Dying for a Public Option

Red Alert

2009-11-05T10:48:00.000-08:00

I've had a hard time making sense of the latest news about health care legislation. In the Senate, Joe Lieberman seems to be backing off from his threat to filibuster a reform bill; maybe he realized that a filibuster isn't necessary because you can shut down the Senate by simply writing a letter.

Over in the House, the wacky extremists at the AARP are supporting the House health bill, but Republican congresswoman Virginia Foxx responds that health care reform is worse than terrorism. Apparently, either my grandmother is a card-carrying member of a terrorist organization, or Virginia Foxx is a raving lunatic. I'll see grandma in a couple weeks, so I'll let you know what I find out.

Truth in Advertising?

2009-10-18T22:07:00.000-07:00

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

2009-10-15T13:28:00.000-07:00

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

2009-10-12T12:05:00.000-07:00

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

2009-10-09T12:32:00.001-07:00

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

2009-10-08T19:31:00.000-07:00

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

2009-10-06T23:16:00.001-07:00

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

2009-10-06T09:36:00.000-07:00

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

2009-10-05T11:03:00.000-07:00

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

2009-10-04T12:30:00.000-07:00

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?

2009-10-03T10:26:00.000-07:00

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

2009-10-01T13:35:00.000-07:00

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.

If It Gets Real Bad, Think About Space

2009-09-30T09:22:00.000-07:00

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.

The Loss Ratio and Insurance Industry Profits

2009-09-28T23:05:00.001-07:00

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

2009-09-28T03:22:00.001-07:00

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.

Thinking Cap

2009-09-27T12:51:00.000-07:00

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.

Don't Know How She Sorts It

2009-09-26T08:50:00.000-07:00

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.

The Public Option Amendments

2009-09-25T09:54:00.000-07:00

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.

Treating Swine Flu: Unprofitable!

2009-09-24T18:22:00.000-07:00

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?

Gradmed: Spending Your Insurance Dollars Wisely

2009-09-23T00:47:00.001-07:00

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.

Insurance Companies Need Our Support

2009-09-22T10:21:00.000-07:00

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:

Protect Insurance Companies PSA from Will Ferrell

Socialist (not Socialist)

2009-09-21T10:48:00.000-07:00

Background music here.

SOCIALIST:

NOT SOCIALIST:

SOCIALIST:

NOT SOCIALIST:

SOCIALIST:

NOT SOCIALIST:

Olympia Snowe and the Audacity of Cost Control

2009-09-20T09:30:00.000-07:00

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.

Updates

2009-09-19T10:01:00.000-07:00

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.

Cost Control

2009-09-18T10:25:00.000-07:00

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.

Getting Involved -- New Media Style

2009-09-16T19:55:00.000-07:00

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

2009-09-16T15:12:00.001-07:00

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.

Doctors and the Public Option

2009-09-15T08:52:00.000-07:00

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.

GradMed Insurance Review

2009-09-14T10:55:00.000-07:00

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.

Giving One

2009-09-13T11:27:00.000-07:00

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.

Who's protesting?

2009-09-12T09:26:00.000-07:00

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.

Attention Deficit Disorder in the NYTimes

2009-09-10T10:31:00.001-07:00

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.

The 9/9/9 Speech

2009-09-09T20:41:00.000-07:00

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

2009-09-09T09:19:00.000-07:00

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.

Holding Pattern

2009-09-08T15:11:00.000-07:00

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.

Presidential Address to Congress, 9/7/09

2009-09-07T11:44:00.000-07:00

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.

Sunday Shorts

2009-09-06T12:09:00.001-07:00

A few entertaining links I've run across this week. I'd write more, but I just accidentally had some double-strength coffee and I am flipping the hell out inside.

First, momentously, Auto-tune the News 8 is out, and features Sen. Chuck Grassley, who for a brief time was considered a reasonable, moderate voice on health care in the Senate, but is in fact a total woop-the-loo. He shows up at 2:00, but the whole video is fun:

Also, from the Onion: Man Succumbs to 7-Year Battle with Health Insurance.

And Ze Frank on the "Health Care Argument" at Time.com here: he does a better job than I do pointing out that the health care industry shouldn't be treated like a regular business. Also, cereal-box vasectomy.

Sound Bites

2009-09-05T08:40:00.000-07:00

I got an opponent-of-reform-posing-as-a-liberal comment last night, which I deleted (I didn't know I had this policy, but I Forbid Outright Lies in the Comments [FOLC]), but something about it interested me -- namely, that this person who wants no reform, never seriously considered reform, and has a deep-seated ideological opposition to reform repeated the oft-trotted-out phrase that President Obama has done an awful job of "explaining" the health care bill to Americans.

Now, this muttonhead Libertarian dude did not invent that argument. Republicans didn't invent that argument. I don't even think it was the media -- I think supporters of the public option invented this argument. Many supporters of reform are supporters of the President -- many supporters of the President have significant faith in and high hopes for his administration -- but this can also create a kind of dependence. The President, remember, is not a legislator -- where the Constitution's concerned, he doesn't have much role in making bills past the presence or absence of a veto. He is a leader to the extent that we agree with him and support him, and he's the first one to admit this.

What is required of us now is a new era of responsibility -- a recognition, on the part of every American, that we have duties to ourselves, our nation and the world; duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task.

This may have come off in the Inauguration as a stirring show of faith in America -- but the way I heard it was that we don't get anything we don't earn. No administration-backed disinformation campaigns to confuse and divide our opponents. No use of the bully pulpit to drown out opposition. No dirty tricks; no cash lubrication of difficult obstacles. We get the policies that we support, and the ones we agitate for. If he opens his mouth and we don't understand, it's our job to do the legwork, decide what we believe, and go out and get it. Every, every single supporter of the public option that wastes ink or time analyzing the President's inability to tell a good, sound-bite narrative about health care reform has lost a chance to educate his or her fellow citizens about health care reform.

So here are my sound bites:

Our priority as a nation must be providing insurance and care to the 11 million uninsured American children, who make up all too large a part of America's 45 million uninsured citizens. It is a moral duty and an investment in the future: no plan currently considered by Congress does this, except for HR 3200.

Insurance costs are strangling our neighbors and our households. 30% of the dollars we pay to private insurance companies go to overhead, paperwork, and profit. If this system works for you, you'll have the choice to retain it. If it doesn't, HR 3200 will give you the chance to enroll in a government-run insurance program that is responsible to citizens and not shareholders. The Congressional Budget Office estimates that inclusion of a public option in any health reform bill will decrease the costs of that bill by $400 billion over ten years.

The regulations of the current insurance system discourage small business and individual entrepreneurship, make spouses dependent on one another, create obstacles to those who want to change jobs or industries, ruthlessly punish those with chronic illness, and create dangerous levels of uninsurance among those under 25. These injustices can be ended with the stroke of a pen: they are failures of government to regulate insurance, and they cost Americans not just money, but suffering and lives.

And here's a shorter take on the situation --

Right on. In case you missed it yesterday, you can call your congresspeople through the service at 1-877-264-HCAN. We have, probably, less than two weeks to affect what legislation is written and whether or not it passes -- this is the exact wrong time to analyze the varying effectiveness of our elected officials, and the exact right time to decide what you believe and work to make it happen.

LA Health Reform Rally, 9/4/09

2009-09-04T10:30:00.000-07:00

So yesterday I said, 'man forget this stuff man' (in person, I say 'man' at least once in every sentence), took a few hours off work, and I left sweet Hollywood.
(ghost of Michael Jackson entertaining tourists. A-wew-hew!)

My destination: a health care rally that, according to the website I signed up on, had 14 RSVPs. I was visualizing something like a crack team of organizers, surrounded by massive waves of angry, insurance-company supported teabaggers. But it was in Chinatown, and I do love Chinatown:
(it's funner than it looks.)

When I got there, though, I didn't find fourteen people, but hundreds -- two organzations (Organizing for America and Health Care for America NOW), a dozen speakers, Representative Jane Harman, the chief resident of LA County Hospital, a representative of the LA city council (which recently passed a resolution calling on the President and Congress to pass a strong public option), Veronica De La Cruz, who I wrote about early this week (she is apparently attempting to be everywhere at once -- she was in Nevada yesterday and on the East Coast at the beginning of the week) as well as all kinds of other folks. It looked like this:
The teabaggers I was so worried about: not in attendance. There were about eight abortion protesters, though, but even with their massive chopped-up baby pictures (which, if you can tell, were repurposed from another, likely more significant anti-abortion campaign) and their megaphones, they seemed sort of lonely and sad.
Still, though, someone there was taking them seriously -- the LA Times, apparently on the strength of their shouting, looked into the public option bill overnight and ran this editorial this morning, arguing that the bill is actually written, with respect to abortion, in a particularly sensitive way with respect to the abortion debate -- it cannot increase, and may decrease, the number of abortions for which the government provides funding. Still, it's a little bit depressing that somewhere, somebody is manipulating believers who want to help children into opposing legislation expressly designed to help children. It makes me a little bit happy that they're not having much success.
(Note: the cancer survivor's sign did not say "rightwing pies". Rightwing pies are actually pretty good pies.)

At the height of the rally, the organizers hefted up 200,000 Californian pledges for health care reform, in a mighty-big suitcase, added those we had signed during the rally, and headed off to Washington. Our representatives are reconvening -- President Obama will address Congress next Wednesday, September 9. This is, for the best chance we will have to see comprehensive reform in our generation, the final and most crucial stage. Everything -- and the energy and effort that President Obama's Organizing for America put into creating these rallies for a strong public option proves this to me -- everything is on the table. Anyone who is wasting their time arguing over who lost the health care battle has given up too early. If you care, you need to pitch in and call your senator (which Health Care for America will help you do with their toll free number at 877-264-HCAN).

I did. We called Diane Feinstein right there from the fairgrounds and told her to get it done. Afterwards, Chinatown seemed much nicer:
But Hollywood was still exactly the same. I didn't ask this guy if he has health insurance: that question would be silly, since nobody who works Hollywood Boulevard as a look-alike character does. Which is a shame, because he was working that suit hard.

Late Game Gunk

2009-09-03T09:16:00.001-07:00

Let's say you're a fence-sitter. You like fences -- you're from Arkansas and they've got a lot of them, and you like to sit on them. No problem! You can be a Senator; you can be a senior senator. All you have to do is make statements that hedge and shift. Arkansas has a lot of hedges, too, often placed directly adjacent to fences.

All you've got to do is watch out that you don't get pushed off the fence by a fire-hose intensity gush of insurance industry money. This will be delivered with particular force, since your previous health care advisor now works for Blue Cross/Blue Shield.

And if you do drop off, Lord forbid, the fence? Make sure you don't get embarassing, money-green gunk all over your nice clothes, Senator.

The price of one senator to vote against legislation that will save lives, money, and prevent human suffering -- especially in her home state of Arkansas, where 20% of the state is uninsured? That price is apparently $325,350.

Her move today to come out strongly against the public option in the late days of the debate is a live-action dramatization of this cartoon -- by waffling for months instead of choosing a policy and negotiating for it (the attitude of several more principled senators who are also not firm 'yesses' on the public option -- those who are pulling for their own plans), she helps ensure that no reform at all passes this year.

What a shame! You know how hard it is to get gunk off a nice silk suit.

EDIT: Forgot to give you fine people a way to contact the Senator with advice on repairing expensive fabrics. There's still time to apply stain stick before the grease soaks all the way through!

DOUBLE EDIT: You can donate to an ActBlue campaign to run a pressure advertisement pushing Senator Lincoln to represent her constituency here.

Neighborhoods

2009-09-02T09:04:00.000-07:00

One of the things I'm realizing is that while the opposition to the public option is national, and includes large numbers of people who have essentially the same empty talking points (government is always bad, socialism is always bad, you have to read every page of the House bill because there are weird hidden genocidal policies in it), support for the public option is local and personal.

At first I thought that this was because of party politics, etc. -- but now I think it's more that you don't really know how broken our system is until you encounter it. So you have full-time politicians, pundits and talk-radio hosts who see nothing but cost and political ideology, and then you have citizens and patients who have seen how destructive the system can be. I say this as a way to introduce Veronica De La Cruz, who lost her brother to a treatable heart problem even though she raised a million dollars to pay for his transplant and treatment. She explains it better than I could in this open letter. Veronica was on-air at CNN and has a big microphone, but this system repeats itself in small ways every day:

-- a new father forced into hour-long negotiations on his cellphone in a hallway at work because the insurance company has once again delayed payment for his son's care (Hi Bryan!)

-- the terrifying job hunt of a recent college graduate who is not just trying to avoid moving back in with her parents, but to keep her insurance from lapsing and causing her recently diagnosed depression and anxiety to become uninsurable pre-existing conditions (Hi M!)

-- an adjunct teacher making $15,000 a year who pays $250 a month in insurance premiums -- that's $3000 a year, 20% of her take home pay (Hi Emily!)

These are the activists we have in the fight for the public option -- their suffering is the motivation to get this bill passed and this system reformed -- and there are millions of them, scattered out over the whole country. The trick is to make sure their voices are heard.

So: I found two events this week in my area through Health Care for America NOW, which can show you where town halls, rallies and speeches in your area will be held, and I've seen events planned through President Obama's community organization website. There's also a really vigorous conversation on Twitter, centered in part around (but certainly not limited to) the #PublicOption hashtag -- a lot of this seems to be among and between networks of friends and acquaintances. Finally, though, the ultimate effect of organization is to put pressure on your representatives -- you can find out where your senator stands on reform here, and contact them through the same site, or any of a number of others.

EDIT: forgot to mention this site, where you can see some of the impact HR 3200 would have on your community specifically.

Socialist Seniors

2009-09-01T11:21:00.000-07:00

Support for the public option -- the health care reform bill -- is highest among those between 18-29, and lowest among those over 65 -- among whom only 35% support current proposals for health care reform. Seniors are particularly important right now as we approach the 2010 midterm elections -- in midterms, they tend to vote in large numbers, and were instrumental in putting a Republican majority and the Contract for America into power during Bill Clinton's first term.

Simultaneously, though, seniors benefit the most from government-mandated, government-run health insurance. While 28% of people 18-29 are uninsured, those over 65 are the least likely demographic to lack insurance, coming in at just 3.6%. Medicare is the difference. Moreover, the way that economic expansion and tax burdens have progressed over the course of the 20th century, seniors alive today have on average received $2.50 in benefits for every $1 they've paid in health-care related taxes. Not only that, but the costs of Medicare are increasing at about 8.8% a year -- high, but not as high as private insurance's 9.9% yearly cost increase.

As has been pointed out almost infinitely, senior anger over the public option can't rationally come from a fear or dismissal of government involvement in health insurance. Instead, I believe it comes from a desire to protect their benefits -- as is the case made in this Ezra Klein editorial. Health care reform, although the vast majority of it doesn't affect seniors at all (and this includes all parts of the public option, for which seniors are not eligible, since they're already covered by Medicare), does try to cut costs across the board, and some of those cuts -- even if they're just attempts to decrease non-beneficial waste spending -- may affect Medicare.

Echoing Klein, a note to everybody under 60: seniors depend on and prefer Medicare to the point that they will throw screaming fits when confronted with reforms for everybody else that affect their benefits. This is absolutely their right -- they got their Medicare benefits in the first place through vigorous participation in the political process, and by insisting that their government serve their needs. I don't think there are very many people who would begrudge the Greatest Generation a warm bed and a course of antibiotics when they're sick.

Don't we deserve it too, though? Isn't the conviction of the one population in the United States that enjoys socialized medicine a strong recommendation for a government option in health insurance? And don't they show us that we can improve our system and provide for each other through concerted effort, and American stubbornness?

Why People Under 30 are Uninsured

2009-08-31T13:43:00.000-07:00

I had a spirited debate this morning over whether people under 30 are irresponsible if they stay uninsured. My answer: in the current system, heck no. Why?

-- People under 30 are most likely to hold down jobs that give no insurance. Internships, adjuncting, freelancing, trial period, all of it: as our economy weakens, benefits decrease, and the disproportionate victims of weaker benefits are new workers.

-- Individual insurance is considerably more expensive than employer-paid benefits.

-- People under 30 are healthier than people over 30; additionally, people under 30 feel more bulletproof than people over 30 -- out of innocence, they don't see the need for health insurance.

-- High-deductable catastrophic insurance is the biggest racket the insurance industry has going: when you take small premiums from many, and pay large benefits to very very few, it becomes extremely profitable to hire lawyers and deny coverage in the case of the few. Most people with catastrophic insurance never figure out just how little their policies cover, or how susceptible they are to shenanigans.

-- Many of the most serious health issues that appear between the ages of 20 and 25 are psychological or neurological: the onset of serious depression, schizophrenia, and bipolar disorder is all likely to take place. These are not only difficult diseases, often severely undercovered by private insurers, but they also make it less likely that a young person will go through the conflict and struggle that's required to get a policy in the first place.

-- A young person's insurance situation needs to be taken care of the minute their insurance through their parents (if they're lucky enough to have it) elapses, or else they can be rejected for pre-existing conditions (here, just as an example, is a letter to the editor from a young person denied a half-dozen times for having easily treatable skin conditions, the middle letter on the page).

It is not good that people under 30 often go without insurance, especially those who can pay for it -- but when given the choice between sinking large percentages of their incomes into exploitative and ultimately useless private health insurance, I can understand how a sense of invulnerability could make them forego insurance entirely. A public option -- something that would be affordable, and a plan that would promise that young people could get out what they put in to the system (as opposed to contributing to insurance company profits) would make a real difference.

Specifically, Women

2009-08-30T09:22:00.000-07:00

The public option is good for society at large -- it would vastly decrease the number of uninsured in America, reduce reliance on expensive emergency-room treatment, and compete with health insurance companies that use monopoly market shares to abuse the health and finances of regular Americans. It's for everyone. HOWEVER, there are some groups that, because they're treated particularly unfairly in the present system, would receive particular benefits from a public option.

Specifically, women.

Whether or not you think one parent should stay at home and take primary responsibility for child rearing, it still happens quite a bit, and happens disproportionately to women -- and I think everybody agrees that neither men nor women should be forced into marriage, or kept from leaving one that s/he no longer wants to be a part of. There are a lot a lot a lot of reasons for this, but let's radically oversimplify them all into just one: your spouse has become abusive or presents a danger to your children. No left-right issues about saving the family, or religion, or anything else. Time to get out.

Now, we fortunately live in a society where it is possible -- not easy, or even particularly likely, but possible -- for a parent who lives and works at home to get a divorce, get child support, find a job, get an apartment, find child care and whew. Survive. It's a lot of work, and we still lack lots of critical services, but it's a big improvement over earlier times when women leaving a marriage encountered nothing but resistance and judgment. What is, however, practically impossible for that woman to get -- the most regressive part of the way our society treats stay-at-home parents -- is health insurance.

Divorced spouses and their children are eligible for COBRA -- which means that they have the right to be charged 102% (no kidding -- the insurance companies have the right to raise the cost of their plans by 2% for COBRA enrollees) of the cost of the insurance that they just lost by getting divorced. What this means is that if you don't want any gap in coverage (which is when your health problems become 'preexisting conditions,' and therefore uninsurable), you are responsible to pay the full premium for you and your children in cash the moment you ink your divorce papers. Congratulations! You have escaped a loveless and destructive marriage. Please send a $1200 check to Wellpoint Corporation....

Thirty-six months later, this insurance runs out whether you can pay for it or not. And COBRA is for the lucky ones -- people whose spouses worked at a business with 20 or more employees. If your spouse worked in the restaurant industry, you're just out of luck. And keep in mind that while it may be worth it for many women to go without health insurance for a brief period just for the benefits of avoiding Johnny, the presence and needs of children makes this problem life-or-death, damned if you do, damned if you don't.

All of this applies, less frequently but in the exact same way, for any men who get their insurance through their spouse, as well -- whether they're caregivers for children or not. If you've been at home with paralyzing nerve damage from a car accident, getting your insurance through Janie, and Janie starts disappearing for entire weekends with Tom, you're probably better off just pretending you don't know. You need Janie: you depend on her. More precisely, you depend on her insurance because our system of insurance is a joke.

But there are more indignities and injustices in our present health care system that specifically target women: the Truth-o-Meter at politifact.com measures claims about the health care debate, and one of the only statements it has completely verified is that it is nearly impossible for women who are pregnant to get health insurance. This, to me, seems like blunt, no-brainer proof that our system is designed for the profit and convenience of health insurance companies, and works at the expense of people.

Add to this the fact that a public option -- because it would be purchasable by an individual, at reasonable cost -- would ease the suffering and difficulty of thousands of people in nontraditional, nonmarriage relationships, gay and otherwise, by offering the opportunity for each American to get affordable insurance, whether or not they are married, whether or not they are employed by large businesses.

What's the Public Option, Anyway?

2009-08-29T10:44:00.000-07:00

Fivethirtyeight.com has an essay up about people's misperceptions and misconceptions about the public option, and how it's not even accurately defined in poll questions, much less in the answers of regular voters. So here's my best crack at a short definition of the public option as it appears in the House bill that passed earlier this August:

The public option is a set of government-run health insurance options available to those who make less than 400% of the poverty line and who have no employer-provided health insurance.

Estimates of the number of people who would actually choose this option vary widely, but the range of estimates I see is somewhere less than twenty million, and somewhere more than seven million. No seniors would be affected (although they might be affected by other parts of health care reform). No person would be 'forced' into public option insurance -- there will also be standardized private options made available to the same people.

So when I see people up in arms about socialized medicine, or a government takeover, I feel like there's a certain amount of disinformation at work -- this is a policy that bends over backwards to make sure that everybody gets to choose the insurance they want. It simply creates opportunities for working families, small business employees, and others who make too much to be eligible for Medicaid, but not enough to be able to afford terrifically overpriced private insurance. The argument that the public option will put private insurers out of business assumes 1) that the government-run insurance option will be so successful that private insurers can't compete, and 2) that our system of private insurance is somehow financially dependent on the working poor and the lower middle class -- that they'll collapse if 10-15% of the population, many of whom are uninsured or underinsured, choose a government option. That doesn't, to me, make sense -- how can you price a group of customers out of the market, deny them the opportunity to be covered, and then turn around and argue that you can't survive without them?

For more, here's a description of the bill at OpenCongress and a journalist from the Nation describing the public option.

Friday Short

2009-08-28T17:44:00.001-07:00

Quick because I have to make dinner and I spent all afternoon taking the 212 bus to go watch pure light. (Note: also not a euphemism. Admission cost me $8.)

By my count, there are three reasons we make an industry public (i.e. give the government significant power over it). 1) when the thing the industry sells is absolutely necessary for survival and people who need it will pay any amount of money for it (i.e. water, perhaps electricity). 2) when the item or items it sells are a finite resource that has to be shared (water, roads + highways). 3) when the nature of the industry is such that a monopoly corporation in that industry would have too much control over the nation (defense, the post office).

Health insurance clearly fits all three categories: the vast majority of us rely at some point or another on some form of health care; we have come to the point where we realize that this is not an infinite resource that we can continue sinking 15% of our GDP into funding it; and increasing monopolization and control by large health insurance companies (Wellpoint, United, Blue Cross) has meant that they, not us, are setting national health policy.

The public option for national health insurance, because it would be operated by the government, would be more socialist than the current system. That's true. But no more socialist than our water system -- and you'll still be able to buy the bottled stuff if you want it.

EDIT: PS -- a veterans' organization is in the news today for defending their own socialized medicine against flat out lies by opponents of the public option (in this case Republican National Committee Chairman Michael Steele).

Mailsack

2009-08-27T10:06:00.000-07:00

Surprisingly fat mailsack this morning, raising two very discussable questions.

First, from a debonair conservative gentleman: why put the government into health insurance? Why not simply legalize cross-state competition in the insurance market, and enact tort reform?

My answer is that while the two reforms could be useful, neither will nearly be enough to manage costs and provide more care. While cross-state competition (which I mentioned in this post) would certainly make the industry more competitive and could drive down prices, it would also likely increase a problem already acute in the current system: localities that are difficult or unprofitable to serve could still have one or two large for-profit insurers, and it has been pretty conclusively proven that the insurance industry will shake down communities where there is little competition in the attempt to maximize profits. The only difference for these citizens would be that they'd now be dealing with a much larger corporation, and one unregulated by state law. To see what the possible changes/efficiencies from a plan like this might be, consider insurance costs in extremely large states (since we would essentially, where insurance is concerned, be making the country one big state market) -- for example, this argument by Governor Schwarzenegger that California's health care system is broken, in part because of unstoppably rising costs. That's a big, unified market -- but costs are still out of control, and people are still uninsured, and the state and taxpayers are still footing the bill for insurance industry profits. The Terminator, who is not exactly a socialist, is exactly right when he says that Californians already pay a 'hidden tax' to provide care for the uninsured -- it's just done in the most inefficient, secretive, dehumanizing way possible.

Tort reform, although it could also help control costs, would have an even smaller impact. Several states (and there are conservative thinkers in favor of tort reform that believe that a state solution, instead of a national one, would be best) have made significant strides towards reform, foremost among which is Texas. There are some positive indicators that their reform has helped increase numbers of doctors in the state, and decreased the cost of malpractice insurance, but Texas still has four of the top ten most expensive health care markets in the nation, 25% of its citizens are uninsured, and its costs increased 6.1% in 2007. Maybe, it stands to reason, a combination of a national health insurance market and tort reform would decrease costs, but Texas is a pretty large state, too -- its GDP is the size of Canada's.

Long story short, a national health insurance market and tort reform might both be great, but neither is more than a small and incremental improvement to a system which is methodically and swiftly bankrupting and sickening America. The insurance industry, in my opinion, will allow the passage of both types of reform -- neither is likely to cut into their profits in a significant way, and backing them will make the industry look like it cares about us while it blocks the reform we need -- a government-run health insurance option for all Americans.

That brings me to the other piece of mail that was lodged in my bulging mailsack -- an east-coast liberal contrarian/grammarian who wants to point out the difference between health care and health insurance. The public option is a government provision to provide health insurance -- what we are debating, in most cases, is reform to the national system of health insurance -- basically, who pays for treatment, and not who delivers medical care. I'm roundly guilty of confusing the two, because I think that one of the reasons me and mine have received such poor health care during our young adulthood is because we had completely shoddy, or no health insurance. But he is right that even though health insurance might affect health care, we are actually engaged in a very unsexy movement to ensure equitable and affordable health insurance. "National Health Care" in the Canadian or British sense, where government owns the overwhelming majority of care providers, is not under consideration by either house of Congress and makes up no part of the current debate.

An End and No End

2009-08-26T09:18:00.000-07:00

"For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die."

-- Senator Edward Kennedy, 1932-2009

"I called Blue Shield today to find out when they would resume paying UCLA for Janni's care. Surprise, surprise, they knew nothing about the State's Department of Managed Health overturning their denial. They asked me to fax the letter from the state to them, then told me that UCLA had not sent medical records to them for the last 15 days so they were about to deny care again! I don't understand how they can deny when they have already denied. That would be a denial of the denial."

--Michael Schofield, father of January Schofield, aged six

AHIP's Army

2009-08-24T13:24:00.000-07:00

I had thought that the insurance industries were satisfied with direct lobbying and cash donations ($133 million in the last quarter!) in order to unfairly sway reform bills towards corporate profits, but apparently they're instructing corporate employees to attend town halls in an attempt to simulate the existence of a pro-insurance company constituency, and they have 50,000 shills walking in lockstep. I'd dismiss this as conspiracy if the effort wasn't large enough to be a matter of public record.

I've met a lot of people who don't support a public option or who don't support reform, but I've never heard anyone rationalize that opposition by saying good things about the health insurance industry. Unless, of course, (and this includes Joe Lieberman) they are PAID by the health insurance industry.

Baby and Bathwater

2009-08-24T09:00:00.000-07:00

This from 538.com:

From progressives' point of view, they have been waiting many, many years for this moment -- for an ostensibly fairly liberal Democratic president, an ostensibly filibuster-proof majority in the Senate, an ostensibly lock-solid majority in the House, and a discredited opposition party. For a variety of reasons, the situation isn't as good for progressives as it appears on paper and never was. But that doesn't mean that expectations aren't very high. And yet they've seen little progress on climate change, on gay rights, on torture policy, on regulating the banks -- and now they're running into a stiff headwind on health care. It's 1994 all over again. To the progressive mind, it seems to be -- pardon my French -- the same old bullshit re-asserting itself. The moment is on the verge of being lost.

Silver's question, couched in (another) poker metaphor, is this: will progressives will go all-out batshit and absolutely insist on a public option that doesn't have a terribly strong chance of passing? I think that his analysis, which breaks up possibilities into discrete options, misses some of the gray areas that will doubtlessly be hammered out as a final bill is offered to the Senate: first, that there is such a thing as a strong and weak public option, just as there is such a thing as strong and weak reform (I'm speaking here from what he would call the 'progressive' point of view, and what I would call the 'pro-reform' point of view), and second, that these are all on the same spectrum. Enter the spectrum:

This is a simplification, of course, but it's a different one than Silver's -- I can't control Congress, not exactly, but I feel like my support for the public option, even if we end up with no strong public option, pushes the conversation to the right (on the chart, that is). I'll take an end to the way that health insurance companies profit from our fractured state-based insurance system, for example, and I'll support any politician brave enough to enact it -- even though I want more.

That's maybe the difference between now and 1994 -- because we have so many options on the table, there is much greater space for moderates of all kinds, and a much larger chance of getting some reform, even if it's not ideal reform, passed by the fall.

The only problem, really, is the fake reformers like Lieberman -- Democrats and Republicans (or in his case, neither) who accept large amounts of insurance company money and then it's all aww, shucks, do we really have the cash for this sort of thing? Ooo, it seems so complicated -- let's wait until it's impossible to pass reform, and then pass some reform.

Sunday Short

2009-08-23T09:56:00.000-07:00

Very short post today because I'm going to a cat show for the lord's day. (note: not code. Literal truth.)

In this article, in response to hero Senator John Rockefeller's request for statistics from health insurance companies about profit/care ratios, AHIP (America's Health Insurance Plans) group spokesman Robert Zirkelbach said, "Some in Washington are trying to shift the focus to the insurance industry rather than talk about solutions to the health care concerns raised by the American people."

Kind of looks like, from my reading, the health care concern most commonly cited by the American people IS the insurance industry.

Awakening?

2009-08-22T11:37:00.001-07:00

A short link round-up, today, because oddly -- and I maybe have to chalk this up to more thoughtful parts of the media taking a little bit longer to mull over complicated issues like health care -- there seems to be an awful lot of really good writing about national health care reform in the electrowebs today.

First, a super-brilliant post on Metafilter demonstrating that some of the most untrue stories about health care reform come, in fact, directly from health insurance companies and related industry media organs. The post has links to a John Stewart interview with the originator of the "death panels" story, who one day later resigned from the board of directors of Cantel Medical.

Second -- and I'm not ashamed to say I look to a movie critic as a moral touchstone -- Roger Ebert made a pair of posts (part one, part two) that, among other things, point out that the "end" of the public option caused a big gain in health insurance industry stocks, compare "death panels" to the slogan "king of beers", and find the ethical roots of communally shared health care in Matthew 25, verses 31-46. It's kind of a tour de force.

Third -- Andrew Sullivan has collected and archived his posts on health care, which include the "views from your sickbeds" -- stories of what it's like to go through critical illness with American health insurance.

Finally, this op-ed by Gail Collins isn't as good as some of the stuff above, but she makes the point that the 'Gang of Six' that has been responsible for slowing down reform directly represents 2.77 percent of the American people. Thanks, guys! Allowing a small elite to paralyze reforms that serve the majority was exactly what James Madison had in mind when he argued for a bicameral legislature.

Heavy Is the Chest that Wears the Gunk

2009-08-21T08:40:00.000-07:00

I taught myself to use the GIMP to create this masterpiece:

Well worth it, well worth it.

So why junk up a perfectly good centrist? Because centrism doesn't mean chase money and votes in a completely self-servingly strategic fashion. Here's the NYTimes analysis of why Lieberman voted repeatedly to limit damages that could be awarded to people that sue insurers:

"Many of Mr. Lieberman's friends said he had no alternative but to take this position because it was the one favored by the insurance industry. The industry is important to Connecticut's economy and has generously donated to Mr. Lieberman's campaigns over the years."

Well, you know, everybody has constituents, right? At least he's a continuous and strong supporter of private health insurers, right? Lieberman in 2004, during the Democratic primary:

"LIEBERMAN: There is a morally scandalous fact-that that 43 million Americans don't have health insurance, 2 million more than when George Bush became president. I'm proposing to create a national health insurance pool like the one that members of Congress get our insurance from. If you don't have insurance now, you'll be able to get it, probably free, if you're among the low-income working poor. If you're a child, you will be covered by insurance at birth. If you are fired from your work or lose your job, you will not lose your health insurance."

Sounds great, Joe. People really should have health insurance, and since this is the electoral primary and public options for health care are really popular among Democrats, I'm sure this will really help your primary numbers! But what's this business about "probably free"? Oh, right. It's wiggle room, so that he can crawl back to the insurers that fund his campaigns, tongue lolling like an overheated spaniel:

"I don't favor a public option," Lieberman told Bloomberg News in an interview broadcast this weekend. And I don't favor a public option because I think there's plenty of competition in the private insurance market. We have a unique opportunity, a real opportunity to do this year what we've been trying to do for years, which is to reform American healthcare, I think the one thing that will stop that is pressure on the so-called public option. Let's get something done instead of having a debate,"

So the new message is threefold. One: we are doing GREAT. Helluva job. It is absolutely not true that the senators most likely to oppose the public option come from states with the least competition in health insurance or that Lieberman's home state of Connecticut is dominated by Wellpoint, which commands more than 50% of the state market (although the people of Connecticut are fed up -- their state legislature just overrode a Republican veto to establish universal healthcare statewide). Second: Lieberman is on the side of a nebulously defined 'we' -- which doesn't mean Democrats, exactly (Lieberman is technically an independent) or his constituents (see above state policy, which is overwhelmingly supported by residents of Connecticut). I'm guessing that health insurance companies make up a good bit of this 'we', and it's true -- they've been trying to write health policy for decades. Third: shut up already! Why is everybody debating what's best and not just jumping in with some halfhearted, bandaid-on-a-sucking-chest-wound reform-lite package? This, I think, is a very respectful echo of what we could call the Bush Doctrine.

So all told, until you get on board, Joe, you're going to have a chest full of poorly Photoshopped gunk.

EDIT: Also, there is a rhymey bunch trying to kick you out of the Democratic Party.

Nothing's Over

2009-08-18T21:17:00.000-07:00

I took a few days and posted pieces I had saved up so that I could mull over what's happened to the public option in the last week -- after the Obama administration hinted that it was willing to drop a public option as part of a health reform bill and then said that nothing was settled yet. I didn't want to flip the hell out without really thinking about it.

And I'm not flipping out. It's U. S. politics. We didn't suddenly get a better political system once President Obama was elected, and I've never doubted that if he was Imperial Lord, we'd probably already have a health insurance guarantee for every American. I've looked at questions about whether the administration is working hard enough on our behalf, and tried to figure out, but I just don't know.

Here's what I can answer, though. Am I working hard enough to be able to say that I've done everything I can to ensure that all American children have health insurance? That my friends and neighbors don't have to put off doctor visits or lose their homes over medical bills? The answer to that would be no.

One thing that has held me back a great deal was the assumption that what proponents of a public option have been working against is the attitudes and beliefs of other citizens, but this isn't entirely true. This statistical analysis at fivethirtyeight.com makes an argument that should be familiar to most of us: insurance company PAC money and direct donation have had a significant impact on health care reform votes in the Senate. Democrat Mark Warner of Virginia has raised $69,000 in health insurance contributions in the six months since he entered the U. S. Senate -- that's $10,000 a month, and he's not up for reelection for another five years. This article breaks down contributions accepted by the Gang of Six, the bipartisan committee that called for a slowdown of public option legislation in July. Republicans accept health insurance corporate funds across the board -- and that certainly has strengthened their resolve to oppose a public option -- but what is surprising is that Democrats like Joe Lieberman of Connecticut and Ben Nelson of Nebraska have each, over the course of their careers, raised more than two million dollars from donors in the pharmaceutical and health insurance industries. This is more than a debate between people who want a government option for health insurance and those who want an unrestricted free market; all citizens who want what they feel is best for their nation are pitted against corporate interests who are attempting to purchase favorable policies for themselves.

If you aren't convinced that health insurance companies intentionally and aggressively court industry-positive policies in Washington, check out this interview with a former executive for CIGNA who helped end reforms during the first Clinton administration, and is now speaking out about the excesses and cruelties of the current US health system.

So no basic principles, for me, have changed -- I support affordable health care for every American, and a competitive government option for the provision of that health care. I oppose profits earned by encouraging human suffering, and the disproportionate voice that monied interests have in our government.

What has changed is that I no longer trust my elected officials to make good law without the energetic oversight and intervention of people like me and you. So let's get to intervenin'.

German National Treasures

2009-08-16T22:41:00.000-07:00

This source from yesterday's globetrotting survey of world health policies has the following line in it. It describes the German system of national health insurance:

"...premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility."

So, whereas 0% of German children suffer without healthcare, 11% of US children were uninsured at some point in 2007. I spent a little bit of time last week leaving comments in conservative territory, and I can pretty much ventriloquize what they'd say about the statistic above: forget them, they're illegal fucking beaners (this is really how they talk on their own blogs, although some do use rudimentary code language -- I'll spare you a link to the sites themselves). And although I think the 'fuck beaners' crowd is just a slim little minority in the US today, can the rest of us honestly say as a group that we consider our children to be 'national treasures'? The far right has the advantage of ignorance and race hate -- operating under the assumption that all uninsured children are of other, detested groups (although wrongly -- 7% of white children were uninsured last year), they have deluded themselves into thinking that no child they care about is going without yearly checkups, or worse, without lifesaving care. The rest of us don't really have those illusions to excuse inaction.

But they speak up -- the same tired, racist fears that poor or illegal immigrant children will steal health care from our embattled system -- and we stay silent, and we never remind anyone that there are sick little kids out there, and we never make the argument that it is always a good thing to give health care to any child, and that treating children who are placed into the system under false pretenses is the right thing to do, especially when it allows us to offer care for all American children.

Every stingy measure we pass to exclude certain children from public health care -- tests of citizenship, proof of parental income -- creates paperwork and increases the likelihood that some children won't make it through the process of getting covered. The humanitarian -- hell, the human system -- is that anyone under 4' gets free healthcare that we all pay for. The system would, ideally, be a reverse version of this:

Image thanks to

http://www.flickr.com/photos/futurowoman/ / CC BY-NC-ND 2.0

More on my thoughts on this new co-op compromise tomorrow.

Around the World

2009-08-16T21:41:00.000-07:00

I'm kind of spinning my wheels trying to figure out what the new legislative direction in Congress will actually look like -- so I thought now would be a good time to figure out how some other industrialized nations structure their health systems. There's been a lot of talk about Canada and the UK, so I'll leave them out and focus on some other nations. This is initial research, and just an attempt to put some summaries side-by-side, so leave a comment if you feel the urge to disagree. Massive oversimplifications to follow:

FRANCE -- The French system is made up generally of private practices for ambulatory care, and public hospitals for acute care; the government provides a national health insurance plan that pays 60-70% of health care costs, and almost 80% of the population supplements that with additional insurance from a private source. Although they've had cost increases similar to (although smaller than) cost increases experienced in the American system, government negotiation with care providers and drug manufacturers have helped limit prices. Because France has three times as many doctors per capita than the US, and because its citizens lead the world in use of prescription medicine (note -- not necessarily a good thing), the WHO called it the world's #1 health care system in 2000, and many Americans who have lived there or studied their policies advocate strongly for their system.

JAPAN -- In Japan, insurers are not allowed to profit from health insurance, and health insurance is guaranteed through one of two national systems, one that covers large employers, and one that covers small employers and the uninsured. While access to basic care is reasonably equitable, the system has considerable problems ranging from overutilization of some services (because doctors are paid by the service) to poor resource allocation (leading many to be turned away from emergency rooms) to insufficient oversight (doctors receive a lifetime medical certificate that requires no re-certification, and many believe they operate at an unacceptably low standard). All this having been said, Japanese citizens are actually some of the world's healthiest -- they lead the UN's list of the nations with the longest lived citizens.

GERMANY -- Germany's first universal guarantee of health care was apparently instituted by Otto von Bismarck, here seen pensive in a pointy helmet. The modern system guarantees insurance for all, paid for through a combination of payroll tax and employer support. Their social insurance system is something like the Japanese, but instead of being assigned a government option, insurance can be purchased from one of over 200 "sickness funds" which are independent, not-for-profit, and which compete with each other for clients. The government does engage in top-down negotiations to decrease costs, and these have been reasonably successful in keeping costs considerably below those in the US.

What do these systems all seem to have in common? First, all industrialized nations I've read about guarantee all their citizens at least a minimal amount of care. Second, the nations above tend to keep electronic or otherwise portable records, like the French carte vitale or the German eHealth card (which has admittedly hit lots of snags). Third, almost all these nations pay their doctors less, but cover medical training of all kinds, often completely. Finally, most of these systems, with some exceptions, were created gradually, using a series of reforms that increased coverage bit by bit.

Ok, last thing, can't resist: Around the World by Daft Punk. The video is intended to metaphorically represent the legislative process of the US Congress.

EDIT: Worst health care systems in the world. We made the list! Wooo.

Good News or Bad News?

2009-08-16T10:55:00.000-07:00

This made a banner headline at the NY Times -- which has apparently started to feel guilty about failing to more aggressively report the truth about the false "death panels" claim, because they slip a rehash in at the bottom. Medium-length story made short, the administration seems like they're willing to drop support for a public option in favor of a network of private, not-for-profit cooperative insurers.

What does that mean? Are health insurance co-ops -- non-profit organizations that provide an alternative to private insurers -- going to serve the US in the same way that the public option will?

Looking into it just a little bit, I can already see a few differences. 1) Negotiation power. The NYT makes this point -- small co-ops, regional or local co-ops, have less muscle to force price cutting by hospitals and pharmaceutical companies. 2) Regional inequity. The co-cops here in Los Angeles will likely be really nice -- there are a lot of motivated people and a lot of resources pressed up together. In Arkansas, though, or Georgia, they'll probably be considerably less nice, because enrollees will have less money with which to support the co-op, more problems, and the talent and dedication needed to run the co-op itself will be spread over larger areas. 3) Secret profit. Lots of 'non-profit' organizations are actually highly motivated by profits in the form of individual and executive salary -- this could provide the same incentives to deny care in order to 'keep the co-op afloat', i.e. maintain the for-profit employment of the not-for profit's employees. Because there will likely be many of these co-ops, government oversight will be a challenge.

These are significant concerns. They can be addressed -- a national purchasing system that unites the co-ops, for example, or some kind of federal sliding scale for funding them. Whether that will happen or not remains to be seen. What I am not interested in, very specifically, is analysis of this nature, from Cenk Uygur. Here's the key spot where he and I part company:

"But that's still not the main reason why the public option is so important. It's because it is a standard bearer. It is a road sign. It tells you what Obama is all about. Is he willing to compromise something he knows is essential to get a deal done so that he can brag in the next election that he got "healthcare reform" passed? Or does he actually give a damn about policy and getting it right? That is the central question."

This is not a standard bearer -- this is a policy. Uygur has here joined the ranks of people who are playing political football with health care reform -- I've become used to calling them "Republicans" -- and who are interested in forging win/lose politics and short-term horse-race headlines out of this very complex issue. A public option has to be for everyone, and that includes the farm family in Iowa who doesn't trust the government, or the 46% of the nation that voted for John McCain. That the far left is willing to sniffle and return to their tents because they lost a legislative battle, and that they can only conceptualize opposition to their chosen reform as an unwillingness by their elected officials to "insist" on a public option, shows a certain lack of civic engagement.

Which is to say that we should all maintain strong support for a policy that will cut costs, insure the uninsured, increase the quality of care, and strengthen competition against and between insurance companies. The reason for that? Comments like this one, from a man who had to fight his insurance company to receive lifesaving and medically necessary treatment. The goal of the public option is identical to the goal of health care reform -- better care for people. Narrow-minded dependence on scorecard politics isn't going to improve our health care.

Why's Wayne Worried?

2009-08-14T13:57:00.000-07:00

Talked to a friend the other day whose father, who we'll call Wayne, is still a bit on the fence about significant national health care reform -- he doesn't want to lose his current insurance. I think he's probably representative of a good portion of the lukewarm opposition to a public option -- it'll be hard and expensive to make a big switch, learn a new system, and he's doing fine now.

One of the reasons that this kind of attitude can persist is that health insurance companies hide costs and show benefits -- your health insurance payments don't appear, itemized, on your paycheck, so you're often not exactly sure how much your employer's paying per year. Plus, a good portion of insurance company cost-saving measures (abandoning paying customers -- rescission -- and refusing to cover drugs and procedures because of the costs) are hidden, and blamed on the customers and the drugs, respectively. This means that the customer who develops an expensive, life-threatening condition is found, by some slight of hand, to be at fault, and expensive treatments are labeled as 'insufficiently tested' or 'unnecessary'. There is currently no way to measure or compare how, and how much, insurance companies use these methods. So we don't really know how much we're paying, and we don't really know what we're getting.

What we do see is that when we go to the doctor's, our insurance coverage knocks off a significant amount of the price -- my doctor's visit goes from $80 to $10. That feels like a great benefit. But if you're paying $2400 a year (and that'd be a pretty cheap policy), it's nothing -- you'd need to go to the doctor's 32 times in a year to break even, which is a little more than once every other week. What you're paying for is what happens if you get very sick. Brain scans and protracted physical therapy and hospital stays, etc. etc. Wayne's never gotten that sick: he doesn't know how quickly the insurance company turns from a no-hassle discount into a tight-fisted adversary.

That's why there's this immense flood of stories of people who have been heartlessly screwed by their insurance companies. We are promised that we will be covered, and then we're not -- and it's shocking (note the family in the last link that is dropped from their insurance provider of 35 years), and we are surprised, and we want to tell someone.

Because of the system, though, this will happen over and over again -- until Wayne hears enough stories to realize that this can and will happen to him unless he works hard to ensure a public option for himself and his family.

PS: I also have found one person who got screwed by our health care system and then fell in love with it later -- but I think he's more or less one-of-a-kind.

What can we do?

2009-08-12T22:01:00.000-07:00

Most of my posts are about why it's good to support a public option for national health care -- but I just read this brilliant post, which gives a solid set of guidelines about having health care debates with those who don't support reform, and it reminded me of this AskMetafilter question, which asks what supporters of the public option can do to ensure that it becomes law. Here's my brief list:

1) Write your representative and senators. If they support a public option/legislature you like, write a letter of support; if they don't, call on them to change their minds. Here's a brief introduction that will help get you started -- all I would add to their list is to be persistent! Every polite letter gets read and considered, if only briefly.

2) Write a letter to the editor or op-ed piece for the press you read -- including alternative weeklies, magazines, newsletters, church bulletins, and anything else. Another brief introduction, to which I would add that many letters in city newspapers refer specifically to an article run in the paper, and that you have an advantage in writing to a paper that you already read.

3) Visit a town hall -- here are lists of upcoming Democratic and Republican town halls all over the country, and they run through late September, so there's plenty of time. I'm of the opinion (I've never been) that just going and sitting quietly and listening to what your representative has to say has a positive impact on the debate -- six people screaming makes a lot less sense when they're in a crowd of two hundred who came to listen.

4) Get organized with a Public Interest Research Group -- they're organized by state, like MoPIRG (Missouri) and CalPIRG (California). They're running campaigns right now in support of the public option, and are usually happy to accept letters, volunteers and donations.

5) Leave me a comment! Well, that's more of a gesture of support than it is actual support. Start with 1-4, and then use 5 to let me know what happened.

EDIT: 6) Or, if you're a Whole Foods customer, write them and let them know that you think this op-ed is a stellar piece of trash (which is to say, stellar trash, which is to say a plume of hot waste gas).

Melting to the Money

2009-08-12T09:53:00.000-07:00

Dr. Rob left this comment a few days ago, and this was the most thought-provoking part to me: "[I] hope the congress will avoid melting to the money and actually push primary care." I agree with him -- I hope that primary care is a priority in the new system (and since the legislation is still being debated, it's not certain that the final draft of the reform bill will prioritize primary care), but it took me a while to figure out why ignoring primary care would be "melting to the money."

Here's what I figured out: since we have, excepting Medicare and Medicaid, a largely for-profit health care and insurance system, the most profitable parts of the health economy become larger, and the less profitable parts shrink in size -- the system flows towards the money. Examples:

1) Notice how you never see television advertisements for prescription drugs that cure disease or fix a problem? The drugs worth advertising -- the most profitable ones -- are new treatments for chronic disease like irritable bowel syndrome, fibromyalgia, erectile dysfunction, etc. These are treatments one has to take over and over again, and the reason only new drugs are advertised is because the profit margin is highest on drugs that are still under patent. This book puts it particularly well:

Jurgen Drews, a physician who has been the research director of a major global pharmaceutical company...argues that in recent years an obsessive, and ultimately self-defeating, focus on the bottom line, and the increasing costs of launching a new product, have led pharmaceutical companies to devote their research efforts increasingly to so called "me too" remedies for conditions such as high cholesterol and hypertension for which useful therapies already exist.

Because it's quicker, and more profitable, to seize control of a market that already exists than it is to undertake the long process of truly improving public health.

2) Why is it that a trip to the dermatologist, even a very simple one, is likely to cost three times as much as a trip to a general practitioner? Supply and demand -- there are fewer dermatologists, and they can demand a higher price, even though their specialty is no more complicated than general practice medicine, and they don't have more training, just different training. It is weird that we have plastic surgeons driving around in Benzes while some rural counties with obvious need have a crisis-level doctor shortage. I'm not arguing that people should be stopped from paying for health care, I'm just pointing out that under the current system, the most profitable branch of medicine is cardiology, followed by radiology, orthopedic surgery, ophthalmology, anesthesiology, and dermatology. Those are all great, and deeply necessary for good health care, but they're not the medical care that we need most. They're the kind of care that is most specialized -- when you need a specific surgery on your eye, there's a very limited number of people who can do it, and they can charge whatever they like. Meanwhile, your primary care physician is deeply involved in saving your life in a number of ways (monitoring your blood pressure, providing early cancer diagnoses, catching diabetes before serious symptoms set in) but they're not paid a premium for it -- because there's lots of general practitioners.

3) Public health initiatives -- education and availability of the most simple, most effective health interventions -- make zero profit (because they address a need before the point of crisis) for private industry and provide measureless profit to the community. So we leave it to non-profit, often non-medical groups to do things like encourage HIV prevention, provide flu shots (which are organized in my neighborhood by the LA County government), educate expecting mothers (a service of the March of Dimes), etc. etc. Resources -- money -- literally melts away from these needs, because they don't fit into our current profit-based model. This is not cost-effective -- if we had an organized, national health care system that could ensure that folic acid was provided for every pregnant mother, we would pay less in emergency room visits, government-sponsored care for premature newborns, lost work and wages, etc. etc. etc. The problem is that it's not profitable to tell women to take a multivitamin in the first weeks of pregnancy -- at least not profitable in the narrow, free-market sense.

I probably come off sounding a little bit critical of the free market in the examples above, and I'm really not -- private companies can be, under certain conditions, terrifically helpful. Unfortunately, too much money has melted to the shape of that free market, and we're missing all the benefits that can be had from a not-for-profit, community option for health care. That's the public option -- and to get it, we're going to have to overcome the entrenched interests (and the money they've accumulated) that profit from the current system -- namely, insurance companies and the politicians they support.

Small Business and the Self-Employed

2009-08-11T20:39:00.001-07:00

I got a visit from Zach Everson today, which reminded me how much I learned from his archive post about freelancers and health insurance. His argument is that our system of employer-based health insurance makes people more likely to tolerate jobs they're overqualified for, and less likely to strike out on their own.

Because it's so hard to get individual health insurance -- because we have so few legal and competitive protections in the current health care system, and have to depend on employers to negotiate on our behalf with health insurance companies -- the status quo makes it hard not just for freelancers, but for small business as well. In a business with one owner and five employees, just acquiring and maintaining health coverage is a significant amount of expense and work -- and in a small business, labor and resources are often in short supply. The fact that so few small businesses are in a position to give health benefits makes them considerably less competitive for workers than larger employers -- would you really choose to work as a bookkeeper at an Internet startup when you could get health insurance running receipts at the Gap?

I think both political parties are in favor of entrepreneurship and small business innovation -- but the current system of health insurance discourages those values. Being able to rely on a standardized, centralized option for health insurance would be a godsend for a lot of small businesspeople. When opponents of the public option claim that they are pro-business, they're really only talking about one kind of business -- health insurance companies!

UPDATE: James Kwak's essay "You Do Not Have Health Insurance" got picked up at the Washington Post -- very excellent!

Gunk Club redux

2009-08-10T09:54:00.000-07:00

Still thinking about FIRM, Objectivism, and health care reform. A few things:

-- It occurs to me that what liberals and conservatives disagree over are which community values should be most important -- equality? Christian morality? Financial security? Competitiveness? Defense? -- but I think that liberals and conservatives would both easily agree that we should have community values in the first place. That's where both groups differ with the Objectivists, and the reason that Objectivists almost never identify themselves or their philosophy when they write articles. They don't hide it -- at least they don't put much effort into hiding it -- but they prefer to identify themselves with meaningless abstractions like 'reason' or 'objectivity'. I suspect that there are fiscal and social conservatives who read articles by Hsieh and company who would probably disagree with FIRM's fundamental beliefs, and I know that there are much stronger arguments against a public option than "doing things for other people is an immoral weakness."

-- Here's an interesting post on Objectivism in popular culture, in the video game Bioshock and the movie The Incredibles.

-- It occurred to me this morning how weird it is to call yourself FIRM. I mean, don't get me wrong -- I'm the founder of RIPPED (Rationalists In Peril of Perpetrating Educated Debate) and a signatory member of TURGID (Tactical Understatement Really Gets It Done), but FIRM strikes me as odd, somehow.

-- I found this entertaining tidbit on reddit.

In non-FIRM news (inFIRM? UnFIRM?), the New York Times published a solid introduction to health care reform today -- good on them for replacing their horse-race analysis of whether the bill will pass and who will win or lose with an actual investigation of the issue at hand.

The Gunk Club

2009-08-09T15:44:00.000-07:00

I had thought there was an almost infinite amount of health reform debate on the web -- but I was sort of wrong, because it seems that about 25% of it is the work of Dr. Paul Hsieh, the co-founder, most prolific author, and most furious reposter of the group FIRM (Freedom and Individual Rights in Medicine). So hey, I like freedom, and I'm real big on individual rights -- what's not to love?

Oh, right. Gunk. FIRM's other co-founder is Lin Zinser, JD (if you squint hard enough, it looks like 'MD'), who is an employee of the Ayn Rand Institute (scroll to the bottom) in charge of "outreach to professional communities". In fact, almost all links going to and coming from FIRM's web presence go to magazines and communities associated with Ayn Rand's philosophy, Objectivism. But hey, I like philosophy. No philosophy could possibly be made of gunk, could it? It couldn't, under any circumstances, be positively dripping with gunk, now, could it?

The gunkiest part of Objectivism, first theorized by Russian-American exile Ayn Rand during the height of the Cold War (she served, actually, as a friendly witness to the House Un-American Affairs Committee, which kicked off the Red Scare), is its ethics. Objectivist ethics are founded on what they call rational self-interest, with an emphasis on the self-interest. One of her most famous characters, John Galt, makes this oath: "I swear — by my life and my love of it — that I will never live for the sake of another man, nor ask another man to live for mine." In another of her novels, The Fountainhead, when architect Howard Roark feels that the vision of the building he's designed has been altered, he blows it up, regardless of the fact that he didn't physically build it and doesn't own it.

"Rational" self-interest is what Objectivists like Hsieh and Zinser are talking about when they publish articles like "Health Care is not a Right" or insist that "the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly." The vision of a doctor as someone who serves others out of love for humankind, or in order to create a more perfect society, never enters into the equation: doctors have the skills to heal, and they exchange them for profit. That's all. If it is more profitable for doctors to enrich themselves by treating a few people and ignoring the rest, then they should do it -- they have to do it, it's their moral responsibility.

What is most infuriating, though, about Objectivist self-interest is that it willfully ignores the contributions of others towards creating the very privilege that gives doctors their special knowledge and skills. Paul Hsieh got his MD from the University of Michigan, and Lin Zinsler attended not one but two state schools -- taxpayer funded, socialist education -- but even if they had been private school graduates, and hadn't received any government loan options, scholarships, or other community support, they would still be constantly dependent on the rest of us for day to day survival. Paul Hsieh is a radiologist -- he spends his days, I would guess, with complex CT, MRI, X-ray and other scanning machinery, each having hundreds to millions of parts, each part requiring its own manufacture, its own raw materials, and its own know-how. It is incontrovertable that one of those miners, manufacturers, plastics assemblers, or welders is uninsured or underinsured. That without the labor of people who Objectivists look down on, and intentionally refrain from helping, they would be unable to perform the tasks that bring them such pride and wealth.

Saying that doctors should have 100%, individual, self-interested control over who to treat and when is counter to the Hippocratic oath, which promises that "in every house where I come I will enter only for the good of my patients." To accept public funds and support for your own medical education, and then claim that public health care is immoral, is what we call the classic, creamy-style, industrial grade gunk.

You Do Not Have Health Insurance

2009-08-08T19:57:00.000-07:00

I wanted very quickly--it's hard sometimes to keep from posting more than once a day, and I've got work to do -- to direct you to this argument at The Baseline Scenario, which does a better job than I could of showing what a long, arduous road it can be from the day you pay your insurance premium to the day you are reimbursed for health care.

He hits the nail on the head when he points out that "as long as your health insurance depends on your job, your health is only insured insofar as your job is insured – and your job isn’t insured." Employer-based health care has some positives -- for one thing, our employers are likely to be organizations large enough to negotiate professionally with insurers -- but it shouldn't be the only game in town.

It just takes a minute to imagine what your life would be like if you got too sick to work. Try it now: if you can't work, how can you get insurance? Without insurance, how are you going to get medical care? Without medical care, how can you get back to work?

Noise

2009-08-08T11:54:00.000-07:00

Some disturbing news from my hometown, where a fistfight ended a town hall meeting on healthcare reform.

A lot of the negative commentary below the article centers on buzzwords -- socialism, 'Dimocrats', welfare, freedom vs. tyranny -- that I'm not really interested in. Where health care is concerned, I don't care which party wins a legislative victory, or whether a policy is capitalist/socialist, or any of that. Here's what I care about:

1) I don't have the money to get insurance from anyone except my school. I have never had enough money to get insurance from anyone except an employer; I probably never will.

2) I do not trust the insurance company my school has hired. I have never trusted an insurance company, and I have never seen or heard stories about an insurance company acting selflessly in the best interests of its clients.*

3) I want something else. I want a health insurance system that is not based on corporate profits, where I'm not working against a large, parasitic industry designed to extract as much money as possible from me. I see the public option as the best way to escape their control.

That's what's important to me. To my mind, the rest of it -- the partisan bickering, the resentment towards Obama, the screaming, the noise -- it's not good for anybody except the insurance companies.

* Feel free to leave counterexamples in the comments! There has to be, somewhere, one good and helpful private provider of health insurance, and I would like to know their name.

Rescission

2009-08-07T10:32:00.000-07:00

Rescission! Hah! Good God! What is it good for?

Profit profit profit.

Rescission is the insurance company practice of denying coverage to insured policyholders, and it is overwhelmingly applied in situations where the policyholder has a right to significant payment.

Here's the step by step:

1) You or your employer pay thousands of dollars in dues to an insurance company.
2) You get sick.
3) Your insurance company decides that in retrospect, you weren't eligible for coverage from the start, sometimes because you didn't fill out forms correctly, sometimes because they identify a previous condition that you didn't know about, and call you ineligible because of it.
4) The insurance company keeps all those dues, and you are suddenly sick, uninsured, and broke (because those dues weren't cheap!)

Rescission is different from the argument that expensive treatments aren't covered, it is a complete denial of all insurance and it's much more profitable for insurance companies. This article is the best explanation I've seen about rescission's impact on insurance company profits -- all the companies have to do is get rid of about half of a percent of their sickest patients, and their financial outlook becomes much rosier. Remember, though -- one of the things you pay for when you or your employer sends a check to the insurance company is a promise that if you become part of that expensive 0.5%, you'll be taken care of.

And let's not forget -- we live in a country where even 'not for profit' health insurance CEOs make millions and for-profit CEOs take hundreds of millions of dollars in stock options, while the number one cause of bankruptcy is health care bills.

Gunk

2009-08-06T23:26:00.000-07:00

There are some things about Sandy Szwarc's blog "Junkfood Science" that I really like -- but where the public option for health care reform is concerned, she's gone off the deep end.

"An ongoing debate has been unfolding among the public and medical professionals about whether the healthcare reform bill really requires mandatory counseling for every senior that will steer them to make advance healthcare decisions that could end their lives sooner, perhaps in order to lower healthcare costs."

This immediately makes my nostrils dilate, as if I have smelled fresh feces in strong sunlight. What she is opposed to is counseling? And is it even possible to force anyone into counseling outside of the legal system? I don't see any words like 'mandatory' in the legislation she quotes -- the only use of 'shall' I see is one that describes what counseling session 'shall' include, and I certainly don't see an enforcement mechanism -- i.e., what happens if people don't go. She claims that they will be identified as "noncompliant", which doesn't sound so bad to me.

While we're asking questions, though, who are "the public and medical professionals" that Sandy is talking about? They're debating, you say? Who exactly are those professionals? After a long excerpt from the legislation, she name-drops the "Bioethics Defense Fund" (I won't link you to them, because I find them pretty lame), which is an anti-stem cell, anti-choice, anti-cloning outfit that seems to be made up of as many lawyers as it is doctors. Any "Ethics Defense Fund" worth paying attention to doesn't resort to lame tactics like calling American health reform "Obamacare" or sponsoring bills to avoid "Octomom abuses". She also dings Wesley J. Smith, who works for the pro-intelligent design Discovery Institute. I would expect, if health legislation threatened the individual right to life, to see real organizations like the ACLU or the Catholic Church to step in -- not these ultra-right think tanks.

But they're not wasting their time, because this fear and outrage is just made up. Seniors will benefit greatly from the public option -- from not having to change doctors like they do now during the transition to Medicaid, from not being targeted by greedy and unethical 'additional insurance' scams, and most of all, from cheaper drugs whose cost is driven down by the government's ability to negotiate prices.

In any event, the shrill, alarmist tone, completely weak argument (Counseling! The horror!), and constant dependence on untrustworthy source material all lead me to sadly pin the first Medal of Gunk on the lapel of "Junkfood Science".

Image courtesy of:

http://www.flickr.com/photos/woodysworld1778/ / CC BY-SA 2.0

POSTSCRIPT: The people at Pulitzer Prize-winning PolitiFact look into claims similar to those that Szwarc makes and find them to be unequivocally false.

The Invisible Hand

2009-08-06T10:47:00.000-07:00

Some of the resistance to a national public health option that I've seen goes like this: free competition naturally makes services cheaper and more effective, and government interference ends incentives to excel (because nobody has to compete to succeed -- they just line up for free government money). This, I think, is true for transistor radios, furniture, cars, etc. But what about health care?

Unmoderated, unrestrained free-market competition is the last thing we want for health care. Can you imagine what would happen if one corporation gained a majority share in all the nation's hospitals? What would it be like if there was only one company (something like Microsoft in its heyday) that you had to deal with every time you needed an MRI or an X-ray? Compared to furniture, medical treatment is not a luxury -- when one of your feet goes numb and stays that way, it's likely that you'll pay whatever you have to.

We allow this kind of competition -- i.e. we allow insurance companies to grow until they have an unacceptable level of power over us and our lives -- right now. The AMA released an analysis (here) that says that two insurance companies -- WellPoint and United -- control 36% of the national market for health insurance. With mergers taking place faster than ever before, this amount could easily increase.

That's the national scene, though -- it gets worse in the cities. 16% of American metropolitan areas are dominated by an insurance company with a market share over 90% -- so if you want to get insurance in Texarkana, TX, or Battle Creek, MI you can pretty much only deal with Blue Cross/ Blue Shield. And if they don't want you? Tough!

Republicans and Democrats alike love to talk about the free market and free competition as if it is a basic American belief. It's not. Our innovations and our competition -- from cars to computers -- are built on a system of government-maintained roads and railways, protected by a government-run military, and managed by laws that we all agree upon. For some parts of our economy, this is the best choice -- to have government intervention. Health care is one of those parts!

But the insurance companies, greedy as all hell, hang outside our window -- don't you want free trade, they say? Don't you believe in the invisible hand?

Smoking

2009-08-05T22:00:00.000-07:00

I smoked for about seven years, and quit almost three years ago. Like many smokers, as time went on I started to get bronchitis every year, or an upper respiratory infection, or something -- I'm still not exactly sure what it was/is, because every time I went into the doctor's there was an odd unwillingness to talk about it. I'm pretty sure they knew I was a smoker, and I'm pretty sure they didn't want to put that down in my chart.

Now, I understand that people don't want to share costs for illnesses that come from bad behavior -- I regret every single cigarette I've ever smoked -- but in our present system, my doctors were unwilling to diagnose me as a smoker, unwilling to give me help in quitting, and unwilling to talk about the long-term risks of smoking. These are all free services, especially considering I was at the doctor's already. Why not even mention smoking? To protect me from the insurance company, of course, and to avoid increased premiums.

But wait -- doesn't the insurance company work for me? No, no they don't. They own me -- I don't have the resources to find insurance any other way than through my school, and everyone knows this, my doctors included. That's why I need to be protected from the company -- I'm at their mercy.

Or we could all work together to give everyone another option.

How do you get your insurance?

2009-08-05T03:23:00.000-07:00

How do Americans get their health insurance? Mine comes from my school -- but I'm going to graduate soon, and many of the entry-level jobs in my field (education) don't offer health benefits. This thread at Cynical-C has people sharing their situations and, most often, their resentments:

What are your insurance stories?

I had no idea that there were circumstances under which an employee wasn't eligible for COBRA, but Tom Woolf writes in:

"The company I worked for was the subject of a hostile takeover (”hostile” in this case making the Hatfields and McCoys seem like a petty disagreement). In the end, I kept my job, but it was very very iffy for a while. Because of that, I got my own health insurance. Folks who did not make the transition did not have Cobra as an option, and the original entity ended up going under, with all the assets being purchased by the takeover company."

The best way to get health insurance seems to be through Canadian citizenship -- I'm getting a little bit sick of the surprise and pity of Canadians that learn how bad the system in the US really is. They're particularly smug in these Metafilter comments:

Canadians pity USians!

Our system is perfect in one respect -- perfect for health insurance companies, who insure the well-employed, the healthy and the young, and leave the unemployed, the sick, and the elderly to be paid for by the government.

Insurance Companies Kill

2009-08-05T02:47:00.000-07:00

It might seem like a dramatic title -- do insurance companies really kill people? -- but the video below is one of the reasons I started this blog in the first place:

Linda Peeno confesses to manslaughter

They are stealing from us. Our government doesn't allow any of the things we need to live to be monopolized by businesses. We subsidize food -- we share water -- we give the air away for free. Why do we have a system in which one company determines the extent of your health care?

Basic Principles

2009-08-05T02:19:00.000-07:00

Hi, everyone.

My name is Nick, and I've been reading about health care reform pretty intensely over the last couple of months. I care about it because many of my friends have been uninsured for periods ranging from weeks to years. For reasons that will hopefully become very clear, I believe America and Americans need a public option for health care, and I don't intend to be particularly considerate of opposing views. In situations concerning abortion, drug arrests, euthanasia, welfare, or HUD, liberals and conservatives have real and reasonable differences. Where national health care is concerned, though, the United States is the ONLY developed nation that doesn't guarantee its citizens access to basic health care. At the same time, though, there are estimates (like this from Bloomberg) that the US will spend 20% of its GDP on health care by the year 2018.

Why? From my reading -- and I'm no expert -- I think there is one reason we are in this crisis.

The reason is that insurance companies have complete control over who gets care and who is paid for receiving care. Insurance companies have monetized and profitized our very lives -- if you need a kidney transplant, you have to call a bureaucrat at the home office and convince him that it's going to save the corporation some money. If you have leukemia -- and I'm sorry for using strong language -- go fuck yourself. No private insurance company will cover you -- you have to apply for Medicaid.

Insurance companies, some of the most profitable companies in America, make money when they insure the healthy, and lose money when they insure people who need significant amounts of health care. In this situation, they have chosen to ensure mainly the young and healthy, and have put great energy into denying the insurance claims of the sick. It's good business -- why would you insure a person you knew would get ill, and cost you money? Why wouldn't you try to reject them from your corporate program?

But we all get ill. We all need health care. Healthy twenty-year olds turn into very sick eighty-year olds. The most profitable attitude for an insurance company is to insure the twenty year old and reject the eighty-year old. Insurance companies have a lot of methods and justifications for doing this -- they are all unfair, and many are illegal. My blog hopes to shed some light on regular people's stories, and show why insurance companies are bad managers of our nation's health and well-being.

Anyway, I've talked too long. I hope you learn something from my blog, and I hope it makes you willing to talk to your senator and your representative. We can pass significant health care reform -- we have a President who wants it, and a Congress that generally prefers a public option. All we need is the strength of American citizens, demanding that ALL OF US deserve medical care.