Recently in Healthcare Category

It never ceases to amaze me how the busiest woman in Washington remains so accessible.  Just this week alone, I am aware of 8-10 hours of direct Washington senior staff time devoted to Maine doctors, patients and health care professionals in reviewing the impact of the Baucus bill on Maine families and businesses.  Impressive. 

Unfortunately, it would appear that there are a number of folks in Washington who are unwilling to make the same time commitment, as they rework one sixth of our economy.

Senator Snowe laid out her understanding of the need for "full consideration" during the health care debate in a statement she released on her website on September 22:

Given the gravity of this landmark endeavor... there should be no question this undertaking commands a painstaking process and the requisite time for full consideration of the spectrum of alternatives and improvements...and to ensure the numbers "add up" within the final product - as we are the only committee of jurisdiction with respect to financing a package.  The implications of this legislation are simply too broad and monumental to do otherwise.

Senator Snowe's statement is pretty straight forward. She believes that members of the Senate Finance Committee should be able to read the bill and know how much it costs -- a sentiment she shares with her constituents back home.

On the following day, September 23, Senate democrats voted down an amendment proposed by Republican Senators Bunning and Cornyn, which would have required that the actual legislative language and a final Congressional Budget Office price tag be posted for 72 hours on the Committee website for public review. This would occur before the Senate Finance Committee could vote on final passage.

One way to easily get a sense of how irritated Senator Snowe is on a particular issue, is to time the release of one of her "statements" to the actual event to which it is referring.  Think of it like a thunderstorm - where you time how far apart the lightning and thunder are to judge just how close the storm is. I would say the storm is directly over head at this point as Snowe's statement flashed on her website shortly after the vote. She did not mince words saying,

"The fact is words matter and so do the numbers.  This amendment represents a common sense, practical, pragmatic, good government approach to understanding the totality and the collective impact of what we do. We want to be sure that we are absolutely confident in the integrity of the product that we are going to be voting on in the final analysis." Senator Snowe Press Release

Let me translate that statement for the Democrats on the Senate Finance Committee. You are skating on Potomac River ice in the middle of a Snowe storm.  It's not going to end well.  When she uses words like "common sense"  "practical" and "pragmatic" in the same sentence - you might want to consult with your Senate colleagues on the Right.  They learned to speak Moderate in the previous Administration.   The grimace on their faces -followed by a Cheshire cat smile- should be translation enough.

The way I see it -- Senator Snowe and her staff have work tirelessly to save the health care bill from complete implosion by offering a series of amendments designed to breathe new life into the reform effort --and perhaps provide the Gang of Six a little more time to work out some type of bipartisan bill.  She continues to be accessible to folks back here in Maine, and her staff is speaking daily to doctors, state legislators, other health care professional as well as patients -- in an attempt to find solutions that will work for Maine people.

I can assure you right now - that reading the bill and knowing how much it costs are the first two items on Senator Snowe's health care reform agenda and the same goes for her constituents back here in Maine.  The failure of Democrats on the Finance Committee to recognize that fact may very well signal the end of any hope for bipartisanship in health care reform.

Tarren Bragdon is the CEO of The Maine Heritage Policy Center and has been involved in health care policy research and analysis for over 13 years.  He served four years in the Maine House of Representatives and is the youngest person ever elected to that body.  He testified before the U.S. Senate Small Business and Entrepreneurship Committee regarding health reform in 2007, at the invitation of Chairman John Kerry and Ranking Member Olympia Snowe.  He can be reached at tbragdon@mainepolicy.org.

The email dings started around 10:00 pm, and continued throughout the night as folks throughout Maine sent me the latest report on CNN.com that quotes "sources" who claim, "President Obama and top aides have quietly stepped up talks with moderate Republican Senator Olympia Snowe of Maine on a scaled-back health care bill, according to two sources familiar with the negotiations."

I know that Washington DC folks spend a great deal of time in an alternative world, but seriously - Senator Snowe engaged in behind the scenes talks with the President?  Forget for a moment that Senator Snowe has been working on health care issues since President Obama was in grammar school, the real issue here is that Senator Snowe doesn't need to do anything behind the scenes with the Whitehouse, or anyone else for that matter.

I met with her personally during the August recess back here in Maine when she talked to dozens of Maine folks in a series of health care talks throughout the state.  Here is what I learned: She is worried about costs and the impact on the deficit, the public option plan is "off the table", she wants more private insurance companies in Maine (we have 3), and she doesn't support higher taxes - especially during a recession.

Those concerns and opinions were not from "unnamed sources," they were straight from Senator Snowe.  And just to be certain, I spoke to her Chief of Staff and her Health Care Legislative Aid this morning.  There is nothing new - other than the fact that Senator Snowe continues to be committed to working for health care reform with her colleagues in the "gang of six" and that "nothing has changed that would justify the CNN story." 

I think the fundamental problem here is that the folks at the White House - who are very likely spinning this story in an attempt to pressure Senator Snowe - are totally misreading the way she operates.  While the "moderate" label is often used by the far right to protest Senator Snowe's actions - the left is about to learn a very important lesson from the Moderate from Maine. 

It is not an act.  It is not something Senator Snowe does to get re-elected or to curry favor.  She believes that there is middle ground and she looks for it. For her, middle ground means giving businesses the opportunity to join together and purchase health care - regardless of state lines. It involves tort reform, it involves ensuring folks have skin in the game (not "free" government health care) and it involves truly bending the cost curve.  The bottom line is that Democrats in Congress, and this President, have failed to find the middle ground in the health care debate. In fact, they have veered so far off the center that they will find no sympathy - behind the scenes or not - from Senator Snowe or her other moderate colleagues.

As for the other "White House" strategy where CNN reports,  "Allies of the president hope that if Snowe accepts a health care agreement, she might also bring along her Republican colleague from Maine, moderate Senator Susan Collins." Don't hold your breath.

In fact, watch and listen to the video below - Senator Collins rejects the public option, and the health care reform effort in her own words, as she responds to a question from an SEIU member. (The relevant part starts at 55:25 and runs for two minutes). 

So, my suggestion to the White House: put away your shovels, there is no Snowe in the forecast.

-Tarren R. Bragdon is Chief Executive Officer of The Maine Heritage Policy Center. Prior to becoming CEO in January of 2008, Tarren served for five years as the Center's Director of Health Reform Initiatives.

During 2001 and 2002, he served as the special assistant to the President of the Maine Senate, Senator Richard Bennett. In this capacity, he provided policy research, analysis and advice on a variety of policy areas, focusing on healthcare and tax policy.

From 1996 through 2000, Tarren served in the Maine House of Representatives representing District 119, part of Bangor. He is the youngest person ever to be elected to the Maine House, being sworn in when he was just eleven days past the constitutional requirement of twenty-one years of age. During his tenure in the house, he served on the Joint Standing Committee on Health and Human Services.

email: tbragdon@mainepolicy.org 

The Dirigo Health Board is discussing changes to Maine's government plan - DirigoChoice.  One of the considerations is a $100,000 a year limit on benefits. 

This is a great lesson learned for proponents of government-run health care.  Government health care is great...as long as you don't get sick.

DirigoChoice enrollment is down to 9,472.  A far cry from the 128,000+ that were promised when Dirigo passed in 2003, as noted most recently in today's WSJ opinion piece.

The $825 billion (and growing) stimulus package working its way through Congress contains a dramatic expansion of Medicaid, which entitles anyone laid off and receiving unemployment, regardless of income or assets, to be on Medicaid at the federal government's (read: the taxpayer's) expense.

Here is a description from a New York Times article about this $11 Billion Medicaid expansion: "With little notice and no public hearings, House Democrats would create a temporary new entitlement allowing workers getting unemployment checks to qualify for Medicaid, the health program for low-income people. Spouses and children could also receive benefits, no matter how much money the family had....Democrats said the current economic crisis did not allow time for public hearings on the legislation."

Consider this (according to the NYTimes):

• The economic stimulus bill prevents states from enforcing a means test, saying, "No income or resources test shall be applied with respect to any category of individuals" who become eligible for Medicaid because they are receiving unemployment benefits.
• The federal government would pay 100 percent of the costs for people enrolled under this option through December 2010.

What incentive would someone on unemployment have to accept a job offer for a position without health benefits (or less than Medicaid-level coverage)?

How much would the federal government expand the dependency culture as a result of providing Medicaid coverage to those at any income or asset level - simply because these individuals receive unemployment for a period of time?

According to the US Department of Labor, there are 30,293 people in Maine receiving unemployment for the most recent week ending January 10, 2009.

That means up to 30,000 more people on Maine Medicaid for this "temporary new entitlement." 

Lastly, isn't "temporary entitlement" an oxymoron?

It's here!

Maine people now have the ability to actually see the Public Information needed to understand how the State of Maine spends tax dollars.

This new Web site is a searchable, downloadable database of Maine's Payroll, Pension and other Spending accounts for 2006 and 2007. 

Search by category to see what your Tax Dollars buy.  Do research on state vendors and the state agencies who buy their goods and services.

 -  Curious about how many Maine State employees make more than the Governor? 

 -  Want to know how much the State of Maine buys from New York companies?

 -  Ever wonder what Maine spends on airline tickets?

It's easy to find out at MaineOpenGov.Org 

According to a new survey by United Benefit Advisors Inc, an employee benefit advisory company, enrollment in Health Savings Accounts (HSAs) has almost doubled in the past year.  Now 11% of those privately insured are enrolled in HSAs compared to 6% last year.  HSA-compatible plans now account for 13% of all health plans offered by employers.

A Health Savings Account ties a savings account with a low premium, high deductible health plan.  That means that the individual, not the insurance company, is controlling the first few thousand spent in health care consumption.  Typically, after a $2,500-$3,000 deductible is met, the insurance company pays 100% of health care costs.

HSAs encourage the individual to take ownership of their own health, focus on preventative care, make good health choices and to be smart price and quality shoppers when using health care.

To learn more, you can read my overview of HSAs.

The National Center for Health Statistics released a report last month finding that fewer than 1 person in 20 in Maine has been uninsured for more than a year (half the U.S. average and half that reported last fall for Maine by the U.S. Census Bureau, page 22 of the report).  However, Maine fares poorly with regards to adults with private health insurance - just 65% of Maine adults have private insurance compared with 70% nationally and 78% in nearby Connecticut (page 14).

Last fall, I authored a report on Maine's uninsured rate using U.S. Census Bureau figures, which tend to report the uninsured at that moment in time rather than the longer-term uninsured.

Given the very low number of longer-term uninsured adults in Maine and our low rate of people with private health insurance, maybe the public policy focus should be on expanding private health insurance choices, competition and enrollment and not on further expansions of public programs like Medicaid. 

The Bangor Daily News reported that the Maine Department of Health and Human Services has delayed $39.6 million in Medicaid claims one week to push the transaction into the 2009 fiscal year, which began on July 1.  Apparently, accrual accounting is necessary for businesses, but playing games with cash transactions to balance the books is just business as usual for Augusta. 

It is because of such games that the Governmental Accounting Standards Board issued GASB Statement 45 to require governments to report future retiree liabilities accurately.  In March 2008, The Maine Heritage Policy Center released a report noting that Maine has promised to pay its state employees and teachers $4,756,000,000 in unfunded retiree pension and health care benefits.  Clearly the strategy in Augusta is just to "push" that $4.8 billion bill onto our children and grandchildren and future elected officials.

The Wall Street Journal recently reported on a meeting of the world's top eight economists (five Nobel laureates) at the Copenhagen Consensus Center in Denmark.  The economists recommended, in priority order, the way to acheive the most good with finite resources, in this case $75 billion worldwide over four years. 

Their recommendations are enlightening and available here:

1. Micronutrient supplements for children (vitamin A and zinc) - Malnutrition - $60 million
2. The Doha development agenda - Trade - $0
3. Micronutrient fortification (iron and salt iodization) - Malnutrition - $286 million
4. Expanded immunization coverage for children - Diseases - $1 billion
5. Biofortification - Malnutrition - $60 million
6. Deworming and other nutrition programs at school - Malnutrition and Eduction - $27 million
7. Lowering the price of schooling - Education - $5.4 billion
8. Increase and improve girls' schooling - Education - $6 billion
9. Community based nutrition promotion - Nutrition - $798 million
10. Provide support for women's reproductive role - Women - $4 billion
11. Heart attack acute management - Disease - $200 million
12. Malaria prevention and treatment - Disease - $500 million
13. Tuberculosis case finding and treatment - Disease - $419 million

Total $18.75 billion a year

To quote the WSJ: "...providing vitamin A and zinc would help some 112 million children in sub-Saharan Africa and South Asia for merely $60 million a year. The minerals would help prevent blindness and stunted growth - increasing lifetime productivity by an estimated $1 billion. "

To put this in context, the world's top economists recommend the best way to improve health is to spend $60 million worldwide on vitamin supplements for 112 million kids.  Interesting, $60 million is about what Governor Baldacci wants to Maine taxpayers to spend on Dirigo Health in fiscal year 2009.

Where are our State's priorities?  What logic drives such foolish decisions?