When I saw the notice about Delos M. Cosgrove, M.D., the CEO of the Cleveland Clinic, speaking at the Center for American Progress in downtown Washington, DC, I figured I had to go for several reasons.

1. I grew up in Cleveland, and was familiar with the Clinic’s legendary status. When President Obama cited the Cleveland Clinic as a model for healthcare reform, I felt some hometown pride.

2. I have quite an interest in healthcare reform, both personally and as part of NETWORK’s work on the issue, and I want to know how we can make sure that everyone gets quality, affordable care in the future.

Here are some things I learned from Dr. Cosgrove:

• The doctors at the Clinic are salaried employees on a one-year contract, with no tenure, and an annual peer review. There are no financial incentives for doctors to do more, or less, procedures than necessary.
• Electronic medical records tie all the Clinic locations together, and they have a transportation system to move the patient to the right facility for the right care at the right time.
• Administrators of the Clinic are former doctors, whose philosoply is that it is better to keep people healthy than to treat them when they are sick. They actively promote wellness among their employees and in the community by offering weight-loss and smoking-cessation programs. They do not hire anyone who smokes, they’ve banned trans-fats and fryers from their food service, and eliminated pop (a.k.a. soda) and candy from vending machines.
• The Clinic is organized around patients’ problems, not doctors professions. That means there is no “department of surgery” where different types of surgeons may have nothing in common, but there is a heart institute, a neurology center, a urology center, and other centers where different types of doctors can collaborate on a patient’s specific problem.

It was heartening for me to hear that the Clinic administrators are getting lots of questions from other healthcare providers around the country about how they can replicate the Clinic’s success.

Republicans have offered far more political rhetoric than actual policy proposals over the past two years. They have appeared to spend more energy opposing President Obama than suggesting solutions to our country’s challenges. Since Republicans have taken control of the House, however, they have put forward more concrete ideas. Chief among them is the “Roadmap for America’s Future,” advanced by Rep. Paul Ryan of Wisconsin. The Roadmap is indeed a concrete proposal, though it is far from a good idea.

The Roadmap for America’s Future includes all kinds of problematic economic policy ideas, but the healthcare provisions are especially frightening. The Roadmap would shift the burden of healthcare costs onto the most vulnerable people and would force more people to fend for themselves on the private insurance market. Moreover, it does not include the important insurance industry reforms that are included in the new healthcare law nearly a year ago (the Patient Protection and Affordable Care Act). The new law includes reforms designed to hold insurance companies accountable and work at lowering healthcare costs over the long-term. The Roadmap does not.

Here are some of the problems with the Roadmap in more detail:

• The Roadmap would move us away from employer-sponsored health coverage. All taxpayers would instead receive a federal tax credit ($2,300 for individuals, $5,700 for families) to purchase health insurance. Many employers would likely stop providing health benefits, meaning that people would be responsible for purchasing coverage on the private market. This would drive up premiums for older, less healthy individuals. Moreover, these tax credits would not increase as fast as healthcare costs, meaning that they would be worth less and less over time.
• The Roadmap would leave people with pre-existing conditions out to dry. The plan relies on “high-risk pools”: state-based collectives through which people can purchase insurance if they can’t purchase it on the private market. In the current employer-sponsored healthcare system, sick people and healthy people are “pooled” together to purchase insurance, which keeps premiums reasonable for all. In the high-risk pools, sick people would all be purchasing insurance together, which would mean higher premiums for those people.
• The Roadmap would end Medicare as we know it, transforming it into a voucher program. For those enrolling in 2021 or later, Medicare would provide a voucher for individuals to purchase their own insurance on the private market. Insurance companies would be free to charge elderly consumers as much as they like, and there would be no requirements about what benefits they must provide. Just like the tax credits above, these would not grow enough to keep pace with increasing healthcare costs, so elderly people would be stuck with a growing share of healthcare costs over time.
• Finally, the Roadmap would not do anything to significantly lower healthcare costs over the long-term. The growing cost of healthcare is perhaps the biggest threat to our national fiscal sustainability. The Roadmap does not address these rising costs, but merely shifts the costs to individuals.

Now, compare these with what the healthcare law is already doing for us:

• Expanding healthcare to millions who could not afford it previously.
• Implementing important reforms to hold insurance companies accountable, including prohibiting them from denying coverage because of pre-existing conditions.
• Establishing mechanisms to control the growth of healthcare costs over the long-term.

These are the kind of solutions we need, not a misguided “Roadmap” that would lead us back to the days when healthcare was beyond the reach of too many people.

I’m tired of the Medicare fight. But I’m afraid we’ll have to endure it for at least another 18 months since 2012 election politicking has already started, and Medicare is the hot issue.

If we want to save Medicare, which political party should we trust?

The Republicans say that Medicare will go broke because Democrats are doing nothing to make it solvent. The Democrats say that Medicare will no longer exist if Republicans get their way. Both sides are using the issue to whip up fear among seniors who are on Medicare now, and near-seniors who are looking forward to getting Medicare.

Demagoguery on Medicare is nothing new. In recent history, during the debates on the Affordable Care Act (ACA) in 2009 and 2010, opponents accused supporters of “cutting Medicare.” As with most sound bites, the actual truth was a bit more complex. The ACA cut funds to Medicare Advantage plans, which are optional private insurance plans that seniors can get. They sometimes offer additional benefits such as vision and dental coverage.

(I don’t know exactly why Medicare Advantage came to be, but I do remember that Sr. Catherine Pinkerton, who was NETWORK’s healthcare lobbyist at the time, saw this as a step toward privatizing Medicare and did not approve.)

It turns out that the federal government pays about 11%  more for each Medicare Advantage enrollee than it does for an enrollee in traditional Medicare. This is due to a complicated formula that allowed Medicare Advantage insurance companies to get higher payments than traditional Medicare fee-for-service costs. Most of these overpayments went to the insurance companies, not to additional benefits for the people enrolled. So in an attempt to cut growing Medicare costs, the ACA will restructure payments to Medicare Advantage insurance companies to bring them more in line with traditional Medicare costs. But there were no cuts to basic Medicare benefits in the ACA.

Now the Democrats are saying they want to preserve “Medicare as we know it”, meaning the traditional Medicare plan run by the government. And Republicans want to change Medicare into a plan that would give government subsidies to seniors to buy private insurance. To me, the Republican plan sounds similar to what the ACA did for people under 65 who couldn’t afford insurance: give subsidies to help them buy insurance in the private market. So I’m not sure why Republicans complain so much about the ACA if they like that idea.

I do know why most seniors don’t like the private insurance idea. Seniors typically need more healthcare than younger people do, and it cost them more to get it. The Republican-proposed subsidies would not increase at the same rate that healthcare costs increase. And I’m guessing that seniors would have more “pre-existing” conditions when they retire and therefore have a hard time getting private insurance. Come to think of it, isn’t that why Medicare (as we know it) was put in place to begin with?

Most people agree that we need to find ways to control not just Medicare costs, but healthcare costs in general. The Affordable Care Act has many provisions to experiment with different ways to pay for healthcare services. Some of these have the potential to make our whole healthcare system more effective and efficient.

We should give the ACA a chance to work, and build on what we learn to do more to control healthcare costs for everyone. Other countries have done this, and America should be able to do this too.

I just hope we don’t have to wait another 18 months before we can have a rational discussion on healthcare.

If you would like to read a little more about the current Medicare fight, I recommend this article:http://www.kaiserhealthnews.org/Columns/2011/May/052511cohn.aspx

Over the past 40 years, NETWORK has made healthcare a top priority in our lobby and legislative advocacy work. Eighteen months ago, we were gratified by the passing of healthcare reform. However, we are still working to guarantee that the progress we made is not reversed.

NETWORK’s Executive Director, Sr. Simone Campbell, highlighted the many benefits of the bill and explained why we must continue to work to preserve it in an online interview. She also reiterated that this is a responsible prolife bill that does not subsidize abortions.

Listen to the full interview here.

Already, major improvements have been made in many areas:

• Coverage has already been extended to over one million Americans
• Limitations on obtaining healthcare for those with preexisting conditions are being eliminated.
• Working to ensure that we, as consumers, are not exploited.
• Making sure we do not lose healthcare when changing jobs.

We have much more to look forward to. This bill will promote competition in the market place in order to bring prices down.

For more information on the Patient Protection and Affordable Care Act, visit Healthcare.gov. This website offers a wide range of resources explaining the law and allows you to shop comparatively for health insurance.

For the nearly two million college seniors across the country, this spring will be one of the most intimidating, stressful and exciting points in their lives. Years of hard work in the classroom will finally be rewarded in the form of a diploma. Some will choose to continue their education. Some will submit their resumes to job openings, working tirelessly to secure work. Some will be fortunate enough to begin their careers immediately after walking across the graduation stage. However, no one will have to fear losing their health insurance.

One year ago, I found myself in the same whirlwind the Class of 2012 is now absorbed in. I began the process of submitting my resume to numerous organizations. As I started the interview process, I reflected on which path would be the best way forward in my efforts to advocate for those who did not have a voice in their society. Whether it was in the field of communications, grassroots activism, or other non-profit career paths, my first venture into the professional realm post-college would undoubtedly shape the rest of my life. This was a decision that would not weigh lightly on me.

When I found out I had been accepted as a NETWORK Lobby Associate in March 2011, there was no hesitation in my acceptance of the position. This is exactly where I needed to be. Their work was inspiring and shaped the lives of millions of people across the country. Every day, I would be able to work alongside a dedicated staff who would not be idle in the midst of a gridlocked climate that ignored the needs of people in poverty.

Had I graduated a year beforehand, I would not have had this opportunity.

If the Patient Protection and Affordable Care Act had not been signed into law on March 23, 2010, I could have faced a three-month gap in health coverage, as NETWORK’s Associate Program begins on September 1. This provision in the law allows me to stay covered under my parents’ insurance coverage until the age of 26, and now over 2.5 million young adults find themselves with health coverage.

Without healthcare reform, I would have considered other job options first and foremost because maintaining my healthcare coverage would have been a priority. Because I was able to stay under my parents’ health insurance coverage, I was secure in choosing the path that I felt compelled to take based not on health insurance, but on what career would allow me to advocate for issues I care about.

For young adults like myself, this is a personal and moral issue. I’m also not alone in this essential benefit. Before the act passed, 40% of all the uninsured came from the youth population between the ages of 18 and 34. My fellow Associates also understand the moral importance of protecting the law.

“I am so grateful to be able to stay on my parents’ insurance. Individual policies are very expensive compared to group plans, and since I am working a public interest job, paying the lower premium on my parents’ plan has allowed me to stretch my tight finances.  I’ll be going to graduate school in the fall, and the ACA prevents me from being uncovered between the end of my job and the beginning of school, as well as preventing the disruption of switching to the school’s insurance plan. Additionally, unlike my older brothers, I am fortunate to not have to face the uncertainty of not having health insurance during transitional phases from college to the workplace, or while changing employers. My oldest brother had to keep switching insurers, choosing from pricey individual policies that didn’t provide sufficient coverage. Ultimately, without the ACA, young adults who are not at the height of their earning potential are put in a difficult spot.” –Claire Wheeler, NETWORK Lobby Associate

“It is a blessing to not have to worry about having healthcare when my associate program here at NETWORK wraps up later this year. If I was not able to stay under my parents’ insurance while I looked for my next career move, whether it be a new job or a graduate school program, it would be a much more challenging time in my life if I had to worry about how to afford the medical services I rely on.”­ –Matt Shuster, NETWORK Field Associate.

As the Supreme Court debates the constitutionality of the healthcare coverage, we must think of the wellbeing of all those who would not have coverage today without the Affordable Care Act.

We must think of the three-year-old who would not have coverage after her fifth birthday because it would be too expensive. We must think of the college graduate struggling to find a job, unable to visit a doctor because he was unable to stay on his parents’ insurance coverage. We must think of the child denied health insurance because of a condition she was born with. We must think of marginalized families living just above the poverty level who will now have affordable access to healthcare. We must think of the common good, and what it says of our society if the law is overturned.