Sen. Feinstein: Time to Lead on Health Reform!

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

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

Defending entitlements

Ronald Brownstein's National Journal article of Feb. 7 presents a misguided and confounding attack on "entitlements." He states in the course of 2 sentences (in "The Solvency Solution"):

"The president's universal health care plan will cost at least $100 billion a year. Washington can't shoulder such costs, much less simultaneously increase investment, without eventually generating significant savings from existing entitlements..."

Medicare IS the major entitlement that threatens runaway costs, and if the President's "universal health care plan" actually succeeds, "Washington" could in fact "shoulder such costs," because it would be "eventually generating significant savings from existing entitlements."

We shouldn't choose. We can't choose. Health reform is the answer to the entitlement problem, and one of the answers to the current economic crisis.

But confusing statements by Brownstein, and more importantly by policy-makers, raise echoes of the roundly defeated attacks by the Bush Administration. They lumped entirely resolvable minor problems with Social Security funding (the other main entitlement) with the knottier - but also resolvable - problem of controlling health care expenditures. They also lumped endless tax cuts with alarms about entitlements to suggest that the solutions lie in undermining the already shaky social safety net: people's lives at the service of The Economy, rather than the reverse. This agenda was a non-starter even during the last 4 years, and showed no greater signs of life in the recent election.

There is not a feedback mechanism on the National Journal website. But I've asked Mr. Brownstein - generally a fair-minded observer, who has worked both for Nader and with the Hoover Institution, and is also a columnist at the L.A. Times - to explain what he means.

More importantly, what do Senator Conrad (quoted by Brownstein) and President Obama have in mind? Budget Committee Chair Conrad seems to get it right, commenting on health reform in a recent interview:

And not only does it [health reform] have to be paid for, but it also has to bend the longterm
cost curves so that we do begin to deal with what has been described here. Time
is running out. We can wait; we can kick this can down the road. However, if we
do, this problem only grows, and the solutions will become more draconian, more
difficult, more painful. It is in all of our interests to act. I believe the
President understands that. I believe his top economic advisers are committed to
an approach to take these problems on. This is not going to be easy, and it is
not going to be fun, but it has to be done.

Conrad has joined former U.S. Comptroller General David Walker in calling for the creation of a bipartisan process to confront the looming budget crisis. Walker, who is now the President and CEO of the Peter G. Peterson Foundation, has unveiled a new Peterson Foundation $1 million-plus advertising campaign to raise public awareness of the nation’s deteriorating long-term fiscal condition. The effort is also supported by Senator George Voinovich (R-OH), Representative Jim Cooper (D-TN), and Representative Frank Wolf (R-VA). The campaign rhetoric and agenda bear watching.


- Ellen Shaffer