Truth in Advertising?

If you've been following the news on TV lately you may have seen this ad for Blue Shield. (For those who can't or don't want to watch the video, here's a summary: A man's face appears in front of the word "happens" on the screen. The man speaks with a lisp and says "I lost my front tooth the other day, which would be great if I was 7. I'm 46. And the tooth fairy doesnt come when you're 46, just lots of referrals, and appointments, and bills that cost tons. Maybe I'll keep it. It adds character, right?" The Blue Shield logo then appears, and a voice-over says "We know life can be unpredictable, we offer affordable health coverage, and also dental plans. Choose Blue Shield today."

The ad reminds us of why insurance exists - to protect against unforeseen harms, like losing a tooth. We are led to believe that having Blue Shield insurance will take care of the hassle and expense of unexpected medical (and dental) problems.

All that makes sense. But is it true? Or is Blue Shield earning its initials here? We'll come back to that in a minute. Meanwhile...

Pop Quiz!

Imagine waking up and finding your shirt soaked in blood. You remove the shirt and find that blood is seeping from your nipple. What do you do?

A) go back to sleep and hope it stops bleeding by itself
B) seek medical care to find out why blood is coming out of your nipple and stop it
C) invite your kinky vampire friend over

Which of those choices would you consider reasonable under the circumstances? Think carefully because the answer might cost you.

Faced with this situation, Rosalinda Miran-Ramirez went to the Emergency Room at a nearby hospital. When it was time to pay the ER bill, her insurer (surprise: Blue Shield) refused to pay for the ER visit, saying that Miran-Ramirez "reasonably should have known that an emergency did not exist."

That kind of thinking puts Miran-Ramirez (and anyone else who has health insurance and might experience an unexpected medical condition) between a rock and a hard place. She can either err on the side of caution (and risk being stuck with a massive ER bill) or else wait (and risk that the problem will get worse because she didn't seek prompt medical attention).

I won't pretend that insurers like Blue Shield are entirely responsible for this situation. Of course, health care costs in general are too high and continue to rise. And the need to make up for unpaid bills is a big reason why emergency care in particular is so expensive. (Basically, people who don't have insurance use emergency services when they need medical care, and when they can't pay the bill, everyone else gets overcharged to balance things out). A public health insurance option would go a long way toward solving this problem, by creating access to scheduled, non-emergency care for those who are currently uninsured.

So perhaps it's a bit unfair to blame Blue Shield, when the problem is systematic. But I can't help thinking that Rosalinda Miran-Ramirez would be calling "BS" if she saw one of those commercials right now.

Crunch Time

A few weeks ago, things looked pretty bleak for the public option. But the fight is not over.

House Speaker Nancy Pelosi confirmed today that she intends to push for a government-run health insurance program as part of health care reform package currently moving through Congress.

It's not going to be an easy fight. Although Maine Republican Olympia Snowe voted in favor of the Senate Finance Committee's health reform package, that proposal does not include a public option, and Snowe says she won't support a plan that does (though perhaps she should reconsider that position, considering that a strong majority of Maine voters support a public option).

At this point it looks like the best chance for a public option would involve a program administered by the states - Nebraska Senator Ben Nelson, who had not previously voiced support for a public option, said last week that he's open to a state-managed alternative.

Although he's not exactly the guy you want making headlines, and probably won't have much, if any, influence over his colleagues in the Senate, Illinois Senator Roland Burris is demanding a public option. You go, Roland.

Finally, an update on the big baby: Rocky Mountain Health Plans reversed course and said it will no longer categorically deny coverage for overweight infants. This is great news for the Lange family, but the rest of us are still stuck with a system where insurers can make arbitrary decisions to refuse coverage based on a pre-existing condition. Let's fix that: contact your senators to tell them we need a public option.

You can't make this stuff up

In case you were wondering how low the insurance companies are willing to go ... according to The Denver Post, an insurer called Rocky Mountain Health Plans recently refused to cover Alex Lange because of a pre-existing condition.

Now, you might be wondering why that's newsworthy. If you've been paying attention to the news lately (and I'll assume that if you're reading this blog, you're paying attention) you know that countless Americans are being denied insurance because of pre-existing conditions.

In this case you have to look a little closer. What is Alex Lange's pre-existing condition that makes him uninsurable? He's overweight - specifically, he's at the 99th percentile for weight among his age group. Now the kicker: Alex is 4 months old.

"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."

Alex Lange's story is a good example of why we need a public option: insurance companies will always favor the bottom line over doing what's right for society. Until we have a legitimate public option that forces private insurers to truly compete, they will have no reason to offer insurance to cute, chubby people like Alex Lange.

The Face

The reason I started this blog was seeing my friends, neighbors and relatives suffer without affordable, comprehensive health insurance -- but there's another reason, I think, that it seems like such a serious responsibility to me that we all cooperate to provide that insurance.

I experienced an incident in China about five years ago that has made the fight for a public option, and for real, affordable health care for all Americans seem critical, immediate, and crucial. China is controlled by its communist government, but their health care system is considerably more influenced by the free market even than ours in the United States, and (partially due to limited resources) they don't have guarantees we have such as the emergency room mandate, guaranteed basic health care for seniors, or care for the poor.

My partner and I were traveling in Dandong in northeast China, and were coming back to our hotel one night when we saw a couple on a motorcycle run over an older man on a bicycle who was making a left turn. It was dark, but not late, and there were about fifteen or so people on the street. She ran over to see if he was okay; I started trying to get passers-by or people working in shops to call an ambulance; the couple on the moped, who had been knocked off it, got up and fled.

I couldn't get anyone to place the call, or even to lend me their phone so that I could make the call in my half-broken Chinese. Who will pay for it, they said? We'll be responsible if we call an ambulance. They'll trace my phone. I can't call from my business, because they'll fire me for putting them at risk.

I was essentially having a health insurance policy debate. They can't make you pay, I said, they'll pay. Who is they, they said. Everybody pays, I said. The city keeps the hospital open. The city will pay. The city won't pay.

Sadly, they were right and I was wrong -- there was no system in place to help this man, and no community support to help those watching him do the right thing.

What I didn't have to do -- what too few of us who are having this debate ever do -- is what my partner did: stay with the man lying there waiting in the street, his bike twisted underneath him, ribbons of his face hanging from his jaw, trying to breathe through the blood.

Waiting for his neighbors to make the call. Waiting for me. Running out of time to wait while we figured out who is responsible and what we should do.

It was one incident in an enormous city in an enormous country -- only fifteen people saw it start to finish -- but if you did see it, if you had stood there, helpless, waiting for nothing, it would be as clear to you as it is to me. The health of our brothers, sisters, mothers, fathers and children is our responsibility. When a man dies who could have lived, it diminishes us all. We can shirk our responsibility -- can get up in Congress and say that we don't have the money or we don't like the government -- but we can't escape it. 44,000 Americans will die this year because they lack health insurance. You and I may not have seen it happen, but it is happening, and until we take responsibility for ourselves, our communities, and our nation, it will continue to happen.

We're the people on the roadside: we look away from the suffering around us, because we feel helpless to do anything about it. But we're not helpless. Public option legislation is our best chance to provide real protections and real care to people at affordable prices. We are so close -- today, with just a few Senate votes between us and the change that we need -- we have come so far from the days when disinformation (death panels! socialism!) and apathy dominated the debate. We can keep up the pressure -- increase it -- and we can have a strong, national public option. But it will not be given to us; we have got to take it.

The injured, the sick, and the suffering wait for you and for me; they've waited for years. What are you going to do? Who is responsible?

brb Asia

Got some news for you -- while the debate in Congress drags on, and incredible organizations like Health Care for America Now, Sick for Profit, Rock the Vote, Physicians for a National Health Program as well as millions of committed individuals fight for sane, effective, humane, and efficient American health care, my job's taking me out of the country for the next few months, and I won't be able to post here or respond to comments.

I was never really supposed to be doing this: my regular bit basically involves reading, language, and travel. I started this blog out of a kind of sense of compulsion, and have been trying to run it in my spare time (which should be obvious to anyone who reads every day -- some pretty thin entries, back there in the archives...).

If all goes well, I won't be back before our Congress votes on, and Barack Obama signs, a strong public option. One that gives the government the power to negotiate for lower health care costs, and one in which any American can choose to participate.

Until then, this blog will slow down a great deal -- I'm going to put the comments on moderation to avoid dozens of ads for Cialis cluttering up the place, and hopefully Mattlo In His Infinite Wisdom will have plenty to say (although he's got a full time job too, so you know), but there may be a good bit more silence in the next few weeks.

As long as I'm doing a meta-what-about-the-blog post, here are blog-related facts: since I started monitoring traffic on September 12, a little under a month ago, the blog has had 712 page views and 403 unique visitors. The most linked-to post was "Specifically, Women", which got picked up by feminist blog Feministing. The most commonly viewed individual page was GradMed Insurance Review, thanks to our OCD, underutilized friends at GradMed aka American Insurance Administrators aka all sorts of things. The blog has been accessed from Britain, Singapore, Turkey, Japan, and Spain. Someone from Vilnus, Lithuania arrived here last week by doing a Google blogsearch for "bill +method" (I don't think they were looking for info on the Baucus bill, but that's what they got).

My favorite picture on the blog is this one, a real circular from the early 60s outlining the treasonous Communist sympathies of John F. Kennedy. The cutest person on the blog is this person. My favorite reader comment is this one, which outlines what an AIDS patient had to do in order to get his life-saving medication covered by Pacificare. His success -- and his willingness to fight -- gives me hope that the rest of us can win our fight against the insurance industry, too.

Also, Dying for a Public Option is the only Internet site in the entire world which contains the phrase "internet fancyparties". This phrase, wholly invented by me personally, is not a registered trademark and may be freely used for any and all purposes.

I have one more post ready for tomorrow, but after that, I'm out. I sort of had fun doing this. If we end up with affordable health insurance for all Americans, I will have really had fun doing this. Thank you all for the outgoing links to HCAN and the calls to Congress. Please keep up the good work.

Republicans for Reform

A quick rundown of the surprisingly numerous and influential Republican supporters of comprehensive, cost-saving health insurance reform. I'd assumed Republicans were a solid front on this because I was focusing on Senate Republicans: the party at large is not quite so partisan, or quite so monolithic. They're listed by name (with a link to their statement of support), position, and secret superpower.

Arnold Schwarzenegger, governor of California, can dual-wield shotguns;

Michael Bloomberg, mayor of New York City, poops money;

Shepard Smith, Fox News commentator, able to fit his whole fist in his mouth;

Bill Frist, former Senate majority leader and medical doctor, secretly repairs railway trestles;

Bill O' Reilly, Fox News host, world's third hardest blower;

Bob Dole, presidential candidate and former senator, can bench press a VW microbus.


Now, this is more complicated than it looks -- Bill Frist said straight out that he'd vote for the Baucus bill, then sort of walked back from it -- Shep Smith basically just made an impassioned argument for the public option on TV (he said "every vote against the public option is a vote for the insurance companies"), and then contradicted himself later, as is the nature of his show -- but Bloomberg and Schwarzenegger both cited the Obama administration's plan by name in official press releases, and Bill O'Reilly was quite explicit about favoring the public option in particular, and the reasons he cited -- that it will keep insurance costs down for working Americans -- were identical to those you'd find here.

Even admitting, though, that the views of these conservatives are varied and occasionally tentative, this is not what the picture looked like in August. The public option and other forms of wide-ranging health insurance reform are no longer poorly understood, fringe ideas -- they're something the nation has clearly grown more comfortable with, and more able to analyze in practical terms (what saves money? What insures the most people) rather than emotional terms (who is a Commie? Who is killing my grandmawmaw?).

Here's hoping that this collection of elected officials, elder statesmen, and political commentators finds some kind of voice among the Senate Republicans, and opens the way for a practical bill to be passed -- one with provisions to insure everyone and keep costs down.

Yeouch

Thought I'd be working today, but had to share this. I've seen more than a few insurance industry employees supporting their industries in the debate over the public option. That's their prerogative, but this news kind of indicates that they shouldn't necessarily picture themselves as members of a big corporate 'family'.

In the memo from Randy Brown, WellPoint's chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. "Your cost per paycheck will probably increase," the memo said.

Hard times for everyone, but I have to point out -- if you make pens, you usually get some free pens. If you're a cook, free soup. I get free database access. My partner gets free textbooks. Shouldn't insurance employees have, you know, particularly good insurance? Or maybe the legal fees, top-level salaries, and lobbying expenditures (they made the exceptional step this year of phoning 3 million of their own customers with a push-poll robocall opposing reform) are getting a little bit too expensive for Wellpoint to cover?

As It Should Be

There's a lot of disappointment and outright snark that SuperObama hasn't trained his unstoppable firevision on the evil hordes that have delayed public option legislation for so long:
Sold us out. Obviously holding back the ultra-falcon-punch maneuver that could have ended this debate long ago. And maybe that's true -- maybe he's an alien exile, biding his time to see whether or not humanity is worthy of his advanced technology. People who believe this are probably really heartened by the news that he's quietly trying to shore up support for a public option. They might say, here it comes! The part where a million lobbyists surround him and he wrecks them all with nunchucks or maybe a Klingon Bat'leth.

I'm heartened, too, but not because I spend much time paying attention to the president's temperature on the public option. I'm heartened because I see lines like this in the article above:

...at a closed-door meeting of Senate Democrats on Tuesday, Assistant Majority Leader Richard J. Durbin (D-Ill.) marshaled polling data from districts represented by conservative Democrats that showed a majority would back the requirement that Americans get health insurance so long as there was a public option.

"To argue that this is some fringe position is to ignore the obvious," Durbin said.

That's us represented there -- not swept up in the wake of a charismatic politician or a wave election, not knee-jerk motion towards Democrats because George W. Bush was a bad president and the economy went sour, but people reading the newspaper and deciding that this policy is good for them and their children, and supporting it.

We're the only part of the political process that can't be bought outright -- we are the only part of this debate that isn't worried about re-election, or donations, or finding a golden parachute in private industry. This is why FreedomWorks tried to falsely inflate the numbers of people who attended the 9/12 rally -- it's why town hall opponents tried to yell over the voices of others, and why opponents of reform generally want to look like 'regular people' and not an amalgamation of strong party supporters, industry beneficiaries, and ideological extremists. Because we, and by that I mean we the people, have the promise of the Constitution that the policies that we want will become law.

And what we want is cheaper, less exploitative health insurance for more people. Of the many programs that have been proposed, it is the strong public option that puts people over profit and respects the American tradition of private industry. We know -- the mortgage crisis and Bear Stearns/AIG/Fannie/Freddie taught us -- that unregulated industry can literally destroy itself, and we're the ones that end up suffering when that happens. Any crucial industry, and there are few more crucial than health-related industry, has to be carefully balanced into our national community.

This will only be brought about through citizen action: that's as it should be. We wouldn't want something as important as this to be dictated from Washington.

All this is to say -- keep up the pressure. Google your Senators and put in four calls -- two for each, one at the national office, and one at the nearest local office. If they have an office in your town, stop by and tell them what you care about and what you expect from your representatives.

I'll do the same, and somehow try to encourage constituents from Arkansas to visit the blog. I've got a dozen hits from Turkey, and one last night from Japan, but no Arkansas so far -- and people from Japan can't pressure Blanche Lincoln (D-AR) to get her head right.

EDIT: This great article ably underlines the point that it's not just whether we get a public option, but how strong that public option is -- which is a great point to make when you're talking to your representative. The best public option is one that anyone can choose, as well as one that has significant license to negotiate prices with providers.

Every Country You Wouldn't Mind Moving To

Proponents of the public option often point out that nearly every industrialized country has created a government-based policy to address the basic health needs of their population. This is hard to visualize -- which may be a reason that detractors of public option legislation barely ever mention the fact. But look at this:

(from this blog, which is the weirdest place I've ever been in my life, via reddit)

Knowing just a little bit about which countries are rich and which are poor, the map above basically shows that nations who have resources guarantee their citizens health insurance. Even some nations that don't necessarily have the resources -- India and Mexico, for example -- are working on a way to provide basic universal care. Now, not all these health care systems are top notch -- Japan's has had some problems during their long recession, and Russian hospitals are famously corrupt -- but none of these nations are seriously considering or have seriously considered giving up their universal health insurance.

I believe this is because the people in the blue countries above -- over a billion people, by my count -- understand that health insurance and the profit motive do not mix. Insurers who are responsible to their stockholders will always try to take more in premiums and give less in care -- exactly opposite to our interests as a nation and our individual benefit. This is why simple regulation of insurers won't decrease their ability to refuse insurance and care to the sick or needy -- if a company like GradMed has the resources and motivation to monitor the entire web looking for mentions of their brand, then they have plenty of resources and motivation to discover ways to get around government regulation. We end up in an arms race: a well-funded industry trying to outwit a less well-funded government agency. The insurers have been winning that fight for generations.

A public option would, for a small part of the population, change that equation. It would create an insurer whose responsibility was first to the people, and only to the people -- the voters that create and shape it are the same people that it is intended to serve. This is no big secret to the countries on the map above -- they all know this -- those who haven't created a system of universal health insurance haven't because they lack the resources to put such a system in place.

We've got those resources. What's stopping us? Industry lobbyists? Partisan bickering? Lack of political will among those who support real change?

How Much is Too Much?

The long-awaited second part of Professor Reinhardt's article on insurance costs and loss ratios was posted yesterday. In the first part, he explained that it's not just insurance company profits that drive the cost of insurance up: they have considerable overhead and costs, sometimes reaching, sometimes passing 15%.

That article, though, was about the group market. When you insure a large group, risk is distributed more widely and you can do things like look at historical data, rather than give individual physicals, and cut out a great deal of brokering and marketing. For the individual non-group market, which is especially important now that Fox News is reporting that 149 million Americans are unemployed, overhead is much, much higher. How high? I say I say, how high?

-- So high that insurance lobbies fought 2008 state laws that tried to restrict their 'loss ratio' (i.e. the percentage of income that they pay out in care) from going below 70%.

-- So high that they claim that 55 to 60% is average -- which means that for every dollar you give them, you have purchased the right to get two quarters and a dime's worth of health care.

-- So high that small firms, who buy insurance for fewer than 10 people at a time, pay up to 18% more in premiums than large firms.

-- So high that three fourths of all families who shop for individual health insurance policies end up buying nothing.

That's hiiiiigh. Forgetting your debit-card at the grocery store while you're buying a bag of Doritos and a 2-liter bottle of Squirt high.

A public option would allow the government to create one large group out of this terribly underserved part of the population. These people have money; they need and deserve insurance -- although opponents of reform like to blame the victim ("I don't want to pay for somebody else's..."), these people would be happy just to have a deal similar to those who are covered by large companies. Large companies, I would add, that almost all started as tiny businesses, or groups of freelancers -- if we continue to unfairly punish customers on the individual or small-group market, we may not even have the next generation of innovative large businesses -- the financial and health risk won't be worth striking out on one's own.

But a 55% loss ratio (let's call it a 55% care ratio) makes insurance industries big financial players with a lot of money to throw around, and this is why we have Blanche Lincoln channeling Ronald Reagan in the Senate Finance Committee. 45% of our premium dollars are more than enough to buy a little democracy.

EDIT: but not all the democracy: progressive stalwart Shakesville transcribes this exchange between White House spokesman Robert Gibbs and ultrajournalist Helen Thomas, who has been asking him whether Obama will veto a health care bill without a public option over and over again for over a week.

Money and the Power

Just a brief note: I have to go talk about kigo in a train station cocktail lounge.

This article in the Guardian tries to count the obscenely huge amounts ($380 million!) that the insurance industry has spent in its quest to prevent a strong public option, or any other reforms that might affect their income. Sad, perhaps-I-will-have-a-cocktail-in-abovementioned-lounge ironic twist: it's our premium money they're using to buy off our own elected officials.

The other notable thing about the article is that it relies in part on officials from the Clinton administration, who are a particularly interesting kind of witness, having themselves gone up against the opposition to reform and failed. Here is Clinton-era labor secretary Robert Reich, explaining the public option in concrete terms:


EDIT: sorry about the overlap with the sidebar -- Reich is ok-looking, but I'm not so sure that anybody really needs to see him in widescreen. We should at least have the option to see him in a variety of dimensions, but alas.