Monday, September 14, 2009

A Town Hall Meeting That Worked: Sta. Clara, CA

I was heartened by Rep. Mike Honda's civil, orderly town hall meeting at Santa Clara University at 1 pm in Sunday. There were about 400 advocates for health reform, including a strong public option, and about a dozen or so opponents. At about 12:45, they showed a videotape of 3 local residents with health care stories, interspersed with facts about the number and percent of people in the country and the district who are suffering from lack of coverage, health-related bankruptcies, etc. I saw 2 of the people from the video in the crowd. They included: A retired county worker with an uninsured son; a woman whose grown son could not get coverage, having developed juvenile diabetes early in life; a man who identified himself as a Republican, and whose wife had a serious chronic condition that would never be covered if he lost his job and insurance.

Rep. Honda opened the meeting with a welcome, and a request for mutual respect. He called on constituents to submit written questions on index cards, including name and address; questions from constituents were chosen at random; he then invited the constituents to stand and pose their questions. Reflecting the crowd, most of the questioners spoke in favor of a strong public option, or a single payer. A few were opposed. We cheered every time he responded that he supported a strong public option, and had no plans to compromise on that; the dozen booed. We cheered for a brave young Latina who works in reproductive rights, and said that coverage for abortion was important to her; the dozen booed. (The cheers and boo's took a few seconds, then stopped; we all respected Rep. Honda's request for respect.) A few times Mike pointed out that the present system of private insurance had had quite a bit of time to work, if it was going to, and that too many people were hurting financially and physically (he gave details); it was time for a change. We all cheered. No one booed. The final 2 questioners asked how we could afford the President's health proposal, since similar socialistic systems like Great Britain are facing financial shortfalls. Mike said there is a way to do it, and we would. He promised to respond in writing to the remaining questions. That was it.

Outside an older man approached a younger fellow giving out water and wearing a pro-reform button. Tell me one government program that works! he demanded. Medicare, was the response. End of conversation.

Sunday, September 13, 2009

What We Need In a Health Reform Bill

What, specifically, do we need in a health reform bill? Here's the view from EQUAL partners. To download as a flyer, go to

EQUAL Health Reform That Meets Our Needs

Fight to keep what works in the bills we have:

• Regulate insurance: No denials for pre-existing conditions. Once you’re covered, you stay covered.
• Pass Dennis Kucinich’s state single payer amendment as part of the health reform bill.
Some states that have attempted to expand health care coverage have been successfully challenged in court under the Employee Retirement Income Security Act (ERISA), which says that only the federal government can pass laws “related to” employee benefit plans. The House bill would allow single payer states to override ERISA.
• Public health: HR 3200 and the Senate HELP bill shift resources to wellness and prevention.

Here’s what we must have!

A stronger public plan option. For too many of us, insurance doesn’t work or isn’t available or affordable. We need an affordable, dependable public plan that is open to anyone, and starts right away.

Putting federal spending in perspective: Partly to minimize federal outlays, HR 3200 delays the public plan until 2013, and it only covers individuals and small businesses initially. In fact, starting the public plan sooner, with higher enrollment, will be key to controlling costs. The Congressional Budget Office estimates that HR 3200 will require $1 Trillion in new federal expenses over 10 years, for subsidies and other benefits. This is equal to $100 Billion a year, or only 4% of current annual spending of $2.5 Trillion. An effective public program will have lower administrative expenses, provide competition to private plans, and act as a countervailing force against health care expenses that are rising twice as fast as inflation. It should be open as a choice to everyone, and very soon.

• Use Medicare’s reimbursement rates: The public plan will only control costs overall if it builds on the public sector’s leverage. It would save $75 billion over 10 years if it uses Medicare rates, vs. only $20 billion at most if it negotiates rates independently as proposed in Blue Dog amendments.
• Use Medicare’s provider network: The public plan should include all Medicare providers as a base. They can be allowed to opt out. (Included in Energy and Commerce as an amendment.)

Insurance company care share (loss ratio) 90%. Insurance companies now spend up to 30% of our premium dollars on administration, profits and bonuses. This feature would require them to spend 90% of our money on actual patient care. One version of HR 3200 would require a limit of 85%, but only for insurance plans that are part of the new Health Insurance Exchange, which would start in 2013.

Real affordability: the “affordability threshold” must remain 11% and sliding scale subsidies must be provided up to 400% of the Federal Poverty Guidelines.

Expand Medicaid - funded by the federal government, not states.

Eliminate age rating. HR 3200 allows insurance companies to charge older people at least twice as much as younger ones. Age rating will cost everyone more, and is a loophole for the for-profit insurance industry. While a few will pay the lowest premium, premiums for most will rise sharply. Community rating works. If everyone pays the same, risk is fairly spread. Insurers already use community pooling for large group, employer-sponsored insurance, under which most Americans with private insurance are covered.

Women’s health: Assure women have access to reproductive services. Respect women’s decisions.

EQUAL Health 􀂐 Equitable Quality Universal Affordable
The EQUAL Coalition includes public health, women’s groups, and advocates for Equitable, Quality. Universal, Affordable health care. * The Center for Policy Analysis * The California Public Health Association-North an affiliate of the American Public Health Association * Rekindling Reform * Older Women’s League San Francisco * California Women’s Agenda

Friday, September 11, 2009

The Speech

We have our work cut out for us.

The President snapped the country back from the delusional debates of August to the more rational debate about health reform. If he has created policy space, it is an opportunity we will need to exercise until the final vote.

In rebalancing the politics of reform, he called out both elected officials and pundits who have invoked scare tactics. He also reminded us explicitly that the deficits we face today are directly attributable to Republican policies of waging an unfinanced war, and tax cuts for the super-wealthy.

We’ll know if it was effective in part if advocates for reform continue to build momentum, at town hall meetings. Will the chorus on the right become more civil? The official Republican response by Rep. Boustany was indeed a respectful disagreement. Rep. Joe Wilson of South Carolina set a different and shocking standard, accusing the President of the United States of lying about an indisputable fact.

The President made the clearest possible case for the importance of insurance reform, describing the human and financial cost of our uniquely inhumane system. The baseline proposals remain, and they would be important: eliminating pre-existing conditions and recisssions.

He offered a new benefit: A guaranteed catastrophic plan to be made available beginning in 2010.

But he proposed a public option as one of a few possible alternatives to private, for-profit insurance plans, signaling openness to a cooperative or generic nonprofit plan, and calming concerns that such a plan could lead to a single payer system. Even at best, a “robust” public option would be hard pressed to muscle out private insurance. But it must have the basics to succeed on its own terms: open to everyone as a voluntary choice right away, using the government’s power to protect the public from predatory insurance companies. As policy, that means it should start out of the gate as a nationally administered program, with the clout to intervene with drug companies and other providers. It must build on Medicare’s rates to pay providers, and use Medicare’s network of doctors and hospitals. It is time to start saying: If the private insurance industry cannot survive on terms that benefit the people who need health care, it is not the government’s role to bail them out.

It was disturbing to hear the President refer more than once to his proposals as balancing the concerns of left and right. Single payer supporters and advocates for a public plan are his base and his field team. The teabaggers and opponents of any reform are not pulling the same way. Despite his nod to Sen. McCain’s proposal for catastrophic coverage, and Republicans’ interests in medical malpractice reform, none appeared interest in voting with the President afterwards.

His discussion about our skepticism of government was important. It is understandable that many are frustrated with a government that has been unresponsive and derelict for so long. But it is a system we can influence. Mobilizing for what we want is the road to generating energetic support, and demands that our elected officials act responsibly and effectively. Resorting to demonization breeds disaffection.

The challenge is before us: to hit the air waves, the Town Hall meetings, the mail to the President and Congress to demand the change we voted for.

Sunday, September 6, 2009

Obama's Health Care Speech: Ominous Warnings in NY Times

What will Obama say on Wednesday about health reform? Today's New York Times could be an ominous early warning. Expanding public sector clout is at the heart of any meaningful proposal to control health care costs, and to expand coverage. Over the past year, the Times has published a lot on the potential for a strong public option to get us there, and also given unusually wide visibility to a sure-fire solution, single payer. Today's edition is a reverse road map to defeat.

The editorial calls on the President to "stand tough for a large and comprehensive plan," and "point out the cynicism of Republican opponents who are late-blooming advocates of deficit reduction," having passed passed "tax cuts for wealthy Americans that will cost more than $1.7 trillion over 10 years."

What is his wiggle room? Go for insurance reforms, and hold strong for a public plan, but, "if he decides to bargain it away later, he should insist, minimally, that a strong public plan be introduced if private insurers fail to hold costs down in the future." To echo Barney Frank, on what planet have the editors been spending most of their time? Apparently it will now be up to the public that voted for change to demand it.

It gets worse. The editorial goes on to bemoan that neither party has a "sure-fire solution to rein in medical inflation" while improving quality of care. Well, sure we do, and the Times has coeverd it. The news pages report on deliberations with former Clinton-era advisors, recounting the errors of failing to pass health reform, once having opened the door, and pointing out candidate Obama's relatively moderate positions on universal coverage.

It's time to take stock. It's been a bad summer. Opponents of reform, and of the Administration, have had one clear goal: Stop it. They've had the expansive coffers of the insurance industry to draw upon. Advocates have been taken aback at the teabaggers' vitriol, unhinged demeanor, and outright threats.

The union movement and other organizations that have led reform movements in the past have been weakened by decades of economic globalization and at least 8 years of vicious political attacks. In the face of shockingly hard times for many, we in the public appear to be struggling but stunned. And yes, there's been some internecine squabbling among reform factions.

But we have resources, and we should have leadership. The President and his team showed us they know how to run a great ad campaign. They likely calculated that they couldn't eliminate the insurance industry in one fell swoop; and they lost a great legislative strategist in Ted Kennedy. But isn't there a Plan B? The Congressional Progressive Caucus has done a great job of describing what a strong public option should be: open to all from day one, building on Medicare's reimbursement rates and provider base. They have had constraints in articulating and conveying these views to the public. There must be a way to support the President while using their considerable clout to mobilize support for the reform they know we need.

Health care can be a wonky issue. It can also shake us up and build alliances. If we need to pass something let’s make it a step forward, for policy and politics.

Between now and Wednesday, we need to tell the White House we expect to hear a call to arms. We knew all along that voting for President would not be the last thing we had to do to achieve social change. Hopefully, it was at least the first.