The Devil you know

Up to this point, Obama has been absorbed with doing massive clean-up of Dubbys slop and handling the issues of the day — now comes health care, dear to his heart. This is both emotional, given how many suffer … and pragmatic, given how large a percentage of the economy medical costs gobble, due to almost double in the coming decades; just about everybody agrees that something must be done. And that’s where it breaks down.

It’s become obvious that the for-profit insurers and hospital conglomerates suck up tons of money [approximately 1/3rd of the take] while denying services for those who can’t pay, over-testing and treating those who can. If I had to pick one word for this whole system … proposed and nurtured in the Tricky Dick Nixon era … I’d select ’scam.’ Money is greasing palms all along this conveyer belt and let’s not forget that Big Pharma has their stake in it; everything is configured to make change unlikely or impossible. Clinton tried … we all remember that stunning defeat.

Obama is breaking his habitual pattern to become deeply involved in this process; he usually leaves it all to the Congress, trusting Emmanuel to move the players around. He’s determined that the Summer will produce something workable in the Fall — but the lobby’s are busy issuing warnings and handing out money, and the Pub swiftboaters are already on it, trying to sway with scare tactics.

Although only one of the issues that brought down GM, employer-paid health care [factored into car costs] was a big chunk of it; this is a large portion of what drives outsourcing to other countries. As small businesses struggle, providing insurance becomes a moot point; and bankruptcies still reflect medical bills as the major provocateur. The financial recovery of the nation depends on remediation of the medical debacle. Costs are simply outrageous … and rectifying this nonsense is looooooong overdue. For instance, I have a dear friend who is having a kidney stone dissolved today, in an out-patient procedure [Be well, Deb!] Cost for this no-frills afternoon? $10,000. Freaking absurd!

Most Libs want single-payer; I certainly do. And not just liberals, despite the PR and punditry cross-chat. Back in 2003, an ABC/Washington Post poll [pdf] gave us these numbers:

79% of Americans say they support “providing health care coverage for all Americans, even if it means raising taxes” over “holding down taxes, even if it means some Americans do not have health care coverage.”

62% say they support a universal health care system “run by the government and financed by taxpayers” over the current system.

57% say they would support this program even “if it limited your own choice of doctors” (which doesn’t necessarily have to be a side-effect of a single-payer system).

62% say they would support this program even “if it meant there were waiting lists for some non-emergency treatments” (again, not necessarily a side-effect).

If it looked like that in ‘03, imagine what it looks like today, given the unemployment [1 in 10.] The recent Bill Moyer’s PBS piece on single payer was widely watched and approved — even the uber-conservative Spokane, WA [I lived there awhile] Spokesman-Review ran the ledeline, “Logic backs single payer.”

Obama has his sleeves rolled up, but those he had on board during his campaign, Daschle and Kennedy, have less to offer; Kennedy has engaged as he is able, Daschle is a memory. Obama seems to think single payer isn’t in the cards, but insists on an optional government entity that would provide competition for the Usual Suspects. Just getting to that spot will take some elbow grease. Now Obama has to deal with bid’ness-cozy Blue Dog, Ben Nelson, of Nebraska:

Sen. Ben Nelson (D-NE) is no longer opposed to including a public option in health care reform, saying, “I have not closed my mind to any option.” However, he told the Journal-Star newspaper that he does not want it to “‘destabilize or adversely affect’ the private health insurance coverage now in place for most Americans.”

Single payer doesn’t look to have much of a shot, and there are many reasons this is an uphill battle [and one cause: money] — media won’t support it, insurers don’t want to compete with it, the Socialism meme still makes hay with the over-insured seniors, the Dems are beholden … don’t doubt it … to big Med $$ and the Pubs are in the corporate pocket. It’s been by sheer presidential will and Dem opportunity-sniffing that the entire health conversation has come this far. And there’s nothing, really, stopping it … but obstructive POLITICS. Pfffffft!

Let’s face it — health care is personal; it’s even intimate. You establish a trust relationship with your providers; you may love your doctor, but is it necessary to choose between seeing him/her and eating? NO, it isn’t. The article at bottom [above the bonus] is a clear example of why this shouldn’t have to happen — a myth-buster from a Canadian about what their government-provided health care produces indicates that Doctors are happy, patients are happy — and taxes aren’t higher. Mike Moore’s given us the visual; this article is a good pass-around, for sure.

Health insurers also have a cozy relationship — with our money. They’re BANKERS … believe it. And everything seems to be configured to keep us dancing with the Devil we know — it’s up to us to demand a New Deal. NOW’s the time … it won’t come again soon. You’ll find info on Dr. Howard Dean’s grassroots movement, Health Care For American Now, at this link. The DNC is pushing off an Obama grassroots barrage called Organizing for America, as well.

And speaking of devils, the two young reporters — Lisa Ling’s sister, Laura, and Euna Lee — held on spying charges for crossing the North Korean border, inadvertently if at all, have been … tragically … sentenced to 12 years hard labor. It’s amazing how clueless L’il Kim is … and how determined to get swept up with the trash as the world moves forward. Hillary spoke very sternly of NK this weekend; rumor has it that perhaps Bill Richardson and Al Gore will negotiate for a pardon. While most people have their yea’s or nay’s about most foreign problems, everybody is agreed on North Korea — the only argument is about HOW to put it out of its misery before it hurts anyone else.

Below — a timely collection. A really interesting, in-depth NYT’s piece about how Obama is attempting to remediate the balance between the Executive and Congressional branches; a couple of good reads on the ‘trigger’ issue that could kill off effective change; media and swiftboating obstructions.

The bonus is WELL worth a glance, and worth passing around, as well. A young Christocratic medical student discusses why she will provide abortion, and why she changed her mind about it — this conversation has been prompted by Dr. Tiller’s murder … which wouldn’t have happened if the FBI had done their job!

If you’re only going to read one today, I’d recommend Bob Reich’s piece — but if I were you, I’d savor the rest. Good stuff here, and being informed will keep the Devil away.

Jude

Taking the Hill
MATT BAI, New York Times
Published: June 2, 2009

Sometime in the next few weeks, Congress and the White House will descend into the labyrinthine politics of comprehensive health care reform. For Barack Obama, this signals the end, in a sense, of the eventful prologue to his presidency. Impressive as they are, Obama’s legislative victories to this point — most notably the $787 billion stimulus bill and a stunningly ambitious $3.6 trillion budget resolution — have been relatively easy lifts for a popular new president installed at a time of economic crisis and buffered by comfortable majorities in the House and Senate. Sure, getting those bills passed required a fair amount of perseverance on the part of the White House, but persuading congressmen to spend public money in their districts doesn’t exactly qualify as dark magic. Designing a new health care system, on the other hand, is a legislative goal that has eluded every Democratic president since Harry Truman and that Obama repeatedly vowed to accomplish during last year’s campaign; he has said that it is not only a moral imperative but also a crucial part of his plan to remake the American economy, an ever-expanding share of which is swallowed up by doctors’ bills and hospital stays. Making good on his promise will require not just public expenditure on a disorienting scale but also the kind of activism and creativity, the birthing of new rules and institutions, at which Washington hasn’t succeeded for generations.

It has been 16 years, in fact, since another young, freshly inaugurated Democratic president with a Democratic Congress tried to remake the architecture of health care, and the catastrophe that followed is generally cited as the main deterrent to thinking big about anything in the capital. The plan Bill Clinton took to Congress then, running to more than 1,000 pages of impenetrable new regulations, wasn’t what you’d call politically savvy, but the strategy used to sell it was even worse. Having been elected as the latest in a series of outsider presidents after Watergate, ex-Governor Clinton seemed to believe he had been sent by the voters to purify the fetid culture of Washington; he installed a boyhood friend as his chief of staff and stocked his White House with loyal Arkansans and campaign aides ready to overrun a fossilized Congress. His wife, the current secretary of state, developed the health care plan largely without taking House and Senate leaders into her confidence, instead dropping it at the doorstep of the Capitol as a fait accompli. Ever jealous of its prerogative, Congress took a long look, yawned and kicked the whole plan to the gutter, where it soon washed away for good — along with much of Clinton’s ambition for his presidency.

The first senator elected directly to the Oval Office since 1960, Obama has an entirely different theory of how to exercise presidential power, and he has consciously designed his administration to avoid Clinton’s fate. After winning the office with the same kind of outsider appeal as his predecessors, he has quietly but methodically assembled the most Congress-centric administration in modern history. Obama’s White House is run by Rahm Emanuel, a former House leader who was generally considered to be on a fast track to the speakership before he resigned to become chief of staff, and it is teeming with aides plucked from the senior ranks of both chambers. Obama seems to think that the dysfunction in Washington isn’t only about the heightened enmity between the parties; it’s also about the longstanding mistrust between the two branches of government that stare each other down from twin peaks on either end of Pennsylvania Avenue.

And so, from Obama’s perspective, passing a health care plan this fall isn’t primarily a question of whether to include an “individual mandate” requiring every American to have insurance or how fully to regulate providers or even how to hit back against “Harry and Louise”–type attack ads, although his aides spend time contemplating all of those things. It’s more about navigating the dueling personalities and complex agendas within his own party’s Congress. Rather than laying out an intricate plan and then trying to sell it on the Hill, as Clinton did, Obama’s strategy seems to be exactly the opposite — to sell himself to Congress first and worry about the details later. As Emanuel likes to tell his West Wing staff: “The only nonnegotiable principle here is success. Everything else is negotiable.” [...]

[open link to finish this article]

How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do
Robert Reich, Common Dreams
Saturday, June 6, 2009

I’ved poked around Washington today, talking with friends on the Hill who confirm the worst: Big Pharma and Big Insurance are gaining ground in their campaign to kill the public option in the emerging health care bill.

You know why, of course. They don’t want a public option that would compete with private insurers and use its bargaining power to negotiate better rates with drug companies. They argue that would be unfair. Unfair? Unfair to give more people better health care at lower cost? To Pharma and Insurance, “unfair” is anything that undermines their profits.

So they’re pulling out all the stops — pushing Democrats and a handful of so-called “moderate” Republicans who say they’re in favor of a public option to support legislation that would include it in name only. One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they’ve been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers.

Max Baucus, Chair of Senate Finance (now exactly why does the Senate Finance Committee have so much say over health care?) hasn’t shown his cards but staffers tell me he’s more than happy to sign on to any one of these. But Baucus is waiting for more support from his colleagues, and none of the three proposals has emerged as the leading candidate for those who want to kill the public option without showing they’re killing it. Meanwhile, Ted Kennedy and his staff are still pushing for a full public option, but with Kennedy ailing, he might not be able to round up the votes. (Kennedy’s health committee released a draft of a bill today, which contains the full public option.)

Enter Olympia Snowe. Her move is important, not because she’s Republican (the Senate needs only 51 votes to pass this) but because she’s well-respected and considered non-partisan, and therefore offers some cover to Democrats who may need it. Last night Snowe hosted a private meeting between members and staffers about a new proposal Pharma and Insurance are floating, and apparently she’s already gained the tentative support of several Democrats (including Ron Wyden and Thomas Carper). Under Snowe’s proposal, the public option would kick in years from now, but it would be triggered only if insurance companies fail to bring down healthcare costs and expand coverage in he meantime.

What’s the catch? First, these conditions are likely to be achieved by other pieces of the emerging legislation; for example, computerized records will bring down costs a tad, and a mandate requiring everyone to have coverage will automatically expand coverage. If it ever comes to it, Pharma and Insurance can argue that their mere participation fulfills their part of the bargain, so no public option will need to be triggered. Second, as Pharma and Insurance well know, “years from now” in legislative terms means never. There will never be a better time than now to enact a public option. If it’s not included, in a few years the public’s attention will be elsewhere.

Much the same dynamic is occurring in the House. Two members who had originally supported single payer told me that Pharma and Insurance have launched the same strategy there, and many House members are looking to see what happens in the Senate. Snowe’s “trigger” is already buzzing among members.

All this will be decided within days or weeks. And once those who want to kill the public option without their fingerprints on the murder weapon begin to agree on a proposal — Snowe’s “trigger” or any other — the public option will be very hard to revive. The White House must now insist on a genuine public option. And you, dear reader, must insist as well.

This is it, folks. The concrete is being mixed and about to be poured. And after it’s poured and hardens, universal health care will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers — one that gives the public insurer bargaining leverage over drug companies, and pushes insurers to do what they’ve promised to do. Don’t wait until the concrete hardens and we’ve lost this battle. ++

Time to Trash the Trigger
Mike Lux, HuffPo
June 2, 2009

In every major legislative battle, there are a few critical moments that decide the fate of that legislation. In health care reform, we have already seen two: the first when President Obama insisted that we do health care reform this year; the second when Senate Democrats had the guts to ignore Republican hysterics and decided they would move health care in a way that required a simple majority instead of 60 votes. The third big moment is upon us, and the fate of whether we can get real reform of the health care system accomplished will likely be decided over the next few days. The moment I am talking about is the debate of the so-called trigger mechanism for having a public option in health care insurance.

The insurance lobby has had multiple tactics for stopping the public option idea, which they despise because they know if regular folks have choice to go to a public option, insurance companies won’t have the same ability to treat their customers like garbage when they get sick. The first tactic was just to try to kill the public option outright, and the good news is that they appear to have failed at that. This so-called trigger proposal is the second tactic: the idea is to write a “trigger” that will allow for a public option only under certain conditions, but write the legislation so that those conditions would never get met in the real world. It’s a classic DC tactic, right up there with calling for a commission to study something. Olympia Snowe is carrying the insurance industry water on their trigger proposal, proposing triggers that would only get tripped in some fairyland none of us have ever visited.

The great thing for the insurance companies in a tactic like this is that it gives “centrist” Senators (centrist in Washington, DC usually means those who have taken massive amounts of campaign contributions from the affected industry) an excuse to help the insurance industry while looking like they are open to the public option that their constituents have been demanding.

Barack Obama and Democrats in Congress have gotten some good things done so far, and are building real momentum in getting us moving in the right direction on health care. But if conservative Democrats force the adoption of the trigger, it will destroy Democratic unity and doom health care reform, because progressives will start attacking Democrats rather than insurance companies. We really are at a critical moment.

The only committee seriously considering the trigger turkey is the Senate Finance Committee, whose members average several hundred thousand a piece in insurance industry contributions. If you care about getting true health care reform, now is the time to make your voice heard: call the Senate Finance Committee members and tell them “NO to a trigger.” ++

Michael Winship and Bill Moyers: Rx and the single payer
The Galesburg Register-Mail
May 26, 2009

CANANDAIGUA, N.Y. — In 2003, a young Illinois state senator named Barack Obama told a local AFL-CIO meeting, “I am a proponent of a single-payer universal health care program.”

Single payer. Universal. That’s health coverage, like Medicare, but for everyone who wants it. Single payer eliminates insurance companies as pricey middlemen. The government pays care providers directly. It’s a system that polls consistently have shown the American people favoring by as much as two to one.

There was only one thing standing in the way, Obama said six years ago: “All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House.”

Fast forward six years. President Obama has everything he said was needed — Democrats in control of the executive branch and both chambers of Congress. So what’s happened to single payer?

A woman at his town hall meeting in New Mexico last week asked him exactly that. “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense,” the president replied. “The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based health care. … We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

President Obama favors a public health plan competing with the medical cartel that he hopes will create a real market that would bring down costs. But single payer has vanished from his radar.

At that big White House powwow in Washington last week, representatives of the health care industry promised to cut health care costs voluntarily over the next 10 years. The press ate it up — and Mr. Obama was a happy man.

But anyone with any memory left could be excused for raising their eyebrows at the health care industry’s latest promises. They’ve done this before — ask Presidents Carter and Clinton. Hardly had their pledge of volunteerism rung out across the land than Jay Gellert, chief executive of Health Net Inc. and chairman of the lobbying group America’s Health Insurance Plans, assured his pals not to worry abut the voluntary reductions. “We believe that we can do it without undermining the viability of companies,” he said, “and in effect enhancing the payment to physicians and hospitals.” In other words, their so-called voluntary “reforms” will in no way interfere with maximizing profits.

According to the non-partisan Center for Responsive Politics, the health sector spent more than $134 million on lobbying in the first quarter of 2009 alone. And some already are shelling out big bucks for a publicity blitz attacking any health care reform that threatens to reduce the profits from sickness and disease.

In May, the group Conservatives for Patients’ Rights is spending more than $1 million for attack ads. They’ve hired a public relations firm called CRC. You remember them — the same high-minded folks who brought you the Swift Boat Veterans for Truth.

The ads feature Rick Scott, an entrepreneur who took two hospitals in Texas and built them into the largest health care chain in the world, Columbia/HCA. In 1997, he was fired by the board of directors after Columbia/HCA was caught in a scheme that ripped off the Feds and state governments for hundreds of millions of dollars in bogus Medicare and Medicaid payments, the largest such fraud in history. The company had to cough up $1.7 billion to get out of the mess.

Rick Scott got off, you should excuse the expression, scot-free. Better than, in fact. According to published reports, he waltzed away with a $10 million severance deal and $300 million worth of stock. So much for voluntarily lowering overhead.

With medical costs rising 6 percent per year, that’s who’s offering himself as a spokesman for the health care industry. Speaking up for single payer is Geri Jenkins, a president of the California Nurses Association and National Nurses Organizing Committee — a registered nurse with literal hands-on experience.

“We’re there around the clock,” she told our colleague Jessica Wang. “So we feel a real sense of obligation to advocate for the best interests of our patients and the public. Now, you can talk about policy, but when you’re staring at a human face it’s a whole different story.” ++

Swiftboating Health Care Reform
Faiz Shakir, Amanda Terkel, Satyam Khanna, Matt Corley, Benjamin Armbruster, Ali Frick, and Ryan Powers - American Progress Report
June 1, 2009
[open for lots of links]

Yesterday, immediately following NBC’s Meet the Press, the right-wing group Conservatives for Patients’ Rights (CPR) aired a 30-minute paid advertisement titled “The End of Patients’ Rights: The Human Consequences of Government Run Health Care.” Hosted by former CNN reporter Gene Randall, the program featured “horror stories” aimed at chipping away public support for reforming the U.S. health care system. As Fox News explained, “the new infomercial, despite the ‘paid programming’ label in the upper-left hand corner of the screen, had the appearance of a ‘60 Minutes’ special” — without the credibility, of course. The disgraced former CEO of Columbia/HCA Healthcare and now chairman of CPR, Rick Scott, appeared multiple times in the program warning that health care reform would result in the rationing of care, long waiting lists, and diminished quality. CPR’s ad was premised on the false notion that “certain nefarious Democrats want to import British and Canadian health care into the United States.” But as Wonk Room health care blogger Igor Volsky has noted, “CPR conflates deficiencies of the foreign health care systems with American reform efforts, but fails to cite a single Democrat who would want to copy-and-paste the British or Canadian examples.” CPR’s infomercial “presents the Democrats’ reforms not as they are, but as conservatives wish for them to be,” and as such, spends time warning Americans about the so-called “horror stories” of foreign health care system on which they will never have to rely.

A HISTORY OF FRAUD: If CPR wants to appear credible, it is indeed strange that Scott is such a prominent feature of its campaign against health care reform. As Progressive Media documented in a video report on Scott’s history (view the short video here), Scott is “credited with transforming the American health care system into the profit above-all-else culture that is currently plaguing America.” In his zealous attempt to turn his former company Columbia/HCA into the “McDonald’s” of the health care industry, Scott’s company “increased Medicare billings by exaggerating the seriousness of the illnesses they were treating,” “granted doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA,” and “gave doctors ‘loans’ that were never expected to be paid back, free rent, free office furniture, and free drugs from hospital pharmacies.” The government pursued Scott’s company in a seven-year fraud investigation that resulted in Columbia/HCA being fined $1.7 billion. While the fraud was illegal, the real horror stories came out of the abusive and negligent ways in which Columbia/HCA hospitals treated patients. ABC News reported in 1993 that nursing staffs were reduced in size to save costs, but resulted in newborns being “attended as infrequently as every three hours. Once, the only nurse caring for seven ill infants was so busy she failed to hear an alarm when a baby stopped breathing.” In a hospital run by Columbia/HCA in California, employees protested “filthy conditions,” while hospital staffers in Florida complained that “gloves come in only one size, and rip easily.” Despite this, CPR’s documentary touted Scott’s background as CEO of Columbia/HCA saying, “under his leadership…Columbia had the lowest cost per patient of any category of hospital.” Scott’s tenure as head of Columbia/HCA is a prime example of what Americans can expect from their health care system in the future of so-called “free market” health care advocates win out.

SWIFTBOATING HEALTH CARE REFORM: To coordinate its attack on health care reform, CPR hired CRC Public Relations, the group “that masterminded the ‘Swift Boat’ attacks against 2004 Democratic presidential candidate John F. Kerry.” CRC is reportedly using as a model the “‘Harry and Louise’ ads that helped torpedo health-care reform during the Clinton administration.” As in the Swift Boat campaign, CPR’s anti-reform campaign is well-financed and is misleading the public. Indeed, in March and April, the group spent $1.2 million on ads, with another $1 million spent in May alone. In all, the group has been seeded with millions from Scott’s personal fortune. As for the group’s apparent distaste for honest debate, their campaign is rife with warnings that health care reformers are determined to emulate the health care systems of Great Britain and Canada for use in the U.S. But as Volsky notes, “Most policy makers are looking for a ‘uniquely American solution’ that preserves the employer-sponsored system and creates a hybrid public-private partnership.” The system would leave the “provision of health care…in private hands” and create a marketplace within which public and private insurers can compete on price while insuring the sickest patients. Fundamentally, however, CPR’s fear mongering about single-payer health care systems is dishonest. As Jonathan Cohn explains in his book Sick, “The stories about Canada are wildly exaggerated. And the pinched access to services in Britain, at least, isn’t a product of universal health care. It’s a product of universal health care on the cheap.” “The British spend just 7 percent of their national wealth on health care, less than half of what Americans spend. It’s possible to spend more than that–and get more–while still spending less than the United States does. A perfect example is Japan. Relative to the United States, Japan spends about 60 percent as much of its wealth on health care. But the Japanese don’t wait for medical services. … Japan leads the world in the availability of technology such as CT scanners and MRI machines,” Cohn writes. As Washington Post blogger Ezra Klein notes, despite there being wait times for non-essential care in Britain, the outcomes for care do not appear to be worse.

EMBRACED BY THE RIGHT WING: Klein recently remarked that Scott’s high-profile defense of the health care status quo was akin to former President Bush “tasking Donald Rumsfeld with a comprehensive defense of his administration’s legacy.” Indeed, despite Scott’s well-known history as a health care fraudster, the right wing appears to be wholeheartedly embracing him, his organization, and his message. In recent weeks, Scott has been hosted at an “influential weekly breakfast organized by anti-tax activist Grover Norquist.” The right-wing National Review promoted CPR’s ad campaign and interviewed Scott at length without ever noting his background. Fox News hosted Scott multiple times in recent months before they disclosed his controversial past. Rep. Michael Burgess (R-TX) “invited Mr. Scott to meet with him on Tuesday because he liked what Mr. Scott had been saying.” It’s clear why the right has embraced Scott. While he’s yet to use such language in his current attempt to scuttle reform, in 1993 he vowed to do “everything I can” to defeat Clinton’s health care proposal. But while conservatives are getting on board with Scott, the Washington Post explains that, “for the moment,” his campaign is relatively independent of “major insurers, hospitals and other health-care providers” because such stake holders have hopes of working with President Obama and the Congress to constructively “shap[e] the outcome of a final reform package.” Indeed, a senior executive with the insurance industry organization that ran the “Harry and Louise” ads which helped stop former President Clinton’s attempts at health care reform told the New York Times, “I just don’t understand why he would be a messenger people would listen to. I don’t think people are waiting to hear from him.”

Eleven progressive groups are planning to spend at least $82 million to push health care reform that includes a public health insurance plan option. The announcement of the progressive push, which is being billed as their largest health reform campaign ever, is being timed to coincide with the kick off the America’s Future Now conference.

Ignoring Its Own Reporting, NYT Can’t Find Any Supporters of a Public Health Plan Option
Scarecrow, FireDogLake via Oxdown
Saturday June 6, 2009

“Why, oh why can’t we have a better press corps?”
– Brad DeLong et al

The New York Times informs us that President Obama is launching a major effort to generate support for health care reform, taking personal responsibility for promoting a central piece of his domestic agenda.

After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the health care debate and is preparing an intense push for legislation that will include speeches, town-hall-style meetings and much deeper engagement with lawmakers, senior White House officials say.

But according to Times reporter Sheryl Gay Stolberg, the battle may already be lost because of bipartisan opposition to, among other things, a public health insurance option:

If he embraces a tax on employee benefits, an idea he attacked when he was running for president, he may infuriate labor and the middle class. If he insists on a big-government plan in the image of Medicare, he could lose any hope of Republican support and ignite an insurance industry backlash. If he does not come up with credible ways to pay for his plan, which by some estimates could cost more than $1 trillion over 10 years, moderate Democrats could balk.

So where is this ominous rejection of a public plan option coming from? Why it’s all the Republicans who just got thrashed in the last two elections and a few “moderate” Democrats who just don’t get it. Never mind that the Senate has already voted to allow health reform to be adopted with 51 votes.

Thus, Stolberg tracks down Sens. Mitch McConnell and Chuck Grassley to complain about how a public plan would doom any chance of reform. And of course Stolberg doesn’t get any push back from Grassley’s pal, Max Baucus, nor from Sen. Wyden, also quoted, who’s pushing a rival plan without a public option. Finally, to confirm the imminent death of the public plan, we read about Kent Conrad’s wish to get Republican support.

So nobody wants a public plan, right? Wrong.

Let’s see:
[open for lots of links]

1. The New York Times just published a story about Senator Kennedy’s draft of a reform bill that prominently features a public plan in direct competition with private insurance.

2. The Congressional Progressive Caucus with 77 members just issued a strong statement supporting a public plan option, while noting the “overwhelming majority” of them prefer an even stronger “single payer” version of the public plan concept.

3. Despite his opposition, Max Baucus has been forced repeatedly to say that a public plan is “still on the table,” and at recent home-state meetings, his constituents pounded him for excluding single payer and selling out to the insurance industry.

4. Despite being unable to express any coherent position on health care reform, even Sen. Nelson (D-Neb.) had to deal with hometown anger over his earlier opposition; he later “clarified” his views to say he hasn’t ruled out a public plan.

5. As reported by the Times, Obama just strongly endorsed the need for a public plan to “give [consumers] a better range of choices, make the health care market more competitive, and keep insurance companies honest.” Sounds like this is an essential feature that Obama will fight for.

6. Polls repeatedly show broad public support for a stonger government role in guaranteed health coverage and for a public health insurance option. This might have some connection to the fact that another “large government health program,” Medicare, enjoys overwhelming public support.

7. The concept also has the support of major newspaper editorial boards and respected op-ed columnists. Part of the reason is that the current failed insurance system is driving Americans into bankruptcy, as the Times reported. (h/t Dru)

8. And the NYT just reported that the private insurance industry has utterly failed to provide affordable health insurance to small businesses, which could be solved if their employees had open access to an affordable public plan.

9. And there are lots of other supporters — e.g., these, or these, or these, or these, or this guy, or . . . — the Times might have asked.

So whom does the Times seek out for quotes to express support for a public plan option or give us a more favorable view of its importance?

[crickets]

Update: Not to be outdone by the New York Times, the LA Times’ Lisa Girlon has an equally one-sided article focused on the insurance industry’s point of view, though at least Ms. Girlon found one supporter of a public plan to quote. But she doesn’t tell her readers that an individual, universal mandate to purchase insurance, which the insurance companies naturally want because it’s a guaranteed market, would be unacceptable unless coupled with giving consumers a choice of an affordable, quality care public option. ++

Democrats mobilize on health care
CAREY GILLAM, Capital Hill Blue
June 8, 2009

From a living room in Kansas to a bagel shop in New York to an Alabama church, Democrats have started mobilizing support for President Barack Obama’s healthcare reform plans.

Suburban housewives and social workers mixed with Baptist ministers, college students, retirees and many others at grassroots gatherings over the weekend. Spurred by the Democratic National Committee’s burgeoning political machine dubbed “Organizing for America,” thousands of such meetings had been planned for Friday through Monday.

Those attending the scripted two-hour events viewed a videotaped message from Obama, shared personal stories and made local battle plans to counter the expected stiff opposition.

“It’s going to be a vicious fight,” said 76-year-old Hank Putsch who attended an organizing meeting on Saturday at a Kansas City restaurant. “The insurance companies and healthcare companies are gearing up to oppose this. We’ve got to get our voices heard.”

Obama has declared this summer “make-or-break” time for healthcare reform and has called on Congress to pass comprehensive legislation by the end of the year, saying America can no longer afford the costs of a system dominated by profit-driven insurance and healthcare companies which leaves 46 million people uninsured.

Though he is leaving the details to Congress, Obama has said reform must ensure a public
health insurance option operating alongside private plans, a reduction in basic costs, and assurance that no one is denied insurance.

“This is why we elected him,” said Sarah Starnes, a hospital social worker who has volunteered to help campaign for the Obama plan in Missouri. “It used to be that we’d elect a president and then the lobbyists would determine what happened. This time it is going to be us who determine what happens.”

The Democrats’ strategy calls for tapping an estimated 2 million volunteers and a database of more than 10 million e-mail addresses built during Obama’s election campaign.

Supporters are receiving talking points and scripted messages to lobby friends and family. A signature drive is underway to petition members of Congress and online fund-raising is earmarked for TV and radio advertisements.

Supporters hope to demonstrate their strength in a “National Health Care Day of Service” later this month.

“All it takes is one big medical crisis to ruin a family,” said Melissa Carlson, who with her husband Bob, hosted an organizing effort on Saturday in their Overland Park, Kansas home.

“One person can’t make a difference but if we all do something eventually it adds up.”

White House economic advisers last week said U.S. healthcare spending accounts for about 18 percent of the country’s economic output, but could reach 34 percent by 2040 and the uninsured population could climb to 72 million.

Even those with insurance are finding it harder to pay their portion of medical bills while job losses are making healthcare costs more burdensome.

At one meeting held Saturday in a suburban Dallas, Texas, home, 59-year-old Grace Allison said she could not pay for a recent emergency room visit after losing her health insurance along with her job as a university administrator.

“I don’t have $1,000 in my bank account. If I don’t pay it affects my credit,” she said.

Previous administrations, most notably President Bill Clinton’s, have attempted healthcare reform. But well-financed opposition from corporate and political interests derailed their efforts.

It’s too early to tell whether or not the Organizing for America efforts will translate to much pressure on Congress. The effort is fresh and no numbers were available on how many people are jumping on board.

Opponents are also getting organized. One group, Conservatives for Patients’ Rights, last week launched a television ad warning that if the federal government becomes a player in healthcare insurance, it will erode private plans, leaving citizens with no choices about their care.

Critics also charge reform efforts could be too costly, adding to an already bloated deficit.
Observers said the aggressive grassroots push started this weekend could easily falter.

“Healthcare reform means different things to different people,” said Peter Brown, assistant director of the Quinnipiac University Polling Institute.

“To some people it means covering everybody, to others it means lowering their premiums. Almost everybody is for healthcare reform but they may not be for the same kinds of reform.” ++

Debunking Canadian Health Care Myths
Rhonda Hackett, The Denver Post via Common Dreams
Sunday, June 7, 2009 by

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I’ll avoid answering, regardless of the questioner’s nationality. To choose one or the other system usually translates into a heated discussion of each one’s merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America’s health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada’s taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada’s health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn’t when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada’s government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don’t get one no matter what your doctor thinks - unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists’ care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society.

Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not “socialized medicine” but “social insurance” systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren’t enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn’t the big bad “socialist” bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty - who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care - will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life. ++

Rhonda Hackett of Castle Rock, Colorado is a clinical psychologist.

bonus

My Choice
I grew up believing that abortions are wrong. Now, I expect to perform them someday.
Rozalyn Farmer Love, Washington Post
Sunday, June 7, 2009

If I’d passed her on the street, I probably wouldn’t have known her. Her gait is a bit stiff and her left eye somehow different from her right. She’s not famous, exactly, but some people might know her name: Emily Lyons. She’s the nurse who survived the 1998 bombing of an abortion clinic in Birmingham, Ala.

I was 14 years old when that clinic was bombed, killing a police officer and spraying Emily’s body full of hot nails and shrapnel. Back then, I lived in a small Alabama town, went to church every Sunday and was adamantly opposed to abortion. But by the time I met Emily last year, I was president of the Birmingham chapter of Medical Students for Choice, a group supporting abortion rights. Watching her walk slowly into our fundraiser on her husband’s arm — a woman who’d endured more than 18 operations — I thought of all she’d been through and knew that I’d come to the right decision in my support of reproductive rights.

That conviction only became stronger after I read that Kansas physician George Tiller had been shot and killed in the lobby of his Wichita church a week ago.

I’m a third-year medical student at the University of Alabama at Birmingham. I plan to become an obstetrician-gynecologist. I dream of delivering healthy babies, working with families and supporting midwifery. But as part of my practice, I also envision providing abortions to women who need them.

The road I took to get here isn’t your stereotypical one. My parents are conservative Christians who believe that abortion is wrong. Growing up, I naturally shared their view. But I’ve also wanted to be a doctor since I was 4 years old, and in high school, I began to feel drawn to issues of women’s health. In college, I designed my own major to broaden my understanding of women’s health by including psychology, sociology and women’s studies courses.

I also served as a counselor for a volunteer organization that helps victims of rape. I sat in hospital rooms with young women who would look at me and say, “I can’t be pregnant. I just couldn’t carry his baby.” I could feel their desperation.

At the same time, I found myself shocked at how little many of my friends — women who were studying biology and planning to become doctors — knew about their own sexual health. They didn’t know about or couldn’t get the reproductive health care they needed because of barriers put up by their culture, their religion and their parents, whose sole contribution to sex ed was generally an unspoken “Thou shalt not!” One friend begged me to help her concoct a legitimate-sounding excuse — painful or irregular periods, say — for why she needed to be on birth control. No one could know the real reason: She was sexually active and didn’t want to get pregnant.

I began to feel as if I were leading a double life. At school, the choices I saw women struggling with were forcing me to question my old convictions. When I went home, I’d go to church with my parents but would find that my views contrasted starkly with those I heard in the sermons. It was a difficult time, because I felt that neither my family nor my church would welcome my questions or understand my struggle.

For the most part, I don’t talk to my parents about those beliefs. They already feel as though I’ve turned my back on much of what they taught me because my husband and I bought a house and lived together for a few months before we were married. “How could you do this to us?” they asked. Two and a half years later, that rift isn’t fully healed. I know that my views on reproductive rights would be another blow.

But ultimately, we have more in common than they might think. I agree that ending an unwanted pregnancy is a tragedy. When I advocate for reproductive rights, for choice, I don’t claim that abortion is morally acceptable. I think that it’s a very private, intensely personal decision. But I was stunned when one of my professors, a pathologist and a Planned Parenthood supporter, told me that decades ago, entire wings of the university’s hospital were filled with women dying from infections caused by botched abortions. It’s clear that women who don’t want to be pregnant won’t be deterred by limited access to providers or to clinics. And I believe that it’s immoral to let them die rather than provide them with safe, competent care.

I still have a long way to go in my medical training. I’ve never witnessed an actual abortion procedure, though I have been trained, through my work in Medical Students for Choice, in manual vacuum aspiration, a simple procedure used for both incomplete miscarriages and elective terminations in the first trimester. I plan to choose a residency program that provides further training — a place where I won’t worry that asking to be taught to perform an abortion could somehow limit my future options. At the start of medical school, I was very careful about how I presented my pro-choice views to the faculty for fear that I could jeopardize my grades or hurt my chances for recommendations or of being accepted into a program run by any of the professors. This experience of treading lightly is unique to medical students in more conservative parts of the country, where opposition to abortion is widespread — and it astounds many of my fellow Medical Students for Choice leaders from the Northeast and the West Coast.

As I continue my education, my views on abortion are still evolving. Take late-term abortions. When I first heard about them, I was horrified. I remember the flyer I saw at a pro-life event that described the procedure: It claimed that when the baby’s head emerges, the doctor jabs a pair of scissors into the back of its neck, severing the spinal cord. Even after I became pro-choice, this crossed a line for me. But later, I learned that this description was misleading and graphically politicized.

It wasn’t until I spent time in ultrasound rooms during a research job in graduate school that I began to see late-trimester abortions in a very different light. In one case, the patient’s baby had just been diagnosed with a lethal congenital anomaly. The high likelihood was that it wouldn’t survive after birth for more than a few minutes. As long as the baby remained in her mother’s womb, however, she would live. I asked the physician what this woman’s options were. The answer was, not many. She could choose to continue the pregnancy, but then she might be waiting for almost 20 more weeks to give birth to a baby that would never take more than a few breaths on its own. She was past the point where she could legally terminate the pregnancy in Alabama. If she could get an appointment in Atlanta within the next week, she might be able to have the procedure there. Beyond that, there were only a few physicians in the nation who would perform an abortion in such a case.

I could hardly wrap my mind around the agony that this woman and her husband must have been facing. They needed a caring and compassionate physician to help them through this dark moment, and if they chose not to continue the pregnancy, they also needed a physician who was both skilled enough and brave enough to provide them with the care they needed. They needed Dr. Tiller.

I can’t yet imagine doing precisely the kind of work that he did. When I think about my future practice, I think about a doctor I met at a conference who spoke candidly about the harassment his children endured at school because of what their father did. I wonder what seventh grade might be like for my children if I choose to provide abortions.

I’m not the only one with questions, of course. Once, after Medical Students for Choice co-hosted a panel discussion on reducing the number of abortions by providing better education on reproductive health, some of my classmates approached close friends of mine. They were puzzled that a pro-choice group was talking about wanting to reduce abortions — and that it viewed ending unwanted pregnancies as a tragedy. Mostly, though, they were confused about what I was doing there. “I know Roz goes to church every Sunday and that she’s a good person,” one classmate asked. “Why would she be involved in a group like this?”

I know my answer to that question. Someday I hope my classmates will understand, too. ++

rlove.comments@gmail.com

Rozalyn Farmer Love is a third-year medical student at the University of Alabama at Birmingham School of Medicine.

“I’m asking you to believe. Not just in my ability to bring about real change in Washington … I’m asking you to believe in yours.”
~ Barack Obama

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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