Beth's Health Care Reform Blog

[roxybeast]

San Francisco might provide a model for an effective public option ...

A Public Option That Works
By WILLIAM H. DOW, ARINDRAJIT DUBE and CARRIE HOVERMAN COLLA
Published: NY Times, August 21, 2009

TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?

Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year. San Francisco and Massachusetts now offer the only near-universal health care programs in the United States.

The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program. Covered services include the use of a so-called “medical home” that coordinates care at approved clinics and hospitals within San Francisco, with both public and private facilities. Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.

To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.

There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.

Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.

As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants.

So how have employers adjusted to the higher costs, if not by cutting jobs? More than 25 percent of restaurants, for example, have instituted a “surcharge” — about 4 percent of the bill for most establishments — to pay for the additional costs. Local service businesses can add this surcharge (or raise prices) without risking their competitive position, since their competitors will be required to take similar measures. Furthermore, some of the costs may be passed on to employees in the form of smaller pay raises, which could help ward off the possibility of job losses. Over the longer term, if more widespread coverage allows people to choose jobs based on their skills and not out of fear of losing health insurance from one specific employer, increased productivity will help pay for some of the costs of the mandate.

The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.

William H. Dow, who was a senior economist for President George W. Bush’s Council of Economic Advisers, is a professor of health economics at the University of California, Berkeley, where Arindrajit Dube is an economist at the Institute for Research on Labor and Employment and Carrie Hoverman Colla is a doctoral student in health economics.

Source: http://www.nytimes.com/2009/08/22/opinion/22dow.html

More Op-Ed from the NY Times ...

The Obamas Leave Town: http://www.nytimes.com/2009/08/22/opini ... llins.html

Voices of Anxiety: http://www.nytimes.com/2009/08/22/opini ... rbert.html

Masters of Slaves of Deception: http://www.nytimes.com/2009/08/22/opinion/22blow.html

[roxybeast]

Here's a breaking NY Times editorial ... "Any nation as rich as ours ought to guarantee health coverage for all of its residents."

EDITORIAL
The Uninsured

One of the major goals of health care reform is to cover the vast numbers of uninsured. But how vast, really, is that pool of people? Who are they? And how important is it to cover all or most of them?

Critics play down the seriousness of the problem by pointing out that the ranks of the uninsured include many people who have chosen to forgo coverage or are only temporarily uninsured: workers who could afford to pay but decline their employers’ coverage; the self-employed who choose not to pay for more expensive individual coverage; healthy young people who prefer not to buy insurance they may never need; people who are changing jobs; poor people who are eligible for Medicaid but have failed to enroll. And then there are the illegal immigrants, a favorite target of critics.

All that is true, to some degree. But the implication — that lack of insurance is no big deal and surely not worth spending a trillion dollars to fix — is not.

No matter how you slice the numbers, there are tens of millions of people without insurance, often for extended periods, and there is good evidence that lack of insurance is harmful to their health.

Scores of well-designed studies have shown that uninsured people are more likely than insured people to die prematurely, to have their cancers diagnosed too late, or to die from heart failure, a heart attack, a stroke or a severe injury. The Institute of Medicine estimated in 2004 that perhaps 18,000 deaths a year among adults could be attributed to lack of insurance.

The oft-voiced suggestion that the uninsured can always go to an emergency room also badly misunderstands what is happening. By the time they do go, many of these people are much sicker than they would have been had insurance given them access to routine and preventive care. Emergency rooms are costly, and if uninsured patients cannot pay for their care, the hospital or the government ends up footing the bill.

•

So how many uninsured people are out there, facing those risks? The most frequently cited estimate, 45.7 million in 2007, comes from an annual census survey. That number was down slightly from the year before, but given the financial crisis, it is almost certainly rising again.

Some or even many of those people may have only temporarily lost or given up coverage, but even that exposes them to medical and financial risk. And many millions go without insurance for extended periods.

The Agency for Healthcare Research and Quality in the Department of Health and Human Services estimates that 28 million people were uninsured for all of 2005 and 2006 and that 18.5 million of them were uninsured for at least four straight years. That does not sound like a “temporary” problem, and the picture today is almost certainly bleaker.

Various analyses have tried to decipher just who the uninsured are. These are the main conclusions, with the caveat that there is overlap in these numbers:

THE WORKING POOR The Kaiser Family Foundation estimates that about two-thirds of the uninsured — 30 million people — earn less than twice the poverty level, or about $44,000 for a family of four. It also estimates that more than 80 percent of the uninsured come from families with full-time or part-time workers. They often cannot get coverage at work or find it too expensive to buy. They surely deserve a helping hand.

THE BETTER OFF About nine million uninsured people, according to census data, come from households with incomes of $75,000 or more. Critics say that is plenty of money for them to buy their own insurance. But many of these people live in “households” that are groups of low-wage roommates or extended families living together. Their combined incomes may reach $75,000, but they cannot pool their resources to buy an insurance policy to cover the whole group.

Still, about 4.7 million uninsured people live in families that earn four times the poverty level — or $88,000 for a family of four — the dividing line that many experts use to define who can afford to buy their own insurance.

Those people who could afford coverage but choose not to buy it ought to be compelled to join the system to lessen the possibility that a serious accident or illness might turn them into charity cases and to help subsidize the coverage of poorer and sicker Americans.

YOUNG ADULTS Some 13 million young adults between the ages of 19 and 29 lack coverage. These are not, for the most part, healthy young professionals making a sensible decision to pay their own minimal medical bills rather than buy insurance that they are unlikely to need. The Kaiser foundation estimates that only 10 percent are college graduates, and only 5 percent have incomes above $60,000 a year, while half have family incomes below $16,000 a year. Many of these younger people would be helped by reform bills that would provide subsidized coverage for the poor and an exchange where individuals can buy cheaper insurance than is now available.

ALREADY ELIGIBLE Some 11 million of the poorest people, mostly low-income children and their parents, are thought to be eligible for public insurance programs but have failed to enroll, either because they do not know they are eligible or are intimidated by the application process. When such people arrive at an emergency room, they are usually enrolled in Medicaid, but meanwhile they have lost out on routine care that could have kept them out of the emergency room. They will presumably be scooped up by the mandate under reform bills that everyone obtain health insurance.

THE UNDERINSURED The Commonwealth Fund estimates that 25 million Americans who had health insurance in 2007 had woefully inadequate policies with high deductibles and restrictions that stuck them with large amounts of uncovered expenses. Many postponed needed treatments or went into debt to pay medical bills.

NON-CITIZENS Some 9.7 million of the uninsured are not citizens; of those, more than six million may be illegal immigrants, according to informed estimates. None of the pending bills would cover them.

If nothing is done to slow current trends, the number of people in this country without insurance or with inadequate coverage will continue to spiral upward. That would be a personal tragedy for many and a moral disgrace for the nation. It is also by no means cost-free. Any nation as rich as ours ought to guarantee health coverage for all of its residents.

Source: http://www.nytimes.com/2009/08/23/opinion/23sun1.html

Here's a Fox News new story now trying to extend Government death panel lie and a new "death book" lie to Veterans health care ... http://www.youtube.com/watch?v=C6WBiDfH6xQ

Which, as usual, is not true:
http://www.huffingtonpost.com/2009/08/2 ... 66275.html

New Rachel Maddow video on Fox News influence on Republicans misunderstanding of "facts" and belief of false myths about health care: http://www.youtube.com/watch?v=zpi5PaAIj8Q

And here are some stories posted on the OK Democratic Party website:

Health Care Reform: A Time for Real Action
By JOHN W. DEAN (former White House Counsel to Pres. Nixon)
Friday, August 21, 2009

President Barack Obama has called on his army of volunteers, those who were responsible for sending him to the White House, to go to work on health care reform. It is not a moment too soon.

Republicans have succeeded beyond their wildest dream in derailing President Obama's mandated election issue of 2008. I know this because I have talked with many of them. They are ecstatic, and they understand well that if they beat Obama on his signature issue, they have seriously damaged him politically and hurt his presidency. Today, Americans clearly disapprove – according to Gallup, by some six points – of Obama's handling of the issue that he used to win his near-landslide election victory.

Of course, the true losers will be the American people, if Republicans succeed in defeating health care reform using tactics more suited for war against a true enemy of the nation, than for opposition to a program that seeks to make Americans more secure and to better their lives.

The Republicans' Effective Use of Asymmetrical Tactics

Booing, shouting, and incivility have worked. Outrageous comparisons of Obama to Hitler; claims that "death panels" would be part of "Obamacare"; assertions that care will be rationed; descriptions of inchoate proposals as socialism; and total distortions of the facts have – together -- so confused many Americans (particularly the Fox News audience) so thoroughly, that they simply do not have a clue what actually is, or is not, being proposed. Republicans have made it ugly, if not impossible, for countless Democratic members of Congress visiting with their constituents at town hall meetings to try to rationally discuss health care reform.

This situation was sadly predictable. Just as John Kerry let the outrageous Swift-boaters totally distort his record, so too the Obama White House and the Democrats have given these more recent tactics all the running room they needed to get going. President Obama decided to allow the processes of democracy to work, and Republicans are masters at gaming the system.

Unlike the Republicans, who seek to silence the opposition, President Obama encouraged all voices and interests to be heard. Also unlike the Republicans, who embrace an imperial presidency that tells Congress what to do and supporters how to think, President Obama requested that Congress develop a new law, on its own, to fix the ailing American health care system.

Apparently concerned by the example of President Clinton, who in 1993 had mistakenly tried to tell Congress what to do regarding health care and had lost the battle entirely, President Obama may conversely lose for failing to give Congress the guidance it needed. He allowed the opponents of reform to frame the debate, and to set its tone.

Apparently, contemporary Republicans must shout at one another at home, for they plainly believe this incivility is appropriate public conduct. Because reform is contrary to the interests of corporations who are getting rich under the present system, they have enlisted those who are willing to lie, cheat, and deceive to block reform, and in the process, they have taken honesty out of the debate.

The current public rancor is scattered throughout the country and actually rather insignificant. Yet Republicans have counted on its being exaggerated by talk radio, cable news channels, and the Internet. Conflict attracts attention, and these enterprises all want attention, so they are employing their media megaphones accordingly.

Many who support reform are now calling for a massive "Heath Care Reform March on Washington" in September. It is a terrible idea, which if put into practice would be a waste of time, energy and money that would not help pass healthcare reform. Rather than marching on Washington, it is time for truly appropriate action, which President Obama has now called for, in a virtual meeting yesterday with his grassroots organizers via the Internet.

Marches on Washington Change Nothing

Marches on Washington do not result in new laws or fundamental changes in policy. Such high-profile demonstrations have a long, and tired, history throughout the last century. If you examine a few of the many celebrated demonstrations, it is clear that they accomplish little – other than symbolism.

In the spring of 1913, some 5,000 women joined the Suffrage March to Washington to seek voting rights equal to those of men. Not until after defeats in 1915 and 1918, and not until President Wilson called a special session of Congress to pass a Constitutional amendment in 1919, was such a law actually sent to the states for ratification, which was accomplished in 1920. The Washington march produced nothing.

In 1932, over 10,000 World War I veterans marched to Washington to demand that Congress change the law so that they might receive their agreed-upon war bonuses before the 1945 due date. They needed the money because of the hard times, with the nation in the midst of the Great Depression. Yet the Senate voted against them and encouraged President Hoover to send them away, using as much force as necessary.

In the fall of 1963, some 250,000 people joined the March on Washington for Jobs and Freedom, and heard Dr. Martin Luther King Jr. deliver his "I Have A Dream" speech. Yet landmark civil rights legislation would not be passed by Congress until July 1964. The massive gathering had nowhere near the impact that the Civil Rights Movement did, by working on voters and members of Congress in their districts.

Throughout the Vietnam War, there were over a dozen major marches on Washington, ranging in size from 100,000 to nearly a million people, to protest the continuation of the war. The marches on Washington did not change the policies of either the Johnson or Nixon Administrations.

In the summer of 1978, over 100,000 women marched on Washington for the Equal Rights Amendment. It has never been adopted.

In fact, there have been so many marches on Washington that even their symbolism has been diluted. Such gatherings once created networks for people who, after meeting in Washington, continued to work -- usually with more success -- in their respective states. But the Internet means that it is no longer necessary to travel to Washington to join a community of like-thinking people who are interested in taking action.

It Is Now or Never For the First Internet President

Conventional wisdom correctly credits Obama's 2008 election victory to his innovative use of the Internet. It was more than an awesome fundraising tool; it was also a grassroots organization with an unparalleled reach. When Obama moved into the White House, his 13-million-email Rolodex became Organizing for America (OFA).

On Thursday, August 20, 2009, President Obama called on his grassroots supporters to assist him in doing what they elected him to do, and accomplish real health care reform. As Florida Congresswoman Debbie Wasserman said, when introducing the President to his assembled supporters, "This is our moment."

Since June 6, 2009, when initial OFA assistance was requested by the Obama White House to organize grassroots support for health care, OFA reports that over 1.5 million of its members have volunteered to take action. They have organized 11,906 local events; collected 231,572 personal stories; and made 64,912 local Congressional office visits in a single week, and they have consistently outnumbered protesters at town hall meetings.

This data would be impressive if Obama was winning the fight for reform. In fact, it is anything but clear that he is going to prevail. As President Obama reminded his supporters at the outset of his pep talk and tutorial, he had once been down by 30 points in Iowa primary caucuses before his supporters went to work, and he had been down in the polls in the general election before they went to work. Reminding his supporters that he had long ago told them that getting elected was only the first task, he urged them that it was now time to employ their efforts to accomplish the goals for which they had elected him. "Let's go get 'em," he urged, before engaging in a question-and-answer tutorial on how to deal with the misinformation and phony arguments being spread by Republicans.

In fact, Obama has a majority of Americans supporting him. He has now given his active army of supporters the information tools they need to win the debate. Just as the election was a true test of the impact of the Internet on presidential election politics, President Obama's organized followers are now being tested to see if, in fact, they can change the ways of government. They will not do it by taking the old roads like marching to Washington, but we must all hope they can use the tools of the Internet and the power of their virtual community to spread the truth, for as the President explained, the truth wins the case for health care reform. It is, in fact, now or never for the first Internet President.

http://writ.news.findlaw.com/dean/20090821.html

Something else you can do ...

"Mad as Hell Doctors" hit the road for Single-Payer"

On September 8, 2009 a group of dedicated Oregon physicians will take the message of Universal Health Care "on the road" in a wrapped and branded Motor Home headed for Washington D.C. Our cross-country mission: to stop in big cities and whistle stops alike, conducting pre-booked, local and national media appearances for a curious press. Every move we make along the way will be recorded on camera and then edited and uploaded to the internet that same day. This will allow our Mad As Hell Doctors Tour to leverage the edited video segments on social networking web sites such as Facebook, Twitter, YouTube, MySpace, et al. In this way, our effort becomes an unprecedented hybrid of reality television and political activism that offers people the opportunity to follow us, in real time, as our story unfolds. The message will be unmistakable: caravan with us to Washington and help make a public demonstration of support for Single Payer Health Care that will be heard around the world.

Website: https://madashelldoctorstour.com/Home_Page.html
Source/Full Story: http://journals.democraticunderground.com/marmar/13690

Here's an interesting "spin" on the President's statement that if no reform is passed, Medicare will run out of money within 8 years ... unlike the author of this next opinion piece, I don't see Republican opposition to reform as some big conspiracy to kill Medicare as much as just plain stupidity, stubbornness, and a desire to defeat the President ... but I suppose you could choose to see is this way -- make up your own mind, ... but I left it in because it contains significant quotes from the President, and well, it is sort of funny, even if a little over the top ...

The Republican "Do Not Resuscitate" Plan to Let Medicare Die
by Leo Gerard, President of United Steelworkers International

During a webcast meeting with Organizing for America on Thursday, President Barack Obama outed the covert Republican plot to strangle Medicare to financial death.

He explained to the group that if Congress does nothing, if health care reform fails, "Medicare will run out of money in eight years."

Obama and the Democrats are pressing for health care reform to provide people under 65 with some semblance of what those over 65 have - government-assured affordable medical insurance. At the same time, for Medicare, Obama said, "Part of what we want to do is strengthen it, so it is there over the long haul."

"It is not as if," he said, "if we just stand still, everything is going to be okay."

Immobility is exactly what Republicans want, however. "No change" is their slogan. They've offered zero substantive reform for health care. In the years when they controlled Congress and the White House under former President George W. Bush, they did nothing to repair financial problems with Medicare. In fact, they falsely minimized the price tag of the new prescription drug program, Medicare Part D, and drove up the cost by forbidding government negotiation for lower medicine prices. In addition, although they failed to accomplish it, they pressed to privatize that socialist program called Social Security -- just months before the stock market tanked.

This is philosophical warfare, and for the Republicans, Medicare is an appropriate casualty. The GOP has made it clear they believe the public option being proposed in health care reform is socialism - an evil that must be eradicated at all costs. Of course, Medicare, a government-sponsored health care program for all people over 65 actually is socialist.

It's a slippery slope. First Republicans kill the opportunity for all Americans under the age of 65 to choose their own private insurance or get government-sponsored health care under the public option. Then, by doing nothing, Republicans destroy the ability of those over 65 to retain their government-sponsored health care.

Senior citizens are more frightened about health care reform than anyone else. That may be, President Obama said, because they routinely need health care more than any other group. So lying to them about it, especially for political gain, is cruel and despicable.

It's true, Democrats want change. They seek to reform and improve the health care system so that Medicare is strengthened and funded for the future. For example, Obama noted, under the Democrats' plan, the "donut hole" in Medicare Part D, during which senior citizens must pay for their prescription medications, would be eliminated. President Obama got the pharmaceutical companies to step up and pay more - if Congress manages to pass reform.

A huge portion of the cost of health care reform would come from changes in the way the federal government pays for Medicaid and Medicare. What the Democrats want to change are payment methods that are just wrong. No bid contracts, for example. Introducing real capitalist competition in the system would reduce costs without affecting benefits. "No one is talking about messing with your Medicare benefits," Obama said, attempting in a mere statement to counter screaming "tea baggers" featured continuously on Fox News. Of the Democrats he said, "We think Medicare is a sacred trust."

On health care reform, the Republican plan to do nothing means death. Death for the public option. But also death for Medicare.

President Obama explained: "The status quo is unsustainable. If you like what you have now, unless we make some changes, you are not going to have what you like because health care costs are rising three times faster than wages. . . If you have a private plan, you have something to worry about. If you are on Medicare, you have something to worry about because we are going to run out of money."

Democrats are trying to resuscitate Medicare and deliver health care reform. Republicans are forming death panels to kill all of it.

Source/fully story: http://www.huffingtonpost.com/leo-w-ger ... 65499.html

Meanwhile, on the heels of her on air "fact-slapping" by Jon Stewart on the Daily Show this week, death panel myth creator Betsy McCaughey resigned from her post on the board of directors of Cantel Medical Corporation to "avoid any appearance of a conflict on interest." ... Source/Full Story: http://www.huffingtonpost.com/2009/08/2 ... 65547.html

And in our daily "slap" - this one's sent out by Rick Sanchez to Rick Scott, convicted of medicare over-billing fraud, on the false claims in his new anti-health reform ads (with video): http://www.huffingtonpost.com/2009/08/2 ... 65573.html

Final Thought: Here's a suggestion ... why don't we pay for meaningful reform of health care inclusive of a strong public option with money we require Wall Street and Banks, and their executives and CEO's, to pay back over the next year or two in full ... after all, if we can pay to save banks, we can pay to save patients ... families ... citizens ... Americans.

[roxybeast]

Here's a link to a new NY Times blog called "Prescriptions" which features lots of short articles about new developments in the health care debate ... they update it regularly, so save this link:

http://prescriptions.blogs.nytimes.com/

[Arcadia]

I couldn´t follow the thread´s develop so I read the final thought: it sounds good!


Final Thought: Here's a suggestion ... why don't we pay for meaningful reform of health care inclusive of a strong public option with money we require Wall Street and Banks, and their executives and CEO's, to pay back over the next year or two in full ... after all, if we can pay to save banks, we can pay to save patients ... families ... citizens ... Americans.


priorities are priorities!

[Arcadia]

some questions:

Is Lieberman´s step-by-step theory more emphatic with the promedio emotions towards the reform?

how health issues became so complex?

[roxybeast]

Attack on the Public Option Intensifies as Supporters Rally the Troops
by Beth Isbell

The weekend was filled with attacks on the public option by the right and calls by and for those on the left to dig their trenches even deeper. Consider these articles ...

From NPR, "The Public Option: Time to Let It Go?" (w/ audio/interview):
http://www.npr.org/templates/story/stor ... =112156817

From the LA Times, "Healthcare Insurers Get Upper Hand." Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza' for the insurance companies if passed in it's current form without a strong viable public option. But big insurance is throwing the kitchen sink of lobbying efforts to kill the public option ... http://www.latimes.com/news/nationworld ... 2720.story

The industry continues to spend up to $1.5 million a day to oppose reform - and to outpace lobbying efforts by the of the oil & gas industry ... http://voices.washingtonpost.com/health ... h_sec.html

From the Wall Street Journal, investors believe that big insurance is winning the reform fight. Consequently, health care stocks are up ... http://online.wsj.com/article/SB125106656304052223.html

In it's Prescriptions post, the NY Times compiles a lot of good articles on health care reform. Today's post features articles about an interview by CNN's John King with Sen. Lieberman in which he calls for a timeout to slow down the debate until the country's economy recovers, ... an examination of the GOP's goals for health care reform and Republicans newly unveiled health care bill of rights for seniors, ... what is behind opposition by older Americans to reform efforts, ... here's the link: http://prescriptions.blogs.nytimes.com/

In a shocker, a Republican strategist admits that Republicans don't fight fair ... http://www.teambio.org/2009/08/19/repub ... -strategy/

But it may not be Republicans that are the biggest obstacle to Democratic efforts to pass health reform with a public option, but instead the party's own Blue Dog Democrats. But some Blue Dogs are finding out over the recess that constituents in their own districts may not back their efforts to de-rail the public option ... http://www.huffingtonpost.com/2009/08/2 ... 67308.html

Meanwhile, over the weekend, the Democrats hit the talk-shows continuing to suggest that they may attempt to pass health care reform with a simple majority. Consider this from Sunday's NY Times ... http://www.nytimes.com/2009/08/24/healt ... ealth.html ... and see ... http://www.huffingtonpost.com/2009/08/2 ... 67166.html

So why isn't health care getting done?

There is legitimate concern that some folks with coverage may get dropped if reform is enacted, ... personally, I suspect that any final reform bill will be drafted to alleviate this concern, but CBO forecasts under the current legislative proposals do raise legitimate concern ... http://voices.washingtonpost.com/health ... _your.html

Former US Labor Secretary Robert Reich takes a look at the "gang of six" - the group anointed to spearhead the effort to obtain bi-partisan legislation ... http://www.huffingtonpost.com/robert-re ... 65684.html

One of the leading Democrats in the "gang of six" D Sen Max Baucus, told his constituents recently that he actually wants a public option ... http://www.politico.com/blogs/glennthrush/

So where are they currently at in their attempt to get a bi-partisan bill? Here's a look inside the current efforts of the "gang of six" ...

New Splits Emerge in Health-Plan Talks
By JONATHAN WEISMAN and NAFTALI BENDAVID

WASHINGTON -- Senate Finance Committee negotiators are trying to bring down the cost of a broad health-care bill, but new splits are emerging on whether to reduce subsidies for people to buy insurance, according to Senate aides familiar with the talks.

The Finance Committee, led by three Democrats and three Republicans who make up the so-called Gang of Six negotiators, is the only committee in Congress seeking to produce a bipartisan bill.

Republicans are pressing to reduce the size of tax credits for families with incomes that are below three times the poverty rate. They would also like to trim back insurance coverage mandates in hopes of lowering premiums that would have to be subsidized.

But the three Democrats believe savings can be found without going to the heart of the bill. "There are not going to be significant changes to coverage," said one Democratic aide familiar with the talks. "We're finding other ways to bring down the cost."

The six negotiators are working against a Sept. 15 deadline to reach a deal before Democratic leaders give up and move ahead with a partisan bill. A conference call went until nearly midnight Thursday with no major breakthroughs.

Both sides say the core of a bill has already come together that would represent dramatic changes, both for those with health insurance and the uninsured. That core bill would impose new regulations on insurance companies, preventing them from withholding coverage for applicants with pre-existing conditions or dropping coverage when a customer gets sick. It would also cap out-of-pocket expenses and end lifetime coverage caps. And insurers would have to narrow price differences for comparable policies.

In exchange, the insurers would get a huge new customer base: most of the 46 million uninsured, who would be mandated to purchase insurance through a new, federally created exchange. Families up to three times the poverty rate would get generous tax credits for those purchases. Medicaid, the federal-state health plan for the poor, would be expanded to 133% of the poverty level.

To hold down health inflation, health-care providers such as doctors and hospitals would be encouraged to coordinate care. Negotiators are looking at several ways to do that, perhaps by paying higher reimbursements to providers in coordinated-care clinics or by sending out lump-sum payments for a given patient's care. That way, all providers involved in a case -- from the emergency-room doctor who admitted a broken-hip patient, to the orthopedist and the physical therapist who treated the patient -- would have to work together to divide up payments.

Under the Finance plan, wellness programs would also be targeted at the populations most in need, such as diabetics, smokers or the obese. The senators have already said their bill won't include a Medicare-like public-insurance plan to compete with private insurers, and they are now weighing whether to omit as well an alternative idea for nonprofit health-insurance cooperatives.

Ron Pollack, executive director of Families USA, a liberal health-care group, said it was important that controversial elements of the health-care bill "do not obscure" the broad agreements reached on key issues. "The American public does not yet fully understand all these other elements that are close to consensus," Mr. Pollack said.

But aides involved in the negotiations say the controversies are taking a toll. Liberals are ratcheting up pressure on Democrats to demand a public option in any health-care overhaul. Liberal bloggers, in 72 hours, raised $309,393 from 5,155 donors for congressmen demanding a government insurance option. Jane Hamsher, one of the bloggers organizing the campaign, said Friday the left will never accept an individual mandate to purchase insurance if the insurance must come from private insurers.

The three Senate Republicans on the Gang of Six -- Charles Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine -- won't sign off on a deal without a public option if they think Democrats would later bow to pressure and insert one, one Republican aide said.

The Senate Finance negotiators are still far away from agreeing on how to pay for the subsidies to people for buying insurance. Finance negotiators are counting on raising $180 billion by taxing high-cost insurance plans, but Democrats are under pressure to whittle that down or drop it altogether.

Source: http://online.wsj.com/article/SB125089698657350611.html

So are insurance exchanges the answer? What do we know about them? ... http://voices.washingtonpost.com/health ... rance.html

What is the Opportunity Cost of Opportunity Lost? ... here's an editorial by Paul Krugman which appeared in Sunday's NY Times ...

All the President’s Zombies
By Paul Krugman

The debate over the “public option” in health care has been dismaying in many ways. Perhaps the most depressing aspect for progressives, however, has been the extent to which opponents of greater choice in health care have gained traction — in Congress, if not with the broader public — simply by repeating, over and over again, that the public option would be, horrors, a government program.

Washington, it seems, is still ruled by Reaganism — by an ideology that says government intervention is always bad, and leaving the private sector to its own devices is always good.

Call me naïve, but I actually hoped that the failure of Reaganism in practice would kill it. It turns out, however, to be a zombie doctrine: even though it should be dead, it keeps on coming.

Let’s talk for a moment about why the age of Reagan should be over.

First of all, even before the current crisis Reaganomics had failed to deliver what it promised. Remember how lower taxes on high incomes and deregulation that unleashed the “magic of the marketplace” were supposed to lead to dramatically better outcomes for everyone? Well, it didn’t happen.

To be sure, the wealthy benefited enormously: the real incomes of the top .01 percent of Americans rose sevenfold between 1980 and 2007. But the real income of the median family rose only 22 percent, less than a third its growth over the previous 27 years.

Moreover, most of whatever gains ordinary Americans achieved came during the Clinton years. President George W. Bush, who had the distinction of being the first Reaganite president to also have a fully Republican Congress, also had the distinction of presiding over the first administration since Herbert Hoover in which the typical family failed to see any significant income gains.

And then there’s the small matter of the worst recession since the 1930s.

There’s a lot to be said about the financial disaster of the last two years, but the short version is simple: politicians in the thrall of Reaganite ideology dismantled the New Deal regulations that had prevented banking crises for half a century, believing that financial markets could take care of themselves. The effect was to make the financial system vulnerable to a 1930s-style crisis — and the crisis came.

“We have always known that heedless self-interest was bad morals,” said Franklin Delano Roosevelt in 1937. “We know now that it is bad economics.” And last year we learned that lesson all over again.

Or did we? The astonishing thing about the current political scene is the extent to which nothing has changed.

The debate over the public option has, as I said, been depressing in its inanity. Opponents of the option — not just Republicans, but Democrats like Senator Kent Conrad and Senator Ben Nelson — have offered no coherent arguments against it. Mr. Nelson has warned ominously that if the option were available, Americans would choose it over private insurance — which he treats as a self-evidently bad thing, rather than as what should happen if the government plan was, in fact, better than what private insurers offer.

But it’s much the same on other fronts. Efforts to strengthen bank regulation appear to be losing steam, as opponents of reform declare that more regulation would lead to less financial innovation — this just months after the wonders of innovation brought our financial system to the edge of collapse, a collapse that was averted only with huge infusions of taxpayer funds.

So why won’t these zombie ideas die?

Part of the answer is that there’s a lot of money behind them. “It is difficult to get a man to understand something,” said Upton Sinclair, “when his salary” — or, I would add, his campaign contributions — “depend upon his not understanding it.” In particular, vast amounts of insurance industry money have been flowing to obstructionist Democrats like Mr. Nelson and Senator Max Baucus, whose Gang of Six negotiations have been a crucial roadblock to legislation.

But some of the blame also must rest with President Obama, who famously praised Reagan during the Democratic primary, and hasn’t used the bully pulpit to confront government-is-bad fundamentalism. That’s ironic, in a way, since a large part of what made Reagan so effective, for better or for worse, was the fact that he sought to change America’s thinking as well as its tax code.

How will this all work out? I don’t know. But it’s hard to avoid the sense that a crucial opportunity is being missed, that we’re at what should be a turning point but are failing to make the turn.

Source: http://www.nytimes.com/2009/08/24/opini ... ugman.html

Which brings us to the question - will Democratic party in-fighting kill the bill? Consider this Sunday NY Times editorial ... http://www.nytimes.com/2009/08/24/opini ... hat-1.html

Meanwhile, the President is finding that he may have serious problems controlling his base if he backs away from the public option ... http://www.huffingtonpost.com/jeffrey-f ... 65997.html

Columnist Mike Lux makes suggestions to the left flank on actions it should take in general to have a more effective voice ... http://www.huffingtonpost.com/mike-lux/ ... 67191.html

Perhaps it's time to turn up the heat on the insurance companies, for all the reasons this next article suggests ... http://www.huffingtonpost.com/peter-dre ... 66698.html

Dr. Marcia Angell, M.D., former editor of the New England Journal of Health and Harvard Medicine Professor weighs in. She has previously advocated a medicare buy in system which would gradually lower the age to qualify for medicare. In this article, she wonders if current reform efforts would just be throwing good money after the bad ...

Health Reform: Throwing Good Money After the Bad
By Marcia Angell, M.D.

It's not just the right-wing crazies who oppose health reform. In addition, there are many sane Americans who worry about committing a trillion dollars to it. They have a point. We already spend more than twice as much per person on health care as other advanced countries, and our costs are rising faster. How much is enough?

Make no mistake, sky-high and rapidly rising costs are the core problem. If money were no object, it would be easy to provide full care for everyone. But even a perfectly designed system will fail if it is unaffordable, or rapidly becomes so.

So it's crucial to ask just why we are spending so much more than other countries. Where is all that money going? Yet, that question is seldom asked in the current debate, even though it's not logical to try to fix something without understanding why it's broken.

In the trenchant words of Deep Throat, let's follow the money. This year we will spend roughly $2.5 trillion on health care. Although about half that money comes from federal and state governments, most of the total is funneled to private insurers and entrepreneurial providers. Alone among advanced countries, we treat health care like a market commodity to be distributed according to the ability to pay, not like a social service to be distributed according to medical need.

For nearly two-thirds of Americans, we rely on hundreds of private insurance companies to set prices and benefits and pay providers. They profit by refusing to cover the sickest patients and limiting services to others. In fact, we have the only health system in the world based on avoiding sick people. Insurers cream 15 to 25 percent off the top of the premium dollar for profits and overhead (mainly underwriting) before paying providers.

Providers themselves have high billing and collecting expenses to deal with the Byzantine requirements of multiple insurers. The innumerable health facilities, both for-profit and nonprofit, also have high overhead expenses to cover their business costs, executive salaries, and the promotion of their profitable services. Altogether, overhead accounts for at least 30 percent of our health bill. If we spent the same percentage on overhead as Canada, we would save about $400 billion this year.

Our method of delivering care is no better than our method of paying for it. We provide much of it in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most doctors are paid on a piecework basis -- that is, fee-for-service -- which gives them a similar incentive to provide too many services for the well-insured. That is particularly true of specialists who receive very high fees for expensive tests and procedures (like cardiac angiography and MRI's).

Not surprisingly, our ratio of specialists to primary care providers is much higher than in other countries. There is no way to know exactly how much money is wasted in medically unnecessary tests and procedures, but it is probably on the order of hundreds of billions of dollars per year. Many people point to technology as a cause of our high health costs, but the culprit is not technology per se (all advanced countries have the same technologies), but the flagrant overuse of it for financial gain.

In sum, the answer to the question, "Where is all that money going?" is that much of it is diverted to profits and overhead, and to exorbitantly priced and medically unnecessary tests and procedures. Any reform that has a prayer of containing costs, hence being sustainable, must deal with these two massive drains.
Yet, most reform proposals would leave the present profit-driven and inflationary system essentially unchanged, and simply pour more money into it.

That's what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are bleak unless we drastically cut benefits and greatly increase deductibles and co-payments, or change the system. We're learning that health insurance is not the same thing as health care; it may be too limited in what it covers or too expensive to actually use. It is ironic that the President is said to have looked to Massachusetts as a model for national reform, even though the state has the highest health costs on the planet.

To control costs, the President is pinning a lot on electronic records, disease management, preventive care, and comparative effectiveness studies. But while these initiatives may improve care, they're unlikely to save much money because they don't deal with the underlying problem -- a system based on maximizing income, not maximizing health. Promises by for-profit insurers and providers to mend their ways voluntarily are simply not credible. Regulation of the present system is also unlikely to modify profit-seeking behavior very much, without a bureaucracy so large that it would create more problems than it solves.

Nearly every other advanced country has a largely nonprofit national health system that guarantees universal care. Even countries with private insurers, like Switzerland and the Netherlands, require uniform prices and benefits and limit profits. Not only are expenditures much lower in other advanced countries, but health outcomes are generally better. Moreover, contrary to popular belief, they offer on average more basic services, not fewer -- more doctor visits and longer hospital stays, and they have more doctors and nurses and hospital beds. But they don't do nearly as many tests and procedures, because there is little financial incentive to do so.

It's true that there are waits for some elective procedures in some of these countries, such as the U. K. and Canada (although hardly the long lines of desperately ill patients depicted by the Republicans). But that's because they spend far less on health care than we do. If they were to put the same amount of money into their systems as we do into ours, there would be no waits. For them, the problem is not the system; it's the money. For us, it's not the money; it's the system. We already spend more than enough.

Judging by the current debate, it would seem that Americans think they have nothing to learn from other countries, or perhaps that we are all alone in the world. Still, we might be willing to learn from parts of our system that are similar to systems in other countries. Medicare is a single-payer program very much like the Canadian national health insurance system. (Some of the more vociferous town hall meeting protesters seemed not even to know that Medicare is a government program.) The Veterans Health System is a socialized program very much like the U.K.'s national health service. Both deliver better care at lower prices than our private system.

I believe our best bet now would be to extend Medicare gradually to the rest of the population. We could begin by lowering the eligibility age from 65 to 55, then after a few years, drop it to 45, and so on. Medicare is the most popular part of our health system; unlike private insurers, it offers free choice of doctors, it covers all eligible beneficiaries for a uniform package of benefits, regardless of medical history or how much care is needed, and it cannot be taken away by job loss or illness.

But it would need some changes. Its costs are rising almost as fast as those in the private sector, despite the fact that its overhead is much lower, because it uses the same profit-oriented providers. If Medicare were extended to everyone, it should be in a nonprofit delivery system. In addition, fees would have to be adjusted to reward primary care doctors more and specialists less, or better yet, doctors should be salaried. There is now a bill in Congress that calls for exactly that -- H.R. 676 ("Expanded and Improved Medicare for All"), which was introduced by Rep. John Conyers of Michigan and has many co-sponsors. Unfortunately, given the power of the health industry lobbies, it's unlikely to make it out of committee without strong public pressure.

In economic terms, health care is a highly successful industry -- profitable, growing, and virtually recession-proof -- but it's a massive burden on the rest of the economy. I'm aware that phasing out private insurers would mean a loss of jobs. But I believe the job loss in that sector would be more than offset by job gains in the rest of the economy, which would no longer be saddled with the exorbitant costs of an industry that offers very little of value to justify its existence.

One thing is certain: We need a complete overhaul of our health system. Tinkering at the edges won't do it. Expanding coverage through government subsidies and mandates, as advocated by the president, won't either. Besides being a windfall for insurers and drug companies, that approach will just add to our soaring costs and be a temporary fix, at best. In my opinion, it makes no sense to throw good money after bad.

Source: http://www.huffingtonpost.com/marcia-an ... 66596.html

Here's an interesting look at the coverage afforded to members of Congress posing the question, why can't we get some of that? ... http://www.huffingtonpost.com/d-brad-wr ... 66707.html

And here's a poignant and chilling reminder of why health care reform is necessary, even if you already have insurance coverage! ...

The View From Your Sickbed
by Patrick Appel
The Atlantic, Aug. 23, 2009

A mother describes her family's struggle to keep their daughter Sophie insured:

Quote:
In fall of 2005, we decided to switch from our private, self-employment insurance that we had used for years to Blue Cross. There was a week long gap between the policies - something that we didn't think anything of, because we simply did not know better. Just as our Blue Cross plan was set to start, we received a notice from them stating that they considered Sophie to have a pre-existing pulmonary problem (due to the amount of doctor's visits for pneumonia), and that while they would cover her in general, they wouldn't cover any pulmonary/respiratory issues until she had gone two years without needing medication or problems.

Our reaction: OMG. Actually I believe it was OMFG. All of a sudden,

Sophie was without coverage for pulmonary problems. This was absolutely terrifying. What if she got sick?! What if she needed to be hospitalized?! We spent the next couple of months researching every insurance company that we could, begging them to take Sophie. Nope, it wasn't going to happen.

And then our biggest fear came true: Sophie got very, very sick.
And I'm ashamed to say that although we knew that she was incredibly ill, we actually considered keeping her home from the doctor's office, as we knew that this would be yet another strike against her getting insurance. Luckily we pulled our heads out of our asses and took her to the doctor anyway, and it's good that we did, because Sophie was so critically ill that she was sent straight from the doctor's office to ICU. She was so sick that we couldn't even wait for an ambulance; they helped me throw our limp, blue daughter into our car, and I drove like hell to get her to the hospital next door.

Let me state that very clearly one more time: we almost didn't take our baby girl, who was in severe respiratory distress, to the doctor because we knew that it would hurt her chances of getting insurance.

I realize that your reality of living in the U.S. and of health insurance is likely very different than this. But I'm going to ask you to sit for a moment and imagine being in our shoes in that situation. Imagine the shame and guilt of almost keeping your child home from the hospital until it was too late, and then imagine the horror of seeing your child naked in ICU, hooked to many different machines. There is no way to describe how this felt.

One night in ICU? $10,000, not covered by insurance.

After this hospitalization, we were approached by a hospital social worker, who suggested we apply for SoonerCare. SoonerCare is Oklahoma's Medicaid program for kids. Luckily I'm a social worker who was working for a non-profit at the time, so we had no problems meeting financial criteria. (Ha ha. A little social work humor there.) SoonerCare does NOT exclude kids for pre-existing conditions, and it covers Sophie's medications and treatment 100%.

Since that horrible October in 2005, Sophie has needed hundreds of thousands of dollars worth of treatments, hospitalizations, surgeries, medications, testing, and interventions in order to stay strong and healthy, and in some instances, to stay alive.

She has required three bronchoscopies, the middle section of her lung removed, extensive genetic testing, cardiology work ups, dozens of x-rays, CT scans, and a two week trip to a pulmonary hospital in Denver. When she's healthy, she requires three steroids, twice a day, and when she's sick she is usually on five steroids, twice daily. She's been diagnosed with right middle lobe syndrome (though not anymore, since she had it removed), a genetic mutation of cystic fibrosis, severe uncontrollable asthma, and severe sinus disease.

Since SoonerCare is the only insurance that will accept Sophie, we have to meet their financial criteria, which means living at or below the poverty level. I have had to quit wonderful jobs because I made too much money to qualify for SoonerCare. At this point I can only work either part-time, or for a very small salary, because we CANNOT afford to lose Sophie's healthcare coverage. It's the most important thing in our lives. We structure every single financial and professional decision we make around staying eligible for SoonerCare.

And while we'll gladly continue to live at the poverty level in order to provide our daughter with the healthcare that keeps her alive, we SHOULDN'T HAVE TO. We would happily pay outrageous premiums and co-pays, and do whatever else it took to get Sophie covered by regular health insurance. But you know what they all tell us?
She has to go two years with no pulmonary medications and no doctor's visits because of respiratory problems before anyone will accept her. Sophie can't go two DAYS without her medications, let alone two years.

Source: http://andrewsullivan.theatlantic.com/t ... ed-29.html

Finally, here's an editorial from the New York Times over the weekend examining the uninsured in America ... who are they? Significantly, the NY Times Editors conclude "Any nation as rich as ours ought to guarantee health coverage for all of its residents." I reprinted the full editorial in a prior post, but here's the link again in case you missed it ... http://www.nytimes.com/2009/08/23/opinion/23sun1.html

And for our daily "snozzlebunny" (that one comes from my twins) ... I've decided to reprint this editorial by Marty Kaplan, a professor at USC, because, frankly, well, he has a point - sometimes the left is just not cut throat enough when dealing with a right that almost always is ...

Kumbaya, Not Kevorkian, Will Kill Grandma
by Marty Kaplan

I don't know which is more dispiriting: the New York Times' failure to call Betsy McCaughey a liar, or Barack Obama's failure to call Chuck Grassley a liar. It's tempting to think of both failures as cowardice, a mortal fear of being branded "liberal." But ironically it's liberalism itself that makes them both mistake their cowardice for fair-mindedness.

Exhibit A is how the Times covered Jon Stewart's evisceration of McCaughey on The Daily Show.

McCaughey, a former Republican lieutenant governor of New York, is the ventriloquist who put "death panels" in Sarah Palin's mouth. A provision that permits Medicare to reimburse patients voluntarily seeking advance counseling from their doctors about wrenching end-of-life decisions -- something that plenty of Republicans like Palin and Senator Grassley (R-IA) have supported -- was maliciously twisted by McCaughey to mean that Obama will force people to pull the plug on Grandma.

When McCaughey walked onto the set of The Daily Show last week, she brandished a huge binder containing the House health care reform bill. When Stewart asked her to show him where the death panel provision was, she couldn't. In a 15-minute interview he gave her all the rope she needed to make the case that Obamacare means mandatory euthanasia, and with that rope she hanged herself.

"Making Sense of the Healthcare Debate" was the Times' heading for its coverage of the encounter. But instead of telling its readers that Stewart caught McCaughey lying about the bill, the Times reported that "they could not agree on what it actually said." He said her reading of the bill was "hyperbolic and in some cases dangerous"; she said "Democrats intended to intrude on the medical decisions of dying people." He said, she said: that's what the Times means by "making sense" of a debate.

What requires the Times to castrate itself? How did excellence in journalism come to mean impotence in the face of untruth? Fox News, which excels in promulgating untruths, purveys its propaganda under an Orwellian banner: "We report, you decide." It does, of course, the opposite; Fox decides, ideologically, and it cleverly packages its partisanship as reporting. What makes the Times worship a Fox News definition of journalism -- "fair and balanced" -- that not only gets violated at Fox, but that cravenly substitutes stenography for adjudication?

The answer, I suspect, is liberalism -- not the muscular democratic liberalism of civil rights and social justice, but the flabby postmodern liberalism of on the one hand and on the other hand. The Right is righteous; it claims to know what God wants. But the secular response to fundamentalism isn't science, it's kumbaya, a campfire that requires reason and ignorance to pay mutual respect, a moral cowardice that values pluralism more than it values values.

That's why it's so dispiriting to watch Obama let Grassley play him. Grassley tells his Iowa constituents that Obama wants government to get rid of Grandma, yet Obama says Grassley is working "constructively" on health care reform. Grassley calls Obama "intellectually dishonest," Grassley has the gall to accuse Obama of using the end-of-life flap "to divert attention," yet Obama hostages his presidency to "bipartisanship." Republicans crow that destroying health care reform will destroy Obama, polls show Obama's Democratic base deserting him because of his deference to Republican nihilists and to health and insurance industry special interests, yet he defers to Max Baucus (D-MT), the Senator who, as the Montana Standard reported, raised more campaign money from "drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals" than any other member of Congress.

The people carrying loaded assault weapons to Obama's events are not our swell fellow citizens simply exercising their rights, nor are the people carrying Obama-as-Hitler signs to town hall meetings merely a heartwarming demonstration of America's commitment to free speech, nor are the moms and Rush Limbaughs and Glenn Becks saying "Nazi" just proof of the robust vitality of our democracy, nor are the Sarah Palins and Betsy McCaugheys and Chuck Grassleys only colorful players in the theater of politics.

If journalism had the courage to tell the truth, and if liberalism had the stomach to confront evil, maybe good leaders would be as willing to wield power as bad ones.

Sure -- and if Grandma had wheels, she'd be a bus.

Source: http://www.huffingtonpost.com/marty-kap ... 67281.html

Well, as an afterthought, at least there's one thing the left seems to do well ... & that is to pressure Glenn Beck's advertisers to drop his show!: http://www.huffingtonpost.com/2009/08/2 ... 66732.html

[roxybeast]

Best Advice for the President on Health Care Reform:
Do What Is Best for and Right by America's Children!
by Beth Isbell
Aug. 25, 2009

Republicans announce their new Seniors Health Care 'Bill of Rights' -- while the nation's leading advocate for seniors the AARP dismisses RNC announcement of 'Seniors' Health Care Bill Of Rights' as alarming and misleading ... Consider these two articles by the WSJ and the Post: http://online.wsj.com/article/SB125112553661853921.html ... and ...
http://voices.washingtonpost.com/44/200 ... _righ.html ... and the quick Democratic response that Medicare recipients would not see any reduction in benefits whatsoever if Democratic plans for reform are passed ... http://prescriptions.blogs.nytimes.com/ ... -medicare/

Remember the Republicans, the same party who brings you ...

More false claims about government death panels … http://www.huffingtonpost.com/david-day ... 65290.html

You remember death panels, don't you ... seems familiar ... I wonder why ... oh, yeah, now I remember ...

Seems to me that a better example of a "death panel" are the health insurance claims review boards, such as the ones document in the movie SICKO, that deny valid claims knowing that their decisions will mean that the patient/claimant, perhaps you or your family member, will die. After all, that earns the medical reviewers promotions and is good for the company's bottom-line! Of course, maybe instead of the truth, these right wingers with broken brains would rather hear the left's "secret sinister plan," so here goes: Yes, we proponents of honest health reform focused on prevention and coverage to all Americans, even those that can't afford it, are secretly planning to kill your grandmothers and use them as fuel when oil prices get too high while enjoying our nice tasty soylent green salads! And yes, Sarah Palin, your grandmother's children's children will be first! (borrowed from one of my prior columns)

While ignoring that we already have big insurance death panels … http://www.huffingtonpost.com/carolita- ... 68055.html

Their party leader, Michael Steele, tells the public that the VA is Encouraging Vets To Commit Suicide! (w/ VIDEO) ... http://www.huffingtonpost.com/2009/08/2 ... 68310.html ... but actual Vets don't see the issue or the VA's pamphlet that way and instead think the VA does an excellent job with seniors and end of life care, as eventually discussed by a Vet interviewed by NPR in this next article & radio clip ... http://www.npr.org/templates/story/stor ... =112182583

While Republican representatives run home and tell their constituents "Prayer And Fasting" Will Defeat Health Care Reform ... http://minnesotaindependent.com/42612/b ... are-reform

Meanwhile, moderate Republicans like John McCain get booed just for saying he believes that President Obama understands and respect the U.S. Constitution, that there is a fundamental difference in philosophy and the role of government, and that the President is absolutely sincere in his beliefs! ... even having to chide the overwhelmingly right wing crowd "to be respectful" ... http://www.huffingtonpost.com/2009/08/2 ... 68531.html (with VIDEO of incident)

In my home state Oklahoma, this is what happened at Republican Sen. Tom Coburn's town hall meetings ... Oklahoma Democratic Forum:

At one of Senator Coburn's town hall meetings on Monday, a woman attended, and was so emotional and in such obvious distress, at times she could barely be understood through her tears and anguish. She came to see the Senator out of sheer desperation, to beg for help. Her husband was home suffering from a brain trauma. Their insurance company had declined coverage, and the nursing home where he had been receiving care turned them out, even though he had a feeding tube implanted, informing them, "You're on your own." She asked Senator Coburn for help, adding that their insurance company wouldn't even cover helping him drink.

It was a heart-wrenching story, but the video that aired on CNN showed the crowd in attendance was unmoved. Unmoved, that is, until Senator Coburn responded. First he informed her his office would look in to it; then he told the distraught woman two astounding things. He told her that her neighbors should be the ones helping. That brought a reaction from the crowd, a round of applause. Then he said to her, "The idea that the government is a solution to our problems is an inaccurate, a very inaccurate statement." There was an immediate burst of approving applause from the crowd for that remark. It was the Senator's comments, and response it drew from the crowd that made the video worthy of national media attention.

The government that Senator Coburn said shouldn't help her is the same government that created the rules and regulations that allowed the insurance company to decline coverage. Obviously the insurance company got help from the government, but in his view there should be no help for our citizens. Then there's the part about who Senator Coburn is. Before he became Senator Coburn he was Dr. Coburn, a practicing M.D. from Muskogee. If he had a patient suffering from a condition as serious as this, would it be his professional medical advice to get out of the nursing home with a feeding tube, and just go home? "You're on your own." Is that what Dr. Coburn would inform them? "There's no help you deserve from your government or medical practitioners, just go ask your neighbors for help." Is that what Dr. Coburn would tell the family? What if there were no neighbors skilled in medical care of critical patients? Would Dr. Coburn accept the liability for this advice, which he was comfortable dispensing as Senator Coburn?

As tragic as the woman's story was, the real appalling part, that reflects on all of us, was the enthusiastic round of supporting applause from the crowd as Senator Coburn informed her she didn't merit help. What have we become?

K. Belford, Tulsa, OK, Post on Oklahoma Democratic Forum, Aug. 25, 2009

All of which is a bit hard to swallow, until you actually see the video. While Coburn does initially offer to help the woman, his primary and immediate instinct, as you will see, is to immediately turn and use the issue to push support his right wing position on reform to the larger crowd by first directing her to seek help for her husband not being able to eat or drink or speak properly from her neighbors, and then firmly chastising her and the rest of the crowd that government is not the answer. Now I don't know if Sen. Coburn personally cares what happens to that woman and her husband or not, but if he does, one thing perfectly clear from this video clip is that his political views do not reflect that he actually does. Here's a link to the CNN video of the actual incident:
http://www.youtube.com/watch?v=e3jwhLcW_c8

And the same right wing Republicans that continue to claim that Obama is an evil Nazi ... http://www.huffingtonpost.com/2009/08/2 ... 67804.html

So it's no wonder the public is confused by all these intentionally misleading and proven false health care myths, as polls indicate ...

Majority of Americans Believe Health Care Reform 'Myths'
By LiveScience Staff
24 August 2009

More than 50 percent of Americans believe a public insurance option will increase health care costs, according to a new survey on assertions the White House has called myths.

The national survey, conducted from Aug. 14 – 18, involved a random sample of 600 Americans aged 18 and older living in the 48 contiguous states and Washington, D.C. Respondents indicated whether or not they believed 19 claims about health care reform, each of which is considered a myth by the White House.

The results could speak to the current partisan debate on a proposed health care overhaul. While overall the majority of Americans said they believe many of the assertions, more Republicans and Independents than Democrats stood by the claims.

"It's perhaps not surprising that more Republicans believe these things than Democrats," said study scientist Dr. Aaron Carroll, director of Indiana University's Center for Health Policy and Professionalism Research. "What is surprising is just how many Republicans – and Independents – believe them. If the White House hopes to convince the majority of Americans that they are misinformed about health care reform, there is much work to be done."

Among the results on items the White House considers myths:

67 percent of respondents believe that wait times for health care services, such as surgery, will increase (91 percent of Republicans, 37 percent of Democrats, 72 percent of Independents).

About five out of 10 believe the federal government will become directly involved in making personal health care decisions (80 percent of Republicans, 25 percent of Democrats, 56 percent of Independents).

Roughly six out of 10 Americans believe taxpayers will be required to pay for abortions (78 percent of Republicans, 30 percent of Democrats, 58 percent of Independents)

46 percent believe reforms will result in health care coverage for all illegal immigrants (66 percent of Republicans, 29 percent of Democrats, 43 percent of Independents).

54 percent believe the public option will increase premiums for Americans with private health insurance (78 percent of Republicans, 28 percent of Democrats, 58 percent of Independents).

Five out of 10 think cuts will be made to Medicare in order to cover more Americans (66 percent of Republicans, 37 percent of Democrats, 44 percent of Independents).

There were exceptions.

Fewer participants believe "myths" regarding the impact of proposed changes on current health insurance coverage. For instance, less than 30 percent think private insurance coverage will be eliminated. And just 36 percent think a public insurance option will put private insurance companies out of business.

In addition, only three out of 10 respondents believe the government will require the elderly to make decisions about how and when they will die.

Source: http://www.livescience.com/environment/ ... myths.html

Not only do Americans not believe that current reform efforts will result in meaningful change, neither do hospitals apparently which are projecting a huge windfall in profits if current reform measures pass ... Consider this next article in which the Tennessee Hospital Association projects a $16 million windfall if some of the current legislation passes ... http://prescriptions.blogs.nytimes.com/ ... ouse-deal/

Surely, Congress will come to a bi-partisan agreement to fix this mess, right? ... Well, maybe not according to Republican Sen. Grassley, one of the members of the "bi-partisan" gang of six who is now declaring that Bi-Partisanship on Health Care Is Likely Impossible ... http://www.huffingtonpost.com/2009/08/2 ... 68635.html

Prompting a Democratic member of the gang of six, Sen. Jeff Bingaman of New Mexico, to declare his support for using the budget reconciliation to pass the Democratic proposals for health care reform ... http://www.huffingtonpost.com/2009/08/2 ... 68518.html

Here's some insight into the most conservative Republican member of the "gang of six", Sen. Mike Enzi (R-Wyoming) ... Consider this article and/or listen to this recent radio report by NPR ... http://www.npr.org/templates/story/stor ... =112196348

The gang of six had recently been considering an insurance co-op plan forwarded by Sen. Kent Conrad, which we now come to learn was an idea pushed to him by Sen. Tom Daschle, who now lobbys for both sides ... Consider this next article from Huffington Post concerning the recent NY Times article on Daschle's role in the current health care debate ...

DASCHLE HAMMERED
Huffington Post Lobby Blog
August 24, 2009

This weekend, The New York Times offered a lengthy profile of Tom Daschle and his various roles as a go-between, serving the interests of clients of Alston & Bird -- a lobbying firm with many health care industry clients and the White House. Throughout it all, he claims to not be any sort of lobbyist. In fact, he's got an awesome new euphemism at his disposal:

Mr. Daschle is not registered as a lobbyist and recently told U.S. News and World Report that he preferred to describe himself as a "resource" to those in government and industry.

"I'd like to be a resource to my former colleagues, to the extent that I can, to the administration, to the stakeholders and to people interested in just kind of knowing how this is all going to play out," he said. "I am most comfortable with the word resource."

White House officials say they appreciate his help. "He is one of a number of people that provides outside advice to the White House, and the president greatly appreciates that advice and Tom's friendship," said Dan Pfeiffer, a spokesman for the White House who previously worked for Mr. Daschle. Mr. Pfeiffer added that the former senator was "a recognized expert on health reform who knows more about the legislative process than just about anyone."

Critics, though, say his ex officio role gives Alston & Bird's health care clients privileged insights into the policy process. They say Mr. Daschle's multiple advisory roles illustrate the kind of coziness with the lobbying world that Mr. Obama vowed to end. If he had been confirmed as health secretary, Mr. Daschle would have been subject to strict transparency and ethics rules.

Writing on these pages, Allison Kilkenny makes the case for connecting the dots:

But it was Daschle who first introduced the idea of nonprofit insurance cooperatives as an alternative to the public option. Daschle and his good buddy, Blue Dog Kent Conrad, came up with the idea of insurance co-ops which included the concept of "triggers" that landed Rahm Emanuel in hot water with progressive groups like Firedoglake when he first floated the idea past the public. Basically, the trigger idea meant that the public option would only become a reality if state co-ops or other programs failed to meet certain cost and coverage goals within five years. The idea sank almost immediately thanks in large part to progressive watchdog groups. Now, Henry Waxman told Roll Call, "[Emanuel] doesn't stand by the trigger...He said the president and his administration and he are for a public plan as one of the options."

Privately, Daschle tells his health care industry buddies that the public option is far from finalized. In order to calm the nerves of drug company executives, Daschle told them that "there is no consensus on whether there ought to be a public option." As recent as last week, he told the hospital executives, "There is virtually no support among Republican members for a public option, and that remains an unresolved element of this debate." Of course, Daschle is only concerned with support in Congress. Meanwhile, the newest polls indicated that Americans overwhelming support the idea of including a public option in health care reform.

Source: http://www.huffingtonpost.com/2009/07/0 ... 28657.html (scroll down to Aug 24, 2009, entries to find story)

As the desperate plea of the Oklahoma woman who showed up at Sen. Coburn's recent town hall poignantly demonstrates, the need for prompt and meaningful reform of our current health care system is indeed real. This next article/radio piece from NPR discusses how the homeless in America currently receive medical care and why change is indeed necessary ... http://www.npr.org/templates/story/stor ... =112177360

Then consider this new study reported by the Washington Post indicating that as the nation's economy plunges and more families face losing their homes their health deteriorates dramatically ... http://www.washingtonpost.com/wp-dyn/co ... 02333.html

And exacerbate those effects to consider the horrible economic news earlier today that the CBO is now project that the budget deficit will be $2 Trillion worse that the White House had originally projected due to the poor economy http://www.npr.org/templates/story/stor ... =112203044 ... which is projected to result in higher unemployment and even more foreclosures ... http://www.npr.org/templates/story/stor ... =112203044 ... or listen to this report on this new development from NPR ... http://www.npr.org/templates/story/stor ... =112203044

I think the biggest concern the Democrats have in passing health reform is not all the fear-mongering and recalcitrance from the right, but the huge budget deficit sitting in their own back yard. Consider this next article suggesting that perhaps the nation's budget woes should not be allowed to de-rail meaningful health care reform and why ... http://www.huffingtonpost.com/josh-bive ... 67540.html

Or perhaps, members of their own party blocking reform. This next article looks at that possibility and argues in favor of the Democrats remaining unified to bring about progressive social change for the good ... http://www.huffingtonpost.com/lincoln-m ... 67497.html

And from a political point of view, in the final analysis, losing or alienating the progressive wing of his own party may be a far more lethal blow to Obama's presidency than anything the GOP can muster ... http://www.huffingtonpost.com/earl-ofar ... 68091.html

So what can you do? If you support passage of reform legislation whcih includes a strong public option, you can help support OpenLeft.com, Democracy for America and Health Care for America Now efforts aiming to convince 8 Senators now on the fence about supporting a public option to announce their support and join the other 45 Senators who have already done so. The group hopes that by getting at least 50 senators on the record as supporting a public option, they can persuade other fence-sitters to jump to their side and push through a bill with a public option, even if only with Democratic support. Source/full story: http://prescriptions.blogs.nytimes.com/ ... ic-option/

So what can you do? (Notice the recurring theme) Well, if you're a progressive, maybe the better question is what can you not do? I love the sentiment and cynicism of this next progressive activist ...

My Dog Just Watered Your "Tree of Liberty"
by Michael Seitzman
Huffington Post, Aug. 25, 2009

Are you sick to death of the I-can-out-crazy-your-crazy screaming, the Obama-wants-to-kill-yo-mama infantilism, the he's-a-Kenyan-Nazi-Communist, America-doesn't-apologize, torture-shmorture, government-is-evil-except-when-it's-interrogating-Muslims, my-gun-gets-bigger-when-you-rub-it, and the O'Reilly-Beck-Hannity-Limbaugh Axis-of-Evil? If the answer is yes, I salute you. If the answer is no, I also salute you... with this one finger.

I have some advice for all of us. Stop trying to get these people to realize how wrong they are and how right you are. Stop trying to apply reason to the profoundly unreasonable. Stop trying to mitigate or explain their collective temper tantrum. Stop trying to curry their favor, their votes, their attention. They don't care about truth, right and wrong, good or bad. They care about stomping feet, crying victim, and pointing fingers. Barney Frank had it exactly right, it's like arguing with a dining room table. Enough is enough. Fuck Kumbaya.

I'm not sure what bothers me more, the profound and disturbing ignorance displayed by some, or the ones who know what's right but protest simply because what's right was proposed by the Left. Ironically, their elected representatives don't care about them any more than they care about us. They care about reelection, they care about influence and power, they care about themselves, and they mindlessly adhere to an antiquated ideology at our collective peril (see Sunday's Paul Krugman).

Don't be afraid of them. Don't let them question (or make you question) your basic instincts for goodness, decency, humanitarianism, and the attainable America you want and deserve. Don't let them intimidate you. Think of Vivian Jones and James Hood trying to attend their first day of college, facing those bloodthirsty crowds led by none other than the Governor of Alabama seething, "Segregation now, segregation tomorrow, segregation forever!" Those kids didn't run. Martin Luther King didn't run when that same governor called him a communist threatening the fabric of America. If they didn't run at the first sounds of anger, the first sight of guns, the first smell of stubborn ignorance, neither should we. And neither should President Obama.

Source: http://www.huffingtonpost.com/michael-s ... 68288.html

So for progressives, this bit of encouragement from fearless reform leader Mike Lux ...

Defeating the Coalition to Kill Health Care Reform
by Mike Lux,
Huffington Post, Aug. 25, 2009

For those of us continuing to fight for the President's proposals on health care- including covering everyone at a price they can afford, strong regulations on insurers, tough cost containment measures, and a public option to keep insurers honest- it can get discouraging sometimes. I continue to be concerned by the number of progressive friends I have who have become convinced that we cannot win this fight, and are on the verge of giving up. I believe that we are very much in this fight, that there is a clear path to victory, and that it would be a tragedy for those of you who have been fighting for this moment for so long to give up now.

It is easy to get discouraged. The array of forces in outright opposition- insurance companies, somewhere between 98% and 100% of Republicans in Congress, the massive right-wing attack machines- is huge and very loud. Traditional media is so relentlessly negative and cynical that it frequently seems as if they have just joined the coalition mentioned in the previous sentence- I guess they prefer covering a train wreck to seeing something substantive done. And the conventional wisdom/establishment-oriented Democrats who are all too ready to give up the fight for really comprehensive reform and just take the easier path of not really taking on the powerful insurance industry are perhaps the most discouraging of all- they have probably done more to undermine enthusiasm for the President's goals than anyone.

But for those of us fighting this battle in the trenches every day, it is clear that there is a path to victory. It's far from a lock, it will require work and backbone by progressives, but the path is in front of us. And my sense is that more and more people are seeing it as a real possibility- David Sirota had a column today on it, Chris Bowers has been writing about it, Digby and many others as well. And progressive groups and the Congressional Progressive Caucus are doing meetings every day, continuing to work the strategy.

So how do we win this fight?

Hold the progressives in the House to only vote for a public option. So far, so good. They've signed multiple letters, taken multiple pledges, sent a very clear message about their determination. They need to stay strong.

Get the Democrats in the Senate to accept that this will have to be a Democrats-only bill. This seems to be moving in the right direction. Schumer sent exactly the right message over the weekend, and it's clear things are beginning to head that way.

Split the bill into two parts in the Senate, with the public option and the financing going through the reconciliation process. Democats are sending signals that they are moving in that direction as well.
Get enough Senators on board for the public option. The whip count DFA and we at OpenLeft have been running shows us at 45. We need five more, and there are several Democrats I think are prime possibilities to come along if this is the path we go down.
Above all, don't panic. There will be some rough days ahead. Certain Senators will keep saying we can't get this done, and pundits will continue to shed the worst possible light on each day's events. But we just need to hang tough, hold strong, and keep working.
We are within range of a truly historic victory. Right now is exactly the wrong time for conventional wisdom Dems, or progressive activists, to throw in the towel.

When I was in the Clinton White House, our biggest victory was the 1993 budget fight. At a dozen points along the way, the media pronounced us dead, and some staffers in the White House had pretty much given up as well. But we kept fighting, and we ended up with the most progressive budget bill in the 43 years between 1965 and today. We raised taxes on the wealthy, cut them on the poor, and gave much-needed money to job training, education, environment, low-income folks, and other important domestic priorities. And we did it without a single Republican vote in the House or Senate.

We are now on the verge of a much greater achievement, but only if we don't lose our will and lose our nerve. If we keep fighting until the fight is done, we can make history.

Source: http://www.huffingtonpost.com/mike-lux/ ... 68396.html

Perhaps there are good lessons to be learned from the health care systems established by other leading democratic societies and nations ... like Canada: http://prescriptions.blogs.nytimes.com/ ... ad-canada/ ... or even Japan: http://prescriptions.blogs.nytimes.com/ ... oad-japan/

Perhaps President Obama does just need to be tougher - decide what is good, what is best, and then JUST DO IT! After all, that is what the winning throngs of citizens actually elected him to do. Consider this next piece by Arianna Huffington suggesting Obama should look to other Presidential role models like FDR and employ their strengths ...

Lessons in Leadership: Why Obama Needs to Brush Up on His FDR,
by Arianna Huffington,
Editor, Huffington Post, Aug. 24, 2009

Watching the gun-toting, Nazi-sign-holding town hall crazies, the talk radio charlatans, and the Palin-infected politicos, my first instinct has been to rally around President Obama and defend his handling of the health care debate against this Cuckoo's Nest menagerie.

But my better instinct has prevailed over my protective instinct. It's time to take a cold, hard look at how the president's leadership -- or, more accurately, his lack of leadership -- on health care has helped create the vacuum that allowed these fringe-dwellers and their preposterous claims to dominate the debate.

Recent polls show that while Obama's personal approval rating remains high (57 percent), only 49 percent of the public has confidence that he will make the right decisions -- down 11 percent from April. This means that Americans still like him, but have less faith in his leadership.

Given his incredible skills as a leader, this is deeply ironic. How could someone with a renowned ability to inspire, communicate complex ideas, and connect with voters find himself in this position?

Chalk it up to another of his strengths that seems to have failed him this time around. The president, though a dedicated student of history, has failed to learn the lesson of our nation's most significant political confrontations: they've required single-minded determination and the willingness to battle entrenched opponents until the fight was won.

The 19th Amendment, giving women the right to vote, the New Deal, Social Security, Medicare, the Voting Rights Act -- each of these required a bloody fight. Only after they were pushed into law, and people saw that they worked, did a consensus grow up around them.

Isaiah Berlin famously laid out two opposing styles of leadership in his essay "The Hedgehog and the Fox." The hedgehog doggedly and relentlessly pursues one big idea. The fox, on the other hand, flits and floats and tries to advance the way Obama has on health care -- by spinning, triangulating, and splitting the difference. And it's this foxy slicing and dicing of the message that the public is truly sick of, and which has created the vacuum that allowed the debate to devolve into nonsense about death panels and socialized medicine (In June, the public option was essential; in August it was "just one sliver" of reform. In September, not negotiating with PhRMA was called "a profound mistake"; in July, he agreed to do just that. Etc, etc, etc.).

There is no better example of what the hedgehog approach to leadership looks like than the way FDR handled the fight over Social Security. The story of how it passed, succinctly laid out by Prof. Jerome Karabel on HuffPost, shows that FDR faced many of the same obstacles Obama is facing, including stiff opposition from within his own party.

At one point, Sen. Bennett "Champ" Clark, a conservative Democrat from Missouri, introduced an amendment to weaken the bill by allowing employers to opt out of the program. It passed with the majority of Democrats voting for it. But FDR knew this would, as Karabel puts it, "fatally undermine" Social Security and vowed to veto any legislation containing the amendment. As Yale Professor Jacob Hacker sums it up, "Social Security passed not because Congress wanted it but because Roosevelt demanded it."

Soon after his election in 1932, FDR told a group of labor leaders who were pushing reformist legislation: "I agree with you, I want to do it, now make me do it." Contrast this with Obama, who has told his most avid supporters to settle down and avoid putting pressure on recalcitrant Democrats.

Of course, even if Obama were to summon his formidable grassroots army, as he attempted to do last week, exactly what is it they would be rallying around when knocking on doors or holding house parties? We've heard the mantra that the president wants "choice and competition." But how does he intend to do that? Specifically. He's been way too fuzzy -- and foxy -- on the fundamentals, with his administration delivering mixed messages from the very beginning.

Instead of laying out his vision for reform in unequivocal strokes -- drawing clear lines in the sand on what he will and won't accept in a bill -- Obama's plan is apparently whatever Charles Grassley and Max Baucus and Kent Conrad will accept. The president "guaranteed" he'll get reform done. But we're not worried that there will be no bill to which Obama affixes his signature. We're worried that the bill will be the equivalent of a Social Security bill containing Clark's poison pill amendment. And we are even more worried that the president will sign it, declare victory, and move on.

This is where Obama the pied piper, who builds consensus by charming and seducing, has to give way to Obama the leader who brings about change by laying down the law. This is not an issue where you are going to be able to get all the stakeholders together and have the health care equivalent of a beer summit, with everyone walking away singing Kumbaya. The president needs to drop the delusional notion that there is some perfect plan that will make everyone happy, from insurance companies to PhRMA to the people who want the government to keep its hands off of Medicare.

The consensus will come later, once reform has taken hold. You don't see many Republicans these days willing to come out in favor of repealing Social Security and Medicare. But if those programs weren't already in place, you can bet they'd be fighting against them just as hard are they are fighting against health care reform now. (Back in 1961, Ronald Reagan warned that if we passed Medicare we would "spend our sunset years telling our children and our children's children what it once was like in America when men were free.")

Speaking of the entrenched interests arrayed against him, FDR said: "Never before in all our history have these forces been so united against one candidate as they stand today. They are unanimous in their hate for me -- and I welcome their hatred." Obama, on the other hand, welcomes these entrenched interests into the Oval Office and invites them to amputate another limb off health care reform and dump it in the garbage on the way out.

Such is the desire for real reform that even the poorly explained -- and only fitfully supported by the White House -- public option (which, it's worth noting, is already a half-a-loaf compromise from a Medicare-for-all single-payer plan) still has 77 percent support among the public.

But Kent Conrad is telling us again and again that "there are not the votes" for a public option. And Marc Ambinder reported last week that "privately, White House aides have communicated to the House leadership that the onus on changing minds about the public plan is on Congress, not on the president."

That is not, to say the least, leadership.

The issue that is, for now, the defining moment of Obama's presidency is itself at a defining moment.

The president has, rightly -- finally -- started speaking of health reform as a "moral imperative." If he really believes that it is a moral imperative, then the time for dealing with those who oppose it needs to come to an end. Martin Luther King, Jr. didn't march on Selma so Rosa Parks could sit two rows up from the back of the bus.

During the campaign, Obama frequently said that this wasn't about him, but about all of us. That's true, but we're now at a juncture where it actually is about him.

The president has the leadership skills to reclaim this debate and take it directly to the American people, sidestepping -- or running over, if need be -- those who have decided to stand in the way of real change.

Source: http://www.huffingtonpost.com/arianna-h ... 67710.html

Well said Arianna! Mr. President are you listening?

And finally, here's the daily "snozzleknocker" (hey, it's my twins only chance to participate in the column!) – Bill Maher discusses health care reform on the tonight show … Here’s Maher’s advice, if Obama wants to win the health care debate, “Obama should just wake up tomorrow and declare ‘Jesus told me to fix health care’” … & although Maher’s being funny, he’s also right … maybe the President should just stand up and rally his party to ignore the fear and do the right thing by America and her (read - yours/my/our) children - Provide Them Health Care! ... Watch the video: http://widgets.nbc.com/cscallback/urlex ... 86.j.fap8Q

[roxybeast]

Rather than discussing legislative reform, I found this next article interesting because it is by a doctor who is an advocate for wellness and prevention, who discusses the 10 things in his medical view that will best address and fix the problems with America's current health care system ...

True Health Care Reform: 10 Missing Pieces
by Dr. Frank Lipman, Integrative Physician
Huffington Post, August 25, 2009

I applaud President Obama for his efforts. I too believe that everyone deserves proper healthcare and that access to healthcare must be a right for all. But I think Washington is barking up the wrong tree. They're busy arguing about what amounts to health insurance reform, while what this country needs is true health care reform.

Interestingly, what is happening in Washington mirrors much of what we do in Western Medicine. We suppress symptoms instead of dealing with the root causes of the problem. All the options on the table now only address how we pay for healthcare, rather than why we are unhealthy and how we change that. If we don't change why we are unhealthy, not only are we unlikely to secure better medical outcomes, but it will probably bankrupt us too. In terms of getting better health care or becoming a healthier nation we have to make serious changes. We will only flourish if we address the root causes of the problem.

As a nation, we're highly skilled in crisis care and the treatment of life- threatening diseases. But we're rank amateurs when it comes to the equally important issues of preventative care and the management of chronic diseases such as diabetes, heart disease, obesity and many cancers. True healthcare reform needs to provide greater support to these areas as at least 75% of our medical costs are spent on treating these chronic diseases.

Recently on Huffington Post, four physician colleagues of mine Andrew Weil, Dean Ornish, Deepak Chopra, and Mark Hyman all eloquently articulated the problems we face. I won't repeat their arguments, instead I will present some facts about our system and will offer some recommendations many of which complement their thoughts.

We have an outrageously expensive medical system. Our costs are more than double that of any other country.
In spite of the expense, over 45 million of our citizens have no coverage, whereas most other developed countries insure everyone.
Our system doesn't work well for preventing and treating the chronic diseases that are causing our costs to skyrocket.
According to the World Health Organization's rankings, the U.S. (health-care system) is 37th in overall performance.
Our system is not particularly safe. Millions of people are hospitalized annually or suffer from serious side effects of properly prescribed drugs or medical errors.
I don't claim to have all the answers and some of these suggestions may seem unrealistic given our current system, but to fix health care in this country we need radical change.

In addition to my strong belief that any civilized society should guarantee healthcare for all its citizens without exception, here are 10 recommendations that I feel should be an essential part of any health care reform.

1) Invest in educating the public in self care

Ultimately the most effective way to increase the health of the nation and to cut healthcare costs in the long term is if we all take responsibility for our own health and learn prevention. It has been repeatedly shown that what we eat, how we respond to stress, how much exercise we get, our exposure to chemicals and the quality of our relationships and social support systems is powerful medicine. Unfortunately most of us don't know how to do this, so training health coaches to go out and educate the public would help.

2) Motivate people by rewarding lifestyle changes that foster health.

We should encourage and reward people who take responsibility for their own health. Help pay for or give tax deductions for gym memberships, yoga classes, cooking classes, instruction in relaxation techniques, and appropriate doses of certain supplements like Vitamin D, fish oils and probiotics. Visits to Healthcare Professionals for lifestyle counseling and disease prevention should be encouraged and covered.

3) Educate Doctors and other Healthcare Practitioners in nutrition, exercise, stress reduction techniques and natural remedies.

Hundreds of billions of dollars are wasted by doctors when they request unnecessary tests, over prescribe drugs (often with harmful effects), and perform unnecessary surgeries. Many of these services are reimbursed because of lobbyists and clinical practice guidelines established through industry influence or custom, not because the reasons for doing them are scientifically sound. Educating doctors to start with the least expensive, least harmful and least invasive treatments, while having a backup of the "big guns" when needed, would prevent a lot of unnecessary expense. The Institute of Functional Medicine, has a clinical model that is extremely effective for the prevention, assessment and management of chronic diseases. It has already trained over 10,000 doctors and should become part of every doctor's training.

4) Reimburse doctors for their time in preventing and managing chronic diseases.

In the current model, the reimbursement structure financially rewards crisis care and disease care, but not prevention, early intervention and effective long-term management. But we now understand that chronic diseases develop over many years because of an individual's genetic makeup combined with their lifestyle, environment and social network. The effectiveness of a Functional Medicine approach to chronic disease has been demonstrated, so the tools we need to reduce the burden of chronic disease are available. But it requires more than just a 10 minute consultation. To encourage doctors to practice preventative care, they need to be paid not only for expensive procedures, but for the time they spend with patients supporting them through these changes. In addition, we need to train health coaches or other health care practitioners to provide this personalized, preventive and participatory medicine.


5) Practice the Precautionary Principle.

In brief, the Precautionary Principle states that: "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." Before chemicals or other engineered substances that may impair body functions and cause diseases are put into our food, water, soil, air, cosmetics and home products, they need to be proven safe. At the moment, our attitude to these chemicals is that they are innocent until proven guilty. They should be assumed guilty until proven innocent.

6) Protect our food supply and encourage healthy eating

The Health and Agriculture departments should work together and apply the Precautionary Principle to our food production. Harmful pesticides, additives and other chemicals should not be used in our food production until proven safe.
Food labeling should be honest, for instance, irradiated and GMO foods should be labeled as such.

Local farmers and farmers markets and the consumption of fresh and seasonal foods should be actively supported and encouraged.

7) Feed our children healthily and educate them responsibly.

Serve fresh unprocessed food for school lunches, food that's nutritious instead of just cheap and convenient. Eliminate junk food and soda vending machines from all schools (and while we are at it, from all public buildings and airports).

Put organic vegetable gardens in schools especially in low-income areas. This not only provide kids with nutritious food to eat, but it also teaches them about the importance of nutrition in general and how to grow their own food.

Ban the advertising and marketing of junk food, sodas and fast food to children...$13 billion is spent annually on it. We should not be convincing children--or adults--to buy products that harm them.

Don't eliminate physical education programs from the schools as is happening now with budget cuts.

Subsidize healthy foods like fruits and vegetables.

Most of the billions of dollars in subsidies go to huge agribusinesses that produce feed crops, such as corn and soy. By funding these crops, the government supports the production of factory farmed meats and dairy products. Corn is also made into high fructose corn syrup. All of these contribute to our growing rates of obesity and chronic disease. Fruit and vegetable farmers, on the other hand, receive less than 1 percent of government subsidies. Switch these subsidies around.

9) Remove corporate influence from healthcare.

Corporate influence should not be what drives the system. According to The Washington Post, 1.4 million dollars a day is being spent by healthcare interests to get what they want in the new health bill. There are 4 lobbyists for every Congressman on Capitol Hill. They should be banned. Unfortunately the self interest of these parties often works against outcomes that would better serve our collective and societal good.

Stop direct-to-consumer drug advertising and radically limit the more than $30 billion that is spent by the pharmaceutical industry on marketing drugs to physicians.

10) Give everyone freedom of choice

Lastly, people should have the freedom to choose what method of treatment they want to follow, whether conventional or alternative, western or non western, traditional or non traditional.

Focusing only on how people can get access to costly disease treatment, without having the more important discussion about how lifestyle changes can be implemented to prevent these diseases in the first place, is like rearranging the deck chairs on the Titanic. We will simply be perpetuating a flawed and costly healthcare model. For the sake of not only our personal health, but also for the financial health of the nation, we must address the causes that underlie the prevalence of chronic disease that we are experiencing. Unless we address why people are getting sick or the underlying mechanisms of their illnesses, our system will lack a solid foundation. Unless we change our disease care model to a true health care system, we are bound to both overpay and underachieve in the long run.

Frank Lipman MD, is the founder and director of the Eleven Eleven Wellness Center in NYC a center whose emphasis is on preventive health care and patient education.

Source: http://www.huffingtonpost.com/dr-frank- ... 66734.html

In case you doubted the need to heed any of the doctor's advice, consider this next article examines how our current health care money is being spent ... and not surprisingly finds that the largest portions are going to treat the elderly, obese, and (what a surprise!) those who identify themselves as "unhealthy" ... did we really need a study to tell us this? Or to remind us that we need better wellness and prevention programs, which is another primary reason to reform our current system: http://prescriptions.blogs.nytimes.com/ ... ollars-go/

[roxybeast]

Can and should the Democrats use the budget reconciliation process to pass sweeping health care reform? Well, based on Republican history in using the very same process to pass their non bi-partisan agenda prior to the 2004 elections, the answer is plainly, yes. Or will the Democrats put form over substance? Consider the next couple of articles ...

We Are Not At the Mercy of 60 Votes
by: Chris Bowers
Mon Aug 24, 2009

When it comes to passing health care reform through the Senate, Matthew Yglesias thinks that we are at the mercy of a handful of "moderate" Senate Democrats:

As I've said from the beginning of this process, the most important known unknown in health reform is nothing to do with the Obama administration's tactics and everything to do with the actual subjective premises of the handful of moderate Democrats who control the balance of power in the Senate. If Max Baucus, Kent Conrad, Mary Landrieu, etc. want to see a universal health care plan enacted there's nothing stopping them. But if they don't want to see a universal health care plan enacted, neither the left nor the White House has any particularly impressive leverage to use against them.
--Matthew Ygelsieas, August 24th

I am going to have to disagree with Matt on this one. As a wise man wrote only 19 days ago, there is nothing that can stop Senate Democrats from passing health care reform with fifty votes if they want to:

But the flipside of that is that, as I've said before, if Joe Biden, Harry Reid, and 49 other Senators want to change the filibuster rule or deem a health plan eligible for reconciliation or whatever else they like nobody can stop them. The Senate itself is the only adjudicator of its own procedures.
--Matthew Yglesias, August 5th

The reason I am going to side with August 5th Matthew Yglesias on this one is that he was right. The fact is that Democrats only need 50 votes, plus the Vice-President, to sustain a ruling from the Senate chair that health care reform legislation with a public option can be passed with only 51 votes. This is the case even if the Senate Parliamentarian disagrees.

The only objection to this is political, not substantive. It can be argued that pushing health care reform with a public option through reconciliation is a bad idea politically. However, it cannot be accurately argued that it is impossible to do so. After all, if 50 Senate Democrats plus Vice-President Biden wanted to do so, they could actually eliminate the filibuster altogether, much less get around it only for health care reform legislation.

If they want to, Democrats can pass health care reform with a public option through the Senate with only 50 votes plus Vice-President Biden. If reconciliation is not used, it is because Senate Democrats decided Senate process is more important than a public option, not because Senate Democrats were forced into abandoning the public option by Senate process.

Remember and consider that the Bush administration used the reconciliation process several times (at least 6) to push their stuff through with less than 60 votes, on far less important issues, and still kept the White House in the elections that followed.

Democrats Beginning to Seriously Consider Using Reconciliation on Health Bill, from (Non-Partisan) Electoral-Vote.com

After months of trying to get a bipartisan deal with the Republicans on health care reform, there is increasing momentum now on using the budget reconciliation process to ram a bill through the Senate using a parliamentary maneuver that cannot be filibustered. Once the House and Senate have passed (different) bills, a conference committee will come up with a single bill or possibly two bills. It is likely that aspects all Democrats agree on will be in a single bill that will follow the normal rules and on which cloture will be invoked. The controversial parts will likely go in a second bill that will be subject to a straight up-or-down vote, with 50 votes (plus Joe Biden) being enough to pass it. In this way, even if some conservative Democrats, such as Sen. Ben Nelson (D-NE) and Sen. Blanche Lincoln (D-AR) vote against it, it will still pass.

While Republicans will be enraged by this tactic, the Democrats are now circulating an unsigned memo explaining how reconciliation works and pointing that it has been used 19 times since the process was established in 1980, most recently six times during the Bush administration. In particular it was used in 2001 and 2003 to pass large tax cuts for the wealthy over Democratic objections. Some of the things Republican senators said then may come back to haunt them now. For example, Sen. Judd Gregg (R-NH) said: "Is something wrong with 'majority rules'? I don't think so."

An alternative way to get things done is the way Lyndon Johnson got his health care bill (Medicare) through. He knew exactly how to cajole and pressure every member of Congress. He'd get Billy Graham to call Baptists, Cardinal Cushing to call Catholics, Martin Luther King to call blacks, etc. He'd have a list of everyone's campaign contributors and get them to pressure lawmakers. He'd tell reporters why it was important for their own families. And on the dark side, he knew where all the skeletons were buried and wasn't afraid to remind members that he knew. In short, he could play Congress like a violin, something Obama doesn't know how to do or isn't willing to try. Here is an interesting summary of the LBJ treatment.

Source: http://www.electoral-vote.com/evp2009/S ... 5-s.html#1

Since we called on President Obama in our earlier piece today to look to FDR for guidance, perhaps we should also consider this CNN article describing what LBJ had to do politically to pass Medicare originally:

Commentary: What LBJ would do
CNN, August 24, 2009

Editor's note: President Lyndon B. Johnson secured passage of Medicare, the Voting Rights Act and other milestone legislation. Tom Johnson, who served as one of LBJ's White House press secretaries, is former chief executive of CNN News Group and former publisher of the Los Angeles Times. He is an associate member of the board of visitors of the University of Texas M.D. Anderson Cancer Center.

(CNN) -- LBJ would:

Have a list of every member of Congress on his desk.

He would be on the telephone with members (and their key staffers) constantly: "Your president really needs your vote on this bill."

He would have a list of every special request every member wanted -- from White House tours to appointments to federal jobs and commissions.

He would make a phone call or have a personal visit with every member -- individually or in a group. Charts, graphs, coffee. They would get the "Johnson Treatment" as nobody else could give it.

He would have a willingness to horse-trade with every member.

He would keep a list of people who support each member financially. A call to each to tell them to get the vote of that representative.

He would have Billy Graham calling Baptists, Cardinal Cushing calling Catholics, Dr. Martin Luther King calling blacks, Henry Gonzales calling Hispanics, Henry Ford and David Rockefeller calling Republicans.

He would get Jack Valenti to call the Pope if it would help.

He would have speeches written for members for the Congressional Record and hometown newspapers.

He would use up White House liquor having nightcaps with the leaders and key members of BOTH parties.

Each of them would take home cufflinks, watches, signed photos, and perhaps even a pledge to come raise money for their next election.

He would be sending gifts to children and grandchildren of members.

He would walk around the South Lawn with reporters telling them why this was important to their own families.

He would send every aide in the White House to see every member of the House and Senate. He would send me to see Sen. Richard Russell and Rep. Carl Vinson because I am a Georgian.

He would call media executives Kay Graham, Frank Stanton, Robert Kintner, and the heads of every network.

He would go to pray at six different churches.

He would do newspaper, radio and TV interviews -- especially with Merriman Smith, Hugh Sidey, Sid Davis, Forrest Boyd, Ray Scherer, Helen Thomas, Marianne Means, Walter Cronkite, Phil Potter, Bob Novak.

He would threaten, cajole, flirt, flatter, hug -- and get the health care bill passed.

Source: http://us.cnn.com/2009/POLITICS/08/24/j ... index.html

[roxybeast]

The Nation Holds Its Breath and Awaits Obama's Remarks
by Beth Isbell
August 26, 2009, 11:00 pm

Yesterday marked the death of the "Lion of the Senate," Sen. Ted Kennedy (D-Mass), who was a leading proponent of national health care reform. Thus the question arises, Will Kennedy's Death Revitalize Health Care Push? Consider this story from NPR ... http://www.npr.org/templates/story/stor ... =112249206

This editorial offered by Robert Reich in the Huffington Post earlier today nicely sums up this growing sentiment:

Ted Kennedy's Passing: An Inestimable Loss
by Robert Reich
Huffington Post, Aug. 26, 2009

America has had a few precious individuals who are both passionate about social justice and also understand deep in their bones its practical meaning. And we have had a few who possess great political shrewdness and can make the clunky machinery of democratic governance actually work. But I have known but one person who combined all these traits and abilities. His passing is an inestimable loss.

Most Americans will never know how many things Ted Kennedy did to make their lives better, how many things he prevented that would have hurt them, and how tenaciously he fought on their behalf. In 1969, for example, he introduced a bill in the Senate calling for universal health insurance, and then, for the next forty years, pushed and prodded colleagues and presidents to get on with it. If and when we ever achieve that goal it will be in no small measure due to the dedication and perseverance of this one remarkable man. We owe it to him and his memory to do it soon and do it well.

Source: http://www.huffingtonpost.com/robert-re ... 69025.html

Improving the nation's health care system and providing universal coverage was a major legislative focus for Kennedy, and sadly, as the Washington Post and Associated Press report, one of his biggest regrets: “Generations of aides recall Kennedy telling them the biggest mistake of his career was turning down a deal that President Richard M. Nixon offered for universal health care,” The Associated Press writes. “It seemed not generous enough at the time. Having missed the opportunity then, Kennedy spent the rest of his career hoping for an elusive second chance.” Source/full story: http://prescriptions.blogs.nytimes.com/ ... -presence/ ... and ... http://www.huffingtonpost.com/2009/08/2 ... 69935.html

Perhaps, this is why, in his last days, Sen. Kennedy pushed so hard to have a Democratic successor appointed to fill his Senate seat ... http://www.nytimes.com/2009/08/27/us/po ... cceed.html

In her editorial, Arianna Huffington noted, "Kennedy has been fighting to guarantee every American access to affordable, quality health care for forty years. Writing about that battle this summer, [Sen. Kennedy] called it the 'cause of my life.' 'It has never been merely a question of policy," he said, 'it goes to the heart of my belief in a just society.'" Source/full story: http://www.huffingtonpost.com/arianna-h ... 70053.html ... in a TV interview, Ms. Huffington went on to say: "Obama needs to rise to that occasion and actually speak passionately about health care as a moral imperative, the way Ted Kennedy has been speaking about it for forty years." Arianna told Ed Schultz Wednesday night on The Ed Show. "This is not just about cost cutting, important though cost cutting is, this is really about the next step in America's journey towards becoming a more perfect union." Source with VIDEO of the interview: http://www.huffingtonpost.com/huff-tv/a ... 70008.html ... the video includes actual footage of Sen. Kennedy on the floor of the Senate railing against opposition to reform!

So perhaps it is fitting that we correct his biggest regret and honor Sen. Kennedy by passing meaningful health care reform for all Americans. Already, Sen. Robert Byrd has now called to rename the health care reform legislation in Kennedy's honor ... http://voices.washingtonpost.com/capito ... eform.html

While chief right wing fear monger radio show host Rush Limbaugh patted himself on the back for predicting this would happen ... http://www.huffingtonpost.com/2009/08/2 ... 69711.html (with an audio clip from his radio show featuring clips from a lot of Democratic sources on the meaning of Kennedy's death to passing health care reform, followed by his back patting), reform opponent Rick Scott pulled his group's anti-reform ads saying that he wanted to pay respect to the passing of Sen. Kennedy ... http://www.huffingtonpost.com/2009/08/2 ... 69920.html ... while the former Republican VP-Presidential candidate Sarah Palin encourages the nation to "watch Glenn Beck!", seriously ... http://www.huffingtonpost.com/2009/08/2 ... 69559.html

Consider this editorial by Robert Creamer at the Huffington Post ...

Greatest Tribute to Kennedy: Pass Health Care for All
by Robert Creamer,
Huffington Post, Aug. 26, 2009

There has been much commentary that the Senate debate on health care would have benefited from the parliamentary and personal skills of Senator Ted Kennedy had he been present over the months of illness that took his life last night. But it would have benefited even more from his moral clarity.

He knew - better than anyone - that the debate over health care is not mainly about competing policies, programs and formulas. It is certainly not about the myths and lies propounded by the far right. He knew it is about right and wrong.

The decision facing America is whether - at long last - we will inscribe into our law the principle that health care is a human right - that everyone among us deserves health care simply because we are all human beings.

Ted Kennedy believed that to his core. It was his life's passion. It would be fitting if his passing itself served to refocus the health care debate on the moral principle that lies at its center. It would be his last great contribution to the struggle that more than any other defined his 47-year career in the Senate - the battle to make health care for all a reality in America.

Yesterday, many Americans watched footage from a health town meeting conducted by Senator Tom Coburn. We watched as a woman begged Coburn for help so that her husband could afford the care he needs to recover from the affects of traumatic brain injury. Coburn offered the aid of his office. But then he argued that the real problem is that neighbors don't help neighbors --that we should not depend upon "government."

Kennedy knew - as his friend Congressman Barney Frank says - that Government is nothing more than the name we give to the things we choose to do together.

He knew that it is wrong for any American to have to beg to get health care for their husband - or their child - or themselves. Just wrong.

We can debate the relative effectiveness of structures and the systems of incentives needed to most efficiently provide the health care we need. But there should no longer be any debating the fundamental principle that all of us deserve the same quality health care - no matter how much we earn, or who our parents are, or where we live, or the color of our skin, or how old or sick we may be.

That principle is accepted worldwide as a central element of what it means to live in a civilized society. It is a core tenant of what we understand to be universal human rights.

Yet the Republicans and far right have fought against the implementation of that principle in America ever since Roosevelt first called for universal health care in the 1930s. They fought it under Truman. They fought Medicare when it was passed as a first step to fulfilling that principle in the 1960s. They fought the State Children's Health Care Program that expanded that principle to children.

Their rhetoric is always the same. Ronald Reagan's speeches against Medicare in the 1960s - his charges that Medicare would lead to socialism and tyranny - could just as easily be transcriptions of the talk show tirades of Limbaugh and many Republican members of the Senate today.

But this time things will be different. This time the spirit of Edward Kennedy will infuse all of us with the determination and moral clarity to make his life's passion into the law of the land.

Source: http://www.huffingtonpost.com/robert-cr ... 69244.html

Consider Sen. Kennedy's view on health care in his own words:
http://www.youtube.com/watch?v=LhYtMmw9OVk

Which leads to the inevitable conclusion that any health care reform legislation named after Sen. Kennedy had better not suck! As Huffington Post columnist Bob Cesca both reminds & warns us ...

Healthcare Reform Named After Ted Kennedy Must Not Suck
by Bob Cesca
Huffington Post, Aug. 26, 2009

If they're going to name the final healthcare reform bill after Senator Kennedy, we ought to be demanding with voices as powerful and booming as the late senator's...

The bill must not suck.

But if it does, perhaps they should name it after Max Baucus and Chuck Grassley. The Blame Baucus and Grassley for This Sucky Act. Or maybe borrow the name of the House bill, the America's Affordable Health Choices Act, which, by the way, reminds me more of a frozen diet meal than a robust healthcare reform bill (the final House bill is actually pretty robust -- it's just a ridiculous name).

On this day of national mourning, we're reminded that Senator Kennedy's political legacy has been inextricably bound to the cause of universal healthcare. Affordable, portable, reliable healthcare.

It's difficult to know for sure, but I can't imagine, had he not been stricken with cancer, that the senator would be lending his unmistakable baritone to the awfulness, equivocation and bipartisan hackery that's on display within the ranks of the Max Baucus 'Gang of Six'. It goes without saying that left to their own spineless and corrupt devices, these six senators will absolutely deliver a terrible healthcare reform bill, one that would only serve to besmirch the Kennedy legacy.

So what exactly does a sucky healthcare bill look like?

Naturally, without a beefy public health insurance plan, healthcare reform would be an utter disaster -- or worse. To refer to the public option as just a "sliver" of the bill, or to push for eliminating it altogether is almost as bad as having no reform at all. Journalists, writers and bloggers who I otherwise respect have been damning the public option with faint praise lately. Let's not sabotage healthcare reform with partisan ultimatums, they say. We can have a great bill without it, they say.

No, sirs. No we can't.

They're not seeing the big picture here. I get it, though. There are many other meaningful aspects to healthcare reform. Banning exclusions for pre-existing conditions, setting caps on out of pocket expenses, bans on rescission. These are all excellent and historic.

But tossed into the mix with these items is the necessity for individual and employer mandates which, like car insurance, would require everyone to buy health insurance. Simply put, mandates will spread out the risk and help to control costs by making sure everyone can pay for medical treatment. So if your 1040 shows that you can afford it (around $88,000 per year for a family of four), you'd have to purchase insurance by law, though there are proposals on the table for allowing government subsidies to help families earning up to $110,000 annually.

However, as I've been writing about on my daily blog for the last week or so, without the public option, such mandates would be nothing less than an ongoing financial endorsement of corporate crime.

In other words, the public option is an option of good conscience.

Without a public plan, mandates would transform what would otherwise be a landmark reform bill into a massive and perpetual handout to the healthcare industry. You and I would have no choice but to pay a monthly tribute to the worthless bastards at UnitedHealth, CIGNA, Aetna and Blue Cross every month until we died, went broke or reached the age of 65.

Put another way: either we're forced to financially support an industry that has knowingly allowed thousands of Americans to die by denying them healthcare when they need it most , or we operate without a safety net while also paying a hefty annual penalty to the federal government. Nice. I'm not sure which is more punitive. A solid public option, on the other hand, solves this wicked catch-22. It will allow many of us to both purchase affordable, portable and reliable health insurance, while also serving as an expression of our disgust with the Mafioso-style business practices of the private insurers.

The former scenario -- the mandates but no public option scenario -- is practically unthinkable (with or without Senator Kennedy's name). Wrapping my conscience around a being legally forced to buy private health insurance, regardless of new regulations and knowing everything I know about how the private insurance industry has operated all these years, would be almost impossible for me. I honestly don't know what I'd do. In a political sense, the president and the Democratic Party will have succeeded in authoring and passing a bill that would boil down to nothing less than a massive, almost unprecedented subsidy to the private health insurance oligarchy.

And we'd have no way out. In fact, you and I would've spent years of our lives mobilizing and activating for healthcare reform only to wind up with a bill that sanctions us to subsidize the very enemy we've been fighting all this time. Senator Kennedy would've spent his career fighting for what will have devolved into an enormous corporate giveaway disguised as "universal healthcare."

That's what a sucky bill looks like.

Regardless of the name of the bill, I can think of no greater way to honor Senator Kennedy's legacy of activism for this cause than for us to stand up and, in his place, to vigorously fight for a bill that includes an option of good conscience -- a bill that provides a real public insurance option.

Source: http://www.huffingtonpost.com/bob-cesca ... 69690.html

So what progress is actually being made in the effort to fulfill Kennedy's dream? The parties remain at loggerheads. While Democrats continue to try to rally support for their version of meaningful health care reform ... http://prescriptions.blogs.nytimes.com/ ... ic-option/ ... the GOP continues to push it's new senior health care bill of rights, http://voices.washingtonpost.com/44/200 ... _righ.html ... and it's campaign to de-rail the public option.

For example, Ron Williams, the mega millionaire CEO of health insurance giant Aetna, said: “This whole question of the public program is really a diversion against the central goal that we should have to get and keep everyone covered. One person who is uninsured is one person too many.” Of course, then he went on to argue that the public option will not work to spur industry competition. Source/full story: http://prescriptions.blogs.nytimes.com/ ... straction/ ... Gosh, would you expect him to say otherwise? After all universal coverage through only private plans will boost his revenues. A public option would cut into anticipated windfall profits.

The GOP's leaders push the same argument offered by their funders. For example, former Republican Presidential candidate, Sen. John McCain (R-AZ), (when not chiding his supporters to show more respect for the President, as discussed [with video] in yesterday's column, or for more details, see: http://www.huffingtonpost.com/phil-bron ... 69555.html), laid out the Republican strategy for health care reform at his town hall meeting earlier this week. McCain stressed to the crowd that "to do nothing is not the answer," but then said that "to have a government takeover is exactly the wrong way to go" ...

"You don't have to take my word for it, friends, we're talking about a new trillion-dollar or multi-trillion dollar debt laid on Americans,'' he said. McCain, who agrees with Obama on the need for reform but disagrees with his approach, used his time to stress a main point of contention. "What we cannot, and must not do is the quote, public option, which is really the government option," he said. A public option, he asserted, will lead to "the disappearance of private insurance over time." McCain said he'll view health-care reform talks slated to resume in September as "a beginning" if lawmakers remove the public option from the negotiating table.

Source (with VIDEO of Sen. McCain's remarks): http://voices.washingtonpost.com/capito ... lleng.html

All the anti-President cheering and lack of respect shown by audience members at McCain's rally may be the result of a deliberate shift in the GOP to move more toward the hard political right, as columnist Jonathan Chait recently noted in the New Republic:

"What we are witnessing is the convergence of the mainstream Republican culture with the right-wing political subculture. Last year, the two remained clearly distinct. During the presidential election last fall, angry people began showing up at John McCain's rallies, screaming out various lunatic conspiracy theories. McCain reacted to these supporters with discomfort or puzzlement. Here he was accusing Obama of massive tax hikes or palling around with Bill Ayers, and attendees at his rallies were shouting about Obama being an Arab or plotting to destroy the country. McCain would squint his face as if to wonder, 'What are these people talking about?'

"Now, mainstream Republican leaders are reading from the same hymnal. You don't need to rely on poorly written, all-capital-letter e-mails for your lunatic conspiracy theories. You can get them straight from the GOP and its message organs.

"What distinguishes the right-wing subculture is not that it relies on lies. The mainstream political culture does, too. But mainstream lies -- John McCain wants to give special tax breaks to oil companies; Obama voted for kindergarten sex education -- operate within the context of plausible assumptions about how government works. The lies of the right-wing subculture, on the other hand, incorporate fantastical beliefs."

Source: http://www.washingtonpost.com/wp-dyn/co ... 024_2.html

Need more proof of this shift in the Republican party's platform & opposition tactics? Their newest tactic seems to be to enlist the hard core anti-abortion activists to do their town hall dirty-work. Consider this WSJ article entitled "Abortion Is New Front in Health Battle" ... http://online.wsj.com/article/SB125132812733462063.html ... and here's video of an anti-abortion activists being thrown out of a recent town hall meeting on health care reform after rushing the stage and ritualistically chanting Congressional Representative Jim Moran (D-Va), appearing with Democratic pro-reform strategist Howard Dean, "We Won't Pay For Murder" ... and calling him a baby-killer and then declaring that Howard Dean supports killing babies by supporting this legislation. Here's the link with video of this disturbing incident ... http://www.huffingtonpost.com/2009/08/2 ... 69974.html ... didn't the Supreme Court already settle that?

Republican Sen. Mike Enzi, "one of three Republicans ostensibly negotiating health care reform as part of the Senate's 'Gang of Six,' told a Wyoming town hall crowd that he had no plans to compromise with Democrats and was merely trying to extract concessions. Meanwhile, some of his "constituents criticized him for taking significant campaign cash from the health insurance industry while opposing a public insurance option that would compete with private plans and take a bit out of their bottom line." "Sen. Charles Grassley (R-Iowa), another of the three Republicans continuing to negotiate -- or at least to meet -- has said that even if he agrees to a deal, he won't vote for it unless he can persuade a good many of his fellow Republicans to go along as well -- a prospect that would only be possible in the face of a dramatic Democratic capitulation. The Republican negotiators are under intense pressure from GOP leadership to walk away from the discussions. Earlier this week, one of the three Democrats in the talks, Sen. Jeff Bingaman of New Mexico, said that he would support passing health care with a simple majority if it became clear the GOP wasn't serious." Source/full story: http://www.huffingtonpost.com/2009/08/2 ... 69447.html ... and the pressure on GOP Senators to roadblock reform is only intensifying ... http://voices.washingtonpost.com/ezra-k ... ssley.html

So who's paying to kill health care reform? I love this new chart! http://www.facebook.com/photo.php?pid=3 ... 1084699987 ... and see this story for details ... http://www.huffingtonpost.com/mike-papa ... 69991.html ... and then consider ...

"They're playing a sophisticated game at the front of the pack," said Campaign for America's Future's Roger Hickey in an interview with the Huffington Post. "They're trying to pretend that they're in favor of reform and they're spending some money on advertising that looks like
it's pro-reform. And at the same time they're working pretty hard to make sure the public plan is not in the final version. They're primarily using their political contributions and their lobbying
efforts to do that."

As the chart shows, AHIP is encouraging the employees of its members to attend town hall meetings. The chart also has AHIP pumping money into big PR firms, something unproved that AHIP denies -- though reform advocates suspect it's true.

"'Launder' is a strong word, but that's essentially what happens," said Wendell Potter, a former CIGNA executive turned reform advocate. "They pay money to big PR firms and set up front groups and use connections with members of Congress. These are their shills."

Source: http://www.huffingtonpost.com/2009/07/0 ... 28657.html

That the GOP's opposition may be disingenuous and driven by health insurance contributions more than true ideology is aptly demonstrated by the following observation:

But as the liberal Web site Think Progress has pointed out, Steele's own Republican National Committee took to the airwaves in 1996 to support a resolution in the Republican-controlled Congress mandating $270 billion in Medicare cuts over seven years. That works out to $39 billion in cuts per year, which (factoring in inflation) would be equivalent in 2009 dollars to $53 billion in cuts per year. The $500 billion in Medicare cuts projected in the House health reform bill would occur over 10 years. That works out to $50 billion in cuts per year. The GOP is therefore sounding the alarm over Medicare cuts that, on an annual basis, are smaller than cuts the GOP itself has called for in the past.

Source/full story: Timothy Noah, Slate, http://www.slate.com/id/2226278/ ... and ... http://thinkprogress.org/2009/08/24/ste ... e-savings/

Meanwhile, this column in the Washington Post argues that pushing through a Democrat only version of health care may hurt the President and portends a failure of Presidential leadership. (Note, I did not find these arguments at all convincing, but you can read the piece and make up your own mind) ... http://www.washingtonpost.com/wp-dyn/co ... 02545.html

However, Ross Douthat of the NY Times disagrees, noting that if health care reform fails, the failure of leadership will not be the President's, but the Democratic leadership in Congress ....

"The health care wrestling match is less a test of Mr. Obama's political genius than it is a test of the Democratic Party's ability to govern. This is not the Reagan era, when power in Washington was divided, and every important vote required the president to leverage his popularity to build trans-party coalitions. Fox News and Sarah Palin have soapboxes, but they don't have veto power. Mr. Obama could be a cipher, a nonentity, a Millard Fillmore or a Franklin Pierce, and his party would still have the power to pass sweeping legislation without a single Republican vote . . .

"If the congressional Democrats can't get a health care package through, it won't prove that President Obama is a sellout or an incompetent. It will prove that Congress's liberal leaders are lousy tacticians, and that its centrist deal-makers are deal-makers first, poll watchers second and loyal Democrats a distant third. And it will prove that the Democratic Party is institutionally incapable of delivering on its most significant promises."

Source: http://www.washingtonpost.com/wp-dyn/co ... 82501024_3

To be sure, the current polls measuring public opinion on various aspects of health care reform are a bit confused and confusing. Here's an experienced polling industry executive's explanation of why the current health care polling may be inaccurate or misleading: http://www.huffingtonpost.com/jeremy-ro ... 69412.html

The Wall Street Journal suggests that the President channel Harry Truman and do what needs to be done. "Maybe Democrats are afraid it will hurt their standing with those generous fellows on K Street if they channel Harry Truman and say what needs to be said: That government can be made to work for average people. But it will hurt even worse if they refuse to say it." WSJ Editorial, Aug. 25, 2009, Source: http://online.wsj.com/article/SB1000142 ... 95482.html

The Democratic party, however, has it's own internal road block, the Blue Dog Democrats, who favor throwing out the public option in favor of less stringent reform, have been doing well according to sources tracking their recent mega-earnings from the health care industry. Source/full story: http://www.mcclatchydc.com/226/story/74426.html

As I have previously discussed, the biggest obstacle to passing meaningful health care reform legislation may not be GOP claims, insurance lobbyists, or a failure of Democratic leadership, but instead the real concern about the rising "out of control" deficit spending. We've all seen the Congressional Budget Office forecasts regarding the respective plans for reform, and have been told that the CBO's analysis is very reliable. But I've noted previously, as have others, that the CBO's analysis seems ill-equipped and unable to accurately forecast savings to the overall economy and family spending generated by the reform proposals. This next article examines the accuracy of past CBO forecasts on health care measures, and concludes that the historical data shows that the CBO has consistently overestimated costs and underestimated savings in their estimates regarding health care measures. Perhaps their cost concerns regarding the current reform efforts are equally overstated, while projected savings go understated.

Congress’s Health Care Numbers Don’t Add Up
by Jon R. Gabel
N.Y. Times, Aug. 25, 2009

FOR competence and integrity, few organizations command more respect in Washington than the nonpartisan Congressional Budget Office. As health care reform makes its way through Congress, the budget office’s assessment of how much various elements might cost may determine the details of legislation, and whether it ultimately passes. But when it comes to forecasting the costs of reform, the budget office’s record is suspect. In each of the past three decades, when assessing major changes in Medicare, it has substantially underestimated the savings the changes would bring.

* * *

The Congressional Budget Office’s consistent forecasting errors arose not from any partisan bias, but from its methods of projection. In analyzing initiatives meant to save money, it helps to be able to refer to similar initiatives in the past that saved money. When there aren’t enough good historical examples to go by, the estimated savings based on past experience is essentially considered to be unknown. Too often, “unknown” becomes zero — even though zero is not a logical estimate.

The budget office has particular difficulty estimating savings when it considers more than one change at once.

* * *

The budget office’s cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects. This, in turn, forces Congress to believe it can pay for reform only by raising taxes, which then makes reform legislation more difficult to pass.

The Congressional Budget Office’s integrity is beyond questioning. But the record shows that it has substantially overestimated the cost of health care reform three times out of three. As Congress now works on its greatest push for reform in generations, the budget office needs to revise the methods it uses to make predictions about costs.

Jon R. Gabel is a senior fellow at the National Opinion Research Center of the University of Chicago.

Source/full story: http://www.nytimes.com/2009/08/26/opinion/26gabel.html

These next two articles examine head on the frequently bantered argument that "America has the best health care system in the world, and thus, we shouldn't mess with it!" Do we really? Can and should we do better? And how?

EDITORIAL
World’s Best Health Care

Critics of President Obama’s push for health care reform have been whipping up fear that proposed changes will destroy our “world’s best” medical system and make it like supposedly inferior systems elsewhere.

The emptiness of those claims became apparent recently when researchers from the Urban Institute released a report analyzing studies that have compared the clinical effectiveness and quality of care in the United States with the care dispensed in other advanced nations. They found a mixed bag, with the United States doing better in some areas, like cancer care, and worse in others, like preventing deaths from treatable and preventable conditions.

The bottom line was unmistakable. The analysts found no support for the claim routinely made by politicians that American health care is the best in the world and no hard evidence of any particular area in which American health care is truly exceptional.

The American health care system puts patients at greater risk of harm from medical or surgical errors than patients elsewhere and ranks behind the top countries in extending the lives of the elderly. It has a mixed record on preventive care — above average in vaccinating seniors against the flu, below average in vaccinating children — and a mixed record of caring for chronic and acute conditions.

Contrary to what one hears in political discourse, the bulk of the research comparing the United States and Canada found a higher quality of care in our northern neighbor. Canadians, for example, have longer survival times while undergoing renal dialysis and after a kidney transplant. Of 10 studies comparing the care given to a broad range of patients suffering from a diverse group of ailments, five favored Canada, three yielded mixed results, and only two favored the United States.

There is no doubt that American medicine at its best can be awesomely effective. But there is clearly room for improvement. Far from threatening a superb health care system, reform should be seen as a way to improve a system whose bright spots are undercut by its flaws.

Source: http://www.nytimes.com/2009/08/26/opinion/26wed3.html

And ...

The Question No One Asks About Healthcare
Dr. Andrew Weil M.D.,
Huffington Post, Aug. 25, 2009

The query gripping the nation: "How do we reform health care?"

But I don't hear anyone asking a far more essential question: "What is health?"

Given that we all want health and spend trillions to "care" for it, it's sobering how little thought we give to its true meaning. When I ask, the response I receive is typically "the absence of disease." Health is much more interesting and consequential than this. To define it in this negative sense is no more accurate than to define wealth as the absence of poverty.

I define health as a positive state of wholeness and balance in which an organism functions efficiently and interacts smoothly with its environment. Good health comes from an innate resilience that allows you to move through life without suffering harm from toxins, germs, allergens and changing environmental and dietary conditions.

By no stretch of the imagination does mainstream American "health care" move us closer to this vision of robust, resilient health. It is a fiscally unsustainable, technology-centric, symptom-focused disease-management system. Consider that two-thirds of all Americans die from cardiovascular disease, cancer, and diabetes, which are all strongly associated with lifestyle choices. Maintaining and paying for our current system will serve only to continue - if not exacerbate - this trend, and bankrupt the nation in the process.

A truly reformed health care system will care for our health rather than care for our ills. This does not mean it will abandon those who are sick or injured. Instead, measures that maximize our innate self-healing capacity - our health - will be used first whenever possible to both facilitate recovery and keep us whole and balanced.

How do we get there? Here is a summary of the health-promoting, disease-preventing agenda that I set forth in my new book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future available September 8, 2009.

• Our medical schools must teach health promotion along with disease management and crisis intervention. If the National Board of Medical Examiners included questions on these subjects in required student exams, schools would quickly add them to their curricula.

• Insurance companies, whether private or government owned, must be compelled to pay for health-promoting measures. In turn, this will encourage physicians to offer such treatments in earnest.

• The federal government must create new departments within the National Institutes of Health and the Department of Health and Human Services to emphasize health promotion and disease prevention. An Office of Health Education should be set up within the Department of Education to establish a K-12 curriculum of health, healing and disease prevention.

• Citizens must pressure the American Hospital Association, the American Public Health Association, the Centers for Disease Control and other relevant governmental agencies to make greening our hospitals and medical centers a top priority so that they themselves don't create even more illness. Examples of such changes: stopping environmental pollution caused by hospitals (e.g. mercury discharge) and banning the sale of junk food on their premises.

• We need to accept the seemingly obvious fact that a toxic environment can make people sick and that no amount of medical intervention can protect us. The health care community must become a powerful political lobby for environmental policy and legislation.

• We need to support grassroots movements to ban sales of soft drinks and junk foods in public schools, make schools serious about physical education and health education, and fight attempts by agribusiness to weaken federal organic standards.

• We must insist (with the power of our pocketbooks, voices and written words) that television networks, movie studios, radio, the internet and print use their tremendous influence in a positive way. The media showers us with destructive, illness-promoting messages (such as kids devouring junk food and adults popping pills for trivial, transient discomforts) and fear-based news reporting on health. We must use creative messages in the media to counteract this influence.

• American businesses are struggling to pay outrageous, exploitive insurance bills for their employees, hampering our ability to compete globally. In 2005, General Motors paid an estimated $1,525 in health-care costs for each car it made; Japan's Honda paid $97 (citing, Relman, Arnold S., M.D. A Second Opinion: Rescuing America's Health Care. Public Affairs, 2007, p. 78 ). We must convince corporate America that preventable employee absenteeism and diminished productivity can be counteracted in a cost-effective way by offering workers health-promoting programs such as discounted gym memberships, smoking cessation programs, and more nutritious cafeteria food. Ultimately, the sophisticated American marketing talent that pushed us toward unhealthy behaviors might be marshaled to move us all in directions that are more consistent with good health.

Benjamin Franklin's adage "An ounce of prevention is worth a pound of cure" has never been more relevant. In Franklin's time, contagious disease was the scourge of humankind, but focused effort has rendered it a historic footnote. With sufficient will, we can do the same with chronic disease that now costs us so much to manage.

Source/full story: http://www.huffingtonpost.com/andrew-we ... 68873.html

And now we get this breaking news ... President Obama will deliver the eulogy address at Sen. Kennedy's funeral (likely with national TV and radio coverage of his speech) ... http://www.huffingtonpost.com/2009/08/2 ... 70063.html ... I wonder what he will say to the nation? Mr. President, this is your moment to change history. Be wise. Seize it.

----------------

And in our daily "snakeyfoo" (thank my 5 year old twins for that one!) .. we have two ... first, consider this new ad from Americans United for Change blasting the already existing insurance company death panels & promoting reform:
http://www.youtube.com/watch?v=ja8h2wxTzJY ... and then this tricked out version of Obama conducting a more relaxed vacation style press conference from Jimmy Kimmel ... http://www.huffingtonpost.com/2009/08/2 ... 69744.html

[roxybeast]

If you favor naming health care legislation to honor Senator Kennedy, you can fill out this internet petition ... http://salsa.wiredforchange.com/o/5649/ ... t_KEY=2768

[roxybeast]

"Let us resolve that the state of a family's health shall never depend on the size of a family's wealth ... and guarantee that every American - North, South, East, West, young, old, - will have decent quality health care as a fundamental right and not a privilege." Sen. Ted Kennedy

[roxybeast]

Those words come from Kennedy's remarks at the 1980 and 2008 Democratic National Convention ... here are his full remarks on health care from those 2 events:

"We cannot have a fair prosperity in isolation from a fair society, so I will continue to stand for a national health insurance. We must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real controls over what doctors and hospitals can charge. And let us resolve that the state of a family's health shall never depend on the size of a family's wealth. ... And this is the cause of my life. New hope that we will break the old gridlock and guarantee that every American - North, South, East, West, young, old, - will have decent quality health care as a fundamental right and not a privilege." Sen. Ted Kennedy

[roxybeast]

Special Report: How Do the World's Other Developed Countries and Leading Democracies Handle Health Care?
Compiled by Beth Isbell,
August 27, 2009, 11:00pm

This is a great NPR audio interview with T.J. Reid which contains a very simple to understand and interesting explanation of the differences between the (1) British/UK, (2) French/German/Japanese, (3) Canadian & (4) third world/underdeveloped countries models of health care, and notes that we currently have bits of all 4 systems in use in the US already. T.R. Reid: Looking Overseas For 'Healing Of America'
http://www.npr.org/templates/story/stor ... =112172939

I also highly encourage you to watch this Frontline Documentary entitled "Sick Around the World: Can the U.S. Learn Anything From the Rest of the World About How To Run a Health Care System?" Just go to this site and click on the Watch Now button in the top menu: http://www.pbs.org/wgbh/pages/frontline ... dtheworld/
The Frontline website and special video report examines the health care systems used by the United Kingdom, Japan, Germany, Taiwan, and Switzerland (i.e., five other capitalist democracies similar to ours) and also has pages with graphs comparing % of GDP spent on health care, life expectancy, infant mortality, & the number of MRI & CT machines per million patients.

And, here's a really nice article that compares the differences in other developed countries health care delivery systems. Very interesting.

5 Myths About Health Care Around the World by T.R. Reid
By T.R. Reid, Special Report for the Washington Post
Sunday, August 23, 2009

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.
Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.

Source: http://www.washingtonpost.com/wp-dyn/co ... 01778.html

[roxybeast]

The next series of reply posts will feature interviews conducted by PBS Frontline with some of the world's leading experts on health care discussing the systems in other leading developed countries and offering some good suggestions & advice based on their expertise for Americans to consider in deciding how to best reform our system:

First Topic: What Lessons Can We Learn from Other Countries?

GERMANY

PROF. KARL LAUTERBACH
Health economist and member of the German parliament

How would you assess the U.S. health care system?

The U.S. has a system [that] does have a poor cost-benefit ratio. I mean, 40 million people lack insurance; another 30 [million] or so are underinsured. The people who are insured do have to worry whether they are able to pay the bills. People become bankrupt because they cannot pay the medical bills, and there are vast differences in the quality of care depending on how much you are prepared and able to pay. I think the system is not working well.

You watch American politics; you're in German politics now. Do you think we're going to change?

I think the Democrats will win the election, and they will then not change the system is my personal view; then they will lose a lot of credibility. ... This is my view.

... What would you say to Americans? What could we learn from looking at the German health care system?

... One can learn that competition is good. You need competition in the health care system and transparency, but you do not need for-profit competition. So limit profit and maximize competition and have everyone covered, and limit bureaucracy wherever possible. ...

... Another problem with the American health care system is that American insurance companies can a, turn you down and not cover you at all and, b, they deny claims.

Well, denying people and denying claims is both unfair and a waste of money and time for everyone. It is major bureaucracy, very frustrating, and ultimately someone has to pick up the bill. So this is only, let's say, repairing failures in financing the system. If the system is well financed, and if there is a risk adjustment among competing sickness funds, you do not have to deny people or claims.

Very important is that there's a pool of money from which sickness funds do get money if they have poorer or sicker patients because if that is working then you do not have deny anyone, you do not have to deny claims, and it is of interest to you to take everyone. Risk adjustment and the risk pool for the sickness funds, I think that is the most important single piece of the German health care system which might be of interest to you.

Source: http://www.pbs.org/wgbh/pages/frontline ... ssons.html

GREAT BRITAIN/UNITED KINGDOM

NIGEL HAWKES
Health editor, The Times of London


Americans are very unhappy with our health care system. We're looking for ways to fix it. That's why we came here. We're looking for ideas. Do you think the NHS is a good model?

It's not one I would go with, to be honest. I think when it was invented in 1948, it may have seemed a logical thing to do, but that was the high-water mark of central planning, and things have moved on. We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern market-orientated world.

So I wouldn't go for a centrally organized, tax-funded, free-at-the-point-of-use system for many, many reasons. One is, you've got no control of demand whatsoever. The other is, it tends to be captured by the people who work in it. The money all tends to go into salaries, centrally negotiated contracts for nurses, doctors and so on, ... and you don't get a very patient-focused service. ...

My view, I have to say, is a minority in this country, in Britain. Most people believe that taxation is the way to go; for reasons I've explained, I don't. But if I were starting from scratch, I'd go for an insurance-based system, but with pretty firm price controls, centrally controlled, a bit like [how] the Japanese do it. And I think that works better.

But if you're starting from the NHS, to move to that system would be quite difficult. If you're starting from the American system, to move to that system would be quite difficult. Once you've got a health system embedded, changing it much is really quite a difficult job.

Source: http://www.pbs.org/wgbh/pages/frontline ... ssons.html

BROAD COMPARISON OF UNITED STATES OF AMERICA TO TAIWAN, GREAT BRITAIN, SWITZERLAND AND OTHER NATIONS

PROF. UWE REINHARDT AND TSUNG-MEI CHENG
Princeton University


If you're going to fix American health care, what do you have to do first? Do you first get universal coverage and then worry about costs? Or do you do it in the opposite order?

Cheng: ... Absolutely coverage first, providing access to all. Take Taiwan, for example. That is the route that they took. When National Health Insurance came in, in 1995, overnight they folded into the system 41 percent of the population who had no health insurance at the time. So overnight, immediately, these people had access to health care, and that saves lives. We all know that. ...

Reinhardt: ... Almost any policy wonk will now tell you, you must have universal coverage first. Then you have an even playing field, [not] one hospital saddled with a lot of uninsured, another one has few, and of course they can't compete. After you have that, you can have competition on quality, you can have competition on costs, etc. Everything hinges on there being universal coverage first. ...

If an economist were designing a system, would it be wise to put everybody into a single health care system, like, say, Britain's?

Reinhardt: I think that would make a lot of sense. Or you could have a system where everyone has the same standard benefit package, and then insurance companies could lay more stuff on top. ... In Germany they have 200 distinct sickness funds, but it's really one system. So you could have that. But what we have here makes absolutely no sense at all. ...

... May, what lessons do you [think] America could learn from Taiwan's health care system?

Cheng: ... [A] very valuable lesson is that the effective use of information technology does wonders for a health system, whether it be from a cost perspective or a quality perspective. In Taiwan's case, first of all, people access care with a smart card. It's a credit card-sized card. You go to a doctor or hospital, you present this card, and you're logged into the system. Then the doctors put in their provider's card, and now both the patient and provider are logged into the pairs system. ...

And this way, they can really monitor utilization. Taiwan's single-payer actually requires all the providers to submit, every 24 hours, a complete record of every piece of service delivered, ... and it can question you if it sees something untoward. ... So that's cost control. And also in terms of quality, they can see, by looking at what services are rendered for what diagnosis, whether the treatment was appropriate. ...

Is there a political lesson America could learn from the Swiss reform?

Reinhardt: Well, [the lesson] from the Swiss reform is that you certainly can have a private insurance system doing the purchasing of health care and administering that, and you can have some competition. Much of it is just actually imagined. It's just like having the airlines. ... American and United are pretty much the same, and yet, as a customer, it may please me to tell one of them to go to take a walk and fly with the other, although I get the same service for the same price. Still, that choice and that competition may have some use. You can learn that.

What you could learn from the Germans, they have a very clever system where the government tells private interest groups -- the doctors, the hospitals, patients -- to sit at a table and say: "We want you, within six months, to figure out how to solve this problem. ... And if it's reasonable, we'll accept it. If not, after six months, we will tell you what you will do." ... It's just like parents telling teenagers: "You go and do what you want. As long as you're reasonable, we'll let you do it. Otherwise, we'll take care of it."


PROF. WILLIAM HSIAO
Harvard School of Public Health

[Could] Americans ... learn valuable lessons from looking at the health care systems in other countries?

Oh, certainly. There's no doubt in my mind United States can learn so much. To give you a concrete example, the U.K. began the paying of primary care doctors on a capitation basis [based on how many patients they cared for] and had them serve as a gatekeeper [to the rest of the medical system]. That started in the late 1940s, and the United States actually copied it in the managed care in the 1980s.

It was a good idea that worked and we could borrow?

Yes, no doubt about it. And other countries try new things, and some of them they have to discard because they didn't work, and others they defined as very successful.

... Do you have to get universal equitable coverage first before you can control cost, or do it the other way around?

In my experience, working in more than 40 nations around the world, I have never encountered a country [that] can control its health expenditure without establish[ing] a rational financing system first, because you need the info to control the health expenditures, and you need the financial power to influence the providers. ...

So in my world, when we advise nations we always say: Deal with the financing part first. And then, once you have done that, you actually have the capacity to deal with how to control the health expenditure inflation.

You have helped design health care systems in Colombia, Cyprus and Taiwan. Suppose you were going to do the same thing for the United States. Which model should we follow?

I will not say to the United States to follow any model. I think, if I'm designing for the United States, I will follow the principle [that] I will try to pick the best part of a system, and I will actually then try to go beyond that to remedy their shortcomings, because every system has some shortcomings. ...

Describe the Hsiao plan for reforming American health care.

If I had the influence of power, I would introduce a universal social health insurance for America, and that social health insurance would cover everything, but not long-term care. ... I will actually require people to save for their long-term care; then at age 65 they buy a single-premium, long-term care insurance policy.

So I will have universal social insurance cover everyone and a very comprehensive [benefits] package. I will require people to pay a modest amount [toward] company insurance, so people are aware there [are] resources used when you demand health care.

When you say "universal social health insurance," could we simplify that to "Medicare for everybody"?

Yes, Medicare for everyone.

Is that a solution for America?

That will be a solution for America on the financing side, ... and I will say if you have a unified system you can save billions of dollars in administrative costs, and that money can be used to pay for the uninsured poor people. So the total cost doesn't have to go up for the United States.

I would, on the provision side, require everyone to have a designated primary care, and I will actually follow the pay-for-performance system the U.K. has: I will let primary care doctors be the gatekeepers, and then they receive a fixed amount for every patient [who] selects that primary care doctor as their doctor.

If we went to Medicare for everyone, is there a place for Aetna and other for-profit insurance companies?

For America I think, in realistic terms, now they will have a role. They will become the administrators; this is what's done in Colombia. So you can create a role for the insurance companies, but they don't have the freedom they have [now] to operate and to generate the most profit.

Source: http://www.pbs.org/wgbh/pages/frontline ... ssons.html