Just Trust Us

(This is part of my work as a blogger fellow for Brave New Films' Sick For Profit campaign)

Rattled by their failed effort to kill health care reform, Karen Ignagni, the head of the health insurance lobby, took to the Washington Post today to claim, no, really, we love reform, trust us!

Let me be clear and direct: Health plans continue to strongly support reform. In fact, last year we proposed new insurance market rules and consumer protections to achieve universal coverage, remove restrictions on preexisting conditions and end the practice of basing premiums on health status or gender. We firmly believe that all the cost concerns the report raised can be resolved.

Practically every option Ignagni brings up to "resolve" those cost concerns, like killing the excise tax on high-end insurance plans, would only exacerbate them by draining the system of resources and eliminating cost controls.

Furthermore, the entire notion that the industry supports health care reform is ludicrous on its face. They are the cause of most of the practices that need reforming. If they supported reform they wouldn't sustain a system that led to outcomes like this:

Jenny Fritts was 24 years old. Jenny lived with her husband Sean for the past five years, and together they had a little girl named Kylee, 2. Jenny was seven-and-a-half months pregnant with her second child – a beautiful, baby girl.

Jenny is dead. Jenny’s unborn baby is dead. They died because they were turned away for appropriate care at a for-profit hospital because they did not have health insurance. Sean rushed Jenny back to another hospital when her symptoms became even more severe, and he lied about having insurance to get her in the door. She was placed on a respirator in intensive care, but she didn’t make it. She died. And so did her baby.

They become two more of the more than 45,000 Americans who die preventable deaths due to our broken healthcare system every year. Two more. Mother and child.

Nor would they tell mothers that they must be sterilized in order to qualify for health insurance:



It's completely outrageous for someone like Ignagni to even open her mouth about reform. The entire premise should be rejected. The industry has lost their right to speak on the issue.

Insurance Industry Drops ANOTHER Flawed Report

(I'm writing this post in my role as a blogger fellow for Brave New Films' Sick For Profit campaign)

Not content having embarrassed themselves once this week with a "study" of health reform that doesn't look at any of the elements of health reform, AHIP has done it again. Blue Cross Blue Shield has sponsored this report, put together by the accounting firm Oliver Wyman, claiming that premiums will rise 50% on the individual market and 19% on the small group market should health reform pass.

Once again, the report doesn't factor in almost everything in the bill that would mitigate the premium increases, though it does come to a slightly better conclusion than the original AHIP report from PricewaterhouseCoopers, the one that they immediately distanced themselves from. The White House characterized it this way - "if the AHIP report was a $3.50 bill, this one's a $3.00 bill."

As Ezra Klein points out, the real value in these reports is how it shows the bankruptcy of the insurance industry as a whole, and how they simply cannot conceive of anything resembling a legitimate market for their services:

Essentially, they've spent so long pricing the sick and the old out of the individual market that they don't really know what to do when they're allowed back in [...]

This is the house they've built: an insurance market where plans are written for the healthy and all legal efforts are made to exclude the sick. That's meant premiums are somewhat lower than they'd otherwise be, but only because the people who most need health-care insurance aren't able to afford it, or in some cases, aren't able to convince anyone to sell it to them. Now that arrangement is ending and they're scared that they can't provide an affordable product to the people who need it. They may be right, but it's evidence of how deeply perverse their business has become, not of what's wrong with health-care reform. When they say that the individual market would be cheaper in the absence of health-care reform, they're saying the individual market would be cheaper if they could continue refusing to sell affordable insurance to people who need health-care coverage.

That's not the kind of business anybody should be working to protect.

Insurers Turn Out Their Own

The Los Angeles Times has the latest about the insurance industry's efforts to game health care reform legislation, which seem to be working. Most of the substantive benefits come from the legislation being written in the Senate Finance Committee, which can be overcome simply by bypassing that committee. More troubling are their public efforts to demonize the public option, for which insurers have marshaled the manpower of their own employee base.

One of the Democratic proposals that most concerns insurers is the creation of a "public option" insurance plan. The industry launched a campaign on Capitol Hill against it, grounded in a study published by the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group. The lobbyists contended that a government-run plan, which would have favorable tax and regulatory treatment, would undermine private insurers [...]

Leading insurers, including UnitedHealth, urged their employees around the country to speak out. Company "advocacy hot line" operations and sample letters and statements were made available to an army of insurance industry employees in nearly every congressional district.

Some insurers supplemented the effort with local advertising, often designed to put pressure on specific members of Congress. Late in the spring, Blue Cross Blue Shield of North Carolina -- the home state of several conservative Blue Dog Democrats -- prepared ads attacking the public option.

United Health Group in particular has been active in using its employees to rally support against a public option. Even when they denied that they invited employees to attend right-wing tea party protests, they acknowledged that their talking points read as follows:

Our company is very concerned that a government-run health plan would be a road block to meaningful health care reform. It would significantly increase costs for individuals and families, would add billions of dollars in new liabilities to the federal budget, would break down the current health care system upon which more than 160 million Americans rely, and would violate the President's commitment that those who like their current coverage can keep it.

That anyone would listen to a health insurance behemoth with a vested interest in maintaining the viability of their business is odd enough in itself. But in addition, these talking points are incorrect. The CBO has scored a strong public option in isolation and found that it would save $150 billion dollars over ten years, and that's just to the federal budget. The real savings would come to individuals who would be able to choose a plan without large administrative costs and without a significant portion of their premiums going to company jets and balloon payments of compensation and stock options to CEOs. If insurers are so adept at providing quality health coverage, and the federal government so bumbling that their option would add billions to the federal budget, then they should have nothing to fear from such a plan. The fact that UnitedHealth and their cohorts in the insurance industry have mobilized 50,000 employees (and I wonder if they have a choice in their mobilization) to contact lawmakers and kill the public option shows that they fear it - and would rather create a forced market for their services that individuals would actually have to buy at risk of violating the law.

Insurers may be confident that they will reap a "bonanza" from the legislation, but they haven't counted on regular people mobilizing on their own. Supporters of the public option have raised nearly $400,000 to back the 60-plus members of the House who will not vote for a bill with anything less. And the White House is determining how to pass that with a simple majority in the Senate.

Insurance companies have an army of lobbyists and are turning out their own employees to try and claim a monopoly over your health. But this fight is not over.

Health Care Breakthrough?

In what is being pitched as a major announcement, health industry groups are vowing to slow the growth of health care costs over the next decade, to accommodate President Obama's reform strategy.

Reporting from Washington -- Leading health industry groups have agreed to slow the explosive growth of healthcare spending, according to administration officials and others knowledgeable about the agreement.

Hospitals, drug makers and doctors, among others, wrote a letter to President Obama outlining their plan, which estimates $2 trillion in savings over the next decade.

The letter lacks much detail but suggests savings could come from simplified billing, restructuring the way hospitals are paid and using more information technology, among other steps.

Obama plans to promote the letter at a White House event today.

Although the agreement does not outline any industry commitments to accept specific reductions in revenue, it does signal continued engagement by powerful healthcare interests in the Obama administration's effort to overhaul the nation's troubled healthcare system [...]

Signatories include the American Medical Assn.; the American Hospital Assn.; the Pharmaceutical Research and Manufacturers of America; the Advanced Medical Technology Assn., which represents device makers; America's Health Insurance Plans, which represents insurers; and the Service Employees International Union, which shepherded the agreement.

Specifically, they want to reduce the annual spending growth rate by 1.5 percent, which translates into $2 trillion in the next decade. Like the article says, the letter is thin on specifics, preferring to instead talk about "encouraging coordinated care" and "addressing cost drivers" and "reducing over-use and under-use of health care." Some of the reforms, like prevention and dealing with obesity and health IT, are familiar.

The positive development here, as Krugman writes, is that health insurers and the medical industry want to be part of a solution instead of committing themselves to blocking one. They believe that reform will happen with them or without them, and so they'd rather be around to influence the outcome. Another plus: in addition to agreeing to work with the Administration on reform, they appear to have accepted the basic economic arguments about how to bend the cost curve in health care.

How are costs to be contained? There are few details, but the industry has clearly been reading Peter Orszag, the budget director.

In his previous job, as the director of the Congressional Budget Office, Mr. Orszag argued that America spends far too much on some types of health care with little or no medical benefit, even as it spends too little on other types of care, like prevention and treatment of chronic conditions. Putting these together, he concluded that “substantial opportunities exist to reduce costs without harming health over all.”

Sure enough, the health industry letter talks of “reducing over-use and under-use of health care by aligning quality and efficiency incentives.” It also picks up a related favorite Orszag theme, calling for “adherence to evidence-based best practices and therapies.” All in all, it’s just what the doctor, er, budget director ordered.

However, I think there's also reason to be skeptical. By committing themselves to lowering costs, these industry leaders are essentially committing themselves to lower profits, which is illogical unless they see that as a best-case scenario. AHIP and some of these other groups have every incentive to guard their profits while rejecting reforms that would cut into them too heavily. For instance, cost control could be a bargain in exchange for killing the public option. The lack of detail in the letter should not go unmentioned, either, and the Administration must make mandatory some changes to reduce costs rather than relying on these former enemies of reform to voluntarily reduce. Because "reducing over-use" of health care can mean a lot of things - denying care, for example. Specifics like those in this CAP report on health care modernization could be mandated. The White House had better put all this in writing and ensure that the effort is sustained - voluntary efforts in the past have lasted for only a year or so.

I agree that there's an absolute benefit to this, strictly in the sense of optics. Stakeholders are working toward reform rather than pushing against it. The conservative bullshit artists led by the discredited fraud artists Rick Scott, who are trying to demonize the Obama plan, have no friends this time around. But let's verify these changes instead of accepting the industry offer at face value.

See also this potentially bigger breakthrough in financing for the health care plan, potentially a much bigger deal, because these assumed cost controls still don't get the reform out the door, dedicated revenue sources do. Joe Biden recently said "we believe that the committees will come back to our plan for financing." The Administration became the prime mover on finding revenue, and even if the initial efforts were tossed out, the Finance Committee will need that money eventually, and they'll have an off-the-shelf option to return to.

...just got off a call with HHS Secretary Kathleen Sebelius, and she made a few points:

• Everyone understands that the current system is unaffordable, unsustainable, and unacceptable to the American people.
• Health care sits atop the President's domestic agenda.
• Today was not a day for these stakeholders to talk about their specific cost control plans, and legislative specifics have not been addressed either.
• I did appreciate her saying that transforming health care does not equal providing more insurance.
• The stakeholders made a commitment to report back to the President on June 1 with progress on cost containment.

Borrowing Into Health Care Minutiae

Jonathan Cohn, one of the more knowledgeable health care writers out there, has an interesting defense of the proposal to tax health care benefits as a means to overall reform. His argument appears to be that John McCain's conception of taxing health care benefits offered nothing in the exchange, while Obama at least offers... something.

To be clear, such a move would happen in the context of an entirely different health reform proposal than McCain was suggesting. McCain's plan would have undermined employer-sponsored insurance and forced large numbers of people to purchase insurance as individuals through an unregulated market, where it can be incredibly tough to buy decent coverage. Obama's reforms, if executed properly, would make good coverage available to everybody. And they'd still leave in place most employer-sponsored insurance. Changing the tax treatment of health benefits would simply provide a nice way of financing these reforms.

Employer-provided health insurance is a quirk of the 1940s, when it was seen as a way to increase job market stability. Unfortunately, as currently constructed this has transformed into a tax break for very wealthy employees and their coroprations, reinforcing inequality. I think taxing all health care benefits would be wrong, but capping the amount excluded for the benefit of funding a plan that offers affordable care to the broadest number of people makes a good deal of sense, particularly if the cap was phased in progressively, and ultimately I think that's where Obama's team will fall on this. The budget does not provide the funds needed to enact reform, so no sacred cow can really come off the table at this point.

Looking at another piece of health reform, the public option, the Chairman of the health insurance lobby, AHIP, has apparently endorsed the inclusion of a public plan with Medicare bargaining power that would lower prices for consumers by 20-30%. I say "apparently" because he appended the endorsement shortly afterward:

Updated: Halvorson's office e-mails with a correction. When Halvorson signed the document, he privately attached a "signing statement" expressing concerns about -- you guessed it -- the public plan. Sort of like an insurance policy in case anyone noticed. I have the letter for download here. The wording remains a bit vague, so I've asked for an interview with Halvorson in which he can clarify his stance.

Halvorson also runs Kaiser Permanente, which has always been a little more daring than his compatriots in the health insurance world. By and large insurers would rather not compete on price and quality and instead just have customers funneled to them. And of course they wield a certain amount of political power. But public option advocates have something going for them - the enormous popularity of public plans. Seeing the outrage over soldiers possibly having to use private insurance instead of the VA for treating combat injuries should be a warning to those who would kill a public plan. The principles are exactly the same.

Health services provided by the Veterans Health Administration (VHA) are truly socialized medicine, because the doctors and other health care providers who serve veterans work for the government and the government owns and runs the hospitals and other health care facilities where veterans get treatment. The VHA treats over 5 million veterans a year.

It may surprise you to know that in the U.S. members of Congress and Presidents have a long history of also enjoying the socialized medicine taxpayers provide for them. In fact, members of Congress have the choice many of them want to deny you. They can choose a private health insurance plan through the Federal Employees Health Benefits (FEHB) program or they can get top-notch medical care at government facilities, like the Bethesda Naval Medical Center in Maryland [...]

But the socialized medicine veterans, members of Congress and U.S. Presidents enjoy is not what Barack Obama is proposing when he includes a choice of public health insurance in his health reform plan. The public health insurance plan being discussed as part of national health reform would work more like Medicare, in which the government runs the insurance coverage, but the doctors, hospitals and other health care providers people go to are the same private, independent providers that currently care for them.

In fact, people with Medicare currently have the choice of public health insurance or private plans that contract with Medicare. About eighty percent of the 44.8 million older and disabled Americans who have Medicare coverage—about 35.4 million people—choose the government-run public plan over the private Medicare plans.

It is the choice 73 percent of voters want, including Democrats (77 percent), Independents (79 percent), and Republicans (63 percent).

Seems elementary to me. Harness the power of public opinion and even Congress will be forced to listen.

Health Care Sausage Making

If you thought the sausage-making on the stimulus was bad, wait until you see health care reform. The players are more invested in getting their way and more rigid in their opinions. Chuck Grassley seems to be mad about the Obama Administration cutting 60 worthless private tax collection jobs in Iowa (that were costing the IRS more money than the tax collectors were taking in), and folks are worried that he'll take it out on the bill. That's the silliness that we're dealing with.

Everyone's making goo-goo eyes at each other at this point, but when you get to the actual facts, there are yawning divides between the parties. Karen Ignani of AHIP, the health insurance lobby, thinks she's sketching a "deal" by offering guaranteed issue in exchange for an individual mandate. In other words, force everyone to buy health insurance and we'll sell it to everyone! But there's one missing ingredient:

The missing ingredient is affordability. And the expectation is that affordability will be guaranteed by "community rating," a policy that ends the ability of insurers to charge different customers different prices based on age, health status, location, etc. At Brownstein's forum, Ignani addressed this, too, and her comments are worth quoting:

She suggested an arrangement in which insurers and the government in effect would divide the cost of insuring the biggest risks through a combination of rating reform and public subsidies. "You have to think about the ratings and the subsidy in tandem," she argued. For instance, she noted, a pure form of community rating--in which everyone is charged the same premium regardless of their age or health status--would substantially increase rates on young healthy families (while reducing them on older or sicker people). In that instance, "you might decide well then we could subsidize those [young] individuals to cushion that," she said. Alternately, she said, you might allow insurers to vary rates somewhat based on age, but use subsidies to ensure that say, "nobody over 55 would have to pay more than 10 per cent of income" for premiums--as California did in its reform. More details on the issue are coming: "You will hear a great deal from us soon about rating," she said.

That just doesn't seem like it would work, but Ezra Klein argues that insurers are not even the main factor in affordability concerns (they take one out of every three dollars for themselves, so I'm not sure I agree), compared to pharmaceutical companies and device manufacturers and doctors and hospital associations.

So this is, simply put, a mess. And Max Baucus addressing costs by wanting to tax health care benefits, precisely what John McCain got hammered for during the campaign, is not helpful at all. I could possibly see capping the health care deduction at a certain level of care, but employers are really not the people to bargain with for revenue. It's far more important to bring down costs.

Meanwhile, Republicans are laying down markers.

Does that matter? It's hard to say. Rhetorically, the GOP has staked out a very narrow corner of opposition. Last week, Mitch McConnell, Chuck Grassley, Mike Enzi, Orrin Hatch, and Judd Gregg -- essentially, all the Senate Republicans with jurisdiction over health reform, and McConnell -- co-signed a letter to President Obama. I've obtained a copy, and it's up for download here. They draw two lines in the sand. First, they warn against using the budget reconciliation process to pass heath care. Doing so would "make it difficult to gain broad bipartisan support" and "do a disservice to this important issue." Substantively, they fear a public insurance option. "Forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition," they say. "Ultimately, we would be left with a single government-run plan controlling the market."

That leaves, of course, plenty of room for eventual argument and obstruction. But there's a caution worth recognizing here, too. Republicans do not want to begin in opposition. They have begun this debate by claiming that their objections lie at the margins of health reform, not at its core.

Ah, but it's on the margins where you can kill policy, and the Republicans know it. I think the health care debate is going to give me heartburn. Although one of these demands is silly. "Don't use budget reconciliation or the bill won't be bipartisan"? The POINT of using budget reconciliation is that you'd only need 50 votes. They're getting it backwards. And the Obama Administration should threaten to use reconciliation at every step to force Republicans to come along. They can either be involved in the process, or on the outside.

They've Created A Monster

They've Created A Monster

by dday

Tom Daschle came right out today and said that you can't fix the economy without fixing the health care crisis. Interestingly, health care is one of the only sectors in today's washout of a jobs report where hiring went up. The demand is there, and making the system more equitable, accessible and affordable would not only help every American cope with their bills and move from job to job, but would also make American business more competitive. It's very good that the connection between health care and the broader economy is being made.

"There is no question that the economic health of this country is directly related to our ability to reform our health-care system," Daschle said.

Daschle cited the fact that high health care costs are preventing U.S. businesses from staying competitive and creating jobs. "That's what makes this so urgent and so much a part of the economic recovery process," Daschle said. "I believe that for the first time in American history, health-care reform will be done."

Almost as important as making health care a priority is how Daschle and the transition team is laying the groundwork for getting it done, connecting with the grassroots to push the policy from the bottom up.

Former senator Thomas A. Daschle, Obama's point person on health care, launched an effort to create political momentum yesterday in a conference call with 1,000 invited supporters culled from 10,000 who had expressed interest in health issues, promising it would be the first of many opportunities for Americans to weigh in.

The health-care mobilization taking shape before Obama even takes office will include online videos, blogs and e-mail alerts as well as traditional public forums. Already, several thousand people have posted comments on health on the Obama transition Web site [...]

It is the first attempt by the Obama team to harness its vast and sophisticated grass-roots network to shape public policy. Although the president-elect is a long way from crafting actual legislation, he promised during the campaign to make the twin challenge of controlling health-care costs and expanding coverage a top priority in his first term.

This really looks like they're requesting policy ideas from citizens to work into their overall framework, although you never can tell. But by allowing people to invest in the policy, it certainly gives momentum to any effort to get it through Congress. The transition team is soliciting ideas through online comments and community forums. And health care came up quite a bit in the transition team's meeting with community organizers and activists yesterday. Plus, they're providing open access to all meetings, documents, and position papers from various groups, as well as offering the ability to post comments about them.

The most important thing is that the emphasis on building a grassroots movement on health care is unmatched by any other issue. It's clear they want to make a go at this early in the first term, with the help of their supporters.

And that provides an opportunity. There's been a lot of hand-wringing in the traditional media over "what is Obama going to do with his email list," but I think that has it a bit backward. It's really "what is the list going to do with Obama." Already in California I'm seeing a lot of ideas exchanged, ad hoc groups formed, meetings set up, and initiatives set, both on national and local issues. In essence, Obama doesn't have total control over "harnessing" the grassroots network from the campaign; the grassroots will make the determination about what they want to work on and how. Marshall Ganz, who kind of pioneered Obama's community organizing in the campaign and whose roots in community activism go back to Cesar Chavez and the United Farm Workers, had this to say about it:

"Here we have a guy who won who was really propelled into office--I don't want to say that--supported through the creation of a movement. And so, now what? Can he lead it from the presidency? Probably not. There are lots of good reasons why that would be problematic. Or why that would quickly turn into emails from Barack saying 'Please send a letter to X.' Which is just the old form of what we were talking about before, politics as marketing. It could become a network of some kind, it could become an organization. If it became an organization, something like Campaign for a New America, we have to look at questions of finance and governance, as to how to enable something like that to work. But there's a foundation out there that didn't exist before, and it's not going to go away. My colleague Bob Putnam talks about social capital, there's a kind of civic capital that's been created here. It's not going to disappear."

I then asked him where all that social knowledge embedded in the network was going to go--the 23,000 Camp Obama organizers, the super-volunteers, the awareness of all the nodes at the local level. What would it be like to govern with this capacity?

Ganz replied, "I agree. That's what's being debated right now. There's a team of organizers in Chicago right now who are working on this question. The field organizers and a lot of the people who built this thing--not all of them want to go off and have jobs in Washington. A lot of them are committed to an organizing vision here and they fought for it throughout the campaign. That's one reason the campaign adopted much more of an organizing approach than it was inclined to at the beginning....New Hampshire was one of the worst marketing operations that we've seen. And so he lost, and we learned something from that. It was as stereotypically a marketing operation as South Carolina was an organizing operation, or Iowa. The caucuses are interesting because even if you don't believe in organizing, you have to, otherwise you're screwed. You arrive at a lot of organizing elements tactically, not because you necessarily want to create democratic organization." [...]

"People are all so used to thinking, a lot of groups and organizations are sort of saying, 'who's going to get the list? who's going to get the list? They sort of think of 1.5 million names, who's going to get it? You can transfer a list, but you can't transfer people that way. That's what's out there, is people. Over the next few weeks, months, there's going to be some working thru this. It's very important what Obama decides. Whether to try to support some kind of organized effort, that's rooted in the campaign, or not."

I think the way the transition team has approached health care offers an opportunity for grassroots types to "make them do it." Because coming up with something called "reform" would be a waste. Heck, the insurance industry lobby has a reform proposal (their big idea is for the government to subsidize health care to make it affordable while they get to charge the same price for the same kind of crappy care! Brilliant!). Progressives have an opportunity to be in on the conversation for what shape the actual reform will take, and since the Obama Administration is tipping their hand as to how fundamental to success the grasroots will be, progressives have non-trivial leverage over that form. There is a calculation that something as big as reforming the health care industry cannot get done without individuals all over the country playing a part. That process is something new and I would imagine pretty flexible. It's not an actual seat at the table, but it's pretty darn close.

There's a potential to become an active participant in how these issues play out instead of the passive role of commenting and harrumphing after the fact. And yes, the same tools and techniques can be applied when Obama does something many of us don't like. This is going to be a powerful force in the years to come, and it will most certainly not be an adjunct of the President. I don't think it can be fully understood where it will go just yet, but the potential is exciting.

The Health Care Moment Has Its Epiphany

There's something of a consensus that Netroots Nation didn't offer enough adversarial panels and instead largely consisted of bloggers agreeing with one another. But that's not true. I personally witnessed the most adversarial panel of the weekend, and it was spectacular, because finally, both factions of the debate about health care policy on the left were able to come together and understand the political contours of the brewing fight in the Congress.

The panel was entitled "Time for Action: How the Netroots Can Lead on Healthcare Reform," and was put together by Eve Gittleson, who blogs at Daily Kos under the moniker nyceve. There's a good liveblog of the panel here, but what you need to know is that Gittleson stacked the deck. She had some great health care activists who are doing great work in different areas of the space: Giuseppe Del Priore, MD, MPH a New York cancer surgeon; Hilda Sarkisyan, whose daughter, Nataline, died after being denied a liver transplant by Cigna; Rocky Delgadillo, Los Angeles City Attorney, who is pursuing civil and criminal investigation into insurance practices; Geri Jenkins, RN a member of the Council of Presidents of the California Nurses Association/National Nurses Organizing Committee. And then Ezra Klein, associate editor for The American Prospect and a health care policy guru, appeared at the end of the panel. The aforementioned speakers were all powerful advocates. Sarkysian, whose family HAD health insurance and still couldn't get their daughter what she needed, said bluntly "This is not a good country anymore." Del Priore discussed the need for doctors and patients to handle questions of care and the need to arrest insurance executives for their crimes in denying coverage. Rocky Delgadillo outlined the schemes, like rescission (even based on spousal applications), that insurers are engaging in to maximize profit at the expense of patient care. He also mentioned how California regulators ignored a million-dollar fine to Blue Cross because they feared they would lose the case if it went to court, which is just unbelievable. And Jenkins argued that the insurance industry will play no role in reforming health care, and we need to move immediately to a not-for-profit system.

Good points all. And then Eve turned to Ezra:

Eve: Ezra, why does HCAN want to condemn Americans to this kind of system? I get confusing emails from Elizabeth Edwards and MoveOn talking about the atrocities of the insurance industry, then marginalizing the only viable solution. Can you explain this new Edwards HCAN initiative, the TV commercials, etc. . . What's it all about? What are they trying to do? It seems there are three initiatives on the table--676, Wyden and HCAN. What's wrong with Wyden and Edwards? And a follow-up...what can we realistically expect from President Obama?

I hope you don't mind that I'm sand-bagging you. I love you, really, Ezra. I just don't agree with you on this point.

This apparently startled Mr. Klein. But for him to not know the position of Eve and the CNA and an activist like Hilda Sarkysian speaks a lot to his cloistered state in Washington. Because I know all about this fight. I made one positive comment about HCAN upon their launch and took massive amounts of crap for it. I was called a defeatist and admonished for not being true to the cause. My only point was that having an organization with $40 million dollars to spend on calling out health insurers on their garbage is going to be tremendously helpful to whatever reform we get through the Congress, and furthermore I didn't see them having much of a place at the table in the policy debate. In other words they were finally an organization concerned with moving public opinion and playing the health care debate out on political grounds rather than policy grounds. And on the panel, Klein echoed the importance of politics over policy:

You can take a lot of approaches to health reform. You can emphasize policy, politics, principles, or some mix thereof. Judging from the panel, Health Care for All, and the California Nurses, could use a bit more politics in their approach. It was a panel about "health reform" -- not care or policy, but "reform" -- at a conference of engaged politicos that never mentioned the Senate, or votes, or the conditions required for presidential signature.

There was a lot of talk about "fighting" insurers and other special interests, but not much about what that fight will look like, or where it will take place, or who decides the winner. My argument, was that, for reformers, insurers aren't the real enemy. Setting them up as the opponent actually gives them too much credit. Insurers are stupid, profit seeking beasts -- the enemy is American politics, and in particular, the structural feature of the US Senate that have repeatedly killed health reform in the past. No matter what your policy preference, that's where your organizing has to be focused, because that's where the actual fight happens: In Congress. Not on panels, or on blogs, or among the Left. In the US Senate, where you have to get to 60, or at least figure out how to get rough Democratic unity for using budget reconciliation and then convince Kennedy and Carper to vote "aye" on the same bill.

This is basically the same argument Ezra makes continuously on his site, but it appeared to hit the audience like they never heard it before. And considering that it's largely the correct analysis, it was generally well-received, I thought. I spoke later with Eve, who told me that she had a conversation with someone from HCAN and "they are not the enemy." What a concept - all elements of health care advocacy on the left working together, for a change, toward a common goal.

Now granted, this week they all had a big juicy target. AHIP, the health insurance lobby, put together a fake grassroots front group called The Campaign for an American Solution. Of course, that "solution" involves funneling more cash and customers to the same broken insurance system we have now. Now, who was the very first group to coordinate a counter-attack on this front group on the first stop of their listening tour in Columbus, OH? That's right, HCAN

Well, that didn’t take long.

A day after Politico reported the health insurance industry is launching a health care reform campaign next week, the progressive reformers are firing back.

Health Care for America Now announced Friday that it plans a news conference and a rally next week to counter the insurance industry’s Campaign for an American Solution, which launches in Columbus, Ohio, on Tuesday with a roundtable discussion among uninsured locals.

“They’re pretending that the health industry represents the American public, and we need to make it really clear to them and the public that all they represent are their own profits,” said Richard Kirsch, national campaign manager for Health Care Now.

Indeed they did attend the launch, and got to ask some tough questions, confronting the head of AHIP and asking her how an insurance industry group could possibly be objective in pushing for lower rates and higher quality coverage when they are concerned solely with the profit motive. It got heated, and I'm glad they did. And all of a sudden, Daou's Triangle started closing. Rep. Pete Stark came up with a great quote:

"America's Health Insurance Plans' new 'Campaign for an American Solution' rings as true as the tobacco industry's efforts to end smoking. There is nothing grassroots about it. It is designed, financed, and coordinated through their Washington trade association with the singular goal of protecting their profits.

"I hope it is true that these companies intend to be a positive force in health reform efforts, but I tend to be cautious when the fox starts drawing up plans for a new henhouse."

HCAN called up the hotline for the Campaign for an American Solution that they set up for the public to provide input... and they got an answering machine. They've trickled this out one by one and pretty much ruined the launch of AHIP's front group. That's REALLY important for the future of health care reform. Because on the policy the views are far closer on the left than most people imagine. Everyone knows that whatever system is ultimately put forward can be paid for in a far better manner than the current wasteful, inefficient system. So expense should never be a deterrent, meaning we can build whatever system we choose and it is extremely likely to go revenue-neutral very quickly once we eliminate the shoddy budgeting of the current broken system. We know that health insurers will not jeopardize their profit margins unless they're forced to. Once you recognize these two realities, the policy goals become fairly clear. The political goals have to include attack dogs pushing back on the false memes of the right and the insurance industry, and pressuring the Senate to do the right thing.

Now Obama's plan includes some better regulation toward insurers (including guaranteed issue and community rating) and a public option to compete with the private insurance market and take the step toward a sequential single-payer. (His latest addition to the plan, a tax credit for small businesses who offer quality health care, is borrowed directly from the Clinton plan, raising hopes that eventually he'll just borrow all of it, as he should). Despite this being a fairly modest set of reforms, McCain and the right are going to denounce it as government-run "Hillarycare" anyway. So it's vital to have a broad coalition to give as good as they'll get from the right and give the lawmakers backbone to push the policy forward. Matt Stoller writes:

Coalitions are strange beasts, with multiple moving parts, but they are also the only way anything gets done. A coalition has a core of organizers behind it, and a variety of groups out in front who each take different roles. Some people can talk to Republicans, some people can talk to Democrats, some people threaten, some people cajole, some people talk to businesses, etc. HCAN is driven by labor in the form of SEIU, the NEA, AFSCME, and United Food and Commercial Workers, as well as groups primarily funded by labor such as Americans United for Change and the Campaign for America's Future. It is also driven by direct mail and Foundation based organizations, such as La Raza, Planned Parenthood, Center for American Progress Action Fund, Center for Community Change, and the National Women's Law Center.

Stoller goes on to make the point that HCAN should broaden their mandate and make this a fight about general health, and I agree. Going after convenience stores that sell fatty, sugar-laden food to kids sounds like it could be a part of their mandate. The farm bill, the transportation bill (more mass transit and more livable, walkable cities means healthier lives), and others could be brought onto the field of battle. But the larger point is that coalitions of this nature are built because they work. And the benefit is that they give lawmakers breathing space to do their job and the spine to do it right. This moment in health care demands that everyone understands the political spade work necessary to reach the desired outcome. So out of the ashes of that contentious NN panel came something pretty special. Groups across the center-left ideological spectrum working together to end the health care crisis in America and restore treatment as a basic human right.

The Fight For Health Reform

Today begins the AHIP (Association of Health Insurance Plans) conference in San Francisco, and Hillary Clinton's lead shill Terry McAuliffe will be addressing the crowd. The health insurance industry is the single largest force blocking meaningful reform in the United States, and for any Democrat to treat them as a partner and an ally - and to take money from them in speaking fees - is unacceptable. McAuliffe, of course, is part of the establishment crowd who is very cozy with corporate interests and dismissive of conflicts with the values and principles they don't seem to have. David Broder makes a mint on corporate speaking deals even though he covers a lot of the corporations that pay him. They don't see a problem with this - it's how things are done in Washington. Which is why the rest of us see no progress on the issues that affect us.

The Courage Campaign (I've done a little work for them but am not an employee) has highlighted this disconnect and is rallying in San Francisco today.

I was quite surprised when I learned that Terry McAuliffe was going to appear at a major convention of health insurance corporations in San Francisco on June 19.

After all, how could the former Chair of the Democratic National Committee show up as a guest of health insurance executives -- much less accept any money for his appearance at the AHIP (America's Health Insurance Plans) convention? This appearance seems inappropriate at best, especially after Barack Obama and Howard Dean courageously directed the Democratic National Committee last week to reject contributions from lobbyists, including the health insurance industry.

And now it's personal. My sister, who suffers from severe and rapidly deteriorating hearing loss, just told me that she has been denied useful health care coverage. Again. Why? Because her hearing problems have been diagnosed as a "pre-existing condition," precluding her from receiving cochlear implants so she can hear again.

The last I checked, being able to hear is not "optional" medical care. Unfortunately, my sister is one of over 100 million Americans who either have no health insurance coverage or are underinsured. My entire family worries about her, but the system is designed by these health insurance executives to keep her out -- not to help her.

Health care is a human right. The middlemen have a fiduciary obligation to their shareholders to deny that. Politicians and insiders like Terry McAuliffe get paid off by these middlemen to legitimize it.

The coalition is building to end this perversion. In California we're going to end rescission and ban junk insurance. It's a game of inches, but we're putting an end to the stranglehold groups like AHIP have over public policy.

Why Yearly Kos Is Being Attacked

In case you want to understand why Bill O'Reilly is freaking out about Yearly Kos, and why he's leading the charge by the conservative noise machine to discredit the progressive movement, I think you have to read this story.

A July 23 Daily Kos diary by "nyceve" noted that three medical correspondents -- Robert Bazell and Nancy Snyderman of NBC News and Susan Dentzer of PBS' NewsHour -- "all participate on the AHIP [America's Health Insurance Plans] Speakers Network." AHIP describes itself as "the voice of America's health insurers" and "the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans." Its board of directors consists mainly of insurance-company executives. A July 25 Roll Call article (subscription required) described AHIP as "the lobbying group for the health insurance industry." The Daily Kos diary also noted that none of the bios for the three journalists on the websites of NBC or PBS disclosed the journalists' roles with the AHIP Speakers Network. Each of the reporters was, indeed, listed on AHIP's website as part of its speakers network, but all three names have since been removed from the list.

The diary highlighting Bazell's and Snyderman's ties to AHIP was posted on Daily Kos less than a week after Media Matters for America noted that their colleague Jim Miklaszewski, NBC chief Pentagon correspondent, reportedly took $30,000 from the Greater Providence Chamber of Commerce to address its Business EXPO 2007. During his talk, Miklaszewski reportedly attacked Democratic presidential candidate John Edwards, calling him a "loser."

So a diary on a website broke the news that major media reporters were literally working for a health insurance industry lobbying group, and after the revelation, they were all scrubbed from the website.

This is the real reason why progressive bloggers are being targeted. Because they represent a threat. A very real threat to upset the conservative corporate media consensus and move the country in the direction it wants to go. The media is a stakeholder in that status quo, and so they must turn out their attack dogs. Very little of this may be conscious; but the overall thrust is unquestionable.

I am proud to stand with my progressive colleagues and friends and announce that we will not be cowed into submission, that this is a new world and we will be heard. And now I'm about to jump onto a plane, so let that be that.