Subverting the Public Option

Unless you've been living in cave for the past few months -- to be fair, not entirely unreasonable these days -- you've probably noticed the intense battle for health care reform currently sweeping the nation. While there are a great many aspects to the proposed reform, it's impossible to get around the fact that the flashpoint has been the so-called "public option." A public option -- a non-profit insurance option with lower overhead and administration costs provided by the government with a startling lack of CEO compensation bonuses -- is expected to drive up quality and drive down costs, and is consequently popular among doctors, academics, teachers, students, parents, the AARP, unions, business leaders, and everybody who isn't a Republican or a pharmaceutical lobbyist. So, obviously, it's causing a massive fight.

Full disclosure -- I'm engaged to a Canadian (I love you, sweetheart) and visit the country weekly, so I must confess I'm periodically frustrated at having to have my nose rubbed in an effective, efficient, universal, single-payer health care system. Say what you like about Canadian health care, but consider that their country isn't the one with the massive health care crisis -- or the budget deficits. But I digress.

Last time I wrote in this space, covering Congressman Massa's townhall in Horseheads, New York, one of the topics discussed was tying the premium rate for the public option to that of private insurers -- or, to use a scientific term, "making the whole flippin' thing useless." Send a bill to the floor with that sort of language and I'd hope my Congressperson would vote against it. This called for more research.

The base bill, H.R. 3200 -- in all its many iterations in committee -- pegged public option rates to Medicare. However, according to one senior Congressional staffer, a Blue Dog amendment has been offered and accepted -- meaning this is now part of the base bill -- which ties public option premiums to the average rate offered by private insurance companies in the same region. That is gutting the public option. Be sure you understand this - and be sure your Congressperson knows you do.

That said, this fight is far from over. H.R. 676, the United States National Health Insurance Act ( http://thomas.loc.gov/cgi-bin/query/z?c109:H.R.676: ) -- a true single-payer bill -- will be up for a vote this fall; however, the relevant portions can be submitted as an amendment to H.R. 3200 and, according to one source, Rep. Anthony Weiner plans to do just that. Additionally, Rep. Dennis Kucinich has also submitted an amendment to H.R. 3200 giving states the legal right to adopt their own single-payer system -- any Republicans out there ought to love the chance to walk the walk on states' rights by supporting that one.

Well, that used up the last of my irony quota for the day, so I'm off til next week. In the meantime, make sure your Congressperson knows where you stand on this issue. When people are dying to pad profit margins, that's not neglectful -- that's murder. This is the time for real health care reform.

The clock is ticking.

Follow Tim Ellis on Twitter: www.twitter.com/DJDynamicNC

Comments

[sarawaters]

So let’s take Republican ideology to its typically illogical conclusion:

To trace delays in payments, the staff at my son's medical office must call a phone bank that has been outsourced to India by private insurance companies. Fine. Free enterprise is free to outsource and sacrifice American jobs.

Americans can buy a cheaper foreign car or an American model. That is capitalism at its purest, and allowing consumers real free choice in the marketplace.

Not so American manufacturers. The American automobile includes the costs of supporting our expensive private health insurance industry. Conservatives are quick to limit capitalism when it suits their wins and mandates for the industries that support their political agenda and campaigns.

It is selective logic at its best.

But here’s a thought: How about allowing individuals the freedom to outsource? The health care systems of most other industrialized countries provide lower mortality figures, and they manage this at lower costs.

There was hardly a congressional whimper when American business outsourced American jobs—in the name of cost savings and increased profits. Why do I have to support a system that only offers me denials, delays, and labeling medical of procedures as “experimental” while taking away 15 to 30% of my health care dollar?

Personally, I am all for the free market.

Let's see, do I want a Canadian or British vehicle for health care delivery? Or maybe a French model? Forget an American public option.

Personally, I am ready for a foreign import.

[Edmonsky]

Finance Senate Committee has 12 Democrats and 10 Republicans.
Three Democrats, Max Baucus, Kent Conrad and Blanche Lincoln have stated categorically that they are opposed to public option. Two Democrats, Jeff Bingaman and Bill Nelson, are suspected to be against public option. Any reasonable person knows that public option is dead. If the bill does not pass in the Senate Finance Committee, it means that the healthcare legislation has failed again and has to start all over again in 10-15 years again when Democrats have majority in the both Houses of Congress.

Democrats
http://finance.senate.gov/sitepages/committee.htm
Max Baucus, MT
John Rockefeller, WV
Kent Conrad, ND
Jeff Bingaman, NM
Blanche Lincoln, AR
Ron Wyden, OR
Charles Schumer, NY
Debbie Stabenow, MI
Maria Cantwell, WA
Bill Nelson, FL
Robert Menendez, NJ
Thomas Carper, DE

Republicans:
CHUCK GRASSLEY, IA
ORRIN G. HATCH, UT
OLYMPIA J. SNOWE, ME
JON KYL, AZ
JIM BUNNING, KY
MIKE CRAPO, ID
PAT ROBERTS, KS
JOHN ENSIGN, NV
MIKE ENZI, WY
JOHN CORNYN, TX

[valboski]

WHAT'S WRONG WITH HEALTHCARE? PORTABILITY, PRE-EXISTING CONDITIONS, HIGH COSTS. THE GOV OPTION WILL CHANGE THAT TO RATIONING,LACK OF DOCTORS AND HIGHER TAXES. NO THANKS

[Tim Ellis - Huffpost Blogger]

Actually, I'm afraid it won't "change" to rationing. We are already rationing care. We already have a lack of doctors. So a more accurate breakdown:

Current problems = no portability, no coverage for pre-existing conditions, rapidly spiraling costs, rationing by finance, lack of sufficient doctors, recission, insurance company "death panels."

With health reform = higher taxes... maybe.


It's honestly really difficult to figure out why people who aren't working for a health insurer are opposing this.

[PlaceboStudman]

I'd just like to know why the statistic that the Journal of the American Medical Association recently announced, stating that 106,000 die every year from drug interactions and unexpected side effects is somehow less important or less worthy of mention than the 45.000+ who die from lack of insurance?

Have we really stooped so low as to believe that one avoidable death is more worthy than another when we should be equally concerned with both?

Those who do not have insurance have a voice in this fight, those who have insurance but suffer and die for other reasons apparently dont matter, because all that anyone can talk about is insurance

[who38]

Several years ago, California enacted a law re/ gas emissions. At that time, lawnmowers made in Missouri could not meet the guidlines. A national representative from that state introduced a bill, which was enacted, that nullified the California law. I can hardly wait to see which lawmakers would deny states a right to develop a single payer plan.

[JBGabriel]

In the following article, Paul Krugman who I think is a great economist provides a solution to the healthcare controversy. I don't always agree with Paul, but he is highly respected as an thinker on things economic.

The healthcare plan will need to be amended so that illegal immigrants will not have free healthcare access. A legal status verification regime like "Everify" must be added to the bill to give it credibility.

http://www.nytimes.com/2009/09/18/opinion/18krugman.html?_r=2&ref=opinion

[annis]

Do you not get that isn't the influx if illegal immigrants that will make up the costs of "health care" but the profits of pharmaceutical companies and t heir advertising costs? Do you not get that so-called diagnostic test prices are also inflated to take advantage of the lack of oversight of the "health care" system? When was the last time you really examined your hospital bill? And, why are so many hospitals being forced to close their doors anyway?

Can you think about any other issues than who has the right to . . . . whatever . . . . just who decides who has real rights, and why would that be YOU. Maybe we citizens have the right to have as good a health plan as our government members as maybe hard-working immigrants have a right to the same health care as some not-so-hard working American citizens.

Do you really view "health care" as a business rather than a human right?

[swimbiker]

Well, it seems to me that Christians would have to be for universal healthcare. I seem to recall something about "what you do to the least of these you also do to me..." somewhere in the book of Matthew.

The strange thing about the fight over illegal immigrants is that the Republican Party is really angering Hispanics and doesn't seem to realize that...or care.

[BusGreg]

While your argument makes good sense, how do you propose we deal with "illegals" who end up in the ER and receive the most expensive care on the tax payer's dime?

[Tim Ellis - Huffpost Blogger]

Interestingly, a single-payer system provides an easy answer.

How do illegal aliens end up taking advantage of our medical system? The same way they get jobs in our country. There is no single identity system for American citizens, and so Social Security cards have been adopted as stop-gap identification - which is actually supposed to be prohibited.

Enact single-payer health reform, and what do you get? The Health Card - the premier form of identification in Canada, and extremely difficult to forge (as opposed to the simple paper cut-out social security card).

[myrddin]

It's irrelevant whether the bill excludes illegal immigrants or not. Under a law passed by Ronald Reagan, yes that Ronald Reagan, all people will get treated if they come to an emergency room for care. Even illegals. We are all paying for it regardless.

[wildedge]

There is no bill in Congress offering anyone 'free health care,' let alone illegal aiens. This is really a health INSURANCE reform project, everyone will still pay something to somebody for some service.

[comrade leviathan]

Fantastic article. I love seeing Wiener and others out there doing what the rest of the progressive nation has been dying for (literally) for so long. If a state-by-state option for single payer is possible then we can fight this battle on the ground instead of in the air, where (to continue the metaphor) our planes are getting shot down by our own guys (looking at you, Sen. Baucus!).

[tnkeating]

Fact is Tim that not only is there no place in the U.S. Constitution that says our government is resonsible for the general health of the Republic, likewise there is no place in my state Constitution. Not to mention my state just as broke as my nation. There are already hosbitals and clinics where our poor can go now if they need to, granted they aint pretty, but the people there give there time and energy to help any way they can. I myself go to these clinics as I have no job as of July 3 and my health insurance was canceled by my last employer, most medications can be purchaced at Wal-mart for under 5 bucks and ones that are not are subsidized or given to me at the clinic. I would much rather live and die this way, instead of putting my childrens, children in debt. I am not my brothers keeper, and if I was, my brother would not be free.

[luckynewman13]

wow...LEAR­N YOUR HISTORY before you start spouting your tripe about the Constitution.

"There is no place in the U.S. Constitution that says our government is responsible BLAH BLAH BLAH BLAH"

If the Constitution specifically said the government COULD NOT provide health care, then you would have an argument. The Constitution gives our legislators broad power to do whatever the majority says...lim­ited only by CONSTITUTIONAL AMENDMENTS.

it is clear the right has succeeded in destroying our history. Please go back to sixth grade social studies.

[BusGreg]

Article One, Section 8 of the Constitution reads"

"""The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;"""

The part; "and general Welfare of the United States", is the constitutional basis on which Social Security and Medicare are founded.
It would be hard to argue that single payer health care does not fall under this provision.

[Tim Ellis - Huffpost Blogger]

I'm afraid not. If that were the case, then Medicare - government health care - would have to be declared unconstitutional. And if THAT were the case, then one would expect the people whose job it is to analyze the constitutionality of the law to have done so.

However, a review of Supreme Court rulings regarding Medicare shows no such constitutionality challenge. It is their job - as stated in the Constitution - to analyze the constitutionality of laws enacted by Congress. It is therefore reasonable to conclude that Medicare passes muster in the Supreme Court and is - by genuine constitutional standards - completely acceptable.

If that is the case, then extension of Medicare - even greatly diluted ones, such as a public option - are also constitutional.

Further, all powers not explicated to the Federal government or directly prohibited fall to the states, and consequently even if the Supreme Court were to suddenly ignore decades of precedent and find Medicare unconstitutional, state-based single-payer would still be completely acceptable.

Finally, I have to take issue with your closing remarks. You are not your brother's keeper because you have chosen not to be, not because it is some sort of inviolable law of the universe. But I know that this country can do better. I care about this nation and I care about my fellow human beings, and I know that by being my brother's keeper I also help ensure the strength of this nation, a nation worth defending.

Greed

[swimbiker]

"Provide for the Common Welfare". I know I saw that in there somewhere. As far as "putting my childrens, children in debt", where were you when George W. Bush was starting two wars of choice?

[PhilipTaylor]

BOTH SIDES HAVE IT RIGHT - BUT BAUCUS IS DE@D WRONG! SO DOES HR 3200!

Republicans have it RIGHT! We need Health Care Competition with an Internet Exchange so 100% of Americans can compare 1,300 Insurers on Total Cost, deductibles, coverage, co-pays, etc.

Democrats also have it RIGHT! We need a STRONG Medicare Public Option as part of that Internet Exchange! HR 676 should be that OPTION!

Baucus has it WRONG! Isolates 180 Million people from having a CHOICE of employer Coverage or buying through the Internet Exchange!

If 0BAMA agrees with Baucus then 0BAMA is also WRONG!

If Medicare is ranked with the 1,300 Insurers by ANNUAL COST then Medicare will more frequently than NOT be the Best Plan (Top in the Sorted List) so competition will be the key to having a market!
_______________

COMPETITION with Private & Public Options = Lower COST Health Care for ALL

Insurers will have to lower prices and increase coverage to compete! That will be the best way to insure Innovation and lower costs!

NO Rejections of any kind by Insurers!

[BusGreg]

NO!!! The republicans have it dead wrong, and so does Baucus. It is time to get rid of for profit insurers and go to single payer. All these band aid fixes will only prolong the inevitable. Check this link:
http://www.democracynow.org/2009/9/21/ralph_nader_on_the_g20_healthcare

[cobobs]

Yes, let those who want in, vote in and pool into a single payor system.

[swimbiker]

Everyone has to be covered; the pool has to be as large as possible.

[cobobs]

I meant to say states, not individuals.

[sociocanuck]

The State by State approach would be interesting; and the immediate shifts predictable. Blue States would take advantage first; especially those closest to the Canadian border.

The CBC greatly admires Dennis K., at least based on how often he's called up for comments on political issues of interest to Canada and the U.S. alike (this being one of them). His amendments speak to the least of the qualities worth admiring.

[GoDems2012]

I'd love the single-payer by state option. Will narrow down the field of where I will be moving to.

[coffeejoe69]

single-payer is a no brainer. that's how you do healthcare right, but unfortunately corporate interests have already entrenched in american politics. it will never happen simply because people who have money and power don't want it to happen.

[yakmeat]

Single payer by state could work in some places (California) where there are enough people to share the cost and distribute the risk. I'm not sure if it would work in other states (Wyoming) with small populations.

Here's a crazy idea: Wouldn't it be nice to choose where you live based on where you actually want to live, rather than which state has affordable health care?

[BusGreg]

Does this country have to go completely bankrupt?????
Quit the bandaid fixes and do what France does. They are number one in health care according to the WHO, we are 37th! What is so hard to figure out. The insurance companies are killing us!

[who38]

They are in the forefront with science as well, but they don't take any crap from religious groups. Good model.

[looking4thelight]

Letting states choose health care for all sounds great to me. I don't want to have the Senate Finance Bill the way it is forced upon us. I would have a really hard time affording it. We need real reform. Thank you to all the hard working US Representatives who are working on true reform for the American people.

Congratulations Tim! Hope you have a long, happy marriage and thank you for this hopeful reporting.

[jsgaetano]

States can already choose to do a public health care. But they haven't.

More laws on the national level aren't going to change that. All making it "states rights" will do is continue to allow citizens in Red States to receive sub-par coverage, and protect the huge profits the health care monopolies (like that owned by the Frist family) take from providing that sub-par health care.

[MalteseTiger]

If those people want to live in a state that didn't setup a single-payer system.. that's their right. If they wanna pad the corporations pockets.. let them.. Why should those whiners force me to increase the profits of a soulless corporation just cause they wanna vote based on their religion.

Remember the quote.. "Kill all the lawyers...­"... new one says Insurers.

[kevinbracken]

A single payer system is the only way to create a state of heath care that is truly equitable and just. Canadians are fighting hard to prevent private, for-profit clinics from opening up in order to prevent a two-tier health system.

Although I do not agree with the statement that Canada "is not the country with a health crisis" - the crisis there is organ donation wait times, surgery wait times, emergency room wait times, and doctor and nurse shortages. Many good doctors defect to the U.S. because they get paid more here.

[pup sydney]

I haven't met a single canadain doctor defecting to the USA unless their signficant one moved her. Where do oyu get the data on waiting times? Who waits? Elective surgeries or emergency surgeries.
We wait here too: my mother had t wait 3 months to see an oncologist to have chemo started: 3 MONTHS. Of course then more wait before she actually got the chemo.
Do not spread lies about single payer: they are efficient if they get funded and if honesty is there.

[pfrogger]

in Canada, everyone with an elective medical issue (ELECTIVE!!!) may wait.
in the US, if you don't have insurance, there are no wait times, because you won't have that operation till it becomes an emergency. then you can get treated. but only then.
in the US, if you have insurance, you may be denied coverage, or dumped immediately. so now you're in the same spot as the uninsured person.

so the "richest" country in the world can't do what Canada and other modern countries do, ie. take care of their own.
and which country would the average person live in if they had a medical issue? think about it.

[BusGreg]

I think Bill Maher summed it up best, when he called the current "solution"
"A BL....B (oral sex act) for the Health insurance companies"
As long as "reform" does not include a strong public option, it won't be reform, it will only be a guaranteed 45 million new customers for the FOR PROFIT insurers. EWuropean nations are well ahaed of us, as most of them mandate that health "insurance" companies are NON PROFIT.
As long as FOR PROFIT insurers are allowed to syphoon off as much as 30% of premiums for multi million dollar CEO salaries, advertisement and LOBBYNG, we the people will never get our money's worth in health care. That 30% mentioned amounts to 300 billion dollars every year that are not used for health care.

[coffeejoe69]

for-profit insurance companies in USA makes 30% margin, that's after paying their CEOs and shareholders.

[swimbiker]

And Medicare has a much lower administration rate!