Everybody, but mostly members of Congress, should read this article by Jacob Hacker and Rahul Rajkumar about what life would be like if we passed health reform - an individual mandate, an insurance exchange, and all that other great stuff - and not a public health insurance option.

That future is bleak. Insurers still control the markets, as they do now, and in fact, the giant insurance companies have grown. Hacker and Rajkumar predict we’ll have a choice “basically between WellPoint and UnitedHealth–gargantuan for-profit insurers each about the size of Medicare.” Sounds great, right?

Hacker and Rajkumar also pointed out a peculiar fact our geography and politics:

Ironically, the problem is worst in the rural areas of the country whose Democratic Senators–such as Kent Conrad of North Dakota and Finance Committee Chair Max Baucus of Montana–have been among the Democrats most willing to forsake the public health insurance plan. In these rural areas, one or two dominant insurers hold over 90 percent of the market. (In all of Montana, for example, one insurer has 75 percent of private enrollees.) For people in these parts of the nation, a real choice of health plans is as mythical as unicorns.

I would add that the overwhelming majority of rural voters support the choice of a public health insurance option [pdf]. They know what’s best for them.

What if we passed a co-op plan? Not much:

Equally mythical, it soon becomes clear, are the consumer cooperatives that Conrad and Baucus had backed to attract Republican support. The reform legislation envisioned that these cooperatives would be chartered by the government and owned by consumers–the idea being that a democratically-controlled enterprise would be driven not by profit, but by serving the interests of its citizen-owners. But the cooperatives are almost impossible to get off the ground, just as similar consumer-oriented ventures have been in the past. Doctors largely boycott them, insurers undercut them, state politicians argue over them, and federal dollars are woefully insufficient to nurture them. It soon becomes clear that they represent little more than a fig leaf covering a lack of commitment to the basic aim of a public plan: having a tough competitor that forces large insurance companies to bring up their standards and bring down their prices.

All this means premiums remain high, as do provider rates and drug prices. Medical inflation keeps increasing. And guess who pays for that? Taxpayers, seeing as how people who can’t afford the skyrocketing premiums get government subsidies to help them pay for their private health care. Needless to say, the plan isn’t terribly popular.

Rationing of care by private insurers continues. This hits people’s individual lives:

Those with chronic conditions or nearing retirement age who are self-employed or work for small businesses are hit hardest. A 59-year-old self-employed man with diabetes, or a 48-year-old single mother with breast cancer who works at a small retailer–these are the sort of people who will fall through the cracks without a public plan available in all parts of the nation. They may qualify for a “hardship exemption” so that they are not compelled to buy insurance under the reform legislation’s “individual mandate.” But not being forced to buy insurance they can’t afford is a poor substitute for having access to a public plan they can afford.

These are the stakes before us. If we do reform right, with a public health insurance option, costs can come down, people will be covered, and none of this will come to pass. But if we remove just one element in the reform package, this idea of choice and competition, we’ll end up with an unpopular and ineffective plan that does nothing to control costs and keeps us crushed within the status quo.

This is what makes health reform so hard - change just one piece of the whole plan and suddenly it doesn’t work anymore.

Hacker and Rajkumar have another point to make on this idea of public/private competition:

This is a not a radical idea. In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities–all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that’s there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don’t spin out of control. Just as it is comforting to have Social Security in case your 401(k) evaporates or an FHA loan in case your credit score tanks, a new public plan provides an added level of protection against the vicissitudes of an unaccountable insurance market. A public plan is about competition as well as choice.

This is exactly right. The idea that private industry can’t ever compete with government is, as President Obama says, illogical, especially because the same people who say this say at the same time that government is too inefficient to run anything correctly.

As Hacker and Rajkumar make desperately clear, we need the public health insurance option. It’s not negotiable. We need one available nationally on day one, accountable to voters and Congress, and able to set rates with providers. If we get something less, we don’t get health reform.

(also posted at the NOW! blog)

When it comes to important change that requires political action, success never seems to be easy.  Consider womens’ suffrage, Social Security, the abolition of slavery, federal anti-discrimination laws (we’re not all the way there on these yet).  Reactionaries opposed each of these measures, and made it incredibly difficult for liberals to achieve these basic norms we now take for granted.

I guess that achieving a modern, rational health care shouldn’t be any different–and it hasn’t been.  It’s clear that there’s nothing easy about health care reform, despite the fact that Americans overwhelmingly support substantial change to the health care system, including the so-called “public option”–the idea that a government insurance plan ought to compete with private insurers.

Why is it so hard to achieve something that most Americans support?  Opponents of change are skillful marketers.  While they may not have much to offer when it comes to substance, but they have proven skillful at crafting slogans that dominate debate–scary sounding terms like “socialized medicine” are trotted out at every turn.

Another thing opponents of what is essentially popular reform have going for them is the traditional media.  Media Matters is shining a much-needed light on how this is playing out.  As Media Matters points out, it’s not too much for us to ask that the media report accurately and fairly on health care reform.  Unfortunately, things aren’t working out that way at the Washington Post.  The Post’s Ceci Connolly recently wrote that Change Congress interim chief executive Adam Green was, in an interview, “hard pressed to articulate a substantive argument for the public plan...”  Green counters that Connolly didn’t ask him about the substance of the health care reform, she asked him about the politics, and when he gave her an answer on the political front, she wrote that he had failed to answer on the substance.  (Media Matters also points out that it’s pretty easy to find an eloquent substantive argument for the public option, if that’s what Connolly was looking for–by leaving this out, she made it seem that there simply is no substantive argument for the public option).

I don’t think Connolly has any sinister motive–as Green put it, she simply doesn’t understand the debate over health care, and she falls back on comfortable, but inaccurate shibboleths: for example, she wondered why Green was “attacking [his] friends” by holding Senate Democrats accountable for taking money from insurance companies.

It may not fit Connolly’s script to acknowledge that not all Democrats are on the progressive side of the health care debate, but it happens to be reality.  As she continues to cover this critical debate, I hope that she, and the Post, will give careful consideration to the serious questions Media Matters has raised about her reporting.

This is pretty much what I imagine goes on in the meetings of Conservatives for Patients Rights, or Patients United Now, or AHIP’s Campaign for an American Solution, or Blue Cross Blue Shield’s Get Health Reform Right. They’re clueless.

Meet HAARM - Healthy Americans Against Reforming Medicine:

The front group “Get Health Reform Right,” funded by the insurance industry, sent out their first “grassroots” email today. Here’s what it says:

The healthcare reform debate is heating up in Washington and we all have a stake in the outcome. Draft health reform legislation in the House of Representatives is now under consideration. While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also takes a huge leap in the wrong direction by creating a new government-run health plan.

We all agree that it is critically important to enact comprehensive healthcare reform this year, but legislation that includes a government-run health plan will actually undermine the goals of reform and have devastating consequences on our healthcare system. Take action now and tell Congress to get health reform right.

More government bureaucracy will only create more problems, not solve the ones we have. A new government health plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan. This is not the answer for improving our healthcare system. Instead, Congress should build on the current employer-sponsored healthcare system that is already working for more than 160 million Americans. Tell Congress to build on healthcare that’s working for most until it works for all.

Thank you for making your voice heard on this important issue. With so much riding on healthcare reform, Congress needs to get health reform right for America.

Now, given that it’s the insurance industry sending this message, I’m going to rewrite it so you can see what they really mean:

The healthcare reform debate is heating up in Washington and our profits have a stake in the outcome. Draft health reform legislation in the House of Representatives is now under consideration. While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also forces us to compete and actually provide health insurance, or lose money. We don’t like that.

We keep saying that it is critically important to enact comprehensive healthcare reform this year, but we’re really worried that our CEOs won’t be able to take that 2nd vacation this year if our profits get cut a couple percentage points. So we’re going to tell people that offering them a choice of a public health insurance option somehow will cause them to lose health care. It’s not true, but it sure is scary! And if we scare them enough, maybe they’ll complain to their Members of Congress!

If we actually had to compete, we couldn’t pay our CEOs billions, and we would have to stop denying care for prexisting conditions. That would be a big problem - for us. And of course, though we’ve argued for years that government is so incompetent that it can’t do anything, we’re going to pretend that we’re so vulnerable that we can’t compete with government. Yes, we know this doesn’t make sense, but we’re going to say it anyway. If we make it sound scary enough, people might not realize they would love to choose to dump us if they could, and that most of them (76%) support giving us a bit of competition.

We hate competition, and so we’re against health reform. And we’re trying to scare you so you are, too.

Boo!

I don’t expect anything better from the industry - they lie about everything else, why not lie about being grassroots.

Update: The Education and Labor Committee sends along this fact-check of the insurance industry’s lies:

1. Government plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices.

The public health insurance option would be just one choice for consumers and families in a menu of private health insurance options called the national health insurance exchange. The public health insurance option would be required to follow the same rules as private insurers (level playing field). And, the public health insurance option would self-sustaining through premiums, not government subsidies.

If we are serious about real competition to help control costs, and most Americans agree, a public health insurance option must be one of many choices consumers will have. As studies have shown, many Americans have little or no choices in health plans in their region.

2. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.

No one will be forced into the public health option. If an employer drops their insurance coverage for their employees, those workers would have a choice of any plan in the health insurance exchange, including a public insurance option. In addition, the employer would then have to pay an 8 percent penalty, based on their payroll, for not covering its employees in order to assist low and moderate income employees to obtain insurance coverage that is right for them.

(also posted at the NOW! blog)

Some text for the HELP Committee’s public health insurance option leaked last night. The language includes:

–HHS-based plan: The community health insurance option would be run by HHS. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, the option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self sufficient. This would make the health insurance option quickly available in all areas of the country.

–Plays by the same rules: The option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs. The only difference between this option and others is that the Secretary would set the reserve requirements for this plan rather than states.

–Provider payments and participation:

• Negotiated rates within limits: The payment rates paid by the option would be no more than the local average private rates – but could be less. The Secretary would negotiate these rates.

• Input from Advisory Councils: Each State would create a Council of provider and consumers to recommend strategies for quality improvement and affordability. States would share in the savings that result.

• Purely voluntary: Health care providers would have the choice of participating in this plan; there would be no obligation to do so.

Why It Will Make Health Care Affordable:

–Pooled purchasing power: This health insurance option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.

–Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the plan, with a financial bonus for success.

–Lower administrative overhead: The community health insurance option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.

This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good.

(also posted at the NOW! blog)

Via Talking Points Memo:

For all of the foregoing reasons, we affirm the decision of the trial court that Al Franken received the highest number of votes legally cast and is entitled under Minn. 32 Stat. § 204C.40 (2008) to receive the certificate of election as United States Senator from the State of Minnesota.

Now, will Pawlenty sign the certificate, or make an ass out of himself in front of the country for his Presidential ambitions (because apparently, you’re a better shot for President if you defy Supreme Courts…).

Chris Bowers has been keeping track of the answers you all have gotten from the Senate over the last few weeks. For those just joining the campaign, we, along with Chris at OpenLeft and Democracy for America, are asking Senators to answer for questions on the public health insurance option:

• Do you support a public healthcare option as part of reform?
• Do you support a public healthcare option that is ready on day one?
• Do you support a public healthcare option that is national, available everywhere, and accountable to our government?
• Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

The answers are starting to trickle in, and we’re going to publish them all this week. But we want to make sure we’ve gotten all the responses so our count is accurate. So, if you’ve gotten a response from your Senator, click here to report it.

Of course, if you haven’t gotten an answer yet, keep asking. As Chris says (and I concur), if there’s one thing he’s learned from blogging, it’s that you have to keep asking Senators over and over until you get the answer you want. So, click here to email you Senator.

And of course, tell your friends about this campaign, so we can turn up the pressure.

Stay tuned for the answers!

(also posted at the NOW! blog)

In the previous maladministration, the constitution was viewed as an annoyance. That made it hard to make a fuss when other presidents in other countries violated their constitutions. In Colombia, President Uribe sought to keep office despite constitutional term limits. While Uribe courted the previous maladministration by participating in its ‘drug war’, it distinguished itself by building up body count figures to court more U.S. funds by murdering civilians and re-labeling them as the enemy. That was overlooked by the then U.S. maladministration in its big rush to get ‘free’ market trade going with Colombia despite the atrocities involved.

How embarrassing, now Uribe is visiting the U.S. under Obama while President Zelaya of Honduras is kicked out for seeking to do the same thing Uribe is seeking to do. While we can’t officially announce that a coup has happened because then we’d have to cut off all aid to Honduras, our government, along with most of the world, is sternly admonishing the army, Congress, courts and presently installed president of Honduras to take him back.

This would make great comedy material, except that it concerns serious concerns of worldwide emergencies. In June, 2008, riots in Honduras and neighboring countries protested hunger, a problem that is on the increase as the world suffers from the greedy manipulations of deregulated financial industry in the U.S.

Concerned humanitarians of the world still look on the security of a country as the well-being of its people. The Guardian features one expression of those humanitarian aims.

We condemn the military coup and kidnapping of the democratically elected president of Honduras, Manuel Zelaya. On Sunday 28 June, President Manuel Zelaya Rosales was kidnapped, removed from his home by force, rendered incommunicado for several hours and expelled from his country. Soldiers also seized Honduran foreign minister, Patricia Rodas, and the ambassadors of Cuba, Nicaragua and Venezuela. The military and coup conspirators are trying to suppress popular demonstrations and news by blanket military presence, curfews and intimidation of reporters.

President Zelaya was working to free his country from decades of hunger and poverty. This military coup is an illegal attempt to use armed force to overturn the course of democracy and social progress chosen by the Honduran people at the polls. We urge every government in the world to demand the restoration of the democratically elected president and to pledge not to recognise the illegal government put in power by a military coup.
Colin Burgon MP, Ken Livingstone, Dr Francisco Dominguez Venezuela Solidarity Campaign, Tony Woodley Unite, Gerry Doherty TSSA, Matt Wrack FBU, Brian Caton POA

While the U.S. lost the right to represent itself as an example to follow, in the last maladministration, it has the opportunity now to represent our basic decency and get out of the process of making world affairs purely a business.

The public interest has not lost out to profit motive in much of the world. The U.S. can turn that around now, by cutting out support for tyrants and leaders who violate their constitutions and undercut their people.

The visit of Uribe would make a great opportunity for just that. We overlooked the attempts of Uribe to overthrow the constitution of Colombia, along with his regime’s brutality. We have violated our nation’s principles in seeking good relations with regimes that violate their own people’s rights, and their interests. What a good time to turn that around, by ending our partnership with Uribe and the pretense of a ‘war on drugs’ that has failed there and throughout the world.

President Obama can depart from the very bad example set by his predecessor by giving our support to people rather than to big business interests. This would be a major advance back into civilization from the atrocities of the previous regime.

(This post also at http://cabdrollery.blogspot.com/ )

The NY Times has a piece in today’s paper entitled “Journalism Rules Are Bent in News Coverage from Iran.”  The piece questions the accuracy of news reporting on recent events in Iran that is based on “anonymous Twitter messages”, blogging and “unverified videos.”  The Times piece calls this type of reporting evidence of a “publish first, ask questions later” approach to journalism.

I think it’s absolutely fair for the Times to ask questions about the sources for news coming out of Iran, but I also think they’re incorrectly suggesting that the axiom “check the source” especially applies to reports associated with new media.  Let’s not forget the Times’ failure to consider the source when it uncritically published reports by Judith Miller and others that accepted at face value the Bush administration’s misinformation about WMD in Iraq The Times ultimately conceded that its coverage of the buildup to the war in Iraq was “not as rigorous as it should have been.”  It admitted that reporting had often depended on “Iraqi informants, defectors and exiles bent on regime change in Iraq” whose credibility “c[a]me under increasing public debate.”  That’s putting it mildly.

I think it’s a great idea for the Times and others across the media spectrum to be skeptical, to ask questions, to consider and check the source when it comes to recent events in Iran.  I just hope that this scrutiny is not limited only to reporting that involves new media and is not limited to recent events in Iran .

As usual:

This won’t come as the slightest surprise to those versed in health care policy issues. But I fear it’s only barely permeated the health care reform debate in the country, certainly in Washington. And that’s this: the opposition to a so-called ‘public option’ comes almost entirely from insurance companies who have developed monopolies or near monopolies in particular geographic areas. And they don’t want competition.

Note, I’m not saying more competition. I’m saying any competition at all. As Zack Roth explains in this new piece 94% of the health care insurance market is now under monopoly or near-monopoly conditions — the official term of art is ‘highly concentrated’. In other words, there’s no mystery why insurance costs keep going up even as the suck quotient rises precipitously. Because in most areas there’s little or no actual competition.

That’s exactly right. As President Obama pointed out last week, the arguments used by the industry and by conservatives are illogical at best and dishonest at worst:

If private insurers say that the marketplace provides the best quality health care; if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.

They’re not against the public plan because it would be bad for you and me, they just don’t want the competition. Pretty self-serving, no?

(also posted at the NOW! blog)