Health Care Systems Debated

(Ann Landry Lombardi, a League member in Prince George’s County, attended a health care conference on behalf of LWVMD in the Fall of 2007. Here’s her report.) “Medicare is the first problem to solve” said President Lyndon B. Johnson in his presidential campaign of 1964. Today, with the estimated number of Americans without health insurance at 15%, or 47 million and rapidly increasing, the options and consequences of delivering and paying for health care present a major dilemma for the nation. The speakers at an October Wilson Center program explored the options of changing the present cost-based system of health care, including efforts to reduce cost and improve health. The facts of the present system were generally agreed on, with no one accepting the present system without amending its parts. All agreed that health care cannot be solved by incremental reform. From different points of view, they civilly criticized the others’ methods regarding health care and its funding. They spoke clearly on the subject without belittling each other nor resorting to the jargon that laces health care arguments. Each speaker expressed hope that the presidential election of 2008 will offer the opportunity to resolve its availability and cost. Robin Cook cited the ignorance or apathy concerning health care, when a universal plan would reduce cost and improve health. The United States is rated 37th in world health care. It is presently cost-based with a reimbursement for each procedure. The single payer system discussed by James Monrone would be an expansion of the Medicare plan. He said it would avoid the increasing cost of America’s current health care. All medical persons, facilities and drugs would be tailored to the individual’s needs. It would be paid for by a method similar to Social Security. Universal coverage is the advantage; profit would not be the central consideration. He considers that the cost of such a system would be a constant percentage of the country’s GDP. Government would set the fees [taxes] to assure that providers are paid. An outcome might make Medicare information assessable on the Internet. Presently employer mandates erode the economic logic since employees change jobs often. And he cautions that the government can’t run a market-based plan. Paul Seltman promoted a hybrid of employer mandate, citing the advantage as shared responsibility. He criticized a single payer program, “No individual is responsible,” he said. Under his proposal an individual would pay a percent of income; with a penalty to be applied to non-contributors. The employer would pay four percent and the government would pay a subsidy for low wage earners. Newcomers would be picked up immediately with no swapping of insurance and/or waiting a year to be eligible. There would be guarantee issues: the market would have “pool risk”, spreading the care across a greater population. And everyone would have to be covered in the chronic disease program. Community rates would be sustainable and keep the employer involved as well as health regulators. Medical pricing is not now transparent. It would increase the transparency of Medicare as well, he said. . Seltman commented that the other health system plans would exceed cost. A single payer plan would ration health care, causing waits for surgery and elective surgery postponed. He suggested this is what we want to avoid. He questioned that business would be willing to shoulder health care costs. Seltman said that under his proposal the job-tied family health plan of current employees would experience no delay in effectiveness when members change jobs. The package would provide fewer choices but employers would be considering its cost on a larger scale, effectively therefore spreading the burden. It would be funded by payroll deductions and employer contributions. Michael Cannon questioned net results of prior concepts of funding health care. He likes innovation such as nurse practitioners in department stores. The present rules of health care funding prohibit natural competition. These laws favor the big lobbying market, he said. The average annual health care cost: $ 14,000 health care industry plus $12,000 paid by family insurance and co-pays equals $26,000. Food and drug regulations are strong enough. They usually affect more than health services. He cites “4 E’s”: Earn, Entry, Exchange and Enterprise. A competitive health care market would provide savings, IRS can establish a standard health deduction on tax forms, and its application would cross state lines as jobs and housing cross state borders. Cannon considers measures of equity which point to a look at health outcome rather than procedures. It would alter outcome by factors that are not health issues and would improve the distribution of health. Considering life expectancy and car accidents as health outcomes are not related to health costs. Employers could budget a portion of employee cost to spend on health care. Government needs to define health care. Cannon said that the state of Massachusetts health program is regulated, and its cost is no higher than in the year 2000. “Government is in the driver’s seat,” he said. He said that mandating health care coverage is advantageous to insurance markets. The current system is a band-aid to insurance and pharmaceuticals. He questioned who has the “right to health care.” The United States does well at specialized medicine but there is no national plan. He suggested higher premiums and deductibles on upper-income seniors enrolled in Medicare's new prescription drug benefit, raising fees on beneficiaries with incomes over about $80,000 a year Speakers were Robin Cook, physician, author and member of Wilson Center Board; James Monrone, Professor of Political Science and Urban Studies, Brown University; Michael Cannon, Director of Health Policy Studies, Cato Institute; Paul Seltman, Counsel, Dinker Biddle & Reath LLP.

Hearing on Election Administration and False or Misleading Political speech

October 2007 (Lu Pierson, LWVMD president, attended an October hearing of the Senate’s Education, Health and Environmental Committee’s subcommittee on Ethics and Election Law. The topic was “Election Administration and False or Misleading Political speech.” Presenters were from the State Board of Elections, local Boards of Elections and staff of the Department of Legislative Services. Here’s her report.) The Subcommittee Chair, Sen. Roy Dyson (D – District 29) was the only Senator in attendance. Del. Sandy Rosenberg (D – 41st District) was also present. Linda Lamone, State Election Director, gave a briefing about current projects in her department. She first implored the committee chairman not to pass any legislation in the 2008 session that would require any changes to election procedures. She noted that revised election judges training manuals have already been published, and training by local Election Boards is anticipated to start within the next six to eight weeks. Limone said the State Board of Elections (SBE) has identified and contracted with a local printer to print absentee and provisional ballots, which should reduce the problems associated with timely dissemination of absentee ballots in the 2006 elections. She noted that fully one-third of local Elections Directors are new in their positions since the last election, and almost half of them will be conducting their first presidential elections in 2008. Senator Dyson said he has been hearing about understaffing from local Election Boards. Responding that this is an ongoing situation, Limone said she understands that most local Election Directors are meeting regularly with their county elected officials to stress the importance of fully funding local election boards. Lamone spoke very highly of the electronic poll books (EPB), noting that not only do they make election day run more smoothly and reduce line wait time for voters, they are also very useful in providing post election data. They experimented in the recent Baltimore City primary with estimating turnout figures based on EPB real time data. Using the data about who had voted by 11 am, they estimated that 28.5% of voters would participate in the election. The final figure was about 29%. Frederick County Election Director Stuart Harvey reinforced the positive reactions that election officials, judges and voters have to the EPBs, and suggested that no matter what voting machines are in use by the state, the EPBs are invaluable. Lamone shared exciting news about SBE having applied for and been awarded a grant by the Pew Charitable Trust for research and development of comprehensive post election audit procedures. They will be working with the University of Michigan on this project. SBE expects to have a final report under the grant by October, 2008, in time to test the developed procedures after the 2008 General Election. She reported that SBE staff, in conjunction with several local elections directors, has recently completed a state plan for election judge recruitment. Katie Brown, Deputy Election Director for Baltimore County, discussed the successful program the county has adopted in which they contract with the University of Baltimore to provide all training for election judges. She reported that the improvements to the State Voter Registration Database are going well. She said that out of 3,000,000 registered voters in the database, they have been able to reduce the number of duplicate registrations to less than 100. Lamone said that SBE staff is in the process of preparing a Request for Information relating to the development and implementation of a web-based campaign finance report filing system. She said that SBE has applied for $155,000 in federal funds to do a complete polling place accessibility assessment and to upgrade the accessibility attributes of their website. An Overview of the Regulation of False or Misleading Political Speech Joshua E. Loh, of the Intergovernmental Matters and Public Administration Workgroup in the Office of Policy Analysis, gave a presentation entitled “An Overview of the Regulation of False or Misleading Political Speech.” and distributed a report by that name. The report is not yet available electronically. The report provides an overview of both federal and state approaches to the regulation of political speech. There is also a section in the report dealing with “robo-calls.” Delegate Rosenberg (he and Senator Gladden introduced into the 2007 General Assembly cross-filed legislation dealing with false and misleading political speech), asked Mr. Loh whether he had reviewed that introduced legislation and the related Attorney General’s letter. Mr. Loh said that he had, but that he felt, based upon what has been happening in other states’ courts, that the Attorney General may have been somewhat generous in his interpretation of what would be constitutionally acceptable in this area. Mr. Loh noted that it is impossible to predict just how any particular court would rule on such issues.