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.
Showing posts with label single payer. Show all posts
Showing posts with label single payer. Show all posts
Friday, May 6, 2011
Sunday, November 14, 2010
Acceptance of Dr. Paul Cornely Award for Social Activism from the Physicians' Forum at the American Public Health Association, Nov. 7, 2010
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!
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!
Friday, October 15, 2010
Health Reform: Declaring and Winning Victories on the Way Forward
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.
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.
Friday, March 12, 2010
Three Things Worth Fighting For: A Public Option. Women’s Rights. Single Payer.
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.
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.
Saturday, February 20, 2010
Plots
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."
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."
Tuesday, February 2, 2010
What's At Stake
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.
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.
Saturday, January 16, 2010
3 Poles in the Health Reform Debate
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.
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.
Thursday, November 19, 2009
Real Health Reform: Positions for Progressives
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)
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)
Sunday, November 1, 2009
Is 2% Worth It?
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.
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.
Monday, September 14, 2009
A Town Hall Meeting That Worked: Sta. Clara, CA
I was heartened by Rep. Mike Honda's civil, orderly town hall meeting at Santa Clara University at 1 pm in Sunday. There were about 400 advocates for health reform, including a strong public option, and about a dozen or so opponents. At about 12:45, they showed a videotape of 3 local residents with health care stories, interspersed with facts about the number and percent of people in the country and the district who are suffering from lack of coverage, health-related bankruptcies, etc. I saw 2 of the people from the video in the crowd. They included: A retired county worker with an uninsured son; a woman whose grown son could not get coverage, having developed juvenile diabetes early in life; a man who identified himself as a Republican, and whose wife had a serious chronic condition that would never be covered if he lost his job and insurance.
Rep. Honda opened the meeting with a welcome, and a request for mutual respect. He called on constituents to submit written questions on index cards, including name and address; questions from constituents were chosen at random; he then invited the constituents to stand and pose their questions. Reflecting the crowd, most of the questioners spoke in favor of a strong public option, or a single payer. A few were opposed. We cheered every time he responded that he supported a strong public option, and had no plans to compromise on that; the dozen booed. We cheered for a brave young Latina who works in reproductive rights, and said that coverage for abortion was important to her; the dozen booed. (The cheers and boo's took a few seconds, then stopped; we all respected Rep. Honda's request for respect.) A few times Mike pointed out that the present system of private insurance had had quite a bit of time to work, if it was going to, and that too many people were hurting financially and physically (he gave details); it was time for a change. We all cheered. No one booed. The final 2 questioners asked how we could afford the President's health proposal, since similar socialistic systems like Great Britain are facing financial shortfalls. Mike said there is a way to do it, and we would. He promised to respond in writing to the remaining questions. That was it.
Outside an older man approached a younger fellow giving out water and wearing a pro-reform button. Tell me one government program that works! he demanded. Medicare, was the response. End of conversation.
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.
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.
Monday, August 31, 2009
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.
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.
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.
Wednesday, July 15, 2009
The Good, the Bad and the Murky: Health Reform on July 14
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.
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.
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