Medicare

Op-ed by Mark Trahant

President Barack Obama answered an important philosophical question last week: How will the federal government fully fund a starved Indian health system?

The answer is budget by budget: The administration boosted spending by 13 percent in fiscal year 2010 and is proposing another 9 percent increase for 2011. But this budget does not resolve the contradiction between “historic underfunding” and the larger reality about federal spending. The proposed budget calls for $5.4 billion in spending for Indian health care, ranging from clinical services to facility maintenance and construction. (The bulk of that money, $4.4 billion would be from appropriations, the rest comes from health insurance collections and special grants.)

HHS Secretary Kathleen Sebelius said: “Our budget also contains a significant increase in funds for the Indian Health Service as we continue to work to eliminate health disparities. It is the principle that we are trying to establish in our healthcare system – that regardless of race, ethnicity, gender or geography every American deserves high quality and affordable care.”

But while spending on Indian health is increasing – is it growing fast enough to catch up? There remains a significant gap between what is spent on an American Indian/Alaska Native patient than a federal prisoner, $2,130 per person versus $3,985. One measure used by the federal government is a benchmark based on spending for federal employees. The Indian Health Service is currently appropriated about 55 percent of that standard on per person basis.

Indeed, last April a tribal task force recommended a $2.1 billion increase in the budget authority for IHS in fy 2011. The tribal leaders called for a ten-year phase in of $21.2 billion to reach spending parity.

Help for Washington seniors

Health care reform could make life better for doctors and hospitals in Washington state that provide medical care to more than 780,000 seniors if three congressional Democrats have their way. Sen. Maria Cantwell and Reps. Norm Dicks and Jay Inslee join four other congressional Dems in a letter to House and Senate leaders saying they won’t support health care reform unless it overhauls a complex Medicare reimbursement formula that for years has shortchanged doctors and hospitals in Washington state.

The changes should make it easier for Medicare patients in Washington to find and keep doctors. It also may help attract additional doctors to Washington state, reports Les Blumenthal of the McClatchy News. Cantwell, Inslee and Dicks expect the changes to become part of the what could be a historic health care bill being negotiated with the White House.

Help for Portland transit riders

Imagine this – major transit project funding based on livability issues including economic development and environmental benefits – in addition to cost and congestion fighting attributes. Those are newly issued guidelines from the Obama administration for funding mass transit projects and a it’s a major departure from Bush administration practices. It could make it easier for Portland to expand its light rail and street car systems, the Oregonian reports.

"Our new policy for selecting major transit projects will work to promote livability rather than hinder it," said Transportation Secretary Ray LaHood.

Op-ed by Mark Trahant

    Are we in the final days of the health care reform debate?

      "The historic movement to bring real, meaningful health insurance reform to the American people gathered momentum this week as we approach the final days of this debate," President Barack Obama said in his weekly radio address. "The Senate Finance Committee is finishing deliberations on their version of a health insurance reform bill that will soon be merged with other reform bills produced by other Congressional committees."

      "What's remarkable is not that we've had a spirited debate about health insurance reform, but the unprecedented consensus that has come together behind it," the president said. "This consensus encompasses everyone from doctors and nurses to hospitals and drug manufacturers." He listed a Republican governors and out of office politicians as part of that consensus.

      But when Congress votes it's more likely we'll see something other than consensus. We could call it a "spirited consensus." There is clearly consensus to do something - but any agreement breaks down when the specifics are spelled out. It's likely there will not be a single Republican vote in the House and at best only one or two Republican votes in the Senate. That division is both partisan and philosophical.

      But it's that divide that represents our biggest challenge as a nation, our ability to govern ourselves.

      There is consensus that our health care structure is not sustainable. But that will remain true even if the health care reform proposals pass.

Indian Country & Health Care Reform

By Mark Trahant

      There is growing consensus about a key element of health care reform: a requirement that you must buy health insurance. The idea is that the insurance pools would be less expensive if every American were included - especially younger, healthier workers who for a variety of reasons decide not to buy insurance. The reform proposals would require people to sign up for Medicaid, buy subsidized insurance, or purchase a policy at work or on their own.

      This would be difficult in Indian Country. Already Indian Country reflects the highest number of Americans who do not sign up for Medicare, the closest thing we have to universal coverage for the elderly (by my count almost a quarter of Native American elderly are not on the program). The story for Medicaid is similar. Moreover in recent studies one of the reasons for the low participation is the notion expressed by many who did not believe they should have to sign up for any program because health care is a treaty obligation of the United States.

      Speaking at the National Indian Health Board Consumer Conferencein Washington, D.C., Health and Human Service Secretary Kathleen Sebelius said the president supports an exemption from that mandate for individual American Indians and Alaskan Natives. "I'm going to make it very clear," she said, "the administration strongly believes that the individual mandate and the subsequent penalties don't apply to American Indians or Alaska Natives."

      There is consensus that the Senate Finance Committee's billwhen it surfaces will reflect this notion.

By Mark Trahant
You hear a lot about grandma now that Congress is back to work on health care reform legislation.

"Poor old grandma" is a reason opponents say they will fight health care reform. Grandma will lose services, her Medicare will be less than it is, and some bureaucrat far away will decide when it's her time to die.

This is not the first time this debate has surfaced. In the 1960s opponents of Medicare used the phrase "poor old grandma" to warn that the legislation would rob elderly of their Social Security or provide insufficient care. They were wrong, of course. Medicare has probably become the most popular government program ever. These days it's common to speak as if Medicare is the universal coverage for American elderly. (Medicare is for the elderly and disabled, Medicaid is partnership with the states aimed at some people with low-income.)

And that's mostly true. Mostly. But Indian Country was largely left out of the original Medicare and Medicaid, plan, a problem that was fixed when President Ford signed the 1976 Indian Health Care Improvement Act into law.

Rick Lavis, a Republican, who was working for Arizona Sen. Paul Fannin, sent a memo to the Ford White House raising the question why it was even necessary to amend the law to include American Indians and Alaskan Natives. Then Lavis answered his own question by saying the act would "permit Indian Medicare and Medicaid beneficiaries to utilize their benefits in IHS facilities, which under present law is disallowed."

Lavis also argued that the IHS should be reimbursed at 100 percent rates in their facilities because "the federal government has obligations to provide services to Indians.

Seniors are emerging as a battleground in the health care reform war, Michael Booth and Karen E. Crummy of the Denver Post report, and politicians are finding out just where the minefields are.

"Democratic reform backers who want seniors on board meet resistance from many who like Medicare as it is, and others who reject higher taxes to expand care for the young. A whopping 94 percent of senior Medicare enrollees said they were satisfied with their coverage in a July poll conducted by Suffolk University in Boston.

Meanwhile, the senior lobby AARP has lost tens of thousands of members over health care reform. These are members angry at a perceived endorsement of President Barack Obama's health care proposals, as it faces daily assaults on its claim to speak for seniors. Republicans are jumping in to take advantage of the seniors' fears that Medicare cuts will pay for the reforms, issuing a "bill of rights" to protect against benefit trims or alleged rationing. You know, like death panels.

-- Rita Hibbard

Today's topic:  The health care debate.

Category: Making stuff up.

Timing: August

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."  -- Sarah Palin

"Death panels? Seriously? Could Palin see the Soviet gulag from her house?" Asks Denver Post columnist Mike Litwin.

Writing in the LA Times, columnist David Lazarus points out the anti-ad featuring the Canadian woman who fled fled to the U.S. to get treated for a brain tumor. "I'm here today because I was able to travel to the U.S., where I received world-class treatment," she says. "Government health care isn't the answer." Lazarus points out that the problems with this ad include the fact that no one is proposing Canadian style health care for the U.S. Canada offers it citizens a single-payer insurance program, not medical treatment, and a single-payer insurance system isn't part of the leading proposals now on the table here.