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.
Saturday, January 16, 2010
Friday, January 8, 2010
Progressive Caucus: Fight for Us!
CONGRESSIONAL BRIEFING
The Benefits of the Public Option and Other Progressive Health Care Reforms
Thursday, January 7, 2010 , 2pm-4pm,
Remarks by Ellen R. Shaffer
(I was invited by Rep. Dennis Kucinich’s office to present the case for an ERISA waiver as part of the health reform bill. Following are my comments.)
Thanks to Reps. Sheila Jackson Lee; Raul Grijalva; Donna Christensen; and Hank Johnson for organizing today’s briefing.
I am a policy analyst. I worked in the past in the Senate. In 2009 I helped craft the ERISA amendment that passed in the House Education and Labor Committee, building on the great work of others in the House and Senate, and with the support of the California Nurses Association.
As Co-Director of the Center for Policy Analysis, I coordinate the EQUAL Health campaign for Equitable, Quality, Universal, Affordable health care. We sponsor a listserve, analyze proposals, and conduct district legislative visits. Our list reaches progressive health reform advocates, women’s organizations, public health groups, as well as Congressional staff and the media.
Topics today:
Why it is important to fight for and win an ERISA waiver.
More broadly, why it is important to fight and win for progressives.
ERISA
The Employee Retirement Income Security Act (ERISA) is a:federal law that pre-empts the rights of states to enact legislation if it is “related to” employee benefits plans, as well as for other reasons.
It was passed in 1974 at a moment like this one, when Congress expected to pass national health reform, and sought to limit state variations. It has been used in the years since then by employers to initiate court challenges to a wide range of reforms that would require them to contribute to the cost of health benefits.
It is unusual among laws involving health care in that there is no administrative remedy built in to ERISA. Only Congress can take action to definitively change ERISA. Because it has not done so, Hawaii sought and won an ERISA waiver for its state law in 1983, in order to be able to continue its employer mandate system. There has been no subsequent amendment on this subject.
Why progressives must fight for an ERISA waiver
We know how progressives are feeling this week.
We have been encouraged by the statements of Quad Caucus leaders, that we wanted single payer, and the public option is our line in the sand.
At the same time we watched the Senate turn down an abortion amendment, and then be forced to include it.
After winning a victory in committee on an ERISA waiver for single payer states, we saw it fall from HR 3692.
We’ve watched Joe Lieberman move from supporting expanding Medicare, on the air, as recently as September, to hijacking the public option.
We know that your offices did your best to respond to requests for a floor vote on a single payer bill.
We hear that maybe we can get a public option next year, by a majority vote. And maybe we can.
But we also know that the health reform debate is developing as a contest for power.
Progressives cannot emerge from this debate demoralized.
Victory breeds victory. Leadership summons participation.
Progressive leaders have a real opportunity to stand fast for significant policies that we know will make a real difference in people’s lives.
There are a number of important issues on the table, that will vastly improve the health reform bills. These include:
• the public option,
• a strong employer mandate, and affordability protections including adequate subsidies,
• a nationally based health exchange,
• fair financing
• and a strong stand on reproductive rights and immigrants’ rights.
I hope you’ll get a chance to look at our op ed on some of these important issues.
But we know that at best all of these provisions are a step towards a system that is truly universal, controls costs, and improves quality. The fight for single payer systems will move immediately to the states, where there are already strong and successful movements in California, Pennsylvania, Maryland, Illinois, New Mexico, Ariona, and elsewhere.
These campaigns face the same obstacles as the national effort: massive industry spending and opposition, corporate media, the need for organizational bases.
They face one additional obstacle: ERISA.
Single payer advocates around the country are energized around amending this arcane piece of legislation, for two reasons.
First it will make a real, immediate, significant difference in their ability to enact and implement single payer bills. Without an ERISA waiver, single payer states face at a minimum automatic court challenges that could drag on for years.
Equally importantly, it will demonstrate that progressives can and will fight hard, and win, for changes that are fundamental.
This battle has implications far beyond health reform – in itself important enough.
We know we are entering the new decade with a sputtering economy, and a controversial war. We will need a mobilized, energized leadership, and a mobilized, energized base, to take these issues on and win them.
We know the opposition. They are relentless in the minority. They have demonstrated what they will do when in the majority. They cannot be defeated by lukewarm campaigns.
Progressives must have a health reform bill and it must be one we will celebrate at the end of the day. Your offices can demonstrate the leadership and the determination to fight for and win a provision that will be celebrated daily by advocates around the country as our fight for universal coverage continues. Please fight for the ERISA waiver.
[Post-script: An ERISA amendment would be an important victory. The EQUAL campaign continues to advocate for the full range of policies identified in this presentation.]
The Benefits of the Public Option and Other Progressive Health Care Reforms
Thursday, January 7, 2010 , 2pm-4pm,
Remarks by Ellen R. Shaffer
(I was invited by Rep. Dennis Kucinich’s office to present the case for an ERISA waiver as part of the health reform bill. Following are my comments.)
Thanks to Reps. Sheila Jackson Lee; Raul Grijalva; Donna Christensen; and Hank Johnson for organizing today’s briefing.
I am a policy analyst. I worked in the past in the Senate. In 2009 I helped craft the ERISA amendment that passed in the House Education and Labor Committee, building on the great work of others in the House and Senate, and with the support of the California Nurses Association.
As Co-Director of the Center for Policy Analysis, I coordinate the EQUAL Health campaign for Equitable, Quality, Universal, Affordable health care. We sponsor a listserve, analyze proposals, and conduct district legislative visits. Our list reaches progressive health reform advocates, women’s organizations, public health groups, as well as Congressional staff and the media.
Topics today:
Why it is important to fight for and win an ERISA waiver.
More broadly, why it is important to fight and win for progressives.
ERISA
The Employee Retirement Income Security Act (ERISA) is a:federal law that pre-empts the rights of states to enact legislation if it is “related to” employee benefits plans, as well as for other reasons.
It was passed in 1974 at a moment like this one, when Congress expected to pass national health reform, and sought to limit state variations. It has been used in the years since then by employers to initiate court challenges to a wide range of reforms that would require them to contribute to the cost of health benefits.
It is unusual among laws involving health care in that there is no administrative remedy built in to ERISA. Only Congress can take action to definitively change ERISA. Because it has not done so, Hawaii sought and won an ERISA waiver for its state law in 1983, in order to be able to continue its employer mandate system. There has been no subsequent amendment on this subject.
Why progressives must fight for an ERISA waiver
We know how progressives are feeling this week.
We have been encouraged by the statements of Quad Caucus leaders, that we wanted single payer, and the public option is our line in the sand.
At the same time we watched the Senate turn down an abortion amendment, and then be forced to include it.
After winning a victory in committee on an ERISA waiver for single payer states, we saw it fall from HR 3692.
We’ve watched Joe Lieberman move from supporting expanding Medicare, on the air, as recently as September, to hijacking the public option.
We know that your offices did your best to respond to requests for a floor vote on a single payer bill.
We hear that maybe we can get a public option next year, by a majority vote. And maybe we can.
But we also know that the health reform debate is developing as a contest for power.
Progressives cannot emerge from this debate demoralized.
Victory breeds victory. Leadership summons participation.
Progressive leaders have a real opportunity to stand fast for significant policies that we know will make a real difference in people’s lives.
There are a number of important issues on the table, that will vastly improve the health reform bills. These include:
• the public option,
• a strong employer mandate, and affordability protections including adequate subsidies,
• a nationally based health exchange,
• fair financing
• and a strong stand on reproductive rights and immigrants’ rights.
I hope you’ll get a chance to look at our op ed on some of these important issues.
But we know that at best all of these provisions are a step towards a system that is truly universal, controls costs, and improves quality. The fight for single payer systems will move immediately to the states, where there are already strong and successful movements in California, Pennsylvania, Maryland, Illinois, New Mexico, Ariona, and elsewhere.
These campaigns face the same obstacles as the national effort: massive industry spending and opposition, corporate media, the need for organizational bases.
They face one additional obstacle: ERISA.
Single payer advocates around the country are energized around amending this arcane piece of legislation, for two reasons.
First it will make a real, immediate, significant difference in their ability to enact and implement single payer bills. Without an ERISA waiver, single payer states face at a minimum automatic court challenges that could drag on for years.
Equally importantly, it will demonstrate that progressives can and will fight hard, and win, for changes that are fundamental.
This battle has implications far beyond health reform – in itself important enough.
We know we are entering the new decade with a sputtering economy, and a controversial war. We will need a mobilized, energized leadership, and a mobilized, energized base, to take these issues on and win them.
We know the opposition. They are relentless in the minority. They have demonstrated what they will do when in the majority. They cannot be defeated by lukewarm campaigns.
Progressives must have a health reform bill and it must be one we will celebrate at the end of the day. Your offices can demonstrate the leadership and the determination to fight for and win a provision that will be celebrated daily by advocates around the country as our fight for universal coverage continues. Please fight for the ERISA waiver.
[Post-script: An ERISA amendment would be an important victory. The EQUAL campaign continues to advocate for the full range of policies identified in this presentation.]
Tuesday, January 5, 2010
The Public is Right About the Public Option
This article appeared on page A - 8 of the San Francisco Chronicle, January 6, 2010.
The insurance industry hates it because it would ding its profits. Democratic leaders fear it could kill passage of health care reform. But reports of the death of the public option have been greatly exaggerated.
Poll after poll shows that Americans want to be able to choose a public insurance plan, and for good reason. It would be tragic to lose this pillar of health care reform to cynical inside-the-Beltway political horse trading. Here's why we need the public option:
It can really deliver on the benefits. The proposed bills would outlaw common and perverse industry loopholes such as pre-existing condition exclusions, which exclude sick people from buying insurance as individuals, and rescissions, which let companies deny treatment retroactively for people they already insure. While outlawing these rules will help, private insurance plans have demonstrated that they are willing to challenge patients' rights to the grave and beyond in the interest of clinging to the premium dollar.
We've witnessed a heartbreaking parade of insured patients trooping to corporate headquarters to plead for lifesaving treatments that were denied, even though the benefits are covered in writing. In contrast, no one at the government-run Medicare program gets a bonus for turning away sick people. We need to be able to choose a plan in which the financial incentives to provide needed care line up with the proposed new laws, and that can only happen in the public sector.
It will drive down costs. Health care reform will cover millions more Americans - a great achievement. But we need to use the increased buying power of this newly covered population to control costs, a job at which private insurance companies consistently fail. Some companies can't reduce premiums because they're too small to hold leverage in negotiations with private hospital chains and big drug companies. Or if they do save a buck, they put it back in their own pockets in the form of profits and executive bonuses.
In Massachusetts, large nonprofit insurers recently testified that they had negotiated sweetheart deals that benefited certain employers and hospitals - and confidentiality agreements that kept the details secret. When the Veterans Administration negotiates lower drug prices, the savings buy more drugs for veterans, and the transactions are all transparent. We'd like to be sure that the change we voted for turns into change we save on reduced premiums, which is possible only in a public plan.
It will allow us to re-engineer how we deliver and pay for care. How? By coordinating with Medicare initiatives that will bolster quality while lowering costs, like financial incentives that promote primary care and better coordination of medications. The public plan will be most effective if it starts right away and is available to everyone - policies we can continue to fight for. But the projection that the public option would offer savings too small for too few, or would be too expensive, is off the mark.
It's democratic. Most Americans know this in our bones. The majority of the House voted for it, including many in our powerhouse delegation from California. The majority of senators expressed support for it - including committee chairs Max Baucus and Tom Harkin. We're tired of arcane rules that let minorities of one hijack the public's interest.
There will be efforts to leverage the public option for other benefits. One benefit of that debate would be if the antitrust exemption for health insurance companies were revoked so they can be regulated by the Federal Trade Commission. But we need a real institutional alternative to the present system. Americans want - and need - a public option. Don't let your representatives trade it away.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/05/EDNG1BDU6L.DTL#ixzz0boXMcwU1
The insurance industry hates it because it would ding its profits. Democratic leaders fear it could kill passage of health care reform. But reports of the death of the public option have been greatly exaggerated.
Poll after poll shows that Americans want to be able to choose a public insurance plan, and for good reason. It would be tragic to lose this pillar of health care reform to cynical inside-the-Beltway political horse trading. Here's why we need the public option:
It can really deliver on the benefits. The proposed bills would outlaw common and perverse industry loopholes such as pre-existing condition exclusions, which exclude sick people from buying insurance as individuals, and rescissions, which let companies deny treatment retroactively for people they already insure. While outlawing these rules will help, private insurance plans have demonstrated that they are willing to challenge patients' rights to the grave and beyond in the interest of clinging to the premium dollar.
We've witnessed a heartbreaking parade of insured patients trooping to corporate headquarters to plead for lifesaving treatments that were denied, even though the benefits are covered in writing. In contrast, no one at the government-run Medicare program gets a bonus for turning away sick people. We need to be able to choose a plan in which the financial incentives to provide needed care line up with the proposed new laws, and that can only happen in the public sector.
It will drive down costs. Health care reform will cover millions more Americans - a great achievement. But we need to use the increased buying power of this newly covered population to control costs, a job at which private insurance companies consistently fail. Some companies can't reduce premiums because they're too small to hold leverage in negotiations with private hospital chains and big drug companies. Or if they do save a buck, they put it back in their own pockets in the form of profits and executive bonuses.
In Massachusetts, large nonprofit insurers recently testified that they had negotiated sweetheart deals that benefited certain employers and hospitals - and confidentiality agreements that kept the details secret. When the Veterans Administration negotiates lower drug prices, the savings buy more drugs for veterans, and the transactions are all transparent. We'd like to be sure that the change we voted for turns into change we save on reduced premiums, which is possible only in a public plan.
It will allow us to re-engineer how we deliver and pay for care. How? By coordinating with Medicare initiatives that will bolster quality while lowering costs, like financial incentives that promote primary care and better coordination of medications. The public plan will be most effective if it starts right away and is available to everyone - policies we can continue to fight for. But the projection that the public option would offer savings too small for too few, or would be too expensive, is off the mark.
It's democratic. Most Americans know this in our bones. The majority of the House voted for it, including many in our powerhouse delegation from California. The majority of senators expressed support for it - including committee chairs Max Baucus and Tom Harkin. We're tired of arcane rules that let minorities of one hijack the public's interest.
There will be efforts to leverage the public option for other benefits. One benefit of that debate would be if the antitrust exemption for health insurance companies were revoked so they can be regulated by the Federal Trade Commission. But we need a real institutional alternative to the present system. Americans want - and need - a public option. Don't let your representatives trade it away.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/05/EDNG1BDU6L.DTL#ixzz0boXMcwU1
Sunday, December 20, 2009
Why Fight Now? A Single Payer View on the Public Option
Time to say a few things:
Health reform is important. The bills before Congress can make a difference for millions.
The President needs to win this one, soon. If the insurance industry can demoralize progressives over the holidays, the win comes on their terms. If progressives keep up the fight we could win.
The public option is not optional. It is our toe-hold on structural change.
Women and immigrants are more numerous and better organized than the turkeys who think we are wedge issues.
On the other hand, there is no organization that will swoop in and win this for us. Social justice, labor, women’s rights and other groups have been battered by 30 years of neoliberal economics and politics. Progressive political leaders in the Senate – Sanders, Brown and Burris - took their bows for talking up a single payer amendment that failed even more spectacularly than expected, and they ducked last minute appeals to them to cross Harry Reid and the White House by threatening a No vote.
Mike Huckabee is heading to Omaha to rally and revive the teabaggers. It won’t matter right now. Huckabee, like a lot of others, is building his lists and organization for other fights.
For those of us who think the next step toward health reform, however limited, should be at least a step forward and not a wholesale retreat on reproductive and immigrants’ rights, we will have to be enormously creative and persistent this week. Stay tuned..
Health reform is important. The bills before Congress can make a difference for millions.
The President needs to win this one, soon. If the insurance industry can demoralize progressives over the holidays, the win comes on their terms. If progressives keep up the fight we could win.
The public option is not optional. It is our toe-hold on structural change.
Women and immigrants are more numerous and better organized than the turkeys who think we are wedge issues.
On the other hand, there is no organization that will swoop in and win this for us. Social justice, labor, women’s rights and other groups have been battered by 30 years of neoliberal economics and politics. Progressive political leaders in the Senate – Sanders, Brown and Burris - took their bows for talking up a single payer amendment that failed even more spectacularly than expected, and they ducked last minute appeals to them to cross Harry Reid and the White House by threatening a No vote.
Mike Huckabee is heading to Omaha to rally and revive the teabaggers. It won’t matter right now. Huckabee, like a lot of others, is building his lists and organization for other fights.
For those of us who think the next step toward health reform, however limited, should be at least a step forward and not a wholesale retreat on reproductive and immigrants’ rights, we will have to be enormously creative and persistent this week. Stay tuned..
Tuesday, December 15, 2009
Fight for Real Health Reform!
The President and the Senate are likely to meet on Tuesday regarding health reform. Following is a message to Congress and the President - please add your own, and call or write TODAY!
Also: links to statements below from the Congressional Progressive Caucus and Rekindling Reform
To Congress and the White House:
We need and support real health reform. Stick with us and demand a bill that preserves and expands the strongest points of House and Senate proposals, starting on day one:
1. A public option is critical to advance access, quality, affordability and cost control. A buy-in to the public Medicare program for ages 55-65 must also be affordable.
2. All plans must be affordable, limit out-of-pocket expenses, require fair financing by employers and high-income individuals, end insurance company abuses, and require insurance companies to spend at least 90% of revenues on health care.
The federal government should promote innovations in delivery and financing of health care, including more primary care providers and public health funding.
3. Defeat diversions on wedge issues:
Advance reproductive rights.
Assure that all people who live in the U.S., including immigrants, have access affordable, quality, culturally appropriate care.
4. Promote states’ ability to move to single payer systems.
This historic bill will be an important step forward. States must be empowered to advance to a single payer system.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Congress: thomas.loc.gov
_____________________________________________
Statement by Congressional Progressive Caucus: http://cpc.grijalva.house.gov/index.cfm?ContentID=564&ParentID=0&SectionID=107&SectionTree=107&lnk=b&ItemID=562
Statement by Rekindling Reform: http://www.rekindlingreform.org/index.php
______________________
We have won important victories for better access to affordable health care.
Enemies of reform are now out in force.
Progressives must stay informed and engaged to achieve a truly historic victory.
Also: links to statements below from the Congressional Progressive Caucus and Rekindling Reform
To Congress and the White House:
We need and support real health reform. Stick with us and demand a bill that preserves and expands the strongest points of House and Senate proposals, starting on day one:
1. A public option is critical to advance access, quality, affordability and cost control. A buy-in to the public Medicare program for ages 55-65 must also be affordable.
2. All plans must be affordable, limit out-of-pocket expenses, require fair financing by employers and high-income individuals, end insurance company abuses, and require insurance companies to spend at least 90% of revenues on health care.
The federal government should promote innovations in delivery and financing of health care, including more primary care providers and public health funding.
3. Defeat diversions on wedge issues:
Advance reproductive rights.
Assure that all people who live in the U.S., including immigrants, have access affordable, quality, culturally appropriate care.
4. Promote states’ ability to move to single payer systems.
This historic bill will be an important step forward. States must be empowered to advance to a single payer system.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Congress: thomas.loc.gov
_____________________________________________
Statement by Congressional Progressive Caucus: http://cpc.grijalva.house.gov/index.cfm?ContentID=564&ParentID=0&SectionID=107&SectionTree=107&lnk=b&ItemID=562
Statement by Rekindling Reform: http://www.rekindlingreform.org/index.php
______________________
We have won important victories for better access to affordable health care.
Enemies of reform are now out in force.
Progressives must stay informed and engaged to achieve a truly historic victory.
Saturday, December 12, 2009
The Senate Compromise: Does it Help?
The Senate compromise seems to be this:
For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.
The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.
Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.
No public option.
Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)
The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.
But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.
And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).
Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.
Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.
For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.
The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.
Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.
No public option.
Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)
The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.
But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.
And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).
Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.
Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.
Wednesday, December 9, 2009
The Senate: Getting to the Public Option
It is important that health reform continue to move forward through the Senate. The most recent announcement offers some elements that sound attractive. As a whole, though, the package seems to leave a lot of gaping holes, that the Senators will need to address, or that will be resolved in conference.
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
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