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!
Showing posts with label Ellen R. Shaffer. Show all posts
Showing posts with label Ellen R. Shaffer. Show all posts
Sunday, November 14, 2010
Saturday, March 6, 2010
What Is Good Enough? Following the Education Strike, Quoting Ted Marmor
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.
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.
Monday, October 5, 2009
Why It Matters: A Strong Public Plan, Medicare Rates, and Affordability
Let’s start from the end. You want health reform. Republicans say they want it. The insurance industry wants it. People who pay individually for health insurance want it - they can’t afford coverage. People with insurance want it – they too often have their claims denied – 1 in 5. 44,000 people die every year because they are uninsured. Medicare is going broke because prices are going up outside of the Medicare system, and lots of families are going bankrupt for the same reason.
To put the middle in the middle: Getting there means finding 218 members of the House of Representatives, plus 51 Senators, to convince the White House they will vote for reform.
Keeping it there after it passes means we all need to be able to afford it, and still get the care we need.
Here is the part to nail down this week: A strong public option, that pays Medicare rates and uses Medicare providers, is the only way to make the plan affordable.
There are 2 parts to making insurance affordable. The first part is limiting how much we pay providers – hospitals, doctors, drug companies. Basing payments on Medicare rates is the key here.
The second part is making sure these limits get passed back to you, in the form of lower insurance company premiums.
We need a strong public option for both.
The Congressional Budget Office says using Medicare rates saves $110 billion over 10 years, $85 billion more than a public option that doesn’t use Medicare rates.
Medicare already establishes payment rates to hospitals and doctors on behalf of 40 million Americans. These rates are accepted by all hospitals and most doctors, but aren’t susceptible to the hyper-inflation that has driven prices in the private sector over the last 10 years. Adding millions of enrollees to this system will help put the brake on payment rates.
So if the public plan limits payments to providers, how will that translate into lower premiums? The public plan won’t pay profits or bonuses, and will benefit from lower overhead than private plans. All the savings go right back to you, in the form of lower premiums.
Private insurance companies on the other hand can charge whatever they want, even if they are paying providers less. They have to charge higher premiums, to pay their shareholders and executives. This is true even if they paid less to hospitals and doctors – they have no reason to pass those savings on to you, in the form of lower premiums, and every reason to just do what they always do: hold onto the money themselves. Unless, of course, they have to compete with a public plan.
A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
Will doctors still treat you if you are on the public plan, even if it pays less than private plans? For those who think Medicare rates are too low, the version of the public option linked to Medicare rates gives plenty of flexibility. First, we’re not talking about today’s Medicare rates. The bill will require changes in rates to address regional differences, including adjustments for rural areas, and ways to promote quality. Second, it provides an extra 5% (Medicare +5) for individual providers. Third, it allows any provider to opt out – and the decision can be made (and reversed) each year. Finally, it gives the HHS Secretary authority to go higher than Medicare rates if necessary to attract doctors, hospitals and other providers based on local conditions.
Why not negotiate the rates the new public plan will pay providers? Simple: They'll be higher. That's why providers and insurance companies want them. A new plan, with new enrollees, needs to build on the strongest platform we have. That's improved Medicare rates, with a cap of 5% extra. (Even a public plan with negotiated rates saves $25 billion more than relying solely on private insurers.)
Again: A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
So here we are with the beginning for this week:
We need a public plan.
That pays Medicare rates plus 5%.
And includes Medicare providers.
Pass it on to 218 of your friends in the House, and 51 Senators.
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.
Friday, September 11, 2009
The Speech
We have our work cut out for us.
The President snapped the country back from the delusional debates of August to the more rational debate about health reform. If he has created policy space, it is an opportunity we will need to exercise until the final vote.
In rebalancing the politics of reform, he called out both elected officials and pundits who have invoked scare tactics. He also reminded us explicitly that the deficits we face today are directly attributable to Republican policies of waging an unfinanced war, and tax cuts for the super-wealthy.
We’ll know if it was effective in part if advocates for reform continue to build momentum, at town hall meetings. Will the chorus on the right become more civil? The official Republican response by Rep. Boustany was indeed a respectful disagreement. Rep. Joe Wilson of South Carolina set a different and shocking standard, accusing the President of the United States of lying about an indisputable fact.
The President made the clearest possible case for the importance of insurance reform, describing the human and financial cost of our uniquely inhumane system. The baseline proposals remain, and they would be important: eliminating pre-existing conditions and recisssions.
He offered a new benefit: A guaranteed catastrophic plan to be made available beginning in 2010.
But he proposed a public option as one of a few possible alternatives to private, for-profit insurance plans, signaling openness to a cooperative or generic nonprofit plan, and calming concerns that such a plan could lead to a single payer system. Even at best, a “robust” public option would be hard pressed to muscle out private insurance. But it must have the basics to succeed on its own terms: open to everyone as a voluntary choice right away, using the government’s power to protect the public from predatory insurance companies. As policy, that means it should start out of the gate as a nationally administered program, with the clout to intervene with drug companies and other providers. It must build on Medicare’s rates to pay providers, and use Medicare’s network of doctors and hospitals. It is time to start saying: If the private insurance industry cannot survive on terms that benefit the people who need health care, it is not the government’s role to bail them out.
It was disturbing to hear the President refer more than once to his proposals as balancing the concerns of left and right. Single payer supporters and advocates for a public plan are his base and his field team. The teabaggers and opponents of any reform are not pulling the same way. Despite his nod to Sen. McCain’s proposal for catastrophic coverage, and Republicans’ interests in medical malpractice reform, none appeared interest in voting with the President afterwards.
His discussion about our skepticism of government was important. It is understandable that many are frustrated with a government that has been unresponsive and derelict for so long. But it is a system we can influence. Mobilizing for what we want is the road to generating energetic support, and demands that our elected officials act responsibly and effectively. Resorting to demonization breeds disaffection.
The challenge is before us: to hit the air waves, the Town Hall meetings, the mail to the President and Congress to demand the change we voted for.
The President snapped the country back from the delusional debates of August to the more rational debate about health reform. If he has created policy space, it is an opportunity we will need to exercise until the final vote.
In rebalancing the politics of reform, he called out both elected officials and pundits who have invoked scare tactics. He also reminded us explicitly that the deficits we face today are directly attributable to Republican policies of waging an unfinanced war, and tax cuts for the super-wealthy.
We’ll know if it was effective in part if advocates for reform continue to build momentum, at town hall meetings. Will the chorus on the right become more civil? The official Republican response by Rep. Boustany was indeed a respectful disagreement. Rep. Joe Wilson of South Carolina set a different and shocking standard, accusing the President of the United States of lying about an indisputable fact.
The President made the clearest possible case for the importance of insurance reform, describing the human and financial cost of our uniquely inhumane system. The baseline proposals remain, and they would be important: eliminating pre-existing conditions and recisssions.
He offered a new benefit: A guaranteed catastrophic plan to be made available beginning in 2010.
But he proposed a public option as one of a few possible alternatives to private, for-profit insurance plans, signaling openness to a cooperative or generic nonprofit plan, and calming concerns that such a plan could lead to a single payer system. Even at best, a “robust” public option would be hard pressed to muscle out private insurance. But it must have the basics to succeed on its own terms: open to everyone as a voluntary choice right away, using the government’s power to protect the public from predatory insurance companies. As policy, that means it should start out of the gate as a nationally administered program, with the clout to intervene with drug companies and other providers. It must build on Medicare’s rates to pay providers, and use Medicare’s network of doctors and hospitals. It is time to start saying: If the private insurance industry cannot survive on terms that benefit the people who need health care, it is not the government’s role to bail them out.
It was disturbing to hear the President refer more than once to his proposals as balancing the concerns of left and right. Single payer supporters and advocates for a public plan are his base and his field team. The teabaggers and opponents of any reform are not pulling the same way. Despite his nod to Sen. McCain’s proposal for catastrophic coverage, and Republicans’ interests in medical malpractice reform, none appeared interest in voting with the President afterwards.
His discussion about our skepticism of government was important. It is understandable that many are frustrated with a government that has been unresponsive and derelict for so long. But it is a system we can influence. Mobilizing for what we want is the road to generating energetic support, and demands that our elected officials act responsibly and effectively. Resorting to demonization breeds disaffection.
The challenge is before us: to hit the air waves, the Town Hall meetings, the mail to the President and Congress to demand the change we voted for.
Sunday, September 6, 2009
Obama's Health Care Speech: Ominous Warnings in NY Times
What will Obama say on Wednesday about health reform? Today's New York Times could be an ominous early warning. Expanding public sector clout is at the heart of any meaningful proposal to control health care costs, and to expand coverage. Over the past year, the Times has published a lot on the potential for a strong public option to get us there, and also given unusually wide visibility to a sure-fire solution, single payer. Today's edition is a reverse road map to defeat.
The editorial calls on the President to "stand tough for a large and comprehensive plan," and "point out the cynicism of Republican opponents who are late-blooming advocates of deficit reduction," having passed passed "tax cuts for wealthy Americans that will cost more than $1.7 trillion over 10 years."
What is his wiggle room? Go for insurance reforms, and hold strong for a public plan, but, "if he decides to bargain it away later, he should insist, minimally, that a strong public plan be introduced if private insurers fail to hold costs down in the future." To echo Barney Frank, on what planet have the editors been spending most of their time? Apparently it will now be up to the public that voted for change to demand it.
It gets worse. The editorial goes on to bemoan that neither party has a "sure-fire solution to rein in medical inflation" while improving quality of care. Well, sure we do, and the Times has coeverd it. The news pages report on deliberations with former Clinton-era advisors, recounting the errors of failing to pass health reform, once having opened the door, and pointing out candidate Obama's relatively moderate positions on universal coverage.
It's time to take stock. It's been a bad summer. Opponents of reform, and of the Administration, have had one clear goal: Stop it. They've had the expansive coffers of the insurance industry to draw upon. Advocates have been taken aback at the teabaggers' vitriol, unhinged demeanor, and outright threats.
The union movement and other organizations that have led reform movements in the past have been weakened by decades of economic globalization and at least 8 years of vicious political attacks. In the face of shockingly hard times for many, we in the public appear to be struggling but stunned. And yes, there's been some internecine squabbling among reform factions.
But we have resources, and we should have leadership. The President and his team showed us they know how to run a great ad campaign. They likely calculated that they couldn't eliminate the insurance industry in one fell swoop; and they lost a great legislative strategist in Ted Kennedy. But isn't there a Plan B? The Congressional Progressive Caucus has done a great job of describing what a strong public option should be: open to all from day one, building on Medicare's reimbursement rates and provider base. They have had constraints in articulating and conveying these views to the public. There must be a way to support the President while using their considerable clout to mobilize support for the reform they know we need.
Health care can be a wonky issue. It can also shake us up and build alliances. If we need to pass something let’s make it a step forward, for policy and politics.
Between now and Wednesday, we need to tell the White House we expect to hear a call to arms. We knew all along that voting for President would not be the last thing we had to do to achieve social change. Hopefully, it was at least the first.
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.
Saturday, August 15, 2009
Pickpockets and the Public Plan
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
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
Sunday, August 9, 2009
thugs and health policy
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.
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.
Thursday, July 2, 2009
Senate HELP Bill Doesn't Help Enough
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.
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.
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