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If Barack Obama's healthcare plan gets changed to exclude a public option like Medicare, then it is not healthcare reform. Legislation rises and falls on whether the American public is allowed to choose a universally available public option or not.

-- Gov. Howard Dean, M.D.

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Private Muscle and the Public Option in Health Care

Cross-posted from The Huffington Post

We’re headed into the end game for health care reform. The president has put himself in the arena. The insurance lobby is unleashing the scare campaign. A strong bill will pass the House. But at this point, too many Senators are still standing in the way.

The reform includes a broad range of measures to extend and improve care and help curb rising costs, but the epicenter of the debate is over what is called the “public option.” Health care reform will mandate businesses provide insurance or pay into a general fund. Individuals will be responsible to get health insurance, with subsidies for those that can’t afford it. We’ll able to retain the insurance we have, or have the choice of a range of plans, including a public option, modeled after Medicare. A strong public option, competing with private insurance, is key to helping to get costs under control.

And costs must be brought under control. We now spend nearly 50% more on health care per capita than any other country, with mediocre results. We ration care by price, with some 47 million Americans uninsured. It costs the rest of us about $1000 a year to pay for the price of their care when they are forced finally to check themselves into emergency rooms.

Tell stories, not statistics, the pollsters tell us. But after adjusting for inflation, health care costs have soared by 58% since 2000; while wages for most Americans were stagnant or lost ground. As the auto companies showed, businesses increasingly can’t afford health care. Families find it unaffordable. Virtually the entire long term debt challenge facing the US government is from the projected rise of health care costs. Get health care costs under control, the US has no long term fiscal problem. Fail to get them under control, the costs will bankrupt the federal government, state governments, businesses that offer health care (and increasing numbers won’t) and families. Reform that gets costs under control is imperative. There is no choice.

A key to getting costs under control is the public plan. It can take advantage of its purchasing power to gain cost reductions. It can model best care practices. Private insurance — which in most localities translates into a couple of dominant providers that don’t compete on price — will be forced to measure up with greater efficiency, innovation, and cost savings techniques.

Yet the debate in the Senate has been fixated on how to weaken or abandon the public plan rather than strengthen it. Republicans, for the most part, have taken themselves out of the adult conversation. Like first generation robots, they endlessly repeat the exact same words crafted by Frank Luntz – “government takeover,” “no choice of doctor,” “bureaucrats not doctors prescribing medicine.” It’s frankly pathetic. We have no choice as a society but to figure out how to fix this – and Republican leaders have chosen simply to peddle lies and scare stories and absent themselves from any serious discussion.

A gaggle of Democratic Senators — led by Senator Baucus and the so-called “moderate” Senators — have publicly thrashed around for ways to weaken or gut the public option. Outside groups like the Third Way have provided guidelines for disemboweling it. Some have suggested putting it off until private insurance competition proves it can’t get costs under control — as if that hasn’t been proven over the last decades. Baucus suggested decentralized local “co-ops” would serve as the public option — an idea notable for being both unmanageable and ineffective. Even if a network of coops somehow arose to insure that people had an option, they wouldn’t have the clout to hold costs down and force private insurance to compete.

Others, remarkably, have detailed ways to deprive the public option of the power to lower costs. They call for a “level playing field” with private insurance. The public plan can’t be subsidized, can’t use its buying power to lower costs, can’t take advantage of lower administrative overhead.

This sounds silly. We face soaring health care costs that will literally cripple our future. Surely, no Senator concerned about the country would work to undermine the key idea that would help get a lid on costs. They wouldn’t, as Barack Obama warned, just “create a system where the insurance companies have more customers on Uncle Sam’s dime, but still fail to meet their responsibilities.” If you assume that, you would be wrong. They’ve done it repeatedly in the past.

For example, early in Bush’s first term, Republicans decided that passing a prescription drug benefit for seniors would help cement Karl Rove’s permanent majority. The benefit would help 41 million Americans with a soaring cost of care not yet covered by Medicare. It would also create massive new market for the drug companies. And, of course, Medicare could do what governments across the world do — use its buying power to lower the cost of the drugs.

Only, when Republicans passed the law — in the dead of night, twisting arms to get it done — it actually prohibited Medicare from negotiating a lower price for drugs. Don’t worry, they argued, competition would lower drug costs (even as they banned the import of cheaper drugs from Canada or Mexico).

Why? Well, using government muscle violated “free market” sensibilities. More importantly, the drug companies have one of the most powerful lobbies on Capitol Hill. Billy Tauzin, the chair of the key House committee ushering the bill through, left soon after to get a two million dollar a year job as a head of Big PhRMA, the drug company lobby. Tom Scully, the administration’s point person who helped secret the actual cost of the bill, was already negotiating his million dollar job as the debate was going on. In all, 15 congressional representatives, aides and administration officials involved in the debate left shortly thereafter to take jobs with the drug lobby. With a $9 billion increase in annual profits at stake, the drug industry got an amazing return on its investment.

Today, seniors pay 60% more for the same drugs than the price charged veterans becuse the Veteran’s Administration does negotiate lower prices.

Extreme? Not really. The health insurance companies decided they should be allowed to compete with Medicare in providing health insurance options to seniors. Seniors would get more choice; Medicare, the bureaucratic behemoth, would get agile competition. Win, win, they argued, calling the program “Medicare Advantage.”

Only the insurance companies couldn’t compete with Medicare straight up. So they demanded subsidies from the government to enable them to vie with the Medicare program they described as horrendously inefficient, unpopular and bureaucratic.

And they stand to pocket an estimated $177 billion in excess payments over 10 years to compete with Medicare – subsidies that Obama would sensibly cut to help pay for health care reform.

Money talks. Nine Republican Senators on the key Senate Finance Committee wrote President Obama to say they would oppose any reform with a public plan. The Center for Responsive Politics reports that the nine had had pocketed $17.7 million in contributions from insurance and health care interests over the course of their careers.. http://www.bio-medicine.org/medicine-news-1/Senators-Who-Signed-Letter-Opposing-Public-Health-Plan-Took—2417-7-Million-in-Campaign-Donations-from-Health-Care-and-Insurance-Industries-48233-1/

Not surprisingly, the 20 largest insurance and drug companies and their trade associations have pumped up their lobbying by 41% over last year — with reported spending over $75 million in the first quarter alone.

This is the corruption of crony capitalism; a compromised congress using taxpayer’s money to enrich entrenched interests. Only now, the cost of this in health care is not sustainable. Dramatic reform is vital or we all follow the auto companies and go belly up.

So if your Senator says he or she is opposed to a public option, or wants a weaker public option, or a non-profit co-op that isn’t big government, or prates about the “government takeover of health care,” about losing your choice of doctor, about bureaucrats not doctors prescribing medicine, don’t fall for it. Either he or she is either utterly clueless or more likely is representing the interests of the industry, not the voters.

This business as usual is no longer affordable or acceptable. We shouldn’t let cynicism lower our expectations. Soaring health care costs and the human tragedy of those without insurance can no longer be ignored. Reform can’t be postponed. It is a stunning disservice that Republicans have taken themselves out of serious discussion. And it is an open scandal that Senators are catering to the private insurance industry that has profited from the problem rather than helping to solve it. We must expect more and demand more from those given the privilege to represent us.
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The HELP Committee needs HELP

By Nyceve

mcjoan at Daily Kos has a clear and excellent diary about the machinations going on at the Senate HELP Committee. Here’s the very frightening take home message mcjoan received from a contact on the Hill:

“We’re still hearing conflicting things, but there is a very real danger that the HELP committee is considering going ahead without putting a public option in the bill, making it necessary to add the public option in via amendment as opposed to protecting it from being stripped. This would stack the deck against the public option and make it much more likely we couldn’t get the votes in committee to add it at all, or would have to weaken the public option to get it passed. Bottom line, going forward without a public option in the bill is like starting the game down by 10 points.”

If you ask me, this is like fighting George Foreman with one arm tied behind your back.

So you’ve got to get on the phones, especially to the so-called Democrats on the HELP committee. Here’s all the contact information, courtesy of mcjoan. Call, baby, call.

Tom Harkin (IA): (202) 224-3254
Barbara A. Mikulski (MD): (202) 224-4654
Jeff Bingaman (NM): (202) 224-5521
Patty Murray (WA: (202) 224-2621
Jack Reed (RI): (202) 224-4642
Bernard Sanders (I) (VT): (202) 224-5141
Sherrod Brown (OH): (202) 224-2315
Robert P. Casey, Jr. (PA): (202) 224-6324
Kay Hagan (NC): (202) 224-6342
Jeff Merkley (OR): (202) 224-3753


Sen. Dodd needs some special attention because as mcjoan says, “Sen. Dodd, [who] is Kennedy’s standard-bearer on this one.”

Tell Dodd a robust public option must be included in the draft that goes to markup: Tel: (202) 224-2823 | Fax: (202) 224-1083.

PS: And Harry Reed, who’s supposed to be on our team, is confusing the issue even further with his call for Nonprofit Community Health Plans. Call Harry and demand that he stay focused on the public option.

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Fight the Smears

Rep. Boehner Townhall op-ed purposely misleading

By Joe Frandino

House Minority Leader John Boehner recently wrote that attempts to criticize Democrats’ plans for environmental, financial and healthcare reform. Boehner’s claims, however, are in direct contradiction of several recent surveys and investigations by major, respected organizations:

Rep. Boehner said new legislation addressing global warming and healthcare will have “devastating consequences” for the middle class …

However:

Investment in clean energy technology will create more than 1.5 million American jobs, Center for American Progress, “Green Recovery,” Sep. 2008

Boehner’s home state of Ohio would gain more than 80,000 jobs from increased investment in clean energy, Center for American Progress, “Green Recovery,” Sep. 2008

More than 70% of Americans polled want an increased government role in health care, CNN survey from 3/5/09

Boehner attempts to promote the Republican plan of offering $5,710 tax credits to all families to pay for their own health care…

However:

In 2008, the full annual cost of employer-sponsored health insurance averaged $4,704 for an individual policy and $12,680 for a family policy, according to a report by The Kaiser Commission on Medicaid and the Uninsured, Jan 2009
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Bipartisanship needed?

By Joe Frandino

The private insurance industry and its spokespeople in Congress are making the argument that for healthcare reform to last and have the support of the American people, Congress must pass a “bipartisan” reform plan.

But as :

Of course you never heard a word about “bi-partisanship” from the insurance industry or Republicans when they passed the notorious “Medicare Part D” prescription drug plan in 2003. Back then, they froze Democrats out of all negotiations, and passed the bill …

Now that the political tide has turned … the Republicans and insurance companies have had an eleventh-hour conversion to the benefits of “bipartisanship” when it comes to health care reform.

According to Creamer, in order for the American people to support this reform, they care more about results than bi-partisanship.

More than bipartisanship, the American people want to make sure that:

* Something gets passed.
* It provides health care for everyone.
* It puts the brakes on skyrocketing health care costs.

The best way to produce these results is to create a public health insurance option that would compete with private insurance companies. The resulting competition would keep private insurance providers honest and seek more cost-effective and efficient healthcare for everyone in America.

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RX for Reform Online Chat with Gov. Howard Dean

By Joe Frandino

Last night, Gov. Howard Dean held a national live online chat with grassroots activists from across the country. Those who logged into the Stand with Dr. Dean website were able to submit their questions electronically to Gov. Dean.

The online chat was a big success, with more than 2,500 questions being submitted and more than 2,000 people taking part in the chat.

To list a few of the excellent questions posed to Gov. Dean last nigt:

Does the public health care solution cover those who cannot pay at all?

DEAN: Yes, premiums would be income based.

The money and lobbying staff of drug and insurance companies are huge. What makes you think we can effectively counter that?

DEAN: Real change always comes from the grassroots, but its hard work and that’s why you are so important. You can write letters to the editor, contact members of Congress, sign the petition at standwithdrdean.com and make it clear that you want real change in healthcare or that you’ll work very hard for change in Congress.

What [are you] doing to spread the need for a public healthcare alternative to the non-believers?

DEAN: I’ve been spending a lot of time on the road doing town hall meetings to make sure people know what’s at stake and have been explaining this on television, radio and in print. I also wrote a book, Howard Dean’s Prescription for Real Healthcare Reform.

What would be the incentive for people to move from employer-based healthcare to this new program?

DEAN: It’s cheaper, comprehensive, and it travels with the individual wherever they live, no matter who they are employed by, and even if they are unemployed.

Do you think private insurance companies would really be able to compete with the public option?

DEAN: They will be if they behave themselves. As I point out in my book, they will have to treat their clients better and treat providers better. They will have to focus more on patient care and less on profits.

To read more questions and answers from last night’s online chat, click here.

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