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Health-Care Overhaul 2010

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Post Politics: Health-Care Special Edition

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Ceci Connolly
Washington Post Staff Writer
Wednesday, August 12, 2009; 11:00 AM

Staff writer Ceci Connolly, The Post's lead reporter on health-care reform, took your questions about the proposed bills, the town halls, the views of both sides of the debate, and more.

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Ceci Connolly: Good morning everyone.

Health care's hot. Let's dive right in.

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Single-payer: Hi Ceci,

Still do not understand why a single-payer system option was thrown out? We already have socialized medicine for the seniors in the form of Medicare. Whereas Medicare might not be the best, it is still better to have one set of rules, etc than umpteen rules/procedures with each insurance company having their own (like it is currently).

Ceci Connolly: Although on the merits, President Obama has said positive things about the European-style single payer approach, he has also said he does not think it is politically viable in the U.S. at this time. He and other Democratic leaders announced early on that intended to build on the existing employer-based system we have in this country.

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Washington, D.C. : Hi Ceci,

Thanks for the chat.

In the Health care debate, there seem to be a lot of people saying this isn't in it, that isn't in it. And the articles have been decent at debunking them. But is there anywhere in the Post or elsewhere which breaks down what the bills are and how they work? It seems this simple information is lacking.

The Post has been good about covering the debate, but less so about covering the actual legislation and whether or not it will work independently.

Thank You,

Ceci Connolly: Thanks very much.

You can go to washingtonpost.com/healthcare to see much of our coverage. I recommend several of the graphic elements, which summarize what we know about the pending legislation so far.

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New Britain, Conn.: I thought Obama did a great job at yesterday's town halls and I was wondering what you thought of his performance? He's doing a hell of a lot better at talking about this than most other Democrats who, as Jon Stewart aptly described, just sound incoherent.

Ceci Connolly: Health care is a very difficult subject to talk about, in part because it is so complex and in part because it touches each and every one of us in very direct, personal ways. Health care represents more than one-sixth of the U.S. economy. Industries such as hospitals and drug manufacturers are major employers.

Most people say that Obama has done a good job of articulating what the problem is, but that he has not always conveyed what specifically would change as a result of reform.

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Anonymous: "There are no such "death panels" mentioned in any of the House bills." That is a what you wrote in the eighth paragraph in your front section story in the WP on Sunday.

You know, this would have been a good time for the media to explain there really are "Death Panels." They are comprised of insurance underwriters and hospital administrators and they issue their bureaucratic death sentences every day in perfect anonymity.

The system that Palin and other "conservatives" are freaking out over is the one we have in place today. Just read the MD&A at the back of any health insurance company's Annual Report if you don't believe me.

Ceci Connolly: Well, I certainly wouldn't use the term Death Panel, but I think you are getting at an important issue. Every day in America, medical care is rationed. The uninsured and underinsured get significantly less care, generally at a later stage in their illness. We know that many people with insurance can be turned down for all sorts of procedures. The challenge is in getting to rational rationing, figuring out what are the best therapies in each circumstance and getting those to people in a timely fashion.

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Burke, Va.: What can those of us who would like an actual debate on health care do to counteract the poisonous bunch of shouters that have been showing up at town hall meetings?

Ceci Connolly: That is a difficult question, given the current situation. I know that members of Congress are interested in constructive input from their constituents. You might consider calling your representatives' office and seeing if you can get an appointment or send a letter outlining your views.

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New York: Ceci, I pay for my own health insurance through a professional organization, $5,000/yr. with co-pays and no drug coverage. I am unemployed, and know that at some point soon I'll be unable to afford health insurance altogether. If the reform proposals went into effect tomorrow, how would my situation change? Thanks for the chat.

Ceci Connolly: It is hard for me to say precisely without knowing a few more details about your own situation. For people earning less than $66,000 (or maybe $88,000 depending on the bill), there will be discounts for purchasing insurance. The legislation also aims to open Medicaid to a larger group of recipients. Small businesses might receive some tax credits for buying coverage or given the opportunity to purchase insurance through a new exchange, which supporters say should provide better group rates.

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Falls Church, Va.: What is it precisely that the pro-reform forces are trying to present to the country at this point, given that no decisions have been made on what reform is supposed to look like?

We don't know whether there will be a public plan.

We don't know whether there will be an individual mandate.

We don't know whether employer benefits will be taxed.

We don't know whether the cost curve will bend.

Obama is basically telling the country to support whatever emerges from Congress, without any notion of what that will actually be. How can that possibly succeed?

Ceci Connolly: It is true that the legislation is still being negotiated and much could change in the next few months. On the other hand, we are seeing some areas of broad consensus that hint at where Congress could end up if a bill is enacted. So far, every bill being considered would require individuals to carry insurance (with discounts or waivers for people who cannot afford it.) We know that every bill would include tight new restrictions on how the insurance industry operates (no denying coverage based on age or pre-existing conditions, no lifetime caps). There continues to be debate over a public plan, although it appears unlikely any public option would rely on Medicare rates. And lawmakers are still arguing over whether to tax employer-sponsored benefits.

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No-rep in DC: Regarding the "death panels" -- my understanding that this is end-of-life-care counseling by a doctor, is that right? And is it voluntary? And if I am over 65 and suffer a heart attack or get run-over I will never get the "death panel counseling" right?

Ceci Connolly: There are a few elements to this proposal. The voluntary sesin would be between a Medicare beneficiary and a medical professional (doctor or nurse, most likely). Some proposals would offer this consultation as part of a "welcome-to-Medicare" check in. But let me stress, it would be up to each and every individual patient.

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Washington, DC: This might be a delicate question, but in the talk of health care reform, where is the talk about actual HEALTH reform? I remember reading an article not long ago about how ambulances are requiring new equipment to handle obese patients. If we want to control health care costs, isn't it worth investing in making us actually healthier?

Ceci Connolly: Excellent point. The discussion about good health does tend to get overshadowed by some of the politics. Most of the bills circulating in Congress have some new initiatives around health and wellness, but probably not enough.

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Virginia: Ceci - Re the out of control town halls: wouldn't it be smart for everyone admitted to the hall (and the rep or senator speaking) be given a copy of the house proposal (since it is the most comprehensive and contains the controversial "death panel" bit) and then each speaker could point to the part of the proposal that they disagreed with or needed clarification.

It seems like the shouters have not read any of the bill. Or maybe the guys with the microphones could just have copies of the bill for the use of the speakers. Wouldn't this diffuse some of the anger issues or at least demonstrate that some the speakers were not interested in the actual legislation?

Ceci Connolly: Well at a minimum it would give everyone a chance to build up their biceps! It's a pretty heavy tome. But I certainly endorse the idea of folks taking a look at the bills and deciding for themselves what they think.

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Little Rock: Arkansas has worked hard to help uninsured children get coverage through ARKids First, our version of CHIP. Do the new health reform proposals keep those kids covered? Do they help the children whose families don't qualify for CHIP but can't afford private insurance? Thanks!

Ceci Connolly: Most of the current proposals would keep CHIP unless or until every family has insurance coverage. President Obama and Congress reauthorized the Children's Health Insurance Program earlier this year. It now covers about 11 million low-income children, I believe.

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Dunn Loring, Va.: Twice yesterday in his town hall, Obama stated that AARP endorsed the Democratic health-care reform proposals. Isn't it true that the AARP has not taken any official position? Given that fact, is Obama actually contributing to the misrepresentations being made about health care reform?

Ceci Connolly: Very good point. AARP has not endorsed any piece of legislation. But the group blessed the deal the White House struck with PhRMA to contribute $80 billion over the next decade, largely by giving discounts on brand name drugs when seniors hit the "donut hole" in Medicare. And now AARP is running ads touting the need for reform. Does anyone out there think the group is trying to have its cake and eat it too? I'm curious what others think?

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Columbia, Mo.: Thanks for the column today. I look to you as a lonely voice of reason and logic on this and other matters. My question: where will the reasoned conversation take place? If there is to be a two-sided conversation, there has to be another side, and I don't any credibility there - all they do is scream.

Ceci Connolly: I hope that we at the Washington Post can contribute to calm, reasoned discussion of health care and other important issues. I encourage everyone to weigh in on our website. I also get the impression that while some town hall meetings have gotten pretty wild, that lawmakers are finding other ways to discuss the issue with people offering a variety of viewpoints. This may be the fault of the media in only reporting on the disruptions. We'll do some more checking.

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Minneapolis: If they made some sort of health insurance reform, couldn't they start with everyone on a level playing fields and say there's no such thing as a pre-existing condition? I would be happy to pay for health insurance, but cannot even get in the front door because of a pre-existing condition.

Ceci Connolly: That is something President Obama is spending a lot of time talking about lately. The bills being considered in Congress would include significant insurance market reforms. I think the question is whether the legislation might go any further than that.

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New York, NY: Thanks so much for the chat. Why do you think the president keeps assuring us that those with plans they like will not have to change, when no one knows what the changes in health care will mean until they are implemented?

Ceci Connolly: I can't speak for the president, but my guess is that he is sensitive to the reports by many of the people who have insurance that they do not want that disrupted. Obama is probably half right -- most of the proposals would enable people to keep the doctors they have or allow employers to continue offering the plans they now provide workers. But you are right that there are many unknowns in an overhaul this sweeping. Ideas to implement comparative effectiveness research and incentivize doctors to coordinate care still need to be fleshed out and tested.

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New York, N.Y.: May I please see some cost and savings estimates? What are the claimed possible costs of each of the major components of the health care bills, according to both supporters and opponents? What are the possible savings, if any, that supporters and opponents see from major parts of these proposals?

Ceci Connolly: Generally speaking, experts estimate it will cost about $100 billion a year over the next decade to provide coverage to 46 million uninsured Americans. President Obama has said he wantshealth reform to be deficit neutral. The current plans call for squeezing about $550 billion out of Medicare growth over the next 10 years (that is out of total Medicare spending of nearly $7 trillion). Congress is considering tax increases to cover the rest of the cost (perhaps higher taxes on the wealthy or a tax on high-priced employer-sponsored insurance policies). The big unknown is whether over the long term, we as a nation can slow the rate of growth through better coordination of care, eliminating duplication, investing in wellness, etc.

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Washington, DC: Do any of the current pending bills include something akin to the UK's National Health Service's NICE panel, which prohibits the use of certain procedures and drugs that are not "cost-effective"? Thank you.

Ceci Connolly: Not exactly. Congress approved about $2 billion in comparative effectiveness research in the large stimulus bill. That money is supposed to examine what works best for which patients under what circumstances. None of the proposals call for using those findings to determine what is covered, as I believe NICE does.

It is worth noting, that many private health insurance plans in this country today (along with the VA and about 15 state medicaid programs) use this sort of information today to decide what gets covered. But most people are not very aware that that goes on now.

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Silver Spring, Md.: In reading the Constitution, I cannot see where We The People have given the Federal Government the power/authority to manage health care or to require citizens to have insurance (note: whether this is a good idea or not is a separate issue). My question is: Am I missing the article in the constitution? Or have we reached a point where "we can't let the Constitution get in the way of a good idea"? I've seen no debate on this in the MSM.

Ceci Connolly: I've not heard many people apply a constitutional argument to health care reform. Thanks for the update.

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"But I certainly...: endorse the idea of folks taking a look at the bills and deciding for themselves what they think."

Given that most congressmen haven't read the bill, why should protestors be held to a higher standard? Nonetheless, did you watch the Specter townhall, where several protestor did cite sections and page numbers, and snarlin' Arlen was unable to respond.

Ceci Connolly: You are correct, many lawmakers have not read the bills approved by 3 House committees and one approved by the Senate health committee. I would encourage them to do so.

In fairness, many of the people at town halls citing sections and page numbers have not read the bills either; those citations have been provided to them.

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Arlington, VA: Why doesn't the main stream media rebut the story of the Canadian woman who supposedly had to come to the U.S. for surgery on a cancerous brain tumor which, as she claimed in TV spots sponsored by opponents of reform, would've killed her if she had to rely on the Canadian system (long wait time, etc.)? Turns out she had a non-cancerous, non-life threatening Rathke's cyst on her pituatary gland at the base of her brain. She was losing eyesight (which was reversible), but her life was never in danger. All this is on the Mayo Clinic (where she was treated) website.

Ceci Connolly: We're trying to run down the precise details of this case. If you have information, we'd love to take a look.

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The Basic Question: Doesn't the health insurance reform basically boil down to: Make health care more accessible to all Americans, make sure an unforeseen health issue doesn't bankrupt you, and make sure an insurance company cannot toss you off their list for spurious reasons?

If so, why are so many "people" getting unhinged at the idea of expanding accessibility?

Ceci Connolly: That's a pretty good summary of the top goals of reform. The challenge of course, is in refashioning a sector that consumes more than one-sixth of the U.S. economy. There would certainly be financial winners and losers in that kind of overhaul, which is why we are seeing such intense lobbying.

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Boonsboro, Md.: Despite the claims of secret coordinated disinformation campaigns, I think the real problem with the current health-care proposals is most people simply do not believe our elected officials when they basically say "You will get better care at no additional cost. No one will lose their current insurance". Do you see a credibility gap between the elected and the voters?

Ceci Connolly: I can understand the skepticism. Interestingly, many of the smartest people involved in our health system say that there is an enormous amount of waste that could be eliminated. On the question of cost, we are all paying today for the nation's uninsured -- in taxes to support programs such as Medicaid, in higher insurance premiums and in higher prices at hospitals. The hope is that by covering everyone in a rational way, some of that cost-shifting could be reduced.

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DC: My problem with the rowdy people at the town halls is not so much their opposition or their methods. I get it, they disagree and want it out there. But what bothers me is that I have not heard one coherent question, concern, or argument posed by any one of those folks being run all over cable news and/or blogs. So have any of them raised a real question/objection at any of these town halls? (not including Obama's)

Ceci Connolly: Not sure I can add to this, but wanted to post it for others to see.

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New York: Ceci, I don't have the numbers at hand, but I recall health insurance industry profits have been pretty robust, even in this economy, and the executives' compensation rivaling that of Wall Street. So it seems to me that the private insurers should have no problem competing against a public option. Is this a valid argument? Thanks.

Ceci Connolly: I think the insurance industry would disagree. They say that a public option, especially if it has the ability to set low rates, would undermine the industry and even force some companies to go out of business.

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Charlotte, NC: Is it true that insurance companies have been backing (financially or organizationally) the anti-reform protests at town hall meetings? If not, who is behind these organized protests?

Ceci Connolly: We are pursuing these reports. It appears that some organizations have been involved in recruiting people to protest but in many other instances individuals are showing up at town halls on their own to register their concerns with lawmakers.

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Ceci Connolly: Thanks very much to everyone who participated today. I'm sorry we couldn't get to every question, but I promise to return for a future session.

And please check out washingtonpost.com/healthcare

There's a feature at the top of the page called Rx, which includes our expert panel and a place to weigh in with your views.

Stay healthy!

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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