Friday, November 14, 2008

OWL Medicare-For-All Report Author releases an article...

November 13, 2008

From the National Academy of Social Insurance: Ideas on Medical Care Reform

The Economical Way to Assure Medical Care for Children and Young People That Also Reduces Strains on Family, Business and State Budgets: Medicare

By Nancy J. Altman and Merton C. Bernstein.  [Both have served as senior staff to the 1982-83 National Commission on Social Security Reform and in the United States Senate, and as board members of the National Academy of Social Insurance.  They can be reached at, and]

President-elect Obama’s proposed health care reform includes a requirement of mandatory, universal, and comprehensive health care coverage for all children.  No reform is more urgent, offers greater returns, or is more readily achieved at such low cost.[i]

We suggest that Medicare offers the readiest and least expensive platform for this advance,[ii] one already familiar to the nation’s health care providers, insurers, and consumers.  A straightforward, universal children’s health plan is extremely efficient.  Social Security, which has low administrative costs (less than 1% of outgo), demonstrates how cost effective an objective test like age is.  Using Medicare’s simple and low cost machinery, rather than the myriad private and public sector programs, like SCHIP[iii] and Medicaid,[iv] will assure universal coverage while eliminating a number of costly and time consuming steps, such as processing hundreds of thousands of billings using innumerable differing formulas.  Massachusetts alone, for example, has used eight different eligibility/payment formulas for similar populations.  Private plans vary in coverage and procedures.  Using but one formula saves effort, time, and lots of money.

Funds now applied to SCHIP and Medicaid will go farther by eliminating the costly means testing that must be done repeatedly – every thirteen weeks in the case of Medicaid.  Indeed, the Urban Institute has concluded that Medicare’s administrative costs are about 4 percentage points lower than Medicaid’s.

In addition to its efficiency, a unitary, comprehensive program for children will improve health outcomes.  When medical attention is needed, no one need first ascertain which program, if any, will foot the bill; patients can proceed directly to the intake nurse, without first stopping at the financial office.

Reducing the per capita cost of children’s medical care and shifting those costs to Medicare will reduce the financial stress upon families and business.  Employers will find the costs of employment-based insurance reduced, as will their employees.  Inclusion of children in employment-based insurance has always been a matter of convenience; consequently, it can be modified without violating principle.

Such a program will increase the nation’s productivity.  By assuring timely and adequate health care to all of our children, we reduce the disruptions to family life and employment that inevitably accompany child sickness, which can be especially disruptive for single parents.  Fewer sick kids means fewer work absences by adults.

By assuming the cost of the state shares of SCHIP, Medicaid coverage for children, and similar state programs, the federal government can deliver effective assistance to state governments where they urgently need it.  Expenditures for Medicaid and the health care costs of public employees have become the largest or second largest outlays by states.

We will all be better off by fully meeting the health needs of all the nation’s children in the most effective, least costly way.  Providing health care to children is comparable to our national policy of providing education, free of cost, to all children.  As a nation we debated and settled that policy in the 19th century.  We decided as a nation that we all have a stake in the education of everyone’s children.

We must recognize children’s health and child education are as much a part of the national infrastructure as our ports, roads and bridges.  Medicare provides an efficient, time-tested platform for making this goal a reality.

[i] In 2006, Medicaid covered more children (29.5 million) than any other beneficiary category and with the lowest per capita cost - $1,070 as compared with $1,310 for adults, $6,630 for aged, and $7,360 for blind and disabled (Congressional Budget Office fact sheet, March 6, 2007).  What we propose here would lower per capita cost even further.

[ii] Out-of-control costs are pervasive throughout both public and private health care programs.  Controlling all such costs are essential to overall health care reform.

[iii] State Children’s Health Insurance Programs, enacted in 1997, have substantially decreased the numbers of children lacking assured health care.  Together, SCHIP and Medicaid have improved coverage of poor children.  However, the older the youngster, the less likely such coverage is.  Further, both programs are limited by income caps – typically 200% of the federal poverty level.  The most dramatic element of the Massachusetts plan is that it raised the cap for subsidized assured health care to 300%.  SCHIP and Medicaid coverage keeps changing; a recent study of five states, all with generous standards, found temporary but substantial coverage gaps (How Stable Is Medicaid Coverage for Children?”, Fairbrother, Emerson and Partridge, Health Affairs, March 20, 2007).

[iv] Medicaid provides more extensive care than SCHIP.  Both use federal and state funds with the federal share the larger.  As with several other economic stimulus measures, this proposed shift of the state contributions would require deficit spending.

Wednesday, November 12, 2008

Obama wins the election! Now what?

Obama wins the election!  Now what?

In the last week, we have seen the incredible power of hope.  The election of Barak Obama to the Presidency of the United States ignited celebration not only in this country but around the world.

Americans have reaffirmed the dream that you can succeed to the highest political office regardless of your race or ethnicity.  At a time that our economy is failing and our reputation around the world is embarrassing, voters proved that our aspirations are most powerful when things seem most gloomy.  As President-elect Obama encouraged us, we must believe in the “audacity of hope.”

Equally amazing in the last week has been the reaction of the world to Obama’s election.  There literally has been dancing in the streets.  People in all parts of the world care about what Americans do – with good reason.  In the last eight years we have invaded two countries and started a global financial crisis.  Can we also start a revolution of hope?

For individual citizens and members of OWL, we should learn from what has been accomplished.  President-elect Obama is a man who believes in a vision of the country and has worked successfully to convince others to believe he can make a difference.  If nothing else, he has shown us that he can convince thousands of volunteers to work for him, millions of people to contribute money, and tens of millions of people to vote for him regardless of race, party affiliation, or a funny name.

It is time for all of us to make the vision a reality.  What are your hopes for which you would volunteer and contribute money?

For me, I can imagine a country where everyone has equal access to health care.  Where women don’t pay more for health insurance or retirement annuities just because they are women.  Where wage discrimination on the basis of gender is eliminated.  Where elder abuse never happens.

Now is the time for us to hope, but hope is not enough.  It must be followed by action.  As Tish Sommers and Laurie Shields understood when they formed OWL – and Obama just demonstrated – “Organize, don’t Agonize”.  Join with your neighbors & friends to support the change that is possible.  Join with the women & men of OWL that are working to bring our vision of women in mid and later life to reality.  Be the change you desire.