Mark Shurtleff as healthcare reform poster child

   The Salt Lake Tribune reports Attorney General Mark Shurtleff, a state employee enjoying some of the best healthcare benefits available, has somewhere between $50,000 and $130,000 in outstanding medical bills as a result of surgeries related to a motorcycle accident.  If ever anyone needed proof health insurance in America has ceased to offer families protection from medical related bankruptcy, Mark Shurtleff is it.

Given Shurtleff's historic support for the payday lending industry, it is tempting to suggest he take out a payday loan to cover his medical expenses.  However, unlike millions of fellow uninsured and under-insured Americans, Mark Shurtleff does have a six figure salary and somewhere between $366,000 and $815,000 in assets he can fall back on according to a financial report he recently filed as a candidate for the US Senate.  This provides him the luxury of avoiding both payday lenders and the kind of sympathy for working families that might motivate him to provide a healthcare reform plan of his own. 

Through a spokesman Shurtleff told the Tribune he remains steadfastly opposed to a public health insurance option for businesses and the public.  Shurtleff has spent much of his adult life receiving insurance from the government either through the military, Salt Lake County government, or the State of Utah. Still, he does not see the fact the state purchases about the best coverage available for him, his family, and other state employees as being inconsistent with this position.  Nor apparently does it give the AG pause that even with his gold plated policy he is still carrying a medical debt that would bankrupt many middle income families and virtually every low income family out there. 

In light of Shurtleff's personal experience, the voters should expect some empathy - a much maligned word on the right lately.  If not a public option, then what?  What is Shurtleff's answer to Utah families lucky enough to have insurance but still facing annual increases in premiums and co-pays that out pace inflation?  What is his answer to those both with and without insurance that must choose between years of debt or bankruptcy when faced with a motorcycle accident or worse? 

It is no longer enough to simply criticize proposals currently on the table.  The time to start providing serious solutions has come.  What say you Mr. Shurtleff?

Healthcare Reform: What is it?

While the political world is fighting about healthcare reform, the public seems largely in the dark about what is actually being proposed.

It is no wonder that the public isn’t in on the details.

Senators Chuck Schumer (D-NY) and Charles Grassley (R-IA) said on Face the Nation this weekend announced that they agree on 90% of what needs to be done, but are still fighting over three issues. They then talk about the three issues that are under dispute.

President Obama needs the plan to pass Congress, so he is letting them develop it with minimal guidelines. Most of his comments are seeking to reassure the public that if they are happy with the insurance they have, they can keep it.

The big boys all seem intent on NOT talking about what they ARE doing.

So, here is a run down of the main proposals (much of it provided by Democracy Corps):

• This plan prohibits insurance companies from denying coverage for pre-existing conditions or dropping coverage when someone gets sick and requires them to cover preventive care.
• It creates a health insurance exchange where individuals can comparison shop among different private plans or a public insurance option. (GOP & Dems are arguing over the public option.)
• The plan requires all Americans to have health insurance while subsidizing the cost for those with low and moderate incomes. (Some dispute, but mostly agreement.)
• It requires all companies to provide health insurance
  for their employees or contribute to a fund that will help pay for their coverage with small businesses getting help covering some of the cost. (There is disagreement over the mandate for small business.)
• The plan will be paid for by reducing Medicaid and Medicare spending by 400 billion dollars over the next ten years and implementing some new taxes that might include a small sales tax on goods except for food, higher taxes on those making over 200,000 dollars OR new taxes on alcohol or sugary drinks. (This is the area where much of the fighting will take place. As you can see, there is no consensus about the funding.)

Some of positive changes reform will bring:

• Never losing health insurance when you lose a job or get sick.
• Power shifted from insurance companies to people, who no longer face higher rates or lost coverage for a pre-existing condition, getting sick or getting older.
• Reduced costs for you and your family, business and country.
• Guarantees that quality, affordable coverage will be there for you no matter what happens, giving you the peace of mind that even if times get tough, you will always have access to quality health care at a price you can afford.

The reform is monumental because at heart it is about taking power away from the insurance companies and giving it to people. The control and power that insurance companies have over people, their ability to refuse care because of pre-existing conditions and use the fine print to drop people when they
get sick is the part of the status quo that voters most want to change.

Some of these changes will lead to lower costs:

• Competition created by a health insurance exchange where individuals and small businesses can shop for competing private plans or choose a public one (the public plan may be like Medicare or it may be a co-op or mutual insurance company owned by the policy holders like a credit union).
• Paying first-dollar for preventive care and supporting wellness.
• Preventing insurance companies from raising rates when people age or get sick.

Seniors who are already covered by Medicare should also know that there are benefits for them. 

• Under this plan seniors would still receive Medicare coverage, just as they do now with no reductions in benefits.
• If nothing is done to decrease healthcare costs across the board there will have to be cuts in services, or increased premiums and taxes.
• The plan would also provide seniors with better prescription drug coverage by eliminating the so-called "donut hole" - the gap in Medicare coverage that forces millions of seniors to pay thousands of dollars out-of-pocket for prescription drugs.

Continuing as things are now is not sustainable:

• Keeping the status quo means the insurance companies are still in charge, jacking up rates and denying coverage.
• It means more people losing insurance or enslaved to their job, prices skyrocketing for families and businesses and our companies less competitive.

We need change so that people no longer lose coverage, get dropped for a pre-existing conditions, and see lower costs.

This was originally written for Utah Policy Daily.

UTA: Average Utah Family will not pay Federal Income Tax in 2010

The Deseret News reports on a Utah Taxpayer’s Association study- Utahns to get federal tax refund in 2010:

For all the complaining some GOP Utah politicians do about federal taxation, a new study finds an amazing fact:

The typical Utah family — which will make just over $63,000 for 2009 — will actually get a federal tax refund in April 2010.

That's right, that typical family — a married couple with three children — will get $356 back from the federal government, not paying any federal income tax at all, the Utah Taxpayers Association says in a new study on tax burdens in the Beehive State.

And for heavily Republican Utah, the check comes because of President Barack Obama and congressional Democrats' federal stimulus package, which also includes a middle America tax cut via the Making Work Pay tax credit.

Obama Coverage Not Liberal Media Bias, Just Good Business

The corporate news media's bias isn't toward ideology...it is toward making money. If they couldn't make a ton of money off of President Obama, they wouldn't be covering him nearly as much as they do.  -- Comment from BradKT on Politico’s story on the ratings bonanza for coverage of President Obama

What do they cite:

1. Last week’s healthcare forum on ABC brought in more viewers at 10 PM than the network had had in six weeks. While the forum didn’t win the ratings battle the night it aired, “Nightline” beat out both of its top competitors: “The Tonight Show With Conan O’Brien” and “The Late Show With David Letterman.”
2. Both parts of NBC’s “Inside the Obama White House” cracked the weekly Top 10. The second night’s segment even delivered NBC’s highest rating over the previous six months among 18-to-49-year-olds in that time slot.
3. When Obama appeared on “The Tonight Show” in March, the show had its highest rating for a Friday episode in the 17 years with Jay Leno at the helm. “The Tonight Show” numbers, 126 percent above average, also helped boost the shows that followed: “Late Night With Jimmy Fallon” and “Last Call With Carson Daly.”
4. An Obama interview led to a spike in ratings with “Face the Nation” bringing in its largest audience in four years and tying the perennial leader “Meet the Press” in the important 25-to-54 age group.
5. When Obama appeared on the November 16 “60 Minutes”, it drew 25.1 million viewers and, at the time, it was the season’s most-watched broadcast. Not only did “60 Minutes” win the week, but the post-election interview with Steve Kroft drew the show’s biggest audience in nine years.

Wow, talk about stimulus. The interest in the new president won’t continue forever, but it is nice while it lasts. And it shows why the Obama Administration is trying to accomplish so much this year while a conversation with the American people continues.

There is another huge spillover benefit: Networks airing Obama specials can squeeze every drop out of them for morning shows, nightly newscasts, cable and online.

But as one wag noted: Obama’s not Simon Cowell. He doesn’t do those types of numbers. Indeed, ABC’s airing of the Neighborhood Ball, which included the Obamas’ first dance on Inauguration night, was beaten soundly by the only ratings juggernaut that may be more powerful than Obama: “American Idol.”

Beware of simple solutions to complex problems

Campaign financing is the most heavily regulated industry in America per dollar of financial activity. Private financing of campaigns creates an ethical schism that pits the concept of a “public office is a public trust” against “those who pay the piper call the tune.”

Yesterday’s Salt Lake Tribune editorial “Lawmakers for Sale”  correctly points out that Utah has not found an appropriate balance of those concerns. Unfortunately, it concluded with the silly prescription that, “Limiting donations by individuals or corporations to $1,000 for each candidate, political party or political action committee per election cycle seems reasonable.”

There is nothing reasonable about a $1,000 across the board limit for each of these entities. They each have different functions with different resulting costs. We have seen what happens when these limits are set too low. There simply becomes an unending morass of entities created to funnel funds into the important contests. This results in making campaign finances less transparent. Or in the alternative it reduces public discourse because these entities cannot afford the tools of communication.

The more difficult the regulatory scheme the less likely citizens are to participate since the knowledge barrier to keep on the right side of the law is raised too high leaving only the professionals to participate in the contest.

Such limits are slightly effective only with five other major reforms: 1) An aggressive watch-dog agency like the Federal Election Commission; 2) A limit on total political contributions for an individual entity. So, for Utah that would mean creating and funding a State Election Commission and capping any entity from giving more than $20,000 total to all candidates, parties and PACs; 3) A method for coordinating expenditures that allows these entities to take advantage of economies of scale through joint purchasing (i.e. the FEC allows unlimited transfers between party committees and some coordination for candidate services and allows for the limits to be relaxed for “building funds”); 4) A prohibition against giving in the name of another; and, 5) An exemption for certain “grassroots” activities that encourage public participation (i.e. at the federal level there are exemptions for house parties, internet communications, friend-to-friend mail campaigns, slate cards, lawnsigns, bumperstickers, and a host of other activities).

Utah campaign finance laws cry out for some limits to prevent corruption of public officials. But a $1,000 limit for all entities is far too low for some of these entities like statewide campaigns and state party committees and Utah lacks an appropriate regulator with sufficient resources to fairly enforce such limits in a timely manner.

Before limits are contemplated, Utah first needs an independent State Election Commission and an independent Ethics Commission to oversee all public officials and candidates(these could be one and the same). Then, with experience and professional guidance, we can craft rules that work for Utah.

This was originally written for Utah Policy Daily.

Salt Lake County: Look around the Attic

We had the pleasure of visiting with Salt Lake County Mayor Peter Corroon last evening. He described Salt Lake County’s main budget problem is that with interest rates so low county investments likely will yield $9.4 million less than expected this year. Similar shortfalls are predicted in 2010.

It strikes us that this is the same problem that every retiree in the state is coping with: lower yield on their savings resulting in reduced income. There are really only two solutions for the healthy and only one for those not fortunate to enjoy good health – cut costs or go to work and earn more from another source.

Mayor Corroon has suggested that the economy is not healthy, other sources are not available, and that only one responsible option exists -- to cut costs (and some of those cuts may hurt).

We also had the pleasure of discussing this issue with Council Chair Joe Hatch. The Democrats on the Council believe that by asking for a small sacrifice from a large number will cause less pain in the long and short term. The Council Democrats are asking for less than $1 per month from the typical homeowner.

The Council is rightly concerned about another steep drop in revenue from property taxes if housing prices have declined dramatically. This could push any future tax increases to levels far beyond what the public is able or willing to absorb. Regular small increases are more feasible than large occasional increases – just ask any Davis County Commissioner. The Council’s concerns are legitimate and a strong reason for the good management of Utah’s second largest governing entity.

Salt Lake County has already absorbed some painful cuts like the suspension of hiring and matching contributions to retirement programs. We appreciate the sacrifice. But, sadly, the times call for more – and over time perhaps much more.

We are sorry to see Democrats publicly at odds with one another. But we agree that the debate is a good one and waged by responsible people who are concerned about the public well-being.

The options on the table are either additional cuts in services or a small increase in taxes . . . or perhaps we do what retirees across our state are doing -- clean out the attic and put our personal effects up for sale on e-bay (just kidding, of course, the county already auctions off surplus property).

Other solutions, anybody?

Healthcare Reform: Public plan is essential

With a health care system in crisis, it is up to us to understand the issues and what is at stake: The 47 million uninsured, the minimum 20 million underinsured, our rank of 37th in the world in overall quality of care while we spend 82 percent more than other industrialized nations, businesses crumbling under the weight of providing health benefits, disparities in quality and cost, medical bankruptcies. All are driving a commitment to reform.

And yet, the usual forces are lining up in opposition. The insurance companies, which don't want to compete against a public plan, have conceded that they can forego preexisting condition qualifiers and premium penalties for health conditions. But they agreed to this in 1993, and now, 16 years later, we see no change. They clearly have a vested interest in swarming the halls of Congress with lobbyists to make sure that they're not threatened with serious change or competition.

The American Medical Association, which represents barely one-fourth of physicians and is heavily weighted to specialists, has long expressed opposition to a public plan. However, a year ago, the Annals of Internal Medicine reported Aaron Carroll's study that found that 59 percent of doctors said they support a national health insurance program.

Co-author Dr. Ronald Ackerman states, "As doctors we find that our patients suffer because of increasing deductibles, co-payments and restrictions on patient care."

Last week a New York Times /CBS poll found that 72 percent of the public support a government-administered insurance plan that would compete for customers with private insurance. On the brink of making decisions about "real change," we must define why a public plan matters.

First, a public plan will provide coverage for the 47 million uninsured people in America. The cost burden of paying for charity care in place of being reimbursed for the uninsured will be eliminated by a public plan.

Second, with the other federal plans in place, there will be enough bargaining clout to significantly impact pharmaceutical as well as other costs.

Third, a public plan with adequate size and influence could implement recommendations from the newly established Comparative Effectiveness Board to improve quality and cost.

We know from research out of Dartmouth that high cost does not equal high quality. Practices vary across the country, with some areas provide better quality for lower cost. This kind of disparity represents opportunities for cost savings by reproducing the best care provided.

Fourth, perhaps the most vital function that a public plan could have would be as a platform to reform the way that doctors get paid. The fee-for-service model in which doctors get paid more for doing more drives up cost and lowers quality.

The payment system needs to be structured to pay for quality health care, not quantity. Until payment reform is accomplished there will not be a sustainable, coherent system.

While President Obama is advocating for a plan that protects choice and fosters competition, let's not fall prey to the fear tactics of Harry and Louise and those who try to scare us into believing that this is the road to socialism.

We, the people, elected Obama to deliver us from the crushing weight of our broken health care system. The people want it fixed. Doctors want it fixed. Now is the time for us to stand up and refuse to let power politics deliver plans that amount to putting Band-Aids on a hemorrhaging, fractured system.

Julie Day is a practicing primary care physician with the University of Utah Community Clinics and serves as the medical director of quality improvement for the clinics.

This op-ed was published in the Salt Lake Tribune.