Jerrold Nadler vs The Machine-- What Is Change? Health Care And Air Safety Meet The Republican Party Philosophy

Right wing mindset is far from dead

Yesterday I saw something so horrible on CNN-- an interview with FAA safety inspector Christopher Monteleon about the Colgan Air crash near Buffalo on February 19-- that I haven't been able to get it out of my head. You see, I fly a lot... and after watching the interview, I'm nervous about air safety. I couldn't find the CNN tape and the one below (on Fox) isn't nearly as powerful. What scared me most about the interview, something touched on by this NY Times story as well is that the FAA, Federal Aviation Administration, made it clear that their job was not to protect passengers but to protect the bottom line of the airline companies. This is right in line with what Arianna Huffington reported in her brilliant indictment of the way the Bush Regime governed in Right Is Wrong: How the Lunatic Fringe Hijacked America, Shredded the Constitution, and Made Us All Less Safe.

Since closing down EPA headquarters altogether or turning the Consumer Product Safety Commission's offices into a Home Depot might reveal the radical extent of their plans, the Right embarked upon a sneak attack: put the foxes in charge of the henhouses and let them eat the chickens so gradually that no one would notice. Free markets are inherently self-regulating, the reasoning goes, so why can't businesses be? Irresponsible or incompetent corporate behavior produces poor results and, in turn, a change in management or management strategy. At least that's how it's supposed to work.

Perhaps we should ask the relatives of the 50 people who died as a result of the Colgan Air Flight 3407 crash. They were victims of the Republican Party's philosophy about regulatory agencies-- that their job descriptions had morphed into protecting corporate profits, not to look after the consumers for which their agencies were founded to protect.

Listen to Monteleon's description of what happened when he reported violations of the safety codes to his superiors, who he says were "cozy" with the very folks they were supposed to be regulating. If your hair doesn't stand on end, you've got greater intestinal fortitude than I do.



So what does all this have to do with New York Congressman Jerrold Nadler? Glad you remembered. He's dealing with healthcare today and he wrote an Op-Ed for The Hill about the need for a robust public option. Nadler's one of the smartest, savviest members of Congress I've ever spoken with-- and he's still a true believer. He starts his argument right at the crux-- the difference between progressives and reactionaries, Democrats and Republicans, Blue Dogs and normal Democrats: "The true test of a healthcare system is how effectively and affordably it delivers care, not how profitable it is for business." The statement sounds obvious enough, right? I bet not even ultimate corporate whores like Mitch McConnell or Max Baucus would dare argue against it, at least not publicly.

But how far have we come in the culture of government since January 20? Was the banishment of Bush to Dallas and Cheney to Fox News the end of the Republicans' and their allies' war against American working families? The tenor of the health care debate tells us the answer is no.

Around the country, we see millions of people with inadequate or no coverage, families who go to sleep at night knowing they are one serious illness away from bankruptcy, and rising ranks of the unemployed who face going it alone in the prohibitively expensive individual coverage market-- or worse, going without insurance at all. So, while insurance companies have unabashedly experienced record profits, it is clear that our healthcare system is failing.

Because of the current upside-down approach to healthcare, I have long advocated for a single-payer system, the most effective and least costly way to provide everyone with quality care. Unfortunately, the political winds have drifted away from single-payer.

Today, the road to refocusing our misguided healthcare approach to put patients and doctors, not corporate bottom lines, at the forefront, and ensuring that all of us have access to the health services we need for a price we can afford, runs through a robust and competitive public health insurance option.

The public option must be robust and competitive, and incorporate, at a minimum, the following principles:

• Effective immediately. The public health insurance option cannot merely be a “fallback,” a “trigger,” or some other dubiously named mechanism out in the future. A trigger proposal, like the one in Medicare Part D, will do nothing more than ensure that the public option never happens.

A public plan in name only serves no one. The public health insurance option must be a part of overall reform, and it must have a clear and unambiguous start date.

• Run through a government or independent agency. While it is heartening to hear the insurance industry tout its openness to oversight, merely setting up a marketplace with regulated private insurance options will not bring about the reform we deserve. To achieve true cost savings, create competition in the marketplace, ensure that people are getting the health care they need, and promote transparency in the private insurance market, we must establish an insurance option that is administered by a government agency or some other independent entity. This is the only way to keep private insurers honest.

• Open to anyone. The public plan should be open to everyone, and not reserved only for those without insurance. Consumers should not be limited to the choice of their employers when it comes to their healthcare, and should be able to elect their employer’s private plan or the public insurance option.

• Based on Medicare. There is no reason to reinvent the wheel. Medicare’s existing infrastructure keeps overhead costs low (a miniscule 2 percent compared to private insurers’ 15-30 percent) and spending down (from 1997 to 2006, per-enrollee spending in private insurance grew 59 percent faster than spending in Medicare), and should be available for the public option.

Moreover, to ensure that the public option does not operate at a disadvantage with respect to private insurers, it must be able to use Medicare’s preexisting payment structure and physician base as it transitions to being a self-sufficient plan. And this should not scare providers who know that Medicare is a timely payer who pays in full-- the same cannot be said of private insurers.

• Competitor in the marketplace. The public option should compete in the marketplace like private insurers and should become reliant on collected premiums to cover costs. Similarly, the public plan should be able to use its purchasing power-- for medical services, pharmaceuticals and durable medical equipment-- to establish or negotiate rates the same way private insurers can.

• Instrument for innovation. If deemed necessary by the overseers of the program, the public plan should be able to offer rates to providers that exceed Medicare rates in order to remain competitive and spur use of innovations, such as e-records, medical homes, strengthening home-based care, and implementing cultural competency programs and translation services.

• Accompanied by additional reform measures. A robust public option cannot, on its own, repair our healthcare system or ensure that services are delivered in a more effective or efficient way. In conjunction with the public option, we must establish a baseline of coverage that includes necessary care such as mental health and prevention measures. We must move toward community-based rating, and we must end discrimination against pre-existing conditions, gender and geography by requiring guaranteed issue. We also must do more to support and grow the medical workforce-- from primary care physicians to nurses to home health workers-- because no amount of coverage can do any good if there is no one to deliver quality care.

To some, this plan may seem monumental, impossible even. But President Obama is right that we have a unique opportunity to do something remarkable this year. We have an opportunity to make fundamental changes to the way we view healthcare and deliver services, to implement a robust public health insurance option that puts the patient before the quarterly financial report. That really would be monumental. But, I hope, not impossible.

Nor is it just a liberal from Manhattan's Upper West Side and Greenwich Village who sees the opportunity to address this glaring inequity-- although I am wondering who's going to explain all this to reactionaries and sell-outs like Mary Landrieu, Arlen Specter, Blanche Lincoln and Ben Nelson. Take a look at this short clip of Oregon's pro-family senator, Jeff Merkley, addressing this last night on the Senate floor: