30 October 2007

"Pro-life" votes and SCHIP

The Archbishop Romero Catholics have started a fight in D.C., pointing out the inconvenient fact that voting against SCHIP and against expanded healthcare for children is not a "pro-life" position.

SCHIP is admittedly not sustainable — to be sustainable, healthcare reform must eliminate the protection racket we call the health insurance industry. However, there are millions of children who need healthcare now.

Catholics United, a progressive, nonpartisan Catholic organization, ran ads urging 10 congresspeople to vote for SCHIP. The politicians were:

Rep. Ginny Brown-Waite, Florida
Rep. Joseph Knollenberg, Michigan
Rep. Thaddeus McCotter, Michigan
Rep. Tim Walberg, Michigan
Rep. Steve Chabot, Ohio
Rep. Gene Taylor, Mississippi
Rep. Michele Bachmann, Minnesota
Rep. Sam Graves, Missouri
Rep. Thelma Drake, Virginia
Rep. John Peterson, Pennsylvania

In Rep. Thaddeus McCotter's district, the ad's script looks like this:

“I'm the mother of three children, and I'm pro-life. I believe that protecting the lives our children must be our nation’s number one moral priority. That’s why I’m concerned that Congressman X says he’s pro-life but votes against health care for poor children. That’s not pro-life. That’s not pro-family. Tell Congressman McCotter to vote for health care for children."

Rep. McCotter, the fourth highest ranking Republican in the House, then wrote False Prophets Arise, a diatribe against Catholic United for the National Review. Catholics United, he writes, is"a Leftist political front group. No one should be fooled when this devil cites Scripture for his own purpose."

The U.S. Conference of Catholic Bishops, Catholic Charities USA, and the Catholic Health Association all urged Congress and President Bush to support SCHIP.

25 October 2007

An issue crying out for leadership

Kevin Drum offers insight into the LA Times poll on healthcare, which found that 29 percent thought that healthcare is the responsibility of the government, but 53 percent thought the healthcare solution is extending Medicare to cover everyone.
So 29% think government should be responsible for providing healthcare, but 53% approve of extending Medicare to cover everyone. Uh huh. And then this Blendon fellow suggests that maybe this contradiction is the result of people not realizing that Medicare is paid for with taxes. That's completely crazy, of course, but it's also quite possibly true.

So what to think? Two things: (a) Support for national healthcare really isn't as strong as a lot of liberals would like to believe. (b) People really are confused on this subject, and their opinions are shallow and malleable. Genuine leadership could change a lot of minds.

Don't let them choose

Mort Kondracke, executive editor of the Capitol Hill newspaper Roll Call, offers up conventional beltway wisdom on healthcare reform in a piece decrying the idea that people should be able to choose a public plan.
The case against Clinton's health plan -- and it's applicable to Edwards and Obama as well -- is that by creating a Medicare-like government alternative to private insurance and heavily regulating private plans, people will flood to the government plan, leading to Canadian-style medicine.

As Joseph Antos, a scholar at the American Enterprise Institute put it, Clinton has designed "a reasonably clever way to prove that the private sector doesn't work and have the government swoop in on a white horse. ... [She's] not jumping immediately to a single-payer system -- politically, that's a smart move -- [but] indirectly."

Antos and others contend that Clinton's proposed requirements that insurance companies cover everyone who wants a policy ("guaranteed issue") and charge everyone the same premium regardless of health, age or pre-existing medical conditions ("community rating") will hugely raise the price of private insurance, giving an advantage to her government-run insurance plan.

At a forum last week sponsored by the Kaiser Family Foundation, Clinton said, "We're going to change the way insurance companies do business in America. Right now, [they] spend $50 billion a year trying to figure out how not to cover people. Well, I'm going to save them a fortune and a whole lot of time because the new policy is, no more discrimination, period."

Clinton's $50 billion figure seems to encompass all underwriting, marketing and administrative costs for the insurance industry. She said government programs were far more efficient, but neglected to note that insurance companies provide services like disease management that public plans don't.

Various studies show that several states that have imposed guaranteed-issue and community rating requirements in the past ultimately repealed them after insurance companies dropped coverage and quit selling in the states.

Other studies document that public satisfaction with Canada's single-payer system is low because of long waits for diagnostic tests and surgery. Canada's Supreme Court overruled the government's ban on private insurance.
Kondracke's got a couple things wrong. First of all, Canadians are more satisfied than Americans on their healthcare, and only 8 percent say they'd prefer to switch to the U.S. system.

Second of all, disease management? Disease management is something our private insurance system does well? What?

According to Wikipedia, disease management concerns itself with coronary heart disease, kidney failure, hypertension, heart Failure, obesity, diabetes, asthma, cancer, arthritis, depression, and other common ailments. Exactly the kinds of chronic conditions that American health plans cherry pick against.

Most if not all of these ailments are managed far better in Canada and other universal healthcare nations. Far too often an HMO's management consists of making insurance coverage unaffordable and then, once a person drops coverage, no other insurance plan being willing to take that person on. And in any case, disease management would of course be part of public plans — even today. Because they're a function of the providers. Whether it's the VA or a physician getting paid through Medicare — or even an HMO being paid through Medicare — providers either do a good job or not of disease management. Because there's continuity of care in, for instance, France, disease management is done better than we can manage.

I'm not a regular reader of Roll Call. Who knew it was funded by lobbyists? Makes sense, though. Someone's got to pay the bills.

Conscience of a liberal

Paul Wellstone died with his wife, daughter, and campaign aides five years ago today, in a plane crash disturbingly reminiscent of the crashes used to kill South American progressives who wouldn't go along with the corporate program.

Ezra Klein writes a fine tribute to Wellstone in The American Prospect, including these lines:

"Politics is not about power," he would say. "Politics is not about money. Politics is not about winning for the sake of winning. Politics is about the improvement of people's lives. It's about advancing the cause of peace and justice in our country and the world. Politics is about doing well for the people."

Because of this, Wellstone had an immunity to the political trends that few politicians exhibit. When liberal was an epithet, Paul Wellstone wrote a book called The Conscience of a Liberal. When unions were in deep decline, Wellstone stood with them, and now the AFL-CIO now gives an annual award in his honor. After the Clinton health plan was crushed and Democrats retreated from health reform, Wellstone pushed for single-payer....

Krugman redux

Can we really turn away from Paul Krugman? Really?

Here's an outtake from his new book, Conscience of a Liberal:
The transformation of the party of Lincoln to the party of Willie Horton is one of the abiding tragedies of American political history. Harry Truman's efforts to complete the New Deal by putting into place a national healthcare plan were sabotaged by Southern Democratic senators who were afraid that guaranteed healthcare would mean desegregated hospitals.
That from a review in Salon. Evidently Krugman makes the case that we're the only industrialized nation without guaranteed, universal healthcare because of racism. And he suggests this is a glass half full, because we're becoming a less racist society.

Maybe so. A less racist society, with a renewed commitment to xenophobia. Try this statistic:
According to a January 2007 survey of Californians by the Public Policy Institute of California, over 70% favored government led universal health coverage, with a drop to 56% when the question implied coverage for children of illegal immigrants.
Meanwhile, a lot of the white children of those folks who hated the idea of integrated hospitals now can't afford to go to the integrated hospitals.

22 October 2007

Listen to Lakoff

George Lakoff has written a topnotch explanation of how conservatives, progressives, and neoliberals view the healthcare debate.

Lakoff posits that conservatives see the market as the definition of morality: it forces people to take individual responsibility, it punishes those who do not, and it rewards those who do. Healthcare is no different than a plasma TV: if you've been good and worked hard, you get one (or you get healthcare); and if you've not been good and worked hard enough you don't. End of story.

Progressives, on the other hand, see morality in terms of empathy and taking responsibility for ourselves and others.

Neoliberals see morality in those empathetic terms as well, but also see the market as a potential tool for morality — that is, it can be reformed and constrained to be an agent for good.

Lakoff argues that's not the case with health insurance, since the very structure of the market rewards companies that decline to give care.
The basic fact is this: the sicker you are, the more you cost and the less the company makes by covering you. This is the opposite of the way markets normally work; namely, the more product a company delivers, the greater its profits. But in the health care industry, it is the opposite: the less care an insurance company authorizes, the greater the profit. As long as insurance companies are responsible for authorizing health care, this will be true.
Lakoff ends by arguing that the neoliberal compromise here won't work. By going along with the idea that the perverse health insurance market can work, we've conceded that the market is moral — which in this case it certainly isn't.
The best way to proceed is to keep what we care the most about at the center of the discussion of health care security. What we care the most about is the actual health and well-being of flesh-and-blood people. Keeping this care in our hearts does not mean that temporary compromises will not be necessary. It means only that we don't begin with compromise....

System tinkering — eliminating pre-existing condition exclusions, adding mandatory coverage for this or that ailment, subsidizing (substandard) health care for the poor — will make a difference for many, but not for all. It will leave many more people with the kind of dissatisfaction that those with present health insurance have rightly been complaining about. Tinkering like that is more concerned with saving a system that has already failed than it is with the health of a society, indeed, with saving lives.

21 October 2007

208 Commission's Fifth Proposal

Colorado’s 208 Commission met Thursday to hear from a harried John Shiels of The Lewin Group on the results of the modeling of their own, fifth proposal for comprehensive healthcare reform in Colorado.

Their proposal is a mosaic of plans designed to shore up the leaks in covering Coloradans. Admirably, the plan attempts to offer “single-payer” to those of us who do not believe in the private insurance market and would like to buy into something like Medicare.

It would be similar to programs that allow you to buy “green” energy, in a way — with this rather large difference. You would be at the mercy of politicians wanting to gut it for ideological reasons, and you would not have the protection that British or Canadian citizens have. There, when they vote for a politican or party that promises to “cut the fat” from public expenditures, voters know they may be personally hurt when it's healthcare on the chopping block. That’s the reason behind keeping Social Security for the wealthy. When a program benefits everyone, it’s more bullet-proof.

A single-payer program only for those of us crazy enough to pay for green energy (we are mostly the same people, aren’t we?) is pretty vulnerable to attack.
Witness the slimmed down benefits that the fifth proposal gives people wanting to buy into Medicaid for all — the rational being that if you made the benefits too rich, everyone would want in. But isn’t that the point?

Shiels also presented a couple of charts showing how little the single-payer portion of the fifth proposal saves in comparison with the Colorado Health Services Plan. Because, Shiels pointed out, the benefits from single-payer come because it is, in fact, a single-payer. If it’s just one more payer, that doesn’t really help much.

The fifth proposal as it now stands would cost $1.4 billion more, according to the Denver Post. Health Care for All Colorado's single-payer plan, the Colorado Health Services Plan, would save $1.4 billion.

The commissioners decided to call the plans by numbers, instead of their crazy appellations, i.e., Healthy Colorado, Better Health for Colorado, Healthy Solutions for Colorado….

The commissioners also heard the final reports from the four advisory task forces: rural, vulnerable populations, providers, and business.

Kelly Esselman of the Mountain States Employers Council in Denver said that the business people in her task force had not really understood single-payer, and that once they found out more they were supportive of paying 4 percent or 6 percent payroll tax to cover their employees. However, they thought it would be better done at a national level than state level.

We can live with that!

BJ Scott, president of Peak Vista Community Health Centers in Colorado Springs, gave a less inspiring report from the providers task force. I’d heard that the providers were overwhelmingly positive towards single-payer. Their analysis of the various proposals seems to show that. It was difficult to say what the providers thought from the overview. I guess it was realism, the providers telling the commissioners what they’d like to see within the bounds of what is feasible.

Or not.

Scott emphasized that the group was concerned about the ongoing process of reform going in one direction. They didn’t want reform "to end up in Michigan when they thought they were going to Texas." So they wanted to see the action steps, and to see a strong plan for reform.

That’s feasible but single-payer isn’t?

She said that providers said it’s not so much how much they get paid, but rather how they get paid, with the implication being that providers are sick of fighting private insurance companies.

Commissioner Linda Gorman, from the Independence Institute, evidently picked up on troubling communitarian attitudes from the providers — what sounded like generalities to me evidently sounded alarming to her. She said that the task force’s report indicates a lot of agreement on things “I know are highly contentious.”

Gorman wanted to know just how much disagreement there had been on those broadly held do-good notions.

Complete consensus, said Scott.

A doctor in the audience who had served on the task force spoke up to agree — and also to say that while the proposals focused on financing, the providers were concerned about the delivery mechanisms. If the infrastructure of care isn’t fundamentally reorganized, he asked, how will you flatten the negative trends now occurring?

Commissioner Arnold Salazar said that the rural task force had only finished their report a couple minutes earlier, and that it would be emailed to commissioners soon. Basically he said that the rural folks were uneasy with workforce issues. They don’t like employer mandates, and the employer mandates’ possible effect on already fragile rural economies. He also noted that many rural areas have access to urban amenities, but truly frontier areas are isolated.

They had a lot of discussion around the need to have access to care if there are mandates. The safety net in many rural communities is the primary source of health care. Public health systems are also very important. Salazar also said that it’s difficult to establish providers in rural areas over the long term. “The moment they’re done with loan repayment they move back to urban areas,” he said.

The rural folks agreed that there needed to be more focus on oral health, behavioral health, and substance abuse.

Colorado’s laws against “co-location,” where different kinds of providers aren’t allowed to practice out of the same facility, don’t necessarily make sense in rural areas. Salazar also said that telemedicine isn’t the answer. First of all, it’s not a substitute for care, but also the infrastructure is in cities and not available in rural areas.

In rural Colorado, public health systems are very important.

The rural task force also felt leery of geographic ratings, which they felt could negatively impact rural communities.

The task force evidently advised using public health systems and protecting the work they’re able to do.

Sounds like single-payer to me.

The vulnerable populations task force issued the most complete report, pages of information that I’m going to give short shrift to here. Hope to do better tomorrow...

Arthur Powers of Thrive, a support group for people living with HIV and AIDS, spoke about their group’s work.

04 October 2007

Vigils and the Smiths

Last Friday's vigils, in Kansas City, Oklahoma City, Denver, Los Angeles, Pueblo, Chicago, Louisville, and Washington, D.C., brought together a couple thousand health care activists.

That story in Workers World ran a photo with Larry Smith, on the far left. Donna writes:
Check out that banner and who is walking with it!

I am so proud of my husband, with serious artery disease and pain when walking, who marched the whole route proudly holding up one end of the healtcare not warfare banner.... Three cheers for Larry.

This is a fight worth dying for -- and we will not be silenced. There is great courage being shown on this battlefield.

01 October 2007

Cancer & single-payer

Timothy Noah over at Slate has a good article examining the right's new health care canard (they found something beyond waiting times for nonemergency surgery in Canada!) Turns out we need to be scared, real scared, as W might say, of dyin' of cancer if single-payer becomes the law of the land.

See, the Lancet came out with a study that shows the British cancer survival rates for five years out are far less than ours — near the bottom, in fact of 23 European countries — all of which have universal health care, virtually all of which do so through public financing. How that shows that single-payer is to blame is hard to say.

In fact, looking at the entire chart, Noah points out that with the exception of Britain, wealth correlates with survival rates. So what's with Britain?

It's hard to say, but one reader notes that the entire debate is a bit off kilter, since in fact:
The biggest determinant of cancer survival statistics is something called lead time bias - people only appear to live longer because they are diagnosed earlier; the relationship between early detection and cure for most cancers is weak. In addition, some cancers detected by early screening grow so slowly that they are unlikely to cause problems for an elderly person before he or she dies of something else. As a result, in most developed countries, increased cancer survival times and cure rates correlate with increasing cancer rates but its largely an illusion of more agressive testing.
Scary if true. The good news is that Europe probably has fewer cancers to begin with because their environmental regulations are stronger and their auto lobby wasn't powerful enough to destroy all of their mass transit, biking, and pedestrian options. So people move more with fewer toxins.

Plus, early detection and prevention is indeed good for most ailments. Like, say, appendicitis.