
That will be the last 10 minutes I watch of this series.
from TV to the Internet to TV and back again
fought for health care reform & now figuring out what's next
Insurers participating in the Advantage program responded to inquiries by Senate Democrats that led to a report this month providing some fuel in their fight against the subsidies. The companies reported, on average, spending more than 15 percent of premium revenues on profits, marketing and corporate expenses, nearly 10 times the rate of traditional Medicare.As I've said before, cutting overpayments to private insurers does not mean a cut to Medicare Advantage benefits UNLESS that's what private insurance companies CHOOSE to do. It's up to them. If they get less government subsidy money, they can cut marketing, salaries, overhead, administrative expenses, lobbying, advertising, corporate retreats, bonuses, etc. before they touch benefits. They might not, but that's not the government's fault. That's all on private insurance companies. Plain and simple.
Meanwhile, Advantage companies were paying for multimillion-dollar corporate retreats in exotic locales and hundreds of their executives were being paid more than $500,000 annually. Government reports have shown Medicare Advantage providers continually outpace profit projections. The congressional review released this month showed 34 Advantage companies devoted $27 billion in government subsidies from 2005 through 2008 to profits, marketing cost and other corporate expenses.
“With passage by the Senate, the nation has moved one big step closer to comprehensive health care reform. Health Care for America Now will work to get the strongest bill to the President’s desk, one that provides good, affordable coverage to all and holds insurance companies accountable. To realize the promise of reform, we need to be sure that employers are required to help pay for good coverage for their workers, that premiums are affordable to families, that we do not tax benefits, that we enact tough insurance regulations, and that we offer the choice of a public health insurance option. We will urge President Obama to work with leaders in both houses of Congress to agree on legislation that meets these goals, guaranteeing good health coverage we can count on.”
As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.
These are signal achievements, and they all would have been politically unthinkable just a few years ago.
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Progressives have good reason to be angry. Yet we should harness our anger to fix the bill--now and every year from now. The current bills in Congress do too little to help Americans immediately; their main actions are delayed for years. If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.
So a bill must pass. Yet it must be a better bill that passes. And it must be understood by the President, the Congress and every American as only a step--an important but ultimately incomplete step--toward the vital goal that the campaign for the public option embodied: good affordable health care for every American
We shouldn't have had to settle for half a loaf. If the president had simply placed appropriate blame on the health insurance industry for its pre-existing conditions, it's cutting off care for breast cancer victims in the middle of treatment, and its doubling our premiums and co-pays during the Bush years, he would have harnessed populist anger and pushed this bill through six months ago, and it would have looked like the change we were told to believe in. But if you cut backroom deals with every special interest who is part of the problem and offer the American people no coherent message while the other side is messaging straight out of the messaging memo written by Frank Luntz ("government takeover," "a bureaucrat between you and your doctor"), you can expect half a loaf. And the other half will be paid for by middle class taxpayers, as in the Senate bill, which includes provisions like taxing good middle class tax plans like PPOs, which will disappear as soon as insurance companies and big businesses have the excuse of the missing tax break. Remind me, when we've just had the largest transfer of wealth to the upper 1 percent of the country from working and middle class Americans in a century, why it would be such a terrible thing instead, as in the House bill, to ask people who make over a million dollars a year to pony up for the health care of their (and their friends') housekeepers, instead of taking away health care plans union workers traded for salary increases?The whole thing is here.
The roll was called shortly after 1 a.m., with Washington still snowbound after a weekend blizzard, and the Senate voted on party lines to cut off a Republican filibuster of a package of changes to the health care bill by the majority leader, Harry Reid of Nevada.It's good to be moving forward. The key now is to work as hard as we can to get the strongest bill possible to the President's desk, hopefully before the end of next month. What we'd like to see:
The vote was 60 to 40 — a tally that is expected to be repeated four times as further procedural hurdles are cleared in the days ahead, and then once more in a dramatic, if predictable, finale tentatively scheduled for 7 p.m. on Christmas Eve.
That's the wish list. Here's hoping Santa's paying attention.
- Fair financing instead of taxation of higher cost health care plans
- True affordability
- A public insurance option to bring choice and competition to the marketplace
- Employer responsibility so people get good coverage at work, and it's coverage they can afford
I'm pissed off at having to compromise while a handful of lopsidedly powerful conservadems get whatever they ask for.Read the whole thing. Trust me. It may help.
I'm pissed off at the Senate health care reform bill. I'm pissed off at the House health care reform bill. I'm preemptively pissed off at the conference report, too, and I don't even know if we'll even get that far.
And I'm pissed off that my progressivism leads me to the unavoidable conclusion that if we don't pass health care reform now, innumerable bad things will continue to happen due to the fact that there's a very serious health care crisis in America. I'm pissed off that I can't, in good conscience, allow my anger to coerce me into believing that we should "kill this bill." I'm pissed off about that, too, because I know what could have been, and yet I have no other choice but to settle for what is. For now.
J,Email 2 (from J to staff):
Just to let you and the HCAN staff know that we just received 2 delicious-looking apple pies as a Christmas gift from—don’t laugh—two Citibank reps who dropped by. Please let everyone at HCAN know - D
Citibank has graced us with pies. It’s a Christmas miracle.Email 3 (from A to staff):
Thank the taxpayer-financed bailout for funding their largess.Email 4 (from J to staff):
I was a little confused how two pies cost $10 Million, but I’m not an accountant.Outburst from down the hall:
I want bailout pie!p.s. I should clarify that we rent space from another organization. The pies were delivered to them. Citibank is not trying to shmooze HCAN.
At the end of the day, Brown and Rockefeller and their allies simply care too much about people struggling with their medical bills--people who would still benefit, clearly, from reform without a public option--to mount further resistance. Lieberman, by all appearances, felt no compunction to put people over pique. That's why he won.UPDATE: This one too - John Aravosis:
Disappointed progressives may be wondering whether their efforts were a waste. They most decidedly were not. The campaign for the public option pushed the entire debate to the left--and, to use a military metaphor, it diverted enemy fire away from the rest of the bill. If Lieberman and his allies didn't have the public option to attack, they would have tried to gut the subsidies, the exchanges, or some other key element. They would have hacked away at the bill, until it left more people uninsured and more people under-insured. The public option is the reason that didn't happen.
Bush was willing to use his bully pulpit to create an environment in which the opposition party feared taking him on, feared challenging his agenda, lest they be seen as unpatriotic and extreme. By going public, early and often, with his beliefs, Bush was able to fracture the Democratic opposition (and any potential dissent in his own party) and forestall any effort to mount a filibuster against the most important items in his agenda.Important note: In no way, shape, or form does my linking to these writes from my personal site constitute an HCAN agreement with or endorsement of said posts and should not be construed or interpreted as such.
It's not about the votes, people. It's about leadership. The current occupant of the White House doesn't like to fight, and the leadership in Congress has never been as good at their jobs, at marshaling their own party, as the Republicans were when they were in the majority. The President is supposed to rally the country, effectively putting pressure on opposition members of Congress to sit down and shut up. And the congressional leadership is supposed to rally its members to hold the line, and get the 51 votes necessary for passing legislation in a climate where the minority is too afraid to use the filibuster. When you have a President who is constitutionally, or intellectually, unable to stand for anything, and a congressional leadership that, rather than disciplining its own members and forging ahead with its own agenda, cedes legislative authority to a president who refuses to lead, you have a recipe for exactly what happened last night. Weakness, chaos, and failure.
Q: Madam Speaker, as you well know, the Democrats in the Senate have come to a tentative deal to drop what everybody knows as the public option from their health care bill. You have said there is, quote, no way I can pass a bill in the House of Representatives without a public option. Is that still the case?What was written:
Speaker Pelosi. Well, what I said — it is a two part statement that quotes what the President has said. We believe, we in the House believe that the public option is the best way to hold insurance companies honest — to keep them honest and also to increase competition. If there is a better way, put it on the table.
As soon as we see something in writing from the Senate, we will be able to make a judgment about that. But our standards are that we have affordability for the middle class, security for our seniors, closing the donut hole and sustaining the solvency of Medicare. Responsibility to our children, so not one dime is added to the deficit. And accountability of insurance companies. We will take a measure of that bill in those regards.
Q: From what you know of what the Senate is doing, do you think — there have been some pretty positive statements from some of the most liberal members in the caucus.
Speaker Pelosi. What I have said, as I have always said to our members: Give the Senate room. I said that about the President. Give the President room, give the Senate room. But we honestly have had no paper on this. And probably we will know a great deal more when the paper comes back from the Congressional Budget Office.
But between their bill and our bill, I know one thing for sure, we will have a great bill when we put them together.
The public health insurance option died on Thursday, December 10, 2009, after a months-long battle with Senate parliamentary procedure. The time of death was recorded as 11:12 a.m. Eastern Standard Time.Ok, I'll kind of comment. The way it should be written:
Its death had been rumored numerous times over the past year, but the public option repeatedly and defiantly battled back. The Senate's insistence on 60 votes, combined with President Obama's decision not to intervene on its behalf, eventually proved overwhelming.
While expressing enthusiasm for the Medicare buy-in, House Speaker Pelosi isn't ready to sign onto the Senate compromise yet.Or even this:
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She also showed some flexibility on the public option, but is still in wait-and-see mode...
Without commenting directly on the tentative Senate deal, Pelosi told reporters, "There's certainly a great deal of appeal about putting people 55 and older on Medicare" - one plank of the pending compromise to gut a controversial public option.
"These bills are perhaps 75 percent compatible," she said.
Of course, the remaining 25 percent includes not-so-little issues, like abortion funding, immigration, when the new programs begin, when – and how far – to close a gap in prescription-drug coverage under Medicare and whether to provide optional government-sponsored insurance, among other things.
The Senate Committee on Commerce, Science and Transportation launched an investigation last summer into the percentage of premiums insurers spend on medical care versus profits and other administrative expenses. That percentage, known in the industry as "the medical-loss ratio," is watched closely by detractors who say insurers take too much money from the system in profits.
In a statement Monday, the committee said Aetna overstated by $4.9 billion the amount of money it spent on patient care for small businesses. As a result, the insurer's medical-loss ratio for small businesses was 79%, not the 82% Aetna initially reported, it said, drawing attention to a correction that Aetna had made to its filings last week.
Aetna said the error was a simple mistake...
HCAN Statement on FEHBP-style Nonprofits as “Compromise”
Washington, DC – In response to news accounts that one possible compromise on the public option is having national nonprofit insurance plans regulated under the Office of Personnel Management, similar to the Federal Employees Health Benefit Plan, Health Care for America Now (HCAN) put out the following statement on behalf of its Steering Committee:
“To meet the goals of lowering health care costs and keeping insurance companies honest, a public option must be publicly established and accountable and operating nationally when the Exchanges start. Using nonprofits to replace a public option won’t work. In fact, with half of people in private insurance currently enrolled in nonprofit plans, they are part of the problem.
As for FEHBP, it too has failed to control health care costs, doing just as badly as private insurance and with much higher costs than Medicare. HCAN urges the Senate to enact legislation that includes a national public health insurance option, which is now part of the legislation introduced by Majority Leader Reid, H.R. 3590.
We have said from day one that we believe the best way to create competition, lower prices, and ensure Americans get the quality, affordable health care they deserve is for Congress to pass comprehensive health care reform including the choice of a public health insurance option.”
Health Care for America Now
AFL-CIO
American Federation of State, County and Municipal Employees (AFSCME)
American Federation of Teachers (AFT)
Campaign for America’s Future
Campaign for Community Change (CCC)
Communications Workers of America (CWA)
MoveOn.org
NAACP
National Education Association (NEA)
Service Employees International Union (SEIU)
United Food and Commercial Workers (UFCW)
United Auto Workers (UAW)
USAction
Working America
Wrestling with the historical moment
Nick's note: I was asked by the Illinois Campaign For Better Health Care to confront the lack of energy and even negativity at their packed annual meeting.
Then this past week folks from quite a few health care groups agreed that the question of energy and outlook needs to be addressed, observing that many of their troops in the outside the Beltway field have "battle fatigue" or worse. It gets harder to ask for one more call or write one more press release. One terrific communicator said "I'm out of words." (A wonderful, poignant, sad commentary.) This is no time to run out of words. I offer these.
Edited transcript of remarks at the November 19, 2009 Annual Meeting of the Illinois Campaign for Better Health Care by Nick Unger, AFL-CIO’s Health Care Campaign Training Director
Every once in a while, a country gets to have a conversation about what kind of people we are and who we are as a country. Sometimes it's in an election, but most of the time it isn't. An election might start the conversation, but Election Day usually ends it. And you haven't quite finished.
And most elections don't even start the conversation. They just keep business as usual going. The 2008 election began a conversation as to what kind of country we are, but I don't believe it finished it. I think it just opened it up, and that conversation continues.
There are those out there who act like they want a recount on the 2008 election, that Obama is not their president and you - we - can't have “their country.” And they say it with vigor and with passion and with earned and unearned media (in that they own TV stations and TV networks). Their view of earned media is that they get to say what they want, whatever they want, and echo it over and over and control the national conversation from above.
But they don't control the national conversation from below. The 2008 election showed that. People were wrestling with who we are. Actually, it was mainly about who we're not. That election seemed more of a rejection of what was wrong than a climbing onto what was right. That means we didn't finish the conversation.
We did say that the country is going wrong. And there was a deep sense of it, of pain and suffering. The presence of my brother Rev. Sal Alvarez being here representing the faith community reminds me that the word compassion means shared suffering. It doesn't mean feeling for somebody else. It means suffering with somebody else.
So last year people got a sense that the country ain't doing it right, and we can't go down that road anymore. But we haven't picked the road that we're going to be on yet. We haven't turned the corner yet.
But I would offer to you that we are at the corner. And when you're at a corner, you best turn because we don't know when the next one comes up. From a political analytical point of view, the last time America turned the corner was 1980, and we sure turned wrong. And we are living with the price of it now. We are at a corner now. If we miss this one, I don’t know if I will ever get a shot at another one.
The battle to turn that corner is on health care. Health care doesn't “deserve” to be the battle. It’s not that health care is more important than any other issue. It could have been fought over jobs. It could have been fought over education because education's real important. I'm not going to say health care's more important than education. It turned out that the two armies have met on the battlefield of health care. It could have happened some other way, but this is what it is.
My wife and I went to Gettysburg this past summer. Anybody here been to Gettysburg? To a New Yorker, Gettysburg is a one stoplight town. In 1863, when they had the battle there, it was a one-horse town.
They weren't fighting for Gettysburg. The battle was not about Gettysburg. They were fighting for what kind of country America was going to be. Two armies met in one little town in Pennsylvania and right there in Gettysburg. At the end of the battle, one army was beaten and one army was marching ahead, and America found its soul on Little Round Top in Gettysburg, PA.
If you go to Gettysburg, the ghosts of that battle speak to you. The field is empty, but you can hear the battle. One monument stands out. It's the Pennsylvania Monument. It lists the names of all the Pennsylvanians who fought and died there.
A hundred years before the Vietnam Wall, they just listed the names, and every one of those names talks to you.
We are in a battle for the soul of America today, right now. It is being fought over health care. Six weeks, tops eight weeks from now, one army marches ahead and the other one is on the side of the road with their banner in the dust.
On one side you have Fox News, Glenn Beck, Rush Limbaugh, the insurance companies, the Chamber of Commerce, Goldman Sachs all saying, “If health care reform fails, that's good for us and our team.” All of them lined up on that side saying to us, “You are not going to decide the future of America your way, and we will take you down over health care.”
So where are we today? There are a thousand things wrong with that bill, and the process of getting to it was a pain in the ass. Each day you say: “we lost this, we gave up this, we conceded this, what about this, this isn't in it, they don't have enough here." I mean, no part of it is quite right.
And yet today, November 19, we are closer to defining the soul of America properly than we have been in decades, in your lifetime for most of you. The metaphor I would use is we are falling uphill. We keep falling down. But turn around. You will see we are so much further ahead. Each time we fall and get up we are getting closer to where we've got to be.
We have pushed this process so far that America can say eight weeks from now, maybe six weeks from now, we are going to establish a new “public good” with government and the public in it, a public health care structure, and we're going to say that everybody in America should have health care. This is the first time America will say it, and it comes after two generations of attacks on these kinds of ideas.
And we're going to tax the rich to pay for a public good after two generations of saying taxes are bad and the rich can have all the money - all of my money and all of your money. Man, that is heavy!
And we are going to say to the insurance industry, you can't write all the rules. You can write some of them, but not all the rules, and this is after thirty years of telling corporations, do whatever you want cause that's the way the world should work.
We are six weeks from doing that as a people. We are six weeks from setting America in a direction where We the People act like we, instead of every man for himself. We are six weeks from turning the corner, making history, and somehow here today we don't feel the energy of it.
And so when Reverend Sal Alvarez says it's a moral issue and when Dr. Jonathan Arend says it's a medical issue and when the woman who said she can make $60,000 but can’t afford health care says it's an economic issue, they are all right.
And each of you is the center of a universe of people to talk to. You are not just the Illinois Campaign For Better Health Care. You are much more than that. If the only people you talk to are in this room, I have some advice for you: You should get out more.
You come from churches and neighborhoods and groups and mosques and all sorts of things, and you have to talk to your friends about the history that is being made right now and what kind of country we are going to be so that 75 years from now, they read your names the way I read the names on the Pennsylvania memorial: These are the people who made the country that I live in be the way I wanted it to be.
And 75 years from now, people will look at the fall of 2009 the way I look at the summer of 1863. They’ll say America had a chance to become who we should be, and we took it. That's where we are today.
For many of us, this is the first time in our lifetime that we have had this chance. Some of us were around in the Civil Rights Movement. This moment feels like that was for those of us who were around then. This is the moment that you get to turn around the entire future, and it’s over health care. And if you didn't stand up strong over it, you will always regret it.
There are better organizers than me who throughout their whole life were getting kicked in the face, fighting a defensive battle, getting smacked around, and they were better - they worked harder, they were more straightforward, they cursed less ... and they never once had a chance to be on the offensive to make the world the way it should be because it was their dumb luck to start their work when the world was going wrong and retire before it got right.
And you should think about the people whose shoulders you stand on today because we've got six or eight weeks to decide what kind of country we are, to decide which army wins. This is our opportunity, and if you get lost in the weeds of that bill, then some friend of yours better stand you up and say, “We are making history, and I am writing my name down on the memorial that people are going to visit 75 years from now, and if you miss it, shame on you!”
There should be anger and energy and elation and glee because we get a
chance to make this country right.
In 1964, in Alabama, an old civil rights worker said to a young reverend...the old civil rights worker was my age, and the young reverend was Dr. Martin Luther King, Jr .… and he said to him, “How long, how long do we have to wait for justice?”
And Dr. King replied, "The moral arc of the universe is long, but it bends towards justice.” But he knew it doesn't bend by itself. You bend it. You reach up, you grab it, and you bend it. And when enough of us grab the moral arc of the universe, it bends towards justice. And in 1965, the Voting Rights Act was passed.
So the person who just asked, "How long do we have to wait for health care justice?" is repeating the history of our movement. That's the same question they asked Dr King in 1963. And the answer: when enough of us put our hands on the arc, it bends towards justice.
Right in front of our eyes, the moral arc of the universe is about to decide which way it bends. In six weeks. You can't ask for anything better than that. You are blessed with this opportunity. How long? You decide. Thank you.
[J]ust because an entity is nonprofit does not mean it is public service oriented. It simply means it is not distributing profits to shareholders. The idea behind the public plan was to present a choice, not an echo of our already failing insurance system, of which nonprofit insurance plans are a prominent part.Jacob Hacker weighs in too:
In short, the new compromise proposals are anything but. They represent calls for advocates of the public plan to eat their crumbs and be happy. But a majority of Senators support the public plan. At least two--Senator Bernie Sanders, an independent from Vermont and Senator Burris of Illinois--have said having a real public plan in the legislation is a precondition for their support. Those who believe in the public plan—and, more important, who believe in the principle it embodies: that no American who lacks access to good insurance should be forced to buy coverage from the private plans that got us into our present mess--should stand firm in the face of these non-compromises.
This includes President Obama. He made the public plan part of his promise of change in 2008. Now he needs to put his weight and influence behind the public plan and its essential goals, rather than allow them to be gutted. This is in our nation’s interest. It is also in his and his party’s political interest. A bill that forces people to take private insurance but doesn’t create competition or a public benchmark is a prescription for unaffordable coverage, runaway costs, and political backlash. The “middle ground” is nowhere to stand if it’s going to crumble beneath you.
If you ever needed proof that big government programs are popular with the American people, the Republican defense of Medicare could be exhibit one. Medicare is so popular that the best political attack Republicans have against the health care reform bill is to scare seniors about the legislation's impact on Medicare.
For Republicans, the leading example of the alleged government takeover of health care is giving some people the choice of a public insurance plan to compete with private insurers. The public option would be a very small version of the very big Medicare program.
Over the last few years, drug-makers have embraced a startlingly simple tactic for fending off competition from generic brands: paying them off. In a nutshell, the company that holds the patent on a profitable drug strikes a deal with the maker of the cheaper generic brand: you hold off on marketing your generic for several years, and in return, we'll give you a share of our profits on the drug.It's worth a read on how this scam is totally legal and totally ripping you off.
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So common have these deals become lately that they've been given a name: pay-for-delay. The approach -- a textbook anti-competitive tactic -- is worth billions to drug-makers, because it essentially allows them to buy more protection than their patent confers.