The Stimulus – The Good, the Ugly, and the Bad

The Good

It looks like the stimulus package is on its way to becoming law.

The Good news is that health care safety net provision have survived somewhat intact.  The additional support for Medicaid and for COBRA continuation coverage are still in the package.  In addition the features of health care stimulus that encourage the development of the electronic medical record and research on the comparative effectiveness of treatments were only slightly modified.

The Ugly

The way those on the right react to these provisions is ugly.   I commented on this last week.  Not only do they see impending doom with each additional patch on our leaky health survival raft;  they have a way of turning long standing truths on their head and interpret liabilities of the current maze into positives.

Last week I pointed out right wing reactions to “comparative effectiveness research” and the electronic medical record.  Recently the Washington Times outrageously equated comparative effectiveness research with Nazism.  Most people reading or listening to the scares on this topic would assume the Office of the National Coordinator for Health Information Technology is some new and sinister bureaucracy.  In fact, the office was created by executive order of President George W. Bush in 2004.  This was pointed out by Keith Olbermann on MSNBC’s Countdown.  

The same on COBRA.  An early version of the stimulus package excluded people earning over one million dollars from COBRA eligibility.  But is that how the right reports it?  No!  According to their upside down worldview, Congress was now permitting people who earn as much as one million dollars to be eligible for COBRA coverage. 

Have they ever raised the issue during eight years of the Bush administration or, for that matter, the preceding 25 years or so that the COBRA law has been around, that people earning over one million were eligible for COBRA coverage. 

And why shouldn’t they?  The slogan health care for all does mean health care for all.  Besides, they are probably the only ones who can afford COBRA coverage.

In the Blumberg article by the same Betsy McCaughy criticized by MSNBC’s Keith Olbermann she makes the following argument:

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry.

She indeed turns the world upside down.  Health care is a cost problem!  We do not have 50 million uninsured people because people don’t value their health.  We have fifty million uninsured people because individuals, businesses and governments can’t afford it.

 Imagine if you could take that first sentence and change out the words health-care for any of the following: “war”, “disaster relief”, “prison”.   Defense, crime prevention, disaster relief are necessary endeavors, but what economy wants to be consumed by them?

Let’s take this one step further.  Let’s assume that the 17% of the US economy now spent on health care came entirely from US tax dollars.  Do you think that the likes of Betsy McCaughy would still be celebrating health care as a growth industry?

On to the Bad

The theme of this blog is that our health care maze is an administrative nightmare that even Lewis Carol or Franz Kafka could not have invented.  So as someone who will be on the implementation end of the new COBRA subsidies, I shudder at the administrative complexities of a program that ultimately will not benefit that many people.

Our plan has very generous provisions for continuing health care coverage for people who are off for extended periods of sick or disability, as well as for survivors of active and retired members.  They pay between ten and twenty percent of the full cost of coverage.  Yet every month we terminate individuals who can’t keep up with the payments.  People without jobs don’t have money.

As I understand it, under the new plan the individual has to claim the subsidy which is determined by the eligible individual’s adjusted gross income.   It would be a  lot simpler from an administrative point of view, to make the determination based solely on the individual’s pre-termination earnings.

As is, the individual claims the subsidy simply by paying the subsidized amount.  But the subsidy is payable to the plan sponsor only if the individual is eligible.  How does that get resolved?

Who determines eligibility?  How does the plan sponsor get reimbursed?  And how does any of that effort add real value to the health care system?

Yes, it is good to take care of those in need.  But please!  Can’t we find our way to a simpler, more rational system?

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