Reader Connects Health Rationing Argument To ‘Death With Dignity’

third rail

(Photography.mojado.com via Flickr/Creative Commons)

The New York Times letter page carries a bounteous harvest of responses today to a provocative recent opinion piece titled “Beyond Obamacare” that began, “We need death panels.”

Opinion writer Steven Rattner went on:

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

Today, one reader responds by connecting dots between rationing and physician-assisted suicide (which is on the upcoming Massachusetts ballot and was discussed today on WBUR’s Morning Edition.) Readers, thoughts?

To the Editor:

Steven Rattner wants to reduce medical costs by not offering “every treatment, regardless of expenses or efficacy” in the last year of life. That’s reasonable — if and when we give the elderly (I am one of them) the right to choose their own gentle death, something that many religions would obstruct.

But even before we get to that, let’s consider the 76 million baby boomers who are or will be retiring and will drain Medicare. Would they be willing to join me in choosing death with dignity? Or would they prefer heart transplants at 85?

Baltimore, Sept. 17, 2012

Mr. Cape Air Goes To Washington (To Defend Health Reform)

Mass. state senator Dan Wolf, CEO of Cape Air, testifies in Congress (Photo: Rory Sheehan, House Committee on Oversight and Government Reform)

In a prelude to today’s House vote on repealing Obamacare, quite a dire economic picture was taking shape at the House Committee on Oversight and Government Reform yesterday.

Obamacare will hurt business by making labor more expensive, the committee’s Republican chairman, Darrell Issa of California, warned. It will encourage employers to pay their workers less, to hire workers part-time instead of full-time, and to stay small instead of expanding. It will mean higher taxes and more government red tape. (See his statement here.) A line-up of witnesses shared other concerns and warnings.

Then there was Dan Wolf, a Democratic state senator from Massachusetts — in a role a bit like the fairy at Sleeping Beauty’s party who contradicted all the other fairies. Actually, he testified, in his experience as the founder and CEO of Cape Air and a resident of Massachusetts, health reform doesn’t stunt business growth or cost jobs. His full testimony is here. Some excerpts:

I’m here to debunk myths, and dispel fear and misunderstanding about the 2006 health care reform act that Massachusetts enacted with strong bipartisan support. It also is the template for much of the Affordable Care Act now sanctioned as the law of our land.

From Cape Air’s first day in business, we offered health care coverage, knowing that affordable health care coverage helps us retain a great workforce. This year, Cape Air’s health insurance premiums will total close to $3 million, roughly 3 percent of the company’s gross income. The company will pay just over half of that cost, employees the rest.

In 2007, when Massachusetts health care reform went into effect, there were dire predictions of the impact on businesses like Cape Air.
Here’s what really happened: Continue reading

5 Quick Facts About Mass. Health Reform You Now Need To Know

Prominent backers of Massachusetts health reform speak at the State House after the Supreme Court ruling. (Carey Goldberg/WBUR)

Now that the Supreme Court has upheld the federal health overhaul, which was based on the Massachusetts model, the state’s experience becomes more relevant than ever for the rest of the country. WBUR’s Martha Bebinger has been covering Massachusetts health reform since soon after its inception almost a decade ago. What better time to ask her to distill it all into a 5-part FAQ?

WBUR’s Martha Bebinger

1. Does the requirement that virtually everyone get health insurance actually work to bring universal coverage?

Let’s begin with basic numbers. The latest figures show that about 98 percent of Massachusetts residents now have health insurance, up from 94 percent before the reform (this earlier number varies a bit depending on the source.)

2. Does the threat of having to pay a penalty if you don’t get health insurance actually work?

Some economists say that yes, the threat of the penalty has been the key reason that more people have been signing up for their employer’s insurance or buying their own, but I haven’t seen that quantified.

What we can say is that only a small percentage of the Massachusetts population has actually been penalized since the state reform passed in 2006:  About 200,000 in a state of about 6.5 million. And as the penalties rise (see the chart at left) the number who pay them has been dropping.

The number of residents who, according to their state tax returns, are subject to paying the penalty:

67,000 in 2007
53,000 in 2008
48,000 in 2009
44,000 in 2010

3. How much has the law cost Massachusetts? Continue reading

No Supreme Court Obamacare Decision Today, But When It Comes…

Looking for clues on health overhaul from the U.S. Supreme Court

Stand down, everybody. Or at least the several dozen of us who were waiting with bated breath for news on whether the Supreme Court would issue its decision today on the federal health overhaul also known as Obamacare.

But one can never be too prepared, right? The Associated Press has just put out a lovely run-down of several possible permutations of the impending court decision. (I can just imagine the newsroom discussion. Editor: What’s going to happen with the Supreme Court decision? Reporter: Nobody knows. Editor: Well, write something forward-looking anyway.)

It’s worth reading the whole thing, but here are some of the beautifully brief bottom lines:

Q: What if the Supreme Court upholds the law and finds Congress was within its authority to require most people to have health insurance or pay a penalty?

A: That would settle the legal argument, but not the political battle.

Q: On the other hand, what if the court strikes down the entire law?

A: Many people would applaud, polls suggest.

Q: What happens if the court strikes down the individual insurance requirement, but leaves the rest of the Affordable Care Act in place? Continue reading

Mass. Health Connector In NYT: Promise And Perils Of Insurance Exchanges


Abby Goodnough, the outgoing Boston bureau chief of The New York Times, is now shifting to the health care beat, and if this surprisingly readable profile of The Massachusetts Health Connector is any indication, that is a very good thing.

The Connector, of course, is the agency that helps Massachusetts residents shop for and obtain health insurance — the sort of insurance marketplace or “exchange” that is slated to crop up in states nationwide, as many more people get health insurance under Obamacare. If Obamacare continues to exist after the Supreme Court’s expected ruling this month, that is.

So, as in so many things related to health reform, the nation’s eyes (or their media surrogates) turn to Massachusetts to see how this stuff works. The state of play:

The law requires every state to establish an exchange, but many are balking, complaining about everything from the expense to the perceived federal intrusion. Some, like Louisiana and Maine, are refusing. Others are deferring crucial decisions until the court rules and the November election plays out. So far, only about 15 states and the District of Columbia have established exchanges, with California and Maryland among the furthest in their planning.

The experience of Mr. Kim in Massachusetts, which with Utah is one of only two states with an exchange up and running, illustrates how exchanges are ideally supposed to work. After just an hour of research on the exchange’s Web site, he says, he found a better deal. He enrolled in a plan through Harvard Pilgrim for which he pays $1,086 a month for his family.

Sounds good so far. Now for the challenges: Continue reading

Neutralizing The Term ‘Obamacare’

President Obama signing the health care bill into law

I seem to be willfully tone-deaf to political nuance. But that’s not the only explanation for why I’ve been blithely using “Obamacare” in our headlines, insensitive to the negative spin put on the term by the president’s foes. It’s just simply the shortest, liveliest way to say “The Patient Protection and Affordable Care Act,” far pithier than “the federal health care overhaul.”

So when I read Ben Zimmer’s fun column in Sunday’s Globe about President Obama’s attempts to take back the term and turn it positive, I thought, “Let’s all take back the term! Can’t we all just consider it a neutral term and make life easier for headline writers everywhere?” Just for the records, that’s how we use it. Change starts here.

From the Globe:

For five years now, “Obamacare” has been a dirty word in American politics: a term used by conservatives to dismiss President Obama’s agenda for health care reform. The bumper-sticker-friendly sentiment “Repeal Obamacare” has become a favorite mantra of Republicans on the stump. Continue reading

What Went Wrong With The Supreme Court And The Health Law?

Updated at 11:35 AM, April 6th, 2012

United States Supreme Court building. (IslesPunkFan/Flickr)

United States Supreme Court building. (IslesPunkFan/Flickr)

Last week, the Supreme Court heard arguments regarding, among other topics, the individual mandate provision of Affordable Care Act. There were protests outside the court and extensive media coverage — much of it predicting that the mandate, and possibly the entire law, will be overturned.

On Wednesday, the Health Law, Bioethics & Human Rights Department at Boston University School of Public Health posed the question many of us had been asking ourselves: “The Supreme Court and the Affordable Care Act: What Went Wrong?”

A panel of three legal scholars from the department — George Annas, Wendy Mariner and Leonard Glantz — reflected on last week’s Supreme Court proceedings and explained what they believed the arguments were really addressing.

Below you can listen to the remarks from all three professors as well as the subsequent question and answer session.

Leonard Glantz


  • Individual rights not the issue: “This is not a case about individual rights. The case is about federal power. The case has nothing to do with individual rights at all. And the case has to do with whether or not the federal government has the power to make people buy stuff. That is solely what the case is about.”
  • Federal vs. state power: “The reason why that’s controversial is that we tend to think of the federal government as having all the power. They have like nuclear bombs, the income tax and lots of money. They must have all the power in the world — but they don’t. The federal government has what’s referred to as enumerated powers. If it’s not listed in the Constitution, they don’t have it. What this question is about is whether or not there’s something in the Constitution that says the federal government can make people do this.”

Continue reading

The Supreme Court Health Law Hearings: The 3-Minute Cartoon

Supreme Court Health Law Hearing: The 3-Minute Cartoon

I couldn’t do it. I couldn’t. Every time I tried to read the Supreme Court transcript in order to try to write some nice, value-added post for this historic health-law occasion, my eyelids drifted downward and my breathing deepened.

Finally, I decided that instead of wallowing in guilt, I’d ask for help from an expert teacher: Kevin Outterson, director of Boston University’s Health Law Program and a frequent blogger on health policy at The Incidental Economist. I told him that three minutes was the limit of my attention span for this topic, and though this challenge required of him a degree of simplification perhaps more radical than any he has ever attempted before, he was a great sport, and collaborated on concocting the quick script for the short video above. Political note: The guru character in the video has a bit of a point of view.

This is CommonHealth’s second feature in a new genre, Wonk Cinema, dedicated to helping people stay awake long enough to learn about health policy issues that affect their lives. The first was “What The Heck is an ACO?”

Huge Similarities Between ObamaCare And RomneyCare, Group Finds

Many people focus on the “individual mandate” (the requirement that folks must purchase health insurance) as the chief similarity between the 2006 health reform law passed in Massachusetts under then-Gov. Mitt Romney, and the 2010 national health law signed by President Obama. But the similarities between RomneyCare and ObamaCare go far, far beyond that, according to a new side-by-side analysis by the liberal-leaning nonprofit advocacy organization, Families USA (with help from Harvard School of Public Health’s John McDonough and Brian Rosman, Research Director of Health Care For All).

From insurance exchanges to new rules for insurers and employers and beyond, the two plans really do have a deep twin-like resemblance according to this analysis, if not identical, then at least fraternal. Continue reading

Mass. Briefs To Supreme Court: ‘Hey, Health Reform Works For Us’


Have you filed your Obamacare amicus brief yet? What? You haven’t? Then you’re way behind your fellow Americans — at least those in organizations with a dog in this fight. The Supreme Court is expected to consider Obamacare — better known as the Affordable Care Act or the federal health care overhaul — in March, and the deadline for some of the amicus briefs in support of the government was Friday. (“Amicus” = friend in Latin. Amicus brief: An argument from someone with a strong interest in the case, but who is not actually a party to the legal action.)

A few highlights on the Supreme Court’s “friends” in Massachusetts:

• Attorney General Martha Coakley filed her brief on Friday. From the press release:

BOSTON – Arguing that Massachusetts’ own experience supports the federal government’s basis for passing national health care reform, Attorney General Martha Coakley filed a brief today in the U.S. Supreme Court supporting the federal Patient Protection and Affordable Care Act (PPACA).

Massachusetts’ health care reform law served as a blueprint for the PPACA. In her brief, the Attorney General argues that the successful results from the Massachusetts law enacted in 2006, including a reduction of the number of uninsured people utilizing the “free-care” pool (so-called “free riders”), demonstrate that Congress had a rational and constitutional basis to enact an individual coverage requirement in PPACA. Continue reading