Proponents (usually liberals) say that every industrialized country has more government-provided healthcare than the United States, and we are unnecessarily creating an economic burden by not having more national coverage.
  • Some proponents (usually liberals or populists) advocate "single-payer" as the best means to provide national healthcare. The single-payer would be the government, hence simplifying the system by removing health insurers and HMOs (or restricting them, under some plans). Examples are the Canadian system and Medicare.
  • Key issues in this election cycle are "portability", which means how (or whether) employees leaving a job can keep their health coverage between jobs. Some proponents want to separate health insurance from employment altogether.
  • A key state issue is allowing "drug reimportation", usually from Canada -- which means crossing the border to buy less expensive prescription drugs, and bringing them back for resale, either individually or as a collective effort. A related issue is state government negotiating bulk purchases of prescription drugs from drug companies (some proponents advocate the federal government doing the same). MEDICAID / MEDICARE
  • The top issue in this election cycle is "Medicare Part D", which took effect on Jan. 1, 2006. Enrollees must sign up by May 15, 2006, or pay a growing penalty (1% per month) to sign up late.
  • A standard plan requires members to pay a $32 monthly premium, a $250 deductible, and 25% of drug costs up to $2,550, 100% of drug costs beyond that to $5,100, and 5% of drug costs over $5,100.
  • Additional subsidies are available for people earning under 150% of the federal poverty line.
  • Proponents (usually conservatives or libertarians) say the new plan empowers the consumer and introduces much-needed market elements.
  • Opponents (usually liberals or populists) say that the new plan confuses elderly people by requiring study of dozens of conflicting plans, and cuts benefits for the most needy.
  • Additional Medicare and Medicaid background is covered in theSocial Security section (but some quotations are cross-referenced here). PATIENT’S BILL OF RIGHTS Congress debates a ‘Patient’s Bill of Rights’ which would establish rules of dealing with HMO managed care. The buzzwords in this debate are:
  • External Appeal: Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.
  • Medical Necessity: At issue is whether the doctor or the HMO management determines what is necessary. Determination of ‘necessity’ may become subject to expert review as well, or it may become measured against established standards of ‘generally accepted practices.’
  • Legal Liability: Patients would be granted the right to sue HMOs for medical costs and damages, which is not a right under current law. Generally, liberals supoprt the right to sue HMOs while conservatives do not. This is the primary distinction between Republican and Democrat versions of Patient Bill of Rights proposals.
  • Scope of Coverage: Some states regulate HMOs in ways similar to those described here; a ‘Bill of Rights’ could apply to them, to all HMOs, or to all patients.
  • Prevention: Advocating prevention implies support for removing government from health care, or opposition to more federal health care funding or national insurance.
  • Consumer Choice: Advocating consumer choice or reduction in healthcare bureaucracy implies support for removing government from health care, or opposition to national insurance. EUTHANASIA
  • The Supreme Court ruled unanimously in June 1997 that there is no constitutional right to euthanasia, but that states can allow euthanasia without federal intervention.
  • ‘Euthanasia’ means ‘good death’ in the context of terminal illness. Buzzwords:
  • Passive Euthanasia: Hastening death by withdrawing life support.
  • Active Euthanasia: Causing death in response to a request from that person. The best-known examples are by Dr. Jack Kevorkian, who was found guilty of 2nd degree murder in March 1999.
  • Physician Assisted Suicide: A physician supplies information and/or the means of committing suicide so that a patient can easily terminate their own life.
  • Involuntary Euthanasia: A synonym for murder; used by anti-euthanasia activists.
  • Right to Die: Establishing suicide as a civil right; used by pro-euthanasia activists.
  • The state of Oregon passed a Death With Dignity law, which was active until the federal Department of Justice reversed its enforcement policy in November 2001. TOBACCO SETTLEMENT
  • In Nov. 1998, 46 states settled the cases they had filed against the tobacco companies. (The other 4 states had previously settled, on similar terms)
  • Now, the state legislatures are debating the best use of the settlement funds, which totals $246 billion to be paid over the next 25 years ($5 to $9 billion per year starting in April, 2000).

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    Related issues:

  • Medicare/Medicaid in Social Security
  • Public medical care in Welfare Reform
  • Trust Fund in Budget & Economy MANAGED CARE:
  • Background.
  • HR 2362, Uninsured Act.
  • Against managed care.
  • Against Health Reform.
  • For Health Reform.
  • For National Health.
  • Against National Health.
  • Patient Bill of Rights.
  • Medicare background. EUTHANASIA:
  • Background.
  • Supreme Court case.
  • For Euthanasia.
  • Against Euthanasia.
  • Dr. Jack Kevorkian. TOBACCO DEAL:
  • Background.
  • Settlement, full text.
  • CDC info, federal view.
    Click here for The Forum discussion on Health Care.
    Click here for policy papers on Health Care.
    Other candidates on Health Care: Background on other issues:
    George W. Bush
    Dick Cheney
    Hillary Clinton
    John Kerry
    John McCain
    Ralph Nader

    2006 Senate retirements:
    MD:Sen.Paul Sarbanes (D,retiring)
    Mfume vs.Cardin vs.Steele
    MN:Sen.Mark Dayton (DFL,retiring)
    Kennedy vs.Bell vs.Klobuchar
    NJ:Gov.Jon Corzine (D,retired)
    Menendez vs.Kean
    TN:Sen.Bill Frist (R,retiring)
    Ford vs.Bryant vs.Hilleary
    VT:Sen.Jim Jeffords (I,retiring)
    Sanders vs.Parke

    Hot 2006 Senate races:
    FL:Nelson vs.Harris
    MT:Burns vs.Morrison
    PA:Santorum vs.Casey
    RI:Chafee vs.Brown       		Abortion
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