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.

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.

The Public Option: The Backdoor Approach

This is a great article by Mark Trahant on two successful public health agencies most of us didn't even know existed. Maybe the administration needs to be a bit more cagey. Drop the Public Option and quietly expand the existing ones.

Rumors of the Death of the Public Option Are Greatly Exaggerated

To hear the news you'd think the public option is dead in the water, but according to Democracy for America, it isnt. The house will need at least 218 votes to pass a healthcare reform bill and 64 Democrats have said they will not vote for a plan without a public option. That would leave only 198 Democrats, not enough to pass any kind of reform bill. While I've noted that the Congress would rather err on the side of doing nothing, they also don't want to appear to do nothing. They'd prefer passing a bill that kind of fades out like an old fifties pop song, but they know passing nothing will lead to death by a thousand cuts come election time. So the public option looks like the only alternative.

So, is the public option really so important? I agree with Howard Dean that reform without a public option is not real reform. It will just be another attempt at reform that sputters and dies. Think about it. Some are floating the idea of medical cooperatives, similar to Kaiser Permanente. In these cases doctors and other healthcare providers work for the coop as opposed to contracting with it as they do with HMOs and PPOs. Often these coops are contained within single buildings or several buildings throughout the area they cover. I think this is an excellent idea for providing low-cost healthcare. I really do, and if these coops had started organizing 30 years ago when President Carter proposed healthcare reform, they might have taken root by now. As it is, I can't imagine it is going to be very easy to incentivize enough healthcare providers in enough places to challenge private insurance companies soon enough to bring any relief to those of us chafing under the costs.

The other idea is health insurance coops. This, as best I can tell, is where the consumers, or the insureds, own the company, kind of like the venerable Green Tree that sold perpetual fire and homeowners. However as this article points out, they are difficult to start, difficult to keep going, and even harder to gain any real bargaining power.

In other words, these are smoke screens, exactly the kind of programs that will be rolled out with great fanfare as the Dems celebrate victory. Maybe even some money will be put behind them, but they won't get off the ground, and even if a few do, they will be the first budget items cut if/when another Republican administration comes in.

The real reason we need a public option is that it is the only way to make reform permanent. I'm old enough to remember the outcry against Medicare. Plenty of people then, including Ronald Reagan who was still just an actor, warned that it was a step toward Communism. Now that we have it, people can't think of living without it. Yes, Medicare has its funding problems, mainly because there was no way to predict how healthcare costs would rise and how different healthcare delivery to the elderly would become, and how long people would live. However, now that it is a fixture we continually find solutions to keep it going. We don't scrap it because without it tens of thousand of elderly would be bankrupted by their medical costs.

While Dean says it's a go, I do see signs of Obama caving. So much has been made of this being his Waterloo, that he may be finding it politically expedient to call whatever Congress passes a success. I think it's time to bring out the threats, like the Republicans did to Arlen Specter. The Dems need to get with the program, or as Dean warned, the Dems will put up more progressive primary candidates to run against everyone who voted against reform.

I hope and pray Howard Dean is right and the public option is not really dead. If it is, we are too.

Single Payer Advocates: Why You Should Support ObamaCare

The problem with polls, or at least the way they are usually reported in the media is that they require a yes or no answer. With regard to healthcare reform, many of the contacts I've made through meetings and organizations don't support any of the current reform options, because they don't believe they go far enough. Many feel that a single payer plan is the only way to truly reform the system.

Until a few weeks ago, I was one of them, and I continue to prefer single payer and remain appalled that it was never even considered as an option. A single payer system involves more than the government simply picking up the tab for healthcare. At its best it would be an overhaul that would lead to an integrated system of healthcare delivery with oversight by a cabinet office or government agency. I still fear that anything less will not contain run away healthcare inflation or ensure delivery to under-served communities. Without cost containment and without the requisite number of doctors (particularly General Practioners) and hospitals to serve all those new insureds, I see a strong possibility for failure.

So it may sound odd that I am exhorting supporters of single payer to get on board with the Obama plan. The reason is what I stated in the beginning of this post. This is being cast both by opponents and our famously no-nuance media as a "for us" or "agin us" issue. If health reform goes down this time, no one is going to re-visit it and push for single payer. Congress will be only too glad to let this drop, hiding behind the excuse that the American people once again decided they weren't ready for change.

Real healthcare reform isn't one of those feel-good issues everyone can get behind, like just telling insurers to cover everybody. Real reform is complicated and requires major concessions from everyone involved (including consumers). Even a half-way measure like a public option means facing contentious issues like denying certain services and reconsidering end-of-life expenditures. Members of Congress today see their job more as a popularity contest and with Americans having notoriously short memories, they'd rather err on the side of doing nothing––which voters will soon forget––than facing the merest chance of a failure that could still be hanging over their heads at re-election time.

While I have my fears that the simple addition of a public option won't be enough, there's still the possibility it could turn into the opponents' greatest nightmare–– a success that will lead to even more changes. If, with the public plan, premiums are lowered and outcomes improved, individuals as well as businesses will vote with their premium dollars and we may achieve single payer by evolution rather than revolution. Once all the dust settles and citizens take the public option for granted as they do Medicare and no member of Congress worth his/her salt would threaten it, maybe it ccould be used as a platform for the next step.

If the public option fails now or eight years from now, it means the end of major healthcare reform, but if we let it fail now, we'll never know if it could have worked or at least served as a stepping stone. That is why it is extremely important for those who prefer single payer to step up and support the public option. Call your senators and representatives, show up at rallies, attend town hall meetings, and make your voice heard. If you are asked in a poll or on the street if you support the president's healthcare reform plan, say yes instead of no.

Don't let the perfect become the enemy of the possibly good.

Comments on Insurers Have Hill Defenders

Just a few comments on the article I posted in my sidebar about Hill Defenders of Insurance Companies. Sen. Nelson wants his colleagues to "tone down the rhetoric," but Susan Collins' warning "that creating a public, government-run insurance program to compete with private insurers could disrupt state-regulated insurance markets" sounds to me like as good an example of empty rhetoric as I've ever heard. What exactly does that mean? Disrupt in what way? And is disruption necessarily a bad thing? If investigators disrupt a terrorist plot, that's a good thing, right? That is the type of language often used by politicians to stir up fear by hinting that reeling in the profits of a certain industry will have a dangerous rippling effect through the entire community. Conspicuous in their absence are any specifics. Something like saying, "these lawsuits will completely disrupt the tobacco industry in this country."

"All four say Congress would need to include provisions to ensure that the government program would not have an advantage over private insurers." Say-wha? A plan with affordable premiums that does not deny coverage for pre-existing conditions and has lower administrative costs couldn't help but compete with private insurers. Do we really need a public plan that doesn't meet those criteria?

“I’m always surprised when I hear some of my colleagues describe the public plan as being needed to keep the insurance companies honest . . . when insurance carriers are regulated in every state in the nation,” Collins said. They are a heavily regulated industry.” But obviously still not regulated enough. The problem is provisions vary from state to state and most states still allow private insurers to get away with all or part of what I mention above. To her credit, Susan Collins' state of Maine has moved in the right direction in some areas as requiring individual policies " be written on a guaranteed issue basis, meaning insurance carriers are not permitted to deny you coverage due to unfavorable current or past health history." Looking at the website, however, I don't see anything that would prevent an insurer from finding an excuse to drop individuals suffering a major illness.

It doesn't really matter, though, whether Maine has that provision or not. Probably the best regulated and most efficient running health system in the country is the system created under Dr. Howard Dean when he was governor of Vermont. Only we can't all move to Vermont. That's why we need regulations that go beyond state borders and a public option anyone is free to choose.

Watch out for those who call themselve "moderates" who claim to be looking for a compromise and accuse reform proponents of being too "partisan." One public health plan competing against all the existing private plans is a compromise. It is not single payer or socialized medicine. Without a public plan there can be no reform, just some regulations that, like regulations on the financial industry that went into effect following the Great Depression can be repealed or ignored whenever the political tide changes.