Beliefs and Values Held by the American People
Pundits and politicians hold mistaken assumptions about American values regarding health care reform. Both those for and against, use their perceptions as a smokescreen when debating an issue. Public figures make several assumptions. One is that reliable inferences can be made about any chosen American as to the views he or she considers important in health care.
The second assumption made is that American values can be translated into predictable organization structures. It cannot be assumed that prizing liberty and freedom means a preference for private insurance. The freedom they want may be freedom from worry in the event they become ill. An effort is being made to tell Americans what they should want instead of trying to understand objectively the desires of the people.
Organizations such as Herndon Alliance know how heterogeneous American people have become in their views. The Alliance identifies American beliefs and values as a provided service. They state this service in the link explaining the focus of the Alliance.
Barrier to Health Care Reform
Payment is the number one issue of health care. The public is frustrated with the current payment approach and skeptical about a system shift. A current system is a quantity approach. The shift would be quality-based. Here are some particular solution component suggestions in determining the quality of care.
Inadequately measured quality of care could be resolved if all procedures and conditions that significantly drive the cost of health care had quality measures developed. Instead of process measures, outcome measures should be used. Outcome-based criteria allow providers with the flexibility to design care that supports effective patient choices. Regional Health Improvement Collaborative should be used. This website discusses this issue in the link about quality care pricing.
Setting the context of a strategic plan begins with the areas of concern that are indeed shared by the majority of the people. Those items include:
- Improving the quality of care
- Bringing down the costs
- Improving the patient experience
- Encouraging and supporting doctors to be the best possible providers
Coordinated patient care is something proponents of the above items understand and value. Doctors try hard to provide high-quality care. Juggling information can be challenging. Medicare is on board with coordinated care. Those in charge want all doctors to have the information and resources needed to ensure care can be coordinated.
Medicare has two coordinated care programs, the Comprehensive Primary Care Initiative, and Accountable Care Organizations. That does not mean Medicare recipients must see a provider participating in these programs. Nobody, including a doctor, can insist upon a patient seeing a particular caregiver. If the provider accepts Medicare, all benefits remain in place. The Herndon Alliance views of coordinated patient care are stated on this link.
Defining Goals of Health Care Reform
The Obama Administration has been instrumental in signing the Affordable Care Act into law. There are six objectives to the Strategic Goal 1, meant to strengthen health care. The first objective is for those having insurance to be secure in their coverage. Coverage is being extended to the uninsured. Secondly, patient safety and healthcare quality will improve. The next objective links community prevention services, emphasizing preventative and primary care. Reducing the growth rate of healthcare costs without compromising effective, high-quality care, is the fourth objective. The fifth objective is ensuring culturally competent quality care accessibility that includes vulnerable populations having long-term supports and services. Having the meaningful information technology utilized to improve population health and healthcare, is the final objective. This link provides more information about the Affordable Care Act.
Medicaid is sponsored by federal and state programs that help some people with limited resources and income with medical costs. Personal care services and nursing home care are benefits covered by Medicaid that Medicare generally does not cover.
The rules of eligibility and how to apply are different in each state. Some states allow a “spend down” process in which otherwise ineligible recipients can subtract medical expenses from income to be eligible for Medicaid. These folks are labeled “medically needy.” The measure of resources of these individuals has to be below the allowable resource amount of the state. The Herndon Alliance position is explained on this link.
The Centers for Medicare and Medicaid Services manage Medicare, which is a federal program. U.S. citizens and people who have been permanent residents for five or more years are eligible for the health insurance Medicare provides.
One must be 65 or older to receive Medicare benefits. There are certain disabilities that are covered before the age of 65. Lou Gehrig’s disease and kidney transplants and dialysis because of end-stage renal disease are covered prior to becoming 65.
Beneficiaries receive health coverage in one of two ways, Original Medicare or private Medicare Advantage plans. These two links have more information about Medicare.
Competitive Health Marketplace
Patients and doctors, employers and employees, the uninsured and the insured, taxpayers, and hospitals have a stake in health care reform. Differences on some measures exist. There is a common belief that the United States health insurance market is broken. Poor accountability and transparency result in costly health care that hinders economic competitiveness, bleeds the federal budget and personal finances, and harms national health. These are unacceptable consequences.
It is believed the health insurance market can be repaired, in the same way most economic sectors are repaired, by well-supervised, healthy competition. The Alliance believes the Competitive Healthcare Marketplace gives consumers better protection, quality choices, and more control. Click on the link to learn more.
Benefits of Healthcare Reform
- Insurance exchanges set up that will give certain families and individuals federal subsidies that will substantially reduce the purchase cost of insurance
- Expand Medicaid eligibility
- Reduce the growth rate of Medicare payments
- Impose insurance plans having relatively high premiums with an excise tax
For more information about the benefits, click on the links above.
The Herndon Alliance and Know Your Care did a poll recently looking at how to most effectively increase the support for the Affordable Care Act in the context of the recent proposals to end Medicare and Medicaid as we know them.
- Stress that the Affordable Care Act will make healthcare more secure by ending denials based on pre-existing conditions and that it will require Congress to get their healthcare from the same place as millions of Americans.
- Compare it to the GOP budget, which privatizes Medicare and dramatically increases healthcare costs for seniors over ten years. Their Medicaid cuts hurt 80% of nursing home residents and they allow insurance companies to continue to deny coverage due to pre-existing conditions.
- When highlighting any of the GOP’s proposed changes to healthcare, contrast them with the party’s support for tax breaks for the wealthy or big oil companies.
- Emphasize that the policies you are working on support the middle class and working families.
Medicare Medicare Medicare – We win overwhelmingly on this issue.
- The Republican budget privatizes Medicare, ending Medicare as we know it while protecting billions in tax breaks for big oil companies.
- It would make current seniors pay even more for prescription drugs and allow insurance companies to continue to both deny coverage to people with preexisting conditions and drop coverage for those who get sick.
Use Medicare to Defend the Affordable Care Act – The huge overreach on Medicare can fundamentally shift the debate over the Affordable Care Act.
- Some members of Congress voted to end Medicare, and now they want to take away benefits under the Affordable Care Act that are helping millions. Their actions would allow insurance companies to deny coverage to people with preexisting conditions, eliminate the new requirement that members of Congress get the same healthcare as millions of Americans and would make prescription drugs more costly for 4 million seniors on Medicare.
- Given that some Members of Congress want to take away your Medicare, why would we believe anything they say about the Affordable Care Act?
Use the Affordable Care Act to Defend Medicare.
- The Affordable Care Act protects Medicare for current seniors and strengthens it for future generations by cracking down on waste, fraud and abuse, ending handouts to insurance companies and providing free preventive care to reduce costly emergency room visits and reduce health care costs in the long-term.
Don’t Forget Medicaid – It tests just as well as Medicare if connected to seniors.
- The Top Testing Message Pushing Back on the Budget addresses Medicaid: “The budget would cut seven hundred and fifty billion dollars from Medicaid, including funding for eighty percent of nursing home residents, forcing many seniors to be kicked out of their nursing homes.”
Positive Affordable Care Act Message.
- The parts of the law people like best (especially independents, seniors and people undecided on the Affordable Care Act) are ending pre-existing conditions and having the same coverage as Congress. Any effort to increase support for the ACA should highlight these two benefits as examples of how the new law will make healthcare more secure for the middle class.
- The Top Testing Positive Message on the Affordable Care Act: “Healthcare coverage will be more secure because working families can’t be denied care due to a pre-existing condition, or lose their coverage or be forced into bankruptcy when someone gets sick. It will also require that members of Congress get their healthcare from the same plans as millions of Americans.”
Questions and Answers
Aren’t we broke and can’t afford the ACA?
The middle class is getting crushed – struggling to get by because of fewer jobs and fewer jobs with good benefits. More than ever we have to make sure families can succeed. The new health care law helps get us there by cutting waste, fraud and abuse in Medicare; increasing prevention to reduce costly ER visits; and creating competition among insurance companies.
Isn’t this government over-reach – controlling our health care?
This is the argument made by the same people trying to end Medicare and Medicaid but in reality it supports working families, requires members of Congress to get their healthcare from the same plans as millions of Americans, and makes health care more secure for all working families because it eliminates preexisting conditions.
Won’t the Affordable Care Act – the new law – mean I won’t get the care I need?
This is the argument made by the same people trying to end Medicare and Medicaid but in reality it supports you and your family getting the care you need. It requires members of Congress to get their healthcare from the same plans as millions of Americans. It eliminates preexisting conditions – keeping insurance companies from coming between you and your doctor. It requires coverage of preventive care like colonoscopies and mammograms, so you and your doctor can decide what is right for you. It frees up doctors to spend more time with their patients and less time on paper work for insurance companies.
Doesn’t this law make people buy insurance even if they don’t want to?
If everyone has insurance, we reduce costs and improve the health of our communities. This law keeps insurance companies from denying coverage due to pre-existing conditions or dropping coverage when someone gets sick, and we can hold down costs because people will get preventive care instead of having to go to the emergency room. Currently, when someone who is uninsured gets sick and can’t pay, those of us who have insurance are forced to pick up the tab.