Insurance, health interests fill Baucus' coffers

By Mike Dennison, Billings Gazette, State Bureau, published June 14

As Sen. Max Baucus has taken the lead on health reform legislation in the U.S. Senate, he also has become a leader in something else: campaign money received from health and insurance industry interests.

In the past six years, nearly one-fourth of every dime raised by the Montana Democrat and his political action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical supply firms, health service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee, which is drafting a major health care reform bill this month, insists that this cascade of money is not unduly influencing his work.

"No matter the issue, Max always puts Montana first," said his spokesman, Ty Matsdorf. "Max will continue to do what's right for our state, and groups like SEIU (a union representing thousands of health care workers) and AARP (a senior citizens' group) wouldn't line up in support of his health care reform effort if this wasn't true."

Baucus' office also lists numerous examples of how his proposed reforms are challenging the health care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it's foolish to think this money doesn't hold some sway.

"When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have," said David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. "It's just human nature. ... and members of Congress are human."

Advocates of national, public health insurance for all -- a proposal largely excluded from the health reform debate -- say their exclusion points to the power of moneyed interests in Congress.

"I'm convinced that this (money) has a profound influence," said Quentin Young, national coordinator for Physicians for a National Health Program. "Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?"

Only Baucus' Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Gazette State Bureau examined fundraising data for Baucus, Grassley, Sen. Edward M. Kennedy (who chairs the Senate Health Committee, which is drafting health reform legislation), the other two members of Montana's congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here's a summary of what the State Bureau discovered:

From 2003 to 2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health products, $851,000 from health professionals, $467,000 from hospitals and nursing homes, $466,000 from health service and HMO interests, and $784,000 from insurance.

The insurance sector money includes donations from all types of insurance company interests, including health insurance.

• Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

• Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

• Kennedy, a Massachusetts Democrat and a longtime advocate of health care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

• Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

• Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy "white paper" last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health care interests - a public, nonprofit insurance plan offered by the government - Baucus has been more ambivalent, saying he supports the idea but declining to specify in what form.

Baucus's office supplied nearly 20 examples of stances he has taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

He has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical industry contributors at a fundraiser, "You should worry about me coming after you."

Donnelly, the Campaign Money Watch director, says the proof on health care reform will be in the final product - and that he's not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he said.

"This debate on health care is a microcosm ... that even after a 'change' election, how much the special interests view (Washington) as their fiefdom," Donnelly said.

Supporters of national health insurance are even less optimistic, noting how Baucus, Obama and leaders in Congress won't even consider their proposal, which they believe would have broad public support.

"I can't think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate," said Young of the physicians group. "Until we get campaign finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it's a very bad status quo."

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Labor Leaders Disappointed by Lack of Working People's Voices at Vermont Healthcare Reform Discussion

by the Labor Campaign for Single Payer Healthcare, posted on CommonDreams.org on March 18

Working people's voices were not heard at the Obama Administration's second regional Health Care Summit in Burlington, VT on March 17.

"Despite the fact that several union spokespersons attended the meeting, we were not called upon and unfortunately the voice of workers was shut out of the discussion," said Peter Knowlton, president of the Northeast Region of the United Electrical Workers Union (UE). "When it came to the financial discussion, Gov. Douglas and Gov. Patrick [the two governors moderating the session] only called on wealthy special-interests from the worlds of business and professional circles."

Sandy Eaton, a nurse who attended the forum stated that nurses' voices went unheard as well. "Nurses were well represented, but our voices were not heard -- and the term "nurse" or "hospital worker" was never mentioned in the two hour forum," said Eaton who is a member of the executive board of the Massachusetts Nurses Association.

Outside the auditorium where the summit was held, over 250 labor and community members rallied in support of HR 676 and single payer healthcare. "Our system needs fundamental reform," said Dawn Stanger, President of the Vermont Workers Center-Jobs with Justice. Stanger, a UPS employee and member of Teamsters Local 597, was joined by dozens of unionized nurses who worked next door at Fletcher Allen Health Care, the largest hospital in Vermont.

"We need to build a movement to demand change," Stanger told the crowd. The Vermont Workers Center is coordinating a major statewide "Healthcare Is a Human Right" rally on May 1 at the Vermont Statehouse, which will include U. S. Senator Bernie Sanders. The rally will oppose Vermont Governor Douglas' proposed budget cuts to healthcare programs and support state and national single-payer legislation.

"I was really hopeful that these forums would finally give voice to workers concerns," added UE leader Peter Knowlton. "There were many people there who could have reminded them about the serious problems hourly workers face with skyrocketing premiums and dealing with the horrors of co-pays, deductibles, out-of-pocket expenses and the run around all workers face with managed care. If this forum is any indication of future ones, we will need to be much more aggressive to get our voices heard."

Knowlton, Eaton and Stanger were among the several labor leaders at the forum who support HR 676, the "Expanded and Improved Medicare for All" Act. HR 676 was re-introduced this year by Congressman John Conyers. It currently has 66 congressional co-sponsors. Because it eliminates the private insurance industry from profiting from people's misfortunes and, like Medicare, establishes the federal government as the "single payer" of everyone's medical bills, HR 676 can provide healthcare for all with no co-pays or deductibles in a fiscally prudent manner. HR 676 has the endorsement of hundreds of state and local labor federations and local unions as well as many other civic and religious organizations.

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A Spoiler in the Health Care Debate

by Matthew Murray. Published in Roll Call March 16

By inviting a vast spectrum of stakeholders to collaborate with the White House on its health care reform push, President Barack Obama is trying to pre-empt opponents of his plan from blocking his campaign promise to insure 46 million Americans.

To date, labor unions, seniors advocates, business interests, pharmaceutical companies and insurers are all assured a seat at the table during the ongoing debate - that is, provided they stick to the script and forgo attempts to sabotage the eventual proposal.

With billions of dollars at stake, not everyone is expected to be on board when the legislation is unveiled. But one group will undoubtedly be disappointed: the single-payer lobby, an allegedly 20 million-strong coalition that is pledging no compromise in the upcoming debate and is rallying around a bill recently introduced by House Judiciary Chairman John Conyers (D-Mich.).

"Single payer is the only means that we know to get the ends we seek," said Joe Jurczak, a lobbyist for the California Nurses Association. "We want to see guaranteed health care for everyone."

Jurczak's group is part of the Leadership Conference for Guaranteed Health Care, which is pushing the administration to adopt a universal health care system similar to Medicare, a program for seniors paid for by taxpayers that would use the country's existing private infrastructure of facilities and health care providers.

The California Nurses Association also runs Guaranteedhealthcare.org, which states that "only a single-payer system would assure that everyone is covered with one high standard of benefits and care ... establish effective cost controls, curb administrative waste, and end insurance industry interference with care."

"We don't want doctors to work for the federal government and hospitals to be run by the federal government. We want health care to be a right," Jurczak said. "No co-pays, no deductibles."

The Leadership Conference for Guaranteed Health Care also has written to the White House, explaining its reach. The group wrote to Obama that the coalition includes "thirty organizations representing doctors, nurses, the homeless, faith based organizations, community activists, students, consumers, seniors, women's interests, and organized labor ... organizations [that] represent over 20,000,000 members, many of whom are community and political leaders at the grass roots level."

According to the group's Web site, its membership includes anti-war activists CODEPINK, watchdog Public Citizen and the Ruckus Society, an Oakland, Calif.-based group that recently protested coal use at the Congressional power plant.

Jurczak said single-payer advocates host a monthly call-in for supporters and is planning a lobbying blitz on the Hill in May.
He also said supporters of a single-payer plan - whose biggest celebrity advocate undoubtedly is documentary filmmaker Michael Moore - will be "very visible" at an April 6 White House Forum on Health Reform in Los Angeles.

The California Nurses Association and the National Nurses Organizing Committee are distributing polling that the organizations claim shows public opinion on their side. In one March 2008 survey conducted by Indiana University, 59 percent of those polled supported a single-payer system.

Despite the their apparent support, it appears unlikely their proposals will win out. A White House spokesman said any ultimate health care fix is unlikely to resemble Medicare or any other federally implemented system.

Still, along with major insurance providers, pharmaceutical companies, insurers and other major stakeholders, the White House invited single-payer advocates like Conyers and the Physicians for a National Health Program to the recent White House summit, according to the spokesman.

"We don't expect that the plans they produce will be single-payer plans," the spokesman said. "We are working with partners on the Hill from both parties and they're the ones that ultimately will craft legislation.

"The plan the president laid down during the campaign was not a single-payer proposal," he said.

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Health insurance industry works on an image makeover

by Ricardo Alonso-zaldivar, Associated Press, March 15

WASHINGTON – The health insurance industry is working on a transformation that could come right out of "Extreme Makeover."

Long cast as villains for denying coverage or refusing to pay for treatment, insurers now are representing themselves as indispensable partners in health care overhaul. In their pitch to lawmakers, the companies say they are in a unique position to help improve quality and root out waste, saving money so everyone can be covered.

"They are making inroads," said John Rother, public policy director for AARP. "They are getting past the rhetoric and starting to talk about more concrete ideas for improving quality and getting value."

In a big change from three or four years ago, insurers are writing bigger campaign checks to Democrats, now the party of power in Washington. The insurance industry gave $10.7 million to Democratic candidates for federal office in the 2006 elections, according to OpenSecrets.org. Last year, it was $20.7 million.

The stakes are high.

If the industry's pitch succeeds, insurers will be guaranteed many more customers. The industry wants all people in the United States to be required to carry medical coverage, with government providing financial help for those who cannot afford it.
Even if insurers end up making less per customer because of anticipated consumer safeguards, they still could come out ahead.

But if the overhaul that President Barack Obama has promised goes against them, insurers could find themselves trying to compete against a new government-run health plan offering cut-rate premiums to middle-class families. That's exactly what many liberal Democrats want, and Obama hasn't taken the option off the table.

"No one is naive enough to believe that insurers aren't going to have problems with parts of this," Rother said. "But they are pushing back in a rather quiet way."

Said Karen Ignagni, president of America's Health Insurance Plans and the industry's top strategist in Washington: "We understand we need to come to the table with very specific solutions."

Ignagni is hedging her bets by building ties to groups such as small businesses, whose conservative outlook and grass- roots clout could be crucial.

Yet the industry has won a measure of respect from some longtime adversaries. "I have seen very few groups, including the insurance industry, that are willing to exercise the nuclear option and torpedo reform," said Ron Pollack, executive director of Families USA, a liberal advocacy group. "They have participated in a good faith manner."

Others on the left are not convinced. "Private insurance is the problem," said Carmen Balber of Consumer Watchdog, a California-based group. "Individuals can't afford to be forced into buying private insurance."

If insurers have come to see government as a partner, that's not as strange as it may seem. Employer coverage has dwindled in recent years, but government programs for older people, children and the poor have grown into a vital business. The Medicare prescription drug benefit is delivered by private insurers. Also, about 10 million older people are signed up in Medicare managed care plans. Many states operate their Medicaid programs through private insurers. The same goes for the federally backed State Children's Health Insurance Program.

Government programs "are a significant contributor to growth for us," said Angela Braly, chief executive of Wellpoint, which covers 35 million people in 14 states. "We think we can be a significant part of the solution for the uninsured."

Insurance companies can do more than just pay claims, Braly said. They can use the data in their files to monitor whether doctors and hospitals are providing the right level of care — not too little, not too much.

For example, a soon-to-be released study by Wellpoint looks at treatment of back pain, a condition that costs roughly as much as cancer or diabetes to treat. Most back pain clears up in about six weeks, and national guidelines recommend postponing surgery and sophisticated imaging tests. But the study found that 35,000 patients had imaging tests and an additional 1,000 had surgery before the six weeks were up. Potential savings over a 12-month period: $23.6 million.
In the future, insurers could use such findings to cajole doctors into changing the way they practice.

"We think we can play a central role in delivering value," said Braly.

Wellpoint says such studies don't always endorse the low-tech option. Its research also found that a costly medication for multiple sclerosis was worth the investment, because it helped patients avoid relapses. But there's concern that insurers and government could one day use such studies to deny coverage for expensive new treatments and diagnostic tests.

It's hard to tell whether the industry's makeover will work. So far, the Obama administration doesn't seem to be sold. While Obama invited Ignagni to the White House health care summit, he's also asking Congress to slash payments to private insurance plans in Medicare. Far from being efficient, Obama says the plans get 14 cents more on the dollar than it costs to care for older people in the traditional program.

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The Business Roundtable spotlights a US health care "value gap"

The Business Roundtable does a good job explaining the problem, but falls short on the solution!

by Ricardo Alonso-Zaldivar, Associated Press, published March 12

If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday. (note: you can read the report here)

The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.

Concern about high U.S. costs has existed for years, and business executives — whose companies provide health coverage for workers — have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.

Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

In a different twist, the report took those costs and factored benefits into the equation. It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point "value" scale. That hasn't been done before, the authors said.

The results are not encouraging.

The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.

The cost-benefit disparity is even wider — 46 points — when the U.S. is compared with emerging competitors: China, Brazil and India.

"What's important is that we measure and compare actual value — not just how much we spend on health care, but the performance we get back in return," said H. Edward Hanway, CEO of the insurance company Cigna. "That's what this study does, and the results are quite eye-opening."

Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.

"Spending more would not be a problem if our health scores were proportionately higher," Dr. Arnold Milstein, one of the authors of the study, said in an interview. "But what this study shows is that the U.S. is not getting higher levels of health and quality of care."

Other countries spend less on health care and their workers are relatively healthier, the report said.

Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the "value gap" is being felt by more CEOs — and their hard pressed workers.

One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.

The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.

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If Private Insurers Compete with Government, They'll Lose

Should government bolster the public good by instituting universal Medicaid, or protect the profits of insurance companies?

by Dean Baker. Posted Tuesday, March 10 on CommonDreams.org

We all know that people have different ideologies about the proper role of government. Some people, who tend to be left of center, think that the government's role is to try to promote the general good, by providing basic services, protecting the poor and the sick, and ensuring a well-working economy. On the other hand, there are others, who usually place themselves right of center, who believe that the proper role of government is to redistribute as much income as possible to the wealthy.

These competing views of government are coming to a head in the debate over national health care reform. Those who think that the role of government is to serve the public good are likely to favor some form of universal Medicare. Such a system would almost certainly save a huge amount in administrative costs at the level of insurers, providers and government oversight.

Private insurers spend more than 15 percent of the money they collect in premiums on administrative costs. By contrast, Medicare spends about 2 percent. Part of the insurers' administrative expenses go toward marketing - an expense that would be unnecessary in a universal Medicare system.

The other major factor driving administrative costs with private insurers is associated with their efforts to game the system. Gaming is the best way to make profits in the current system. If insurers can find effective mechanisms for either keeping sick people from being insured, or finding ways to deny coverage for expensive care, then they stand to make large profits. Naturally, profit-maximizing
insurers will therefore devote substantial resources to trying to avoid ways to provide health care to people who need it.

At the level of providers, the wide range of divergent forms and policies employs hundreds of thousands of people in administrative positions in hospitals, doctors' offices, nursing homes and other providers. These people are often quite adept at dealing with various insurers, which is an important skill in our current system, but a task that would disappear if we had a universal Medicare system.

Finally, the state and federal governments must devote substantial resources for oversight to police the practice of insurers. Oversight agencies are essential for limiting abuse. This task would be much simpler if there were not corporations that stood to profit by keeping people from getting needed care.

While we could in principle shift to a universal Medicare system immediately, this would be an extremely difficult task politically and would present some serious practical problems as well. During his campaign, President Obama proposed something far more modest: give employers and individuals the choice to buy into a public Medicare-type program. Under this system, if people are happy with their current health care insurance, they would have the option to keep it. However, if they decided that the plan offered by the government was better, they could buy into it.

In this situation, insurers would compete with the government plan in the market. If private insurers could offer health insurance that provided better coverage or charged less, then people would have the option to buy into a private plan. Of course, the government would also regulate the market so that private insurers could not cherry-pick their way to profitability by insuring only healthy people and dumping them when they became sick.

The insurance industry already recognizes that it will lose out in this sort of competition. A government-run plan will be more efficient. We already know this based on the experience with Medicare. When private insurers have competed side by side with the traditional government Medicare plan, in the absence of government subsidies, the overwhelming majority of beneficiaries opted to go with the traditional Medicare plan.

This is why the insurers are yelling that they don't want to face "unfair" competition from a government plan. But, their complaint should be all the endorsement that the public needs to support a public Medicare-type plan. The public
plan will be cheaper and better than what the private insurers have to offer. Why shouldn't the public then have this option?

We all know that the insurance industry executives and the company shareholders want to make lots of money, but maybe they should try to find an industry where they can compete. If the government can provide health insurance better and cheaper, then why do we need private insurers?

Dean Baker is the co-director of the Center for Economic and Policy Research (CEPR). He is the author of The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer (www.conservativenannystate.org) and the more recently published Plunder and Blunder: The Rise and Fall of The Bubble Economy. He also has a blog, "Beat the Press," where he discusses the media's coverage of economic issues. You can find it at the American Prospect's web site.

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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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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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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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Labor Notes: Labor's "Medicare for All" advocates test their strength

by Mischa Gaus, for Labor Notes

Labor activists from 31 states gathered in St. Louis last weekend, solidifying their strategies to push “Medicare for all”—and to oppose the half-hearted health care plans circulating in Washington.

The meeting launched Labor for Single-Payer Healthcare, a campaign whose reform would cut the insurance industry out of health care and expand an improved Medicare system to everyone.

The single-payer concept has been endorsed by 39 state AFL-CIO federations, 100 central labor councils, and more than 400 local unions.

Yet some major unions that have endorsed single payer, including AFSCME and the Service Employees, in practice are backing plans that would preserve private insurers. Both union federations, the AFL-CIO and Change to Win, already have lined up behind compromise plans.

"There's another agenda out there. It's not what's best or what's right, but what's opportune," said Sandy Eaton, a regional president of the Massachusetts Nurses Association.

Heavy hitters in D.C., including Senators Edward Kennedy and Max Baucus, are pushing mixed public-private reform ideas. AFL-CIO President John Sweeney praised the plan Baucus floated in November, calling it a "giant step."

But their approach is fatally flawed, said Martha Livingston of Physicians for a National Health Program. Because it leaves the profit-making insurance companies as major players, it can’t control spiraling costs and does nothing to prevent insurers from denying care.

The new campaign was launched to make clear to policy-makers that a substantial section of the labor movement sees through the flawed proposals and believes the moment is right to embrace truly universal health care.

In contrast, Democrats are likely to put forward a Massachusetts-style plan, adopting an approach the state initiated in 2006. It mandated that each resident purchase health insurance, yet Eaton said tens of thousands in his state are still uninsured because they can’t afford premiums but don’t qualify for subsidies.

Grassroots Pressure
Representatives from 13 central labor councils and four state federations attended the kick-off meeting.

"Single payer is the only reform in health care that has a constituency," said Rose Ann DeMoro, executive director of the California Nurses Association (CNA). "We have to light the fire that builds the movement to get single payer."

The 150 delegates discussed how to grow support for single payer in their unions and communities. They’ll be coordinating actions, from plant gate and parking lot rallies to lobby days to more dramatic confrontations at insurance companies.

They believe they will have some breathing room, as Obama will likely not attempt a full overhaul of the system in his first year. They anticipate instead that the administration will focus immediately on smaller changes, such as expanding medical insurance for poor children and reining in excessive costs from private insurers that lure healthy seniors out of Medicare.

Tackling union opposition

Conference-goers said one problem within labor is that unions that run their own welfare funds tend to oppose single payer. These funds, which typically administer health care plans directly to union members, are common in the building trades and Teamsters. Union officers there generally argue that their members are happy with the status quo.

But whether plans are union-run or not, others said, the price of private health care is climbing, eating into salary gains and eroding members' benefits.

Some attendees foresee even the strongest unions being dragged into health care concessions.

"We don’t want to be the ones going back to members, saying, 'it's going to be more expensive this year,'" said Mark Dudzic, the campaign's coordinator. "Suddenly we become the agent of retreat for our members."

Dudzic added that activists need to challenge union leaders to think about what unions could do with the savings that national health care could achieve.

"You could convert a $6 per hour cost into a $2 per hour cost," Dudzic said, "and do incredible things—subsidized childcare, educational benefits—with the surplus we create as workers."

Indeed, single payer could pull the U.S. economy out of its quagmire by injecting $317 billion in public and private funds into the economy and creating 2.6 million new jobs, according to the CNA’s research arm.

A study the union previewed at the St. Louis conference said the spending would pump $100 billion in wages into the economy and create almost as many jobs as the economy lost last year.

Many activists raised a big, unanswered question: How to approach union supporters of the mediocre health care reforms competing for attention in Washington?

Essentially, they won't—for now. Unions and coalitions that support combined private-public plans will go their own way, while activists raise the profile of single payer and pressure Congress members back in their home districts.

"If everybody puts this plan into play," said Al Cholger, a Steelworkers staffer in Detroit, "this train won’t leave the station without us."

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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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Paul Krugman: A little closer to universal coverage

This good news in Paul Krugman's report on the initial Senate vote has stayed good--yesterday both House and Senate overrode Bush's veto on Tuesday by wide margins. This column originally appeared in the July 11th New York Times

It was the worst of days, it was the best of days. On Wednesday, Senate Democrats capitulated to the Bush administration on wiretapping — with Barack Obama joining the coalition of the craven.

Later that day, however, those same Senate Democrats won a huge victory on Medicare.

News reports stressed the cinematic quality of the event: Ted Kennedy, who is fighting a brain tumor, made a dramatic appearance on the Senate floor, casting the decisive vote amid cheers from his colleagues. (Only one senator was absent: John McCain.)

But the vote was bigger than the theatrics. It was the first major health care victory that Democrats have won in a long time. And it was enormously encouraging for advocates of universal health care.

Ostensibly, Wednesday’s vote was about restoring cuts in Medicare payments to doctors. What it was really about, however, was the fight against creeping privatization. Democrats finally took a stand — and, thanks to Senator Kennedy, seem to have prevailed.

The story really begins in 2003, when the Bush administration rammed the Medicare Modernization Act through Congress, literally in the dead of night. That bill established large de facto subsidies for Medicare Advantage plans — plans in which Medicare funds are funneled through private insurance companies, rather than directly paying for care.

Since then, enrollment in these plans has been growing rapidly. This has had a destructive effect on Medicare’s finances: the fastest-growing type of Medicare Advantage plan, private fee-for-service, costs taxpayers 17 percent more per beneficiary than Medicare without the middleman. It also threatens to undermine Medicare’s universality, turning it into a system in which insurance companies cherry-pick healthier and more affluent older Americans, leaving the sicker and poorer behind.

What does this have to do with cuts in doctors’ fees? Well, legislation passed a decade ago makes such cuts automatic whenever the growth in Medicare spending exceeds an unrealistically low target. This year, the automatic cuts would have reduced doctors’ payments by more than 10 percent, a pay reduction so deep that many physicians would probably have stopped taking Medicare patients.

In previous years, payments to doctors were maintained through bipartisan fudging: politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit.

This year, the Democratic leadership decided, instead, to link the “doctor fix” to the fight against privatization and offered a bill that maintains doctors’ payments while reining in those expensive private fee-for-service plans. Last month, the Senate took up this bill — but Democrats failed by one vote to override a Republican filibuster. And that seemed to be that: soon after that vote, Senators Max Baucus and Charles Grassley had another bipartisan fudge all ready to go.

But then Democratic leaders decided to play brinkmanship. They let the doctors’ cuts stand for the Fourth of July holiday, daring Republicans to threaten the basic medical care of millions of Americans rather than give up subsidies to insurance companies. Over the recess period, there was an intense lobbying war between insurance companies and doctors.

And when the Senate came back in session, it turned out that the doctors — and the Democrats — had won: Senator Kennedy was there to cast the extra vote needed to break the filibuster, a number of Republicans switched sides and the bill passed with a veto-proof majority.

If the Democrats can win victories like this now, they should be able to put a definitive end to the privatization of Medicare next year, when they’re virtually certain to have a larger Congressional majority and will probably hold the White House.

More than that, however, advocates of universal health care, like Health Care for America Now, the new group headlined by Elizabeth Edwards, have to be very encouraged by this week’s events.

Here’s how it will play out, if all goes well: early next year, President Obama will send his health care plan to Congress. The plan will face vociferous opposition from the insurance industry — but the Medicare vote suggests that this time, unlike in 1993, Democrats will hold together.

Unless Democrats win even bigger than expected, however, they won’t have the 60 Senate votes needed to override a filibuster. What the Medicare fight shows is that the Democrats could nonetheless prevail by taking their case to the public, daring their opponents to stand in the way of health care security — so that in the end they get some Republicans to switch sides, and get the legislation through.

A lot can still go wrong with this vision. But the odds of achieving universal health care, soon, look a lot higher than they did just a couple of weeks ago.

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Selling Out Grandma

By Emily Udell
January 21, 2008
http://www.inthesetimes.com/article/3486/selling_out_grandma/
http://www.truthout.org/docs_2006/012108H.shtml

Tags corporations medical health

Protestors picket outside the Carlyle Group's headquarters in Washington, D.C., in September 2007

In late 2007, the investment firm The Carlyle Group purchased one of the country’s largest nursing home chains despite the concerns of regulators, lawmakers and workers’ groups that the acquisition would lead to staffing cuts and cause a decline in quality of care for residents. The $6.3 billion purchase of Toledo, Ohio-based Manor Care Inc. closed after a Michigan judge lifted a restraining order that temporarily halted the sale.

“The problem is, in the nursing home industry, making money means cutting care,” says Julie Eisenhardt, a spokeswoman for Service Employees International Union (SEIU), which represents employees at about 15 Manor Care homes and which spearheaded a campaign to raise awareness about the buyout.

In 2006, Manor Care, which operates more than 500 nursing, rehabilitation and assisted living facilities in 32 states, posted $167 million in profits and $3.6 billion in revenues. Manor Care shareholders were slated to get $67 for each share as part of the deal.

The Carlyle Group has holdings in several industries, including healthcare, defense and energy. Former President George H.W. Bush was one of its advisers until 2003.

Officials from both firms have denied plans to reduce staffing or slash services following the takeover, and have said Manor Care will continue to be run as it was before the buyout. “There’s not going to be a cut in staff and there’s no reason for quality to go down,” says Rick Rump, a spokesman for Manor Care. “Carlyle is going to realize a return in investment by our company growing and becoming a better provider of healthcare.”

The deal’s critics also say investment companies create Byzantine ownership structures that impede regulation and shield the firms from accountability for negligent care or wrongful death accusations.

Rump says that Carlyle would not separate its assets from its operations as some private equity firms have done and that the Manor Care management team would remain the same.

Carlyle officials did not return calls by deadline, but Karen Bechtel, the company’s managing director and global head of healthcare, said in a statement: “We are pleased to back a high-quality company and management team. We support [Manor Care CEO] Paul Ormond’s strategic vision and support his commitment to quality patient care.”

But a preliminary study of a large nursing home chain owned by a private investment firm found that staffing of registered nursing homes dropped by 8 percent and deficiencies that harmed residents doubled.

“They’re not there to invest in the care for the residents, they’re there to make money,” says Charlene Harrington, a professor of nursing at the University of California, San Francisco, and author of the 18-month study. “The way these chains have made money is by cutting the staff to the bare bones and pocketing the profits.”

Harrington, who is part of a team that has researched nursing homes for 25 years, says the privatization of chains allows companies to shirk regulatory scrutiny because they are not required to file financial documents with the Securities and Exchange Commission (SEC) or state regulatory agencies.

“These chains have had so many quality problems that they have wanted to go private in order to keep from having the litigation they have,” she said.

A recent New York Times analysis of government data from 2000 to 2006 found that the quality of care declined at nursing homes that were taken over by investment firms such as Warburg Pincus and Carlyle because of cost-cutting and staff reduction.

David Adams, 40, entered one of Manor Care’s homes in Pittsburgh, Pa., after he ruptured his Achilles tendon playing basketball. He says the care at the Shadyside Nursing and Rehabilitation Center was substandard before the takeover, and he’s concerned it will only get worse.

“They’re coming up short—they do the minimum they can get away with and no more,” says Adams, a former construction worker and cook, who testified during state hearings in Pennsylvania on the buyout. Adams says he contracted infections because his bandages weren’t changed regularly, received the wrong medication and was stranded for 45 minutes after falling in his bathroom.

“One day I will leave,” he says, “but there are people that are going to die here.”

The Carlyle Group’s buyout was announced last summer and given the green light by the SEC. Shareholders approved the deal in a December 2007 meeting. After the sale, several state health departments, including those in Illinois and Michigan, still had to approve the transfer of licenses from Manor Care to Carlyle, but Manor Care’s Rump says he expected the transfers to be granted.

In November, legislators in Washington, D.C., held hearings on the issue of care at facilities owned by private investment firms, and hearings took place in several states.

In West Virginia, regulators reconsidered their initial approval of a deal just days before the completion of the sale. But after a Dec. 14 hearing, the state Health Care Authority lifted a stay on the approval, which would affect seven West Virginia nursing facilities. Manor Care had protested the stay, saying the delay was costing investors $1 million per day.

In Illinois, legislators and union leaders voiced concern about the deal.

“I think the size of the transaction, the nature of the business of the proposed buyer and the effects that could be felt by our most frail and vulnerable populations require us to give the proposal extra scrutiny,” said State Rep. Greg Harris (D-Chicago) at a December hearing before the Illinois Department of Public Health, which regulates the state’s nursing facilities.

In December, financial news service Bloomberg reported that the Manor Care purchase was the eighteenth sale of a nursing home operator in the United States in four years. Experts say investment firms’ interest in nursing facilities is partially an effort to cash in on the aging of baby boomers into the system.

“As boomers get older, taking care of them is going to be big business,” says Eisenhardt of SEIU. “The question is: Do we as a society think it’s right that people are trying to make money off taking care of our most vulnerable population?”

Emily Udell is an itinerant journalist who has reported for the Daily Southtown newspaper in southwest Chicago, the Associated Press in Indianapolis and Radio Prague in the Czech Republic. She was co-host of In These Times' monthly radio show "Fire on the Prairie."

More information about Emily Udell

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Simple Healthcare Fix Panics Right-wing

Washington state Sen. Karen Keiser (D), chairwoman of her legislature's powerful health committee, this week introduced the nation's most far-reaching universal health care proposal. Her legislation is the American West's version of a parallel Wisconsin initiative, and the replication suggests this model may begin building the universal health care system our country wants.

Employers and employees pay a modest [state] payroll tax in exchange for full medical benefits, with no premiums. Save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade. States to "pool all existing health care expenditures and then replace the middlemen with one publicly controlled, not-for-profit system." This "will save private-insuring employers almost $700 million a year. Create 13,000 new jobs." Can provide "property tax relief." Also "reduces out-of-pocket copayments and increases the number of mandated medical services covered."
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Digging In the Right Place

By David Sirota, Creators Syndicate. Posted January 18, 2008.

http://www.alternet.org/healthwellness/74256

There is a simple fix for our ailing healthcare system, and it has the right-wing in a panic.

There's a memorable moment in "Raiders of the Lost Ark" when Indiana Jones sees a rival's archaeological excavation and realizes the buried treasure is somewhere else.

"They're digging in the wrong place!" he exclaims.

The line could explain why our national elections leave us feeling empty. By expecting so much so fast from Washington D.C., we are digging for "change" in the wrong place.

Think about it: The White House can only be won by raising truckloads of cash from moneyed interests looking to preserve the status quo. Likewise, the U.S. Senate's filibuster rules allow 41 lawmakers, representing just 11 percent of the population, to stop anything. These are institutions designed to prevent change, not embrace it.

Thankfully, the same cannot be said for the so-called "laboratories of democracy" -- state legislatures. Amid pundits' breathless analyses of Hillary Clinton's tear ducts, these arenas quietly opened throughout America this month. And from beneath the rubble of celebrity-obsessed campaign journalism and the ruins of national political gridlock, change is being exhumed in two bellwether states.

In a move making health care lobbyists quiver, Washington state Sen. Karen Keiser (D), chairwoman of her legislature's powerful health committee, this week introduced the nation's most far-reaching universal health care proposal. Her legislation is the American West's version of a parallel Wisconsin initiative, and the replication suggests this model may begin building the universal health care system our country wants.

The plan is simple: Employers and employees pay a modest payroll tax in exchange for full medical benefits, with no premiums. Patients never lose coverage and pick the doctors they prefer. And for the spendthrifts, here's the best part: According to an analysis of the Wisconsin proposal by the nonpartisan Lewin Group, the plan would save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade.

Seem too good to be true? That's because you're used to being bilked by an insurance industry that drives up premiums, drives down benefits and gives executives like former UnitedHealth CEO William McGuire $1.6 billion worth of stock options in one year. Eliminating that greed is precisely how the Washington state and Wisconsin proposals simultaneously save money and cover everyone.

Unlike the much-touted Massachusetts law forcing citizens to buy insurance from the private profiteers, the Washington and Wisconsin models pool all existing health care expenditures and then replace the middlemen with one publicly controlled, not-for-profit system. That structure attacks problems beyond the immorality of allowing 18,000 Americans to die each year because they lack health coverage.

For businesses faced with crushing health care costs, the Lewin Group predicts the plan will save private-insuring employers almost $700 million a year. For politicians looking to provide economic stimulus in the face of a recession, the nonpartisan Families USA estimates the proposal's investments will create 13,000 new jobs. Even tax reformers have something to like, as Wisconsin's version directs much of the system's savings into property tax relief.

The Royalist Right is distraught about the plan. When an initial draft passed the Wisconsin Senate last year, the Wall Street Journal's editorial board attacked it on the grounds that it "reduces out-of-pocket copayments" and "increases the number of mandated medical services covered" for patients. Wow. Sounds just awful.

The paper then criticized it as a tax increase and labeled it "government-run" -- as if patients are better served by paying even bigger premium increases to corporate CEOs whose paychecks grow with each coverage denial.

The screed showed how little conservative elites care, not just for the uninsured, but for the working-class wing of the Republican Party -- the roughly 40 percent of GOP voters who, according to the Pew Research Center, tell pollsters they "favor universal health coverage, even if it means higher taxes." These voters are part of a new transpartisan consensus -- one that believes the words of the hero we remember this week. "Of all the forms of inequality," Dr. Martin Luther King Jr. said, "injustice in health care is the most shocking and inhumane."

Those desiring "real change" should applaud these Washington and Wisconsin leaders confronting that injustice. Unlike the nearsighted nabobs of national politics and the adversaries of Indiana Jones, these state legislators are digging in the right place.

See more stories tagged with: healthcare, campaign finance, election08

David Sirota is a bestselling author whose newest book, "The Uprising," will be released in June of 2008. He is a fellow at the Campaign for America's Future and a board member of the Progressive States Network -- both nonpartisan organizations. His blog is at www.credoaction.com/sirota.

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