Public Option Good Politics

Robert Creamer has an article at Huffington Post on Four Reasons Why Giving Consumers Is Great Politics.http://www.blogger.com/img/blank.gif
He cites the popularity of such a program:

In a poll taken earlier this year by Lake Research, 73% of respondents favored a health plan that gives them the choice between a private plan or a public health insurance plan. Only 15% preferred to have only the choice of a private plan. And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%).

According to an NPR report, "Republicans argue that upward of 100 million Americans would opt out of private insurance in favor of a public plan if such a plan were available."

And yet the story is being spun that Congress would never pass such a thing. Haven't we gotten to the point where nearly everyone understands that our healthcare system sucks, that other countries do it better, and that they do it better because there's a government guarantee of healthcare?

Lincoln was for govt-financed health care

James Nowlan, a Republican at the University of Chicago, has a column in today's Chicago Tribune. It's notable both for what it says and what it doesn't say.

"Abraham Lincoln declared that government should do only that which the people cannot do so well for themselves -- defense, highways, public safety, education. And government has done a good job of fulfilling this compact with the public. In recent decades, we have been adding health care to the compact, in increments: first the elderly with Medicare, then the poor, and more recently, children, both through Medicaid. If you're not in one of these categories, you scramble for health care. Everyone in my rural area hustles to find the shelter of health-care coverage. Farmers' wives take jobs at the school in town -- for health coverage for the family. Whenever a job change is contemplated, the biggest question is: 'Will there be benefits [health coverage]?'"

Nowlan addresses the irreconcilable tension between Americans believing that their taxes are too high and at the same time believing that the government should make sure everyone has health care.

Then, as if he can't quite help himself, he points out that Medicaid and Medicare are the biggest chunk of government expenditures on health care - something that is misleading because it doesn't note the other government expenditures on health care, such as the tax breaks for companies that provide health insurance and the cost of paying for private insurance for all municipal, county, state, and federal workers, including the military.

He notes that the cost of Medicare and Medicaid have gone up 7 percent a year, "far outstripping inflation," without noting that the rate of increase of private insurance puts Medicare and Medicaid increases in the dust.

Even so, the quote from Lincoln was nice. The experience of other industrialized democracies fairly proves that government does a better job of managing health care financing than does the private sector. (If, of course, you factor in health of the population as being at all important. If you're willing to write off a substantial portion of your work force - the Darwinian cost of doing business - then our system clearly is more profitable and therefore better, capitalistically speaking.)

Then again the right has so vilified the competence of the American government that it's possible that people think that whereas the Swedish or German or Taiwanese government can competently manage health care financing, our own government cannot.

The question then becomes "Why does the right wing hate America?"

Howard Dean on single-payer

Time Magazine offers up 10 Questions for Howard Dean, DNC chair:

As a former physician, what are your thoughts on the Democratic candidates' health-care plans vs. a single-payer system? Megan Prouty CARROLLTON, TEXAS

I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.

Nader as a (damaged) single-payer mirror

Slate's Timothy Noah wants people to lay off Ralph Nader.

Fine.

I actually haven't heard much about Nader in recent weeks. There was the wince and shake of the head when I heard he was running, maybe one cynical comment from CLJ, and that was it. OK. I guess I did also wonder aloud how much the Republicans had paid him in order to get him to run again.

We've mostly gotten over Nader. We're part of that common wisdom that sees Nader as part of the reason that Gore didn't win in 2000, yes. Along with blatant cheating on the part of the Bushies, and a disinclination on Gore's part to fight as dirty.

And because Gore didn't win, we got an addled born-again wannabe cowboy for a president who didn't pay attention to frantic warnings that we were about to be attacked. 9/11 happened and the Bushies immediately used the tragedy to their partisan advantage, whipping up fear and using it to get questionable legislation passed. Worse, they played off it to put us in a pointless war that has killed hundreds of thousands of people.

It is impossible to say whether 9/11 would have happened if Gore were president. It is possible to say that Bush wasn't paying attention and did not raise the alert level as Richard Clark and so many others advised. It is also reasonable to suppose that Gore would not have chosen to take us into Iraq.

So thanks, Ralph.

It wouldn't have come to mind except that Nader's running again. Even then, had he acknowledged that yes, turns out there is a difference between Republicans and Democrats, we could have seen him in a better light. It would also help for him to be able to see that he did play a role in the 2000 debacle.

Noah differs.

In the current election, Nader is the sole presidential candidate you're likely to hear about (now that Dennis Kucinich has dropped out) who stands forthrightly for adopting a single-payer solution to the health-care crisis, a stance universally regarded as politically impractical. But single payer is the only solution of much practical value in the real world, as evidenced by the experience of nearly all advanced democracies. If Nader does no more in the 2008 election than oblige major-party candidates to consider that stubborn reality for five minutes, he'll have done us all a big favor.

OK.

Two Kinds of Health Reformers

Brad Warthen says this well:

We continue to concentrate on the wrong thing -- getting the uninsured into the present system -- when we talk about health care reform.

Increasingly, those of us who are privileged to be in the system find that we can't afford health care, either. The whole system is rotten, wasteful, too expensive and too inefficient. We pay more money to be sicker than folks in any other advanced nation.

There are a lot of problems with our system, but the biggest is the basic premise -- employer-based health care through for-profit (and we're talking for HUGE profits) private insurance companies.

If private health care coverage weren't so expensive for all of us, the 1 in 7 who remain uncovered would be in it. But it is, and will be, expensive by definition. A profit has to be made.

A single-payer system is the logical way to go.

So what kind of health reformer are you? The kind who is trying to get the uninsured into the system, or the kind that is trying to change the system? Mother Teresa or Archbishop Romero? Charity or justice?

FL's Ben Graber & single-payer

Ben Graber, MD, is running a sleepy campaign against six-term Democratic Rep. Robert Wexler in Florida. Congressional Quarterly reports that Graber only raised $700 in the last quarter of 2007 -- unlikely to be enough to unseat an incumbent.

His lack as a candidate makes for bitter reading when compared to his good sense in health care reform. In an opinion piece in the Sun Sentinel, Graber writes, "A wise person once said, 'There is nothing as powerful as an idea whose time has come.' A single-payer health plan is that idea."

Here's are his talking points:

• Expand Medicare to include people 55 to 64 years old, veterans and the chronically ill.
• Eliminate the need for any HMO involvement in regular Medicare by stabilizing premiums. This is accomplished by providing a formula for a much expanded and reduced-risk population.
• Offer an affordable premium until age 74 and then freeze the premium at age 75 and beyond.
• Enhance the Medicare D program by eliminating the doughnut hole and negotiating with pharmaceutical companies worldwide for a bulk discount on medications.
• Remove research and development costs from the price determinator and offer independent U.S. research grants.
• Incorporate the Veterans Health Administration into Medicare and Medicaid.
• Fund Medicaid premiums for those below the poverty line — 75 percent by the federal government and 25 percent by the states.
• Develop Medicare and Medicaid buy-in programs to expand the single-payer system to all ages, including children.
• Place premiums for small businesses and individuals on a sliding scale based on the ability to pay.
• Change annually based on individual financial circumstances.
• Utilize existing infrastructure, saving billions in conversion costs.
• Allow insurers to participate, but in a new capacity as facilitators, product enhancers and recruiters.

This phased-in approach may have a better shot than HR676.

Minnesota Health Plan

The Bemidji Pioneer reports that Sen. John Marty, a Minnesota state legislator, led a delegation of freshmen legislators to Bemidji to unveil the Minnesota Health Plan, a bill he introduced late last session and which he hopes will be heard this session.

It would create a single-payer system -- or, as the Legislators introducing the bill prefer, a single-administrator plan. A board, set up by the Legislature, would collect premiums from all Minnesotans -- based on ability to pay.

The plan obviously creates savings by centralized billing and by spreading premiums among all Minnesotans. They take pains to explain that the plan is not socialized medicine as providers such as doctors are still private.

Marty outlined the proposal as:

• Allowing people to go to the doctor, clinic or hospital of the patient’s choice.
• The plan covers all medical needs including prescriptions, mental health care, dental services, chiropractic.
• A patient cannot be rejected because of a pre-existing condition.
• No deductible or co-payments.
• Premiums on individuals and businesses are based on ability to pay.
• The plan is administered by a 15-member public board representing the public, not just insurance company executives.
• The plan focuses on preventive care and early intervention to keep people healthy and save money.

Marty expects it may take four or five years to make a full change.

Health insurance, he says, is not something we should be selling. It is rather something we should be making sure we all pay into and we all get the service, like we do with police and fire.

Well put.

Greeley Tribune on single-payer

The Greeley Tribune has published a wonderful piece by Tom Linnell on single-payer. He begins,

I am starting to see why all of us -- liberals, conservatives, and independents -- might really like single-payer health insurance. Here are some principles that I believe most of us can agree on: 1) the least possible amount of government involvement in our lives, 2) efficient delivery of services and, 3) freedom of choice for individuals.

Bravo!

San Franciscans covered for now

USA Today's headline reads "Businesses fight plans to ensure health care" -- the worst possible head for advancing health care.

That's because the polls show that small business is the key icon for Americans, held in higher esteem even than moms and apple pie. If small business is against it, so is America.

But consider this. It's true that a couple San Francisco businesses sued so they wouldn't have to pay more for health insurance for their employees -- and a lower court agreed with them, that the Employees Retirement Insurance Security Act forbade the state to require employers to insure their employees. But there's always going to be some businesses against minimum wage, health insurance, child labor laws, whatever.

At issue in the restaurant association's lawsuit is a 1974 federal law, the Employee Retirement Income and Security Act. It bars states from requiring employers to offer health insurance or regulating the benefits they do offer to protect companies from varying laws. Congress gave only one state, Hawaii, an exemption from the law in 1975. It is the only state that requires employers to provide health insurance.

Last week, a three-judge panel of the 9th U.S. Circuit Court of Appeals said business owners such as Scherotter will have to comply with the law, at least until the full court can review the lawsuit later this year. A lower court sided with business owners.

More important were the poll last year that showed that California businesses are in favor of universal health care:"Despite High Cost, Small Business Says It Supports Universal Health Care -- 80 Percent Say Employees Deserve Health Coverage" from the San Diego Business Journal:

About 500 small businesses across the state were randomly surveyed by phone and e-mail; many were in support of a 1 cent sales tax solution, while favor for a single-payer system was split, with the majority of business owners who don’t provide health care voting for the single-payer system, according to survey results.

Another article, this one from the Sacramento Bee covered that same poll. Some key findings:

• 57% regard health care financing as a shared responsibility among individuals, employers and government – three times as many as do not (19%).
• 55% were in favor of paying into a statewide pool that would enable their employees to obtain coverage at favorable rates – over three times greater than those opposed (17%).
• A substantial plurality (near-majority) said that they favored two leading California healthcare reform proposals, with a small plurality supporting a single-payer plan:
• Governor’s proposal -- 47% in favor; 31% opposed
• AB 8 (legislative leaders’ proposal) -- 47% in favor; 33% opposed
• SB 840 (single-payer) -- 42% in favor; 40% opposed

Health care: a shared responsibility

Reponsibility without authority in your work is the worst of all worlds. In health care too -- and yet that's exactly where we are right now. No wonder we're so stressed. The guys with the authority, the health insurance companies, have but little responsibility. Their responsibility is to their shareholders, and they're doing just fine in that department, thank you very much. Individuals, on the other hand, are told time and again that it's up to us to find that job with good benefits, to exercise and eat healthily (amidst all the conflicting advice from experts -- wine or no wine? Coffee or no coffee? Fish or not too much fish? Vitamin C helps with colds or doesn't it?), to understand insurance policies that even lawyers can't make heads or tails of (that's the point), to hire advocates to look out for our interests with providers and insurers (or to tell our insurer that we're close personal friends with Michael Moore) -- and so on.

The public knows we need reform, but what kind of reform? That scary single-payer? Mandates forcing everyone to buy insurance from the same people who seem to be at the root of the problem? Expanding access to SCHIP? Insurance market reform? HSAs? The Commonwealth Fund released a survey of Americans' views earlier this week. Ezra Klein and the media largely picked up on the question that showed 68 percent of Americans favoring mandates forcing individuals to buy private insurance (with the government helping those who are unable to afford it).

There's more to the survey, however, beginning with the fact that support for mandates included soft support:


There is stronger agreement that financing for health insurance coverage for all Americans should either be paid mostly by the government or else be a responsibility shared by employers, government, and individuals:


Most single-payer supporters, by the way, would probably answer that question along with the majority -- that costs should be shared by employers, the government, and individuals -- as is true in most countries with guaranteed health care. Personal responsibility is an important part of the single-payer message.

Note that the portion believing that the government should "mostly" pay for health care costs is 15 percent of the total, versus 6 percent who think those costs should be "mostly" paid by individuals.

One more chart from Commonwealth Fund -- which is a treasure trove of charts in powerpoint and pdfs formats. This one shows the percentage of Americans who think there should be a business mandate:


Quite a bit higher than the numbers in favor of an individual mandate. When single-payer groups around the country have written single-payer bills and proposals (like the one modeled here in Colorado), they typically discover what we did -- that to pay for the program it's necessary to collect contributions (a tax, premium, whatever you want to call it) not only from individuals but also from businesses.

The business task force to the Colorado Blue Commission for Health Care Reform told commissioners that they could live with a 4 to 6 percent tax in order to fund health care. That would be far more affordable than the average of 10 to 12 percent they now pay -- and the quotes of 25 percent that smaller businesses with older employees regretfully decline, leaving their employees uninsured. The task force told the commission that they'd been surprised to learn the truth about single-payer during their meetings, and that members had said they could indeed support a single-payer plan. They just thought it needed to happen at a national level rather than a state level -- something with which HCAC disagrees.

Back to what kind of reform is needed. Health care is a devilishly complicated subject, encompassing many variables. It's no wonder that most people hope that the experts will hand us a solution, no wonder that folks are misled by ideologues and obscenely wealthy special interests. But consider this. At the National Congress for the Un- and Underinsured last month there was exactly one speaker among dozens who unambiguously called for single-payer. David Himmelstein, MD, told the crowd of health policy professionals and academics that single-payer financing for health care is the only sustainable, workable solution that will give Americans the kind of quality health care we want.

There was also exactly one standing ovation at this entire conference of health care policy wonks.

It was for Dr. Himmelstein.

250 Mass docs call for single-payer

The California Nurses report that Doctors Give Massachusetts Health Reform a Failing Grade - Poor Early Outcomes Raise Red Flags, Only Private Insurers Profit.

You don't say.

Starting January 1, 2008 Massachusetts residents face fines if they cannot offer proof of insurance. Yet as of December 1, 2007 only 37% of the 657,000 uninsured had gained coverage under the new program. These individuals often feel well served by the reform in that they now have health insurance. However, 79% of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan. In effect, public funds for care of the poor that previously flowed directly to hospitals and clinics now flow through insurers with their higher administrative costs.

Among the near poor uninsured (who are eligible for partial premium subsidies) only 16% had enrolled in the new coverage. And barely 7% of the uninsured individuals with incomes too high to qualify for subsidies had enrolled according to the official state figures. Few can afford premiums for even the skimpiest coverage; the lowest cost plan offered for a couple in their fifties costs $8,200 annually, and carries a $2,000 per person deductible.

Moreover, the state's cost for subsidies is running $147 million over the $472 million budgeted for fiscal year 2007. Meanwhile, collections from fines on employers who fail to provide coverage are 80% below the original projections. The funding gap will widen in future years as health care costs escalate and insurers raise premiums. Already, state officials speak of making up the shortfall by forcing patients to pay sharply higher co-pays and deductibles, and by slashing funds promised to safety net hospitals.

While patients, the state and safety net providers struggle, private insurers have prospered under the new law, and the costs of bureaucracy have risen. Blue Cross, the state's largest insurer, is reaping a surplus of more than $1 million each day, and awarded its chairman a $16.4 million retirement bonus even as he continues to draw a $3 million salary. All of the major insurers in our state continue to charge overhead costs five times higher than Medicare and eleven-fold higher than Canada's single payer system.

Edwards' health plan

Democratic Talk Radio, in publicizing the Daytona Beach paper's endorsement of John Edwards as the Democratic candidate for president, has this synopsis of the Edwards' health plan:

He wants to repeal Bush tax cuts that favor rich Americans and use the money to pay for universal health care. He would require employers to cover their employees or help finance their health insurance.

Additionally, he would lower insurance costs by creating tax credits, expanding Medicaid and coverage for children, reforming insurance laws, and containing health care costs. He would create regional markets to encourage more consumer bargaining power in buying health plans, compel broader choices among insurance plans, and cut costs for businesses offering insurance. Once these are accomplished, Edwards would require all American residents to obtain insurance. It is a bold but realistic reform for this country’s crippled market-based system. [Insurance rates would not be based on current rates because everyone would be included. Coverage would be free or subsidized for those with incomes under $100K. Edwards plan would lead to single payer]

How would it lead to single-payer? The idea is that the Edwards' plan would lead to single-payer because it also calls for a public buy in plan -- so that people like me could buy in to Medicare for All. That's an important element. If it could withstand the corrupting influence of the health insurance industry's lobbyists trying to cripple such a plan it could indeed show that state-guaranteed health care is quality coverage at a bargain -- instead of junk coverage at a premium, as many of us now have.

And thankful for it!

Donna Smith, whose story was told in Sicko, stood at this month's Health Care for All Colorado meeting to say she was uninsured for the first time in her life. Donna is doing great work to better this country, and there's no way she should be left stranded.

What the hell is single-payer?

On Saturday I was cold-calling in person at a conference, approaching people and asking them if they were for single-payer universal health care. It's a bruising thing to do, because you're not insulated from people who are annoyed by your invading their space and people who disagree with your message.

But it's also instructive.

One guy was impatient. "What's single-payer?" he asked. "What is that?"

I began to explain and he cut me off after less than 10 words, saying his life was too short. "You mean socialized medicine," he informed me. "Why don't you just say 'socialized medicine'?"

He went on to say that to him, single-payer is what we already have. He's the single-payer for his health care.

He was so arrogant, dismissive and nasty that I was left reeling -- and wondering what he was doing at a "Faith in Action" conference. I suppose this is why the "heartland" feels the way it does towards academics, because that's all I could imagine that he was. But trying to put it into perspective, his observation was a good one. It's not something that we didn't already know, but it's a confirmation, once again, that the term "single-payer" is a head scratcher.

Guaranteed health care might be better. How would we describe the police or fire departments? Guaranteed police or fire? Universal police protection... with single-payer financing? State police protection? Municipal fire protection? Government-sponsored health insurance?

George Lakoff likes "doctor- and patient-run health care" -- like citizen- and police -run policing?

Or, back full circle, universal health care with single-payer financing?

I'm reminded of the Family Research Council employee who got a month sabbatical to go work for Huckabee. He said that among the things he learned were that the mainstream media were far more fair and balanced than the right-wing media, and that whenever people asked for real information, not just a soundbite, their attention would be gone after 30 seconds. And those were people who wanted to pay attention.

People want things to be easy. We want someone else to have to make the changes, to do things differently, in order to better the system. Mandates are just the ticket for that in many politicians' eyes. Since the majority of Americans do already have Medicare or employer-sponsored insurance, it's a siren call for them to hear that if we just force the uninsured to buy insurance out out-of-control costs will be solved.

They won't be.

Cost-shifting (providers charging insurance companies more to make up from losses elsewhere) is only part of the problem, and only a small percentage of cost-shifting is due to the uninsured. The rest is from Medicare and Medicaid. But even if it were mostly from the uninsured, who really thinks that companies and families would reap the benefits of forcing everyone to buy insurance -- who really thinks the insurance companies would turn around and lower their costs? This is one of the most profitable industries in the world -- has that led them to step back and reconsider their profit margins?

But from what I heard Saturday, a number of people, especially elderly women, are enthusiastic about forcing poor single moms to buy insurance. These seniors were also outraged about their personal out-of-pocket costs.

Rockefeller says AMA coming around

Sen. Jay Rockefeller (D-WV) has this to say about health care reform:

After years of incremental improvements in health care, Rockefeller said it is time for Congress to focus on a comprehensive solution.

"Even people who have health insurance don't believe they will have it next week, because no one can afford it," he said.

The American College of Physicians' recent endorsement of single-payer, universal health care is a sign that change could be coming soon, Rockefeller said. The organization has 124,000 members and is the nation's largest medical specialty group.

"The (American Medical Association), some of whose board members I know, are not far away," he said. "It doesn't mean it's going to happen, because there's such a mindset against one solution for all. But it shows the range we're working in."

One solution for all?

I still don't quite understand how that works in the health care debate.

Is it like one solution for all, in terms of police or fire protection? In fact, we all want the one solution, don't we? That would be police and fire departments keeping us safe. In the same way, we want our health care system to keep us safe. If we're in a car accident, we want treatment. If we get diabetes, we want treatment. If we have a bad belly ache, we want treatment. So yes. One solution. Health care. Police protection. Fire departments.

Those of us in favor of single-payer are not advocating for some giant system parallel to a nightmare version of the same regimented public school track for all. We're advocating for what the right is calling for in the case of universal education -- that is, government guarantee of an education, but you get to chose the school according to what's right for your child.

I hope that the AMA continues to evolve towards a more generous position.

Poll shows most want single-payer

Graham at Over My Med Body has the wording on that AP Poll on single-payer — which seems more important to me than to most. I predicted in December that it wouldn't get much play, and indeed it hasn't.

Associated Press-Yahoo Poll
Interview dates: December 14 - 20, 2007

14. Which comes closest to your view?

34% - The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance

65% - The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers

2% - Refused / Not Answered

15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?

54% - Yes

44% - No

2% - Refused / Not Answered

I was struck by this comment at Over My Med Body: "... keeping competition and a profit motive in at least parts of the system preserves innovation, and that’s important to me. Getting *EVERYBODY* in the pool and defining a minimum level of benefits that working adults and their families are, in fact, *entitled* to - that’s where we need to start healthcare reform."

First of all, single-payer proposals would keep competition in the system — competition between docs and hospitals, just not between insurance companies.

Second, please explain how insurance companies have anything to do with innovation. They regularly deny covering procedures that are standard in European countries. Here those procedures are "experimental."

Third, as long as insurers are competing with one another to exclude caring for sick people and only covering healthy people, you've got a system where a big chunk of health care dollars might as well be flushed down the toilet. It's simply not sustainable. Even if you do rescind the Bush tax cuts. We can't spend a fifth or a quarter of our GDP on health care — any more than you can spend a fifth or a quarter of your family budget on it. But that's where we're headed with the current system.

Vermont rallies for single-payer

A crowd of 150 people rallied for single-payer yesterday. It's a Vermont plan that would begin by covering all hospital care. The story begins:

MONTPELIER -- Caroline Donnellan, a 21-year-old restaurant worker from Burlington, joined a crowd of more than 150 Wednesday to rally for a bill that hadn't received much attention -- until now.

Donnellan said she sees the bill as a significant step toward changing the way Vermonters pay for health care, a step she said it sorely needed. "The health insurance industry is a mess," she said, explaining that she based her assessment on her physician father's accounts and her mother's experiences as a cancer patient.

A Republican legislator, Francis "Topper" McFaun, introduced that bill, H. 304.

McFaun said he didn't recruit the sticker-wearing supporters who poured into the Statehouse on Wednesday morning. That was the work of a new coalition called the Citizens Advocacy Network. Still, he said he knew support for his proposal was growing outside the Statehouse. "People have been calling me," he said. "The more I talked about it, the more people say, 'Hey, this sounds pretty good.'"

... Dr. Deb Richter, a family practice physician and longtime advocate for dramatic health care reform, led the rally and made the case for the legislation. "It satisfies the governor's criterion of not increasing spending and has the potential of lowering property taxes. It satisfies the Democrats' agenda of wanting to cut premiums and expand coverage compatible with Catamount. And it does what no other bill before the Legislature does now: It includes everyone, cuts costs, cuts premiums and has a mechanism for holding down costs in the future."

Why we don't have universal health care

Ampersand runs in Zmag. Go to Zmag to see it bigger. By Barry Deutsch.

Robert Reich stands on his head

Robert Reich writes a column in the Wall Street Journal complaining that mandates are nothing, meaningless, the least of our worries as progressives stand on the crest of the victory of universal health care. Or at least universally forced subsidization of the insurance industry.

But instead of celebrating, the candidates and left-leaning pundits are squabbling over whether the plans should include so-called mandates that require everyone to purchase health insurance. Talk about self-inflicted wounds. Mandates are a sideshow, and fighting over them risks turning away voters from the main event.

He doesn't address whatsoever the fact that with mandates all that's wrong and unsustainable with the American system is preserved and strengthened, in particular underinsurance and the out-of-control costs that don't provide care but only enrich a failed industry.

The WSJ article stands on its head what Reich got right about single-payer just a year ago:

... three cheers for the politician who bypasses America’s inefficient private insurance market and establishes a single payer that provides all Americans with health insurance just as good as the health insurance their representatives in Congress receive free of charge. Note I said single payer, not single provider. Americans want to keep their choice of doctor and hospital. But a single payer – either through Medicare or the federal employee’s health insurance program – would avoid the current insanity by which private insurers spend hundreds of millions of dollars a year advertising and marketing to younger and healthier beneficiaries, and seeking to discourage older and riskier ones, or people with pre-existing medical conditions. America now has the only health-insurance system in the world designed to avoid sick people.

None of that will change with mandates.

The other main point of that article was that the one good thing about Bush's health plan was that it would spell the end to employment-based healthcare — and good riddance, Reich wrote. Now, suddenly, it's to be strengthened, and we're supposed to cheer that. Inconceivable.

Indiana 30th state AFL-CIO to endorse HR 676

This from Kay Tillow at Unions for Single-Payer:

At its December convention, the Indiana AFL-CIO became the 30th state federation to endorse HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-Michigan). The Indiana AFL-CIO represents 320,000 union members and retirees.

Endorsement resolutions were submitted to the convention by the Northwest Indiana Federation of Labor in Hammond and the White River Central Labor Council in Bloomington.

Steven E. Henderson, Staff Representative for the Indiana AFL-CIO, said of the endorsement of HR 676: “Starting in the mid-to-late 1980s, health care has been the number one issue in collective bargaining. We cannot, this time, allow the Insurance-Medical Complex to buy our legislators and congress to kill this needed law.”

Henderson noted that in the early 1990s many thought that Americans were not yet ready to accept a single payer system despite a report by the GAO that showed the effectiveness of single payer health care. “The State AFL-CIO now thinks that we are at that point, the single payer system is the only solution,” concluded Henderson.

Policy wonks like mandates

Jonathan Cohn of the New Republic blogs that he doesn't understand the reaction to mandates from progressives: "I confess I've been a bit taken aback at the hostility it generates even from the left (which, perhaps, Obama anticipated).... the main complaint about mandates is that people are being forced to buy private insurance. But Clinton and Edwards both make a public plan available to anybody who wants it. Not only does open the door to a full-single payer plan down the road, it also guarantees that anybody who doesn't trust private insurance can get into a better option."