Health Care Thursday: 8 out of 10 Edition

digby: The Eulogies

There are some really great eulogies for EMK all over the internet and I hope you take the time to read as many of them as you can. Liberal heroes don't come along every day and it's immensely gratifying to read all these thoughts from people who knew him and lived through his time.

For instance, via Eric Alterman, I came across this wonderful piece from a few years back by the great Charles Pierce:

If his name were Edward Moore . . .

He would not have served so long, if he'd served at all. He might not have served with more than 350 other senators. He would not have served with all three men - Everett Dirksen, Richard Russell, and Philip Hart - after whom the Senate office buildings are named. He would not have had his first real fight over the poll tax and his most recent one over going to war in Iraq. None of this would have happened if his name were Edward Moore.

If his name were Edward Moore . . .

If his name were Edward Moore, Robert Bork might be on the Supreme Court today. Robert Dole might have been elected president of the United States. There might still be a draft. There would not have been the Civil Rights Act of 1991, which overturned seven Supreme Court decisions that Kennedy saw as rolling back the gains of the civil rights movement; the 1990 Americans With Disabilities Act, the most
wide-ranging civil rights bill since the original ones in the 1960s; the Kennedy-Kassebaum Bill of 1996, which allows "portability" in health care coverage; or any one of the 35 other initiatives - large and small, on everything from Medicare to the minimum wage to immigration reform - that Kennedy, in opposition and in the minority, managed to cajole and finesse through the Senate between 1996 and
1998, masterfully defusing the Gingrich Revolution and maneuvering Dole into such complete political incoherence that Bill Clinton won reelection in a walk. None of this would have happened, if his name were Edward Moore.

Go through his speeches of just the last decade and you'll find that he was on the right side every time, making the argument. God knows there were few enough who did.

Update: I just got an email from Bold Progressives with this mesaage, which I think is great:

Senator Kennedy called health care reform "the cause of my life." We've seen comments from across the country saying the Senate should pass the strong reform bill that came out of Kennedy's health committee -- which includes the public health insurance option -- and name it "The Kennedy Bill" in his honor.

We agree. So we created a petition to the Senate that we'll deliver Monday -- can you sign it?

PETITION: "Ted Kennedy was a courageous champion for health care reform his entire life. In his honor, name the reform bill that passed Kennedy's health committee 'The Kennedy Bill' -- then pass it, and nothing less, through the Senate."

Please click here to add your name.

In less than an hour, over 1,000 people have already signed! All signatures will be hand-delivered to the offices of Harry Reid and other key senators in Washington DC next Monday, August 31 -- just as the Senate is returning from August recess.

Senators will soon choose between Kennedy's bill and another being written by conservative Democrats and Republicans, which likely will not include a public option. Let's honor Kennedy's memory by naming his own bill after him -- and telling his Senate colleagues it would be a disgrace to vote against it or to water it down.

Can you join us? Click here to add your name.

Then, please forward this email to others.

Singer: AARP Poll: 8 in 10 Back Public Option

A new survey commissioned by the AARP asks respondents to what degree they support or oppose "[s]tarting a new federal health insurance plan that individuals could purchase if they can't afford private plans offered to them" -- a public option, in other words. The results are interesting, though not necessarily surprising to those who have been closely following the debate.

All: 79 percent favor/18 percent oppose
Democrats: 89 percent favor/8 percent oppose
Republicans: 61 percent favor/33 percent oppose
Independents: 80 percent favor/16 percent oppose

Not only does a public option enjoy strong support (AARP finds 37 percent strongly supporting such a choice), it enjoys broad support -- a finding based not only in this new survey but also in SurveyUSA polling released last week. Indeed, a supermajority of even Republicans supports a federal program to provide individuals with a choice for their health insurance coverage, with just a third of the party membership opposing such a plan.

So why, again, are supporters of a public option finding such difficulty in Congress?

kos: Nebraska is tough sell for public option

Blue Dog Rep. Jim Cooper, to Daily Kos:

He who pays the piper calls the tune .

That was Cooper's way of charging Daily Kos with buying the poll results it wanted, since it turns out his constituents strongly support the public option, and aren't too happy with his performance. Given that he himself is bought and paid for by insurance industries, what we saw was a clear case of projection. If the insurance execs can get him to vote against his constituents' interests by lining his pockets with cash, why then couldn't Daily Kos buy the poll results it wanted?

Well, not really. The results of our Nebraska health care poll pretty much proves that.

Research 2000 for Daily Kos. 8/17-19. Likely voters. MoE 4% (No trend lines)

Do you approve or disapprove of Sen. Ben Nelson's actions on health care?

Approve Disapprove

All 56 39
Dem 22 72
GOP 76 19
Ind 61 35

Do you favor or oppose creating a new public health insurance plan that anyone can purchase?

Favor Oppose

All 39 47
Dem 76 14
GOP 15 68
Ind 38 49

Nebraska is a fairly conservative state (despite Obama's grabbing of a single electoral vote in 2008), and so it should come to no surprise that the public option faces a tough fight. If anything, the surprise is that opposition to the public option doesn't have majority support (just plurality). And while the state's Democrats are on the right side of the debate, they are grossly outnumbered and independents aren't with us.

Unlike Max Baucus or Jim Cooper, Ben Nelson is actually not out of touch with his constituents.

If Ben Nelson joined Republican Senators in filibustering and killing a final health care bill because it had a public health insurance option would that make you more or less likely to vote for him or would it have no real effect on your vote?

More Less

All 21 15
Dem 7 24
GOP 31 9
Ind 19 15

We can assume Nelson will vote against any bill with a robust public option. The big question is whether he will join Republicans in filibustering such a bill. Nebraska Republicans would sure love that, but at the end of the day, they'll vote for a real Republican in a contested election. Nelson would gain a small sliver from Independents, per this poll, but his real danger is among Democrats -- where he would lose a full 17 points of support.

There's a danger that Nelson could so alienate the Democratic base in Nebraska that it could cost him in 2012. It's a small base, but in a tight election (like he had in 2000), every vote would count:

If Nelson was to play this properly, he'd vote against any robust public option (and be justified doing so, given his constituency), but allow an up-or-down vote on the bill. Given the political realities of his state, that's the best we could hope for.

tristero: Deja Vu All Over Again

Healthcare wonks should know this amazing article by James Fallows re: the Clinton/Magaziner attempt to reform healthcare in the early 90's (h/t Bob Somerby). But apparently the ones working for the Democrats don't or they wouldn't have been caught with their shortpants around their ankles this summer.

It's all terribly familiar, even many of the same liars making up the same shit, and the same strategies. A few choice excerpts below, but, as they say, RTWT:

Much of the problem for the plan seemed, at least in Washington, to come not even from mandatory alliances but from an article by Elizabeth McCaughey, then of the Manhattan Institute, published in The New Republic last February. The article's working premise was that McCaughey, with no ax to grind and no preconceptions about health care, sat down for a careful reading of the whole Clinton bill. Appalled at the hidden provisions she found, she felt it her duty to warn people about what the bill might mean. The title of her article was "No Exit," and the message was that Bill and Hillary Clinton had proposed a system that would lock people in to government-run care. "The law will prevent you from going outside the system to buy basic health coverage you think is better," McCaughey wrote in the first paragraph. "The doctor can be paid only by the plan, not by you."

George Will immediately picked up this warning, writing in Newsweek that "it would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem 'necessary.'" The "doctors in jail" concept soon turned up on talk shows and was echoed for the rest of the year.

These claims, McCaughey's and Will's, were simply false. McCaughey's pose of impartiality was undermined by her campaign as the Republican nominee for lieutenant governor of New York soon after her article was published. I was less impressed with her scholarly precision after I compared her article with the text of the Clinton bill. Her shocked claim that coverage would be available only for "necessary" and "appropriate" treatment suggested that she had not looked at any of today's insurance policies. In claiming that the bill would make it impossible to go outside the health plan or pay doctors on one's own, she had apparently skipped past practically the first provision of the bill (Sec. 1003), which said,

"Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services."

It didn't matter. The White House issued a point-by-point rebuttal, which The New Republic did not run. Instead it published a long piece by McCaughey attacking the White House statement. The idea of health policemen stuck...

Through most of 1993 the Republicans believed that a health-reform bill was inevitable, and they wanted to be on the winning side. Bob Dole said he was eager to work with the Administration and appeared at events side by side with Hillary Clinton to endorse universal coverage. Twenty-three Republicans said that universal coverage was a given in a new bill.

In 1994 the Republicans became convinced that the President and his bill could be defeated. Their strategist, William Kristol, wrote a memo recommending a vote against any Administration health plan, "sight unseen." Three committees in the House and two in the Senate began considering the bill in earnest early in the year. Republicans on several committees had indicated that they would collaborate with Democrats on a bill; as the year wore on, Republicans dropped their support, one by one, for any health bill at all. Robert Packwood, who had supported employer mandates for twenty years, discovered that he opposed them in 1994. "[He] has assumed a prominent role in the campaign against a Democratic alternative that looks almost exactly like his own earlier policy prescriptions," the National Journal wrote. Early last summer conservative Democrats and moderate Republicans tried to put together a "mainstream coalition" supporting a plan without universal coverage, without employer mandates, and without other features that Republicans had opposed. In August, George Mitchell, the Democratic Party's Senate majority leader, announced a plan that was almost pure symbolism--no employer mandates, very little content except a long-term goal of universal coverage. Led by Bob Dole and Newt Gingrich, Republicans by September were opposing any plan. "Every time we moved toward them, they would move away," Hillary Clinton says.

"Republicans by September were opposing any plan."

Hey, it worked the first time. Worked like a charm.

Kristof (NYT): Health Care Fit for Animals

Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.

“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.

Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.