More Moore … and more

July 10th, 2007

I’d guess that settles the earlier word-play question.

Mikey cult-of-personality issues aside, health care has to take a more prominent role in our discussions — with only a year and a half to go with the Knuckle Draggers [I sound confidant, don't I?] this issue needs to be properly explored … and it’s a tough sell. Details, details, details — not something on which the public wants to waste it’s beautiful mind. Getting a simple picture of options is important. Here are a few reads to help you get a bite on this … we’ll be called upon to choose at some point, and only Kucinich has thus far eliminated the middle-men.

Below, you’ll find a Krugman, a really encouraging experience a theatre-goer enjoyed, an article by the president of the California Nurses Association, and a piece filled with analysis and links. The first link will give you stats, including your own state numbers — pretty revealing. The last piece tells us about the Dem’s fight for kids coverage, and the Dubby that stands in the way — always compassionate, these conservatives [sic.]

Before that, though, I’d like you to go to FireDogLake and read this article:

Speak Up Now To Save The Internet

We only have a few days left to weigh in on internet access … and this is critical to our rights of Free Speech, not to mention your continuing ability to receive these posts and others important to you without paying per. SIGN ON. Important stuff!

Jude

SICKO Required Reading: U.S. Health Care by the Numbers
June 29, 2007
Go here for essential info, including your own states healthcare rating

Health Care Terror
PAUL KRUGMAN, New York Times via Welcome to Pottersville

These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming.

“National healthcare: Breeding ground for terror?” read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism.

While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about morality.

That’s what we learn from the overwhelming response to Michael Moore’s “Sicko.” Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn’t focus only on self-interest. They should also appeal to Americans’ sense of decency and humanity.

What outrages people who see “Sicko” is the sheer cruelty and injustice of the American health care system — sick people who can’t pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn’t a participant in her mother’s health plan won’t treat her, hard-working Americans driven into humiliating poverty by medical bills.

“Sicko” is a powerful call to action — but don’t count the defenders of the status quo out. History shows that they’re very good at fending off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the dangers of government insurance. “Sicko” plays part of a recording Ronald Reagan once made for the American Medical Association, warning that a proposed program of health insurance for the elderly — the program now known as Medicare — would lead to totalitarianism.

Right now, by the way, Medicare — which did enormous good, without leading to a dictatorship — is being undermined by privatization.

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result — but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here.

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American — and much better than that of uninsured Americans, many of whom never receive needed care at all.

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There’s a scene in “Sicko” in which expatriate Americans in Paris praise the French system. According to the hard data they’re not romanticizing. It really is that good.

All of which raises the question Mr. Moore asks at the beginning of “Sicko”: who are we?

“We have always known that heedless self-interest was bad morals; we know now that it is bad economics.” So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can’t overcome those forces here, there’s not much hope for America’s future.

Sicko Spurs Audiences Into Action
Josh Tyler, Cinema Blend
2007-07-01

Long time readers of this site no doubt know that I live in Texas. As everyone knows there’s no more conservative state in the Union than here. And I don’t just live in Texas; I live in the Dallas/Fort Worth metroplex. Dallas isn’t some pocket of hippy-dippy behavior. This isn’t Austin. Dallas is the sort of place where guys in cowboy hats still drive around in giant SUV’s with “W” stickers on the back windshield, global warming and Iraq be damned. It’s probably the only spot left in America where you stand a good chance of getting the crap kicked out of you for badmouthing the president.

So when I went to see Sicko for a second time this afternoon, I wasn’t sure what to expect from the audience. I wasn’t watching it downtown, where the city’s few elitist liberals congregate and drink expensive lattes. I went to a random mall in the mid-cities, where folks were likely to be just folks. As I sat down, right behind me entered an obligatory, cowboy hat wearing redneck in his 50s. He announced his presence by shouting across the theater in a thick Texas drawl to his already seated wife “you owe me fer seein this!”

Sicko started; the stereotypical Texas guy sat down behind me and never stopped talking. He talked through the entire movie… and I listened. The first ten to twenty minutes of the film he spent badmouthing Moore to his wife and snorting in disgust whenever MM went into one of his trademark monologues. But as the movie wore on his protestations became quieter, less enthusiastic. Somewhere along the way, maybe at the half way point, right before my ears, Sicko changed this man’s mind. By the forty-five minute mark, he, along with the rest of the audience were breaking into spontaneous applause. He stopped pooh-poohing the movie and started shouting out “hell yeah!” at the screen. It was as if the whole world had been flipped upside down. This is Texas, where people support the president and voting democratic is something only done by the terrorists. Michael Moore should be public enemy number one.

By the time the movie was over, public enemy number one had become George Washington, Abraham Lincoln, and John F. Kennedy all rolled together. When the credits rolled the audience filed out and into the bathrooms. At the urinals, my redneck friend couldn’t stop talking about the film, and I kept listening. He struck up a conversation with a random black man in his 40s standing next to him, and soon everyone was peeing and talking about just how fucked everything is.

I kept my distance, as we all finished and exited at the same time. Outside the restroom doors… the theater was in chaos. The entire Sicko audience had somehow formed an impromptu town hall meeting in front of the ladies room. I’ve never seen anything like it. This is Texas goddammit, not France or some liberal college campus. But here these people were, complete strangers from every walk of life talking excitedly about the movie. It was as if they simply couldn’t go home without doing something drastic about what they’d just seen. My redneck compadre and his new friend found their wives at the center of the group, while I lingered in the background waiting for my spouse to emerge.

The talk gradually centered around a core of 10 or 12 strangers in a cluster while the rest of us stood around them listening intently to this thing that seemed to be happening out of nowhere. The black gentleman engaged by my redneck in the restroom shouted for everyone’s attention. The conversation stopped instantly as all eyes in this group of 30 or 40 people were now on him. “If we just see this and do nothing about it,” he said, “then what’s the point? Something has to change.” There was silence, then the redneck’s wife started calling for email addresses. Suddenly everyone was scribbling down everyone else’s email, promising to get together and do something… though no one seemed to know quite what. It was as if I’d just stepped into the world’s most bizarre protest rally, except instead of hippies the group was comprised of men and women of every age, skin color, income, and walk of life coming together on something that had shaken them deeply, and to the core.

In all my thirty years on this earth, I have never ever seen any movie have this kind of unifying effect on people. It was like I was standing there, at the birth of a new political movement. Even after 9/11, there was never a reaction like this, at least not in Texas. If Sicko truly has this sort of power, then Michael Moore has done something beyond amazing. If it can change people, affect people like this in the conservative hotbed of Texas, then Sicko isn’t just a great movie, seeing it may be one of the most important things you do all year.

On Health Care Reform
Long waits are really SiCKO
Deborah Burger, San Francisco Chronicle
Tuesday, July 10, 2007

What country endures such long waits for medical care that even one of its top insurers has admitted that care is “not timely” and people “initially diagnosed with cancer are waiting over a month, which is intolerable?”

If you guessed Canada, guess again. The answer is the United States.

Scrambling for a response to the popular reaction to Michael Moore’s “SiCKO” and a renewed groundswell for a publicly financed, guaranteed single-payer health care solution, such as SB840, the big insurers and their defenders have pounced on Canada, pulling out all of their old tales of people waiting years in soup kitchen-type lines for medical care.

But, here’s the dirty little secret that they won’t tell you. Waiting times in the United States are as bad as or worse than Canada. And, unlike the United States, in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, pre-existing conditions or because it wasn’t pre-approved.

U.S. waiting times are the elephant in the room few critics care to address. But, listen to what the chief medical officer of Aetna had to say in March.

Speaking to the Aetna Investor’s Conference 2007, Troy Brennan let these pearls drop:

The U.S. “health care system is not timely.”

Recent statistics from the Institution of Healthcare Improvement document “that people are waiting an average of about 70 days to see a provider.”

“In many circumstances, people initially diagnosed with cancer are waiting over a month, which is intolerable.”

In his former stint as an administrator and head of a physicians’ organization, he spent much of his time trying “to find appointments for people with doctors.”

Brennan’s comments went unreported in the major media. But some reports are now beginning to break through, spurred by the debate “SiCKO” has spawned.

Business Week reported that “as several surveys and numerous anecdotes show, waiting times in the United States are often as bad or worse as those in other industrialized nations — despite the fact that the United States spends considerably more per capita on health care than any other country.”

A Commonwealth Fund study of six highly industrialized countries, the United States and five nations with national health systems (Britain, Germany, Australia, New Zealand and Canada) found waiting times were worse in the United States than in all the other countries except Canada .

There’s something else you probably don’t hear about Canada. Substantial progress is being made.

Most of the wait-time problems derive from funding cuts by conservative national or provincial governments, or from the siphoning off of resources by private providers. But precisely because the Canadian system is publicly administered, Canadians are able to force their elected officials to fix problems, or get voted out of office.

Throughout Canada, there are multiple pilot programs that have succeeded in slashing wait times. Canada’s latest statistics show that median wait times for elective surgery in Canada is now three weeks — that’s less time than Aetna’s chief medical officer says Americans typically wait after being diagnosed with cancer.

Canada also has no waits for emergency surgeries. It also doesn’t have 44 million people who are uninsured because everyone has a national health-care card guaranteeing health care from any doctor or hospital they choose. And it doesn’t burden those with insurance with rising deductibles or co-pays. A study reported by Health Affairs, a policy journal, for example, found that out-of-pocket costs to U.S. consumers jumped 76 percent this year over last year alone.

Canada also surpasses the United States in a broad array of health barometers, including life expectancy, infant mortality rates, adult mortality rates, deaths due to HIV/AIDS, mortality rates for cardiovascular diseases and years of life lost to injuries and diseases, according to data from the World Health Organization and the Organization of Economic Co-operation and Development.

No wonder some people are so afraid we’ll learn the real comparative story about Canada’s system — and our own.

Deborah Burger, R.N., is president of the California Nurses Association.

SICKO Builds a Movement
Roger Hickey, TPM Cafe
7/8/07

[open for informational links]

Americans want big changes in our heath care system. And now Michael Moore’s great new film, SiCKO is helping to turn a desire for change into a crusade for change. Now breaking box office records in its second week in theaters, SiCKO conveys powerfully emotional stories of Americans trapped in a system controlled by insurance and drug companies that deny care and destroy lives in order to maintain their profits. We walk into the movie house individuals with our particular gripes about the health care system. And we walk out wanting to be part of a national movement for health care for all. For great account of how spontaneous organizing literally occurred in the theater lobby – at a Dallas, Texas suburban cineplex – click here.

So, what kind of movement should we be building? Unlike this weekend’s very expensive Live Earth rock and roll extravaganza whose major message (in the face of looming global environmental catastrophe) seemed to be to make personal life changes: “Buy better lightbulbs, unplug your cellphone chargers, and run your tour bus on bio-diesel,” the thoughts of people who see Moore’s movie turn immediately to institutional and political change.

After seeing Moore’s film, most people want to pose a big question to all politicians: Will you work to guarantee health care for all? Not incrementally – one disease at a time, or one group (like kids) and then another group (like their parents) in another program – but through a universal system of health care for all?

Here’s a second crucial question we should politicians: Will you pledge to cut the big insurance and drug companies out of a central role in the design of your universal health care plan? This week the Campaign for America’s Future joined with MoveOn in a campaign to urge our members to take friends to see SiCKO and then to communicate with all the candidates for president, asking them to reject contributions from big insurance and drug companies. We will publicize the answers.

The good news for those of us who come out of SiCKO inspired to change our health care system: Several of the presidential candidates – Edwards, Obama, and Kucinich – have already pledged not to take contributions from the insurance and drug companies, their pacs and their lobbyists. And each of those Democratic candidates has already put forward a plan to achieve health care for all. Hillary Clinton has announced she will come forward with a plan for universal health care in the coming months – a big step forward from her original posture of just covering kids first. It appears that Clinton’s campaign IS taking insurance and drug industry money, but she is under pressure to change that policy – which is the one of the goals of our email campaign. (Click here for info on how to reach her campaign and others.)

This is where two different tendencies in the health care movement diverge. Some people want to understand which of the possible nominees has the best plan – or discuss how we put pressure on him or her to get better. The other reaction – which I’ve gotten in person and in angry emails – says don’t even bother talking about the promising proposals coming from politicians like Edwards and Obama. They are just not as good as Dennis Kucinich’s plan (HR 676) which would create one national public (single-payer) health plan for everyone. Michael Moore, although he has generally wisely stayed above the details of specific policy, has given a few interviews dismissing Edwards and Obama as fatally flawed because they preserve a role for private insurers.

Now, there is nothing wrong with unremitting public pressure. If everyone who sees SiCKO is enlisted in the Kucinich campaign – and if everywhere the other candidates go, they are confronted with crowds chanting for single-payer, it could (in theory) convince Obama or Hillary or Edwards to embrace HR 676. Or failing that, if a Democrat gets to the White House anyway, he or she (or the more progressive new Congress) might be forced to support a pure single-payer plan sometime after the election. The debate about health care for all won’t be over on election day, it just begins. And everyone should energically raise their voices. Tell the politicians that we want a comprehensive health care plan that covers everyone. And those who think HR 676 is the only way to achieve that goal, should be vociferous – and they will. That kind of democracy in action is good.

But one big problem with “single-payer or nothing” – or Dennis Kucinich or nobody – is that it runs the risk of ignoring potentially important differences between the candidates who actually have a chance to win the nomination – and it takes the pressure off those candidates to try to improve their health care plans if they think that all the “SiCKO voters” are going to give our votes only to Kucinich.

Now, I happen to think that the health care plans put forward by Edwards and Obama represent pretty important proposals – much more understandable than Hillary Clinton’s 1993 plan or John Kerry’s undecipherable health care proposals in 2004. The prospect of debating Dennis Kucinich before audiences of progressive primary voters probably made Edwards’ and Obama’s plans somewhat more progressive – but they also got better because some of us paid attention to the details of what they and their advisers were saying – and pushed them in the right direction. (See links below.)

Do the Edwards or Obama plans remove the private health insurance industry from any and all role in expanding health care coverage? No. But both Edwards and Obama create a public program, similar to Medicare, that would play a central role in making sure all Americans have coverage. Here’s a description of Obama’s plan from David Cutler, one of his key advisers:

If you don’t have health insurance through your employer, you will be enrolled into a new, comprehensive public health insurance plan that emphasizes prevention, chronic care management and quality care. This plan will enjoy the great efficiencies we see in public plans like Medicare but, if you still cannot afford it, you will receive a subsidy to pay for it. Of course, you can choose private insurance if you prefer but the private plans will have to compete on a level playing field with the public plan—without the extra payments that tip the scales in favor of private Medicare Advantage plans today.

It ain’t pure single payer, and people have a choice of a regulated private insurance, but the plan people are automatically enrolled would end up being a pretty big single-payer public insurance program – like Medicare.

Edwards has a similar public insurance plan, and when he rolled it out for public discussion (well before Obama), he told Tim Russert of Meet the Press: “One of the choices . . . is the government plan. So people who like the idea of a single-payer insurer health plan, that is actually one of the alternatives that people can choose.”

We don’t know what Hillary Clinton’s plan will look like. She could cautiously aim at covering everyone only if she is re-elected for a second term (as she has hinted). And she could aim at achieving that goal incrementally, insuring all poor children first in one program, and middle-class kids in a separate program, and all adults in a separate program. That would be a disappointment. And people who think of themselves as “health care voters” should be letting her know that RIGHT NOW.

In this crucial primary season, some in the movement for health care for all will dismiss the differences between candidates, embracing only Dennis Kucinich and single-payer. But the rest of us, more realistically, should emphasize the most progressive elements of the Edwards and Obama – and Kucinich – proposals, while trying to use them to leverage a better, more progressive plan out of Hillary Clinton.

The single-payer advocates get the diagnosis of what’s wrong with American health care correct: the for-profit drug and health insurance industries who profit by denying people care and by manipulating the system. But even if you would like to completely cut these corporate interests out of our basic health care system, it would be real progress to achieve a public health insurance plan like Medicare that covers over half the population. And some of us think there could be a political advantage – and a good reply to the “Harry and Louise” propaganda from the insurance companies – if we can show that people who like their private insurance plans will get to keep things just the way they are.

Michael Moore has generated a lot of very productive emotion by exposing how the insurance industry denies care to people who thought they were covered or keeps sick people from getting insurance. But we all need to get used to another populist attack on the private health insurance industry – but not designed to take them out but to regulate them.

You can see it in California, where Arnold Schwarzenegger is trying to cover everyone without a public plan, so he has to try to put strong new restrictions on private insurance companies (who want to participate) to get them to insure all comers – even people with pre-existing conditions – and to do it at affordable premiums.

If any of the leading Democrats – Edwards, Obama, or Clinton – get elected president, we are likely to see two parallel experiments with the insurance industry: displace them as much as possible with the best possible public plan AND regulate the hell out of them to try to get them to change the business model so well described by Hillary Clinton at the Las Vegas health care debate: “Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.”

Our most important job is to build a strong movement with a clear goal: good health care guaranteed for all. And then we have to explain and re-explain how the business practices of the big health insurance and drug companies actually prevent us from achieving that goal. If we keep up pressure for strong reform and not just weak reform – perhaps we can build a health care system that puts people ahead of profits: the kind of system that – as Michael Moore showed us – the Canadians, the British and the French have enjoyed for decades.

http://commonsense.ourfuture.org/the_great_risk_shift_healthcare_for_all

http://commonsense.ourfuture.org/health_care_for_america

http://commonsense.ourfuture.org/health_care_for_america_blog_roundup

http://commonsense.ourfuture.org/edwards_gives_nod_toward_health_care_for_america

http://commonsense.ourfuture.org/blog_reaction_to_edwards_health_care_plan

http://commonsense.ourfuture.org/the_universal_health_care_debate_is_over

http://commonsense.ourfuture.org/where_the_health_care_debate_is_going

http://commonsense.ourfuture.org/health_care_answers_we_need/

http://commonsense.ourfuture.org/universal_care_getting_right_mix

http://commonsense.ourfuture.org/advisor_describes_obama_health_plan

http://www.tompaine.com/articles/2007/06/04/obamacare_clearing_away_the_fog.php

A Battle Over Expansion of Children’s Insurance
ROBERT PEAR, NYT
July 9, 2007

WASHINGTON, July 8 — The fight over a popular health insurance program for children is intensifying, with President Bush now leading efforts to block a major expansion of the program, which is a top priority for Congressional Democrats.

The seemingly uncontroversial goal of insuring more children has become the focus of an ideological battle between the White House and Congress. The fight epitomizes fundamental disagreements over the future of the nation’s health care system and the role of government.

Democrats have proposed a major expansion of the program, the State Children’s Health Insurance Program, to cover more youngsters with a substantial increase in federal spending.

Administration officials have denounced the Democratic proposal as a step toward government-run health care for all. They said it would speed the erosion of private insurance coverage. And they oppose two of the main ideas contemplated by Democrats to finance expanded coverage for children: an increase in the federal tobacco tax and cuts in Medicare payments to private insurance companies caring for the elderly.

White House objections to the Democratic plan are “philosophical and ideological,” said Allan B. Hubbard, assistant to the president for economic policy. In an interview, he said the Democrats’ proposal would move the nation toward “a single-payer health care system with rationing and price controls.”

Democrats said the insurance program, created 10 years ago with bipartisan support, had improved access to care for millions of children and sharply reduced the number who were uninsured. Democratic leaders in both houses of Congress — with support from doctors, consumer groups and many state officials — want to increase enrollment in the program, which served 7.4 million people at some time in the last year.

“We expect a showdown on the Senate floor at the end of this month,” said James P. Manley, a spokesman for the majority leader, Senator Harry Reid, Democrat of Nevada. “The program, which has enjoyed broad bipartisan support, is under assault by right-wing Republicans.”

State officials fear that the conflict in Washington could lead to an impasse.

“I am getting more and more nervous about the future of the program,” said Judith Arnold, director of the Children’s Health Insurance Program in New York.

In California, Gov. Arnold Schwarzenegger, a Republican, said it was “absolutely essential” that Congress renew and expand the program. Like many Democrats, he said Congress should increase spending by $50 billion over the next five years — the amount decried by Mr. Bush as “a massive expansion.”

Several Republican senators said they would work with the White House to prevent a major expansion of the program.

John Hart, a spokesman for Senator Tom Coburn, Republican of Oklahoma, said Mr. Coburn saw the Democratic plan as “part of an effort to bring everyone into a socialized health care system, a clarion call for Hillary Care, part two,” referring to the Clinton administration plan for universal coverage. Senator Jim DeMint, Republican of South Carolina, shared that view.

In a June 28 memorandum, House Democratic leaders said they hoped that providing coverage for more children would be “the signature Democratic health achievement” of this Congress. But, they predicted, “The administration will battle us every step of the way.” The memorandum was sent by Representatives John D. Dingell of Michigan, Frank Pallone Jr. of New Jersey, Charles B. Rangel of New York and Pete Stark of California.

Bush administration officials recently advised drug company executives not to support a major expansion of the program.

The Pharmaceutical Research and Manufacturers of America, a trade group, has been running television and newspaper advertisements that praise the program and urge Congress to renew it. The television advertisements show children cavorting on a playground and singing a jingle, “If you’re healthy and you know it, clap your hands.”

The drug industry has joined four organizations in a coalition to whip up support for the program. The coalition, Americans for Children’s Health, was incorporated last month and has a budget of several million dollars, mostly for advertising. Directors include lobbyists from the American Health Care Association, which represents nursing homes; the American Medical Association; Families USA, a liberal-leaning nonprofit consumer group; and the Federation of American Hospitals, which represents for-profit hospitals.

Mr. Hubbard said such groups “would be making a huge mistake to support expansion of the Children’s Health Insurance Program” along the lines proposed by Democrats.

In an interview, Michael O. Leavitt, the secretary of health and human services, said he had conveyed the administration’s concerns to Billy Tauzin, the president of Pharmaceutical Research and Manufacturers of America, and Kevin W. Sharer, the chief executive of Amgen and chairman of the trade association.

The federal government spends $5 billion a year on the children’s insurance program. If spending continues at that level, it would total $25 billion over five years. Congress has adopted a budget blueprint providing up to $50 billion more, for a total of $75 billion over five years. That dwarfs the $5 billion increase over five years proposed by Mr. Bush in February.

The Congressional Budget Office estimated that enrollment in the program would “fall to 6.7 million” under the president’s proposal.

In recent days, the Bush administration has taken several steps to slow momentum for expansion of the program:

¶ The Department of Health and Human Services has tried to redefine the magnitude of the problem by issuing a new study that says one million uninsured children are already eligible for Medicaid or the children’s insurance program. Previous estimates by private researchers and government experts put the number at more than 5 million.

¶ Regional directors of the department have sent identical letters to newspapers, warning against “a government takeover of the health care marketplace.”

¶ Administration officials said Congress should include the president’s proposal to change the tax treatment of employer-sponsored health benefits as part of any legislation to renew the children’s insurance program.

In his 2008 budget request, Mr. Bush proposed replacing virtually all of the current tax breaks for health insurance with a new standard deduction for any taxpayer who buys a qualifying health plan. House Democratic leaders have flatly rejected the proposal. Senate Democratic leaders have said it has no place in a bill to cover children.

To return the children’s insurance program to what he calls “its original intent,” Mr. Bush has asked Congress to reduce federal payments to the states for coverage of children in families with incomes of more than twice the poverty level. (A family of four is considered poor if its annual income is less than $20,650.) At least 18 states cover children with family incomes more than twice the poverty level.

In Indiana, Gov. Mitch Daniels, a Republican who was Mr. Bush’s first budget director, recently signed a bill into law that raised the ceiling to 300 percent of the poverty level, from 200 percent.

The New York State Legislature recently approved a proposal by Gov. Eliot Spitzer, a Democrat, to increase the eligibility limit to 400 percent of the poverty level.

Mr. Leavitt said it was absurd that “families making over $81,000 a year would have children eligible for public assistance.”

Mr. Bush and some Republicans in Congress worry that as public coverage becomes available to families with higher incomes, it tends to replace private coverage.

In a recent report, the Congressional Budget Office said that for every 100 children who get public coverage as a result of the children’s insurance program, “there is a corresponding reduction in private coverage of between 25 and 50 children.”

That increases the cost of efforts to expand coverage, according to the budget office, because the government inevitably picks up some people who recently had private insurance when it tries to sign up the uninsured. Thus, the budget office said, to reduce the number of uninsured children by three million, states may need to add four million to six million children to the rolls.

Peter R. Orszag, director of the budget office, said that other efforts to expand coverage — for example, by offering tax breaks for buying private insurance — faced a similar challenge: some benefits would go to people who already had coverage.

“So keep fightin’ for freedom and justice, beloveds, but don’t you forget to have fun doin’ it. Lord, let your laughter ring forth. Be outrageous, ridicule the fraidy-cats, rejoice in all the oddities that freedom can produce. And when you get through kickin’ ass and celebratin’ the sheer joy of a good fight, be sure to tell those who come after how much fun it was.”
~ Molly Ivins, 1944 - 2007

In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.
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