If We Had A Real President...

If we had a real president in the White House, instead of a grifter pretending to be a clown, he would have announced that his party has tried and failed to repeal the Affordable Care Act and that the next step is to have the Republicans and the Democrats sit down together and figure out-- for the good of the country-- a nonpartisan/non-ideological approach (based on Trump's own campaign promises) for fixing the problems in the ACA. Instead, Trump lamely tried blaming the Democrats for his own party being unable get its huge congressional majority to even take up the bill they had spent 7 years "working" on. So rather than opting for something vaguely presidential, he sent out this mean-spirited and destructive tweet Saturday morning:

Ted Lieu (D-CA), one of the most effective and consistent voices of the congressional resistance, responded angrily at the implied threat-- and in kind:

People are worried-- rightfully so-- that Trump and Ryan will now go on an orgy of recriminations against people who get medical treatment based on the Affordable Care Act. They are committed to causing it to crash and burn and they can do tremendous damage-- as they already have. In fact, on Wednesday, even before their own TrumpCare bill went down in flames, Thom Hartmann, writing for Alternet, noted that the GOP has been sabotaging the Affordable Care Act even before Trump was sworn in.

When the ACA was rolled out, telling insurance companies that they had to insure anybody who signed up, regardless of previous conditions or sickness, everybody realized that the insurance companies would probably lose money in the first decade or so, until previously-uninsured-but-sick people got into the system, got better, and things evened out.

To get the insurance companies to go along with this danger of losing money, the ACA promised to make them whole for any losses in any of the first decade’s years.  At the end of each fiscal year, the insurance companies merely had to document their losses, and the government would reimburse them out of ACA funds provided for by the law.

The possibility of their losing money was referred to as the “risk corridor,” and the ACA explicitly filled those risk corridors with a guarantee of making the insurance companies, at the very least, whole.

And then something happened. As the NY Times noted on December 9, 2015, “A little-noticed health care provision slipped into a giant spending law last year has tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama’s signature health law.”

Rubio and a number of other Republicans had succeeded in gutting the risk corridors. The result was that, just in 2015, end-of-fiscal-year risk corridor payments to insurance companies that were supposed to total around $2.9 billion were only reimbursed, according to Rubio himself quoted in the Times, to the tune of around $400 million. Rubio bragged that he’d “saved taxpayers $2.5 billion.”

And, indeed, he had. But the insurance companies were thrown into a crisis. And, with Republicans in Congress absolutely refusing to re-fund the risk corridors, that crisis would get worse as time went on, at least over a period of a few years.

So the insurance companies did the only things they could. In (mostly red) states with low incomes and thus poorer health, they simply pulled out of the marketplace altogether. This has left some states with only one single insurer left.  In others, they jacked up their prices to make up their losses.

As Robert Pear in the Times noted, Rubio’s “plan limiting how much the government can spend to protect insurance companies against financial losses has shown the effectiveness of quiet legislative sabotage.”

This is a big problem going forward-- one that Trump and Ryan will pour gasoline on so they can repeat their bullshit about how Obamacare is collapsing. Democrats in Congress absolutely must be able to effectively communicate an affirmative health care agenda that moves toward Medicare for All (alongside alongside employer coverage that 150 million people now have). The Democrats should consistently be advocating for the public option-- in effect, Medicare for All-- along with the federal government setting prices for prescription drugs. The alternative is chaos and misery. Just ask Samantha Bee:

Will Mainstream Democrats Support or Oppose Single-Payer Health Care for California?

Yes, health care can be this simple. We just have to choose it. Californians will be able to choose it very soon.

by Gaius Publius

As we wrote recently, California has a unique opportunity to both resist the Ryan-Trump destruction of the ACA and establish a state-wide single-payer health care system. Two state senators have introduced legislation to do just that.

Emily Green, writing at the SF Chronicle:

California legislation would create single-payer health care system

A push for a single-payer health care system in California is making a comeback.

State Sen. Ricardo Lara, D-Bell Gardens (Los Angeles County) plans to introduce legislation Friday to create a single system that would provide health insurance to every California resident.

“This is our opportunity to put ourselves on the record and be proactive against a Trump administration that is hellbent on eliminating the Affordable Care Act,” Lara said.

The two-page bill contains no specifics. Friday was the deadline for introducing new legislation, and the bill will be fleshed out over the coming month, Lara said. It will first head to the senate Health Committee and then to the senate Appropriations Committee, which Lara chairs.

As Green notes, this is not the first time that single-payer health legislation was introduced in California:

Previous efforts to create a single-payer system have failed. At least eight bills were introduced between 1992 and 2009 that attempted to create one. They failed to get through the Legislature or were vetoed by Republican governors.

Efforts to create a single-payer system in California ended after the passage of the Affordable Care Act under President Obama.

More on those previous attempts in a moment.

Will Democrats Support or Help Defeat This Bill?

The question for California state Democrats is this — Will enough of them support single-payer legislation to get it to the governor's desk?

If they do, the Resistance — the Revolt, really — will take a huge leap forward. It will show the Trump-Republican national government that denying what almost everyone in the country wants is not going to work. It will also embolden other states to likewise resist, both on this issue and many others. If there's to be a fight against the backward-facing federal government, states like California must help lead it, if only for the momentum they will provide.

But there's a catch — Democrats. In particular, money-fed mainstream Democrats, the same people who got us into this Trumpian nightmare to begin with by being far less interested in what people wanted this time around than in what they wanted for themselves, the power to enact more pro-austerity, incrementalist policies. (Remember, the 2016 electoral squeaker should have been a landslide, and not just at the top of the ticket.)

It will do no good for most state Democrats to support this legislation, if they let just a few cross the aisle to defeat it (keeping the rest of their fingerprints off of the kill). The insurance industry hates single-payer, because it would put them out of business. If the Party lets some of its members help defeat this legislation, the Party is responsible for the consequences, which may be momentous.

One more test for the "reborn" Democratic Party. The question: reborn as what? In this newborn Trumpian Age, the entire country is watching.

Why do I worry about Democrats helping kill this attempt at single-payer in California?

Mainstream Democrats Helped Kill Single-Payer in Colorado

Let's look at the last attempt to enact single-payer health care, this time in Colorado as recently as 2016. Ace corruption reporter Lee Fang at The Intercept, wrote this in May 2016 (my emphasis):

Prominent Democratic Consultants Sign Up to Defeat Single Payer in Colorado

INFLUENTIAL DEMOCRATIC CONSULTANTS, some of whom work for the Super PACs backing Hillary Clinton, have signed up to fight a bold initiative to create a state-based single-payer system in Colorado, according to a state filing posted Monday.

Coloradans for Coloradans, an ad-hoc group opposing single payer in Colorado, revealed that it raised $1 million over the first five months of this year. The group was formed to defeat Amendment 69, the ballot measure before voters this year that would change the Colorado constitution and permit a system that would automatically cover every state resident’s health care.

The anti-single-payer effort is funded almost entirely by health care industry interests, including $500,000 from Anthem Inc., the state’s largest health insurance provider; $40,000 from Cigna, another large health insurer that is current in talks to merge with Anthem; $75,000 from Davita, the dialysis company; $25,000 from Delta Dental, the largest dental insurer in the state; and $100,000 from SCL Health, the faith-based hospital chain.

Here's what this sweeping legislation would have done:

Under the new system, there would be no health insurance premiums or deductibles, and all health and dental care would be paid for by the state through a new system called ColoradoCare. The plan calls for raising $25 billion through a mix of payroll taxes, along with bringing down costs through negotiations with providers.

Needless to say, the effect would be sweeping. Here's who to blame for its failure to pass:

The filing reveals that the anti-single-payer group has retained the services of Global Strategy Group, a Democratic consulting firm that has served a variety of congressional candidates and is currently advising Priorities USA Action, one of the Super PACs backing Clinton’s bid for the presidency.

Last month, Global Strategies Group circulated a polling memo that contends that the single-payer ballot measure can be defeated because voters “overwhelmingly reject” the idea.

But, the memo warned, the measure “has some traction with key groups,” including Democrats and millennials, and that the 2016 election year has proven difficult to predict. “[A] sustained campaign pointing out the many flaws in Amendment 69 is essential, especially in such an unpredictable environment,” the memo concluded.

It's not just Global Strategies Group. Other Democratic Party-associated consulting firms were involved:

A number of other Democratic firms have signed up to help defeat single payer, too. Hilltop Public Solutions, a firm managed by former campaign staffers to Barack Obama, was paid $45,000 by the group. Hilltop has also provided consulting services to Ready PAC, another Clinton-supporting Super PAC that eventually folded into the Clinton campaign.

The Trimpa Group, a consulting company run by Democratic strategist Ted Trimpa, also received a payment from Coloradans for Coloradans.

The Democratic consultants are listed alongside several Republican firms, including Brandeberry-McKenna Public Affairs, a GOP company that also lobbies for the drug industry.

Let's be plain. Manistream, health care industry-fed Democratic consulting firms took money from a secretly-funded ad hoc organization to defeat single-payer health care in Colorado. And they succeeded. That effort — Democrats defeating single-payer in Colorado — got some press, but not enough, given the broader public interest in the national campaign for the presidency (and the anti-Trump press's interest in protecting, to the extent it could, the reputation of the Democratic Party and its lead candidate, Hillary Clinton).

They won't get that protection this time, given the visibility of the effort and the press's interest in "the Resistance."

Democrats Have Consistently Helped Kill Single-Payer in California

California has a long history trying to enact single-payer health care. Above we noted the SF Chronicle saying this: "Previous efforts to create a single-payer system have failed. At least eight bills were introduced between 1992 and 2009 that attempted to create one. They failed to get through the Legislature or were vetoed by Republican governors."

Here's some of that detail. Larry Potash in Labor Notes writes this about the 2012 effort (h/t Naked Capitalism for the link; my emphasis):

Why Did Single Payer Health Care Fail in California?

Though it’s passed the legislature twice before, a bill to establish a single-payer universal health insurance system in California failed in the state senate in January.

Not surprisingly, the bill received no Republican votes, but it fell just two votes short of passage when two Democrats voted no and four Democrats failed to vote, despite intense lobbying efforts by community and some labor health care activists.

Angry activists pointed to the fact that five of the six errant Democrats had received money from the insurance industry and Big Pharma, ranging from $100,000 to over $250,000. Three of the six senators had been endorsed by the California Labor Federation which, along with unions such as the Service Employees and AFSCME, was on record supporting the single-payer bill. The California Democratic Party was also on record supporting it.

I'm certain that some (or many) yes-voting Democrats sincerely supported the bill. I'm also certain that some (or many) other yes-voting Democrats were thankful that those six Democrats helped kill it ... so they didn't have to. What percentage of politicians in both parties, do you think, take money from the health insurance and Pharma industries? Most, would be my guess.

Other efforts in California failed because these same Democrats could count on a Republican governor's veto to make their Yes vote meaningless:

Similar bills passed the legislature fairly easily in 2006 and 2008, only to be vetoed by then-Governor Arnold Schwarzenegger. At a time when premiums were rising and there were few other proposals out there, it was an easy vote for Democrats certain of the governor’s veto.

Then came Obamacare, and the Obama-era effort failed out of "party loyalty":

But when Congress passed federal health reform in 2010, defending that bill, as well as President Obama, became paramount for many Democrats. It became more difficult for legislators to vote for a single-payer bill that might be interpreted as deserting the president, and the Democratic leadership refused to put the bill up for a final vote in the Assembly.

Which led to the 2012 effort, which failed because six Democrats helped kill the bill so the rest wouldn't have to. Again, since 1992, not once were Democrats able to pass single-payer in California. It would break the mold if they succeeded this time. Will they succeed this time?

Will Democrats Support the People or the Money That Pays for Campaigns?

There's more than just single-payer health insurance at stake here. First, if the ACA is gutted or repealed, people will die in every state. It's that simple.

Second, how many more tries will the Democratic Party get to prove they are worth a second look in this new era, the era that sent Trump to the White House instead of Clinton?

Predicting the future is almost has hard as predicting the past, but I will say this: If Democrats don't get on the people's side in an obvious way — by deeds and not just by "messaging" — they may wander the wilderness for a generation. That's far too long, given the nation's actual need for a strong, hard U-turn now.

Support SB 562 in California, starting today. If single-payer health care wins there, it could win in many more places.

Scheduling note: My comments appear regularly here on Monday and Thursday, or Tuesday and Thursday if Monday is a holiday.

GP
 

We Don't Have Grayson To Call Them Out On It Any Longer But Republican Health Care Is Still "Die Quickly"

This week NBC News and the Wall Street Journal released a poll showing Trump with an unfavorable rating from 46% of Americans and a favorable rating with 40%, an improvement for him since last month, but the lowest favorability rating of any president-elect about to take office ever. Although he's being installed by an antiquated, anti-democratic electoral college that should have been abolished at the turn of the century (the 20th Century), Trump actually lost the election to Clinton 65,844,610 (48.2%) to 62,979,636 (46.1%). Trump has no mandate to make any drastic changes-- not that that will stop him, of course.

And the first drastic change he and his party want to make is to health care. Everyone wants "change" but we'll soon see if the kind of change the GOP has been talking about-- basically, less health care-- is what Trump voters are going to feel comfortable with. As Steve Benen explained it, the long-standing difference between the progressive approach (embraced by most, but not all, Democrats) and the conservative approach) embraced by all Republicans, is that "Dems saw a system in which too many Americans paid too much and received too little, while the GOP saw a system in which Americans’ health coverage was too good and families enjoyed too many benefits." That second one takes a lot of tap-dancing to explain to constituents. Benen references an unremarkable right-wing backbencher, Bill Huizenga, from west Michigan who admits that when the GOP starts rolling back Obamacare parents will have to consider waiting and thinking about more carefully before bringing in their sick or injured kids for costly treatments.

The Republican congressman explained to the Michigan outlet that he and his wife thought about taking their son to the emergency room, but they decided instead to wait and gauge his injuries the next day, to see if the child’s arm improved. (It didn’t.) Huizenga sees this anecdote as a model for how the process should work on a more systemic level.

“If you don’t have a cost difference, you’ll make different decisions,” the congressman said, adding that financial burdens should be shifted to consumers because the current system “continue[s] to squeeze providers.”

Huizenga went on to say, “Way too often, people pull out their insurance card and they say ‘I don’t know the difference or cost between an X-ray or an MRI or CT Scan.’ I might make a little different decision if I did know [what] some of those costs were and those costs came back to me.”

This is not a new argument. Among Republicans, it’s not even unusual. It is, however, kind of terrifying.

I first started writing about this about seven years ago, right around the time former House Majority Leader Dick Armey (R-Texas) summarized the Republican position in just 17 words: “The largest empirical problem we have in health care today is too many people are too over-insured.” Two Republican congressman had a Wall Street Journal op-ed around this time making the same case: “When was the last time you asked your doctor how much it would cost for a necessary test or procedure?”

It wasn’t a rhetorical question. For most of us, if we have an ailment, we see a doctor and follow his or her recommendations. If physicians recommend tests they consider medically worthwhile, we naturally agree, knowing insurers will cover most of the costs.

And for Republicans, therein lies the problem. If the system shifted the cost burden away from insurers and employers and onto individuals and their families, the result would be amazing savings-- because consumers would seek and receive less health care.

The GOP idea, in other words, is to create a medical environment in which Americans are acutely aware of costs, to the point that we turn down recommended treatments. Our kid may have a broken arm, but can we really afford an emergency-room visit? My doctor says I need a CT scan, but can I really afford such an exam? My friend has a lump and an unsettling family history, but can he really afford to have it removed and sent to pathology? His spouse was prescribed medication by her doctor, but does she really have to take it or can she save some money by going without?

In the Republican model-- by GOP officials’ own admission-- these are the kinds of questions Americans should be asking themselves. Having excellent health coverage, Republicans argue, is a problem in need of a resolution. As the aforementioned Rep. Bill Huizenga (R-Mich.) put it, “If you don’t have a cost difference, you’ll make different decisions.”

As Republicans move forward with repealing “Obamacare” and looking for some kind of alternative blueprint, keep this simple fact in mind: much of the GOP is convinced your insurance is too good, and they intend to help improve the system by making your coverage worse.

I was delighted that on the same day Benen wrote that, Jonathan Rothwell, writing for Gallup about American healthcare inefficiency made the case against Obamacare that progressives have always made and that I wish-- futilely-- Republicans would adopt. The only social health insurance plan that actually works is single payer-- the polar opposite direction in which Trump, Pence, Ryan, Price and McConnell intend to take the health care system.

Rothwell starts from the supposition that "costs are increasing much faster than any incremental improvement in quality... From 1980 to 2015, healthcare expanded from 9% of the national GDP to 18%. Some of this is natural and good. The aging population requires more healthcare, and even modest economic growth has freed up spending power for healthcare. The problem is that the per-unit costs of healthcare-- actual procedures, visits with doctors, pharmaceuticals-- have all soared. So the question must be asked: Has it been worth it? I conclude not."

One way to evaluate advances in healthcare is to compare new treatments with the current standard treatments (e.g., how a new fever-reducing drug compares with ibuprofen) in terms of both costs and effects on "quality-adjusted life years." University of Chicago economists have done this for every healthcare advancement analyzed in medical journals since 1976. The results suggest that the quality-to-cost ratio has fallen. Most new treatments introduced since 1976 have lower benefits per dollar than standard treatments. Indeed, for typical treatments, quality advances were very modest (1%) but cost increases were substantial (8%).

One can see evidence of systemic healthcare inefficiencies in the general health of the U.S. population, which collectively is much lower relative to peers in other developed countries despite the U.S. spending about twice as much on healthcare on a per capita basis. Mortality rates, which remain high by international standards, have fallen since 1980, but most of the progress has occurred among infants and the elderly. The working-age population has seen little improvement-- and for whites and American Indians, there have been no gains in age-adjusted mortality for people aged 15 to 64, at least since 1999.

Even as Americans are living slightly longer, the quality of life hasn't necessarily improved for people of working age. For U.S. residents, self-reported health status has fallen among each age group between 25 and 59 since 1990.

Additionally, the share of the working-age population suffering from a disability that prevents them from working rose from 4.4% in 1980 to 6.8% in 2015, adjusting for age.

One reason for the decline in Americans' self-reported health status is the extraordinary inefficiency of the U.S. healthcare system.

It may be tempting to dismiss these poor health outcomes as driven by cultural or demographic changes, but the broadest evidence suggests this would be misleading. The fastest-growing minority groups-- Hispanics and Asians-- are typically healthier than whites and blacks. Moreover, compared with 1980, Americans are exercising more, smoking less and eating somewhat healthier diets, and they are less likely to be abusing drugs and alcohol. The exception is the rise of prescription opioid use and related abuse, but our healthcare system bears much of the blame for that.

On the cost side, it is easier to identify specific causes for rising inefficiency.

Administrative costs related to healthcare billing are astronomical (hundreds of billions of dollars annually)-- especially compared with other advanced countries, where single-payer systems streamline procedures. Compared with their Canadian counterparts, nurses in the U.S. spend an extra 18 hours per week on administrative tasks and clerical workers spend an additional 37 hours. In 1983, Medicare started requiring that medical service providers identify the specific diagnostic code (out of roughly 90,000 in the latest system) to get reimbursed. Complicating matters more, Medicare and private insurance companies have different billing, documentation, and submission rules and procedures, making it extremely difficult to create efficient software.

Even without a single-payer system, Congress could reform the medical billing system with the goal of creating a simplified, universal, digital process. The goal should be to require only the minimum information that is necessary to avoid fraud. Reimbursement should be based on reasonable approximations of the actual costs to providers in terms of time and use of equipment, and the application process for providers to become a qualified biller of either private or public insurance should be streamlined.

Another issue relates to competition. Consumer advocates at the Federal Trade Commission argue that state laws protect hospital monopolies and raise prices by blocking the introduction of competitors into the market, driving up costs by tens of billions of dollars. State licensing regulations restrict qualified healthcare providers-- like nurse practitioners and dental hygienists-- from practicing independently, as pointed out by the Institute of Medicine. Addressing these restrictions could reduce the costs of medical care.

There are other problems with the U.S. healthcare system. The complicated practice by which pharmaceutical companies develop new drugs and set their (often very high) prices continues to come under scrutiny and provides the opportunity for potential reform. Likewise, agencies are forbidden by Congress to explicitly recommend or deny public funding for treatments based on the most widely used quality-to-cost comparisons.

The overarching point is that the absurd inefficiency of U.S. healthcare is not necessary or permanent. The system we have now is harming us through its exorbitant costs and weak efficacy, which drive down economic growth and deprive future generations of greater prosperity.

If only Price, Ryan, Pence and McConnell weren't so deeply committed to the right-wing ideological frame for looking at this. The only hope that this change that's coming won't be change for the worse is if the one person on the team not wedded to the ideology, the captain of the team, somehow gets persuaded to do the right thing for the American people. I'd say the chances of that are one in a hundred-- which was about the chances he had of winning the Republican nomination and then the electoral college.

UPDATE:

"The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread." – Anatole France

"The GOP, in its majestic equality, prevents the ill as well as the healthy from affording the care that they need to stay alive." - Alan Grayson

UnitedHealth May Quit Obamacare Market

by Gaius Publius

Thanks to the Democratic primary, there's been a lot of discussion on the left about the benefits and ills of ACA, the Obamacare public health law, versus single-payer and "Medicare For All," which Bernie Sanders is advocating. Clinton is a strong defender of the ACA and a strong, if disingenuous, critic of Sanders' Medicare For All.

From the second debate, here's Clinton defending Obamacare over Medicare For All (h/t Lambert Strether at Naked Capitalism for quotes and analysis):

NANCY CORDES: Secretary Clinton, back in– (CHEERING) Secretary Clinton, back in 1994, you said that momentum for a single-payer system would sweep the country. That sounds Sandersesque. But you don’t feel that way anymore. Why not–

HILLARY CLINTON: Well, the revolution never came. (LAUGHTER) And I waited and I’ve got the scars to show for it. We now have this great accomplishment known as the Affordable Care Act [ACA]. And– I don’t think we should have to be defending it amount [sic] Democrats. We ought to be working to improve it and prevent Republicans from both undermining it and even repealing it. [...]

I’ve looked at the legislation that Senator Sanders has proposed. And basically, he does eliminate the Affordable Care Act, eliminate private insurance, eliminates Medicare, eliminates Medicaid, Tricare, children’s health insurance program. Puts it all together in a big program which he then hands over to the state to administer. [...]

And I have to tell you, I would not want, if I lived in Iowa, Terry Branstad administering my healthcare. (APPLAUSE) (CHEERING) I– I think– I think as Democrats, we ought to proudly support the Affordable Care Act, improve it, and make it the model that we know it can be–

The middle paragraph in Clinton's reply above is disingenuous; it makes people fear what they're losing while mischaracterizing what they get in exchange. Here's Sanders on his proposal:

BERNIE SANDERS: We don’t– we don’t eliminate Medicare. We expand Medicare to all people. And we will not, under this proposal, have a situation that we have right now with the Affordable Care Act. We’ve got states like South Carolina and many other Republican states that because of their right-wing political ideology are denying millions of people the expansion of Medicaid that we passed in the Affordable Care Act. Ultimately, we have got to say as a nation, Secretary Clinton, is healthcare a right of all people or is it not?

As I said, the debate has been reignited on the left. It's also been reignited among the populace, as more and more people are finding they don't qualify for subsidies but can't pay the premiums without signing up for large deductibles:

Many Say High Deductibles Make Their Health Law Insurance All but Useless

Obama administration officials, urging people to sign up for health insurance under the Affordable Care Act, have trumpeted the low premiums available on the law’s new marketplaces.

But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.” ...

That's just a taste; much more at the link.

You can see the controversy, which in truth started the day the ACA was proposed and which has more or less never stopped, even on the left. The problem for single-payer (Medicare For All) advocates is, what to do? Has the failing private insurance industry, which the ACA was designed to prop up, fully and permanently occupied the space that should have belonged to a public program like Medicare? How can we "fix" ("improve" in Clinton's framing) the ACA in a way that gives us what, frankly, most citizens would support — again, Medicare for all of us?

Which is why this news is so intriguing...

UnitedHealth May Quit Obamacare Market

The industry that ACA was designed to prop up may be starting to abandon it. Bloomberg:

UnitedHealth May Quit Obamacare Market in Blow to Health Law

The U.S.’s biggest health insurer is considering pulling out of Obamacare, a month after saying it would expand its presence in the program.

UnitedHealth Group Inc. is scaling back marketing efforts for plans it’s selling this year under the Affordable Care Act, and may quit the business entirely in 2017 because it has proven to be more costly than expected. It’s an abrupt shift from October, when the health insurer said it was planning to sell coverage in 11 new markets next year, bringing its total to 34. The company also cut its 2015 earnings forecast.

A pull-back would deal a significant blow to President Barack Obama’s signature domestic policy achievement. While UnitedHealth has been slower than some of its rivals to sell Obamacare policies since new government-run marketplaces for the plans opened in late 2013, the announcement may indicate that other insurers are struggling, said Sheryl Skolnick, an analyst at Mizuho Securities.

“If one of the largest and presumably, by reputation and experience, the most sophisticated of the health plans out there can’t make money on the exchanges, then one has to question whether the exchange as an institution is a viable enterprise,” Skolnick said.

UnitedHealth said it suspended marketing its individual exchange plans and is cutting or eliminating commissions for brokers who sell the coverage. ...

There's quite a bit more. For example:

Insurers have struggled to profit from the government-run marketplaces created by Obamacare. About a dozen non-profit “co-op” plans created under the Affordable Care Act have failed, after charging too little to cover the cost of patients’ medical care, and because an Obama administration fund designed to stabilize the market paid out just 12.6 percent of what insurers requested. And Anthem last month said some rivals were offering premiums too low to provide the coverage patients require and book a profit.

If the industry that ACA was supposed to benefit won't offer policies, and if policies that are offered are unaffordable for those who fall "in the cracks" of the population that was supposed to benefit, what's next for ACA?

Letting the Blackmailer Kill the Hostage

The argument all along for Obama's health care proposal, minus his never-intended-to-be-enacted public option, was the number of uninsured Americans combined with the lack of alternatives the administration would support. If you wanted to insure uninsured Americans, you could take ACA as offered, or take nothing. For progressives in the House, who insisted on a public option (though most supported single-payer), this was a very tough vote. Would they bend to administration blackmail — "Vote for the ACA or millions go without health insurance" — or would they tell the blackmailer, "You're the one with the power. You're the one with the gun. It's not my fault you didn't give us a bill we could vote for."

Ultimately, the entire House progressive caucus took "Dennis Kucinich's plane ride" and enough let the blackmailer win, thus passing the ACA into law. They couldn't, in our blackmail metaphor, let the blackmailer kill the hostage. Perhaps the right decision, perhaps not, but it's why we're here today.

Will Health Insurers Kill the ACA?

But the ACA's holes, its inadequacies, its dependence on the private health insurance industry to "do the right thing," remain. UnitedHealth is not "doing the right thing," if the right thing is serving the public. They are doing the right thing if the right thing is serving themselves and their CEO compensation package:

UnitedHealth CEO Stephen Hemsley made more than $66 million in 2014

CEO Pay Watch UnitedHealth Group Inc.
Stephen Hemsley, CEO
Total compensation: $66,125,208 for the year ended Dec. 31, 2014
Salary: $1,300,000
Non-equity incentive pay: $3,949,000
Other compensation: $107,479
Exercised stock options: $45,569,049
Value realized on vesting shares: $15,199,680
New stock options: 83,918

Keep that in mind the next time someone talks about a CEO's "salary." Hemsley made $66 million with a base salary of just $1.3 million. Nice multiplier. His "non-equity incentive pay" alone was three times that. Tell me he's not a predator.

The broader point though may be more important than one man's predation. If progressives weren't able to replace the ACA with Medicare for All, will the insurance companies inadvertently do the job instead, by killing the ACA themselves and clearing space for a rewrite?

Is this the end of the ACA? Stranger things have happened.

(Blue America has endorsed Bernie Sanders for President. If you'd like to help him, click here. This page also lists every progressive incumbent and candidate who has endorsed him. You can adjust the split in any way you wish.)

GP

You Know Why Americans Are Unhappy About The Healthcare Bill, Right?

Yesterday's biggest news-- biggest news the mainstream media buried so they could continue talking more about how minority rights champion Harry Reid should resign for using the words, "light skinned Negro"-- isn't something Obama, or Reid for that matter, should feel very good about. In fact, both Democrats-- and their advisors and colleagues-- should hang their heads in shame. Greg Sargent's Plum Line broke the story early in the morning. It's nothing progressives following the healthcare debate didn't already intuit but it's far from what is constantly insinuated in the mainstream media.

You see, most people who don't like the healthcare reform bill, are disgruntled for the right reasons: the bill doesn't go nearly far enough to provide healthcare coverage, to control costs or to regulate the avaricious insurance gangsters. This is the most tepid and insubstantial reform imaginable, something designed-- unsuccessfully-- to get Republicans to not make such a godawful ruckus.

Well, it wasn't only designed for that. It was also designed to please the Big Insurance Giants and other bad players in the Medical Industrial Complex who Obama and the Democrats are counting on to keep funding their political careers. Is that working, you ask? Well... Since 1990 Big Insurance has given 62% of $325,222,386 in bribes to Republicans and 37% to Democrats. Last year it was 55% for the Republicans and 45% for the Democrats. But in the current cycle-- lo! and behold!-- Big Insurance is suddenly supporting more Democrats than Republicans! So far this cycle has seen 53% go into Democratic coffers and 47% accrue to Republicans. What a coincidence! And who's getting the big money from Big Insurance this cycle? Powerful players in the reform game:

Chuck Schumer (D-NY) $197,600
Chris Dodd (D-CT) $165,750
Earl Pomeroy (Blue Dog-ND) $135,400
Paul Kanjorski (D-PA) $130,700
Chuck Grassley (R-IA) $126,450
Melissa Bean (D-IL) $123,550
Barney Frank (D-MA) $120,099
Blanche Lincoln (D-AR) $113,450
Eric Cantor (R-VA) $111,450
Robert Bennett (R-UT) $107,400

It's much the same story at the Medical Industrial Complex. Since 1990 their $869,112,200 in bribes allocated to members of Congress went largely to Republicans-- 56% as opposed to 44% for Democrats. The current cycle sees a complete turn around. Either the Medical Industrial Complex has turned progressive or the Democrats have sold out. You be the judge. In the 2010 cycle the Democrats are getting 59% of the loot and the Republicans are down to their lowest percentage in recorded history: 41%. And whose palms have been the most generously crossed?

Harry Reid (D-NV) $649,975
Blanche Lincoln (D-AR) $478,550
Arlen Specter (D-PA) $471,810
Chuck Schumer (D-NY) $456,500
Ron Wyden (D-OR) $361,821
Chuck Grassley (R-IA) $340,510
Richard Burr, (R-NC) $330,132
Frank Pallone, Jr (D-NJ) $321,300
Kendrick Meek (D-FL) $311,550
Chris Dodd (D-CT) $295,570

One name you'll never find on any of those lists of members of Congress getting megabucks from corporate interests is Raúl Grijalva, chairman of the Congressional Progressive Caucus, and one of the most tireless and unrelenting fighters for the kind of healthcare working families are asking for. He seemed frustrated with new polling from CBS. A few hours ago he told DWT that “It’s unfortunate that this reform effort has gotten away from the common sense of the American people. At this point, the convoluted response we seem to be pursuing could end up leading to a weaker system.”

The CBS poll shows that among those dissatisfied with the healthcare reform legislation "more people think reform doesn’t go far enough in multiple ways than think it goes too far."

The CBS poll finds that Obama’s approval rating on health care has dipped to 36%. But the poll also asked whether people think the reform proposal, in various ways, goes too far, is about right, or doesn’t go far enough:



In every one of those polled-- covering Americans, controlling costs, and regulating insurance companies-- more think the bill doesn’t go far enough.

Do you know any progressive blogs that haven't been shouting that from the rooftops for months? Many Democrats don't seem to want to hear it though... do they?

Since I first met him in 2005 Eric Massa (D-NY) has never wavered from his insistence that what American families need and want is single-payer healthcare. He was one of only two progressives to vote against the bill because he felt-- like most Americans seem to-- that it doesn't go nearly far enough. When we told him about the CBS poll he said, "Our current healthcare system is beyond flawed and I'm deeply concerned that the reforms being offered do not go far enough to cut costs and improve healthcare for all Americans. For Healthcare reform to truly be reform, we can't have a series of half measures which fundamentally alter the process to buy the support of a handful of Senators. The last W.H.O. survey showed that the United States had the highest per capita costs, but only ranked as the 37th best overall care in the world. Strengthening the monopolistic powers of the for-profit HMOs is not the right way forward and that's why I have been on record supporting Single Payer healthcare as the best option for almost half a decade.”

Unlike Massa, Donna Edwards (D-MD) voted for the legislation in the House, after fighting as hard as she could-- something she's continuing to do on a daily basis-- to improve it. She tells me that she thinks the House can succeed in making it more affordable with better subsidies for less fortunate families. She is also clear that this is just step one and that Congress will be working on healthcare reform next year and the year after and the year after that. This poll didn't come as a surprise to her, not in the slightest. I spoke with her last night and she said "[The CBS poll] is further evidence of what many of us in Congress already know-- Americans want bold action when it comes to health care reform that will expand coverage, control costs, and hold insurance companies accountable. The American people understand the importance of this opportunity, and I will work to convey this message to my Congressional colleagues as we navigate the process to achieve health care reform for the first time in decades. It is a call for us to do more, not less."


UPDATE: Today's Bonus Video

This is why Alan Grayson is the most beloved member of Congress... well, most beloved among regular Americans, not among the people who wish our country will fail:

Hard To Imagine Why No One In Congress Came Up With This Simple Proposal To Fix The Health Care System

Did Blue Shield really give you $75,200? Kewl!

George McGovern lost a lot of credibility-- pretty much all of it-- when he teamed up with the GOP to campaign against employee free choice. He went from being a respected progressive elder statesman to being a waking joke and a pariah. So people may have been surprised this morning to wake up and find such a fine OpEd penned by him in the Washington Post. Could anyone not currently working inside the sausage factory have not come to the same conclusion as McGovern-- that the way to solve the country's health care problem is Medicare for all? As he points out, it is simple and even teabaggers might understand it: "If we want comprehensive health care for all our citizens, we can achieve it with a single sentence: Congress hereby extends Medicare to all Americans."

Obama's speech last week had one fatal flaw-- his insistence that the insurance industry has a legitimate role to play in the country's health care system. They don't-- unless you also consider the role of Typhoid Mary legitimate. This insistence, fueled by obscene campaign donations-- thinly disguised bribes-- is what blocks the path to meaningful health care reform.

Those of us over 65 have been enjoying this program for years. I go to the doctor or hospital of my choice, and my taxes pay all the bills. It's wonderful. But I would have appreciated it even more if my wife and children and I had had such health-care coverage when we were younger. I want every American, from birth to death, to get the kind of health care I now receive. Removing the payments now going to the insurance corporations would considerably offset the tax increase necessary to cover all Americans.

I don't feel as though the government is meddling in my life when it pays my doctor and hospital fees. There are some things the government does that I don't like -- most notably getting us into needless wars that cost many times what health care for all Americans would cost. Investing in the health of our citizens will enhance the well-being and security of the nation.

We know that Medicare has worked well for half a century for those of us over 65. Why does it become "socialized medicine" when we extend it to younger Americans?

...Many people familiar with politics in America will tell you that this idea can't pass Congress, in part because the insurance lobby is too powerful for lawmakers to resist.

As matters now stand, the insurance companies claim $450 billion a year of our health-care dollars. They will fight hard to hold on to this bonanza. This is a major reason Americans pay more for health care per capita than any other people in the world. The insurance executives didn't cry "socialism" when their buddies in banking and finance were bailed out. But to them it is socialism if the government underwrites the cost of health care.

Consider the campaign funds given to the chairman and ranking minority member of the Senate Finance Committee, which has jurisdiction over health-care legislation. Chairman Max Baucus of Montana, a Democrat, and his political action committee have received nearly $4 million from the health-care lobby since 2003. The ranking Republican, Charles Grassley of Iowa, has received more than $2 million. It's a mistake for one politician to judge the personal motives of another. But Sens. Baucus and Grassley are firm opponents of the single-payer system, as are other highly placed members of Congress who have been generously rewarded by the insurance lobby.

Far be it from me to call any fine politician a whore but I would be remiss if I didn't point out that Senator Grassley is up for re-election next year and very much counting on the Insurance Industry and the Medical-Industrial Complex to pay the costs. So far they haven't let him down. In the current year the Insurance Industry has already forked over $89,800 to Grassley's re-election efforts. Compare that to the $16,070 they've given to Bernie Sanders-- in his entire career (and not one cent this year)! The Medical-Industrial Complex is also favoring Grassley this year-- so far to the tune of $186,600. And, believe me, Grassley has earned every cent of it spreading shallow lies about death panels and sabotaging reform efforts every step of the way. If America winds up without health care reform, or with inadequate reform, no list of culprits will be complete without Chuck Grassley. Baucus, of course, will be the first name on the list-- or at least fighting for pride of place with Rahm Emanuel.

Yesterday John Amato called me, pretty excited for John, to say he was watching Obama's Minneapolis speech on health care and that the president was sounding more behind the public option than he would if Rahm Emanuel and his corporate buddies were calling all the shots. The audience reaction speaks for itself. John put the video up at Crooks and Liars today and gave me permission to use it here as well:

David Gill, MD-- A Progressive Response To Obama's Speech

The "official" Republican response tonight was given by the would-be Lord Boustany, but the real GOP response was the teabagger outburst by lunatic fringe South Carolina Republican Congressman Joe Wilson, trying to impress secessionists back home, when he screamed "Liar" at the president. The Democrat running against Wilson next year, Rob Miller, makes a good point:

“Representative Wilson’s behavior tonight exemplifies everything that is wrong in Washington. Instead of engaging in childish name-calling and disrespecting our Commander-in-Chief, Joe Wilson should be working towards a bipartisan solution that makes quality, affordable health care available to each and every South Carolinian.”

But that isn't what Republicans have in mind. What they have in mind-- as their leader, Rush Limbaugh, explained even before the inauguration is to do everything they can to obstruct whatever Obama tries and pray he fails.

I asked Doctor David Gill, a progressive running against Republican obstructionist Timothy Johnson in Illinois' 15th congressional district along the state's eastern border south of Chicago, to give DWT readers a progressive perspective on Obama's speech tonight.

As a practicing physician for the past 21 years, I’m well aware of the problems with the financing and delivery of American health care.  As a candidate for the U.S. House of Representatives, I look forward to working to provide solutions to these problems.
 
The health care issue, which has been the subject of so much discussion and heated debate over the last several weeks, has been at the forefront of each of my three Congressional campaigns.  I bear witness on a daily basis to the multiple problems inherent in our current system; these problems impact all Americans, regardless of race, age or income level.  Virtually every American would be far better served with a reformed system.
 
As a full-time Emergency Room doctor, my work brings me into contact with far too many stories which demonstrate the failure of our current “system.”  Not long ago, I watched a 39-year old man die of a heart attack, leaving behind a wife and two young children.  He worked as a full-time house-husband and father, while his wife worked full-time outside their household.  He had experienced mild, intermittent chest pain for one week, but because he was unable to afford health insurance he ignored his wife’s pleas to have his chest pain evaluated.  And as so often happens over and over again, he arrived at my Emergency Department too late.  His children will now grow up without their father, leaving them with broken hearts and putting them at increased risk for a host of negative social consequences. 
 
Many view the health care issue as a matter of great moral importance.  However, the reforming of our health care system is far more than just a moral issue-- it bears tremendous importance with regards to our economic well-being as a nation. The time is long past due for us to stop permitting large insurance and pharmaceutical companies to run roughshod over all other American businesses and citizens.  When we finally put in place a program which extends Medicare services to all American citizens, regardless of age, the boon to our economy will be like none ever seen before.  For far too long, we have permitted 25 to 30 cents of each of our hard-earned health care dollars to be wasted on items which have nothing to do with heath care.  When we enact “Medicare for All” legislation, 25 to 30 percent of our health care budget will be put back into the pocketbooks of American businesses and taxpaying citizens; in addition to providing this broad economic stimulus, the health care of American citizens will be vastly better served under such a system.  No longer will the well-being of American citizens be sacrificed to maximize the outrageous profits of a small number of large corporations.  No longer will young adults suffering with a week’s worth of chest pain be forced to ignore their symptoms, while CEOs such as William McGuire of United Healthcare receive retirement packages of 1,600,000,000 dollars.
 
I’ve known President Obama for many years, and I know that he fully understands the need to extend Medicare to all American citizens.  I have little doubt that he wishes to see this type of boost to the American economy, along with the dramatic improvement in the health care of all Americans that such a change would bring.  But President Obama needs more strong leaders in the House of Representatives and the U.S. Senate; many of the lawyers and CEO’s in Congress do not truly understand health care.  As an Emergency Room physician who has long served as the last line of defense for patients jeopardized by our failed system, I am well-prepared to serve as a strong leader in the House.  All Americans will benefit from having a physician who deals with the healthcare crisis on a daily basis as an active member of Congress. 
 
David M. Gill, M.D.

A Real Grassroots, Inexpensive Way To Make A Point About Health Care Reform

That wonderful little video that Noah sent me explains the health care reform debate far better than most members of Congress have-- and far better than Katherine Sebelius or anyone else from the Obama Administration has. The message has pretty much been one of the main themes of DWT for the last few months. We can't depend on the ghost in the clip though. There are no Republicans who are good on health care-- none, not one. You want health insurance reform? No more Republicans! And no more Democrats who play footsie with them-- like the DLC shills or the Blue Dogs!

These corrupt, reactionary senators are working full time to undermine even modest health care reform-- the public option compromise. Each has taken large enough amounts in thinly disguised bribes from Big Insurance that they should recuse themselves from voting of anything pertaining to the industry. The dollar amount next to their names is how much they've taken from the Insurance Industry-- listed from the most corrupt to the almost as corrupt. More than anyone else in Congress, these seventeen bribe besotted slime-balls from both parties are the ones who are keeping our families from getting health care:

John McCain (R-AZ- $2,894,353)
Ben Nelson (DLC-NE- $1,231,299)
Max Baucus (DLC-MT- $1,190,463)
Arlen Specter (R-PA- $1,055,655)
Joe Lieberman (DLC-CT- $1,033,402)
Mitch McConnell (R-KY- $936,507)
Chuck Grassley (R-IA- $931,874)
Kent Conrad (DLC-ND- $828,787)
Jim Bunning (R-KY- $794,499)
Richard Shelby (R-AL- $679,048)
Orrin Hatch (R-UT- $670,057)
Kit Bond (R-MO- $644,571)
Saxby Chambliss (R-GA- $642,466)
John Ensign (R-NV- $626,466)
Kay Bailey Hutchison (R-TX- $617,200)
Evan Bayh (DLC-IN- $602,752)
John Cornyn (R-TX- $566,178)

And in case you think it's just senators who are on the take, there are also 10 especially bad House members just as corrupt and fighting just as strongly against health care reform as the senators above: Earl Pomeroy (Blue Dog-ND- $1,819,606), Richard Neal (R-GA- $934,781), John Boehner (R-OH- $911,806), Eric Cantor (R-VA- $712,674), Spencer Bachus (R-AL- $689,350), Pat Tiberi (R-OH- $602,594), Roy Blunt (R-MO- $564,032), John Tanner (Blue Dog-TN- $559,118), Ed Royce (R-CA- $536,780) and, alas, the Insurance Industry's secret weapon, Steny Hoyer (D-MD- $529,227).

And then there's Peter Clothier's idea for how we can make a difference-- a virtual march on Washington on Sept. 1. This is a good idea.

Inconvenient Truths For Republicans

-by NOAH

The other night, I channel surfed over to the padded cell station on my TV (“FOX News-- You’re Padded Cell On The Air”) and I saw the RNC’s titular lead goofball, Michael Steele, sharing my TV screen with Sean Insanity. It was a bizarro thing to behold. I swear I saw propeller beanies capping each of their heads. The propellers spun wildly as the studio air blew through their empty craniums. Dali could not have painted a more surreal and disturbing picture. It was an event that gave new meaning to the phrase ‘Boob Tube’. OR, was it ‘The Vast Wasteland’?
 
When Steele opened his mouth and spewed out the lie that “Obamacare will have our federal government paying for abortions on demand”, I also thought of the recent NBC poll that showed that millions of lied to and misled American citizens sadly believe that the proposed health care reform legislation in Congress will represent a government takeover of health care, free health care for illegal immigrants (especially, you know, those illegal brownish ones from incomprehensibly strange i.e. non-white lands), Death Panels, etc.
 
So, I thought that, although much truthful info is available in uncounted articles about health care reform, it might just be very practical to simply gather it up and compose a list of FACTS, not Republican “facts” or lies as rational folks call them, but FACTS. Presented in this JUST THE FACTS FORM, they could be useful to readers who encounter crazies at the water cooler, at town hall meetings, or in Congress itself. Why, you could even mail it to your own Congressperson, whether they are sane or not. If your Senator is a Republican, you could even go over to your local airport and plaster the men’s room stalls with it. If you are having family over for any Labor Day festivities and your family suffers the shame of having a Republican in its midst, it might also come in handy for such an occasion. Come to think of it, though, you might mention that you are surprised that a Repug celebrates Labor Day.
 
Here you are: JUST THE FACTS:      
 
1. Our country has been trying to develop a national health care plan since Teddy Roosevelt split from the Republicans and formed the Bull Moose Party in 1912.

2. According to the World Health Organization, the US is the 37th in overall quality of health care in the World.

3. 78% of Americans with no health care are full-time workers.

4. 22,000 Americans die every year because of delayed medical treatment.

5. Insurance companies make their profits by denying care to those who most need it, AFTER they’ve paid their premiums, of course.
 
6. The rest of the civilized world regards health care not as a market commodity, but as quality of life issue.

7. Under our current system, Americans live about 3 years less than the French do. It’s not just the wine.

8. 46 of the 50 states in the US have single insurance monopolies. For instance, Blue Cross/ Blue Shield covers about 90% of all people insured in North Carolina. This situation does not bring NC citizens the lowest prices for health care. Capitalism thrives on competition, doesn't it? How about a Public Option!

9. There are no co-pays for preventative care. Preventative care saves money and wear on you just as it does for your car.

10. End of life decisions and living wills were mandated to all hospitals in the US by a bill that passed in the Congress and was signed into law by Republican President George H. W. Bush. The only difference in the currently proposed legislation, is that counseling on these issues now could be reimbursed by Medicare. Republicans call this process a Death Panel. Rational folks call it getting money back.

11. The Medical-Industrial Complex is spending $1.4 million PER DAY on 1000 “lobbyists” (bribers) to STOP health care reform and keep things just as they are. Works for them! You? Not so much.

12. Big Pharma’s profits now stand at $90 BILLION per year. They make their money by denying your claim, not by helping you maintain your health.

13. Insurance Company profits grew 42% from 2000 to 2007 while the wages of middle and working class Americans stagnated or declined AND co-pays increased. Hmmm, who was President then?

14. If you want the uninsured to just go to emergency rooms as Dubya suggested, consider the price of the uninsured. It amounts to a HIDDEN TAX of approximately $1,700 per couple per year. That’s $42.7 BILLION per year. If you enjoy paying such hidden taxes, fight for the status quo, just as those who make millions running the Medical-Industrial Comlpex and their lackeys in Washington want you to. 

15. Paying for it all: Bush’s war in Iraq is still costing over one BILLION per week. Projected cost for 2009 is $87 BILLION. That’s $87 Billion that could go a long way towards improving our health care system. And, you can bet that the cost of health care reform would be less per week! We can also repeal the Bush tax cuts for the wealthy Top 2%. Soak the rich!

16. The United States has the highest infant mortality rate of any industrialized nation.

17. The United States has the shortest longevity rate of any industrialized nation.
 
18. The United States has the highest incidence of no-communicable diseases, such as obesity (that one’s pretty obvious), diabetes, heart troubles, high blood pressure, high cholesterol, etc., of any industrialized nation.

19. Approximately 1,800 more of our fellow citizens will have died due to poor health care in just the time that the Harry Reid led Senate has been on recess.

20. Here’s one of my favorites and most staggering: We in the USA spend 50% more per person per year on health care than the citizens of the nation with the next most expensive health care. And no, spending more does not equate to better, no matter how advanced we may be.

21. The United States is the only industrialized nation that does not provide universal health care. So, are those who say we can’t do the same just defeatists? Do they think America can’t do health care better than them damn foreigners; you know, like those dreaded Frenchies, or, God forbid, the Germans or the Swedes?

22. In the European Union, health care is defined as a right, just as President Obama said in the debates. His decrepit, crotchety, surly opponent claimed it was only a privilege. America chose Obama, so what are we waiting for?

23. American families deserve the same level of health care as not only our federal employees and Senators and Representatives, but as our prison inmates, such as Bernie Madoff and Charles Manson have. Congresspersons, crooks and murderers have even more in common than meets the eye! 
  
24. Costs of health care for small businesses are a serious drag on hiring and therefore the growth of small businesses.

25. 40% of small businesses are unable to afford health care for their employees at all.

26. The health care costs of the average American family will double in the next 9 years. What do you spend now? Can you afford not to have a reformed, more efficient health care system? Do you really think your pay will rise along with your health care costs? Are you ready to gamble with your family’s health just because you’ve bought into the lies of those who only want to preserve the status quo of making millions for themselves while downsizing you into oblivion and making sure you can’t afford to educate your kids thus tying them to a life of back-breaking, life-shortening manual labor at starvation wages?
 
                                               ************
OH, CANADA!


The Republikooks like to bitch about the Canadian health care system that they know nothing about, so, how about a list of facts about Canadian health care, too?

1. The Canadian system distributes health care at the provincial (state) level. Most of the money is federal, but each province also kicks in money. So, if you live in the wealthy provinces of British Columbia, Alberta and Ontario, there is less “rationing” (meaning you get non-critical services more quickly). Non-critical service is slower in the poorer provinces. But, if you have a serious or acute problem you are seen and treated immediately. 

2. There are no death panels in Canada. 

3. There is no paperwork for patients in Canada. You show your Social Insurance card and that’s it.  All the paperwork is between the doctor and the government. There are NO DEDUCTIBLES OR CO-PAYS, and the insurance covers dental. But, it does not cover prescription drugs until you are 65. Then, coverage is 100% (drugs are free). However, Canada negotiates with big pharma and drug prices average 35%- 40% less than in the US, so until you are 65, you pay less. After 65, you pay nada.

4. Yes, there are fewer doctors and hospitals in Northern Canada, because it’s sparsely populated.  But, if you do live there and require hospitalization, insurance even covers the cost of FLYING YOU TO THE HOSPITAL!

5. As a comparison, in the US doctors and hospitals are more prevalent in urban areas and rich states, so people in Alabama or rural Idaho, for example, have the same problems Canadians have and, in the US, the patient has to pay to get to the doctor.
 
6. Canadian health care is not socialized. Doctors are in private practice and people choose whatever doctor they want. Some hospitals are private and some are public, just like in the US.
 
7. Canadians (92%) are happy with their health care and wouldn’t trade it, especially for the US system and no Canadian government would ever try to limit the program. 

8. The Repug “horror stories” about Canadians not being served and coming to the US in droves are more propaganda. There are people, however, who, if they have the money, will come to the US for elective, not critical procedures. They will sometimes do this rather than wait in their home province, or they might come to the US to see a particular specialist or hospital for a unique condition. Chances are, though, that you will be allowed a longer recovery stay in a Canadian hospital.

9. Canadian health care began in 1947 with Saskatchewan government leader Tommy Douglas. He is now regarded in Canada as a national hero, complete with statues. Ironically, the “father” of Canada’s single payer system could be said to be Lyndon Johnson. Back in 1964, LBJ proposed a dream single payer system. Canadian Prime Minister Lester Pearson, not wanting to be outdone and embarrassed by his neighbor to the south, successfully rushed through his version of LBJ’s dream proposal. LBJ had to compromise with the Repugs of the day and ended up with a scaled back co-payer plan for senior citizens called Medicare. Pearson did not have such Repugs to bargain with. Pearson is also regarded as a HERO in Canada.

10. Canada’s health care system is between 30% and 60% cheaper than ours for procedures, medications, and hospital stays. If you like paying more, then, by all means, keep screaming like a loon at town hall meetings or following deviant cult leaders like Hannity, Beck or Limbaugh.  
 
So, there you are. While vacant-eyed Republican zombie women are accusing openly gay Jewish congressmen of being Nazis and pro-Hitler and not even noticing a scintilla of irony in their batshit crazy thoughts, and while the ironically named Dick Armey goes to Hollywood to pal around with Hollywood stars in liberal Hollywood and dance all over healthcare reform while more people suffer and die needlessly, you will now have a handy checklist of real, honest to goodness facts about the state of healthcare. You can even turn it into flashcards for your intellectually impaired Repug acquaintances. Hell, if I owned a coffee shop or diner, I’d laminate it and use it for placemats while serving up some of President Obama’s prized recipes for human baby meat that I’m sure we will be hearing about on FOX any day now. The possibilities are endless; even free thorazine for Glenn Beck. 

There is nothing substantive against the public option except the Insurance Lobby:

Is It Too Late To Rescue Health Insurance Reform From The Corporate Shills In Washington?

Listen to Obama being applauded when he was running for office; it can't be denied that the prolonged applause wasn't sparked by his charisma and charm but by his words: "I happen to be a supporter of single player universal health care." Perhaps he believes that his cult of personality is bigger than the ideas that propelled his popularity. If he does, he's in for quite the shock.

It was lovely when Bill Clinton rescued those two American journalists from the clutches of North Korea and when last week 4 European and 2 Kenyan hostages were released after 9 miserable months in Somalia, but the insurance companies have been holding health care hostage for decades, not months. And it was nice when President Obama seemed to promise a crowd in Montana a couple days ago that he intends to rescue the long-held hostage and succeed where Democratic presidents since FDR and Harry Truman have failed.

There was a lot to recommend Rick Perlstein's piece in today's Washington Post, In America, Crazy Is A Preexisting Condition about birthers, town hall hecklers and the return of right-wing rage. But one section that has really stood out in my mind implies a comparison between Obama and his compromised administration and an earlier Democratic president who faced mobs of hysterical white conservatives and racists screeching-- and fully believing their own screeches-- how passing Civil Rights legislation would lead to the enslavement of the white race: "Good thing our leaders weren't so cowardly in 1964, or we would never have passed a civil rights bill-- because of complaints over the provisions in it that would enslave whites... The tree of crazy is an ever-present aspect of America's flora. Only now, it's being watered by misguided he-said-she-said reporting and taking over the forest."

That and lots of suckers eating up the Fox/Hate Talk Radio disseminated Insurance Industry distortions and then running wild with them. Even the fake "Christians" have an angle.

When Obama passed over credible health care reform advocate Howard Dean and picked a suspiciously conservative Democrat, Kathleen Sebelius, to be his Health Secretary-- after his first choice, a blatant corporate shill tainted by years of K Street connections, was proven to be too corrupt for confirmation-- many people realized the game was being thrown. This morning Ms. Sebelius confirmed that they were correct in an interview on CNN's State of the Union.

Health and Human Services Secretary Kathleen Sebelius says Obama still believes there should be "choice and competition" in the health insurance market-- but that a public option is "not the essential element."

Obama has been pressing for the government to run a health insurance organization to help cover the nation's nearly 50 million uninsured. But he had not seen a not-for-profit co-op as sufficient to offer consumers choice and competition that would bring down the costs of private insurance.

With half the teabaggers claiming they've personally lived in Canada or the U.K. and can absolutely attest to the horrors of health care in those downtrodden countries, today's Independent weighed in from the UK. They recognize that the teabaggers aren't about debate but about shilling and psychosis.

Although the Americans spend more on medicine than any nation on earth, there are an estimated 50 million with no health insurance at all. Many of those who have jobs can't afford coverage, and even those with standard policies often find it doesn't cover commonplace procedures. California's unemployed-- who rely on Medicaid-- had their dental care axed last month.

...President Obama's healthcare plans had been a central plank of his first-term programme, but his reform package has taken a battering at the hands of Republican opponents in recent weeks. As the Democrats have failed to coalesce around a single, straightforward proposal, their rivals have seized on public hesitancy over "socialised medicine" and now the chance of far-reaching reform is in doubt.

Most damaging of all has been the tide of vociferous right-wing opponents whipping up scepticism at town hall meetings that were supposed to soothe doubts. In Pennsylvania this week, Senator Arlen Specter was greeted by a crowd of 1,000 at a venue designed to accommodate only 250, and of the 30 selected speakers at the event, almost all were hostile.

Healthcare compared

Health spending as a share of GDP
US 16%
UK 8.4%

Public spending on healthcare (% of total spending on healthcare)
US 45%
UK 82%

Health spending per head
US $7,290
UK $2,992

Practising physicians (per 1,000 people)
US 2.4
UK 2.5

Nurses (per 1,000 people)
US 10.6
UK 10.0

Acute care hospital beds (per 1,000 people)
US 2.7
UK 2.6

Life expectancy:
US 78
UK 80

Infant mortality (per 1,000 live births)
US 6.7
UK 4.8

Meanwhile over at the Republican Party propaganda station, Kent Conrad (DLC-ND), a notorious insurance industry whore ($828,787) further bashed the public option, using lobbyist-prepared GOP talking points. “Look, the fact of the matter is there are not the votes in the U.S. Senate for the public option, there never have been. So to continue to chase that rabbit is, I think, a wasted effort.”

Not all Democrats have given in yet, though. Democrats more concerned with ordinary working families than with the viability of the utterly useless and no-value-added insurance companies have taken a pledge to vote against any health care bill Insurance Business "allies" try shoving down Congress' throat. With sleazy ex-congressional wheeler dealers Rahm Emanuel, now White House chief of staff, and Bill Tauzin, now head of Big Pharma's lobby, working together with some of the insurance CEOs to do a Bush-like deal to enrich the insurance companies and pharmaceutical giants at the expense of the public, it will be the ultimate act of political courage for the Progressive Caucus to stand up and just say no. Jerrold Nadler (D-NY) says progressives aren't about to give in to Emanuel's threats. "We signed a pledge to reject any plan that doesn't include a robust public option, and this plan doesn't have a robust public option."

And it isn't just Nadler who's standing up against the Insurance Industry, Big Pharma and the corrupt wheeler dealers who would sacrifice the HOPE of the millions of Americans who believed in Barack Obama when he was running for president. 57 dedicated progressives signed a letter to Nancy Pelosi pledging to oppose any health care legislation that doesn't include a robust public option now being bad-mouthed by Emanuel's team inside and outside the administration. 18 members have also signed onto the FDL pledge to only support a bill that includes a public option. This afternoon Jane explained the strategy of how this could work to prevent the Insurance Industry from running away with the reform package. These are the heroes of American families who refuse to be cowed by corporate America or by the political hacks who enable corporate America (phone numbers are included so you can call and say thanks; they deserve a thanks):

First, the members who signed the letter to Speaker Pelosi:

Earl Blumenauer (D-OR)- 202-225-4811
Corrine Brown (D-FL)- 202-225-0123
Michael Capuano (D-MA)- 202-225-5111
André Carson (D-IN)- 202-225-4011
Judy Chu (D-CA)- 202-225-5467
Yvette Clarke (D-NY)- 202-225-6231
William “Lacy” Clay (D-MO)- 202-225-2406
John Conyers (D-MI)- 202-225-5126
Elijah Cummings (D-MD)- 202-225-4741
Bill Delahunt (D-MA)- 202-225-3111
Lloyd Doggett (D-TX)- 202-225- 4865
Donna Edwards (D-MD)- 202-225-8699
Keith Ellison (D-MN)- 202-225-4755
Sam Farr (D-CA)- 202-225-2861
Chaka Fattah (D-PA)- 202-225-4001
Bob Filner (D-CA)- 202-225-8045
Marcia Fudge (D-OH1)- 202-225-7032
Raúl Grijalva (D-AZ)- 202-225-2435
Luis Gutierrez (D-IL)- 202-225-8203
Phil Hare (D-IL)- 202-225-5905
Alcee Hastings (D-FL)- 202-225-1313
Maurice Hinchey (D-NY)- 202-225-6335
Mazie Hirono (D-HI)- 202-225-4906
Michael Honda (D-CA)- 202-225-2631
Jesse Jackson, Jr. (D-IL)- 202-225-3816
Eddie Bernice Johnson (D-TX)- 202-225-8885
Hank Johnson (D-GA)- 202-225-1605
Marcy Kaptur (D-OH)- 202-225-4146
Carolyn Kilpatrick (D-MI)- 202-225-2261
Dennis Kucinich (D-OH)- 202-225-5871
Barbara Lee (D-CA)- 202-225-2661
Sheila Jackson-Lee (D-TX)- 202-225-3816
Eric Massa (D-NY)- 202-225-3161
Jim McDermott (D-WA)- 202-225-3106
James McGovern (D-MA)- 202-225-6101
Gwen Moore (D-WI)- 202-225-4572
Jerrold Nadler (D-NY)- 202-225-5635
Grace Napolitano (D-CA)- 202-225-5256
John Olver (D-MA)- 202-225-5335
Bill Pascrell (D-NJ)- 202-225-5751
Donald Payne (D-NJ)- 202-225-3436
Chellie Pingree (D-ME)- 202-225-6116
Laura Richarson (D-CA)- 202-225-7924
Lucille Roybal-Allard (D-CA)- 202-225-1766
Linda Sánchez (D-CA)- 202-225-6676
José Serrano (D-NY)- 202-225-4361
Albio Sires (D-NJ)- 202-225-7919
Jackie Speier (D-CA)- 202-225-3531
Pete Stark (D-CA)- 202-225-5065
Bennie Thompson (D-MS)- 202-225-5876
John Tierney (D-MA)- 202-225-8020
Ed Towns (D-NY)- 202-225-5936
Nydia Velazquez (D-NY)- 202-225-2361
Maxine Waters (D-CA)- 202-225-2201
Diane Watson (D-CA)- 202-225-7084
Mel Watt (D-NC)- 202-225-1510
Lynn Woolsey (D-CA)- 202-225-5161

And these are the members who are credibly onboard with the FDL Pledge:

Emanuel Cleaver (D-MO)- 202-225-4535
Pete DeFazio (D-OR)- 202-225-6416
Lloyd Doggett (D-TX)- 202-225- 4865
Donna Edwards (D-MD)- 202-225-8699
Keith Ellison (D-MN)- 202-225-4755
Bob Filner (D-CA)- 202-225-8045
Barney Frank (D-MA)- 202-225-5931
Raúl Grijalva (D-AZ)- 202-225-2435
Phil Hare (D-IL)- 202-225-5905
Rush Holt (D-NJ)- 202-225-5801
Carolyn Maloney (D-NY)- 202-225-7944
Jerrold Nadler (D-NY)- 202-225-5635
Chellie Pingree (D-ME)- 202-225-6116
Maxine Waters (D-CA)- 202-225-2201
Robert Wexler (D-FL)-202-225-3001
Lynn Woolsey (D-CA)- 202-225-5161
John Yarmuth (D-KY)- 202-225-5401

Another way to say thanks might be to stop by a brand new ActBlue page: Standing Up For The Public Option and leaving a little something for the members you want to thank.


Insurance Industry Still Holding Health Care Reform Hostage

But Jim Webb (D-VA) persuaded the Myanmar dictatorship to free John Yettaw, an American being held there. Something tells me FDR and a more robust kind of Democrat would have freed health care reform by now as well. Obama's a big disappointment. "Better than Bush or McCain" isn't enough, not even close.