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Health Freedom Watch
October 2008

Contents:


Lawsuit Challenges Coercion of Seniors into Medicare

Seniors Defend Right to Social Security Benefits in Brian Hall, et al. v. Michael Leavitt, et al.

A lawsuit challenging the withholding of Social Security benefits from seniors who decline Medicare Part A (hospital insurance) was filed October 9 in U.S. District Court for the District of Columbia. (The Social Security Administration’s Policy No. HI 00801.002 imposed this restriction.)

Two of the three plaintiffs in Brian Hall, et al. v. Michael Leavitt, et al. want to apply for Social Security but don’t want to participate in Medicare Part A.  The other plaintiff did not want to participate, but was automatically enrolled when he applied for Social Security.  The plaintiffs have other insurance plans (catastrophic coverage) and savings to pay for their hospital care.  One plaintiff has a Health Savings Account (HSA) that he wouldn't be able to contribute to because the Medicare Prescription Drug, Improvement and Modernization Act of 2003 and IRS rules prevent beneficiaries from doing so.  Most important, all three plaintiffs want their doctor-patient relationships free of interference. For them, paying privately is the best way to ensure that freedom. 

At a news conference October 9 at the National Press Club, plaintiff Norman Rogers stressed that both his parents were in a nursing home and their doctors’ freedom—and thus his parents’ care—was restricted by Medicare.  He doesn’t want to face the same situation.  “I didn’t think the medical care my parents got under Medicare was that great and I’d rather not participate,” Rogers said.  Plaintiff Brian Hall added, “I believe I should be able to decide whether or not to receive a government benefit.  In this case, I’d rather not receive it.” 

Attorney Kent Masterson Brown explained that the Social Security policy is illegal because:  

  • “The Social Security Act and Medicare Act state clearly that applying for Social Security monthly benefits and enrolling in Medicare are voluntary and that the applications for each of these programs are not dependent on the application for the other.  For the [SSA rules] to make enrolling in Medicare mandatory violates the Social Security Act and Medicare Act as well as Article I, Section 1 of the Constitution.” [Emphasis added.] 
  • “Forced participation in Medicare infringes on a citizen’s right to privacy and to make necessary choices about his or her own health care, and, accordingly, violates the First, Fourth, Fifth, Ninth, and Fourteenth Amendments to the Constitution.” 
  • “The new SSA rules were put into place without undergoing the required ‘notice’ and ‘comment’ rule-making requirements. The policies should have been published in the Federal Register and open to comment by the general public prior to implementation. Not doing so violates the Administrative Procedure Act.” 

The 60 Plus Association distributed a press release on October 10 supporting the case, calling the policy “arbitrary, discriminatory, punitive and improper.”  It also criticized the Social Security Administration for adopting rules “in secret, without proper notice to those involved” that “harm many U.S. retirees and the already stressed Medicare system, further damage the credibility of the federal government, and undermine individual rights in our country.” 

Sources:

  • “Lawsuit Against Social Security Administration and HHS Filed Today,” press release distributed on behalf of plaintiffs in Brian Hall, et al. v. Michael Leavitt, et al., October 9, 2008: http://www.medicarelawsuit.org/pdf/LAWSUITFILING.pdf
  • “Background on Brian Hall, et al. v. Michael Leavitt, et al.,” paper prepared on behalf of plaintiffs in Brian Hall, et al. v. Michael Leavitt, et al., October 9, 2008: http://www.medicarelawsuit.org/backgrounder.html
  • The “Medicare Prescription Drug, Improvement and Modernization Act of 2003” (Pubic Law 108-173) prevents seniors from contributing to their Health Savings Accounts (see Title XII–Tax Incentives for Health and Retirement Security, Sec. 223. Health Savings Accounts).
  • “Health Savings Accounts and Other Tax-Favored Health Plans,” IRS Publication No. 969.
  • Direct quotes from Norman Rogers and Brian Hall at the National Press Club press conference on October 9, 2008.
  • Social Security Administration, Policy No. HI 00801.002, “Waiver of HI Entitlement by Monthly Beneficiary.”
  • “60 Plus Association Calls Government Medicare Rules Arbitrary, Discriminatory, Punitive and Improper,” press release from 60 Plus Association, October 10, 2008.

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Four in Ten Voters See No Advantage in Candidates’ Health Care Plans

Among Those Who Do, Obama Has Only Modest Lead over McCain

As part of the ongoing poll series, Debating Health: Election 2008, the Harvard Public Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive® conducted a new survey focused on how voters think the presidential candidates’ health care reform plans would affect them personally—rather than how they think the plans would affect the nation as a whole. The survey found that voters view the candidates’ plans differently from this perspective.

Four in ten registered voters don’t believe one candidate’s health care plan would be better for them than the other. (This includes those who think there wouldn’t be a difference for them between the plans (27%) and those who don’t know if there would be (13%)). More voters think Senator Barack Obama’s plan would be better for them than Senator John McCain’s plan (33% vs. 27%). This survey was conducted September 17-21, 2008, by telephone among a national cross section of 935 registered voters in the United States.

“The most interesting finding is not that Obama does better than McCain (Obama has a more substantial lead in other polls about which candidate is better at handling health care), but that Obama’s lead is narrower on these questions that focus on how the plans would affect them personally,” says Humphrey Taylor, Chairman of The Harris Poll®. “These are not bad results for the McCain campaign.”

Among several critical voting groups, many don’t see one plan as offering an advantage to them over the other. Among independents, a majority either see no difference in whether the two candidates’ health care plans would be better for them or don’t know if there would be a difference (51%). Those who do feel there would be a difference are split in a statistical tie (26% for McCain vs. 24% for Obama). Among seniors, a near majority see no difference or don’t know which plan would be better for them (46%), and those who do see a difference are also tied (27% vs. 27%).

“Ultimately independents are the key to winning this race, and at the moment they are up for grabs in terms of whether they see McCain’s plan or Obama’s plan as better for them,” says Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

On the other hand, certain segments do believe Obama’s plan would serve them better. More women think Barack Obama’s health care plan would be better for them personally than John McCain’s plan (38% vs. 21%), even though a large share also thinks there would be no difference between the plans or doesn’t know if there would be (41%). By comparison, men are tied even among those who think there would be a difference between the plans (29% vs. 32%). Thus, women appear to be driving Obama’s current lead on this question. The uninsured are also more likely to think Obama’s health care plan will be better for them (53% vs. 26%), as are the disabled (37% vs. 22%).

Obama’s plan leads the most on the issue of providing insurance coverage. Those who are uninsured believe Obama’s plan would be more likely to provide them with coverage (45% vs. 14%). And, people who are currently insured believe that they would be more likely to be protected from losing their insurance under Obama’s plan (31% vs. 19%).

Obama has a smaller lead with respect to views of the cost and quality of health care under his plan. More people think Obama’s plan would require lower payments from them (27% vs. 19%) and would deliver better quality of care for them (27% vs. 21%). But, the plans come out equally in terms of how long it would take to get an appointment with their doctor (19% vs. 18%) and how much they would pay in taxes (33% vs. 32%).

The previous poll in this series focused on health care for veterans: “Americans Believe Wounded Iraq War Veterans Are Not Receiving High Quality Medical Care When They Return to the U.S.; Families With Military or Veteran Connection Also Hold Critical View; McCain Seen in Poll as Best Candidate on Issue.” This topic was discussed as part of the first presidential debate. (The Veterans survey can be found at: http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=1309.)

Table 1

Presidential Candidate’s Health Care Reform Plan More Likely to Be Better For You:

Obama Vs. McCain

“Overall, whose health care reform plan—John McCain or Barack Obama’s—would be better for you, or do you think there won’t be much difference?”

 

Total

Party ID

Gender

Insurance Status

Disability Status

 

 

Rep

Dem

Ind

Male

Female

Insured

Uninsured

Not

Disabled

Disabled

Obama’s Plan Better

33%

4%

68%

24%

29%

38%

30%

53%

33%

37%

McCain’s Plan Better

27%

62%

3%

26%

32%

21%

27%

26%

27%

22%

No Difference

27%

21%

21%

35%

27%

28%

29%

16%

27%

29%

Don’t Know/
Refused

13%

12%

8%

16%

12%

13%

14%

5%

13%

11%

Table 2

Presidential Health Care Reform Plan Coverage: Obama Vs. McCain

“When it comes to [COVERAGE], whose health care reform plan—Barack Obama’s or John McCain’s—would be better for you, or do you think there won’t be much difference?”

 

Insured

Uninsured

Obama’s Plan
Better

McCain’s Plan
Better

Obama’s Plan
Better

McCain’s Plan
Better

Providing you with health insurance coverage

--

--

45%

14%

Protecting you from losing your health insurance

31%

19%

--

--

*Voters stating there would be no difference or don’t know/refused have been omitted.

Table 3

Presidential Health Care Reform Plan Advantages: Obama Vs. McCain

“When it comes to [ADVANTAGE], whose health care reform plan—Barack Obama’s or John McCain’s—would be better for you, or do you think there won’t be much difference?”

 

Obama’s Plan Better

McCain’s Plan Better

How much you pay in taxes

33%

32%

The quality of the health care you receive

27%

21%

How much you pay for health care and insurance

27%

19%

How long it takes you to get an appointment to see your doctor

19%

18%

*Voters stating there would be no difference or don’t know/refused have been omitted.

Base: 935 Registered Voters
Source: Debating Health: Election 2008, Harvard School of Public Health/Harris Interactive
September 17-21, 2008

Methodology

This survey is part of the series, Debating Health: Election 2008. The series focuses on current health issues in the presidential campaign. The survey design team includes Professor Robert Blendon, Gillian Steel Fisher, John Benson and Kathleen Weldon of the Harvard School of Public Health; and Humphrey Taylor, Scott Hawkins and Justin Greeves of Harris Interactive.

This survey was conducted by telephone within the United States among a nationwide cross section of adults aged 18 and over, and statistics here focus on those who are registered to vote. The survey was conducted September 17-21, 2008 among a representative sample of 935 respondents. Figures for age, sex, race/ethnicity, education, region, number of adults in the household, size of place (urbanicity) and number of phone lines in the household were weighted where necessary to bring them into line with their actual proportions in the population.

All sample surveys and polls are subject to multiple sources of error including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. The sampling error for registered voters is +/- 3.2% in 95 out of 100 cases for results based on the entire sample. For results based on a smaller subset, the sampling error is somewhat larger.

Source:  “Four in Ten Voters Don’t See Either Obama’s or McCain’s Health Care Plan as Better for Them,” press release (reprinted in its entirety) from the Harvard Public Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive®, October 1, 2008: (http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=1338).

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Medical Licensing: An Obstacle to Affordable, Quality Health Care

The following abstract is from a Cato Policy Analysis by Shirley Svorny, professor of economics and chair of the department of economics at California State University, Northridge, and an adjunct scholar at the Cato Institute.

In the United States, the authority to regulate medical professionals lies with the states. To practice within a state, clinicians must obtain a license from that state’s government. State statutes dictate standards for licensing and disciplining medical professionals. They also list tasks clinicians are allowed to perform. One view is that state licensing of medical professionals assures quality.

In contrast, I argue here (http://www.cato.org/pubs/pas/pa-621.pdf) that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today. 

Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts. 

If eliminating licensing is politically infeasible, some preliminary steps might be generally acceptable. States could increase workforce mobility by recognizing licenses issued by other states. For mid-level clinicians, eliminating education requirements beyond an initial degree would allow employers and consumers to select the appropriate level of expertise. At the very least, state legislators should be alert to the self-interest of medical professional organizations that may lie behind the licensing proposals brought to the legislature for approval. 

Source:  “Medical Licensing: An Obstacle to Affordable, Quality Care,” Cato Policy Analysis no. 621, by Shirley Svorny, September 17, 2008: http://www.cato.org/pub_display.php?pub_id=9640 

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Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2008 Institute for Health Freedom.