Olympia Snowe, Abortion, and the Public Option

It's been some time since I posted here, and I must admit much of it is out of frustration. It's bad enough that Congressional Republicans practice obstructionist politics, but Max Baucus seems set on being a one-man show, developing his own healthcare bill that does not include a public option, just because. And now, big surprise, Republicans are trying to eliminate coverage for abortions from any plan that is part of the pool from which uninsureds and small business will purchase coverage.

Orrin Hatch's proposed amendment denying abortion coverage was defeated in the Senate Finance Committee by a vote of 10-13. Abortion is legal, so I wish these folks would get over it. Frankly, I think it's absurd that Medicaid does not cover abortions, meaning those who need it most must figure out a way to pay out of their own pockets. Proponents of healthcare reform have danced around the issue by saying that only amounts attributable to individual premiums can be used to fund abortions. Of course, that's impossible to do administratively, but honestly, saying women have the right to seek an abortion while at the same time allowing state and federal laws to make it all but impossible, is like saying every accused has a right to a fair trial only if your state doesn't want to build a courthouse and hire judges they have the right to just put you in jail. Expect more screaming and yelling from the nut jobs on the right, but this time I really hope the Dems will treat this as the non-starter it is.

In other interesting news, it turns out according to a Poll by Democracy Corps the majority of Senator Snowe's constituents in Maine support the public option. I can't help but think Ms. Snowe, like Mr. Baucus, just enjoys having her name in the news and being courted by both sides. Both want to come up with that "compromise" plan that will mesh both sides of the aisle. The American people long ago realized that was a pipe dream, and that there's no value in compromise for compromise sake. It's becoming more and more obvious that Congressional Republicans represent no one but themselves. So if Ms. Snowe wants to break from the pack and represent the people who voted for her, she's going to have to warm to the public option.

Finally, my favorite amendment comes from Senator Charles Grassly who proposed that members of Congress should have to purchase their medical coverage from the same pool they establish for uninsured Americans.

“My interest in having members of Congress participate in the exchange is consistent with my long-held view that Congress should live under the same laws it passes for the rest of the country.”

Short of the public option, I think that's the best idea they've come up with yet.

Senate Finance Committee Dems Rebuff Republican Attempt to Delay Vote

House Democratic leaders are looking to blend the three House Healthcare Reform bills together by next week, though Speaker Nancy Pelosi prefers to postpone a vote until the Senate Finance Committee does before bring their bill to the House floor.

In the meantime, a Republican member of the Senate Finance Committee, Jim Bunning of Kentucky, sought to delay the SFC's vote until the bill was put into "actual legislative language" as opposed to the "plain English" version, and the Congressional Budget Office had made its final estimate of cost. Olympia Snowe (R-Maine), whom the Dems are courting as the possible only Republican vote, agreed that she wanted to know the final numbers as well.

The request didn't fly as Dems pointed out that Republican committee members had, in the past, voted on plain English versions of legislation and based on general but not final CBO estimates, in particular the Medicare prescription drug plan and the Bush tax cuts. No wondering why the Republicans pushed those through without final estimates. I can't say I blame Democrats for doing the same. We can't cut back on this bill anymore anyway.

Information from CQ Politics Sept. 23, 2009 Midday Update.

Baucus v Snowe

As noted in the sidebar, Senator Baucus wants to send his healthcare bill to the Senate floor by the end of the week. However, Olympia Snowe wants more time. Senator Snowe is under fire from an ad by MoveOn. Org and other members of the coalition fighting for a public option.

Will Ferrell Adds a Little Humor on Behalf of MoveOn.Org

Will Ferrell stands up for the real healthcare victims.

Employer Paid Heathcare at $30,000?

Here are some sobering statistics from Drew Altman at the Kaiser Family Foundation. In 2009 average healthcare premiums for family coverage will hit $13,375. I already knew that since that's what I would pay if my daughter hadn't graduated to a separate policy. (Come to think of it, that is what I pay since she can't afford to pay her own premiums.) But here's something I didn't know. If premiums continue to rise at only the relatively modest rates they have over the last five years, by 2019, the average family premium will reach $24, 180. If prices rise at the average rate they have over the last 10 years, family premiums will average $30,803.

Let's add some perspective in addition to what Mr. Altman notes. According to the US Census Bureau the real median household income for 2008 was
$50, 303. So let's say in 2008 the average family premium was $12,500, since that's what I was paying. That amounts to nearly 1/4 of the median family income. What is even more frightening in terms of healthcare costs is that between 2007 and 2008 real household median income declined by 3.6%.

These are household statistics, not individual income statistics. So what this says is that by 2019, healthcare costs for employers could amount to more than the cost of hiring another employee. Is it any wonder that, already, many companies that provide medical benefits are hiring more part-time, and consequently ineligible, employees?

In my second post on this blog, "It's Your Problem Too" I noted the many ways the currently insured can find themselves unexpectedly uninsured. So what do you think will happen to your employer provided healthcare when costs go that high?

Under most of the current bills, employers will be penalized for dropping coverage, but with costs like that it may be worth it to just pay the tax. That's why we need cost containment as well as universal coverage, and that's where the hard part comes in.

As Altman points out, cost containment has been cut back or eliminated from most bills. This same issue has arisen every time any attempt has been made toward healthcare reform since the '80s. Somewhere along the line we, as consumers, bought into the idea––as we did with housing and cars––that more has to be better and side-effects be damned. But the side-effects of too much healthcare, like the side-effects of too much oil consumption, can be detrimental to your health as well as your wallet.

Statistics show there is no correlation between the greater number of tests and procedures Americans undergo as opposed to other nations, and better health. As I've pointed out in more than one post, our overall health outcomes are not the same as countries with more streamlined healthcare delivery, they are actually worse.

Opponents of healthcare reform since the first Clinton attempt have used the word "rationing" as a scare tactic. Rationing in today's political lexicon connotes something necessary being withheld. In reality we are talking about elimination of wasteful spending on unnecessary services that could harm your overall health.

Let's take as an example the proliferation of CT scans and MRIs. In this blog post by Judith Graham of the Chicago Tribune on the need for data sharing to cut down on unnecessary testing, a physician points out how too many of these imaging tests can be harmful.

There’s the rub. If the physician had access to the [original] MRI, he wouldn’t need to order three CT scans that expose the young woman to radiation and potential complications associated with the chemicals used to produce color contrast in the scans, Anastos said. The MRI would have been enough to determine whether the tumor was benign.

Another post at KevinMD points out:

The problem is that these scans are so sensitive, incidental findings are often found. In many cases, they may not be the true cause of the symptoms, and worse, can necessitate more invasive testing that can have serious side effects.

I can personally attest to the back pain issue he mentions later in the article. The first time I experienced a pain down my right thigh, I went to my PCP who sent me for an MRI and then to an orthopedist, who had me return regularly for appointments where he'd do no more than ask me to bend this way and that. One day, I noticed the pain subsiding and canceled my next appointment. Two years ago, suffering from more severe pain that I traced to a new exercise I had added to my regimen, I considered seeing my PCP again. Treatment had changed by then, and I figured he'd send me for physical therapy. Instead I went online first and read exactly what Dr. Kevin said, wait six weeks and, in the meantime, stretch your hamstrings whenever possible. I continued my exercise regimen but eliminated anything I could feel in the back area. In six weeks it was gone, and I had saved my insurance company thousands of dollars while saving myself the dangers of another MRI.

This isn't rationing. It's good practice that benefits everyone. Changing healthcare delivery is also the only way we can make healthcare affordable to all, but it will never happen if opponents whip up a frenzy of fear and politicians continue to pander to the uninformed.

Baucus Plan Falls Short––No Surprise

The Baucus plan for healthcare reform––more accurately the Senate Finance Committee plan–-has been unveiled. It puts me in mind of the much awaited Iraq Study Group report a few years ago. Everyone, including the President and Congress, took a holiday from voicing any Iraq policy until the report came out. As though it would actually turn up something new that everyone didn't already know.

The Baucus plan comes in as far less expensive than the House plan––$774 billion over ten years vs. 1.042 trillion over the same period.

Paul Krugman outlines the problems better than I can, but the biggest and most important issue–-and the one probably responsible for the lower price tag––is the replacement of a public option with those useless non-profit insurance cooperatives that will never happen.

Pelosi Says House Bill WILL Include a Public Opton

House Speaker Nancy Pelosi says the bill the House will send to the President this fall will include the Public Option.

Read more...

Public Option: Yes We Can

Add your name now.

Note: There are a lot of petitions going around, and you may think if you've signed one, you've signed them all. Up until now most have exhorted Congress to pass some form of healthcare reform. Another went to President Obama urging him to give his strong suppport to the Public Option. This one is different. This petition tells Congress that we the voting public demand the Public Option be part of any healthcare reform package.


In the latest news from Democracy for American, Howard Dean says they've polled Congress and tally 218 House and 51 Senate Democratic votes for the Public Option. He goes on to explain why 51 (and not 60) Senate votes is enough for passage. There's also a new CBS News Poll that shows a vast majority of Americans (77%) believe a Public Option is important to reform.

Add your name to the petition.

US Chamber Plans to Butcher Financial Overhaul

This Monday President Obama will deliver a speech on Wall Street, one day prior to the first anniversary of the Lehman Brothers bankruptcy filing, with the purpose of jump-starting plans for a financial overhaul. Part of the plan is to establish a federal Consumer Financial Protection Agency. Get ready, taking a page from the Healthcare Reform opponents' handbook, the U.S Chamber of Commerce is planning a campaign to fire up the little guy. Only this time, they may have gotten, shall we say the wrong end of the cleaver?

According to a September 8 article in the Wall Street Journal, the Chamber spent $2 million on an ad that shows a picture of a butcher and the caption, "Virtually every business that extends credit to American consumers would be affected -- even the local butcher and the credit he extends to his customers."

The local butcher? Who the heck are they after with this one anyway? Do these guys spend so much time on Wall Street that they believe the Main Street the media keeps referring to really exists outside of Disney World?

About the only place you find a local butcher these days is in those gentrified city neighborhoods where customers pay through the teeth so they can walk to their shopping from high-end condos and tote home specially ordered cuts in eco-friendly reusable shopping bags. All the credit extended is on a plastic card. Somehow I don't think that's the demographic the Chamber is trying to reach.

But here's the really funny part. When you think of a time when the local butcher did extend credit to cash-strapped families, what does it bring to mind? Like maybe the Great Depression? So is that the best image for the Chamber's anti-financial reform message?

I guess they figure they're too big to fail.

Obama's Speech to Congress: Did It Do the Trick?

Many of us were hoping for one of those rousing campaign speeches by Barack Obama, sending us onward and forward for healthcare reform, and over all, I think he did a good job at appealing to our better angels. It's about time an American president pointed out that there are things only the government can do, and that you can't expect businesses to regulate themselves. Just a few short months ago, everybody was on board with that and ready to hang bank CEOs in effigy. I've always known Americans had short memories, but over the past few decades we've fallen into collective Alzheimer's. Which is why I don't get all the fretting from the Blue Dogs. By the next election most of their constituents won't even remember there was a healthcare debate, let alone how their members of Congress voted on it.

The president came out a little stronger on the public option than members of his administration were hinting he would. I have to believe it had something to do with all those petitions from Progressive organizations.

To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.

Can't disagree with that. I just don't know what other means there would be. Certainly not silly ideas like coops, but maybe Senator Baucus will be so tickled at having been singled out for his payment plan, that he'll drop that non-starter.

Here's my question, though. If it's true, as members of the Obama administration have been saying lately, that the public option is such a small part of reform that it could be jettisoned for the sake of compromise, then why do the private insurers take it so seriously? If people like House Minority Leader John Boehner believe so strongly that the government can't run anything, then why are they saying a public option would drive private insurers out of business? Of course, I should know better than to look for logic in any of this.

It's not time to quit yet. Click on these sites to learn what you can do to support the public option.

Pledge to donate a symbolic minimum of $3.26 to members of Congress who support the public option.

Call the White House: 202-456-1111

Call Your Representative in Congress: 202-224-3121

Call Your Senators: 202-224-3121

Then go to Senator Russ Feingold's site to let him know you called.

Call your own Representative.

Baucus Plan: The War of the Pages

Senate Finance Chairman Max Baucus added yet another healthcare reform proposal to the already headache inducing pile. This one, it was pointed out more than once in the news coverage, is only 28 pages.

I don't get it. All through August America's town halls echoed with numbers––page numbers––and echoed is the perfect word, because most of them were just picking up something they heard from someone else. What is this new system that rates bills by numbers of pages, inflated numbers to boot. HR 3200 comes in at only 328 pages. When Senators, Representatives, bloggers, and screaming talk show hosts talk about 1000 pages, they are including all the different proposals. By that count, Senator Baucus just made it 1028. So does that count as simplification or complication?

A complication, definitely. First, the proposal can afford to be short because the main part of it, regulations on private insurers requiring things like guaranteed issue and no denial for pre-existing conditions, is already covered at length in HR 3200. The main thrust of the Baucus proposal is in two areas: Expansion of Medicaid to those without insurance making 133% of the poverty level, and funding to establish healthcare cooperatives. This combination has the additional benefit of appearing to cost $100 billion less than HR3200

This proposal is a sop to those seeking a public option. Here's why they add nothing, and possibly detract from HR 3200.

Expanding Medicaid instead of a public option appears to save money, because Medicaid is only partly funded by the federal government. The rest is funded by the individual states. They also administer the plan under broad government guidelines. I can't imagine that states, many of which are struggling under their own huge budget deficits, will be very keen on this one. As you can see from the report linked to above, overall spending on Medicaid nearly doubled between 1998 and 2003. It spends more than Medicare, which is a government run plan, and the variations in administration make it less efficient. If we're looking to expand an existing plan rather than start a new one, we'd be better gradually lowering the eligibility age for Medicare.

With regard to healthcare cooperatives, I'm not clear whether this refers to medical cooperatives or insurance coops. I covered both in an earlier post and I see nothing wrong with adding some incentives into the bill for those so inclined to try something like this, but both types are difficult to get off the ground and would require more than just money. To provide guidance for start-ups as well as compliance monitoring would, no doubt, require another government agency.

While I haven't seen a lot of detail about Baucus' idea for funding his proposal, what I've read so far sounds reasonable. I don't think any Democrat is against trying to save more money if it doesn't cut back on the number of people covered.

One of the major problems I see with the so-called compromise proposals is that shorter, in the long run, does not mean less complicated. Somewhere along the line it became the mantra of health reform––on both sides––that people want choice. Really? Did you ever try to assist a senior in choosing a Medicare Prescription Drug Plan? It makes choosing a cell phone plan seem easy. As a Benefits Manager, it was my experience that individuals felt overwhelmed by choices in healthcare coverage and would often call may office hoping we could just tell them which plan to enroll in.

That's one reason why I don't see coops of either type getting off the ground. Even on entering an already established coop, individuals will gamble on whether the cost savings today will be there five years later, or whether additional cost equates to more or better care, or whether a lump sum outlay will get as good a return as it would in a standard investment.

Whether 28 pages or 328 or 1028, it's time to stop coming up with so-called compromise proposals that do nothing but complicate the issue even more.

We Can't Afford to Wait Video by Moveon & R.E.M.

Bill Moyers: Obama's Moment

If you missed Bill Moyers Journal on PBS last Friday, take a moment to listen to Obama's Moment. Moyer urges the president to take a strong role in pushing for the public option.

It's one thing for average Josephines like me to say what Obama should do, but I've never held any political office let alone a high one. Moyers, on the other hand, was a major adviser to Lyndon Johnson who took part in everything from drafting bills to messages to Congress. In short, he knows a thing or two about rallying lawmakers. I've always admired Moyers' bold and intelligent editorials. I'm often moved by his words. I hope the president is as well.

Public Option or Bust?

As noted in my last post and various articles, there is much question whether President Obama will draw a line in the sand for the public option. Most indicators say, no. The thinking on this, I would imagine, is going one of two ways. Appease the conservatives so sometime later on they will concede on something the administration wants––though I can't believe Obama is that naive––or half a loaf is better than none.

Half a loaf is better if the bread is fresh, but what if it's stale? Without a public option what we have is a utopia for private insurers where everyone is mandated to have coverage. They never had any quibble with that part of the reform package, but what incentive is there for them to keep costs down? And if people worry about healthcare rationing under a public plan, what do they think will happen when insurers are forced to community rate and cover pre-existing conditions? They will cut back on services in order to continue making huge profits, but they are not likely to do that in conjunction with oversight panels working toward the best care at the best price.

Maine Senator Olympia Snowe has a put forward a compromise option where the public plan would kick in in any state where private insurers don't reduce costs to a level set by the Department of Health and Human Services. A complaint I've heard over and over is that the House reform bill is too complicated. This would make it more complicated. One of the criteria for rate-setting is location. What private insurers can charge will differ not just from state to state, but within the state, as will the allowable costs of healthcare providers. These trigger points not only need to be set, they will need to be monitored, and I assure you, private insurers will start squawking immediately that limits are too restrictive. Then, as soon as we have a Republican Congress again, the limits will be raised or done away with. Or, conservative governors will say the federal government has no right to impose a public option on their state.

The only way to force private insurers to lower costs is to have a public option that acts as the pace car. It has to be the final line in the sand.

So the question remains, what if the bill can't pass without it? Politically I think it's better for the bill not to pass at all than to pass without the public option. Congress is mistaken if they think their constituents will let reform die this time. Unlike the Clinton years, too many have been following this for too long, pouring their money and their time into the effort to get this done. Many are from the Obama campaign who picked up where they left off after the election. They've been at this for nearly three years and they don't believe in lost causes.Should reform not pass this time these folks (or should I say we) will take to the streets and demand it. We should start by demanding single payer. Next to that HR3200 will look like heaven to conservatives, and we'll be d---ed sure to get real reform passed this time.

Obama and the Public Option

The latest news says Obama will not insist on the public option when he addresses the joint session of Congress on September 9. If you support the public option, especially if you voted for Obama or were an active member of his campaign, you can sign a petition to let him know.

The message not making it through to the administration is much of the support he is losing is among those who want Obama to take a stronger, not a weaker stand on reform. There are many, both among the general public and in Congress, who feel the current bill is already a huge compromise. Now he apparently is considering a betrayal of those in the House who stand by the public option. Where will that leave him next time he needs their support?

Why would a president want to prove he can stare down his own party? Does he really think the Republicans will have a sudden epiphany and take his side the next time around? Did he learn nothing from the Clinton administration? President Clinton supported a number of traditionally Conservative measures like NAFTA and Welfare Reform. He backed off gun control and made little efforts for abortion rights. He came out against big government, and what did he get for it? Impeached.