State of the Union: State of Health Care
State of the Union: State of Health Care
The Progress Report
The Progress Report reviews the state of health care in the United States before the President's State of the Union address.
|January 18, 2007|
||State Of Health Care|
||Go Beyond The Headlines|
||Coffee and Donuts Not Included|
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The U.S. health care system is not healthy and Americans are worried. In his State of the Union address last year, President Bush promised to provide Americans with “affordable health care.” Yet, while the United States continues to spend more than any other country on health care, nearly 47 million Americans — a record high — remain uninsured. Health care costs are increasing faster than wages, and six in ten insured Americans are “worried about being able to afford the cost of their health insurance over the next few years.” With the cost of health care a top concern of the American public, the President will likely address the issue in this year’s State of the Union address. But rather than provide solutions that would extend affordable coverage to all Americans, Bush appears ready to re-hash his tired, unpopular proposals for expanding consumer-driven health care continue his efforts to unravel the employer-based health care system by changing the tax treatment of some employer-sponsored health benefits.
SKYROCKETING COSTS: Last year, Bush promised that his administration would “confront the rising cost of care, strengthen the doctor-patient relationship, and help people afford the insurance coverage they need.” He has not lived up to his promises. Health care costs skyrocketed 87 percent over the last five years, despite wages increasing just 20 percent. Over three million fewer workers received employer-based coverage in 2005 than in 2000 and the cost of a health premium for an average family is $11,480 — roughly equal to the salary of a full-time, minimum-wage worker. Additionally, the high costs of health care are creating larger numbers of uninsured Americans. The number of Americans without health insurance has increased by 6.8 million — to nearly 47 million — under the Bush administration, and the Center for Budget and Policy Priorities predicts that another 600,000 people would have lost insurance under Bush’s 2007 budget proposals. Last Friday, the new Congress attempted to alleviate the high costs of prescription drugs by passing a bill requiring federal officials to negotiate for lower prices within the Medicare prescription drug program, but the President has promised to veto the measure. A November poll by the Kaiser Family Foundation found that 85 percent of Americans support prescription drug negotiations.
PAYING MORE, GETTING LESS: The United States spends more on health care per person than any other country, including countries that provide health care coverage to its entire citizenry. But the quality of our care — and the quality of our health — continues to lag. We have fewer practicing physicians and nurses per 1,000 people than comparable countries. Approximately 70 percent of deaths and health costs in the U.S. are attributable to chronic disease, some of which may be preventable. Yet only half of recommended preventive services are provided to adults. In his 2006 State of the Union, Bush promised to “make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors,” but currently, just 28 percent of U.S. doctors said they use electronic medical records. (Ninety-eight percent of doctors in the Netherlands do so.) In light of the high costs and low quality of care, Americans on average die at a younger age compared to the average age of death of comparable nations. The U.S. infant mortality rate is 6.9 deaths per 1,000 live births, while Japan and Sweden have rates below 3.5 deaths per 1,000 live births. The Center for American Progress has put together a plan for a Wellness Trust, which would prioritize prevention in the U.S. health care system.
HEALTH SAVINGS ACCOUNTS NOT OFFERING SAVINGS: Last year, Bush’s health care proposals in his State of the Union address focused on expanding health savings accounts (HSAs), and this year, he will likely do the same. According to the Bush administration, these special medical savings accounts will “allow people to save tax-free for health-care needs provided they choose low-cost, high-deductible coverage. The ultimate idea is to expand health-care coverage while reducing cost pressures, in part by giving people more of a financial incentive to be smart shoppers.” But in reality, HSAs disproportionately benefit the wealthy. The Government Accountability Office (GAO) found “that the average income of HSA users was $133,000 in 2004, compared to $51,000 for all non-elderly tax filers.” Additionally, these HSAs are being used as tax shelters for the wealthy. In 2004, the “majority of people with HSAs withdrew no funds from the accounts…and HSA participants in the focus groups that the GAO convened spoke of using their HSAs for tax sheltering purposes.” Most low-income individuals “do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs” and people “with chronic conditions, disabilities, and others with high-cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans.” Multiple studies have shown that HSAs are likely to increase the number of uninsured and increase health care costs, all while costing taxpayers tens of billions of dollars.
STATE PROGRESS: Approximately 69 percent of Americans believe it is the responsibility of the federal government to provide health care to its citizens. While 2006 saw no movement toward universal health care by the Bush administration, the states made more progress and set off a national debate on health care. In 2006, Vermont and Massachusetts joined Maine in providing near universal coverage to their residents. This month, California Gov. Arnold Schwarzenegger (R-CA) proposed unveiled a $12 billion proposal to extend health coverage to the 6.5 million Californians who currently have no insurance. Schwarzenegger’s proposal responded to the demands of approximately 80 percent of California voters who indicated they want the government to guarantee access to affordable health coverage for the state’s residents. While some aspects of Schwarzenegger’s proposal raise concerns — particularly, whether health care will be truly affordable for lower-income Californians — as a whole, the proposal represents a positive and exciting step in the national debate on health care reform. “I look forward to everyone now having those debates,” Schwarzenegger said.
JUDICIARY — CRITICAL QUESTIONS REMAIN OVER ADMINISTRATION SHIFT ON WARRANTLESS SURVEILLANCE: On the eve of his first appearance before the Senate Judiciary Committee since control of that chamber changed hands, Attorney General Alberto Gonzales yesterday announced what appears to be a timely tactical retreat in connection with the Bush administration’s warrantless domestic spying program. According to a letter issued by Gonzales, “any surveillance that was occurring as part of the Terrorist Surveillance Program will now be conducted subject to the approval of the Foreign Intelligence Surveillance Court,” a move that President Bush strongly resisted for more than a year. Yet it remains unclear “whether the administration found a friendly judge who gave a blanket approval to the program or whether it will have to seek individual approval each time it wants to eavesdrop.” This distinction is critical, and the administration will not say one way or the other. However, in today’s New York Times, Rep. Heather Wilson (R-NM) charged that the new approach in fact relies “on a blanket, ‘programmatic’ approval of the president’s surveillance program, rather than approval of individual warrants.” Administration officials “have convinced a single judge in a secret session, in a nonadversarial session, to issue a court order to cover the president’s terrorism surveillance program,” Wilson said. Center for American Progress Senior Fellow Mark Agrast writes today, “Before the senators give the administration their blessing, they must be satisfied that this is not a fresh attempt to circumvent the independent case-by-case review which the Constitution requires before the government may lawfully intercept domestic communications.” More commentary from legal analysts Marty Lederman and Glenn Greenwald.
ETHICS — MCCAIN FLIP-FLOPS ON GRASSROOTS LOBBYING PROVISION: In Dec. 2005, Sen. John McCain (R-AZ) announced that he was introducing The Lobbying Transparency and Accountability Act of 2005. Section 105 of his bill called for “disclosure of grassroots activities by paid lobbyists.” McCain said of the proposal, “It requires greater disclosure of the activities of lobbyists, including for the first time, grassroots lobbying firms.” The religious right sprang into action, assembling a coalition to help “bring down” the McCain provision. While grassroots groups on both sides of the political spectrum oppose the proposal, “social conservative leaders such as Dr. James Dobson, founder of Focus on the Family, who broadcasts a radio program to hundreds of thousands of evangelical Christians, have been its most vehement critics.” After months of pushing back against the influence-peddling operations of grassroots lobbyists, McCain has decided to give in. According to The Hill, “Sen. John McCain (R-Ariz.) has told conservative activists that he will vote to strip a key provision on grassroots lobbying from the reform package he previously supported.” McCain has engaged in a pattern of flip-flopping on lobbying reform. He has been soliciting contributions from K Street lobbying firms while talking tough against lobbyists, and he has been trying to scuttle the lobbying reform effort by adding a “poison pill” to the bill.
INTERNATIONAL RELATIONS — INCREASING VIOLENCE PUSHES DARFUR AID TO ‘BRINK OF COLLAPSE’: Yesterday, fourteen U.N. aid agencies working in Darfur “warned that their relief operations will collapse unless security improves.” “With repeated military attacks and shifting front lines, December was the worst month in Darfur in over two years,” and it “followed six months of escalating violence, during which 30 U.N. and other aid compounds were attacked, forcing some 400 U.N. and other aid workers to relocate. During the same period, 12 aid workers were killed in zones controlled by rebels and government forces.” “Security fears led to the distribution of double food rations in some areas in the month of December, and also prevented some 47,000 people in need being reached,” the World Food Programme said. “Villages have been burned, looted and arbitrarily bombed, and crops and livestock destroyed. Sexual violence against women is occurring at alarming rates. This situation is unacceptable,” a statement from the aid groups said. Last month, the Center for American Progress outlined the steps the U.S. can take – both diplomatically and militarily – to stop the genocide.
Iraqi PM Nouri al-Maliki took “a page out of the Bush administration playbook,” saying yesterday that criticism of his administration from President Bush and other U.S. officials “give morale boosts for the terrorists and push them toward making an extra effort.”
The Senate’s high-profile ethics and lobbying reform bill was sidetracked yesterday after conservatives voted against further consideration of the bill because it didn’t include an amendment giving President Bush line-item veto power, the ability “to single out individual spending items in legislation for elimination.”
The Justice Department’s shift on warrantless surveillance yesterday “doesn’t mean the government can’t still gather personal information about Americans without a court order,” a USA Today editorial states. “How? Through something called a National Security Letter. Unlike the warrantless wiretapping program, these letters don’t violate any laws, though perhaps they should.”
Speaker Nancy Pelosi (D-CA) is moving to create a special House panel to address global warming, headed by climate champion Rep. Ed Markey (D-MA). The decision, “to some degree, would sidestep” some powerful committee chairmen, specifically energy chairman John Dingell (D-MI), who is less aggressive on global warming issues.
Schwarzenegger calls for redeployment…and escalation. Gov. Arnold Schwarzenegger (R-CA) yesterday said the U.S. “should withdraw its military forces from Iraq by the end of this year.” He also gave support to Bush’s escalation “plan to send an additional 21,500 U.S. troops to Iraq.”
“The federal government’s biggest program to help people rebuild after natural disasters is on the verge of running out of operating money because of budgeting problems at the agency that runs it, the Small Business Administration,” the New York Times reports.
In a speech at the neoconservative American Enterprise Institute, Attorney General Alberto Gonzales said federal judges are not “equipped to make decisions about” national security. “I try to imagine myself being a judge,” Gonzales said. “What do I know about what is going on in Afghanistan or Guantanamo?”
The National Association of Evangelicals and the Center for Health and the Global Environment at Harvard Medical School “joined forces on Wednesday to protect the environment from the ravages of global warming, calling on President George W. Bush and others in power to help.”
And finally: Two titans of journalism square off tonight. Stephen Colbert will appear on the “O’Reilly Factor” at 8 pm, while Bill O’Reilly appears on the “Colbert Report” at 11:30 pm. “I think it’s fine,” O’Reilly said of Colbert’s shtick. “I’m a prominent person in the media. I think satire is very, very entertaining for any society to have. I have never had a problem with it as long as it’s not mean-spirited, and I don’t think he is.”
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