Soft Support for Reform

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Americans: OK with Inequality

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?

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?

Military benefits from desperation

The Wall Street Journal blog shares a NYT article on how healthcare reform could hurt military recruiting goals. Turns out that when an illegitimate war drags on, when troops are abused, and when people realize that a war is illegitimate and troops are being abused, young people don't sign up to fight.

The NYT piece is accompanied by a chart showing that in the late '80s, 25 percent of young people figured they'd sign up for military service during the next few years. Now only 13 percent think that's a reasonable choice.

Young people signing on to military service evidently say they're partly motivated by medical need for their young families. Tricare for their spouses and children is a trade-off for signing up for Bush's war. "It seems a bit perverse that the incentives for a young person with children to join are greater than the incentives for his childless friend," writes Floyd Norris in the Times. "But that is the way it is. All that could change if the push for some kind of national health insurance program were to be successful."

Geography & healthcare

Consumer Reports has published an article on the Dartmouth Atlas of Health Care - a wonderful thing. Consumer Reports is really on a tear about healthcare, and this article provides our friends and neighbors information about a big part of what's wrong with U.S. healthcare.

Because physicians are paid on a fee-for-procedure, cost-plus basis, the incentives are to do more procedures, rather than just the right procedures. Physicians and nurses are generally ethical people, but they're just human. Add the need to pay for that MRI machine to the old lady's son insisting on "Do whatever's necessary, doc," and you end up with unnecessarily aggressive treatments - something proven out by the crazy regional differences on how many procedures patients are getting some places - without better outcomes.

Geography and health care
The amount of medical care that people get for serious illnesses varies enormously from place to place. In the last two years of life, the average patient spent 11 days in the hospital in Bend, Ore., and 35 days in Manhattan. In those same two years, patients visited the doctor an average of 34 times in Ogden, Utah, and 109 times in Los Angeles.

The Dartmouth Atlas based those findings on the Medicare claims records of millions of patients who died from (in order of prevalence) congestive heart failure, chronic pulmonary (lung) disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease. Together those ailments account for about 90 percent of deaths of people older than 65.

Over the years, Dartmouth research has yielded some startling insights:

• The local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions have. The more medical resources a region has, the more aggressive the treatments are.
• In the regions that deliver the most care, patients have a slightly higher death rate than patients with the same conditions treated in areas that treat less aggressively.
• Patients treated most aggressively are no more satisfied with their care.
• The cost differences are vast. Average Medicare spending over the last two years of life for all hospitals ranged from a high of $81,143 in Manhattan to a low of $29,116 in Dubuque, Iowa.

So the Dartmouth folks are big on best practices, as are other medical systems that keep down healthcare costs - and simultaneously maintain good access. (Note in the Consumer Reports' articles that "Patients in the high-spending, aggressive-care regions waited longer in emergency rooms and doctors' offices than patients in lower-spending regions did.")

Linda Gorman, from the libertarian Independence Institute and a commissioner on Colorado's Blue Ribbon Commission for Health Care Reform, was always vehemently against "best practices." She argued that the science was too soft, that it was subjective, that by God if a patient wants bad care then it's their right to get it - or something along those lines.

These are folks who also consider the science behind global warming to be a bunch of hooey. I don't know whether they also think the moon landing was a hoax.

Part of progress - and survival - comes from measuring cause and effects and paying attention to the answers. Dartmouth has come up with some pretty good answers here - information that's important whether we get a healthcare system or remain stuck with laissez-faire, for-profit healthcare. If we had a healthcare system, we could move more quickly and surely with this information towards more efficient and humane standards. Until that day, we'll muddle through and probably get partway there. Or not.

Consumer Reports becomes activist!

There's a great new website and initiative up from, of all organizations, Consumer Reports. It shouldn't really be a surprise - they did some great work earlier this year on the failure of the American health insurance industry.

The Cover America Tour begins with a bus with speakers that's traveling around to bring focus on this issue. Shades of Healthcare Now! That's exactly what Donna and Larry Smith did last autumn.

They're not single-payer, but it looks to me like most of their information points in that direction. Take a look at their media page - one of the choices there is a piece on "Six Prescriptions for Change," which reports the results of a survey of what Americans want (on a page titled: "Health-care security: Losing confidence in the health-care system." Their findings:

• Coverage for all uninsured children.
• Protection against financial ruin due to a major illness or accident.
• The ability to obtain coverage regardless of a pre-existing condition.
• Coverage that continues even when people are laid off, changing jobs, or starting their own business.
• Premiums, deductibles, and out-of- pocket expenses that are affordable relative to family income.
• The ability of people to keep their current health insurance if they choose.

It's too bad that folks don't get it - that last item effectively trumps all that came before.

Commonwealth's proposal

Commonwealth Fund's principal researchers and president have authored an article for Health Affairs with Lewin Group modeling that shows a path to dramatically improving U.S. healthcare. It seems far superior to the flawed Wyden plan.

Health Affairs has a firewall, but you can see a synopsis of the plan at Commonwealth Fund or at Medical News Today.

Here are the basics, from Medical News:

• A national entity known as a "connector" that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
  
• Requiring that all applicants be given health insurance at standardized rates regardless of their health status.
  
• Tax credits to make sure premiums are affordable. Premium assistance would be available to all to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
  
• Expanding Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
  
• Requiring that everyone enroll in a health insurance plan-uninsured individuals who file taxes would be automatically enrolled.
  
• Requiring employers to either provide health insurance or pay 7 percent of payroll up to $1.25 an hour into a pool to help to finance coverage.
  
• Medicare reforms that would extend Medicare Extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled, and allow adults age 60 or older to buy in to Medicare.

How Many Support Single-Payer?

Do pundits and politicians misstate the facts or lie about single-payer and the U.S. healthcare system? Is it because they're uninformed or because they figure they can get away with it?

Steven Maviglio writes about "Single-Payer Dreamland" that "single payer polls in either single digits or low double-digits when Californians are asked what type of health care system they want. Its proponents are vocal, yet few."

Does he also think there were WMDs in Baghdad and that global warming, if it exists, is caused by sunspots?

A number of polls show something quite different than such low support both nationally and in California. Here's a national one by Gallup.

It showed that in November 2007, 41 percent of Americans were in favor of "replacing the current health care system with a new government run health care system," and 48 percent favored "maintaining the current system based mostly on private health insurance." 11 percent weren't sure.

In 2006, it was 39 percent wanting a government system; in 2005, 41 percent; in 2004, just 32 percent; in 2003, 38 percent; in 2001, 33 percent. Those wanting to retain our current for-profit system have declined from 61 percent to 48 percent, with "don't know" rising from 6 percent to 11 percent.

The bigger changes came not between 2001 and today, but rather between 1987. In 1987, answering the open-ended question of what was "the most urgent health problem facing this country at the present time?" only 1 percent said costs. (68 percent said AIDS/HIV.) Today 26 percent say costs. Then, nobody mentioned access as a problem. In the November 2007 poll, 30 percent came up with access.

A number of other resources as well show it's either uninformed or dishonest to suggest only a tiny minority of Americans support single-payer.

Daily Kos on Obama & single-payer

There's a wonderful essay by a serious healthcare reformer, a professor of Health Policy; Director, Center for Health and Public Policy Studies, UC Berkeley. She writes about Barack Obama and Hillary Clinton (and Hillary's nasty clip accusing Barack of lying about single-payer):

Both of these candidates are very smart people. They both understand that single payer is THE best system for affordable, comprehensive, equitable, secure, efficient health care for all Americans. This is good news.

But the realities of our current system and how it has evolved over time, make it difficult, if not impossible, to move from where we are now to 100% single payer system over night.

I actually proposed this idea of giving Americans the choice of a single payer plan that competes along side the existing system in 2002. I first developed the idea for the state of California as part of the State's HRSA grant for Health Care Options. I will provide links below to both the original proposal as it was developed for California and the a link to the ESRI report (funded by RWJ) on Covering America, which includes the federal model I developed for CHOICE as a plan that would voluntarily transition the entire US health cares system to a single payer system, with private plan options for those who do not want single payer.

Interesting. Here's the link to her site about CHOICE OPTION for California and her federal plan as well -- about which she writes,

The federal plan speaks specifically to the point of having a single payer plan compete with the existing system and allow people to choose which they want. And guess what? Our current inefficient, inequitable, ineffective system cannot compete with a single payer plan. The Lewin Group, using their Health Benefits Simulation Model, modeled the CHOICE proposal and found that within one year of adoption a plan with the option of single payer, 70% of Californians would chose to enroll in the single payer plan and 94.4% of the Californians have health insurance coverage, all without a mandate.

For the sake of the health of the American people let's agree to agree. The goal of health care reform for the Democrats is universal coverage and they all support a plan that will enable the US to voluntarily transition to a single payer system.

Ezra on healthcare comparisons

Ezra's evidently back from New Hampshire, and reading the new Health Affairs study "Measuring the Health of Nations" — which shows 101,000 excess deaths annually due to "amenable mortality -- 'deaths from certain causes that should not occur in the presence of timely and effective health care'." He notes,

Every other country posted significant progress in reducing amenable mortality. Save for us. In 2002-03, for both males and females aged under 75, America had the highest rate of amenable mortality -- which is to say, preventable deaths -- in the OECD. That means we were behind Canada, behind the United Kingdom (whom we'd beaten in 1998), behind France, behind Ireland. And not by a little -- France's preventable death rate was only 58 percent what ours was. Had we achieved the average gains -- not their rates, but simply the improvements -- posted by the other countries, we would have saved 75,000 lives. Had we achieved the gains of the top performers, we would have saved 101,000 lives.

Repeat that to yourself: 101,000 lives. That's more than the total population of Boulder, Colorado.

Let God sort them out

Yaron Brook, executive director of the Ayn Rand Institute, has spelled out the healthcare solution for Republicans. They've got to come out strong against the pernicious idea that healthcare is some kind of right. This is the only thing that will get government out of healthcare and allow people to die in the streets. Where hopefully their families will remove the bodies, since that's not exactly an appropriate government function either, is it?

Gotta love those libertarians. They see things so clearly. I bet no amount of carnage could persuade Yaron differently Let them all die, he won't be moved. Yaron writes:

The solution to this ongoing crisis is to recognize that the very idea of a "right" to health care is a perversion. There can be no such thing as a "right" to products or services created by the effort of others, and this most definitely includes medical products and services. Rights, as our founding fathers conceived them, are not claims to economic goods, but freedoms of action.

You are free to see a doctor and pay him for his services--no one may forcibly prevent you from doing so. But you do not have a "right" to force the doctor to treat you without charge or to force others to pay for your treatment. The rights of some cannot require the coercion and sacrifice of others.

So long as Republicans fail to challenge the concept of a "right" to health care, their appeals to "market-based" solutions are worse than empty words. They will continue to abet the Democrats' expansion of government interference in medicine, right up to the dead end of a completely socialized system.

Contrast that with this sensible article that Don McCanne of PNHP sent out via his wonderful Quote-of-the-Day service:

JAMA
January 2, 2008
Market Justice and US Health Care
By Peter P. Budetti, MD, JD

In the United States, health care competes for consumers with other items in the marketplace. Individual resources and choices determine the distribution of health are, with little sense of collective obligation or a role for government. Known as market justice, this approach derives from principles of individualism, self-interest, personal effort, and voluntary behavior. The contrasting approach, social justice, allocates goods and services according to the individual's needs. It stems from principles of shared responsibility and concern for the communal well-being, with government as the vehicle for ensuring equity. Social justice in health care requires universal coverage and ensured access to care, whether through social insurance, private insurance, or some combination.

The End of Market Justice

The dominance of market justice as the vehicle for allocating health resources in the United States has been associated with numerous troubling characteristics of its health system. The US population has clearly rejected using pure market justice to apportion health care goods and services, yet has expressed no collective demand that
society achieve equity through social justice. The general public has insisted on the buffer of insurance, but has focused on coverage for individuals and their respective families, not the population as a whole. Consequently, health care coverage, although desired by the vast majority of Americans, is incomplete. Now, the key element, employment-based insurance, is disintegrating in both the population that is covered and the benefits provided.

Simultaneously, health care has become a valuable commodity that created enormously influential vested commercial interests with little motive to abandon market justice. Medicine, which might have played a role in promoting social justice, has not done so, and has been transformed by the imperatives of market justice. Fragmented and struggling to come to terms with externally imposed pressures, medicine is losing both its political force and moral compass. The medicalization of health has simultaneously enhanced the investment in health care goods and services while distracting clinicians and policy makers from attention to the needs for health promotion and disease prevention and constraining the capacity to meet the expanding challenges to public health. Market justice may have outlived its role in US health care.

That appeared in JAMA, but there's a firewall.

Obamass

Ezra Klein reminds me today why Obama might not be so bad. It all goes back to the idea that liberals want to be inspired, conservatives led. And Obama can inspire. From Klein:

Obama's finest speeches do not excite. They do not inform. They don't even really inspire. They elevate. They enmesh you in a grander moment, as if history has stopped flowing passively by, and, just for an instant, contracted around you, made you aware of its presence, and your role in it. He is not the Word made flesh, but the triumph of word over flesh, over color, over despair. The other great leaders I've heard guide us towards a better politics, but Obama is, at his best, able to call us back to our highest selves, to the place where America exists as a glittering ideal, and where we, its honored inhabitants, seem capable of achieving it, and thus of sharing in its meaning and transcendence.... a call to create something better, bigger, grander, and more just than the world we have. When that happens, as it did with Robert F. Kennedy, the inspired remember those moments for the rest of their lives.

It's about an Obamass.

Ezra's beautiful writing makes me wonder why I can't hear it — and maybe this is a facile answer, but it's the first that came and it won't leave. It's his wife.

To backtrack a bit, I am concerned about his lack of experience, what Paul Krugman today described as the idea that "among at least some of Barack Obama’s supporters there seems to be a belief that if their candidate is elected, the world’s problems will melt away in the face of his multicultural charisma."

This seems like a mirror image of why people voted for Bush. Sure, at an Obamass you get a chalice with communion wine rather than a spit-flecked plastic cup of beer, but it's the same idea that character and image are more important than competence and experience.

But that's not fair. A look at Obama's record and achievements show him to be competent and a man of good judgment. The folks who saw that in Bush were willfully ignorant.

Obama is the only one of the three front-running Dems who doesn't include mandates in his healthcare plan. That should be enough to have me supporting him right there — but then there's Michelle.

She's vice-president for external affairs for a hospital, making $275,000 a year. Hospitals should be on the side on single-payer and reform, but in my experience they're not. This is a strong woman who has made it in cut-throat capitalism, and may well buy into the idea that she deserves to stand on her side of the chasm that divides rich and poor in America — and that the poor deserve to be where they are.

Let's hear what Michelle has to say about healthcare reform.

Howie's rant!

Funny how these things work — Howie Wolf, MD, a longtime board member of Health Care for All Colorado, says he's not a writer, and I'm pretty sure he wrote this in a flush of annoyance (or rage!) last weekend, never expecting to get it published.

The Daily Camera, the publication of record for what the rest of Colorado calls the People's Republic of Boulder, did well to print it. He writes:

Thank you, President Bush.... As a family doctor with more than 45 years of experience working in our disjointed, unjust and inhumane health system, your endorsement of the status quo will surely help the efforts of those of us who are activists eager for major reform. The polls indicating that 65 percent to 70 percent of Americans favor a government-funded health-care system, plus the latest ABC News poll revealing diminished support for your leadership at a mere 20 percent gives me hope that again you are on the wrong side of an issue.

Bravo Howie! Keep writing!

Conason, Lux on Hillary

Joe Conason, who wrote a great book about the witch hunt against the Clintons, reveals the soft spot he has in his heart for Hillary with this article at Working Assets. Conason ends it with a good point:

Ever since Harry S. Truman first proposed universal health care in 1948, the insurance industry has refused to create a system that would cover everyone, erecting instead a nightmarish edifice of corporate bureaucracy, unaffordable waste and cruel exclusion.

Rather than rant against the constructive alternatives, let them--and their political mouthpieces--explain why we should continue to tolerate their failure.

Mike Lux, who used to work for Hillary, gives his analysis on what's different about this program at Open Left. Lux writes,

But there's one other reason the issue haunts me and drives me. Being part of that health care fight in 1993-94 was an experience that I can never forget. I don't like losing, especially when the stakes are this high, and unlike elections where you have another chance to win just two years down the road, a chance at getting something this big and complicated done comes along only once a generation. So we better get it right this time.

I think Hillary's new proposal is pretty damn good. I still think, have always thought, a Canadian-style single-payer system is the best way to go policy-wise, but that ain't happening absent a miracle, and Hilary's proposal is pretty sound policy-wise in terms of doing the things a health reform policy should do: it covers everybody, cuts costs and improves quality. And there's no one in the country who knows more about health policy than Clinton- she is pretty amazing in that regard.

Lux believes that this plan may work because it:

1. Emphasizes that if you like your health insurance you can keep it.
2. Keeps it simple to explain.
3. Buys off small businesses with no mandates to cover employees.

About Hillary....

For a rousing denunciation of Clinton's healthcare "reform" plan, give John Nichols' a read. Nichols writes how it should be done.

...Clinton and the Democrats would have a far easier time selling “European-style socialized medicine” than what the senator from New York is peddling. And that does not even take into account the potential appeal of a uniquely American single-payer system that might intelligently combine the necessary efficiency of a publicly-funded and defined payment program for covering costs with the appealing prospect of allowing Americans to choose their own basic plans and doctors.

Steven Pearlstein of the "liberal" Washington Post, on the other hand, thinks Clinton's plan is the best of the bunch. Feasible, you know?

Newt Gingrich explains, via his interview on Hannity & Colmes, why incremental and "feasible" won't work.

COLMES: All right. Getting to Hillary Clinton's health care plan, this is not a government-run plan. In fact, you can keep the plan you have now.

GINGRICH: Alan, Alan...

COLMES: You can buy a new plan for profit. You can pick a plan from the menu of quality private insurance options. You can get the plan that Congress has. You can choose a public plan similar to Medicare.

So you've got a bunch of options here. It's not like it was, as you called "Hillary Care", back in 1994.

GINGRICH: Alan, it has a huge tax increase. It costs $110 billion a year more. It has government intruding all over the place. It cripples the insurance companies. It takes money away from executives. It has government interfering at all sorts of levels.

If you add up the total amount of red tape this is going to cause, I agree with you. This is not Hillary Care. So let's call this "Daughter of Hillary Care". OK? This is way beyond Hillary Care.

So. Clinton (and the rest of the Dems, except Dennis Kucinich) surrender — she goes along with keeping all the blood money for the insurance industry on the table.

Guess what? She loses again. Because it's too expensive.

Walter Shapiro at Salon seems to be talking about a different plan than Nichols, Pearlstein, or Gingrinch. He quotes from Clinton's ad about the plan: "it lets you keep your coverage if you like it [and] provides affordable choices if you don't." and suggests it will be harder to demonize this time.

(That malicious laughter is coming from Newt, who has already accepted the challenge.)

Shapiro writes,

Rather than being timid and incremental, her proposals are as ambitious as those offered by John Edwards, who was the first major Democrat to offer a plan for universal coverage. (Dennis Kucinich remains a voice in the wilderness with his call for a government-run single-payer plan.) Like Edwards, she would legally mandate that uninsured individuals obtain health coverage -- and would provide hefty subsidies for those who cannot afford it on their own. The Clinton and Edwards plans (along with a more narrowly drawn proposal advanced by Barack Obama) would be largely financed by rolling back the Bush era tax cuts for those earning more than $250,000....

Less than four months before the Iowa caucuses, there is scant evidence that Democrats will be mobilized to choose a candidate based on his or her healthcare position papers. All Democratic contenders agree on the goal of universal coverage for the 47 million without insurance -- and, Kucinich aside, their road maps for getting there only differ in the details.

"The candidates would do just as well to hold up blank reams of paper and say, 'This is my healthcare plan,'" joked pollster Andy Smith, the director of the Survey Center at the University of New Hampshire. "Healthcare has been consistently coming up as the second or third most important issue in the polls after the war. But are the voters following the debate over the nuances of policy? No."

The sorry part of this article is Shapiro describing Clinton's policy as "bold."

Bold it's not.

California Dems cave

Don McCanne has a good column at the California Progress Report on the foolishness of turning in your best cards before you even sit down at the negotiating table. In A Nunez-Schwarzenegger Compromise or Single Payer for California?, he writes,

in a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.

It's sad stuff, in part because it's exactly the same — as 1993. It's like Groundhog Day for healthcare reform.

Not one Republican voted for this compromise, and Blue Cross of California is spending a couple million dollars in an advertising campaign opposing reform. So much for compromise. The Democrats have violated the first rule of negotiation. Before they even seriously sit down with the governor, they have removed from the table the most important polices that would bring comprehensive, affordable, high quality care to everyone.

McCanne notes that underinsurance is the fastest growing problem in U.S. healthcare. It's key in a brilliantly crafted scheme that the health insurance industry has put together. See, you don't usually know you're underinsured until you need your insurance. That happens to less than 10 percent of the insured in any given year. And so most people can be convinced that it was their own foolishness or bad luck, not part of a carefully designed plan in which their health is nothing more than collateral damage in the quest to create wealth for others.

Sen. Johnson gets it now — but do the rest?

By Donna Smith

DENVER – It was a moving scene. Sen. Tim Johnson of South Dakota returned to the U.S. Senate today, nine months after suffering a brain hemorrhage that nearly took his life.

I vividly remember that day. I was working at a contract position here in Denver when someone came out of our break room and said some Senator from South Dakota had a stroke or something. My stomach flipped. We had just moved from South Dakota weeks before, and Tim Johnson was one of my U.S. Senators.

When I arrived home that day to my daughter’s home where we were living in a small storage room, a hand-written note was waiting in her mailbox for me. It was to me from Sen. Tim Johnson. The irony of receiving that note on that day was spooky for me. The note is on his U.S. Senate note paper, and he thanked me for my efforts to be a fair reporter in western South Dakota where most media leans heavily and easily to the far right. I still have that note and will treasure it always. It wasn’t easy to report on any Democrat in western South Dakota, and it was kind of him to acknowledge that fact.

But now it is months later. I have been in Michael Moore’s SiCKO and to Cuba for health care, and Sen. Johnson and his family have been through hell and back with his brain injury. Both of our families have much yet to endure.

I listened to his statement today and marveled at his courage. How many of us would step to that microphone and do what he did and what he had obviously fought to do with every fiber of his body. Every American should take great comfort that among all the terrible falsehoods and shams we watch unfold from Washington, these few moments were very human and very American – in the best senses of both.

In part, Sen. Johnson said, “But I return to work today to this great body with a renewed spirit and a sharper focus. I better appreciate today what individuals and families go through when they face crippling hardship – whether that hardship be the consequence of catastrophic health issues, economic hardship, or lack of an opportunity to reach one’s full potential in life.

“I believe I have been given a second chance at life. I vow to take that second chance and work harder than ever to be the best I can be for my state and for my nation; to be a voice for those individuals and families who too often are ignored or forgotten; and to fight to live up to the ideals that have made this nation great. That is my focus and that is my commitment to my constituents back home in South Dakota, to the people of this great nation, and to my colleagues here in Washington.” When he finished his statement, his colleagues stood and honored him with applause, as well they should.

Then our Senate Majority Leader, Harry Reid of Nevada, spoke. In his moving tribute to his friend and fellow Democrat, Sen. Reid shared a truth that might have been lost by some but that seared at my heart and soul like a hot knife.

In praising Sen. Johnson’s doctors and acknowledging the serendipity that allowed his medical crisis to occur when and where it did, Sen. Reid inadvertently highlighted some of the very issues the rest of us out in America face today.

Reid said that if the hemorrhage had occurred one day later, Johnson might have been on an airplane bound for South Dakota. OK, that would be bad. It would have taken precious time for a plane to land and for care to reach my Senator. He might have died or had a very bad outcome indeed.

But then Reid added that if the crisis had occurred two days later, Johnson might have been on an Indian reservation. Oooh, now that’s not good. Everybody knows that having a medical emergency on one of the nation’s Indian reservations would necessarily mean pretty lousy chances for high quality trauma care or even minimal stabilization of a medical emergency.



So, my good Senators, Sen. Johnson was blessed to have his emergency in Washington, near an awesome medical facility with doctors who were top-notch and able to work with the best of the best to save his life and to save his brain so we could applaud him today.

Most Americans are not so lucky. We don’t have the insurance benefits and access to quality care that saved Sen. Johnson’s life and brain. And the kicker still is that we – the American taxpayer and voters – give our Congressional members better benefits at better prices and therefore a better chance for life than we even demand for ourselves.

I would like to hold Sen. Johnson to the words he spoke today and challenge him to work now on bringing the health care crisis in this nation forward once again in the Senate. He has a unique perspective and a unique opportunity -- Perhaps a God-given opportunity to argue that he values the health and lives of his constituents and of everyday Americans just as much as he does his own. In my heart, I know he does. Now I just need to find out if he has the courage to stand up and say it in spite of the re-election race decision looming in the not-too-distant future.

In 2004, another U.S. Senator from South Dakota offered a resolution in the Senate saying that every American should have access to health care benefits like those given to every member of Congress at a fair price. Senate Minority Leader Tom Daschle offered that resolution but was later defeated by the young Republican, John Thune, who introduced Sen. Johnson today as he returned to the Senate. Thune does not believe every American deserves the same health benefits he does.

I would like to challenge Sen. Johnson to go back to that resolution and read it again. Give it your own touches and please reintroduce it again. Let the courage and compassion you now know even more intimately exists in America guide you to bring this discussion back into the Senate before another year and another election cycle – and the deaths of 18,000 more Americans – passes. This nation needs health care reform now, please help us Sen. Johnson.

Bravo to Larry Smith

Donna Smith yesterday posted an entry on Michael Moore's blogsite about her husband Larry's rather brilliant idea about unionizing patients. It's pretty simple. Don't patronize doctors who aren't for single-payer, universal health care. Larry's a union man, and it shows in his thinking here. (By the way, if you've never heard Natalie Merchant sing this classic, you'll be richer for finding a way to hear it.)

WHICH SIDE ARE YOU ON?

Florence Reece/ Stormking Music, Inc.(BMI)

Come all you good workers
good news to you I’ll tell
of how the good old union
has come in here to dwell

Which side are you on boys?
Which side are you on?

My daddy was a miner
he’s now in the air and sun
he’ll be with you fellow workers
until the battle’s won

Which side are you on boys?
Which side are you on?

They say in Harlan County
there are no neutrals there
you’ll either be a union man
or a thug for J. H. Claire

Which side are you on boys?
Which side are you on?

Oh workers can you stand it?
oh tell me how you can
will you be a lousy scab
or will you be a man?

Which side are you on boys?
Which side are you on?

Don’t scab for the bosses
don’t listen to their lies
poor folks ain’t got a chance
unless they organize

Which side are you on boys?
Which side are you on?

Cancer Society focuses ads on uninsured

The New York Times reports today that the Cancer Society's $15 million ad budget for the coming year will focus on the uninsured. The article notes, "The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies."

Other disease-fighting charities have applauded the move.

Before we get too misty-eyed about what a good sign this is, let's point out that the Cancer Society's theme is the "consequences of inadequate health coverage." That promotes buying more health insurance, putting more money into bonus checks to Aetna executives at the expense of struggling families. j

Then again, before we get to cynical, the Cancer Society risks its funding with these ads from foundations associated with the obscenely profitable medical-industrial industry. That money is crucial to the existence of the society. They have to walk a fine line here.

Celinda Lake's research shows that fear entrenches the status quo. Hopefully these ads will inspire anger and not fear. Which will it be?

One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”

The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.

The NYT piece also refers to a 2003 study estimating that one of every 10 cancer patients was uninsured and other surveys that "have found that one of every four families afflicted by cancer, which is projected to kill 560,000 Americans this year, is effectively impoverished by the fight, including one of every five with insurance."

Divide and conquer

The Atlantic Monthly continues its downward spiral with a new writer, Megan McArdle, who fits their criteria for clever writing that leaves aside those quaint notions of morality, as Alberto Gonzolez has said. Entertaining!

The benchmark for this kind of dross ran a few years back, positing that the earth could easily support 30, 50, who knows how many billions of humans! and that our human population could vary by huge amounts — 30 billion to 3 billion! — within a few generations, without problems.

Right. Unless, I suppose, you consider starvation, war, pestilence and economic dislocations problematic.

Megan performs this trick on a smaller scale in "The Morality of Health Care Finance," by accusing those of us who see single-payer financing as a way out of the immoral and deadly morass in which healthcare is now mired in the United States. We are, she thinks, simply in love with government, and would be in favor of single-payer even if it could be proven that private health insurance could do a better, cheaper, more efficient job — "as long as a substantial population remained uninsured."

What?

Huh?

Megan. How is a system better if it leaves "substantial" numbers uninsured? How could that be cheaper in the long run? How more efficient? You've been reading too much Ayn Rand.

That's like accusing progressives of being against torture, even if it could be proven that torture does a better, cheaper, more effective job — "as long as a substantial amount of the information gathered turned out to be false."

See, the fact is that torture is wrong because it's immoral AND it doesn't work. Same as our private health insurance system.

Megan's argument that single-payer is a way to transfer money from the young and healthy to the old and infirm sounds like a trial balloon from the health insurance industry. Will we learn in a few years that she was lavishly compensated by that industry for this bit of "journalism"?

The fact is that our current system transfers money from the young and healthy to the old and infirm without benefit to the young and healthy. A single-payer system does collect from everyone, but its efficiency and appeal lie in the fact that there is benefit for the young and healthy. They have the security of knowing that if they hit a tree snowboarding next winter, they'll be cared for. They have the satisfaction of knowing that if they're one of the unlucky few who wake up tomorrow morning suddenly transformed by a diagnosis of cancer, suddenly no long one of the healthy but one of the stricken, that their children will continue to have a parent, and they can concentrate on recovery, not the consequences of bankruptcy.

Shame on you, Megan, for working to divide people, to set the young against the old, and suggest to them that their interests are served by turning their backs on others. She complains that liberals have been calling her "evil," but in fact, to work to divide people, one from the other, is an evil action.

First they came for the Socialists, and I did not speak out -
because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out -
because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out -
because I was not a Jew.

Then they came for me - and there was no one left to speak for me.

Shame. We're in this together, Megan. Because it's moral, and because it's what works.