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Archive for the ‘Health Care’ Category

Medicare: Where Is the $716 Billion Robbery

Mon ,03/09/2012

With the heating up of campaign rhetoric, I’ve been hearing a lot about this $716 billion dollars that Romney is publicly saying President Obama “robbed” from Medicare. That is the exact word Romney uses. Well, if someone is stealing, I want to know how they are getting away with it so I did my research and discovered what the $716 billion is.

First, let me remind you that the Medicare trust fund does not have that much money and it’s not a piggy bank that can be raided. At the end of 2011 the Part A trust fund had only $244.2 billion.  The Part A, hospital insurance program, is financed through a payroll tax that goes into a trust fund similar to the Social Security trust funds. And that hospital insurance trust fund is being spent much more rapidly than the Social Security funds. No president can actually take money out of the Medicare trust fund as this money is in Treasury bonds which can only be cashed by Medicare at any time it is needed. As it is, with the continued increase in medical cost, Medicare can’t cover all the benefits without either more revenue (taxes) or reduced spending.

Ok, so where did the $716 billion come from? Actually this figure is for reductions in spending, so it really doesn’t take any money that is in the trust fund out of the trust fund. (Hum, isn’t that what Republicans are always saying—that we need to reduce spending?)

 Sorry Romney, there is no “robbery”. These reductions do not take any money out of Medicare, they are necessary adjustments to vendors who receive Medicare payments, and do not affect payments to beneficiaries.  They are aimed at insurance companies, hospitals, nursing homes and most of all, the Medicare Advantage companies. Medicare Advantage was started under President George W. Bush, with the idea that competition among the private insurers would reduce costs. But in recent years the plans have actually cost more than traditional Medicare. So the health care law scales back the payments to these private insurers. Medicare Advantage plans currently receive higher payments from the government on average than traditional Medicare – 9% higher than it was in 2010. The government pays Advantage companies 14-20% to manage patients health care. The Affordable Care Act cuts this fee to private companies. Romney and Ryan have a countdown clock showing how many days until Medicare (part A) is broke. The truth is that there would be even fewer days until the fund’s exhaustion if Obama’s health care law hadn’t included those $700 billion in spending reductions.

Romney’s campaign ad incorrectly claims that the “money you paid” for Medicare is being used to pay for Obama’s health care law. It is incorrect because the law doesn’t take money out of the existing hospital insurance trust fund. It cuts the future growth of spending. And in the future, seniors will still receive the benefits to which they are entitled.

Sources: Politifact.com, Factcheck.org

This is a guest post from Barbara Moore.

© 2012 Barbara Moore

Bits and pieces 14: A Summary of the Affordable Care Act

Sun ,08/07/2012

 The goals of healthcare reform were to see that every citizen had adequate healthcare, ensure that healthcare was affordable, and protect citizens from insurance company abuses. Although many of the criticisms of the law were baseless, the law’s effect on the deficit and its constitutionality were serious questions. An analysis by the nonpartisan Congressional Budget Office predicted the Affordable Care Act would decrease the projected deficit by $138 billion over the first 10 years and by approximately $1.2 trillion over the next 10 years.  The Supreme Court , in National Federation of Independent Business v. Sebelius,  upheld the constitutionality of the Affordable Care Act. Below is a summary of the provisions the law that may affect you :

  • students and unemployed young adults may stay on their parents insurance until age 26
  • insurance companies may not limit the amount of care a person receives in their lifetime
  • insurance companies may not cancel coverage because a person is sick  
  • lowers the cost of care for Medicare recipients and closes the “doughnut hole” in prescription drugs, saving seniors $3.1 billion in prescription costs since 2010
  • insurance companies must cover preventive services like yearly checkups, mammograms, cancer screening, and inoculations
  • increases the penalties for Medicare fraud
  • insurance companies may not deny coverage to children with pre-existing conditions
  • insurance companies must provide justification for raising rates
  • insurance companies must spend 80% of their premiums on health care or refund the difference. Americans are scheduled to receive $1.4 billion and Oklahomans $21 million in refunds this August.
  • provides tax credits for small business owners so they can afford quality insurance for their employees
  • provides for the creation of hundreds of community health centers and incentives for new doctors to staff them

Beginning in 2014:

  • provides working Americans tax credits to help them afford quality insurance
  • ends discrimination against adults with pre-existing conditions
  • prevents insurance companies from charging women more than men or overcharging those in need of care
  • provides funds to create state based insurance exchanges where people can compare prices of insurance
  • provide states with funds to increase their Medicaid programs

       Source: healthcare.gov

 There are also hidden benefits: 

  • It would improve the competitiveness of American companies. Most working Americans obtain health insurance through their employers; however, this putsU.S.businesses at a disadvantage with foreign competitors. Small companies have the added disadvantage that they cannot negotiate rates as low as larger companies.
  •  It would cut down on the number of the uninsured using emergency services. Emergency room care is expensive and unpaid bills must be passed on to paying customers.
  • It would reduce bankruptcies. A Harvard study found that about 50% of all bankruptcies in theUnited Statesare caused by illness and medical bills. Health providers, banks, businesses, and credit card companies who lose money in bankruptcies pass the cost on to the rest of us.
  • It would improve everyone’s health. You and your family come into contact with many people each year. People without health insurance are less likely to receive immunizations and are much more likely to have untreated communicable diseases.

Research Credit: Barbara Moore

(C) 2012 J.C. Moore

Healthcare Reform: The Affordable Care Act

Mon ,02/07/2012

 ”Your family’s health and prosperity depends on that of everyone.”

The United States has just been through a recession that has left many Americans without jobs, financial security, and adequate healthcare. What could be a better time to see that every American has adequate healthcare? President Obama promised during his campaign to reform healthcare. His goals were to protect citizens from insurance company abuses, see that every citizen had adequate healthcare, and ensure that healthcare was affordable. It was up to Congress to write the details of the law.

For those who claim making law is like making sausages, the Affordable Care Act is more than an apt example. In the 1990’s, Hillary Clinton tried to reform healthcare – but attempts at reform stalled when Republicans came up with an alternate bill and the opportunity passed with no decision being made. In 2010, Congress used many of the ideas of the Republican bill to create the Affordable Care Act. Many of those ideas formed the basis of the Massachusetts health care bill that Governor Romney signed into law in 2006. The Affordable Care Act is certainly not ideal, but it came about as a series of compromises necessary to get it through Congress and avoid a filibuster in the Senate.

Controversies: Much of the controversy over the Affordable Care Act was about things that didn’t really exist in the law. It did not create death panels, provide public funds for abortions, provide payments to undocumented immigrants, take away fundamental rights, or threaten to bankrupt the country. Although there were many claims that the affordable care act will greatly increase the deficit, the nonpartisan Congressional Budget Office predicted the affordable care act would decrease the projected deficit by $138 billion over the first 10 years and by approximately $1.2 trillion over the next 10 years. However, the laws constitutionality was a serious question – and several states filed suit claiming that the federal government could not require citizens to purchase health insurance. The lawsuits reached the Supreme Court and in  National Federation of Independent Business v. Sebelius, 6/28/2012, the Supreme Court upheld the constitutionality of the Affordable Care Act. It ruled that the penalty for not purchasing insurance was a tax, and that Congress had a right to impose taxes.

Benefits: Now that the Affordable Care Act has been declared constitutional and will become law , below is a checklist from Whitehouse.gov  that summarizes what the affordable care act might mean for you:

  

 

The Future: There is still concern that the Affordable Care Act does not do enough to control the insurance costs or reduce the cost of care. The healthcare exchanges should provide more competition, and the 80/20 rule means that at least 80% of the premiums must be paid out in healthcare services.  There are also some intangible benefits to health care reform that may materialize in the future: 

  • It would cut the unpaid bills for emergency services. Currently, emergency rooms are required by law to treat everyone, and those without medical insurance often use them for medical care when they cannot pay. Emergency room care is expensive and those costs must be passed on to paying customers.
  • It would improve the competitiveness of American companies. Most working Americans obtain health insurance through their employers; however, this puts U.S.businesses at a disadvantage with foreign competitors who do not provide health insurance for their workers. Small companies have the added disadvantage that they cannot negotiate as low rates as larger companies.
  • It would reduce bankruptcies. A Harvard study found that about 50% of all bankruptcies in the United States are caused by illness and unpaid medical bills. Bankruptcies affect everyone because the health providers, banks, businesses, and credit card companies who lose money in the bankruptcy pass the cost on to the rest of us.
  • It would improve everyone’s health. Your family’s health depends on the health of everyone. You and your family will likely come into contact with thousands of people during this next year. People without health insurance are less likely to receive immunizations and are much more likely to have untreated communicable diseases.

 More information:  Here is some additional information from Whitehouse.gov with links to the topic: ”

A major impact of the Court’s decision is the 129 million people with pre-existing conditions and millions of middle class families who will have the security of affordable health coverage. 

We should also remember that under today’s ruling, having health insurance is and will continue to be a choice. If you can’t afford insurance or you’re a small business that wants to provide affordable insurance to your employees, you’ll get tax credits that make coverage affordable. But if you can afford insurance and you choose not to purchase it, the taxpayers will no longer subsidize your care for free.” 

 

Research Credit: Barbara Moore

(C) 2012 J.C. Moore

 

Should Entitlement Programs Be Reformed?

Sun ,10/06/2012

Many who are successful attribute it to their ability and hard work. That is often true, but most Americans also owe their success to the opportunities, education, and resources that our country provides us – and also to good fortune. Our country provides safety nets so that no matter how fortunate or unfortunate a person is in their life, they will receive healthcare and not be destitute in old age. Those safety nets are often called “entitlements programs “, and that is true. We all pay to support those programs through taxes and contributions and we are all entitled to the benefits. Those who do not need the safety nets, or who do not wish to pay their share, often want to reform them in ways consistent with their self-interest.

 In the Tulsa World article, “Social Security, health care reform needed”, John Brock lays out a plan to remove government from managing retirement funds, Social Security, workers compensation, and health care. Mr. Brock says “the solution to our government’s problems is to empower people to manage their own affairs.” Though empowering people sounds good, the article is based upon questionable assumptions.

 The first assumption is “that the government is controlling our lives more and more.”  That is a common theme in politics these days, but hardly true. We democratically elect our representatives and leaders, and we have much more control over our government than probably any other country in the world.

The second is “having a government manage these necessities is risky. “ He points out that Greece, Spain, and a number of state and local governments are having financial problems. That’s true, but is not necessarily because of their entitlement programs. Many of the problems stem from the fact that the wealthy have found ways to reduce or avoid paying taxes. He goes on:  “For decades governments have been taking on future obligations without making provisions to cover the costs.” However, in many cases, provisions were made to cover the cost but later tax cuts reduced the expected revenues. Then, there are many who do not think that teachers, policeman, fireman, serviceman, and other government employees are worth the retirement funds provided them.

The next assumption is that Social Security “will default in the near future”. The Social Security trust fund is adequate to pay benefits through 2023, and raising the FICA cap could extend it through 2080. The Social Security Trust Fund is invested in US Treasury bonds, which earn interest and are as solid as theUS government. We are lucky that Social Security was not privatized in 2006, as the recession would have wiped out much of our retirement savings.

The final assumption is that we all have the time and the expertise necessary to deal with the work that Mr. Brock’s plan would require. Those who are wealthy and lucky would certainly profit from managing their own accounts, but those who lack expertise or are not lucky may end up with no medical care provisions or retirement funds.

 The idea of insurance is to spread risk and the larger the population, the less expensive and more reliable insurance is. Spreading the risk over every citizen increases the efficiency and provides a safety net for everyone. We are lucky to live in a country where we enjoy the benefits that self governance and cooperation affords us. We should resist efforts to remove programs which provide our safety nets from government management, particularly if it makes them less reliable or managed by those who desire to profit from them.

(c) 2012 J.C. Moore

George Will’s War on Regulations

Fri ,25/05/2012

                     “Good regulations make good citizens.”

 You would not think that if you read George Will’s article “Obamacare: Regulatory state’s war on business”. He tells how Carl Karcher built his hotdog cart business up to Carl’s Jr. Restaurants, now CKE Industries, a multibillion dollar business. However, Mr. Karcher passed on in 2008 and Mr. Will has written an anecdotal story based upon quotes from CEO Andy Puzder.  He claims that “CKE’s health care advisers, citing Obamacare’s complexities, opacities and uncertainties, said it would add between $7.3 million and $35.1 million to the company’s $12 million health care costs in 2010, unless CKE converted many of its full-time employees to part time.“ He felt it would be necessary to do that to avoid providing them with the health insurance required by Obamacare. The article goes on, blaming Obama’s policies for the poor economic climate, the high cost of fuel prices, and for creating “ multitudes of regulators who regard business as the enemy” and are conducting a “regulatory state’s war on business”.

 Although the healthcare bill is called Obamacare, Mr. Will should remember that what we have is not the universal health care that President Obama wanted. It is the half-a-loaf that remained after the compromises necessary to get the bill through Congress and overcome the Senate’s plan to filibuster it. Had universal care been enacted, CKE and other businesses would not be responsible for providing health care for their workers. Mr. Puzder apparently also missed the point that even now Obamacare requires that insurance companies use 80% of the premiums collected to pay for healthcare. In many cases, this will mean lower premiums and rebates to the insured *. The affordable health care act was passed requiring universal coverage, but Congress weakened the restrictions on what insurance companies can charge. The problems CKE has in covering employees with health insurance is more the fault of Congress than of the administration.

There is also an ethical problem that Mr. Will passed over. Most of CKE Industries’ employees work for near minimum wage and are covered by the company’s “mini-med health care program”. If that program does not meet the requirements of Obamacare, is it adequate to cover their needs if they have a serious health problem? Mr. Karcher is not here to speak for what he would do, but Mr. Puzder apparently sees it as a trade-off between job creation and providing adequate health care for his employees. He is apparently willing to convert many employees to part time in order to cut costs on their health care. In 2007, before the company went private, CKE Restaurants, Inc. earned revenues of approximately $1.5 billion. Is it possible that Mr. Puzder is making a trade-off between his employees’ healthcare and the company’s bottom line? Perhaps Mr. Will should look into that issue.

* Note: Under the Affordable Health Care Act, health insurers must pay 80% of the premiums collected for medical expenses or return the difference. Here is a list, by state of the amount expected be refunded under this provision.

Bits and Pieces 12 : Should We Tax Unhealthy Foods?

Mon ,03/10/2011

Would people be more likely to avoid unhealthy foods if they received a tax incentive to do so? A few countries think so, and have enacted laws to increase taxes on fat, sweet and salty foods. The outgoing conservative Danish government has passed a “ fat tax” on foods high in saturated fats. Hungary has also introduced a new tax popularly known as the “Hamburger Law” that involves higher taxes on soft drink, pastries, salty snacks and food flavorings.  

Denmark now has a life expectancy much lower than other surrounding countries. “Higher fees on sugar, fat and tobacco is an important step on the way toward a higher average life expectancy in Denmark,” health minister Jakob Axel Nielsen said, because “saturated fats can cause cardiovascular disease and cancer.”  The “fat tax” would help curb the country’s obesity problem and estimates are that it will increase the average life expectancy of Danes by three years over the next 10 years.

 Denmark’s and Hungary’s efforts to tax unhealthy foods might not be such a bad idea. While it seems that many people will not act to protect their own health, they might be a little more likely to eat healthy foods if they receive a financial incentive to do so. I doubt that the United States would ever have the political will to raise taxes on unhealthy food. We will just wait and pay the health costs. However, perhaps we could do it by lowering taxes.

Since many state legislatures have exhibited a passion for cutting taxes, they could encourage people to live longer and lead healthier lives by removing the sales tax on healthy foods. There are a number of resources such as Harvard’s Nutrition Source  that could provide the information that would be necessary to do that. Even without the financial incentive, it would be a good idea for everyone to become familiar with Nutrition Source, or even Dr. Oz’s list of 100 healthy foods.

(c) 2011 J.C. Moore

Research Credit: Barbara Moore

Why Not Privatize?

Sun ,17/04/2011

Privatization. It is usually assumed that private enterprise will find efficient ways to do things and lower costs to the benefit of consumers and taxpayers.  That assumption is probably true when it comes to providing innovation and developing resources. The recent failure of some of our largest private companies have caused an  economic downturn which, along with tax cuts, have left the federal, state, and local governments with financial problems. Privatizing public services and resources is being considered as a way to reduce costs and raise money.

City Services: As a way to save money, many small towns and cities are considering turning their basic services such as water, trash and sewer over to private companies. This has not always worked out well.  As an example, Coatesville, Penn decided to sell off its drinking water and wastewater infrastructure in 2001 and invest the money in a trust fund to be used for city services. But privatization hasn’t been the economic boon the city hoped.  The residents have seen their water and sewer rates jump 85 percent since American Water, the largest water corporation in the country, took the helm. Last year the company proposed a 229 % rate hike for sewer services, forcing the city to cobble together money for legal fees to fight back. (1) Privatization doesn’t always promote efficiency. The trash in Wichita, Kansas is collected by several private trash companies, and customers in any part of town can contract with any of the companies. The result is that several large trash trucks navigate most streets of Wichita each week, resulting in increased noise, wasted energy, more exhaust fumes, and damage to the streets, which of course, the city repairs.  Even though residents of Wichita pay 30 to 50% more than residents of comparable cities with public trash services, a measure to franchise the trash system was defeated amid criticisms of “government control” and “loss of freedom to choose”.

CompSource. The state of Oklahoma gave its wealthiest citizen a nice tax cut in 2004, which, with the economic downturn,  has left the state government strapped for cash. One proposal to raise money was to sell CompSource Oklahoma, which has been providing workman’s comp to state workers for 76 years – apparently successfully. State Rep. Dan Sullivan pushed for privatization of CompSource because: “It’s a fundamental issue of what is the proper function of government . Is it to compete with private enterprise? We think not.”  He also claimed the increased competition would lower rates. That sounds good, except an expert in comp insurance pointed out it would cost more to insure state employees and 40% -70% more to insure workers in high risk categories, such as volunteer firefighters, oil field workers, and farm workers. The plan fell through, for the time being, when it was discovered that the state might not get the proceeds from the sale and that the politicians pushing the matter had ties to the insurance companies who would profit from the sale. (2)

Medicare and Social Security. Privatization of Government services for ideological reasons often fails as a practical way to lower costs. While privatizing Medicare was ostensibly done to reduce costs, the Medicare Advantage Plans created have increased the cost to the government by 14% and decreased the long term stability of the program. Also, to reduce costs, the plans created the infamous “donut hole“ that costs seniors an additional $25 billion annually. (3) The cost created by privatizing is not a mystery, as the VA and Medicare  have a 3-5% overhead while private insurance companies have an overhead of 15% or more. That is something that should be considered when thinking of health care reform.

Social Security is one of the most effective and popular government programs. It provides a safety net so that no matter how fortunate or unfortunate people are in their choices and investments, they will not be destitute when they retire.  The recent attempts to privatize SS would have been a boon to the financial services industry and money poured in for promotion and campaign donations. After the recent economic downturn, we should all be grateful that the plans to privatize Social Security failed. Some private pension accounts lost as much as 40%, while Social Security paid reliably. The idea that SS is going broke, part of the PR created to try to justify privatizing SS, still lingers on. (4)

Public Service: Our public servants, teachers, firefighters, police, military personnel, and the myriad employees that run our country, actually serve us well. Their pay is usually determined by their responsibilities, experience, and education, as in the GS ratings of federal employees that determine their compensation. Public servants seldom receive bonuses and sometimes little appreciation for doing their job well. The government does not make a profit so their services can be provided at lower cost. And, while we have little say about what goes on in the boardroom, our elected representatives are in charge of public employees.  While it may not be the role of government to compete with private industry, it is certainly not the role of government to make policies that favor private companies over the needs of our citizens. Certainly, privatization for purely ideological reasons is a bad idea that should not override practical considerations.

(1) http://www.alternet.org/story/149725/vision:_how_small,_mostly_conservative_towns_have_found_the_trick_to_defeating_corporations

(2) http://jcmooreonline.com/2009/10/01/will-privatizing-compsource-lower-costs/

(3) http://www.cbpp.org/cms/index.cfm?fa=view&id=2917

(4) http://jcmooreonline.com/2010/08/04/is-social-security-going-broke/

(C) 2011  J.C. Moore

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Bits and Pieces 4: Is It Safe to Fluoridate Water?

Sun ,07/11/2010

Fluoride is toxic at high levels but has health benefits  at low levels. Fluoride  is added to water at concentrations less than 1 ppm as it  helps to prevent tooth decay by hardening tooth enamel.  Tooth decay can allow bacteria to enter the bloodstream where they cause heart disease and other infections.  There are places where fluoride occurs naturally in water at ten times the concentration used to fluoridate water and there have been no long term effects except fluorosis, a brown stain on children’s teeth.

Fluoride is chemically about like chloride ion in the body – except that at high concentrations it forms a precipitate with calcium and ties it up. That’s the reason it is toxic at high levels. Fluoride can be used at fairly high doses to treat osteoporosis as it will keep calcium from leaving bones.  At 0.5 to 1 ppm, the amount usually used to fluoridate water, there have been no serious side effects. At above 1.5 ppm, fluorosis, a brown stain on the teeth may form in a few % of the population. There are places where natural sources of fluoride are as high as 10ppm and fluorosis is the only health effect found. Fluoride is toxic at high levels with an  LD50 of  125 ppm in rats and it is assumed to be about the same in humans. For comparison, the dose rate for aspirin is about 5 ppm  and the  LD50 in rats is 200 ppm (1 ppm is 1 milligram per kilogram of body weight).

There are very few sources of fluoride in people’s diets except water or products where it is an additive. The source of the fluoride doesn’t really matter as most inorganic fluorides hydrolyze to form fluoride and bifluoride ion in water. Many toothpastes use stannous fluoride. Many countries add fluoride to salt or even to milk as tooth decay  is considered to be a much more serious health risk than fluoride exposure. The exposure from all sources should be kept below 1.0 pm so those who have fluoridate water or salt should not use other fluoridated products or toothpaste. If you are worried about fluoride in you water, there are water filters that remove it from drinking water and it is easy to avoid it from other sources.

Update, 3/14/2011: The U.S. Department of Health and Human Services is announcing a proposal to change the recommended fluoride level to 0.7 milligrams per liter of water. The standard since 1962 has been a range of 0.7 to 1.2 milligrams per liter. There was no health risk at the higher level, but fluorosis has been observed in kids teeth, particularly those who may get fluoride from other sources.

Update, 11/13/2012  Poor oral health, dental disease, and tooth pain can put kids at a serious disadvantage in school, according to a new Ostrow School of Dentistry of USC study. “The Impact of Oral Health on the Academic Performance of Disadvantaged Children,” appearing in the September 2012 issue of the American Journal of Public Health, found that  73 percent of disadvantaged kids in Los Angeles have dental caries, the disease responsible for cavities in teeth. Children who reported having recent tooth pain were four times more likely to have a low grade point average—below the median GPA of 2.8—when compared to children without oral pain. Poor oral health and dental problems also cause more absences from school for kids and more missed work for parents. Treating tooth decay is prohibitively expensive for some and tooth decay has been implicated in a number of later health problems, even heart disease.

Update, 04/11/ 2014: Some people are concerned, not about the toxicity of the fluoride, but of arsenic in the fluorosilic acid that is used to fluoridate most city water supplies. The fluorosilic acid from fertilizer manufacture, used to treat most water supplies, comes as a 20% solution and one source was analyzed to contain about 3.3 ppm of arsenic. By the time the solution is diluted to 1 ppm of fluoride, the concentration of arsenic is diluted to about 1 part per trillion. That is about 10,000 times less than the EPA standard for drinking water, which is 10 parts per billion (ppb) arsenic. It is difficult to see how that can be a health risk.

For perspective, some lakes near older coal-fired power plants have been found to have upward of 200 ppb of arsenic in the water. If I were concerned about arsenic in my city’s water supply, I would look at the concentration in the water from the lake, if that is the water source.

(C) 2010 J.C. Moore

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Senator Coburn’s Town Hall Meeting ( Part 1)

Sun ,11/07/2010


Integrity in Politics:
It is the purpose of this site to apply observation and reason to current events. Good government depends upon our Legislators and our voters having up-to-date and accurate information. Senator Tom Coburn is considered to be the best informed of the Oklahoma Legislators. However, some things he presented at his town hall meeting, though they play well with his base, are not supported by research. We feel that Senator Coburn should thoroughly research the topics upon which he votes and speaks and that he should provide his constituency with accurate information.

Supreme Court: When asked about the recent court appointments, Senator Coburn disparaged the latest Supreme Court Justice, Sonia Sotomayor, by claiming she had lied, a very serious accusation to make against a Supreme Court Justice – especially when wrong. Coburn said that Sotomayor had reneged on a promise made during her confirmation hearing not to use foreign law to interpret the Constitution of the United State. He used as evidence the ruling of the Supreme Court on the case of Graham v Florida, in which a juvenile offender had been sentenced to life in prison for nonhomicidal crimes.

After reading the Supreme Court response which was actually presented by Justice J. Kennedy, not Justice S. Sotomayor, it appears that Senator Coburn was actually not being honest in his presentation of the information. As shown in the section of the Supreme Court brief below, the only reference to foreign anything is that the practice has been rejected the world over. This does not refer to any foreign laws but merely reflects on our standing in how humanly we treat juvenile offenders compared to the global community to which we belong and by whom we are scrutinized and in no way reflected that any foreign law was used to interpret the United States Constitution.

This misleading charge by  Senator Coburn raises a concern about any information he uses to support his views and whether he is just another typical politician trying to manipulate his constituents with “smoke and mirrors”.  Additional support for the Court’s conclusion lies in the fact that the sentencing practice at issue has been rejected the world over: The United States is the only Nation that imposes this type of sentence. While the judgments of other nations and the international community are not dispositive as to the meaning of the Eighth Amendment , the Court has looked abroad to support its independent conclusion that a particular punishment is cruel and unusual. (See, e.g., Roper, supra , at 575–578. Pp. 29–31, 982 So. 2d 43, reversed and remanded. )

Elena Kagan: Senator Coburn also said he could not support the appointment of Elena Kagan to the court because she considers the Constitution to be a living document. Senator Coburn believes that the Constitution should be interpreted as the Founding Fathers meant it. That, however,  has been as an excuse used by some politicians and judges to interpret the Constitution as they wish and claim it is what the Founding Fathers actually meant. The Founding Fathers were wise enough to give us a mechanism for amending the Constitution and there are now 27 Amendments. The Constitution is alive and better for it.

Recess Appointments: When asked about President Obama’s recess appointment of Dr. Berwick to head the Center for Medicare and Medicaid Services (CMS), Coburn emphatically declared that it was wrong and  illegal. Yikes! Coburn should polish up on his history of the much-used recess appointment. By this same point in his Presidential career, George W. Bush had used this technique to make 15 appointments and he used it 179 times during his career. Where were those Republicans then? The last group of appointments will bring Obama’s total to 18. It has been noted that Bush was not facing the same level of obstruction.Currently, Obama has 189 nominations pending before congress and 28 have been on the floor for more than three months. Bush only had six nominees that had been waiting that long. It might also be an interesting FYI to note that even George Washington used the practice to appoint the then controversial judge John Rutledge to the Supreme Court after he had failed to be confirmed by the Senate.

Reccess Appointments are a legal practice granted to the President of the United States by the Constitution of the United States in Article II, section 2.

“The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session.”

Some have indicated that they feel this power should only be used when the position becomes vacant during a recess but this has been adjudicated by The Eleventh Circuit, in an en banc decision in Evans v. Stephens which held that the Constitution permitted both intrasession recess appointments and recess appointments to fill vacancies that existed prior to the congressional recess.( Evans v. Stephens, 387 F.3d 1220 (11th Cir. 2004). ) Since the position filled by Dr. Berwick has been vacant since 2006 it fulfills the courts requirements and is clearly legal.

Health Care: Senator Coburn said he  objected to the appointment of Dr. Don Berwick to head the CMS as Dr. Berwick  promotes medical rationing. Coburn’s basis for this premise uses “cherry-picking“, a technique which picks out a quotation and presents it out of context. A statement that Dr. Berwick made in 2008 in an interview with the respected publication, Biotechology Healthcare has been “cherry-picked” and this partial quote has been publicized many times by zealous Republican in order to create the specter of medical rationing. Here is the partial quote Senator Coburn refers to: “The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open.”  But, here is the actual quote in context, “We make these decisions all of the time. The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open. And right now, we are doing it blindly.”

Despite what Senator Coburn might claim, that statement isn’t particularly radical. Rationing currently occurs in our health-care system as resources are limited, and medicine and medical procedures are approved or disapproved by insurance companies regardless of whether that system is privately or publicly funded. “Blindly” as used by Dr. Berwick indicates we are currently doing it badly and not with an eye to the best practices to be used for the good of the patient; and not with an eye to which practices are unnecessary and therefore unnecessarily costly; and not with an eye to what medicines, tests and equipment are provided unnecessarily and sometimes even to the detriment of the patient.

“Ezra Klein, a blogger for the Washington Post, notes that Berwick’s statement is no different than a statement from Republican Rep. Paul Ryan of Wisconsin (seen as an up-and-coming leader within the GOP), who said with respect to health care, “Rationing happens today! The question is who will do it?” www.cbsnews.com/8301-504763_162-20009880-10391704.html.
Here is another more honest Republican’s statement on Berwick’s appointment. Tom Scully, who ran the CMS under President George W. Bush, noted, “You could nominate Gandhi to be head of CMS and that would be controversial right now.” http://www.newsweek.com/blogs/the-gaggle/2010/07/07/don-berwick-appointed-to-drive-health-care-changes-sidestepping-congress.html

With the use of the “cherry-picking” technique, some Republicans appear to be using medical rationing as a scare tactic to gain support in the up-coming elections without regard for what is actually good for the patient, I mean constituents. And to make matters even worse, Senator Coburn is a doctor. He also  said that other countries have national health care at lower cost because they ration health care. He says you and your family are responsible for paying for your own health care. Isn’t that just rationing health care by using money. If you, or your family can’t pay, would he just let you die?

By Guest Author: Barbara Moore

Can Kids with Preexisting Conditions Be Excluded?

Fri ,26/03/2010

After a year of wrangling over the Health Care Reform Bill, there are claims that the bill may not cover kids with preexisting conditions until 2014. That is not so. The Weekly Standard has championed this idea with an article titled Oops: Health Care Bill Does not Cover Kids Preexisting Conditions.(1) The language of the Bill was written by the Senate but the focus of the article is to blame President Obama . There seems to be some ambiguity in the way the bill is worded and insurance companies may be trying to use it as a loophole. One might wonder why this is just now being brought up. But, there is more to the story.

The Weekly Standard took its information from an AP news article. It is an example of cherrypicking as the Weekly Standard didn’t tell the whole story. The AP news article also goes on to quote HHS spokesman Nick Papas who said: “To ensure that there is no ambiguity on this point, the secretary of HHS is preparing to issue regulations next month making it clear that the term ‘pre-existing exclusion’ applies to both a child’s access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today,” (2)

In spite of all the hullabaloo created by the Weekly Standard, the Christian Science Monitor says denial of insurance to kids with preexisting conditions will end this year. They say ” Six months from the day the bill was signed (let’s see … that’ll be Sept. 23, by our calculation), insurers will no longer be able to exclude children with preexisting conditions from being covered by their family policy. For current policies, that means insurers will have to rescind preexisting-condition exclusions.” (3)

The medical information site, WEB-MD has some answers about what reform will mean to consumers: Question: “What provisions begin soon? “Answer: “Starting this year, children up to age 26 would be allowed to remain on their parents’ health plan. People with pre-existing medical conditions would be eligible for a new federally funded “high-risk” insurance program. Small businesses could qualify for tax credits of up to 35% of the cost of premiums. Insurance plans would be barred from setting lifetime caps on coverage and would no longer be able to cancel policies when a patient gets sick. Health plans would also be prohibited from excluding pre-existing conditions from coverage for children. “(4)

So there is no “Oops” as the Weekly Standard claims. Kids with preexisting conditions will be able to get insurance coverage this year.

Update, 03/29/2010:  Apparently, this has been completely straightened out:

“After Health and Human Services Secretary Kathleen Sebelius wrote a letter warning insurers against using loopholes to avoid covering children with pre-existing conditions, AHIP President Karen Ignagni wrote back to say insurers will comply with all regulations.”(5)


(1) http://www.weeklystandard.com/blogs/oops-health-care-bill-does-not-cover-kids-pre-existing-conditions
(2)http://www.google.com/hostednews/ap/article/ALeqM5jYnajhWrPEXihcCrpRNfUKN7rN-AD9EKTKIG0
(3) http://www.csmonitor.com/USA/Politics/2010/0324/Health-care-reform-bill-101-rules-for-preexisting-conditions
(4) http://www.webmd.com/healthy-aging/news/20100322/faq-how-health-care-reform-will-affect-consumers-employers?ecd=wnl_day_032410

(5) http://tpmlivewire.talkingpointsmemo.com/2010/03/ahip-responds-to-sebelius-letter-about-kids-with-pre-existing-conditions.php

Research credit: Barbara Moore