Our Editorial in the New York Times: “We Stand For Access”

As a member of the American Society of Law, Medicine & Ethics, I’m proud to add my name to this letter to the editor in the New York Times:

To the Editor:

We, many of the nation’s health law and health policy professors from law, medical, public health and graduate schools across the United States, write to address one of the most fundamental issues impacting our country: the potential repeal and replacement of the “Affordable Care Act” (“Obamacare”). It is clear that the House-passed “American Health Care Act,” as well as the legislation likely to be considered by the Senate, will cause severe, lasting harm to all of us, especially our society’s most vulnerable and middle class.

Today we raise our voices to oppose these proposals. While the Affordable Care Act has its shortcomings that should be fixed, the current proposals are merely “repeal,” with no effective “replace.” These proposals are wrong, and must be rejected. At a time when we are seeing significant declines in the number of uninsured and inadequately insured in our country, the House and Senate proposals represent a giant step backward. By cutting Medicaid funding, eliminating federal assistance for families securing private coverage, and encouraging individuals to either not purchase insurance or to buy barebones coverage, these proposals will result in a less equitable, less accessible system of health care. Ultimately, the public’s health will decline as needed care is forestalled or not sought, and costs will rise as a shrinking pool of Americans with “good” insurance pay more to subsidize those without.

Given the many health care challenges that we face— an aging population needing an increasing amount of health care services; a young and middle age population facing growing rates of obesity, heart disease, and other chronic conditions; a rapidly expanding “gig” economy of independent contractors needing to secure insurance without employer subsidies; and a rising number of individuals addicted to new and more prevalent illegal drugs— reducing access to health care services simply cannot be an acceptable policy option.

We also are deeply concerned about what this new legislation portends for women and children. Currently, the United States leads the developed world in maternal mortality. More women die during childbirth in the United States than in any other Western nation. Despite the urgency to protect women’s health and strive for better outcomes, lawmakers have specifically targeted maternal health coverage for cuts.

The same is true for infants in the U.S, whose health care is also at risk with these proposals. Our nation ranks 50th in the world on infant mortality. By shifting more families off of Medicaid, and creating a larger uninsured and under-insured population, children’s access to health care services will decline.

The Affordable Care Act protects all Americans from discrimination based on preexisting conditions, expands coverage for mental health treatment and drug addiction, and fosters preventive care. Millions of Americans have health insurance for the first time, and we are at an all-time low in the percentage of citizens who lack coverage. The reform legislation under development proposes to wipe away these essential gains, returning Americans to the pre-Affordable Care Act era of coverage limitations and exclusions thwarting the provision of essential health care services.

In 1966, Dr. Martin Luther King explained to a group of health providers, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” We agree.

Obamacare Is Not a Reason to Give Up on Government Programs

Health Insurance Enrollment Under Obamacare

The biggest myth of the Obamacare debate goes like this: The failures of Obamacare prove that the government can’t be trusted to run our health care system.

This single myth is so powerful that it has become the rallying cry of every Republican who’s considering a run for the presidency in 2016. It has single-handedly brought the Tea Party back to the forefront of American politics. It has been uttered on every cable news channel everyday since HealthCare.gov launched on October 1.

And it is wrong on every possible level.

First of all, the premise is wrong. Obamacare cannot be a litmus test for government-run health care because Obamacare is not government-run health care.

Obamacare creates an online exchange where people can buy private insurance. The government merely sets basic standards that every plan has to meet and gives consumers a place where they can locate those plans. The rest is up to the free market.

This simple concept has been so twisted and misunderstood that many Americans actually believe that the government will have access to their medical records. This is completely false. Under Obamacare, the IRS only needs to verify that you have health insurance. It does not — and cannot — see any of your private health information.

The second problem with this myth is that it’s too soon to judge Obamacare. All new software goes through a trial period. It’s frustrating, but it’s inevitable — and temporary.

Back in 2005, the same thing happened when the Bush administration launched the website for Medicare Part D. First, they had to delay the launch. Then, when they finally rolled it out, it didn’t work at all. Then they got it working, but it was too slow and full of inaccuracies.

Every major news outlet carried stories about the failures of Medicare Part D. According to polling data, the program was actually less popular than Obamacare is today.

Within a few months, the glitches were fixed. Medicare Part D now has a 90 percent approval rating. No one remembers the initial bugs in the system.

The third problem is that many of the so-called “failures” of Obamacare aren’t actually Obamacare’s fault. Remember that Obamacare wasn’t supposed to create one big national insurance exchange. Each state was supposed to create its own insurance exchange, but the Republican governors in half of the states refused to follow the law.

As I wrote back in May, “These Republican governors, who say the states are better at governing than the feds, ceded enormous power to the federal government, violating a core principle of their party’s ideology. And then they crowed that Obamacare was a failure because it required a massive federal bureaucracy — the very bureaucracy that they chose to create!”

What’s worse, these governors didn’t announce their decisions until 2013, so it’s completely false to assert that the federal government had three years to build a national online exchange. They really only had a matter of months.

The fourth problem with this myth is that Obamacare is not a failure. This week, the government announced that more than 500,000 Americans signed up for health insurance through Obamacare in its first month of operation.

Think about that. Obamacare, with all its kinks and snafus, has already improved the lives of over half a million people.

You’ve probably heard that 106,185 people have signed up for health insurance through the new online exchange, but even more impressive is the 396,261 people who got their insurance through Medicaid or CHIP.

In all the hubbub about HealthCare.gov, we seem to have forgotten the Medicaid expansion under Obamacare, and the media hasn’t bothered to remind us because…well, it’s going so smoothly.

And that brings us to the fifth and most fatal flaw in this myth: The biggest success story from Obamacare has been Medicaid, the one part of the law that actually is government-run insurance. To say that the government can’t be trusted is to say that the millions of Americans who benefit from Medicare and Medicaid and CHIP don’t count and don’t matter.

That’s an ugly thing to say, but if you listen closely, you can hear it all around you. Every time the government tries to help the less fortunate, there is always a contingent of Americans who oppose it. But that doesn’t mean we shouldn’t help them. And it certainly doesn’t mean we can’t.

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An abbreviated version of this op-ed was published in today’s South Florida Sun-Sentinel and Huffington Post.

“You Could Nominate Gandhi to Be Head of CMS and That Would Be Controversial Right Now”

by Norman Horowitz

Do we determine the politics of our soldiers we send off to possibly die in Iraq and Afghanistan? Do we send only Democrats or only Republicans to die on our behalf?

Do we determine the politics of a firefighter who comes to put out a fire in your house? Do we allow only Democrats’ or Republicans’ to risk their lives in order to defend our lives and property?

Do we determine the politics of a plumber who will unclog a drain in your home? Does a plumbing problem respond more to a plumber who is a Democrat or a Republican?

Do we determine the politics of the police when you have called them to protect you and your property? Can we rely on either Democrats or Republicans to do this job?   Continue reading ““You Could Nominate Gandhi to Be Head of CMS and That Would Be Controversial Right Now””