9/11 Responders and Health Care

By Greg Scandlen

The old Congress has passed a $4.2 billion 9/11 Responders health care bill. It was passed by a unanimous voice vote in the Senate after the price tag was lowered from $6.2 billion.

All of the news articles I have seen mention it was mean old Tom Coburn who was trying to deprive our heroes of needed health care, and that Jon Stewart rode to the rescue by highlighting the plight of the victims. Not a single – not one – article I have seen had anything to say about exactly what this bill does or whom it would help.

The whole discussion seems to place 9/11 heroes at one end and a pile of money at the other end and anyone who gets in between as a villain.

But no one ever mentions how the money will be spent. Presumably these responders have pretty good health insurance. Is treatment denied them? Is this excluded from coverage because it was an act of war? I don’t know. Nobody ever says.

How many people will be helped? How much money will they each get? It’s not reported. Is there a death benefit involved? Who knows? Is there compensation to the families of victims? I can’t tell. It was $6.2 billion and now it is $4.2 billion – why? How did they calculate the number?

More importantly, what does this process say about the future of health care in America now that the federal government is in charge of all health care spending? Is every decision going to be based on a split-the-difference calculation between heart-hearted Republicans and generous Democrats? That certainly seems to be the case if you look at the sorry history of the SGR payments to physicians in Medicare. One month they are cut by 20%, the next month it is restored for a few months, then it gets cut by 25%, until it is restored once again.

Will your treatment depend on the political machinations of Congress? Will you, too, have to recruit Jon Stewart to plead your case? It’s beginning to look that way.


6 Responses

  1. It seems to be impossible for politicians not to spend other people’s money on “good causes.” Maybe we need a simple agreement that politicians can not require any money out of our pockets on anything until they have generously contributed voluntarily out of their own pockets first!

  2. Repetition is the Mother of Learning.
    Our country’s Founding Fathers believed that serving in Congress is an honor, not a career.
    Congress has the lowest approval of any entity in our Government.
    We need Congressional Reform and we need it now!!

  3. Most of these questions are either answered or not applicable in the bill itself – H.R.847, accessible at Thomas.gov. Basically it does not duplicate the benefits of workers compensation, and it is a secondary payer for public or private health plans.

    The bill merely reduces the burden of financial hardship for those who do have significant medical disorders related to their post 9/11 exposure.

    This says little about the future of health care in America since the basic plans in the exchanges will have a relatively low actuarial value – 70 or even 60 percent. To meet that low standard, most plans will have high deductibles. Since the subsidies will be inadequate for most individuals, financial hardship will be the norm for most individuals with significant health care needs.

    Although some might suggest that this would be the ideal plan for consumer empowerment by adding health savings accounts, that doesn’t work well for individuals who deplete their accounts or can’t fund them in the first place.

    With a comprehensive single payer system, customized legislation for the first responders would not have been necessary.

    • Thanks for the comment, Don. I still don’t understand what these gaps in coverage would be. I expect most of the responders are union members and so should have pretty comprehensive coverage already. Are you saying a single payer plan would be even more comprehensive than a typical union contract? That is, of course, not the case with Medicare currently.


      • I believe that you are correct in implying that individuals with generous union-negotiated plans will receive very little benefit from this legislation, since they are already well covered.

        Regarding the comprehensiveness of single payer, those of us at Physicians for a National Health Program do advocate for an improved and expanded Medicare for all. We would include all essential benefits such as dental, optometry, long term care, etc., and we would eliminate cost sharing. That is obviously quite different from the consumer-driven model with high deductibles and health savings accounts for which you have advocated.

        Although you and I agree on many of the problems with the Patient Protection and Affordable Care Act, it is unlikely that we’ll ever agree on the policies that should replace it.

  4. Don,

    Yes, we agree on a lot. I applaud the work PNHP has done on ACOs and individual mandates and cite it a lot.

    As for the “final solution,” your single payer would not have to exclude HSAs. In fact, HSAs would provide a way to deliver your comprehensive benefits more efficiently. You provided quite a list of “essential” benefits, but ended it with an “etc.” In fact, no single agency or program could possibly cover everything every person wants. That “etc.” is not small.

    HSAs could be a mechanism for supplementing the core benefits of your single payer. Your concern about the poor is easily managed by funding the HSA based on income. But you would still get the efficiencies of direct payment for smallish claims.


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