| Today's Feature Blunt Questions
Low Vaccine Supply.
Washington, D.C. –
Southwest Missouri Congressman Roy Blunt has
voiced real concern for Missouri families and
demanded answers from the Obama Administration
about their response to the breakout of H1N1 in
the United States.
"The onerous regulatory
and legal environment in the United States has
placed America’s most vulnerable in
danger," Blunt said. "The federal
government has clearly failed to meet a basic
responsibility to move quickly to ensure the
availability of H1N1 vaccines."
"Congress needs to be
asking serious questions about why the vaccine
isn’t yet widely available, even though
we’ve known for six months that we needed to
be fully prepared," Blunt said.
Recent reports suggest that the
Administration’s response on H1N1 has fallen
short, leaving many Missourians, including school
districts, with no way to vaccinate the most
vulnerable. Missouri’s Department of Health
and Senior Services this week reported that it
only has 28 percent of the H1N1 vaccine that it
needs.
Grading the
Public Options
That Already
Exist
by Sabrina Shankman, ProPublica
Pundits and politicians from
both sides of the fence have been hollering
themselves blue about a potential public health
care option. Instead of relying on private
insurers, the government would insure people
itself. The idea is that if a government-run
option were offered to compete with private
insurers, it could help keep pricing in check and
ensure quality.
Two of the three health care
reform bills in Congress have a public option.
What might a public option look like in practice?
One way to find out is to look at what’s
already out there. About a third of Americans
already get health care from a publicly
administered program. From celebrated programs
like the VA’s or the military’s, to the
troubled ones like the Indian Health Services,
here’s a snapshot of how they actually work:
TRICARE
The good: TRICARE isn’t an
insurance program—it’s considered a
government benefit for active members of the
military, retirees and their families. This means
that if you qualify, you’re automatically
covered, regardless of pre-existing conditions.
And if you use TRICARE Prime, which operates like
an HMO and is the most popular option, there are
no out-of-pocket fees so long as you go to a
Military Treatment Facility.
The bad: If you enroll in
TRICARE Prime, which charges non-active-duty
members $230 a year, there are just nominal
out-of-pocket expenses to visit non-military
providers. But if you only have the default
coverage, TRICARE Standard, the fees can be
steep. Inpatient costs for civilian facilities
under the Standard plan, for instance, are $535 a
day.
The ugly: Walter Reed.
Veterans Health
Administration
The good: Like TRICARE,
it’s a government benefit, so if you
qualify, you’re in. In many cases, that
means you’re exempt from co-pays and
deductibles. If not, costs are comparable to
Medicare’s. And unlike veterans of previous
wars, if you served in Iraq or Afghanistan, the
VA will cover you even if you were not injured,
because it now recognizes that it can take a few
years for symptoms of post-traumatic stress
disorder to show. What’s more, you
can’t knock the product—the VA is known
for its high standard of care.
The bad: If you don’t sign
up within five years of discharge, you’re
out of luck.
The ugly: Enrollment has boomed
in recent years, because of an influx of vets
from Iraq and Afghanistan. But the budget
hasn’t kept pace. In the last 10 years, the
VA’s medical spending per veteran increased
23 percent, from $4,374 to $5,390. But health
care costs have inflated by 50 percent. Taking
that into account, the VA is actually spending
$1,184 less on each veteran now.
Indian Health
Service
The good: If you’re a
member of one of the country’s 564 American
Indian and Alaska Native tribes—or a
descendant—you are automatically enrolled
(although no dice for tribes that aren’t
federally recognized). To receive services, you
have to live on or next to a reservation, and you
can visit, for free, any of the IHS or tribal-run
hospitals or clinics.
The bad: The coverage is better
than nothing ... but just barely. Each year IHS
receives about $600 million for Contract Health
Services, which covers any services outside the
IHS system. In places where IHS already has a
hospital, this might pay for visits to a
specialist. In locations that just have clinics,
the funds have to cover more. But the problem is,
the money runs out every year. So if you need to
see your cardiologist, get a mammogram or get a
colonoscopy, you’d better ask for it in
January. Because by March, funds for these will
start running low. By June, they will have run
dry. (This was explained to us by Elmer Brewster
of IHS, who also explained it to Slate.)
The ugly: Let’s look at
the numbers —American Indians’ life
expectancy is 2.4 years less than the overall
average, and their infant mortality rate is 8.5
per 1,000 live births, as opposed to 6.8 for the
entire country. They are six times as likely to
die from tuberculosis, and nearly twice as likely
to die from diabetes. Of course, there are
multiple factors explaining why Native Americans
have more health problems, but health care
coverage is likely one of them: While the average
health care expenditure in the U.S. is about
$6,000 per person, IHS shells out just $2,100.
Healthcare
Group of Arizona
The good: The state of Arizona
started this program in the 1980s to offer more
affordable health insurance to businesses with
between two and 50 employees, allowing them to
choose from three managed-care options.
The bad: The program operated
in the red from 2004 to 2007 [16]. While
it’s back in the black, that is in part
because the plans with the lowest deductibles
were eliminated. So, where there used to be zero
and $500 deductibles, now most are close to
$2,000.
The ugly: Even the
administrator of the program admits that it might
not be the most affordable option. For a small
business with a young, healthy staff, you’ll
do much better on the private market, the
administrator, Monica Coury, told us.
Medicare
The good: Taking Part D (the
confusing prescription drug program that’s
administered by private programs) out of the
picture, people are basically happy with
Medicare. The fees are pretty low, and you can go
to any health provider that accepts
Medicare—which means most providers. And
studies show that Medicare’s administrative
costs are low compared with those of privately
run programs.
The bad: There’s a lot of
evidence of wasteful care. The program spends
about $10 billion annually in payments to
suppliers of medical equipment, but an inspector
general for the program estimated last year that
as much as $2.8 billion of that was waste.
Meanwhile, take a look at the discrepancies in
how much patients cost the system. In 2006 in Des
Moines, Iowa, Medicare doled out an average of
$6,335 in reimbursements per enrollee. The same
year in Miami, that average was $16,351.
The ugly: It’s really,
really expensive. In 2008, Medicare funding
accounted for more than 13 percent of the federal
budget, coming in at a whopping $391 billion.
(For the sake of comparison, 2 percent of the
budget was spent on education). Because it’s
an entitlement program, there’s no way to
limit the number of people who qualify, so as
baby boomers age into the system, expect to see
that budget balloon even more.
Medicaid
The good: More than 50 million
low-income people who might otherwise go without
insurance have it because of this program.
It’s state-administered, meaning eligibility
can differ, but typically, if you’re
low-income, have children, or are disabled, you
qualify.
The bad: Because states decide
eligibility, you may qualify in one state, but
not in others. For instance, in New York [25],
someone making less than $706 a month qualifies.
In Georgia, the bar is set at $235. Of course,
cost of living varies geographically too, but
eligibility differences go beyond just income. In
some states, if you don’t have children, or
aren’t pregnant, you may not qualify at all.
One reason for this is a Medicaid waiver program
that started during the Bush administration,
which allowed states to skirt federal guidelines
in order to cut costs and, in theory, better
serve the states’ Medicaid population.
The ugly: As the economy has
tanked, more people have joined Medicaid, which
has squeezed already tight budgets. Many states
have used stimulus funds to supplement their
budgets. But when the funds run out, it’s
unclear what will happen to the program, which
accounts for more than one-fifth of total state
spending.
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