Political Diagnosis, Part II: Reduce Healthcare Costs, Support Midwives; Healthcare Reform Should Leave Out Moral Values; Funding Long-Term Care ...

By Christine Cupaiuolo — July 13, 2009

A continuation of the latest in health reform politics and discussions

Speaking of reducing bureaucratic interference, Lois Uttley of Merger Watch wrote the definitive get-your-act-together letter to Congress warning against drafting healthcare legislation that shortchanges women.

Referring to numerous Senate amendments, such as no funding for abortion, that “would deny health care to women, gays and lesbians, people with HIV and anybody else conservatives don’t like,” Uttley offers the following advice:

Apparently, you conservative Republicans have forgotten the advice GOP consultant Frank Luntz gave you just two months ago about how to talk about health reform: “What Americans are looking for in health reform is more access to treatments and more doctors … with less interference from insurance companies and Washington politicians and special interests.” That means we don’t want any more interference in our health care from you, or any of the right-wing groups urging you to use health reform to restore the rejected Bush “moral values” agenda.

There’s enough blame to go around. Indeed, Uttley lashes out with a masterful bipartisan critique:

Now, let’s turn to you Democrats who are supposedly running Congress. You are spending far too much time trying to win over colleagues who are never going to vote for health reform, no matter if you offer them abortion exclusions or new provider “conscience” laws or other provisions that would hobble health reform. You need to get over your worries that if you support inclusion of a strong public plan in health reform, somebody is going to call you a socialist.

Don’t forget that women are among the strongest supporters of moving quickly on health reform this year. Why? Women are grassroots experts on what is broken in the current health system.

Insurance plans try to squirm out of covering us when we are having babies by declaring our pregnancies to be “pre-existing conditions.” In a lot of states, insurance companies charge us more than men for health coverage, largely because of the costs of having children. They call this “gender rating.” We call it discrimination.

Read on for more about what makes us (frustrated) experts.

The Near Future of Long-Term Care: Here’s an aspect of health reform that hasn’t received much news. From NPR:

As the Senate Health, Education, Labor and Pensions (HELP) Committee marked up the long-term care part of a health care change bill Tuesday, Health and Humans Services Secretary Kathleen Sebelius sent a letter to committee Chairman Ted Kennedy with an endorsement. She signaled the Obama administration’s support for something called the Community Living Assistance Services and Supports Act (CLASS Act).

That legislation, which is part of the committee’s health bill, would let workers choose to have government deduct money from their paychecks — maybe $65 to $100 a month — and put it in a savings account. When they get old or disabled and need care, they could then use that money.

There’s opposition from Republicans, but they’re not the only ones voicing concerns:

Bob Kafka, of the disability civil rights group ADAPT, said not enough is done for poor people who can’t afford to have the money deducted from their weekly paychecks — or who, because of their illness or disability, may not be able to work at all. “Secretary Sebelius’ letter adds insult to injury,” said Kafka. “This administration has totally said to low income people with disabilities, ‘You do not count.’ ”

Kafka’s group endorsed the CLASS Act but wants it paired with passage of another bill called the Community Choice Act. That would allow people who get long-term care services through Medicaid to use that money for help to stay at home. Now, the only thing they are guaranteed is that Medicaid will pay for them to live in a nursing home — and home services are limited, require being on yearlong waiting lists, or are unavailable.


Want to Reduce Healthcare Costs? Support Midwives: Writing at The American Prospect, Miriam Perez reports on advocacy efforts to get all states to recognize and license certified professional midwives. Unlike certified nurse midwives, who are allowed to practice in all 50 states and generally work in hospital settings alongside obstetricians, CPMs practice outside of hospitals, mostly in homes or birth centers. How is this related to health care reform? Perez explains:

Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women. […]

David Anderson, economics professor at Centre College in Kentucky, has run the numbers and says that midwifery care could save us billions of dollars annually, without affecting quality of care (maybe even improving it). Anderson posits that if we increase the percentage of women giving birth out of hospital by 10 percent (currently at only 1 percent nationally) we could save close to $9 billion per year. He points to the difference in baseline costs for out-of-hospital birth — a difference of more than $6,000 when comparing the average cost of a home birth to an in-hospital one. Another main cost reducer, according to Anderson, is the significantly lower rate of C-sections for out-of-hospital births.

It’s not just the costs that are lower, according to these advocates. The outcomes are better too, which in turn, further lowers cost by reducing additional care needed by sick babies and mothers. Anderson adds that if CPMs are allowed to practice in all 50 states, competition will drive down prices for maternity care, since more women will have access to a low-cost alternative to hospital births.

Visit The Big Push for Midwives for more information.

How To Fund Health Care Reform: House Democrats are expected to add details today to a proposed healthcare bill. The bill will include a tax increase on wealthy couples.  House Ways and Means Committee Chairman Charles Rangel (D-N.Y.) predicted the plan could generate as much as $540 billion over 10 years. From the Chicago Tribune:

Married taxpayers earning more than $350,000 a year in adjusted gross income and single filers making more than $280,000 a year would pay a surtax of at least 1%. Rates would rise on higher incomes, with families earning more than $1 million paying about 3%.

The tax plan faces an uncertain fate in the House and the Senate, where Democrats and Republicans are working on their own proposals to offset the costs of helping tens of millions of people get health insurance. Senate leaders have shown much less interest in a new income tax. President Obama, meanwhile, has proposed raising more than $300 billion over 10 years by limiting the deductions that wealthy Americans take on their income taxes.

News Analysis: Another site to add to your healthcare reform reading list — The New England Journal of Medicine has a useful section featuring the latest news and articles on costs and coverage.

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