Reform Rx - Change, Yes We Will

The bills have passed. We did not get everything we desired and need to understand and accept for the present that the conference committee on the combined bill will be a compromising committee. What we have today is largely what we will see in the bill that will pass both the House and Senate and be health care reform...for now.

One perspective to view health care reform from is the historical development of Social Security. The original legislation in 1935 had many coverage gaps and was a far weaker program than it is today. Significant amendments to the act in 1939 and 1950 (when it became much more universal) along with the constant attention to improving the program's effectiveness to the present day are a result of expanding on Franklin Roosevelt's vision.

The public option, the dissolution of the insurance cartel, and single payer are not sacrificed forever.

Reform Rx: Stock Tip

No comment nor investment advice on this sad state of affairs reported by Huffington Post:

The rise in stock prices has been particularly striking in the period since Sen. Joe Lieberman (I-Conn.) said on October 27 that he would filibuster a Senate health care reform bill if it included a public option - a threat that caused Senate leaders to cave without much of a fight. Here's a quick breakdown of major health insurance company stock performance from
Oct. 27 to Friday's market close:

Coventry Health Care, Inc. is up 31.6 percent;
CIGNA Corp. is up 29.1 percent;
Aetna Inc. is up 27.1 percent;
WellPoint, Inc. is up 26.6 percent;
UnitedHealth Group Inc. is up 20.5 percent;
And Humana Inc. is up 13.6 percent.

By comparsion, the Dow Jones Industrial Average is only up 2.3 percent during that time; the NASDAQ Composite is up a (relatively) paltry 1.4 percent.

Thanks Joe. (CT-I*)
* Insurance Party

Reform Rx: Collins goes to 7-11

An excerpt from Senator Susan Collins’ statement on deciding to vote against health care reform:

It is unfair that Republicans were allowed to offer only seven amendments to a bill that affects every single citizen and one-sixth of our nation's economy.

Unfair? Seven? Of course it depends on what Senator Collins is counting to make her "it is unfair" point I counted twenty-four (24) significant amendments or amending motions with the following eleven (11) offered by Republicans. Collins math lesson: 11 out of 24 = 45%, not bad for having 40% of the seats. By the way, many of us in Maine think that Susan Collin has been unfair to us in regard to fighting for our health care needs.

Here are the seven, I mean eleven Republican offerings (Source Slate):

Republican Sen. Kay Bailey Hutchison's motion to delay taxes used to pay for the bill until the bill is actually implemented. Set aside Dec. 16, 56-41.

Republican Sen. Mike Crapo's motion to strip the bill of any provisions that will result in a tax increase for individuals earning less than $200,000 or families earning less than $250,000. The obvious point of this amendment was to embarrass President Obama for violating his promise that health care wouldn't impose taxes on this group (which, for the most part, it won't). Failed Dec. 15, 45-54.

Republican Sen. John McCain's motion to send the bill back to the finance committee so it can extend to all Medicare Advantage beneficiaries the special deal Democratic Sen. Bill Nelson won for his Florida constituents. Score one for McCain: This amendment shines a spotlight on a cheesy political bargain. Nelson, after trying unsuccessfully in the finance committee to "grandfather" (i.e., maintain for existing beneficiaries) benefit levels for all current Medicare Advantage recipients, got a narrower provision inserted providing relief to Medicare Advantage recipients living in certain "local areas" as determined by a complex formula that fits South Florida like a glove. McCain is in effect saying: Hey pal, share the wealth! Can you blame him? The motion failed Dec. 8, 42-57.

Republican Sen. Judd Gregg's amendment (2942) requiring Medicare savings to be used to "save Medicare." Gregg is the author of a Dec. 1 letter to fellow Republicans offering parliamentary tips on how to obstruct health reform. So don't waste too much attention on this. Failed Dec. 7, 43-56.

Republican Sen. John Ensign's amendment (2927) limiting contingency fees to malpractice lawyers to one-third of any awards of $150,000 or less and one-quarter of any awards of more than $150,000. Not an entirely terrible idea. Failed Dec. 6, 32-66.

Republican Mike Johanns' motion to strip from the health reform bill $42 billion in cuts to home health care agencies. Failed Dec. 5, 41-53.

Republican Sen. John Thune's amendment (2901) removing Community Living Assistance Services and Supports (CLASS), a proposed new voluntary program for nursing-home and other long-term care insurance, from the bill. Failed Dec. 4, 51-47. (This amendment required 60 votes to pass.)

Republican Sen. Orrin Hatch's motion to strip the bill of cuts to the privately administered Medicare Advantage program. Failed Dec. 4, 41-57.

Republican Sen. John McCain's motion to strip the bill of Medicare cuts. McCain proposed more than twice as many Medicare cuts to fund his own health plan during the 2008 election. McCain is unbelievably touchy about this! His amendment failed Dec. 3, 42-58.

Republican Sen. Lisa Murkowski's amendment (2836) barring the U.S. Preventive Task Force from being used to deny coverage for anything. Failed Dec. 3, 41-59.

Republican Sen. David Vitter's amendment (2808) amending Mikulski's amendment (see below) to prevent the United States Preventive Task Force from restricting mammograms, which it can't do anyway. (Vitter is a well-known feminist.) Passed by unanimous consent Dec. 2.

Reform Rx – End Results Count Most

Senator Barbara Mikulski’s amendment to the Senate’s health care bill to promote and expand preventive healthcare for women passed yesterday on a 61 to 39 vote.

The amendment is in part a political reaction to the controversy that arose over the U.S. Preventive Services Task Force’s updated guidelines regarding mammograms for women in their 40s. The conservative fear machine spun the Task Force report into an ugly specter of rationing. Both Senators Snowe and Collins voted with the Democrats on the amendment which received a great deal of coverage similar to that from Health Leaders Media:

The amendment, which calls for coverage of screening procedures, such as mammographies and Pap smears, would also cover cervical cancer, postpartum depression, heart disease and diabetes. The amendment received some bipartisan support with three Republicans—Sen. Olympia Snowe (ME), Sen. Susan Collins (ME), and David Vitter (LA)—voting for it.

We can expect Senators Snowe and Collins to vote for several amendments during the course of the debate on issues on which they are routinely lauded as moderates. Amendment debates and occasional supportive votes on all of these matters may create an impression of moderation but in the end, voting for final legislation that contains substantive health care reform with a robust public option is the vote that counts.

That final vote needs to be where we focus considerable effort to influence our Senators to a greater degree than the insurance industry. What we do not want is Senators Snowe and Collins to earn moderate accolades for voting on a bunch of amendments and then voting down the final bill because of cost, government control, or public option opposition. We cannot afford to be cheated in the end with their explanation of “I worked so hard to improve the bill but the gosh darn Democrats just made it impossible in the end to support in good conscience because of blah, blah, blah...”

And we also must avoid a watered down bill that is not substantive or carrying a robust public option because Senators Snowe and Collins traded a few amendment votes along the way in exchange for the watering down of other key provisions. Those means would not justify the ends.

Reform Rx – Shoot to Kill

An August Reform Rx piece entitled Unreal, Unhealthy, Un-American covered a subject that one would never think of being part of the health care debate: guns. The column piece was written in reaction to the carrying of guns to town hall meetings or near Presidential speaking events by right-wing fanatics to inject intimidation into the health care debate.

Imagine how my ears perked up this morning when I heard NPR’s Cokie Roberts reporting on health care reform bills saying:

And add to that, Renee, we have these continuing fights over abortion and immigration. And now we're discovering there are going to be new fights over guns in the insurance bill. And so, the work just gets harder and harder to get it passed. (Emphasis mine.)

The full NPR report can be listened to here and the passage above is at about 2:40:
http://www.npr.org/templates/story/story.php?storyId=120676331

How are guns and the intrusion of this divisive issue being scatter shot into the debate? A tour around the internet yielded these insights of attempts to poison health care reform:

The Examiner

The day before the Senate passed the $848 billion health bill on a party-line vote, the Virginia-based Gun Owners of America sent out a mass alert to its 300,000 members, warning them that the legislation "will most likely dump your gun-related health data into a government database. ... This includes any firearms-related information your doctor has gleaned or any determination of post traumatic stress disorder or something similar, that can preclude you from owning firearms."

The Freedom Medium

They will attempt to make their case by presenting statistics showing that gun violence causes health care resources to be spent in ways that could be better utilized in other areas.
Of course, many of the American public will fall for this gibberish, not realizing that it is simply another ploy by the Obama administration to drum up support for an increasingly unpopular health care reform bill, while having the added bonus of being an assault on Second Amendment rights as well.

Buckeye Firearms Association

Don't forget the new taxes on guns and ammo to help provide insurance for those poor Crips, Bloods, Triad, Mongols and Mexican Mafia members who find themselves suffering from uninsured gunshot wounds incurred during a drug deal gone wrong. The anti-gun possibilities are limited only by the imagination.
Please don't delude yourself into thinking that this would only be part of any "public option" insurance plan. The private insurance companies are going to be in direct competition with any of the pre-existing or new government insurance plans, so if the public plans get an "upcharge" for gun ownership you know the private ones are going to demand this extra money, too.

All right-wing forces are allied against health care reform and every conceivable issue group’s attack will need to be countered. In this case, the fact is that there is absolutely nothing in the two health care bills that addresses or has any intended consequence regarding guns. Period. Rinse and repeat: period. Apparently there is no honor on the right; if a bill cannot be legitimately defeated, just assassinate it.

Reform Rx – The 2011 and 2013 Amendments

During the last couple of weeks, gaining perspective on the two health care reform acts working their way through Congress has been a priority over commentary. Observing whether or not the public option is being so weakened as to make it ineffective has been a constant concern. Watching the developing and predicted force feeding of abortion issue politics as a poison pill within the debate has been disquieting…more doses unfortunately will be forthcoming.

On balance, not everything in these bills is as progressive as one might desire but with liberal Representatives and Senators we can trust staying with the process and compromises, it continues to be reasonable to be supportive of both bills prior to conference committee work at some time in the future. Perfect is always the enemy of the imperfect. If the outcome is a marked step forward toward regulating insurance company discriminatory practices, will increase access to quality and affordable care, and develops a public option, we will have a framework on which to build, modify, and expand further substantive health care reforms in the near future.

One perspective to view health care reform from is the historical development of Social Security. The original legislation in 1935 had many coverage gaps and was a far weaker program than it is today. Significant amendments to the act in 1939 and 1950 (when it became much more universal) along with the constant attention to improving the program’s effectiveness to the present day are a result of expanding on Franklin Roosevelt’s vision. Republicans do also recognize that health reform today will open the door to additional reforms tomorrow. It is no wonder that right-wing efforts to engage in revisionist history and to vilify FDR and the New Deal are at a fever pitch on scream radio and conservative blabsites.

In Maine, once again our efforts must be focused on preventing our Senators from derailing or damaging the initial legislation.

Reform Rx – GOP Healthy Insurance Companies Bill

Republicans are finally getting to work and producing a GOP alternative health care bill that offers the public the option to evaluate their commitment to reform. Of course it does not have the diabolical public option. The GOP says it is all about costs and obviously concludes it is not about care.

Here are key emerging features:

- Insurance companies can continue refusing to cover pre-existing conditions so that the industry’s financial health does not deteriorate.
- The bill will allow the purchasing of health insurance policies across state lines so that insurance companies will be able to cherry pick where to sell based on lack of regulation and other requirements that suppress healthy profits for insurance companies. As a bonus, insurance companies could decide to charter in weak regulatory states to build low benefit–high profit plans to sell in other states to help the bottom line.
- The government does not get diabolically involved in health care except to encourage expansion of expensive state based high risk pools to help ensure that insurance companies avoid costly individuals so that insurance companies do not have any risks of low profits.
- Small businesses will be permitted to band together to buy health care so that after satisfying insurance company risk elimination and eliminating pre-existing conditions risks another market opens up to insurance companies bolstering their overall income. The pools themselves or insurance company determinations will reject businesses with high risk individuals to keep costs low and profits high.
- Medical malpractice awards for pain and suffering will be capped at $250,000 so that insurance companies will not have to endure the pain and suffering of paying out of profits for things like an individual’s loss of income for life or decades of misery.

Republicans do get velvet glove tough with the insurance industry in one area. There will not be a mandate that everyone must be covered which does not deliver another new market to insurance companies. Since the Republican plan also does not include tax credits for the poor that would make sense under such a mandate, a conclusion that insurance companies only need to have a giant profit protection guarantee rather than a mammoth one must have been reached.

Finally don’t worry, illegal aliens and abortions are not covered to keep the base fired up on social issues while shoveling the cash into health insurance company coffers.

GOP: Guaranteeing Outlandish Profits!