Monday, September 28, 2009
Here's the problem. Everybody (or most everybody) agrees that insurance companies need an incentive to decrease premium prices and to stop increasing them at a rate faster than the rate of inflation. Our small group insurance has increased over 100% in the past four years. The average rate-hike over the past year was just under 6%, but Anthem Blue Cross in Connecticut just tried to increase individual rates up to 30% -- the state made them decrease to "only" 20%, which is still ridiculous. If health care reform is going to work -- and if subsidies for the middle class aren't going to increase by at least 6% every year -- there needs to be some mechanism for controlling premium prices.
There are two basic public option proposals. Both of them would create a publicly run plan that would stand beside all of the commercial insurance plans as an option for people who are uninsured. Because the administrative costs of a public option are expected to be far lower than the administrative costs of private plans, it is anticipated that the public option would create competition with private plans, thereby driving down premium costs.
The two public option proposals are very similar. One would set provider reimbursement rates at Medicare plus 5%; the other would have the plan negotiate reimbursement rates (the rate at which the insurance plan pays the doctor, hospital, labs, imaging vendors, etc.). The Medicare plus 5% option saves $85 billion more than the negotiated rate option, which saves about $25 billion over not having any public option.
There is a third public option proposal known as "public option with a trigger," favored by moderate Republican Olympia Snowe. This option, which may or may not be debated by the Finance Committee, would create a public option that would not be invoked unless private insurers weren't offering "affordable" plans, with "affordable" most likely being defined as a percentage of gross income of the middle class -- somewhere around 10-12% of income.
So why do people oppose a public option? They believe it's the first step towards "socialized medicine." The theory is that people will quit their current plan, and employers will stop offering insurance, and people will flock to the public option, so the public option will grow until it's the largest plan around. Personally, I suspect there will be some of that, but people (like me) are scared to death of changing their health insurance if what they have is good, so I think there will be less of this than the critics thing. But still, it's probably true that the public option will grow over time.
I just don't have a problem with that. If Medicare -- the public plan for the elderly and disabled -- is good enough for them, then why can't the rest of us have a public plan, too? Yes, it grows government. But if it really does create long lines or less efficiency, then people will flock back to the private insurance options. As long as there's choice, I fail to see the problem.
As for the trigger, liberals don't trust triggers to be pulled. There's a trigger in Medicare Part D (drug benefit) that should have been pulled a long time ago, but hasn't been. So, the argument goes, a public option with a trigger is really no public option at all. Conservatives oppose any form of public option, including one with a trigger, for the reasons already stated above.
The issue with the reimbursement rates are pretty much the same. Conservatives want the public option to have to compete with private insurance, and that means they have to negotiate rates the same as private insurance companies. Seems to me that saving an additional $85 billion is more important. But I don't have a strong feeling about this piece of it.
And that's what you can expect to be hearing about this week.
There's one other option that I think you'll hear about -- choice for all, meaning even employees of large companies that provide insurance for their employees will have the right to switch plans. The current Finance Committee proposal only puts individuals and small employers in the "exchange," where they can shop for a plan. Congressman Ron Wyden and others want everybody to have a choice. That may come up this week, too.
Meanwhile, the two Senate drafts are already being consolidated. Of course, that process can't be finalized until the Finance Committee passes whatever it ends up with, but the leadership is starting to look at ways to combine the two -- one with a public option and one presumably (for the moment) without it.
That's where we are today. I'll continue to update you as best I can. Jennifer
Friday, September 25, 2009
Wednesday, September 23, 2009
The long-awaited draft from the Senate Finance Committee was released and it's already been amended in some important ways. But there still are real problems created by the desire to find ways to pay for covering the uninsured and providing subsidies and tax credits to the middle class that make it hard to get excited about this.
There are no pre-existing condition exclusions, and there's an insurance "exchange" or marketplace for individual and small group plans where people can go and compare and choose coverage. Policies sold through the exchange can't have annual or lifetime caps, but policies NOT sold through the exchange -- meaning large group plans -- CAN still have caps as long as they are not unreasonable. That's useless and a cop out.
There's an individual mandate, which is going to be part of any plan. The insurance companies only agreed to take on people with pre-existing condition if they get the benefit of everybody being required to have insurance so the healthy people balance out the sick ones. But this draft has monetary penalties on people who don't buy insurance, and insurance is allowed to cost as much as 12% of income for people earning 300% of the federal poverty level -- around $40,000. That's down from 13% in last week's draft, but it's still too high. The penalties are down to $1900 for a family that doesn't buy insurance, but that's also still hefty since it's most likely that a family that doesn't buy insurance will make that decision based on finances.
In addition, so-called "Cadillac plans" will be taxed heavily. The current draft says any amount over $8750 for an individual will be taxed to the insurer at 40%! That means either the insurer will pass the cost onto the insurer or these plans won't be available. I have what they think of as a Cadillac plan. I have no deductible, very small co-pays, but a very high premium of $1000 per month. It's a plan that the insurer is required to offer to nonprofits in Connecticut. So people like me can expect to have to pay up to a $2000 deductible (that's the limit in the current draft), much higher copays -- and the real question is whether my premiums really will be lower. Since there's no public option to compete with private insurers, the private insurers have no incentive to bring premiums down to anything less than 12% of salary. Of course, 12% of my salary makes the plan a Cadillac plan, so go figure how that's going to work out.
There's no public option, but there is the creation of nonprofit co-ops that will be owned and governed by members. There currently is debate over whether the co-ops should be allowed to negotiate rates with providers or, instead, whether the rates should be tied to Medicare rates -- something the doctors and other health care providers are very much against because Medicare rates are lower than private insurance rates. The question is whether co-ops are really viable.
Today's draft has a $2000 cap on deductibles, but unlike the other drafts out there, there is no cap on out-of-pocket expenses, so this version would not eliminate catastrophic losses for patients.
It's important to understand where we are in the process. The Senate HELP Committee already has voted out a bill with a public option, lower premiums and out-of-pocket expenses. Since the Senate Finance bill -- which will change all day every day for the next several days -- and the Senate HELP bill will be vastly different, the Senate will then have to come up with a single bill to be voted on by the whole Senate. The Senate Majority Leader Harry Reid will exert some very real control over that process. The only truly engaged Republican, Olympia Snowe of Maine, has been advocating for a public option with a trigger, meaning that there would be the THREAT of a public option if private insurance wasn't sufficiently affordable. That, she believes, would be a better incentive on insurers to keep premiums down. Her idea may well be a middle ground between a public option without a trigger and co-ops. We'll have to wait and see.
Once there is one Senate bill, there will be floor debate, and here's where the Republicans have some muscle. They can filibuster -- dragging out debate and precluding a vote on the merits -- unless the Democrats invoke "cloture," which means an end to debate and time for a vote. The catch is that the Democrats need 60 votes to invoke cloture. Right now, they have 59 Democrats in the Senate, with Senator Kennedy's seat open. However, the Massachusetts legislature has passed legislation that would allow the Governor to appoint someone to that seat immediately, until the special election in January. Governor Deval Patrick definitely will appoint a Democrat, giving the Democrats 60 votes. But will the conservative Democrats who oppose the merits of the Senate bill stick together to get to cloture? If so, then the Democrats just need a majority to pass the bill.
The House of Representatives has to do the same sort of thing, although there are no rules about filibusters and cloture, so getting to a vote will be easier. Speaker Nancy Pelosi will reconcile the House bills that already have passed committee -- all of which have a public option -- and then there will be a House vote. The Democrats have a much wider margin in the House, so Speaker Pelosi should be able to get her bill passed.
Then comes the real negotiating in what's called the Conference Committee -- all of this other stuff has just been a prelude. The House and Senate bills will be substantially different, with the House bill being far more expensive and, if the President holds tight to his pledge to keep reform deficit neutral, the Senate bill being much closer to reality, and much less generous, as well. The big question: Will there be a public option? Your guess is as good as mine.
One more point. The exchange is NOT a public option -- these are two completely different ideas. The exchange is a place where all of the available policies can be posted for people to be able to compare and select a plan. All of the versions have a minimum benefits package, but there will be "premium" plans that are somewhat more generous for more money. Consumers will be able to shop for health insurance in a way that they never have been able to do before.
The public option would be a plan just like any other insurance plan except run by the government. So the public option would be one of the plans listed in the exchange that consumers could choose if they wish.
That's it for today. Stay tuned. Jennifer
Monday, September 21, 2009
Pearl Jam's new CD Backspacer was released yesterday, although my copy came in Thursday's mail, so I got a little jump on it. Wow! It's fabulous -- high energy for the most part, with a gorgeous Just Breathe reminiscent of the Into the Wild soundtrack, and a new anthem, Amongst the Waves, that I dare you to try NOT to sing along to!
Why does my excitement about a rock album belong here? Pearl Jam announced last Friday that part of the proceeds of its tour starting tonight will go to the Vitalogy Foundation, to be distributed to a number of charities. My friend and Pearl Jam guitarist Mike McCready chose Advocacy for Patients with Chronic Illness and our new partner, Lybba, a brilliant website (not yet live -- I promise to tell you when it is), the brainchild of the inspired and inspiring Jesse Dylan. Yup, I got Pearl Jam, Mike McCready, and Jesse Dylan in one sentence!!!!
THANK YOU MIKE!!!!!!!!!! You'll keep our doors open a little longer.
Enjoy the video, friends! Jennifer
Thursday, September 17, 2009
From the Huffington Post here:
Insurance Company Must Pay $10 Million For Revoking Policy of Teen with HIV
The South Carolina Supreme Court has ordered an insurance company to pay $10 million for wrongly revoking the insurance policy of a 17-year-old college student after he tested positive for HIV. The court called the 2002 decision by the insurance company "reprehensible."
That's the most an insurance company has ever been ordered to pay in a case involving the practice known as rescission, in which insurance companies retroactively cancel coverage for policyholders based on alleged misstatements - sometimes right after diagnoses of life-threatening diseases.
The ruling emerges from a conservative Southern state with one of the most pro-business climates in the country. And it comes as progressive Democrats on Capitol Hill are pressing for health care reforms, such as a public insurance option, that reflect wariness about the private insurance industry's motives.
The Supreme Court on Monday upheld a lower court's verdict against Fortis Insurance, now known as Assurant. The trial jury had awarded the former college student, Jerome Mitchell, $15 million in punitive damages; the Supreme Court reduced that amount by $5 million.
Mitchell learned that he had HIV when, while heading to college, he donated blood. Fortis then rescinded his coverage, citing what turned out to be an erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy.
Before the cancellation of the policy, an underwriter working for Fortis wrote to a committee considering whether or not to rescind his policy: "Technically, we do not have the results of the HIV tests. This is the only entry in the medical records regarding HIV status. Is it sufficient?" The underwriter's concerns were ignored and the rescission went forward.
In the ruling, Chief Justice Jean Hoefer wrote: "We find ample support in the record that Fortis' conduct was reprehensible ... Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
An investigation this summer by the House Energy and Commerce Committee, and earlier ones by state regulators in California, New York and Connecticut, found that thousands of vulnerable and seriously ill policyholders have had their coverage canceled by many of the nation's largest insurance companies without any legal basis. The congressional committee found that three insurance companies alone made at least $300 million over five years from rescission. One of those three companies was Assurant.
In Febuary 2008, a private arbitration judge in Los Angeles ordered Health Net Inc. to pay more than $9 million to a breast cancer patient whose health insurance it revoked shortly after her diagnosis and while she was undergoing chemotherapy. The plaintiff in that case, Patsy Bates, a then-52-year-old grandmother and hair-salon owner, was unable to continue her chemotherapy for several months.
During the case, evidence emerged that Health Net had paid bonuses to employees to reward them based on the number of policyholders they had rescinded. The judge who awarded Bates the $9 million said in his decision: "It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive."
William Shernoff, the attorney who represented Bates, said in an interview Wednesday that he was not unhappy that there was a new verdict larger than the one he won for Bates. "I am glad to see that the courts in other parts of the country are coming down hard on this reprehensible practice of dumping sick patients," he said. "It has been a practice going on decades, is widespread, and ruins lives."
Shernoff currently said he has more than 100 pending cases against California insurance companies on behalf of patients he alleges were wrongly rescinded. He said he has already settled about 90 similar cases over the last three years.
President Obama cited other cases of rescission in his recent speech before a joint session of Congress as a major reason that health reform is necessary.
Obama cited the case of a retired Texas nurse, Robin Beaton, who had her heath insurance canceled by her insurance company as she was about to undergo breast cancer surgery. As a result, Beaton had to delay her surgery for five months. In the interim, the size of the mass of her tumor had grown from 2 centimeters to 7 centimeters, greatly reducing her chances of survival.
A "woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne," the President asserted in his speech, "By the time she had insurance reinstated, her breast cancer more then doubled in size. This is heart breaking. It is wrong. And no one should be treated that way in the United States of America."
Obama wasn't exactly correct in his telling of Beaton's ordeal. Beaton's insurance was canceled because a doctor wrote that she potentially had a precancerous lesion on her face. Further investigation showed that she instead had acne. But even after her physicians pointed out the error, her insurance remained rescinded. Only with the help of her congressman, was she able to pressure her insurance company to pay for her breast cancer surgery--five months later.
And, of course, Puff.
Mary died yesterday. Thankfully, I saw them a couple of years ago at her first show after undergoing treatment for leukemia. Her long hair was short, just coming back from being lost to chemo. She sounded as wonderful as ever, and the three of them were so happy to be together.
There's been a lot of loss lately, it seems. I cried for days over the loss of Ted Kennedy, and now I cry again, as it sinks in that I have heard those three voices together for the last time.
Thank you, Mary, for making my spirit sing. Jennifer
For Peter and Paul's remembrances, and some wonderful photos, go here.
Tuesday, September 15, 2009
NONE of the proposals for health insurance reform amounts to a government take-over. What they're calling the Exchange or Gateway is a web-based marketplace where all insurers -- all PRIVATE insurers, plus a public alternative if one is offered -- will, for lack of a better word, "advertise" their offerings so consumers can see what plans are available, what they cover, and what they cost. If you've ever tried shopping for health insurance, you know that it's almost impossible to get quotes and find out what all of your options are. The Exchange would allow you to do that.
No government take-over. Just a marketplace.
And the public option would be just that -- an option. There would be all the private insurance plans, and alongside them would be a publicly run plan. Nobody would have to sign up for it. Indeed, President Obama last week said only the uninsured would be eligible for it. Nobody would HAVE to select it -- it would simply be a choice. If you think it's a bad idea, then leave it alone, choose a private plan.
But again, no government take-over. Just an option.
I'm tired of explaining this over and over again, but people don't believe it because they've been sold such hooey by people they're supposed to be able to trust -- elected officials who publicly accuse the President of the United States of lying when it's they who are lying. Elected officials who take hundreds of thousands of dollars from the health care industry in exchange for which they chant the mantra "government take-over, government take-over."
And I'm so very sad that it seems to be working. The public option is all but dead. It can't pass the Senate without Senator Kennedy's vote, and without every other Democrat. And there are plenty of scared Democrats -- scared because people are believing the lies, "government take-over, government take-over."
Don't fool yourself into thinking for one minute that government doesn't already regulate insurance. Individual plans and group insurance plans that are not what's called "self-funded" -- which means the vast majority of plans in the United States -- are regulated by state law. The only difference here is that the regulations being discussed in Congress would be federal instead of state. What would those regulations do? Things even the staunchest of Republicans can't oppose -- elimination of pre-existing condition exclusions, lifetime caps, and the ability of insurers to cancel policies when a person gets sick based on some made-up nonsense about a previously undisclosed pre-existing condition, like the nurse who testified before Congress that she got cancer and her insurance was canceled because of a previously undisclosed case of acne. Yes, acne.
I'm sad that the lies have had their intended effect of killing a public option. Why does a public option matter so much? In the four years since Advocacy for Patients was founded, our insurance has gone up more than 100%. Yup, more than 100%. What makes anybody think these runaway prices are going to end if the insurance companies face no competition? What incentive will there be to lower the cost of premiums? Because I'll tell you where we're going without a public option -- everybody will be required to have insurance, but insurance will continue to cost $1000 per person per month, as it does for our group plan, making it impossible for us to even consider hiring more staff. This will be a catastrophe, with families being fined for not having insurance when there is no affordable insurance for them to buy.
And so I'm scared. The special interests are winning the day. They are eliminating competition, and so doing nothing to control premium prices. They are now so focused on making sure no illegal immigrant gets a penny's help, and no abortion gets a penny's subsidy, that they have taken their eye off the ball and forgotten that the goal was to provide universal, affordable, portable, and comprehensive insurance for everyone. A disgusting outburst from a member of Congress and the Senate Finance Committee spends days crafting provisions to make sure the new system is airtight -- do we really think it's more important to make sure illegal immigrants are shut out than it is to make sure that we get what we need?
I've been saying the same thing over and over. I write about health care reform in our e-newsletter, correcting the outright lies, and people actually unsubscribe at a rate higher than when I write about anything else. People don't want to hear the truth. Or they assume I'm the one who's lying -- after all, would an elected official really lie to them? I suppose, according to at least one member of Congress, only the President is capable of lying, eh?
I'm tired of having to say the same things over and over. I'm very sad that people are buying into the complete fictions that are being put out there. And I'm scared to death of what happens when the lies drive the outcome and we get either a lousy bill or nothing at all. A lousy bill that people will blame on the President, on those who advocated for real change, on people like me.
I hope these blog posts are archived for a long time. I don't want to have to say I told you so, but it looks like too many of you aren't leaving me much of a choice. Jennifer
From Huffington Post here:
When Getting Beaten by Your Husband Is a Pre-Existing Condition
With the White House zeroing in on the insurance-industry practice of discriminating against clients based on pre-existing conditions, administration allies are calling attention to how broadly insurers interpret the term to maximize profits.
It turns out that in eight states, plus the District of Columbia, getting beaten up by your spouse is a pre-existing condition.
Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you're more likely to get beaten again than the average person and are therefore more expensive to insure.
In human terms, it's a second punishment for a victim of domestic violence.
In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.
All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill. A spokesman for Enzi didn't immediately return a call from Huffington Post.
At the time, Enzi defended his vote by saying that such regulations could increase the price of insurance and make it out of reach for more people. "If you have no insurance, it doesn't matter what services are mandated by the state," he said, according to a CQ Today item from March 15th, 2006.
Robert Zirkelbach, a spokesman for an insurance industry trade group, America's Health Insurance Plans (AHIP), said that the National Association of Insurance Commissioners (NAIC) has proposed ending the discrimination. "The NAIC has a model on this that we strongly supported. That model bans the use of a person's status as a victim of domestic violence in making a decision on coverage," he said.
During the last health care reform push, in 1993 and 1994, the industry similarly promised to end discrimination against people with pre-existing conditions.
Murray pushed to include the domestic violence concern in this year's comprehensive health care bill. "Senator Murray continues to believe that victims of domestic violence should not be punished for the crimes of their abusers. That is why she worked to include language in the Senate HELP Committee's health insurance reform bill that would ban this discriminatory and harmful insurance company practice," said spokesman Eli Zupnick.
In 1994, then-Rep. Charles Schumer (D-N.Y.), now a member of Senate leadership, had his staff survey 16 insurance companies. He found that eight would not write health, life or disability policies for women who have been abused. In 1995, the Boston Globe found that Nationwide, Allstate, State Farm, Aetna, Metropolitan Life, The Equitable Companies, First Colony Life, The Prudential and the Principal Financial Group had all either canceled or denied coverage to women who'd been beaten.
The Service Employees International Union asked members to write letters to Congress regarding the exclusion and have quickly generated hundreds, says an SEIU spokeswoman.
The relevant provision:
SEC. 2706. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
'(a) IN GENERAL.--A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(1) Health status.
(2) Medical condition (including both physical and mental illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
(8) Disability.(9) Any other health status-related factor determined appropriate by the Secretary.
Monday, September 14, 2009
And if you missed yours truly on weblog this afternoon, the programs are all archived at the webinars page.
Really, folks -- this is an amazing collection of information and experience. Don't miss it. Jennifer
Tell me we don't need health care reform. Jennifer
Thursday, September 10, 2009
From Kaiser Health News:
When President Barack Obama pledged that health reform would be deficit-neutral, he offered an idea advanced in June by two Democratic health care economists — a "failsafe" — as a way to hold the government accountable. If health reforms do not generate the projected savings, specific spending cuts would 'kick in' to make up the difference.
That failsafe approach (.pdf) was developed by David Cutler, an economist at Harvard University, and Judy Feder, a senior fellow at the Center for American Progress, a liberal think tank. Under such an approach, legislation would require that deeper spending reductions, including limits to Medicare payments and other public subsidies, would begin if projected savings didn't keep health care costs on track to not add to the deficit.
In his speech to a joint session of Congress, Obama didn’t detail the specific funding sources, saying only “there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize."
Feder and Cutler outlined the way they would implement the failsafe during a Thursday afternoon conference call with reporters.
It could start as soon as 2015, they said, would have to be specific enough that the Congressional Budget Office could calculate its costs and could include reducing Medicare and Medicaid payments. It could also include changing tax policy and strengthening a public plan — one of the more controversial elements of the reforms Obama supports — to pressure the insurance industry to change its costs.
But in terms of the costs of sweeping reforms, Cutler said more than $900 billion — enough to pay for all of Obama's overhaul plan — could come from revising the administrative structure of hospitals and doctor's offices, getting rid of underwriting and marketing overhead and reducing acute care episodes and hospital readmissions through preventive and better-focused care. Those savings are in addition to the $500 billion to $600 billion in cost reductions to public programs already calculated, Cutler said.
"In the first decade what we need to do is make it be deficit neutral," Cutler said. "But beyond that, health care reform, even covering people has to contribute to reducing the deficit."
What's unclear is just who will make these cuts, although some experts have suggested that the Medicare Payment Advisory Commission could make the cuts under new powers it may be given to reform payment structures as part of the health care overhaul.
Cutler said that since little is done to empower or offer incentives for specific cost savings by medical care providers and hospitals, many people are discouraged by current reform proposals.
"I think the bills have gotten a bad rap in that people say, 'Oh, they don't have anything in there so, therefore, they clearly won't lead to (cost savings),'" Cutler said.
Spreading risk will be important to holding costs down, either through a national high risk pool of the insured or by using Republican Sen. John McCain's idea of doing high risk pools on a state-by-state basis, the analysts said.
"What the president is saying is 'Look, we need to do something right away,' and this is the thing right away, but that cannot be the end of it," Cutler said.
President Obama spoke with a passion that was necessary. Reading part of the letter from Senator Kennedy (see below) firmly placed him in favor of universal healthcare, and he said he strongly favors a public option. He didn't draw a line in the sand and promise to veto a bill that doesn't have one, but he explained, clearly, the need for something to compete with private insurers so that they stop increasing premiums at a rate of 20% or more each year.
He dispelled some of the main LIES that have been circulated to deliberately distort the reform process -- there never were "death panels"; none of the proposals would cover illegal immigrants; and no federal funding would be used to pay for abortions.
"'I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it,' Obama said. 'I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time.'"In addition, he clearly explained the public option as an option, to stand beside the private insurance options. Indeed, he said the public option would only be available to the uninsured who can't afford other choices. This is not a government take-over of the health care system, he said.
And he reminded us that the cost of providing health insurance to all Americans is LESS than the cost of the Iraq and Afghan wars. It's also less than the cost of the Bush tax cuts, which benefit only the wealthiest of Americans.
He adopted John McCain's idea of an immediate safety net, affordable, catastrophic coverage for people with pre-existing conditions until the public option is up and running. He even came out in favor of malpractice reform, another Republican idea.
But mostly, he made it clear that this IS going to happen. It is going to happen NOW. As he said, he will be the last President to fight the fight for universal healthcare because it WILL happen this year.
I hope the American people watched and listened. (And by the way, I hope the ratings for "So You Think You Can Dance?" on the FOX News channel were lousy. I'll never understand how what's supposed to be a major network can broadcast a reality show instead of an historic Presidential speech to a joint session of Congress.)
I have a lot more hope today than I did yesterday. The President is engaged. He is determined to get this done. He is prepared to lay his reputation, his Presidency, on the line for this. He will not tolerate the lies. He will not stand idly by as people try to kill reform just for the sake of killing it rather than improving the ideas that are on the table. He insists that we be the America of ideals, a country that does not simply toss our sick aside and ignore them. We must rise up as a nation and do the right thing.
“I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history’s test."I'm prepared to follow his lead. Jennifer
Below is the text of the letter from Senator Edward M. Kennedy referenced by the President in tonight's address to a Joint Session ...
I wanted to write a few final words to you to express my gratitude for your repeated personal kindnesses to me - and one last time, to salute your leadership in giving our country back its future and its truth.
On a personal level, you and Michelle reached out to Vicki, to our family and me in so many different ways. You helped to make these difficult months a happy time in my life.
You also made it a time of hope for me and for our country.
When I thought of all the years, all the battles, and all the memories of my long public life, I felt confident in these closing days that while I will not be there when it happens, you will be the President who at long last signs into law the health care reform that is the great unfinished business of our society. For me, this cause stretched across decades; it has been disappointed, but never finally defeated. It was the cause of my life. And in the past year, the prospect of victory sustained me-and the work of achieving it summoned my energy and determination.
There will be struggles - there always have been - and they are already underway again. But as we moved forward in these months, I learned that you will not yield to calls to retreat - that you will stay with the cause until it is won. I saw your conviction that the time is now and witnessed your unwavering commitment and understanding that health care is a decisive issue for our future prosperity. But you have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.
And so because of your vision and resolve, I came to believe that soon, very soon, affordable health coverage will be available to all, in an America where the state of a family's health will never again depend on the amount of a family's wealth. And while I will not see the victory, I was able to look forward and know that we will - yes, we will - fulfill the promise of health care in America as a right and not a privilege.
In closing, let me say again how proud I was to be part of your campaign- and proud as well to play a part in the early months of a new era of high purpose and achievement. I entered public life with a young President who inspired a generation and the world. It gives me great hope that as I leave, another young President inspires another generation and once more on America's behalf inspires the entire world.
So, I wrote this to thank you one last time as a friend- and to stand with you one last time for change and the America we can become.
At the Denver Convention where you were nominated, I said the dream lives on.
And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.
With deep respect and abiding affection,
But the heckling during last night's speech by the President has me fuming. How dare Rep. Joe Wilson (R-SC) yell out during a speech by the President of the United States "YOU LIE" in the great Chamber of the Congress of the United States? How dare he? No apology makes up for the disrespect he showed the President of the United States.
When "we can no longer even engage in a civil conversation with each other over the things that truly matter," Obama said, "we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves."I'm just going to say it. What has been going on over the past several months, calling the President awful names, painting a Hitler mustache on his picture, OUTRIGHT LYING about the health reform proposals, and accusing the President of indoctrinating school children -- actually keeping children from hearing a speech that even Newt Gingrich said should be required for all school children -- and this heckle, this name-calling, on the Floor of the US Congress, well, in my view, this doesn't happen to a white President. This is racist.
I believe that the summer shouters and name-callers were among the people who want to believe that the President wasn't really born in the United States (known as "birthers"). I believe that these folks were freaked out by having an African-American President in the first place, and they are looking for ways to twist and distort to undermine him. They believe he is Muslim although he has attended Christian churches for his entire adults life. They believe he is a communist even though he hasn't given them ONE reason to say that. They LIE about death panels that absolutely never existed in any draft of the legislation. They have spread LIES that have caused fear among senior citizens with NO REGARD WHATSOEVER for the truth. They made a huge to-do about the speech to school children -- the same sort of speech that has been given by both Presidents Bush and President Clinton -- that it was communist indoctrination!
And today, there are comments on Politico and other sites saying he's a communist. He's a liar. He should resign. Because he wants to make sure most people in the United States have access to health care? Really?
Disagreement does not give a member of the Congress of the United States the idea that heckling the President, calling him a liar, is acceptable behavior. Honest differences of opinion don't lead to Hitler mustaches.
Let me be VERY clear. I will debate health reform with anybody on the merits. I respect the right of people to disagree. I also respect the fact that not everybody is going to take the time to read the bills and look for the death panel language that's not there, or see that there's no coverage of illegal immigrants, and no federal funding of abortions. I'm willing to take the time and find you the language of the bills that show that these are flat-out lies. And I'll debate whether we should have a public option (a choice, not a government take-over) with anybody who's inclined to want to have an honest conversation.
But if you are a member of Congress, you are obligated to read the bills. You must know it's a lie that they would cover illegal immigrants. And even if you don't, you must know that it is nothing short of outrageous to call the President a liar during a session of Congress.
The lines of decency have shifted for this President. And yes, I believe it is fueled by racism. Let me be very clear again -- I do NOT believe that everybody who opposes health care reform is a racist -- not by a long shot. That is not what I'm saying. What I'm saying is that there are people in this country who still can't get over the fact that we have an African-American President. They think they have a right to challenge his birthplace even after being presented with a certified birth certificate from the State of Hawaii. They think they can call him anything from Hitler to communist, knowing it's just not true. They scare parents into thinking he is indoctrinating their children. And they call him a liar when it's they who are lying.
I simply do not believe this sort of attack -- this sort of slanderous, false, malicious, fear-mongering -- would happen to a white President. Jennifer
Wednesday, September 9, 2009
EXCERPTS OF THE PRESIDENT’S ADDRESS TO A JOINT SESSION OF CONGRESS TONIGHT:
I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.
Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.
During that time, we have seen Washington at its best and its worst.
We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.
But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.
Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.
The plan I’m announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it’s a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans – and yes, from some of my opponents in both the primary and general election.
Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.
What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
That’s what Americans who have health insurance can expect from this plan – more security and stability.
Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we’ve given ourselves.
This is the plan I’m proposing. It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.
That is why we cannot fail. Because there are too many Americans counting on us to succeed – the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.
Tuesday, September 8, 2009
Thursday, September 3, 2009
What will the President prescribe?
As I've been saying all along, parts of this are pretty much a done deal:
- No pre-existing condition exclusions
- No policy cancellations because of illness
- No premium increases based on illness
- No lifetime caps
- Insurers can sell across state lines
- Individuals will be required to have insurance (an individual mandate)
- There will be subsidies for individuals who can't afford insurance
- There will be a centralized, web-based marketplace where people can review their options and make decisions about what plan to choose
- Something will be done to plug up the Medicare drug benefit "doughnut hole"
- Private insurers who administer Medicare Advantage Plans will lose their subsidy (and no, this shouldn't mean they'll cut back on benefits -- indeed, they already deny coverage of things that traditional Medicare covers -- so if you're nervous about this, switch to traditional Medicare and your problem is solved)
- There will be incentives for people to seek preventive care
There are a bunch of other, narrow provisions that I think will not be controversial. In the end, I suspect there will be a minimum that insurers have to cover -- hospital, doctor, prescription drugs, etc. -- things like that.
So what's left? The public option.
First, let me say AGAIN that this is NOT a government take-over of insurance. There would be choice -- you could buy United Healthcare or Blue Cross or Aetna or other private plans OR you could buy the public option. The reason people think this is important is that a public option will have lower administrative costs (no huge salaries for executives, for one), so by setting up this lower cost competitor to the private insurers, the hope is that we will drive the private insurers to lower their premium rates, as well. After all, if we're going to have an individual mandate, we have to have subsidies, and to keep the subsidies affordable, we have to keep premiums as low as possible. And for all of us who have insurance now, there has to be an end to these 25% premium rate increases every year or eventually, most people no longer will be able to afford insurance.
So if you're opposed to a public option, then my question to you is how are you going to force insurance companies to lower their premiums?
I posed this question to Senator Lieberman's office, and his answer was insurance market reforms -- like the bullets above -- and an individual mandate so you broaden the pool, spreading the risk over more people. The insurance market reforms are great, but they don't bring down cost. If anything, they increase it because people with pre-existing condition will have to be covered, and they tend to be expensive. And spreading the risk over more people may help a bit -- if a bunch of healthy young people are forced to buy insurance they didn't think they needed, that should bring down the costs somewhat because those people will pay the same as others, but cost the insurance companies less. However, you're also going to be covering people with pre-existing conditions, and they are expensive. So broadening the pool is not likely to do a whole lot to decrease premiums.
People oppose a government option because it will cost the government money. Yes, it will, although you'd be BUYING the government option -- it wouldn't be free. People oppose a government option because it means government-run healthcare and they think that's a bad thing. Setting aside the fact that countries with government-run healthcare really aren't as miserable as some would like us to think -- Germany, France, Netherlands don't have long lines and so on -- we already have government-run healthcare in the form of Medicare, VA, military, and prisoners health care. So it's not a huge leap to adding another government-run plan. And people oppose a government option because they are opposed to big government. When the private sector doesn't price itself into extinction, forcing more and more employers and individuals to drop their insurance, this argument may have more weight. But where the private sector fails in an area as important as health care, it's not unreasonable to look to government to step in.
There's talk about co-ops as an alternative. Nobody -- including the people proposing this -- can tell you how they would work though. There's talk about a public option that would be triggered at some point down the road if other attempts to reduce costs failed. Why wait when the private market already has failed?
On the other hand, if the only way to get EVERYTHING else is to give up a public option, what should the President do?
Here, I ask: What would Senator Kennedy have done? He was a master at compromise, a believer in incrementalism. He'd have pushed for a public option, held a vote, let it fail in the Senate -- and then he would have found a way to compromise.
Perhaps caps on the percentage that premiums could increase each year. Perhaps caps on the percentage of premium dollars that could go to administrative costs, so we force insurers to scale back their expensive executive bonuses. With all the really smart people working on this, you have to believe that they can think of at least as many things as I can -- after all, I'm not an accountant, actuary, or policy wonk. If this is what it takes to get people covered, then I say we give it a try and revisit it later.
The Americans with Disabilities Act 2008 amendments are a good example. They passed the Act. They saw how it worked for awhile, how the courts would interpret it, how the government would enforce it. They saw there wasn't enough back-bone, so Congress reversed some of the limiting court decisions and clarified some of the language. The same could happen in health care -- if it's imperfect, it can always be fixed down the road.
But I'm not in favor of sacrificing what we can get because it's not perfect. I think a public option is the way to go. I think it's the best way to make insurance companies decrease premiums. I think we'll be sorry if we don't have a public option because lowering the costs won't happen without it. That's why the insurance companies are saying they're in favor of reform -- they get all these new healthy insureds because of the mandate -- but against a public option. I sort of feel like I should be in favor of anything they should be against.
Still, though, if giving that up (for now) is what it would cost to get everything else, let's make a deal and get this done. Now. Jennifer
Wednesday, September 2, 2009
And so I muse, happily, peacefully. Until . . . crack!
Oh, no. A filling. My teeth are really difficult. Between all the medication I take and the fact that my mouth is dry so much of the time because I'm constantly dehydrated, I get a lot of fillings. And sometimes the fillings get so big that a filling isn't enough. Root canals and crowns are their own challenge. I'm still fighting off a Crohn's flare that started last February with an infection after a root canal, antibiotics, c-difficile, more antibiotics . . . a six month ordeal and counting.
But I call the dentist and get an appointment for this morning. And so I return to musing, happily, peacefully. Until . . . clunk!
The flushing mechanism in my toilet breaks. MY toilet. The one I use 20 times a day. The one that's three steps from my office -- close enough to get there in an emergency. Yes, I have other toilets, but none as close. None that flushes quite as well. I have a plumber. The last time I called him, though, he never returned the call. I go to swim and ask my friend Lynn -- who knows absolutely everybody -- for the name of a plumber in case I need a back-up. She comes through, and so I have a plan.
I call the plumber. He answers and says he'll be here around 9 am. Fabulous. And so I return to musing, happily, peacefully. Until . . .
Lynn says these things come in three's. I've heard that before. So I'm ready for you, Fate. You're going to deal me one more relatively small but urgent blow. And then you're going to move onto the next person. As long as I know it's going to be a relatively small problem -- a cracked filling, a toilet flusher -- I can handle whatever comes.
See, we with chronic illnesses always live waiting for the other shoe to drop, don't we? An emergency is an intestinal obstruction, not a cracked filling. Vomiting is something to be alarmed about, not a broken toilet. Even a broken toilet that belongs to a Crohn's patient.
So today, I count myself lucky. Because it could always be worse. Jennifer