New York Times: Obama Taps Health Aide With Links to Industry

By Sheryl Gay Stolberg. Published March 2 in the New York Times

WASHINGTON — In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, President Obama selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from Harvard Law School and Oxford University.

But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate.

In announcing her appointment Monday as the director of the White House Office of Health Reform, Mr. Obama expressed “absolute confidence” in Ms. DeParle, who ran the agency that oversaw Medicare and Medicaid during the Clinton administration. But the White House instantly faced questions about whether her appointment was skirting the spirit, if not the letter, of the president’s tough conflict-of-interest policy.

Since leaving the Clinton administration, Ms. DeParle has been managing director of a private equity firm, CCMP Capital, and a board member of companies like Boston Scientific, Cerner and Medco Health Solutions. White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.

“It is our view, and the view of counsel here, that the incidence of that will be very low,” an administration official said of the need for Ms. DeParle to recuse herself from decisions. The official, who was not authorized to speak publicly, said Ms. DeParle would be working mostly with federal agencies and lawmakers, and not directly with companies.

Allies of Ms. DeParle described her work in the private sector as a plus, because her familiarity with the industry would enable her to lean on companies to make tradeoffs essential in expanding access to the uninsured.

“She can call their bluff far more credibly and say, ‘Come on, guys, I’ve seen the books, I know you can do this with lower margins and higher market share, and you’ll do quite well,’ ” said Chris Jennings, who was President Bill Clinton’s top health policy adviser. “To me that’s very, very helpful.”

The appointment drew praise from some Republicans, including Bill Thomas and Jim McCrery, both former House members who worked closely with Ms. DeParle on health care. Mr. McCrery described her as “very knowledgeable, and very reasonable.”

At 52, Ms. DeParle, who is married to a New York Times reporter, Jason DeParle, is also no stranger to personal hardship. She grew up in a small town in eastern Tennessee and was raised by a single mother who died of lung cancer when Ms. DeParle was 17.

She went to college on scholarships and loans (she was the first woman president of the student body at the University of Tennessee) and attended Oxford on a Rhodes scholarship. At 29, she was hired by Ned McWherter, then the governor of Tennessee, to run the State Department of Human Services.

After working as a lawyer in Washington, Ms. DeParle joined the Clinton administration in the budget office and later oversaw a vast overhaul of the way Medicare operated.

Donna E. Shalala, a good friend of Ms. DeParle’s who was health secretary to Mr. Clinton, called Ms. DeParle “smart, fair, highly ethical and tough as nails,” and said her appointment, and the nomination of Gov. Kathleen Sebelius of Kansas as health secretary, should erase any concern about the withdrawal of the man Mr. Obama originally wanted for both jobs, Tom Daschle, the former Senate Democratic leader.

“This is a very good one-two punch,” Ms. Shalala said. “This is as good as it gets if you can’t have Daschle.”

This article has been revised to reflect the following correction:

Correction: March 6, 2009
An article on Tuesday about the appointment of Nancy-Ann DeParle to run the White House Office of Health Reform referred incorrectly to the ancestry of Ms. DeParle’s mother. She was a native-born American, not a Chinese immigrant. (Ms. DeParle’s father was from China.)

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Mark Weisbrot: Health Care Reform Is Needed Now More than Ever

Published on Monday, March 2, 2009 by McClatchy Newspapers

With the U.S. economy's downward spiral still accelerating and the federal government looking at its largest budget deficits since World War II, some are saying that this is not the time to expand health care coverage to all Americans.

But this is exactly the time for the Obama administration to move boldly on its campaign promise to implement a universal health care system.

Obama wants spending that stimulates the economy in the short term, but he also wants to reduce the long-term deficit problem after the economy recovers. This is exactly what health care reform will do.

In the short run, health care spending, like other government spending on goods and services, creates jobs and generates income. This will help arrest the economy's downward spiral.

With the collapse of private spending, the federal government must act as the consumer of last resort - hence the vital importance of the $787 billion stimulus package that Congress passed last week. Fortunately this package did contain at least some health care stimulus. In included $87 billion for Medicaid payments to the state governments, $25 billion towards helping unemployed workers extend their employment-based health insurance after being laid off, and $19 billion for health information technology.

But health care reform would do vastly more. President Obama has proposed a reform that would, while keeping the employer-based health insurance that covers most Americans, create a public health insurance system for the 46 million that do not have insurance. Large employers would be required to either pay into this system or provide their employees with insurance that is at least as good as the federal system. Individuals without insurance could buy into the public system, and the federal government would subsidize these payments so that they would be affordable for low-income households and those without ties to the labor force.

The White House estimates that their plan would cost $50-65 billion annually, but it would be better to spend much more than this, with more federal subsidies to employers to cover uninsured workers and improve existing coverage. As big as it may seem, the $787 billion stimulus bill passed by Congress amounts to less than 2.7 percent of GDP. This is not nearly enough to counteract our deep recession: the Congressional Budget Office estimates the output gap (i.e., how much output is below the economy's potential) at $2.9 trillion over the next three years.

Besides saving thousands of lives by providing health care to the uninsured, and supplementing the fiscal stimulus, health care reform has another huge advantage: it can drastically reduce future federal budget deficits. The vast majority of our government's long-term shortfall is due to exploding health care costs in the private sector. These spill over to the public sector, which currently finances about half the nation's health care costs. The United States spends about twice as much per person on health care as other high-income countries, and yet has worse health outcomes, including life expectancy and infant mortality.

The main economic reason for this colossal failure is that our system of private insurance and powerful monopolies is vastly more wasteful and inefficient than the health care systems of other developed countries. Insurance companies spend tens of billions trying to insure the healthy, avoid the sick, and deny payment for claims. Pharmaceutical companies take $350 billion of our health care dollars for drugs that cost a small fraction of that sum to produce.

The Obama health care plan won't eliminate most of these perverse incentives and waste - eventually we will need a truly national, single-payer system like Medicare to accomplish that. But it would be a big step in that direction, creating a nearly universal insurance system and laying the foundation for a sustainable system that can contain costs.

Mark Weisbrot is Co-Director of the Center for Economic and Policy Research (CEPR), in Washington, DC. His column is distributed to newspapers by McClatchy-Tribune Information Services.

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Katrina vanden Heuvel: Revolutionizing Primary Healthcare

originally posted on The Nation's Editor's Cut blog on February 28

“"If you are willing to volunteer in your neighborhood or give back to your community or serve your country, we will make sure that you can afford a higher education.”
-- President Obama, Address to Joint Session of Congress

I’'ve always believed it’s important that we redefine national service so that it isn'’t the exclusive province of the military. That is why this line in President Obama’'s powerful speech on Tuesday night was good to hear. One critical achievement in the Recovery bill was that it tripled funding for the National Health Service Corps (NHSC) to $300 million to provide incentives -- including debt forgiveness and grants -- for physicians and dentists, medical and dental students, to practice in underserved areas.

Thursday, Senator Bernie Sanders and House Majority Whip James Clyburn announced legislation that is very much in sync with the President’s stated priorities. The Access for All Americans Act -- with 21 Senate cosponsors and 72 cosponsors in the House -- would greatly expand the Federally Qualified Health Centers (FQHC) program
that currently provides primary care to 18 million Americans in 1,100 community health centers so that every American in a medically underserved area would have access to care. (Even George Bush supported this program.) It would also increase funding for the NHSC over the next five years to $1.1 billion, providing loan repayment and scholarships to those who pursue primary medical and dental care careers in underserved communities, recruiting 24,000 new healthcare professionals to serve those areas.

“"Insurance coverage is not the only health care crisis that we face,"” Sen. Sanders said Thursday at a press conference at the Capitol. “"Today, over 56 million Americans -- insured and uninsured--are finding it extremely difficult to gain access to a doctor. They'’re looking all over their community, they cannot get into a doctor’'s
office. This means that when [many] Americans get sick... they delay going to a doctor, then they end up getting sicker... and then go into an emergency room or end up in a hospital at great cost to our society and to themselves."” He noted that 18,000 Americans die annually due to their inability to afford insurance or care.

The legislation is timely since President Obama--who Sen. Sanders noted was the first co-sponsor of a similar bill he introduced last session--signaled Tuesday night that he intends to focus on "“preventive care, because that is one of the best ways to keep our people healthy and our costs under control.”" Also, President Obama
announced that his 10-year budget will include a $634 billion reserve fund for health care reform, half of which “"would come from proposed cost savings in Medicare, Medicaid and other health programs,”" according to the New York Times.

Both Sen. Sanders and Rep. Clyburn pointed out that federal community health centers in mostly impoverished areas--providing doctors, dentists, mental health counselors and low-cost prescription drugs on a sliding-scale fee so that no one is turned away--are one of the best ways to achieve those cost savings.

“"The American Academy of Family Physicians found that total medical expenses for health center patients were 41 percent lower compared to patients seen elsewhere, okay?”" Sen. Sanders later told me. “"On average, Medicaid patients seen at health centers have total medical expenses per year that are almost $1,000 less than Medicaid patients who use other providers--due to inappropriate emergency room use and unnecessary hospital admissions.”"

Sen. Sanders said that fully funding the bill would raise fifth-year spending from the current $2 billion for 1100 health centers, to $8.3 billion for 4800 health centers that would provide care to 56 million Americans. It’s estimated that about 17 million Medicaid patients would be among those receiving care. Just through reducing expenses by $1,000 per Medicaid patient, this would save the health care system $17 billion, more than twice the amount Sen. Sanders and Rep. Clyburn propose spending on the health centers.

Rep. Clyburn reflected on the history of the program that was created in 1966 by one of the cosponsors of the current legislation, Senator Edward Kennedy. Sen. Kennedy was inspired by a clinic opened in Boston by two graduates of Tufts Medical School. The Majority Whip said that the centers have become “"pillars in their communities”" throughout South Carolina, "often serving people who are “50 or 60 miles away from an emergency room.”"

In a statement, Sen. Kennedy -- who chairs the Health, Education, Labor and Pensions Committee -- said: “"At a time when the cost of health care and the number of uninsured are rising, community health centers and the National Health Service Corps are more important than ever. From inner city clinics to low-income communities across the country, they make a large difference in the health of millions of our people... I look forward to working with my colleagues to strengthen these two vital programs as part of our commitment to achieve quality, affordable health care for all Americans.”"

Rep. Clyburn said he would be speaking with President Obama about the legislation later in the day at a Congressional Black Caucus meeting at the White House.

“"Through these proven cost-effective programs, we have an opportunity, over the next five years, to provide comprehensive primary medical care, dental care, mental health counseling, and low cost prescription drugs in every medically-underserved region in the country, and remarkably, to actually save money in the process,”" Sen. Sanders later told me. “"In this hour of deepening economic crisis, President Obama has called on us to invest in programs that work and that meet our people’s needs. Community health centers and the National Health Service Corps do both.”"

With reporting from Capitol Hill by Nation Reporter/Researcher Greg Kaufmann.

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A Mother Asks President Obama To Be Honest About Healthcare

Note: The video from Wednesday's briefing on the Massachusetts healthcare system, which Donna Smith discusses here, is available online from Healthcare-Now.

by Donna Smith. Published on Friday, February 27 at CommonDreams.org

I am haunted again. Two stories told in very different venues and for very different reasons are nagging at my conscience. And I ponder the President's budget points designed to begin some down payment on healthcare reform. All I know for certain is that the two stories and the human suffering associated with them do not add up with Obama's confident campaign assertion of healthcare as a human right or the 10-year plan he'll now support as he charges Congress to work on larger reform issues.

We need honesty going forward. We need full disclosure of our options. We need courage and clarity. And we cannot have that if this President and this Congress participate is a pre-choreographed dance to reward the big health industry interests at the expense of the rest of us. Simply asking for-profit insurance giants to bid on Medicare Advantage business that is robbing many seniors and disabled folks of access to care they were promised under traditional Medicare is simply a poor attempt at gilding the lily - it is not reform.

During a briefing held in DC on Wednesday, Dr. David Himmelstein of Harvard Medical School (we still think those credentials adequate, do we not?) recounted the shortcomings of the Massachusetts model for health reform. Plan after state plan has cost more than anticipated, covered fewer than the promised universal claims and left states like Massachusetts and those that came before them in the same mess now faced throughout the land with soaring costs, inadequate delivery of what is sold as the financial protection called "health insurance," and with health systems begging for more cash.

Yet it was Dr. Himmelstein's final points that left me shaken. He said he has just treated yet another cancer patient who has decided to decline chemotherapy because he or she cannot afford the co-pays associated with the treatment. Dr. Himmelstein will have no choice but to honor the patient's declination of treatment for what they both know is a curable cancer. My heart breaks just thinking about it. Getting a cancer diagnosis stinks. I know. My cancer ripped open my life. I had to fight like Obama's mother to make sure I kept my job and got care - even though I had insurance. And knowing another cancer patient is deciding to die due to a lack of cash in the state some want us all to model is barbaric. And I didn't fight for this hope for change to remain in a barbaric state of healthcare delivery and financing.

I do not think for one minute that my new President has truly internalized this struggle - nor that of his own mother - as this Massachusetts cancer patient decides to die rather than bankrupt his or her family. Some kill themselves more abruptly. Others live longer but often fight with insurance companies as Obama's mother did. But this person in Massachusetts is hurting - this American citizen is dying a preventable death. And I am at a loss about how President Obama would explain his down payment on reform to this patient or the patient's kids or spouse... especially when it could be fixed.

Then I listened to ABC News tell the story about a McDonalds employee in Arkansas who came to the defense of a female customer being attacked in the restaurant by another man. The abuser shot the McDonalds employee in the chest. And now the McDonalds workers comp insurance company has decided that the employee's medical bills of more than $300,000 should not be covered because the employee was not acting during the normal scope of employment. Huh? Apparently, McDonalds thinks employees who see crimes being committed should first remember that flipping burgers and salting fries are their duties, not defending customers. Again, how very barbaric. But no sign of our President on this one either, no siree.

But, he tells us, he gets it. Really? Either I need to take President Obama at his word that he gets the immediate suffering of the American people and is willing to allow insurance companies to dictate life and death - quite literally - for years longer and become even more powerful dictators of the value of American life or he is just flat lying and he doesn't get it at all. I don't really like either of those possibilities.

If either of these patients - one with cancer in Massachusetts or the other trying to recover from a gunshot wound to the chest in Arkansas - lived in any one of the other industrialized nations on earth, they'd be treated with dignity and get the care they need without going broke. Maybe hero pilot Sully can fly them to another nation that respects human life enough to help? Somehow I think that would be fitting. Sick Americans need a hero long about now - a 10-year plan or a lousy expansion of the defective product known as private health insurance won't cut it.

Making the insurance industry bigger and more powerful through expansions of "coverage" to the millions of uninsured is not the only answer. It isn't even the best answer. And the severity of the crisis demands intellectual and policy design honesty from the get-go. If the American people get three years down the road and have another and deeper mess in healthcare robbing them of health and financial security brought to them by this President and this Congress, it won't matter much who inherited what - especially if this part of the process was tainted by dishonesty and special interest powers.

Lofty rhetoric cannot hide a basic dishonesty of discourse and this President knows it. Doing what's right requires us to fully explore every option available. "Ye Shall Know the Truth and the Truth Shall Set You Free," seems maybe a verse we may want to explore. And this President is not allowing that -- yet. He is tightly controlling who offers opinion and testimony, and only those already friendly to his pre-selected agenda are welcomed.

Let's open next week's summit to all plans and ideas - all we have to fear is - well, we know the finish to that line. If we see all reform ideas explained, studied for their costs (and scored by the Congressional Budget Office), their benefits and evidence of their viability, and we hear testimony from clinical RNs and practicing doctors invited and prized in the same way as the opinions from corporate docs and industry vetted officials and industry friendly voices, then we'll know that our President is serious about honest reform.

So far, many who advocate for the publicly financed, privately delivered option for health reform have been purposely and carefully screened out. That's dishonest and shows a lack of confidence that if all the facts were known clearly by the American people that they would choose the currently preferred political strategy -- to keep the defective product of for-profit health insurance and expand it and truss it up with massive amounts of taxpayer money and package it as healthcare reform. If that is the outcome that has already been promised to the health insurance industry that so heavily invests in this President and his friends, then tell us that up front, skip the expense of the forums and the summits and the exercises in self-congratulatory polls and just tell the patients in Massachusetts and Arkansas that you don't give a damn - you have friends to whom you are beholden above and beyond the citizens of this nation.

On the other hand, if Dr. Himmelstein's cancer patient in Massachusetts deserves at least some of the care afforded another prominent Massachusetts cancer patient - Senator Ted Kennedy - then let's open up the process, be as honest as we can and get to it. Because if we let another 10 years go by, more than a million Americans will die preventable deaths with the life and death decisions administered by those who don't care about any one of us anywhere near as deeply as they care about profits.

Mr. President, fully vet and fully disclose every available option for healthcare reform. Invite all voices into the summit - even a patient or two. To do otherwise would dishonor your mother's struggle and the two patients haunting my thoughts. And as the mother of three sons, I hope I can trust that even political ambition cannot trump a son's love for the woman who gave him life and fought for his welfare even as she fought her own cancer.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

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Josh Gerstein: It's Not Universal Health Care, but…

Published on Wednesday, February 25, 2009 by Politico.com

To the casual listener, President Barack Obama's promises on health care Tuesday may have sounded like an unequivocal vow to get all Americans health insurance coverage by the end of 2009.

But in reality, that's not exactly what he pledged Tuesday night.

Obama stressed the importance of "quality, affordable health care for every American" and struck an urgent tone. "Let there be no doubt: health care reform cannot wait, it must not wait and it will not wait another year," Obama said.

But in truth, Obama's speech contained several caveats and deliberately avoided language that could box in Obama as he turns swiftly toward health reform in coming weeks.

For one thing, Obama spoke of making a "down payment on the principle" of getting affordable health care for every American. It's a phrase that shows Obama believes that it could take some time to get everyone on board, and that helping everyone is a goal rather than a reality that will be achieved in the near future.

Parsing his statements even more closely, Obama never actually said he would get insurance coverage for all, just "quality, affordable health care."

And he stopped well short of setting any final timetable on broad-based healthcare - and also avoided the sweeping notion of providing "universal health care" to Americans, a phrase Obama himself largely avoids.

During his campaign, he was more specific than he was last night. ''We can have universal health care by the end of the next president's first term, by the end of my first term,'' Obama told a union convention in March 2007.

But if Obama left himself some wiggle room on the timing and particulars of a plan, he made clear he'll tackle it soon - even amidst the economic meltdown.

In fact, Obama said he believes solving the health-care crunch is an integral part to solving the recession - that he must do one to accomplish the other. In fact, Obama's talk on health-care often seems to spring more from the brain of an economist than the heart of a caregiver, as he often paints the solution in budgetary terms rather than in humanitarian ones.

"It's a step we must take if we hope to bring down our deficit in the years to come," Obama said.

Obama pledged to convene a health-summit next week that will bring together "businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue."

And advocates on both sides at the issue will get a clearer picture of what Obama has in mind when he releases his first budget Thursday.

Already some who favor universal coverage are watching Obama's words - and actions - very closely.

Ron Pollack of Families USA said he would accept a bill that phased in universal coverage. But he said before Obama's address that "piecemeal" legislation that covered some people now and left others to be dealt with later would be "truly troublesome."

Obama's delicate dance on health care reform is made more difficult by the fight he had with Hillary Clinton over the issue during the Democratic primary contest last year. Clinton favored requiring all Americans to get insurance-in policy parlance, a mandate.

Obama rejected that approach, saying he expected that most uninsured people would buy coverage if it was cheap enough. Obama isn't expected to endorse the mandate many experts say is essential to achieve "universal" coverage - but he's also expected to go along in the likely event that Congress includes one in health reform legislation.

A blogger with the American Prospect, Ezra Klein, reported Tuesday that Obama's new budget will strike an aspirational tone, by urging Congress to "aim for universality." White House spokesmen declined to confirm that language, though one top budget official did take issue with a portion of the Prospect report that said the budget's wording on health care "is changing hourly."

"The budget overview has been at the printer since Friday," said the official, who asked not to be named.

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Ezra Klein: How Entitlement Reform Became Health Reform

Medicaid and Medicare pay for health services on the private market; keeping those program costs under control depends on broad health reform. Check out the graphs at the "read more" link.

Published online at the American Prospect, February 23, 2009

It's testament to how deeply the idea of an entitlement crisis has embedded itself in Washington that news that Obama planned a "fiscal accountability summit" was immediately taken as proof by The Washington Post that he was readying a frontal assault on Medicare, Medicaid, and Social Security.

It was an understandable leap for the paper to make. Fiscal responsibility has, in this town, long been an anodyne synonym for entitlement reform. The "responsible" part signaled that you were courageous enough to cut treasured social programs in service of the national debt. The left, which never bought into this ruthlessly austere vision of responsibility, reacted with a defensive fury. It had just spent eight years protecting the entitlement programs from sharp-knifed "reformers." Would it have to do so again?

Today's "White House Fiscal Summit" will take place at 1:30 in the State Dining Room. It will feature speeches from the president and vice president and "breakout" sessions where Cabinet officials and White House advisers will gather in small groups to work on health care, Social Security, taxes, contracting and procurement, and the budget. (You'd think, by the time you were appointed to a presidential Cabinet, you'd be rid of "breakout sessions." You'd be wrong.) Notice what's not in there: Entitlement Reform.

Its absence is the product of a quiet but powerful change in thinking that has taken place in the offices of elite Washington and, now, the halls of the White House. Where a decade ago the looming fiscal threat of entitlement spending led economists and budget wonks to wear out their worry beads, today a more subtle understanding of our fiscal future dominates. In this telling, there's no such program as "SocialSecurityandMedicareandMedicaid." There's Social Security, which has modest long-term liabilities and needs little, if any, help. And then there's health-care reform. "That," says Henry Aaron, a senior economist at the Brookings Institution, "is the big kahuna."

How this happened depends on whom you talk to. Dean Baker, an economist at the Center for Economic and Policy Research, points to the 2005 Social Security privatization fight. "A lot of people were suddenly out there arguing that there's no crisis and we don't need to do anything on Social Security," he says. That forced left-of-center wonks who'd not thought much about the crisis to confront the numbers or, more precisely, the graphs. "We've done a graphic that shows what deficits look like in every country with longer life expectancies than us and what the deficit looks like going 70 years with the same per-capita health-care costs of that country."



It's a startling image. That orange line shooting into orbit? That's our projected deficit. That blue line levitating gently upward? That's our deficit if health costs grew more slowly. And those other lines sinking downward? They're our deficit if we had the per-person health costs of countries like France, Germany, and Canada. In all cases, Social Security spending remains unchanged.

Aaron locates his light-bulb moment in a paper written by Richard Kogan, Matt Fiedler, Aviva Aron-Dine, and Jim Horney for the Center on Budget and Policy Priorities. He remembers sitting around a table with Peter Orszag, now director of Obama's Office of Management and Budget, Bob Reischauer, who runs the Urban Institute, Bob Greenstein, who founded the CBPP, and an array of other economic luminaries while Kogan and Horney presented their findings. "The long-term fiscal outlook is bleak," they wrote, and "rising health care costs are the single largest cause."

Aaron says that the "meeting was sort of a slap-the-forehead moment. I said 'you guys are saying there is no problem other than a health-care financing problem long-term!' Credit goes to them, in my opinion." (An updated version of their paper, written with Kris Cox, can be downloaded here.)

What everyone agrees on is that the thinking entered government in the person of Peter Orszag. In 2007, Orszag was named director of the Congressional Budget Office. From that perch, he brought Kogan and Horney's thinking to the halls of Congress. Orszag liked to show a particular slide in his public presentations and speeches that broke down the interplay between the government's various fiscal commitments:



Government spending and Social Security, it says, will hold relatively constant in coming years. It's Medicare and Medicaid that chew up federal spending.

This graph, however, could be used as evidence for a simple focus on Medicare and Medicaid. The programs are unsustainable. They need to be slashed. The next slide in Orszag's presentation is titled "misdiagnosing the problem." The fiscal threat, it argues, is not more beneficiaries or the type of beneficiaries that are the factors internal to Medicare and Medicaid. It's the cost per beneficiary. Orszag has a graph for this, too:



And since Medicaid and Medicare pay for health services on the private market, this can only be fixed through broader health reform. Orszag now directs the Office of Management and Budget. He will lead today's "health care" breakout session. Richard Kogan works for him. So it's no surprise that asked for details on today's fiscal summit, one senior administration official told me that "the most likely outcome at this point is that we focus on health care given that it's the key to our fiscal future." Another explained the focus starkly. "Health is mathematically bigger," he said. The rumors originally held that eager entitlement cutter Peter G. Peterson would give the day's keynote. Now Robert Greenstein, director of the very think tank that released Kogan and Horney and Cox's paper, will speak.

Fiscal responsibility, in other words, is no longer a stand-in for entitlement reform. In Obama's Washington, it means health reform.

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Paul Waldman: There Is No Social Security Crisis

The conservative call for Social Security privatization has been drowned out by that crashing noise from Wall Street, but fear-mongering over long-term solvency continues. Should we believe the hype?

Published online at the American Prospect, February 24, 2009

There's a time-tested way to curry favor with the permanent Washington establishment. That is, having David Broder praise you for being "responsible" and being considered a Very Serious Person by the Sunday shows. All you need to do is proclaim ominously that entitlements are a ticking time bomb, a looming storm on the horizon, a hungry beast ready to devour our nation's finances, or whatever metaphor you find most frightening. The more unpleasant the solution you propose -- tax increases are good, but benefit cuts are even better -- the more the Beltway Brahmins will approve.

So yesterday's White House entitlement's summit, which appeared, when announced, to repeat the conventional doomsday wisdom, wasn't too much of a surprise. And indeed, at various times over the past couple of years, President Obama has seemed to suggest that he will be addressing this thorny long-term problem, leading to no end of heartburn among progressives who view Social Security as one of the cornerstones of the American social contract.

But as he has made clear, Obama is not unsheathing his blade to begin hacking away at our government pensions. Nonetheless, because conservatives will continue to conflate issues that should be separate and to further the assault on Social Security launched at the program's enactment in 1935, it's an opportune time to get a few things straight. The most important is this: There is no Social Security crisis.

If there is an "entitlement crisis," it's a crisis in Medicare. But as Ezra Klein explains so well, there really isn't a Medicare crisis, either. Medicare's funding problem is a problem of the ballooning cost of health care in general; fix that, and you've fixed the Medicare problem.

The myth of the "Social Security crisis" is so pervasive and so pernicious that it's necessary for those of us who actually believe in the program to respond to the crisis-mongers whenever we can. And they've got muscle -- witness the recent round of full-page newspaper ads featuring a looming iceberg and screaming headlines about the $56 TRILLION!!! we're supposedly in the red (these are funded by hedge-fund billionaire Pete Peterson, the Daddy Warbucks of the entitlement fear factory). So let's examine what the crisis-mongers say, and what the truth is.

For years, we've been told that Social Security is "going broke." It is also often said that at some future point, the program will "run out of money." Just last week, The Washington Post said matter-of-factly that "Social Security is projected to run out of money by 2041." This implies that at some future date, elderly recipients of Social Security will receive checks in the amount of $0, all the money having disappeared.

This is simply bogus. The truth is that the system is quite healthy and can meet all its future obligations with only minor adjustments or perhaps no adjustments at all, depending on what happens to the economy over the coming decades.

Before we get to that, let's remember how Social Security works. The payroll tax on today's workers is used to pay out benefits to today's retirees. When you retire, your benefits will be paid by people working then. (Of course, to many conservatives, a system built on this kind of mutual obligation is redder than Joe Stalin's underwear.) For some time now, the taxes being paid in have exceeded the benefits being paid out. What's left over goes into that famous "Social Security trust fund," also known as the Social Security surplus. The trust fund is still growing; in 2007, $179.3 billion was added to the fund, bringing its total to over $2 trillion.

If we weren't concerned about the future of the program, we could just take every bit of the collected Social Security taxes and pay them out in (extremely generous) benefits. That wouldn't be very smart, though, because that would leave us with nothing left over for the day when we start collecting less in taxes than we need to pay in benefits.

Enter the baby boomers, that endlessly self-absorbed, blood-sucking leech of a generation (I kid). Boomers have just begun to retire; in a few years, their numbers will cause the system to pay out more than it pays in. According to the Social Security trustees, who are responsible for overseeing the system, this will happen in 2017.

The prophets of doom believe that this date -- 2017, remember it, because they'll always bring it up -- is when the sky will tear loose from its moorings and begin hurtling toward our heads. But here's the thing: The period of benefits exceeding tax payments that is supposed to begin that year is exactly the reason why the Social Security surplus exists in the first place. We keep adding to the surplus every year precisely so that it will be there to draw on when we need it. And the baby boomers' retirement is when we'll need it.

But ah, you say, what happens when the trust fund is exhausted? Isn't that when all hell breaks loose, as the system truly "goes broke"?

No. The system will never "go broke." If you listen to the most commonly used estimate (we'll get to its inherent problems in a moment), the trust fund will run out in 2041, 32 years from now. "Even if a trust fund's assets are exhausted, however," the trustees write, "tax income will continue to flow into the fund. Present tax rates are projected to be sufficient to pay 78 percent of scheduled benefits after trust fund exhaustion in 2041 and 75 percent of scheduled benefits in 2082."

Like anyone else, I'd much prefer getting 100 percent of my benefits, rather than 75 percent of my benefits. But a "broke" system would give you zero percent, so if 75 percent is what the system can pay, I'll take it. A system that pays 75 percent of benefits isn't great, but it's not a disaster either.

Now we get to the reason why the system may actually be able to pay all its benefits. If you're going to make a prediction about tax revenues coming in over the next 75 years, as the Social Security Trustees must, you're going to have to make some assumptions about the economy. The stronger the economy is, the more people will be employed and the more they'll be earning, so the more tax revenue we'll have. The weaker the economy is, the less revenue we'll have. So what do the trustees assume about the strength of the economy? It turns out that their assumptions are remarkably pessimistic.

The trustees actually make three sets of predictions: a "high cost" prediction (the pessimistic one), a "low cost" prediction, and an "intermediate" prediction. The intermediate prediction is the one that gives us the 2041 date for the exhaustion of the trust fund. But it isn't just the "high cost" prediction that is pessimistic -- all three are.

As bad as things are right now, it's important to remember that the economy is going to recover from our current crisis. And after it does, we'll experience up periods and down periods, just as we have before. Although nobody can say what the economy is going to be like 30 or 40 years from now, the best tool we have to predict long-term economic growth is past performance.

But for some reason, the trustees are of the opinion that in the upcoming decades, the economy is going to grow at a far slower rate than it has. Although gross domestic product growth averaged 3.1 percent from 1966 to 2006, all three of the trustees' projections assume GDP growth lower than that. Even the optimistic "low cost" projection assumes that GDP will average 3.1 percent only until 2017, after which it predicts that growth will slow, averaging 2.9 percent for the rest of the 75-year window they're projecting. The "intermediate" projection assumes that economic growth will average 2.1 percent after 2017.

That's a prediction of pretty anemic growth, but that's the "intermediate" projection which everyone uses when talking about the future of Social Security. And perhaps it will prove true. But it seems that it wouldn't be too radical to assume that the "low cost" projection -- the one in which the economy over the next 75 years looks a lot like it has in recent decades -- is the one that will be closer to reality.

And what happens if you accept that low-cost projection? When does the Social Security trust fund run out in that case? Never. It never runs out (here's the graph, if you're interested).

The Social Security trustees aren't the only ones who have tried to crunch these numbers; the Congressional Budget Office estimates that the trust fund will be exhausted in 2049, not 2041, and that at that point tax revenues will cover 84 percent of benefits, not 78 percent. But looking at all the various projections, one has to conclude the following:

At some point, somewhere between 30 and 70 years in the future, the Social Security trust fund may be exhausted. If it is exhausted and taxes are not raised, beneficiaries will see a reduction in benefits that will be meaningful, though not catastrophic.

If that's how you understand the issue, it suggests that a fix to ensure that benefits end up where they're supposed to needn't be anything radical. You could raise the cap on Social Security taxes, for instance (the tax is only paid on the first $106,800 of income, meaning most people pay it on 100 percent of their salaries, while Alex Rodriguez pays it on less than 4 percent of his salary). If, on the other hand, you think the system is in crisis and is going broke, you're going to favor much more painful solutions.

Thankfully, President Obama seems to understand the difference between a manageable problem and a looming calamity. "Social Security, we can solve," he recently told The Washington Post with a dismissive wave of his hand. But we know that the conservatives will continue to harp on the myth of the Social Security crisis. One positive result of the economic meltdown is that they've been deprived of the main weapon they had in their arsenal on this issue: an alternative proposal. Until last year they had an analysis of the problem (the program is going broke) and a solution (privatize it). They could claim, however disingenuously, that they were offering a painless alternative: Put Social Security funds in the stock market, and everyone will get rich.

No one's going to say that now, of course, and probably not for a long time to come. Former President Bush's 2005 attempt to partially privatize Social Security was a spectacular flameout, and that was when the stock market was riding high. So all the Social Security Chicken Littles have to offer now is tax increases (unpopular) and benefit cuts (really unpopular).

The real problem is not that their solution to the crisis is unpalatable. It's that there is no crisis. Don't let them tell you otherwise.

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PNHP: Massachusetts Is No Model for National Health Care Reform

Another reason to urge your Representative to attend a briefing this Wednesday on the serious problems with Massachusetts health care reform. A new study by Physicians for a National Health Program reveals serious gaps and inadequacies in the state's mandated individual coverage. Physicians and this public interest group now urge Sen. Kennedy to introduce single-payer legislation.

The Massachusetts health care system, widely regarded as an example of how to provide universal coverage and keep costs low, is in fact faltering badly and should not be held up as a national model for reform, according to a study released this week by Physicians for a National Health Program (PNHP) and Public Citizen.

The study comes at a time when the health insurance industry is reportedly weighing in heavily in secret talks on Capitol Hill in favor of an individual mandate, a legal obligation requiring persons to have or to buy health insurance. The insurance industry's position was described in today's New York Times.

However, such mandates - which have been a cornerstone of the Massachusetts health reform - have failed to assure universal coverage, the new study says. For example, the state's most recent figures show that it had to exempt 79,000 residents from the mandate in 2007 because they could not afford to buy insurance.

The Massachusetts plan has also failed to make health care sufficiently affordable or to control costs, the report says.

The groups urged Sen. Edward Kennedy (D-Mass.) to reject his home state's approach and, instead, introduce Senate legislation crafted after the House's United States National Health Care Act, H.R. 676, which would implement single-payer financing of health care while maintaining the private delivery system. The two groups also released a letter to Kennedy signed by approximately 500 Massachusetts physicians and health professionals urging the senator to embrace single-payer reform.

"Massachusetts physicians have the unique opportunity to observe the effects of this reform on patients every day," said Dr. Rachel Nardin, president of the Massachusetts chapter of PNHP and lead author of the study. "The nearly 500 doctors who have signed the open letter to Sen. Kennedy see that the reform is deeply flawed." [Read Dr. Nardin's statement here.]

PNHP's study of the Massachusetts model found that the state's 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.

Many low-income residents, who used to receive completely free care, now face co-payments, premiums and deductibles under the new system - financial burdens that prevent many of them from receiving necessary medical treatment. Since the state's reforms passed, premiums under the state insurance program have increased 9.4 percent. The study found that if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

Many residents remain uninsured or have inadequate insurance.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government.

"We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits - all at the expense of American consumers," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "Massachusetts' failed attempt at reform is little more than a repeat of experiments that haven't worked in other states. To repeat that model on a national scale would be nothing short of Einstein's definition of insanity." [Read Dr. Wolfe's statement here.]

The study reported that a national nonprofit single-payer system could save Massachusetts about $8 billion to $10 billion a year in reduced administrative costs. Currently, Americans spend 31 cents of every health care dollar on administrative costs, by far the highest rate in the world and much higher than the 17 cents spent in Canada, which has single-payer universal health care.

"Big hospitals and insurers have gotten rich off reform, but a survey shows that more people directly affected by it have been harmed that helped," said Dr. Steffie Woolhandler, a PNHP co-founder and associate professor of medicine at Harvard Medical School who helped prepare the study. "We're seeing patients who now can't afford vital medications and treatments that they've been on for years because of the new co-payments and deductibles imposed by the law." [Read Dr. Woolhandler's statement here.]

To read the PHNP report, click here. For a letter from Massachusetts labor organizations to President Obama, click here. To read about how the Massachusetts law has affected some residents, see this article at Public Citizen.

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Et Tu, Atul?: Test-Case for a Single-Payer Hypothesis

"If you dig deep enough, you will find that that most people and groups who are opposed to single payer have ties to the health insurance industry."

by Russell Mokhiber
Published on Tuesday, February 10 at CommonDreams.org

A politician says -- I support health care for all.

That is a politician you should support, right?

Wrong.

A politician says -- I support universal health care.

That is a politician you should support, right?

Wrong.

Universal health care.

Health care for all.

More often than not, these are code words for -- keep the private insurance companies in the game.

The only way we are going to dramatically improve the health care system is to get the private insurance companies out of the game.

That means replacing the hundreds of private insurance companies with one payer.

One nation.

One payer.

Single payer.

Single payer already exists for Americans over 65.

It's called Medicare.

Why not single payer for everyone else?

Because the insurance companies don't want it.

And they have a lot of money and political influence.

Last week, Tom Daschle was forced to pull out as Obama's nominee for Secretary of Health and Human Resources because he failed to pay taxes on a limousine and chauffeur.

Or as one DC insider summed up Daschle's problem -- "he's a limousine liberal who didn't pay taxes on his limousine."

But what was widely overlooked in the flood of news last week?

Daschle's close ties to the health insurance industry.

The fact that he gave speeches to the industry's key lobbying group -- America's Health Insurance Plans (AHIP) -- at $20,000 a pop.

AHIP has one litmus test -- you must oppose single payer at all cost.

If you oppose single payer, you are with the insurance industry.

If you favor single payer, you are against the insurance industry.

Daschle opposed single payer.

He was with the insurance industry.

And against the interests of the American people.

Just go down the list of health advocates and advocacy groups -- and apply
this test.

Ron Pollack and Families USA -- opposed to single payer now.

Physicians for a National Health Program -- for single payer now.

SEIU -- opposed to single payer now.

California Nurses -- for single payer now.

Health Care for American Now -- opposed to single payer now.

Public Citizen -- for single payer now.

AARP -- opposed to single payer now.

And if you dig deep enough, you will find that that most people and groups who are opposed to single payer have ties to the health insurance industry.

I decided to test out my thesis with the case of Atul Gawande.

Gawande is the Boston surgeon and New Yorker writer.

And he's being pushed by Pollack and others as a replacement for Daschle at HHS.

In his most recent article in the January 26 New Yorker titled "Getting There From Here: How Should Obama Reform Health Care?" Gawande argues against single payer now.

I started looking to find out whether Gawande had ties to the insurance industry.

And sure enough, there it was.

Gawande is scheduled to give the keynote speech to AHIP's annual public policy conference on March 11 in Washington, D.C.

So, I shoot off an e-mail to the New Yorker and to Gawande and ask - is Gawande being paid by the health insurance industry for this speech?

And how much has he been paid by the insurance industry for speeches in the past?

And why weren't New Yorker readers informed of his ties to the industry?

Alexa Cassanos from the New Yorker writes back first.

"Atul Gawande does not accept speaking fees from pharmaceutical or medical-device companies, and speaking payments from insurers or insurance lobbyists are relayed directly to charity," Cassanos says.

Okay, a follow-up.

Why does he take money from the insurance industry but not from the pharmaceutical or medical device companies?

And how much has he taken from the insurance industry?

On the phone, Cassanos says "there's no story here," but that she will try and track down the information.

I next hear from Dr. Gawande, via e-mail, who points me to a just updated (February 6, 2009) conflicts of interest disclosure statement on his web page.

In it, Gawande says: "I don't benefit financially from speaking to for-profit medical businesses (whether they are drug companies, device companies, or insurance companies) -- either I'm not paid or I arrange for the fee to be donated to charity (including my family's church, our WHO work in patient safety, and a rural college my father started in India)."

I write back to Dr. Gawande.

I again ask him why he says he will not take money from medical device and pharma companies, but will take money (for his charities) from health insurance companies.

This time, he clarifies what Cassanos from the New Yorker said.

"The reason I haven't received money from for-profit drug or device manufacturers is that neither have asked me to lecture," Gawande says. "If either did and I accepted, I would donate the fee to charity or not accept the fee."

As for his insurance industry ties, Gawande writes:

"Since I decided in April, 2007, to write on health reform policy - I spoke to AHIP once (and the fee I received was donated to charity), I've scheduled to speak to AHIP again in March (that fee will be donated to charity), and I've not lectured to any for-profit insurers."

AHIP is of course the lobbying group (technically a non-profit) of the for-profit insurance industry.

"I would have received $31,500 in 2008 after the speaking agency's 30% fee was taken, and $28,000 in 2009," Gawande writes.

"I chose the charities independently and AHIP is not informed whom they are," Gawande says. "The charities are the Trinity Church, Boston, the Student Education Support Association which provides for students attending a nonprofit college my father started in rural India, and the Brigham and Women's Hospital Foundation for our work with the WHO to reduce unsafe care globally -- I am not permitted to benefit financially from these funds."

Gawande does not reveal what he was paid by the insurance industry prior to April 2007.

He has been speaking to AHIP groups around the country since at least 2004, according to the AHIP web site.

But more importantly, don't his New Yorker readers deserve to be told that his favorite charities -- including his church, a non-profit set up by his father, and a foundation affiliated with the hospital where he works -- are benefiting financially - and by how much -- when he speaks to the private health insurance industry ?

As for his opposition to single payer, he remains steadfast.

In a q/a with New Yorker readers last week, Gawande defended his opposition to single payer now.

"Replacing the entire health-financing system with Medicare would require most working-age people to leave their current insurance plans," Gawande writes. "It would change the finances of every hospital and doctor in the country overnight. It would require replacing the premiums we pay with a tax, with massive numbers of both losers and winners. It seems simple in theory, but in practice it never is. This would be a whole new path for health care. No country has swept away their health system and simply replaced it like that. As I said in the article, one would have to be prepared for an overnight change in the way people get 3.5 billion prescriptions, 900 million office visits, 60 million operations - because how these are paid for is critical to whether and how they are provided. Doing away with private insurance coverage is no less sweeping than saying we'll do away with public insurance programs or do away with employer-paid health care. No major country has simply swept away the way so many people's care is paid for. And the reason is that people have legitimate fears about what will happen to them."

Dr. David Himmelstein, a founder of Physicians for a National Health Program, calls this argument "bogus."

"Patients do not care what their insurance plan is - just that it pays for the care they need. A transition from a system where virtually everyone has only partial coverage to one where they have full coverage is not a disruption for patients," Himmelstein said when we asked him to respond to Gawande. "Several nations have made abrupt changes in the financing of care. The UK instituted the National Health Service - eliminating insurance and private payment for care at a stroke. Each Canadian province went from a private insurance system very like ours to its current system virtually overnight -- though not all provinces underwent the change simultaneously. Taiwan changed to a single payer system about 10 years ago at a stroke."

"Medicare replaced private coverage for the elderly -- who account for about 30% of all hospital patients -- about nine months after its passage. That occurred in an era before computers. The entire task of enrolling tens of millions of patients, inspecting virtually every hospital in the nation -- to certify that they were desegregated, which was mandated by the Medicare law -- and set up a new payment apparatus was carried out using paper records. Why is a shift of the other two-thirds of our system more difficult?"

"The new payment system would be far simpler than the current one -- hospitals would receive a global budget, which initially would be based largely on their previous year's revenues. Medicare currently collects all of the financial info needed to do such budgeting at the outset. Per-patient billing for hospital care would be eliminated. For doctors, Medicare already has a fee schedule, which should be modified somewhat, but already serves as the benchmark for most private plans. Expanding this payment system to cover all fee-for-service billings would be trivial. Paying for drugs is similarly pretty simple and straightforward, with most of the needed infrastructure already in place."

"In sum, his arguments are bogus unless you assume that we are far less competent than people in other nations, and than we used to be," Himmelstein said.

Gawande will travel to Washington on March 11 to speak to AHIP.

The title of his speech -- Fixing Health Care from the Inside Out: The Physician's Role in Health Care Reform.

The majority of physicians in the United States now support a single payer system.

Dr. Gawande does not and is coddling the private health insurance industry.

When Daschle was driven out of office last week, a DC insider made the following observation:

When people first come to Washington, they see it as a putrid swamp that breeds corruption.

But after they stay awhile, they begin to see it as a hot tub.

Et tu, Atul?

Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter.

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Cognitive Dissonance: The Healthcare Reform Battle's State of Mind

by Donna Smith. Published on Friday, January 30, 2009 by CommonDreams.org

It seems everyone in the healthcare reform movement is hitching up his or her britches and feeling mighty proud of the prospects for action under President Obama and the adoring Democrats in his Congressional arsenal. Even some prominent Republicans are inching ever closer to supporting change to the broken health system. But I'm feeling significant dissonance between the words spoken and the policy offered to move forward.

So listening to the speakers here at the Families USA Health Action meeting this week has been upsetting - OK, it is outrageous to watch these folks being self-congratulatory while also promoting those purporting the overhaul of the health system with the biggest bailout we've yet given any industry in recent months. The proposed mandates for all Americans to purchase private, for-profit health-insurance (or buy into a public pool that will be weakened by the insurance interests) is being sold to us as reform and it simply is not. And my brain hurts from the disconnect.

I cannot reconcile Princeton's Uwe Reinhardt's message that we've become an aristocracy - not a middle-class society or even a democracy - with his embrace of the insurance industry and expansion of the broken healthcare system that clearly provides better healthcare protection for our American royalty and not the peasants among us. He carefully charts for us the rising debt of American families - including crushing medical debt assumed under the for-profit health insurance based system-and the lack of savings by Americans in recent years. But there is little acknowledgment that some of the debt and lack of savings directly relates to the increased costs American families and workers must shoulder for health coverage - health coverage that doesn't adequately protect financial standing.

Sen . Charles Grassley of Iowa assured the crowd that there's a big difference between the Hillary Clinton plans of years gone by and the Obama plan now - "He (Obama) will stick to his guns on a private-public mix (for insurance)." Grassley goes on to say everyone knows you get over-utilization when you have "gold-plated" plans. The implication is always that if you give access to care then millions of us will clamor to sit in doctors' offices and get procedures and tests done simply because we have the means to do so. I actually think the gold-plated stuff will be reserved for Sen. Grassley and his cohorts - the rest of us will work hard to even get a plan that can assure minimal coverage or care. Grassley said they'd remind the Democrats that they said they'd adhere to a "pay as you go" with healthcare reform and other programs. Here's the nod to the "bi-partisan" efforts we hear will guide the day for us all - the new agenda, the cooperation that will bring us all to the promised land of expansion of the insurance industry.

Then the Dems. I hear Rep. Steny Hoyer rightfully cite his outrage about a Maryland child dying for want of a tooth extraction, yet stay safely and clearly away from angering the insurance industry. I listen as Sen. Debbie Stabenow of Michigan talk about her compassion for families struggling for care yet quickly adding when she talks about providing healthcare for immigrants that we should reward with healthcare those doing "the right thing." I have a hard time reconciling the disconnect between the suffering unfolding every day - death by death by denial by denial - as the dance continues.

We want a "uniquely American" answer to the healthcare nightmare, they all say. I've heard that until my brain hurts just considering it. Oh, we're unique all right. We're the only industrialized nation on earth that tolerates the killing of its citizens on our own soil at the hands of this healthcare system and then wants to fix it all by handing more business, more money and more power to the same industry committing the murders. That's unique enough.

None of this sounds like the language of basic human rights. And I think I heard our new President say that he clearly understood healthcare to be a human right in response to a debate question just a few months ago. That was such a gift just to hear the words spoken. I just know he knows that this basic human right is not going to be protected by hoodwinking the American people into bailing out the insurance industry.

The heavily funded activists (come on folks, that alone should send up big, red flags - heavily funded activists for human rights?) pushing for a private-public national healthcare policy are in and of themselves a conundrum to me. I hear on the one hand the message that the private, for-profit health insurance industry is very bad indeed - blocking healthcare through denials and high premiums and all the practices the American people have had to endure for years. But then I also see the activists and the industry folks co-mingling ever so deftly in a dance of political theater aimed at convincing us all that in response to demands for insurance regulation and restriction the industry will put up a fight but then capitulate to the demands or risk being left behind.

Look at the list of bedfellows and trust your instincts America. Like our moms and dads taught us, if it walks like a duck and quacks like a duck, guess what? It's a duck. A bailout called healthcare reform is still a bailout even if we're told otherwise. If AARP and UnitedHealth Care and Wal-Mart and SEIU and the others in the HCAN coalition are joining hands and forces, is there anyone among us who doesn't know that's about money and power and influence still? That's a duck. And that's going to be a very well treated duck.

So, let me get this straight... the insurance industry has been a big part of the problem. Worse. The industry has allowed the deaths of tens of thousands of Americans every year in order to protect profits.

I think of dead -- 2-year-old Mychelle Keyes and dead 17-year-old Nataline Sarkisyan and dead 38-year-old Tracy Pierce, and that dead little boy with an infected tooth in Maryland -- and I don't wonder at all what the new for-profit insurance-friendly political coalitions are fighting to protect. And it isn't the future Mychelle's or Nataline's or Tracy's. They are fighting to protect the folks who killed them.

All of these dead were killed at the hands of the industry now being simultaneously chastised and coveted. This same greedy industry can be trusted to roll over just a little while helping craft their own industry's regulations going forward? Oh, yes, that seat at the table is firmly fixed and being kept ever so warm for the insurance folks. In exchange for setting some of their own regulation, the insurance industry will be rewarded with the business of millions more of us who have had absolutely no say in the matter. None.

Those Americans not acting as political operatives for the quasi-activists organizing the reform transition for the insurance industry are not exactly anxious to hear from you and me. No, they have well-heeled and well-connected leaders who rub elbows and move easily within all of the halls of power where we can never go.

And unless we rise up and say we know what is going on and we smell a lot of big, fat rats, reform that expands the broken system and enriches the already elite of the healthcare profit-mongers will be sold to us by bipartisan bluffing and insurance company operatives slip-sliding us forward.

As for me, I will keep listening to Rep. John Conyers talk about human rights and healthcare for all and the long arc of history leaning towards justice. Oh, and his talk about how the automakers just barely across the river in Canada can build cars much more cheaply than in his native Michigan because they don't suffer the health-insurance nightmare. Huh? Human rights and good business. I do like the quack of that. And my dissonance subsides...

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

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John Nichols: Single-Payer Health Care Would Stimulate Economy

Published on January 15, 2009 by The Nation, and posted on CommonDreams.org, here.

There is an unhealthy tendency on the part of politicians and journalists to see discussions about economic recovery and health care reform as separate debates.

In fact, one of the most important steps on the road to economic recovery - or, more precisely, toward a new, responsible and sustainable prosperity - involves the fundamental reform this country's broken health care system.

But it must be the right reform: the establishment of a national single-payer style healthcare reform system by expanding the existing Medicare system to cover all Americans. According to a new "Single Payer/Medicare for All: An Economic Stimulus Plan for the Nation" study released today by the National Nurses Organizing Committee/California Nurses Association, such a reform would provide a major stimulus for the U.S. economy by creating 2.6 million new jobs and infusing $317 billion in new business and public revenues into the economy. This reform would, according to the study, add $100 billion in wages to the currently sputtering U.S. economy.

Indeed, notes the NNOC/CAN, the number of jobs created by a single-payer system, expanding and upgrading Medicare to cover everyone, parallels almost exactly the total job loss in 2008. "These dramatic new findings document for the first time that a single payer system could not only solve our healthcare crisis, but also substantially contribute to putting America back to work and assisting the economic recovery," says NNOC/CAN c o-president Geri Jenkins, RN.

Specifically, notes Jenkins, expanding Medicare to include the uninsured, and those on Medicaid or employer-sponsored health plans, and expanding coverage for those with limited Medicare, would:

1. Create 2,613,495 million new permanent good-paying jobs (slightly exceeding the number of jobs lost in 2008) -- and jobs that are not easily shipped overseas
2. Boost the economy with $317 billion in increased business and public revenues
3. Add $100 billion in employee compensation
4. Infuse public budgets with $44 billion in new tax revenues

"Through direct and supplemental expenditures, healthcare is already a uniquely dominant force in the U.S. economy," says the study's lead author, Don DeMoro, who directs the Institute for Health and Socio-Economic Policy, the NNOC/CNA research arm. "If we were to expand our present Medicare system to cover all Americans, the economic stimulus alone would create an immense engine that would help drive our national economy for decades to come.

The union is highlighting its "Single Payer Job Recovery" plan with a major rollout today and activists with Progressive Democrats for America and other groups that support single payer are staging a national call-in to Congress Thursday. Here's the PDA Action Alert on the new push for single payer:

"Congressman John Conyers will reintroduce HR 676, his single-payer healthcare bill in the 111th Congress. Please ask your representative to cosponsor the bill and actively work with Rep. Conyers to gain additional cosponsors. In order to ensure HR 676 is part of the healthcare discussion in Congress, we need 150 cosponsors by the end of February.
Former Sen. Tom Daschle, President-Elect Obama's nominee for Secretary of Health and Human Services, called for "a government-run insurance program modeled after Medicare" in testimony before the Senate Committee on Health, Education, Labor and Pensions as part of the solution to our healthcare crisis. His plan also includes health insurance corporations. Only HR 676 would implement a sustainable, fair, and efficient solution to the healthcare crisis as well as providing economic stimulus.

"While single-payer healthcare proponents have made good headway in the House, there is still no companion bill in the Senate. Urge Sen. Edward Kennedy to sponsor a companion bill to HR 676 in the Senate."

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Derrick Z. Jackson: The nation's social bargain with the rich

An op-ed from the Boston Globe, September 30, 2008

Congress has been rushing to save financial CEOs from themselves with a $700 billion bailout that amounts to a tax of $2,333 on every man, woman, and child in America. This is after three decades of the nation's leaders punishing struggling Americans for their lack of personal responsibility, from Ronald Reagan's assault on "welfare queens" to the bipartisan slashing and capping of welfare benefits by President Clinton and House Speaker Newt Gingrich.

More recently, presidential candidates John McCain and Barack Obama have said undocumented folks should pay fines to get in line for citizenship.

Then, of course, there were the 1.5 million home foreclosures last year and the 2.5 million foreclosures projected for this year by Treasury Secretary Henry Paulson. Many economists and politicians have washed their hands of them, saying, tsk, tsk, they were irresponsible for taking on too much responsibility!

If scapegoating struggling Americans on personal responsibility fails to work, we just ignore them, as sure as the Ninth Ward of New Orleans remains the American Dresden after Hurricane Katrina - while rebuilt Gulf Coast casinos break new revenue records.

All those millions of Americans, facing everything from slashed food stamps to swamped homes, live in a patronizing America where Clinton signs the 1996 welfare bill by saying, "We're going to take this historic chance to try to recreate the nation's social bargain with the poor. We're going to try to change the parameters of the debate. We're going to make it all new again and see if we can't create a system of incentives which reinforce work and family and independence. We can change what is wrong."

No broad parameters are being changed for greedy or incompetent Wall Street CEOs, as the financial sector assures itself a compliant Congress with $2 billion in campaign contributions since 1990 (Obama and McCain have respectively received $25 million and $22 million in campaign contributions from the financial sector in this campaign cycle, according to the Center for Responsive Politics).

Negotiators on the hill do say they will tax bailed-out companies for executive salaries over $500,000, but Wall Street found its way around similar rules in the past.

Yesterday, amid increasing outrage, the House failed to pass the bailout bill.

No bailout should happen without recreating the nation's social bargain with the rich. The nation can no longer afford the disparity where the average American CEO makes 344 times the pay of the average worker, according to the Institute for Policy Studies and United for a Fair Economy. The CEOs and their boards should pay toward the bailout before a penny of that possible $2,333 comes out of the pockets of Americans.

There is more than enough money among the financial elites to pay for the bailout. The Institute for Policy Studies last week calculated that a securities transaction tax of a penny for every $4 invested would add $100 billion a year to the treasury. Had such a tax been in place after the 2001 Enron scandal, it would have added up to the current cost of the bailout.

A wealth surcharge of no more than 3 percent on households worth more than $10 million would add another $300 billion. In response to the news this year that two-thirds of American corporations paid no income tax between 1998 and 2005, a corporate minimum income tax could add another $60 billion.

The institute said a 50 percent tax on salaries of $5 million or more and 70 percent on salaries of $10 million or more - until the bailout is over - would add another $105 billion. Killing overseas tax shelters, loopholes for excessive CEO pay and the sale of mansions, and creating a progressive inheritance tax would add another nearly $300 billion.

Institute senior scholar Chuck Collins said that would be a much more fair way to deal with the consequences, and discourage a worsening of "casino capitalism," than
the rush to dump this on the taxpayer. "Many of these things have been examined, but not implemented," Collins said, "But Congress essentially punted on how to pay for
the bailout."

If Congress is the punter, the people are the football being kicked once again far downfield as Congress and the CEOs high-five with relief from the skybox.

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Bernie Sanders: Bailout Transfers Wealth - Upward

by John Nichols, posted on CommonDreams.org, September 21, 2008

Democratic presidential candidate Barack Obama, like rival John McCain, has yet to take a stand one way of the other on the proposal to have U.S. taxpayers bail out the worst players in the U.S. financial system with a scheme to buy up $700 billion worth of bad loans.

Obama calls McCain "the great deregulator" and warned that the Republican would do to the health care system what had been done to the banking.

McCain's campaign called Obama a "directionless driver" on the economy.

Obama was for helping Wall Street and Main Street, which was better than just helping Wall Street... but not much, when you consider that Main Street rarely wins these wrestling matches. McCain was for keeping "people in their homes and (safeguarding) the life savings of all Americans by protecting our financial system and capital markets," which is this week's variation on the "sound economy" in "crisis" dichotomy of last week.

But neither candidate took a clear stand on the proposal that's being placed on the table.

So what should the contenders -- especially Obama -- be saying?

How about borrowing a page from Vermont Senator Bernie Sanders, who served as a member of the House banking committee before his election to the Senate, where he is now a member of the budget committee.
Sanders actually understands how the current crisis got started.

And the independent senator understands that what is being proposed by the Washington and Wall Street mandarins who got us into this mess as a fix is actually bad policy on steroids.

Here's what Sanders says -- and what Obama and the Democrats should be saying:
For years, as a member of the House Banking Committee and now as a member of the Senate Budget Committee, I have heard the Bush Administration tell us how "robust" our economy was and how strong the "fundamentals" were. That was until a few days ago. Now, we are being told that if Congress does not act immediately and approve the $700 billion Wall Street bailout proposal these "free marketers" have just written up, there will be an unprecedented economic meltdown in the United States and an unraveling of the global economy.

This proposal as presented is an unacceptable attempt to force middle income families (and our children) to pick up the cost of fixing the horrendous economic mess that is the product of the Bush Administration's deregulatory fever and Wall Street's insatiable greed. If the potential danger to our economy was not so dire, this blatant effort to essentially transfer $700 billion up the income ladder to those at the top would be laughable.

Let us be clear. If the economy is on the edge of collapse we need to act. But rescuing the economy does not mean we have to just give away $700 billion of taxpayer money to the banks. (In truth, it could be much more than $700 billion. The bill only says the government is limited to having $700 billion outstanding at any time. By selling the mortgage backed assets it acquires -- even at staggering losses -- the government will be able to buy even more resulting is a virtually limitless financial exposure on the part of taxpayers.) Any proposal must protect middle income and working families from bearing the burden of this bailout.

I have proposed a three part plan to accomplish that goal which includes a five-year, 10% surtax on the income of individuals above $500,000 a year, and $1 million a year for couples; a requirement that the price the government pays for any mortgage assets are discounted appropriately so that government can recover the amount it paid for them; and, finally, the government should receive equity in the companies it bails out so that when the stock of these companies rises after the bailout, taxpayers also have the opportunity to share in the resulting windfall. Taken together, these measures would provide the best guarantee that at the end of five years, the government will have gotten back the money it put out.

Second, in addition to protecting the average American from being saddled with the cost, any serious proposal has to include reforms so that we end the type of behavior that led to this crisis in the first place. Much of this activity can be traced to specific legislation that broke down regulatory safety walls in the financial sector and allowed banks and others to engage in new types of risky transactions that are at the heart of this crisis. That deregulation needs to be repealed. Wall Street has shown it cannot be trusted to police itself. We need to reinstate a strong regulatory system that protects our economy.

Third, we need to address the needs of working families in this country who are today facing very difficult times. If we can bail out Wall Street, we need to respond with equal vigor to their plight. That means, for example, creating millions of jobs through major investments in rebuilding our crumbling infrastructure and creating a new renewable energy system. We must also make certain that the most vulnerable Americans don't freeze in the winter or die because they lack access to primary health care.

Finally, we need to protect ourselves from being at the mercy of giant companies that are "too big to fail," that is, companies who are so large that their failure would cause systemic harm to the economy. We need to assess which companies fall into this category and insist they are broken up. Otherwise, the American taxpayer will continue to be on the financial hook for the risky behavior, the mismanagement, and even the illegal conduct of these companies' executives.

These are the last days of the Bush Administration, the most dishonest and incompetent in modern American history. It is imperative that, at this important moment, Congress stand up for the middle class and for fiscal integrity. The future of our country is at stake.
Read the original posting here.

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Health Care Could Sway Nevadans

By JENNIFER STEINHAUER

Published: January 18, 2008

http://www.nytimes.com/2008/01/18/us/politics/18nevada.html?ref=us
http://www.truthout.org/docs_2006/011808O.shtml

LAS VEGAS — Voters in Nevada fret about the economy. Many are disquieted by the war. They worry about taxes, the federal threat of a nuclear waste site in their midst, immigration and gun rights.

Multimedia Interactive Graphic State Profile: Nevada Graphic The Presidential Candidates on Health Care Isaac Brekken for The New York Times "Is that the kind of life we fought for?" ANTHONY DiMARIA, a former marine who says the V.A. will no longer provide care Isaac Brekken for The New York Times "There are millions of people who can’t get coverage." TERRENCE M. JACKSON, a lawyer who pays $15,000 a year for his daughter’s health insurance Isaac Brekken for The New York Times "It’s the pits. Don’t ever get old." CAROL WILKEN, with her husband, Jim, at a Las Vegas retirement community

But with the Nevada caucuses coming Saturday, little seems to concern people here as much as health care. The state has an unusually high number of people with no insurance, doctors are hard to come by, Medicaid reimbursements are low and health care safety nets are eroding. “I used to be able to go to the V.A. and they’d take care of us,” said Anthony DiMaria, 84, who served in the Marine Corps. “Now they send you a letter saying you have what they call ‘means,’ and they aren’t going to take you in anymore. Is that the kind of life we fought for?” Just as the presidential nominating contests in other states have been defined in part by national issues with local poignancy — immigration in Iowa, unemployment in Michigan — Nevada’s caucuses could turn on how well the candidates address the United States’ growing health care crisis. Older voters — and the children who help care for them — worry about Medicare benefits, young people in jobs without coverage say they cannot afford to pay for their own and most everyone knows or has cared for someone with too little insurance. In interviews with 30 registered voters around this city — in a retirement community, a middle-class neighborhood and downtown on the steps of a courthouse — almost half said that health care was the most compelling and worrisome problem the candidates needed to solve. “I have a daughter who had a major car accident three years ago and she can’t get health insurance,” said Terrence M. Jackson, 61, a lawyer. “I pay $15,000 a year for her medical coverage. And there are millions of people who can’t get coverage.” Among Democrats — whose caucuses are the main event on Saturday because Republican candidates have largely sidestepped the state — voters were particularly outspoken in identifying health care over the mortgage foreclosure crisis, the national economy or the war in Iraq as their principal concern. “We had to go to one of those plans that are Medicare-driven and they tell you what you’re going to do and not going to do,” said Carol Wilken, 62, who said at a retirement community here that the candidates’ health care plans would drive her vote. “It’s the pits. Don’t ever get old.” While insurance difficulties plague nearly every state, Nevada has come to its problems in some unique ways. The fastest-growing state for most of the last two decades, it has a largely mobile employee base — particularly in Las Vegas — with residents who move from job to job, often never gaining insurance. The state’s large Hispanic population — which tends to lead the numbers of uninsured — further contributes to the high numbers. Finding doctors who will accept Medicaid is difficult in the state, especially in rural areas, and the state’s income eligibility requirements are high and the paperwork required to enroll is excessive and inaccessible compared with other states, health care experts say. A recent poll of 500 likely Democratic voters in Nevada found health care to be “the single most important issue in determining” a presidential vote among 20 percent of those polled. Only the economy, with 21 percent, was mentioned by more respondents. (The poll, conducted by Research 2000 for The Reno Gazette-Journal, has a margin of sampling error of plus or minus four percentage points.) The percentage of people without insurance in Nevada is among the highest in the nation, significantly higher than in Iowa, New Hampshire or Michigan — the states that have already voted. According to the Census Bureau, an average of 18.3 percent of Nevadans did not have health insurance from 2004 to 2006, compared with 9.3 percent in Iowa. The Democratic and Republican candidates concur that affordable health care eludes many Americans, but they are deeply divided on how to remedy the problem and insure the 47 million people without health insurance. The Democrats, whose plans would cost $65 billion to $100 billion annually, believe that the federal government should play a role, in part through the elimination of the Bush administration’s tax cuts for the wealthy. Senator Hillary Rodham Clinton of New York and John Edwards, the former North Carolina senator, say they would require all Americans to get coverage and would provide subsidies to that end, while Senator Barack Obama of Illinois would require only children to have coverage. Mr. Obama’s plan would require employers to provide coverage or contribute to a new public program. They have all mulled expanding the Federal Employees Health Benefits Program. Republicans prefer plans that rely on the marketplace over government, and they generally eschew mandated coverage. Rudolph W. Giuliani, the former mayor of New York City, has called for a voluntary move from the employer-based system to one granting tax benefits to those who buy their own insurance. Mitt Romney, who signed a universal coverage plan into law when he was governor of Massachusetts, would give states the flexibility to come up with their own answers, with federal assistance. Senator John McCain of Arizona is focused on containing health care spending, and has said that essentially high-cost diseases, like diabetes and heart disease, should get more attention. Mr. McCain proposes that hospital and doctor compensation be linked to performance measures. Among the voters interviewed here, few were particularly informed about what any of the candidates have proposed. While no candidate was overwhelmingly supported by those interviewed, Mrs. Clinton’s association with health care registered with some voters. “I know it was a major issue when she was a first lady,” said Jeffrey Eskin, 55. “And my feeling is that it was started and not completed.” The issue cuts both ways for Mrs. Clinton, whose health care plan in the Clinton administration failed spectacularly. “I think with Senator Clinton, she’s trying to bring in a socialistic health care system which would probably bankrupt the country,” said Marlene Lansdell, a registered nurse and a Democrat. “Health care is my No. 1 issue, but they are going to make changes that are going to be extremely costly and the taxpayer will foot the bill. I don’t want a free-for-all.” So for the next few days, most everyone here seems to be listening intently — and hoping for inspiration. Cheryl Reber, who at 26 was recently removed from her parent’s coverage, has no insurance in her job as a legal secretary, but says she tries not to think about that. “I haven’t had to face any health care problems yet,” Ms. Reber said, adding that the possibility haunts her. “I don’t want to go as far as Canada, but we need something more affordable.” Amanda Cox contributed reporting from New York.

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