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Susan Estrich - Even with Obamacare, no such thing as a free lunch

Those of us who live in California woke up to some pretty scary headlines on morning last week. According to a new report, Obamacare could result in increases of 30 percent in health care premiums. Thirty percent!
Of course, even without Obamacare, premiums have been going through the roof. But 30 percent for the same health care you've been getting? It's enough to send chills down the backs of even the staunchest Obama supporters.
Except that it isn't quite right. It isn't just the devil that's in the details.
First of all, the numbers only apply to the 2 million folks who buy health care as individuals or will when the law goes into effect, not the 19 million people covered by their employers. Everyone agrees that the impact on plans covering large groups of employees will be much less.
Second, those who make less than 400 percent of the federal poverty line ($46,000 for individuals, $94,000 for a family of four) will actually pay about 47 percent less for coverage because of federal subsidies.
Third, 30 percent is the headline, not the real number. The new plans will offer people more and better benefits with lower deductibles, which means that families will actually save more and get more for their coverage. Those who are paying 30 percent more in premiums will be saving one-third of that because of better coverage and lower deductibles.
As many of us know, there's health insurance, and there's health insurance. I have many friends who could only find (not to mention afford) the skimpiest of policies, which exclude everything from prescription drugs to mental health. In order to comply with new federal requirements, everyone is entitled to "essential health benefits," which even many who are insured don't get today.
Fourth, a big factor in the increase is that people who, for all intents and purposes, can't even buy insurance today, let alone good insurance, will be able to do so.
That brings sicker people into the system, rather than leaving them in line at the emergency room — which, by the way, is not only the most expensive place to get care, but also one the rest of us pay for in other ways.
When I asked a friend to explain what looked to me like an outrageous hospital bill, including charges for everyday items I could have bought for half as much at the drug store, the answer was simple: The cost of "my" supplies effectively included the cost of services and supplies for those who could never pay for them.
Fifth, the cost of care is going up anyway. Without Obamacare, healthier folks who can buy insurance (as opposed to those with pre-existing conditions who are turned away) would be paying about 10 percent more in premiums anyway. And that's with no guarantee of prescription drug coverage or mental health services and the like.
Sixth, and most important, the issue here is not just money; it's also values.
I have told this story before and have heard similar ones countless times from friends, acquaintances and folks in line at the market. Some years ago, I went out to buy health insurance for the woman who has, for the past 25 years, taken care of my children, my dogs and me. I insisted that she be covered. All I can say is thank God for Kaiser. No one else would take my money. Why? Because she had gastritis. Seriously. Because they aren't looking to add 50-somethings to their books — because they might get sick. Of course. And she did, years later, get sick, and frankly, without insurance, good insurance, doctors who gave her world-class treatment, she would not be here.
Of course we should be cost-conscious. Of course changes will have to be made. There will be problems — as there are with any new program — and we should be ready for them.
But the bottom line, for me anyway, is this: There is no such thing as a free lunch. Providing good health care for every American is not something we can do for free. But it is something we should do. And we will. And once we do, as was true of Medicare, it will be difficult to imagine that it ever could have been otherwise.
(Susan Estrich is a professor of Law and Political Science at the University of Southern California Law Center. A best-selling author, lawyer and politician, as well as a teacher, she first gained national prominence as national campaign manager for Dukakis for President in 1988.)

Last Updated on Tuesday, 02 April 2013 11:04

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Roy Sanborn - Great time to be out house hunting

Hey, if you are looking for home bargains in the Lakes Region of New Hampshire they just keep coming on the market! What a great time it is to be out house hunting. With extremely low prices and historically low mortgage interest rates it really is one of the best times ever to buy a home. A quick spin around the MLS revealed some new residential listings that appear to be pretty good deals... at least on paper.
Down in the big city of Tilton at 91 Winter Street there is a solid, 1925 vintage, New Englander with "lots of potential in a nice area." This six room, three bedroom, 1-1/2 bath home has 1,674-square-feet of living space with an appealing kitchen, large living room, a dining room with hardwood floors, a large 24' x 11' master bedroom, a walk up attic, and a wrap-around porch. The home has had some extensive winterization work done to it in 2009 and received a new furnace, spray foam insulation on the basement walls, and new basement windows. It sits on a .28-acre lot within walking distance to schools and downtown. This property in being offered as a short sale at $84,900 which is 52 percent of the tax assessed value which would seem to make it a great deal for buyers willing to go through the process!
Another older property at 142 Garfield Street in Laconia could be a good investment and is billed as "a diamond in the rough." That always scares me a little, but you gotta go check it out to find out for sure! This is a 1912 vintage New Englander that sits on a .21 acre lot and has 1,326-square-feet of living space, three bedrooms, 1-1/2 baths, hardwood and softwood floors, and a two car attached garage. The listing says it needs some TLC but at only $79,900 and a tax assessment of $130,200 there could be some good upside here for an investor or first time buyer. And, you won't bother the neighbors at the Union Cemetery if you have to stay up late working on the place.
There's a couple of nice single level homes that just popped up that should be of interest to some buyers. The first is at 44 Highcrest Drive in Belmont. This is a five room, three bed, two bath ranch built in 1993 and has 1,424-square-feet of living space. It has an open floor plan, hardwood floors, a stone wood burning fireplace, cathedral ceiling with skylights, an oversized master bedroom suite, a farmer's porch, and a detached two car garage. Exterior renovations have been completed with interior updating being left for the new owner. It is kind of hard to tell from the pictures how much needs to be done because, well, there just aren't any pictures there. That can be scary, too! But the house is listed at $179,000 which is 76 percent of the assessed value of $238,200. Let's go look and see if we are surprised.
There's another ranch style home on a 12.66 acre lot at 89 Threshing Road in Sanbornton. This one, however, is a manufactured home built in 1999 with 1,792-square-feet of living space and features an open floor plan, large living room with fireplace, formal dining room, four bedrooms including the large master suite, two full baths, sunroom, and deck. It also has central air, a new roof, a 14' x 10' shed, and a detached two car garage. This home is priced at $177,500 and has a tax assessed value of $237,700.
Another good residential value appears to be at 585 Union Road in Belmont. This home is a 1,981-square-foot cape built in 1989. It has an open floor plan, a living room with wood cathedral ceilings, eat in kitchen, dining room, three bedrooms, 2-1/2 baths, fully finished basement with an office and family room, and an attached two car garage. It sits back from the road on a 1.22 acre lot providing great privacy. This home is priced at $239,900 which is 83 percent of the tax value of $289,500. Good deal? Go check it out and see!
These are just a sampling of the many potentially good bargains that are currently on the market. Contact a REALTOR® today and begin your new home search. The time is right to make your move.
Please feel free to visit www.lakesregionhome.com to learn more about the Lakes Region real estate market and comment on this article and others. Data was compiled using the Northern New England Real Estate MLS System. Roy Sanborn is a REALTOR® at Roche Realty Group and can be reached at 603-677-8420

Last Updated on Friday, 29 March 2013 10:42

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Jim Hightower - Drones overhead are a danger, no matter their color

In a recent senatorial dustup, Sen. John McCain called Republican colleague Rand Paul one of "the wacko birds" of Congress.
McCain (who sometimes appears not too tightly wrapped himself) was giving Sen. Paul a tongue-lashing for having mounted a 13-hour, old-fashioned, stand-alone filibuster over the possibility that murderous drones could be used for targeted assassinations of Americans right here at home.
McCain said that the Kentucky senator's talk-a-thon had veered into the "realm of the ridiculous," adding, "I don't think (it) is helpful to the American people."
I hate to interrupt when one Republican solon is hammering another, but I'm siding with Paul. While I do think that plenty of the tea party senator's extreme right-wing stands are wacko, this isn't one of them. Unfortunately for America, powerful corporate interests are eager to reap billions in profit from the spread of drones across our land, and police agencies at all levels are drooling at the prospect of adding fleets of surveillance drones — including ones that will be weaponized to their arsenals. Indeed, what's really ridiculous is that so many other congress-critters have not been paying attention, speaking out and taking action.
Call it grandstanding if you want, but at least Paul took an actual stand. And, contrary to McCain's opinion, his stand was quite helpful to the American people. Thanks to Paul's attention-getting combination of principle, ego and chutzpa, the great majority of Americans heard for the first time that these inherently invasive, liberty-busting and potentially deadly drones are on the verge of being deployed domestically.
That's why the Congressional Progressive Caucus and such alert Democrats as Sen. Ron Wyden of Oregon have joined in sounding the alarm and demanding a full public debate. As Paul says, "At least we need to know what are the rules." Before we let profiteers unleash this technology on Americans, bring the discussion into the open so the people can grasp the danger that these "Orwellian gnats" pose to our democracy.
Sen. Rand Paul is not the only speed bump slowing down the push by government contractors, police authorities and politicians of both parties to litter our nation's airspace with up to 30,000 of these surreptitious unmanned aircraft by year 2020. Inevitably, many of these will be used to spy on, invade the constitutional rights of and even fire on American citizens.
While the senator's outrage raised the drone issue to a new level of public awareness, opposition had already been percolating across the country, uniting such diverse constituencies as the ACLU and the tea party. Indeed, from city halls to Congress, many officials are working to ban or at least restrict drone deployment in our Land of the Free.
Clearly, the drone-industrial complex has a growing political problem. But, hey, in Corporate America, where there's a way, there's plenty of will. We're talking extremely big dollars here.
As reported by The New Republic, drone pushers at an industry confab (ominously titled "The Reapers Come Home") decided that theirs is merely an image problem, starting with the off-putting d-word itself.
"That term 'drone' kills us every time," moaned a police official who's been advocating the proliferation of the devices in police departments from coast to coast. Another pusher suggested to conferees that the menacing black color of the weapons is the problem. He noted that Seattle's police chief tried to get city officials there to okay drone use by making them appear less threatening. He had a black Dragon Flyer X6 repainted and rechristened it as "Soft Kitty 2000."
That didn't work in Seattle, but still, the droner-complex can be expected to launch a PR campaign that'll make you want to hug one of their machines. Already, the peddlers are describing a sky full of drones over your city as "a nice safety blanket." Good luck living under that.
(Jim Hightower has been called American's most popular populist. The radio commentator and former Texas Commissioner of Agriculture is author of seven books, including "There's Nothing In the Middle of Road but Yellow Stripes and Dead Armadillos" and his new work, "Swim Against the Current: Even Dead Fish Can Go With The Flow".)

Last Updated on Wednesday, 31 December 1969 07:00

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Michael Barone - Republicans grow less hawkish in wake of Iraq War

Are Republicans no longer the party more inclined to military interventions and an assertive foreign policy?
It's a question raised by the enthusiastic response to Sen. Rand Paul's 13-hour filibuster and to his not-very-interventionist foreign policy. It's raised also by House Republicans' willingness to accept the budget sequester, which includes defense cuts that former Defense Secretary Leon Panetta called "devastating."
Barack Obama thought those cuts would be so unpalatable that Republicans would agree to increase tax revenues to avoid them. A decade or two ago, that would have been true. Not so today.
And it's a question raised by the silence on the part of most Republican officeholders and the contrition of others on the 10th anniversary of the U.S. intervention in Iraq. Only John McCain and a few others have been defending a war that almost all Republicans and many Democrats, including Hillary Clinton and John Kerry, initially supported.
Historically, neither party has always been either hawkish or dovish. Democrats supported the Mexican war; Whigs were against.,Republicans backed Abraham Lincoln during the Civil War; many Democrats wanted a compromise peace. Republican supported the Spanish American War and suppression of the Philippine insurrection; Democrat William Jennings Bryan ran against "imperialism."
For half a century, Democrats were the party more supportive of military intervention. Democrat Woodrow Wilson, after winning re-election as the man who kept us out of war, called for a declaration of war against Germany six months later. He got it, with 50-some dissents. In the 1930s, Republican ranks included more isolationists than interventionists, and vice versa for Democrats. Franklin Roosevelt scrambled to send arms to beleaguered Britain and cut off oil sales (when the U.S. produced most of the world's oil) to hostile Japan. When the Japanese attacked Pearl Harbor, all but one member of Congress voted to declare war.
But some notable Republicans, including Chicago Tribune publisher Col. Robert McCormick and former President Herbert Hoover, charged that FDR had maneuvered us into what people today call a war of choice.
Democratic presidents led America into wars in Korea and Vietnam, with death tolls more than 10 times what we have suffered in Iraq and Afghanistan. That was the history Bob Dole was referring to when he talked of "Democrat wars" in the 1976 vice presidential debate. But by that time, the term was obsolete.
Only two Democrats (and no Republicans) voted against the 1964 Gulf of Tonkin resolution that Lyndon Johnson used as his license to send up to 550,000 U.S. troops to Vietnam. But by 1968, opposition to that war was welling up, primarily but not entirely within the Democratic Party.
LBJ was opposed by antiwar Eugene McCarthy and dropped out of the race. In 1972, Democrats nominated the dovish George McGovern. For nearly half a century, they have been the party less supportive of military intervention.
Not that Republicans have invariably supported it. Ronald Reagan aided the Nicaraguan Contras and intervened in Grenada but withdrew from Lebanon. He built up the military but didn't find much occasion to use it. George H.W. Bush got approval from the United Nations before asking Congress to authorize the Gulf War. George W. Bush sought U.N. approval for Iraq, too.
Democrats remained obsessed with Vietnam. Their speeches opposing Contra aid and the Gulf and Iraq wars were full of arguments more relevant to the Gulf of Tonkin resolution than to the issue at hand. Some Democrats disagreed. Bill Clinton used force (without U.N. approval) in Serbia and Kosovo. Almost all Democrats supported intervention in Afghanistan after 9/11. But almost all congressional Democrats tried to stop George W. Bush's successful surge strategy in Iraq. Hillary Clinton found cause to question the veracity of Gen. David Petraeus.
The surge came too late to salvage the reputation of the Iraq War. Polls now show majorities think it was a mistake. Most Republican politicians seem disinclined to suggest we should intervene anywhere else.
World problems loom: North Korea, Iran, Syria, North Africa. Barack Obama may choose to respond militarily. He has just beefed up missile defense in response to North Korea. If he follows up on his threat to attack Iran's nuclear program, we could have a 2016 presidential race in which Republican Rand Paul criticizes military action and Democrat Hillary Clinton defends it.
That would be a political turnabout as stark as in the 1960s. Could it happen?
(Syndicated columnist Michael Barone is senior political analyst for The Washington Examiner, is a resident fellow at the American Enterprise Institute, a Fox News Channel contributor and co-author of The Almanac of American Politics.)

Last Updated on Wednesday, 31 December 1969 07:00

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Froma Harrop - Often you don't really need to see a MD

You want a routine checkup. Or your throat is sore. It's probably nothing, but you're concerned. Do you need a full-fledged MD with all those certificates and perhaps a God complex?
Even if you want to see a physician, there's a shortage of family doctors these days. And it will only get worse as the Affordable Care Act (Obamacare) brings health coverage to 30 million more Americans. If you do have a primary care doctor, it may be hard to get an appointment.
A nurse practitioner may be in your future — if he or she is not already in your present. This is a kind of super nurse, who's gone through four years of nursing school plus at least two more years of training in diagnosing and treating disease. Nurse practitioners may specialize in women's health, pediatrics or cardiac care.
"A lot of people view them as a pretty obvious way to help deal with the number of people expected to get insurance," Joanne Spetz, professor at the Institute for Health Policy Studies at the University of California, San Francisco, told me.
But the extent to which they can fill the gaps depends on where you live. States regulate health care, so the latitude given nurse practitioners varies widely.
In Missouri, for example, nurse practitioners may not see patients unless a physician is under the same roof. In New Mexico, by contrast, they don't have to work with a physician at all. In some states, they are restricted from prescribing narcotics. In others, they may prescribe certain kinds of narcotics and not others.
Western states tend to give nurse practitioners the greatest autonomy. Perhaps it's the libertarian spirit, or perhaps their vast rural areas, where doctors are few and far between. Colorado is considered "the cradle of nurse practitioner practice," according to Spetz.
A personal note: I went to a superb nurse practitioner for years, seeing the doctor she worked with only at parties. When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call.
Her accessibility was a big plus. She had time to shoot the breeze about my every little ache and whether running is bad for the knees.
Health economists see primary care providers as key to curbing medical costs. Americans overuse expensive specialists. For example, they run off to gastroenterologists and have endoscopes shoved down their throats when their problem is simple heartburn. Primary care providers could have saved these patients money, discomfort and anxiety by prescribing Tums as a first step.
"They know what they know, and they know what they don't know," Spetz said. "If a complicated diabetes situation is going on, they will send the patient to an endocrinologist."
We're talking money here, hence some heavy turf battles. The American Medical Association worries about nurses taking business from its doctor-members and lobbies in state capitals against giving nurse practitioners more independence. The AMA argues that patients' health may be jeopardized if doctors don't monitor nurse practitioners.
Obamacare provides some money for training nurse practitioners but sidesteps the matter of what role they might play. Early in the deliberations, there was reportedly talk of requiring states to give them more independence in return for Medicaid money. The AMA is said to have stopped that line of inquiry.
Cutting health care costs — and making health care services more convenient for consumers — demands moving basic medical services away from hospitals and, in many cases, doctors' offices. Sometimes we need a doctor; sometimes we don't. A well trained nurse practitioner can help point us in the right direction.
(A member of the Providence Journal editorial board, Froma Harrop writes a nationally syndicated column from that city. She has written for such diverse publications as The New York Times, Harper's Bazaar and Institutional Investor.)

Last Updated on Wednesday, 31 December 1969 07:00

Hits: 398

 
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