Beth's Health Care Reform Blog

[roxybeast]

<center>This Bill Is The Beginning of Reform, Not the End</center>

<center>The Senate's "Starter Home" Health Reform
by Sen. Tom Harkin (D-Iowa)
Huffington Post, December 30, 2009</center>

Last week, when Senate Democrats passed the Patient Protection and Affordable Care Act, the right wing's quest to kill President Obama's No. 1 domestic priority ended. Santa has delivered a lump of coal to Senator Jim DeMint, who gleefully predicted that defeat of health reform "will be [Obama's] Waterloo; it will break him."

Progressives in the Senate have reached a momentous crossroads, just as our predecessors did in 1935, when they passed the Social Security Act, and in 1965, when they passed the Medicare Act. Both of those bills were giant steps forward for the health and economic security of the American people. Both were bitterly opposed by conservatives, who waged strident campaigns of fear and loathing, warning that the bills would lead to "socialism."

Make no mistake, the Patient Protection and Affordable Care Act is a profoundly progressive bill. As Ezra Klein wrote in the Washington Post, "The bill is the most important social policy achievement since the Great Society." It will usher in three truly historic reforms.

First, we are going to extend access to quality, affordable health care coverage to nearly every American. An estimated 30 million Americans who do not have coverage will get it thanks to this bill. By itself, this is an historic achievement every bit on par with passage of Social Security and Medicare.

A second great reform in this bill is an array of provisions cracking down on abuses by health insurance companies - abuses that currently leave most Americans just one serious illness away from bankruptcy. Among other things, this bill will extend coverage to people with preexisting conditions, and it will eventually ban the practice of denying coverage due to preexisting condition. It will stop insurers from canceling the policies of people who get sick. And it will stop discrimination against women, who now pay premiums up to 48 percent higher than premiums for men.

A third great reform is something I have championed for many years. Our bill includes a whole array of provisions designed to jumpstart America's transformation into a genuine wellness society. For example, we are going to require reimbursement for recommended preventive services such as mammograms without deductibles or other cost-sharing requirements. We expand Community Health Centers, and help businesses to create workplace wellness programs. This bill will begin to transition our current sick care system into a true health care system - one focused on preventing chronic disease and keeping people out of the hospital in the first place.

By passing this legislation, we will achieve a progressive prize that has eluded Congresses and Presidents going back to Teddy Roosevelt. And we now know why those earlier efforts failed: Because the special interests defending the broken - but highly profitable - status quo are extraordinarily powerful. At long last, we are going to break their stranglehold.

To be sure, the path to securing 60 votes was paved with painful compromises. That's also the way our predecessors were able to get the votes to pass Social Security and Medicare, both of which had big gaps in coverage when they were first enacted. They passed bills that were less than a full loaf, and then they came back for more in later years.

Instead of that "partial loaf" analogy, I like to think of this bill as like a starter home. It is not the mansion of our dreams. But it has a solid foundation, giving every American access to quality, affordable coverage. It has an excellent, protective roof, which will shelter Americans from the worst abuses of health insurance companies. And this starter home has plenty of room for additions and improvements.

The reforms in the Patient Protection and Affordable Care Act are extraordinary achievements. That's exactly why the right wing has pulled out the stops to try to kill it. But let's be clear: This bill is the beginning of health reform, not the end.

Source: http://www.huffingtonpost.com/sen-tom-h ... 07155.html

-And-

<center>Final Public Option Push Targets Sanders, Feingold, Brown And Franken
by Sam Stein
Huffington Post, December 30, 2009</center>

With just weeks left to affect the content of health care reform, a leading progressive group is launching a last-ditch effort to ensure that a public option for insurance coverage ends up in the final bill.

The Progressive Change Campaign Committee is targeting four liberal members of the Democratic caucus in the Senate, urging them to filibuster legislation that does not include a government-run insurance option. Titled the "We need a hero" campaign," the list of targets includes Sens. Russ Feingold (D-Wisc.) and Bernie Sanders (I-VT) as well as Sherrod Brown (D-Ohio) and Al Franken (D-Minn.)

Already, the PCCC is making moves in the media markets of the first two. On Monday, the group put out a television ad urging Feingold to fulfill President Obama's pledge to include a public option in any insurance reform. On Tuesday, it followed with a round of 10,000 robocalls-a-day in Vermont, in which a local resident pleads with Sanders to block a bill without the public plan.

"[The current plan] just mandates that people buy insurance from big insurance companies," says Northfield, Vermont resident AJ Van Tassel-Sweet. "That's not reform."

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In addition to the television and robocall efforts, the PCCC is also running online ads in the states of each of the aforementioned four senators. It is certainly an uphill battle, since each of these members already voted for a version of reform that did not include the public plan and none have expressed the die-hard willingness to hold up the process should the final vote be on a similar piece of legislation.

It's curious, however, that the PCCC is going after Franken, as confirmed by the group's co-founder Adam Green. The Minnesota Democrat has kept an incredibly low profile during the health care debate (as he has throughout much of his first year in office). And while it seems fairly evident that Franken's sentiments do lie with PCCC's policy objectives, it's hard to imagine a freshmen member of the caucus -- especially one who's been eager to avoid the spotlight -- going that far out on the line.

Source: http://www.huffingtonpost.com/2009/12/3 ... 07127.html

[roxybeast]

<center>What the House May Demand for Dropping The Public Option: Latest Public Option Concession Comes Into Focus
by Sam Stein
Huffington Post, December 30, 2009</center>

With several prominent House Democrats acknowledging that they will likely have to give up a public option for insurance coverage in health care reform negotiations with the Senate, the focus has shifted to what concessions they can extract in return.

The main issue on the radar is to try and ensure that newly created health insurance exchanges are national (the House version) and not state-based (the Senate version), say sources on and off the Hill.

"That's where people are going to be looking," said Rep. Rosa DeLauro (D-Conn.) when asked if this would be the key compromise if the public option is dropped. "I'm going to give you my own view, which is the House view, which is that I think we need a federal insurance exchange.... I think we've got to look closely at this. I think that it's much easier... to keep insurance companies in check -- it is simpler to administer. We're going to have a checkerboard here [with the Senate bill]. And also I think you have to take a look at the political reality. Implementing reform is going to be much more difficult in some states than in others."

Progressive activists, in addition to well-respected health care reform advocates, feel the same way. A national health insurance exchange, they argue, has the potential to fundamentally change the accessibility and affordability of insurance. Set up as a virtual market in which consumers have a list of policies from which to pick and choose (think Expedia.com but for health insurance), it would be limited to small businesses and individual buyers. Moreover, state governments, if they meet certain standards of accessibility and regulatory oversight, will have the option to opt out. But the prospect of having providers compete side-by-side -- unlike some of the monopolized markets that exist today -- with the federal government in a regulatory role, is an obvious and alluring way to reduce costs.

The Senate, by contrast, has structured its legislation differently -- choosing to set up exchanges in individual states that in turn would be regulated by state governments. Such a structure may prove effective in lowering costs but likely on a lesser scale. It also will cater better to local health care needs and markets. But the concern is that it won't foster the type of institutionalized competition, risk-spreading and purchasing power that one national exchange presents.

"The Senate is a weaker version, a more insurance-friendly version," said one progressive health care activist. "The state-based exchanges are weaker on the structural level because you have less number of people in these exchanges. There would be more competition and lower prices in the national variety. But also, state-based exchanges would be a lot more subject to the insurance industry lobby."

Diane Archer, the director of the Health Care Project at the Institute for America's Future, also commented on the preference for a national exchange over the state variety in a small entry at the Washington Post's Website.

"The single biggest weakness in the Senate bill is its reliance on states to implement the exchanges," she writes. "The federal government should implement the law in a uniform way and relieve the states of the burden of setting up whole new insurance markets and regulatory structures -- unless they choose to and demonstrate their ability to -- as the House bill provides. And, we need the will, skill, resources and power of the federal government to ensure that the insurers behave. History and experience suggest the states will almost always be outgunned by the insurers. The states should hold complementary regulatory authority over the insurers and also have the right to innovate and improve the insurance market."

Faced with the likelihood that a government-run insurance option will be scrapped when the Senate and House hold their conference committee to mesh their respective pieces of legislation, Democratic lawmakers are now going more public with these arguments. DeLauro, for one, stressed that the debate over the public option "was never just about the public option for the public option."

"It was about: where's the competition?" she added. "People can choose something and still not have any choices in the selection."

But, as has been the case with the entire reform process, there are impediments. Conservative Democrats in the Senate are wary of creating a new bureaucratic regulatory structure to oversee a newly-created national exchange -- preferring instead to rely on already existing state regulatory bodies. And the argument for a more federalist approach also holds deep sway inside the corridors of that chamber.

"It's hard to imagine how Ben Nelson would get on board with national exchanges," said one health care reform activist. "The states rights/every state is different argument" is an impediment.

Not everyone thinks Nelson will draw a line in the sand when it comes to the structure of the exchange. But one senator is all it takes to derail the entire reform process. And if the conference committee chooses not to make too much hay over this aspect of reform, there are other policy battles that the progressive community will wage. Jon Walker, over at FireDogLake for instance, has penned an essay making the case that Democrats should demand that some of the benefits of reform (including the exchanges themselves) kick in well before their slated date of 2014 -- citing the policy and political sense of accelerated action.

"If there was any one single completely terrible political decision made by Democrats during this health care debate, it was to 'save money' by delaying the start of reform," he writes. "This is an act of political foolishness so profound, I'm, to this day, at a loss for words. Making the bill appear $100-300 billion cheaper simply is not worth the medium term political damage that delaying reform will do to the Democrats."

Source: http://www.huffingtonpost.com/2009/12/3 ... 07369.html

[roxybeast]

The big news today (Jan. 19, 2010), of course, is whether Democratic Candidate Martha Coakley will defeat Republican candidate Scott Brown in the election to fill Massachusetts Senator Ted Kenedy's vacant Senate seat. The great irony here is that a victory for the Republicans in this race would spell the end of health care reform, at least as currently envisioned in the bills passed to date by the House and Senate, and would also place the rest the President's legislative agenda in jeopardy by giving Republicans 41 seats in the Senate.

<center>Democrats May Seek to Push Health Bill Through House
By DAVID M. HERSZENHORN and ROBERT PEAR
New York Times, January 18, 2010</center>

WASHINGTON — The White House and Democratic Congressional leaders, scrambling for a backup plan to rescue their health care legislation if Republicans win the special election in Massachusetts on Tuesday, have begun laying the groundwork to ask House Democrats to approve the Senate version of the bill and send it directly to President Obama for his signature.

A victory by the Republican, Scott Brown, in Massachusetts would deny Democrats the 60th vote they need in the Senate to surmount Republican filibusters and advance the health legislation.

And with the race too close to call, Democrats are considering several options to save the bill, which could be a major factor in how they fare in this year’s midterm elections.

Some Democrats suggested that even if their candidate, Martha Coakley, scraped out a narrow victory on Tuesday, they might need to ask House Democrats to speed the legislation to the president’s desk, especially if lawmakers who had supported the bill begin to waver as they consider the political implications of a tough re-election cycle.

It is unclear if rank-and-file Democrats would go along, and House Democratic leaders said no final decision would be made until they talked to their caucus.

But even as Democratic leaders pondered contingencies, the House speaker, Nancy Pelosi, insisted that the legislation would move forward, though she acknowledged that Tuesday’s results could force a tactical shift.

“Certainly the dynamic will change depending on what happens in Massachusetts,” Ms. Pelosi told reporters in California on Monday. “Just the question of how we would proceed. But it doesn’t mean we won’t have a health care bill.”

“Let’s remove all doubt,” she added. “We will have health care one way or another.”

Still, some lawmakers, aides and lobbyists described numerous obstacles to House approval of the Senate-passed bill.

House Democrats have voiced a number of complaints with the Senate measure, and top White House officials and Congressional leaders have struggled to bridge differences between the two bills. Despite promises by Mr. Obama and Congressional leaders to add those hard-fought deals and other changes later, there would be no guarantees.

In an interview on Monday, Representative Bart Stupak, a Michigan Democrat who opposes the Senate bill in part because of provisions related to insurance coverage of abortions, said: “House members will not vote for the Senate bill. There’s no interest in that.”

When the idea was suggested at a Democratic caucus meeting last week, Mr. Stupak said, “It went over like a lead balloon.”

“Why would any House member vote for the Senate bill, which is loaded with special-interest provisions for certain states?” Mr. Stupak asked. “That’s not health care.”

In addition to his concerns on the abortion provisions, Mr. Stupak said the Senate bill did not do enough to improve the quality of health care, and it preserved the federal antitrust exemption for health insurance, which the House bill would repeal.

Officials in Congress and at the White House emphasized that the backup plan was hypothetical, and that they hoped it would never be needed.

Many Democrats, eager to exude confidence, declined to comment publicly on the possibility of a Plan B. A House Democratic leadership aide said: “Obviously, the outcome of Tuesday’s election will be a factor in how we move forward, but we are hopeful and continue to work towards a compromise that will garner 60 votes in the Senate. If we end up short of 60, we will need to see. But there will be problems with just taking up the Senate bill.”

Republicans said they expected Democrats to do whatever it takes to pass the bill.

“They are going to try every way, shape and form to shove this bill down the throats of the American people,” the House Republican leader, Representative John A. Boehner of Ohio, said in a radio interview on Monday.

Persuading House Democrats to adopt the bill approved by the Senate on Christmas Eve would obviate the need for an additional Senate vote. If Mr. Brown wins, there might be enough time for Democrats to rush a revised bill through the Senate before he is sworn in. But Democratic leaders have essentially ruled that out as a politically perilous option.

Asking House Democrats to adopt the Senate bill is itself a high-risk call. Agreements to resolve differences would essentially be out the window.

The White House and labor unions, for instance, reached a tentative deal last week on an excise tax on high-priced, employer-sponsored insurance plans. Labor groups, an important segment of the Democratic Party’s base, strongly opposed the version of the tax included in the Senate bill because they said it would hit too many union-sponsored health plans and hurt middle-class workers.

And then there is an array of outstanding issues on which no consensus has been reached, like the emotionally charged issue of insurance coverage for abortions.

The House bill was passed by a vote of 220 to 215 in November. The restrictions on abortion coverage were approved on a 240-to-194 vote, with support from 64 Democrats, including 41 who also voted to pass the bill.

The Republican whip, Representative Eric Cantor of Virginia, said he had identified 11 “pro-life House Democrats” whose votes “could be in play” if the abortion restrictions were weakened.

There are other disagreements. Members of the Congressional Hispanic Caucus, for example, strongly oppose a Senate provision to bar illegal immigrants from buying health insurance through new government-regulated exchanges even if they paid the full cost with their own money. The House bill would permit illegal immigrants to buy coverage on their own.

Despite these differences, the bills over all are similar, if not identical, on a vast majority of issues. And supporters of the fallback strategy say it puts Democrats just a single vote from sending historic legislation to Mr. Obama for his signature.

Still, several House Democrats sounded less than enthusiastic Monday about the possibility of adopting the Senate bill.

Representative Allyson Y. Schwartz, Democrat of Pennsylvania, said, “It is my hope that we will continue to work to take the best provisions from the House and Senate bills to produce the right bill for America.”

Representative Robert E. Andrews, Democrat of New Jersey and chairman of the Education and Labor subcommittee on health, said: “Obviously, our first preference would be to continue to negotiate and achieve 60 votes in the Senate. Until it becomes obvious that we can’t do that, I don’t think we want to speculate on any other possibility.”

Eric M. Ueland, a lobbyist who used to work for the Senate Republican leadership, described the uncertainty surrounding a two-bill strategy this way: “It’s tantamount to the Senate saying to the House, ‘We cannot tell you what, when, why or how, but trust us, it will all work out.’ ”

Ms. Pelosi, however, said that it was Republicans who could not be trusted on health care, and that Democrats would not squander the opportunity to pass a bill.

“I heard the candidate in Massachusetts, the Republican candidate, say ‘Let’s go back to the drawing board,’ ” Ms. Pelosi said. “The drawing board for the Republican Party on health care is to tear it up and throw it away and shred it and never revisit it.”

She added: “Back to the drawing board means a great big zero for the American people.”

Source: http://www.nytimes.com/2010/01/19/healt ... ealth.html

[roxybeast]

<center>What Does the Republican Win in Massachusetts Mean for Health Care Reform?
by Beth Isbell, Jan. 20, 2010</center>
You want to understand yesterday's Massachusetts message: As Clinton put it "it's the economy stupid!" President Obama has to create jobs NOW - whatever it takes! And on health care, conservatives aren't right, the reality is progressives don't like the compromise they forced either - nobody likes the current compromised mess in either chamber!

Health care has problems because not enough progressives were elected in either Chamber - had more been elected, we would have gotten the job done right the first go round. As it is, I'm not sure any compromise can save it. Maybe the Wyden plan is a start, but I don't see that successfully moving forward either. But maybe.

Since we are back to the drawing board, the pressure is off to support any of the current bad compromises. It's the perfect time to start fresh & simply demand what is right. We need to pass national health care - it's the right thing to do & the only real solution. We are the only leading country in the world that can't figure that out. And the reason is because we let the greedy bastards wanting to hang on to their ability to line their pockets use their wealth to cloud and confuse our judgment. We will never pass the perfect health care reform bill, but we need to quit letting fear of this & that "potential" problem or imperfection prevent us from doing the right thing - the thing that every other leading nation has done - because they value their people's health more than they value corporate greed. If problems arise after we pass the plan, we address them head on & fix them like normal rational adults!

Obama needs to come out in his state of the union swinging and talk about creating jobs NOW, regulating & controlling wall street, making health insurance fair & affordable for all, including sufficient subsidies, controlling costs & make plans competitive without red tape or state lines that prevent competition. He has to address voters' fears and concerns about the lack of progress being made head on. And he finally has to call the game like he sees it. Call out the BS, be brutally honest, be the leader, paint the future, and be the visionary that leads us to it.

We need to regulate Wall Street, protect our markets, protect homeowners from fraud, end excessive compensation and greed. We need to pass real reforms like those envisioned by Liz Warren.

He needs to treat this speech not like a state of the union, but more like a campaign speech that seizes on the anger of the voters that change is not being made that benefits them and chastising those who stand in the way of accomplishing it. He needs to ask voters to send him Congressional representatives and Senators that will help him take on & defeat the monied interests not send folks who ensure gridlock (aka Brown). The President needs to explain that the problem is not his plan for change, but the lack of votes to pass it in the overwhelming way that it needs to be passed. It is time to end the interference and petty bickering, to see the pain in American lives, and get the job done.

Tell folks the truth, you aren't getting what you want because your message when you elected me was not sent clearly or loud enough or with enough progressives in either chamber to get the job done!

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“I think there’s been a misreading of where the public is at: having a health care debate when so many people were focused on their jobs,” said Joe Trippi, a Democratic political consultant. ... Terry McAuliffe, former Democratic National Committee chairman: “We have to keep our focus on job creation. Everything we have to do is related to job creation. We have to do a much better job on the message. People are confused on what this health care bill is going to do.”

"Stripped of the 60th vote needed to block Republican filibusters in the Senate, will Mr. Obama now make further accommodations to Republicans in an effort to move legislation through Congress with more bipartisanship, even at the cost of further alienating liberals annoyed at what they see as his ideological malleability?

Or will he seek to rally his party’s base through confrontation, even if it means giving up on getting much done this year?

Will he find a way to ram his health care bill through Congress quickly in the wake of the Massachusetts loss, so that his party can run on a major if controversial accomplishment? Or will he heed the warnings of Republicans, and now some Democrats, that to do so would be to ignore the message of Tuesday’s election, with its clear overtones of dissatisfaction with the administration’s approach so far?"

Source: New York Times, Jan. 20, 2010

[roxybeast]

Sorry about the break ... Things are finally starting to move forward in earnest again on the health care legislation, so here we go! ...

<center>Why Can't the U.S. Honestly Debate Adopting a Single-Payor System?
The push and push-back against single-payor healthcare ...

WATCH VIDEO: http://www.pbs.org/moyers/journal/02052010/watch3.html
</center>

February 5, 2010

BILL MOYERS: Make me an offer I can't refuse. That's what President Obama said, when he talks about health care reform during his State of the Union last week.

PRESIDENT OBAMA: If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen medicare for seniors and stop insurance company abuses, let me know. Let me know. Let me know. I'm eager to see it.

BILL MOYERS: Dr. Margaret Flowers took him at his word.

MALE VOICE: Can I help you?

DR. MARGARET FLOWERS: Well, last night the President gave his State of the Union address, and I'm a physician. I'm the Congressional Fellow with Physicians for National Health Program.

BILL MOYERS: The very next day she was outside the White House with a letter urging the President to revive the idea of single-payer healthcare. Medicare for all.

MALE VOICE: We can't accept anything, so you'll have to send it through the mail.

BILL MOYERS: The Secret Service turned Dr. Flowers away, but she didn't give up. She tried again the next day in Baltimore, where once again, President Obama made his offer to hear ideas on health reform and once again, she tried to deliver her letter.

DR. MARGARET FLOWERS: Is there somebody here who's in charge that can have somebody who's a representative of the President, come and take this?

BILL MOYERS: This time, she and her colleague, Dr. Carol Paris, refused to move when security told them to, because Dr. Flowers said, "We didn't want to continue to be excluded, marginalized and ignored."

They were arrested.

DR. MARGARET FLOWERS: And we haven't been heard. They continue to exclude us.

BILL MOYERS: When I saw pictures of Margaret Flowers being led away, I remembered those famous words attributed to another Margaret, the anthropologist Margaret Mead who said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Dr. Flowers is with me now. A pediatrician from Maryland who worked at a rural hospital and in private practice, her full-time job is now the fight for single payer health insurance. She works on Capitol Hill for the organization, Physicians for a National Health Program. Welcome to the Journal.

DR. MARGARET FLOWERS: Thank you for having me.

BILL MOYERS: When you were arrested last Friday, were you taken to police headquarters?

DR. MARGARET FLOWERS: I was, with Dr. Paris.

BILL MOYERS: Were you handcuffed?

DR. MARGARET FLOWERS: We were.

BILL MOYERS: Were you interviewed independently by the Secret Service?

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: What did they want to know?

DR. MARGARET FLOWERS: They wanted to make sure that we didn't have a psychiatric history or did we wish the President any ill harm.

BILL MOYERS: What did you tell?

DR. MARGARET FLOWERS: That no, we don't wish him any harm. In fact, if we passed a Medicare for all system, it would be a huge win, not just for the American people but for this administration. And that, in fact, we didn't really want to have to go through this to have our voices heard. We'd much rather be working with Congress and the administration.

BILL MOYERS: I was watching that tape of your arrest. And I think I heard you say, you know, "Would you please-" to somebody. "Would you please call my husband?" Is it true he didn't know you were out there and were going to get arrested?

DR. MARGARET FLOWERS: It's true. Yeah.

BILL MOYERS: What did he think when he found out? Did somebody call him?

DR. MARGARET FLOWERS: Actually, his brother called him because he saw it on the news. And he said, "Do you know where your wife is right now?" And my husband said, "No." Well, we weren't sure. Dr. Paris and I weren't sure what was going to happen that morning. We just knew that we would go down there with our banner and our letter and that hopefully, we could get our message across and that hopefully they would call a staffer to take our letter. And there came a point, though, when they kept saying, you know, "Go across the street and no, we're not going to call anybody," that we looked at each other. And without speaking, we both knew that, no, this is too important. We're not going across the street.

BILL MOYERS: When you stood outside the White House last week, did you really think that the leader of the free world was going to respond to a petition from a single individual, standing outside his--

DR. MARGARET FLOWERS: I--

BILL MOYERS: --his gate?

DR. MARGARET FLOWERS: --did make the point that I was representing the majority of the public and the majority of physicians.

BILL MOYERS: How could you make that claim?

DR. MARGARET FLOWERS: Because numerous polls have shown that the majority of the American public want a national health system. When the poll actually describes what it is, you know, a system where everybody pays in and everybody can get the care that they need, people desire that. They favor that. And more and more doctors-- well, we do have polls on doctors, but my experience also traveling around is the doctors support this.

BILL MOYERS: Had you taken him seriously when before his campaign, he was an advocate for single payer?

DR. MARGARET FLOWERS: I did. I even worked the polls on election day, and I knocked on doors to get people out. I guess I was naïve. I was kind of hopeful.

BILL MOYERS: You took him seriously.

DR. MARGARET FLOWERS: Well, we knew that he understood what single payer was. In the debates, he said that he understood health care was a human right. I know that he didn't campaign on single payer or anything like it. But we felt it was an opportunity to, if we built the grassroots movement and showed that this is what the American people want, that he would actually, in some ways, include us. We saw the exact opposite. We saw that this whole process was very tightly scripted. And very exclusive. And he didn't want us causing any trouble for, you know, trying to get some reform passed.

BILL MOYERS: If the President had sent a staff person out to invite you in for coffee last week, what would you have told him?

DR. MARGARET FLOWERS: I would have told him that the American people were expecting more from him, that there's been such a huge amount of suffering in this country and preventable deaths. And that it's completely unacceptable that we are the only industrialized nation that allows this to happen. And that, it doesn't have to be this way, because we have the money. We're already spending more than any other country, so it's not an issue of whether we have the money. We have the resources to have one of the top health systems in the world. And why wasn't this debate about what is best for the people? Knowing that this is even, in terms of our economic recovery, this is vital, because our whole health system is a drag on our entire economic situation. So why is he excluding us? Why isn't he letting us be at the table, when this makes complete sense from a public policy, public health policy, economic health policy standpoint?

BILL MOYERS: What made you such a passionate advocate for single payer?

DR. MARGARET FLOWERS: Why be-- I went into medicine because I really do care about taking care of my patients and particularly, I chose pediatrics because I feel like if you give children a great start, a healthy start, they can carry that through them for the- with them through the rest of their lives and when I looked at what was going on and looked at what works in other places and what has worked here, what models have worked here, I saw that if we have a Medicare for all system, then really, doctors can practice medicine again, the art that we train to do.

BILL MOYERS: Why did you feel you weren't able to do the medicine you wanted to do, because of the health care system?

DR. MARGARET FLOWERS: Well, it started when I was working in the rural hospital where I was. And when we would admit a patient to the hospital, the first person that would come to visit us was someone from utilization review, which is the group that interfaces with the insurance company. And they would say, "You have this many days to make this patient better. This is how many days they've been authorized for." And what we often found is that didn't match the number of days that we felt the patient needed to be in the hospital. So it puts you in a really uncomfortable position of, do you send a child home before they're ready? And then in private practices it's the same kind of thing, you see a patient, you determine what's the best treatment, and then the insurance company says, ‘No they can't have that test' or can't have that medicine. It didn't make sense. It wasn't based on what the patients need. It was based on what the insurance companies could get away with.

BILL MOYERS: Was there the eureka moment?

DR. MARGARET FLOWERS: It was a eureka moment when our office manager sat down with us in our practice and said, "Okay, if we want to keep in business, this is what you need to do. You can only see one well child a day, and the rest of the patients have to all be sick patients that you can churn through this many patients each hour." And if your patient happens to bring up something else that's bothering them, you have to ask them to reschedule and come back to talk about that other thing, which means they have to take, you know, more time off of work and continue to carry that worry with them, while they're waiting for the next appointment. That just wasn't why I went into medicine. I like the relationship that I have with patients. I want to take care of them. And when you build that relationship with your patient and you get to know them, you can provide the best care for them, not the way things are right now.

BILL MOYERS: But you know, you didn't go into medicine to get arrested. And yet there you are, on the-- out there being handcuffed and led away?

DR. MARGARET FLOWERS: Yeah, I never really dreamed that this was a path that I would go down. I mean, I'm a mother. Good citizen in my community. But it came to a point where that was the only way that we could have our voice heard. We were being completely excluded, when we tried the traditional avenues of having our voice heard. We were just put aside.

BILL MOYERS: Last May, before the Senate hearings at Max Baucus-- Senator Max Baucus were conducted, it seemed like there might be a momentum behind this single payer Medicare for all movement. What happened?

DR. MARGARET FLOWERS: They actually did start inviting us in to have a seat at the table. Senator Kennedy's committee contacted us. And I was the first person to testify in the Health Education and Labor and Pension Committee hearing. I sat next to the CEO of Aetna, which was a very interesting experience. And then when we went over to the House and spoke to the leadership there, they said, "We want your voice to be heard here." And we testified there. And so we actually thought we were starting to get our foot in the door. And then we had some amendments that were introduced that were good amendments. They would have substituted a national single payer system for the legislation that was going through, so we were really pushing on that. And then we saw that all of that fell apart.

BILL MOYERS: And then?

DR. MARGARET FLOWERS: Well, what we learned through this process is there was a lot of control coming from the White House. And they did not- they wanted to pass something. They were putting everything off on passing something in health care reform. And they were concerned that if we let the single payer voice in, or if it was associated in any way with a legislation, that it would hurt their ability to pass that legislation. So they kind of put the kibosh on it.

BILL MOYERS: The White House.

DR. MARGARET FLOWERS: Yes, it really came down from the top. We tried to bring our viewpoint in this summer. We actually brought doctors and nurses in. That was a lot of what I was doing, to meet with staffers and meet with legislators and educate them about health policy, what makes good sense from a health standpoint, not an, you know, special interest standpoint. But when we tried to reach the White House and ask to be included there, we requested meetings with the president on numerous occasions. And they just said no.

BILL MOYERS: The health reform process is broken. It's stalled, stymied. And many people think nothing is going to happen now. Do you think that's a good thing?

DR. MARGARET FLOWERS: In some ways, it is. But what we were starting to see in December, as they got close to passing the Senate version, was they were already these huge proclamations of success. You know greatest thing since Social Security and Medicare, and look how great we are for passing this. And we knew that what they were passing was designed to fail. And-- but that if it passed, it would take years for people to realize.

BILL MOYERS: The failure.

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: And then--

DR. MARGARET FLOWERS: So--

BILL MOYERS: --it would be what, too late to--

DR. MARGARET FLOWERS: Well, then it would be, you know, if you look at the number of people that are dying in this country every year, and you say, "Okay, we're going to wait four or five or six years to see whether this works or not," when we already know from a health policy standpoint that it's not going to work. It's that many more people that are going to be lost during that period.

BILL MOYERS: What have you learned about our political process this last year?

DR. MARGARET FLOWERS: I didn't realize how broken it was. I knew that there were special interests influencing the process. But I didn't realize that the degree, the depth to which they're involved in our political process.

BILL MOYERS: What was the most revealing moment that told you how strong and powerful the special interests, the industries are?

DR. MARGARET FLOWERS: That was really last May, when we decided that we needed to go to the Senate Finance Committee and stand up, because we had been working for months prior to that, meeting with members of Congress who would tell us, "Yes, it makes perfect sense that we should include your proposal along with what we're putting together." We just said, "Just compare them. Compare them on universality. Compare them on cost control. Just let's have an honest debate about what's really the best." And when it came down to it, they just said, "Oh, no, we didn't really mean what we said about that. And we're not going to include you." And when we heard that they weren't going to allow us to have someone testify at that Senate Finance Committee, we just knew right then we have to do something different.

SEN. MAX BAUCUS (D-MT): The second of three roundtable discussions--

DR. MARGARET FLOWERS: Senator Baucus--

SEN. MAX BAUCUS (D-MT): --on healthcare in america. We order that we stand in recess until the police can restore order.

DR. MARGARET FLOWERS: My name is Margaret Flowers--

SEN. MAX BAUCUS (D-MT): We stand in recess until the police can restore order.

BILL MOYERS: And that was the first time you were arrested.

DR. MARGARET FLOWERS: Uh-huh.

BILL MOYERS: What was that experience like?

DR. MARGARET FLOWERS: It was terrifying. But I knew at that moment. I looked around the room, and I looked at the people who were sitting at the table, both from the senators to the people who had been invited to testify, who represented the industry. And in my mind, I juxtaposed that with the stories and the people that I've met, and the doctors I've talked to. And I felt like I was there on behalf of them. And I would do what I needed to do. And that I was ready for that.

BILL MOYERS: You still ready? You're going to stay with this?

DR. MARGARET FLOWERS: Completely. Yeah. It's too important.

BILL MOYERS: Dr. Margaret Flowers, thank you for being with me.

DR. MARGARET FLOWERS: Thank you.

DR. MARGARET FLOWERS: We've been cooperating and we haven't been heard. They continue to exclude us! Phil, can you call Kevin?

MALE: Kevin? Yeah, ok.

DR. MARGARET FLOWERS: My husband doesn't know.

MALE: Give him a call? Ok.

DR. MARGARET FLOWERS: And maybe if you can call Jill Carter, if you can be our lawyer that would be great...You know Delegate Carter.

MALE: Oh, Jill, yeah, ok.

[roxybeast]

<center>Anyone Remember What's In The Health Care Bill?
by JULIE ROVNER, NPR</center>

March 9, 2010
Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.

So here's a short refresher.

According to the Congressional Budget Office, the Senate-passed bill would expand coverage to roughly 30 million of the 46 million people in the U.S. who lack health insurance. Most of the remaining uninsured would be undocumented immigrants, who would be ineligible for benefits under the bill.

Insurance Mandates

One of the most popular things the bill would do is ban insurance companies from excluding people or raising their rates, because they have what's known as a pre-existing medical condition.

What's that? Here's how California Democratic Rep. George Miller described his: "I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I'm dead in that insurance market if I have to switch policies or switch companies."

But in exchange for getting insurance companies to agree to accept everyone, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that's a lot more controversial: It requires everyone to have insurance.

That's something many Republicans used to support, but don't now. "Never has the federal government said any American had to buy anything. Now, [you] have to buy insurance. If you don't buy insurance, pay the IRS more money," said Sen. Charles Grassley (R-IA) during the Senate's floor debate in November.

Grassley is correct in that the mandate would be enforced at tax time. If you can't prove you're covered, you'll pay a penalty.

Helping Hand

But help will be available. If you're poor, you'll get health insurance for free through the Medicaid program. For the first time, able-bodied adults who are simply low-income would become eligible for Medicaid.

Middle-class people who have to buy their own policies would get government subsidies. And small businesses would get tax credits to encourage them to help pay for insurance for their workers.

Those who have to buy their own health insurance get another leg up — a new marketplace called an exchange. There they could pool their buying power and compare their options.

At the same time, said Senate Finance Committee Chairman Max Baucus (D-MT), "exchanges will make it easier for consumers to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans."

Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health care professionals.

"We ... believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed," House Majority Leader Steny Hoyer (D-MD) said at the White House health meeting last month. In other words, the new payment system would be based on how health care professionals do their jobs, rather than just how many tests they order or exams they perform.

Political Deal-Making

But politics has had a lot to do with getting the bill this far. Now House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they'll have to approve that Senate bill with no changes.

That means, as Sen. Lamar Alexander (R-TN) reminded everyone at last month's meeting, "It still has the sweetheart deals in it. ... I mean, what's fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what's fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming?"

Alexander was referring to several deals cut by Senate Majority Leader Harry Reid to win the 60 Democratic votes needed to get the bill passed by the Senate.

Of course, here's where this process gets even more complicated. Those so-called sweetheart deals are expected to be cancelled in a second bill. That so-called fix bill will carry the compromises now being made between the Senate and the House. That bill is also likely to alter the way the health care program is paid for.

But that second bill is still being drafted, and House Democrats are skittish about its ultimate prospects. Don't expect a House vote on the Senate bill until they get some assurances about what that second bill will do — and that the Senate can actually pass it.

Source: http://www.npr.org/templates/story/stor ... h-20100309

[roxybeast]

<center>Democrats Poised to Pass Health Care</center>

by DAVID M. HERSZENHORN and ROBERT PEAR
New York Times, March 17, 2010

WASHINGTON — House Democrats, gearing up for a possible vote on Sunday to pass health care legislation, pledged that the details they were about to publish would produce significant cost savings in the decades ahead.

The House Democratic leader, Rep. Steny H. Hoyer of Maryland, said that the nonpartisan Congressional Budget Office had determined that the package of legislation would produce “the largest deficit reduction of any bill we have adopted in Congress since 1993,” when it passed President Clinton’s budget proposal including substantial tax increases.

In the first ten years, the legislation would reduce deficits by $130 billion, Rep. James E. Clyburn of South Carolina, the House majority whip, said after a meeting of the party’s caucus. The effect on deficits over the following decade would be much greater, a total of $1.2 trillion, he said. The savings would come largely from reductions in the growth of Medicare spending, with new fees and tax increases also contributing.

The full text of the legislation, which would put the final touches on a delicate compromise between the House and the Senate, and a detailed cost estimate from the budget office are likely to be issued later on Thursday, House Democrats said.

The bill that the House passed in November would have reduced deficits by slightly more — $138 billion compared with $130 billion — in the first ten years, while the version passed by the Senate in December would have reduced deficits by somewhat less — $118 billion — according to the budget office, whose estimates are considered authoritative.

The cost of the legislation has been a major concern for many centrist Democrats, a crucial bloc for leaders who are trying to muster the majority to pass the bill.

“We are absolutely giddy over the great news,” said Mr. Clyburn, who as the party whip is the keeper of its tallies, as the leadership seeks the 216 yes votes it will need for the decisive vote, expected this weekend.

House Democrats locked in two more votes Wednesday, giving them added confidence as they worked out the last details of the bill and girded for a showdown with Republicans Behind the scenes, Democratic leaders were still working to secure backing for the legislation from among roughly three dozen members of the party whose votes are considered to be in play.

But they sought to portray the measure as gaining momentum from the public declarations of support from two Democrats: Dennis J. Kucinich of Ohio, who had previously opposed it, and Dale E. Kildee of Michigan, who had been among a group seeking tighter restrictions on the financing of insurance covering abortions.

Democratic leaders say they have not yet nailed down the 216 votes they need for passage, but they are pressing ahead in the belief that they can get them. Mr. Hoyer said the House could take a final vote on the legislation by Sunday.

The endorsement from Mr. Kucinich suggested that Democrats who have been pushing for more ambitious legislation might put aside their reservations and unite behind the bill as their best opportunity to secure health insurance for millions of Americans who now lack it. The backing from Mr. Kildee — and new support from nuns who lead major Roman Catholic religious orders — indicated that Democrats were having some success in addressing an issue that has cost the votes of some Democrats who oppose abortion rights.

But House Republicans said they still believed they could block the bill, a top priority for President Obama and Speaker Nancy Pelosi.

Under a two-step plan devised by House Democratic leaders, the House would approve the health care bill passed by the Senate in December, then make changes in a separate bill using a procedure known as budget reconciliation to avoid the threat of a filibuster in the Senate. Republicans like Representative David Dreier of California have accused Democrats of ducking a straight-up vote on the Senate bill, which has provisions that many House Democrats do not like.

In an interview with Fox News, Mr. Obama dismissed Republican criticisms of the parliamentary tactics, saying he does not “spend a lot of time worrying about what the procedural rules are.”

“What I can tell you is that the vote that’s taken in the House will be a vote for health care reform,” Mr. Obama said. “And if people vote yes, whatever form that takes, that is going to be a vote for health care reform.”

Mr. Obama likened the measure to fixing the financial system or passing the economic recovery act. “I knew these things might not be popular, but I was absolutely positive that it was the right thing to do,” he said.

Representative John A. Boehner of Ohio, the House Republican leader, said Republicans were engaged in a variety of activities to stir opposition to the health care bill in the home districts of Democrats considered vulnerable in the November elections.

“We are going to do everything we can to put the pressure on these guys because they are going to have to choose,” said Mr. Boehner. “Are they going to vote with Nancy Pelosi and the president, or are they going to vote with their constituents?”

“It’s going to be a wild ride,” Mr. Boehner predicted.

Besides securing commitments from Mr. Kucinich and Mr. Kildee, House Democratic leaders said they were pleased at the prospect of winning support from Representative James L. Oberstar, Democrat of Minnesota and an opponent of abortion.

John A. Schadl, a spokesman for Mr. Oberstar, said the congressman was “a strong likely yes” on the health care bill. Mr. Schadl said Mr. Oberstar was generally satisfied that the bill before the House would not allow the spending of federal money on abortion.

Democrats had hoped to unveil the text of the reconciliation bill on Wednesday afternoon, setting up the possibility of a decisive vote on Saturday, but the Congressional Budget Office was not yet finished analyzing the cost of some provisions.

House Democratic leaders have promised that lawmakers would be given 72 hours to review the legislation before voting on it.

The No. 2 Democrat in the Senate, Richard J. Durbin of Illinois, said the Senate could pass the reconciliation bill as soon as next week if the House approves it over the weekend.

In announcing his support, Mr. Kucinich said he would keep working for a government-financed single-payer health care system. But after coming under intense pressure, which included a visit to his district on Monday by Mr. Obama, Mr. Kucinich said he did not want his objections to stand in the way of the legislation.

“If my vote is to be counted, let it count now for passage of the bill, hopefully in the direction of comprehensive health care reform,” Mr. Kucinich said.

Explaining factors he had considered in making his decision, Mr. Kucinich said, “We have to be very careful that the potential of President Obama’s presidency not be destroyed by this debate.”

“Something is better than nothing — that’s what I keep hearing from my constituents,” Mr. Kucinich said.

A last-minute hitch developed Wednesday over a couple of provisions of the Senate bill of great interest to organized labor.

One provision singles out the construction industry for special treatment, in a way that benefits union members and contractors who use union labor. It was unclear whether that provision had survived in the final package, and on Wednesday, Richard L. Trumka, the president of the A.F.L.-C.I.O., met with Mr. Obama at the White House to discuss the issue.

Labor leaders are also concerned about a provision of the Senate bill that would impose an excise tax on high-cost employer-sponsored health plans. In January, Mr. Trumka and the White House reached an agreement that would delay the tax to 2018 and reduce the number of health plans affected.

Republican senators said they believed they could successfully challenge the inclusion of that agreement in the final health care package, on the ground that it would violate the rules for budget reconciliation. If the compromise is dropped from the bill, labor groups and some of their allies on Capitol Hill would be much less supportive of the bill.

At the same time, Democrats said they were making progress on the divisive issue of abortion.

Mr. Kildee voted for the House health care bill in November, after Representative Bart Stupak, also a Michigan Democrat, won passage of an amendment imposing tight restrictions on insurance coverage for abortions.

Mr. Stupak has said he will vote against the Senate bill because he sees the restrictions on abortion as inadequate. But Mr. Kildee said he was satisfied that the provisions in the Senate bill would prevent the use of federal money for coverage of abortions.

“I have always respected and cherished the sanctity of human life,” Mr. Kildee said. “I spent six years studying to be a priest and was willing to devote my life to God.”

“I have listened carefully to both sides, sought counsel from my priest, advice from family, friends and constituents, and I have read the Senate abortion language more than a dozen times,” Mr. Kildee said. “I am convinced that the Senate language maintains the Hyde Amendment, which states that no federal money can be used for abortion.”

Mr. Stupak reiterated his opposition to the Senate bill, as did the United States Conference of Catholic Bishops.

But in a letter to House members on Wednesday, more than 50 nuns from various religious orders said, “The time is now for health reform, and the Senate bill is a good way forward.”

Source: http://www.nytimes.com/2010/03/18/healt ... ealth.html

[roxybeast]

Access, Access, Access
By NICHOLAS D. KRISTOF
Published: March 17, 2010

First, a question: When in American history did life expectancy improve the most?

Was it the late 1800s, when anesthesia made surgery easier and far more common? Was it the 1930s, when antibacterial medicines became available? Or recent decades, when CAT scans and heart bypasses proliferated?

The correct answer is: none of the above. While data differ and the statistics aren’t fully reliable, a good bet is that the best answer is the 1940s. In that period, life expectancy increased about seven years.

Indeed, American life expectancy appears to have been longer in 1942, 1943, 1944 and 1945 — even as hundreds of thousands of young Americans were being killed in World War II — than it had been when America was at peace in 1940.

A prime reason is that with the war mobilization, Americans got much better access to medical care. Farmers and workers who had rarely seen doctors now found themselves with medical coverage through the military, jobs in industry or New Deal programs.

In short, great health care is often less about breakthrough technologies than it is about access. And for all the disagreements about President Obama’s health care proposal, let’s focus on this: it unquestionably would increase access, while its defeat would diminish access.

Most of American history has seen a steady increase in access to first-rate health care. But we’re now seeing a reversal of this long trend. A new report has found that one-quarter of Californians are now uninsured.

The reason for the declining access? Our politicians’ ignominious failure over the last half-century to provide universal health care, despite the efforts of Democratic and Republican presidents alike to pass it. It’s astonishing that Republicans today are lined up overwhelmingly against a health care package that is more modest and moderate than one that Richard Nixon proposed in the early ’70s.

If Republicans succeed in killing Mr. Obama’s reform package, the share of Americans with medical coverage will continue to drop. The Robert Wood Johnson Foundation estimated this month that if significant reforms do not pass, the number of uninsured Americans could grow by 10 million over just the next five years.

Partly because of lack of access, American health statistics are notorious: Our children are two-and-a-half times as likely to die before the age of 5 as children in Sweden. American women are 11 times as likely to die in pregnancy or childbirth as Irish women. The average person in Honduras or Vietnam is expected to live longer than the average African-American in New Orleans.

Opponents of health care reform claim that America’s health statistics are poor simply because of America’s racial diversity and large underclass. But there is one group of Americans who do fine in international comparisons — and that’s the 65-plus crowd. They have Medicare.

One careful study after another has shown that uninsured people are significantly more likely to die than insured people. That’s because diseases are caught at later stages on uninsured people, and they don’t get treated so well.

There’s one group that should be particularly passionate about supporting Mr. Obama’s efforts: opponents of abortions. There’s abundant cross-country evidence that the best way to hold down abortion numbers is to improve access to health care and thus prevent unwanted pregnancies.

As T.R. Reid (my editor way back in the 13th century when I was a college intern at The Washington Post) noted in The Post this week: “Increasing health-care coverage is one of the most powerful tools for reducing the number of abortions — a fact proved by years of experience in other industrialized nations.”

The United States has one-third more abortions per 1,000 women of reproductive age than Canada, and more than twice as many as Germany, said Mr. Reid, author of an excellent recent book on health care around the world. While countries with liberal social policies typically make abortion accessible and cheap, they make other elements of health care accessible and cheap as well — such as contraception and child care. Research by the Guttmacher Institute suggests that access to contraception could be the crucial factor in reducing pregnancies and abortions.

The tide of history has taken us and other Western countries toward steadily greater access to medical coverage — until recent reversals in the United States. Put aside quarrels over the mechanisms used to pass the bill, and focus on the central question of Americans’ access to decent medical care. On that issue, those trying to kill this health care reform proposal are simply on the wrong side of history.

Source: http://www.nytimes.com/2010/03/18/opini ... istof.html

[roxybeast]

"Comprehensive health care reform will cost the federal government $940 billion over a ten-year period, but will increase revenue and cut other costs by a greater amount, leading to a reduction of $130 billion in the federal deficit over the same period, according to an analysis by the Congressional Budget Office, a Democratic source tells HuffPost. It will cut the deficit by $1.2 trillion over the next ten years.

The source said it also extends Medicare's solvency by at least 9 years and reduces the rate of its growth by 1.4 percent, while closing the doughnut hole for seniors, meaning there will no longer be a gap in coverage of medication. The CBO also estimated it would extend coverage to 32 million additional people."

Source: http://www.huffingtonpost.com/2010/03/1 ... 02543.html

[roxybeast]

The Cost of Doing Nothing on Health Care
By REED ABELSON
New York Times, February 26, 2010

“Hands off my health care,” goes one strain of populist sentiment.

But what if?

Suppose Congress and President Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose — despite the Democrats’ latest and possibly last big push that began last week at a marathon televised forum in Washington.

Then “my health care” stays the same, right?

Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.

“People think if we do nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. “In fact, what we will have is a substantial deterioration in what we have.”

Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone’s dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.

Policy makers, in the end, may be forced to address the issue.

“It will break all of our banks if we do nothing,” said Peter V. Lee, who oversees national health policy for the Pacific Business Group on Health, which represents employers that offer coverage to workers. “It is a course that is literally bankrupting the federal government and businesses and individuals across the country.”

Even those families that enjoy generous insurance now are likely to see the cost of those benefits escalate. The typical price of family coverage now runs about $13,000 a year, but premiums are expected to nearly double, to $24,000, by 2020, according to the Commonwealth Fund. That equals nearly a quarter of the projected median family income in 2020.

While some employers will continue to contribute the lion’s share of those premiums, there will be less money for employees in the form of raises or bonuses.

“It’s also cramping our economic growth,” said Frank McArdle, a consultant with Hewitt Associates, which advises large employers and reported on the need for change for the Business Roundtable, an association of C.E.O.’s at major companies. Spending so much on health care is “really a waste of people’s money,” Mr. McArdle said.

The higher premiums will also persuade more businesses, especially smaller ones, to decide not to offer insurance. More people who buy coverage on their own or are asked to pay a large share of premiums will find the price too high. It doesn’t take too many 39-percent increases, like the recent one proposed in California that has garnered so much attention, to put insurance out of reach.

“We have an affordability problem that is moving up through the middle class now,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a nonprofit Washington research group.

While estimates vary, the number of people without insurance is expected to increase by more than a million a year, said Ron Pollack, the executive director of Families USA, a Washington consumer advocacy group that favors the Democrats’ approach. The Urban Institute, for example, predicts that the number of uninsured individuals will increase from about 49 million today to between 57 million and 66 million by 2019. The Democrats’ plan is expected to cover as many as 30 million individuals who now are uninsured.

There will be a cost in lives, too. Mr. Pollack’s organization estimates that as many as 275,000 people will die prematurely over the next 10 years because they do not have insurance. Even people with insurance will find their coverage providing much less protection from financial catastrophe than it does now. Individuals will pay significantly more in deductibles and co-payments, for example. “More and more families will experience huge debts and bankruptcies,” Mr. Pollack said.

Federal and state governments will also feel the squeeze. Medicare, the federal program for the elderly, is already the subject of much hand-wringing as its spending balloons. Medicaid, a joint program of the federal government and the states, is already struggling as states try to balance budgets hit hard by the economic downturn. Many states may be forced to cut benefits sharply as well as reduce financing for community health centers and state hospitals that serve the poor.

“I think we’ll just see the decline of public services,” said John Holahan, the director of the Health Policy Center at the Urban Institute.

Exactly how politicians, or anyone else, will react to the increasing pressures on the system is anyone’s guess. If the system actually collapses, could there be a movement to adopt a government-run system, something like Medicare for all, where the whole health care system would be much more heavily regulated?

Or maybe employers would take up the effort to figure out a better way of providing coverage.

The states may also step up their role. Some may try to follow the lead of Massachusetts, which overhauled its own insurance market for individuals and small businesses, while others may try a series of regulatory fixes. A state senator in New Hampshire, for example, recently introduced legislation that regulates hospital prices in a fashion similar to an approach favored in Maryland.

What seems unlikely, say policy analysts, is that Congress would try to pass anything nearly as ambitious as the bills that went through the House and Senate last year.

“If we fail this time, you’re not going to get this Congress to take this up on a big scale,” said Len Nichols, a health policy analyst at George Mason University who says he thinks the Democrats should go ahead and pass legislation.

But few policy analysts think Congress can afford to do absolutely nothing. Lawmakers are instead likely to try a series of smaller fixes, said Stuart Butler, a health policy analyst at the Heritage Foundation, a research group that favors market solutions over a larger government role.

After President Bill Clinton failed to get Congress to pass his health care bill in 1994, Republicans, who then had substantial victories in the House and Senate, worked with him to pass legislation like the health care privacy bill, a children’s health insurance program and the Balanced Budget Act, which contained significant changes to the Medicare program. Under President George W. Bush, the Republicans went on to pass a drug benefit under Medicare. “In the space of less than 10 years, you have several major bills,” Mr. Butler said.

If nothing passes now, Mr. Butler says he thinks Congress will tackle narrower areas, like insurance regulation, to make it easier for people with pre-existing medical conditions to find coverage, or maybe it will try another expansion of Medicaid or the children’s program.

But President Obama clearly prefers passage of a broader bill. In wrapping up Thursday’s session with lawmakers, he and other Democrats warned that an incremental approach was likely to provide too little relief to the people already feeling the effects of a broken system. “It turns out that baby steps don’t get you to the place that people need to go,” he said.

And even some people without a partisan point to make argue that the series of bills passed in the last 15 years have not made enough of a dent in slowing down medical costs. “We’ve had a lot of incremental reforms already,” said Mr. McArdle, the Hewitt consultant.

And many argue that putting off the inevitable has an additional cost. The Commonwealth Fund estimates that the nation would be spending hundreds of billions of dollars less than it does today if any of the health care legislation proposed by previous administrations had been enacted, assuming that they reduced costs by about 1.5 percentage points. If President Nixon’s plan had passed, the United States might be spending a trillion dollars a year less than it does now, and President Clinton’s plan would have reduced spending by some $500 billion a year.

“It makes a huge difference over a long period of time,” said Ms. Davis of the Commonwealth Fund.

This article has been revised to reflect the following correction:

Correction: March 7, 2010

An article last Sunday about the cost of doing nothing to change the health care system misstated when health care premiums are likely to be nearly a quarter of a typical family’s income. A premium of $24,000, projected for 2020, is a quarter of what a family is expected to earn then, not of what it earns today.

Source: http://www.nytimes.com/2010/02/28/weeki ... elson.html

[roxybeast]

My employment attorney friends, who literally represent 10s of 1000s of disaffected employees every year, unanimously support immediate passage of health care reform & shared the unanimous message below earlier tonight ...

"So many of us have represented folks who found themselves dealing with a serious health issue and then had their insurance coverage canceled. I think it is incumbent on us to share that perspective with members of Congress as they enter the final 'make it or break it' phase for this health care reform bill. I urge everyone to call their Congress member and let our voices and the voices of our clients be heard."
"Amen" ... "Yes, Yes, and Hell Yes!"

"We have seen the destruction & devastation caused by insurance gamesmanship on the lives of our clients firsthand. It is time for these abuses to stop. The time has finally come to save our economy, to save America's families, and ultimately, to save millions of lives. The time has finally come to pass health care reform!"
"Amen" ... "Yes, Yes, and Hell Yes!"

[roxybeast]

<center>What's In, What's Out in Health Care Reform Bill
Huffington Post, March 19, 2010</center>

WASHINGTON (AP) — Bye bye, Cornhusker Kickback. Hello, special treatment for Tennessee and North Dakota.

Democrats unveiling revisions Thursday to their health care overhaul bill decided to kill the extra $100 million in Medicaid funds for Nebraska that has become a symbol of backdoor deal making.

But the 153 pages of changes to the massive health care package include extra money for hospitals in Tennessee that serve large numbers of low-income patients. And though the bill would revamp the nation's student loan system to make the government the only lender, one bank – the state-owned Bank of North Dakota – would be allowed to continue making student loans.

That provision ended up rubbing Sen. Kent Conrad, D-N.D., the wrong way. Fearing it would become a target by Republicans in what he said is "an overly heated partisan environment," he asked the House late Thursday to remove it from the legislation.

Still alive is special spending for Louisiana, Connecticut, Montana and other states that was included in the health care bill that the Senate approved in December. The House may give it final approval this weekend.

Senior White House officials have sent mixed signals about the special deals. They initially demanded that they be eliminated, but by Sunday senior White House adviser David Axelrod said they only objected to provisions affecting just one state.

White House spokesman Robert Gibbs last week singled out projects from Montana and Connecticut as items President Barack Obama wanted removed. There was resistance, however, from two influential committee chairmen, Democratic Sens. Max Baucus of Montana and Christopher Dodd of Connecticut, and their projects have survived.

To help win the vote of Sen. Ben Nelson, D-Neb., the massive measure the Senate passed on Christmas Eve had included $100 million that only Nebraska would get in added federal Medicaid assistance.

Immediately mocked as the Cornhusker Kickback, critics called it the epitome of special Washington dealing, and even Nelson advocated ending his state's special treatment. Under the changes announced Thursday, the Nebraska provision would be deleted and all states would get additional Medicaid help from Washington.

Also eliminated from the Senate measure was a provision allowing about 800,000 elderly Floridians to keep enhanced Medicare benefits that are being cut for residents of other states.

The changes also include an additional $99 million in 2012 and 2013 for Tennessee hospitals that treat many poor people.

Retiring Rep. Bart Gordon, D-Tenn., has fought for the funds for years to bring the state's aid up to par with the rest of the country, spokeswoman Emily Phelps said. She said their inclusion had nothing to do with his announcement Thursday that he will vote for the final health legislation after opposing an earlier version in November.

The new package also promises new aid for colleges serving minority students, using money the government is supposed to save by no longer paying banks to make student loans. Included are annual payments of $100 million for schools with large numbers of Hispanic students, the same amount for colleges with many black students, and millions more for schools with large numbers of native Americans and other minorities.

Based on Thursday's changes, the health legislation also:

_Retains $300 million in extra Medicaid aid for Louisiana, which had helped win support for the Senate health bill from Sen. Mary Landrieu, D-La. The state is still struggling to recover from Hurricane Katrina.

_Keeps $100 million included in the Senate bill that is expected to go for a public hospital in Connecticut sought by Dodd, who is retiring.

_Preserves language won by Baucus permitting many of the 2,900 residents of Libby, Mont., to qualify for Medicare benefits. Some of them have asbestos-related diseases from a now-shuttered mine.

_Provides an additional $8.5 billion over the next decade for 11 states and the District of Columbia to help them pay for the more generous Medicaid assistance they have been providing low-income residents. These states are Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin.

_Maintains a Senate-approved provision giving extra money for hospitals and doctors in North and South Dakota, Montana and Wyoming.

Source: http://www.huffingtonpost.com/2010/03/1 ... 05288.html

[roxybeast]

Here's a link to the full text of the current pending bill ...

http://www.scribd.com/doc/28579240/111-hr4872-amndsub

[roxybeast]

<center>Health Care Reform Bill: Cost, Details, Changes Released
THE ASSOCIATED PRESS | 03/18/10</center>

Congressional Democrats have released a final version of President Barack Obama's health care overhaul bill in advance of a House vote planned for Sunday. Some of the main features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve:

COST: $940 billion over 10 years, according to the Congressional Budget Office.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.

INSURANCE MARKET REFORMS: Major consumer safeguards take effect in 2014. Insurers prohibited from denying coverage to people with medical problems or charging them more. Higher premiums for women would be banned. Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, and from denying coverage to children because of pre-existing medical problems. Parents would be able to keep older kids on their policies up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of the tab for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent.

PRESCRIPTION DRUGS: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.

EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire workforce, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.

SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.

GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION: The proposal keeps the abortion provision in the Senate bill. Abortion opponents disagree on whether restrictions on taxpayer funding go far enough. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to cover abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

STUDENT LOAN OVERHAUL: Requires the government to originate student loans, closing out a role for banks and other private lenders who charge a fee. The savings – projected to be more than $60 billion over a decade – are plowed into higher Pell Grants for needy college students and increased support for historically black colleges.

GOP HEALTH CARE SUMMIT IDEAS: Following the bipartisan health care summit, Obama announced he was open to incorporating Republican ideas in his legislation. But two of the principal ones – hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives – didn't make it into the bill released Thursday. Only one did, an increase in payments to primary care physicians under Medicaid, proposed by Sen. Charles Grassley, R-Iowa.

Source: http://www.huffingtonpost.com/2010/03/1 ... 05128.html