Co-authored with Rose Ann DeMoro, executive director, California Nurses Association/National Nurses Organizing Committee
Now we know why they've stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.
Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.
But, overall, the leading bills and the President's proposal are, like the dog that didn't bark, more notable for what is missing.
Here are 13 problems with the current health care bills (partial list):
]]> Why the Current Bills Don't Solve Our Health Care CrisisBy Michael Moore
Huffington Post
Posted: September 29, 2009
Co-authored with Rose Ann DeMoro, executive director, California Nurses Association/National Nurses Organizing Committee
Now we know why they've stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.
Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.
But, overall, the leading bills and the President's proposal are, like the dog that didn't bark, more notable for what is missing.
Here are 13 problems with the current health care bills (partial list):
1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.
2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.
3. No restrictions on insurance denials of care that insurers don't want to pay for. In case you missed it, the California Nurses Association/National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.
4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.
5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.
6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.
7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.
8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.
9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.
10. No definition of covered benefits.
11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn't want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.
12. Long delay in implementation. Many reforms don't go into effect until 2013.
13. Nothing changes in basic structure of the system; health care remains a privilege, not a right.
We may be slow learners, but the rest of the industrial world has figured it out: Universal, single-payer or national health care systems. That's the reason why all those other countries cover everyone, have better patient outcomes, cause no one to declare bankruptcy or lose their homes because of medical bills, and spend less than half per capita on health care than we do.
We could do it too, by reducing the starting age for Medicare from 65 to 0. There's still time to act.
Call on your Congress member to support the vote coming up on the House floor on the Anthony Weiner amendment to protect, expand and improve Medicare for All. Senators have the same opportunity in a vote on Senate bill 703, being offered as a floor amendment by Senator Bernie Sanders.
Democrats must also ensure that whatever bill passes includes a provision enabling states to set up their own single-payer systems. These votes are the true litmus tests of the Democrats' commitment to guaranteeing health care for all, and finally solving our health care crisis.
The Tennessee Anthem Blue Cross organization is one of only few "independent" organizations using the Anthem brand not owned by WELLPOINT.
]]>"It's my duty and pride tonight to be able to announce exactly what the Republicans plan to do for health care in America," announced Rep. Alan Grayson (D-FL) on the House floor Wednesday night. Taking out a chart, he continued, "Here it is.
The Republican health care plan for America: 'don't get sick.' If you have insurance don't get sick, if you don't have insurance, don't get sick; if you're sick, don't get sick. ...
If you do get sick America, the Republican health care plan is this: 'die quickly.'"
THE STATUS QUO: Many Americans do indeed die simply because they can't afford medical care. According to a recent Harvard Medical School study, nearly 45,000 Americans die each year -- one person every 12 minutes -- because they are not covered by health insurance. "We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease -- but only if patients can get into our offices and afford their medications," said the study's lead author Dr. Andrew Wilper. Although having private insurance should make this better, high deductibles and other expenses can still result in unaffordable bills. In fact, 78 percent of people who filed for bankruptcy because of medical costs had health insurance, underscoring the importance of not just extending coverage to the uninsured, but also shoring up inadequate coverage. In addition, many people who went into medical bankruptcy had private coverage, "but lost it when they became too sick to work," concluded a Harvard University study. "Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year." The "proportion of all bankruptcies attributable to medical problems has increased by 50%" since 2001, and will continue to rise without significant reforms to the health care system.
EXACERBATING THE STATUS QUO: "Just say no! Just say no! Just say no! Now Republicans -- that's going to be our chant from now until Election Day," declared Rep. John Shimkus (R-IL) as recently as August, making clear that he and many of his colleagues want to keep the status quo on health care. "There are no Americans who don't have health care," Rep. Virginia Foxx (R-NC) has said, agreeing with Shimkus. "Everybody in this country has access to health care." There is no unified GOP alternative health care plan (even though on June 17, Missouri Rep. Roy Blunt told reporters that he "guarantee[s] you we will provide you with a bill"). House Minority Whip Eric Cantor (R-VA) recently faced heat from constituents who demanded to know, "What is your substantive proposal to meet these real everyday problems that people have? Where's the beef?" Republicans claim they have introduced 37 health care bills. But as the Center for American Progress has noted, "[E]ight of the ideas have already been incorporated into Democratic legislation; five lie outside the jurisdiction of the relevant committees; and five have been around for more than a decade, so Republicans could have enacted them when they were in power." A close look at the GOP's so-called "principles" shows that they would break-up employer-based coverage, endanger the coverage of Americans with pre-existing conditions, and drive-up health care spending. In the Senate, Republicans have been spending time introducing frivolous amendments to the Finance Committee's legislation, such as Orrin Hatch's (R-UT) amendment to raise the excise tax threshold "for any state with a name that begins with the letter 'U,'" or John Ensign's (R-NV) idea to strike the word "fee" everywhere it appears in the bill and replace with the word "tax."
INSURANCE INDUSTRY CONTROL: The sole group rooting for maintaining the health care status quo is the insurance industry -- and it has managed to get key lawmakers on its side. Sen. Pat Roberts (R-KS) made clear he was one of those individuals when he called for a provision that would allow health insurance lobbyists "at least 72 hours" to read the bill. A recent Center for American Progress Action Fund analysis found that of the 534 amendments that have been offered to the Senate Finance Committee's bill, at least 47 of them directly reflect the health insurance industry's wish list. Indeed, in the last two and a half years, the health insurance industry has spent more than $585 million lobbying Congress to protect its investments in Medicare Advantage, defeat competition from a public option (or even a cooperative), and preserve policies that allow it to attract a disproportionate number of healthy applicants. Predictably, health insurance stocks shot up when the committee voted down two amendments that would have created a public health insurance option, which is favored by the majority of Americans. "We are pleased by the rejection of both the Rockefeller and Schumer amendments," said Tom Currey, president of the National Association of Insurance and Financial Advisors. However, Senate Majority Leader Harry Reid (D-NV) has promised that we "are going to have a public option before this bill goes to the president's desk."
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The Employee Retirement Income Security Act (ERISA) pre-empts legislating health care reform at a state level if the state efforts challenge employer-based health care plans.
This would change under:
]]>Indeed, few if any of the major arguments about the scope and costs of the historic undertaking are settled as congressional leaders prepare to take legislation to the floor in the next two weeks.
]]>Democrats on the Senate Finance Committee came together early Friday -- after 2 a.m. -- to finish the heavy lifting on a bill designed to appeal to moderates. Obama hailed it as a milestone and noted, for history, that overhauling health care has eluded presidents from Harry S. Truman to Richard Nixon to Bill Clinton.
"We are now closer than ever before to finally passing reform that will offer security to those who have coverage and affordable insurance to those who don't," Obama said.
But not yet. And not for sure.
The 10-year, $900 billion bill would remake one-sixth of the U.S. economy, clearing a path to health insurance for millions who don't have it now. It would be financed by reducing Medicare and Medicaid payments to health care providers, and by ordering new taxes and fees that are already meeting resistance. Insurers would no longer be able to turn away those in poor health.
Final passage in the Finance Committee, a political bellwether, is all but assured next week. After that, things really start to get interesting.
Senate Democratic leaders will begin tugging on Finance Chairman Max Baucus' hard-won compromise to try to meld it with a liberal-leaning version passed by the Senate Health, Education, Labor and Pensions Committee. That second version would allow the government to sell insurance in competition with private industry, a highly controversial issue, while the plan from Baucus, D-Mont., would not.
The government-run plan doesn't appear to have the votes to clear the Senate. In the House, it's the other way around. A bill that doesn't include a government plan to compete with private insurers won't get off the floor, Democratic leaders say.
That's not the only fault line.
The House plan taxes the wealthy to pay for subsidies needed to make health coverage affordable for millions who are now uninsured. The Senate instead taxes the health care haves -- those with expensive insurance plans.
The House plan -- and the Senate health committee bill -- would require employers to offer coverage to their workers or pay a tax penalty. The Senate Finance bill has no requirement that employers offer coverage, although it would levy a charge on businesses whose workers end up getting government subsidies.
If lawmakers manage to work their way through those issues, they still won't be safely through the political minefield. They'll face contentious issues including how to deal with coverage for abortions and how to keep benefits from going to illegal immigrants.
"A lot of people have a lot of non-starters, and they are different non-starters," said House Majority Leader Steny Hoyer, D-Md. "If you add up all the non-starters, it makes it very difficult to pass a bill. When we get an agreement in the House, it will contain things some people will prefer weren't in there. It will also contain things they want. As in every major piece of legislation, you have to find a balance."
Increasingly, Obama will have to step in to settle disputes and keep the bill moving forward. That will please some lawmakers and alienate others. He can't afford to lose many of his fractious Democrats.
Polls show the public has many concerns and questions about the legislation. But for now, most Americans seem to want Congress to keep working.
Republicans are certain that the more people learn, the less they'll like about the Democrats' approach.
"What we know for sure about this proposal, the core of it will include half a trillion dollars in Medicare cuts over 10 years and hundreds of billions of dollars in tax increases on both individuals and businesses," Senate Republican leader Mitch McConnell of Kentucky told reporters Friday.
Senate Majority Leader Harry Reid of Nevada has said he wants meld the Finance and health committee bills in fairly short order. He could have a bill on the floor the week after next, with debate expected to last for weeks. The Democrats have 60 votes in the Senate -- 58 from their party and two independents -- and that's the magic number needed to overcome roadblocks. But as yet there's no bill that 60 Democrats would agree to.
In the House, the third week of October is the earliest a bill could come to the floor, Hoyer said. Leaders are still meeting with rank-and-file Democrats to work through disagreements.
On Friday, more than 100 Democrats sent House Speaker Nancy Pelosi, D-Calif., a letter opposing the tax on high cost insurance in the Senate Finance plan. They argued the tax would ultimately be paid by middle-class union members who bargained hard for comprehensive health plans.
"The purpose of this letter is to put a big red flag in front of the White House and the congressional leadership," said Rep. Joe Courtney, D-Conn., who circulated the letter. "This will be a problem."
Finance Democrats have felt the pushback already. Baucus accepted an amendment by Sen. Jay Rockefeller, D-W.Va., that would ease the bite of the insurance tax on retirees over the age of 55 and for plans that cover workers in high-risk jobs like coal mining.
Still, the wrangling obscures considerable agreement on what the health care system would look like after it's reengineered. Some of the outlines have emerged:
• Although government will play a bigger role than it does now, most people will still be covered by private insurance plans sponsored by their employers.
• Medicaid will be expanded to cover more low-income people, including childless adults for the first time.
• Self-employed people and those working for a company that doesn't provide health insurance will be able to buy coverage through new insurance purchasing pools called exchanges. Government would provide tax credits for many middle class people. Insurers participating in the exchanges will have to take all applicants and will be limited in what they can charge those who are older and sicker.
• Medicare would adopt a new philosophy geared to better coordinating care for seniors with chronic illnesses and trying to keep them out of the hospital.
Even Democrats who are upset with the Senate Finance bill say they're optimistic that Congress can get legislation to Obama.
"There is enough momentum now that I would disagree with the characterization that it's going to be impossible to meld the two sides," said Courtney, the Connecticut Democrat trying to derail the insurance tax. "My hope is it will be by Thanksgiving, and my honest opinion is closer to Christmas."
By RICARDO ALONSO-ZALDIVAR
___
Health care reform involves much more than money. It involves intense personal feelings about the kind of our society we want. These feelings too often go unspoken, even unappreciated, making intelligent discourse impossible.
Below are key principles taken from public health care debates. All are important to a few of us, and some to all of us. But we can't have it all - any one is achievable, but not every one. It's a tough choice.
]]>Therefore, to render our discussions more productive, identify the single most important principle for you. Once you determine which one is most appealing, with the others being expendable, you can prepare yourself for the sobering task of health care reform.
Ready? Remember - pick the one, and only one, most important to you.
· Preserve our market-driven health care system; Specifically, protect our for-profit health insurance industry. Some of us believe that not only will our American free enterprise system solve this problem, but that if the solution compromises our free market we shouldn't even solve a problem. Perhaps our for-profit insurance company sold our family a fine policy. Why should we give it up for an unknown, untested program?
· Provide health care to all regardless of ability to pay, employment, or medical condition. Some other countries (in fact every industrialized country except us) make this their highest priority. Should we join them?
· Avoid increases in taxes or national debt. Taiwan cleverly avoided this issue when collecting money for their universal health care. "You never want to call it a tax," said Dr. William Hsiao. "If you call it a national insurance premium, then you're asking people to pay for a product, not to pay a tax to some huge government entity." Is paying a premium for universal health care better than paying a tax? Does it matter if the premium goes through a government agency or a for-profit insurance company?
· Reduce costs of health care. Guess what is our health care system's single biggest expense? Here's an answer: Our overall cost of health care is twice that of the average industrialized nation, but the specific cost of administering health care (through for-profit insurance companies) is ten times higher than our neighbors. Is this where we should cut expenses?
· No taxes for free services; i.e., How much will I pay for someone else to get free health care? Is it acceptable for my taxes to provide care to those too young or too old to work? Or too lazy, too illiterate, or too unmotivated to pay taxes? Curiously, we believe it appropriate that taxes taken from working people provide universal police service, fire protection, and elementary education to tax-payers and non-tax payers alike. Is health care different?
· Avoid rationing of health care; i.e., unlimited care for all. In fact, for those of us unable to pay out of pocket, health care in the US is rationed by insurance administrators and occasionally by Congress. For us, the real issue is not whether to ration health care, but who do we trust to do the rationing?
· Improve our public health. This is tricky. What health care measures really matter to us? Wait times for elective procedures? Access to essential health care? Infant and maternal mortality? Life expectancy? Avoiding preventable complications of common diseases? Subjective satisfaction? If we can't measure it, we can never achieve it.
· Avoid public interference in private lives. If the only method to improve public health or reduce health care costs or provide universal care is to tolerate more government responsibility, is it worth the sacrifice?
Now you've picked your favorite. It's time for the tough questions. Would you protect our for-profit private health insurance system if it meant allowing our individual health costs to escalate? Would you accept rationing by a regulated agency if this provided universal health care? Would you accept more government interference in your life if your health (and society's health) improved?
And so on. Each choice of priorities requires trading off another. We can't have it all. Pursuing the single issue packing the highest emotional satisfaction may feel good initially, but it may compromise another goal, perhaps a more important one, when we achieve it.
This is not a rhetorical exercise. The answers define our individual visions of our health care problem. If we explicitly understand the principles that drive us and our fellow citizens, we can define the challenge. When we define the challenge, we will find a solution.
What's your answer?
Is everyone with me? Chuck Todd: stop applying your beard rouge and pay attention. Bartiromo: leave the cork on the fork.
Okay, here we go.
The public health insurance option as defined in both the Senate HELP bill and the House bill (HR 3200) is not a far-left liberal proposal. A far-left liberal proposal would actually be a single-payer plan. The public option is actually a program supported by almost everyone, despite the misleading way it's currently being discussed by Republicans, town hall wingnuts, cable news "smackdown" panelists and other very serious members of the Washington establishment.
To wit, David Brooks' column the other day urged the president to reconnect with "the center" on issues like healthcare reform, and to also exercise more "fiscal restraint." Naturally, Brooks isn't prescribing this approach in a vacuum. It's all over Washington, including within certain corridors at the White House.
And it only takes a few minutes of cable news viewing to arrive at the assumption that the "centrist" position on healthcare reform, according to Brooks and other establishment people, is a bill without a public option. The health insurance lobby in collusion with both the corrupt and spineless Blue Dogs and the lying hacks who control the cartoonish Republican Party have successfully convinced large chunks of Washington that the public option is some sort of ultra-left concoction manufactured inside the secret underground Wellstone Memorial Lib-ratory located beneath Howard Dean's cavernous walk-in Birkenstock closet.
The reality, however, is that a healthcare reform bill with a robust public option is both extraordinarily popular and fiscally responsible, while, on the other hand, the kind of "centrist" bill that David Brooks wants is actually more expensive and generally more corrupt. In other words, a bill without the public option can hardly be called "centrist" by any definition of the term.
If Brooks wants "fiscal restraint," as he writes in his column, he'd endorse the public option. What I'm about to write is old news, but with the apparent prevalence of breaking news stories on cable news about bears wandering into suburban swimming pools, I suppose it's easy for people to forget. Nevertheless, here it is. You may recall that the CBO scored the Kennedy HELP bill as costing around $1 trillion over ten years. But that was an early version of the bill without a public option included. What did the bill cost with the public option inserted into the mix?
$400 billion less.
Less!
The public option reduced the price tag of the HELP bill by $400 billion. By Grabthar's Hammer, what a savings.
How is this not indicative of fiscal restraint and centrist politics, Mr. Brooks? The public option is the very definition of fiscal restraint and anyone who opposes the inclusion of the public option in a final healthcare reform bill is actually in favor of spending more money -- not less. To the tune of hundreds of billions of dollars.
Additionally, I'm not aware of any centrist voters who are particularly in love with the idea of a healthcare reform bill that contains mandates but no public option escape hatch. As I wrote last week, this is without question a transparent, massive and compulsory government handout to corporate criminals.
Such a bill would require us to buy a policy from a private health insurer -- the same corporations that are currently denying coverage to paying customers and literally getting away with murder; the same type of corporation that randomly tripled my monthly premium, forcing me to either cancel my policy or go out of business. Every American citizen would be mandated by law to pump their cash into a system that's inherently corrupt and, from a production standpoint, wholly worthless. The public option, though, would provide an option of good conscience for those of us who find it morally repugnant to financially support the private insurers.
The convergence of government power and corporate greed is centrist? Really? Once again, the public option solves the problem.
And then there are the polls. Last week, the AARP published the results of a poll showing 79 percent of the American people support "a new federal health insurance plan that individuals could purchase." Unless 79 percent of the American people are far-left liberals, this poll indicates that the public option enjoys support from practically everyone. 61 percent of Republicans support the public option. 80 percent of independents. Literally, the "centrists."
The latest SurveyUSA poll, meanwhile, showed that 77 percent of Americans think it's important "to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." When the same question was asked by NBC News back in June, the poll showed 76 percent support. Virtually unchanged, even with all the coverage of the screeching tea party hooples last month.
There's no ambiguity here. The public option is resoundingly popular, fiscally conservative and morally sound. It's centrist, it's liberal, it's conservative. Unless you don't believe in, you know, numbers.
As for the president, his position on healthcare reform generally hasn't changed since the campaign. The public option, cost controls, insurance reform, revenue neutral, and so forth have all been part of his healthcare reform plan. The "centrists" who supported the president were well aware of what the president had in mind for healthcare. So the current policy shouldn't be a surprise.
Incidentally, Brooks also wrote about a reconciliation vote on healthcare alienating "the center." Believe me, no one other than junkies and wonks will care about the parameters of a reconciliation vote. In fact, I would wager that most Obama voters in "the center" don't even really know what reconciliation is. And if they're told, my hunch is their reaction will be, "A simple majority? What's wrong with that?"
I don't claim to know what David Brooks' actual motivation might be, but if I had to guess I would wager that it has much to do with a dishonest attempt to recalibrate the scales on healthcare reform. To redefine known reality in the face of incontrovertible evidence to the contrary. While the numbers show every reason for there to be almost unanimous support for the public option, the best way to diminish its support is to peg it as somehow fringe, scary, shrill and out of the mainstream, and to subsequently define the "center" as essentially what we've been hearing from the wingnut right. The ultimate goal achieved in this process is to give cover to Republicans and conservadems who have corporate mafia dons they're required to vigorously stroke.
I can only recall the lead-up to the invasion of Iraq when the establishment press and most of Washington got it so wrong. Deliberately or accidentally -- it doesn't matter. It's wrong and it's deceptive. And they're doing it all over again.
What we can conclude at this point is that the press and the far-right have managed to largely change the terms of the debate without regards to reality. Knowing this, we have a couple of months here to set the record straight and to achieve a robust, affordable, portable and reliable public health insurance plan. Considering the dishonesty and insanity of the opposition, it ought to be a winnable fight.
Alright Washington people, you're dismissed. Except for you, Bartiromo. You need to go here and learn about Medicare before you go on television and make an ass of yourself again.
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The 5% increase we found in premiums is moderate by long-term historical standards. For example, two different times during the last decade premiums increased by 13% a year, in 2002 and 2003. This year's increase continues a multi-year period of relative moderation in premium increases. Still, over the last ten years premiums have increased by 131%, while wages have grown 38% and inflation has grown 28%. Consider this: If people (and businesses) are as concerned as they are now about rising health care costs in a period when they are actually moderating, how much more concerned will they be when rates of increase return to historic averages?
Let's do some very simple arithmetic. Start with a fairly conservative assumption: If we assume that premium increases over the next ten years will average what they did over the last five (about 6.1% per year), the average premium for a family policy in 2019 will be $24,180. That's a big number. On the other hand, if we assume increases revert to the average of the last ten years--an average annual increase of about 8.7% and a very plausible scenario--premiums in 2019 will average a whopping $30,803, a very scary number...
The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide for $11,136 per year (though it is quite a bit more here in Menlo Park, California where our Foundation is based). You can also buy a new Chevy Aveo for $12,000, and it gets 35 miles per gallon on the highway.
The other result that jumped off the page was the stark contrast between increases in health insurance premiums and overall inflation in the general economy. Premiums went up 5% and prices overall fell 0.7% (mainly driven by a big drop-off in energy prices).
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