Print | Comments (39) Posted by John McDonough August 27, 2012 10:54 PM
Mitt Romney has ended his self-imposed silence on his signature achievement as Massachusetts Governor -- declaring himself "very proud" of his signing of the Massachusetts Health Reform law (aka: RomneyCare, Chapter 58) in April 2006.
Appearing on Fox News and other outlets, Romney also declared that the Massachusetts Health Reform law is "better" than the Affordable Care Act (aka: ObamaCare).
Reasonable question: which is better? Personally, I am delighted that the two presidential contenders might debate which government-engineered scheme to expand affordable health insurance is better. Let me try and offer my own answer.
There is no simple answer. On some things, RomneyCare wins, on others, it's hands-down ObamaCare. And on some, it's more complicated. Let's look at some details:
Ways that RomneyCare (RC) is better than ObamaCare (OC):
1. RC provides deeper premium support and cost sharing subsidies to make health insurance more affordable to those receiving public subsidies.
2. RC established an insurance exchange (Connector) with a directive to be an advocate to keep consumers' health insurance premiums more affordable.
Ways that ObamaCare is better than RomneyCare:
1. OC premium support and cost sharing subsidies help families with incomes up to 400% of the federal poverty line, vs. 300% FPL under RC.
2. OC bans lifetime and annual benefit caps and RC does not.
3. OC eliminates medical underwriting and pre-existing condition exclusions for all health insurance policies. Massachusetts did this in the 1990s and so there was no need for this to be addressed in RC.
4. OC requires health insurance companies to spend at least 80-85 cents of every premium dollar on medical costs as opposed to profits, marketing and overhead. RC includes no such provisions.
5. OC allows young adults to stay on their parents' health insurance policies until they reach age 26. RC allows young adults to stay on their parents' plan for up to two years after they are no longer dependent, and no older than age 25.
6. OC requires that all health insurance policies cover preventive care services (ie: contraception) with no co-pays or other cost sharing. RC has no such protections.
7. OC requires that all Members of Congress and their staffs can receive federal health insurance coverage via the new state health insurance exchanges. RC did not make any similar requirement on Massachusetts state legislators.
8. OC improves Medicare for its beneficiaries by: closing the prescription drug "donut hole;" providing an annual wellness checkup with no cost sharing; lowering beneficiary premiums; and extending the life of the Hospital Insurance/Part A Trust Fund by about 8 years. RC does not address or improve Medicare at all.
9. OC instigates a significant effort to lower the health care system's administrative costs. RC has no such provisions at all.
10. OC instigates a series of reforms in the delivery of medical care services, including the establishment of accountable care organizations, medical homes, value-based insurance designs, penalties for excessive rates of hospital acquired infections and readmissions, and more. RC does not address delivery system improvements at all.
11. OC establishes a series of programs and initiatives to improve public health, prevention and wellness, including the creation of the first-ever national prevention strategy. RC provides funding for some existing public health programs, though no new public health or prevention initiatives.
12. OC requires every chain restaurant with at least 20 outlets to post on menus and menu boards the calories of every item on its menu. RC has no such public information requirement.
13. OC includes major new funding for community health centers and the National Health Service Corps to improve the nation's supply of primary care services. RC has no such provisions.
14. OC requires the establishment of a National Health Workforce Commission -- appointed, though blocked from convening by House Republicans. RC does not address health care workforce needs at all.
15. OC establishes major new provisions to combat health care fraud and abuse in Medicare, Medicaid, and private insurance. RC includes no provisions addressing fraud and abuse in any sector.
16. OC establishes new standards and a national framework to combat elder abuse, including violence, neglect, and financial exploitation. RC includes no such provisions.
17. OC requires that drug, medical device, and medical supply companies publicly report all gifts, honoraria, and other gratuities to physicians and other licensed medical professionals. RC includes no such provisions.
18. OC directs the Food & Drug Administration to create a pathway for the approval of so-called "bio-similars" or generic-like versions of biopharmaceutical drugs, provisions strongly supported by the pharmaceutical and biotechnology industries. RC has no such provisions.
19. OC includes provisions to ensure that nursing patients and their families are able to obtain transparent information about the ownership and corporate responsibility of nursing homes. RC includes no such protections.
20. OC establishes a new 10% tax on indoor tanning services, which have been linked to the explosion in serious skin cancers, especially melanomas, among young women ages 15-35. RC does not address this epidemic.
OK -- 20 versus 2. You may have others which will add or subtract from either column. My verdict -- as a BIG fan of MA health reform -- ObamaCare wins easily.
Now, one other BIG difference: financing. Here's Mitt:
~~~~~~~~~~~~~~~ "My health care plan I put in place in my state has everyone insured, but we didn't go out and raise taxes on people and have a unelected board tell people what kind of health care they can have," Romney said in an interview with CBS' Denver affiliate, KCNC. ~~~~~~~~~~~~~~~
So which plan is better when it comes to financing? Again, fair question.
It's true, there were no tax increases (unless you count individual and employer tax penalties for non-coverage) associated with MA health reform. But there's a big difference -- Massachusetts got the federal government to pick up the lion's share of the cost. MA health reform would have been impossible without the Administration of President George W. Bush playing Sugar Daddy.
I would propose -- the appropriate comparison is how ObamaCare was financed in comparison with the major health achievement of Obama's predecessor, George W. Bush.
In 2003, with Bush's strong support, a Republican-controlled House and Senate approved the Medicare Modernization Act (MMA) that created the Medicare Part D prescription drug benefit, a big advance sought by senior citizen groups for many years. How was that law financed? 25% was financed by Medicare enrollee premiums and 75% was financed by lathering the costs onto the federal deficit. The Congressional Budget Office estimates that between 2010 and 2019, the MMA would increase the federal debt by about one trillion dollars.
In 2010, with Obama's strong support, a Democratic-controlled House and Senate approved the Affordable Care Act (ACA). White House and Congressional leaders decided that the law needed to be entirely self-financed so that it would not increase the federal debt at all. The CBO estimated in 2010 that the ACA would reduce the federal debt by about $140 billion 2010-2019.
Mitt Romney and the Republican Party support the Part D drug program and indicate no desire to eliminate it. They also indicate no desire, retrospectively, to develop a plan to pay for it beyond allowing the Chinese (and other purchasers of U.S. debt) to finance it. Barack Obama and the Democrats support the ACA and made the most difficult decision to pay for it. You can easily disagree with how they chose to pay for it -- and still respect their integrity in taking the political hits to pay for it.
Advantage -- Obama and ObamaCare.
This blog is not written or edited by Boston.com or the Boston Globe. The author is solely responsible for the content.
from the post this one is in reply to .. "Barack Obama, Pro-Life Hero?
Those who oppose abortion are all set to vote for Romney because he has done things like voice approval for the personhood amendment, which would ban abortion, but what they don’t seem to realize is that, as I found out for the first time last week, Obama has already done more to reduce the number of abortions .. http://www.religiondispatches.org/archive/sexandgender/6501/barack_obama,_pro-life_hero_/ .. than any other president ever has or ever will.
~~~~~~~~~~~~~~~~~~~~ On October 3, researchers at the Washington University School of Medicine published a study .. http://journals.lww.com/greenjournal/Abstract/publishahead/Preventing_Unintended_Pregnancies_by_Providing.99945.aspx .. with profound implications for policy making in the United States. According to Dr. Jeffery Peipert, the study’s lead author, abortion rates can be expected to decline significantly—perhaps up to 75 percent—when contraceptives are made available to women free of charge. Declaring himself “very surprised” at the results, Peipert requested expedient publication of the study, noting its relevance to the upcoming election.
As most observers surely know, the Affordable Care Act (a.k.a. “Obamacare”) requires insurance coverage for birth control, a provision staunchly opposed by most of the same religious conservatives who oppose legalized abortion. If Peipert is correct, however, the ACA may prove the single most effective piece of “pro-life” legislation in the past forty years."
Jessica Valenti on November 15, 2012 - 11:14 AM ET
A protester holds a picture of Savita Halappanavar outside University Hospital Galway in Galway, Ireland November 15, 2012. Reuters/Cathal McNaughton
This week, the first American study ever .. http://io9.com/5958187/what-happens-to-women-denied-abortions-this-is-the-first-scientific-study-to-find-out .. to look at what happens to women when they’re denied abortions was released. It’s a fascinating, but not all that surprising, read. The research shows women who seek out abortions and are unable to obtain them fare significantly worse over time than women who are able to procure the procedure. Women who are denied abortions are more likely to end up on welfare, more likely to stay in abusive relationships, and more likely to be emotionally distressed over their pregnancy outcome.
The 31-year-old Indian dentist, who was seventeen weeks pregnant, went to the hospital with severe back pain. Within hours of being admitted, doctors told her she was miscarrying. The law in Ireland—which only allows for abortion if a woman’s life is in danger—prevented Savita from being able to end her pregnancy and her excruciating pain because there was still a fetal heartbeat present.
As Savita’s condition worsened over the course of three days, she and her husband begged doctors to end the doomed pregnancy. They refused, saying “this is Catholic country.”
Savita countered, “I am neither Irish nor Catholic.” Still, she was denied. That night she vomited repeatedly and collapsed in a restroom.
The following day, the fetus’s heartbeat finally stopped and it was removed by the doctors. But it was too late. Savita was transferred to the ICU where she died of sceptic shock.
Savita died in terrible pain, over the course of several days, begging for a medical procedure that would save her life. She was killed—murdered by a law that places women’s humanity beneath that of a fetus.
American women would do well not to dismiss this as a tragedy that could only happen in another country. This is what happens when you legislate something as personal and complicated as pregnancy. How do doctors decide when a woman is close enough to dying to give her an abortion? Or to what degree does a woman’s health need to be at risk?
I had a life-threatening pregnancy. I was lucky to be far enough into my pregnancy that I was able to deliver my daughter—had it been just a few weeks earlier, I would have been forced to end the pregnancy to save my life. I went into an emergency C-section with my blood pressure rapidly escalating and my liver failing. If there were a law trumping the rights of my fetus over my own, what would have been considered a reasonable risk for me to take? Undergoing a liver transplant? Having a few eclamptic seizures?
It’s not just our lives and health that are in danger, but our human dignity. Consider the women in Ireland who suffered as Savita did but lived—put through needless torture in the name of “life.” Or the American women who are denied late-term abortions even when the fetus has no chance of survival—forced to carry dying babies. Or the women with doomed pregnancies who—thanks to draconian ultrasound laws—are made to listen to a nurse describe the organs and details of their dying fetus before being allowed to have an abortion.
Where is the compassion—the basic human desire to end suffering and injustice?
I’ve been thinking about why it is that Savita’s story has struck such a chord with so many, and why it’s impacted me. I hear awful stories about women every day, but it is Savita’s that has had me in tears since I first heard of it.
It’s about her family, the needless suffering and death, and a life cut short. I think about how scared she must have been, how frustrated, how angry. But there’s something else—another reason why so many women are infuriated and despondent about Savita. Savita’s death is a reminder that no matter how far we think women have come, to some we are simply not people. Our lives are worth nothing, valuable only for our bodies and what they can provide men, the state and the culture. Most days—even when there are constant reminders of our second class status through policy or the media—I can put this feeling aside. But every once in a while there is a stark, horrifying reminder of what it means to be considered less than. There is no way to describe the pain of knowing that to so many—to your country, even—you are nothing.
But we are not nothing. Savita was not nothing. She was a person and she was loved—as we all are. If we want to honor Savita we cannot stand by while others enshrine women’s dehumanization through policy.
Savita’s husband told a newspaper .. http://pics.lockerz.com/s/261298173 , “What is the use in being angry? I’ve lost her. I am talking about this because it shouldn’t happen to anyone else.”
Demand justice for Savita. Join the women and men worldwide who are protesting .. http://www.irishtimes.com/newspaper/breaking/2012/1114/breaking48.html , shaming those who would ensure more tragedy, heartache and needless death in the name of ideology and religion. Let them know this cannot, this will not, happen again.
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