There is no fixing the American Health Care Act currently under review by a Senate committee of 13 Republican men. The whole package needs to be tossed. That is the blunt assessment of Carol Keehan, D.C., the president and chief executive officer of the Catholic Health Association of the United States.
“The Senate cannot just dicker around with it a little bit and then say, ‘We fixed the worst parts of it,’” Sister Keehan told America on May 25. “It is really important to understand that this bill is so incredibly flawed, there is no fixing it.”
“It is really important to understand that this bill is so incredibly flawed, there is no fixing it.”
Earlier this month the A.H.C.A. was rushed through the House of Representatives before it could be “scored” by the nonpartisan Congressional Budget Office. An earlier version of the bill that did not draw enough support from fractious Republicans had fared poorly under a C.B.O. analysis, and the latest incarnation of the effort to “repeal and replace” Obamacare did only slightly better when a new analysis came out of the C.B.O. on May 24.
According to C.B.O. analysts, an estimated 51 million people under age 65 would be uninsured by 2026 under the latest version of the House Republican health care plan. That is one million less than would have been uninsured under the original bill, but it is 23 million more than Obamacare would leave uninsured by 2026 (presuming Congress does nothing before then to improve the program).
Congress is asking the nation to make “immoral choices,” said Sister Keehan. The proposed $824 billion cut to Medicaid under the A.H.C.A. would only be exacerbated by the $600 billion more in reductions (both over 10 years) sought by the president’s recent budget plan. The hits on health care, she argued, are “clearly for the purpose of finding the money to handle [G.O.P. proposed] tax cuts,” pointing out that while 14 million people are dropped from Medicaid under A.H.C.A., the bill provides almost $16 billion in annual tax cuts for people who make over $1 million a year.
“These are just intolerable choices,” she said.
The A.H.C.A. would “undermine in a huge way people who are very vulnerable,” said Sister Keehan, “the working people, many of whom wait on us: They cut your hair; they do your nails; they work on our farms; they get your coffee. These are hard-working Americans.”
Congress is asking the nation to make “immoral choices,” said Sister Keehan.
Sister Keehan noted the Affordable Care Act’s positive impact since 2010 on thousands of U.S. families who had been cut off from insurance because of pre-existing conditions or low income or who previously faced crippling debt because of lifetime limits on health benefits. “We have 20 million people who have for the first time just got health insurance, and now we are going to take it away?” she asked.
“We don’t need to do this,” Sister Keehan said. “You can’t do a tax cut for corporate America and the nation’s highest earning people on the backs of the poor; we cannot as a people tolerate that.”
“You can’t do a tax cut for corporate America and the nation’s highest earning people on the backs of the poor.”
By a couple of measures not related to health care, the bill scores well—if the primary aim were not to provide adequate coverage to as many people as possible but to reduce government spending or taxes on higher income Americans. The C.B.O. reports that as it reduces subsidies to low-income people to pay for health insurance, the A.H.C.A. would reduce the federal deficit by $119 billion over the next 10 years. And compared to President Obama's 2010 overhaul, average premiums for people buying individual policies under the A.H.C.A. would be lower, but the savings would be partly attributable to reduced benefits as coverage minimums are lifted.
Speaker Paul Ryan, a Republican of Wisconsin, was quick to celebrate the impact on the deficit reported by the C.B.O. score. But why is driving down the deficit the goal of “health care” legislation, Sister Keehan wonders, when it should be focused on finding a way to pay for something closer to universal health care for all Americans?
Cutting back on Medicaid expansion will certainly positively impact the deficit but so would not cutting $1 trillion in taxes, she points out. She marveled at “the stupidity of all this,” after noting that cuts in benefits surely would translate into lower premiums but would result in “skinny” health insurance that was inadequate.
“You can bring down your household food budget, too, if you only eat twice a week,” she said. She worries the G.O.P. plan would encourage employers to buy into such reduced benefit options, in the end undermining coverage even for people who receive health insurance at work.
Sister Keehan strongly disagrees with the argument that the A.H.C.A. is necessary now because the A.C.A. is failing. She argues Obamacare is flawed but that it was on a trajectory to stabilization before moves by congressional Republicans and now the Trump administration to undermine it. “It needs improvements,” she said. “It is not a bill that I would have passed; it’s not a bill [former President Obama] would have passed; it’s a bill we could get passed.”
But the A.C.A. has made “remarkable progress” toward the universal health coverage most industrialized states take for granted. Acknowledging that 28 million people would be uninsured by 2026 even under Obamacare, she argues: “We could have fixed that. Remember we have 20 states that have not accepted expanded Medicaid; if those 20 states accept expansion and we made the improvements we need to make, we could make a huge dent in that number [by 2026].”
For Catholic Americans, equitable, adequate health care cannot be considered a free-market deliverable but a basic human right.
She is especially troubled by the lack of consultation maintained through the rush to “repeal and replace” and continuing as reconciliation talks get underway in the Senate. Not only are congressional Republicans locking Democrats out of the process, they have not consulted with hospitals and insurance providers nor with average people who have come to rely on Obamacare. “That’s no way to treat the health care of this nation,” Sister Keehan said.
The best outcome of the current negotiations in Congress, she suggests, “would be for the Senate to stabilize the Obamacare program for a period of two to three years, at least, while they looked at what should we do for the future in a reasonable and responsible way with input from providers and patients.”
“Let’s take our time and get it right,” Sister Keehan said.
That way, she added with a wry laugh, “by the time I am in a nursing home, you won’t still have to be writing about this.”
Because of the notoriously high costs of health care in the United States and its comparatively worse outcomes, “getting it right” might mean taking a harder look at models that have proved successful over decades among other peer industrialized states. “Maybe you could do Medicare for all or as Europe does, where everybody has the basics, but you can buy up [to higher benefit plans]” or other mixed private and public strategies, which have achieved universal coverage in other countries.
Sister Keehan added that however the nation manages to fund health care, for Catholic Americans the bottom line is that equitable, adequate health care cannot be considered a free-market deliverable but a basic human right. “Every one of the recent popes in our lifetime make it abundantly clear that health care is a human right,” she said. “This particular holy father has been as blunt as he can be on the importance of health care as a human right and not letting money being the deciding factor in health care.”
"tax cuts for corporate America"---the gas station owner---the McDonalds owner, the entrpreneur---if businesses---big and small have more capitol---fewer unneccessary restrictions---maybe we can get more people working--and able to afford health care---like the majority of Americans.
Ever since the horror of the democrat-only Obama care---I have wondered--has ACTUAL HEALTH IMPROVED---??? BY WHAT MEASURE? DOES THE CHURCH CARE?
Sister Keehan's position as stated above is that for ......"Catholic Americans ...health care is not a free market deliverable but a basic human right." She simply ignores that all of the components of that system from Doctors to equipment to facilities constitute free market deliverables that she cannot control , command or demand.
One must assume that she means the government must guarantee that right with all its resources and thus as the ultimate purchaser of all these components , government will control the prices of all these factors. The flaw is of course that governmentstill cannot control availability: if they don't like the government payments Doctors don't have to practice; equipment manufactures don't have to produce; drug m anufacturers don't have to supply etc
Sister says "For Catholic Americans ....heath care is a basic right" But all Americans are not Catholic so the "Catholic View" is hardly persuasive in determining the creation of health care as a right. ( e.g.,see the abortion issue).
All physicians and nurses and health care workers must be paid and having the government commandeer their future salaries is a recipe for fewer people entering the field and huge numbers exiting it. Has Sister Keehan considered that as fewer people enter medical school that fewer "residents in training" will be available to staff hospitals with basically free/ low cost labor. Staffing costs would soar and Hospital overhead would skyrocket with a significant increase in national heath care costs.
Government inefficiency is endemic to every government program. In 2014 the government administrative expense of Obamacare for an insured exchange member more than doubled the total administrative costs of an insured from a non exchange cost of $414 to an exchange member cost of $893 per covered life year(see the Centers for Medicare and Medcaid Chart reproduced in "The ACA Exchanges Increased Admistrative Costs Of Health Insurance" by Robert Book in the American Action Forum, December 21,2016). Government control is demonstrably a cost addition even though the problem is described as cost control. Even assuming government could squeeze down provider costs it generally more than offsets that saving with bureaucratic overhead costs. So the doctor and nurse will be paid less so that another couple of bureaucrats who don't provide health care can be added to the government employment roles.
As to the quality/availability of a government run health care based on "a health care right" see the continuing scandal of the Veterans Administration whose quality and availability have been subject to one continuous expose and failure to correct for over 5 years.
But most importantly if Health Care in the United States is recognized to be a right, it will not be a Constitutional Right but a government created right. And if this government created right is administered, paid for/reimbursed , or enforced by the administrative agencies of the government you must accept typical government agency regulation and control. Questions of types and kinds of treatment, use of prosthetics, a drug pharmacy list created by an agency and most importantly limits on care given to end of actuarial life patients in excess of determined amounts and care for patients with a poor recovery prognosis. If you doubt this result simply check out the increasingly restrictive rules for current government reimbursed health care services and drug plans such as Medicare and Medicaid.
In a 2009 interview with the Wall Street Journal Dr Zeke Emanuel, one of the architects of Obamacare, described his concept of the "Complete Lives System " as an underpinning of future health care. He stated: "When implemented the 'complete lives system' creates a priority curve on which individuals between age 15 to 40 get the most substantial chance,whereas the youngest and the oldest get chances that are attenuated".
Net net if health care becomes a government right as Sister Keehan demands then she , the Catholic Health Association and the values they espouse will become relics in the dust bin along with the "free market deliverables"which she deplores. Doubt it? Ask Cardinal Dolan and the Little Sisters of the Poor about government promises not to interfere in religious institutional care under Obamacare
The "pro-lifers" are earnest about advocating for the births of children. But baby care, maternity care, health care to stay alive throughout that child's life, that's a toss of the dice depending upon economic and social circumstances. The political advocacy and strategy of "pro-lifers" in the USA is terribly flawed and woefully inadequate.
Vince
I suppose that the most logical extension of your citique would be that the the "pro choicers" should be thanked for saving us all a lot of money by eliminating competition for health care dollars. Your observation seems to be that it's better for a person not to have entered "life's game" in the first place rather than risk losing. That might be an acceptable conclusion if only that decision were left to "the person involved" and not his mother. But there I go coloring the argument with the dreaded word "mother" .
Amazing how one can begin the argument for the "the right to health care" by denying "the right to life". You might critique some "pro lifers" for failure to follow through but a "pro choicer" simply eliminates the issue in the first instance..... An effective but hardly morally superior position. The "pro lifer" might be , as you put it, "woefully inadequate" but its the the "pro choicer" who deserves your epithet of "terribly flawed".
Hello Stuart,
Your logic is rather perverse. You twist my words to imply that I do not oppose abortion. In fact I do.
What I oppose, however, and what I oppose strenuously is the “pro-life” policy and political strategy that vigorously seeks only to ban abortions while failing concomitantly to support - equally vigorously - policies which provide economic, social, and health supports for those lives that are preserved through the ban. In 65 years of churchgoing I’ve never heard a Catholic pulpit plea for the latter to be sure!
The bishops and the "pro-lifers" come up seriously short on the latter. Both politically and socially they undermine their own arguments in favor of an abortion ban among those who neither share their faith nor their basic beliefs in the natural law. In that sense, on the larger scale in a nation of diverse religious or no beliefs, my "epithet" of "terribly flawed" is a well deserved description of a poor political strategy indeed.
Vinny
Vince
You put forth the argument that a generic catagory of "pro lifers" fails to support the broader social justice issue.
My point was AND is that when it comes to broad generic categories "pro choicers" support only broader social issues but deny the most basic right of all..the right to life. I believe that what you see as the "mote in the eye of the "pro lifer" is the "beam" in the eye of the "pro choicer"
Hello Stuart,
You are rhetorically adept to be sure!
You do not address, however, the strenuous opposition that I expressed to the overall POLITICAL strategy of the “pro-life” movement. You either see concomitant economic, social and health supports along with a ban on abortion as either a POLITICAL necessity or not. If you don’t, then just say so. Your forensics may be exemplary for a debate panel but, where life is at issue, obfuscation merely delays resolution.
As for me, the end of the back and forth on this issue for this article.
Vinny
Vince
My original post above was about the inefficient economics of government provided health care and about the perils of government created rights vs constitutional rights.
You responded not on these points but with a broad brush attack on the generic catagory of "pro lifers" alleged failure to support other social justice goals. I responded by pointing out that if you go to generic catagories that then the "pro choicers" have a bigger problem since they support denial of the most basic social justice element ...the right to life.
Finally you decide the issue is about POLITICAL strategy/necessity : so by paraphrase let's turn your final question around
"Either you see as a political necessity a concomitant ban on abortion as the basic underpinning of all catholic social justice issues or not.... if you don't just say so!"
As for myself I am happy to answer your final question: I do support concomitant economic, social and health supports along with my pro life position. But going to my original point I see the federal government as a disqualifyingly flawed and inefficient vehicle for accomplishing these goals and its involvement as an historically demonstrated Trojan horse for regulations that offend both of our principles.: Again I refer you to Zeke Emanuel's health care curve , cited above, that government health care should ration its availability by limiting services to the very young and the very old.They are relegated to getting "attenuated health care". That approach would embed the Margaret Sanger ideal of weeding out those whose contribution to society is deemed too limited or exhausted to be of value .....as determined of course by the federal government!
I work in healthcare, so I see its inconsistencies and failures. Taking healthcare away from poor people to give a tax break to the wealthiest people in our nation is a fine example of sinfulness in our leadership.
We pay more for healthcare and get second-rate results because we do not cover everyone. We would save money by covering everyone - this fact seems to be overlooked in the discussion. People can always buy more healthcare coverage if they want it, but covering the basics for everyone ensures that no one dies or goes bankrupt over easily treated illnesses.
It is easy to bash government-run healthcare systems like the VA, but I have friends who receive their healthcare exclusively through the VA and are very happy with it. I have not interacted a lot with the VA system, but I have seen nothing untoward in the times that I have. I have noticed that senior citizens are not clamoring for the chance to get rid of Medicare so they can buy health insurance on the private market.
The government is the only entity big enough to force drug prices and healthcare prices down. Health insurance companies do nothing but take money away from the provision of healthcare. We fail to regulate the pricing of drugs though we regulate access to them. If prescription drugs were sold over the counter, like they are in some countries, we would see a huge drop in the price because there would actually be competition on pricing.
I am appalled at the corruption of the Republican party in its attempts to take healthcare away from those who need it most and are least able to pay for it. It is hard to avoid seeing that their basic attitude is that poor people can live miserable lives and die early.
Lisa
As noted above Obamacare doubled the administrative overhead for an exchange member insured vs a non exchange insured (see report of Centers for Medicare and Medicaid Services referenced above). This administrative burden did not support a dime of actual health service and for the just the first three years of Obamacare amounted to $2.76 Trillion vs the original projected cost for a full ten years of $950 Billion. . You comment that "insurance companies do nothing but take money away from the provision of health care"..... but those companies are a bargain by comparison to what the government has demonstrably added to health care administrative costs under a Obamacare.
You state that one can buy more/better insurance coverage if you want it . That nonegalitarian loophole was intentionally blocked by the infamous "Cadillac Tax" on high benefit plans. That's the part of Obamacare that the Unions ( see Trumka) have been demanding repeal of. They were only successful in getting that tax delayed until 2020. That tax was originally imposed precisely because higher benefits was deemed non egalitarian.
You push the idea of having "over the counter sales" of prescription drugs to create competition and bring down prices. It is your ever present Government that prohibits such sales. Everything the government touches adds costs which support bureaucrats and not program benefits.
Government /SEIU /civil service have populated the VA system with incompetents who effectively cannot be fired. Employee Suspension is permitted by government, but it has created embedded costs to support even those suspended employees. Those few employees who could be fired are usually allowed to retire and maintain their full pensions.
Government inefficiency is endemic to all the programs it supports and even more so in the area of health care .
Part of the problem with the ACA is that payment for healthcare still goes through insurance companies. The inefficiency in healthcare administration comes from insurance companies.
The Cadillac tax on high benefit plans makes sense because employer-provided healthcare coverage is a benefit that is not taxed. If a Cadillac plan pays for cosmetic surgery that others would have to pay for with after-tax dollars, then the Cadillac plan is providing a benefit that should be taxable.
"Government inefficiency is endemic to all the programs it supports and even more so in the area of health care" is a blanket statement intended to cover a multitude of lies. Inefficient compared to what? Endemic to all programs - really? Privatizing government functions always results in efficiencies and lower costs? I have yet to see it. What I see in privatizing government functions is taking public dollars and putting them in the hands of corporations that have no interest in the common good.
Every other civilized country in the world provides healthcare for all of its citizens. Those who advocate for the AHCA ideal of allowing poor people to suffer needlessly and die early have the most difficulty refuting that evidence. There is no evidence to support the claim that the USA is superior in the area of healthcare, with the possible exception of those who have Cadillac health insurance plans paid for by employers. The USA will be inferior in the area of healthcare until all citizens have healthcare coverage. The foremost question, the only one worthy of discussion at this point is "How do we provide healthcare coverage to all?" Mealy-mouthed evasions like "access to healthcare" meaning "unaffordable healthcare" are useless.
Lisa
If you go to the Center for Medicare and Medicaid Services you will find that the administrative costs of the participating insurance companies in Obamacare was reduced by more than half but that the new added Federal administrative costs not only ate up all those savings but added another 200% to the overall administrative costs. I believe I gave you the source and the numbers in my original post.
I quote a report on CNBC May 27, 2015...,"Obamacare is set to add a quarter of a trillion ---that's TRILLION--dollars in extra
Insurance administrative costs to the US health care system"
Lisa, please note this was for just the first three years of this disastrous experiment ...just google "Obamacare administrative costs" -you will find innumerable newspaper reports on this added cost from reliably liberal news sources.
K
You dispute the relevance of my comment on the Cadillac Tax: The Cadillac Tax only applies to very high benefit employer plans......but all of the employer plans are tax free but only these high benefit plans got hit with the new tax. The question is why? The new tax does raise revenue from those who were deemed to have excessively good benefits. But It is basically a tax to restore a "need for equality of benefits"......please note the derogatory, sneering label "Cadillac Tax" as proof of this social leveling purpose. But my point in mentioning it was that despite what you said above you can't just buy or negotiate for better benefits in addition to Obamacare even if you want to. .....well you can but you will be taxed for YOUR temerity!
As to examples of government inefficiency in multiple programs, I suggest you just examine the VA .....if you need a special act of congress in order to fire 1500 known deficient employees you know you have a seriously flawed program. This has been a problem for almost 80 years and is just now being tackled??? Government inefficiency in the defense department is legendary with the publicized $100+ hammers and the $500 toilet seats. Medicare experiences over $60 billion in annual unrectified fraudulent and erroneous payments....more than 10% of its annual budget. Medicaid is worse but is spread between states and federal payors
As for you plea for affordable rather than accessible health care coverage: Note please: for 2016 ADD the average $12,500 DEDUCTIBLE for a bronze plan for a family of five to the bronze plan family PREMIUM of $20,000. (Source IRS tables for computing tax if you fail to be covered). $32,000 is hardly an affordable base cost for a family of five! Remember you pay the deductible first! So you incur some $30,000 in expense before you get any insurance benefit!.....what a deal! The reason for this lousy deal : all of the government mandated coverages ...all which must be purchased whether or not they are wanted. So I guess we could agree to chalk up Obamacare as an unaffordable failure......not to mention the enormous administrative costs being added by the government which you want to ignore.
The essential aspect to keep in mind is that every civilized country in the world other than the USA provides healthcare for all of its citizens. It is easy to bash the ACA and the healthcare provided by the VA, but I see nothing in your posts that suggests how this country might provide healthcare for all. I see only arguments for choosing to fail in the goal of providing healthcare for all. No matter how persuasive the arguments for failure, the fact remains that every other developed nation in the world has not failed with healthcare.
Lisa
Your "essential aspect" rejoinder is based on the assumption that every other civilized country has SUCCESSFULLY provided health care. That depends entirely on your definition of "Success". I again refer you to ACA architect Zeke Emanuel's "COMPLETE LIVES SYSTEM" the bases for proceeding beyond providing just insurance for health care to providing actual health care . Dr. Emanuel fully recognizes that health care must be rationed if there is a single payer system. He stated to the Wall Street Journal,
"When implemented 'The Complete Lives System' creates a priority curve on which individuals between age 15 and 40 get the most substantial chance, whereas the youngest and the oldest get chances that are attenuated"
This concept underlying the ACA co-architect's design principle simply embeds Margaret Sanger's view that we must weed out those whose contribution to society is too limited or exhausted to be of value. The United Kingdom universal care system has steadily marched down the Sanger yellow brick road: increasing waiting times for specialized services or operations (20 months); a Costs /benefit analysis that severely limits life extending drugs; and deteriorating morale of its medical staff due to chronic underpayment (see 14% decline in Medical School Applications in United Kingdom from 2014 to 2016- GP Magazine /Online by David Millett, August 6, 2016 ....attributed to wages/long hours and NHS negative press).
A small scale attempt was made in Vermont to provide single payer State wide sponsored health care. The law was actually passed and then cancelled ......it collapsed when it was realized that the necesssary new taxes would crush small businesses in Vermont. Johnathan Gruber, the co architect with Zeke Emanuel of the ACA, was responsible for the design of this Vermont plan. The California Senate has just passed a single payer plan with an estimated annual cost of $400 Billion With over half required to be made up of new taxes. LLet's see what happens with this latest experiment before we compound the national ACA disaster by going to a national single payer system.
I still see no suggestions for how we might provide healthcare for all. And if your argument is that it is not possible to provide healthcare to all, how do we choose the populations that do not receive healthcare?
Lisa
"How do we provide health care for all"?
You move to a Nordic Country founded on totally different governmental principle;without the protections and liberties guaranteed by the Constitution; where neutrality was your choice in the face of overwhelming human chaos brought by Nazi Germany; where you rely on the United States for your defense ; where you total population is less than NewYork; and where homogeneity of ethnic background ensures no cultural differences.......not to mention an historic social contract that has the tolerance for about a total tax rate of about 70%+ and is just starting to roll back its legendary social benefits as it discovers that the changes in age demographics no longer permits such open ended largess.
Duplicate entry deleted.
Free market healthcare costs the US nearly as much as the entire "inefficient" federal government. Factor in 51 million uninsured and US free market healthcare can out inefficiency the federal government. Unbelievable.
Chuck
The Federal Government is so efficient that it has managed to spend in 3 years on just Obamacare Administrative Costs $2.76 Trillion or $900 Billion+ Per year against its Original Projected cost over 10 years Of $950 Billion or $90 Billion + per year. Gee that is only about 10x error. Consider that this 10x error demonstrates the ridiculous incompetency of the government's ability to do a reasonable budget projection of its own program!
Yesterday the Secretary of the VA had to ask for an act of congress to be passed to fire 1500 employees who were determined to be grossly deficient..........This is an agency under full federal control and funding since 1930 and it needs special emergency Congressional legislation in 2017 to run it like any other reasonably efficient hospital?
Only the federal government could spend so much to accomplish "0" in actual health care benefits. Only the federal government could embed employment inefficiencies without correction for over 80 years. Only the federal government could be off in its cost projection by a factor of 10 with 7 more years to add to the error.
I don’t know details of the 1500 employees, but the email excerpt below perhaps vindicates the VA. The email was forwarded to me last year and refers to a WWII bomber navigator. I was acquainted with one of the other crew members.
“On Thursday, June 16, (2016) in Oklahoma City, Dad Will Be Awarded the French Legion of Honor…in recognition for his service in World War II. Dad is in amazingly good health, almost 98 years old, still drives (which drives me nuts) and occasionally gives algebra lessons to kids trying to get their GED.”
Where is the success in the US free market healthcare system? It failed to cover 17% of the population compared to 100% coverage in Japan, Germany and Canada. It cost sixty percent more than the average of Japan, Germany and Canada. US life expectancy runs three years shorter than the average of Japan, Germany and Canada. Trump praised Australia’s healthcare which compares favorably with Japan, Germany and Canada.
http://www.bu.edu/law/files/2016/01/EllisPaper.pdf