Where's the Outrage?

Again on a Saturday there is an announcement of a deal. Sen. Ben Nelson seems to have the capitulation that he’s been asking for. Something smells rotten to me.

In Pres. Obama’s weekly address, he asks for a vote. unfortunately, he used Republican terminology in asking for a “up or down vote.” I’m not sure why he did this. I’m not sure that this is a good thing. Reminding Americans of Republicans trying to push through conservative (ultraconservative) judges is not what President Obama wants, I don’t think.

From DK:

1. Section 2711 – Annual limits are now banned after 2014, and before then, shall be set at a limit that doesn’t impair “essential” health care services. This is a huge improvement over Reid’s original draft of the bill, that only banned “unreasonable” annual limits (without defining such term). By the time the exchanges are set up, there won’t be any annual limits on qualified health care plans.
2. Section 2718 – Medical loss ratios are set at 85% in the large group market and 80% in the small business/individual market (down from 90% initially floated by Rockefeller), with consumers refunded the difference from any health insurance provider that doesn’t spend the required amount on medical coverage.
3. Section 2719 – Stronger appeals process provided for medical denials, with the Secretary of HHS authorized to review such processes.
4. Section 1303 – States may prohibit abortion coverage on plans offered through the exchange!
5. Section 1334 – The public option is scrapped and replaced with OPM-negotiated private, non-profit (read: Blue Cross/Blue Shield) “multi-state” plans, which are also subject to state regulation? OPM’s role is limited to negotiating and certifying plans that meet its qualifications with respect to: (1) medical-loss ratios, (2) profit margins, (3) premiums charged, and (4) all other terms and conditions.

From HuffPo:

A holdout no more, Sen. Ben Nelson agreed Saturday to provide the 60th and deciding vote for Senate passage of sweeping health care legislation, capping a year of struggle and a final burst of deadline bargaining.

Nelson, D-Neb., said he made his decision after winning fresh concessions to limit the availability of abortions in insurance sold in newly created exchanges, as well as tens of million in federal Medicaid funds for his home state.

“I know this is hard for some of my colleagues to accept and I appreciate their right to disagree. But I would not have voted for this bill without these provisions,” he said at a news conference in the Capitol. (more… )

Tags: Healthcare, Party Politics by ecthompson
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I have complained about Harry Reid on a number of occasions. I think that he has been lead-footed on important issues and has been outflanked by the Republicans on a number of occasions. I think he has the forethought and insight of a gnat. Six months ago, everyone knew that the Senate was going to be a problem. What did he do to prevent the problem?

From C&L: Can we please have new Senate leadership now? The White House and Harry Reid have made one bad decision after another. We can’t do anything about Obama, but why do we have to put up with an incompetent Senate Majority Leader?

Four days before the Senate jettisoned the idea of expanding Medicare to younger Americans, a dozen Senate Democrats, including some of the chamber’s most liberal members, dispatched a stern letter warning that the proposal would make it harder for elderly patients in parts of the country to find care.

The letter, sent to Senate Majority Leader Harry M. Reid (D-Nev.), attests to the effectiveness of a ferocious campaign by influential hospital and physician lobbyists to defeat the idea. And it underscores the difficulty of forging policy and political deals in the warp-speed, supercharged environment in which Congress is trying to reshape the nation’s health-care system.

The proposal to allow people ages 55 to 64 to buy insurance through Medicare — one of the most significant ideas to emerge from the Senate’s side of the debate — appeared and vanished in a mere six days.

Sources on and off Capitol Hill say the quick life and death of the Medicare buy-in reflects the complex politics and a brutal reality at this stage of the Senate’s deliberations, in which there is little time to refine proposals that do not immediately attract the 60 votes needed for health-care legislation to pass.

The broad contours of the proposal emerged early last week from 10 liberal and moderate senators whom Reid had assigned to negotiate a bill. The group reached for the Medicare buy-in as a compromise between members who favored a new government-sponsored insurance alternative for Americans of all ages, and those who were wary of more public coverage. The buy-in, they reasoned, would create access to public insurance for people in late middle age — a group for whom medical problems become more common and insurance is particularly expensive.

But in the following days, the proposal met resistance among Senate moderates as well as some liberals. Meanwhile, Reid made a strategic decision, ordering the negotiators to keep the details of their proposal secret until congressional budget analysts examined the impact it might have on consumers and the federal budget. That strategy, however, meant that the proposal did not attract much support from outside constituencies that have, in the past, favored letting younger people buy into Medicare.

“We were immobilized due to lack of information,” said John Rother, executive vice president for policy and strategy at AARP, a lobbying group for people age 50 and older, which has endorsed buy-in proposals in the past. “We couldn’t support something that we didn’t know what it was.”

Tags: Healthcare, Senate by ecthompson
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Now, this is GREAT radio. My special guest is Lance Ulanoff, Editor and Chief of PC Magazine. He is here to help us with Christmas electronic purchases. We’ll chat about the do’s and don’ts. Then I talk with Igor Volsky of the Wonk Room at Think Progress. He has been following the ins and outs of the Healthcare legislation. Plus, I promise… NO Tiger Woods jokes.

I gave away another copy of the GREAT book, Pops by Terry Teachout and another $100 gift certificate to Amazon.com. If you listen, then you can win too!!

 

 The Errington Thompson Show 12-12-09 [49:56m]: Play Now | Play in Popup | Download

Tags: Economy, Entertainment, Healthcare, Podcasts by ecthompson
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Many years ago, Markos was a dude like you and me. At parties, once everyone was all liquored up, folks would listen to him. It is the same way with me. Once everyone has a few, they will listen to anyone. That was then. Now, Markos has an audience of hundredss of thousands, if not millions. Markos has grown with his audience. He has tailored his rants. He makes thoughtful arguments that some of the best columnists in the world don’t or can’t make.

Markos makes an excellent case for giving the Senate a big fat raspberry.

(Raspberry at 2:19)

Markos:

Ezra Klein takes me to task for my opposition to the mandate, pointing out that Switzerland, among other systems, have mandates that require citizens to purchase health insurance from private insurers. It’s true. They do. Those countries also have strict regulatory regimes that heavily regulate those insurance companies. In Switzerland, for example, insurance companies cannot profit from the essential benefits plan everyone must purchase. That’s kind of an important detail missing from the Senate’s monstrosity of a bill. In addition, Switzerland also strictly regulates the price of medicines and medical devices — something this Senate has explicitly refused to allow.

Give me those kinds of restrictions to the Senate bill, and I’ll rethink my opposition.

Then there’s Nate Silver and his 20 questions For Bill Killers, which I’ll happily answer:

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

The assumption here is that this bill is the only option on the table. The House still has a say in the matter. And really, the point of reform isn’t to shovel taxpayer dollars to the insurance companies, it’s to expand care and lower costs. I’m not willing to surrender on costs.

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

This betrays a simplistic view of liberals, as if our answer is to merely shovel money at a problem. What we’re looking for is good policy, which in this case, would also be good politics. So no, throwing money at the insurance companies doesn’t change a thing. The insurance industry would simply absorb the new subsidies just like universities have raised tuition to shovel up any increases in financial aid.

3.  Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

Where is the evidence that insurance companies would rig the system to extract record profits? I don’t know. Perhaps the last decade or two might provide the answer.

4. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

Because it is a measure that would disproportionately affect blue collar workers in high-risk jobs, or workers that have given concessions on wages to preserve good benefits packages. Limit that provision to people making over X amount (say, $100K/year), and I wouldn’t have a problem with it.

5. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

Because without premium caps or a public-run competitive option, there is no incentive for them to lower their premiums. They have a monopoly, and monopolies aren’t in the business of unilaterally reducing their prices. There are two ways to force them to do so — government regulation or market competition. The former is out, and the latter is inadequate.

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: “forcing you to buy government-run insurance?”

If you start worrying about Republican talking points, you’ve lost the game. They’re accusing Democrats of trying to kill grandma. They’re not going to back off because a talking point isn’t 100 percent accurate. 2010 will be the year of the “commie socialist Democrats”, no matter what health care reform bill is passed.

In any case, Republicans have tried to destroy socialist programs such as Medicare and Social Security for years. If people like a program, there’s nothing the GOP can do about it.

Please read more of his thoughts. I think that Markos has done an excellent job at summarizing the thoughts of those of us who are trying to get behind this bill. There are some good things in this bill. Unfortunately, I feel that supporting this bill is like buying a car without the engine. There simply ain’t much there.

Tags: Healthcare, Senate by ecthompson
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I’m still not sold on this Senate healthcare bill. I think it is a sorry excuse of a bill. Yet there are a few good things still in the bill that I can support. Here’s one point of view.

FromThink Progress:

Since Joe Lieberman demanded stripping the public option and Medicare buy-in provisions from the merged Senate bill, some strong progressives like Howard Dean have argued that without a public option or a Medicare buy-in provision, the bill is a giveaway to private insurers and should be killed. Other progressive leaders like Senators Jay Rockefeller, Tom Harkin and Sherrod Brown believe that the bill represents the best chance for passing health care reform in the foreseeable future. “I’m going to vote for it,” Brown told reporters. “I can’t imagine I wouldn’t. I mean there’s too much at stake.”

Change of the magnitude envisioned by health care reformers does not come easily. There have been many frustrations and there will be more. But, as a senior White House staffer with a ringside seat for the slow death of comprehensive care in 1994, I am keenly aware of the real alternative to the bills now before us: millions more Americans without health care and billions more for health care spending as the same challenges President Clinton tried to resolve continue to metastasize unchecked.

So while I have great respect for Governor Dean, and we have worked together to provide the strongest health care reform bill for the American people, I come down on the side of the Senate passing the bill.

Here’s why:

The Senate health care bill is not without its problems. But if enacted, it would represent the most significant public reform of our health care system that Congress has passed in the 40 plus years I have worked in politics. The bill will give health care coverage to a record 31 million Americans who are currently uninsured, lay a foundation that will begin to lower costs for millions of families, and provide all Americans with the access to adequate and dependable coverage when they need it most.

All of us are anxious to see the final language from the Senate. And a final bill must ensure that the subsidies provided are sufficient to make insurance truly affordable for working families. But based on what we know, here are my top ten reasons for why progressives should support the Senate passing the bill:

1. Largest Expansion Of Coverage Since Medicare’s Creation: Thirty-one million previously uninsured Americans will have insurance.

2. Low/Middle Income Americans Will Not Go Without Coverage: For low-income Americans struggling near the poverty line, the bill represents the largest single expansion of Medicaid since its inception. Combined with subsidies for middle income families, the bill’s provisions will ensure that working class Americans will no longer go without basic health care coverage.

3. Insurance Companies Will Never Be Able to Drop or Deny You Coverage Because You Are Sick: Insurers can no longer deny coverage because of a pre-existing condition. They can’t rescind coverage or impose lifetime or annual limits on care. Significantly, the bill also ends insurer discrimination against women — who currently pay as much as 48% morefor coverage than men — and gives them access preventive services with no cost sharing.

4. Lowers Premiums For Families: The Senate bill could lower premiums for the overall population by 8.4%. For the subsidized population, premiums would decrease even more dramatically. According to the CBO, “the amount that subsidized enrollees would pay for non-group coverage would be roughly 56 percent to 59 percent lower, on average than the nongroup premiums charged under current law.”

5. Invests in Keeping People Healthy: The bill creates a Prevention and Public Health Fund to expand and sustain funding for public prevention programs that prevent disease and promote wellness.

6. Insurers Can’t Offer Subprime Health Care: Insurers operating in the individual and small group markets will no longer sell subprime policies that deny coverage when illness strikes and you need it most. Everyone will be offered an essential benefits package of comprehensive benefits.

7. Helps Businesses Afford Coverage: Small employers can take advantage of large risk pools by purchasing coverage through the bill’s state-based exchanges. Employers with no more than 25 employees would receive a tax credit to help them provide coverage to their employees. The bill also establishes a temporary reinsurance program for employers providing coverage to retirees over the age of 55 who are not eligible for Medicare.

8. Improves Medicare: The bill eliminates the waste and fraud in the Medicare system, gets rid of the special subsidy to private insurers participating in Medicare Advantage and extends the life of the Medicare trust fund by 9 years. It also closes the doughnut hole that affected 3.4 seniors enrolled in Medicare Part D in 2008.

9. Reduces The Deficit: Not only would the bill expand coverage to 30 million Americans without adding to the nation debt, it would also reduce the deficit by up to $409 billion over 10 years.

10. Reduces National Health Spending: A CAP-Commonwealth Fund analysis concludes the bill could reduce overall spending by close to $683 billion over 10 years – with the potential to save families $2,500. Even the most conservative government estimates conclude that the bill would reduce national health care expenditures by at least 0.3% by 2019.

Tags: Healthcare, Senate by ecthompson
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What the heck is this about? This should never have happened. Now, we (I) need to get more facts before I go off. This explanation seems a bit weak.

From CNN.com:

One of the five manufacturers supplying H1N1 vaccine to the United States is recalling hundreds of thousands of flu shots because they aren’t as potent as they should be.

The French manufacturer Sanofi Pasteur is voluntarily recalling about 800,000 doses of vaccine meant for children between the ages of 6 months and 35 months.

The company and the Centers for Disease Control and Prevention emphasized that the recall was not prompted by safety concerns, and that even though the vaccine isn’t quite as potent as it’s supposed to be, children who received it don’t have to be immunized again against H1N1. (more…)

Tags: Healthcare by ecthompson
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Look, unless we were blind and still living in the ’50s, we knew that the Senate was going to be a problem on healthcare legislation. We knew this back in March. Senator Harry Reid has had approximately nine months to come up with a strategy to pass a healthcare bill through the Senate. In the nine months, he was unable to garner one Republican vote. He’s been unable to garner enough Democratic votes to stave off a filibuster. If, by some chance, he can procedurally outmaneuver Joe Lieberman, Ben Nelson, Mary Landrieu and Blanche Lincoln, he probably has 54 votes to pass an extremely watered-down healthcare bill which will not cover all Americans. (Let’s celebrate.)

Progressives, we only have ourselves to blame. We’ve known since 2002 that we have an uphill battle to fight. We are fighting not only conservative Republicans but also uninformed Americans, the “liberal media” and the corporatists. This last category is a huge problem. It encompasses both Democrats and Republicans.

Senator Ben Nelson has stated that he wants more abortion controls in the healthcare bill. What? This is not an abortion bill. Yet, Ben Nelson would hold up progress so that we can write a special phrase or clause dedicated to abortion. What is wrong with this man? The current laws are clear. Public money cannot fund abortions. There’s no ambiguity. There is no language in this bill that would support abortions. So what is he talking about?

Back to Joe Lieberman. We saw in his reelection campaign who he really was. Joe Lieberman was vindictive, pompous and extremely flexible on the issues depending upon whether it was advantageous for him and his career to go one way or the other (see video above). He supported expansion of Medicare just a few years ago. Now it is the worst thing ever. If anything good has come out of this healthcare debate is that Joe Lieberman has clearly shown the voters of Connecticut that he is not looking out for them. It’s hard for me to imagine either Republicans or Democrats supporting Joe Lieberman anymore. He has no principles. He has proven this over and over and over again.

Back to Harry Reid. What is he doing? He has shown little or no leadership on this issue. He’s shown the willingness to get in front of the cameras, but he never says anything of substance.

Finally, it is time for progressives to realize that we might have bitten off more than we can chew. We’ve worked hard over the last four years to get Democrats elected to national office. For the most part, we’ve had great success. Unfortunately, maybe we did not do the right thing. We tried to elect Democrats. Maybe we should’ve tried to elect progressives. Maybe we should’ve insisted on trying to find candidates who supported healthcare reform, closing Guantánamo Bay, not spying on Americans without warrants and withdrawing troops from Iraq expeditiously. I think these last nine months should not get us dispirited or disheartened; instead, we need to redouble our efforts. Our country depends on it.

Tags: Healthcare, Party Politics, Senate by ecthompson
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I talk with Joan McCarter from the Daily Kos about what the heck is going on in the Senate. Joan has been following the ins and outs of the Healthcare legislation with posts two or three times per day.

This is clearly worth a listen.

Update from McJoan:

According to USA Today, there’s a new, influential voice pushing reconciliation to get a healthcare reform bill passed.

USA TODAY’s Washington bureau chief Susan Page reports that John Podesta, president of the Center for American Progress and the former head of President Obama’s transition, said some Democrats may be taking another look at the so-called reconciliation process, a budget procedure that would let Democrats pass a health care bill with only 51 votes….

The issue, Podesta said, is whether Lieberman “is trying to get to ‘no’ ” on health care. He said Democratic congressional leaders were surprised by Lieberman’s negative language Sunday on the emerging Democratic plan.

“I suspect musty folders on reconciliation got dusted off this morning” on Capitol Hill in the wake of Lieberman’s comments. “If you don’t have Lieberman and you don’t have Nelson, the question is whether you can get Snowe and Collins.” He said the Democrats were “very close” to 60 and might still be able to get there.

On Lieberman: “I’ve given up on him” — that is, on trying to figure out what he will do.

Snowe says that she’ll only support a bill if they slow things down (because being at the heart of negotiations in the Finance committee for the past year, and being one of the bipartisan Gang of Six that drug on, and on, and on, and on, and knowing this bill inside and out just hasn’t given her enough time to make up her mind). Collins isn’t going anywhere Snowe doesn’t go first. Nelson still wants his abortion amendment.

Figure out enough compromises to make any of the “moderates” happy enough to get to 60, and you risk losing progressives, particulary Brown (who personally invested a great deal in the compromise Lieberman just blew up), Sanders, Feingold, and Burris. You also risk losing a 218 majority in the House.

Let’s hope that those musty folders are being dusted off, because there very well may be no other way to achieve this. And let’s hope the issue compromises a large part of the discussion in the Senate Dem caucus meeting this afternoon.

 

 The Errington Thompson Show - Special Healthcare edition 12-14-09 [14:23m]: Play Now | Play in Popup | Download

Tags: Healthcare, Podcasts, Senate by ecthompson
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I know this sounds like an oxymoron, but stay with me. Joe writes, “…common sense health insurance reform will cost the government little to nothing.” I always liked these common sense solutions. They make me smile. The reason I smile it is that if they were so simple and easy we would’ve tried them already. Congress has been desperately looking for something simple and easy to try for the last 25 years. During this time both Republicans and Democrats have controlled the House and the Senate and could’ve passed “common sense” solutions. Especially, especially if those common sense solutions didn’t require insurance companies or pharmaceutical companies to lose money. Congress would have been all over it.

1. Allow people to band together to buy group health insurance without being an employee-based group.

This sounds nice. You have to find a way to get millions of people to band together, not just a few. As far as I know, Americans have not banded together to buy gas or to buy groceries. Small bands of Americans (a couple thousand) would be almost the same as a small business and its employees. The reason any given small business has stopped covering employees, as a rule, is cost. There’s no way a small band of Americans is going to be able to figure out how to decrease the cost. Now, the exception would be small bands of young healthy Americans. They could easily band together and cover themselves for little or nothing. Basically, this is Kent Conrad’s idea, which has been thoroughly vetted. This is about co-ops. Co-ops will not be competitive because they don’t have the numbers to negotiate drug prices and fees for service.

2. End exemptions for a self-insured plans.

If we are going to end exemptions, why isn’t that the case in the healthcare exemption? The benefit of health insurance is not taxed. Our treasury loses $110 billion every year because of this. This seems to be a much fairer solution, don’t you think?

3. Standardized insurance forms and information systems.

This will cost millions. It will cost insurance companies and doctors’ offices and hospitals millions of dollars to change from what they have to something else. Who’s gonna decide what the standard is? Clearly, we’re not gonna trust the government to do that, so we are going to wait for business to come up with a committee to do this? Expect a decision in three to four years… and a voluntary implementation of this will never happen. There’s no incentive for business to do this. Unless you want to pass regulations — no way. Conservatives hate regulations.

4. End cost shifting.

Cost shifting doesn’t end. Just because you tell them to stop it, doesn’t mean it will end. Hospitals and doctors have incentives to continue cost shifting. They get paid. Personally, as a physician, I’ve been down this road, where we “aggressively” go after those without money and those who don’t pay. The bills simply never get paid off. They end up spending a lot of money trying to track down people who have moved out of state. They end up spending a lot of money on people who are paying $25 and $50 a month on bills that are $50,000 and $100,000 or more. Neither hospitals nor physicians will willingly take this hit.

Remember, we are obligated to provide medical care for those people who are dying. This isn’t like a car dealership. No matter how badly you want a car, if you don’t have cash or financing you don’t get that car. If you come in to the emergency room because of a heart attack or a bleeding ulcer, we take care of you. This is the way it should be. It also should be that we get paid for the services that we render. How we get paid by those who don’t have money to pay is a question that society needs to answer.

So far, none of the suggestions that have been made by some conservatives that I’ve reviewed here amount to any significant cost savings. None of the suggestions will control costs. With healthcare costing $2.2 trillion in 2007, I’m sorry to say that these solutions are weak at best.

Tags: Healthcare by ecthompson
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The more I read on this compromise, the less I like it. It is like that stuff I used to get at the fair – cotton candy. It looks interesting. It tastes nice, but in the end it is mostly nothing but air.

From FDL:

I contacted Dr. Ida Hellander, Executive Director of Physicians for a National Health Program, to get her feedback on whether or not PNHP thought lowering the Medicare age to 55 was a good idea. I respect Ida and the PNHP folks a lot, and wanted to see what they thought.

Here is the PNHP Statement:

Lowering the eligibility age for Medicare to 55 only works if it is mandatory. Otherwise it becomes the place where all the sickest patients get dumped. That might be okay for the sick people since Medicare is often better and more secure than private coverage, but it would drive total health care costs (and premiums) up, not down.

I know Anthony Weiner is saying that lowering the eligibility “would perhaps get us on the path to a single payer model.” That would be the same Anthony Weiner who pulled his single payer amendment when asked by Leadership to do so, while Bart Stupak got waived through.

We don’t know what the restrictions on access to Medicare will be, so I question why anyone is out there promoting a pig in a poke.

Tags: Healthcare by ecthompson
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This could be so simple. We can provide a safety net for all Americans. Medicare for all. Unfortunately, life isn’t simple. Whenever you get 50 or more folks together with newspaper reporters and cameras and people’s jobs at stake, it isn’t that simple. So we’ve been playing around with the public option. Remember, the public option is a watered-down version of what most progressives want, a single-payer program like Medicare for everybody. The public option seems to be too liberal, too expensive… too something for some Democrats. So tonight a compromise has been reached.

Older Americans between the ages of 55-64 can buy into Medicare. Details of this buy-in remain somewhat sketchy. The buy-in seems to start in 2011. This will be available to everybody within the age restrictions who are also under 150% of the poverty line. Also, there appears to be an extension of the Federal Employees Health Benefits Plan. This plan will be allowed to enter the exchange if insurance companies don’t create a nonprofit insurance plan for it. Remember that the exchange does not start until 2014.

These new proposals will send the Congressional Budget Office back to the drawing board. They need to come up with cost estimates before the Senate is able to proceed.

I’m sorry, but this just looks like garbage to me. Let’s tweak this and let’s hope that that somehow we get decent health insurance coverage for everyone. It’s not going to work. The whole thing is too piecemeal and too complicated. Medicare for all… what is so hard about that?

Update:

McJoan adds -

The NY Times Prescription blog has some more details:

But Democratic aides said that the group had tentatively agreed on a proposal that would replace a government-run health care plan with a menu of new national, privately-run insurance plans modeled after the Federal Employee Health Benefits Program, which covers more than eight million federal workers, including members of Congress, and their dependents.

A government-run plan would be retained as a fall-back option, the aides said, and would be triggered only if the new proposal failed to meet targets for providing affordable insurance coverage to a specified number of people.

The agreement would also allow Americans between age 55 and 64 to buy coverage through Medicare, beginning in 2011.

Great, the compromise for a strong public option is even more private plans. That triggered, maybe public option could be the public option Reid said was still in there. If it’s an extremely robust public option, and the trigger is set at a level that could really be triggered, well, it’s silly to speculate on that because the ConservaDems would never have agreed to that.

A Senate leadership aide tells me that “there is a public option in the compromise,” but won’t be able to provide more details until it is scored by the CBO.

Tags: Healthcare by ecthompson
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Limbaugh is good at attracting attention.

From C&L:

Check out how William Shatner questions the head of the GOP about what he thinks about you and health care.

Shatner: If you have money, you’re going to get health care. If you don’t have money, it’s more difficult.

Limbaugh: If you have money you’re going to get a house on the beach. If you don’t have money you’re going to live in a bungalow somewhere — that’s — that’s…

Shatner: Right, but we’re talking about health care.

Limbaugh: What’s the difference?

Shatner: The difference is we’re talking about health care.

Limbaugh: No…

Shatner: Not a house or a bungalow.

Limbaugh: You’re assuming that there’s some morally superior aspect to health care than there is to a house or a bungalow.

Shatner: No, not moral at all. I want to keep the subject for the moment on health care.

In RushBo’s world, houses on the beach are old school, man. Why don’t you have one already? If you got no cash — too bad. Rush makes Alan Grayson’s point for him. Don’t get sick. You’ve got to be a rich conservative to make it in America. Or so Limbaugh says.

Tags: Healthcare, Party Politics by ecthompson
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I’m not sure for whom Snowe, Lincoln and Landrieu are working. They don’t seem to be working for the American people.

From DK:

These are the last three Reid should be trying to work out a public option compromise with. Via Jon Walker, Politico is reporting on an amendment by Snowe, Lincoln, and Landrieu to basically eliminate state regulations on what insurance companies must cover.

Jon:

SA 2859 Snowe/Landrieu/Lincoln – nationwide plans: deletes state opt out language, adds rating requirements to plan requirements

If you live in a state with strong minimum benefit insurance regulations (California, Minnesota, New York, and Vermont come to mind), you will lose your current health insurance, and your insurance coverage will get worse.

What are nationwide plans? As I explained in an earlier post, they are an idea strongly championed by the health insurance lobby. The Senate bill would effectively nullify current state regulations on what insurance plans must cover by allowing insurance companies to sell “nationwide plans” in any state. These nationwide plans would only be required to meet the minimum coverage benefits mandated by the federal government and the state in which they are based. (Think of the deregulation of the credit card industry.) These nationwide plans could sell in other states, and would be exempt from those states’ insurance regulations. In effect, this completely guts state insurance regulation of minimum coverage. Utah, for instance, has very lax regulation, so expect all insurance companies to be based there by 2016.

The merged Senate bill allows for states to opt-out, to prevent nationwide plans that would violate and would nullify current state regulations from being sold in their state, lowering the bar dramatically for what what insurance companies could get away with, and taking away the right of states to regulate insurance. But the insurance lobby sure does love it.

More evidence that these three are not operating in good faith on actually reforming the insurance system, and more evidence that any deal reached with them is unlikely to be worth the price they extract.

Tags: Healthcare by ecthompson
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Prizes? Errington has some seasonal surprises in this week’s show, including upcoming giveaways for listeners and for those who check out the blog. Along with some Amazon.com gift cards and gift certificates to Malaprop’s, there will be some lucky new owners of a great new biography of Louis Armstrong, Pops: A Life of Louis Armstrong by Terry Teachout. Free stuff… what a great way to get started thinking about the holidays, and Errington (unlike your local grocery store) has the grace to wait until after Thanksgiving!

Getting down to business, this show runs the progressive gamut from corporate responsibility (or lack thereof) to the formerly tax-exempt “religious” sanctuary, C Street in Washington, to H1N1 and a guy with fifteen live lizards strapped to his body trying to smuggle them into the U.S. on a plane. Errington and Aaron touch on Big Pharmacy’s price increase this year, up approximately nine percent, and pose the question: is this coincidence, right before probable health care reform, jacking up their prices to increase profit margins? Don’t these guys owe the American public some kind of restraint and responsibility? How about the women in the news lately shut down and shut up by US contractor, KBR after their repugnant practices safeguarding policies sanctioning gang rape in their Iraq facility?

Of course healthcare is all over this episode, looming large as it does is all of our minds right now, hefty bills going back and forth in Congress, progressives and conservatives duking it out over ways it can be improved and wrestling some really big numbers. As a trauma surgeon, of course Errington brings a unique point of view to the debate. What if we focused on promoting healthy habits and tried to move the focus back to the general practitioner and away from Urgent Care and the ER? “Jerry” calls in, wondering about proposed penalties for people who won’t voluntarily get health insurance under some of the suggested healthcare legislation. At least in jail you’d get health insurance… a bed, and three squares!

Now this is progressive radio!

 

 The Errington Thompson Show 11-21-09 [53:59m]: Play Now | Play in Popup | Download

Tags: Healthcare, Legal, Military, Podcasts by ecthompson
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Is there anybody who believes that America is about competition? If you believe that America and business love competition, please email me because I have some swamp land ocean-front property to sell you out in Idaho. Think about that period in American history after World War II. The big companies got bigger because of competition? No. Of course, there are a few exceptions but as a rule big companies split up the marketplace. Whether it was General Motors, Ford and Chrysler or, in steel, United States Steel, Republic and Bethlehem, these big companies split up the marketplace and made profits. There was no competition. None.

Now, it looks like we have more information on the pharmaceutical companies. They paid generic drug companies to keep their generics off the market. Is anyone really surprised? There is so much money in pharmaceuticals that drug companies are able to pay off these generic companies so that everybody makes money but, and this is important, the pharmaceutical companies make a ton more money and the consumers pay a ton more money. Everybody wins except the consumers.

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I talked about mammograms and the controversy surrounding them a couple of weeks ago. It seems that several of the folks who made the recommendations were brought in front of a congressional committee in which they yelled that it was all just some sort of misunderstanding. It was a problem in communication. Horse hockey. I hate when people kind of weasel out of things. Say what you mean and mean what you say. In the formal paper which was published in the Annals of Internal Medicine, this committee stated that it recommended “against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 should be an individual one and take into account the patient’s context, including the patient’s values regarding specific benefits and harms.”

The recommendations weren’t a mistake. They were not something that they just dreamed up out of the air. The panel should’ve stood firm and said that, in their interpretation of the literature, these were their recommendations. Then, they should’ve added a caveat, the same warning in the paper, that treatment should be individualized in these patients.

Again, as I said before, this is a minor task force which has no bearing on the American Cancer Society, really the main medical body to which physicians look for recommendations on cancer, including breast cancer. I believe in screening more women and not fewer. I believe that women need to be informed about their choices. They need to be told that the earlier you start screening the more likely it is that you’re going to have something found on mammography, which will lead to a biopsy, which most likely will be negative. Once women understand this and want to accept this risk then there should be no argument.

Tags: Healthcare by ecthompson
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No, it doesn’t mean that I’m going to charge you for reading this.

I’ve talked about healthcare reform over and over again (I don’t see how Joan does it every day without going insane). I’ve talked about healthcare from an emotional standpoint and from an American legislative standpoint. I’ve talked about all the benefits of healthcare reform. Well, I’d like to take a different tactic. I would like to review the medical literature. I’ve picked several studies which I will describe over the next several days. The one thing that all of these studies have in common is that they point out that health insurance is a predictor of outcome. On Wednesday or Thursday, I’m going to review an article from the Journal of the American Medical Association which clearly states that having a unified health program has survival benefits. (We don’t have a coordinated, organized healthcare system in the United States.)

As a trauma surgeon, I don’t like to talk “shop” with people who are not in the medical profession. As soon as you start mentioning cytokines and mitochondria DNA, most people’s eyes glaze over. But, with watered-down legislation creeping through the Senate at a glacial pace, I thought it was important for me to go over some of this literature. The literature makes approximately the same point that Keith Olbermann made about a month go when he talked about having health insurance being life-and-death.

In trauma, we, trauma folks, would like to think that we treat patients all the same. Many states have trauma systems in which an injured patient, is shunted away from small hospitals that probably cannot help that patient and toward trauma centers who have the expertise and the manpower to help. This move has been shown to save lives. Most, if not all, trauma centers have protocols which are then individualized for a particular patient. We have found through numerous studies that these protocols help save lives. Therefore, you would figure that the outcome for a patient who was seriously injured in a car crash would be directly related to his or her injuries. This is true, for the most part. A recent study, however, has thrown a wrench in this.

A study, published in The Archives of Surgery in 2008, investigated over 400,000 patients who had been entered into the National Trauma Databank. One thing that we have known for years is that socioeconomic status does influence your outcome. As expected, mortality rates for Black and Hispanic patients were higher than those of White patients. Patients with insurance had a mortality rate of approximately half of those without insurance. Now, for the shocker — both Blacks and Hispanics with insurance who were injured had a mortality rate less than Whites without insurance.

This was a very surprising result. Numerous studies in trauma patients over the years have shown differences in outcomes among the races. As more and more studies have been done, it is clear that race is a surrogate for multiple other factors, including eating habits, living conditions and other things that can affect outcome. It is also clear that insurance acts as a surrogate for those same kind of factors. People with insurance have jobs. People with jobs drink less than people without jobs. People with jobs tend to live in better conditions than people without jobs. What was surprising is how strong insurance is as an indicator of lifestyle.

So, if every American had health care coverage would they all have better outcomes from trauma? Well, this question is somewhat hard to answer. On one hand, just having insurance does not get you to live in a better house, in a better neighborhood with better indoor plumbing and a refrigerator that works all the time. On the other hand, one of the huge problems that we have in the trauma community is that we have to send many people home from the hospital after their hospital stay is over, when they should go to a rehabilitation center for more therapy, but they can’t qualify because they don’t have insurance. These patients would instantly do better. Getting adequate health care coverage to all Americans is a step towards better equality.

I would like all members of Congress to read this article. This is important. This is what we’re fighting for. We’re fighting for a more equitable society. I’m not trying to take away any healthcare from anybody; instead, I want to add healthcare to those who don’t have it.

Tomorrow, I’m going to review an article called health insurance and mortality in United States adults. This article expands on the concept that insurance is a marker for outcome.

Tags: Congress, Healthcare, Party Politics by ecthompson
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When we first started talking about Healthcare Reform, I mentioned that I really, really supported a single payer (government run) program. If we provide the exact same healthcare services, we could save over $300 billion per year with a single payer system(although, I must admit, many people dispute this number). There would be significantly less administrative overhead. We would have the ability to direct funding into clinical research that would give physicians answers to the most important medical questions. What is the best drug for hypertension? Are drugs and exercise the best combination for a long life? How much exercise do you need in order to have cardiovascular benefit? We don’t have the answers to these questions.

Now, almost eight months later, we are bickering about a public option. We’re not even bickering about a strong public option. No healthcare plan that has been seriously debated in Congress covers all Americans. So this isn’t really healthcare reform. This is health insurance reform, sort of. Although this is much less than any progressive would’ve wanted, we have to push forward. We have to get something passed. We can’t go back to the American people in 2010 and say that we tried. That simply isn’t good enough. We have to pass some sort of meaningful healthcare legislation.

From DK (McJoan):

Progressive observers of the healthcare reform effort aren’t too heartened after the continuing recalcitrance of three ConservaDems and Joe Lieberman on healthcare reform, and the newfound willingness in leadership, as expressed by Dick Durbin to find a way to mollify them. The problem is, anything that works to make these guys happy isn’t going to be real reform.

Here’s Robert Reich:

But what more can possibly be compromised? Take away the word “public?” Make it available to only twelve people?

Our private, for-profit health insurance system, designed to fatten the profits of private health insurers and Big Pharma, is about to be turned over to … our private, for-profit health care system. Except that now private health insurers and Big Pharma will be getting some 30 million additional customers, paid for by the rest of us.

Upbeat policy wonks and political spinners who tend to see only portions of cups that are full will point out some good things: no pre-existing conditions, insurance exchanges, 30 million more Americans covered. But in reality, the cup is 90 percent empty. Most of us will remain stuck with little or no choice — dependent on private insurers who care only about the bottom line, who deny our claims, who charge us more and more for co-payments and deductibles, who bury us in forms, who don’t take our calls.

As I see it, the Democrats really have two other fights down the road and we need to win both of them if we are going to have any hope of holding on to Congress in 2010. Banking reform. Green jobs legislation. The Republicans and conservative Democrats will fight tooth and nail to make sure that this does not happen. So it is too early for us to get tired and frustrated by the legislative process. Unless we want to turn over Congress to the Republicans, we have to have more to show for our efforts. Let’s tighten our seatbelts, because it is definitely going to be… a bumpy ride.

Tags: Economy, Environment, Healthcare by ecthompson
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From DK:

I’m still amazed that not even one f****g [ed. note - the Republican party does not have any moderates any more. We all know that there aren't any liberals. They are all different favors of ultraconservatives.] Republican could find minimum decency to at least vote for health care DEBATE in the US senate. Quite astonishing. What a disgrace. I’m not even talking about Olympia Snowe, who became half-president in recent months and now refuse to let the debate begin – But Orin Hatch? John McCain? People who served decades with Teddy Kennedy? How disgusting.

Right after the vote, Victoria Kennedy called Harry Reid in tears:

Mr. Reid first mentioned the call in an aside to Senator Christopher J. Dodd, Democrat of Connecticut and one of Mr. Kennedy’s closest friends in the Senate, as they stood at a news conference after the vote. While Mr. Kennedy was battling cancer, Mr. Dodd stepped in as acting chairman of the Senate Health, Education, Labor and Pensions Committee, and helped shepherd the health care bill through a committee vote in July.

“She believes that Ted was watching,” Mr. Reid told Mr. Dodd.

Asked about the call, Mr. Reid said that Mrs. Kennedy had telephoned him in the Democratic cloakroom just after the 60 to 39 vote, which allows debate to begin on the Senate’s health care legislation.

“She called right after the vote,” Mr. Reid said. “I’ll remember the call always. She of course was crying pretty hard. We both felt that he’s watching us tonight.”

Tags: Healthcare, Senate by ecthompson
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I don’t know Senator Ben Nelson. I don’t know if he is a thoughtful man or one of those gut-men who flies by the seat of his pants. It seems to me that it is a little late in the game for Nelson to send Majority Leader Reid an items list of things he wants or does not want in the HealthCare bill.

From Political Animal:

Sen. Ben Nelson (D-Neb.) has a few thoughts about the kind of changes he’d like to see on the health care reform bill. In fact, he has two pages of ideas, which he’s already delivered to Senate Majority Leader Harry Reid (D-Nev.).

“There is not a lot of explanation there. These are just items,” Nelson said.

What’s on it? Public option, abortion, and CLASS Act, among other things.

“There will be a lot of discussion back and forth about what might get enough votes,” Nelson said after the vote. “There will have to be fairly significant changes for others as well, not just me…. Nuance will not be enough.”

I haven’t seen the actual list, but at this point, I’m not altogether sure what any of this means. Nelson hasn’t included “a lot of explanation” with his demands? Wouldn’t “a lot of explanation” be helpful under the circumstances?

He isn’t exactly a rookie. If Nelson has some specific ideas about policy improvements, he should, you know, craft legislative language, put together proposed amendments, start seeking co-sponsors, etc. Handing Reid a list of “just items” doesn’t sound especially constructive.

For that matter, it’d be helpful to know if this is a list or a ransom note. Does Nelson intend to join a Republican filibuster if only some of his list is addressed to his satisfaction?

As the process moves forward, keep in mind that Nelson appears to have a hierarchy of concerns in mind. Just a few days ago, the conservative Democrat said he doesn’t like the existing restrictions on abortion funding, but added, “If there’s no public option, perhaps some of the [abortion] problem goes away.”

In other words, Nelson has a list, but his top target is the public option.

Tags: Healthcare, Party Politics by ecthompson
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I’m wiped out. I’m going to bed, but I wanted to pass this little nugget on to you.

From TPM:

On a perfectly partisan, 60-39 vote, the Senate agreed tonight to debate and amend a far-reaching health care bill. That debate will get started in earnest after Congress returns from next week’s Thanksgiving recess. Democrats and Republicans expect to offer hundreds of amendments (each of which will be held to a 60 vote threshold) and debate for several weeks before holding yet another procedural supermajority vote–to end debate. If that gets 60 votes, then there will be an up-or-down vote on passage of the bill.

If the bill passes it will likely undergo yet more changes in conference with House negotiators. The “conference report” that emerges from that process can’t be amended, but can be filibustered in the Senate, so will likely require 60 votes for passage. Only after both chambers have passed the conference report can the bill be sent to President Obama for a signature.

Tags: Healthcare by ecthompson
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