How low can Republicans sink?

Of all the desperate tactics Republicans have taken to sabotage the Affordable Care Act, this is the absolute worst: They are encouraging people not to buy health insurance!

It borders on the criminal for a pair of wealthy Tea Party right-wingnuts (we all know which brothers I’m talking about here) to tell poor Americans to forgo access to basic health simply because they don’t like the occupant of the White House. "Hey let those poor people suffer if it advances our political cause," they say. "We don’t have to worry. We have more than enough money to buy own hospitals, let alone insurance."

What gaul! What selfishness! These people should be charged with attempted murder.

Are Republican political candidates born stupid or does the party line make them that way

Chris Collins, a Republican running for the House of Representatives from New York, made a fool of himself this week during a newspaper interview in which he cited reasons he would, if elected, work to repeal President Obama’s health care plan.

Republican idiot Chris Collins

"The fact of the matter is, our healthcare today is so much better, we're living so much longer, because of innovations in drug development, surgical procedures, stents, implantable cardiac defibrillators, neural stimulators — they didn't exist 10 years ago," he said. "People now don't die from prostate cancer, breast cancer and some of the other things."

According to the American Cander Society, however, more than a half million people will die of cancer in the United States this year alone, including 39,920 from breast cancer and 28,170 from prostate cancer. Many of the victims would have been saved if the cancer had been detected early enough, but wasn’t because they were uninsured.

Here's why Texas must not opt out of Medicaid

From the editorial pages of today's New York Times:

Texas and several other states are flirting with the idea of dropping out of the Medicaid program and trying to shift most of the burden of providing health insurance for the poor to the federal government.

The idea appears to be driven at least as much by ideology as economics: Republicans’ fierce opposition to President Obama’s health care reform and their insistence that state budgets can be balanced solely by cutting services, like Medicaid, rather than raising taxes.

The idea originated with analysts at the Heritage Foundation, a conservative research organization based in Washington. They argue that many states would be irresponsible not to drop Medicaid in 2014 and direct poor residents to buy commercial insurance on new competitive insurance exchanges, where they would receive generous federal subsidies. A Heritage analyst believes that 40 states and the District of Columbia could save money this way and estimated that Texas could save $46.5 billion between 2014 and 2019.

That may sound great. Even assuming it is legal — a big question — at the core, this would amount to a shell game. It may save money for some state budgets but only by driving up costs for the federal budget and for the poor enrollees, who would have to pay more for commercial policies even with the federal subsidies.

And for all of the me-firstism out there, state taxpayers need to remember that they are also federal taxpayers. Even if their state drops Medicaid, they will continue to pay taxes that support the subsidies in the insurance exchanges and Medicaid programs in other states.

There is no question that Medicaid is badly straining many state budgets. And state leaders need to do a lot more to make their systems more efficient and reduce waste and abuse. The burden, and the need for reform, will undeniably grow under health care reform because the states will have to enroll many adults not previously covered and allow people with somewhat higher incomes to enroll.

The federal government, however, will pay for most of that increase — 100 percent of the cost for newly eligible enrollees for three years and at least 90 percent ever after, as well as 90 percent of the added administrative expenses. Despite that largess, the Texas health agency estimates the state will have to spend $27 billion of its own money over a decade. Outside experts are skeptical of those numbers.

Before any more politicians get excited about the opt-out idea, they need to consider several basic issues.

First, none of these maneuvers will help states meet their current budget crises. The exchanges won’t exist until 2014, by which time state revenues will probably have picked up.

Even more important, no one seems certain whether the federal government can even legally pick up the Medicaid burden, or would be willing to. One provision of the reform law indicates that the poorest people on Medicaid — those earning less than the federal poverty level — could not receive subsidies on the exchanges; a separate table implies that they might be eligible. If that issue is not clarified by federal officials, it may have to be resolved in the courts or Congress.

Large numbers of people, mainly low-income elderly and disabled patients who need long-term care services, would not be eligible to buy insurance on the exchanges. These are the two most expensive groups to cover, and the cost of their care would fall solely on the state. It is conceivable that a state with small enrollments of these groups might be able to shoulder the whole burden; states with big enrollments ought to be wary about relinquishing federal matching funds.

Medicaid is also so intertwined with multiple parts of the health care system that political leaders will need to be wary about harming a wide range of medical institutions that depend on Medicaid reimbursements.

Despite all of the campaign rhetoric, there are no easy fixes out there.

There's more going on here than just anti-health care reform emotions

Has anyone else noticed that the mobsters who storm town hall meetings in the guise of opposing much-needed health care reform are all white?

And The New York Times editorialized today that many of these mobsters are targeting small business owners, telling them that health care reform could drive them out of business. "These proprietors would be wise to ignore the rhetoric and take a closer look. A vast majority of small businesses and their workers are likely to benefit greatly. They should be supporting, not opposing, reform."

"Small businesses would reap substantial benefits if their employees were insured," the Times said. "Their work forces would likely become healthier, and they would have an easier time attracting or holding talented employees. Even more striking, with health care reform, small firms could buy insurance at substantially lower rates."

It did acknowledge that some firms might be forced to pay a penalty if they did not provide health insurance to their employees but it also estimated the number of penalized firms would be about .0065 of all the employers in the country.

Keith Olbermann's "Special Comment" on heath care reform

Finally tonight, as promised, a Special Comment on Health Care Reform in this country, and in particular, the “public insurance option.” In March of 1911, after a wave of minor factory fires in New York City, the City’s Fire Commissioner issued emergency rules about fire prevention, protection, escape, sprinklers. The City’s Manufacturers Association in turn called an emergency meeting to attack the Fire Commissioner and his ‘interference with commerce.

The new rules were delayed. Just days later, a fire broke out at the Triangle Shirtwaist Factory. The door to the fire escape was bolted shut to keep the employees from leaving prematurely. One hundred and fifty of those employees died, many by jumping from the seventh floor windows to avoid the flames. Firefighters setting up their ladders literally had to dodge the falling, often burning, women. This was the spirit of the American corporation then. It is the spirit of the American corporation now. It is what the corporation will do, when it is left alone, for a week. You know the drill. We all know the drill.

You get something done, at a doctor’s, at a dentist’s, at an emergency room and the bills are in your hands before the pain medication wears off. And if you’re one of the lucky ones, and you have insurance, you submit the endless paperwork and no matter whether it’s insurance through your company, or your union, or your non-profit, or on your own dime, you then get your turn … at the roulette wheel.

How much of it is the insurance company going to pay this time? How much of it is the insurance company - about which you have next to no choice, and against which you have virtually no appeal - how much is this giant corporation going to give you back? What small percentage of what they told you they were going to pay you, will they actually pay you?

You know the answer. And, you know the answer if you don’t have insurance. But do you know why that’s the answer?

Because the insurance industry owns the Republican Party. Not exclusively. Pharma owns part of it, too. Hospitals and HMO’s, another part. Nursing homes - they have a share. You name a Republican, any Republican, and he is literally brought to you by… campaign donations from the Health Sector. Sen. John Thune of South Dakota? You gave the Republican rebuttal to the President’s weekly address day before yesterday. You said the Democrats’ plan was for…
“…government run health care that would disrupt our current system, and force millions of Americans who currently enjoy their employer-based coverage into a new health care plan run by government bureaucrats.”

That’s a bald-faced lie, Senator. And you’re a bald-faced liar, whose bald face is covered by…your own health care plan run by government bureaucrats. Nobody would be forced into anything; and the Public Insurance Option is no more a disruption than letting the government sell you water, and not just Poland Spring and Sparkletts. But, as corrupt hypocrites go, Senator, at least you’re well paid. What was that one statement worth to you in contributions from the Health Sector, Sen. Thune?

Five thousand dollars? Ten? We know what you are, Sir, we’re arguing about the price. What about your other quote? “We can accomplish health care reform while keeping patients and their doctors in charge, not bureaucrats and politicians.” Wow, Senator - this illustrates how desperate you and the other Republicans are, right? Because Sen. Thune, if you really think “bureaucrats and politicians” need to get out of the way of “patients and their doctors,” then you support a woman patient’s right to get an abortion, and you supported Michael Schiavo’s right to take his wife off life support, and you oppose “bureaucrats and politicians” getting in the way, and we’ll just mark you down on the pro-choice list. That’s a rare misstep for you Sen. Thune. No twelve-thousand dollar payoff for that statement! I am not being hyperbolic, am I, Senator? On the money?

Sen. Thune has thus far received from the Health Sector, campaign contributions - and all these numbers tonight are from “The Center For Responsive Politics” - campaign contributions amounting to one million, $206,176. So much for Sen. Thune. How about Rep. Ginny Brown-Waite? Good evening Ma’am. You are the Florida representative who claimed on the Floor that Democrats had…”…released a health care bill which essentially said to America’s seniors: drop dead.”

Now those are strong, terrorizing, words - that’s exactly what your Insurance and Medical Overlords wanted to hear. But are you truly worth every dollar of the $369,000,255 of them you have received over the years from the Health Sector? I’d reed the rest of the operative part of your speech myself, but your rendition actually cannot be matched:

Listen up, America, seniors have special needs. This bill ignored the, ignores the needs of Florida’s health care system. We should be fixing what is broke. Not disseminate ... disseminating ... decimating, the care of our senior population. - July 21, 2009

You can always tell, can’t you, Congresswoman, when the hostage is reading her own ransom note, and when she is reading one written for her? So much for Rep. Brown-Waite. There are so many other Republicans, bought and sold - like the unfortunate Congresswoman there -by the Health Sector. Minority Leader McConnell of the Senate?

You’re worth $3.1 million to the Health Sector? A million and a half just for last year’s election? And I’m supposed to think you aren’t a sellout, a liar, a paid spokesman, a shill, a carnival barker? So much for Sen. McConnell. Rep. Joe Barton of Oklahoma - $2,660,000, Congressman? That’s ten times what Sen. Robert Byrd has accepted from the Health Sector. Congressman! What a guy! So much for Rep. Barton. Sen. McCain - $1.6? To serve the Hospitals, and the Drug Companies, and the Nursing Homes? And not to serve the retirement communities of Arizona? Or the cancer survivors? Or the veterans? So much for Sen. McCain. I could go on all night and never exaggerate in the slightest.

PBS pointed out that the health and insurance industries are spending more than a million, $400,000 a day, just to destroy the “public option” - the truly non-profit, wieldy, round-up and not round-down, government, from helping you pay your medical bills with about a billionth of the recklessness with which it is still paying Halliburton and its spin-offs to kill your kids.

And much of this money is going to, and through, Republicans. But that’s the real point tonight.
Not all of it is going through Republicans. Because the evil truth is, the Insurance industry, along with Hospitals, HMO’s, Pharma, nursing homes - it owns Democrats, too.

Not the whole party.

Candidate Barack Obama got more than $18 million from the Health Sector just last year. And you can bet somebody in the Health Trust, somebody responsible for buying influence, got fired over what Obama’s done. No, the Democrats are not wholly owned. Hundreds of Democrats have taken campaign money from the Health Sector without handing over their souls as receipts. But conveniently, the ones who are owned, have made themselves easy to spot in a crowd.

They’ve called themselves “Blue Dogs,” and they are out there, hand-in-hand with the Republicans who they are happy to condemn day and night on everything else, throatily singing “Kumbaya” with the men and women who were bought and sold to defend this con game of an American health care system against the slightest encroachment.

Rep. Mike Ross of Arkansas. Leader of the Blue Dogs in the House. You’re the guy demanding a guarantee that Reform won’t add to the deficit. I’m guessing you forgot to demand that about, say, Iraq. You’re a Democrat, you say, Congressman? You saw what Sandy Barham said?
Sandy Barham is 62 years old, she’s got a bad heart, and she’s hoping her valves will hold together for three more years until Medicaid kicks in, because she can’t afford insurance.
Not just for herself, mind you. For her employees. She needs the public option. So do those six people who work at that restaurant of hers, Rep. Ross. And why should you give a crap?
Because Sandy Barham’s restaurant is the Broadway Railroad Café, and it is at 123 West First Street North in Prescott, Arkansas.

Prescott, Arkansas, Rep. Ross. Your home town. You are Sandy Barham’s congressman. Hers, Sir. Not Blue Cross’s and Blue Shield’s, even if they do insure 75% of the state and they own you. The top donor so far to Congressman Ross’s bid for re-election next year? The Blue Dog PAC - $10,000. Second? Something called Invacare - $7,300. Oh, they make wheelchairs and rollers. And slings, they’re big in slings. Tied for third? The American Dental Association, another $5,000.

Your top donors by industry, Rep. Ross? Health professionals: $29,250. Then, Pharma and Health products: $12,250. And so far in your career, Rep. Ross, your total haul from the Health Sector is $921,000. That’s 90th in the combined list of donations for the House and the Senate, Sir. 90th out of 537. You should be proud, Congressman!

Except for the fact, that before you started living off the public dime, you owned a pharmacy. And your grandmother was a nurse. And turns out you’re not Sandy Barham’s congressman, you’re Blue Cross’s. So much or Rep. Ross.

Rep. Bart Gordon of Tennessee. Congressman? Undecided on the public option? At $1,173,000 in donations from the Health Sector, I’m surprised. You should have already said no - and loudly. The only thing you should be “undecided” about, is whether or not you’re really a Democrat. So much for Rep. Gordon. Sen. Max Baucus of Montana. Good evening, Senator.
So you’re supposed to be negotiating all this out with the Republicans and hesitant Democrats? To gain bi-partisanship with a wholly-owned subsidiary of the Health Sector? Bi-partisanship that will get you, what? A total of no votes? And your price has been, let’s see $414,000 in donations from Hospitals. About $667,000 from the insurance companies and just over a million from Big Pharma. There was a $1,300,000 from other health professional and $237,000 from Nursing Homes.

When you think of getting $237,000 in campaign contributions from nursing homes, Sen. Baucus, do you ever think about whether they subtract that amount of money evenly from all the patients suffering and dying in the lousy ones, or just from a few of the lousy ones? So much for Sen. Baucus. Sadly, this list could go on almost all night, too.

I could ask Blue Dog Congressman, Democrat John Tanner of Tennessee, if, since he’s gotten $215,000 from hospitals over the years, if I and the appropriate number of my friends were willing to make it $216,000, if we could buy his vote - or would there have to be an auction?
We could bring up Senator Hagan, and Congressman Pomeroy, who, at 628-thousand, appears to represent the Insurance Industry and not North Dakota. I could bring up Sen. Carper, and Sen.Blanche Lincoln.

Senator Lincoln? By the way, considering how you’re obstructing health care reform, how do you feel… every time you actually see Sen. Kennedy? I could bring up all the other Democrats doing their masters’ bidding in the House or the Senate, all the others who will get an extra thousand from somebody if they just postpone the vote another year, another month, another week, because right now without the competition of a government-funded insurance company, in one hour the health care industries can make so much money that they’d kill you for that extra hour of profit, I could call them all out by name.

But I think you get the point. We don’t need to call the Democrats holding this up Blue Dogs. That one word “Dogs” is perfectly sufficient. But let me speak to them collectively, anyway.I warn you all. You were not elected to create a Democratic majority. You were elected to restore this country. You were not elected to serve the corporations and the trusts who the government has enabled for the last eight years.

You were elected to serve the people. And if you fail to pass or support this legislation, the full wrath of the progressive and the moderate movements in this country will come down on your heads. Explain yourselves not to me, but to them. They elected you, and in the blink of an eye, they will replace you.

If you will behave as if you are Republicans - as if you are the prostitutes of our system -you will be judged as such. And you will lose not merely our respect. You will lose your jobs!

Every poll, every analysis, every vote, every region of this country supports health care reform, and the essential great leveling agent of a government-funded alternative to the unchecked duopoly of profiteering private insurance corporations. Cross us all at your peril.

Because, Rep. Ross, you are not the Representative from Blue Cross.

And Mr. Baucus, you are not the Senator from Schering-Plough Global Health Care even if they have already given you $76,000 towards your re-election. And Ms. Lincoln, you are not the Senator from DaVita Dialysis.

Because, ladies and gentlemen, President Lincoln did not promise that this nation shall have a new death of freedom, and that government of the corporation, by the corporation, for the corporation, shall not perish from this earth.

Good night and good luck.

A letter about the anti-health reform mobsters

There's been a lot of media coverage about organized mobs intimidating lawmakers, disrupting town halls, and silencing real discussion about the need for real health insurance reform.

The truth is, it's a sham. These "grassroots protests" are being organized and largely paid for by Washington special interests and insurance companies who are desperate to block reform. They're trying to use lies and fear to break the President and his agenda for change.

Health insurance reform is about our lives, our jobs, and our families -- we can't let distortions and intimidation get in the way. We need to expose these outrageous tactics, and we're counting on you to help. Can you read these "5 facts about the anti-reform mobs," then pass them along to your friends and family?

5 facts about the anti-reform mobs

1. These disruptions are being funded and organized by out-of-district special-interest groups and insurance companies who fear that health insurance reform could help Americans, but hurt their bottom line. A group run by the same folks who made the "Swiftboat" ads against John Kerry is compiling a list of congressional events in August to disrupt. An insurance company coalition has stationed employees in 30 states to track where local lawmakers hold town-hall meetings.

2. People are scared because they are being fed frightening lies. These crowds are being riled up by anti-reform lies being spread by industry front groups that invent smears to tarnish the President's plan and scare voters. But as the President has repeatedly said, health insurance reform will create more health care choices for the American people, not reduce them. If you like your insurance or your doctor, you can keep them, and there is no "government takeover" in any part of any plan supported by the President or Congress.

3. Their actions are getting more extreme. Texas protesters brought signs displaying a tombstone for Rep. Lloyd Doggett and using the "SS" symbol to compare President Obama's policies to Nazism. Maryland Rep. Frank Kratovil was hanged in effigy outside his district office. Rep. Tim Bishop of New York had to be escorted to his car by police after an angry few disrupted his town hall meeting -- and more examples like this come in every day. And they have gone beyond just trying to derail the President's health insurance reform plans, they are trying to "break" the President himself and ruin his Presidency.

4. Their goal is to disrupt and shut down legitimate conversation. Protesters have routinely shouted down representatives trying to engage in constructive dialogue with voters, and done everything they can to intimidate and silence regular people who just want more information. One attack group has even published a manual instructing protesters to "stand up and shout" and try to "rattle" lawmakers to prevent them from talking peacefully with their constituents.

5. Republican leadership is irresponsibly cheering on the thuggish crowds. Republican House Minority Leader John Boehner issued a statement applauding and promoting a video of the disruptions and looking forward to "a long, hot August for Democrats in Congress."

It's time to expose this charade, before it gets more dangerous. Please send these facts to everyone you know. You can also post them on your website, blog, or Facebook page.

Now, more than ever, we need to stand strong together and defend the truth.

Thanks,
Jen

Jen O'Malley Dillon
Executive Director
Democratic National Committee

I'm fighting for you

--David Horsey, Seattle Post-Intelligencer

Sessions continues to lie to his constituents about healt care

Like most of his fellow Republicans, congressman Peter Sessions continues to spread false information about pending health care legislation -- or, at least, he's not willing to correct others when they are wrong.

No one -- absolutely no one -- is is even hinting at a government takeover of health care. What is being proposed is a government-subsidized insurance alternative for those who, for whatever reason, don't have health insurance now or those who might want less expensive, more comprehensive health insurance coverage.

But if you're fortunate enough to have health insurance and, if for some strange reason, you are satisfied with your current plan, the proposed legislation would not force you to give it up.

Olberman: "You were meant to serve the people, not the corporations"

Commentator Keith Olberman let individual members Congress who oppose a federal health care alternative have it with both barrels in a marvelously worded and delivered commentary last night. He said the Republican Party was purchased and owned by the nation's insurance and pharmaceutical companies, those that want to keep the costs of health care out of the financial reach of many Americans, but he didn't spare the so-called "Blue Dog Democrats" either, suggesting the word "Blue" should just be removed from their designation.

He brought up an interesting point: The very plan these members of Congress want to deny the American people is the same plan they have for their own health insurance.

Obama explains what he wants and doesn't want in his health care plan

In a speech earlier today at a town hall meeting in Raleigh, N.C., President Obama made it absolutely clear what he wants and doesn't want in his health care reform package:


“Nobody is talking about some government takeover of health care. I’ve been as clear as I can be, under the reform I’ve proposed, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan. These folks (those opposing his reform ideas) need to stop scaring everybody.


“No one in America should go broke because of illness. We will require insurance companies to cover routine checkups and preventive care, like mammograms, colonoscopies, or eye and foot exams for diabetics, so we can avoid chronic illnesses that cost not only lives, but money. No longer will insurance companies be allowed to drop or water down coverage for someone who has become seriously ill. That’s not right and it’s not fair.”

Here are some of the safeguards he promised would be included in legislation he wants:

• No discrimination for pre-existing conditions
• No exorbitant out-of-pocket expenses
• No cost-sharing for preventive care
• No dropping of coverage for serious illness
• No gender discrimination
• No annual or lifetime caps
• Extended coverage for young adults
• Guaranteed insurance renewal.

I know, I know, the devil is in the details, but as broad outlines go, no one who considers himself a humanitarian can argue with these statements.

Health care reform and the Constitution

A number of folks have written me and asked "Where in the Constitution does it say the government should provide health care for its citizens." I don't think you have to look any further than the preamble, the reason the constitution exists:

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic tranquility, provide for the common defence, promote the general welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution ..."

There you have it.

Health care debate: Don't tell me what you're against; tell me what you're for

To all those opposed to President Obama's health care reform initiatives,

Here are two indisputable facts:

• The citizens of 35 other countries have a longer life expectancy than U.S. citizens.
• The United States "spends much more per capita on health care than any other country, but ... despite this higher level of spending, the United States does not achieve better outcomes on many important health measures."

Yet, a major segment of our political leadership is against public involvement in the health care delivery system. OK, I'm willing to listen. Tell me how you would fix the problem. It's obvious from the statistics noted above that the current system isn't working, so just maintaining or even extending the status quo is not the answer. But if you have another solution, I'm willing to listen to it, consider it, discuss it. But, please, come up with an alternative solution instead of just being against the solutions proffered by the President. That's not leadership, that's obstructionism.

McLaughlin: Gov. Hair "is beyond bad;" he "is downright evil"

Blogger Ted McLaughlin wrote today about Gov. Hair's desire to make sure Texas continues to lead the nation in refusing to provide adequate health care to its citizens. To his credit, McLaughlin didn't mince words.

According to figures from the U.S. Census Bureau and other agencies, anywhere from 25 to 40 percent of Texans do not have any health insurance whatsoever. What's so shocking about that number is that 82 percent of them are employed. What's even more shocking is that Gov. Hair will make sure these people remain uninsured, even if Congress passes health reform legislation.

"Texas has a governor named Rick Perry (elected by only 39% of the vote in a sparse election turnout)," McLaughlin writes. "This Republican governor long ago sold out to his corporate masters and the lunatic right-wing fringe of his party. These elements don't want any health care reform. They have their insurance -- to hell with everyone else!"

During a conversation with conservative WBAP talk show Mark Davis, Gov. Hair said he would invoke the states rights protection of the 1oth amendment. "It really is a state issue, and if there was ever an argument for the 10th Amendment and for letting the states find a solution to their problems, this may be at the top of the class," Gov. Hair told Davis and his radio audience.

Perhaps it is a state issue, but, if it is, Gov. Hair isn't lifting a finger to do anything about it.

"The only thing he has done regarding health insurance is try to deny health insurance to many poor children through the CHIPS program," McLaughlin writes. "It was bad enough that the governor refused about 160 million in stimulus money to help the unemployed of Texas, but to deny health insurance and care to sick and dying people for a cause of 'states rights' is beyond bad -- it is downright evil. If this fool follows through on his awful promise, he will be denying preventive care to more than a quarter of Texas' population. They will only get care when they are seriously ill (and in many cases too late to be cured) and are willing to wait for 12 to 20 hours in a hospital emergency room. He is willing to let many die that could have been saved if they had health insurance. Perry simply doesn't care about the people of Texas."

Spot on, Mr. McLaughlin.

That lying Shona Holmes TV commercial

Of course, all commercials lie to us. That's why they're called "commercials." But this one is more insidious than your average TV spot. It depicts a woman named Shona Holmes from Canada who claims that she was denied treatment for her brain tumor in her home country and would have died had she not elected to come across the border where medical care is so much superior to that found in her country. The commercial is designed to get public support mounted against President Obama's health care reform ideas.

The truth of the matter is Shona Holmes never had a brain tumor. She had a cyst. "Shona Holmes chose to jump the queue and go stateside for treatment she didn’t really need..." The irony of all this is that Ms. Holmes was born with this cyst and, thus, it would be classified by private insurance companies as a "pre-existing condition." In other words, her surgery would not have been covered by insurance in the United States, but it would have in Canada.

This jerk paid for the surgery she had in Arizona out of her own pocket and is now back in Canada where she has filed a lawsuit in attempt to get her money back. Lotsa luck on that!

Health Care Reform: What's in it for you and me

If you're like me, if you haven't been passionately involved in the health care reform debate because, frankly, you don't understand the details. Even President Obama's plea to the nation last week on national television did little to explain exactly what effect health care reform will have on the average American citizen.


The New York Times did a superb job today of making "some educated guesses about the likely winners and losers" if such reform passes Congressional muster as well as answering some of the basic questions a lot of folks, including yours truly, have been asking. Here, in full, is that report:


The health care reform bills moving through Congress look as though they would do a good job of providing coverage for millions of uninsured Americans. But what would they do for the far greater number of people who already have insurance? As President Obama noted in his news conference last week, many of them are wondering: “What’s in this for me? How does my family stand to benefit from health insurance reform?”

Many crucial decisions on coverage and financing have yet to be made, but the general direction of the legislation is clear enough to make some educated guesses about the likely winners and losers.

WHAT ARE THE ELEMENTS OF REFORM? The House bill and a similar bill in the Senate would require virtually all Americans to carry health insurance with specified minimum benefits or pay a penalty. They would require all but the smallest businesses to provide and subsidize insurance that meets minimum standards for their workers or pay a fee for failing to do so.

The reforms would help the poorest of the uninsured by expanding Medicaid. Some middle-class Americans — earning up to three or four times the poverty level, or $66,000 to $88,000 for a family of four — would get subsidies to help them buy coverage through new health insurance exchanges, national or state, which would offer a menu of policies from different companies.


IS THERE HELP FOR THE INSURED? Many insured people need help almost as much as the uninsured. Premiums and out-of-pocket spending for health care have been rising far faster than wages. Millions of people are “underinsured” — their policies don’t come close to covering their medical bills. Many postpone medical care or don’t fill prescriptions because they can’t afford to pay their share of the costs. And many declare personal bankruptcy because they are unable to pay big medical debts.

The reform effort should help ease the burdens of many of them, some more quickly than others. The legislation seems almost certain to include a new marketplace, the so-called health insurance exchange. Since there will be tens of millions of new subscribers, virtually all major insurers are expected to offer policies through an exchange. To participate, these companies would have to agree to provide a specified level of benefits, and they would set premiums at rates more comparable to group rates for big employers than to the exorbitant rates typically charged for individual coverage.

Under the House bill, the exchanges would start operating in 2013. They would be open initially to people who lack any insurance; to the 13 million people who have bought individual policies from insurance companies, which often charge them high rates for relatively skimpy coverage; and to employees of small businesses, who often pay high rates for their group policies, especially if a few of their co-workers have run up high medical bills. By the third year, larger businesses might be allowed to shift their workers to an exchange. All told, the Congressional Budget Office estimates that 36 million people would be covered by policies purchased on an exchange by 2019.

IS THERE MORE SECURITY FOR ALL? As part of health reform, all insurance companies would be more tightly regulated. For Americans who are never quite certain that their policies will come through for them when needed, that is very good news.

The House bill, for example, would require that all new policies sold on or off the exchanges must offer yet-to-be-determined “essential benefits.” It would prohibit those policies from excluding or charging higher rates to people with pre-existing conditions and would bar the companies from rescinding policies after people come down with a serious illness. It would also prohibit insurers from setting annual or lifetime limits on what a policy would pay. All this would kick in immediately for all new policies. These rules would start in 2013 for policies purchased on the exchange, and, after a grace period, would apply to employer-provided plans as well.

WHO PAYS? Current estimates suggest that it would cost in the neighborhood of $1 trillion over 10 years to extend coverage to tens of millions of uninsured Americans. Under current plans, half or more of that would be covered by reducing payments to providers within the giant Medicare program, but the rest would require new taxes or revenue sources.

If President Obama and House Democratic leaders have their way, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on who’s talking. There is strong opposition in the Senate, and it seems likely that at least some burden would fall on the less wealthy.

Many Americans reflexively reject the idea of any new taxes — especially to pay for others’ health insurance. They should remember that if this reform effort fails, there is little hope of reining in the relentless rise of health care costs. That means their own premiums and out-of-pocket medical expenses will continue to soar faster than their wages. And they will end up paying higher taxes anyway, to cover a swelling federal deficit driven by escalating Medicare and Medicaid costs.

WHO WON’T BE HAPPY? Healthy young people who might prefer not to buy insurance at all will probably be forced to by a federal mandate. That is all to the good. When such people get into a bad accident or contract a serious illness, they often can’t pay the cost of their care, and the rest of us bear their burden. Moreover, conscripting healthy people into the insured pool would help reduce the premiums for sicker people.

Less clear is what financial burden middle-income Americans would bear when forced to buy coverage. There are concerns that the subsidies ultimately approved by Congress might not be generous enough.

WHAT IF I HAVE GOOD GROUP COVERAGE? The main gain for these people is greater security. If they got laid off or chose to leave their jobs, they would no longer be faced with the exorbitant costs of individually bought insurance but could buy new policies through the insurance exchanges at affordable rates.

President Obama has also pledged that if you like your current insurance you can keep it.
Right now employers are free to change or even drop your coverage at any time. Under likely reforms, they would remain free to do so, provided they paid a penalty to help offset the cost for their workers who would then buy coverage through an exchange. Under the House reform bill, all employers would eventually be allowed to enroll their workers in insurance exchanges that would offer an array of policies to choose from, including a public plan whose premiums would almost certainly be lower than those of competing private plans.

Some employers might well conclude that it is a better deal — for them or for you — to subsidize your coverage on the exchange rather than in your current plan. If so, you might end up with better or cheaper coverage. You would probably also have a wider choice of plans, since most employers offer only one or two options.

WILL I PAY LESS? Two factors could help drive down the premiums for those who are insured. In the short-term, if reform manages to cover most of the uninsured, that should greatly reduce the amount of charity care delivered by hospitals and eliminate the need for the hospitals to shift such costs to patients who have private insurance. One oft-cited study estimates that cost-shifting to cover care for the uninsured adds about $1,000 to a family’s annual insurance premiums; other experts think it may be a few hundred dollars. In theory, eliminating most charity care should help hold down or even reduce the premiums charged for private insurance. When, if ever, that might happen is unclear.

In the long run, if reform efforts slow the growth of health care costs, then the increase in insurance costs should ease as well. And if the new health insurance exchanges — and possibly a new public plan — inject more competition into markets that are often dominated by one or two big private insurance companies, that, too, could help bring down premiums. But these are big question marks, and the effects seem distant.

WILL MY CARE SUFFER? Critics have raised the specter that health care will be “rationed” to save money. The truth is that health care is already rationed. No insurance, public or private, covers everything at any cost. That will not change any time soon.

It is true that the long-term goal of health reform is to get rid of the fee-for-service system in which patients often get very expensive care but not necessarily the best care. Virtually all experts blame the system for runaway health care costs because it pays doctors and hospitals for each service they perform, thus providing a financial incentive to order excessive tests or treatments, some of which harm the patients.

An earlier wave of managed care plans concentrated on reining in costs and aroused a backlash among angry beneficiaries who were denied the care they wanted. The most expensive treatment is not always the best treatment. The reform bills call for research and pilot programs to find ways to both control costs and improve patients’ care.

The bills would alter payment incentives in Medicare to reduce needless readmissions to hospitals. They would promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them. And they call for pilot programs in Medicare to test the best ways for doctors to manage and coordinate a patient’s total care.

Any changes in the organization of care would take time to percolate from Medicare throughout the health care system. They are unlikely to affect most people in the immediate future.

WHAT DOES IT MEAN FOR OLDER AMERICANS? People over 65 are already covered by Medicare and would seem to have little to gain. But many of the chronically ill elderly who use lots of drugs could save significant money. The drug industry has already agreed to provide 50 percent discounts on brand-name drugs to Medicare beneficiaries who have reached the so-called “doughnut hole” where they must pay the full cost of their medicines. The House reform bill would gradually phase out the doughnut hole entirely, thus making it less likely that beneficiaries will stop taking their drugs once they have to pay the whole cost.

Not everyone in Medicare will be happy. The prospective losers are likely to include many people enrolled in the private plans that participate in Medicare, known as Medicare Advantage plans. They are heavily subsidized, and to pay for reform, Congress is likely to reduce or do away with those subsidies. If so, many of these plans are apt to charge their clients more for their current policies or offer them fewer benefits. The subsidies are hard to justify when the care could be delivered more cheaply in traditional Medicare, and the subsidies force up the premiums for the beneficiaries in traditional Medicare to cover their cost.

Reformers are planning to finance universal coverage in large part by saving money in the traditional Medicare program, raising the question of whether all beneficiaries will face a reduction in benefits. President Obama insisted that benefits won’t be reduced, they’ll simply be delivered in more efficient ways, like better coordination of care, elimination of duplicate tests and reliance on treatments known to work best.

The AARP, the main lobby for older Americans, has praised the emerging bills and thrown its weight behind the cause. All of this suggests to us that the great majority of Americans — those with insurance and those without — would benefit from health care reform.

The above account is a copyrighted story that appeared in today's New York Times.

Columnist argues our health care is rather shabby

One of the arguments against universal health care is that we already have the best health care in the world so why would you want to change it to a socialized bureaucracy. Nicholas D. Kristof, in an op-ed column in today's New York Times, debunks the basic premise of that argument:

"Partly because so many Americans fall through the cracks and don’t have insurance, life expectancy is higher in most of Europe than in the United States. Even the people of Cyprus live longer than Americans, according to United Nations figures.

"Meanwhile, American children are twice as likely to die by the age of 5 as children in Portugal, Spain or Slovenia. And the World Health Organization found that an American woman’s lifetime risk of dying in childbirth is more than three times that of a woman in Greece, Spain or Germany.

"Meanwhile, Americans spend $6,800 per person to get these second-rate results, about double what is paid in Canada or much of Europe. It’s true that Canadians and Britons wait longer for non-urgent medical procedures than we do. But we have to wait a bit longer than Germans do. "

He goes on to argue that if President Obama succeeds in gaining universal health care for American families, "even gradually, he has a chance to join the pantheon of truly great presidents like F.D.R. himself."