Arizona Gov. Jan Brewer (R) commented recently on the cuts to her state's Health Care Cost Containment System, which have imperiled the lives of some patients in need of an organ transplant. Brewer said that people branding the cuts as a real-life incarnation of "death panels" should be asking the federal government to send more money -- a perhaps surprising position from someone who continues to oppose the federal health care reform legislation passed earlier this year.
Brewer has declined to hold a special session to reinstate the funds, a refusal that leaves some patients' lives hanging in the balance.
Britain's Channel 4 reports on a recent encounter with Gov. Brewer regarding the matter:
"How many people have to die before you are prepared to reverse your decision on the transplant operations?" seemed like the obvious question.
She said she thought that was unfair and started to explain how dire the state's financial situation is. If people are so worried about the transplant patients then they should ask the federal government in Washington to send us more money, she said. But she would not explain to me, or to any Democrats in the state capitol, what she has done with the nearly $200 million she was already given in 'stimulus funds' to spend on anything she liked.
“We are against forcing all citizens, regardless of need, into a compulsory government program,” said one prominent critic of the new health care law. It is socialized medicine, he argued. If it stands, he said, “one of these days, you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
The health care law in question was Medicare, and the critic was Ronald Reagan. He made the leap from actor to political activist, almost 50 years ago, in part by opposing government-run health insurance for the elderly.
Today, the supposed threat to free enterprise is a law that’s broader, if less radical, than Medicare: the bill Congress passed this year to create a system of privately run health insurance for everyone. On Monday, a federal judge ruled part of the law to be unconstitutional, and the Supreme Court will probably need to settle the matter in the end.
We’ve lived through a version of this story before, and not just with Medicare. Nearly every time this country has expanded its social safety net or tried to guarantee civil rights, passionate opposition has followed.
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In truth, the law is quite moderate. It is more conservative than President Bill Clinton’s 1993 plan or President Richard Nixon’s 1974 plan (in which the federal government would have covered anyone who wasn’t insured through an employer). It’s much more conservative than expanding Medicare to cover everyone. It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.
But the law depends to a significant degree on the mandate. Without it, some healthy people will wait to buy coverage until they get sick — which, of course, is not an insurance system at all. It’s free-riding.
Without the mandate, the cost of insurance in the individual market would rise, perhaps sharply, because some healthy people would not be paying their share. Just look at Massachusetts. In 1996, it barred insurers from setting rates based on a person’s health but did not mandate that individuals sign up for insurance. Premiums then spiked. Since the state added a mandate in 2006, more people have signed up, and premiums have dropped an average of 40 percent.Full Wallets, but Using Health Program for Poor
After immigrating to New York City from China in the 1970s, Z. Y. Tung and his wife worked hard — he as a bank manager, she as a public school secretary — lived frugally and saved every penny they could for the next generation.
Until five years ago, when his wife, Wen Mei Hu, racked by bone-marrow cancer, had to be put in a nursing home, where the bills ran past $100,000 a year, threatening to quickly drain the couple’s life savings of $500,000. The nursing home told him not to worry: If he signed a document essentially refusing to support his wife of several decades, Medicaid, the federal insurance program for the indigent, would pick up the bill.Blue Cross, Oxendine clash over health care pricing
Blue Cross Blue Shield of Georgia, the state's largest health insurer with 2.5 million members, has such a strong grip on the market that it does not permit hospitals to make better deals with other health insurers.
This practice, a routine demand in Blue Cross's contracts with hospitals, means that Blue Cross customers get the lowest prices for hospital stays and related expenses. But some say it also means that the insurance giant uses its clout in the market to restrain competition and keep prices high.
"I don't care if you're a Republican or a Democrat, every American agrees that health care costs too much and we need to reduce the cost of health care," said state Insurance Commissioner John Oxendine. "To have contracts that legally prevent someone from lowering their health care costs . . . that's pretty unconscionable."
Faced with mounting debt and looming costs from the new federal health-care law, many local governments are leaving the hospital business, shedding public facilities that can be the caregiver of last resort.
Officials in Lauderdale County, Ala., this spring opted to transfer their 91-year-old Eliza Coffee Memorial Hospital and other properties to a for-profit company after struggling to satisfy an angry bond insurer.
"We were next to knocking on bankruptcy's door,'' said Rhea Fulmer, a Lauderdale County commissioner who approved the deal with RegionalCare Hospital Partners, of Brentwood, Tenn, but with trepidation. She said the county had no guarantee the company would improve care in the decades to come. "Time will tell.''
Clinton County, Ohio, in May sold its hospital to the same company. Officials in Kenai Peninsula Borough, Alaska, are weighing a joint venture with a for-profit company, similar to one the same company made with Bannock County, Idaho. And Prince George's County, Md., is seeking a buyer for its medical complex.
More than a fifth of the nation's 5,000 hospitals are owned by governments and many are drowning in debt caused by rising health-care costs, a spike in uninsured patients, cuts in Medicare and Medicaid and payments on construction bonds sold in fatter times. Because most public hospitals tend to be solo operations, they don't enjoy the economies of scale, or more generous insurance contracts, which bolster revenue at many larger nonprofit and for-profit systems.The Top Ten Health Technology Threats to Patient Safety
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