Wednesday, September 30, 2009

If It Gets Real Bad, Think About Space

Well, the public option amendments were both voted down yesterday in the Senate Finance Committee. Three questions: first, why? Second, what happens next? Third, what can we do?

1) The reason this amendment was voted down was lobbyist money. One of the votes that almost nobody counted in the press, and which I overlooked as well, was that of Max Baucus himself, the chairman of the Finance Committee -- who kept repeating that the bill didn't have 60 votes in the Senate, so he couldn't vote for the amendment. But Baucus, as 538.com points out, has told his own constituents that he "wants a public option too" and there's a strong argument to be made that his leadership alone could have motivated a fence-sitter like North Dakota's Kent Conrad. The Senate as a whole, when they take up the debate, could easily strip the Finance Committee's public option amendment -- the HELP committee didn't seem to have any trouble putting a public option into their bill, whether it would pass the general vote or not. For the Schumer amendment, Baucus and Conrad alone would have been enough for passage -- just these two senators. But Baucus (as well as Blanche Lincoln, and frankly all the 'no' votes on the public option) is a MASSIVE recipient of health insurance lobbying money. Here is a graphical representation of the clouds of buzzing health insurance industry lobbyists that feed on the Montana senator (explained here). A comparison of 'no' voting Democratic senators with the money they accept from industry lobbies is here -- Baucus is at the head of the list with 7.7 million dollars raised over the course of his career, and Lincoln is second. We could have had this amendment: we should have had it. Voters and activists have done their part and the nation wants it. It is very specifically the political patronage of the health insurance industry that has prevented the passage of a public option.

2) Nobody really knows what happens now. The Baucus Bill will have to be merged with the Health, Education, Labor and Pensions committee (HELP) bill, which contains a public option, and it will have to go up for debate on the floor of the Senate, and it will have to be merged with the House bill, which also contains a public option. It seems true that there are more than 50 votes to pass a public option in the Senate -- but to prevent a Republican filibuster, we need 60 votes, which means all 58 Democrats, plus Sanders of Vermont, plus one other vote. Nobody can work on that one vote, though, and nobody can really put together a strategy to pass parts of the plan through budget reconciliation (a legislative option that only requires 51 votes) until Senate Democrats get it into their heads that a public option is what the nation wants, that it is overwhelmingly what the party wants, and that the coming election will be much harder for everyone if the health care plan they end up passing is a give-away to insurance interests.

3) What we can do now is much more than what we could before we knew what was going to happen in the Finance committee -- in the coming floor debate, we will be well served by Senators of all stripes, from all states coming forward to support the bill. Signing up with HCAN or just using their service to call your senator sends a clear message that supporters of the public option have supporters among the public. If your senator's for the public option, tell them to get up and speak out for it. If they're waffling (this list is a good source to figure out who's a trustworthy supporter, and who's weak), tell them how much you hate waffles, and threaten to make pancakes of them in the 2010 elections (or some such metaphor, which is better constructed and less threatening).

And if you find yourself wanting to hock a lugie at Max Baucus for selling us out, maybe it'd be a good idea to take a second, chill out, and listen to Carl Sagan sing techno about space.

Monday, September 28, 2009

The Loss Ratio and Insurance Industry Profits

John Rockefeller is in the Senate Finance Committee right now hammering away in the speech that everyone needs to hear most -- that health insurance companies are bleeding our benefits dry, and that a strong public option is the best solution to the problem.

Most of what I learned about health insurance industry profits, I learned from a single person's writings -- Uwe Reinhardt, Princeton economist and opinion writer for the New York Times. My favorite article on the topic, so far, is this one -- it breaks down the way to answer the question "how much do insurance companies make" in a comprehensive way.

This is important because an insurance company -- and we saw GradMed claim that they don't even collect this data for themselves or the insurance companies that they broker -- will never share this information with potential customers. They are forced by law, however, to share it with potential investors, and that's where Professor Reinhardt comes in. I've seen pictures, but I picture him with a monocle and a handlebar mustache. Egads, he says.

Insurance industry profits -- that's the amount that the company takes out of the economy, free and clear -- usually hang between 3 and 6%, which is not exceptional for most kinds of industry. What is exceptional, though, is the amount in marketing and administrative expenses that the company spends. Keep in mind that, unlike buying a cell phone, where you give a guy some money and he gives you a cell phone, insurance companies essentially take your money and then give it back -- the product you get is the insurance company holding your money, and the money of many others, for you, and then reorganizing it to pay for the medical care of the people that need it. So these costs become extremely important: the money taken out of your premiums, and the money that's left, determines what kind of coverage you get.

Not much of a product, true. But it's even less of a product when the insurance companies are only paying out 84.4% (in Reinhardt's example, Wellpoint in 2008) of the premium money that they've collected. That's an 84% loss ratio -- to the insurance companies, GradMed included, the company has lost 84% of "its" money (actually your money, but held by the insurance company). 84% loss for them means 84% care for you.

Where does the money go? Profits are substantial, but don't explain the whole picture. The rest is marketing -- GradMed paying alumni associations to run advertisements, insurance executives googling their products and leaving dodgy comments, TV ads, newspaper ads, etc. etc. etc -- as well as 'administrative costs', which covers the salaries of the people who work in the insurance industry. What seems absolutely true to me is that even if these costs aren't considered profit on the company's 10-K, they are profit: the company investing in its own future enrichment through advertising, and directly profiting the people who make up the company through salary and benefits.

You have to hand it to them, though. Taking 15% off the top of your health care dollar: not too shabby as a con game. A strong public option would also have administrative costs, but estimates for Medicare put their administrative cost at between 3% and 8% (and their profits at ZERO, where they should be), which is nowhere near the expense and waste we're experiencing with private insurance.

UPDATE: The Rockefeller public option amendment was just defeated, 8 to 15. Democratic senators voting against it were Conrad of North Dakota, Lincoln of Arkansas, Nelson of Florida, and Carper of Delaware.

DOUBLE UPDATE: The Schumer public option amendment was also defeated, 10 to 13. A slightly weaker option, it picked up Thomas Carper and Bill Nelson, but Kent Conrad and Blanche Lincoln (who was wearing an enormous green lapel pin that said "BLURGH") still voted against it. No Republicans, of course, voted for the amendment or even bothered making serious arguments about the bill -- it all seemed to have been posturing for the general senate debate, and insistence on this new weird "defend Medicare" attitude they've all suddenly come to after decades of trying to slash Medicare.

GradMed III: Revenge of the Sith

So about a week ago, taking time out from advocacy for the public option, I did a review of an insurance broker called GradMed. They sell temporary, non-renewable insurance that doesn't cover any pre-existing conditions to recent college graduates. The way they sell it is by paying royalties to university alumni associations, and then pretending that it is the alumni association that 'sponsors' the GradMed program.

I pointed out that if you get sick while on a 30-day GradMed policy, the second your policy runs out, you're essentially screwed: GradMed won't let you buy another policy, and no other insurance company will cover you, either. I think I probably said something like AVOID GRADMED LIKE THE PLAGUE. Review complete! Good blogger.


I was pretty much convinced that I'd done my civic duty, hopefully let some people know what I thought about a product, and that was that. But GradMed appeared. Almost immediately, and in a big way: over the days after my review, they logged over six hours on the site, viewed each of my tiny little blog's 50-something entries more than once, and did so from somewhere between three and five different IP addresses. This struck me as a pretty poor use of man-hours paid for by the insurance premiums of unemployed college graduates, and I said so. Their page views dropped off a great deal -- but curiously, the number of hits I got from suburbs around their offices increased quite a bit, and I actually got my first few Tor nodes visiting the blog -- a novel use for an anonymity service that I thought was reserved for antigovernment protesters abroad and child pornography afficionados.

At this point, I felt like detonating. I had asked them a series of questions that they were ignoring, but they were still running around trying to sniff out information about me, viewing my profile, looking a great deal at some pictures I took of a local rally. I was rolling up my sleeves and getting ready for, well, you know, midnight deer-fighting:


Two things happened, though -- first, I got a (heavily solicited) letter from internet president Ze Frank that essentially said not to get obsessed with these people, because they're an economics-only operation, and will boringly continue to protect their financial interests, which is not something any real person wants to read about. Second, though, GradMed came back to the comments and tried to sort of whitewash their names. And I couldn't be angry. These people are symptoms: they're the runny mucus that shows that the system is ill.

The epiphany moment, for me, came in question two -- I had asked them to share their "income-to-benefits ratio" with me, a comparison of the money they take in through premiums, and the money they pay out in health benefits. They, predictably, declined to do so, but took the opportunity to haughtily correct me: "I can tell you that what you are referring to are loss ratios." Loss ratios -- these are not only people who consider fulfilling their contractual obligation to pay for the health care of the sick and injured a loss, but see absolutely nothing wrong with that thinking. They've internalized the values of their industry to the extent that they've stopped thinking, exactly, about what 'loss' is, and who's losing. Likewise with their refusal to disclose how much of a kickback alumni associations get every time a student signs up with GradMed -- "Our compensation to associations is protected by contract. " Of course -- a silly question to ask. If they shared the way they sink our premium dollars into marketing, we'd know that sending them money is a massive waste of resources, and we would stop sending checks. We'd probably also think twice about supporting our alumni associations. Thus the secrecy in the contract. It's logical, right?

It's the plight of the parasite: like every other corporation, this one has evolved a culture that serves the survival of the company. But we -- and by this, I mean you, me, recent college graduates, health care providers -- don't want this company. We're harmed by it. Piece by piece, state by state, we're trying to pull it loose from the open sore it's feeding from. But it doesn't know it's a parasite. It acts in self defense just like any other animal would, and it cares about itself and thinks it's a good parasite, a hard-working parasite that does exactly what a parasite's supposed to do:
(Insurance companies actually share risk among large groups of people, which can be interpreted as a kind of service, and so they aren't quite as parasitic as brokers -- more like those little birds that eat bugs off of hippos, at least if they're run right.)

The answer is not to face up to these people and convince them they're wrong -- at some level, I think, they already know that what they do isn't really helping matters much. The answer is to just pinch them off at the sucker and drop them back into the lake. Through legislation, through boycott (although it's not actually a boycott when you refuse to buy a service because it's worthless), through education. I'm so glad that most of the reform legislation in Congress outlaws the use of pre-existing conditions to deny people insurance, and although I'm sure the fine people at American Insurance Administrators, part of USI Affinity, subsidiary of the USI Group, whole broker for GradMed, will be very sorry to clean out their desks and go back on the job market, we'll all be better off in the future for it.




PS: I also had the chance to hang out with blog stalwart mattlo this weekend, and he, in his outwardly reserved but fundamentally hot-blooded Midwestern way, allowed as how he didn't feel so sorry for the GradMed crew, and how even his job, which he enjoys just fine, is not quite as cushy as sitting in an office reading our blog (he has to sit in an office and do real work). So for all the mattloes of the world, here's thirty seconds devoted to unrepentant pushback. The GradMed IP address that has, now, over 90 visits to the blog is 12.104.97.211, which apart from a few fake Wikipedia entries/commercials/some spam, hilariously has also been used to create a large genealogy website for the Sawn family which is run by a gentleman named George (that's their guestbook). A tiny bit of googling shows that one likely (although I'm sure there's a lot of unprotected computer-sharing in the office organism) visitor to the blog is therefore George Sawn, CFO of Univers Workplace Benefits, subsidiary of USI Holdings, whole owner and operator of USI Affinity, parent company of American Insurance Administrators AKA GradMed. You can get in touch with him at gsawn@sawnfamily.com, if you feel like it or if you think y'all are related.

Sunday, September 27, 2009

Thinking Cap

Got to be brief today because, contrary to the assumptions of some, I do have a full time job (and health insurance!) and it today requires me to spend a great deal of time in the company of ye olde thinking cappe. Which looks like this:

(from the late Nagi Noda, via Beauty and the Salamander)

I did want to drop you this tidbit about new polls that show that the public option has crossed the line and is now supported by a majority of US citizens, which means that the administration, if somewhat tardily, has fulfilled its responsibility to educate we the people about what is a very beneficial plan. Remember this in connection with the town hall screaming, and the 9/12 protests -- now that what a public option is, and what it means, has become clearer to voters, they want it, even though we've also had an excruciatingly complete airing of all possible opposition.

Unfortunately, although a majority -- which is to say, 51 senators and most of the Representatives -- of Congress supports the public option as well, there's no clear way right now to 60 filibuster-proof yes votes. Meanwhile, the administration seems to be lobbying public option stalwart John Rockefeller to support the Baucus bill, to some success. He's the author of the best public option amendment and an ideological leader in the Senate Finance Committee. This is all backroom rumor-style stuff, and it's wrong all the time, though -- Tuesday will be the real test.

Saturday, September 26, 2009

Don't Know How She Sorts It

I just watched this short documentary, about a cook at the Sigma Nu frat house at Ole Miss:

Ten Dollars an Hour from Ben Guest on Vimeo.


Here's the math of Leasse William's life, from the whiteboard talk in the documentary:
She makes $10/hour, and works 50 hours a week, nine months a year, and either works minimum wage or gets unemployment (the income is about equal) for the other three. Her taxes (yes, people at this income level pay taxes!) are $3600, and her health insurance, which she buys on the private market, costs $2400/year. This leaves her about $14,200 in take-home pay, which is near the Louisiana poverty line -- and that already includes the possibility of government-subsidized unemployment benefits.

Now, poverty is a systemic problem, and it's not clear whether it can be simply fixed by legislation, more consideration shown to employees by employers, an insistence on racial equality, or any other individual undertaking. But the absolutely back-breaking cost of medical insurance is something we can fix with legislation, and the legislation is in Congress right now, in the form of the public option amendments to the Baucus bill.

Leasse's problem isn't just that her insurance is expensive -- it's that she doesn't have any extra resources to fight her insurance provider to protect her coverage. If, let's say, she wakes up bleeding from the nipple one morning and her insurance company refuses to cover it as an emergency, she's not going to be able to do what any smart person would want to: lawyer up and spend a couple of days making angry, pointed phone calls. She's back to work, if she can work, ten hours the next day. Every dime that insurance providers and brokers like the GradMed people (who don't provide real health insurance and wouldn't insure anybody in this documentary, but who seem like good representatives of the industry to me) steal and waste -- every bit of that $2400 a year that goes into marketing, salaries, profit, obsessive rereading of "Dying for a Public Option" -- comes out of the money that Leasse is setting aside for her own care, and it's money that she frankly doesn't have in the first place. Those costs are passed along to her in the form of claim denials, copays, coinsurance, and rescission.

And this doesn't just cost Leasse. Medical bankruptcy would put her right on unemployment (which her job seems to expect her to collect already), eventually on welfare (if she's lucky). This couple in a recent PBS NOW episode, like many others with chronically ill children, limits their own income so that they can qualify for Oklahoma state child health benefits, because their asthmatic daughter may need an expensive operation to repair her damaged lungs at any time. From a purely practical perspective, we are wasting the country's resources, both human and financial, by dumping them into the insurance industry.

And it doesn't just cost money. Our system of health insurance is unjust. It punishes those who can least afford it, and enriches those who do not deserve it and haven't earned it. Instead of strong citizens united for the common good, it creates fear and division and resentment. We can do better. We're so close to making a change for the better.

Friday, September 25, 2009

The Public Option Amendments

Max Baucus seems to have just now pushed the debate and vote on public option amendments back to next Tuesday.

Here are the amendments:

-- First, the amendment of the honorable and physically attractive Senator Jay Rockefeller of West Virginia, which would place the strong public option from the bill passed by the House of Representatives into the Baucus Bill. This would be the amendment which would most directly and drastically reduce the costs of health care in America. Where amendments are involved, it is the Cadillac made of syrup-kissed, fluffy, golden pancakes -- but because it entitles the public option to negotiate for lower costs, it runs into opposition from those most directly funded by the insurance industry, namely Blanche Lincoln of Arkansas, and Max Baucus, as well as those who believe in an unrestricted free market, which is some Republicans, and those who want reform to fail, which is the rest of them.

-- The other two are weaker public options without the ability for the government-run insurance company to use legal structures to dictate cost -- this means that it would essentially be a very large not-for-profit insurance company that would compete with private insurers on a 'level playing field'. This would still likely cut costs -- since the government's level playing field wouldn't include 30% overhead, corporate profits, or CEO overpayment -- but not quite so much. One is modeled on the Senate HELP bill and is offered by Senator Cantwell, the other by Senator Schumer and would only provide start-up costs for a government insurance co-op, which would then have to be self-sufficient.

Since the Republicans, even Olympia Snowe, are likely to be 'no on all counts', here are the critical votes according to Open Left: Baucus, Carper (Delaware), Conrad (North Dakota), Blanche Lincoln of Arkansas, and Nelson (Florida). Blanche Lincoln increasingly looks bought-and-paid-for -- Baucus might vote no on amendments just to preserve his original bill, if he thinks it has the best chance of passing the whole vote -- Carper has claimed he'll vote no on anything but a trigger. Of those five, however, the public option needs four, which is long odds.

Keep in mind that if a public option passes here, it's in the bill -- if it fails, then something could still happen when the House bill and whatever the Senate passes eventually meet.

If you live in one of the states listed above, this is a good time for direct pressure -- more in the phone call/fax line than letters, of course. If you aren't represented by one of these committee members, maybe you'd be better off taking a walk outside and meditating on the fact that we are all just sentient meat.

Thursday, September 24, 2009

Treating Swine Flu: Unprofitable!

Very short entry today: I burnt out my laptop backlight because I am on the computer all the damn time. So this is coming to you from a new machine that's still busily deleting all of its push-marketing "support" programs.

(Yeti does not NEED link to e-bay on desktop! Do not contact Yeti with offers for new Compaq products! Yeti wants to blog! And smash!)

One of the things I hear from almost all insurance customers who have been forced to file claims -- I heard it again two nights ago, from someone who'd had GradMed-style temporary insurance -- is that the absolute worst time to try to negotiate with insurance industry bureaucrats is when you've just had a staple put in your head, your blood replaced, your eyeballs rotated, etc. etc. But this is, of course, always the time they pick to deny coverage.

Case in point: Ted Rall stood in the pharmacy for over an hour trying to get his TamiFlu covered -- coughing up bloody phlegm and spreading the swine flu like a syphilitic hooker in a Navy port (no offense, Ted).

Did anyone ever really think this system over? Is anyone honestly motivated to persist in entrusting public health to people who have no interest whatsoever in protecting public health?

Wednesday, September 23, 2009

Gradmed: Spending Your Insurance Dollars Wisely

Since my previous post on how exploitative, dishonest, and useless GradMed Health Insurance is, I've had an enormous spike in traffic from the fine folks at GradMed -- since last Friday, they've viewed my blog pages seventy-one times -- have viewed the blog more than four times as much as I have over the same period, an astonishing amount considering that there are only fifty-two pages here -- and spent almost six hours on the site. I've been chatting with them in the comments about the way in which they're negligent in selling a product that even they don't consider a real insurance solution to penniless graduates. They say, "If someone knows that they will need more permanent coverage, many alumni associations sponsor a renewable major medical program through us as well...", neglecting to recognize the fact that everyone needs permanent coverage whether they know it or not, and that the non-permanent coverage they sell only creates pre-existing conditions that are life-long uninsurables.

It didn't occur to me until I was sitting at my desk, procrastinating on my own project, to ask the question: what the hell are these people doing wasting their time at this tiny blog? I mean, look at the drapes. This isn't exactly the Hilton.

So I drilled down into their data a little bit. They found the blog by doing a blogsearch (not a Google search, mind you, but Google's specific search for blogs alone) for "GradMed" and finding my post from there. At that point, the employee that found the site passed it on to another employee, and then spent about the next hour surfing the site and crafting a comment. They checked again at the start of work Monday, and then again about halfway through the day. Since the start of business Tuesday, they stayed on the site continuously until lunch, refreshing or clicking a link at least once every fifteen minutes.

So who is this person? They identified themselves as "Customer Service" in their comment, but it seems clear that one of the things they do on the blog is fighting the war for GradMed on the information front: the IP address that left the comment on my blog is the perpetrator of at least three vandalism reverts on Wikipedia, one of which was an article created to publicize the USI Consulting Group -- GradMed, as far as I can tell, is a subsidiary of USI Insurance Services, a division of USICG.

But none of this is as important as why we care about all this as insurance customers. GradMed/USI doesn't provide care, of course; but they also don't provide insurance. They organize marketing for insurance that they then obtain from state insurers -- they're insurance brokers dealing with alumni associations. But this whole group -- the alumni association, USI, and the insurer -- gets paid with the money you and I send in as premiums. Every billable minute (and all the GradMed access to this site has come during working hours) that they spend promoting, marketing, giving greasy answers to straightforward questions, and making up fake and poorly structured Wikipedia pages is a dollar of your premium money that doesn't get paid in benefits. I am sure that the people at USI consider this good business: I consider it legal embezzlement from America's limited health care resources.

People say that government bureaucracy is inefficient and I agree, it can be -- but it's nowhere near as bad as being a 22 year-old recent graduate, broke, unemployed, and forced to pay for an insurance broker to surf our hooptie blog.

We need a public option to help get the profit motive out of health insurance. The waste and the lies have to stop.

Tuesday, September 22, 2009

Insurance Companies Need Our Support

A meaningful debate about healthcare reform has to include voices on both sides. There just aren't many people willing to take an unpopular stand and defend the interests of health insurance executives. Thankfully, a team of celebrities has stepped up to invigorate the discussion. Check out the Protect Insurance Companies PSA:

Monday, September 21, 2009

Socialist (not Socialist)

Background music here.

SOCIALIST:

NOT SOCIALIST:


SOCIALIST:



NOT SOCIALIST:


SOCIALIST:

NOT SOCIALIST:

Sunday, September 20, 2009

Olympia Snowe and the Audacity of Cost Control

Over five hundred amendments were suggested to the Baucus bill today, which is frankly a little bit disappointing -- I had hoped that one of the other committee bills would be getting more attention for the simple reason that most of them are better bills.

There's one amendment that I'm really interested in, though -- Olympia Snowe's amendment to create a public health plan as a 'safety net' if insurance costs don't decrease in the coming years. This isn't, I don't think, as good as having a public health option -- but it's certainly better than the Baucus bill itself, which does nothing to control costs. One of the things that the bill reflects, though, and I think that this is the reason that this amendment is canny and smart, is that insurance industry costs are under the control of the insurance industry.

It's pretty simple, but it's something that those that insist on the free market don't usually get. When an insurance company has a monopoly, or an 'agreement' with the competition, or when it simply realizes that people can be persuaded, shamed or tricked into paying more money for fewer services, that insurance company will raise rates. This is not the invisible hand: this is someone coming to a meeting with a PowerPoint that ends, "...so if nobody figures out what we're doing, then we can safely raise premiums by 9% in the next year." What limits this -- even in the current system -- is government. We regulate what is fair and unfair to do. The most profitable attitude for an insurance company would be to promise you a bunch of stuff, take your premiums, and then never pay for a dime of your care. And that happens -- except when we make it illegal.

The triggered public option would be another kind of regulation for insurance companies. It would require them to keep costs down, which they have the power to do, and if they failed, it would punish them by opening government competition. In doing so, it would insure that costs were at or below some particular level.

Unfortunately, a triggered public option wouldn't create (absent the trigger) an insurer that people could trust -- it would be fairly easy for insurance companies to keep profits high by surreptitiously cutting benefits every time they cut costs. There's simply no good way to get your health insurance from an entity that has shown itself to be overwhelmingly untrustworthy. Additionally, the 'trigger' part of the public option is just a bone thrown to those untrustworthy industries. If the public option is effective in keeping down costs, and if it can ensure that people pay a rational amount for their health insurance, then why don't we have it now?

All that having been said, there's been a lot of talk about Senator Snowe being an important moderate, and I have to say this amendment really does represent something in between the two sides. This is a very large, very rarely traveled, and very necessary territory in the Senate debate, and the people of Maine should be proud of their representative for having the courage to go there.

Saturday, September 19, 2009

Updates

First a little update on cost cutting -- this story about insurance's refusal to treat an underlying problem is a good example of what I was talking about in yesterday's post, as is this mea culpa from an insurance industry middle-manager. Pull-out quote: "...while your readers are being charged $50 for asprin; my company employs an entire department just to shuffle bills around while they decide what they will pay the hospital for that asprin." Blue Cross/Blue Shield of North Dakota, which has an over 90% market share for the entire state, effectively making it the state's only insurer, was audited today, and predictably found to be paying out huge bonuses, sponsoring vacation travel for employees, and throwing lavish parties with customers' health care dollars. The CEO's reaction: "We will correct areas that need to be corrected." If a government employee did this, they'd be in jail. Postal worker steals less than $1000? Jail. Steal $100,000? More jail.

As it turns out, the pants-on-fire-false estimate of 1 to 1.5 million protesters at the Tea Party protest was made on stage at the protests by FreedomWorks chair Matt Kibbe. ABC News, which Kibbe had claimed was his source, ran an article the next day pointing out that they had never said such a thing, and in fact their estimates were in the "tens of thousands". The comment we got here ten minutes after the article was published makes me feel like there was something more at work than bad math or a Tea Partier reading the paper without his bifocals. I know I reneged on my promise to do an article on Dick Armey, but Bill Moyers did it for me, and he used pictures instead of word-pictures.

In other tea party news, the fine folks of the Objectivist organization FIRM were out at the Tea Party rallies, handing out flyers, giving speeches and trying to swim in the sea of the anti-government, anti-tax demonstrators. As you can see further down the page in the comments to that link, though, this is causing some significant division among the Objectivist ranks -- because Ayn Rand and most real Objectivists are atheist (one might even say ideologically anti-Christian), rationalist (by which I mean to say they consider themselves rationalists), anti-war, and anti-Patriot Act types, all of which they pretty much have to hide when they go to right-wing libertarian/neoconservative/fundamentalist organizations to speak.

Joe Lieberman's election chances aren't looking so good -- he's polling third in his district after a flash poll of possible opposition. This makes a lot of sense, considering that Connecticut favors the public option 68% to 21%, and Lieberman basically opposes it on the strength of insurance industry donations. Eyes on the prize, buddy -- which enormous corporation will you land in after your voters send you home?

Finally, 538.com did an overview of the numbers on public support for health care reform, and it's practically tied -- with a small decrease in the 'strongly oppose' and a small increase in the 'strongly support' columns over the last few weeks.

Friday, September 18, 2009

Cost Control

Almost every serious proposal for health care reform tries to insure more people -- even many conservatives will agree that in the current system, we would all be better off if more people had health insurance. The public option, though, is a special way to provide that insurance, and the best thing about it (and I'm taking off my liberal 'provide health care for everyone and let God sort it out' hat here) is that it cuts costs.

This is an important point that is often lost in the heat of debate. The public option in and of itself does not insure more people -- it's not an entitlement, it's a mechanism for delivering insurance. We could ensure everybody without ever having a public option -- this is what the Baucus plan tries to do, by expanding Medicaid and Medicare. Why have the public option, then? To cut costs.

A lot's been made of the price tag of HR 3200 -- almost $1 trillion dollars over ten years, about 20-30% more expensive than the Baucus bill -- but this is the government expense, or the cost that comes out of our taxes. The costs that the public option would cut would be our private expenses, the money that comes out of our paycheck to pay for health insurance. Look at the history of an average family's health care expenditures:

(from the Kaiser foundation)

In 2007, we spent 16.2% of everything that we produced in the country -- that's one dollar out of every six -- on health-care related expenses. In 2008, we spent 2.4 trillion dollars on health care. If we could enact a plan that cost one trillion dollars but saved 5% of our yearly costs, it would pay for itself in less than nine years. Since we know, too, that 30% of all the money we pay to insurance companies is spent in the form of overhead, administrative costs, and returned to stockholders as profit, the insurance industry is a natural place to try to carve out some of these savings.

Those savings would come from competition. Blue Cross/Blue Shield currently holds 90% of the market in the state of Alabama, and has been raising its rates between 7 and 12% every year since 2003, when its last major competitor exited the market. All across the country, health insurance corporations are getting bigger and taking larger chunks of market share, as often happens in a situation where an unregulated industry gets its hands on a part of the economy where demand is inelastic (i.e. there are really very few situations in which you choose not to purchase a life-saving medicine; most people will buy health insurance no matter how much it costs) -- Enron's control over the deregulated California energy industry comes to mind.

A government option -- one which would be offered to people at cost, and would negotiate with health providers for cost decreases -- would change the competitive landscape. Companies that have long since stopped trying to attract or serve customers would suddenly have to start. Policies would become clearer, trust would start to matter (right now, what's the incentive for monopoly insurers not to deny care? They don't rely on their reputation to attract business), and most importantly, premiums and copays would start to come down. Just as private universities have to either compete financially with, or offer better educations than, public universities, so would insurers have to either do better than the government -- offer more, give better service -- or charge less. Many of the conservative objections to the public options assume that this would happen -- by saying that it's a socialist policy, they admit that it would be extremely competitive with, and threaten the profit margins of, private insurers.

Like a subway line, a public university, a city park, an irrigation canal, or a highway, a public option is a group investment, not a give-away. It's intended to, and will, create returns for government, and especially for individuals.

I've been pretty critical of the Baucus plan in recent posts -- it serves industry interests and leaves us out in the cold with regards to cost. But the insurance industry wins, as well, if we do nothing or make minor changes -- without competition, specifically the kind of competition that would be provided by the public option, we may be able to insure everyone, but we're going to pay through the nose to do it.

Wednesday, September 16, 2009

Getting Involved -- New Media Style

Got a comment yesterday from a facebooker who's starting her own group in support of the public option -- so I thought I'd go through some ways that individuals can affect the debate, but this time, with Web 2.0 sparkle! This will be difficult for me, as my level of social media savvy can be described as Yeti-like.
(Picture of me from About.com. If you crane your neck, you can see that I'm reading HR 3200 on a Dell Inspiron B130 laptop, held in my right hand.)

But my research savvy is average! So away we go:

Public option action on Facebook seems spread out, reasonably enough, among groups of friends -- one of the first and easiest things anyone can do is change their wall status to "I support a strong public option to reform our broken system of health insurance." or "I want lower health insurance costs, so I support a strong public option."

The next step would seem to be joining one of the fan clubs/interest groups. There's one with more than 11,000 members here, one directed at President Obama and the Senate here, and "I Support the Public Option" here. Abby's group, which I haven't been able to get through to yet, should be here shortly.

Twitter is actually -- this is the first time I've really rolled up my sleeves and gotten into it -- kind of cool, although I'll never use it due to the ancient Yeti law which requires me never to be fashionable. Congress uses it like nobody's business -- TweetCongress tracks the last tweets of all the standing members of congress and shows community responses as well. A lot of progressive-to-progressive conversation happens at the #publicoption hashtag, which you can search here, and is full of fast (although not always perfectly accurate) information that falls through regular media cracks (i.e. public statements an official might make that aren't important enough to warrant a news article, but which indicate that they're moving in one direction or the other on health care reform).

All in all, though, my gold standard for organizing is still Health Care for America NOW! -- professional, targeted pressure that is completely issue-specific and designed to create the maximum amount of change. Just in my region, they've got one event coming up in Los Angeles and two in San Francisco -- it's likely they've got something in yours, too.

Regardless of how you get involved, though, it comes down to the same few things: talk to your friends. Call and write your senator. Get your voice heard through letters to the editor, and your face seen through public demonstrations.

And why? Because courts from South Carolina to Los Angeles agree that insurance companies break their promises for the purpose of profit. We deserve at least one trustworthy option for insurance coverage so that no more HIV-positive teenagers or breast cancer victims are dropped by their insurers.

The Baucus Bill

First, a little stock music: as was pointed out in this Metafilter comment, Humana, Aetna, Cigna and UnitedHealth all had a stock gain of more than 3.5% after Senator Max Baucus announced his bill.

I waited most of the day to write about this because I was honestly not sure how the bill would sort out, and I wanted to look at the Chairman's Mark (Baucus' first draft of the bill for negotiation) myself before I jumped in all aggravated with the riot elbow. I've been pretty sure for the last two months that whoever Baucus is representing, it's not Americans -- but this bill seems, all in all, to be pretty clear proof. A rundown:

An insurance mandate for individuals. That means that if you don't buy insurance, you'll be fined by the federal government. This is a major money-maker for insurance industries, who want federal laws to force new customers into the market. Democrats should hate it because it punishes people who are already lower-middle class and have it hard enough; Republicans should hate it because it's a government intrusion into something that should probably be an individual decision.

The free-rider policy. This forces businesses who employ individuals receiving government health insurance services (i.e. Medicaid or other subsidized health services) to pay a fee towards defraying that cost. Ezra Klein has been excoriating it all day -- for the simple reason that it makes businesses less likely to hire low-income employees. If you could hire a high school kid for $7.25 an hour or a mother of three for $8 an hour (because her children are Medicaid recipients), which would you do? This policy expressly reinforces the cycle of poverty. Whether you're on the left or the right, it's a loser.

An end to the use of pre-existing conditions as a means by which insurance companies can deny insurance. This is a good thing, but the insurance companies are likely to raise rates to counteract lost profits caused by having to actually insure sick people. Call it a wash: we'll get more, but it'll come out of our pockets, not out of the insurance companies'.

Medicaid and Medicare expansion and subsidies. This is the bill's method of addressing what drives much of our desire for reform -- the tens of millions of uninsured Americans left out of our current system. It's also, I think, President Obama's key demand: insure the uninsured, and increase national health. The question is how much we will pay to get this, and how we'll do it; Senate Republicans have treated almost any expenditure in this direction as completely nonnegotiably unacceptable. I would also point out, to opponents of the public option, that in its absence what we are getting is an expansion of the considerably more government-centric single payer system that is Medicaid and Medicare.

No cost containment. This is President Obama's other big request -- a way by which we can slow or stop the double-digit yearly increases in health costs that are throttling industry and household finances. A public option -- government competition -- is the best way to control these costs; in its absence, many have suggested regulations on executive pay, profit-taking, coverage maximums, or other insurance industry mechanisms that enrich individuals at the expense of the country. The Baucus plan has neither -- and in this respect, fails entirely to get to the root of the problem. This is why the bill is so popular with the insurance industry and its stockholders: it maintains the gravy train, as is pointed out in this NYT "Room for Debate" brief.


All in all, as much as I want some kind of reform, I can't get behind this bill, which is why I'm glad, I guess, that it has no Republican support (and, as 538.com points out with much better prose, not much Democratic support, either). Back to work, Senators.

Tuesday, September 15, 2009

Doctors and the Public Option

A short post today because I'm going to spend some time trying to get campus newspapers interested in all things GradMed.

As the public option, at least in the opinion of the Times and some other media outlets, fades from view in the Senate negotiations, it's becoming clear just how many people really support it: the New England Journal of Medicine released a study whose results you can read about here. Some highlights:

-- Among doctors, combined support for a public option and a single payer system (which would be a Canadian-style system where the government has an even larger role in health insurance, and whose proponents would likely support a public option if forced to) is at 73%.

-- This proportion holds steady among rural doctors, urban doctors, specialists, general practitioners, etc. -- it's not that one group of doctors intensely supports the public option and others don't, it's that a majority of all doctors support the public option (the ways in which the public option would benefit rural America deserves its own post).

-- Even American Medical Association members -- and this is a large lobbying group that has, after signaling support, come out in opposition to the public option -- even their member base is in support of a public option.

Count this, perhaps, as another kind of sign that the more people know about the public option, the more likely they are to support it. Doctors are particularly well-versed in our current insurance system, have a good idea of the nation's health needs, and have been following the facts of the national debate -- accordingly, they're even more in favor of the public option than the average American.

Monday, September 14, 2009

GradMed Insurance Review

This morning I was looking at reports that in nine states of our fine Union, a history of domestic violence is considered a pre-existing condition and is therefore a reason to be denied coverage. Not worth commenting on: you get it. We live in a Franz Kafka story. "I've been beaten, may I see a doctor?" "No, you cannot see a doctor, because you have been beaten. We only allow those who have not been beaten to see doctors."

The subtler, more widely exploitative insurance industry practice that I really want to talk about is an insurance company called GradMed. Students that are right out of college are some of the people most likely to be uninsured -- there's often a long unemployment period after graduation, people are generally healthy, and there's not a lot of money to go around. It would seem like this is a perfect time for insurance corporations to step in and provide...well, about the worst decision a young person can make.

GradMed is marketed through the alumni associations of various colleges (this is the part of a college that, once you graduate, sends you all kinds of mail asking for donations). They pay colleges for the right to use the school's insignia and to market directly to their students -- and I made sure to call participating colleges to make sure that this is the system. Let me be specific: the 'sponsorship' that colleges engage in is an exchange of student trust and marketing opportunities for cash royalties. No school oversees, manages, or contributes to the insurance fund in any way.

But whatever -- schools raise money all the time. Schools need all the cash they can get -- marketing to their graduates is one of the many ways they raise it. Right? Not when the policy is the most exploitative insurance contract I have ever seen. Once you select your college at their website (pick any: the policies are all basically the same) they outline a short-term (30-180 days), medium-deductible policy that pays 100% of some claims above $5,000 dollars. Here, though, is the kicker, copied straight from the site:
If you need GradMed beyond the end of your first coverage period, depending on your state of residence, you may apply for additional periods of coverage.

Any condition which may have occurred under the first policy will be treated as a pre-existing condition under your next policy. A pre-existing condition is a condition for which an insured was treated or received medical advice during the 12-month period immediately preceding the effective date.
So if you have any condition which in any way lasts longer than your coverage period, you're dumped. And you're absolutely fucked because now you can't get real insurance because you have a pre-existing condition. And we are expected to pay for this -- the quote I got for a fictitious 21-year old St. Louisan was over $100/month. Even the testimonial on the website is a freaking train wreck -- as upbeat as she may sound, the student is still negotiating for her costs to be covered, and still has mobility problems from her accident that doubtlessly need physical therapy.

What happens to a person duped into a short-term, non-renewing insurance policy? This article from Time is a pretty good example -- a man signs up for several policies in a row with Assurant, and is never uninsured, but as soon as he was diagnosed with kidney disease, it is labeled as a pre-existing condition and he is denied coverage. The whole article is summed up by Karen Pollitz, project director of Georgetown University's Health Policy Institute and a leading expert on the individual-insurance market. "These short-term policies are a joke," she says. "Nobody should ever buy them. It is false security that is being sold. It's junk."

People talk about government waste, inefficiencies in Medicare, how slow the Post Office is, etc. -- but there is no comparison between those programs and the crimes of large, powerful corporations who put their full efforts into screwing people out of their paychecks. Part of me wants to call a series of alumni associations and complain -- but this is a completely legal product and they're not the real culprit for allowing it to be marketed -- the real culprit is the sociopaths in the board room who dream up this stuff in the first place, and the foot soldiers who hawk it to schools and young people who don't know better. At the heart of things, the real culprit is the system, which puts our health in the hands of the greedy.

To sum up, AVOID GRADMED LIKE THE PLAGUE. VIRTUALLY NO ONE SHOULD EVER BUY IT.

Edit: After I published this review, I had several entertaining and eye-opening run-ins with the people at Gradmed, which I describe in this entry and then in this one. Although they do nothing to protect your health or insure you in the event of illness or injury, they are very serious about marketing.

Sunday, September 13, 2009

Giving One

I've been reading about the demonstration yesterday, and trying to think about what I want to say about Dick Armey (it looks like the demonstration was somewhere between 60,000 and 75,000), and was poking around at Metafilter when I realized: man, I don't give one. The interests and arguments of the FreedomWorks demonstrators sound a little bit like this to me, or something like this:
(from Cake Wrecks)

Where opponents of the public option are concerned, these protesters are neither the most numerous (rank-and-file Republicans) nor the most committed (the insurance industry) nor the most authoritative (perhaps the AMA, although they only represent about 15% of practicing doctors). But I don't even really give one about them, either -- at the heart of it, their own interests (power, profit, and profit, respectively) drive their objections.

After the coffee runs out and my rancor subsides, basically all I really give one about is the people who will be affected by public option reform. Consider:

-- We currently guarantee universal health care to all Americans by making it illegal to turn away ill patients from emergency rooms. We know and accept that it is wrong for a person who is sick or dying to be refused treatment. However, we make that guarantee in the most inefficient, expensive, and dehumanizing way possible. We know that we are morally responsible for the health of our fellow Americans -- I'd like to see even a committed tea-partier withhold antibiotics from someone with an infected wound -- but we refuse to care for them.

-- Our society provides guaranteed health care to our congressmen, but not our cab drivers; to our child molesters, but not our children. If you are schizophrenic and stab a stranger on the street, you will be locked up and given medical care which can vastly improve your condition. If you are schizophrenic and do not stab a stranger on the street, if you manage to hold down a job, then you will be left alone with the torments of your treatable illness.

-- The reason we do all this? The profit of the few. The health insurance industry employs about 400,000 people nationwide, a FIFTH as many people as are uninsured in Los Angeles County RIGHT NOW. Insurance companies provide no service; they heal no wounds; they are a financial artifact intended to share risk among large pools of people, and they should not be allowed to keep 30 cents out of every dollar we give them.

So call your senator, find an event, or make your voice heard. There's no mechanism in the Constitution or in Congress that will make sure that we do what's right: people have to make that happen.

Saturday, September 12, 2009

Who's protesting?

I have to stop reading the New York Times -- I read their headline today, "Thousands Rally in Capital to Protest Big Government" and eagerly clicked in -- news, news! But the article never once told me who organized the protest. Who's out there? Who's in charge? Who rented the microphone? No answers -- and a group with some kind of specific opposition to some particular policy or government priority is transformed into a faceless checkmark on a party-politics scorecard.

So I figure, hah. Liberal media bias. And I go over to the Drudge Report -- nothing. There isn't even a headline today, but buried somewhere down the page is an article "Bomb Threat Forces Evacuation of DC TEA Party Planners" from which one can find out that the demonstration was planned by FreedomWorks, headed by former House Majority leader Dick Armey. So -- as opposed to the groundswell of opposition to health care reform that the Times (and FreedomWorks) would like us to believe this demonstration represents, let's look at FreedomWorks specifically.

FreedomWorks, formerly called Citizens for a Sound Economy, is funded in part by donations from MetLife, Phillip Morris, and the Scaife family fortune. Their stated goal is to increase individual freedom by decreasing taxes; they were organizers of the April 15th tea parties (pictures here), although they generally prefer to label their events and websites as 'grassroots' in an attempt to prevent the devolution of responsibility onto them personally. The term NPR uses, daintily, is 'faux grassroots'.

As far as I can tell on their website, FreedomWorks formally opposes: the bank bailout, the stimulus package, environmental cap-and-trade legislation, the McCain-Feingold campaign finance reform act, and most other government initiatives that require significant spending or limit corporate power (which they equate with individual liberty) in any significant way. As a group, they also seem to be strong supporters of Israel, strong opponents of abortion, and Christians generally. This has led to them being confused for rank-and-file Republicans, but although they were real supporters of President Bush (who was the right religion, and passed big tax cuts for the wealthy), the last presidential candidate they really loved was Steve Forbes, who serves on their board of directors.

Much of the press online about FreedomWorks centers around discoveries of the extent to which they are willing to go to lie to their own members and the public about their tactics. The Washington Post caught them out secretly signing up members through insurance sales (i.e. want a low group rate? Sure! Just sign this contract -- um, petition/membership form/contract) and they are particularly energetic astroturfers -- creating fictitious sites and conversations online in order to expand positive perception of their issues (we'll see if tagging their name and linking to a bunch of stories about them as I do here attracts some 'concerned democrats' who are worried that government is 'just too big').

Anyway, this is still developing -- if they break 50,000 demonstrators (by any estimate other than their own, which I'm sure is already at like 4 million people) in Washington, I'll do a little bit about Dick Armey tomorrow. He's a colorful fellow!

EDIT: I seem to be getting some traffic from searches for estimates for the size of the rally, so I'll bite: ABC is going with the DC Fire Department's estimate of 60 to 70 thousand people; CNN is elaborately silent on the issue of size; the New York Times's headline says that "thousands" came to the capital; the Washington Post says only that 30,000 people registered for the protest. It seems like all the links estimating 2 million (which, if it really happened, would be larger than the Inauguration, FIFTY times larger than the largest sourceable media estimate, become immediately visible to any onlooker of any party, and be the lead in any news story that wanted to be credible) go back to Michelle Malkin. For a complete debunking of the 2 million figure, see here.

Thursday, September 10, 2009

Attention Deficit Disorder in the NYTimes

I woke up this morning, and to my significant disappointment, found this article at the top of the New York Times: Aim of Obama Health Speech: Reigniting a Presidency. NONONONONONO. Or to use a visual from last night,(Translation: hey, now. Hey there, buddy. That's not good for anyone.)

The article should rightly be titled: "Aim of Obama Health Speech: Health."

My attitude towards a great deal of the media isn't so much that they're skewed liberal or conservative -- different media outlets have different kinds of customers -- but that they're all necessarily in the business of selling papers/ad time/magazine subscriptions, and that each of them fights in their own way between the urge to say a thing that is true and the need to make sales. Glenn Beck wakes up in the morning and thinks, ok. Gotta attract some eyeballs today. The New York Times, same thing -- this is the kind of impetus that ends in a news analysis article (they're not, in their defense, claiming that this is 'news') at the top of the paper the day after an important policy speech, and one that eschews the issue at hand (what kind of health insurance? What kind of bill? When? How much?) for personalities, narratives, and conflict.

My point is that this is essentially a dressed up version of "JENNIFER ANISTON TELLS BRAD: I'M OVER YOU!" or "BRONCOS ROUT CHARGERS" -- the kind of story that they assume we will find inherently compelling. It's got people we know in it, and they're fighting with each other, and we want to know who's winning. Meanwhile, though, these same papers are running articles like "Democrats do poor job of explaining health insurance reform" -- can you see the disconnection? Whether a person is for reform or against it, whether they want a public option or not, the responsibility lies in part with the media to help outline exactly what's in the bills, and what's at stake. Journalists are never going to be entirely objective, but there's a difference between a journalist of any party whose goal is to understand an issue or event and one who just wants to tell a compelling horse-race story. This is the difference between the Olbermann/Limbaugh/Becks of the world and the Cronkite/Woodward/Bernstein/Moyers types.

The proliferation of the former is a problem. While the discussions among voters that I've seen have been largely centered on whether or not we should pass a public option or some other form of health insurance reform, Yahoo and Drudge and the Huffington Post want to talk about Joe Wilson yelling, and the Wall Street Journal has a speech grader. The real exception this morning seems to be the Washington Post: the article's registration-only, but the top headline right now is "Obama Endorses Limited Malpractice Reform." Maybe I should sign up: it feels like it's been forever since I felt the informative and seductive caress of news.

Wednesday, September 9, 2009

The 9/9/9 Speech

First off: people watched it. 2500 comments on Fark, the top two slots at Reddit (this and this -- Reddit is pretty liberal, though, in addition to its Ron Paul contingent), headlines in every respectable newspaper, and twenty-three THOUSAND comments at the Huffington Post, plus another five thousand in the sub-stories about Joe Wilson, etc. Now, Internet fancyparties aren't really an indication of what the rest of America is doing or thinking, but interest online is pretty intense. I didn't hear too many televisions through my thin thin Los Angeles walls -- but the speech played pretty early here, and most people likely weren't home from work yet.

From the perspective of someone who believes very much that a public option for health insurance is the best way to limit costs and provide insurance for those who don't have it, the speech was a punt. Congress will decide -- the President pointed out only that legislation needs to pass, that it's Congress's job, and that too much time has been wasted bickering. He remains, it seems, a personal supporter of the public option (much has been made of the text of his recommendation at the whitehouse website) but seems to have no compunctions about triggers, co-ops, or any other way Congress thinks might work to cost-effectively insure Americans. His "door is open" -- his priority is clearly to get effective legislation in place, and to do it quickly. This is hard to hear for me, a little -- because there's a lot of doubt as to whether a public option has enough votes to pass in the Senate, and other policies might have a better chance -- but I, for one, was never expecting him to release some sort of magic fungus that would digest and then replace senators who've been bought off by the insurance industry, mimicking their shapes long enough to pass a strong public option. I wasn't expecting that at all. It might have occurred to me as a nonzero possibility, but I wasn't expecting it. This is okay. I have always suspected that the best policies are those that the people dictate to the government, rather than the other way around: I'll continue dictating, and I invite you to do the same.

As an American, though, and someone who's sat through interminable debates (I got called a fascist AGAIN today -- wassup, guys? Wass! Up!) that use divisive language, code, and 20th-century cliches in the place of substantive discussion of policy, I was really relieved that the President did his best to insist on change without the assumption that he or his party was the sole determinant of that change. He seemed to understand that there is a significant part of the nation that has their own ideas about how to best bring about reform, and that Congressional Republicans and Blue Dogs represent a lot of those people. At heart, he really is a negotiator, and regardless of the right's fears about him, he seems to be pulling for a majority solution. I'm sorry if we lose the public option -- and I fully intend to keep advocating for it as a fiscally responsible, morally preferable, centrist policy -- but it's a small price to pay for a real reform that we feel like the whole nation weighed in on. I poked around the conservative rageblogs a little bit this evening, and their response was muted: a lot of talk about tax-and-spend, a lot of talk about number-fudging with regards to uninsurance rates and cost overruns. Not a lot of "treason" or "Communism". That seems like an improvement, to me, and well worth some negotiations with regards to reform.

I know that a GOP representative from Louisiana heckled the President during his speech -- he's since apologized, probably realizing that it wasn't that sort of speech and that we're no longer having that kind of argument.

If
, I say if, the reform Congress produces ends up representing a real and positive change. The most valuable plan plank for the insurance companies -- an insurance mandate, with fines for Americans who don't get insured -- seems to have gained wide acceptance in Congress, but cost limiting measures and social assurances for the unemployed and underemployed have not. Luckily, someone's been jamming up the phone lines at the Congressional switchboards (1-877-264-HCAN), and maybe they should just stay jammed until Congress gets the idea.

OKOK

Okok -- since there's so much happening today, with the Gang of Six trying to "wrap up" their negotiations before the President gives his speech, the President giving his speech, libertarians self-destructing off in their no-government vacuum and the House of Representatives fighting the good fight etc. etc. etc., I decided I'm going to just keep updating this one entry, and then do a separate one tonight about the big address. All times are Los Angeles Standard -- so one hour here counts as one half hour in the Midwest, where folks are still hard-working, and fifteen minutes on the East Coast, where they have real public transportation and it makes everyone vastly more efficient. No matter where you are, today's a good day to make some noise by calling your senators or representative through HCAN. Even those that support the public option would probably appreciate an attaboy or a yougogirl.

9:44 AM: lots of unfounded speculation. Obama to Endorse Public Plan in Speech, according to "aides familiar with speech preparations". More interestingly, in the same article, Baucus is still meeting with the Gang of Six, setting deadlines and such, but any progress he could claim and any further draft proposals he could come out with at this point will be swamped by the President's speech. It's past the 10AM deadline he's set for 'feedback', but I doubt there will be more news on that front until tomorrow. I mean, the insurance industries aren't paying him to pass significant reform, after all. He's mainly a song-and-dance man.

Also, here's a Gallup poll on whether or not people want their representatives to vote for reform -- the country seems about evenly split, with about 1 in 4 undecided, the same proportions that we had before August. Of course, this poll falls into the trap that fivethirtyeight.com pointed out -- that nobody really knows what 'reform' means, and that support increases when you outline specific public option proposals.

Among those who are a bit more up-to-date on the debate, the American Medical Association has come out strongly for a list of sweeping reforms, but not the public option; the Times says that means that the "group has evidently concluded no powerful public plan will end up in the final bill."

12:04 PM: I was wrong wrong wrong -- Baucus came out in a big banner headline saying the "Time Has Come" for reform -- except that the time in his opinion is September 21, almost two weeks from now, and the reform is still the chintzy, industry-face-slurping, no-Republican-support crap he was peddling yesterday. After all that huddling and meeting and ganging and other backroom gunk, his basic conclusion is that "If there are not any Republicans on board, I will move forward in any event." Thank you, sir, for wasting a month of national time in undertaking negotiations that have failed entirely. I'm committed to this issue, and I think debate is necessary to pass a good bill, but there are some wars on, and we do have better things to do than wait around while you screw up in slow motion.

I'm starting to worry that the combination of Waterloo-wanting partisan politics and cheaply purchased Democrats are a voting bloc that is simply too big for a strong public option to surmount. Makes my stomach hurt. There's a woman who works at the Super Donut across the street from me with a lesion on her face, and it's kind of a Southeast Asian family-run place and I know nobody there has health insurance, or frankly the skills or experience to negotiate with for-profit insurers.

1:32 PM: Oh, wait, no public option endorsement: "Obama Will Stress 'Security,' Not 'Public Option' in Speech" according to a "senior administration official". So if you put the headlines next to each other and squint, today's breaking news is that "Newspapers Have No Idea What's Gonna Happen". Also, Sarah Palin had an editorial in today's WSJ. Her take is that common sense dictates that government-run health insurance, practiced by every industrialized nation in the world save the United States, will be an expensive failure. I just got curious as to what she meant by "common sense", looked it up in my household's two-volume Shorter OED, and what do you know? Big picture of Sarah Palin under the entry for "common sense".

6:11 PM: The egg-shaped surgeon from Louisiana just finished stumbling through his response. For me, the most surprising moment was when the President said that "I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it." and half the Republican party stood up and clapped, and half of them kind of looked around nervously. On a second view, the Senate Democrats (and those who caucus with them, coughcoughLiebermancough) who I consider obstacles to reform jumped up without thinking.

More on the speech later.

Tuesday, September 8, 2009

Holding Pattern

I'm still waiting on about a million little pieces of news -- I may not put up another entry until after the President's speech tomorrow night -- but here are some interesting tidbits:

1) I haven't seen anyone, of any party, come out in favor of Max Baucus' 18-page draft plan. Delmoi at Metafilter, however, points out that the author listed in the plan's PDF identification data is Liz Fowler, former VP of public affairs (ahem lobbyist chieftain) for Wellpoint. Also, it looks like the special interest lobbies got a copy of the plan before the President. Baucus' moment on center stage, having extended long past several deadlines for delivering a workable bill, and taking longer than any other committee, looks increasingly like a swan song. Democrats believe their representatives are trying to insure more people and save money; Republicans believe their representatives are trying to save money and decrease government control over citizens -- what's Baucus trying to do? Flap till he flies?

2) The actual plan itself absolutely lacks the sense of plan -- it is a list of inchoate, disorganized patchworks with no executive summary and no feeling of direction. It does include an insurance mandate (i.e. the government would fine you if you choose to remain uninsured) and does not include a public option, although it allows for new non-profit co-ops that receive some government start-up funding, which might just mean loans. It also has this hilarious Dungeons & Dragons-inspired marketing system for products in its insurance exchanges -- you can be insured at the bronze, silver, gold or platinum level. (Secret plans will also be provided for celebrities and billionaires: adamantium and mithril, respectively). Seriously, though, this is yet another indication that there are lots and lots of people in government and the health insurance industry who consider individual health to be just another commodity to be bought and sold on the open market.

Monday, September 7, 2009

Presidential Address to Congress, 9/7/09

My fellow Americans and members of Congress,

We have been engaged, for the last four months, in a heated debate over the future of American health insurance and the shape of American health care. Most agree that our system is broken, that when we buy health insurance, we pay too much and get too little as individuals, communities, and as a society.

The debate about reform has too often been described as a debate between parties and ideologies, and I know there are ideological differences here in the Senate about the right kind of reform to make. But the biggest threat to change right now isn't the Republicans or the Democrats. George Bush senior failed to pass health legislation he wanted in 1992, then Bill and Hillary Clinton failed again in 1994. George W. Bush added a prescription drug benefit for seniors in 2003 by a single vote, and his party was forced to write a gap into the bill, in which many seniors still suffer. The biggest threat to reform is moneyed interests, campaign contributions, political action committees, and lobbyists.

The reason we pay so much for so little in the current system is that it is extremely profitable for health insurance, pharmaceutical, malpractice and other industries. The reason that they have spent tens of millions of dollars in the past few years trying to avoid real reform is that they know that they have neither earned nor do they deserve the profits they've earned -- their profits come not from offering us the finest health care in the world, because they don't, but from the inefficiencies and waste of a broken system. They pay government to ensure that the system remains broken.

Soon you will make a vote on a bill to match HR 3200, which has already been passed by your colleagues in the House of Representatives. There is currently no other bill before you with a level of support that makes it likely to pass both houses. Members of my party and yours have gone through the bill to make it as appealing to both sides of the aisle as possible. It is not single-payer socialized medicine, but a piece of legislation specifically crafted to limit costs, insure the uninsured, and prevent the worst abuses of the insurance industry such as rescission and the refusal to insure pre-existing conditions. It is rigorously opposed by that industry, as you well know.

I bring to you tonight a challenge. I challenge this session of Congress to voluntarily and transparently fight the influence of the moneyed interests that have kept us from having reform for so long. I challenge the fifteen senators who have taken the most money from the health insurance and pharmaceutical industries, whether through PAC donations or corporate contributions, to recuse themselves from this vote. To my Democratic colleagues including Max Baucus, Ben Nelson, and Blanche Lincoln, as well as to my Republican colleagues, I mean no disrespect and I do not mean to argue that your vote is or has ever been for sale.

The American people deserve that this issue, about which they feel so passionately, be given a fair vote that lacks even the appearance of submission to the politics of money. Their government has failed them, in this respect, for many years. You have the constitutional power to make this right. May God bless you and give you strength and may God bless America.