Wednesday, October 28, 2009

State single payer amendment pulled from House bill

Rep. Kucinich has announced that his amendment granting an ERISA waiver to single payer states will not be included in the health reform bill that Speaker Nancy Pelosi plans to introduce in the House, probably later this week. The amendment was passed in Committee. It has been a focus of support by progressives, and opposition by the corporate health care industry.

There will be a manager's amendment offered just before the vote on the floor of the House, next week or later.

Who could add the state single payer amendment back into the manager's amendment?

Speaker Nancy Pelosi (202) 225-0100
Rep. Henry Waxman (202) 225-3976
Rep. George Miller (202) 225-2095

Saturday, October 24, 2009

What Do Progressives Want?

What progressives want is the same thing the President wants: to build power for a majority in Congress and the country that will support our issues, and will perceive us as powerful; and to win the best possible health reform.

So far the President has played a pretty smart game. He kept the insurance industry at bay long enough that even the mainstream pundits are willing to say publicly that the industry has no credibility.

But it’s time to cut the cord.

Progressives need to play a smarter hand.

It’s important to sit in at insurance companies. But here’s the thing: 1. Insurance companies have no shame. They really don’t. 2. Even Republicans were willing to throw them under the train back in February. 3. They don’t vote.

Here are some people who vote: Senators Mary Landrieu, Louisiana; Blanche Lincoln, Arkansas; Joe Lieberman, Connecticut; Evan Bayh, Indiana; Ben Nelson. Nebraska

Take Mary Landrieu. She says she won’t support a public option because it would force the country to go bankrupt.

Now Mary Landrieu is not a stupid person. She knows that the CBO says a strong public option saves more money than negotiated rates or no public option.

She’s been elected twice in a Republican state, including in 2008 when Obama got only 40% of the vote.

Is she in the pocket of the insurance industry? The Center for Responsive Politics says she gets virtually no money from health interests, and raises half her money in-state. She’s the 47th least wealthy person in the Senate.

Does Louisiana need health reform? Here’s some information about Louisiana:

Second highest rate of female poverty in the US
Highest rate of black poverty
63% white
4th highest rate of uninsured for ages 0–64 (22%), 3rd highest for ages 19-64
One of the highest recipients in the country of federal Medicaid funds, one of the lowest in per capita Medicaid spending
35% of population live in primary care shortage area, 3rd highest % of population who didn’t see a doctor in the last year because of cost (18%)

In 2008 Obama lost to McCain, but Landrieu won among the same demographics that voted for Obama:
Younger people
African Americans
Among the 9% of voters who said health care was their most important issue, Landrieu got the widest issue-based margin over her opponent: 72% voted for her.

Why can’t a populist organizing campaign rile up some voters in New Orleans and environs to communicate with Senator Landrieu? And in Arkansas, Connecticut, Indiana and Nebraska; and the holdouts in the House. Harry Reid and Nancy Pelosi have signalled they're ready to play. Are we paying attention?

Saturday, October 17, 2009

No Excuse for Apathy

Eva Chrysanthe is my health care hero.

Back in January Senator Dianne Feinstein's staff were telling us she wasn't sure about her position on the public option because she was hearing a lot of opposition from people calling in from southern California opposing it. They seemed to be responding to talk radio shows.

A lot of people wrote articles about Dianne Feinstein's campaign contributions. She kept talking about what she was hearing from voters.

Eva networked with people inside Organizing for America and found 1200 people in the Bay Area who thought Dianne should represent us. They demonstrated, set up meetings, flooded her office with letters, petitions and emails. Dianne finally wrote a very long treatise on health reform, indicating that she was open to a public option; or maybe not. She heard about it from the voters.

Last week, Senator Feinstein was one of 30 senators to sign Sherrod Brown's statement supporting a public option. Period. Eva brought the staff a carrot cake.

Let's not get googly eyed about what we can accomplish. We're talking about a political system trying to manage an economy in deep crisis. The President, a charismatic figure who is well-informed about the health care issue on both the policy and personal levels, campaigned on expanding coverage for children.

But lookit, they're going to pass something here. How come no one knows that the public option as written doesn't start til 2013 and won't be open to most of us until years later, if ever? Are we expecting the media to do this job? The corporate owned media exist to manipulate our emotions between commercials so that we will feel sufficiently inadequate or bored to want to buy whatever the sponsors are selling, and definitely sufficiently cynical, apathetic and confused that we will not consider taking political action.

Some progressives also seem generally to think that dismissing and ridiculing the emerging proposal passes for analysis and agitation. Willingness to consider how we might influence the bill to set the stage for future progress has been compared to compromising on slavery (a great analogy, really - all they had to do in that case was stamp their feet and reframe the struggle as a fight for human rights, and by golly that was that).

Expanding Medicare to cover more people would've been a great thing to do. Max Baucus thought so. He proposed it in a Finance Committee document in January. It wasn't single payer for all, just for people over 55. Wimp. Must be due to his campaign contributions. Wonder how Baucus, the present obstacle to the public option, and the 4th poorest member of the Senate, stacks up against Sen. Rockefeller, the 4th richest:


Cycle Source of Funds, 2009-2010, Campaign Cmte only

Individual Contributions $5,989,921 52%
PAC Contributions $4,872,291 42%
Candidate self-financing $0 0%
Other $640,654 6%


Cycle Source of Funds, 2005-2010, Campaign Cmte only

Individual Contributions $3,756,635 63%
PAC Contributions $1,963,331 33%
Candidate self-financing $0 0%
Other $260,341 4%

Cycle Top vote-getting candidates Election Results
2008 Max Baucus* Amount Raised $11,602,479 Amount Spent:$9,305,359 Reelected
Bob Kelleher $0 $0
2002 Max Baucus* Amount Raised: $6,719,728 Amount Spent: $6,795,547 Reelected
Michael A. Taylor Amount Raised: Amount Spent: $1,839,020 $1,839,020

Cycle Top vote-getting candidates Election Results
2008 Jay Rockefeller* Amount Raised: $5,972,208 Amount Spent: $5,979,250 Reelected
Jay Wolfe Amount Raised: $123,862 Amount Spent:$123,720
2002 Jay Rockefeller* Amount Raised: $3,045,338 Amount Spent:$2,889,425 Reelected
Amount Raised: Jay Wolfe $136,373 Amount Spent:$136,373

Turns out they both raise most of their money out of state (Baucus 90%, Rockefeller 75%), virtually no one runs against them, and they spend most of what they raise to get re-elected. Why do they take different positions on the public option? Interesting question. In casting his vote, Baucus said that the public plan had a lot to recommend it, but it was his job to get the bill out of Committee. Sound like he's been getting calls from the White House?

It's great that people are sitting in at insurance companies. For the 3% of Americans who still thought health insurance companies had any legitimacy, aside from employees of the industry and their friends and relatives, it's probably a revelation. For the rest of us, a worthwhile way to spend time this week will be strongly suggesting to our friend in the White House, and our leaders in Congress, that they must cough up a program that is going to benefit people pretty quickly or else people will notice.

We need a strong public plan, that bases reimbursement on Medicare rates and uses Medicare providers so that it's affordable and viable. It should be a choice for each of us, in 2010. And we need an ERISA waiver for single payer states, so that they can convert to single payer without a lawsuit. For example people could cut and paste the following:

LETTER TO THE PRESIDENT, Senate Majority Leader Harry Reid, House Speaker Nancy Pelosi:

The Senate Finance Committee drama has concluded. The American public will not long remember whether or not any Republican voted for health reform. We do want to know if we'll get more affordable, reliable health care coverage, that provides relief soon. It's time to tell the President, House Speaker Pelosi and Senate Majority Leader Reid:

We need a public plan option with affordable premiums, that pays hospitals and doctors Medicare rates +5% and includes Medicare providers - and all of us want to have that choice in 2010! Put that up for a vote and we'll support you!

And the bill must include the state single payer option, proposed by Rep. Dennis Kucinich.

Thursday, October 8, 2009

CBO should score systemwide savings from health reform

Supporters of comprehensive, single payer health reform are looking forward to a report from the Congressional Budget Office on how much ths kind of system would cost. But in 1993, when I worked with Senator Wellstone on his S.491, the original national single payer bill, CBO's "score" was dramatic and groundbreaking for showing how much the system would save:

By definition any single payer system contributes to federal spending: the feds pick up the tab for all health care expenses. The important part is the escalating savings from single payer - more and more, the longer the system is in place. In its 1993 report, the CBO illustrated that the single payer system not only slows the rate of growth in health spending - what the President calls "bending the cost curve" - it saved more every year from total national health expenditures: a reduction of $67 billion in 2002, $110 billion in 2003.

Look at this:
(By calendar year, in billions of dollars)

1997 1998 1999 2000 2001 2002 2003
Total 1,163 1,263 1,372 1,488 1,613 1,748 1,894 2,052

Changes from Baseline (effects of the single payer bill)
Total a 60 59 35 4 (minus 29) (minus 67) -110

SOURCE: Congressional Budget Office,
a. Less than $500 million.

Now the CBO seems to be saying it will calculate only the cost to the federal government, sending the bill sponsors on the House side into exercises to cut promised benefits and alter other provisions to reduce the impact on the federal deficit. CBO should go back to answering the full range of critical questions for the American public, most notably: How much is this going to cost me? The answer is that single payer would save a ton.

Monday, October 5, 2009

Why It Matters: A Strong Public Plan, Medicare Rates, and Affordability

Let’s start from the end. You want health reform. Republicans say they want it. The insurance industry wants it. People who pay individually for health insurance want it - they can’t afford coverage. People with insurance want it – they too often have their claims denied – 1 in 5. 44,000 people die every year because they are uninsured. Medicare is going broke because prices are going up outside of the Medicare system, and lots of families are going bankrupt for the same reason.

To put the middle in the middle: Getting there means finding 218 members of the House of Representatives, plus 51 Senators, to convince the White House they will vote for reform.

Keeping it there after it passes means we all need to be able to afford it, and still get the care we need.

Here is the part to nail down this week: A strong public option, that pays Medicare rates and uses Medicare providers, is the only way to make the plan affordable.

There are 2 parts to making insurance affordable. The first part is limiting how much we pay providers – hospitals, doctors, drug companies. Basing payments on Medicare rates is the key here.

The second part is making sure these limits get passed back to you, in the form of lower insurance company premiums.

We need a strong public option for both.

The Congressional Budget Office says using Medicare rates saves $110 billion over 10 years, $85 billion more than a public option that doesn’t use Medicare rates.

Medicare already establishes payment rates to hospitals and doctors on behalf of 40 million Americans. These rates are accepted by all hospitals and most doctors, but aren’t susceptible to the hyper-inflation that has driven prices in the private sector over the last 10 years. Adding millions of enrollees to this system will help put the brake on payment rates.

So if the public plan limits payments to providers, how will that translate into lower premiums? The public plan won’t pay profits or bonuses, and will benefit from lower overhead than private plans. All the savings go right back to you, in the form of lower premiums.

Private insurance companies on the other hand can charge whatever they want, even if they are paying providers less. They have to charge higher premiums, to pay their shareholders and executives. This is true even if they paid less to hospitals and doctors – they have no reason to pass those savings on to you, in the form of lower premiums, and every reason to just do what they always do: hold onto the money themselves. Unless, of course, they have to compete with a public plan.

A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.

Will doctors still treat you if you are on the public plan, even if it pays less than private plans? For those who think Medicare rates are too low, the version of the public option linked to Medicare rates gives plenty of flexibility. First, we’re not talking about today’s Medicare rates. The bill will require changes in rates to address regional differences, including adjustments for rural areas, and ways to promote quality. Second, it provides an extra 5% (Medicare +5) for individual providers. Third, it allows any provider to opt out – and the decision can be made (and reversed) each year. Finally, it gives the HHS Secretary authority to go higher than Medicare rates if necessary to attract doctors, hospitals and other providers based on local conditions.

Why not negotiate the rates the new public plan will pay providers? Simple: They'll be higher. That's why providers and insurance companies want them. A new plan, with new enrollees, needs to build on the strongest platform we have. That's improved Medicare rates, with a cap of 5% extra. (Even a public plan with negotiated rates saves $25 billion more than relying solely on private insurers.)

Again: A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.

So here we are with the beginning for this week:

We need a public plan.
That pays Medicare rates plus 5%.
And includes Medicare providers.

Pass it on to 218 of your friends in the House, and 51 Senators.