Health Care Town Hall - West Hartford CT, Sept 2. Part I

Here’s a summary of my notes from the Town Hall meeting on health care, hosted by Congressman John B. Larson, First District, Connecticut. The meeting took place in West Hartford Wednesday evening September 2. For background on this Town Hall, look in the comments section here. Also, there are presently 5 bills in Congress (3 in the House and 2 in the Senate). The discussion September 2 focused on one of the House Bills, HR3200.

This is Part 1 of 2 Parts. It summarizes some of the Q and A interaction in the Town Hall meeting. Part 2 contains my overall impressions and observations.

Each numbered item below includes a question posed to the Congressman, the Congressman’s answer, and where I have a comment it's [in brackets]. I haven't included all the questions that were asked.

1. Obama says we can keep our existing insurance if we like it. Is that just for 5 years?
--Larson simply answered "you can keep your insurance". He did not refer to the 5-year grace period at all. A voice from the back of the room shouted "Sir you are lying! I'm a physician and I've read the bill!" Larson's face got red, he raised his own voice to say "I have never lied to you" and moved on to the next question.

2. Will you pledge that you & your family will join the public option?
--Larson said that there is presently no public option, and that he is not in the federal employees' plan either.

[This was a confusing answer. He apparently has insurance thru his wife's employment. His answer stimulated a lot of crosstalk from the floor, the loudest ones asking if Larson read the bill. Larson responded by stating that he "had the bill read" one day to the Democratic Caucus for "5 1/2 hours" followed by a couple more hours of discussion. I think this is a whopper. This bill is complicated legalese and it's a real tough slog to read. Reading the whole Bill - 1,017 pages - in 5 1/2 hours, works out to less than 20 seconds per page. Is THAT all the attention HR3200 gets from our Congressman? I doubt the complete bill was actually "read" in the time frame Larson claimed. But clearly Larson wanted the audience to believe it was.]

7. Will this raise my taxes? Will it raise my insurance premiums?
--Larson said the Bill will cut Medicare waste and claimed that Medicare savings will help pay for the cost of the Bill. He also cited a RAND Corporation study that there would be $77 billion annual savings from health information technology.

[He didn't explain how Medicare might reduce "waste", he just said it would happen. He also failed to explain how HIT would save anything and I think left the impression that significant savings would come from reductions to HIT spending. Well, how much HIT spending is there, now?]

11. Why can't we just buy our insurance directly from an insurance company? Why does it have to go true an employer?
--Larson said "that would be single-payer"

[Many people shouted No it's not! - including me. Larson just moved on to the next question.]

15. Will drug prices go down?
--"What will make drug prices go down is when the government negotiates them down like VA"

18. In the current system private companies sell Medicare supplement insurance. Will that disappear in the new public option?
--Larson said no, they won't disappear

[btw he gave a very different answer regarding Medicare Advantage - see #19 below]

Larson also stated that the CBO projects "only about 10 million participants in the public option".

[A question no one asked: if there are 47 million uninsured, how does a public option that covers only 10 million in total solve the uninsured problem? My guess is that he would answer that HR3200 will subsidize the uninsured so they can buy insurance either thru the public option or private insurance. My response would then be "doesn't that mean government subsidy of the insurance companies? Isn't that exactly what he objects to in Medicare Advantage?]

19. Do you support dissolving Medicare Advantage to save money?
--Larson said yes, and the reasons he gave were that Medicare Advantage plans are "subsidized by the government" yet provide the "same benefits and no better health outcomes".

[Larson - and the President - ignore (a) MA plans provide extra benefits (vision, hearing, dental, home care, wellness, and others not included in original Medicare; (b) MA also provides other modern health services not available in original Medicare (case management, disease management programs, nurse hotlines) (c) MA participants have fewer out-of-pocket expenses than original Medicare participants - documented by CMS and the Kaiser Family Foundation, (d) CMS data show that fewer MA participants, compared with original Medicare participants, have reported delayed care, and fewer reported having trouble getting care - perhaps because more MA participants report a regular relationship with a physician. An old report in JAMA (Jan 15, 2003) found that MA participants outperformed original Medicare in five of the seven HEDIS quality measures for health care.

Larson also ignored the cost-shift from Medicare and Medicaid into the private sector which has been going on for more than FORTY YEARS.

It appeared to me that Larson substantially skirted important facts on this question.]

22. The President says a public option will keep insurance companies honest. Aren't state regulators doing this? Who will keep the public option honest?
--Larson's answer - "the people - you can vote us out of office"

[This answer strikes me as inane. Federal agencies are the nearest things to immortality on earth. And besides, when has a Congressional election ever resulted in the closure of a federal agency? Ever? Anyway, Larson's seat is very safe as are most Congressional seats. The answer might be acceptable in a 9th grade civics class but in the real world I think it falls flat. It comes across as condescending to the extent that Larson expects anyone is so naive to believe it, and cynical to the extent he does not care if anyone believes it but says it anyway because it's politically correct.]

25. National debt is $12 trillion going up another $9 trillion in the next 10 years. And CBO estimates that health care will increase the deficit.
--Larson said "this bill is paid for by savings and it's revenue neutral."

[Another whopper. CBO said exactly the reverse. According to CBO, House bill HR3200 would increase the federal budget by $239 billion in the first 10 years. What's more, when the Director of the CBO was asked point-blank if HR3200 would “bend the cost curve,” he responded “no.”]

26. Will there be interstate portability?
--"Yes".

[No explanation. I wonder whether most people understood the question or the answer.]

Part 2 is here.