Ellen Shaffer's blog

Trust Women Week and the San Francisco Banner Project

2012-01-04T12:53:00.001-08:00

The majorityof Americans believe that women should have access to basic health careservices and that decisions about reproductive health care including familyplanning and abortion should be left to each person. But in 2011, extremist politicians elected witha mandate to fix the current economic crisis instead chose to divert thepublic's attention with policy battles about these private decisions. They havedeclared a “War on Women.” The U.S.House of Representatives and state legislatures have particularly focused oneliminating access to basic health care services and contraception as well asabortion, with severe consequences for the most vulnerable.

Banners on Market Street in San Francisco aim to spark conversations and to help buildmomentum and solidarity among supporters of women’s rights, equality and autonomyand access to comprehensive health care, including reproductive health careservices. see photos:

https://picasaweb.google.com/117112844015109646967/ReproductiveJusticeBannersInSanFrancisco#

During TrustWomen Week, January 20-27, we will engage the public in a Virtual March, withMoveOn, to express their support online for reproductive health, rights andjustice.

The TrustWomen/Silver Ribbon Campaign is a coalition of 42 national and localorganizations. We include the groups represented on the banners: the Bay AreaCoalition for Our Reproductive Rights (BACORR), Catholics for Choice, NARAL-ProChoiceCalifornia, Planned Parenthood Shasta Pacific, and SisterSong/Trust Black Women[SY1].

The mainbanner messages are:

· HerDecision, Her Health

Most women spend about 30 years trying not tobecome pregnant and only two years trying to become pregnant. Whether and when to have a child is apersonal decision that every individual has the right to make. A healthy pregnancy is more likely for womenwho have access to basic health care services.

U.S.

Out of My Uterus

In 2011,a record numbers of bills were introduced or passed by state legislatures andthe U.S. House of representatives restricting women's access to: basic healthcare services, family planning, and safe abortion care. It has been called a "War on Women,"Many women are shocked and dismayed by these attacks and want to send a strongmessage to policy-makers: Government should stay out of making decisions aboutwhat happens in my womb. I have self-determination, autonomy.

· Fixthe Economy, Support My Autonomy

Many people are suffering due to the downturnin the economy, and are looking to our elected officials for real solutions. Toomany policy-makers focus on whipping up divisions on social issues(such as restrictingwomen’s rights) instead of creating jobs. Government has an important role insupporting and assuring the conditions for a healthy life. In these hardeconomic times, women's ability to conduct productive, independent lives dependson government support for fixing the economy, and providing the education neededto secure rewarding jobs and affordable health care, including reproductivehealth care.

· ReproductiveRights are Human Rights

If women do not have the ability to decidewhat goes on in their bodies, then they are second class citizens. Human rights describe the obligations ofgovernments to create the conditions for all people to be as healthy aspossible. This includes respectingindividual rights about our reproductive health and assuring access toaffordable and comprehensive reproductive health care services.

San Francisco is Pro-Choice

The majority ofthis country supports reproductive rights and feels that the decision aboutabortion should be left to the individual.

Partner banners:

Catholics for Choice

Legal Abortion is aHuman Right: United Nations - BACORR

Freedom, Privacy,Choice - NARAL California

San Francisco Supports Planned Parenthood Shasta/Pacific

We Trust Black Women,Do You? - Sistersong

for background on women's reproductive health and on reproductive justice, see:

http://oursilverribbon.org/blog/wp-content/uploads/banners2-and-trust-women-week-background.pdf

We Are All An 11 year old girl - and she is pretty annoyed

2011-12-08T07:32:00.001-08:00

Women are the last remaining voting majority who are treated like a splinter group. It will stay that way until we stand up for ourselves, together, and demand power.

The Democrats drove us away from the polls in 2010, and they're getting ready to do it again. It's ok, though. They need to focus on creating jobs. We don't want to disturb them with anything controversial.

The Republicans don't care whether or not we experience regret after our abortions. They want to pump up the fanatic religious extremists who they hope will give them control of the Senate and the White House in 2012.

The Pediatricians, Gynecologists, and Adolescent Medicine doctors deplore the decision yesterday by the Secretary of Health and Human Services to override "an evidence-based decision by the Food and Drug Administration (FDA) to approve an application for over-the-counter access without age restriction to the emergency contraception (EC) product Plan B One-Step. This move defies the strong data that EC is safe and effective for all females of reproductive age.

“As advocates for the health and well-being of all young people, the AAP recommends that adolescents postpone sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex,” said Robert Block, MD, FAAP, American Academy of Pediatrics president. “However, as physicians who care for our nation’s children, it is our responsibility to protect the health of our teenage patients, and an unintended pregnancy can have significant implications for adolescents’ physical and emotional health.”

Presumably Sec. Sebelius was following orders from her boss, already jittery because the U.S. Conference of Catholic Bishops is offended that HHS has had the temerity to acknowledge that contraception is a preventive medical service, and should be covered without additional co-payments just like Pap smears.

You can join lots of important efforts to call the White House or sign petitions, including sites for NARAL, the National Women's Health Network, and the Feminist Majority.

Maybe, also, we can snatch some tactics from AIDS activists. Maybe we need to start bird-dogging policy-makers who have difficulty living up to their promises. And working in communities where people who don't have jobs are being convinced to turn their anger against women who don't have rights.

God to Congress: OK to Gang Up on Women's Rights

2011-11-17T23:19:00.001-08:00

"It is not our job as Catholics to tell God what weshould do. It is our job to learn andfollow his teachings. Conscience is notconvenience. We must enforce the laws of God." Rep. Tim Murphy, Republicanof Pennsylvania, having ascertained that the supreme deity is male, explainedwhy Congress should deprive the employees of Catholic schools, hospitals andcharities of the right to purchase affordable birth control, regardless of theemployees' own beliefs or practices. The hearing of the Health Subcommittee of theHouse Committee on Energy and Commerce took place on Wednesday, November 2, 2011.

Republicans in Congress are truly on the warpath againstwomen's rights, and in many cases against reason.

Just a few points here about women and contraception. For starters, while it usually takes two toconceive a child, only women get pregnant. The right and ability to makeindependent decisions about whether and when to become a parent are fundamentalto every other aspect of a woman's life: whether society recognizes women asautonomous, independent, responsible and competent; and whether womenthemselves experience the same opportunities as men to acquire education andemployment, and to construct a meaningful life based on loving relationships.

Cost is a barrier to purchasing birth control forlower-income women. More effective formslike new, safe intrauterine devices (IUDs) cost more than birth control pillsor devices like diaphragms that can be bought in smaller, cheaper quantities, butalso are less reliable. The rate of unintended pregnancies is soaring amonglow-income women, and at 132 per thousand (women aged 15-44) is 5 times higherthan the rate for higher income women (those over 200% of poverty). Low income women are more likely to haveunplanned births. The costs of contraception are minute compared to the costsof pregnancy and delivery, in dollars as well as in human health.

The new health reform law, the Affordable Care Act (ACA), callsfor covering preventive health care services without requiring copayments,effective in 2010. Copayments are feesindividuals must pay when they go for care, in addition to their premiums, andare intended to discourage health care visits. The problem is that they discourage people from getting care they need,particularly low-income people. Preventive health care services like flu shots can protect health byavoiding illnesses entirely or catching them early, and also save money. TheACA eliminated these copayments for prevention.

Except in the case of contraception.

In 1968, despite the recommendation of the majority ofCatholic bishops, the Pope adopted the minority recommendation to declare thatusing birth control was inconsistent with the Church's beliefs. Nevertheless, U.S. Catholics continue to usebirth control, to the same extent as other Americans. The U.S. Conference ofCatholic Bishops has grown increasingly insistent on enforcing the birthcontrol ban.

Virtually all heterosexually active couples in the U.S.of child-bearing age use birth control at times, including Catholics.

As of August, 2011, after a year of studying whether or notcontraception is a preventive health care service, the federal Department ofHealth and Human Services ruled that birth control would count as a preventivehealth care service.

In covering contraception as a preventive service withoutcopayments, HHS granted an exception foractual churches who provide health insurance to their employees, but requiredall other religiously sponsored institutions such as hospitals that offerhealth benefits to follow the rule.

Catholic organizations have gone to court in the past toavoid state rules that require including coverage for birth control in thehealth care plans they provide for employees, and failed every time. The Church sponsors large organizationsincluding health care providers, universities and social service agencies, aswell as churches. They employ millions of Americans, many of whom are not Catholic.Their work generates the funds their employers use to pay for healthinsurance. Most economists assert thatthe costs of employee health benefits are reflected in lower pay; that is,employers calculate benefits as a form of compensation, and many reduce wagesaccordingly. In effect, the money thatpays for health insurance is really money that employees generate, and belongsto them.

Not good enough for the U.S. Conference of Catholic Bishopsand the extremist Republicans running Congress. While dire economic threats face many Americans, Rep. Joe Pitts of Pennsylvaniadecided to change the subject. He calleda hearing entitled “Do New Health Law Mandates Threaten Conscience Rights andAccess to Care?” [http://republicans.energycommerce.house.gov/Media/file/Hearings/Health/110211/Memo.pdf]

Now let's be very clear here. The Republicans and the Bishops are claimingthat institutions have a conscience. Nota policy. A conscience.

Here is Joe Pitts' description of his concern [and mycomments in brackets]:

"Manyentities feel that it [the proposed policy] is inadequate and violates theirconscience rights by forcing them to provide coverage for services for whichthey have a moral or ethical objection. The religious employer exemptionallowed under the preventive services rule -- at the discretion of the HRSA[Health Resources Services Agency] -- is very narrow.

"Andthe definition offers no conscience protection to individuals," [there isno involvement of any individual employer in this matter, or any issue of anindividual's conscience except that of employees deciding to purchase and usecontraceptives] "schools, hospitals, or charities that hire or servepeople of all faiths in their communities. It is ironic that the proponents ofthe health care law talked about the need to expand access to services but theadministration issues rules that could force providers to stop seeing patientsbecause to do so could violate the core tenants of their religion." [The rule requires employers' health plans tocover contraception without any additional copayment. There are three parties involved here:employers, employees, and health plans. No provider or caregiver is involved, nor is any patient, student, orrecipient of charity. At the most extreme, every Catholic institution couldclaim it will close their doors absent this exclusion. So far no such institution has done so wherestate requirements are in effect, and when Rep. Jan Schakowsky asked representativesof Catholic institutions at the hearing if they would close, they affirmed thatthey would not.]

Rep. Gingrey, GA, opined: "Imposing the dictates of thestate on the will of employers sounds un-American to me."

And another gem: "Should we force religious employersto violate their consciences? Torecognize same-sex marriage? Will weethically neuter health care professionals?"

Articulate Democrats on the committee - Henry Waxman, FrankPallone, John Dingell, Lois Capps, Tammy Baldwin, Jan Schakowsky, Edolphus Towns, Eliot Engel - to a personchallenged this tripe.

Tammy Baldwin: "This is a war on women."

Lois Capps: "An employer is not a person. Your boss'conscience is not your own."

Witnesses Jon O'Brien of Catholics for Choice and Dr. SteveHathaway were articulate and brilliant in defending the truth.

But Rep. Tim Murphy, a psychologist in his fifth term in theHouse, was on fire:

"Conscience is at the core of Catholic teachings... andit is not left up to individuals to decide, thank goodness. Father AnthonyFisher tells us that ...there is an objective standard of moral conduct. Vatican II teaches us that the moralcharacter of actions is determined by objective criteria, not merely by thesincerity of intentions or the goodness of motives. It is not, I repeat, it isnot our duty as Catholics to tell God what he should do or what image he shouldadhere to, or what he should think, but it's up to us to shape our conscienceto conform with the teachings he's given us.

"Conscience, sir, is not convenience.

"Conscience is formed through prayer, attention to thesacred and adherence to the teachings of the church, and the authority ofChrist's teachings in the church. Soasking a group in a survey whether or not they have ever acted or thought ofacting in a certain way that runs counter to the Church's teachings is no morea moral code than asking people if they ever drove over the speed limit as afoundation for eliminating all traffic laws.

"I end with a quote from John Adams, in 1776, when hewas writing our Declaration of Independence of the United States: 'It is the duty of all men in society,publicly and at stated seasons to worship the creator and preserver of theuniverse, and no subject shall be hurt, molested or constrained fromworshipping God in the manner most agreeable to the dictates of his ownconscience, or for religious profession or sentiments, provided he does notdisturb the public peace or obstruct others in their religious worship.' Thefoundation of our nation is not to impose laws that restrict a person's abilityto practice their faith, sir."

Well, actually, Tim: Exactly.

Best NYT comment on clearing OWS

2011-11-15T08:10:00.001-08:00

Well, the important thing is that now Jeff (642) can have a bench where he can sit and relax while eating his lunch and contemplating which policy he would like to have changed by exercising his right to vote. It was difficult to focus on that with inappropriate behavior going on and no place to sit. But now that the park has been cleared, and Jeff has his bench back, he can remember that, after all, he was perfectly satisfied with the way things are, that there are no policies he can think of that he would change, and that there isn't enough mayonnaise on his tuna sandwich.

695, Susan

Houston, Texas

November 15th, 2011

11:01 am

Thank you Susan!

Stand up for Our Rights?

2011-10-07T07:57:00.000-07:00

Here is what we are up against:

28 Republican Senators have written to protest that the HHS decision to cover contraception as a preventive health care service interferes with the constitutional right of your religious employer to dictate whether or not you use birth control. (Technically, whether it should be a covered benefit and therefore affordable.)

That’s right: these Senators are distressed because your employer, if it has a religious affiliation, should have a constitutional right to mandate your personal sexual behaviors and to trample on your reproductive health choices.

The signers include, for example, David Vitter. His known use of the public funds that pay his salary for the support of sex workers might seem to contradict his right to dictate your own behavior.

Some on our side say these loony extremist statements rile up the Republican base and turn out their vote. We should keep our powder dry and ignore them, because smart pro-choice voters are motivated more by economics and other issues. But these crackpot ideas are too often turning into crackpot laws. Seems to me it’s time to connect the dots: Our human, economic and reproductive rights are our rights, and no elected official will stand up for us until we stand up for ourselves. The extremists are attacking our economic wellbeing and our freedoms at every level. What do you think?

Johanns/Hatch letter on contraception:
In addition to Sens. Hatch and Johanns, the letter to Secretary Sebelius was signed by Sens. Marco Rubio (R-Florida), Roy Blunt (R-Missouri), Kay Bailey Hutchison (R-Texas), Pat Toomey (R-Pennsylvania), Ron Johnson (R-Wisconsin), Dan Coats (R-Indiana), Jim Risch (R-Idaho), Rand Paul (R-Kentucky), Jon Kyl (R-Arizona), Jerry Moran (R-Kansas), John Cornyn (R-Texas), John McCain (R-Arizona), Rob Portman (R-Ohio), John Boozman (R-Arkansas), Tom Coburn (R-Oklahoma), and Kelly Ayotte (R-New Hampshire), David Vitter (R-Louisiana), Pat Roberts (R-Kansas), Johnny Isakson (R-Georgia), John Hoeven (R-North Dakota), Mike Crapo (R-Idaho), John Thune (R-South Dakota), Lindsey Graham (R-South Carolina), Mike Enzi (R-Wyoming), Chuck Grassley (R-Iowa), and Jim Inhofe (R-Oklahoma).

What would Jesus say? (with Track Changes by Rick Perry)

2011-09-05T21:34:00.000-07:00

Justice: Blessed are they which do hunger and thirst after ~~righteousness~~ accumulation: for they shall be filled. [Matthew 5:6]

Greed and Wealth:
Watch out! Be on your guard against all kinds of ~~greed~~ public assistance; a man's life does not consist in the abundance of his possessions. [Luke 12.15.]

Truly, I say unto you, it will be hard for a ~~rich~~ poor man to enter the kingdom of heaven. [Matthew 19:23]

You ~~cannot~~ can serve both God and Money. [Matthew 6:24.]

Community: Love your neighbor as when they do good unto yourself. .[Matthew 22:39] So in everything, do to others ~~as you would have them~~ before they do it to you. [Matthew 7:12.]

If you would be perfect, go, take from the poor, sell what you possess and give to ~~the poor~~ a tax shelter, and you will have treasure in heaven. [Matthew 19:21]

Equality & Social Programs: But when you give a feast, ~~invite~~ criticize the poor, the maimed, the lame, the blind, and you will be blessed, because they ~~cannot re~~ don't pay taxes. you. You will be repaid at the resurrection of the ~~just~~ entitled. [Luke 14:13 &14.]

Tobacco Control: FDA Warning Labels Get Support on the Eve of Trade Talks

2011-09-03T08:34:00.000-07:00

Five tobacco companies have filed suit once again to try to stop the federal Food and Drug Administration from implementing its rule to require larger, more prominent cigarette health warnings on all cigarette packaging and advertisements in the United States beginning in September, 2012. According to the FDA, "These warnings mark the first change in cigarette warnings in more than 25 years and are a significant advancement in communicating the dangers of smoking."

Tobacco control advocates discussed this new round of tobacco company lawsuits on Aug. 19 with KPFA "Livingroom" host Kris Welch and Health Issues Producer Ellen Shaffer of CPATH - www.cpath.org , highlighting implications for African Americans, youth, and for upcoming negotiations for a U.S.-Pacific Rim trade agreement (Trans-Pacific Partnership) scheduled for Chicago, Sept. 6 -11. They discussed the lethal effects of tobacco and the need to move U.S. trade policy, which views tobacco as a legal substance to be promoted like any other, with guests:

Carol McGruder, Co-Chair African American Tobacco Control Leadership Council (www.savingblacklives.org), pointed out that tobacco use and related illnesses have disproportionately affected the African American community. While the smoking rate among all Californians has plummeted from 23% to 14%, a rate second only to the state of Utah, African American smoking remains the highest in the state at 21.4% of males and 17% of females. "The consequences for our community are sobering: Black men who smoke are 50% more likely to get lung cancer than white male smokers; Black men have the highest lung cancer mortality rate at 81%, compared to a mortality rate of 54% among white men; with 16.3 lost years of life per death compared to 12.0 for white males. Though tobacco related deaths continue to kill more African Americans than car accidents, violence, and AIDS, combined; these deaths have yet to be given the priority on the public policy agenda that they deserve. The great disparities in smoking related morbidity and mortality between African Americans and the general population of California is an open sore in California's tobacco control crusade."

Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids, pointed out that these lawsuits have failed in the past, but that the tobacco industry continues to deploy its vast resources to resist all attempts to restrain it harm. He noted that the warnings are important in motivating calls to public "quitlines," toll-free phone resources known to help adults quit smoking. http://www.tobaccofreekids.org/

Chris Bostic, Action on Smoking and Health (ASH) ash.org, which serves as the Secretariat of the Framework Convention Alliance (FCA) , www.fctc.org, noted the contradictory position of the U.S. Trade Representative, which is advocating for free trade in tobacco products and restrictions on warning labels. The San Francisco Board of Supervisors adopted a resolution supporting the public health position during trade negotiation meetings in the city in July, 2010.

Hear advocates for local and global public health discuss the FDA warning labels on radio KPFA: CPATH, CTFK, FCA, AATLC http://www.kpfa.org/archive/id/72568 (go to minute 34:35)

Utter Madness

2011-06-17T01:09:00.000-07:00

Will this be the month that tips us into action?

We can't get jobs, live in our homes, educate our kids. Get out of the way of the tornadoes. Or, apparently, influence substantially the policy decisions imposed by an increasingly vicious and mean-spirited minority.

In California advocacy has been reduced to documenting the rubble. Medicaid is cutting doctors' visits to 7 a year, for the seriously chronically ill who can still manage to qualify. To his credit, I think, the Governor just vetoed a budget that has been a disaster for decades because no one can wrench control of the process from the 1/3 of the legislature whose most animating vision is to drown the government in a bathtub. We cannot add $70 a year to our car registration fees as a downpayment on staunching the demise. You might have missed this story because there was a sex scandal this week, and some baseball games. (I like baseball; not the point.)

Other states are dealing with the crisis by fomenting mobs who probably do not quite get the biological links among contraception, pregnancy and abortion, but are convinced they're against all of it, whatever it is.

Congress will not tax a cent of a billionaire's gains from gambling on the stock market, but voted to cut the Women and Infant Children program that gets some minimum level of nutrition to indigent kids. The Administration of course is taking a strong lead in rallying the nation to hold off on arbitrary cuts to the Social Security benefits of the 50% of seniors who subsist on meager incomes, and to keep Medicare out of the clutches of the vampires in the insurance industry. Aren't they? I thought they were; or intended to; or might at some point; or will promise to if re-elected.

Ok, it's not their job; when the people lead the leaders will follow. We are the majority, who support the idea of having an actual society, will lend our neighbor a hand, believe in the right to reproductive health care, above all know there's something terribly wrong when so many can't find work while so few bask smugly in obscene excess. I'll write again soon about the people, organizations and campaigns that are trying to corral us close enough to each other so that we can make a difference. We're out here. But right now, it's time to take a moment and call a travesty a travesty.

From Crisis to Progress: This Week In Health Care Politics

2011-05-06T17:02:00.000-07:00

So Republicans say they will not push Medicare repeal as a condition of raising the debt ceiling, which begins to expire on May 16 and still has life through August. Turns out even those deluded by Fox News aren't buying that one just yet, even though the House voted for the Ryan budget bill for 2012 a few weeks ago that featured turning Medicare into a scantily-funded voucher program.

So what other egregious demands can we expect to issue forth from the loonies of the Right?

Well for one hint take a look at H.R. 3, and the Dems' concession in the 2011 budget fight to sacrifice abortions for poor women in DC. H.R. 3 is the bill that would strip abortion coverage from private health insurance plans, on the grounds that employers that provide these plans receive a federal tax credit for doing so. Women who receive the small number of abortions still permitted because the pregnancies were caused by rape or incest could be required to document their trauma to insurance agents or regulators to get coverage. It passed the House on Wednesday by a vote of 251 to 175, with zero R's voting No and 16 Democrats in support: Altmire, Boren, Costello, Critz, Cuellar, Donnelly (IN), Holden, Kaptur, Kildee, Lipinski, Matheson, McIntyre, Peterson, Rahall, Ross (AR), and Shuler. That's

Reproductive rights has lost majority support in the House and the Senate. The 40-plus dependable champions in the Senate can muster a filibuster, but that's still short of the majority that would reflect pro-choice opinion in the country.

Of the 33 Senate seats up in 2012, 23 are Democrats (or Independents who vote with Ds) and 10 are Republicans

So:

Come to the May 13 conference From Crisis to Progress: Health Care Reform, Public Health, and Women’s Preventive Services

Friday, May 13, 2011 ~ 8:30am to 4:00pm

Elihu Harris State Office Building at 1515 Clay Street, Oakland CA

CLICK HERE TO REGISTER ONLINE

Meanwhile, in California, there is progress;

State Senator Mark Leno's state single payer bill, SB 810, moved forward from the Senate health committee this week.

And CA Assembly member Mike Feuer's AB 52 moved ahead. This bill would authorize the state Insurance Commissioner to limit excessive health insurance increases, a power now available for auto insurance but not for health care. AB 52 moved out of the Assembly Health Committee and on to the financing committee (Appropriations) . If successful in Approps, it should go to the Assembly for a vote in June. Think your health insurance costs to much? Call or write your state assembly member and senator and let them know - and send a copy to Mike.

Standard & Poor’s: Canada Highly Rated

2011-04-23T14:05:00.000-07:00

Standard and Poor’s on U.S., Canada, April 18 2011
The brief dust-up over Standard & Poor’s signal of concern over the likely stand-off on the U.S. budget (click on link above) failed to notice the statement’s positive assessment of nations considered the U.S.’ peers. France, the U.K., and Canada all have national, universal health care systems. In particular:
“…Canada, the only sovereign of the peer group to suffer no major financial institution failures requiring direct government assistance during the crisis, enjoys by far the lowest net general government debt of the five peers (we estimate it at 34% of GDP this year), largely because of an unbroken string of balanced-or-better general government budgetary outturns from 1997 through 2008. Canada’s general government deficit never exceeded 4% of GDP during the recent recession, and we believe it will likely return to less than 0.5% of GDP by 2013.”
When they get it right they get it right. But S&P is no bellwether of progressive economics - it still leaves the military budget offline, for example, and while expressing some concern over the extremist Republican agenda of slashing taxes and domestic spending, it mostly fusses that the President may continue to disagree for awhile.
For leadership on the program the public supports and needs – raising taxes on the wealthy and on corporations, protecting and expanding Medicare and Medicaid, and investing in a peacetime economy - look to the Congressional Progressive Caucus, and House Minority Leader Nancy Pelosi.

Mr Reich, Improved Medicare for All is the Solution

2011-04-16T11:48:00.000-07:00

The following widely followed column describes every problem in our health care system, problems Medicare shares and perpetuates.

What’s great about Medicare: everyone’s in it and the government runs it.
What’s wrong with Medicare: Fee-for-service payments, no incentives for quality like more primary care and electronic medical records. All improvements that are included in the Affordable Care Act.
Specifically:

Medicare for All Is the Solution

By Robert Reich, Robert Reich’s Blog – 13 April 2011

Mr. President: Why Medicare Isn’t the Problem, It’s the Solution hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Washington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up.

YES IN MANY WAYS; FINANCING AND DELIVERY SYSTEMS

Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

ALSO TRUE IN MEDICARE. THE ACA FUNDS AND IMPLEMENTS WIDESPREAD USE OF ELECTRONIC MEDICAL RECORDS.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced. Let me say it again: Medicare isn’t the problem. It’s the solution.

ONLY IF WE UNDERSTAND HOW TO FIX IT.

Santorum: Our Abortion Was Different

2011-04-15T06:55:00.000-07:00

Rick Santorum is one dangerously confused denialist. The former Pennsylvania Senator and presidential aspirant is best known for his inability to associate his professed compassion for life at the level of the zygote, with the physical realities of human sexuality. He has equated loving same-sex relationships to bestiality. He is opposed to abortion under any circumstance. Almost.

In October, 1996, his wife Karen had a second trimester abortion. They don't like to describe it that way. In his 2004 interview with Terry Gross, Santorum characterizes the fetus, who must be treated as an autonomous person, as practically a gunslinging threat, whom the mother must murder in self-defense. Karen has had to justify her decision to save her own life by explaining that if she died her other children would have lost a mother.

Republican extremists in Congress and the statehouses propose to make abortion illegal even if it would save the mother's life. Even the Santorums admit they would make that choice, while claiming that they didn't.

Losing a pregnancy because of a fatal fetal anomaly is never cause for celebration. The pain of second-trimester abortions is compounded by the hateful hypocrites who vilify families facing sorrowful circumstances, and the resulting scarcity of abortion clinicians.

It is revolting that Rick and Karen Santorum choose to stigmatize and harass those of us who, as they did, grieve over the loss of a possible child in the second trimester.

Abortion should not be driving U.S. policy. It's not a more fundamental right than the right to a job or safety from violence. But we can't stop it from being used as a wedge issue if we never talk about our experiences.

Here's the Santorums' description of their second trimester abortion, written by Steve Goldstein,
Philadelphia Inquirer, May 4, 1997

Karen was in her 19th week of pregnancy. Husband and wife were in a suburban Virginia office for a routine sonogram when a radiologist told them that the fetus Karen was carrying had a fatal defect and was going to die.
After consulting with specialists, who offered several options including abortion, the Santorums decided on long-shot intrauterine surgery to correct an obstruction of the urinary tract called posterior urethral valve syndrome.
A few days later, rare ``bladder shunt'' surgery was performed at Pennsylvania Hospital in Philadelphia. The incision in the womb carried a high risk of infection.
Two days later, at home in the Pittsburgh suburb of Verona, Karen Santorum became feverish. Her Philadelphia doctors instructed her to hurry to Pittsburgh's Magee-Women's Hospital, which has a unit specializing in high-risk pregnancies.
After examining Karen, who was nearly incoherent with a 105-degree fever, a doctor at Magee led Santorum into the hallway outside her room and said that she had an intrauterine infection and some type of medical intervention was necessary. Unless the source of the infection, the fetus, was removed from Karen's body, she would likely die.
At minimum, the doctor said, Karen had to be given antibiotics intravenously or she might go into septic shock and die.
The Santorums were at a crossroads.
Once they agreed to use antibiotics, they believed they were committing to delivery of the fetus, which they knew would most likely not survive outside the womb.
``The doctors said they were talking about a matter of hours or a day or two before risking sepsis and both of them might die,'' Santorum said. ``Obviously, if it was a choice of whether both Karen and the child are going to die or just the child is going to die, I mean it's a pretty easy call.''
Shivering under heated blankets in Magee's labor and delivery unit as her body tried to reject the source of the infection, Karen felt cramping from early labor.
Santorum agreed to start his wife on intravenous antibiotics ``to buy her some time,'' he said.
The antibiotics brought Karen's fever down. The doctor suggested a drug to accelerate her labor.
``The cramps were labor, and she was going to get into more active labor,'' Santorum said. ``Karen said, `We're not inducing labor, that's an abortion. No way. That isn't going to happen. I don't care what happens.' ''
As her fever subsided, Karen - a former neonatal intensive-care nurse - asked for something to stop the labor. Her doctors refused, Santorum recalled, citing malpractice concerns.
Santorum said her labor proceeded without having to induce an abortion.
Karen, a soft-spoken red-haired 37-year-old, said that ``ultimately'' she would have agreed to intervention for the sake of her other children.
``If the physician came to me and said if we don't deliver your baby in one hour you will be dead, yeah, I would have to do it,'' she said. ``But for me, it was at the very end. I would never make a decision like that until all other means had been thoroughly exhausted.''
The fetus was delivered at 20 weeks, at least a month shy of what most doctors consider viability.
In the months after the birth and death of Gabriel Michael Santorum, rumors began circulating in the Pennsylvania medical community that Karen Santorum had undergone an abortion. Those rumors found their way to The Inquirer, prompting the questions that led to this article.

``There are a lot of people who aren't big fans of Rick Santorum,'' the senator said of the rumors. ``You're a public figure, and you're out there. Maybe it accomplishes a political purpose''...
_____________________________________________________________

see also:

http://www.slate.com/id/1210/ The New Yorker, Jan. 5, 1998

An article chronicles the troubled pregnancy of Karen Santorum, wife of partial-birth-abortion foe Sen. Rick Santorum, R-Pa., and the evolution of the senator's views on the procedure. A birth defect threatened the lives of both fetus and mother, forcing the couple to face the ethical question of whether or not to abort to save her life. Premature labor made the quandary moot--the baby died two hours after birth--but stiffened their resolve against late-term abortion. (A "Strange Bedfellow" bashes Santorum's "pathetic grandstanding.")

__________________________________________________________________

http://mysite.verizon.net/vzeo69a0/id81.html

Audio Interview: Santorum defends the GOP Platform on Reproductive Rights

Terry Gross, Fresh Air Aug 30, 2004 (20 min.)

Santorum discusses:
Human Life amendment to the constitution,
Why judges opposed to Roe are not activists,
That embryos from fertility clinics should be adopted,
The Catholic mass and viewing with his children at home of his son, Gabriel, who was born 4 months premature and lived for 2 hours .
Listen to entire interview.

http://www.now.org/issues/abortion/alerts/11-13-97.html
Activists urged to call Family Circle on abortion article
November, 1997
--------------------------------------------------------------------------------
Family Circle magazine featured an anti-abortion article in the "Full Circle" section of their October 1997 issue. The article, written by Karen Santorum, decried the use of late-term abortion under any circumstances. And it told the story of her own tragic pregnancy and the decision she and her family made - an option she and her husband would deny to other women .

Karen Santorum is the wife of right-wing, anti-abortion Senator Rick Santorum (R-Pa.). In 1996, Senator Santorum led the debate on a bill that attempted to ban late-term abortions, and refused to make an exception even in the case of "grievous bodily injury" to the woman. In Santorum's article, she expresses her view that carrying a non-viable fetus to term is the only option, and apparently does not think the woman's health or future fertility should be a consideration.

The National Abortion Federation (NAF) responded by requesting that a patient response be printed in the next issue, thus presenting an opposing view and bringing the argument "Full Circle." We have learned from NAF that Family Circle is only planning to publish "Letters to the Editor," and your actions could change their decision. Please urge Family Circle to print the article by Sophie Horak, which was submitted to them by NAF, in its entirety. We do not have permission to send you the text of the original article.

We urge you to email Family Circle at fcfeedback@familycircle.com or call (212-499-2000) and express concern over their incomplete (and in this case, biased) reporting on the very private issue of abortion.
Send letters to:
Family Circle Magazine
___________________________________________________________
http://www.post-gazette.com/books/19980623corner.asp

Karen Santorum's letter to ill-fated son express joy, sorrow

Tuesday, June 23, 1998
By Karen MacPherson
_______________________________________________________________
http://www.washingtonpost.com/ac2/wp-dyn/A61804-2005Apr17?language=printer
Father First, Senator Second
For Rick Santorum, Politics Could Hardly Get More Personal
By Mark Leibovich
Washington Post Staff Writer
Monday, April 18, 2005; Page C01

In his Senate office, on a shelf next to an autographed baseball, Sen. Rick Santorum keeps a framed photo of his son Gabriel Michael, the fourth of his seven children. Named for two archangels, Gabriel Michael was born prematurely, at 20 weeks, on Oct. 11, 1996, and lived two hours outside the womb.

Upon their son's death, Rick and Karen Santorum opted not to bring his body to a funeral home. Instead, they bundled him in a blanket and drove him to Karen's parents' home in Pittsburgh. There, they spent several hours kissing and cuddling Gabriel with his three siblings, ages 6, 4 and 1 1/2. They took photos, sang lullabies in his ear and held a private Mass.

"That's my little guy," Santorum says, pointing to the photo of Gabriel, in which his tiny physique is framed by his father's hand. The senator often speaks of his late son in the present tense. It is a rare instance in which he talks softly.

He and Karen brought Gabriel's body home so their children could "absorb and understand that they had a brother," Santorum says. "We wanted them to see that he was real," not an abstraction, he says. Not a "fetus," either, as Rick and Karen were appalled to see him described -- "a 20-week-old fetus" -- on a hospital form. They changed the form to read "20-week-old baby."

Karen Santorum, a former nurse, wrote letters to her son during and after her pregnancy. She compiled them into a book, "Letters to Gabriel," a collection of prayers, Bible passages and a chronicle of the prenatal complications that led to Gabriel's premature delivery. At one point, her doctor raised the prospect of an abortion, an "option" Karen ridicules. "Letters to Gabriel" also derides "pro-abortion activists" and decries the "infanticide" of "partial-birth abortion," the legality of which Rick Santorum was then debating in the Senate. The book reads, in places, like a call to action.

"When the partial-birth abortion vote comes to the floor of the U.S. Senate for the third time," Karen writes to Gabriel, "your daddy needs to proclaim God's message for life with even more strength and devotion to the cause."

The issue came up again the following spring. Santorum, a Pennsylvania Republican, appeared on the Senate floor with oversize illustrations of fetuses in various stages of delivery. He described the process by which a physician "brutally kills" a child "by thrusting a pair of scissors into the back of its skull and suctioning its brains out." He asked that a 5-year-old girl be admitted to the visitors' gallery, though Senate rules forbid children under 6. "She is very interested in the subject," Santorum said, explaining that the girl's mother had been a candidate for a late-term abortion when doctors advised her during her pregnancy that the child was unlikely to survive.

Sen. Barbara Boxer objected, saying it would be "rather exploitive to have a child present in the gallery" during such a debate. Santorum relented, bemoaning Boxer's objection as proof that "we have coarsened the comity of this place."

The same has been said of Santorum. In so many words, or facial gestures....

Government Shutdown Threatens Public's Health in CA, US

2011-04-08T19:49:00.000-07:00

EQUAL Health Network

Women’s Health, Greenhouse Gas Emission Protection, Health Care Reform at Risk

The public’s health would be a collateral casualty of caustic ideological battles over the national budget. Republican demands to defund family planning and to stop EPA regulation of greenhouse gas emissions have brought the federal government to a standstill. Crippling the popular Planned Parenthood clinics and lowering air pollution standards would profoundly damage the health of the nation and of California.

Women and men in many of the poorest neighborhoods rely on Planned Parenthood facilities for basic health care services, family planning, HIV care and cancer screenings. The Planned Parenthood Affiliates of California, Inc., has been instrumental in public policy for the health of women and girls.
These ideologically-driven "social riders" to the proposed budget would also eliminate funds for implementation of the Affordable Care Act and the new consumer protection bureau, leaving hundreds of thousands of families struggling to afford medical care.
Cuts could also fall on the Center for Infectious Diseases & Emergency Readiness at the University of California Berkeley, the only research center in the United States on radiological and nuclear public health preparedness.

The proposed $60 billion in cuts that Congressional Republicans have demanded this year, and trillions to come, would devastate the very projects that could revitalize jobs and ensure prosperity. Millions of people’s livelihoods depend on publicly funded transportation, infrastructure, education, and health care.

In addition, the shutdown itself will weaken the fragile economy, immediately placing 800,000 federal workers on furlough, suspending paychecks for soldiers and delaying business loans.
We need to develop a comprehensive solution that revitalizes federal revenues, while requiring those who benefit the most from our society’s infrastructure to pay the most to ensure its upkeep. Taxes for corporations and for wealthy individuals declined over the last decade, resulting in significant income disparities between the rich and the poor in the U.S., and leading to health inequalities. Reversing tax giveaways to the super-rich and the nation's largest corporations could raise $4 trillion within a decade.
We stand in support of reproductive and public health and against the threat of climate change! We urge our federal representatives to insist that these important programs continue!

California Public Health Association-North http://www.cphan.org/
 EQUAL Health Network www.equalhealth.info

California Pan-Ethnic Health Network www.cpehn.org

Fixing Health Care: Care + Cost

2011-04-08T07:30:00.000-07:00

Yes we have to fix financing. Yes we have to fix the delivery system. It's not a choice. Whichever we do first will not "work" (that is, control costs, and improve health) til we do both. It's understandable that we are having this debate: the Administration has tried to sell the delivery system reforms in the ACA as sufficient cost controls; many mainstream health economists are dubious about this, as are we. But it is also not the case, as Dr. McCanne asserts, that "the single payer model is structured as an altruistic, aspirational system that, quite automatically, actually does, in itself, improve quality and control costs." That's why every single payer bill before Congress also includes delivery sustem reforms, and always did. We need to be ready to fight for these reforms and for equity and accountability, as well as cost control, or we'll be surprised when the elected officials we put in charge of the single payer system cave in to the medical industrial complex. (Read up on Taiwan pre-single payer to get an idea of the relative simplicity and low cost of their system pre-reform. Different universe from the U.S.) Or try to cut funding for family planning.

As a single payer advocate I value the delivery system reforms in the ACA. They will not control costs unless and until we impose a budget on the healthcare system. We need a 900 pound government negotiator saying "no" to the drug, medical supply, institutional care, and provider industries. We can "save" all the money these reforms can achieve and the industry will find another pocket to put it into. (And by the way the ACA does put a cap on the Medicare budget as of 2019; we cd debate about the value of this and the likelihood of it occurring; but can also recognize the value of using the levers we have, including this one.)
But when we get to that point we'll be in better shape to make it work if we understand (as you both do) what we need to do to fix it so that people get care, and what safeguards and incentives we need to have to keep the system accountable. (It helps that Sebelius at HHS and CA's Insurance Commissioner Dave Jones, for example, are modeling what we want our regulators to do.)
Some people will not die in Massachusetts this year who otherwise would have because they have coverage. If they get sick next year, as the system becomes less "affordable" (meaning the state raises co-pays, instead of raising corporate taxes to pay for health care) they may be at greater risk.
We continue to murder people in hospitals through preventable errors in medications and other organizational dysfunctions, to say nothing of antibiotic resistance. This hasn't changed much since "To Err Is Human" came out in the 1990s. Electronic medical records will help address some of these problems. Better nurse staffing ratios will also help (something that nurses continue to fight for while fighting for single payer, because it improves quality and because it gives them more power as workers and professionals; it's a fight we can and must support at the same time as we fight to get rid of the parasitic insurance industry.)
Some teachers in CA took over a Wells Fargo bank in Oakland on Monday and closed it down for 2 hours.
http://sanfrancisco.cbslocal.com/2011/04/04/oakland-teachers-ask-wells-fargo-bank-for-bailout/
If people all over the country were taking militant action on a regular basis, things might look a lot different today. Didn't happen. in 2009-10; might happen now.
So. do we go back now and accept that delivery system reforms in themselves, including those in the ACA, will control costs? Nope.
When we talk - and think - about what a single payer system is going to do and how we're going to make it work, why on earth would we abandon talking about delivery system reforms?

The point is not just to make health care cheaper; we could put the whole military budget into CMS and it wd be a vast improvement in our health. The point is to make the health care system equitable, high quality, universal, accountable and affordable. And to rebalance power relationships so that we have more of it (a major determinant of health).

Looks, presence and power

2011-03-23T21:12:00.000-07:00

I am an Elizabeth Taylor fan. Manohla Dargis summed it up:

"Ms. Taylor managed the role of sex object effortlessly as if it too were just part of the job. In contrast to so many other actresses, she seemed as desiring as desirous, with the gift of a thrillingly unladylike appetite. She was a great lover of food, of course, as her cruelly documented weight gains make evident. Yet the appetite that appeared to drive, at times even define her, exceeded mere food to include everything, and her consumption of men, booze, jewels and celebrity itself was an astonishment."

However contrived and improbable the stories, her performances in "Place in the Sun" and "Butterfield 8" conveyed a passion and humanity that were consistent with her later public discussions about a studio system that gave her 2 weeks off after the death of her husband Mike Todd, and her later support for AIDS activism. Who knows what really goes on in the lives of the impossibly rich and famous - not me for sure. But to the extent our lives are bombarded with celebrity-dom, I liked it that rich gorgeous Liz made it a believable part of part of her public persona to stick up for herself and for the socially excluded. So, a salute.

Do You Have Sex? Do You Have Power?

2011-03-16T17:28:00.000-07:00

Ellen Shaffer, Defend the Dream Rally, San Francisco, March 15, 2011

Robert Reich is an inspiration to all of us, and one of the country's truly great thinkers. There are a lot of very smart people over at UC Berkeley, where he teaches.
As Co-Director of the Center for Policy Analysis, I want to demonstrate to Professor Reich that we can hold our own over here in San Francisco, too. So I have some complicated math questions I want to ask you. Some of them are multiple choice. I want you to huddle up and get warm and stand with some other people you think are really smart and we'll see if we can figure out what the problem is around here.

Are you ready?

Ok here's the first question, tell me if you can answer it:

Do you have sex?

Let me repeat: Do you have sex?

Ok here's the next question, this one has multiple parts:

Have you ever had sex, do you plan to have sex in the future, do you have any friends or relatives who you have reason to believe have ever had sex?

If you said yes to any of these questions, think about this one:

Do you think it's any business of Congress' if you do or if you don't?

All right, now let's get into some really tricky stuff.

When you've had sex, how many of you were surprised at some point when you got pregnant?

Here's a fact: 50% of pregnancies in the US are unintended pregnancies.

And 30% of women have an abortion at some time in our lives.

30%.

Here's another little-known fact: some of those women are - Republicans!

Now let's see what else we can discover here today.
We hear there are deficits, at the state and federal levels. The federal deficit is a big one, $1.5 trillion.

So let's see whose fault that is.

Did you make $810 billion last year? Anyone?

The oil industry did.

Anyone here vote to spend $3 trillion fighting phantom weapons of mass destruction in Iraq, without any way to pay for it?

Fact: Corporate profits went up to $1.6 trillion in 2010. Over half of U.S. companies paid no federal taxes at some time in the last decade.

Anybody here make $1.6 trillion and not pay taxes?

Here in California we have seen some of the starkest financial tragedies, the tragic divide between rich and poor, entire communities devastated by the irresponsible, criminal negligence of banks and finance capital.

Now here's another question:

Do we have any power?

You bet we do. If we didn't have any power they wouldn't have to keep bopping us over the head to keep us down.

The right wing extremists in Congress are marching to the tune of the extremists in the corporate world.

In Congress, and in the states, the far right is going after us, all of us, with their guns drawn, literally and figuratively.

The Republican budget bill would slash funds to implement health care reform, slash Head Start early childhood programs, slash Pell grants to students, close down public radio, deregulate environmental polluters.

And to women, and to those of you who ever have had or ever will have sex, they would do this:

The would defund family planning, period. Defund Planned Parenthood, period - even the cancer screenings and preventive health services in poor neighborhoods that make up 97% of their budget. Remember, half of pregnancies are unintended; that percent would go straight up.

They would make it virtually impossible to get an abortion. Because many employers get a federal tax break for providing health insurance, extremists say this means you should not be able to use your private insurance to pay for an abortion, because there is a public dollar in there somewhere.

It gets worse than that. You've probably heard some of the proposals: defining the murder of abortion providers as justifiable homicide. Authorizing hospitals to refuse to perform an abortion even if the refusal would result in the death of the mother.

The number of reliable pro-choice Senators is now a bare 40.

The vast majority of Americans believe that we as individuals have the right to make our own decisions about how and when we're going to have children. The majority believe that abortion should be legal.

The Trust Women/Silver Ribbon Campaign was formed so that the 80% of us who support individual choices about our reproductive health can be visible and vocal, and can take action.

We can exert tremendous influences over our life courses, as individuals.

But in many other ways, do as well as our communities do.

It is when we are united that we truly have power.

That is why we have to be smart.

They are throwing everything at us at the same time: trying to smash our unions, smash our democracy, smash our freedom of choice about when we're going to have kids, and with whom.

Because we are strongest when we are united, and we are weakest when they can pull us apart.

We are here today with Madison, we are here today with Ohio, we are here today with the LGBTQ community, with undocumented immigrants, with men and women - and for sure with all of us who have sex!

We are here with the people near the Fukushima Daichi reactor, where caretakers kept saying, don't worry, it's perfectly safe.

We're here with each other because we know that when we stand together that is when we have power.

Do we have power?

Do we have power?

Do we have power?

Now let's show our leaders what power is and what to do with it.

Thanks to Weslyan Uncut:
http://www.youtube.com/watch?v=gaxBR1AiFS4

WILL YOU HAVE TO PAY A 3.8% TAX IF YOU SELL YOUR HOUSE? NO!!!

2011-03-06T07:49:00.000-08:00

Here is one of the most insidious and widespread myths about the application of the Affordable Care Act. In presenting about the law in remote areas, I've found that people who had heard nothing about any of the benefits of the ACA had heard this: if you sell your house you'll have to pay 3.8% in new taxes on the amount of the sale.
Here's what is wrong with this:

Sec. 1411 is below. It does impose a 3.8% tax generally on unearned income, a progressive feature of the law.
And the 3.8% tax does apply to the sale of certain property.
But all of the following must be true for the tax to apply to proceeds from the sale of your home:
1. Your annual income must be $200,000 or greater if you file taxes as a single person, or $250,000 if you file as a couple. This excludes about 98% of Americans right there.
AND
2. The net gain from the sale of your home must be declarable as taxable income.
Now if you've sold a residence in the last 20 years you know that Congress is constantly finding ways to exclude home sale gains from taxable income. Right now you usually pay no tax on the sale for a variety of reasons. These change from time to time but right now include these conditions at least:
a. The first $250,000 in profit on the sale of a primary residence (or $500,000 in the case of a married couple) is excluded from taxable income already.
or
b. If you buy another home, you pay no tax.
Remember, you can make a million in taxable gains on the sale of your home and the new 3.8% tax will not apply unless you're also declaring taxable earnings over $200,000 a year.
You can find all this out in summary at FactCheck.org: http://www.factcheck.org/2010/04/a-38-percent-sales-tax-on-your-home/
But I think you're better armed by knowing where to look in the law so here you are:
‘‘SEC. 1411. IMPOSITION OF TAX.

‘‘(a) IN GENERAL.—Except as provided in subsection (e)—

‘‘(1) APPLICATION TO INDIVIDUALS.—In the case of an individual,

there is hereby imposed (in addition to any other tax

imposed by this subtitle) for each taxable year a tax equal to

3.8 percent of the lesser of—

‘‘(A) net investment income for such taxable year, or

‘‘(B) the excess (if any) of—

‘‘(i) the modified adjusted gross income for such

taxable year, over

‘‘(ii) the threshold amount.

‘‘(2) APPLICATION TO ESTATES AND TRUSTS.—In the case of

an estate or trust, there is hereby imposed (in addition to any

other tax imposed by this subtitle) for each taxable year a tax

of 3.8 percent of the lesser of—

‘‘(A) the undistributed net investment income for such

taxable year, or

‘‘(B) the excess (if any) of—

‘‘(i) the adjusted gross income (as defined in section

67(e)) for such taxable year, over

‘‘(ii) the dollar amount at which the highest tax

bracket in section 1(e) begins for such taxable year.

‘‘(b) THRESHOLD AMOUNT.—For purposes of this chapter, the

term ‘threshold amount’ means—

‘‘(1) in the case of a taxpayer making a joint return under

section 6013 or a surviving spouse (as defined in section 2(a)),

$250,000,

‘‘(2) in the case of a married taxpayer (as defined in section

7703) filing a separate return, 1⁄2 of the dollar amount determined

under paragraph (1), and

‘‘(3) in any other case, $200,000.

‘‘(c) NET INVESTMENT INCOME.—For purposes of this chapter—

‘‘(1) IN GENERAL.—The term ‘net investment income’ means

the excess (if any) of—

‘‘(A) the sum of—
‘‘(i) gross income from interest, dividends, annuities,

royalties, and rents, other than such income

which is derived in the ordinary course of a trade or

business not described in paragraph (2),

‘‘(ii) other gross income derived from a trade or

business described in paragraph (2), and

‘‘(iii) net gain (to the extent taken into account in

computing taxable income) attributable to the disposition

of property other than property held in a trade or

business not described in paragraph (2), over

‘‘(B) the deductions allowed by this subtitle which are

properly allocable to such gross income or net gain.

‘‘(2) TRADES AND BUSINESSES TO WHICH TAX APPLIES.—A

trade or business is described in this paragraph if such trade

or business is—

‘‘(A) a passive activity (within the meaning of section

469) with respect to the taxpayer, or

‘‘(B) a trade or business of trading in financial instruments

or commodities (as defined in section 475(e)(2)).

‘‘(3) INCOME ON INVESTMENT OF WORKING CAPITAL SUBJECT

TO TAX.—A rule similar to the rule of section 469(e)(1)(B) shall

apply for purposes of this subsection.

‘‘(4) EXCEPTION FOR CERTAIN ACTIVE INTERESTS IN PARTNERSHIPS

AND S CORPORATIONS.—In the case of a disposition of

an interest in a partnership or S corporation—

‘‘(A) gain from such disposition shall be taken into account

under clause (iii) of paragraph (1)(A) only to the extent

of the net gain which would be so taken into account

by the transferor if all property of the partnership or S

corporation were sold for fair market value immediately

before the disposition of such interest, and

‘‘(B) a rule similar to the rule of subparagraph (A)

shall apply to a loss from such disposition.

‘‘(5) EXCEPTION FOR DISTRIBUTIONS FROM QUALIFIED

PLANS.—The term ‘net investment income’ shall not include

any distribution from a plan or arrangement described in section

401(a), 403(a), 403(b), 408, 408A, or 457(b).

‘‘(6) SPECIAL RULE.—Net investment income shall not include

any item taken into account in determining self-employment

income for such taxable year on which a tax is imposed

by section 1401(b).

‘‘(d) MODIFIED ADJUSTED GROSS INCOME.—For purposes of this

chapter, the term ‘modified adjusted gross income’ means adjusted

gross income increased by the excess of—

‘‘(1) the amount excluded from gross income under section

911(a)(1), over

‘‘(2) the amount of any deductions (taken into account in

computing adjusted gross income) or exclusions disallowed

under section 911(d)(6) with respect to the amounts described

in paragraph (1).

‘‘(e) NONAPPLICATION OF SECTION.—This section shall not apply

to—

‘‘(1) a nonresident alien, or
‘‘(2) a trust all of the unexpired interests in which are devoted

to one or more of the purposes described in section

170(c)(2)(B).’’.

(2) ESTIMATED TAXES.—Section 6654 of the Internal Revenue

Code of 1986 is amended—

(A) in subsection (a), by striking ‘‘and the tax under

chapter 2’’ and inserting ‘‘the tax under chapter 2, and the

tax under chapter 2A’’; and

(B) in subsection (f)—

(i) by striking ‘‘minus’’ at the end of paragraph (2)

and inserting ‘‘plus’’; and

(ii) by redesignating paragraph (3) as paragraph

(4) and inserting after paragraph (2) the following new

paragraph:

‘‘(3) the taxes imposed by chapter 2A, minus’’.

(3) CLERICAL AMENDMENT.—The table of chapters for subtitle

A of chapter 1 of the Internal Revenue Code of 1986 is

amended by inserting after the item relating to chapter 2 the

following new item:

‘‘CHAPTER 2A—UNEARNED INCOME MEDICARE CONTRIBUTION’’.

(4) EFFECTIVE DATES.—The amendments made by this subsection

shall apply to taxable years beginning after December

31, 2012.

(b) EARNED INCOME.—

(1) THRESHOLD.—

(A) FICA.—øAmended section 3101(b)(2) of the IRC, as

added by section 9015 (and amended by section 10906) of

PPACA, including inserting a new subparagraph (B)¿

(B) SECA.—øAmended section 1401(b)(2) of the IRC,

as added by section 9015 (and amended by section 10906)

of PPACA, including inserting a new clause (ii) in subparagraph

(A)¿

(2) ESTIMATED TAXES.—Section 6654 of the Internal Revenue

Code of 1986 is amended by redesignating subsection (m)

as subsection (n) and by inserting after subsection (l) the following

new subsection:

‘‘(m) SPECIAL RULE FOR MEDICARE TAX.—For purposes of this

section, the tax imposed under section 3101(b)(2) (to the extent not

withheld) shall be treated as a tax imposed under chapter 2.’’.

(3) EFFECTIVE DATE.—The amendments made by this subsection

shall apply with respect to remuneration received, and

taxable years beginning after, December 31, 2012.

Plus, if you've gotten this far, you can look up portions of the Internal Revenue Code (IRC) referred to above.

The House's Budget Bill is a Bully's Snigger

2011-02-24T08:56:00.000-08:00

We've had our children, or not. But we remember.
Worried when we were "late." Escaped to New York or California or Mexico where it was legal, if we could, or found lay caregivers through Jane. Mourned our friends, or relatives, or patients, who were not so lucky. The girls who had to quit school; their boyfriends who never did.

We remember when domestic violence didn't have a name. We know that too many still cower in the face of it. We remember when women couldn't get jobs as reporters. We cringe that they are still blamed by some when they are raped on the job.

We fought on the job for decent pay and union rights, and at home for equality and respect. We're so proud of the lives we've created and equally proud of the generations of women and men who are asserting their places in the world.

We're not surprised that Republicans with no solutions for an ailing global economy are going after the rights of individuals to make our own reproductive choices, the rights of workers to a voice on the job, the rights of all of us to public health and health care. We have been startled at how quickly the Democrats will throw us under the bus.

The House's budget bill, HR 1, and the companion HR 3, are the equivalent of a bully's snigger. Their plans to cut health care services including family planning would force more unintended pregnancies on the most vulnerable women. And then deny access to abortions. They have come to push us around and take our money for their own binges, while bellowing about freedom and fiscal responsibility.

So, we need to find each other again, link up as allies, to renew our vision and our voices, to rebuild our power.

The Trust Women/Silver Ribbon Campaign will wear our silver ribbons for reproductive health, rights and justice (www.oursilverribbon.org) at the Walks for Choices this Saturday, Feb. 26 at noon. There's one near you: http://walkforchoice.tumblr.com/

Let's get this party started.

The Trust Women/Silver Ribbon Campaign for Reproductive Rights -- Why Now

2011-01-22T03:49:00.000-08:00

http://www.huffingtonpost.com/ellen-r-shaffer/the-trust-womensilver-rib_b_810010.html

We've learned a lot this past year.

We learned it is not enough to appoint and elect smart, progressive women and pro-choice men to government. They and we need to mobilize visibly and vocally to advocate for reproductive rights and justice.

As we celebrate the anniversary of Roe v, Wade on Jan. 22, we and our partners are launching the Silver Ribbon Campaign to Trust Women.

Since the beginning of time, women and men have found ways to control when and whether to undertake the joys and responsibilities of becoming parents. Most adults use or have used birth control. However, even the best birth control fails one time in a hundred. Half of all pregnancies are unplanned. At least a third of U.S. women have an abortion during their lives. Most adults believe that abortion care, a legal procedure. should be covered by health insurance as part of reproductive health services. 86% of employer-based health plans currently cover abortion. In these hard economic times, it is crucial that families have the choice whether to bring a child into the world.

But abortion has been stigmatized by a well-organized, well-funded minority movement, including extremists who provoke violent acts. Our reproductive health is used as a wedge issue, seizing on voters' anxieties about the economy and social issues to claim support for the regressive, anti-woman, anti-self-determination ideology of the right.

We saw a pro-choice president sign laws restricting access to abortion in at least three different ways: In the health care reform law, an executive order, and a regulation on state health plans. Despite the obvious fact that contraception is prevention, the Administration felt compelled to convene a panel to determine if contraceptives count as preventive care.

87% of counties now have no abortion providers. The burden falls hardest on the most vulnerable. 1 in 4 Medicaid recipients could not afford an abortion because it is not covered by their state. Medicaid funding restrictions also delay abortions by 2-3 weeks because of the hardship of raising funds to pay for the procedure. Delaying abortion results in higher risk for the health of the women and higher health care costs.

For too long, abortion providers have suffered from domestic terrorism by a violent, tightly-organized fringe. Virtually every clinic in the U.S. that provides abortions has experienced systematic harassment. Doctors who perform abortions have been targeted and murdered. Most recently, in 2009, an anti-reproductive rights zealot shot Dr. George Tiller point blank while Dr. Tiller was serving as a church usher. Each time a doctor murderer was apprehended, the media claimed that the perpetrator was a "lone wolf," a fable unmasked in Ms. Magazine's article by Amanda Robb.

It's up to us, the majority, to demand our rights. We have the right to make decisions about our reproductive health. We have the right to decide whether and when to have children. We have the right to use birth control as prevention. But if we do not stand up and be counted and seen, these rights will be chipped away -- or taken away.

On Jan. 22, on the anniversary of the 1973 Supreme Court decision on Roe v. Wade that made abortion legal, we join with men and women around the U.S. to launch a month in which we wear silver ribbons: the Silver Ribbon Campaign to Trust Women.

It's time to express the true voices of America.

It's time to come together and show our strength and numbers.

We need to stand by each other and claim our rights to the legal health care to which we're entitled.

Join the Silver Ribbon campaign to Trust Women, for Reproductive Rights and Justice.

1. Wear a Trust Women Silver Ribbon, representing science over ideology

2. Spread the word.

- Follow us on Facebook: http://on.fb.me/hmKaES

- Follow us on Twitter: @oursilverribbon

- Get your Twibbon: http://twb.ly/hp1HEG

Tweet and Facebook about the campaign the following lines:

Trust Women! Show your support for reproductive health care and women's rights by @Twibbon http://twb.ly/hp1HEG via @oursilverribbon

3. Take action!

Check out our webpage of events and share your story about reproductive rights and healthcare.

We who proudly wear the silver ribbon:

• Support reproductive rights

• Support free access to birth control

• Support keeping abortion legal and accessible

We Trust Women to make to their own reproductive health decisions and ask you to join us in showing that you Trust Women, too! Please wear a Silver Ribbon on 1/22-2/22 to show that you Trust Women and we (who Trust Women) are the majority.

Get involved! Go to: www.oursilverribbon.org

Co-authored by with Sophia Yen MD, MPH: pediatrician, adolescent medicine specialist, mother, woman, wife.

Don't Ask Don't Tell Gone; No on DREAM Act

2010-12-18T13:18:00.001-08:00

I’d rather no one were in the military.

I’d rather no one had to be married to enjoy full benefits of social and political life.

I hope today’s vote removes another barrier to social inclusion. It was a hard fight; this is a milestone.

Next year we’ll fight for immigrants to claim recognition, to trust women with decisions about their bodies, and for equitable, quality, universal affordable health care.

From Politico:

By SCOTT WONG
12/18/10 11:57 AM EST Updated: 12/18/10 3:52 PM EST

The Senate voted Saturday afternoon to repeal the ban on gays in the military, marking a major victory for gay rights and an end to the 17-year old “don’t ask, don’t tell” policy.

The bill now heads to President Barack Obama, who plans to sign it into law, overturning what repeal advocates believed was a discriminatory policy that unfairly ended the careers of thousands of gay members of the military over the years.

The 65-31 Senate vote marked a historic – and emotional – moment for the gay-rights movement and handed Obama a surprising political victory in the closing days of the 111th Congress. The legislation had been left for dead as recently as last week after Republicans in the Senate blocked efforts to advance it, yet on final passage, the bill won surprising support from eight Republicans.

The repeal, which would not take effect immediately, ushers in a major cultural shift for a military that has operated under the “don’t ask, don’t tell” policy since the first year of Bill Clinton’s presidency.

The Senate vote capped months of uncertainty about whether Congress or the federal courts, where gay-rights advocates are fighting the ban, would act first to repeal the policy.

The real drama had already come a few hours earlier when the repeal bill cleared a crucial procedural hurdle. The 63-33 cloture vote was three more than needed to beat back a Republican filibuster.

With support from all but one member of the Democratic caucus and help from seven Republicans, the bill overcame the 60-vote threshold required to move forward.

The Republican senators voting “yes” with the Democrats were Richard Burr of North Carolina, Mark Kirk of Illinois, John Ensign of Nevada, Scott Brown of Massachusetts, George Voinovich of Ohio, Lisa Murkowski of Alaska – and Olympia Snowe and Susan Collins, both of Maine. Burr, Ensign and Kirk were late surprises, bucking their party on the historic vote.

West Virginia Sen. Joe Manchin, who previously stated he opposes repeal, was the only Democrat to miss the vote, apparently because of a family “holiday gathering,” his spokeswoman said.

President Barack Obama called the procedural vote an “historic step” toward ending a discriminatory policy that weakens America’s national security and violates the ideals troops risk their lives to defend.

“By ending ‘Don’t Ask, Don’t Tell,’ no longer will our nation be denied the service of thousands of patriotic Americans forced to leave the military, despite years of exemplary performance, because they happen to be gay,” Obama said in a statement. “And no longer will many thousands more be asked to live a lie in order to serve the country they love.”

The repeal measure, passed by the Senate Saturday, already cleared the Democratic-controlled House this week along a mostly party-line 250-175 vote. It now goes directly to the president for his promised signature.

The repeal, however, wouldn’t take effect immediately. Obama, Gates and Mullen would have to certify to Congress that they have reviewed the Pentagon report on the impacts of repeal, that the Defense Department is prepared to implement repeal and that doing so would not harm military readiness, troop morale, and recruiting and retention.

The policy would be repealed 60 days after the president submits the document.

Read more: http://www.politico.com/news/stories/1210/46576.html#ixzz18V2i4ifj

Acceptance of Dr. Paul Cornely Award for Social Activism from the Physicians' Forum at the American Public Health Association, Nov. 7, 2010

2010-11-14T06:23:00.000-08:00

Thank you so much for this award. It is a deep honor to carry on the historic and inspiring work of Dr. Paul Cornely, a lifelong fighter for social justice. Upon his death in 2002, the Washington Post recalled his outstanding lifetime in public health. He was the first black president of the American Public Health Association (1970), the first black person to earn a doctorate in public health (1934), and a founder and first president of the D.C. Public Health Association in 1963 (now the Metropolitan Washington Public Health Association.) Among his landmark struggles was the fight to eliminate segregated health care.

It is especially meaningful to celebrate the traditions those of us gathered together tonight share.

The APHA annual meeting usually follows just on our national elections, and as a result we've shared many historic moments together.

We were together on the eve of the Bush presidency in 2000, and again when we led him to fire Donald Rumsfeld in 2006.
We were together when we elected Barack Obama in 2008.
And this week, of course, the San Francisco Giants have won the World Series for the first time in decades - against the Texas Rangers, I might add.

It has been a difficult week in some other respects but we are so lucky in so many ways - that we do still have the motivation, the means and the wherewithal to speak up for what we believe in.

And especially that we have each other to come together and share it with.

The corporate assault on politics is not new.

There are real historians here so I'll just talk from two of my personal sources of information - my parents and the movies.

I remember my parents telling me about Glenn Beck's precursor, the hate-spewing Father Coughlin, an anti-Semitic, pro Nazi demagogue who dominated the radio airwaves in the 1930s.

And I've been watching re-runs lately of "Mr Smith Goes to Washington." Freshly minted Senator Jimmy Stewart tries to stop a local wheeler dealer from diverting federal funds to build a dam on his property. Jimmy Stewart did everything he could muster. He filibustered on the floor of the Senate to marshal the local press back home - Mr Big confiscated all the newspapers and paid off the radio announcers. Jimmy mobilized the Boy Scouts to hand out fliers, and Mr. Big's goons beat up the Boy Scouts! But he kept at it and kept at it, til Senator Claude Rains couldn't take it any more and handed Jimmy his victory.

Their techniques are more sophisticated today. But the goal is always the same - to keep us ignorant and quiet, so the bullies of the world can get their way.

I think we've had more than one victory this year. We passed health care reform, after a century of failure. It is pock-marked, bullet-ridden and precarious, but it does two things at the heart of the single payer system we are going to win:

It expands the role of government in assuring coverage and payment for health care - something we must start talking about, positively and effectively.

And it targets administrative waste and reform of the delivery system.

These fundamental reforms are in addition to the immediate benefits I hear about every day, in the work of the EQUAL Health Network to educate about, implement and improve the new law, the immediate reason for this honor tonight.

Nothing could give me greater pleasure than to have the chance to share this room with the many of you who've stood here before me, and forged our identity as people who will speak truth to power - and will bend it!

Health Reform: Declaring and Winning Victories on the Way Forward

2010-10-15T13:12:00.000-07:00

Invitation to a Discussion

Many are mad as hell this election season, including some progressives. Absent the funding of the madly rich and insanely right-wing Koch brothers, what are we to do?

For one thing, take a sober look at the policy and politics associated with the Affordable Care Act.

This is not the single payer system many staunch health care reform advocates - including me - preferred, but lacked the power to enact. As we continue the campaign for a single payer, it is essential to recognize, vigorously defend and advance the victories we achieved in the Affordable Care Act, in order to preserve the gains for people in need and also to shore up the valuable activists, and activism, we will need for what is going to be a long haul ahead.

Here's what the ACA accomplishes, what single payer systems do, why we're absolutely right to continue to advocate for them, and how we can shape policy to get there from here.

What does the ACA accomplish? The U.S. health care system will do a better job of treating illness and improving health at an affordable cost. The Medicare Trust Fund will be solvent for an additional 12 years, through 2029. There are substantial improvements for lower and middle income people, and immediate benefits for women, younger people, seniors and small businesses. Importantly, the ACA creates policy space to continue efforts to cover everyone while controlling costs, goals that are popular with the public. It accomplishes these objectives in part by imposing new progressive taxes and fees on the wealthiest 2% of the population and on employers.

Politically, the ACA opens opportunities to challenge corporate power at the national level, in the formation of extensive regulations. It throws some leverage to the states, which progressives can use to advance our goals of equitable, quality, universal, affordable health care.

The law includes compromises that call out for revision, particularly on affordability, and on coverage for immigrants and for reproductive health care. And the political process that got us here will be grist for analysis for decades to come.

But it is just not true, as some have characterized it, that the law is primarily a victory for business as usual by the insurance industry. Furthermore, the fight to undermine and defeat the law unquestionably empowers and invigorates the most predatory anti-government political and financial interests in the country. Since the facts don't serve their agenda - to profit by destabilizing our social and financial security, including dismantling Medicare - they rely on hyperbole and distortion to mobilize the public's complicity in opposing our own real best interests. In contrast, we can and must remain critical while carefully examining sweeping generalizations that don't fit.

Single Payer: Getting There from Here

Single payer systems funnel all payments for health care to one collection point - usually a state or national government. This single payer then pays all the health care providers: doctors, hospitals, drug companies. There is overwhelming evidence that single payer systems are more cost-efficient and affordable, along with their many benefits for equity and quality of care.

This is different from our current system in at least two ways that are key to controlling health care costs.

• First, it is administratively efficient. It eliminates the middleman: the proliferation of private insurance companies that take a bite out of every health care dollar for the administrative service of paying the bills. These insurance companies, both for-profit and non-profit, now rake off about 30% or more of our insurance premiums, using ploys that at the same time restrict access to necessary health care and inflict great suffering on ailing humanity. They also add to the administrative burdens of doctors and hospitals.

• Secondly, it moderates prices. It gives a powerful negotiator - the government - the authority to negotiate prices with the health care industry: hospitals, doctors, medical supply companies, drug companies.

Largely for these reasons, single payer proposals are fiercely attacked, maligned and misrepresented and in all manner just blocked in the halls of power by the industry, which profits nicely from this mess.

The state and federal governments are now writing the rules for implementing the Affordable Care Act. Advocates can help to shape these rules to get us closer to administrative efficiency, and to expand the public sector's purview over prices. Some examples:

• In 2014, new insurance Exchanges will standardize health insurance plans. People who buy insurance now as individuals or in small groups will be grouped into much larger pools, sharply reducing cost-shifting. Advocates have the opportunity to craft and support state laws implementing the exchanges that can push limits on standardizing health plans and require financial transparency.

• The law sharply expands the number of people covered by public sector health plans. For the first time Medicaid will cover everyone under 133% of the federal poverty level, regardless of health status. State governments already do negotiate drug prices under Medicaid, in which enrollment will grow by almost half by 2014. State laws to adopt a public option would further expand the number of people who receive health care either paid for or provided directly by the public sector.

• There are numerous opportunities to regulate, review and otherwise limit premiums, depending on the rules adopted by HHS, and state implementation laws. The current policy debate on how to define and enforce the Medical Loss Ratio is an important example.

• The law also draws on the public's control over Medicare to address some of the underlying drivers of increasing health costs through new measures such as comparative effectiveness research and payment reforms to encourage more cost-effective delivery systems. It also expands primary care and public health.

• Finally, as soon as 2017 - maybe sooner - there is a defined process for states to prepare for and enact alternative systems, including single payer.

The corporate media surround us with messages - and messengers - that exhort us to succumb to cynicism (nothing will ever work, they'll always sell us out). Voluntarily taking ourselves out of the real health care fights of the day is tantamount to capitulation. Effective strategies for building the power we need will require and emerge from engagement as well as resistance. Advocates can rebuild public awareness and momentum for single payer systems, and at the same time support legislation and regulations that maximize the progressive aspects of the ACA. If done well, our work on the ACA will build the pathways we need to a single payer system.

California’s Health Insurance Exchange Law: Why Does It Matter?

2010-10-11T08:28:00.001-07:00

The Affordable Care Act (ACA) has created a new system of health insurance exchanges. States can design and implement the exchanges to offer new opportunities for access to affordable, accountable health insurance. California’s law is the first in the nation..

Under the federal ACA, exchanges will open in 2014 to offer standardized insurance plans to individuals and small businesses, with subsidies available to people earning up to 400% of the federal poverty level. The California law creates a 5- member governing body with two important features. First, it must “take into consideration the cultural, ethnic, and geographical diversity of the state so that the board’s composition reflects the communities of California.” Secondly, its strong conflict of interest provisions exclude participation by active agents of the insurance and health care industries.

In a key provision for affordability, the state will have the right to engage in “selective contracting” with insurance plans, meaning it will be able to negotiate on premium rates. In addition, it has the right to “require carriers to offer additional products within each of” the five levels of coverage specified by the ACA. These could conceivably refer to supplementary dental plans.

The exchanges for individuals and small employers are initially separate. They could be united in the future, pending a study due by 2018.

The exchange must be self-supporting, after repaying an initial loan for administrative start-up, although there is a prospect for General Fund support. Critics have noted that this funding limitation could hamper the exchange’s viability.

The law includes other important features. It requires coordination with existing health programs. The exchange must provide “oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired.” And, “The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.” Further, the Board must “consult with stakeholders relevant to carrying out” its activities, including “health care consumers who are enrolled in health plans, individuals and entities with experience in facilitating enrollment in health plans, representatives of small businesses and self-employed individuals, the State Medi-Cal Director, and advocates for enrolling hard-to-reach populations.”

Read the bills here:

California Exchange Bill AB 1602

CA Exchange Bill – Senate Bill 900 (Governance)

Do Men Have Sex? IOM to Study

2010-09-17T00:36:00.000-07:00

Today is the deadline for comments on interim federal regulations on what constitutes a preventive health care service. This is relevant because under the new health care reform law, preventive health care services are to be provided without co-payments and deductibles. Which somehow raises the apparently puzzling question as to whether contraception (defined as methods to prevent pregnancy) is preventive.

Or related to health.

The Obama administration isn't sure about this, and so has asked the Institute of Medicine to study it. This isn't really the question.

The question is: Do men have sex?

Based on substantial empirical evidence, though no new primary research, I assert: They do.

I further assert (and this is recent news as of the last few thousand years) that there are statistically zero pregnancies that occur without the involvement of sperm. This is most commonly supplied by a man known to the prospective mother, but could be supplied through artificial insemination.There were about 4.2 million U.S.births in 2009.

I appreciate that it is women who become pregnant. I appreciate and am an active participant in the women's health movement. There are health conditions that actually occur only in women (cervical cancer) or mostly in women (breast cancer), and gender-related factors that determine female well-being, life chances and longevity.

But I submit that contraception, conception and pregnancy are biological events that involve both males and females; and usually, not to be coy about it, sex.

Now here is how the new regulations will work: Every other on-its-face preventive service will be provided without extra cost-sharing. Starting on Sept. 23.

The Department of Health and Human Services was so eager to get this done that it is issuing interim regulations, meaning we can still submit comments on proposed regulations but meanwhile the interim regs will go into effect. But the Institute of Medicine is going to have to determine whether contraception really is preventive, and related to health, and a service. That will take till August 2011. Then, assuming that they do so affirmatively determine, it will be about another year before you get your IUD, birth control pills -- or vasectomy -- without an additional copay.

We in the women's health movement are going about this all wrong. Contraception is not about protecting women, at least not alone. Contraception is about the rights of men to have sex. In fact, contraception should be the corollary of every prescription for Viagra. In fact, that was the argument Jackie Speier used successfully, when she was a state senator, to get contraception covered by Califormia insurance plans.

Men, whatever else you think about health care reform, I think most of you know and like your female partners. (And LGBT adoptive and assisted technology parents generally feel the same.) You share, at least, the financial and emotional expenses of child-rearing, to say nothing of pregnancy; and if you don't, well, we have laws about that, too. So drop a note by clicking here to the EQUAL Health Network, and we'll let HHS know you know where babies come from. They need your help. You're so big and strong.

Medical Loss Ratio and Public Health: Questions Linger

2010-08-25T05:34:00.001-07:00

Should insurance companies be able to get off the hook for paying rebates to customers, who may believe their company is unfairly denying them specific medical care in order to save money, by virtue of engaging in health promotion campaigns?

Last week the National Association of Insurance Commissioners issued proposed rules for measuring the Medical Loss Ratio (MLR), a key instrument for controlling health insurance premiums. The MLR is the 80-85% of premiums that the new health care reform law requires insurance companies to spend on medical care, or improvements to the quality of care, as opposed to administration. Companies that fail to meet that test must give suscribers a rebate. The usually out-gunned consumer representatives at the NAIC supported the state insurance commissioners' vote to adopt the proposed rules unanimously, claiming a victory against insurance industry lobbyists.

But a key provision that slipped through threatens both the effectiveness of the MLR, and the integrity of public health departments. The U.S. Department of Health and Human Services (HHS) is backing a late amendment that would allow insurance companies to count their collaborations with public health departments as quality improvements.

What this means: Partnerships between private, for-profit health insurance companies and cash-strapped public health departments would be counted as part of the expenditures of your premium dollars to improve your health.

The key question is this: Should insurance companies be able to get off the hook for paying rebates to customers, who may believe their company is unfairly denying them specific medical care in order to save money, by virtue of engaging in health promotion campaigns?

Even assuming you like the idea of entrusting health promotion campaigns to your health insurance company, is the MLR a remotely suitable mechanism for encouraging them to engage in these canpaigns?

This is a classic mismatch of policy priorities. The MLR is meant to compel your insurance company to direct your premiums to pay for your health care. If your premium dollars are going to programs that benefit any non-subscriber. it shouldn't count against your right to a rebate. On the other hand, public health departments are meant to use your tax dollars to improve the health of your community. There are simply no grounds to divert public health department efforts to serve subscibers to a particular health plan.

There aren't a lot of these partnerships now - at least not legitimate ones. Most often they take the form of marketing campaigns that happen to focus on public health issues such as smoking cessation. If this rule stands, we can likely look forward to increasing insurance industry incursions into public health territory. So what? At least 3 things: 1. Premium dollars will be further frittered away on marketing campaigns re-dubbed as "health awareness." 2. Real public health department initiatives, and funding for same, will be undermined as already scarce public health staff are diverted to determining whether particular insurance company campaigns are legitimate or not. 3. Smoking cessation campaigns, for exanple, can help insurance companies identify and then cherry-pick customers, either excluding smokers from coverage, or charging them more (the excess charges remain legal even after new rules take effect in 2014).

Interestingly, the insurance industry is also lobbying not to count investment income, or the taxes they pay on investment income, as, well, income, for purposes of calclating the MLR. Those are the taxes that they should be paying to support our state and local health departments.

HHS has to "certify" the NAIC's recommendations before they take effect. The EQUAL Health Network says this one should get a recall.

Background online: http://www.centerforpolicyanalysis.org/index.php/2010/08/equal-to-naic-regs-for-the-public-not-for-insurance-co-s/

Insurance co.s want to make you healthy! They also have a bridge for sale

2010-08-12T02:41:00.000-07:00

The still-fragile Affordable Care Act (ACA) gives the public a fighting chance at reining in health insurance premiums. But we’re going to have to wrestle with the insurance industry every step of the way. As the National Association of Insurance Commissioners (NAIC) convenes in Seattle today, the public has the imperative to stick up for ourselves. Here’s what’s at stake in this round.

Starting in September, health insurance plans are required to spend at least 80-85% of the premium we pay them on actual health care. Executive bonuses, administration, marketing and profits are limited to the other 15% (in large plans) to 20% (in small plans). This is supposed to incentivize the insurance industry to operate efficiently and to negotiate assertively with health care providers. rather than simply passing on cost increases to consumers.

The $2.5 trillion dollar question is this: how do you define actual health care? The Secretary of Health and Human Services defines this figure, known as the Medical Loss Ratio (MLR), after consulting with the NAIC. And the insurance industry has not been shy.

The insurance industry is asking the NAIC to define the MLR to its advantage, by counting marketing programs, including those with public health themes, as medical expenses, rather than the administrative expenses they clearly are.

The aims of the relevant section of the law (Sec. 2718) - low cost care that offers value to consumers – conflict with the financial imperatives of the health insurance industry, to maximize profits and returns to shareholders, as well as administration, including executive compensation. Proposals by the insurance industry call for calculating the MLR in a way that will frustrate the aims of the law. The MLR is a ratio, with all medical claims (in the numerator), divided by total premiums (in the denominator). A high MLR means that the insurance company is spending a relatively higher share of premium income on its members' medical care and less for administration and profit. A low MLR means that the insurance company is returning less in medical care benefits to its members while retaining more for executives and shareholders; this can also signal a solid opportunity for investors.

To fairly achieve an 85% MLR, a company would have to show that the amount spent on medical claims (in the numerator) is high relative to premiums. But companies can frustrate the intent of the law by defining medical claims to include other expenses, including expenses typically considered part of administration.

The Senate Commerce Committee has documented that, "At least one company, WellPoint, has already ‘reclassified’ more than half a billion dollars of administrative expenses as medical expenses, and a leading industry analyst recently released a report explaining how the new law gives for-profit insurers a powerful new incentive to ‘MLR shift’ their previously identified administrative expenses."

The ACA standard for including expenditures for non-clinical care as a medical expense (that is, in the numerator) is that it must "improve health care quality." It’s hard to imagine this test will be met by the few occasions of insurance companies’ co-sponsoring visible public health events, nor do they justify skewing the MLR in ways that would raise premiums, or requiring the additional administrative effort to determine whether or not it is in itself an administrative or medical expense.

In our letter to the HHS and NAIC, the EQUAL Health Network urged, "The NAIC and HHS should discourage efforts by insurance companies to create and benefit from insubstantial programs that masquerade as clinical treatments. These programs should be properly counted as the administrative expenses that they are. Otherwise, a proliferation of such programs, if regarded as clinical care, would have the exact opposite of the intended effect of the measure: it would cause health care expenditures to balloon, and dilute value for consumers."

What About Their Investments?

The ACA standard applies only to insurers' premium revenues. Yet patients and payors should be equally concerned about how an insurer uses income from its investment of the sums it extracted from previous years’ patient premiums. A more appropriate standard would measure the share of insurers' total revenues devoted to care, as some analysts have urged.

NAIC committees have been working largely outside of the public’s view to draft standards. In our letter, the EQUAL Health Network urged, "It is vital that rate review and other pressures be strong enough to prevent insurers from simply raising premiums in order to offset the limit on their administration/profit share. It will also be important to create an ongoing public process to set and review the initial regulations which are required to begin in September, 2010. Public comment on this system's achievements and limitations will provide assessments of the system's success, and offer the groundwork for constructive and equitable adjustments to the rules."

Why Fight About Liz Fowler? Because We Need to Get Real

2010-07-24T07:07:00.000-07:00

Progressives failed to prevail on important policy debates during health care reform, including on the public option. There is no doubt that this was a central victory for the insurance industry. The retreat into magical thinking holds that we can measure the how the industry got its way by measuring campaign contributions, and drawing totally unfounded conclusions about the role of indivduals like Liz Fowler and Max Baucus. The record does not support this simplistic though appealing analysis:

According to the Center for Responsive Politics (opensecrets.org), the largest health insurance PACs gave more money in 2008 to Henry Waxman than to Max Baucus (and it wasn't much, at that). Waxman voted yes on the public option; Baucus voted no.

They gave more to the House, which voted yes on the public option, than to the Senate, which voted no.

PACs:
Wellpoint Inc Contributions to Federal Candidates, 2008

House
Total to Democrats: $152,000
Total to Republicans: $260,100

Senate
Total to Democrats: $48,900
Total to Republicans: $98,500

UnitedHealth Group Contributions to Federal Candidates, 2008

House
Total to Democrats: $138,700
Total to Republicans: $100,500

Senate
Total to Democrats: $71,500
Total to Republicans: $58,300

Henry Waxman: $3,000 - yes on public option

Max Baucus: $1,500 - no on public option

What's my analysis? Over time we'll sort out who did what to whom. It's comforting and titillating to believe that there were a few culprits, and that we've found the main one in Liz. We could note alternatively many more profound truths about how disconnected much of the country is from advocacy at the national level, a pattern that persists, and which we can affect. Retreating into Fox News-style sensationalism is not a substitute for analysis.

New HHS Abortion Restriction Goes Beyond Current Law

2010-07-20T08:37:00.000-07:00

Oppose Restrictions for Abortion Access in the Federal Pre-existing Condition Insurance Plans

Post-script:
This time they did not have to do it. There was no Ben Nelson, no Joe Lieberman. No applicable federal law. Not even much to lose. The Obama Administration chose to deny abortion funding in the new high risk pools, due to start next month. These enrollees will be among the most vulnerable women in the US: uninsured, with an existing health condition. The high risk pools were not already subject to the infamous Executive Order banning use of federal funds for abortion through the health insurance exchanges (due to start in 2014). The Executive Order was part of the price for heath reform. Well, ok, something to be fixed down the road. The road seems to have come to our door.

Why did the Administration extend this bad ruling to the high risk pools? Anti-choice groups went viral about the President betraying them if he did not extend to the already unconscionable Executive Oder to the high risk pools. Who thanked him? The Catholic bishops.

We have allowed abortion to become toxic. A procedure experienced by at least a third of women during our lives has been stigmatized. It is not enough to appoint and elect many fine, smart, progressive women – and pro-choice men – to government. They need, and we need, militant mobilized advocacy for reproductive choice and justice.

Keely Monroe, Lisa Kernan Social Justice Fellow; Ellen R. Shaffer, Co-Director; EQUAL Health Network

The Department of Health and Human Services has released an announcement stating that abortion coverage may only be obtained in the new high risk pool plans in cases of rape or incest, or where the life of the woman would be endangered. This wording mirrors the restrictions articulated in the Hyde Amendments to certain appropriations bills. (See below for full text of announcement)

As federal law currently stands, there are no restrictions placed upon federal or state money regarding abortion coverage in the Pre-existing Condition Insurance Plans (PCIP). The PCIPs are temporary insurance pools to provide insurance coverage to those deemed “high risk,” meaning the individual has some kind of pre-existing condition.

Because no law specifically addresses PCIPs and abortion coverage, the HHS statement would create a new sphere of abortion restrictions, undermining women’s reproductive autonomy.

The EQUAL Health Network believes these new restrictions are a response to pressure from anti-choice activist groups, and are unwarranted.

None of the current federal abortion restrictions that are in place apply to the PCIPs. The Hyde Amendment, which restricts abortion coverage to rape or incest, or where the life of the woman is in danger, only applies to funding appropriated through the Departments of Labor and Health and Human Services, including Medicaid. The appropriations for the Federal Employee Health Benefits Plan also restrict abortion coverage, but this clearly does not apply to the PCIPs.

In addition to nonexistent precedent for this action in prior federal law, there is no precedent in the Patient Protection and Affordable Acre Act (PPACA). The Nelson Amendment, adopted in the new law, only applies to plans obtained in the healthcare exchanges, which will not be active until 2014. Lastly, the Executive Order that the President signed regarding abortion coverage through PPACA gives no indication that it was meant to apply to more than the healthcare exchanges and community health centers.

The abortion coverage restrictions placed on the PCIPs is reminiscent of the Stupak Amendment first seen in the House version of PPACA, but later removed. The Stupak restrictions would have forbidden use of any funds, even those procured privately or through states, to provide abortion coverage to individuals participating in the PCIPs.

Objections to the White House and HHS Secretary Kathleen Sebelius.

White House:
Call: 202 456 1111
Email: public@who.eop.gov

Department of Health and Human Services
Call: 877 696 6775
Email: healthinsurance@hhs.gov

References:
Raising Women’s Voices
http://www.raisingwomensvoices.net/raisingwomensvoices-blog/2010/7/15/white-house-hhs-restrict-abortion-coverage-in-high-risk-pool.html#entry8268887

Jessica Arons from the Center of American Progress
http://www.rhrealitycheck.org/blog/2010/07/15/obama-administration-applies-stupak-amendment-high-risk-pools

Text of HHS announcement:
As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIB) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

Immigration is a NAFTA Problem. This is Not Big News

2010-07-11T21:29:00.000-07:00

It's too bad the governors worrying that challenging the Arizona law will hurt their chances in the upcoming election can't find the NYT article on February 18, 2007 by Louis Uchitelle, explaining precisely how NAFTA has driven Mexicans out of their own fields and factories and into the U.S.' Years later, all the misguided policy gurus at the Peterson Institiute can say is "oops," (and let's dismantle Social Security while we're at it). Concerned about creating jobs and stemming the deficit? Reverse NAFTA and CAFTA, and invest in education and social programs. We need leaders who will follow the President's example, and exhibit leadership.

Here's the news from the NY Times, over 3 years ago.

February 18, 2007
The Nation
Nafta Should Have Stopped Illegal Immigration, Right?
By LOUIS UCHITELLE
THE North American Free Trade Agreement, enacted by Congress 14 years ago, held out an alluring promise: the agreement would reduce illegal immigration from Mexico. Mexicans, the argument went, would enjoy the prosperity and employment that the trade agreement would undoubtedly generate — and not feel the need to cross the border into the United States.

But today the number of illegal migrants has only continued to rise. Why didn’t Nafta curb this immigration? The answer is complicated, of course. But a major factor lies in the assumptions made in drafting the trade agreement, assumptions about the way governments would behave (that is, rationally) and the way markets would respond (rationally, as well).

Neither happened, yet Nafta remains the model for trade agreements with developing Latin countries, including the Central American Free Trade Agreement, passed by Congress in 2005. Three more Nafta-like agreements are now pending in Congress — with Panama, Columbia and Peru.

When Nafta finally became a reality, on Jan. 1, 1994, American investment flooded into Mexico, mostly to finance factories that manufacture automobiles, appliances, TV sets, apparel and the like. The expectation was that the Mexican government would do its part by investing billions of dollars in roads, schooling, sanitation, housing and other needs to accommodate the new factories as they spread through the country.

It was more than an expectation. Many Mexican officials in the government of President Carlos Salinas de Gortari assured the Clinton administration that the investment would take place, and believed it themselves, said Gary Hufbauer, a senior fellow at the Peter G. Peterson Institute for International Economics in Washington who campaigned for Nafta in the early 1990s.

“It just did not happen,” he said.

Absent that investment, foreign factories congregated in the north, within 300 miles of the American border, where some infrastructure already existed. “Monterrey is quite good,” Mr. Hufbauer said, “but in a lot of other cities the infrastructure is terrible, not even enough running water or electricity in poor neighborhoods. People get temporary jobs, but that is all.”

Meanwhile, Mexican manufacturers, once protected by tariffs on a host of products, were driven out of business as less expensive, higher quality merchandise flowed into the country. Later, China, with its even-cheaper labor, added to the pressure, luring away manufacturers and jobs.

Indeed, despite the influx of foreign-owned factories, total manufacturing employment in Mexico declined to 3.5 million by 2004 from a high of 4.1 million in 2000, according to a calculation of Robert A. Blecker, an American University economist.

As relatively well-paying jobs disappeared, Mexico’s average wage for production workers, already low, fell further behind the average hourly pay of production workers in the United States, and Mexicans responded by migrating.

“The main thing that would have stemmed the flow of people across the border was a rapid increase in wages in Mexico,” said Dani Rodrik, an economist and trade specialist at Harvard’s John F. Kennedy School of Government. “And that certainly has not happened.”

Something similar occurred in agriculture. The assumption was that tens of thousands of farmers who cultivated corn would act “rationally” and continue farming, even as less expensive corn imported from the United States flooded the market. The farmers, it was assumed, would switch to growing strawberries and vegetables — with some help from foreign investment — and then export these crops to the United States. Instead, the farmers exported themselves, partly because the Mexican government decided to reduce tariffs on corn even faster than Nafta required, according to Philip Martin, an agricultural economist at the University of California, Davis.

“We understood that the transition from corn to strawberries would not be smooth,” Professor Martin said. “But we did not think there would be almost no transition.”

A financial crisis also dashed expectations. One expectation was that the Mexican economy, driven by Nafta, would grow rapidly, generating jobs and keeping Mexicans home. The peso crisis of 1994-95, however, provoked a steep recession, and while there was some big growth later, the average annual growth rate over Nafta’s lifetime has been less than 3 percent.

The financial crisis struck just months after Nafta came into existence, undermining, early on, the Mexican government’s ability to spend money on roads, education and other necessary government functions.

“We underestimated Mexico’s deficits in physical and human infrastructure,” said J. Bradford DeLong, an economist at the University of California, Berkeley, and a Treasury official in the Clinton administration.

But, he says, without Nafta the migration would have been even greater. For instance, he says, there would not have been as much investment in the north of the country.

Finally, the steady flow of Mexicans to the United States has produced a momentum of its own — what Jeffrey Passel, a demographer at the Pew Hispanic Institute, calls a “network effect,” in which young Mexicans travel to the United States in growing numbers to join the growing number of family members already here.

The upshot is that Mexican migration to the United States has risen to 500,000 a year from less than 400,000 in the early 1990s, before Nafta, Mr. Passel estimates. Roughly 80 percent to 85 percent of immigrants are here illegally, he says.

The peso crisis, recession, the network effect — their impact may have been beyond anyone’s control, but not the assumptions about how the market and the government would act.

“We have indeed had one disappointment after another on this score,” Mr. Rodrik said, noting that the same assumption about government spending is part and parcel of the agreements, now before Congress, with Columbia, Peru and Panama.

While there is opposition to these proposals, it is mainly from Democrats who want a better safety net for American workers who might be hurt.

The European Union, in contrast, assumes little about government spending on the part of economically weaker nations joining it. The union itself has hugely subsidized the improved services needed by entering countries like Portugal, Spain, Greece and Poland, rather than leave financing to the relatively meager resources of entering countries.

The money is used not only for public investment, Mr. Rodrik noted, but also to subsidize companies setting up operations in the new countries and to support government budgets.

“I am not saying Nafta was a bad agreement,” Mr. Rodrik said. “But more than a trade agreement is required for countries to converge economically. And Nafta has been viewed as a shortcut to convergence without having to do all the other stuff.”

U.S. scores dead last again in healthcare study: Health reform can help

2010-06-25T03:36:00.000-07:00

The annual Commonwealth Fund study has found once again that the U.S. stacks up last in five measures of healthcare -- quality, efficiency, access to care, equity and healthy lives, compared with Britain, Canada, Germany, Netherlands, Australia and New Zealand. All these countries spend a fraction on health care compared with the U.S.

The new health reform law could address some of these deficiencies. But the findings are under attack from defenders of the status quo who claim in part that the problem is not in our health care system, but in our poverty rate.

Countries do have to do a number of things right to actually improve health:
1. Cover everyone for ready access to health care, to nip problems before they escalate, and to control chronic conditions with medicines or lifestyle changes.
2. Treat acute cases by well trained teams that have access to information about how to diagnose and treat hospitalized patients safely, and have the financial and organizational incentives to do so.
3. Reduce inequities that aggravate poor health, particularly economic differences between rich and poor, and social discrimination based on race, gender, sexuality, disability, etc. The stress of relative powerlessness takes a physical toll and compounds the lack of resources that can buy healthy circumstances: Violence-free neighborhoods where outdoor exercise is safe, healthy food and time to prepare it, spending on social programs like education and income support, information about sexual and physical health, as well as good health care.
4. Finally, it should be affordable so that everyone can use it, including those who need it most. This usually means authorizing the government to play a major role in negotiating prices with the health care industry.

U.S. is deplorably deficient in these areas of performance. And it doesn't all happen in lower-income states like Mississippi. Access is unquestionably a function in part of coverage and is equally wretched in California (where policy has been held hostage for decades to arcane but effective rules against social spending) as in the south. Preventable hospitalizations for chronic conditions vary by county as well as state and reflect poor access to primary care as well as demographic variables. Patient safety is a function of systems, and adequate staffing. Outside of the VA system, our acute care hospitals have insufficient standards for safe and efficient performance, which compromises patient safety and outcomes. In addition, uncontrolled high prices for overuse of medical technology drives the costs of care in the U.S.

Does all this, or even the promise that it will improve as reforms are implemented, justify cutting payments to disproportionate share (DSH) hospitals, as the new law proposes? Very debatable.

However. Let's grant that the U.S. has a higher percent of poor people than other countries, that people of color are disproportionately poor, and that poorer people in the U.S. tend to be in worse health. Dr. Richard Cooper, for one, suggests that the main reason we are outspending the world on health care is that we are spending more money taking care of our poor who are sick.

To the extent that this is true, it is only possibly the case because we take care of poor people in the worst possible way - not through universal access to timely primary care, but through crisis medicine when even U.S. standards generally would not tolerate outright denials of care.

We should have fewer poor people. Race should no longer be associated with poverty. Relatively lower income should no longer determine the degree of power and control over life circumstances that are in turn associated with longevity and good health (nor for that matter should gender, sexuality, religion, or most demographic factors and lifestyle choices; age of course is the exception.). We should not only continue to document these pernicious trends, we should turn our scholarship and advocacy to redressing them. Furthermore, our health care system can contribute to social equity, and presently does poorly.

An unspoken argument is that poverty and race account not only for our higher health care spending butt also for our worse health outcomes, so it will not help to look to reforms of the health care delivery system for solutions. I don't know whether rates of medical errors or C-sections (or misuse of neonatal intensive care units) are higher in the U.S. than in, say, Finland. I know that they are higher than they should be, that they are not disproportionately prevalent in "poverty ghettos," and that they contribute to unjustifiable costs and poor outcomes. Reforming the health care delivery system should not be an excuse for failing to remedy social inequalities. Pointing to inequalities cannot divert attention from the inefficiencies and remediable deficiencies in our delivery system.

The new health reform law and ongoing HHS initiatives make reasonable efforts to acknowledge and address access, inequalities, and delivery system reforms. They won't be as successful as they could be in a single payer system like Medicare and the VA, but even a single payer system in the U.S. would have to implement the kind of delivery and organizational reforms that are now before us.

Quiz: Why Are Medicines Too Expensive and Cigarettes Too Cheap? Clue #1: The Trans Pacific Partnership (!?) Clue #2: You're Not Authorized to Know

2010-06-25T03:28:00.000-07:00

It's 2005. Three southern Pacific countries including oil-rich Bunei get together with Chile and craft a trade agreement (on the edge of your seat yet?). The "P4"do not include standard U.S. trade rules that escalate drug prices and promote smoking. They do include some weak provisions on labor and the environment.

Fast forward to June 2010. No politician in the U.S. wants to run for reelection during a job-busting depression pushing for another free trade agreement. But tobacco giant Philip Morris, U.S.-based drug companies and other corporate interests think it would be just the thing.

So the U.S. invites the "P4"- Brunei Darussalam, Chile, New Zealand and Singapore - to join up in a Trans Pacific Partnership (TPP) with the United States, Australia, Peru and Viet Nam. The second round of talks descends on San Francisco from June 14-18, aiming for a "high-quality, 21st century agreement that builds on the standards of P4, setting it up as a platform for a regional trade agreement." (The first round was in Melbourne in March; next meeting set for Brunei in October.)

With a trade agenda in flux and facing demands for a voice in trade policy from public health, labor, environmentalists and consumers, the U.S. Trade Representative invited the Center for Policy Analysis on Trade and Health (CPATH) and colleague "stakeholders" to come inside. Sort of. Here's what we found.

The week's activities raised questions about whether there may be new opportunities in this Administration for shifts in trade policy, on public health, labor, development and the environment. US staff were consistently available and insisting that the Administration wanted a new era of transparency and consultation. Further they signaled that they wanted better labor standards; they were open to concerns about tobacco control, though they also said that some members of Congress would be ready to put the brakes on.

CPATH organized a press conference on opening day, where SF Supervisor Eric Mar and public health advocates called for removing tobacco from the negotiating table. We got good coverage, as did events organized by labor and environmental groups, and PETA. (The SF Board of Supervisors passed Supv. Mar's related resolution on June 22.)

While stakeholder groups have convened at the site of trade negotiations in the past, this time we were afforded the use of facilities inside the meeting area, and the opportunity to make presentations. Highlights of the week included well-attended presentations to the delegates by CPATH, the AFL-CIO, Public Citizen, IFG and others.

CPATH's presentation to trade delegates took place on the evening before the final day of negotiations. We identified the threats to health and health care posed by uneven and unsustainable development; investor-state rules that empower corporations to bring trade charges against governments; and rules that undermine tobacco controls, access to affordable medicines, and commitments on health care and health-related services. Every delegation attended except for Vietnam. The response was overwhelmingly positive.

At the same time, the usual shroud of secrecy surrounded the details of the talks. Morning stakeholder "briefings" were held by the U.S. chief negotiator Barbara Weisel, which focused broadly on what topics were being discussed, without any information on the content. The delegates were using "bracketed text" as the basis for some of their deliberations, but the U.S. would not make this text available for us to see.

This points to a key difference in access and participation between "stakeholders" and official trade advisers; stakeholders may participate in broad discussions about topics under consideration, whereas official U.S. trade advisers review and comment on U.S. negotiating positions and actual text to be negotiated. CPATH's national Campaign for Public Health Representation has focused on bringing public health advisers onto U.S. trade advisory committees, to balance the overwhelming representation by corporate interests. HR 2293/S 1644 seek to change this imbalance legislatively.

This is the perfect time for a campaign to add Congressional co-sponsors to HR 2293/S 1644, which will in turn add public health and consumers to trade advisory committees.

Practical Guide to Health Care Reform

2010-05-22T09:03:00.000-07:00

by Ellen Shaffer and Judy Norsigian

(published in Salon, May 22, 2010: http://www.salon.com/news/opinion/feature/2010/05/22/progressives_practical_healthcare_guide/index.html)

Two months after it became law, many progressives are still simmering over healthcare reform, convinced that it did too much for private insurers and too little for average Americans. The stakes are high: Demagogues on the right are whipping up fear of the new law in hopes of big gains in the November elections — and counting on progressives to stay home.

It would be a tragic mistake for progressives to play into the right's hand like this. While we share the long-term goal of a universal "Medicare for all" system, too many on the left are ignoring the important improvements to access and quality of care that the new law will achieve — and the policy space that it creates to go further in the future. In particular, we believe four major myths have unduly undermined progressive enthusiasm for the new law:

Myth: Progressive activists should ignore or undermine the new law, which will get us to single payer more quickly.

Reality: An effective political movement requires both idealistic foot soldiers and politicians capable of achieving the art of the possible.

For now, this means fighting hard to protect what we’ve gained while also fighting for more on the public option, on abortion and on immigrant inclusion. Building the power to change the system involves winning victories that make a real difference in people’s lives, thus encouraging them to fight on. With healthcare reform, Democrats won a huge victory, fueled by millions of activists who need to get a pat on the back — and then get back to work. Women in particular have important reasons to stay active, including the need to defend new laws that prohibit insurance companies from discriminating against them.

It's also worth remembering that sitting out this fall's elections because of healthcare reform would mean handing control of the country back to the most extremist Republican Party in history.

Continue reading
Myth: The new law won’t save money because the insurance industry is still standing.

Reality: The law begins to address the major drivers of excess healthcare costs: the overuse and high prices of new technologies and drugs, and social and economic inequalities.

The health insurance industry is predatory, dishonest and parasitic. It contributes to unnecessary administrative complexity that drives up costs. We’d be better off without it. However, it has had the unenviable and only faintly achievable remit of negotiating with the rest of the healthcare industry, which is equally inefficient.

The new law gives us a lot to work with. We spend 16 percent of our GDP on healthcare, more than any other industrialized country, but our health outcomes are worse than most of them. Americans use fewer doctor visits and prescription drugs; we just pay much more for every procedure and every prescription. The U.S. trains more specialists, who charge more than primary care clinicians and also drive some of the inappropriate use of acute care. As a result, the U.S. experiences more hospitalizations for chronic illnesses like hypertension and diabetes — conditions that could be prevented and treated at a lower cost and with better results by appropriate primary and preventive care. And maternity care that underutilizes midwifery care frequently results in worse outcomes.

The cost-control torch ultimately needs to pass to the government, the only purchaser with sufficient countervailing power to negotiate effectively with the drug, hospital and medical device industries, and with clinicians. This is what a single-payer system would do, and the new law punts on this part. But it does use the power of Medicare and other government programs to shift toward system changes that control costs by improving quality. These changes include making comparative effectiveness research available and expanding primary care and prevention. It sets a global budget for Medicare, which must be achieved without reducing benefits or increasing costs for beneficiaries.

The other significant driver of our crummy health outcomes is the social and economic inequalities that derive from our Wild West brand of capitalism. Expanding coverage for more affordable healthcare will smooth some of these edges and improve health.

To be clear: Without a national budget of some sort, money saved through these policies will likely be shifted and spent elsewhere in the healthcare system. The pilot programs that the new law creates will provide lessons for how to improve care while reducing costs — valuable information for future reform efforts.

Myth: The insurance industry is still standing because President Obama made a backroom deal.

Reality: The president made a well-publicized deal with the entire healthcare industry, which is still a force to reckon with.

The healthcare debate revealed and reinforced important information about where power resides. Vast swaths of the U.S. are still in the grip of Republican or ConservaDem representation in Congress. Democratic campaign funding schemes bolster this arrangement by siphoning party funds from progressive to Blue Dog candidates. Progressive challengers are sprouting up in primaries around the country in response. (Bill Halter, take a bow.)

The healthcare industry accounts for one-sixth of the U.S. economy and remains enormously powerful. It includes pharmaceuticals, insurance, medical devices, hospitals and other institutions, and some groups of clinicians. Employers know that they pay less for healthcare in other countries with more equitable systems, but keeping healthcare benefits rooted in employment helps to discipline workers, who might otherwise unionize or change jobs. And more than ever, the corporate-owned, corporate-dominated media are a barrier to any meaningful population-wide comprehension of why patients and the public are being fleeced and abused, and what can be done about it.

Among the key players in the debate, on both sides, there just wasn't an appetite for major changes in how the system functions. For instance, some of the stronger unions are firmly ensconced in the same hospitals whose budgets would likely take a haircut under more substantial reform.

Remarkably, the public stuck with the issue, breathing life back into the public option time and again. As late as February, the netroots mobilized 1.2 million contacts to Congress on a single day. But no organization ever had a credible strategy for mobilizing the massive uprisings required to get rid of the insurance industry, nor did any uprising materialize spontaneously.

This left the fulcrum of power for change at the White House. Clearly, the White House calculated early on that it needed to buy all possible peace from the healthcare industry and the U.S. Chamber of Commerce. Doing so would give it time and space to nudge the issue into the public’s view long enough to establish support, before the inevitable attacks flooded the media (which they ultimately did). In the end, the administration and congressional leaders reasonably calculated that the whole enterprise could evaporate at any moment, and they didn't want to gamble on losing any votes.

Obama's reluctance to push for a bolder final law — one that included the public option, abortion and immigrant inclusion — was surprising and disappointing. But in the end, progressives should appreciate that he overcame obstacles that have sunk every reform effort over the past 100 years and managed to sign a bill into law. Now the challenge is to build on the law — to recognize the institutional changes that the law enacts, while pushing for more fundamental reform.

Myth: The country is ready to go for a Medicare-for-all single-payer system, run by the government.

Reality: The country has mixed feelings about the government. While only the public sector can truly create affordable coverage for quality care for everyone, we need to contest with corporations for the policy direction of the state.

Progressive movements in the U.S. have often battled both the government and capital. The New Deal and the Great Society marked a coda in U.S. history, characterized by aggressive activism by the federal government in the interest of the majority of the population. This heritage, perhaps now resuscitated by the Obama administration, was damaged by the “credibility gaps” of the Vietnam era, undermined by the Reagan years, and ravaged by the Bush administration.

Since 1980, the prevailing economic agenda has represented the triumph of "free" markets. The exercise of state power to defend corporate interests has been presented as a benefit to society at large: It preserves our individual freedoms and the "right" to buy an unlimited array of cheap products. In return, we are asked to consent to cuts in taxes, social services, and spending on education and health, under the pretext that it’s good for us to compete for these basic human necessities.

It is possible that within the confines of the law we just passed, a law that is both compromised and a compromise, the Obama administration intends to introduce accountability and responsiveness to the public into its healthcare policymaking. Health and Human Services Secretary Kathleen Sebelius is seeking public comment about her regulatory authority to set insurance rates. She is deciding how to define "unreasonable" rate increases and whether in fact all rates should be regulated. These are important issues that advocates and the public can and should be addressing.

Where to From Here?

With the new law, we have won policy space to further challenge corporate control, including control of the healthcare system. Limits on the insurance industry’s ability to bilk and fleece the public now include: laws; an energized public that wants to see the laws enforced; and an administration that has already taken enforcement action and gives every indication of continuing to do so. We have won major advances in coverage for healthcare and maybe for affordability.

The short- and longer-term benefits of the law could discredit the scare tactics at the center of the Republicans’ campaign to repeal the law within months. The Medicare program will not go broke at a faster rate but will be sounder financially, as will our economy overall. The misgivings expressed even by the likes of Obama supporter Merle Haggard — “I’m afraid we just can’t afford it” — should give way to the preponderance of evidence that the law will in fact reduce the deficit, once it trickles out. Many benefits will begin to roll out immediately, including lower prescription drug costs for seniors and expanded coverage for young adults. Little will change — as promised — for the overwhelming majority of Americans who are covered by self-insured or commercial health plans through large employers.

Progressives need a strategy that combines jiujitsu with direct action, and that distinguishes between necessary compromises and sellouts. We have to reach out to congressional districts currently represented by ConservaDems or Republicans and win over some of the population that straddles the middle of the road. Our culture of political debate should aim to attract and develop supporters who are savvy and well-informed to surmount the formidable obstacles we face. Progressives must move forward together. We still have the same goal: equitable, quality, universal, affordable healthcare.

Ellen R. Shaffer, Ph.D., MPH, is co-director of the Center for Policy Analysis, which sponsors the EQUAL campaign for Equitable, Quality, Universal, Affordable healthcare. Judy Norsigian is the executive director of Our Bodies, Ourselves in Boston.

Historic

2010-03-24T13:12:00.000-07:00

Yay! We passed the bill! No question about it, seeing the House pass the health reform bills, and watching the President sign one of them, felt like moments of triumph. Despite our many many reservations, so many of us have worked so hard over the last year to achieve this victory! From my own work with the remarkable network that has sprung up around EQUAL, and my colleagues at KPFA; to the hard work of women's groups, progressive organizations, and public health; to the members of Congress who took on enormous obstacles: we all have a claim to this step forward. Speaker Nancy Pelosi clearly deserved major credit for working the bill through the Democratic caucus.

But there are bitter disappointments. The public option failed though it was and is popular. Reproductive rights and immigrants' rights are under assault. Corporations are gaining legal as well as de facto rights. The rabid right, while possibly diminishing and cornered, is nevertheless frightening. The opposition leadership is fanning the flames of hate, divisiveness and willful ignorance, as they experience defeat for the first time in a decade. Members of Congress are heckling each other, the President and the public. One staff member described the atmosphere as “vicious.”

It’s not all over yet, even on the most pragmatic level. The Senate will debate all week, and Republicans will attempt every possible maneuver to derail the proceedings.

Both the President and Rep. Dennis Kucinich framed the victory as one that could begin to reverse 30 years of regressive Reagan-era policies. While the details of the bill are largely technical, and far from revolutionary, one has only to think back to the tsunami of corporate opposition that buried similar proposals in the Clinton era to appreciate the potential significance of this accomplishment.

The legislation itself offers significant improvements for health coverage for many, while ducking the most far-reaching controls on costs. The immediate benefits this year include a tax credit for small businesses that offer insurance, a ban on pre-existing condition exclusions for children, the elimination of copayments for preventive care, and a $250 rebate to Medicare beneficiaries who fall into the prescription drug plan’s doughnut hole. In 2014, 16 million people will begin coverage through Medicaid (called MediCal in California), and millions more will be able to buy insurance through pools created by new state-based exchanges. The plan will limit insurance plans’ ability to gouge sick enrollees in the small group market.

The public option would be a crucial factor in controlling costs and holding insurance companies accountable. Like Medicare and other public programs, the public option was envisioned as an entity with the clout to demand lower prices from health care providers, and also a real alternative for people seeking an escape from the predatory insurance industry. Its absence leaves a gaping hole in the program’s viability.

There’s no similar dispassionate analysis of the harm inflicted on women and immigrants. At best, the bills strengthen existing prohibitions on spending federal funds on abortion and for the first time intrude on the right and ability to buy abortion coverage with private dollars; and exclude tax-paying immigrants from health benefits others enjoy. These assaults are driven purely by vitriol.

The job for progressives is to rejoice in the prospects that may be opening up, and to stay angry about what we have lost, while taking a cold, hard look at the power dynamics that landed us here. A map of the House vote suggests a huge geographically-based divide in the U.S., with representatives from the more isolated middle of the country accounting for most of the Republicans, and the 34 Democrats who voted no. Can progressives win primaries against ConservaDems in those districts? A number of organizations are chomping at the bit to find out.

We have to come up with strategies to deepen and consolidate the public’s approval of Medicare as a model for a stronger public role in the health care system, and link state based and national campaigns to pursue it.

Challenging sexism, racism and homophobia will be problematic in an era of economic recession. But our communities are organized and articulate. Winning the power to defend and advance our interests is not an option; our opponents have their knives drawn, in some cases literally.

Quoting Rep. Dennis Kucinich:
“We're at a pivotal moment in American history, and in contrast to a crippled presidency, I have to believe that this effort, however imperfect, will now have a broad positive effect on American society, and make possible many things that might not have otherwise been possible. Once this bill is signed into law, more Americans are going to be aware of this as they ask, What's in it for me? And as they become more familiar with the new law, more people will be accepting this bill. The president will have a stronger hand in domestic and international affairs, and that will be good for the country.”

Is this President up for it, and up to it? Are we? The coming months will tell.

Health Reform Debate Devolves (Further)

2010-03-20T21:31:00.000-07:00

It's not just about the money. It's about fairness, and equality, and how profoundly our political culture is infused with the imperatives to keep us divided on the most fundamental bases. Our economic and legal systems have been engines of great progress, and also of divisions by class, race, gender, and all manner of measures of privilege and powerlessness.

It is not the same thing that anti-reform protestors on Saturday spat at Rep. Emmanuel Cleaver, and hurled a racial epithet at Rep. John Lewis, and an anti-gay slur at Barney Frank; that there is now consideration of an Executive Order strengthening even further the ban on federal funding for abortion - a life-crushing measure for millions of women - to win votes for health reform; and that the health reform package would extend no benefits to the undocumented workers who, parenthetically, pay taxes and have by and large been wrenched from their homelands by our own destruction of their domestic agricultural economies. Each of these injustices has its own history of oppression, and its heroes, heroines and triumphs.

But aren't we ready, really, to turn a tidal wave of shame and intolerance against the hate-mongers who are fanning these divisions? It's time to demand apologies, resignations, reparations, from right wing demagogues whose time-worn tactics threaten us with real harm, physical and otherwise, and attempt to keep us divided and to deflect attention from the bankruptcy of their own ideas.

Passage of the House health reform bill would be a landmark event in the march toward human justice and equality. We will no longer take it for granted that where we work should determine whether we get health care. Corporations will have to rely on their many other resources to discipline the workforce. More of us will enjoy longer and healthier lives, with greater security. The health care system itself will be constrained in its ability to penalize us for being women, for being older, for being sicker.

Let's turn our attention this Sunday not just to the vote on the House floor, but also to the march for immigrants' rights in Washington, D.C. And building on that, let's continue the momentum we began in November, 2008, to envision and implement an agenda that unites and lifts up all of us.

Thank You Dennis Kucinich

2010-03-15T14:07:00.001-07:00

Let’s face it, politicians can be exasperating. Politicians who run for President get a level of exposure that would make most of us run for cover.

But Dennis Kucinich is taking a drubbing for doing what more progressives should be doing: standing up for a public option as part of the health reform bill, and demanding an ERISA amendment.

This is not a simple matter of getting the health reform bill passed. Passing a health reform bill is a bare minimum requirement for the U.S. to make progress towards an acceptable level of social justice and it should be done. Today’s “Hill” reports that the votes in play are - well, most of them. There are presently 114 Democrats declaring hesitation about the bill:

Firm No, Leaning No, Likely No (36)
Firm Yes (2)
Leaning Yes (5)
Undecided (71)

We’ll come back to this.

Last November, 219 Democrats voted to pass a health reform bill, 39 voted No. The bill included a public option, and also included odious provisions limiting access to abortions. Now the speaker needs 216 “yes” votes to pass a scaled back version of the bill, with fixes in the form of a budget reconciliation bill. That means she can lose 37 Democrats.

Some history
Congressman Kucinich voted for the House bill when it went through the Education and Labor Committee. That bill included a public option and an amendment he proposed to the Employee Retirement Income Security Act (ERISA), to permit states to implement single payer systems without facing a court challenge by employers.

Employers like ERISA, they like ERISA’s provisions that preempt state legislation on employment-related health care benefits, and they would be just as happy not to see any changes to it. Passing the amendment through the Committee was not an easy task, and it came about because Republican members of Congress joined some progressives to vote yes, doubtless alert to the fact this provision alone could swell Republican political contributions, and possibly sink the bill if it came before the full House. Nevertheless, the majority of the Committee voted to accept the amendment. Under normal circumstances, that would indicate it would show up in the bill that went to the House for a vote.

You didn’t see that amendment in HR 3692. That’s because in the interim the Chamber of Congress wrote to the House leadership and pledged to oppose the entire bill if it included the ERISA amendment. The House leadership crafted a bill they thought would pass, and that did not include any changes to ERISA. This was before the recent Supreme Court decision giving corporations expansive rights to influence politics. Mr. Kucinich voted “No” on the final bill.

Getting to the Public Option

Now Mr. Kucinich says he would like to discuss changing his vote to a Yes. He wants 2 things in the House bill: A public option. And the ERISA amendment.

Turns out the majority of Americans agree with him. The most popular part of the bill is the public option, and with good reason. Skeptical as we are of the government, allergic as we are to wonkitude, we have no doubt whatsoever about what lies in store for us if we have to start forking over our premiums to the private insurance industry without the option to vote with our feet. We’ll agree to pay up to get close to universal coverage. But we want a safe, affordable haven. The public option offers that, or at least the structural hope of something like that. Despite all that, we hear no end of excuses and proclamations from our elected leaders about why we can’t have it. Last week, a local health advocacy group picketed Kucinich in his district for threatening to vote No on a bill without the P.O.

Kucinich isn’t holding out for a boondoggle, or a minority vendetta. He’s staking a claim for a policy most people want. There are 114 votes in play. One of them belongs to a progressive. Let’s see about moving the other 113. Then we can come back and thank Dennis for voting Yes on a bill we actually helped to shape.

Three Things Worth Fighting For: A Public Option. Women’s Rights. Single Payer.

2010-03-12T02:20:00.000-08:00

It was tempting to think that the Bush presidencies were an error from which we’ve now recovered. It’s increasingly apparent that there are deep structural fissures in our society that, like the earthquakes in Chile, have not played themselves out. Unlike that force of nature, we can do something about it – but it will take some work. Here are three tests that demand our commitment:

1. The public option. Americans want an alternative to the predatory insurance industry. They aren’t ready to mandate turning the whole apparatus of paying for health care over to the government, and we’re not going to talk them into it this year. But they damn well want a safety valve from corporate insurance.

Now, the public option is a new entity. We can predict with certainty that it will have lower administrative expenses and won’t pay profits or million dollar bonuses to executives based on denying needed care. The finer points are less certain.

But critics on the left who have consistently contended that the public option could never work seized with relish a 10-page memo dashed off by the Congressional Budget Office to House Ways and Means Chair Charles Rangel on October 29, 2009, stating that the public plan would likely enroll only about 6 million of 30 million newly covered lives. This estimate itself rested on some questionable assumptions. The House bill (in Sec. 213) tightly constrained the grounds for variation in premiums. In Sec. 322, it also limited the amount the public plan could pay to providers. Nevertheless, CBO said the public plan would have higher premiums than other plans in the new Exchanges:

That estimate of enrollment reflects CBO’s assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges.

In addition CBO stated that:

The public plan would have lower administrative costs than… private plans but would
probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that “adverse selection” on the public plan’s premiums would be only partially offset by the “risk adjustment” procedures that would apply to all plans operating in the exchanges.)

These unsubstantiated assumptions were not repeated in CBO’s extensive (167-page) examination in December, 2009, of the factors involved in speculating on the effects of possible reforms.

We need a public option. Progressives should fight as hard as we can for the most robust possible public plan. A new public entity that could enroll up to 31 million is estimable, next to 25 million in the Veterans Affairs system, 45 million in Medicare, 49 million in Medicaid, and millions more in other federal programs. It is just a step, but it is potentially a step forward.

2. Women’s rights. Abortion restrictions were voted down in the Senate, 54 – 45, scant days before Nelson bludgeoned them back in. But the House does not have a reliable pro-choice majority. The state of Utah has criminalized miscarriages if there is a claim that they are related to an attempted abortion.

I repeat: The state of Utah has criminalized miscarriages if there is a claim that they are related to an attempted abortion.

The attack on reproductive rights is not, it turn out, a side show in health reform. It is a major shot across the bow. The assault is serious, it is not going away, and progressives are going to have to fight about it, hard.

3. Single payer. Unlike the abortion issue, health reform is not a step backwards for state single payer efforts. Employers have been using ERISA (the Employee Retirement Income Security Act) for decades to block state reforms that would make them pay up for health insurance. Crusading Dennis Kucinich could still fight to get his ERISA amendment in the final bill, opening an important new avenue for states, and eliminating likely long court battles.

Happily, progressives are figuring out that if we want a progressive Congress, we need to run progressive candidates. Challengers are showing up in Democratic primaries against Bart Stupak and other pretend Dems, and organizations are springing up to support them. It will take more than the election of November, 2008, to recover from decades of neoliberal politics and corrupt economics. Passing health reform is the step we can take in the next few weeks. Fighting to make it work will be one of the projects we dig in for over the next few years.

What Is Good Enough? Following the Education Strike, Quoting Ted Marmor

2010-03-06T06:38:00.000-08:00

Writing from Santa Cruz, CA, a day after the massive one-day statewide strikes and day of action against the draconian budget cuts to public education in California - uniting teachers and school employee associations with parents and students, tartgeting cuts at every level (kindergarten - high school, community college, university) in our massively dysfunctional state. Something we haven't seen in health reform since the community-based struggles of the early 1970s. I found these excerpts from Ted Marmor's article of 2007 interesting:

Universal Health Insurance 2007: Can We Learn From the Past?
By Theodore Marmor

http://www.dissentmagazine.org/article/?article=863

Americans are not well served by their current medical care arrangements. Compared to our major trading partners and competitors, we are less likely to be insured for the cost of care, and the care that we receive is almost certain to be more costly. Although U.S. medicine has produced many “miracles,” we are not the undisputed leader in medical innovation, only in the costliness and ubiquity of high-technology medicine. Most Americans “covered” by some form of health insurance still worry about its continuation should we or a close family member become seriously ill. Some of us are locked into employment we would gladly leave but for the potential catastrophic loss of existing insurance coverage.

While most commentators decry our peculiar ability to combine insecurity with high cost, the substantial reform of American medicine at the national level has been enormously difficult to achieve, and comprehensive reform has been impossible.

There is now once again a remarkable consensus that American medical care, particularly its financing and insurance coverage, needs a major overhaul.

The bad news for reformers then and now is this: for a variety of ideological and institutional reasons, American politics makes it very difficult to coalesce around a solution that reasonably satisfies the requirements for a stable and workable system of financing and delivering modern medical care. Agreement on the seriousness of the nation’s medical ills will not necessarily generate the legislative support required for a substantively adequate and administratively workable program. That is as true in 2007 as it was in 1948, 1971, 1993, and 2000.

Before an administration and a Congress can meet the challenges of workable reform, they have to resolve—or at least cope with—some of the nastiest ideological and budgetary conflicts in American politics. As did their predecessors, they face the seemingly intractable problems of substance, symbol, and support.

The fight over Medicare illustrates the rarely achieved conditions sufficient for successful (if partial) reform. Before 1965, the conservative coalition was formidable. The Democratic landslide of 1964 swept away the key conservative bases of institutional power: dilatory tactics by the Rules Committee, control of other key committees, and a Congress as a whole less liberal than John F. Kennedy or Lyndon B. Johnson. The massive electoral shift of 1964 held a lesson for future reformers: a fully sufficient condition for reform was a two-to-one Democratic majority in the House of Representatives, a margin large enough to contain within it a (smaller) majority on Medicare.

By 1970, the debate had shifted back from Medicare to national health insurance once again. Though it is difficult for many to remember, the striking feature of the 1970–1974 years was the intense competition among proponents of different forms of universal health insurance. There was the catastrophic proposal advocated by Senators Russell Long and Abraham Ribicoff. There was the Kennedy-Corman bill that closely followed Canada’s national program as of 1971. And there was the Nixon administration’s plan for mandated health insurance for employed Americans known then as the Comprehensive Health Insurance Plan, or CHIP.

Reform failed because shifting coalitions defeated every attempt at compromise—cycling negative majorities, we might say in political science jargon. The majority that agreed on the need for reform consisted of factions committed to different proposals. The more modest proposals—such as the Long-Ribicoff catastrophic bill—seemed too limited to those who wanted to translate the negative consensus into universal, broad coverage. The proposal for employer-mandated insurance—similar in financing to what Bill Clinton later proposed—seemed too indirect, incomplete, and incapable of cost control to those favoring more straightforward forms of national health insurance. And even Ted Kennedy, who moved from his more ambitious version of national health insurance to a compromise plan that he and the powerful Wilbur Mills could both accept, was incapable of organizing a coalition of liberal and conservative Democrats.

What worked once may not, in changed circumstances, work again. What failed may succeed. But some constants in American politics are relevant.

First, compulsory health insurance—whatever the details—is an ideologically controversial matter that involves enormous symbolic, financial, and professional stakes.

Second, the limits of political feasibility are far less distinct than Beltway commentators seem to recognize.

Third, the role of language and emotive symbols in this policy world cannot be overestimated.

But the central lesson of the past—of both defeats and victories like Medicare—is cautionary in a different sense. It is wise to wait if what is acceptable is not workable. It is foolish to hesitate if what is workable can be made acceptable. If the central elements of a workable plan are acceptable, the pace of implementation can be staggered. But, American political history in this area shows that the opportunities for substantial reform are few and far between, precious enough to make squandering close to a sin.

The Health Care Summit: Fight On!

2010-02-26T00:03:00.000-08:00

First of all, kudos to Lynn Woolsey, Barbara Lee and the Progresive and Black Caucuses for presenting just the right statement on the public option; to HuffPo for giving it (and us) space; and to the 1.2 million people who stood up in one day(!) around the country yesterday for comprehensive reform. All this certainly paved the way for final statements by Murray and Pelosi on the public option.

The upshot? Obama's timeline - up to 6 weeks - to resolve all this was worrisome, if he meant to suggest this could drag on through Easter recess.

But on the whole, I think it was a careful and methodical dismemberment of every Republican argument and proposal. After both sides agreed that it was imperative to do something about the health insurance crisis, and almost 5 hours of discussion, Boehner retreated back into the standard Republican tropes and misrepresentations. It left the President sounding like the soul of reason and consideration in stating that he could not settle for a Republican plan that made no progress and would at best cover 3 million of the 45 million uninsured. He outlined places where the Democrats had already compromised (no public option, allowing insurance companies to trade across state lines, within the context of a national exchange), and offered a few weeks for the Republicans to consider if they had actual compromise proposals. But he made a firm commitment to move forward if the two sides could not agree soon. It made the reconciliation process, with a 51 vote majority, seem like a desirable process, and perhaps one the country would do well to rise up and demand.

It is clearly the moment for the public to continue the drumbeat.

(see live blog at Huffington Post: http://www.huffingtonpost.com/2010/02/25/health-care-meeting-exper_n_474978.html)

Plots

2010-02-20T12:38:00.000-08:00

The public option, declared dead on a regular basis, is still supported by aboout 60% of the public, and probably a majority of Senators, who are piling on to a ststment of support initiated by Sen. Bennet of Colorado. Ask your senators to join in, or thank them if they did.

For contact numbers and a script, see the PCCC/DFA/Credo public whip count here:
http://whipcongress.com

Read the letter here:

http://whipcongress.com/letter-senate?source=med

The intention is to seek a nationally administered plan as part of the national exchange that will be available to individuals and small employers. It will be more effective if it is open to more enrolleess. Large numbers are the only way any health insurance scheme can work. As recently as December, Senator Rockefeller and others pushed for a PO that everyone could choose, including employees of large firms. This formulation did not prevail. It will have to remain on the agenda for the next round, as will single payer.

Why and how could it work? It's true that large numbers are the centerpiece of effective insurance plans.

It will likely have a higher enrollmenr than the original hastily written and brief CBO projecction, which predicted that the PO would charge higher premiums than the average plan, something that is expressly forbidden in the language of the bill itself.

Is it an attempt to put the risk of expensive cases on the public sector, while leaving the profitable business to the private sector? Death spirals - where healthy people quit and only people with expensive health conditions remain - are a problem now for publicly sponsored high risk pools, and the excuse for Anthem Blue Cross raising its rates by 39%. The difference is that the public option will be one choice for people who are all going to buy insurance anyway. Healthy individuals buying insurance are just as likely to choose the public option as a private one - probably more likely.

Where does something like this work now? While not the definitive case study, in California counties where public plans compete with private plans for enrollees in the State Children's Health Insurance Plans, the public sector does very well in enrollment and cost.

Some single payer supporters have not only retreated from support of the public option, they actively organize opposition, calling it "puny" and a plot that would destroy prospects for single payer in the future.

A great deal has been writtn about the PO, including in hours of Congressional testimony, all online. So just a few comments here:

The public option just isn't an insurance industry plot. Activists are fighting to make it a nationally administered alternative that will be as effective as possible. AHIP's opposition to the public option is a matter of public record, and their payments to the Chamber of Commere to oppose it were reported in the NY Times. If advocacy for the PO is also really an insurance industry plot, surely there would be some evidence somewhere - ?

It's not as good as a single payer, which is not attainable now. It is a placeholder that can be used and improved over time. The alternatives are no bill, or a bill without a public option.

Think about these statements, and then go look up tautology:

The public option could never work; the insurance industry will never let it work; the public option is a plot by the insurance industry to destroy the single payer movement.

You can't trust the government to do anything right; look at how the government mishandled Katrina.

As one commentator noted: "You know who else passed laws? Hitler."

The Truth About Health Reform (Power Point)

2010-02-18T00:32:00.000-08:00

We keep hearing that people like the health reform peoposal - once they find out what it's about. EQUAL's PowerPoint offers slides you can choose from to describe:

The Problems
- Cost, Access, Quality
- Financing, Organization, Delivery
Health Care and Health
Why Insurance Doesn’t Work
The Politics of Reform
The Proposals: House and Senate
Keep Fighting for Single Payer
Fix It and Pass It!

Download it and use it - talk to your class, neighbors, friends - in the lead up to
President Obama's presentation on Feb. 25. Download it at:

http://www.centerforpolicyanalysis.org/id69.html

What's At Stake

2010-02-02T12:31:00.000-08:00

Most people in this country would like to get the health insurance industry off their backs, given a choice.

There is an increasingly polarized clamor from the left and the right claiming that the modest but effective incremental proposals coming from Congress are leading us down the path of tyranny and corporate control.

Let’s be clear about who is controlling what.

Corporations exist to generate profits. They want them now and they don’t want a lot of guff about it. People (other than corporate executives) get to have a bit of the wealth if we fight for it. (It helps motivate us to produce and consume the goods and services that generate profits.) If corporations don’t need us any more and can figure out how to do it all with machines, they will. If they can go somewhere else where the population is under tighter political control, they will.

The government isn’t static. It protects corporations and corporate rights. It also protects people and the rights of people and communities. It can strengthen or weaken organizations (like unions) and rules that protect us. It depends on who’s in charge of the government and who is pushing them.

As corporations face a global meltdown, our communities are experiencing wrenching losses – of jobs, income, housing, education, social services.

The Democrats’ institutional and financial base includes corporations, as well as organizations and individuals committed to limiting corporate power. Some Democrats are reliable allies. Some are not.

Corporations have an unequivocal political voice. It is the Republican party.

The last 8 years of Republican rule brought us direct cash transfers from our taxes to corporations. That’s why we have a deficit. All that money went somewhere. A lot of it went to the war industry and finance capital. The recent clamor from “independents” about the deficit is not only misdirected, it is perfectly misdirected.

We also got a wholesale incursion on our civil liberties and attacks on our rights, in the name of combating terrorism. The right now complains about a lack of debate after a year of televised hearings – on C-Span!! – while their acolytes invade town hall meetings and derail debate.

If the Republicans regain control of Congress in November, the filibuster rule will go down the drain in the first month. I shudder to think what they’ll do in the second. I’ve never lived in a fascist state, I’ve only read about it, and talked to people who have.

How can we protect our rights and challenge corporate power?

We can support laws that rein in the power of corporations to take our money and do whatever they damn well please.

The health reform bills would do that.

They establish that we Americans have the right to get health care, a principle accepted all over the rest of the world. We’re Americans so we say you have to pay in to claim the right. But the bills take a giant step in the right direction.

Not a small, insignificant step. A giant, major step.

They say that once you pay, you have to get what you paid for. The Mafia elements of the health insurance industry are under attack. Will the new laws be strong and effective enough? They could be. We have to pass them and then we have to fight to make them work. This is possible. We can do it this year. Here’s what else we would get:

1. Health care availability for most of those left out now.
2. A requirement that employers also contribute to the cost of health insurance.
3. Premium credits help make insurance affordable for incomes up to 400% of poverty.
4. A national health insurance exchange, the first step towards a national plan.
5. Coverage for comprehensive benefits
6. Ban on insurance industry abuses like pre-existing condition exclusions, rescissions
7. Payment incentives and other measures to improve the quality of care, including moving away from specialty care to preventive care to address our critical public health needs.
8. Negotiated drug prices through Medicare.

Canada had years of doctors’ strikes after passing universal coverage. But they stuck with it, fought for it, and made it work. (No, just passing the law wasn’t the end of it. They still had to fight. They still do.)

We can pass laws that strengthen the power, funding and authority of the public sector vs. the private sector. The public option would do that.

The better route would, of course, be to get corporations out of health care. Let’s talk about why no one who believes that made a serious effort in 2009 to make it happen:

We don’t have the power to do it. We don’t have the movement. It will take massive, determined grass roots mobilizations to make it happen.

The American public might get there some day. It might or might not be about health care. But we’re generally pretty healthy, and the health care system is complex and amorphous.

People are getting educated about “single payer” proposals. This is great. Some assert that the American public is already in favor of single payer, and is being restrained from achieving it because the Democrats haven’t proposed it. This is an inspiring belief. There have been about 30 people arrested nationwide in support of single payer. Maybe 100. This is a good beginning. Expanding Medicare for some or for all is a popular proposal, and we can continue to fight for it.

Is it a ruse that the corporations oppose health care reform? Not according to them. The Chamber of Commerce and American’s Health Insurance Plans joined forced to kill the pubic option. The NY Times (Jan. 31 p. 21) quotes Chamber chief R. Bruce Josten on the fact that “Despite the Democratic majorities in the House and the Senate, they have not been able to muster support for a single final bill [on health reform]. ‘We had a good year. I have no regrets.’”

Are they just fooling? Were their lobbyists all over the Committees writing the bills, just in case something passed? You bet. When they thought it was inevitable and unstoppable they were there getting their licks in. They are, perhaps, rethinking. Do they want the package to pass? No they do not.

The Democrats need to take another look at who’s voting for them and why. They need to go back and pass a bill that expands union organizing rights, as well as a jobs bill and small business tax credits. They need to go through the reconcilation process to pass a health reform bill, and they need to do it soon. They should also change the Senate rules so that they need 52 votes for cloture (or whatever number they reliably have).

Then progressives can get back to work pushing the reforms further, and mobilizing our communities to fight for our rights and our stuff. We’ll be able to do it because we’ll be living in a country that is dominated by corporations but still respects democratic rights, one that plays out daily the tensions between capital and people.

In my experience political and social change are hard, take consistent, intelligent work, strategic engagement with influential actors including the public, an analysis of where power lies, an understanding of the role and life cycles of organizations, including the ones that govern us and those that might create change. Atheist that I am, I have been impressed with my friends in the faith community. They are not health policy wonks, but they learn what they need to know, they identify their targets, they figure out what it will take to move them, and they do it. They attempt to analyze reality, engage with the reform proposals as they are and to try to influence them.

We need to pass the health reform bill, and keep the email lists and the relationships we’re building in the process. It’s going to be a bumpy few years, and we’re going to need each other.

Dear Karen

2010-01-23T04:37:00.000-08:00

Dear Karen:

You've navigated a lot of tricky territory in your health care career. You've outlasted your old bosses Chris Dodd and Lane Kirkland, and made room for Chip Kahn - somewhere else. You watched states fail to rein in health care costs in the 1980s, as the hospital industry (then as now a real driver of exorbitant health care expenditures) captured the Certificate of Need programs that were supposed to regulate them. You encouraged unions to turn to second opinions and managed care as a consumer-driven effort to control costs. No luck there. After Clinton care fell apart, you and the nation's employers turned to the insurance industry to hold down rates - a buck would be turned, but it would have to be better than the systems they all knew worked perfectly well in Canada and Europe. (They use their national and state budgets to set a limit on costs. Works like a dream: health care is affordable, health outcomes are pretty good, and politics focuses on, well, whatever it is Foreigners talk about.)

The Bush years were lots of fun for the insurance industry. Yes, employers were increasingly strained by premiums, but they had outs - they could pass on costs to employees, or just drop coverage. And since finance capital increasingly controlled U.S. businesses and the media, the last thing they wanted to do was call down government regulation on you. Or on anybody. Then came the global economic meltdown.

Now we have the Obama era reform. All ready to pass, with one major sticking point: the public option. Your members insisted on universal buy-in, in exchange for ending the egregious abuses commited on the patients of America, pre-existing condition exclusions and rescissions. Got that. The public, being no dope, wanted an escape hatch. You said from day one, no way. An ambitious but pragmatic new Administration, having read up on Harry and Louise, was strategically cordial. Both sides knew it would take a mass uprising or a miracle to overcome your opposition. And here's what happened:

The masses didn't rise up. Trying to figure out how not to get foreclosed, while staying employed and keeping their kids safe, they consistently told pollsters they wanted health reform but they wanted a public option, too. They didn't think highly of governmenrt but liked the insurance industry even less. But rising up, no. About 100 of them tried to get arrested at insurance offices around the country. You told Joe and Ben to lift their little fingers to stop the public option, the civilized way, in the Senate, where it's always done discreetly.

Then we had elections in Virginia, New Jersey and Massachusetts. Turns out the masses just threw up their hands in disgust. Suddenly it was maybe no health reform at all. Your stocks went up. But your press statements expressed alarm.

Some say you can't survive long without the government subsidies you were anticipating from the reform proposals, clear evidence that the whole thing is fatally flawed.

I say it's a game of chicken. And you should call it off.

I'd rather you disappeared. That isn't happening this year. Your interest is perpetual life and wealth. That isn't happening this year either.

We can get legislation that keeps the insurance industry on life support. The trade off is that you bow to the inevitable, with plenty of estate planning and golden parachutes and whatever else you've figured out after all these years about opening the next chapter. Tell Fox News, the White House and the Senatte that you've recalculated. You can manage with a national exchange and a public option, after all. Warn the hospitals and the drug industry. They'll understand. (They'll be soaking up lots of the same gravy as AHIP members. And they'll be around a lot longer, in any case.)

It's good negotiating. You walk away with a bundle and your power just tarnished. There's always tomorrow. But like another famous scrappy survivor, you can decide you'll think about that, tomorrow.

3 Poles in the Health Reform Debate

2010-01-16T17:44:00.000-08:00

There are at least 3 narratives driving the health reform debates that need to be articulated and challenged.

1. The right-wing anti-social killer pit-bull perspective. Deserves closer scrutiny and analysis, and I’m not close enough to those people or their organizational links to say anything illuminating.

2. The Obama administration and many conservative Dems in Congress have proposed policies rooted in neoliberal economics that undermine the likely success of reform, and support for it. They perpetuate the fallacy that we can control costs by making health care work like a free market, forcing individuals to make choices about our health care by paying more out of our own pockets, and by choosing from a blinding array of health plans and benefits. In fact cost conscious consumers have no power in a market dominated by mega corporations: hospitals, drug and insurance companies.

This viewpoint has driven most of the bad policy decisions the White House has made and has threatened to drive a stake into the heart of the support for reform. Americans may or may not be ready for Medicare for All but we are damn familiar with what the insurance industry is doing to us. Whatever the policy merits of the public option, abandoning it is, was and will be a serious misstep politically. The Administration may not have the power to get rid of the insurance industry entirely. But it is giving away plenty in subsidies and other forms of life support to AHIP members. It is not fighting for the public option and a standardized benefit package and progressive financing in part because the economic gurus at the White House don’t believe in them.

3. Liberals and progressives have worked hard this year. We might have come out swinging in January fighting for a Medicare-for-all, single payer system. We didn’t. Obama’s decision not to go that route was seen as insurmountable, so no one really tried seriously. Recognizing that we would not achieve single payer this year, progressives turned either to improving the bill, or to public education on single payer without any expectation of influencing the national bill. While many of us advocated both for single payer and for a better national bill, it was left largely to HCAN and various offshoots of the Obama campaign, both constrained by direct links to the Democratic Party, to fight for the merits of progressive proposals like the House’s bill. At this point there are three divergent themes that lead the discussion astray:

a. "It's all determined by corporate money." Corporations hold great sway over political life and decisions. And their money works in part through direct contributions to candidates. But voters matter too. Corporate money sways public opinion. We have a better story and so can we.

b. "We'll fix it in the states. The way to get around this problem is to get active on the state level, where we can more easily get rid of the health insurance industry." There are some progressive state campaigns, no question. But not surprisingly, corporations have figured out how to influence state houses too, many of which meet infrequently and briefly.

c. From one blogger: “The best thing that could happen to Obama (and America) is for Congress to FAIL at passing any health legislation. That would give Obama the chance … to say 'OK, we now know that the system is beyond any rational attempt to repair it. We are starting from scratch.'”

Proposing, at this point, that failing entirely to pass a reform bill will clear the decks for a progressive resurgence defies belief. It is quite clear what the result will be.

I believe that defeating the bill now would not open policy space for further progress. It would leave the insurance industry in the same powerful position it is in now. If we fail to pass a bill, the real dedicated and out front enemies of equity and community will be back in the ascendance politically. If we fail, corporate America has open season. We need to continue to build the power and vision of a progressive movement. I see no scenario in which defeating health reform would hasten that agenda.

If we pass it we get – if we fight for it – more standardization and regulation; more guarantees that employers will actually pay in to the system for benefits, the hope of fewer deaths and bankruptcies due to uninsurance.

The House Progressive Caucus has an agenda we should support. Loudly, proudly and actively. We can fight for single payer and fight for fair financing, progressive standards for affordability, and a stronger public sector – through expanded Medicare, a public option or whatever. It is not up to us to bail out a wrong-minded Administration but it is up to us to challenge their ideas and support our allies in Congress for the policies and strategies they actually believe in.

Won’t defeating the bill automatically generate a new progressive movement, with dynamic candidates, platforms and mobilizations? Nice thought. We certainly need all that. I admit it, here’s where my crystal ball gets cloudy. Ralph Nader’s recent novel imagines a bail-out by visionary billionaires like Warren Buffett. I think people like to win, and after they win they’re ready to fight for more. I felt that way on Nov. 4, 2008. It is going to take some serious thinking and working to get back to that place. There is, though, no alternative.

Progressive Caucus: Fight for Us!

2010-01-08T06:52:00.000-08:00

CONGRESSIONAL BRIEFING
The Benefits of the Public Option and Other Progressive Health Care Reforms
Thursday, January 7, 2010 , 2pm-4pm,

Remarks by Ellen R. Shaffer

(I was invited by Rep. Dennis Kucinich’s office to present the case for an ERISA waiver as part of the health reform bill. Following are my comments.)

Thanks to Reps. Sheila Jackson Lee; Raul Grijalva; Donna Christensen; and Hank Johnson for organizing today’s briefing.

I am a policy analyst. I worked in the past in the Senate. In 2009 I helped craft the ERISA amendment that passed in the House Education and Labor Committee, building on the great work of others in the House and Senate, and with the support of the California Nurses Association.

As Co-Director of the Center for Policy Analysis, I coordinate the EQUAL Health campaign for Equitable, Quality, Universal, Affordable health care. We sponsor a listserve, analyze proposals, and conduct district legislative visits. Our list reaches progressive health reform advocates, women’s organizations, public health groups, as well as Congressional staff and the media.

Topics today:
Why it is important to fight for and win an ERISA waiver.
More broadly, why it is important to fight and win for progressives.

ERISA
The Employee Retirement Income Security Act (ERISA) is a:federal law that pre-empts the rights of states to enact legislation if it is “related to” employee benefits plans, as well as for other reasons.

It was passed in 1974 at a moment like this one, when Congress expected to pass national health reform, and sought to limit state variations. It has been used in the years since then by employers to initiate court challenges to a wide range of reforms that would require them to contribute to the cost of health benefits.

It is unusual among laws involving health care in that there is no administrative remedy built in to ERISA. Only Congress can take action to definitively change ERISA. Because it has not done so, Hawaii sought and won an ERISA waiver for its state law in 1983, in order to be able to continue its employer mandate system. There has been no subsequent amendment on this subject.

Why progressives must fight for an ERISA waiver

We know how progressives are feeling this week.

We have been encouraged by the statements of Quad Caucus leaders, that we wanted single payer, and the public option is our line in the sand.

At the same time we watched the Senate turn down an abortion amendment, and then be forced to include it.

After winning a victory in committee on an ERISA waiver for single payer states, we saw it fall from HR 3692.

We’ve watched Joe Lieberman move from supporting expanding Medicare, on the air, as recently as September, to hijacking the public option.

We know that your offices did your best to respond to requests for a floor vote on a single payer bill.

We hear that maybe we can get a public option next year, by a majority vote. And maybe we can.

But we also know that the health reform debate is developing as a contest for power.

Progressives cannot emerge from this debate demoralized.

Victory breeds victory. Leadership summons participation.

Progressive leaders have a real opportunity to stand fast for significant policies that we know will make a real difference in people’s lives.

There are a number of important issues on the table, that will vastly improve the health reform bills. These include:
• the public option,
• a strong employer mandate, and affordability protections including adequate subsidies,
• a nationally based health exchange,
• fair financing
• and a strong stand on reproductive rights and immigrants’ rights.

I hope you’ll get a chance to look at our op ed on some of these important issues.

But we know that at best all of these provisions are a step towards a system that is truly universal, controls costs, and improves quality. The fight for single payer systems will move immediately to the states, where there are already strong and successful movements in California, Pennsylvania, Maryland, Illinois, New Mexico, Ariona, and elsewhere.

These campaigns face the same obstacles as the national effort: massive industry spending and opposition, corporate media, the need for organizational bases.

They face one additional obstacle: ERISA.

Single payer advocates around the country are energized around amending this arcane piece of legislation, for two reasons.

First it will make a real, immediate, significant difference in their ability to enact and implement single payer bills. Without an ERISA waiver, single payer states face at a minimum automatic court challenges that could drag on for years.

Equally importantly, it will demonstrate that progressives can and will fight hard, and win, for changes that are fundamental.

This battle has implications far beyond health reform – in itself important enough.

We know we are entering the new decade with a sputtering economy, and a controversial war. We will need a mobilized, energized leadership, and a mobilized, energized base, to take these issues on and win them.

We know the opposition. They are relentless in the minority. They have demonstrated what they will do when in the majority. They cannot be defeated by lukewarm campaigns.

Progressives must have a health reform bill and it must be one we will celebrate at the end of the day. Your offices can demonstrate the leadership and the determination to fight for and win a provision that will be celebrated daily by advocates around the country as our fight for universal coverage continues. Please fight for the ERISA waiver.

[Post-script: An ERISA amendment would be an important victory. The EQUAL campaign continues to advocate for the full range of policies identified in this presentation.]

The Public is Right About the Public Option

2010-01-05T23:26:00.000-08:00

This article appeared on page A - 8 of the San Francisco Chronicle, January 6, 2010.

The insurance industry hates it because it would ding its profits. Democratic leaders fear it could kill passage of health care reform. But reports of the death of the public option have been greatly exaggerated.

Poll after poll shows that Americans want to be able to choose a public insurance plan, and for good reason. It would be tragic to lose this pillar of health care reform to cynical inside-the-Beltway political horse trading. Here's why we need the public option:

It can really deliver on the benefits. The proposed bills would outlaw common and perverse industry loopholes such as pre-existing condition exclusions, which exclude sick people from buying insurance as individuals, and rescissions, which let companies deny treatment retroactively for people they already insure. While outlawing these rules will help, private insurance plans have demonstrated that they are willing to challenge patients' rights to the grave and beyond in the interest of clinging to the premium dollar.

We've witnessed a heartbreaking parade of insured patients trooping to corporate headquarters to plead for lifesaving treatments that were denied, even though the benefits are covered in writing. In contrast, no one at the government-run Medicare program gets a bonus for turning away sick people. We need to be able to choose a plan in which the financial incentives to provide needed care line up with the proposed new laws, and that can only happen in the public sector.

It will drive down costs. Health care reform will cover millions more Americans - a great achievement. But we need to use the increased buying power of this newly covered population to control costs, a job at which private insurance companies consistently fail. Some companies can't reduce premiums because they're too small to hold leverage in negotiations with private hospital chains and big drug companies. Or if they do save a buck, they put it back in their own pockets in the form of profits and executive bonuses.

In Massachusetts, large nonprofit insurers recently testified that they had negotiated sweetheart deals that benefited certain employers and hospitals - and confidentiality agreements that kept the details secret. When the Veterans Administration negotiates lower drug prices, the savings buy more drugs for veterans, and the transactions are all transparent. We'd like to be sure that the change we voted for turns into change we save on reduced premiums, which is possible only in a public plan.

It will allow us to re-engineer how we deliver and pay for care. How? By coordinating with Medicare initiatives that will bolster quality while lowering costs, like financial incentives that promote primary care and better coordination of medications. The public plan will be most effective if it starts right away and is available to everyone - policies we can continue to fight for. But the projection that the public option would offer savings too small for too few, or would be too expensive, is off the mark.

It's democratic. Most Americans know this in our bones. The majority of the House voted for it, including many in our powerhouse delegation from California. The majority of senators expressed support for it - including committee chairs Max Baucus and Tom Harkin. We're tired of arcane rules that let minorities of one hijack the public's interest.

There will be efforts to leverage the public option for other benefits. One benefit of that debate would be if the antitrust exemption for health insurance companies were revoked so they can be regulated by the Federal Trade Commission. But we need a real institutional alternative to the present system. Americans want - and need - a public option. Don't let your representatives trade it away.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/05/EDNG1BDU6L.DTL#ixzz0boXMcwU1

Why Fight Now? A Single Payer View on the Public Option

2009-12-20T22:20:00.000-08:00

Time to say a few things:

Health reform is important. The bills before Congress can make a difference for millions.

The President needs to win this one, soon. If the insurance industry can demoralize progressives over the holidays, the win comes on their terms. If progressives keep up the fight we could win.

The public option is not optional. It is our toe-hold on structural change.

Women and immigrants are more numerous and better organized than the turkeys who think we are wedge issues.

On the other hand, there is no organization that will swoop in and win this for us. Social justice, labor, women’s rights and other groups have been battered by 30 years of neoliberal economics and politics. Progressive political leaders in the Senate – Sanders, Brown and Burris - took their bows for talking up a single payer amendment that failed even more spectacularly than expected, and they ducked last minute appeals to them to cross Harry Reid and the White House by threatening a No vote.

Mike Huckabee is heading to Omaha to rally and revive the teabaggers. It won’t matter right now. Huckabee, like a lot of others, is building his lists and organization for other fights.

For those of us who think the next step toward health reform, however limited, should be at least a step forward and not a wholesale retreat on reproductive and immigrants’ rights, we will have to be enormously creative and persistent this week. Stay tuned..

Fight for Real Health Reform!

2009-12-15T00:14:00.001-08:00

The President and the Senate are likely to meet on Tuesday regarding health reform. Following is a message to Congress and the President - please add your own, and call or write TODAY!

Also: links to statements below from the Congressional Progressive Caucus and Rekindling Reform

To Congress and the White House:

We need and support real health reform. Stick with us and demand a bill that preserves and expands the strongest points of House and Senate proposals, starting on day one:

1. A public option is critical to advance access, quality, affordability and cost control. A buy-in to the public Medicare program for ages 55-65 must also be affordable.

2. All plans must be affordable, limit out-of-pocket expenses, require fair financing by employers and high-income individuals, end insurance company abuses, and require insurance companies to spend at least 90% of revenues on health care.

The federal government should promote innovations in delivery and financing of health care, including more primary care providers and public health funding.

3. Defeat diversions on wedge issues:
Advance reproductive rights.

Assure that all people who live in the U.S., including immigrants, have access affordable, quality, culturally appropriate care.

4. Promote states’ ability to move to single payer systems.
This historic bill will be an important step forward. States must be empowered to advance to a single payer system.

http://www.whitehouse.gov/CONTACT/

http://speaker.house.gov/contact/

http://reid.senate.gov/contact/index.cfm

Congress: thomas.loc.gov

_____________________________________________

Statement by Congressional Progressive Caucus: http://cpc.grijalva.house.gov/index.cfm?ContentID=564&ParentID=0&SectionID=107&SectionTree=107&lnk=b&ItemID=562

Statement by Rekindling Reform: http://www.rekindlingreform.org/index.php

______________________

We have won important victories for better access to affordable health care.
Enemies of reform are now out in force.
Progressives must stay informed and engaged to achieve a truly historic victory.

The Senate Compromise: Does it Help?

2009-12-12T04:09:00.000-08:00

The Senate compromise seems to be this:

For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.

The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.

Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.

No public option.

Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)

The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.

But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.

And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).

Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.

Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.

The Senate: Getting to the Public Option

2009-12-09T11:52:00.000-08:00

It is important that health reform continue to move forward through the Senate. The most recent announcement offers some elements that sound attractive. As a whole, though, the package seems to leave a lot of gaping holes, that the Senators will need to address, or that will be resolved in conference.

What the proposal is, as far as we can tell:

Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.

Progressives need 3 things:

1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.

2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.

3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.

Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.

But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.

FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.

The Illinois Campaign for Better Health Care proposes this:

"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."

Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."

For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."

What do you think?

Real Health Reform: Positions for Progressives

2009-11-19T12:06:00.000-08:00

What Now

It has been both an exhilarating time for progressives and a bumpy one: the House passed a bill (yay) with a public option (yay). These are victories for progressives, inside and outside of Congress: we made this happen.

But House leaders caved at the last minute to an anti-abortion spoiler, the Stupak-Pitts amendment, and dropped a popular provision proposed by Rep. Dennis Kucinich to protect states that opt for single payer systems from lawsuits under ERISA.

Many of us who both support and desperately need health reform are still trying to make sense of the news of the last week. Advocates and the public need to be unified and energized for the final push to get the best possible bill through the Senate and back through the conference committee with the House.

Here’s what we think all Senators need to hear, and why:

1. The House bill is a major achievement. Preserve and expand on its strong points, including the public option.
There is a lot here for access, quality, affordability and cost control, in fact more than there was in any of the bills that passed through the House Committees. The public option is likely to be more robust than the Congressional Budget Office’s preliminary projection.

2. We need to advance reproductive rights, not retreat.
The anti-abortion amendment is a real threat and a wake-up call.
We can beat it. Many members who voted “yes” on Stupak are on record as pro-choice.
Pro-choice energy can propel reform forward.

3. Protect single payer states from ERISA lawsuits.
It is important to continue to point this out and to organize for single payer, and against the for-profit private insurance industry States will be a far cry further in the march toward single payer if we can win waivers from federal obstacles including ERISA.

The House is still in play; they will be involved in the conference with the Senate, and will vote again on final passage. Our messages to House members depends on how they voted. (See Tables on p. 8):

1. Voted Yes on the bill and No on the Stupak Amendment (178 Democrats): Thank you! You’re the progressive Democratic majority. Help us win the ERISA waiver, and keep what we’ve won.
2. Voted Yes on the bill and Yes on Stupak: Stick with the bill and stick up for women. [For those historically pro-choice: Shame on you for voting Yes on Stupak]
3. Voted No on the bill and No on Stupak: Thanks for opposing Stupak. I’m asking you to stand up for health care reform now and support the bill.
4. Voted No on the bill and Yes on Stupak: We need health care reform now, and need our member of Congress to stick up for women. Will you change your vote and stand up for health reform and for women? [For those historically pro-choice: Shame on you for voting Yes on Stupak]

(for full statement and to see how Menbers voted go to: http://www.centerforpolicyanalysis.org/id62.html)

Anti-abortion amendment threatens all women, all health plans

2009-11-12T12:35:00.000-08:00

Media coverage of the Stupak amendment underestimates its impact on privately-funded abortion. The impact is also being downplayed by the right.

This looks specifically at the language of the amendment to show how it:

1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for any enrollee, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. This would include the public option, but also any other plans that participate in the exchange.

It also prohibits any plan that would offer “affordability credits” from covering abortions.

2. Could eliminate current practices by 17 states to cover abortion under Medicaid, and prevent other states from doing so.

In addition, it has the following potential effects:

3. Can eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, depending on the menaning of "any costs."

This could mean any health insurance plan offered through the new health insurance exchanges. The Exchanges, in turn, include both private insurance plans, and a public option.

4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."

1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for all enrollees, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. In this way it restricts abortion coverage both to low-income and middle-income women who receive federal funds for subsidies. It also restricts coverage for women who pay entirely with their own funds. This would include the public option, but also any other plans that participate in the exchange.

There is general agreement that the amendment prevents health plans in the new health insurance exchanges from covering abortions, if they will accept women who use federal subsidies to pay part of their premiums.

This prohibition applies to all plans in the exchange. These include the public option, as well as all other private insurance plans in the exchange.

Some people (those earning up to 400% of the federal poverty limit, or about $88,000 for a family of 4) will use federal subsidies (or “affordability credits”) to pay for their premiums. Those people could not buy a health plan that covers abortion through the exchange.

It will apply even though the federal subsidies constitute only a part of the premium, and the rest is paid through private funds.

In addition, any plan that intends to enroll people who accept federal subsidies to help pay part of their premiums will not be able to cover abortion, for anyone who enrolls in the plan. This means women who do not accept federal subsidies, who pay the entire cost of insurance privately, cannot buy an insurance plan that covers abortion through the exchange, if the same health insurance plan covers women who do use the subsidies.

The bill offers women the ludicrous option of buying supplemental abortion plans, as long as they do so outside of the exchange and using their own money. Supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This extra punch assures that in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance when they find out their birth control has failed.

All of this is worse than current law. Current law, through the Hyde amendment of 1976, says no federal funds can be used for abortion except if the mother’s life is in danger or in the case of rape or incest. Where the language is ambiguous, the Supreme Court will decide.

"Sec. 265. LIMITATION ON ABORTION FUNDING.
(a) IN GENERAL.- No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from [life-threatening illness related to the pregnancy, or pregnancy is a result of rape or incest]."

2. Could eliminate current practices by 17 states to cover abortion under Medicaid.

17 states now find ways to use state funds to pay for abortion through Medicaid. Medicaid is a program for low-income women which is funded jointly by state and federal dollars. The amendment appears to explicitly prohibit this:

"(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. – Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as –
(2) such coverage or plan is not purchased using –
(B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds."

3. Could eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, whether or not it includes people who use federal subsidies to pay for their premiums, depending on the menaning of "any costs."
This explicitly could mean any health insurance plan offered through the new health insurance exchanges, both private insurance plans, and the public option.

The amendment says “No funds authorized or appropriated by this act…may be used to …cover any part of the costs of any health plan that includes coverage of abortion.”

It also does not restrict the use of federal funds to premiums. “Any part of the costs of any health plan” could refer to the administrative costs of setting up a health insurance exchange.

There will be people covered in the Exchanges who do not receive any federal subsidies for their premiums. They will pay every penny of the premium out of their own pockets. Some others will pay the premium by a combination of funds from their employers and from themselves.

These people may not be able to buy a plan through the Exchange that covers abortion

4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."

It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion. It does not limit the application of this prohibition to funds authorized by any section of the bill, to health insurance exchanges, or to the public option. It applies to every word in HR 3962.

It also doesn’t necessarily restrict its application to funds “authorized” by Congress to be paid through federal sources.

Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.

The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. The funds can be used to buy health insurance entirely privately. Or they could be used to buy insurance within the new health insurance exchanges. It could mean that no health insurance plan purchased as a result of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill.

In the case of ambiguity, the Supreme Court could make the final decision.

Enough

2009-11-09T00:30:00.000-08:00

I think that HR 3962 offers many important improvements over the status quo, in the areas of coverage, affordability and quality, despite significant limitations, I will document these shortly.

The Stupak amendment however is exactly the poison pill it is meant to be. It virtually rolls back women's current legal right to choose abortion. It is an unacceptable political compromise. It cannot stand. Read it here:

http://www.centerforpolicyanalysis.org/id58.html

It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion.

Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.

The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. It could mean that no health insurance plan purchased under the auspices of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill. This may be a debatable interpretation. If it is challenged, the Supreme Court will decide.

It adds that supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This is an extra punch to be sure that just in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance once they find out their birth control has failed.

Why are we facing this devil's bargain at the 11th hour in this campaign? Where was the vigorous organizing and mobilization campaign to get the votes needed to pass this bill without dismantling women's hard-fought rights? Was it news to anyone that the Catholic bishops oppose abortion, that they have access to an energized constituency, or that this constituency represents a minority of opinion even among Catholics?

This is not a re-election pitch or a solicitation for funds, which usually prompts messages like these from our leaders. It is also not a proposal for a particular action, People will need to figure out together what to do about this.

Planned Parenthood to their credit suggests writing to the President, calling this the outrage that it is and calling for actual leadership. Good start.

Is 2% Worth It?

2009-11-01T22:45:00.000-08:00

Now we’re hearing that the public option is too puny to work. Is it true?

Let’s back up a minute, and look at the choices before us right now.

1. No change.
2. A reform bill with no public option.
3. A reform bill with a public option.

The insurance industry thinks #1 and #2 are just grand. (Despite what they say in public.) They’d like us to believe that #3 is so useless that we should settle for #1 or #2. Here’s why they are wrong:

The existence of a public option creates a wedge for the public sector. The public sector already covers people who are over 65, low-income, in the military, and others. Now it will start slicing into working age Americans. It will have the most bargaining clout to pay lower rates to providers – drug companies, hospitals and doctors - if it includes most of us right away, and can base reimbursement rates on Medicare, plus 5% for wiggle room.

Nancy Pelosi tried to get that. She came up short of the 218 votes needed. After a week of “whipping,” she proposed 2nd best: a public option that will negotiate rates with providers. It won’t save as much money as “Medicare plus 5%” version. Not a great performance by our elected members of Congress, who could’ve sided with the voters who use health care services instead of the industries that provide health care, or by the President of Change, who kept his elegant neck tucked in on that subject.

The Congressional Budget Office and Joint Tax Committee did some pretty quick math:
“By 2019, CBO and JCT estimate, the number of nonelderly people who are
uninsured would be reduced by about 36 million, leaving about 18 million
nonelderly residents uninsured (about one-third of whom would be
unauthorized immigrants). Under H.R. 3962, the share of legal nonelderly
residents with insurance coverage would rise from about 83 percent
currently to about 96 percent. Roughly 21 million people would purchase
their own coverage through the new insurance exchanges, and there would
be roughly 15 million more enrollees in Medicaid than the total number
projected for Medicaid and CHIP combined under current law. (Under the
bill, CHIP would no longer exist in 2019.) Relative to currently projected
levels, the number of people purchasing individual coverage outside of the
exchanges would decrease by about 6 million, and the number obtaining
coverage through employers would increase by about 6 million.

“Under the proposal, certain employers could allow all of their workers to
choose among the plans available in the exchanges, but those enrollees
would not be eligible to receive subsidies via the exchanges (and thus are
shown in Table 2 as enrollees in employment-based coverage rather than as
exchange enrollees). CBO and JCT expect that approximately 9 million
people would obtain coverage in that way in 2019, bringing the total
number of people enrolled in exchange plans to about 30 million in that
year. Roughly one-fifth of the people purchasing coverage through the
exchanges would enroll in the public plan, meaning that total enrollment in
that plan would be about 6 million.

“That estimate of enrollment reflects CBO’s assessment that a public plan
paying negotiated rates would attract a broad network of providers but
would typically have premiums that are somewhat higher than the average
premiums for the private plans in the exchanges. The rates the public plan
pays to providers would, on average, probably be comparable to the rates
paid by private insurers participating in the exchanges. The public plan
would have lower administrative costs than those private plans but would
probably engage in less management of utilization by its enrollees and
attract a less healthy pool of enrollees. (The effects of that “adverse
selection” on the public plan’s premiums would be only partially offset by
the “risk adjustment” procedures that would apply to all plans operating in
the exchanges.)”

This is a possible scenario. CBO and JCT are about as smart as anyone, and we need a guidepost in all this, Lord knows. But honestly. We know for sure the public plan will have lower administrative costs and no profits. Will it engage in less utilization management (read, frivolous denial of claims) compared to private insurance plans? We hope so – and we damn well plan to stop the insurance industry from that deadly business plan, too. Will it enroll fewer people, therefore be more expensive, therefore enroll sicker people, therefore be more expensive and enroll fewer people, etc.? Beats me.

Here’s what I’m pretty sure about. I don’t like Options #1 and #2. The public doesn’t either.

I think Option #3 gets us to the next step: coming out of this battle with a victory, and going back to the states to fight for single payer.

Some on the left meet up with the right on this point: they prefer Options #1 and #2. They say the House bill (Option #3) gives more money and power to the insurance industry than they have now. True. But so do Options #1 and #2. In fact, the only way the insurance industry gets less money is to get rid of them. A single payer program funded entirely by the government would accomplish this. We haven’t won the public’s support for that yet, and it’s not just because Max Baucus wouldn’t hold hearings on it.

A bill with Option #3 gives more power to the public sector, and arguably will save some money. It includes the following important benefits for people:

For the first time, most employers will have to contribute to the cost of health insurance. We’re the only system in the world that relies primarily on the workplace to get insurance, but we also have no requirement on employers to actually offer insurance or help pay for it. Right now about 130 million people get insurance through work, but another 27 million workers do not.

It requires individuals to buy insurance, but it provides subsidies to low- and middle-income individuals and families, so they can afford it. Is it affordable enough? Probably something to fight about.

Insurance company abuses will be prohibited: They won’t be able to exclude people with pre-existing conditions, or stop paying for your treatment once it turns out your sick. They’ll have to spend 85% of our premium dollars on actual health care, not executive bonuses and administration.

Costs: gives the government the authority to negotiate for drug prices.

Access: Many more people will qualify for Medicaid, the federal-state program for low-income people. The feds pick up most of the tab. People with COBRA can keep it until the new exchanges kick in, in 2013, and young people can stay on their parents’ plans til age 27. We still need it to start sooner.

Quality: Reform Medicare to encourage better quality of care, eliminate copayments for preventive care, and increase the number of primary care providers.

Is any old thing ok then? I think the victories so far on the public plan are important. We have to fight hard to keep it and strengthen it on the House side, and make sure it gets into the Senate bill in conference. And let’s hold on to each others’ email addresses. We’ll need them for the state single payer fights.

State single payer amendment pulled from House bill

2009-10-28T20:15:00.000-07:00

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 http://speaker.house.gov/contact/
Rep. Henry Waxman (202) 225-3976 http://waxman.house.gov/Contact/
Rep. George Miller (202) 225-2095 http://georgemiller.house.gov/contactus/2007/08/post_1.html

What Do Progressives Want?

2009-10-24T02:39:00.000-07:00

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:
Women
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?

No Excuse for Apathy

2009-10-17T14:55:00.000-07:00

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:

Baucus

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%

Rockefeller

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.

http://www.whitehouse.gov/CONTACT/

http://speaker.house.gov/contact/

http://reid.senate.gov/contact/index.cfm

CBO should score systemwide savings from health reform

2009-10-08T07:25:00.000-07:00

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:

http://www.cbo.gov/ftpdocs/79xx/doc7946/93doc07b.pdf

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:
TABLE 2. PROJECTIONS OF NATIONAL HEALTH EXPENDITURES,
(By calendar year, in billions of dollars)

1997 1998 1999 2000 2001 2002 2003
Baseline
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.

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

2009-10-05T07:30:00.000-07:00

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.

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

2009-09-14T04:37:00.000-07:00

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.

What We Need In a Health Reform Bill

2009-09-13T04:28:00.000-07:00

What, specifically, do we need in a health reform bill? Here's the view from EQUAL partners. To download as a flyer, go to
http://www.centerforpolicyanalysis.org/sitebuildercontent/sitebuilderfiles/flyer11congress.pdf

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 www.centerforpolicyanalysis.org * The California Public Health Association-North an affiliate of the American Public Health Association www.cphan.org * Rekindling Reform www.rekindlingreform.org * Older Women’s League San Francisco * California Women’s Agenda

The Speech

2009-09-11T10:59:00.000-07:00

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.

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

2009-09-06T06:13:00.000-07:00

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.

Sen. Feinstein: Time to Lead on Health Reform!

2009-08-31T06:55:00.000-07:00

Sen. Feinstein has issued, at long last, a thoughtful statement on health reform. There is much to applaud, but there is too much unresolved. She makes the case that this is a vital issue for our state. We should demand clearer leadership on her part.

She rightly notes that California stands to benefit from reducing our high percentage of uninsured, and must protect our extensive system of public hospitals and safety net clinics. She recognizes that most Californians want relief both from the health insurance
industry’s exorbitant premiums and from its unfair practices. She demands that private insurance companies limit spending on administration and profits to no more than ten percent of revenues – a critical issue, and a level even better than the House’s bill. She supports offering the option of a public insurance plan.

However, while criticizing current proposals for not going far enough to assure that health care will be affordable, she opposes the necessary subsidies on abstract grounds of deficit control. She takes the opportunity for an unjustified swipe at entitlements generally, reviving the call for a commission to review not only Medicare, which is threatened by runaway costs in the private system that it cannot control, but also Social Security, a perfectly solvent system that requires well known tweaks to survive with no difficulty.

Finally, she bows to the possibility that a nonprofit coop could take the place of a public plan, in providing an effective and competitive counterpoint to private insurance. This concept has no legs, as everyone knows but the small-state senators whose judgment she questions.

Sen. Feinstein does not serve on the Senate Finance Committee, which has yet to offer a bill. But the people of our state desperately need reform, and we’ve fought for it actively. We have twice passed single payer legislation, the gold standard for effective reform. It is time for Sen. Feinstein to join the majority of the state’s Congressional delegation in unequivocal support for a bill that includes a meaningful public plan option, available to everyone, and that finally makes health care affordable. She’s halfway there. She should complete her deliberations by the time the Senate reconvenes next week.

Pickpockets and the Public Plan

2009-08-15T07:51:00.000-07:00

Ever had your pocket picked? Chances are they charmed you, scared you, surrounded you - in short, distracted you while they grabbed your wallet. Enough said.

So let's get back to the important issue in health reform: the Public Plan. You can have health coverage that is better than what you have, that is more affordable, covers many more of us, and improves quality You need a strong public plan.

The Congressional Progressive Caucus isn't calling for a strong public plan, really. They should.

People who say a public plan can't work are wrong. They should reconsider.

A strong public plan should be open to everyone who's not on Medicare, beginning in 2010.

The House bill says it would start in 2013 - after the next presidential election - and include only a few of us - self-employed, unemployed, employees of small businesses.

The Senate is proposing to have no public plan at all - just a straight cash transfer to your friendly neighborhood insurance conglomerate. (Which is really a way of making sure nothing passes.)

Why does this matter? The public plan needs to have enough people in it so that it can do what Medicare does: influence how the rest of the system works. Bend the cost curve. Improve quality. Provide your doctor, nurse practitioner and acupuncturist with comparative effectiveness studies so you get better care on the first visit. This will scare some of the teabaggers and it apparently scares the hell out of the insurance industry.

This, however, is change we can believe in.

That plus one more thing: we need a state option for single payer, so we can take the next step towards truly universal coverage.

People are mobilizing in remarkable ways to demonstrate why we need real health reform now. Giving out free care to long lines of people in desperate need. Showing up in scrubs at Town Hall meetings. Explaining that Medicare is a government program and we like it.

We need to do one more thing: make it worth it when we win. Take a picket sign for a Real Public Plan. Tell your neighbors. Tell your member of Congress. Tell your talk shows. The insurance industry and their pickpockets do not speak for us. We need real health reform, and this is the time to fight for it.

Need some talking points? Go to www.centerforpolicyanalysis.org/id42.html

thugs and health policy

2009-08-09T10:55:00.000-07:00

Missing the point: Facing down the gangs disrupting her Town Hall on health reform last week with cries against the "government takeover," HHS Secretary Kathleen Sebelius responded, "But this isn't a single payer plan!"

Single payer advocates, recognizing that our gold standard cannot pass this year, taunt supporters of a public plan for saying that our gold standard cannot pass this year.

Meanwhile, the economic stagnation that gripped the poor in the 1990s and never let up is nipping at the heels of the middle class. The financial and housing meltdowns are taking place at a time when countervailing forces to corporate power are hard to find. Private sector unionization rates hover at about 7.6% (the public sector is over 40%; 16 million of America's 130 million wage workers belong to a union).

The public may be favorably disposed toward a public health plan, but probably fewer than 100 can describe how it would work, when it would start (2013), or what it would mean to them personally (would likely help). Meanwhile, right wing blogs and the Republican party are succeeding in whipping up fury on an issue even wonks think of as arcane. Let's assume most of these people are operatives, as were the Bush v. Gore mobs in 2000. The point is, they have organized, well-funded leaders, with a stake in the direction of this wobbly nation and our increasingly ethereal economy.

Maybe we need to rethink the conversation we need to be thinking about.

And You Thought 1984 Was So Last Century: Blue Dogs Claim "Savings"

2009-07-30T09:43:00.000-07:00

The Blue Dog Dems are pulling a fast one, this time claiming that more is less.

These "fiscal conservatives" on the House Energy and Commerce Committee have reached a temporary agreement to do the following: raise Medicare payments to (their) rural hospitals; shift the cost of Medicaid expansions away from the feds and on to (their) poor states; and to increase all provider reimbursement rates under the public plan. (see clips below.) This all will add about $10 billion a year to the bill.

To the public: We will have a busy month in August, getting the Senate to come up with something the House can live with; and getting Speaker Pelosi and other Dem leaders to craft a House bill that the Progressive Caucus can vote for, and which, by the way, would really be fiscally conservative.

http://www.kaiserhealthnews.org/Daily-Reports/2009/July/30/Thursday-House.aspx"The new proposal includes a public health insurance option to compete against private insurers, but it does not tie the payments to Medicare's rates of reimbursement to health-care providers, something many liberal lawmakers had sought. Instead, it calls for the health secretary to negotiate rates with hospitals and doctors, just as private insurance companies do. Rural health-care providers generally receive less in Medicare reimbursements than their urban counterparts, and delinking the public plan from Medicare was considered critical for conservative Democrats" (Kane and Murray, 7/30). The New York Times : "Medicaid would be expanded, as under the original bill, but states would pay a small share of the additional costs, perhaps 7 percent. The federal government would have paid all the additional cost under the original bill. People with low or moderate incomes could still get federal subsidies to help them buy insurance, but they might have to spend slightly more of their own income — a maximum of 12 percent, rather than 11 percent" (Pear and Herszenhorn, 7/29). Kaiser Health News reports that Rep. Mike Ross, D-Ark., "said that, all told, the revised bill would cost $100 billion less over 10 years, although precisely how that would be accomplished will be unclear until the CBO prepares a cost analysis of the overall bill. House senior Democratic aides said that the demands for revised reimbursement rates and more protection for small businesses would actually add $100 billion to the cost of the bill, and would have to be offset with savings elsewhere."

More on HR 3200: Public plan delayed, affordability uncertain

2009-07-19T00:57:00.000-07:00

John Gilman (johnhgilman@yahoo.com) and Ellen R. Shafffer

Concerns
· State benefit mandates – to continue these mandates, state will have to pay any additional cost of affordability credits in the Exchange that are due to the mandates. With tight state budgets, states are likely to drop these benefit mandates, which will effectively reduce the scope of coverage for all state residents whether insured in or outside the Exchange.

· Delayed Implementation of Health Insurance Exchange, Public Option, and Affordability Credits and limited access once implemented.
o Exchanges do not go into effect until 2013. In that year the only employers that may insure through the Exchange are those with 10 or fewer employees. Individuals without other coverage may also enroll, but if they have been offered coverage by their employer they will not be eligible for any affordability credits.
o Beginning in 2014, any employer with 20 or fewer employees may enroll in the Exchange. Individuals without other coverage may also enroll, but if they have been offered coverage by their employer they will be eligible for affordability credits, but only if the employee’s share of premium exceeds 11% of adjusted gross income and the employee’s family income does not exceed 400% FPL.
o Beginning in 2015, and beyond, the Health Care Commissioner may, but is not required to, expand employer participation to larger employers.
· There is an individual mandate to have insurance but Affordability Credits are limited. These credits are not available unless you receive coverage through the exchange, and even then, they are not available through the exchange if you have declined coverage from your employer unless your share of premium under your employer’s plan exceeds 11% of your income.
o For those that qualify, Affordability Credits provide some protection for those with the lowest incomes, but these credits quickly phase-out and are not available for much of the middle class. Anyone with family income above 400% FPL ($43,320 for an individual; $88,200 for a family of four) is not eligible for any subsidy. The following are examples of health care costs for people buying coverage through the exchange:
§ A single person with $16,000 annual income would receive a subsidy and pay no more than a $480 per year premium (3% of income), while having a cost sharing burden of 3-5% of medical costs.
§ A couple with family income of $35,000 would receive a subsidy and pay no more than a $2450 per year premium (7% of income), while having a cost sharing burden of 15% of medical costs with an out-of-pocket family limit of $10,000 per year.
§ A family of three, with family income of $72,000 would receive a subsidy and pay no more than a $7920 per year premium (11% of income), while having a cost sharing burden of up to 30% of medical costs with an out-of-pocket family limit of $10,000 per year.
§ A family of four with family income of $90,000 would not be eligible for any premium subsidy and in addition could expect to have a cost sharing burden of up to 30% of medical costs with an out-of-pocket family limit of $10,000 per year. According to the California HealthCare Foundation, in 2008, the average total family premium for an employer sponsored PPO in California $1251/month ($15,012/year). This family would be paying over 16% of its income just for the health care premium.
· The bill permits a basic insurance plan to have high out-of-pocket expenses. Cost sharing under the basic plan can be up to 30% of medical costs, with out-of-pocket limits of $5000 per individual and $10,000 per family.
· Although the bill offers “enhanced” and “premium” plans with reduced cost sharing–it appears that everyone is entitled to the “basic” plan. The enhanced and premium plans have less cost sharing but higher premiums. Low and middle-income workers will likely not be able to buy enhanced and premium plans because they will not be able to afford the higher premiums, so they will be stuck with the basic plan and its high-cost sharing.
· Play or Pay. Employers must “play” (offer health insurance to employees) or “pay” (pay a fee to the Health Insurance Exchange Trust Fund).
o If the employer plays, the minimum employer contribution to premium (for full-time employees) is 72.5% of the premium cost for a single employee and 65% for family coverage. That means the employee with family coverage may pay 35% of the premium cost of his or her policy. (According to the California HealthCare Foundation, single employees in California pay on average 12% of premium costs, while employees with family coverage pay 24% of premium costs.)
o Employers that choose to pay must pay an amount equal to 8% of total wages (The amount is less for employers with payrolls of up to $400,000). When the employer chooses to pay, none of the amount paid by the employer is credited to his or her employees, who must obtain insurance through the exchange. Many of these employees will find themselves paying for the full cost of their insurance. See the above discussion for Affordability Credit subsidies available through the Exchange.
· State-based health insurance exchange – States, or groups of states, can form their own health insurance exchange. However, it appears that such an exchange would NOT be required to offer a public option. (See Section 208)
· State benefit mandates – to continue these mandates, state will have to pay any additional cost of affordability credits in the Exchange that are due to the mandates. With tight state budgets, states are likely to drop these benefit mandates, which will effectively reduce the scope of coverage for all state residents whether insured in or outside the Exchange.

· Essential community providers: The bill requires that only basic plans contract with essential community providers? [Page 90 - Sec 204 (b)(6)]

Good:
· Prohibits cost sharing for preventive benefits
· Establishes a minimum Medical Loss Ratio, BUT leaves exact ratio to be set by the Secretary of HHS, (effective 1/1/2011)
· Limits policy rescissions (effective 10/1/2010)
· Public Option –Provides incentives for Medicare providers to be public option providers (assures broad, diverse panel of providers)Page 122-123 – Sec 223 (b)(1) – 5% incentive to Medicare providers who also participate in Public Option]

· Medicaid improvements
o Expands coverage: Requires state Medicaid programs to cover childless adults, parents, and individuals with disabilities with incomes up to 133% FPL. Requires state Medicaid programs to cover newborns up to the first 60 days of life who do not have other coverage. These expansions will be paid 100% by federal government. BUT, these expansions do not go into effect until 2013.
o Improves primary care reimbursement: Requires state Medicaid programs to reimburse for primary care services at no less than 80% of Medicare rates in 2010, 90% in 2011, and 100% thereafter. The incremental cost of this increased reimbursement will be paid 100% by federal government.
o Establishes a five-year Medicaid Medical Home pilot program, with 90% federal matching funds for community care workers for the first two years and 75% federal matching for next three years.
o Increases pharmaceutical manufacturer rebates for brand-name drugs purchased by State Medicaid programs from 15.1% of average manufacturers’ price to 22.1%.
· Establishes the Center for Comparative Effectiveness Research

Uncertain effect
· Options for certain individuals to enroll in Medicaid or receive insurance through the Exchange (probably good)
· Eliminate SCHIP; transitions SCHIP eligibles into Exchange, but no earlier than 2013.
· 2.5% tax penalty (2.5% of modified AGI) for failure to obtain coverage, but not to exceed average premium cost; hardship exception available. (If you pass the “hardship test” your prize is not having to pay the penalty and not having health insurance.)
· Up to 50% employer tax credit for premiums paid by small employers with low wage workers
o Phases out beginning at over $20,000/ year average wage, fully at $40,000
o Phases out beginning at 11 employees; fully at 25
o Does not apply to any employee earning over $80,000
· Requires state maintenance of effort (MOE) for Medicaid and CHIP eligibility as of June 16, 2009. This assures that eligibility does not contract (good), but how able are states to do this, given their bleak budget picture.

The Good, the Bad and the Murky: Health Reform on July 14

2009-07-15T07:36:00.000-07:00

Here’s (a partial, one-person view of) what happened:

The House released a 1,017 page reform bill, summarized in 35 pages, promising progress and peril over the next 4 years. It improves affordability of health insurance, and proposes to regulate “rescissions” and other worst practices. The public plan option is semi-strong: it’s available to anyone who gets coverage through the new Health Insurance Exchange, but it’s less affordable for people covered by an employer. And it postpones indefinitely including large employers in the Exchange, running the risk that the Exchange and the public plan will drown in high payments for people likely to need health care.
Bill and summary online: http://www.centerforpolicyanalysis.org/id41.html

More below on the new House bill.

The Senate Health, Education, Labor and Pension (HELP) Committee gamely marched through amendments to its bill. Sen. Bernie Sanders’ state single payer amendment elicits shining and shameful moments: Strong statements of support from Senators Tom Harkin (“We have a dysfunctional system”), Jeff Merkley, and Sherrod Brown. Listen To Your Staff Demerit for Barbara Mikulski (“Can’t states enact single payer anyway?” [She is reminded that states need waivers for ERISA, and transfers of federal funds.] “Oh.” She still voted No. The amendment failed, but may come up again to the full Senate.) Hero award to Kennedy chief staffer David Bowen, at the table full time, accurately describing every technical foible of the draft bill, and every amendment.

The Mainstream Media fuss about the tab. Washington Post and NYT focus on taxes on the wealthiest. Very not the point.

Preliminary Details: The House Bill: Big questions for consumers and providers are: Will it make insurance affordable and dependable?

The bill targets the worst insurance company abuses: pre-existing condition exclusions, rescissions of coverage after the fact, denial of coverage or renewal to sick people. They will have to spend most of the premiums on health care. But enforcing these rules will depend on the existence of a real alternative. Here’s the murky part.

Most employers will have to offer insurance, covering about 70% of the premium, or pay an 8% payroll tax to a Health Insurance Exchange. The Exchange offers Qualified Health Benefits Plans that meet certain rules. The Public Plan is one of the options. Anyone eligible for the Exchange can enroll in the Public Plan. (Why do I see images of Holly Hunter demanding that George Clooney prove he is “bona fide”?)

But until 2013, the Exchange is open only to individuals without coverage, and to small employers.

And after 2013, it is up to the new Health Choices Commissioner to determine whether or not larger employers will be included.

There are affordability limits on what individuals will have to pay, that are better than proposed earlier: Sliding scale subsidies for premiums up to 400% of the federal poverty limit, if premiums cost more than 11% of your adjusted gross income. There are limits on total out-of-pocket spending (premiums, co-pays, deductibles).But: Subsidies in the first 3 years are only available to those who do not have an affordable offer of employer-sponsored insurance.
So you can quit your employer's crummy plan if you don't like it, and join another plan offered thru the Exchange, as long as you can afford to do so without the affordability credits, until 2013.

Payments to providers would be tied to Medicare rates. This is a boon to cost control and affordability in the long run. (There are other benefits that keep provides in the plan.)

Drug Bust: The Health Choices Commissioner can negotiate for drug prices.

The Medicare doughnut hole will close – by 2023!!! We can do better.

Quality Improvements: Many good proposals to improve the quality of care, through Medicare and other programs. The bill would tilt reimbursement and training to primary care providers, gerontologists, and nurse midwives. Needed funds for prevention and public health.
State Options. Still to be explored; from the Summary:
Sec. 208. Optional operation of State-based health insurance exchanges. Permits states to offer their own Exchange or join with a group of states to create their own exchange in lieu of the federal Health Insurance Exchange, provided that the state(s) perform all of the duties of the federal Exchange as approved by the Health Choices Commissioner. The Commissioner has authority to terminate state exchanges if they are not meeting their obligations.

Coming up: House Committee mark-ups starting – today! Get online. Take notes. One way or the other, history is happening.

Hear Ellen on the public plan

2009-07-06T14:48:00.001-07:00

Hear Ellen's comments on the public plan on Free Speech Radio Network on July 6: www.fsrn.org

Senate HELP Bill Doesn't Help Enough

2009-07-02T16:11:00.000-07:00

The health reform bill that will be introduced next week in the Senate Committee on Health, Education, Labor and Pensions (HELP) includes a public plan, but it just skims being adequate. The Center for Policy Analysis has set two key benchmarks for an effective public plan: 1) broad eligibility, to assure a large and stable risk pool; and 2) the government's ability to set reasonable reimbursement rates, in order to control costs.

A letter from Senators Kennedy and Dodd on July 1 promised a strong public option that can keep costs down, expand coverage, and offer affordable options for coverage. The portion of the chairman's mark, released today (July 2), describes a public plan referred to as a Community Health Insurance option (Title XXXI, Subtitle A - Affordable Choices, Sec. 3106).

Eligibility. Employees with access to coverage from work are excluded from enrolling in the Community Health Insurance option (Subtitle B, Sec. 3111,(b)(C); and Sec. 3116 (4)(a)(4)(v)IV), pp. 132-133). An individual who is eligible for employer-sponsored coverage can join the public plan only if the workplace plan's coverage doesn't meet the standard for minimm qualifying coverage, or if it is not affordable ((4)(v)(IV) and (4)(B)pp.132-4). A plan is unaffordable if the premium is greater than 12.5% of the indivudual's adjusted gross income (AGI) (Sec. 3103, p. 70) An employee with an AGI of $50,000 a year, who pays $500 a month for insurance, would not qualify to join the Community option. $50,000 times 12.5% equals $6.250, more than the annual premium of $6,000. An individual with an AGI of $100,000, paying $12,000 a year for family coverage, also just misses the 12.5% mark, which is $12,500. If the same person paid $13,000 a year for coverage she would qualify.

Reimbursement Rates. The Community option cannot reimburse health care providers for a rate higher in aggregate than the average reimbursement rates paid by health insurers through the Gateway (Sec, 3106. (6) p. 80). While this is some limitation, it does not stanch inflation in health spending nearly as much as pegging reimbursement to a fixed rate set by the public sector, as Medicare does.

Affordability. Employers are required to pay at least 60% of the premium for workplace insurance. But if they choose not to buy insurance, they are required to pay on $750 a year per worker to a state fund. Since this is far less than the average annual cost of most premiums, the incentive is for the employer to drop coverage. This would pave the way for more people enrolling in the public plan - as long as that plan is affordable.

Individuals are required to pay from 1% of 12.5% of their annual income, on a sliding scale, for health insurance premiums.

It is widely expected that the Senate will pass a more conservative proposal than the House. The chairs should improve their proposals to make the public plan widely and immediately available, as well as affordable. If they do not, hopefully there will be constructive amendments from other Senators on the Committee.

Sanders State Single Payer Amendment Introduced

2009-06-26T20:02:00.000-07:00

I am in DC, where Senator Bernie Sanders has introduced an amendment to the coverage section of the Senate HELP Committee's draft health reform bill. The amendment would provide funding to up to 2 states a year to establish state-based single payer systems, if the states apply to do so.

We will have more information soon on the full text of the amendment, and suggestions on how to build support for it, especially during the Congressional recess that has just begun. It will be presented for a vote in Committee sometime after Congress reconvenes on July 7.

The amendment is the work of Sen. Sanders and his staff, but our Center was pleased to play a small role in providing advice on drafting. In substance, it mirrors a state single payer amendment proposed by Sen. Paul Wellstone in 1994, as part of the consideration of the Clinton health reform proposal. It was passed by the same Senate HELP Committee at that time (though the Committee had a slightly different name then). (Although the Committee passed this amendment in 1994, and a whole bill, the bill as a whole died before it could come to the floor for a vote.)

House Opens Door to Strong Public Insurance Plan, Improves Medicare;

2009-06-20T11:33:00.001-07:00

House Opens Door to Strong Public Insurance Plan, Improves Medicare;
Extensive Measures to Control Costs, Improve Quality, Require a Strong Public Plan

The House Tri-Committee health reform discussion draft includes a number of positive features for coverage, affordability and cost control, while remaining silent on some key issues. The bulk of the bill makes important proposals to improve the quality of care and prevention, but these will have the greatest impact in areas the government can control, such as Medicare. Coverage and financing for the system as a whole remain fragmented, meaning that these proposals will have limited effectiveness on cost controls and quality of care overall.

This projection could change substantially depending on how the public plan is structured. The draft bill proposes to use Medicare reimubursement rates to pay providers, a key feature for cost control. The House should not compromise on this.

The other essential issue is assuring sufficient enrollment in the public plan so that it can do what the private, for-profit insurance industry fears the most: compete fairly. As written, it seems to allow employees to choose the public plan, but does not provide the same level of subsidies to premium payments. The House must complete the bill to strengthen the public plan.

The basic benefits package for the public plan expands Medicare benefits to include maternity and well-baby coverage.

The joint proposal by three House Committees – Energy and Commerce, Education and Labor, and Ways and Means – requires private insurance plans to spend at least 85% on patient care, institutes price negotiation for prescription drugs under Medicare, and these additional features:

All health insurance plans would have to spend at least 85% of revenues on patient care.

Basic benefits include maternity and well-baby care.

A new public insurance plan would have these features:
· Supported through premiums, after federal subsidies for initial start-up costs.
o This could jeopardize the plan’s financial sustainability.
· Reimbursement rates for providers on Medicare, and can vary by 5%.
· Prescription drug prices negotiated by Secretary of HHS
· Innovative payment arrangements with incentives to improve quality, reduce health disparities, address geographic variation in provision of services, prevent or manage chronic illness, provide care that is integrated, patient-centered, quality and efficient.
· No balance billing: providers cannot charge more than established rates.
· Subsidies for premiums and other cost-sharing available to persons at 400% of the federal poverty level.
o This is a reasonable level but needs to be adjusted geographically to address urban areas with high costs of living
o Subsidy not available to individuals who are eligible for an employer-provided health plan that offers similar financial support. However, in this case premium cost limited to 1% to 10% of family income (determined on a sliding scale).

Employers must contribute to the cost of a health plan provided to employees, or pay into the Health Insurance Exchange.
Employers contribute at least 72.5% of the premium for the lowest cost plan.
Must cover full time employees and dependents.
Contributions pro-rated for part-time
Employer self-insured plans qualify as providing coverage (p. 119, Sec, 321)
Penalty for non-compliance is $100/day
Exemption for small employers, not defined (p.151) . Credits for Small Business Employee health coverage expenses (.p.153)

Individual Tax on uninsured (p. 136, Part VIII, Sec. 59B): 2% of adjusted gross income, limited by a formula, and no greater than the annual national average premium.
Exceptions for non-resident aliens, religious conscience
In all other respects, individual responsibility is not defined (Title III, p. 114)

Medicare, Medicaid, VA, Tricare remain. (p. 141)

Interim programs (p.163) to include a reinsurance program to assist early retirees

Medicare and Medicaid Improvements (p.164)
In addition to standard rate readjustments:
Sec. 1151 aims to reduce preventable hospital readmissions
Sec. D Medicare Advantage Plans – eliminates Regional Plan Stabilization Fund
Sec. 1171 Limits out of pocket costs

Subtitle E. Improvements to Medicare Part D
(Earlier sec. of bill authorizes HHS to negotiate rates)
Sec. 1181. Drug manufacturers must provide rebates
Sec. 1182. Closes doughnut hole!!!
Sec. 1184. Benefits for AIDS, Indian Health Service drug programs

Title IV – Quality p.423

full bill online http://www.centerforpolicyanalysis.org/id41.html

Blue Dog Dems: Call Them on Real Health Reform!

2009-06-18T00:14:00.000-07:00

Want to know who's holding up a vote on a strong public plan option?

51 House Blue Dog Democrats are gonna vote on health reform Here's what they intend to do. The faith community has targeted these errant Dems and gotten CA members to back off on the 'trigger' proposal. Thank you!!! Looking forward to other reports. - Ellen Shaffer

Blue Dog positions on health reform:

http://www.house.gov/melancon/BlueDogs/Press%20Releases/Health%20Care%20Reform%20-%20Ensuring%20Choice%20in%20the%20Marketplace.pdf The Blue Dog Coalition strongly supports health care reform that lowers costs for families and small businesses, increases choice and competition, and allows individuals to keep their doctor. We are concerned, however, about a “Medicare-like” public option and its ability to achieve all of the benefits put forth by its proponents. How a public option is constructed and allowed to compete are critically important to ensuring families have the ability to keep their current health coverage and continue to see the doctor of their choice. While the Blue Dog membership has not endorsed a public option, we feel that should a public option be included in comprehensive health reform, it should adhere to the following conditions at a minimum: • Adheres to the Free Market: Medicare payment rates, which include structural payment inequities involving lower reimbursement to rural areas, must not be used as the basis for reimbursement. Rather, rates must be negotiated between the plan and its providers as is the case currently for all health insurance plans. Available Only as a Fallback: The availability of a public option would occur only as a fallback and in the absence of adequate competition and cost containment. Fundamental insurance market reforms and increased choice through the Exchange should improve access and contribute to lower costs. However, should the private plans fail to meet specific availability and cost targets, a public option would be triggered and be allowed to compete on a level playing field subject to the conditions outlined above. General Description: http://www.house.gov/melancon/BlueDogs/Member%20Page.html The Blue Dog Coalition - who celebrated 15 years of leadership in 2009 - has built a reputation as a serious player in the policy arena, promoting positions which bridge the gap between ideological extremes. Many of the group's policy proposals have been praised as fair, responsible, and positive additions to a Congressional environment too often marked as partisan and antagonistic. The 51 conservative and moderate Democrats in the group hail from every region of the country, although the group acknowledges some southern ancestry which accounts for the group's nickname. Taken from the South's longtime description of a party loyalist as one who would vote for a yellow dog if it were on the ballot as a Democrat, the "Blue Dog" moniker was taken by members of The Coalition because their moderate-to-conservative-views had been "choked blue" by their party in the years leading up to the 1994 election.

*B*lue Dog Leadership Team*_ *__* Rep. Stephanie Herseth Sandlin (SD), Blue Dog Co-Chair for Administration Rep. Baron Hill (IN-09), Blue Dog Co-Chair for Policy Rep. Charlie Melancon (LA-03), Blue Dog Co-Chair for Communications Rep. Heath Shuler (NC-11), Blue Dog Whip

*_Blue Dog Members_* Altmire, Jason (PA-04) Arcuri, Mike (NY-24) Baca, Joe (CA-43) Barrow, John (GA-12) Berry, Marion (AR-01) Bishop, Sanford (GA-02) Boren, Dan (OK-02) Boswell, Leonard (IA-03) Boyd, Allen (FL-02) Bright, Bobby (AL-02) Cardoza, Dennis (CA-18) Carney, Christopher (PA-10) Chandler, Ben (KY-06) Childers, Travis (MS-01) Cooper, Jim (TN-05) Costa, Jim (CA-20) Cuellar, Henry (TX-28) Davis, Lincoln (TN-04) Donnelly, Joe (IN-02) Ellsworth, Brad (IN-08) Giffords, Gabrielle (AZ-08) Gordon, Bart (TN-06) Griffith, Parker (AL-05) Harman, Jane (CA-36) Herseth Sandlin, Stephanie (SD) Hill, Baron (IN-09) Holden, Tim (PA-17) Kratovil, Jr., Frank (MD-01) McIntyre, Mike (NC-07) Marshall, Jim (GA-03) Matheson, Jim (UT-02) Melancon, Charlie (LA-03) Michaud, Mike (ME-02) Minnick, Walt (ID-01) Mitchell, Harry (AZ-05) Moore, Dennis (KS-03) Murphy, Patrick (PA-08) Nye, Glenn (VA-02) Peterson, Collin (MN-07) Pomeroy, Earl (ND) Ross, Mike (AR-04) Salazar, John (CO-03) Sanchez, Loretta (CA-47) Schiff, Adam (CA-29) Scott, David (GA-13) Shuler, Heath (NC-11) Space, Zack (OH-18) Tanner, John (TN-08) Taylor, Gene (MS-04) Thompson, Mike (CA-01) Wilson, Charles (OH-06)

Health Care Leadership: *_Health Care_* /Mike Ross, Chairman/ /Marion Berry, Vice-Chairman/ /Zack Space, Vice-Chairman/ /Parker Griffith, Vice-Chairman/ / / Mike Thompson Jim Cooper Travis Childers David Scott Earl Pomeroy John Barrow Charlie Wilson John Tanner Collin Peterson Jim Matheson

PUBLIC HEALTH AND COST CONTROL: ESSENTIAL FOR HEALTH REFORM

2009-06-03T19:29:00.000-07:00

As advocates for public health, we value proposals by the Senate Finance Committee and the Obama Administration to encourage prevention, fund public health functions, expand the public health workforce, and reduce health disparities. All could improve the health of our nation, and help reduce the burden and the costs of illness. We offer initial comments on strengthening these proposals.

However, these measures can only help to control unsustainable health care costs if they are aligned with reforms of the fragmented system for reimbursing and financing care. Finance Committee proposals would begin this process through Medicare. A new public insurance plan must extend these reforms systemwide.

Public health is integral to health reform. Public health agencies, programs and policies protect and improve our health as individuals and communities, and provide coverage and care directly to many. Greater investments in public health are essential to protect against new strains of the flu and the effects of climate change, to treat chronic illnesses early, and to address the factors that undermine health and drive up costs, such as tobacco use, obesity, social and economic inequalities, and unsafe communities.

Health reform is essential to public health. Universal coverage for affordable health care would improve individuals’ physical health as well as the financial and social security of communities and the nation. Reorienting health care spending priorities could unleash resources for public health.

However, our fragmented, investor-driven financing system routinely defeats savings from improvements in health status and in the quality of care. Private insurers, drug companies, equipment suppliers and hospital chains are able to soak up every dollar we might save by focusing primarily on health care features most visible to consumers but limiting needed benefits that are essential for the nation’s health and pocket book. A system whose core responsibility is to share holder profit leads to cherry picking low risk beneficiaries, limiting as many benefits as possible and providing an extra service or product, or charging a higher price. Instead of reducing costs, potential savings are diverted instead into high administrative expenses and profits..

Americans do not use more pharmaceuticals, doctor visits or hospital days than people in other countries – in fact we in the U.S. use fewer. We are acutely aware that even people with insurance too often face limits on needed services. As a result of our fragmented investor-driven system, the U.S. pays higher prices per unit of service, compared with other countries, and experiences, and also experiences more intensive use of new technologies.

The Senate Finance Committee proposals address these problems in one important system which the federal government can influence directly: Medicare, which covers people over age 65 and some people with disabilities. These proposals combine financial and organizational incentives to provide appropriate, high quality care. Because Medicare is a publicly financed, publicly administered program, the Finance Committee is able to serve the public by proposing to control Medicare’s costs.

The most effective reform would be to improve and expand Medicare’s ability to control costs to all Americans. Strengthening and expanding public insurance programs builds on what works best in our system.
A transitional policy solution is to offer a public insurance plan, similar to Medicare, that can succeed in covering a stable, substantial population sufficiently substantial to influence and realign the costs and quality of care. A strong public plan could use careful levers to control costs by limiting the use of unnecessary revenue-driven care that compromises patient safety.
We have an historic opportunity to transform the human suffering and economic disruption caused by the fragmented and competitive nature of the investor-driven health care financing system, and by the underfundiung of public health programs and policies. We call on Congress to enact legislation that would include the following recommendations:

I.Establish a Public Insurance Plan, with key features to assure that it improves coverage, affordability and quality of care.
Our goals are universal, affordable coverage, with fair and stable financing, that controls costs; an accountable delivery system that offers quality, appropriate, accessible and equitable care; eliminating social and economic disparities that undermine health; and a strong public health system.[iii]

II. Reform Medicare: Implement incentives to cMedicare reimbursement policies ontrol costs and improve quality, and extend eligibility to people under age 65.
We support the Finance Committee’s proposals for incentives to control costs and improve the quality of care through Medicare, which will be strengthened if applied to a larger population through the public insurance plan.

and

III. Improve public health, reduce health inequalities and address social determinants of health.
We support Finance Committee initiatives to improve preventive health services through Medicare, to address health disparities, and to expand the health care workforce. They should be expanded to strengthen the public health infrastructure, and prevention at the community-level, and to implement national policies and programs that address the political, social, economic and environmental forces and policies that shape health and can prevent illness.

[1] The Congressional Budget Office recently observed: The main factor [contributing to the large projected increase in federal spending on Medicare and Medicaid] is excess cost growth-or the extent to which the increase in health care spending exceeds the growth of the economy. Substantial evidence exists that more expensive care does not always mean higher-quality care. (http://www.cbo.gov/publications/collections/health.cfm)
[2] Anderson, Gerard, et al, It’s the Prices, Stupid: why the US is so different from other countries, Health Affairs 22(3) May/June 2003.
[iii] EQUAL Criteria for Health Reform. In 2008, the Center for Policy Analysis and a network of organizations representing public health and women’s health formed EQUAL Health, for Equitable, Quality, Universal, Affordable health care. The Criteria to Evaluate Health Care Reform (2008) calls for universal, affordable coverage, with fair and stable financing, that controls costs; an accountable delivery system that offers quality, appropriate, accessible and equitable care; eliminating social and economic disparities that undermine health; and a strong public health system. http://www.centerforpolicyanalysis.org/id2.html[iii]

Full testimony at http://www.centerforpolicyanalysis.org/

Defending Baucus: Washington Post Censors Itself

2009-05-24T06:34:00.000-07:00

Today's political puff piece in the Washington Post on Senate Finance Committee Chair Max Baucus tells us that his approach to health reform "has been to pull together stakeholders and hold them as long as possible; no idea is ruled out, no policy change dismissed. His mantra is always the same: "Suspend judgment, if only for a nanosecond."

In case we were wondering about editorial bias at the Post, they ignored their own (already slanted) reporting on Baucus' notorious refusal to entertain any discussion of single payer at his hearings, including the infamous arrest of single payer advocates. Surely a decision that will haunt his political future, with unknown consequences for the future of health reform.

Here's how the Post called it at the time:

Police eject protesters from Senate health hearing
The Associated Press Tuesday, May 12, 2009; 10:53 AM
WASHINGTON -- Police have ejected five doctors and nurses who back government-run health care after they disrupted a Senate hearing. Dozens of others protested outside.
The protesters says supporters of government-run health care are being excluded from congressional debate. The Senate Finance Committee met Tuesday to debate how to pay for overhauling the nation's health care system.
At the start of the hearing more than a dozen nurses stood in silent protest and turned their backs on Finance Committee Chairman Max Baucus as he spoke. They had signs attached to the back of their shirts supporting single-payer _ or government-run _ health care and protesting industry influence.
After they left, five others stood up, spoke in favor of single-payer, and were taken out by Capitol Police.

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/23/AR2009052301893.html?hpid%3Dtopnews&sub=AR

HEALTH INDUSTRY SCRAMBLES ~ REPUBLICANS: “THROW THEM UNDER THE BUS”

2009-05-11T16:14:00.000-07:00

The health care industry is playing its final card. Even the Republican Party is ready to "throw the health insurance industry under the bus," according to strategist Frank Luntz – while taking every opportunity to block all reform proposals.

To avert genuine cost control, they are promising to voluntarily hold down prices, per a letter from the America’s Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America; as well as the AMA, the Hospital Association, the Advanced Medical Technology Association, and the Service Employees International Union. Voluntary efforts have been effective in the past at staving off real health reform, but each time have failed to truly reduce costs.

To avoid the political fight of imposing genuine cost control, the Administration may accept the offer. Advocating health reform as a measure to help save the failing economy, it has suggested reducing costs by transforming how health care is delivered. An array of sensible and important proposals, from increasing primary care and incentives to improve quality, to addressing the social and economic causes of illness, are on the table. These proposals are well and good. Our fragmented, profit-driven system means that Americans spend more for using fewer health care services, and get worse health outcomes, compared with other countries. Improving care will help some people.

But the Congressional Budget Office has testified that it will not give much credit to these proposals for savings on costs. CBO and the health care industry know what would work, and it's the third rail of the current debate: In every other country, the government takes responsibility for assuring that health care is affordable and available. Since they know individuals can't bargain over prices when they're sick, the government does it for them, by setting limits on total health care spending, and prices.We're mustering the political will. The question is, will Congress propose a plan like Medicare, that can ensure the government can play its role, and hold down costs while assuring universal coverage? Let's look for robust proposals that can secure the transformation of the health system that policymakers are promising.

Online also at http://www.huffingtonpost.com/ellen-r-shaffer/health-industry-scramble_b_201882.html

Save Health Reform - Expand Medicare for All

2009-03-30T06:08:00.000-07:00

President Obama has created a unique opportunity to transform the health system. Health care consumers, women and public health advocates know we need an Equitable, Quality, Universal, Affordable health system. But special interests in D.C. have other ideas. Sign up to let the President and Congress know we need a publicly financed, publicly administered plan like Medicare. We'll send the message to them by April 6, when the White House health care forum convenes in Los Angeles. Ask your friends and colleagues to sign too!

Go to:
http://org2.democracyinaction.org/o/5890/t/5559/petition.jsp?petition_KEY=307

Dear President Obama,
Thank you for taking leadership towards winning national health reform. We want to help. We are asking you and our members of Congress:
1. Give us an American solution we know and trust. Expand Medicare to make sure everyone in America is covered by this popular, affordable, publicly financed and publicly administered program.
2. We have learned a lot since the last time. Special interests cant scare us about government-run health care, and losing our choices. Too many of us have had to struggle at our sickest for the care we deserve, even when we were insured. We know that everyone on Medicare can choose our own doctor and hospital, and we do not lose coverage when we get sick. That is the choice we care about.
3. Expand Medicare benefits to address all our needs for preventive, acute, and long-term care, including reproductive health services, prescription drugs, dental, mental health, vision, and alternative and complementary medicine.
4. Stick with your plans to let our doctors and nurses know which treatments are most effective, and encouraging team practices. We all deserve the best quality care.
5. Thank you for investing in public health. It is time to make sure all our social and economic policies make us healthier, from the environment to education, from the dinner table to our transportation systems.
We know that keeping the coverage we have is not a real choice for many in todays economy.
Covering everyone under a publicly-financed, publicly- administered program like Medicare slashes administrative costs from 30% to 3% of the health care dollar, and saves money for individuals, employers, and the government.

The Health Care Summit: Or, What Were They Thinking?

2009-03-05T23:23:00.000-08:00

The White House health care summit started out inspiringly. Single payer advocates organized their way into the room. The President had originally refused to invite Rep. John Conyers, the lead co-sponsor of the House’s Medicare for All bill, HR 676. The bill would virtually eliminate the private insurance industry, something the President had taken off the table in a nod to that industry’s power and past political clout. But Physicians for a National Health Program and other activists generated massive phone calls in protest, and threatened to demonstrate in front of the proceedings. Rep. Conyers was invited in, along with PNHP President Oliver Fein, MD.

It was a bracing early victory.

Compared with last week’s economic summit, the health care event had the aura of a classroom political science exercise rather than a call to address a pressing financial and humanitarian crisis, with causes and effects, as well as known – if politically difficult - solutions.

Government officials have spent months excoriating the malfeasance of corporate executives and lax regulators who brought the economy to rack and ruin. And then turned around and given them more bucks. The economic summit ended on a forceful note: Fix the health care system, or we doom prospects for economic recovery.

But once at the health care discussion, no actor was excluded from a civil hearing (including, ultimately, single payer). The insurance industry, pharmaceutical manufacturers, hospitals, employers, doctors and nurses, and national leaders of health care consumer groups flanked members of Congress to describe the crises in access, costs and quality. They broke into several groups to talk about the issues for about an hour and a half, then reconvened to chat further with the President.

In the group televised on C-Span, and moderated by Melody Barnes and Bob Kocher, members of Congress provided the most grounded and the most pointed comments in the face of nearly surreal assertions by others on the panel. Business Roundtable Chair Ken Powell, CEO of General Mills, a processed food giant that has lost 30% of its stock value since September and experienced its share of layoffs, waxed eloquent about how employers are firmly committed to continuing to play a central role in providing health benefits to their employees. They love doing it and by golly they feel good about how good they are at doing it! They’re offering wellness programs that make a real difference in their employee’s lives. He didn’t exactly address how we should deal with the 40% of employers who offer no benefits at all (a detail Rep. Rob Andrews of New Jersey pointed out). In other words: they don’t want the government to do it.

Blue Cross Blue Shield likewise marveled at its own wellness programs. Though they did agree it was time for reform. (Probably need to do something about those pesky pre-existing condition exclusions.) As long as everyone is required to pay into the system. Well actually, to pay them. They didn’t really see the need for a competing public insurance plan.

It was up to Rep. Allyson Schwartz to mention that there are no hospitals left in northeast Philadelphia that deliver babies. She also mentioned the newborn baby who had jaundice for the first five days of life and was denied insurance coverage just about straight out of the womb, because of the risk that she might someday develop liver disease. Rep. Baron Hill of Indiana confessed that 60% of his generally conservative constituency thought that the government should take over the health care system, though they were divided about exactly how. A somewhat ambivalent Jan Schakowsky soldiered on in allegiance to an Obama-like hybrid plan, but stuck up for Medicare as a program popular with its beneficiaries, and well run. Republican Jo Ann Emerson spoke movingly about the failures of access in rural areas, and nodded to Sen. Byron Dorgan who continues to team up with her to propose legal reimportation of affordable drugs. (PhRMA CEO Billy Tauzin was in a different breakout group.)

Rep. Earl Pomeroy and Sens. Whitehouse and Hatch bemoaned the perverse incentives and poor outcomes of the delivery system.

But John Dingell took the cake. In a few sentences, he recalled his father introducing the first single payer bill in the U.S. Congress in 1943, though he was beaten to the punch by “those socialists, Edward VII of England and Bismarck in Germany.” He agreed with his colleagues who suggested, in a masterful stroke of understatement, that the current system is too administratively cumbersome and should be simplified.

I have yet to watch the rest of the discussions online, including the one attended by the ever-eloquent Dr. Fein. The group of Congress members I watched clearly reveres the President, and no one’s breaking ranks just yet. And they all knew they were on TV. But are they ready to contract out the job of controlling health care costs to the same cast of characters that dug us into this hole in the first place? One makes predictions about health care politics only at great peril. So for now the best answer is, maybe. And maybe not.