The argument conservatives use against a public health insurance plan is essentially a “slippery slope” argument. If we create a public health insurance plan, the thinking goes, it will eventually become so big as to swallow up all other health care plans. Never mind that this is the same argument conservatives made about Medicare and SCHIP and it didn’t happen. That’s the line and it always will be.

In the past, these arguments had a whiff of reality to them. Health care reform proposed by Bill Clinton, for example, did have restrictions on people’s choices, giving these arguments purchase. But Barack Obama changed that by running on a health care plan that was different. By starting with the premise that you can keep your health insurance if you like it, individual choice is not threatened.

That fact won’t stop conservatives and insurance industry status-quo defenders from trying out the argument anyway. They say, so what if you can technically keep your private insurance. The public health insurance plan will be so powerful, private insurance won’t be able to compete, meaning that people will be moved onto the public health insurance plan whether they want to be or not.

First, they complain that a public health insurance plan would pay doctors too little, like Medicare. Today, Joseph Paduda, the principal of Health Strategy Associates and an expert in the health insurance field, deftly destroys that argument:

First, physicians don’t have to accept Medicare or Medicaid, and wouldn’t have to agree to any ‘public option’ pricing. In fact many docs don’t accept Medicare today. As participants in the free market, they are able to opt out if they feel the compensation is too low - and many do.

The other factor is just as simple - pricing is but one component of the health cost equation. The others are utilization and frequency. ‘Utilization’ is the number of a specific type of services used by a patient, while ‘Frequency’ is the percentage/number of patients that use that type of service.

Here’s an example. For MRIs, the total cost calculation might be 10 million patients (frequency) X 1.2 MRIs per patient (utilization) X $800 per MRI (price).

Sure, price is a factor - but it is not the most significant factor - not by a long shot. By keeping patients out of the hospital, a private plan would eliminate utilization and prevent price from ever becoming a factor. So, even if a service area was dominated by a public plan, a private plan that did a really good job of keeping members healthy and out of the hospital would deliver lower costs - even if their hospital stays, when they did occur, were more expensive.

Those lower medical costs would enable the private plans to offer lower premiums, which in turn would attract more members, and those members’ dollars. The private payers that could deliver better health would also deliver better returns to their investors, while taking share from both the public plan option and other, less successful private plans.

In other words, it would be possible for a private health care plan to run a business with lower costs than government, even if government were paying a lot less for care. All the private plan would need to do is, as Paduda says, be so good at keeping its customers healthy that it keeps them out of the hospital. Now, this would require innovation on the part of the insurance industry, and a realigning of their chief objectives from defending their turf to keeping their customers healthy. Seems like that’s something Americans would want to see.

Next, Paduda goes further, pointing out that the “health care market” right now doesn’t really function like one:

As noted previously, there’s another reason the arguments against a public plan don’t stand up. Opponents complain that the government’s market power would allow it to dominate a market, thereby making it impossible for a private plan to compete.

The reality today is that almost every market is already dominated by a very few health plans, so much so that in most markets, there really is very little market competition amongst health plans.

Paduda concludes that, “If anything, a robust public plan would add competition to many markets, competition that would, if anything, increase consumer and provider choice.”

And that’s exactly the point. Yes, regulation on the insurance industry is necessary, but if we’re looking for an American solution to the health care crisis, shouldn’t we be looking for something that increases choice and competition?

Really, the insurance industry is most worried about a strong competitor, a plan that would force them to run leaner operations and (gasp!) keep their customers healthier. Like any business, they are opposing that competition by any means necessary. That doesn’t mean we should accept their spin, however. These are inefficient businesses that have gotten away with monopoly power for way too long. It’s time they were forced to earn their keep.

(also posted at the NOW! blog)

On tonight’s Hardball, Chris Matthews said (I’m paraphrasing, because no transcript is available yet) that in the United States we count on the profit motive to get people to make the right decisions.

Actually, that’s exactly the opposite of what the financial crisis has shown us.  Oliver Stone’s Wall Street is a good movie, but the movie’s villain, Gordon Gekko is dead wrong when he famously says “greed is good”.  Greed is not good.  It leads to excess.  It leads to short-term decision-making aimed at producing short-term gains with steep costs to be borne by the people left holding the bag.

That’s what the housing crisis was about.  Greedy people made unjustifiably risky loans to unqualified borrowers but made off like bandits when they sold the loans to some other poor bastard left holding the bag (ultimately, that poor bastard is all of us).

Economics has a term for this–externality.  The classic example is pollution.  Again, greedy people bent on making a profit can rake it in while raping the environment, leaving the rest of us to clean up their mess while they get rich.

What are some examples of the profit motive leading people to make decisions that may be good for them but are bad for the rest of us?  Consider the alcohol and tobacco industries–again, it’s about the externalities, costs absorbed by the vast majority while a few people get very wealthy.  The companies get rich peddling a deadly product while the rest of us bear the increased health costs and, far worse, mourn the people felled by cirrhosis, lung cancer, drunk driving.  Maybe Chris Matthews sees it differently, but it seems plain to me that the profit motive leads to terrible choices in these areas.

The profit motive may be powerful but Chris Matthews is leading us on a dangerous path when he suggests we should trust it to produce good decisions.  He is essentially saying that we should trust people (when guided by the profit motive) to make decisions that will help us all.  Actually, that’s exactly the opposite of what we should have learned from the past year.  When people are left unregulated, guided only by the profit motive, they make decisions that lead to quick profits for a few but leave the rest of us dealing with the fallout.

Crossposted at Mideast by Midwest.

David Lazarus in the Los Angeles Times identifies another reason why the “concessions” agreed on by big business and the insurance industry on health care reform is really much less important than their press releases make it sound:

The insurers are saying that they’ll treat all people fairly in return for a government requirement that everyone buy their product.

Yet if you read the fine print in their plan, it turns out that they’re reserving the right to charge different prices for different levels of coverage — a practice that would effectively keep us where we are, with sick (or potentially sick) people paying more for insurance.

…But Ignagni [of AHIP] and Serota [of Blue Cross] go on to say, almost in passing, that “benefit design” will be needed to keep policies affordable.

That’s insurance-speak for offering bare-bones coverage at relatively low prices and more complete coverage at higher prices — basically the same sort of system we have now.

“We’re telegraphing that if people are allowed to buy more, then it will cost more,” Ignagni told me. “You wouldn’t charge the same for a Cadillac as you would for a Ford.”

The danger, however, is that younger, healthier people would probably gravitate toward the cheaper basic policies, while older people with more health issues would feel compelled to buy the more comprehensive plans.

“It’s a very potent way of segregating sick people from healthy people,” said Karen Pollitz, a research professor at Georgetown University’s Health Policy Institute. “It’s essentially a way of continuing to charge more based on people’s health.”

Which is exactly what the insurers are saying they won’t do in return for that much-desired government mandate.

That was supposed to be the big breakthrough, that the insurance industry agreed they wouldn’t charge you more if you were sick. But clearly, that’s not even the case.

As Richard Kirsch, our national campaign director, said, “They’ve moved the health care debate forward a few inches.” And maybe they didn’t even do that.

That begs the question, why would the industry and big business participate in these talks and even look for breakthroughs? As I argued last week, it’s because they are scared:

The fact, however, that the industry is making these meaningless gestures shows how genuinely scared they are of reform. They know the public is against them. They know they make a shoddy product. And they know reform is coming. They want desperately to stay at the table, and they think - wrongly - that offering meaningless concessions like this will ensure their voices are still heard.

Even those participating in the so-called “Health Reform Dialogue” think the process is a lot of talk and not much action:

“A day late and a dollar short,” said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.

The industry is intent on blurring the lines between real reform and the status quo. They are clearly scared of being cut out of the negotiating process in Congress, but as they’ve shown by agreeing to meaningless “concessions,” they’re not nearly scared enough.

If Health Care for America Now has anything to say about it, they will be soon enough.

(also posted at the NOW! blog)

Having left the United States in the worst economic crisis in 75 years, with two unresolved, ongoing wars abroad and Bin Laden still at large, you’d think the least Dick Cheney could do would be to keep a low profile.  Instead, he has been busy irresponsibly claiming that President Obama’s detainee policies are making us less safe (imagine what VP Cheney would have said if some Democratic leader had dared to level a similar claim at President Bush).

What were the Bush detainee policies that kept us safe?  They included torture.  All right, a Cheney defender (are there any?) might concede, but hard times call for hard choices–sure, we violated the Constitution and basic concepts of humanity, but at least playing Jack Bauer kept Americans safe.

Cheney’s timing was pretty poor.  Just a couple of weeks after he recklessly charged that Obama’s move toward humane detainee policies was making us less safe, there is evidence that torturing a key terrorist suspect foiled a grand total of zero terrorist plots.

If torturing detainees didn’t actually do anything to make us safer, why, exactly, were Bush and Cheney choosing this approach?  Was is that they had absolutely no plan for responding to terrorism (their big plan abroad, of course, centered on invading a country that had absolutely nothing to do with attacking the U.S.), or was is that Cheney has a sadist streak that would put De Sade to shame?  Perhaps the next time Cheney favors us with an audience, he can tell us.

Last Saturday night, people all over the world celebrated an event called “Earth Hour” by turning off their lights for one hour beginning at 8:30 pm.  For an event that started just two years ago, it has achieved a remarkable level of attention and participation. According to the official Earth Hour website:

Earth Hour began in Sydney in 2007, when 2.2 million homes and businesses switched off their lights for one hour. In 2008 the message had grown into a global sustainability movement, with 50 million people switching off their lights. Global landmarks such as the Golden Gate Bridge in San Francisco, Rome’s Colosseum, the Sydney Opera House and the Coca Cola billboard in Times Square all stood in darkness. In 2009, Earth Hour is being taken to the next level, with the goal of 1 billion people switching off their lights as part of a global vote.  VOTE EARTH is a global call to action for every individual, every business, and every community. A call to stand up and take control over the future of our planet.

Many people who know me and my passion for environmental issues will be surprised to learn that I intentionally did not participate in Earth Hour.  I left my lights on, I watched NCAA basketball, and I Twittered and Facebooked about how and why I was blowing off the global demonstration.  The reason I did so is because I believe that such events can actually do detriment to the environmental cause.  In fact, a lot of things we do in the name of good causes do little but get in the way of real progress being made.  

About 10 years ago, I was driving with a group of friends from Richmond, VA to Florida.  We stopped for gas just before we got into South Carolina, because we were being careful not to spend any money in a state that flew the Confederate flag over its capitol.  Joining the economic boycott of the state that was in effect until the flag came down, we felt good about the fact that we were doing our part to fight racism. 

As I look back on that trip, though, I realize that the good feeling we got in our hearts was pretty much all that we achieved.  We didn’t do a damn thing to actually fight racism.  We did nothing to help eliminate the systemic evils in our government, our culture, and our economic system that do much more to oppress minorities than any piece of cloth ever could.  Even now, when the boycott has succeeded and the flag has come down, the deep racial divisions and inequalities in South Carolina remain as strong as ever.  Our well-intentioned “activism” turned out to be nothing more than a self-serving cop-out.  It took the place of more difficult and more effective forms of activism that would have required much greater commitment and sacrifice than just spending our money in one state instead of another.

And that’s the concern I have with Earth Hour.  Of course there is nothing wrong with turning your lights out for an hour and saving a little electricity.  Of course there is nothing wrong with finding solidarity with millions of other people who are doing the same thing.  And of course there’s nothing wrong with raising awareness and making a statement about the fight against global warming. 

But I fear that these mostly symbolic benefits of Earth Hour are outweighed by the practical detriment of what has been called “Point and Click Activism,” of choosing overly simple and convenient methods to address very difficult and complicated problems. 

Certainly, some of the people who turned out their lights on Saturday night are highly dedicated environmentalists who are deeply involved in struggles with corporations, governments, institutions, and entire cultures.  They are working hard and spilling their blood to reverse the suicidal cycles of consumption and destruction that our species is trapped in.  For them, the symbolic event of Earth Hour represents their very real involvement and activism.

But for most who sat and enjoyed the candlelight, an hour in the dark is about as far as they’re willing to go.  Or at least it’s as far as they’ve been asked to go.   At 9:30, when the lights came back on, the lion’s share of Earth Hour participants went right back to the same old lifestyles they had been living before - with one exception - they now have that warm feeling in their hearts that they did something good for the environment, just like my friends and I had when we thought we were fighting racism in South Carolina.

So here’s my suggestion for making Earth Hour more effective:  Make it an event that happens not just one night a year, but every single night of the year.  Imagine if we took the urgency and the spirit that has made Earth Hour so popular, and ingrained it into our culture until it became a part of our everyday lives.  Imagine that the first hour of darkness, the hour when we tend to use the most electricity, becomes a time when we habitually light our candles, sit around the table, and share food and fellowship with one another.  No lights.  No television.  No computers.  Then an hour after dark, we all switch on our electricity and get back to usual evening business. 

Now that really would make a difference, wouldn’t it?

With Center for Constitutional Rights President Michael Ratner now saying that recently uncovered John Yoo memos constitute “treason” against “the institutions of the United States” by arguing formally for the revocation of the First, Fourth, and Sixth Amendments, (free speech, search and seizure without probable cause, and right to a jury trial,) it really boils it down to whether we have accepted a certain premise.

Does the War on Terror meet all the definitions of George Orwell’s state of permanent war?  If we have accepted a state of permanent war, then Yoo’s memos are ultimately sound, as they are based largely upon claims of wartime powers which existed in previous wars.  If we have not, then the attempt to impose a definition of war which has “no end,” in George Bush’s words, amounts to pure treason.

After 9/11 Bush could have said, “We will not allow terrorists to frighten us into abolishing our own freedoms, the very freedoms they so hate.  We will show the world how a free and fearless people rises to this enormous challenge; this is a war for the hearts and minds of the world.  And that is a war America will win.”

Instead, Bush said Be Scared, Be Damned Scared, and Give All Your Freedoms to Me Because I’ll Take Care of You.

More lies from CPR, Think Progress has the fact check:

Not surprising, given that CPR’s head, Rick Scott, is the Bernie Madoff of health care.

It comes down to this: Do you think health care reform should get a straight majority vote in Congress? Or should a few Senators be allowed to single-handedly block reform?

As we speak, the Senate is working on President Obama’s budget. At stake is something called “budget reconciliation,” a Senate rule that forces Senators to take a simple majority vote on the budget. In other words, the budget cannot be filibustered.

The bill the House Budget Committee passed yesterday includes “reconciliation instructions” for health care, which means health care reform, according to the relevant committee in the House, should be passed with the budget and by budget rules. The question is, will the Senate committees do the same? Or will we repeat the mistake Bill Clinton called his worst one?

It goes without saying that having a majority vote on health care, as opposed to needing 60 votes to overcome a filibuster, makes passing health care reform easier. The argument that this is “not bipartisan” doesn’t hold much water. George Bush passed his tax cuts this way. And as Mike Lux points out in The Progressive Revolution, not a single Republican in the House voted for Social Security under FDR.

But there is principle to this argument, too. The American people voted for Barack Obama - largely because of his health care plan - and we only needed a majority vote to elect him. Shouldn’t the Senate only need a majority vote to pass this major piece of his agenda and bring to America the change we need?

We missed this opportunity to do health care reform last time around:

In 1994, the Clintons wanted to use reconciliation to pass health care, but Robert Byrd, the Senate’s hallowed parliamentarian, said no. Clinton has said that his worst mistake in health care was not fully appreciating the blow his strategy had been dealt.

Let’s not make the same mistake again.

If you think a couple Senators should be able to block reform, if you think health care deserves a straight majority vote, then click here to call your Members of Congress. Tell them you want to give health care reform a majority vote.

(also posted at the NOW! blog)