Enemies of Reform
We Agree -- Death Panels Are Bad: The Best of the Weekend
Published August 09, 2009 @ 09:24PM PT
Every Sunday, I’ve taken to posting the best of the best – the three must-reads or must-watches from this weekend. This Sunday, I’m choosing three articles to fill in a big gap in my blogging. Aside from one post earlier in the week on the protesters arriving in town halls to shout down debate on health care reform, I scarcely have mentioned the topic. This is deliberate. While the news might focus disproportionately on the loud and bullying minority, there are many other issues at play, issues that – unlike exemptions for unions, or death panels, or national IDs or what have you – actually exist in the bills themselves, and are worthy of debate and discussion.
Turns out it’s a good thing I did, because I don’t think I could have written about the health care rowdies any better than these three. When you come right down to it, progressives and the rowdies actually agree on a lot of the same principles! Let’s focus on the common ground, shall we?
(Side note: Why do I have a picture of a massive pro-reform rally up? Well, I keep hearing about how progressives aren’t mobilized for reform – I figured a picture was worth a thousand words.)
1.) Daily Kos – “All Right, Republicans. We Give Up.”
What to do when those showing up against reform are making demands against things that aren’t actually in the bill? Blogger Strozeck has a great idea – capitulate! Specifically, we should agree not to include things in the bill like:
1. We will not euthanize your grandmother. This is the big one, and I really hope you guys appreciate how much of a concession this is on behalf of the progressive movement. Since the days of the Bull Moose Party, progressives have wanted nothing more than to slaughter old people by the millions. That much is obvious. After all, if we wanted senior citizens to have long and healthy lives, why would we have created Social Security and Medicare? Think about it. Death to grannies has long been the core of progressive policy, so it's not without some consternation that we give it up. So there: no euthanizing old people. You've got it.
2. Rahm Emanuel's brother will not kill Sarah Palin's baby. While this will require us to gut HR 3200 "America's Health Choices and Murder Sarah Palin's Baby Act of 2009," we're currently working with Henry Waxman to remove the extensive Sarah Palin's baby-killing provisions from the final bill. While this will probably cost us Andrew Sullivan's support, we recognize that this is a necessary sacrifice for securing broad bipartisan support of health care reform.
Read the whole blog post here.
2.) Mark Halperin – “Halperin’s Take: Why Everything About the Health Care Mobs Is a National Disgrace”
Regular readers of Mark Halperin’s “The Page” know that few enjoy reporting the blow-by-blow parry and thrust of politics than the man who originated ABC’s “The Note.”
During the election, Halperin helped hype the horserace first between Obama and Clinton, and then between Obama and McCain to the point of “edge of your seat” drama. This is a man who kept giving out “weekly reviews” that indicated McCain was winning the news cycles consistently. So it’s surprising – in a good way – that he’s unflinchingly down on the street theater surrounding health care.
My three favorite points:
4. It is very easy to disrupt a town meeting and the (apparent) reward is getting their requisite 15 minutes of fame on television news.
…6. Debating whether a given mobster is "real" or "astroturf" is like debating who the third-best professional wrestler of the 1980s was.
…9. Ask Republican members of Congress who voted for President Bush's massive prescription drug entitlement law how many of them read that bill before they voted in favor of it -- or how many bills they EVER read in their entirety.
3.) Harold Pollack, “Have You No Decency?”
Although he’s clearly on the side of reform, I’ve greatly enjoyed reading Harold’s commentary and his laidback and genuinely inquisitive style. After all, I can’t think of many other bloggers who would write a post about his experiences talking to counter-protesters at a big pro-reform rally in Chicago to find out what’s motivating them.
But opportunistic politicians who have injected themselves into the limelight by spreading the most egregious false hoods about health care have prompted quite a different response in Harold – his ire.
First, these issues are quite separate from the main issues being debated in health reform. Under a single-payer system, a strong public plan, or under a libertarian’s privatized dream-system, we will still face fundamental dilemmas in caring for our loved ones, and ourselves. This is not merely or primarily a money issue. Like other forms of care, end-of-life care is sometimes wasteful or ineffective, but nobody is looking to skimp on or ration such care to finance health reform. Nor should they.
Second, health reform would address an equally fundamental dilemma of human dignity and human rights: millions of people’s lack of access to basic care. Many of these people are disabled or live with chronic illnesses. Over at Obsidian Wings, Publius yesterday noted the predicament of children with Down Syndrome denied health insurance because they have a preexisting condition.
Governor Palin writes: “And who will suffer the most when they ration care? The sick, the elderly, and the disabled.” It’s telling that she omitted one category: Poor people, whose care is now cruelly rationed in ways the Obama administration and congressional Democrats are trying to address in health care reform. Palin brings genuine moral passion to the issue of cognitive disability. I wish she would bring that same passion to the plight of uninsured patients forced to seek substandard, delayed care, or the millions of Americans facing the dual challenge of serious illness and large medical bills. If you live in any big city, go down to your local public hospital emergency room. You will probably find people in visible discomfort or illness languishing for hours. A society that cares about human rights and dignity would not tolerate this.
(Photo credit: seiuhealthcare775nw on Flickr.)
The Best Health Care Reform UnitedHealth Could Buy
Published August 09, 2009 @ 06:16PM PT
I’ve just read something that closely mirrors the health care reformer’s worst nightmare – that the current attempt at reform has been so intent on getting special interests to play nicely that it’s conceded too much. That health insurance companies, they of the business practices that at some point decades ago turned from social insurance to big-profit HMOs, have used their money, their power, and their “under the radar” assets to tailor a reform bill that will allow them to actually make more money than before. It reads so much like what single-payer advocates have been warning for years, that some might chalk it up to a leftist conspiracy.
There’s just one problem. It’s the cover story of Business Week.
The title of the article proclaims it all – “The Health Insurers Have Already Won.” And reading the article, a lot of the odd hiccups in progress on health care legislation suddenly make a lot of sense. For one thing, we marveled that the Blue Dogs, with their self-professed emphasis on fiscal responsibility, had actually sought to weaken the employer mandate (by making it apply to fewer businesses) and block the public health insurance option (despite the CBO saying it would cost more to do health reform without it). According to Business Week, this is the cornerstone of the game-plan carried out by lobbyists for United Health and other large insurers: “Impressing fiscally conservative Democrats like Matheson, a leader of the House of Representatives' Blue Dog Coalition, is at the heart of UnitedHealth's strategy. It boils down to ensuring that whatever overhaul Congress passes this year will help rather than hurt huge insurance companies.”
Many have wondered why the impressive “benefits as good as a member of Congress” – a pledge that goes back to at least John Kerry, and repeatedly vouched for by Obama, Clinton, Edwards and others – have turned into a standard benefits that’s more or less dictated by what private insurance is already offering. Business Week has the answer for that, too: “[UnitedHealth] has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry.”
Many mistakenly believe the Congressional Budget Office predicted over 80 million in employer based insurance would jump ship and sign up for the public health insurance option. Actually, the Congressional Budget Office predicted a net increase of 3 million people would be on employer based insurance, and a measly 10-15 million would sign up for the public health insurance option – most of them currently uninsured. Where did the far scarier number come from? The Lewin Group – causing Business Week to note: “Left out of these testimonials or buried in the fine print is that a UnitedHealth unit owns the Lewin Group and thus is ultimately responsible for Sheils' paycheck.”
Not mentioned in the article is that UnitedHealth has not been entirely successful. Courting the Blue Dogs has been a good idea, but they achieved few of the objectives the insurer was looking for except, perhaps, the decoupling of the public health insurance option from Medicare rates. The Senate HELP Committee bill also doesn’t look like it’s paid off for the insurer, other than the fact that any reform is likely to give them new customers subsidized by the government. Left unmentioned are the more stringent regulations on private insurance contained in both bills – although it’s not clear they even seriously tried to stop those.
But Max Baucus’ coalition of the willing is a different story. The details coming out of those closed door meetings has been maddening. Much weaker regulations on private insurance? Check. No public option but instead a weak system of co-ops that could easily get swallowed by UnitedHealth and others? Check. Weak benefits or curtailed subsidies? Check. Cutting subsidies to individuals and cost-sharing relief to keep under an arbitrary $1 trillion price tag? Check. In fact, Business Week helps show exactly how weak Baucus et al are making reform:
This is good news for UnitedHealth, which benefits when patients pick up more of the tab. In late spring, the Finance Committee was assuming a 76% reimbursement rate on average, meaning consumers would be responsible for paying the remaining 24% of their medical bills, in addition to their insurance premiums. Stevens and his UnitedHealth colleagues urged a more industry-friendly ratio. Subsequently the committee reduced the reimbursement figure to 65%, suggesting a 35% contribution by consumers—more in line with what the big insurer wants. The final figures are still being debated.
Some hold out hope that the Baucus plan will be the most bipartisan and, if so, the best for the country. But if this somewhat congratulatory article from Business Week is to be believed, the real winner in Baucus’ version of the bill will be UnitedHealth.
The question is – what are we going to do about it?
(Photo credit: MacRonin47 on Flickr.)
They'd Still Be Trying to Kill Wyden-Bennett
Published August 08, 2009 @ 03:46PM PT
On an episode of the MSNBC show Morning Meeting, host Dylan Ratigan spent some time waving around a copy of the Healthy Americans Act, a Senate bill for universal health care proposed by Democratic Senator Ron Wyden and Republican Senator Bob Bennett. Within the context of the continued stalemate in Max Baucus’ bipartisan “coalition of the willing” and the minority of aggressive protestors swarming Congressional town halls, he kept asking his guests, “Who would be against this?” Prompted by an Op-Ed in the Washington Post by most of the co-signers, we’ve had several days of chatter that we wouldn’t be in the same spot if we had decided to go with something like Wyden-Bennett. This has been at least partially mentioned by some of my favorite writers, including Ezra Klein and Bob Laszewski.
Forgive me, but I just don’t see it.
This is nothing against the policies of Wyden-Bennett, which I summarized in one of the first posts I wrote for this site. If implemented, it would phase out employer-based insurance over two years entirely, require companies to replace the money they spent on benefits in the form of higher wages, and replace it with state-based exchanges where anyone could buy a comprehensive plan, receive subsidies if they could not afford one, and have the security of new insurance regulations to outlaw the most abusive practices. Co-signers on the bill are evenly split between Republicans and Democrats, so it has the fabled bipartisanship smell (second only to “new car smell” inside the Beltway). Moreover the Congressional Budget Office determined that it would be revenue neutral in just a few years – it would take in as much as it gave out. It’s an intriguing idea, which would be loads better than what our current, unreformed system looks like.
But if we had chucked Obama’s campaign plan from the outset, it’s hard to see the politics being very different. For one thing, chucking a president’s campaign plan has consequences of its own – so much of our current progress has derived from a president willing to use his charisma and the bully pulpit to make the case again and again. The minute a president – any president, of either party – deviates from something he ran on so aggressively, that becomes the story. ("Read my lips, no new taxes" springs to mind). For another, it’s not clear that the co-signers on Wyden-Bennett actually mean it. Famously, Arlen Specter went on Meet the Press to denounce most of the moving parts of Wyden-Bennett – removing the employer tax exclusion on benefits – before saying he supported the bill. Sen. Lindsey Graham admits, “There are some people on the Wyden-Bennett bill who are probably there for political cover, because they need to be for something.” There’s zero consideration in the House. And, to be blunt, because Wyden-Bennett would be a much bigger change than the current plan in Congress, you likely see the same special-interest-driven opposition from small businesses, employers, the U.S. Chamber of Commerce, and others. Republicans would still have incentive to see health care reform fail as a political consideration, regardless of which plan failed. All of which means it would likely face similar entrenched resistance in Congress.
And then there’s the street theater. To suggest that the outrage we’re seeing from a vocal minority is in any way related to the bill in front in Congress is not listening to the objections. It doesn’t take much imagination to see the provisions in Wyden-Bennett being fodder for an angry fringe group. For one thing, the “government takeover of health care” metaphor would still exist. Columnist Steven Pearlstein wrote of the Health Exchange in the House bill, “While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.” Nevertheless, that’s how it’s being described. How much worse would Wyden-Bennett be when we’d all be in an Exchange, not just people without insurance through their employer? Why would subsidies for those who cannot afford health insurance be “socialism” under the House bill but not be “socialism” under Wyden-Bennett? (Neither one of them, of course, would be socialism, but that’s hardly the point.) Which of the preposterous "freedoms" as outlined by Fortune Magazine as being lost under health care reform would be preserved under Wyden-Bennett? None.
I’m not trying to suggest these scary stories are valid – they’d still be complete lies. But anyone thinking Wyden-Bennett would be politically easier, either inside the Beltway or outside, doesn't seem to be listening.
(Photo credit: Amber Rhea on Flickr.)
Obama Gave Up the Pharm
Published August 06, 2009 @ 09:20PM PT
As part of building a narrative of momentum for health care, the White House rolled out a couple of “deals” with players in the health care industry. Hospital associations and Vice President Biden rolled out a deal for a more favorable timeline on reducing payments to hospitals for uncompensated care in return for $155 billion in savings to Medicare. That was impressive! Sen. Baucus announced that Big Pharma had agreed to help partially close the “doughnut hole” in Medicare Part D by offering beneficiaries who fell into the gap in coverage a half-price discount on their prescription drugs – up to $80 billion over 10 years. That was less impressive. And now it looks like it comes at far too high a price.
I gave the deal decidedly mixed reviews when it was first announced:
It's also a big deal for PhRMA, who gets to burnish its pro-reform credentials at fairly minimal cost - Dean Baker calculates this commitment is about 2% of what the pharmaceutical company makes off of Medicare Part D. [But] don't expect this to translate into savings for the larger health care reform effort, or to necessarily mean Big Pharma will go any easier if health care reform bites into their bottom line through negotiated drug prices for a public plan [emphasis not in the original post], or more investment in comparative effectiveness research that asks "Why am I paying for drug A at $15 a pill, when drug B is roughly as effective at $0.15 a pill?”
In the short term, when we didn’t know all the details, the deal seemed relatively positive. President Obama had few options to keep his campaign promise to help close the doughnut hole without going to war against the pharmaceutical industry, who would have then gone to war against health care reform. Senior citizens on Medicare are already the hardest audience to convince that health reform creates benefits them directly. This doughnut hole deal was an easy, unambiguous win for seniors – one the House was quick to codify into their bill. And, of course, it’s kept the industry group PhRMA co-sponsoring the next generation Harry and Louise ads that are pro-reform, rather than running ads to kill the plan. It allowed Rahm Emmanuel to boast, “The very groups we have been talking to have been the most vocal opponents of health care reform; they are now becoming the vocal proponents for health care reform.”
But now the truth has come out. Part of the negotiations between the Congressional Progressive Caucus, the Blue Dogs, and Rep. Henry Waxman that allowed HR 3200 to pass out of committee was a new amendment that would allow the public option to negotiate drug prices like the VA does (and very un-like Medicare Part D). As predicted, that was the moment when Big Pharma stopped going easy on health care reform. In a shocking display of chutzpah, PhRMA president Billy Tauzin took the rest of the deal public via the NY Times. He had assurances from the White House and Sen. Baucus that Big Pharma would be shielded from further cuts to their bottom line from reforming health care. The NY Times reports: “The $80 billion in savings would be over a 10-year period. ‘80 billion is the max, no more or less,’ [Tauzin] said. ‘Adding other stuff changes the deal.’” Tauzin’s clearly going public for one reason: to kill the House bill provisions.
After all, in 2006, the top 10 pharmaceutical companies made over $39 billion in profits. I’m sure they’d be on their way to the poorhouse if they were forced to make only $30 billion.
Let’s be honest: capping savings in our health care system from PhRMA is giving away the farm. The whole point of a public option is that it has incentive to lower costs and a large enough member base to get good discounts, like any other big group health insurance plan. One of the reasons the VA has been able to deliver high quality care and lower costs than Medicare is the ridiculous provision in Medicare Part D that prohibits negotiating for the best rates (provisions, it should be noted, written by Mr. Tauzin when he was in the House). For all the talk of a “level playing field,” this gives private insurance plans a marked advantage over the public health insurance option, and betrays one of the key reasons for health care reform: that we can take common sense steps to lower costs.
It’s unacceptable. Now that it’s out in the open, we need to tear it up and start over.
Write to Congress and the President -- tell them to tear up this deal!
(Photo credit: pawpaw67 on Flickr.)
For-Profit Insurance and Creative Accounting
Published August 05, 2009 @ 02:54PM PT
Thanks to the “let’s work with everybody” public persona of Karen Ignagni, America’s Health Insurance Plans (AHIP) has gotten a lot of press for their “restraint” in the face of impending health care reform. It’s a great PR strategy that has paid off for them – the NY Times can marvel that the insurance industry isn’t running negative ads (good cop), while AHIP and its members can continue to run their sub rosa anti-public plan Web sites and phone calls (bad cop). You may have even started to see “Fact Checks” that suggest private insurance isn’t all that bad. Not that they don’t discriminate on the basis of pre-existing conditions, practice rescissions to kick those with health needs off the plan, and charge different rates based on age, gender, health status and even employment. They change the topic rather than talk about those. No, instead you’re seeing reports that private insurance is actually better and more efficient than advertised.
However, it takes some interesting omissions to get there.
I follow healthy policy expert John Goodman, the self-professed “Father of Health Savings Accounts,” because I like to see what new arguments are likely to pop up. A guest blogger today has a link to AHIP’s new study that suggests that without the provider rates of private insurance, California would fall into the sea… or at least their hospitals would. “An analysis by America's Health Insurance Plans found that if all the patients treated in California hospitals were enrolled in a public plan paying rates 10 percent higher than Medicare, virtually none of the hospitals could cover their costs.” It’s the sort of thing you might expect me to spend over a thousand words rebutting.
Actually – it’s not worth it. The whole premise is flawed. For one thing, it’s predicated on a public health insurance option that pays Medicare rates +10%. Thanks to the deal with the Blue Dogs in the House, no such public option proposal exists. The Senate HELP Committee’s “community health insurance option” will negotiate rates like any other insurance plan. Now, so will the public option in the House (something I’ve actually been OK with since April, although the Congressional Progressive Caucus disagrees with me. That’s cool, though. We’re still friends and stuff.) So the payment structure they’re modeling on doesn’t exist. And the population size also doesn’t exist – since the public option is only open to those in the Exchange, the Congressional Budget Office estimates only 10, maybe 15 million nationwide will sign up. Let’s say the Lewin Group – a wholly owned subsidiary of Ingenix and UnitedHealth – is closer to the mark with their estimate of 34.9 million nationwide. That still doesn’t equal the population of California.
On to another popular talking point – that profits for private insurers only equal 1% of all health care spending. Perhaps you heard that private insurance administrative costs were an average of 12% of their health care dollars, with some as high as 30%? (This in contrast to Medicare’s average of 3%.)
Well stop, you’re both right! For one thing, a lot goes into administrative costs – marketing, underwriting (hiring people to evaluate which claims to deny), lobbying costs (about $2 million for April-June of this year alone), or executive compensation ($30 million total compensation for Cigna, $38 million for Aetna). For another, AHIP has very cleverly created their ratio not using the amount of health care dollars in private insurance, but in the entirety of the American health care system, including Medicare, Medicaid, the VA, the Department of Defense, SCHIP, etc. as well as individual’s out-of-pocket costs. As explained on NPR:
Fortune magazine economists calculate insurance company profits this way:
For the 10 biggest insurers in the year 2006 (the year the insurers used for the 1 cent out of every dollar depiction above), profits were anywhere from 2 to 10 percent, or two to 10 pennies on the dollar. That's two to 10 times as much as what the insurance industry group suggests in its illustrations.
It’s really pretty clever – hide about $3 billion in profits for UnitedHealth Group alone last year as an innocuous 1%. Say this for the for-profit insurance industry, they’re excellent at making dollars disappear – particularly out of your wallet.
(Photo credit: mary_thompson on Flickr.)
Full of Sound and Fury, Signifying Nothing
Published August 04, 2009 @ 10:59PM PT
So let’s talk about the Tea Partiers.
Foley’s First Rule of the Media, as I wrote back when discussing why single-payer did not get more press, is “It feeds on stories about conflict… It feeds on the new and surprising… When something meets our expectation – like a grassroots single-payer movement trying to influence health care reform – it tends to get ignored.” So it is that a town hall with a member of Congress where someone tells a horrific story about getting denied the care they need because of cost – an event I have literally witnessed hundreds of times in town halls in mutliple states – gets classified as “meets our expectations.” A town hall where people shout and disrupt the proceedings does not. Are these disruptions new and surprising overall? I suppose so, if for no other reason than they contrasts from the oh-so-visually unexciting visual of old white (predominately) guys sitting around a table adding amendments that we’ve been treated to for weeks. Do they create exciting conflict? Oh yes – they’re all about conflict.
Upon further reflection, I would add to that “So much so that they’re incoherent.”
Are these disruptive actions about health care? Not particularly. For one thing, the participants are virtually indistinguishable from the “Anti-tax” tea parties and the “Anti-Muslim/Socialist/Terrorist/Whatever they called Obama that week” crowds at Palin-McCain rallies. And by the same participants, I mean both similar people showing up, and the exact same wealthy fat cats funding them (more on those guys in a bit). A particularly telling moment comes on the YouTube video of the Kathleen Sebelius and Arlen Specter town hall in Philadelphia – the same YouTube video that the billionaire-funded FreedomWorks proclaims to be “a must watch and a must emulate at town halls across the country over the next month.” Go to 2:17 of that video. A man begins telling the story of a loved one with congestive hear failure, and you know this is going to be one of those gut-wrenching stories that shows you exactly how messed up our system is. Before you learn more, however, our erstwhile vlogger chooses this moment to end the clip. In another clip, the same vlogger hovers over the crowd, singling out the disabled people who are attending with the comment, “This should be fun. They’re bringing all these people in here to act like victims. This’ll be great.” Of course, every angry shout and roar of the crowd is dutifully, even lovingly recorded.
This is about health care as much as "Showgirls" is about the plot.
Is it about getting Senators and Congressman to answer the tough questions so we can hold them accountable? Please. The “Town Hall Action Memo” which is literally the playbook for these disruptions has no traditional “talking points” to lay out a position or an argument. There are no principles, no attempt to personalize the issue, no numbers supporting that argument to cite. Instead, the participants are coaxed to “clearly rattle the Rep and illustrate some degree of his ineptness to the balance of the audience.” More explicitly, “The objective is to put the Rep on the defensive with your questions and follow-up.” That seems to be proven by the event with Rep. Lloyd Doggett of Texas, who explained, “I visited with these people for an hour, listening to their questions, trying to explain the plan, having their taunts, boos and so forth, like my colleagues, and only after they began making so much noise that no one could be heard did I decide first to try to visit with people individually.”
Let’s put it to the test. Go back to that video on Freedomworks’s Web site. After all the speechifying, the man’s question is, in a nutshell, “how can we trust you if you don’t read the bill you vote on?” Some pandemonium erupts – mostly from the herky jerky cameraman, it seems, with only a few raised fists in the crowd. But then Sebelius says, “If people say they haven’t read the legislation, then tell them to go back and read it.” Specter takes a swing at it and, amidst the boos, proclaims, “Every bill is read thoroughly and understood by me before I vote.” And yet, the booing continues! That’s apparently what should be emulated – continue booing even when they agree with you.
Is this about a popular uprising? I believe the attendees are sincere, if somewhat incoherent, in their anger. But it doesn’t represent a populist trend in the health care debate – as Jon Cohn writes about the latest poll, “While the public has its concerns about the plans running through Congress, people remain enthusiastic--extremely enthusiastic--about what Obama and the Democrats are actually trying to do.”
Nor is it serving ends that could be considered populist. This is about wealth, privilege and power -- and the protection of all of the above. Look, we know who stands to gain if health care reform fails. Some will continue making money hand over fist, and others -- particularly conservatives -- will parlay this into political power. So no one should be under any illusions about the financial backers who have helped goad these uprisings – and they are anything but populist. FreedomWorks is governed by former Republican House, Majority Leader Dick Armey, Steve Forbes (who puts the “bill” in “eccentric billionaire”), and Frank Sands, the Chief Executive Officer and Chief Investment Officer of Sands Capital Management. Americans for Prosperity – the business-funded anti-tax organization whose health care rally featured the local Congressman hung in effigy with the sign "Congress Traitors The American [and a word that looks like "idol"]” – is “a group that includes James Miller, a Federal Trade Commission chairman and budget director during the Reagan administration.” Rick Scott – the man who made his millions with Columbia/HCA while having a hand in the single-biggest corporate fraud settlement in American history – is openly boasting of his hand in the chaos.
Is it any wonder then that somehow this all comes down to corporate taxes for some of the protesters – even though the corporate tax rate is entirely unchanged under Obama? It's like the Tea Party in Lafayette Park in DC months ago, where the greatest threat to freedom was Sarbanes-Oxley -- a law that was created in the wake of the Enron and Worldcom scandals to create transparency and protect investors. Sure, the anger is real, but it’s hard not to see the strings being pulled. As Jesse Jackson is fond of saying, "Well then how did that get into the middle of the agenda? If your issues are cancer and Medicare and education and jobs and Social Security and decent housing, then how did someone else put their agenda in the front of the line?"
Watching these mini-dramas, I think Shakespeare said it best: “It is a tale told by an idiot, full of sound and fury, signifying nothing.”
Look, I strongly believe in the spirit of civil disobedience. It is the backbone of the American labor movement, the guiding spirit of the civil rights movement and, yes, an option that may be necessary for getting health care reform passed if the process completely stalls out in Congress. (And before you ask, no, I don’t consider getting legislation past all 3 House committees and 1 Senate committee for the first time in history to be “stalling out.”) The original for the “Yes We Can” chanted during the presidential elections was the “Si Se Puede” of Cesar Chavez and the United Farm Workers. So I believe in civil disobedience. I believe in freedom of speech.
I don’t believe in noise. And I sure as hell don't believe in noise to protect privilege and power.
How Many More Have to Die Before We Fix Health Care?, Part 2
Published August 03, 2009 @ 09:58PM PT
Between the work of the Institute of Medicine and the nonpartisan Urban Institute, we know that between 18,000 and 22,000 people die each year for no other reason than because they didn’t have health insurance. It’s a staggering number considering so many of those deaths could have been prevented. Each one of those numbers is a name. Each one of those names was a family member, a friend, a co-worker, a student, a person. For each of them, reforming health care so more people could afford to get the treatment they need when they needed wasn’t something politicians were rushing.
In fact, if we succeed this year, it will still come too late.
Angel “Inqy” Yates was an incredible artist with a stirring imagination (you can see her portfolio here). She created a whole mythology of a post-World War III world for her series of Web-based comics, entitled “Wicked Alchemy.” A small group of devoted fans knew she was gifted. What they probably didn’t know was how many balls she was juggling at once. As learned in a cartoon tribute by one of her instructors, “Even though she took a full course load, worked a full-time job, raised a family, and worked as a freelance artist, she always raised the bar and excelled in every course I had her in.”
This June -- less than 2 months ago -- she graduated, got her degree, and began working full-time doing what she loved. She was in a situation common to artists – without health insurance from her employer and without enough money to buy her own plan. In a note to her fans on her Web site – the last such note she would write – she revealed a new problem:
I'm also having odd health problems, which make me exhausted for no reason whatsoever. Hopefully.. hopefully.. we'll find a house soon, the health problems will go away on their own (since I have no health insurance at the moment to otherwise deal with them), and free time will return to me. It's going to be a long summer.
That was her public face. On her personal blog, she was confused and frightened by her health problems, but didn’t have the money or the insurance to see a doctor.
After a month and a half, it grew to the point of being winded by even smaller walking spurts. I could climb two flights of stairs, but my chest felt as if someone were crushing it from all sides, and I couldn't get enough air. Which was silly, because I'd be listening to myself breathe hard, and the air was coming and going, it's just as if my lungs weren't registering that. It's a very hard thing to describe... Not like chest pain, although my chest hurt unbearably. Not like heart problems, although my heart would be pounding in my ears. Not like asphyxiating, since the air was coming and going. But for some minutes after exerting myself over two lousy flights of stairs, I could do nothing but stand there and gasp and pant heavily….
I just don't know what to do. I really don't... Can it still be from stress? I still have plenty of it... I graduated, and got a job, and things are falling into place. But there's still so much to worry about... the lack of health insurance, for one thing, or that I'm away from my family for five days a week, or all the driving I do every day, or the crack in my windshield, or trying to find/buy a house...
She had a whole new life ahead of her. Things were falling into place. But the health problems did not go away, the answers didn’t come, and Inqy died on July 7.
One last story.
Eric De La Cruz lived in Las Vegas, came from a loving family and had a good future. What he didn’t have was health insurance. At only 22, he was diagnosed with severe dilated cardiomyopathy, which is primarily a genetic condition – he didn’t ask for it, didn’t do anything to deserve it. The remedy was as severe as it gets – a heart transplant at a relatively young age. In addition to the intense preparation and the arduous nature of transplant surgery, it’s literally a life-changing experience. Transplant recipients need to be on medication to suppress the immune system to prevent their bodies from rejecting the foreign organ. The lifestyle changes are permanent and daunting. And because heart transplants are still relatively infrequent – only around 2,000 per year -- the frustration and uncertainty for families is stressful beyond measure. However, there is good news. As explained on About.com, “Today, almost 90% of heart transplant recipients survive for at least one year after transplant, and up to 75% survive for five years.”
Because of his relative youth, Eric had excellent prospects, as daunting as his health challenges would be. But what he didn’t have was health insurance through his employer, compounded by his being a student. The small business he worked for simply couldn’t afford it. So before he could fight for his life, he had to fight for the opportunity to fight for his life.
You can guess some of what followed – he could not buy insurance now because he had a pre-existing condition. Even if he had miraculously found a plan that would take him, he would have been charged a prohibitively expensive premium based on health status. By shedding his assets and giving up on working, he was able to qualify for Medicaid but, as we know all too well, Medicaid is a hybrid federal-state program. Normally that wouldn’t make a difference – but there are no transplant centers in Nevada. None. In order to be covered for transplant surgery in California, he needed to apply for Medicare coverage with his heart condition as a disability. Medicare is a program designed to give wonderful care to seniors over 65. It gives decent care for those with disabilities. But a heart condition in need of a transplant meant that Eric didn’t get the care he needed. Instead, he got more red tape than he could deal with as he was rejected for Medicare – twice. He appealed one more time – the appeal took over a year to be heard, a year during which his heart function continued to deteriorate.
Eric’s family did what any of us would hope our family would do for us – they fought. Hard. Eric’s sister Veronica, a CNN reporter who had specialized as an Internet correspondent, following the latest stories in social media, took his story public and turned to Twitter for support. You can still follow Eric’s Twitter Army using hashtags #Eric and #ETA, or at www.WeLoveEric.com and www.Tweet4Eric.com. Unlike your average transplant patient, the De La Cruz family had harnessed the Internet, and people they had never met created petitions, web sites and grassroots communities to rally support.
He got his Medicare coverage after all, but the hospital refused to accept Medicare only – they needed supplemental insurance. They wouldn’t admit him. Despite the well-known fact that no hospital can turn someone away, Eric was a state away and could not be taken off IVs. If the hospital didn’t send a transport for him, he could never get there. So they began to raise the money, attracting the attention of singer Trent Reznor and popular rock band Nine Inch Nails.
Eric had tremendous advantages not available to most in this country. He had a sister with connections who was willing to move heaven and earth to give her brother a new heart. He had a community of strangers who loved, supported and raised money for him on Twitter and on the Web. He had celebrities rally to his cause. He raised nearly $900,000 in two weeks. But it was all too late. Eric passed away on the 4th of July.
What the hell does it say about the state of health care in America that all of that wasn’t enough to get him the care he needed to stay alive when he needed it?
If we had HR 3200 10 years ago, Eric would never have had to even look at Medicare or Medicaid. He would have had quality health insurance, either public or private, either affordable (through a tax credit) for his small business employer to provide or affordable (through subsidies) for him to buy. He would have had guaranteed benefits that would never have been taken away and his catastrophic care would have been covered. Instead of raising a million dollars, he would have needed to raise 10% of his income for out-of-pocket expense.
If we had HR 3200 10 years ago, Inqy wouldn’t have had to worry about pinching pennies and worrying about how she would pay for car repairs or saving money for a house before seeing a doctor. Her primary care doctor’s visit would have had no co-pay. She would have had an insurance plan, public or private, that was affordable to her.
If we had single payer 30 years ago, neither one of them would have had to think of anything else except getting better. But we didn’t – we decided an industry’s profit and the libertarian impulse of individualism was worth more than thousands of human lives.
Remember their stories the next time someone tries to tell you an eight month long legislative process is moving too fast. Delay has consequences.
(Photo credit: stimpy89 on Flickr.)
