Questions And Answers On Health Care, Afghanistan, & International Aid

A couple weeks ago, we posted interviews with Angie Holan of Politifact on Health Care Reform and Patricia DeGennaro of NYU and the World Policy Institute on Afghanistan. Some questions were submitted in the comments - now we have answers.

Angie Holan Politifact
In response to: How Much Healthcare Can We Buy With a Trillion Bucks?

My question is - what about the fear that including government into health care will ultimately increase our mortality rate by instituting rationing and cutbacks? Will doctors flee to maintain their high incomes?

This is a big fear among people who oppose the plan. At PolitiFact, we don't take sides on predictions about what will happen if the legislation is passed. We did, however, report an item specifically on rationing. We found there's a lot of rationing in the system right now, and rationing will continue under the Democratic bill. In most cases, rationing is used as a "scare word" for the common sense idea that we have to make decisions somehow about how to allocate limited resources. Read more on how both sides talk about rationing here: 'Rationing' and other scare words in health debate.

Can you please clarify what the $1 trillion means - an addition to what we are already spending, or a comparison cost to what we are spending? My understanding is that the proposed plan cost figures are replacements for the status quo - making this a significant COST SAVINGS.

Nope, the bills will not save us money, at least not according to the nonpartisan number crunchers at the Congressional Budget Office.The $1 trillion over 10 years includes all the new costs associated with the bill. It does not replace old costs for old health care spending. However, that $1 trillion number does NOT count new taxes and spending cuts that are part of the bill. When you count those offsets, the overall impact on the public debt would be $239 billion over 10 years, which is a lot less than $1 trillion.

Many Democrats say they want to make the bill deficit neutral, which means they want to find money in some other part of the budget to wipe away that $239 billion. If they get that done, it means the bill would be "deficit neutral," which means it's sort of a break-even venture.

I should add that the Obama administration believes the bill will save more money than those numbers reflect, but again we'll all have to wait and see if they're right.

One more thing: Congress might significantly re-write the bill in the weeks ahead, and all those numbers might change. So stay tuned!

They say the public option will be paid by premiums and subsidies for low-incomes. What happens if/when those aren't sufficient? Are they going to let the public option truly compete and possibly fail —or are they going to vote to set aside the rules they created and bail it out?

Another question about the future that's difficult to answer! It's a good question, though. Critics fear that if Congress even sets up the public option, then later Congress will go back and change the rules to let the public option take-over the system. Just to emphasize, that's a fear of what will happen in the future. It is not part of the plan now. President Obama has said the public option say it will have to be self-supporting, paid for by the premiums of its customers.

What do you know about the non-profit and co-op health insurance organizations that exist right now? Do they have a lower cost of care and overhead than for profit insurance agencies?

My reporting shows that even government-run programs like Medicare are also seeing rapidly growing costs. So not-for-profit health plans have problems with growing costs, too. It's not just a problem of private insurers taking profits. Some of this has to do with new medical technologies and procedures that make people healthier but still are expensive. We hope to do more reporting on co-ops and nonprofits in the weeks ahead as more details come out.

Without a government-run option, how will people who haven't been able to get private insurance (i.e. people with pre-existing conditions who aren't covered by an employer) get coverage? I've read about nonprofit cooperatives but that information was incredibly vague.

Yes, the information is very vague about co-ops and how they would be part of a national health plan. We should get more details on this when Congress comes back and the Senate Finance Committee releases a plan, if they decide to go with co-ops.

One thing I would like to know is, in light of unemployment being what it is these days, are people talking at all about making it easier for people who lose their jobs to keep their health coverage? I lost a job that had provided my insurance last October. COBRA would have eaten up my entire unemployment check and then some, so it was not an option AT ALL. I just don't get how it's good to keep the employer-provided insurance system in place, because when we lose our jobs, we lose our coverage right when we can least afford to be paying out of pocket.

The health care plan in Congress tries to address this by making the individual market more efficient, so people can buy affordable policies on their own through a national insurance exchange. There may be other details to help people who lose jobs, but I haven't noticed any changes to COBRA provisions in the bills. Just an fyi, the stimulus bill passed earlier this year had money to help people who are laid off pay for health care coverage under COBRA.

Without a public option on the exchange, how can we predict any price decrease for the cost of healthcare? Aren't we just in the same boat in regards to cost?

Actually, there are other things in the bill that seek to control costs, but most of them have to do with Medicare, the government-run health insurance plan for the elderly. Those measures include things like providing incentives for good outcomes, or incentives for doctors to collaborate more on treating patients. The reform advocates hope that those changes will affect the way everyone receives treatment, not just the elderly. But it's hard to say how much those Medicare incentives will affect the overall system. That's a big unknown.

Patricia DeGennaro
NYU/World Policy Institute
In Response to: On Women, War, and the Elections with Afghanistan

That_little_attention_whore wrote "Development or aid workers are there to stop the suffering of people and improve their livelihoods. They are independent of politics and policies. The military is not."

I dunno, I feel like USAID has been plenty politicized. Plus, the current administration has included development as a component of foreign policy....

@That_little_attention_whore
You do have a point that aid is also political. However, non-governmental organizations, which get money from private sources most often pride themselves in being impartial, neutral and independent which means, for example, they don't just give aid to "win hearts and minds," they give it too all people regardless of what the military may considering winning or losing, which is solely based on national interests not humanitarian need.

bluebear wrote "I have a question. Why exactly does the Taliban view themselves as the legitimate government? meaning what justifications would they give to support this? if any."

The Taliban gained control of almost 80% of Afghanistan after a brutal civil war that followed the Soviet occupation of the country. They were deposed not by another Afghan leader or tribe, but by an invading foreign force who they feel has no right to decide who governs. Although through brutal means, they stopped the civil war, basically irradiated poppy, and, in their mind, brought peace and security to the people (many women may disagree here, but this is what they think). Afghanistan has a history of coups, but it is not accepted by any means to be overthrown by an outside power. This is why they view themselves as legitimate and they succeed in maintaining at least some support by people who agree with this way of thinking.

I asked "And a more general question came up in light of a different discussion: how much AID to Afghanistan is routed back to the US?"

Oxfam reported that in 2008 that "40% of aid to Afghanistan has returned to donor countries in corporate profits and consultant salaries." Most of this is through USAID contractors who contract out to smaller contractors and so on. In Afghanistan aid agencies also pay millions to foreign security companies and some ex patriot salaries are estimated to be close to $500,000. US aid went to five top US companies – some private – who from what I saw hire too many friends and pay them high salaries to do little but go home with a larger bank account. Keep in mind though, there are some successes. Small and under the radar non-governmental organization, whose use funds they acquire from private sources not governments, do some very good things like build women's hospitals and orphanages for so many children that lost their families through war.

Official Site [Politifact]
Tricia's Take [Patricia DeGennaro's Blog]
'Rationing' and other scare words in health debate [Politifact]
Major donors failing Afghanistan due to $10bn aid shortfall [Oxfam International]

Earlier:
How Much Healthcare Can We Buy with a Trillion Bucks?

On Women, War, & the Elections in Afghanistan