The Loss Ratio and Insurance Industry Profits

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

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

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

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

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

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

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

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

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

Specifically, Women

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.

Mailsack

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.

Around the World

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?

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?

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?

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

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.

You Do Not Have Health Insurance

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?

Basic Principles

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.