Beth's Health Care Reform Blog

[roxybeast]

The Real Cost of Doing Nothing

Even if you have insurance, you have three real concerns that will continue to haunt you unless & until serious meaningful reform, like single-payor or perhaps HR 3200, is passed:

(1) Insurance Companies May Very Well Deny Your Claim to Enhance Profits:

WATCH THIS VIDEO: http://www.youtube.com/watch?v=G4TsaHmtgfA


(2) You May Lose Your Coverage or Get Dropped:

Census Bureau report shows need for health care reform
Economic Policy Institute,
September 10, 2009

A new Census Bureau report on income, poverty and health insurance coverage in the U.S. shows that the existing health care system is failing to provide stable and secure coverage for a growing number of Americans. The report shows that employment-based health coverage dropped for the eighth year in a row, from 59.3% of Americans covered in 2007 to 58.5% in 2008. The number of Americans without any health insurance rose from 45.7 million in 2007 to 46.3 million in 2008.

It’s a virtual certainty that with the deepening of the recession in 2009, more Americans are losing health insurance every day. Americans need affordable, secure alternatives to a system where losing a job too often means losing health insurance. The status quo is simply not a viable solution. –Elise Gould Archive

or (3) The Cost of Your Insurance Will Almost Certainly Go Up Significantly or Your Benefits Will Be Substantially Rolled Back:

Many Employers to Raise Cost of Health Benefits, Survey Finds
By David S. Hilzenrath
Washington Post Staff Writer
Wednesday, September 16, 2009

Though Americans who already have medical coverage may be wary of change, a new survey indicates that they may be hard-pressed to escape it -- even in the absence of health-care reform.

As businesses contend with rising costs, many workers face an erosion of health benefits next year, according to an annual survey released Tuesday by the Kaiser Family Foundation and the Health Research and Educational Trust.

Forty percent of employers surveyed said they are likely to increase the amount their workers pay out of pocket for doctor visits. Almost as many said they are likely to raise annual deductibles and the amount workers pay for prescription drugs.

Nine percent said they plan to tighten eligibility for health benefits; 8 percent said they plan to drop coverage entirely. Forty-one percent of employers said they are "somewhat" or "very" likely to increase the amount employees pay in premiums -- though that would not necessarily mean employees would pay a higher percentage of the premiums. Employers could simply be passing along the same share of the overall increase that they are doing this year.

The authors of the study said the findings underscore the need for federal action to rein in costs.

The survey is one of several reports providing fresh ammunition to President Obama as he struggles to overhaul the nation's health-care system. One of his biggest challenges has been winning over Americans who are satisfied with their existing coverage.

A major business lobby weighed in Tuesday, saying that if current trends continue, annual health-care costs for employers will rise 166 percent over the next decade -- to $28,530 per employee.

"Maintaining the status quo is simply not an option," said Antonio M. Perez, chief executive of Eastman Kodak and a leader of the Business Roundtable. "These costs are unsustainable and would put millions of workers at risk," Perez said in a statement.

Rather than letting the trends go unchecked, employers will probably adopt a variety of cost-saving measures, said Helen Darling, president of the National Business Group on Health, an alliance of corporations. Those steps could include giving employees financial incentives to participate in weight-loss programs, order prescription drugs by mail and undergo health assessments, she said. In addition, before workers pursue costly procedures such as back surgery, they could be required to receive briefings that explain the potential downside of the treatment, Darling said.

Almost two-thirds of corporations surveyed by the Mercer consulting firm plan to call on employees to pay a greater share of health plan costs next year, according to a report last week.

The Kaiser Family Foundation survey, released Tuesday, obtained in-depth responses from more than 2,000 private firms and non-federal public employers. The foundation focuses on health issues; its collaborator, the Health Research and Educational Trust, is affiliated with the American Hospital Association. Annual premium increases for families, which totaled 13 percent in 2002 and 2003, have held steady at 5 percent since 2007, the groups reported. Premiums for single coverage did not rise significantly in 2009, breaking a long-standing trend.

However, premiums have continued to rise faster than wages and overall inflation, the survey found. Though family premiums for 2009 rose 5 percent, during the 12-month period ending in April, general inflation fell 0.7 percent.

Source: http://www.washingtonpost.com/wp-dyn/co ... 01175.html

And consider these future health cost projections for America's families ...

Family Health Spending to Rise Rapidly
Costs Are Becoming Unsustainable for Families with Employee-Sponsored Care
By Sonia Sekhar
Center for American Progress, September 15, 2009

Escalating health care costs threaten to erode the income of the more than 160 million people who depend on employer-sponsored coverage. Without real changes to our health care system, annual health care spending for families of four with employer-sponsored coverage will grow from nearly $17,000 today to over $39,000 by 2019—or from 19 percent of family income to 31 percent, and will rise to 48% by the year 2029.

Most American families depend on employer-sponsored insurance for their health coverage. Yet premiums and out-of-pocket expenses for families with employer-sponsored plans are rising at an unprecedented pace. Without health reform, health care costs will continue to eat away at family budgets, compromising families’ ability to pay their bills, buy a home, or save toward long-term goals such as their retirement or their children’s education. Health reform promises to slow cost growth by promoting cost-saving innovations, improving payment systems, reducing waste and inefficiencies, and modernizing the health care infrastructure. The uninsured are not the only ones who stand to gain from health reform—the millions of Americans who receive coverage from their employers will also see improvements in their coverage.

Methodology:

The Milliman Medical Index measures annual employer and employee spending on health insurance premiums, as well as employee out-of-pocket cost sharing. We calculated the MMI’s historical average annual rate of growth to trend forward the annual health care spending for a typical family of four with employer-sponsored coverage. For family income, we relied on Current Population Survey historical median income tables of families by size, and because employer-provided health insurance is part of compensation, and added MMI estimates of the employer contribution to premiums. We developed income projections based on the CBO’s average annual wage increase projections, and calculated its historical average annual rate of growth to trend forward the employer share of premiums.

Source: http://www.americanprogress.org/issues/ ... nding.html

[roxybeast]

What Is Needed to Enact Real Reform?

Finishing Strong
by Josh Bivens & Elise Gould
Economic Policy Institute, September 14, 2009

President Obama’s September 9 address to Congress was masterful in defining the challenge the country faces and the urgent need for health care reform. In an era where many politicians mention government’s role in the lives of Americans only when decrying taxes, Obama should be applauded for his bid to redefine government as a potential ally, not an enemy, of low- and middle-income Americans.

In short, Obama provided the perfect springboard for entering the final stages of the debate over health care reform. From here on, however, the debate will move from defining the broad challenge to specifying the precise details of reform. And these details matter a lot.

As we enter the homestretch, proposals remaining on the table are bracketed in their scope by the bill passed over the summer by committees in the House of Representatives on one side, and the framework released in early September by Senator Max Baucus, chair of the powerful Senate Finance committee, on the other.

Both proposals rule out the worst abuses of the private insurance industry. Both would establish new health insurance “exchanges” to allow individuals and small firms to pool together to negotiate with insurers for better rates, while banning the current industry practices of refusing coverage or price discrimination based on health status or pre-existing conditions. Both proposals would provide subsidies for those who find the cost of health insurance burdensome even with the enhanced bargaining power provided to them by the exchange.

However, on almost every issue of interest to progressive reformers, the Baucus framework is inferior to the House bill. The first goal of progressive reformers at this stage is simple: push for the adoption of a bill that looks as much like the House bill and as little like the Baucus framework as possible. The second goal is to make the new national insurance exchanges (including the public insurance option specified in the House bill) as expansive as possible.

The main differences between the House and Baucus framework that should be addressed by progressive reformers are as follows:

--The most obvious difference, and the one that will be most consequential, especially in the short-run, is the generosity of subsidies provided to those who would purchase health insurance through the new insurance exchange. The House bill provides for caps on both premium and out-of-pocket costs for households whose income reaches up to 400% of the federal poverty line (FPL). The Baucus bill does not, providing no protection against out-of-pocket cost-sharing for families whose income is greater than 300% of the poverty threshold. This difference in subsidy generosity is reflected in the overall price tag of the proposals: slightly more than $1 trillion over the next decade for the House bill versus $900 bill for the Baucus plan. On this front, President Obama’s identification of $900 billion as the proper cost of health reform over the next decade was a distressing (if rare) misstep in his speech. There’s no reason to give away the superior subsidies of the House bill.

--The difference between the House and the Baucus proposals most noted by progressive reformers is the lack of a public insurance option in the latter. This is a clear weakness of the Baucus plan; the virtues of a strong public option have been well documented. Non-profit health “co-ops” are no substitute for a robust public option. States today have the ability to set up co-ops, yet they are quite rare and have shown no sign of providing a true competitive check on either the bad behavior of private insurers or on the runaway cost of private insurance.

--Key parts of financing in the Baucus and House proposals differ greatly as well. The Baucus framework relies on taxing high-cost health insurance plans. Previous work has shown that high-cost plans are not always high-quality “Cadillac” plans enjoyed only by the most privileged workers, as they are commonly characterized. While the initial tax specified in the Baucus framework will affect very few taxpayers, it seems clearly designed to impact more and more over time. The House bill, conversely, relies on a surcharge on very high incomes to finance its reforms. This is a much more progressive option. Given this difference, it was another distressing misstep for President Obama to mention the Baucus financing proposal while not endorsing that in the House bill. Further, the President’s own budget had a health care financing proposal that relied on limiting tax deductions for affluent taxpayers that went unmentioned in his speech on Wednesday. Either the House financing mechanisms or those contained in the President’s own budget proposals would be preferable to those of the Baucus framework.

--The Baucus framework asks much less of employers in sharing responsibility for financing; the money raised from employer contributions is structured particularly poorly from the perspective of low-wage workers. The House bill, on the other hand, has a simple “pay or play” mandate on employers: firms must provide good health insurance to their workers or pay a fee to defray the costs of enrolling them in the new national insurance exchange, with only the smallest firms to completely escape this requirement. The Baucus bill, conversely, requires firms pay only for enrolling workers whose family income is below 300% of the FPL in the exchange. This odd mechanism essentially puts the incidence of the employer mandate solely on workers from lower income households. This is a strong argument against the Baucus framework.

--A more subtle difference, but one that will be very important in the longer run, is the composition of the new health insurance exchanges. The Baucus proposal would set up these exchanges at the state level and would segment off individuals from small firms, creating separate pools for each. Both of those moves would be mistakes. The exchanges should be national (through geographic differences in premiums could be allowed) and enrollment in them should be as expansive as possible. Economics teaches that larger insurance pools work better than smaller pools, period.

Aside from the stark differences between the House and Baucus proposals, progressive reformers should also seek to address a problematic provision common to both proposals regarding the national insurance exchange: it unwisely limits enrollment during the first two years to individuals and those who work for very small firms. In the House bill, the commissioner of the exchange has the option to expand enrollment in the third year. Here again, we come to a dispiriting portion of the President’s speech last night. In making the case to centrists about the public plan, he all but bragged about how few people are projected to enroll in it. This small projected enrollment in the public plan is almost purely a function of how few workers would be allowed to enroll in the wider exchange. Remembering again that that larger insurance pools work better than small ones, the new national exchange should be open to all comers, including large firms that think they can get a better deal in it, as well as those workers who have received insurance offers from their employer but would still like the greater choice potentially afforded by the exchange.

Without expansive enrollment, neither the exchange nor a public insurance option contained in it will have a chance to make a real difference. Further, small enrollment exposes both the exchange and the public plan to the possibility that they will simply become dumping grounds for the sickest and most-expensive-to-insure workers.

There is still reason for great hope regarding the outcome of health reform. If the House bill (or something very much like it) prevails, and, if the insurance exchanges are opened up quickly following establishment and contain a strong public option, then health insurance in the U.S. will be fundamentally changed for the better and the ambitious promises made by President Obama as a presidential candidate will be fulfilled.

Source: http://www.epi.org/analysis_and_opinion ... ng_strong/

Interesting, EPI comes to the same conclusions that I reached before & without having read their article in my piece "Let's Address the Legitimate Concerns" that I posted on this blog earlier today (see p. 6 of blog replies).

[roxybeast]

Baucus/Gang of 6 Compromise Unveiled Without GOP Support

Listen to NPR News Broadcasts:

1) Baucus Bill Lacks GOP Support
http://www.npr.org/templates/story/stor ... =112872558

2) GOP Alternative Proposals Don't Address Real Problems
http://www.npr.org/templates/story/stor ... =112855346

Baucus' Long-Awaited Health Bill Lacks GOP Support
by KEVIN WHITELAW
NPR, Sept. 16, 2009

Sen. Max Baucus spent the past few months trying to negotiate a compromise health care reform package that would have bipartisan support. But when Baucus, the Senate Finance Committee chairman, finally released the details of his 10-year, $856 billion bill on Wednesday, there was no sign of Republican backing.

Many Democrats are worried that Baucus offered far too many concessions to Republicans — most notably dropping the idea of a government-run health care plan to compete with private insurers — without securing any firm support from across the aisle.

The top selling point of the Baucus bill was supposed to be its bipartisan appeal. Without some Republican support, Baucus' version could end up adding to the cacophony of competing proposals passed by several committees in the House and Senate.

Baucus (D-MT) is still hoping to attract at least one Republican vote when the committee votes on the measure, which could happen as early as next week.

There are some signals that Republican Sen. Olympia Snowe of Maine is still considering whether to support the compromise. But other Republicans sound unalterably opposed to it. Senate Minority Leader Mitch McConnell has already blasted the bill as a "partisan proposal."

The Bill's Implications

The new bill is notably more moderate, and less expensive, than the proposals passed by other committees in the House and Senate. Instead of the so-called public option, Baucus wants to create a network of private, nonprofit health care cooperatives that could compete with private insurance. The bill would provide $6 billion in seed money to assist with start-up costs.

Baucus did manage to hold the overall cost below President Obama's target of $900 billion over a decade, according to an estimate by the Congressional Budget Office, which analyzed the bill. But many Democrats have said that the cuts made to reach the target could end up hurting the ability of lower-income Americans to afford health care.

The bill does have sweeping implications for individuals, health-care providers and employers:

—Individuals. Almost all Americans would be required to obtain health care coverage, or pay significant fines. Some exceptions would apply for those with certain religious objections. Starting in 2013, tax credits would be offered to help low- and middle-income Americans afford coverage.

Consumers will be able to shop for and compare insurance plans in new exchanges, which would be Web portals created by state governments within federal guidelines.

—Providers. The bill bans carriers from limiting coverage based on pre-existing conditions.

Also, insurance companies and plan administrators would have to pay an excise tax on plans that cost more than $8,000 for individuals and $21,000 for families. Many Republicans are leery of taxing these so-called Cadillac plans at such a high rate.

—Employers. Companies would not be required to provide insurance for their workers, but firms with more than 50 employees would face stiff fines if they don't offer health care coverage. Baucus did include some tax credits and other measures aimed at encouraging small businesses to offer insurance plans.

On the controversial issue of illegal immigrants and health care, which prompted the "You lie" outburst during Obama's recent speech to Congress, Baucus is walking a fine line. Individuals seeking tax credits to purchase health care coverage through new state exchanges would be required to provide their social security number and date of birth to prove their eligibility. But the measure appears to fall short of the demands for tougher checks demanded by some Republicans.

One Vote

In releasing the bill, Baucus defended it as a sensible compromise.

"The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy," he said in a statement. "We worked to build a balanced, common-sense package that ensures quality."

But even Sen. Chuck Grassley, the ranking Republican on the Finance Committee, has already signaled displeasure.

"I'm disappointed because it looks like we're being pushed aside by the Democratic leadership so the Senate can move forward on a bill that, up to this point, does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began," he said.

Democrats hope they will still be able to attract some Republican support before the committee votes, which could come as early as next week. They need at least one Republican vote — and no Democratic defections — to avoid a filibuster.

Source: http://www.npr.org/templates/story/stor ... =112874168

[roxybeast]

Humor: Billionaires for Weathcare!

Some Billionaires show up at a health care rally to thank the little folks for supporting their efforts to line their wealthy pockets!

What's funny about this video is that the folks at the rally either scratch their heads or seem to actually welcome and encourage the billionaires message, but none of them get mad ... like they should!

http://www.youtube.com/watch?v=jHVwrCzRUX0

[roxybeast]

RESCISSION ...
Just Because You Have Insurance Does Not
Mean They Will Actually Let You Use It!

Consider this article ...

Insurance Company Must Pay $10 Million For Revoking Policy Of Teen With HIV
by Murray Waas,
Huffington Post, Sept. 17, 2009

The South Carolina Supreme Court has ordered an insurance company to pay $10 million for wrongly revoking the insurance policy of a 17-year-old college student after he tested positive for HIV. The court called the 2002 decision by the insurance company "reprehensible."

That appears to be the most an insurance company has ever been ordered to pay in a case involving the practice known as rescission, in which insurance companies retroactively cancel coverage for policyholders based on alleged misstatements - sometimes right after diagnoses of life-threatening diseases.

* * *

In the ruling, Chief Justice Jean Hoefer wrote: "We find ample support in the record that Fortis' conduct was reprehensible ... Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."

An investigation this summer by the House Energy and Commerce Committee, and earlier ones by state regulators in California, New York and Connecticut, found that thousands of vulnerable and seriously ill policyholders have had their coverage canceled by many of the nation's largest insurance companies without any legal basis. The congressional committee found that three insurance companies alone made at least $300 million over five years from rescission. One of those three companies was Assurant.

In Febuary 2008, a private arbitration judge in Los Angeles ordered Health Net Inc. to pay more than $9 million to a breast cancer patient whose health insurance it revoked shortly after her diagnosis and while she was undergoing chemotherapy. The plaintiff in that case, Patsy Bates, a then-52-year-old grandmother and hair-salon owner, was unable to continue her chemotherapy for several months.

During the case, evidence emerged that Health Net had paid bonuses to employees to reward them based on the number of policyholders they had rescinded. The judge who awarded Bates the $9 million said in his decision: "It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive."

* * *

President Obama cited other cases of rescission in his recent speech before a joint session of Congress as a major reason that health reform is necessary. Obama cited the case of a retired Texas nurse, Robin Beaton, who had her heath insurance canceled by her insurance company as she was about to undergo breast cancer surgery. As a result, Beaton had to delay her surgery for five months. In the interim, the size of the mass of her tumor had grown from 2 centimeters to 7 centimeters, greatly reducing her chances of survival.

A "woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne," the President asserted in his speech, "By the time she had insurance reinstated, her breast cancer more then doubled in size. This is heart breaking. It is wrong. And no one should be treated that way in the United States of America."

Source/full story: http://www.huffingtonpost.com/2009/09/1 ... 89841.html

[roxybeast]

A Closer Look: Serious Problems with the Baucus Plan

Consider these articles examining the Baucus plan & the politics ...

The Baucus plan may actually hurt uninsured Americans.

Sen. Baucus Health Care Proposals Expands Burdens, Not Coverage, to Uninsured Americans
by Ray Hanania
Huffington Post, Sept. 16, 2009

Senate Finance Committee Chairman Max Baucus unveiled his own-pro-insurance industry health care plan that takes the breath out of President Obama’s health care reform proposals while offering subtle protections to the health care industry.

Sorry Senator, your plan pretends to address the needs of those who can't afford insurance but it only expands the burden to those Americans who are pushed out of coverage not because of costs but because of exclusions and limitations in coverage imposed arbitrarily by the health care industry.

The Baucus plan is designed to lift the burden of the poor and disenfranchised Americans off the shoulders of the health care insurance industry. It mandates that all families to purchase health insurance, or face fines. But it only seems to help low income families whose income is under 3 and 4 times the national poverty level, and only burdens those families who have been pushed out of proper coverage by health insurance industry prior condition exclusions.

That is not a plan.

Families earning up to 3 times the poverty level would receive tax credits, and families between 3 and 4 times the poverty level would have costs capped at 13 percent of their income.

The problem, of course, is that Baucus, who has his own Gold-Plated Government-funded health care plan, doesn’t address the real problem, that the health care insurance industry is limiting coverage for many families by excluding "prior existing conditions" and raising up the price for what little coverage is available. He says it will deny exclusions, but at what higher cost?

Most people can afford health care, but when an insurance provider denies coverage allegedly because of a “prior existing condition,” what’s the point of having health care insurance when it doesn’t cover the challenges you need.

The answer from Baucus is a a formula that dramatically increases costs for coverage.

The insurance industry is lobbying hard and spending our American tax dollars, which they generate from excessively outrageous health care profits and from government subsidies, doesn’t want the exclusions removed.

And, they are opposed to the so-called “Public Option” because they know most Americans burdened either by the high costs of private industry insurance or by the limitations on coverage stemming from exclusions will drop their existing coverage and take the public option of government health care plan.

The public option will not permit exclusions.

Let’s do the math.

Right now, a family of four can purchase health insurance for around $800 a month with a $2,500 deduction on health care and $500 deduction on prescriptions, which basically means they will be paying for most routine medical expenses out of their paychecks, not from the insurance company coverage.

For a typical family of four, the poverty level is $22,050 which means that 3 times that is $66,150. If you make less that $66,150, you will qualify for a tax subsidy.

If you make under 4 times the poverty level, or $88,200, the government will “cap” your costs at 13 percent of your income or $11,466 a year in insurance costs.

That means you will be paying more than what the insurance industry is already charging.

Does that solve the problem. The 30 million Americans (not including so-called illegal aliens who are in this country illegally) who don’t have insurance because it is unaffordable, won’t be able to purchase insurance under the Max Baucus plan.

And for those families above the plan’s ceiling, who make more than $88,200 a year, they will be forced to purchase family insurance that is a) even more expensive – you know the insurance companies are going to jack up costs immediately, and b) will have to take deficient health insurance coverage potholed with health care industry provider exclusions that when covered would increase premiums through the roof.

In other words, excluding exclusions on pre-existing conditions without limiting costs to a reasonable level, makes the Baucus plan unworkable.
That’s why President Obama’s plan to offer a public option is so important.

It’s not about income levels. It’s about competition. The fact is that when most Americans see the savings in a public option compared to the outrageous charges of the insurance industry and the exclusions, they will all drop their existing coverage and take the public option.
No one will be forced to take the public option, except those who feel they can get better and more comprehensive service than the garbage now offered by the insurance industry.

Thanks but no thanks Senator Baucus. Clearly, you are more concerned about the insurance industry needs than you are about the health care needs of our uninsured and poorly insured Americans.

Source: http://www.huffingtonpost.com/ray-hanan ... 88887.html

I don't agree with this next author that taxing "Cadillac Health Plans" is necessarily a bad idea, but do agree that the way the Baucus bill does so indiscriminately for plans over a certain cost threshold could perhaps be re-written to be more equitable & prevent some of the problems the author points out ...

Top Five Reasons the Baucus Bill Is Really, Really Bad
by R.J. Eskow
Huffington Post, Sept. 16, 2009

By now you've probably heard about the draft bill submitted by Sen. Max Baucus. You may even have heard it's not a very good bill -- for the American public, anyway. But it's a complex topic, and a complex bill (even though it has been written in relatively plain English and posted on the Web, to the Senator's credit).

So in order to clarify this complicated issue, here are the top five reasons why it's a really bad bill:

1. Premium rules that are a giveaway to the insurance companies.

The first shocker in the Baucus bill came early on in the draft. Since I've worked in health insurance underwriting I have a certain familiarity with these kinds of numbers. I was stunned to see that the bill allows insurers to charge up to five times as much for some enrollees as for others, based on age. (By contrast, the House draft bill only allows them to charge up to twice as much based on age.)

One of the things we've been hearing from the President and other Democrats is that insurance needs to be affordable to everyone, including those with pre-existing conditions. This new provision, however, is a back-door way to let insurers essentially evade that provision. High-cost medical conditions, including chronic (and therefore pre-existing) conditions, aren't restricted to older people, of course. But they become increasingly common as we age -- so much so that indexing costs to age addresses a lot of the difference. The Baucus bill allows insurers to use age as a proxy for costly medical conditions and make coverage prohibitively expensive for those who need it the most.
There's a principle involved here. The fundamental reason we have insurance in the first place is to spread the risk, so that services are accessible and affordable in our time of need. That's why it's considered a social good (if done right). This provision goes a long way toward undoing the principle of shared risk.

The net result would be to make insurance increasingly unaffordable to Americans as they age. Nevertheless ...

2. The individual mandate is in there anyway.

Although I've been critical of the way many proposals have structured the individual mandate, I've always said that I understand the logic behind them: If you're going to force insurers to take all comers at a relatively average price, the healthy as well as the sick need to enroll. But if you're allowing insurers to charge much more for the (probably) sick than they do for the (probably) healthier, why have a mandate at all? You're not pooling risk in the manner originally proposed, so this is a heads-I-win-tails-you-lose proposition for the health plans.

3. It taxes benefits, slowly but surely.

I've been opposing the idea of taxing so-called "Cadillac benefits" for a long time. This plan does just that, although they're not likely to be "Cadillac plans" for long. As I feared, the tax isn't based on plan design. It targets plans above $21,000 indiscriminately, regardless of the reason for the added cost.

How is this terrible? Let us count the ways. First, it will hit plans hardest when they enroll older employees (who, you will remember, can cost five times as much to cover). That will penalize older employee groups, and will encourage employers to discriminate on the basis of age. Next, it will hurt people who live in urban and coastal areas where medical costs are higher (not that the Senator from Montana cares about that, I suppose). Lastly, if medical costs continue to increase at 10% per year, $21,000 will be the cost of the average plan in five or six years.

This plan's good CBO forecast rests in part on this new tax income. In other words, it achieves much of its vaunted "budget consciousness" on the backs of the middle class. It's a lousy bargain for workers and business alike. Granted, taxes will apply only to that portion of cost that exceeds $21,000 -- but that portion will increase nationally every year. And the tax rate for costs above the cap is 35%, so it will quickly become a huge new burden.

4. No public plan option.

But you knew that already, didn't you?

5. Co-ops can't always "cooperate."

First, the good news: Co-ops will be able to share data systems and some other services. Given the horrible nature of the bill overall, I was surprised to find that. But they can't pool their negotiating ability to get better deals from providers on behalf of the American consumer.

(Congratulations, Dems -- more money out of the taxpayer's pocket.)

The draft language reads: "[Purchasing councils for co-ops] shall be prohibited from setting payment rates for health care facilities and providers." That means less savings to be passed on to enrollees."
It's unclear whether this provision also applies to drug companies and pharmacy benefit programs. If so, guess who that benefits? After all, most physicians serve patients primarily from one state, so this provision wouldn't apply to them. Hospital systems may serve patients in two or three states at most. But pharmaceutical companies are national entities. If co-ops could bargain with them collectively (make that "cooperatively"), they could demand substantial savings.

This issue needs to be clarified right away -- hopefully in the consumer's favor, by indicating that it does not apply to drug companies.

The plan does other bad things, too, like the provision that will encourage employers to discriminate against lower-income workers. But hitting you with more than five of them at once could conceivably be bad for your health.

Source: http://www.huffingtonpost.com/rj-eskow/ ... 89380.html

Bi-Partisan Rejection ...

With a Health Care Plan This Insane, Who Needs Wingnuts?
by Bob Cesca,
Huffington Post, Sept. 16, 2009

There's one positive political aspect to this epic fight for health care reform. We now know for sure which congressional Democrats have to be vigorously challenged and defeated the next time they come up for re-election.

The health care reform debate has forced the toxic slag to gurgle to the surface and consequently revealed a few Democratic senators who, at every turn in this process, have proved to be far more interested in protecting their own asses by way of protecting the asses of their bosses in the health care mafia.

Suffice to say, Joe Lieberman has to be sending lots of "thank you" gift baskets and ponies and backrubs to the offices of Max Baucus and Kent Conrad. In fact, Baucus and Conrad -- the matchstick men of health care reform -- have been so insufferable, I almost forgot about Lieberman. Almost.

In fact, apart from the Republicans from whom we expected outlandish lies and cartoonish behavior, Baucus and Conrad have been much more obstructionist and damaging to real health care reform, chiefly because they possess a disproportionate level of power in relation to the nine people in the upper Midwest they represent, and because their ideas would be laughable if they weren't so ineffectual and dangerous.

To wit: Baucus Plan is just as craptastical as we all suspected it might be.

First, Baucus' entire goal was to construct a bipartisan plan. Mission accomplished. Insofar as both parties hate it. Just as we predicted, Baucus tailored his plan to appeal to the Republicans who, as it turns out, don't support the plan anyway. For example, one of his concessions to the Republicans was tort reform language which not only won't work, but has also failed to bring in any Republicans (bad policy -- bad politics). Meanwhile, the bill is so diluted and bad that roughly half of the Democrats on the Finance Committee appear to be opposed to it. Good job, senator!

Furthermore, as I described last week, there are individual mandates, but no public insurance option. Baucus included his buddy Conrad's pathetic co-ops which are destined to fail due to their limited bargaining power.

The government subsidies in the Baucus Plan don't extend deep enough into the middle class in order to protect families from massive health care debt if a family-member becomes sick or injured. Put another way, mandates would imprison families and force them to buy insurance policies that could still bankrupt them if they actually need to use their insurance for an emergency situation like an accident or being diagnosed with cancer.

The Baucus Plan also discriminates against low-income Americans. In one of the most awful provisions of the plan, the "free rider" provision, Baucus taxes businesses for each hiree who qualifies for subsidies. So this tax incentivizes businesses to not hire poor or disadvantaged workers. (How this tax is determined is corrected in the UPDATE below.)

The list goes on and on.

By Max Baucus' own estimation, his plan carries a price tag of $880 billion over ten years. The press is tossing some very serious kudos and political cover his way because this is clearly less than the $1 trillion mark. It's also $20 billion less than the number President Obama mentioned in his address to Congress last week. And it's the Baucus Plan that many centrist Democrats -- the budget hawks and fiscal conservatives -- appear to prefer.

Allow me to underline this again. The centrist Democrats prefer a bill that more closely resembles the Baucus Plan which will cost around $880 billion over ten years. Fiscal conservatives prefer this. Lawmakers who are worried about government spending appear to be supporting a plan that would cost around $880 billion.

But wait. If the centrist Democrats were legitimately worried about government spending and deficits, they ought to be supporting the Kennedy Bill (the HELP Committee bill) instead, which, according to the CBO, clocks in at $611 billion over ten years, due in part to the inclusion of the public option.

Unless we use backwards wingnut math, $611 billion is significantly less than $880 billion. So the incontrovertible reality is that the Kennedy Bill is the more fiscally conservative health care reform bill. So why aren't the self-proclaimed fiscal conservatives in the Democratic Party flocking to embrace it?

The answers are obvious. One, the fiscal conservatives aren't always fiscally conservative (most of them voted for the Bush wars, the Bush tax cuts and the Bush Medicare Part-D blank check). And two, the Baucus Plan forces you and me to pay more cash to their contributors in the health insurance industry. This works out very nicely for senators like Max Baucus who, as Roy Sekoff pointed out, has pocketed millions in contributions from the health care industry.

So how do the blue dogs and conservadems worm their way around the glaring inconsistency between their so-called "fiscal conservatism" and the cost of the Baucus Plan?

Enter Senator Kent Conrad. Ryan Grim reported Tuesday that Conrad is changing the rules in the middle of the game in order give more weight to the Finance Committee bill and, in the process, "kneecapping" the bills with the public option -- the Kennedy Bill and the House bill. In short, Conrad has asked the CBO to use cost projections that span 20 years instead of the 10 year terms the office had been previously employing.

This will make health care reform more difficult to pass because the cost projections will balloon and will be less accurate to predict over an unwieldy 20 year span -- especially the bills with the relatively new public insurance plan. Plus, due to the political stigma on the more liberal bills, the significantly larger price tags will hurt those bills the most, allowing more room for demagoguery.

Put in medical terms, Conrad has infected all of the reform bills with a virus, and he's calculating that the inaccurately perceived "fiscally conservative" bill will have a stronger chance of surviving the pandemic. He's willing to risk crushing the entire reform effort before he allows the Kennedy or House bills to become law. Yeah, and they say the House progressives are the troublemakers. That's rich.

Nevertheless, the Baucus Plan is better than the current system. But that's kind of like saying, to paraphrase Larry David, it's the "good Hodgkins" -- cancerous, but not as deadly. Either way, their obvious and hackish corruption coupled with this awful plan has made it easy for us to pick the villains out of a lineup. We can be grateful for that, at least. Now it's just a matter of what we do with this stockpile of information.

UPDATE: Ezra Klein, whose blog post about the "free rider" provision is linked here, has revised his post summarizing this discriminatory section of the plan. In short: "The employer will pay the lesser of A) the average subsidy in the exchange times the number of subsidized workers or B) $400 times the total number of workers."

Source: http://www.huffingtonpost.com/bob-cesca ... 89064.html

The cost savings of the Baucus plan over the House bill which includes a public option are dubious even by CBO estimates. The Baucus bill is cheaper only because it doesn't cover everybody who needs to be covered and may actually increase insurance policy costs to the middle class. On the other hand, while the House bill is more expensive to government, even the CBO concedes that a plan which includes a truly competitive public option will be better and result in lower insurance and health costs for America's families. Consider this article ...

CBO: Dumping Public Option for Co-Ops Does Not Save Money
by Bill Scher
OurFuture.Org reprinted Huffington Post, Sept. 17, 2009

The Congressional Budget Office gave Sen. Max Baucus' bill the best scoring yet for a health care bill. But his removal of a public health insurance option in favor of seed money for non-profit co-ops has nothing to do with it.

Baucus' bill costs less in the eyes of the CBO because 1) Baucus covers less people than the other proposed bills and 2) CBO really likes the tax on generous insurance plans. (And as I noted before, CBO is biased against crediting new ideas with generating savings, short-changing the other bills.)

But none of that has to do with the debate between a public option and co-ops.

In fact, CBO didn't think much of Baucus' co-op proposal, concluding:

The proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the specifications, they seem unlikely to establish a significant market presence in many areas of the country....

Whereas, the CBO responded to a public option query from GOP Baucus Caucus holdout Sen. Mike Enzi and said the public option wouldn't change federal spending, while lowering insurance premiums for individuals:

...[A] public plan as structured in the introduced bill would probably attract a substantial minority of enrollees (in part because it would include a relatively broad network of providers and would be likely to engage in only limited management of its health care benefits). As a result, it would add some competitive pressure in many insurance markets that are currently served by a limited number of private insurers. That competitive pressure would probably lower private premiums in the insurance exchanges to a small degree ... net federal outlays on health care would not be appreciably different...

For those so-called moderates who claim this is all about spending and cutting the deficit, and who bow to the CBO in making such determinations, there is no reason to reject the public option on those grounds.

Source: http://www.huffingtonpost.com/bill-sche ... 90291.html

"A study by the nonpartisan Commonwealth Fund found that 'a public coverage program similar to Medicare would reduce projected health care costs by about $2 trillion over 11 years, and reduce premiums by about 20% on average. Within about a decade, 105 million people would be enrolled in the public plan, and about 107 million would have private insurance, according to the Commonwealth Fund.'"
Source/full story: http://www.huffingtonpost.com/2009/09/1 ... 90658.html

On the other hand, the Baucus Plan discriminates against the poor ...

The Baucus Bill: The Worst Policy in the Bill, and Possibly in the World,
by Ezra Klein
Washington Post, Sept. 16, 2009

Baucus's bill retains the noxious "free rider" provision on employers. Rather than a simple employer mandate that forces every employer over a certain size to provide health-care insurance or pay a small fee, the free rider approach penalizes employers for hiring low-income workers who are eligible for subsidies. That will create an incentive to do one of two things: Don't hire low-income workers (hire a teenager looking for a job rather than a single mother, or hire a housewife looking for a second job rather than an unemployed breadwinner), or hire illegal immigrants.

And it actually gets worse. The employer pays more if the low-income worker needs subsidies for his family as opposed to just himself. So it not only discriminates against low-income workers, but it particularly discriminates against low-income parents. Single mothers will get the worst deal, as they have lower incomes, and as you might expect, children who need health care.

The penalty itself is a bit confusing, and if anything, even worse than one might imagine: The employer will pay the lesser of A) the average subsidy in the exchange times the number of subsidized workers or B) $400 times the total number of workers. Two examples should clarify this:

Baucus Corp has 100 employees and does not offer health-care coverage. Thirty of the employees receive subsidies on the exchange. The average subsidy that year is $5,000. Baucus Corp woulds pay $400 times 100 employees, as $40,000 is less than $150,000 ($5,000 times 30 employees). Each of those low-income employees is costing Baucus Corp $1,333 more than an employee who didn't need subsidies.

Now imagine that Baucus Corp. only has five employees who need subsidies, and the average subsidy that year is $5,000. In that scenario, Baucus Corp would pay $25,000 rather than $40,000, because $25,000 is less than $40,000. Each low-income worker now costs Baucus Corp. $5,000 more than a worker who doesn't need subsidies.

So in the scenario where Baucus Corp. has a lot of low-income workers, they cost a huge amount overall because they're multiplied against the total number of workers. In the scenario where Baucus Corp. has a few low-income workers, they cost a huge amount individually because they're multiplied against the average subsidy cost. No matter how you look at it, the policy makes it profitable for employers to discriminate against hiring low-income workers. It is not only the worst policy idea in the bill, but one of the worst policy ideas I've ever seen.

Update: Originally, this post didn't include one of the penalty options, as I was basically confused on how it worked and thought it would apply too rarely to be worth mentioning. I reread the section, though, and corrected the post to offer a fuller picture of this no good, very bad, horrible policy.

Source: http://voices.washingtonpost.com/ezra-k ... _poli.html

Baucus plan does not protect the middle class ...

THE 'GOOD' HODGKINS
by Bob Cesca
Sept. 15, 2009

As more details get crapped out of the Finance Committee, the already awful bill looks even worse. Ezra Klein explains:

The point of health-care insurance is to protect against the financial burden of catastrophe. So imagine a year of catastrophe. The plan includes out-of-pocket limits, but they're tied to the laws governing health savings accounts. For a family above 300 percent of poverty, that means a maximum out-of-pocket limit of $11,600. If that family made $78,000 a year, and paid $10,800 in premiums, that would mean 29 percent of their income would go towards medical costs.

So under the Baucus Plan, families with a sick or injured member could still very easily go broke, or at least could become rapidly buried under medical bills.

From what I understand, the source of this ticking time bomb within the Baucus Plan is the toxic combination of mandates and weak subsidies. In other words, you'll be forced into the system, but if you're of a certain income range the subsidies are too weak to protect you from financial ruin.

Naturally, the current system is causing financial disasters far worse than the Baucus "solution" would. Therefore the Baucus Plan is "better" than the current system. But that's kind of like saying, to quote Larry David, "There's a good Hodgkins."

The Baucus Plan is unacceptable in almost every way. It's more expensive, more abusive, more corrupt, and more politically damaging for the Democrats than any other healthcare reform bill to date.

Source: http://www.bobcesca.com/blog-archives/2 ... odgki.html

Baucus plan hurts the elderly ...

Congresswoman Woolsey: Baucus' Bill Requires Older Folks to Pay Five Times More
by Kathleen Wells
Huffington Post, Sept. 17, 2009

Congresswoman Lynn Woolsey (D- CA) co-chairs the Congressional Progressive Caucus and also serves on the House Foreign Affairs Committee. As the first of only two members of Congress to have been a welfare recipient, Woolsey is a vocal leader committed to promoting issues that directly impact children and families. Initially elected in 1993, Congresswoman Woolsey has used her influence as a member of the House Education and Labor Committee to provide children and families with the tools needed to fully realize the American Dream.

She is a supporter of a "robust" public option to health care reform. Below is our discussion.

Kathleen Wells: I've read a report recently that indicates if insurance premiums continue to increase at the rate we've experienced during the past five years, a family policy will cost on average more than $24,000, in the year 2019. That's only 10 years from now. What are your thoughts on that prospect?

Congresswoman Woolsey: Well, that's why we are facing health reform today. That's why health care reform has to be real and meaningful. One of the most important parts is to bring down the cost of health care to the consumers and that leads us to the public option, which would offer competition to the health insurance companies. That would be one of the steps [necessary] to control the costs of health care, the actual delivery [of] care.

Kathleen Wells: So, if the current pace continues, only the richest Americans would be able to afford to have health insurance. Is that an accurate assessment?

Congresswoman Woolsey: Oh, absolutely. It would fall, then, on the federal government to put together some kind of plan to cover all Americans and it won't be a very good plan because we will be so in debt at that time. One thing the public option does is save over 75 billion dollars in startup costs. So, we save money going in that direction.

Kathleen Wells: Will you remain strong on the public option?

Congresswoman Woolsey: Oh, absolutely.

Kathleen Wells: The media has focused on Senator Max Baucus' bill, which has no public option and provides for co-ops. It has no Republican support and the support of only a few Democrats, if that, thus far. Your thoughts?

Congresswoman Woolsey: Let me tell you something else it [the Baucus' bill] has. An older person has to pay five times more for their premiums than a younger person. Five times more! Under our health care reform [proposed by the House of Representatives], it can be no more than two times [higher for older persons compared to what younger age groups pay].

Kathleen Wells: There is a senate bill from the Health, Education, Labor and Pension Committee (HELP) which does have a public option, but it's not getting a lot of media attention. How do you think the Baucus bill will be reconciled with the [Senator Tom] Harkin bill?

Congresswoman Woolsey: Well, first of all, I don't have to do that, because I'm not in the Senate. But I can tell you [that, we in ] the House need to reconcile our three bills and come out with the strongest plan that we can put together -- [with] the strongest and the best for savings in cost and the best for providing coverage for all Americans. Then, we vote for ours. It [our reconciled bill] passes and Tom Harkin's committee, the HELP Committee, will have the support they need to really push for what is good and strong in their bill when they are reconciling with the Baucus bill.

It doesn't have to be [a case of] you get half and we get half when you are doing reconciliation. It should be what the people of this country want. They have shown loud and clear in every poll that they want a public option and they want health care reform, as long it does not take away from what they already have and helps protect people who already have health care insurance.

Kathleen Wells: The polling I have seen shows the majority of the American people want the public option. So, why has the public option become such a contentious issue?

Congresswoman Woolsey: I think we let the message get away from us when we left in August. The three bills had passed out of the three House committees, but they had not been reconciled. So, we didn't go home to our constituents with "this is what the House bill is." So, the tea party people and those who are against health care got to scare people to death with all kinds of myths and lies.

There are some real concerns, but those concerns have hardly been heard. The real concerns had a hard time being heard over the yelling and screaming. The concerns included costs and seniors wanting to hear how this really does work for them and not against them. There were just a lot of things that they had a right to ask, but they couldn't be heard over the screaming.

Kathleen Wells: Critics have said that the President is moving too fast and that he is not giving careful and critical consideration to everything. Do you think that's a fair assessment?

Congresswoman Woolsey: No matter how fast he moves it would be too fast for them. They don't want change. Out of my town hall, it was very clear to me, that the majority of people who were against health care [reform] and what we were doing, where against any health care reform, whatsoever.

Kathleen Wells: Some critics claim current health care reform proposals represent a government takeover or a move toward socialized medicine, despite the fact that Medicare is run by the federal government.

Congresswoman Woolsey: Veterans programs are the federal government. The military programs are the federal government. Believe me, there is a lot of federal involvement in health care in this country and those are programs that work quite successfully.

Kathleen Wells: Yet, this isn't understood?

Congresswoman Woolsey: They don't want to understand it. Actually, if I had my choice (and the majority of the Progressive Caucus), we would be pushing for single payer that would be universal and we wouldn't have any private insurers. This little slice that is being offered is a compromise, but it is a compromise that is meaningful because we want to have competition available.

The private health insurance companies have huge overhead -- 30 percent. It goes to marketing, it goes to their CEO's gigantic salaries and, then, they have to pay their stockholders because they are public companies -- they are on the stock market. The public plan won't have that overhead, so we will be able to provide the base that everybody has to provide. When this is finished, all heath care insurers will have to have a base amount of benefit. But we will be able to provide more for less because we don't have that huge overhead. That will be quite telling and that is what the private industry does not want. Well, it's too bad.

Kathleen Wells: Since we are seeing so much resistance to the public option, do you think it would have been strategically better for the President to start off with a universal single payer plan and then move to the public option?

Congresswoman Woolsey: Well, I think the public option is going to be accepted in the long run before we are through with this health care reform. I just, in my heart of hearts, believe it is going to go this way because that's what people in this country want.

I sometimes wonder if we, the progressives, should not have started with the single payer and thrown it out there and then used the public option as our compromise. We didn't want to fill the air with arguments that we knew wouldn't win at all. We wanted to start really strong and we told everyone that this was a compromise right upfront and that we don't have any desire to compromise further on this piece of it.

I don't think the President should have [started with universal single payer.] He said if he was starting from scratch, that's what he would have done -- he would have had a single payer. He has all kinds of reasons why he doesn't do single payer now. I'm just hoping he will stay with us on the public option part of this.

When we say robust, we mean that. Co-ops don't work, triggers don't work. If someone can come up with a better way to save money and provide this competition and to make sure that everyone is covered, fine. But, so far, we are pretty sure that the public option is the very best way to go.

Source: http://www.huffingtonpost.com/kathleen- ... 89708.html

The Baucus plan will also undermine Medicare, instead of improving it:

Baucus Plan: Saving Patients Money Would Cost the Medicare Drug Program Billions
By Duff Wilson
New York Times, Sept. 17, 2009

Under the newly proposed plan from Senator Max Baucus, the drug industry’s offer to help Medicare patients save money will end up costing Medicare itself — taxpayers, that is — a lot more money.

Analysis by the nonpartisan Congressional Budget Office places the additional cost to Medicare at $17.4 billion over 10 years.

The reasons are a bit complicated. But the quick assessment is that the budget office analysis puts new perspective on the drug industry’s widely publicized deal with Mr. Baucus, Democrat of Montana, to shave a total of $80 billion off the nation’s drug spending over 10 years. In this case, the money saved by Medicare patients will translate to higher cost to the taxpayers who support Medicare.

Here’s why:

The industry deal, which the trade group the Pharmaceutical Research and Manufacturers of America, worked out in June with Mr. Baucus and the White House, includes an agreement to help Medicare patients navigate the notorious “doughnut hole” within the coverage for prescription drugs.

Once Medicare patients enter that “doughnut hole” — which this year occurs when their drug costs reach $2,700 — they must pay for their own prescriptions until the annual costs have exceeded a certain threshold. This year, they leave the doughnut hole after total drug costs have exceeded $6,153. At that point, Medicare is obliged to pay 95 percent of their drug costs.

To help ease the out-of-pocket burden, the drug industry agreed with Mr. Baucus that they would give patients 50 percent discounts on name-brand medicines while Medicare patients are paying for their own drugs. The industry calculated that offering this discount would force them to forgo $30 billion in revenue over 10 years.

Currently, when Medicare patients reach the doughnut hole — about one in four of them do, each year — many switch to cheaper generics or in some cases simply stop taking their medications. Either way, many Medicare patients as a result never reach the other side of the hole. And so the Medicare program’s spending does not kick back in.

Ever since the drug industry cut its June deal, analysts have been trying to calculate what the deep discounts would mean for total Medicare spending. With more people able to afford drugs during the doughnut hole period, more people presumably would keep buying them and reach the other side. And if more people were continuing to take more expensive name-brand drugs, rather than generics, they presumably might pass through the doughnut hole more quickly.

On Wednesday, the budget office answered the long-pending question: It calculated that enough people would make it through the doughnut hole, many of them staying on name-brand drugs, so that the increase in Medicare’s own drug spending would total $17.4 billion over 10 years. (Because of other cost savings the Baucus proposal would find in the Medicare drug program, the net spending increase would be about $8 billion, according to the budget office.)

Drug makers have not reported their own calculations about how their Medicare drug revenue would be affected by doughnut-hole economics. Some industry analysts say it would be a wash. But no one has come up with an in-depth study.

The House health care proposal would entirely fill the doughnut hole by accepting the drug industry’s 50 percent discount offer — but also levy other fees on the drug makers to make up the remainder.
It should surprise no one that the drug industry vehemently opposes the House version.

Source: http://prescriptions.blogs.nytimes.com/ ... 4-billion/

Further, the reality is that in order to create a more equitable system you have to reign in insurance companies excessive profits and bloated spending through either harsh regulation &/or a viable truly competitive alternative to keep them honest. That is where the real fight is ... the one that we the public must insist we win!

Thus, one important factor to consider is what to insurance companies and their stockholder investors think of the various plans. If they like one plan and hate another, you can be sure that the one they hate will do more to benefit the average American - you and me, and the one they like will do the most to benefit them. So where do they stand? Well, it turns out they love the Baucus plan and their stocks soared dramatically when the Baucus plan was unveiled which did not include a public option. See, e.g., http://www.huffingtonpost.com/2009/09/1 ... 90125.html ... and ... http://thinkprogress.org/2009/09/16/stocks-baucus/

Next, Robert Reich examines the political situation. What happens if Sen. Snowe supports the Baucus plan, and what happens if she rejects it.

Why Olympia Snowe Should Vote Against the Baucus Plan
by Robert Reich,
Huffington Post, Sept. 17, 2009

How is it that a decision next week by a single senator from Maine will almost certainly determine whether America's future healthcare system is still in the hands of private for-profit insurance companies and Big Pharma or enables more Americans to get better health care at lower cost? Bear with me, because you need to know what's likely to happen if she signs on, and if she doesn't. The next few weeks are crucial.

Scenario One: If Olympia Snowe votes in favor of Max Baucus's plan -- which is favored by the medical-industrial complex because it dramatically increases their customer base without a public option that squeezes their profits -- the Baucus plan will be the bill that goes to the Senate floor. Why? Because her vote will give enough political cover to waivering Dems Ben Nelson, Mary Landrieu, Jim Webb, and Evan Bayh to gain their support for the Baucus plan. Which means the White House and the Democratic leadership in the Senate will have a good chance to get the 60 votes they need when the bill goes to the Senate floor in a few weeks.

That Senate vote will push Nancy Pelosi and the House Dems toward the right. That's because it will embolden conservative and Blue Dog House Dems to threaten to vote against the far stronger bill that's already emerged from House committees -- which, in contrast to the Senate Finance bill, includes a public option, an employer mandate, significant expansion of Medicaid, and larger government subsidies to others with lower incomes. Pelosi knows she can't get a single Republican vote, so has to count on the support of at least 218 out of 256 Democrats. That means winning over at least 38 conservatives and Blue Dog Dems-- many of whom were elected from swing districts and some of whom face strong Republican challengers in 2010. With Baucus's bill gaining momentum, or perhaps already having been passed, the conservatives and Blue Dogs in the House will demand a bill that's closer to it. House progressives will put up a fight but there's little question that the emerging compromise will be to the right of where the House is right now.

The two bills then go to a reconciliation committee where the White House can put some final touches on it before it goes back to the two chambers for a final vote. The White House likes this scenario because it keeps private insurance companies, Big Pharma, and the AMA from bolting. It enables the President to call the resulting bill "bipartisan," and to claim that it marks real reform. And maintains the possibility of Republican support for financial reform and environmental legislation next year.

Scenario Two: If Snowe decides not to sign on, history moves in a very different direction. Most importantly, the Senate Dems know they won't possibly have 60 votes they need. So they'll have to say goodbye to bipartisanship -- perhaps even farewell to Nelson, Landrieu, Webb, and Bayh -- and bundle healthcare reform into a "reconciliation" bill that can pass with 51. This new goal post strengthens the hand of Senate progressives on the Finance Committee, like Rockefeller. It also gives more weight to the version of health care reported out by the Senate Health, Education, Labor, and Pension committee -- which includes a public insurance option, employer mandate, and more generous subisidies to the poor and lower middle class. Hence, the bill that goes to the Senate floor is much more progressive, and the final Senate's vote (with 51 votes) better reflects the values of the Democratic base.

This Senate vote, moreover, gives more momentum and legitimacy to the House version of health care -- which also includes the public option, employer mandate, broader Medicaid coverage, and more generous subsidies to the lower middle class. That Senate vote thereby reduces the power of House Blue Dogs and conservative Dems to influence the bill that goes to the House floor. It also enables Pelosi to say to them: It's either this or nothing. If you vote against this bill you're voting against health care reform. The more progressive Senate bill, plus the stark choice Pelosi poses, garners enough votes from the conservative and Blue Dog Dems to pass a strong bill.

The White House doesn't like this scenario because the use of a reconciliation bill in the Senate poisons relations with Republicans and risks their support for financial reform and cap-and-trade. It may even make it more difficult for Obama to rely on Republican support for more troops in Afghanistan. But as we move into the gravitational pull of the 2010 midterms, congressional Republicans won't support Obama anyway, on anything. And remember, George W. Bush used reconciliation early in his first term to enact his huge tax cuts, mostly for the very wealthy. It's a tried-and-true strategy.

I don't know about you, but I'm hoping the Senator from Maine votes no next week. If she does, America has a fighting chance of getting real healthcare reform.

Source: http://www.huffingtonpost.com/robert-re ... 90287.html

Perhaps it's finally time for the Democrats and White House to realize that bi-partisan efforts are fruitless and just pass meaningful reform including a public option with 60 votes or with budget reconciliation if neccessary, even if Republicans unanimously oppose.

Baucus Debacle Shows Why Democrats Have to Stop Trying to Woo Republican Lawmakers
by Mitchell Bard
Huffington Post, Sept. 16, 2009

Excerpt ...

Which brings us back to the Baucus debacle. He spent months -- months! -- negotiating with three Republicans (Olympia Snowe, Chuck Grassley and Mike Enzi) to try and get a bipartisan health care reform bill through his finance committee. Anybody with an IQ above 75 and access to a major daily newspaper knew that there was no meaningful health care reform bill that Enzi and Grassley were going to get behind. Did Baucus listen to and/or read the kinds of things Grassley was saying in interviews and on talk shows? (Two words: death panels.) The Republicans weren't going to give the president a win (remember Jim DeMint's famous health care will be Obama's "Waterloo" remark), and they were too beholden to their corporate interests to support anything that would have any real impact on the status quo. The Republicans were obviously stalling, trying to do anything they could to keep the health care reform process from moving forward. Again, this was all obvious to everyone watching ... except Baucus.

So what ended up happening? Baucus announced today that he was going forward with a bill and ... surprise! ... no Republicans are backing it (not even Snowe). But, thanks to Baucus bending over backwards to try and lure Republicans, the Finance Committee bill is weaker than any of the other versions to get through committees in the House and Senate. Enzi, Grassley and Snowe managed to stall the process for months and ensure a weaker bill emerged from the Finance Committee, and they did so without having to actually do anything or give up anything (or support the legislation). Who won that battle, Baucus or the Republicans? If it was a boxing match, Baucus would be bloody and unconscious, and Enzi, Grassley and Snowe would be dancing around the ring, triumphantly holding their hands up in victory.

What Baucus (and the rest of the Democrats in Congress) have to realize is some exceptionally simple math: 60 seats in the Senate + 256 seats in the House + 365 electoral votes = They get to do what they said they would do during the campaign. It really is that simple. Make the Republicans vote against the bills. Make them filibuster what they oppose. Expose them for what they are: the Party of No that puts political games and corporate interests ahead of what is best for the American people.

But no, to Baucus, 60 + 256 + 365 = He has to get on his knees and kiss Republican butt. Sorry, Senator, you get an F in math.

The Democrats won overwhelmingly last November. Now they have to govern. Especially after the way Republicans played them for fools on the stimulus legislation, Democrats don't have to kowtow to Republicans. They need to get in a room and come up with health care legislation that the 59 Democratic senators (after Ted Kennedy's passing) -- or 51 of them if they go the reconciliation route --and 218 House members can get behind (and that the president will sign) and get it done. If Republicans want to filibuster, vote no, complain, spew lies, hold rallies, go on talk shows, call Obama a socialist, and throw temper tantrums, let them. I am not saying the Democrats shouldn't fight the public relations battle and shoot down the lies slopped to the public by health care reform opponents, I'm just saying they should do it while passing legislation on their own.

To the Democrats I say: Forget Baucus's bill. Don't give the Republicans another victory (one which represents a defeat for the American people). Pass meaningful health care reform, even if not a single Republican votes for it.

Source/full story: http://www.huffingtonpost.com/mitchell- ... 89304.html

That's why crowds cheer the public option (VIDEO):
http://www.dailykostv.com/w/002156/

And loudly boo the Baucus plan (VIDEO):
http://www.dailykostv.com/w/002155/

Gosh, maybe that's why even conservative FOX talk show host Bill O'Reilly now supports the public option (VIDEO):

I want that. I want, not for personally for me, but for working Americans, to have a option, that if they don't like their health insurance, if it's too expensive, they can't afford it, if the government can cobble together a cheaper insurance policy that gives the same benefits, I see that as a plus for the folks.
Bill O'Reilly, Fox News

VIDEO: http://www.huffingtonpost.com/2009/09/1 ... 90658.html

[roxybeast]

Health Care Should Be a Right, Not a Commodity! ...
and Ending the Insurance Anti-Trust Exemption

Consider this point of view ...

Health Care: Is it a Right or . . . Is It a Commodity?
by Miles J. Zaremeski
Huffington Post, Sept. 15, 2009

Excerpt ...

If we all recall, our system of health care was based for so long on the fee -for-service model -- if you wanted treatment, you pay what the doctor charged. That grew too expensive, so our system morphed into managed care products and services. This new system worked like a charm -- for managed care companies. After all, look at the millions (billions?) of dollars these companies and their executives have made since they were first created close to 20 years ago. The cost of health care services and insurance coverage for those services continue to skyrocket. So, too, this system of care interferes with the doctor-patient relationship every day of the year. Just ask your doctor.

Politicians who oppose President Obama's current plan say that by the government imposing a public plan (or whatever you want to call it that keeps in check insurance company costs, provides for stiff competition and allows another alternative (option) for consumers who seek health care insurance) the insurance industry will be gone as we know it in a blink of an eye. Juxtaposed to this is that leaders of the opposition are now also saying that they stand shoulder to shoulder with the President when he calls out for insurance regulation in the form of, for example, no caps on coverage; limits on out of pocket expenses; and making it illegal to deny coverage based on pre-existing conditions, or rescinding that coverage absent provable fraud after care and treatment has already been rendered. But not for any such public option. But, and this is important for everyone reading this post, all these new regulations will mean increased exposures to the insurance industry; increased exposures mean more expenses and payouts for claims, and less revenues that will go to the bottom line. Without an effective check on insurers with a public plan (again, or whatever you want to call such a mechanism), insurers will be free to raise premium costs to recoup the loss of revenues that these additional exposures will cause. We all will be back at ground zero, so to speak, if regulations without stiff competition come about. If we all think there are catastrophic problems with health care now, heaven help us if we have regulations without real and effective competition with insurers.

Mr. President, are you listening?

But if we want the status quo (and it seems that Republicans are for this despite the words their representatives mouth), then we will continue to treat health care as a commodity.

I prefer to say that health care remains a right for all of us. This is the moral imperative of which Obama spoke when he addressed a joint session of Congress. This is a right that Teddy Kennedy said we all had when he spoke at the 2008 Democratic convention; this is what Obama articulated when he debated McCain on the campaign trail a year ago in Nashville; and even I scribed such words a year ago July. If it is not a right, then why do all industrialized nations besides out country treat health care this way, do not allow their countrypersons to fall into debt and go bankrupt over medical bills, and do not allow them to perish from illness or disease because they cannot afford to pay the charges for necessary care and treatment? Is it that our Republican leaders are intellectually challenged when they oppose President Obama without fact or foundation, or can it be that they just plain don't care whether Americans with serious medical conditions live or die because they can't afford or access our present system? It sure seems like the latter given all their recent rhetoric!

In the end, there must be effective competition together with the insurance regulations such as those being proposed by the President.

One other item that should be considered since everything is presently in a state of flux: eliminating the antitrust exemption for the insurance industry. Remember that the opposite of true competition is . . . monopolization (which antitrust laws are intended to protect against). At the moment, insurers don't have a care in the world about this item. It is high time that they should.

Health care should be a right, not a commodity!

Source/full story: http://www.huffingtonpost.com/miles-j-z ... 85155.html

As to Zaremeski's latter point about ending the anti-trust exemption for the insurance industry, it seems that some in Congress are listening:

Conyers Introduces Bill to End Health Insurer's Anti-Trust Exemption
by David Dayen
Huffington Post, Sept. 17, 2009

John Conyers and some allies on the House Judiciary Committee have come up with a fabulous way to get the insurance industry in line -- by threatening to remove their anti-trust exemption.

Many people don't know that the insurance industry, under the McCarran-Ferguson Act of 1945, has a broad anti-trust exemption that facilitates regional monopolies. The Act allows states to regulate the insurance business instead of the federal government, but also allows that, as long as the state regulates the industry, federal anti-trust laws would not apply.

As a result of this exemption, states have seen markets for health insurance where one or two companies predominate. In the state of Maine, Wellpoint controls 71% of the market. In North Dakota, Blue Cross controls 90%. Using the Herfindahl/Hirschman Index, a metric for market concentration, a 2007 study by the AMA found almost every health insurance market in the United States is highly concentrated.

This edition of the study analyzed 313 MSAs. This compares with 292 metropolitan areas in the 2005 study, 84 in the 2003 study, 70 in the 2002 study, and 40 in the 2001 study.

In terms of market concentration (HHI), the study found the following:
In the combined HMO/PPO product market, 96 percent (299) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines. In the HMO product market, 99 percent (309) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines. In the PPO product market, 100 percent (313) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines.

Here's the AMA study: http://www.ama-assn.org/amednews/2009/0 ... sb0309.htm

Paul Rosenberg also has a lot more on this:
http://www.openleft.com/diary/14744/dea ... hman-index

The point is that the concentration of the health insurance market among regional monopolies leads to higher costs for consumers, almost by definition. What the legislation by Conyers (D-MI), Hank Johnson (D-GA) and Diana DeGette (D-CO) would do is end that anti-trust exemption for health insurers, allowing for enforcement in all of these highly concentrated markets. The Senate has companion legislation:

"This legislation would specifically prohibit price fixing, bid rigging, and market allocation in the health insurance industry," said Conyers. "These pernicious practices are detrimental to competition and result in higher prices for consumers. Conduct that is unlawful throughout the country should not be allowed for insurance companies under antitrust exemption. The House Judiciary Committee held extensive hearings on the effects of the insurance industry's antitrust exemption throughout the 1980s and early 1990s. It became clear then that policyholders and the economy in general would benefit from eliminating this exemption. "The legislation we introduced today is intended to root out unlawful activity in an industry grown complacent by decades of protection from antitrust oversight. In doing so, we aim to make health insurance more affordable to more Americans. I want to thank my friend Senator Leahy for his leadership on the bill and for working with the House on this joint introduction."

Many of the actions taken by the insurance industry over the years simply violate federal law. Repealing their anti-trust exemption would force the industry to end their criminal ways or face punishment. As a companion to insurance regulations designed to lower prices for consumers, but perhaps without the kind of enforcement necessary to maintain it, I couldn't think of anything better. And if nothing else, this legislation is a powerful whip to keep the industry in line as they try to extract more perks from the health care bill. Combine this with the multiple investigations into industry practices from Dennis Kucinich, Henry Waxman and others, and you have real pressure on the industry for the first time in a while.

Good for John Conyers.

Source: http://www.huffingtonpost.com/david-day ... 90637.html

[roxybeast]

To Bring Down Costs, American Consumers Need More Choices

Consider this recent op-ed piece by Ron Wyden, Democratic senator from Oregon, appearing in today's New York Times:

Health Reform’s Missing Ingredient
by Ron Wyden
New York Times, Sept. 17, 2009

“MY guiding principle is, and always has been, that consumers do better when there is choice and competition,” President Obama said last week in an address to Congress on health care reform. It’s a good principle, one that may determine the ultimate success or failure of reform, but unfortunately it’s not really guiding the Senate bill unveiled on Wednesday or any of the other health reform legislation now under consideration in Congress.

Under the nation’s current employer-based system, most people have little if any choice about where they get their insurance. They just have to accept the plan that comes with their job. That insurance company, in turn, is provided a captive group of customers, so it has no incentive to earn their loyalty.

Empowering Americans to choose from a broad selection of health plans would turn the tables. Those insurers that charged affordable rates and provided good coverage would attract more customers, while those that treated customers badly would be forced to change their ways or go out of business. To stay competitive, insurers would need to follow the example of places like the Mayo Clinic and offer good, low-cost coverage.

The various bills making their way through Congress would, as the president explained, provide some consumer choice by establishing large marketplaces where people could easily compare insurance plans and pick the one that best suits their needs. Companies participating in these insurance exchanges would be required to offer coverage to anyone who wants to buy it, regardless of their age, gender or health status, and they would be barred from charging someone more for having a pre-existing condition.

The problem with these bills, however, is that they would not make the exchanges available to all Americans. Only very small companies and those individuals who can’t get insurance outside of the exchange — 25 million people — would be allowed to shop there. This would leave more than 200 million Americans with no more options, private or public, than they have today.

I understand the president’s fear of overreaching. Past reform efforts have failed in part because of the public’s distaste for government-imposed change. But walling off most of the health care system from choice and competition could create greater problems — enough to doom health care reform.

I believe there is a way to work with the present employer-based system to guarantee that all Americans have choices, and I am proposing it in an amendment to the latest Senate health care bill. My amendment, called Free Choice, would let everyone choose his health insurance plan.

It would impose only one requirement on employers — that they offer their employees a choice of at least two insurance plans, one of them a low-cost, high-value plan. Employers could meet this requirement by offering their own choices. Or they could let their employees choose either the company plan or a voucher that could be used to buy a plan on the exchange. They could also simply insure all of their employees though the exchange, at a discounted rate.

All payments that employers would make, whether in the form of premiums or vouchers, would remain tax-deductible as a business expense. Reinsurance and risk adjustment mechanisms already in the bill would balance the costs of employers who end up with disproportionately sick pools of workers, and this would avoid any disruption to existing employer coverage. Any employers that did not offer either their own choices or insurance through the exchange would be required to pay a “fair share” fee to help support the system.

My plan would actually strengthen the employer-based system by making it possible for even more employers to afford coverage than can today. Employers who offer high-quality health insurance to attract first-rate employees could continue to do so. And employees who like the coverage they have could keep it. Those who don’t, however, would be able to shop elsewhere.

According to one estimate, injecting this kind of competition into the employer-based system would save people and businesses more than $360 billion over 10 years. At the same time, it would improve the quality of health care.

Americans could take advantage of this change, or ignore it if they like; it would not be forced on them by government mandate. Ultimately, by empowering people to select the health insurance that makes the most sense for them and their family, we could end up with a system that works better for everyone.

Source: http://www.nytimes.com/2009/09/17/opinion/17wyden.html

[roxybeast]

True Need for Reform:
Lack of Insurance Is Killing Large Numbers of Americans

Consider this article discussing a new study and findings by the Harvard Medical School ...

Harvard Medical Study Links Lack of Insurance to 45,000 U.S. Deaths a Year
By Reed Abelson
New York Times, Sept. 17, 2009

As the White House and Congress continue debating how best to provide coverage to tens of millions of Americans currently without health insurance, a new study (PDF) is meant to offer a stark reminder of why lawmakers should continue to try. Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.

“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Health and was posted online Thursday.

The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.

The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.

“As health care for the insured gets better, the gap between the insured and uninsured widens,” Dr. Woolhandler said.

The researchers also concluded that other ways of delivering care to the uninsured, like providing them with community health centers, are not adequate substitutes for health insurance. Individuals need the access to hospitals and specialists that comes only with adequate insurance coverage, Dr. Woolhander said.

Dr. Woolhandler said the study should prompt policymakers in Washington to consider the impact of scaling back any effort to provide truly universal coverage. She expressed concern about some lawmakers’ willingness to adopt a plan that could expand coverage to only a portion of the nearly 50 million people who are without health insurance. As a proponent for a single-payer system — something like Medicare for all — she said she was also disappointed in the current proposals before Congress.

Dr. Woolhandler, who has also conducted extensive research on medical-related bankruptcies, cautioned that expanding coverage would not be meaningful if the coverage is not generous enough. People might still not be able to afford care if they have to pay large deductibles or too great a share of their over all medical bills.

“Health insurance can only make you healthier if you have access to care,” she said.

Source: http://prescriptions.blogs.nytimes.com/ ... hs-a-year/

[roxybeast]

My Twins' Abby & Bella's New Health Care Video!

Watch my twins Abby & Bella in their new health care reform internet ad debut! ...

http://www.youtube.com/watch?v=X0idBGP3ufI

"My health care has a first name, it's MONEY!
My health care has a second name, it's GREED!
When I'm sick and they should pay,
They turn me down in every way,
Cause insurance really has a way with BOLOGNA!

President Obama, we need health insurance!"

In 2008, 7.3 million American children live without health insurance. Due to rising unemployment, that number is climbing higher in 2009. They are twice as likely to die or suffer serious negative outcomes. Pass health insurance reform with a public option NOW before more American children needlessly die!

[roxybeast]

The Hypocrisy of FreedomWorks & the Tea Party Movement

Those who support FreedomWorks & go to Tea Parties really need to watch this expose about their leader Dick Armey by Bill Moyers ...

http://www.pbs.org/moyers/journal/09182009/watch3.html

TRANSCRIPT:

September 18, 2009

BILL MOYERS: I'm Bill Moyers. Congressman Joe Wilson was rebuked by the House this week for heckling the president during Mr. Obama's joint address to Congress. But that shout heard round the world is still reverberating out there in conservative circles, most recently over the weekend where it became a chant for protestors at that huge taxpayer march on Washington.

PROTESTORS: You Lie! You Lie!

BILL MOYERS: They came from all over the country to register their opposition to President Obama and big government.

Their anger was palpable - at taxes...wasteful spending... health care reforms they fear would lead to a nightmare of bureaucracy.

But there were sinister fears, too -- as protestors equated their president to dictators like Stalin.... Mussolini... Hitler...and Saddam Hussein.

MAX: Who do you think is more dangerous Al Quaeda or OBama?

MAN: Obama.

MAX: Obama's more dangerous than Osama?

MAN: Absolutely.

MAX: Why?

MAN: He's trying to change the country from within. We can fight Al Quaeda, we can't kill Obama.

BILL MOYERS: The sentiments got even uglier...

PROTESTOR: I'm afraid he's going to do what Hitler could never do...And that's destroy the United States of America.

BILL MOYERS: Max Blumenthal author of REPUBLICAN GOMORRAH waded into the protesters to sample opinions:

MAX: What is the Obama Revolution? What's going to happen?

MAN: Similar to Germany, as Hitler did, he took over the auto industry. Did he not? He took over the banking, did he not? And Hitler had his own personal, secret service police. Acorn is an extension of that.

MAX: So, you're saying if the government eliminates Soocial Security and Medicare then you'll get out of the program?

WOMAN: No I said if they get out of my life.

MAX: Out of you Social Security and ?

WOMAN: No, out of everything.

BILL MOYERS: Many were here at the urging of their favorite pundit, Glenn Beck.

GLENN BECK: This is a collection of Americans who want parties to stop with the corruption, stop with the spending, and start listening to the people. let's go to Fox's Griff Jenkins...there in Washington DC.

NEWS: Glenn it's unbelievable...Look at this crowd...Glenn, it's one mile from the Capitol to....Do you want Washington to listen....

BILL MOYERS: They were obviously having a good time. And they kept it up even when the other side showed up to protest them -- in the guise of that satirical group from the left who call themselves, "Billionaires for Wealthcare".

Their motto: "If we're not broke, don't fix it." And they had come to thank the marchers "for protecting health-care industry profits."

None of these marchers were billionaires, real or imagined. And they seemed genuinely upset over the unchecked growth of government. But there was more to this march than meets the eye, as there always is in politics. And that's a story the press missed.

ANNOUNCER: Now, put your hands together and welcome the Chairman of FreedomWorks and former House Majority Leader, Dick Armey.

BILL MOYERS: Dick Armey is chairman of the advocacy group FreedomWorks, the main organizer of this protest. They played a big role in launching those so-called "taxpayer tea parties" last April and the town hall disruptions in August.

ARMEY: We protect and cherish freedom because it is precious in its own right and because it works. So let's give them the message: Freedom Works! Freedom Works! Thank you for letting me be here.

BILL MOYERS: Just who is Dick Armey? For one thing, he's among the most ardent opponents of President Obama's health care reform.

ARMEY ON MEET THE PRESS 8-16: It's certainly the largest hostile government takeover in the history of the country, one-sixth of the entire economy. And it's the most intimate. I mean, you have people on the streets today, real people that are saying, "Am I going to in fact end up with a decision regarding how my liver infection is going to be treated in the hands of somebody in a bureaucracy with a degree in sociology?

BILL MOYERS: That kind of exaggeration is an old tactic for Mr. Armey, who recently told the ECONOMIST magazine:

ARMEY: "Politics is about 97 percent fiction and 3 percent imagination."

BILL MOYERS: He should know. Sixteen years ago Dick Armey was a Republican congressman from Texas who teamed up with a Republican congressman from Georgia, Newt Gingrich, to kill President Bill Clinton's health care reform. They called it "Hillary Care" back then and Armey's main adversary was ...Guess who? Here they are sparring in a hearing on Capitol Hill:

ARMEY: "While I don't share the chairman's joy at our holding hearings on a government-run health care system, I do share his intention to make the debate as exciting as possible."

CLINTON: "I'm sure you will do that Mr. Armey, you and Dr. Kevorkian."

ARMEY: "I have been told about your charm and wit and let me say...the reports of your charm are overstated, and the reports on your wit are understated."

BILL MOYERS: After defeating health care reform, Dick Armey and Newt Gingrich crafted the "Contract with Aamerica", paving the way to the republican takeover of Congress in 1994.

ARMEY. Today we Republicans are signing a contract with America. We pledge ourselves in writing to a new agenda of reform, respect and renewal."

BILL MOYERS: Gingrich became Speaker of the House and Armey the House Majority Leader.

But they did nothing about health care except let its costs soar while their corporate backers reaped huge profits. Since then costs have more than doubled and are escalating now at twice the rate of inflation. There were around 39 million americans without health care coverage then. There are more than 46 million now.

And Dick Armey? He retired from his government job to lead an advocacy group called FreedomWorks, which aims to torpedo healthcare reform once again. Curiously, they refuse to disclose their corporate donors. They say they want to protect against "aggressive attacks on companies who people have claimed are donors but aren't even donors." Got that?

But here's the catch. Something these marchers who came to Washington at Armey's urging could hardly be expected to know. For most of his adult life, their leader has benefited from just the kind of government, tax-supported healthcare he's fighting to keep them from having, too.

When Dick Armey taught economics at the University of North Texas for 13 years his health insurance was administered by the state and supplemented by the taxpayers.

When he was elected to Congress, he was covered by the federal employees' health benefit plan. And when he retired from Congress eighteen years later, he was insured by that plan until he turned 66 and Medicare, another government program, kicked in. All the time he's been making some half a million dollars a year working for FreedomWorks and raking in lobbyist fees amounting to what he recently called "a darned handsome pile of dough."

You can't blame him for keeping his government health plan. It's great. It gave him a lot of options, dozens of private insurers to choose from, and with eight million members in it, the federal government's got the muscle to negotiate some of the best premiums and drug prices in the country. That's not all. Taxpayers subsidize these federal health insurance plans by as much as 75% of the premium cost. Beneficiaries -- including members and retired members of congress like armey -- pay their share of the premiums with pre-tax dollars.

Not bad.

Now get this: Dick Armey thought so much of that federal health plan - the cadillac of coverage --that he tried to keep it as his primary carrier, instead of that other federal program, medicare.

Mr. Armey wanted an option. A government option. How about that?

But he couldn't get out of medicare without losing his Social Security (they're hitched together -- you give up one, you give up both), so he's suing to divorce the two ... And now he says he's happy to buy his health insurance on his own - and why not? He's got that pile of dough. And there's the rub.

Dick Armey is the epitome of those people with power and privilege who are insured against the vicissitudes of life, and want no government assistance for any suffering ... Except their own.

And all those members of congress sitting there during the president's speech last week? Joe Wilson, included. They; too have Cadillac federal coverage subsidized by tax dollars.

That's no lie.

Source: http://www.pbs.org/moyers/journal/09182009/watch3.html

[roxybeast]

An American Health Expert's Analysis of the Baucus Bill

Remember our old friend Marcia Angell, former editor of the New England Journal of Medicine and professor at Harvard Medical School? Well, here is her take on the problems with the Baucus bill ...

Baucus Bill: Health Reform That Isn't
by Dr. Marcia Angell, M.D.
Huffington Post, Sept. 21, 2009

With the long-awaited release of the Baucus health plan, which is said to have Obama's approval, the fix is in. Billions of taxpayer dollars will be thrown at the insurance and pharmaceutical industries, much of it diverted from Medicare and Medicaid (despite Obama's protestations that he would not raid Medicare to shore up the private system). We'll simply pour more money into a system that's already shown itself capable of absorbing whatever we put into it without providing anything like commensurate health care.

Look at the bare bones of the plan. Americans will be required to buy health insurance at whatever price the companies choose to charge, many using government subsidies. Businesses will have to contribute or be fined. Drug companies will still be able to charge whatever they like for drugs, and continue to jack up prices at several times the inflation rate. In short, the government will deliver to the insurance and pharmaceutical industries millions more paying customers, with virtually no curbs on their profiteering. The "public option" was first gutted, then all but dropped.

The only savings will come from stopping over-payments to the private Medicare Advantage plans (certainly a worthwhile reform), and from limiting some services now covered by Medicare and Medicaid, presumably on the basis of effectiveness studies. (Few experts believe there are significant savings from preventive care or computerization of records.) Insurers will be prohibited from denying coverage on the basis of pre-existing conditions or reducing benefits when customers have the temerity to get sick, but these prohibitions are easily circumvented.

So what will happen? First, the medical-industrial complex will consume an ever greater fraction of our GDP, at the expense of other social needs, like infrastructure and education. Second, American businesses that compete in the global market, already reeling from the costs of providing health insurance to their workers, will be even less competitive. Third, we'll see the growth of huge bureaucracies to make sure everyone buys insurance and penalize those who don't, and to monitor insurance companies for violations of the regulations against creaming off the most profitable customers. Finally, health care itself -- the ostensible purpose of the exercise -- will progressively deteriorate. We'll see not only rapidly rising premiums, but shrinking benefits and higher co-payments, until even those who have insurance will not be able to use it when they're sick.

We can get a glimpse of what lies in store from Massachusetts, which three years ago adopted a plan similar to the Baucus/Obama plan. Premiums in the state are rising at double-digit rates, benefits are often skimpy, co-payments are rising, and subsidies are costing the state far more than originally predicted. Die-hard advocates now say that universal insurance was always the first goal, to be followed by cost-control and increased benefits, but that hope is belied by the fact that things are moving in the opposite direction. Moreover, Massachusetts offers a best-case scenario, since the state already had a very low rate of uninsurance and was able to tap into a large pool of money set aside to provide free care to the indigent. The lesson is that there is not much sense in expanding coverage if it will quickly become inadequate and unaffordable.

All of this assumes that Baucus/Obama will eventually make its way through Congress in its present form. That is unlikely, but it is probable that some remnant of it will survive. It is now clear that the essential element in whatever passes will be publicly financed expansion of the insurance and pharmaceutical markets. Indeed, the purpose now seems not so much to provide universal health care as to win the heart and minds -- and wallets -- of these industries. They give copiously to Congressional campaigns, and with this health plan, the Democrats are positioned to take the lion's share of their donations. They've rolled right over the Republicans, whose health plan pretty much consists of, "Go out and buy insurance, and lots of luck." While that is good for the industries, it's not as good as the market expansion the Democrats now promise.

Insurance and drug companies will have plenty of opportunities to show their gratitude to the Democrats in the elections of 2010 and 2012. Moreover, since reform is not scheduled to be implemented until 2013, any public disillusionment won't be felt until after those elections.

Those of us who believe that advanced countries should provide universal and comprehensive health care as a matter of course, and who support a single-payer system as the most efficient way to do that, are faced with two unpalatable options: the Democrats' short-sighted and, I believe, cynical proposals to pour more money into a dysfunctional system, and the Republicans' clueless disregard for people not shrewd enough to be rich. In my next blog, I will suggest a practical proposal that would move us toward universal care, while containing costs. But it would take an aroused public to force the Democrats to stop wooing the health industries. Maybe real reform will have to await the emergence of a third party.

Source: http://www.huffingtonpost.com/marcia-an ... 93093.html

[roxybeast]

Baucus Proposes Changes to His Health Bill

In response to some of the Democratic criticism of his plan, Sen. Baucus has decided to make some minor revisions. His minor revisions are mere window dressing that do not make necessary changes or address the fundamental problems with his approach.

Baucus Changes Bill To Address Democrats' Concerns
by Erica Werner
Huffington Post, Sept. 21, 2009

WASHINGTON — The chairman of the Senate Finance Committee revised his sweeping health care bill Monday to address serious concerns from fellow Democrats and a key Republican about insurance costs, part of his ongoing struggle to deliver on President Barack Obama's top domestic priority.

The changes came a day ahead of a committee session beginning Tuesday to amend and vote on the bill, which Sen. Max Baucus, D-Mont., hopes his panel will approve by the end of the week.
The 10-year, $856 billion package would extend coverage to about 29 million Americans who lack it now and institute insurance market reforms, such as prohibiting higher premiums for women or the denial of coverage to sick people. It would make almost everyone buy insurance or pay a fee, give subsidies to the poor to help them buy coverage and create new online exchanges where small businesses and people without government or employer-provided insurance could shop for plans and compare prices.

Release of the bill last week gave a boost to Obama's health care agenda after a summer of angry town hall meetings, though plenty of political and policy hurdles remain before Congress could send a bill to Obama's desk.

In the days ahead, Baucus faces the difficult task of keeping his 13 committee Democrats on board without moving so far to the left that he alienates Sen. Olympia Snowe, R-Maine, the only one of the panel's 10 Republicans seen as likely to vote for the bill.

Snowe's support could become even more critical presuming health overhaul legislation makes it to the Senate floor, where she would be the Democrats' top target as they look for the 60 votes needed to advance the bill. Democrats control 59 votes now in the 100-vote Senate and could get a 60th if the Massachusetts legislature allows a temporary replacement to be appointed for the late-Sen. Edward Kennedy. But the party can't count on support from all of its moderates.

Snowe and a number of Finance Committee Democrats have raised concerns about whether subsidies in Baucus' bill are generous enough to make insurance truly affordable for low-income people. There are also concerns about a new tax on high-value insurance plans, which some fear would hit middle-class workers even though Baucus is directing it at so-called "Cadillac" insurance plans that he says are enjoyed by a minority of U.S. workers.

Senators have offered a raft of amendments on both those issues and Baucus is incorporating some of the approaches in revised legislation he'll unveil at Tuesday's committee meeting. Details weren't final but one possibility was to lower the maximum amount of income people could pay in premiums before becoming eligible for subsidies. It's now 13 percent. Another was to adjust the new insurance excise tax – now set to hit plans valued at $21,000 for a family and $8,000 for an individual – so that it's limited to even more expensive plans.
Baucus was set to meet with his committee's Democrats Monday evening to discuss and finalize the changes.

Aides said the changes could add to the cost of the $856 billion bill, but since the bill would raise about $50 billion more than it spends over 10 years, there is some wiggle room.

Baucus' legislation is the most conservative, and cheapest, of five health care bills in Congress. The four other bills have already passed committees in the House and Senate, but Baucus' is the most closely watched because he tried for a bipartisan deal, though without succeeding in the end. In the other committees, majority Democrats passed legislation without GOP support that reflected mostly liberal priorities.

Also, the Finance Committee has a moderate makeup that resembles the Senate as a whole, so legislation that passes Finance could find favor on the Senate floor.

Source: http://www.huffingtonpost.com/2009/09/2 ... 93838.html

And this article from the NY Times ...

http://www.nytimes.com/2009/09/22/healt ... aucus.html

[roxybeast]

Humor: Bill Maher Rips the Baucus Bill

Bill Maher opened his show Friday night with a blistering monologue that took aim at the health care bill Senator Max Baucus released this week:

"It's everything you could want in a reform bill, you know, except reform. It is a watered-down, ineffectual blow job to the health insurance industry." Bill Maher

Watch the Video here:
http://www.huffingtonpost.com/2009/09/1 ... 92134.html

And ...

New Rule: You Can't Complain About Health Care Reform If You're Not Willing to Reform Your Own Health
by Bill Maher
Huffington Post, Sept. 18, 2009

New Rule: You can't complain about health care reform if you're not willing to reform your own health. Unlike most liberals, I'm glad all those teabaggers marched on Washington last week. Because judging from the photos, it's the first exercise they've gotten in years. Not counting, of course, all the Rascal scooters there, most of which aren't even for the disabled. They're just Americans who turned 60 and said, "Screw it, I'm done walking." These people are furious at the high cost of health care, so they blame illegals, who don't even get health care. News flash, Glenn Beck fans: the reason health care is so expensive is because you're all so unhealthy.

Yes, it was fun this week to watch the teabaggers complain how the media underestimated the size of their march, "How can you say there were only 60,000 of us? We filled the entire mall!" Yes, because you're fat. One whale fills the tank at Sea World, that doesn't make it a crowd.
President Obama has identified all the problems with the health care system, but there's one tiny issue he refuses to tackle, and that's our actual health.

And since Americans can only be prodded into doing something with money, we need to tax crappy foods that make us sick like we do with cigarettes, and alcohol -- and alcohol actually serves a useful function in society in that it enables unattractive people to get laid, which is more than you can say for Skittles.

I'm not saying tax all soda, but certainly any single serving of soda larger than a baby is not unreasonable. If you don't know whether you burp it or it burps you, that's too big. We need to make taking care of ourselves an issue of patriotism. If you were someone who condemned Bush for not asking Americans to sacrifice for the war on terror, the same must be said for Obama and health care.

President Arugula is not gonna tell Americans they're fat and lazy. No sin tax on food on Obama's watch. And at a time when it's important to set new standards for personal responsibility, he appointed a surgeon general, who is, I'm sorry, kind of fat. Certainly too heavy to be a surgeon general, it's a role model thing. It would be like appointing a Secretary of the Treasury who didn't pay his taxes. He did?

And get this: Surgeon General Benjamin had previously been a nutritional advisor to Burger King. The only advice a "health expert" should give Burger King is to stop selling food. The "nutritional advisor" job was described as, "promoting balanced diets and active lifestyle choices" -- and who better to do that than the folks who hand you meat and corn syrup through a car window? When you have a surgeon general who comes from Burger King, it's a message to lobbyists, and that message is, "Have it your way."

Source: http://www.huffingtonpost.com/bill-mahe ... 91852.html

Here's a collection of some of the Funniest Protest Signs of 2009:
http://www.huffingtonpost.com/2009/09/2 ... 92342.html

And this is funny ... Dickipedia: Tea Baggers
http://www.dickipedia.org/dick.php?title=Teabaggers

New Rule: Float Like Obama, Sting Like Ali
by Bill Maher
Huffington Post, Sept. 11, 2009

New Rule: Democrats must get in touch with their inner asshole. And no, I'm not being gratuitously crude when I say that. I refer to the case of Van Jones, and I'm sure you know who Van Jones is. At least I hope you do, because I haven't a clue, or at least I didn't until this week, when I found out he was the man the Obama administration hired to find jobs for Americans in the new green industries. Seems like a smart thing to do in a recession, but Van Jones got fired because he became the Scary Negro of the Week on Fox News, where, let's be honest, they still feel threatened by Harry Belafonte.

Now, I know that right now, I'm supposed to be all re-injected with yes-we-can fever after the big health care speech, and it was a great speech -- when Black Elvis gets jiggy with his teleprompter, there is none better. But here's the thing: Muhammad Ali also had a way with words, but it helped enormously that he could also punch guys in the face.

What got Van Jones fired was they caught him on tape saying that Republicans are assholes. And they call it "news." And Obama didn't say a word in defense of Jones and basically fired him when Glenn Beck told him to. Just like we dropped "end of life counseling" from health care reform because Sarah Palin said it meant "death panels" on her Facebook page.

Crazy evil morons make up things for Obama to do, and he does it.
Same thing with the speech to children this week. If you missed it, the president attempted to merely tell school children to work hard and wash their hands, and Cracker Nation reacted as if he was trying to hire the Black Panthers to hand out grenades in homeroom. Of course, the White House immediately capitulated. "No students will be forced to view the speech," a White House spokesperson assured a panicked nation. Isn't that like admitting that the president might be doing something unseemly? What a bunch of cowards. If the White House had any balls, they'd say, "He's giving a speech on the importance of staying in school, and if you spineless jackasses don't show it to every damn kid in your school we're cutting off your federal education funding tomorrow."

The Democrats just never learn: Americans don't really care which side of an issue you're on as long as you don't act like pussies. When Van Jones called the Republicans assholes, he was paying them a compliment. He was talking about how they can get things done even when they're in the minority, as opposed to the Democrats, who can't seem to get anything done even when they control both houses of Congress, the presidency, and Bruce Springsteen.

I love Obama's civility in the face of such contumely, his desire to work with his enemies, it's positively Christ-like. In college, he was probably the guy at the dorm parties who made sure the stoners shared their pot with the jocks. But we don't need that guy now. We need an asshole.

Mr. President, there are some people who are never going to like you. That's why they voted for the old guy and Carrie's mom. You're not going to win them over. Stand up for the 70% of Americans who aren't crazy.

And speaking of that 70% -- let's call them the sentient majority -- when are we going to actually show up in all this? Tomorrow Glenn Beck's army of zombie retirees are marching on Washington in protest of, well, everything. It's the Million Moron March, although they won't get a million of course, because many will be confused and drive to Washington state -- but they will make news. Because people who take to the streets always do. They're at the town hall screaming at the congressman, we're on the couch screaming at the TV. Especially in this age of electronics and Snuggies, it's a statement to just leave the house. But leave the house we must, because this is our last best shot for a long time to get the sort of serious health care reform that would make the United States the envy of several African nations.

Source: http://www.huffingtonpost.com/bill-mahe ... 84151.html

[roxybeast]

Individual Mandates, New Taxes, and the Reverse Trigger Idea

I think eventually Congress will compromise on the public option by adopting a trigger approach as suggested by Sen. Snowe, but gosh I really like the idea proposed here of a "reverse trigger," i.e., pass the public option, but take it out if insurance companies clean up their act!

Why, Oh Why, Do They Never Listen?
by RJ Eskow, Health Analyst
Huffington Post, Sept. 21, 2009

Why, oh why, do they never listen? I've been warning the Democrats since 2005 that an individual mandate without meaningful out-of-pockets limits would be a hardship for working Americans -- and that eventually Republicans would figure out how to call it a tax hike and run against it.

Now Politico writes:

... Questions about tax increases are part of an emerging Republican line of attack. Senate Republican leader Mitch McConnell on Sunday said "... We don't think it's a good idea to raise taxes on small businesses and on individuals in the heart of a recession."

Democrats: They have ears, Lord, but they hear not. I was especially disappointed to see the President defend himself from these charges by claiming they're not new taxes ...

1. Obama's New Taxes

... when they are. It's bad enough that the Baucus bill says "the consequence for not maintaining insurance would be an excise tax" and the House bill requires a "tax on individuals without acceptable health care coverage." I could defend these provisions if there were a strong public option and other cost containment measures. That might make this mandated insurance affordable to middle-class Americans.

But those things aren't there.

Now PresidentSenator Olympia Snowe is reiterating the position that 13% of income is an acceptable maximum out-of-pocket cost for health premiums. That is financially devastating for families at 400%-700% of the Federal Poverty Level (and many at higher levels). Since the President has ceded extraordinary power to her (as Robert Reich explains), this is likely to become law if she so chooses. It's a windfall to the insurers and body blow to working Americans (what should they sacrifice? That savings account for their kids' college education?)

The President also spoke up in favor of the tax on "Cadillac benefits." That's his other new tax. The idea might have some merit if a) it prevented insurers from passing on these new taxes to their customers and b) it was actually based on benefits. If most Americans pay deductibles and copays, a plan that covers 100% of out-of-pocket costs might legitimately be considered taxable income. (Although even than union plans should be excluded, since many workers gave up wages for their benefits.)

But this new Democratic tax is based on plan cost, not benefit design. So plans with older Americans will be more highly taxed than others. That will hurt older Americans and encourage businesses to discriminate against them. Plus, it's indexed to general inflation, which rises much more slowly than healthcare costs. So more and more plans will be taxed every year. As currently designed, those costs will go back to the consumer.

Let's not pretend Democratic health reform doesn't include new taxes -- and mandated fee payments to highly profitable private companies. If their bill passes in this form they'll pay a heavy political price for it. And they'll deserve to.

2. We're Not Swiss

While we're at it, let's stop defending this proposal by using Switzerland as an example. Paul Krugman and others keep doing it - but we're not Switzerland. First, Switzerland is a wealthier country: OECD figures show that the median household income there in 2007 was $60,288, versus $50,233 in this country. Despite their greater prosperity, roughly one-third of its citizens receive government assistance paying premiums. (Granted, they don't have an employer health insurance system and we do - but that system is eroding quickly.)

All insurance companies in Switzerland are non-profit. What's more, the Swiss system includes rigorous price controls that would never pass ideological muster in the US. And to top that off, the Swiss system includes strong managed care components that Americans would find unacceptable. The Swiss can't "choose their own doctor," to use that well-worn catchphrase.

Needless to say, the Swiss pay much less in healthcare costs than we do, and their costs are rising much more slowly. But we don't intend to do things the Swiss way. You can't impose a Swiss-style mandate on a system that is more expensive, has less control, and is profit-based.

Next topic.

3. Reverse Triggers

Sen. Snowe (sorry about that "President" crack - "Czar" might be more appropriate) is bringing up triggers again, apparently with the help of Rahm Emanuel. So, apparently to woo her, the President is opening the door to the idea that a public option would be "triggered" in states where "affordable" healthcare isn't available through the private market.

This is very bad, in two ways: First, it's a state-by-state solution, not a national one. A state-specific public option will be costlier to maintain and run. That will costs the rest of us money. Secondly, what's Sen. Snowe's definition of "affordable"?

Thirteen percent of income!

They have ears, Lord, but they hear not. Fortunately for our sanity, we have the satirical (also politically incorrect and pretty foul-mouthed - but funny) blogger Bobblespeak. Bobble posted this "tweet" yesterday: "Reverse trigger: public option is created, to be taken away from the people if the insurance industry completely fix US health care by 2012."

Now that makes sense! But wait ... a public option is optional by definition. If the insurance industry fixes US health care, nobody will join it. That's a good enough "reverse trigger" for me.
It should be good enough for Olympia Snowe, too.

Source: http://www.huffingtonpost.com/rj-eskow/ ... 93742.html