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Five Proposals to Control Skyrocketing Health Care Costs: Tell us Your Opinion!
How does the rising cost of health care affect you and your family and your co-workers? What do you think of these proposals? Can you offer ideas we haven’t yet considered? Please tell us what you think!
With time running out to take action, the Oregon House of Representatives has not yet taken up any serious measure aimed at getting Oregon’s skyrocketing health care costs under control. To the House Democrats, this situation is inexcusable.
Although the state Senate has passed three significant bills, to date the Republican-led House has moved with painful slowness on all important healthcare legislation. Bills have actually died in committee. We believe the time has come for extraordinary measures to spur House action on these and other bills that relate to reducing the cost of healthcare.
The House Democrats will hold a special two-hour hearing on Tuesday, June 14, at 4:30 p.m., in Hearing Room E of the State Capitol. The purpose of the hearing is to focus attention on healthcare legislation that the House must consider now if it is to meet its obligation to the people of Oregon. We invite all House members of both caucuses to attend, as well as the majority and minority caucuses of the Senate.
I appreciate that most people lack the time and resources to visit the Capitol to offer their opinions. Therefore, I strongly encourage those of you who cannot come to the hearing on Tuesday to give us your opinion here by posting a follow-up comment.
These are the bills we will consider at tomorrow’s hearing:
• Senate Bill 329, which would expand a popular state program that provides discounts on prescription drugs for low-income and uninsured Oregonians. The bill opens up the Oregon Prescription Drug Program to enrollees in health benefits plans, to people of any age with gross incomes up to 300 percent of the federal poverty level, and to businesses and organizations that provide health insurance to their employees. The bill would enable more Oregonians to take advantage of state buying power to obtain better prices for prescription drugs. It sets a maximum enrollment in the program of 250,000 individuals. The Senate approved the bill last month, but it has failed to advance out of committee in the House.
• Senate Bill 501, which requires health insurers to report certain information to the state in a format that allows policy makers and the public to compare insurers more easily. The information includes the number of members, trends in premiums, administrative costs, net income, and surpluses and reserves. The Senate passed the bill in May, but the House has taken no final action.
• Senate Bill 1040, which would require hospitals to report specific costs to the state, allowing comparisons of costs at different hospitals. Among its goals is making hospital costs more understandable to consumers and insurance companies. The Senate passed the bill in May, but the House Budget Committee has not acted on it.
• House Bill 2817, which would require drug makers to disclose the nature, value and purposes of the gifts they give to physicians, hospitals and other health professionals. With healthcare costs skyrocketing, patients need this kind of information in order to be wise consumers, the bill’s supporters say. The House Health and Human Services Committee heard strong testimony in support of the bill, but the Committee closed down before it could act on it.
• House Bill 3496, which would require full funding of the state program to reduce tobacco use. The $7 million that the Budget Committees are proposing to allocate for the program is 53 percent less than the voters mandated.
Thank you very much for your comments!
June 13, 2005 by Democratic Leader Jeff Merkley
Permalink: Five Proposals to Control Skyrocketing Health Care Costs: Tell us Your Opinion!
Comments
Most private and public sector employees get employer paid health insurance in their wages and benefits packages. About 80% is paid tax-free by the employer and 20% is paid by the employee. I strongly suggest that taxpayers who pay for their own health care should get the same tax consideration by allowing them to take a tax credit for 80% of their health care costs.
Posted by: gus | Jun 13, 2005 10:27:55 AM
How about circular-filing all those plans and draft a bill similar to President Bush's Medical Savings accounts?
Posted by: chris mcmullen | Jun 13, 2005 4:10:16 PM
Chris--
How about a plan that would actually do something to address the rapid increase in health care costs and help people instead?
The Medical Savings Account are a feel good idea that is, at the bottom line, meaningless. You can have a swell old time with your tax free account of several hundred dollars as you try to purchase health care for your family that costs in the thousands.
And the working poor that barely make enough to get by each month? I'm not too optimistic on the prospects for the savings accounts for them.
I'm betting that dislosure as required by HB 2817 would lead to much better results. Why not join with us in demanding that drug companies come clean with how they are spending their money (and how those expenditures cause the cost of drugs to sky rocket)?
Posted by: Rep. Peter Buckley | Jun 13, 2005 7:27:49 PM
Mr. Buckley,
How is the knowledge of how pharmaceutical companies spend funds going to empower consumers? So what if Pfizer, spends 80% of their profits on marketing? If they are the only ones making a drug you need and no alternatives exist, you pay their price. Period.
The Oregon legislature should work on revolutionary reforms which give choice and personal responsibility back to the people. MSAs are not a 'feel good' measure. MSAs have been proven successful. Moreover, they would have made a larger impact if HIPAA wasn't handicapped with so many regulations.
SimpleCare is another example:
This plan allows consumers pay doctors directly without the 30%-50% mark-up in administrative fees.
You guys should be working on freeing up the health care industry; unencumbered by government regulations and restrictions. Let doctors compete in the free market without mandates, then you'll see the cost of health care drop.
Health Care is the individual's responsibility... as is food, shelter, clothing and transportation... not the governments.'
Posted by: chris mcmullen | Jun 14, 2005 11:40:55 AM
Chris,
Is it a coincidence that drug costs began to go up at the same time drug companies were legally allowed to begin advertising?
Posted by: Sid | Jun 14, 2005 11:48:24 AM
Chris--
If you are signed up with something like SimpleCare, best of luck to you. It is a voluntary system used by a handful of doctors in Oregon, but a far, far cry from comprehensive coverage the average family needs. If you think that the free market is the right solution to a basic human right such as health care, please show me how that plays out. Our "free market" system has led to the highest prices for drugs of any industrial country, the highest percentage of citizens without coverage and health care costs rising at such a rate that companies and families are going under.
Simple Care and other ventures like it can save a few bucks on basic health care for healthy people. It doesn't come close to covering long term care needs. So if you are suggesting that something like Simple Care and catastrophic insurance will fill the bill for all our families' heath care needs, you are in line with the Wal Mart approach to health care--a useless band aid on a very ugly wound.
We are proposing steps that make sense across the board--enlarge the pool for prescription drugs to bring down prices for more people and, insist on transparency for drug companies, hospitals and other heath care cost drivers to allow for intelligent consumer protection and choice. These are small steps in a smart direction.
You say health care is each individual's responsibility. I agree that every individual is responsible for doing everything they can towards their own health. But cancer and other illnesses are not the choice of the individual, and at the bottom line, health care is a right, not some kind of privledge offered only to those with the resources to buy it. Again--health care is a right of citizenship. And no corporation has the right of obscene profits at the cost of the health and well being of our fellow Oregonians.
Expand the perscription drug pool to hold down costs. Insist on transparency on the companies that are involved in all aspects of the basic right of health care. Let's find a path forward based on all the information we need, not on half baked theories of every worker somehow being able to earn enough to individally pay for the skyrocketing costs of health care in America as it exists today.
Posted by: Rep. Peter Buckley | Jun 14, 2005 10:52:35 PM
Mr. Buckley,
Your assertion that we currently have a free market health care system is flat out wrong.
Medicare is Single-payer Insurance for The Elderly:
http://www.ncpa.org/iss/hea/2002/pd011002d.html
The US Congress has forced people into HMOs and have made the situation worse:
http://www.cchconline.org/privacy/hmoart.php3
On congress: Bad policy means pages and pages of rules and regulations, which will become expensive mandates, exacting immense amounts of data from every interaction between doctor and patient. Under the new regulations, patients would be able to choose their own doctors, but the government would be demanding and setting treatments, determining fees for service and criminalizing ordinary interactions between caregiver, the patient and the source of medical payment.
http://nj.npri.org/nj98/09/camel.htm
I also take strong exception to your claim that health care is a right. Health care is NOT a right! Health care is a personal responsibility and it is not the role of the government nor the populace to provide it. Food, shelter and clothing is a personal responsibility; or do you propose a socialist-type system where all basic human necessities are provided by the government?
Posted by: Chris McMullen | Jun 15, 2005 12:00:05 PM
Healthcare insurance and delivery in the US is an example of that "monstrosity designed by government committees."
Employer-paid health insurance/care mushroomed during World War II. There were wage and price controls in effect and the government allowed employers to offer tax-free health benefits as a form of indirect compensation.
That wartime privilege should have ended with WW II and the responsibility, along with added pay, returned to employees. Look at all the government mandates, demogoguery and collective bargaining power struggles the country now has over Health Care
Posted by: gus | Jun 15, 2005 5:05:28 PM
Chris & Gus--
Here's two points that might shock you. First, Medicare works. It provides health care at a far lower overhead (about 4% administrative cost) than private plans, and it has helped millions of Americans.
Second, I absolutely believe that health care is a right. So did FDR, Truman and pretty much every Democratic leader you can name. In fact, I have taken FDR's "Second Bill of Rights" that he spoke of in his last State of the Union Address (which listed health care as a basic right) and reworked it into the Oregon Contract Of Responsibilities and Rights. See what you think--I think it is the path back to progress for our families, our communitiies and our state:
THE OREGON CONTRACT
Of Responsibilties & Rights
It is the responsibility of every adult citizen of the state of Oregon to:
--Seek and engage in productive employment, to the best of their ability, and to contribute a portion of their earnings, on a progressive scale, towards the overall shared needs of our state;
--And/or to actively participate in education or training for their individual development and an increased ability to contribute to their families, our communities, and our state as a whole;
--And/or to care for their children, their elders and our communities in a direct and significant manner for the benefit of their families, our communities and of our state as a whole;
until the age of retirement.
It is also the responsibility of every citizen of the state of Oregon to take care for their individual health to the best of their ability.
It is the responsibility of every business operating in the state of Oregon to:
--Practice good citizenship in all business practices, with the impact of business decisions considered in terms of the benefits or damage to its employees, its community and the state of Oregon, in addition to the potential benefits or losses to shareholders;
--Pay its fair share of its earnings towards the overall shared needs of our state;
--Observe all environmental regulations.
In return for meeting these basic responsibilities, all citizens of the state of Oregon have:
--The right to a good education;
--The right to earn enough in a 40 hour work week to provide adequate food and clothing and recreation;
--The right of every business owner, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
--The right of every family to a decent home;
--The right to clean air, clean water and sustainable use of our state’s natural resources;
--The right to adequate medical care and the opportunity to achieve and enjoy good health;
--The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment.
It is the responsibility of the state government of Oregon to formulate laws, policies and procedures based on this contract, and to fulfill its terms to the best of its abilities.
Posted by: Rep. Peter Buckley | Jun 16, 2005 12:00:57 AM
Pfft... Medicare? Works?
Do a google search for "Medicare problems" and see the 3,420,000 results you get. Medicare only aids recipients by confiscating money from the rest of us.
I state again, health care is not a right. Anything that's dependent on someone else's sacrifice cannot be considered a 'right.' It's the individuals' responsibility to feed, clothe and house themselves -- as it is for them to stay healthy.
And where in the Constitution does state that health care is a right?
Posted by: chris mcmullen | Jun 16, 2005 1:00:00 PM
Chris--
Thanks for the continuing posts. The Constitution does not state that health care is a right. That's exactly what FDR was getting at with his "Second Bill of Rights" proposal in 1944, and I believe it is way past time to make that happen.
People who live in continuous fear of not being able to have access to the basic care they need to survive do not make great citizens for a democracy. Just a few questions for you: when health care costs reach a point when you personally can no longer afford care, will you then decide to simply sit back and wait to die? Is that your sense of what responsibility is? Are disabled seniors somehow supposed to find the way to earn enough money to pay for their own health care?
If you view taxes as money being confiscated from you, there's not much I can do. I believe it was Oliver Wendall Holmes who said "Taxes are what we pay for a civilized society." I would have to say that any society that does not find the ways to provide for the basic care of its citizens is uncivilized.
Posted by: Rep. Peter Buckley | Jun 16, 2005 2:42:47 PM
Mr. McMullen:
First of all, I'm not exactly sure why you thought this would be a good forum to spout some libertarian viewpoints. I've appreciated representative Buckley's grace in the back-and-forth dialogue with you, but I thought I would weigh in.
I'm a good democrat, and I support nearly all of the ideas presented. I especially think that the truth-in-sales relationships bill is an important step for Oregon to lead the way on.
But let me start by saying that I do think MSA accounts have their place. For someone like myself, who is young and healthy, an MSA account both makes sense for me financially and can solve some of the cost issues. When I pay for things out-of-pocket, I ahve an incentive to shop around. That becomes even more practical when the state helps out by providing information I can use to compare costs of hospitals, etc. Of course, an MSA doesn't work for everyone. But, for the sake of argument, why not make the government the insurer of last-resort, providing catastrophic coverage for anyone with a deductible of, say, $10,000/individual annually? That would increase the risk pool, and reduce administrative costs, but not go so far as a full single-payer system for day-to-day medical care.
Secondly, I want to say that I think Democrats need to start telling the truth about health care costs more often, as representative Buckley got to after being prodded by you. The truth is that publicly-provided health care (e.g., Medicare) *is* more cost-efficient than the private sector. You can criticize medicare all you want, but it is significantly less expensive than my current employer-provided insurer. Other single-payer systems (ala Canada) show similar cost benefits: greatly reduced administrative costs, and lower expenses over all.
So let's face it: In the modern world, people need health care. And right now, we're alone among the industrialized world in the numer of people without it. And our costs are increasing. So we need to bring costs down. The state can do that in a number of ways, and we should act on them.
On a final note, I am recalling a PBS special I watched the other that mentioned Oregon's solution for perscription generic substitution in medicaid, and the state's efforts to give good, unbiased information on drug costs and benefits to doctors. That is the sort of thing that will move Oregon out to the front of the pack in terms of health care policy that makes sense. Let's show America how to do it, leading the way to a cost-effective and human solution to our state's health care.
--Dave Dyk
Posted by: Dave Dyk | Jun 16, 2005 3:01:49 PM
Representative Buckley:
I never posted anything about Medicare so please don't feel bad if I say I require more proof than your statement that "it works". Perhaps you can explain why my cousin in San Diego gets free medications with his Medicare HMO plan while I have to pay for medications here in Oregon with a similar HMO charging about the same rates? I also think it was unfair to tax Michael Jordan and his employer $720,000 for Medicare the year he was paid $30 million. (2.4% X $30 million = $720,000)
As to YOUR contract of responsibilities and rights. What happens to the tens of thousands of Oregonians who do not currently live up to the responsibilities enumerated therein. I am referring to those who have dropped out of school. Those who would rather drink or drug than work. Those who engage in unhealthy lifestyles etc. etc. Are they excluded from the contract?
On the Rights side of the contract, why do you omit secure borders, security of persons, homes and property, police and fire protection, a justice system or a highway system?
YOUR contract might work in Heaven where everyone should be responsible and free from sin. Here and now, I suggest we continue trying to deliver on the promises of the Declaration of Independence, The Constitution and its amendments as well as closing the Achievement Gap in our 3-tiered public schools providing mostly excellent schools in affluent communities; good enough schools in middle class communities; and mostly bad schools in poor communities.
Posted by: gus | Jun 16, 2005 5:19:00 PM
Gus--
Thanks for the comments. I actually think it was absolutely fair for Michael Jordan to pay that much for medicare from his multi-million dollar contract. That's what progressive taxation is all about, and I a firm believer in it. Your hit on the right ro security of your person, home and property is an excellent point, I will ponder how to incorporate that.
I'm trying to address police/fire protection, along with transportation and other shared services in the reference to "shared needs of the state" line of the contract. The contract is an idealistic statement, without a doubt, but it would give us clear points of responsibilities and rights we could point to. I see it as a possible path to do just what you state--"to deliver on the promises of the Declaration of Independence, The Constitution and its amendments."
As for your comments about a 3-tiered school system, I couldn't agree more. And it is unacceptable. One of my main points is that we have lost the idea of citizenship in our society, and our responsiblity to actually find the ways to ensure every child's right to a good education. It will take all of us to pull it off--to stop pointing fingers and allowing ourselves to be divided, to not wait until the "perfect" system of funding and accountability is found before we agree to put everything we have into it. And I feel the same way about health care--we can't have a 3-tiered system of care, providing excellent care to affluent citizens, good enough care to middle class families like mine, and mostly bad or nonexistent care to poor families...
David Dyk--thanks for your comments as well. You make me look at MSAs from a different vantage point from someone younger. I remember in my 20s I declined to sign up for a health care program with my employer because I was making so little that the monthly share of costs seemed too much and I was pretty darned healthy...maybe MSAs with a fallback system might work for younger folks...
Posted by: Rep. Peter Buckley | Jun 16, 2005 9:07:05 PM
Why is it that those who profess to worship at the alter of Adam Smith and the invisible hand constantly defend corporations who seek government handouts in the form of taxbreaks? Why is it that those same folks oppose attempts to allow consumers the right to possess the very knowledge that would make the free market function? The free market can only function when two individuals (or groups) sit down at the table to negotiate from positions of equal power (and knowledge). Transparency in health insurance and hospital rates will strengthen, not weaken, our for-profit health care system.
Posted by: WmZFoster | Jun 16, 2005 9:45:58 PM
Mr. Buckley,
You and I obviously have major philosophical differences. For the life of me, I cannot understand how you can justify punishing those who are successful by confiscating a huge chunk of their earnings.
It goes against everything this country is about. We should be rewarded for hard work, achievement and success, not forced by gunpoint to give the fruits of our labor to the government.
By your logic, sloth and underachievement are rewarded. It says: "Don't worry if you drop out of school, do drugs, be irresponsible and have children you can't afford... the government will take care of you be stealing money from the acheivers and giving it to you."
Income redistribution is the main cause of this nation's ills.
Posted by: Chris McMullen | Jun 17, 2005 11:13:18 AM
Chris--
Thanks for the continuing posts. I'm afraid you don't understand my logic at all, though. I have no desire to to reward sloth and underachievement. That makes absolutely no sense. And I have no idea what you mean by government stealing money from people. I believe in progressive taxation--do you have a better idea on a formula for paying for schools, roads, public safety, etc.? If so, I'd love to hear it.
As far as income redistibution, I would point you towards David Cay Johnson and his book "Perfectly Legal." He sets out how the tax codes in our country have served to make sure that the income distribution in the last few decades has gone UPWARDS. Check him out. The top 1% is raking in $18,000 for every dollar a working class American is earning, a huge increase from where we were just a handful of years ago.
My view is that a healthy middle class is good for America, and that progressive taxation is the only way to achieve that (as evidenced by the surge in home ownership via the GI Bill in the 50s, paid for by progressive taxation). Your thoughts?
Posted by: Rep. Peter Buckley | Jun 17, 2005 10:50:36 PM
I have been watching this debate from afar but now wish to chime in. I have long been a supporter of universal health care. Why you might ask? Two reasons:
1. Its the right thing to do.
2. It'll decrease costs in the mid to long run. This is because if we invest in a system that emphasizes preventative care for those who can't afford it, illnesses will get detected earlier. You won't have disadvantaged persons only going for care when they are really sick. This will, in the end, decrease the societal load.
Posted by: Andy | Jun 19, 2005 12:45:23 PM
Andy--
How do you convince those who have employer subsidized, tax-free health care that paying taxes to support universal health care is to their benefit?
Posted by: gus | Jun 19, 2005 1:01:27 PM
Why should we pay for a single-payer plan? Because it would be cheaper than the half-assed [non-]system we're ALREADY paying for. It's incredibly frustrating that we're making so little headway on these issues. It was almost 20 years ago that I thought things were coming to a head around health care (Pittston, Nynex, etc.)when there was a series of big strikes/lockouts at the same time largely around sharing the burden of health costs; now things are far worse. Our inability to deal with equitably financing health care is a major drag on our economy (see GM, paying about $1000 per vehicle for retirees' care). Uh, Chris, this is why health may be a slightly bigger issue than the mighty individual or magic market can handle.
All these current proposals the good rep mentions fiddle around the edges - the first and last are probably the only ones worth the effort since they may help a little bit. But major progress hinges on disentangling different parts of the health equation - I see at least five distinct issues:
1) universal access and basic equity
2) pooling risk (related to #1 but not necessarily the same)
3) containing costs
4) maintaining choice of providers
5) ensuring quality
While it would take awhile to spell out the argument, I believe that a Canadian-style single-payer system answers all five of these issues pretty well, and far, far better than the American, devil-take-the-hindmost, approach. To think that we don't need major structural change in health care here is seriously deluded, in my opinion.
As an interim measure, I just don't understand why larger employers don't band together to bargain with HMOs and drug companies on a more even footing.
-Michael
Posted by: michael_pdx | Jun 20, 2005 1:49:07 PM
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