Why Are Some People More Authentic Than Others?

Yesterday, 6 protesters were arrested outside UnitedHealth Group headquarters in Minneapolis for blocking the entrance and refusing to leave during a demonstration. Here's some video of the arrests:


Watch Six Arrested For Stopping UnitedHealth "Business-As-Usual" in News  |  View More Free Videos Online at Veoh.com

Dawn Smith, the brain tumor victim who's struggles to get CIGNA to cover her treatments have become national news, is headed to the headquarters of CIGNA CEO Ed Hanway in Philadelphia, to get some answers on why she was denied coverage. She is live-blogging the trip and has some video on her site as well.

Stacie Ritter is also headed to confront Ed Hanway at his mansion:



Health Care For America Now has transformed the main homepages of UnitedHealth, CIGNA and WellPoint into virtual crime scenes, and they are mobilizing people to visit the headquarters of all these corporate bad actors with yellow police tape and declare them actual crime scenes. There are dozens of events in over 60 cities scheduled.

It is true that these events, scattered throughout the country, have been organized by health care advocacy groups. Of course, throughout the month of August, corporate front groups organized around town hall meetings, busing in folks from out of town and preparing them with talking points and rules to disrupt the events. Yet, in the eyes of the traditional media, only one of these two actions are seen as authentic:

For several months, HCAN—a national coalition of religious groups, community organizations, unions, senior citizen groups, health care professionals, and consumer advocates—has been organizing polite demonstrations, rallies, and public forums, trying to put faces on an industry that has spent multiple millions of dollars lobbying against reform, while angry protests at town meetings swelled August’s big national story. On Sept. 22, HCAN sponsored about 150 demonstrations at various insurance company headquarters around the country. The Los Angeles Times did not bother to report about the several hundred demonstrators at WellPoint’s California subsidiary office, located a few blocks from the newspaper’s office. Nor did The Philadelphia Inquirer note those who descended that day on CIGNA, nor The New York Times those outside UnitedHealth in midtown Manhattan.

The HCAN rallies did attract print and broadcast coverage in dozens of cities, but most reporters treated them as isolated local events rather than components of a nationally coordinated protest (its slogan, “Big Insurance: Sick of It”) and a burgeoning grassroots movement [...]

With Congress debating extensive health care reform, and companies like CIGNA, WellPoint, and UnitedHealth major protagonists, the organizers supposed that their protests would dramatize the exorbitant profits of the insurance industry and the imposing compensation they pay top executives (UnitedHealth’s Hemsley made $57,000 per day last year) while millions of Americans go without insurance or bankrupt themselves with medical bills.

HCAN was mistaken.

“At a certain point,” Indianapolis Star senior editor Jenny Green told us, the demonstrators are “not adding to the debate. They’re just one side saying exactly what you’d expect them to say.”

Her colleague, Greg Weaver, the Star’s deputy public service editor for business, maintained that the raucous town meetings of August, dominated by conservative activists shouting down Democratic Congressmembers, were newsworthy because they “are more of a public forum where you have many sides of the debate, whereas at the [HCAN] protest [at WellPoint CEO Bray’s house] you have only one side of the debate.”

“I did not think the protest at [Cigna CEO] Hanway’s house was news,” Philadelphia Inquirer business reporter Jane Von Bergen told us. “It was a staged event. It wasn’t real news. I avoid them. I can’t stand them. They don’t add anything. They don’t teach anything. If they go to his house, we don’t learn anything more about the health care debate.” The protest was “too manufactured,” said Von Bergen. “Just a bunch of people going blah-blah-blah.”

By contrast, said Von Bergen, who covered the rowdy town meeting in August where right-wing activists confronted Sen. Arlen Specter, the news value of that event was “readily apparent.” “It involved public figures”—members of Congress. So political reporters picked up the story.

Isn’t Hanway a public figure? we asked. He’s well known in the business community, she said, but not among the general public—a condition that HCAN is trying to change, but can’t do if the media won’t cover their events.

This is a revealing set of quotes, showing the true orientation of corporate-run media. They are willing to blind themselves to the corporate front groups who organize town hall meetings, but call demonstrations of insurance companies "staged events." This is not the work of a neutral arbiter in the debate; it looks more like one class is being protected while the other is being savaged.

I don't know what the value of street protests are in the digital age. But I certainly know they have little value if they go unreported. Apparently such protests can get coverage, but only if they feature people with tea bags attached to their hats and guns in their side holsters.

Closing In On The Insurance Industry

Lots of groups are taking action against the insurance industry and their attempts to get a forced market for themselves and increase their profits at the expense of their customers.

Health Care For America Now has a new ad spotlighting Stephen Helmsley, the CEO of UnitedHealth Group, and his $57,000-an-hour lifestyle, contrasted against the thousands of families who have experienced a medical bankruptcy:



In connection with that, SEIU is encouraging supporters to take out Craigslist ads seeking to rent a room in an insurance company CEO mansion. They have the Craigslist sites for Philadelphia (CIGNA's Edward Hamway), Minneapolis (UnitedHealth's Stephen Helmsley) and Indianapolis (WellPoint's Angela Braly), and sample "room for rent" ads to work from. A sample:

Bankrupt Mother of Two, Seeking Room @ Insurance CEO Mansion

I'’m seeking a room to rent in Cigna CEO Ed Hanway’s $13.6 million dollar mansion. (We'’ll take a room in one of his three beach homes, too.) My family would be very quiet and courteous housemates, and given the size of Ed's mansion, he won't even hear us! I'll be bringing along my two twin girls, both of whom were diagnosed with cancer at the age of four. CIGNA is refusing to pay for the human growth hormone they need to grow properly - and the out-of-pocket expenses for this treatment are…

This is the Craigslist ad of Stacie Ritter of Philadelphia, who is literally holding a protest outside Ed Hamway's home as we speak, standing outside until she gets the care she needs from CIGNA.

MoveOn member Dawn Smith is faced with a similar struggle from CIGNA. They raised her prescription drug costs for her treatable brain tumor by 10,000%. She is writing to CIGNA to seek answers, and you can sign her letter.

What makes you think you can treat sick people this way? When will you stop doing this to me and the thousands of people like me who are suffering? And if you solve this latest problem, how do I know you won't do this to me again next week--that you're actually changing your ways and not just trying to make your PR problem disappear?

Please answer these questions. I need to know, for the sake of my health and my life. Many others have signed this letter too, to support me and make sure I get answers.

The truth is starting to leak out. Even the traditional media is covering stories about insurers denying coverage by calling a broken wrist a pre-existing condition. This is an industry that is doing whatever it can to maximize their profits, even though they know a public option wouldn't bankrupt them. The more people understand how the industry works, the easier it will be to get a health bill that works for all of us.

Assaults On The Status Quo

If we're going to get meaningful health care reform in this country, it will be because people talked to their neighbors, rebutted the smears and advocated so loudly that they became impossible to ignore. There are some small stories that can make us hopeful but much work to be done. When Blue Cross of North Carolina started readying Harry and Louise-style attack ads to scaremonger Americans on a public option, the outcry was sufficiently loud that the White House forced the insurer to back down and scrap their plans. When compromisers tried to create a trigger mechanism that would introduce a public option only if insurance companies don't voluntarily reduce costs and expand coverage, health care advocates widely disparaged the idea, arguing that the trigger has already been met, and the talk cooled.

But the forces protecting the status quo won't stop. A brand-new conservative group with links to none other than the teabaggers will launch an ad campaign comparing the US system to (horrors!) Canada's. According to their ad, government bureaucrats in Canada make decisions on coverage and treatment. Good thing we live here in America, where only private insurance bureaucrats get to make those decisions!

And Rick Scott, the corrupt former hospital CEO who paid the largest fine in American history for defrauding the US Government for billions, is planning to run a 30-minute infomercial after "Meet The Press" in Washington, DC designed to influence elite opinion with slanders and lies about health care reform.

Rick Scott will likely continue to mislead viewers about the Federal Coordinating Council for Comparative Effectiveness Research, a newly-created entity by the economic recovery package signed into law by President Obama in February. Mr. Scott will likely make a specific claim: "not only could a government board deny your choice in doctors, but it can control life and death for some patients." This statement is demonstrably false. In reality, the powers of this so-called "government board" are clearly defined and cannot do what Mr. Scott claims. The statutory authority of the Council specifically excludes the power "to mandate coverage, reimbursement, or other policies for any public or private payer." It is worth noting that even under President Bush, the National Institutes of Health already had an annual budget of $355 million to conduct precisely this type of research. Plainly, this has not led to the sort of catastrophic consequences in America that Mr. Scott warns against.

The advertisement will likely deceive viewers by blatantly misrepresenting the positions of two physicians. While the advertisement paints both as opponents of any role for government in health care reform, in reality, just the opposite is true. Both physicians are in fact supporters of universal health care. What they are opposed to is the U.S. ‘two-tiered' system that already rations health care based on the ability to pay. In fact, Mr. Scott misrepresented Dr. Day's comments, and Dr. Day openly mocked the ineffectiveness of the U.S. health care system. What Dr. Day is opposed to is Canada's outdated funding model, not Canada's healthcare system. Dr. Day actually advocates reform of the funding structure to preserve Canada's healthcare system, not dismantle it [...]

If Scott's 30-minute "documentary" contains any falsehoods, NBC will be liable for an FCC violation. Furthermore, Meet the Press needs to know that they're being used by Rick Scott, and will be tarnished by his swiftboating.

Sign the petition, blah blah.

In addition, groups are going after the real source of where any downfall in health care reform will lie, President Nelson and the ConservaDems, who will try their best to please their contributors and friends (Ben Nelson ran an insurance company, incidentally) by stopping anything meaningful.

Centrist Democratic Sen. Ben Nelson (Neb.) is under attack from an advertising campaign that criticizes his opposition to President Obama’s healthcare plan.

The Web and direct-mail ads specifically take on Nelson for opposing Obama’s proposal to create a public health insurance program consumers could choose instead of private plans. The $10,000 ad campaign is paid for by Change Congress, an advocacy group that is calling for publicly financed elections.

The Change Congress ads charge that Nelson’s opposition to a public health insurance plan is linked to campaign funds he has received from health insurance groups. Citing data from the Center for Responsive Politics, the ads say Nelson has accepted $2 million from health insurance companies over three Senate campaigns.

Taken alone, a $10,000 ad buy, even in Nebraska, won't do much. In combination, only a sustained assault on the status quo from all advocacy groups will get reform of this type done. That's just an historical fact. And while it's welcome that the President will deploy the Organizing for America email list for health care, it's going to take progressives concerned about the policy details to drive the discussion.

...Keep pushing...

Earlier this month, Sen. Ben Nelson (D-NE) declared that he was against including a public option in health care reform, calling it a “deal breaker.” But Huffington Post’s Ryan Grim reports that in a meeting with health care advocates in Nebraska yesterday, Nelson said that he was open to including a public plan:

Nelson, according to two people in the room, told the group that he was open to a public option, the primary Democratic goal of reform and anathema to conservatives.

“The good news for all sides involved is that he’s open mined,” said Barry Rubin, the former Executive Director for the Nebraska Democratic Party, who was in the meeting. “He’s not closed minded about a public option.”

Nelson's afraid of his constituents. Good place for progressives to have him.

This Year, We Have Activists

The biggest difference between 1993 and 2009 when it comes to health care is the coordinated message machine - on the left this time - pushing for reform. Under Clinton, the White House horded the policy and nobody could go out and sell it, or at least rebut the attacks from industry. This time, the Health Care for America Now structure allows activists a place both to attack back at industry and keep them occupied, while arguing for a consistent set of principles that must be part of any reform. Today, HCAN did something great, calling on the Justice Department to look at monopolies in the insurance market.

Activists backing President Barack Obama's health care overhaul are asking the Justice Department to open a wide-ranging investigation of what they say is monopoly-like power in the hands of major insurers [...]

"A lack of antitrust enforcement has enabled insurers to acquire dominant positions in almost every metropolitan market," said the letter to the Justice Department, signed by Richard Kirsch, the group's director. "The failure to attack anticompetitive practices has enhanced the dominant positions of these insurers. This must be reversed." [...]

In a report earlier this year, the American Medical Association found that insurance markets in most major metropolitan areas were dominated by two companies, and in many cases only one. In all, 94 percent of the metropolitan areas met the government's definition of "highly concentrated" markets for health insurance.

Separately, a recent report by the congressional Government Accountability Office found that in most states, a single insurer dominates the market for small business health insurance, even though many companies offer coverage. The GAO found that the median, or midpoint, statewide market share of the largest insurer was about 47 percent, although the median number of licensed carriers was 27.

This is all the more important, considering that the health insurance industry's "compromise" solution for reform is to EXPAND THEIR MONOPOLY by mandating that everyone in America buy health insurance from them, without the opportunity for a public plan alternative. With nobody to compete with and essentially a forced market, insurers would have every incentive to consolidate further, the very action which has driven up health care premium costs over the years, as an HCAN report later today will show. While insurers aren't the only cause of rising health care costs - pharmaceuticals, medical device operators, hospitals, there's plenty of blame to go around - this model of activism can be scaled to pressure both the industry and the political class.

Health care reform will rise or fall this year based on the success of these activist efforts, toward both the special interests and the politicians. Frank Luntz (who won't say who paid him for the health care memo) isn't the only game in town anymore.

Health Care State Of Play

One problem with yesterday's "game changer" of an announcement on industry-wide health care cost reduction is that it will not improve prospects to pay for health care from the government's perspective. As long as the Congressional Budget Office cannot "score" the savings into their assessment of paying for the health care plan, you still need to find the same dollars. Igor Volsky thinks that the prospect of savings makes the prospect of health care more plausible, because it provides a counter-weight to the CBO gospel, but if you still have to find the dollars, I don't see how that matters. Ezra Klein offers the idea of "directed scoring," where the CBO is essentially forced to account for industry-wide cost savings, but it's not entirely likely.

Regardless, the Senate Finance Committee is moving forward with a game plan for how to get a bill to the floor.

In a document laying out health-care options, Senate Finance Committee Chairman Max Baucus, a Democrat, and Senator Charles Grassley, the panel’s top Republican, yesterday endorsed the idea of requiring everyone to have coverage. Insurers have sought such a requirement in exchange for agreeing to accept President Barack Obama’s demand that they enroll all applicants, regardless of medical condition.

The committee will discuss the options on May 14 with the goal of getting the measure to the Senate floor in July. Obama has said he wants Congress to create a plan that would reduce medical costs and extend coverage to the 46 million uninsured people in the U.S. They were 15 percent of the U.S. population in 2007, according to U.S. Census data released in August.

So we're seeing the AHIP-friendly individual mandate in exchange for guaranteed issue and modified community rating. People will be able to keep the health care they have if they choose. The government would provide subsidies to allow lower-income Americans to afford health insurance, and employers of large companies may have a mandate to cover their employees. And then there's the real sticking point, the public option:

Obama’s administration says competition from a government- backed health plan will improve quality and lower costs.

Last week, Health and Human Services Secretary Kathleen Sebelius told the House Ways and Means Committee that Obama has no wish to “undermine” private health-insurance companies by supporting a government-backed alternative. She also said Obama would be willing to consider a requirement that everyone have health coverage, a proposal he criticized during his presidential campaign.

The so-called public option to purchase government-provided health care is a central issue. House Speaker Nancy Pelosi has said the chamber will include such an approach in legislation it considers later this year. Republicans and some insurers, including Aetna Inc., have opposed the creation of a new program modeled on Medicare.

‘Medicare-Like’

Baucus and Grassley said one way to fashion a government plan would be to make it “Medicare-like” and have it administered by the Department of Health and Human Services. Alternatively, it could be run by the states or by private- sector, third-party administrators, they said.

Groups like Health Care For America Now are pushing hard from the outside to force inclusion of a public option, and they appear to be having an impact. Kirsten Gillibrand offered her support yesterday, and none other than Arlen Specter has signaled openness to a public plan. As Jon Cohn notes, "the nice thing about nakedly opportunistic politicians is that their ever-shifting positions are a leading indicator of changing political currents."

The President failed to mention the public plan in his statement yesterday, focusing on the matter at hand, the industry wide cost reduction. My personal view is that you need a public option, guaranteed issue, real community rating (where consumers pay the same baseline rate regardless of their medical condition), medical device reform, comparative effectiveness research, and stiffer penalties for non-compliance at a MINIMUM if you're going to go to this individual mandate/shared responsibility model. And all of these must be legitimate, particularly the public plan, which cannot just be a non-profit insurance option without monopsony bargaining power.

But we're moving toward a solution, and even if it passes, it will only be a step to an eventual single-payer system. That's my view on it.

House Whip Getting Whip Counted

So I guess Jim Clyburn, the House Majority Whip, would rather go slow with an incremental approach to health care reform. None of this is new - Clyburn first said this right after the election on Meet The Press, and I question just how influential he is on this issue. Nevertheless, what's interesting to me is the speed with which progressive groups are confronting Clyburn over his comments.

One of the leading health care reform groups in Washington on Monday issued a strong rebuttal to House Democratic Whip James Clyburn for suggesting a comprehensive health care reform bill would not pass Congress in 2009.

Health Care For America Now's National Campaign Manager Richard Kirsch wrote:

"We hope that Congressman Clyburn will join with President Obama and the 178 Members of the 111th Congress, including a great majority of the House Leadership, who have all stated that they want to see comprehensive health care reform passed in 2009. Now is not the time to take small steps to solve big problems. The Health Care for America Now (HCAN) statement signed by President Obama and Members of Congress explicitly states support for an enactment of quality, affordable health care for all in 2009."

The statement, notable for its direct targeting of Clyburn, comes after the South Carolina Democrat said over the weekend that an incremental approach towards health care reform would be better "than to go out and just bite something you can't chew."

HCAN is asking South Carolinians to call Clyburn and urge him to reconsider his comments. His DC office is at (202) 225-3315.

It's important that there is a group ready to mobilize as soon as any Democrat in the leadership gets cold feet or attempts to create some wiggle room on comprehensive health care reform. This happened within a day, and it's something that almost never happened in 1994. Constituent pressure in the direction of a progressive solution has been sorely needed on this issue, and HCAN is fulfilling its role.

Meanwhile, John Conyers is dropping HR 676 today. Backers of the plan need to take that lesson from HCAN - bottom-up pressure is crucial.

Public Option Or Bust

Last week I wondered whether or not key Democrats were already bargaining away the public option in their universal health care proposal. Pete Stark has some control over the final bill in his perch as chairman of the House Ways and Means Health subcommittee, and according to him, either the public option stays or no deal.

Advocates of a government alternative to private health insurance fired the first shot of the new battle to reform the nation’s health-care system on Wednesday, saying that efforts to water down this key component of Barack Obama’s health-care plan should be rejected by members of Congress.

“In the absence of a public plan you would have to so strictly regulate [private] health plans that they would all have to become public plans,” said Rep. Pete Stark, D-Calif., chairman of the House Ways and Means Health sub-committee.

Stark spoke out on Wednesday because he is concerned that any effort to reform the private health-insurance market will prove ineffective if Americans are not offered the kind of Medicare-style government option contained in Obama’s 2008 campaign proposal.

Most important, Health Care for America Now backed Stark up on it, with their national campaign manager declaring any plan without a public option a "non-starter." I think HCAN is going to be crucial in this fight to beat back right-wing smears and insurance industry lies, so they probably have to be on board with any proposal.

Jacob Hacker released a report last week describing the importance of a public option in any universal health care plan. Especially if a "Medicare-for-all" single-payer plan is not being considered, the public option is crucial to create competition over quality care instead of over profit. And the current public plans (the VA, Medicare, Medicaid, etc.) do a much better job at reining in costs. Of course, there's a case to made that if the public plans improve upon private industry so much, they should be the only option allowable, because otherwise insurers will cherry-pick the healthiest clients and either drive the public option into bankruptcy or increase their costs and make themselves look more attractive. On the other hand, there are measures like guaranteed issue and community rating that can be written into the bill to ensure this cannot happen, and in addition, scaling up Medicare might have drawbacks of its own.

Overall, I think that untangling the mess that is our health care system is priority number 1, because it's woefully inefficient. Streamlining all the various public programs to deliver health care along with a public option anyone can buy would certainly increase that efficiency and hopefully lower costs, no matter the set of patients. So would placing limits on insurers, through guaranteed issue and community rating and mandatory percentages of premium money going to treatment, to reduce the energy and cash that goes into blocking care. So there's a lot we can do.

Interestingly, John Dingell is going to do a lot of it. Despite being upended as Chair of the House Energy and Commerce Committee, Henry Waxman has offered Dingell the lead sponsorship on national health care legislation. The Waxman-Dingell fight was always over energy, not health care, and this allows Dingell a legacy setter at the end of his career while still giving liberals what they desired on energy and global warming policy. It's a magnanimous and smart move. Hopefully Dingell understands the importance of a public option, too.

Republican Credibility On Health Care MIA

Republicans never had a health care plan any deeper than "shovel money to the insurance companies." So the death of any right-wing brand on health care isn't much of a death because there wasn't much of a brand. But by proposing to alternately 1) tax health care benefits from employers and 2) cut Medicare to pay for insufficient vouchers to purchase individual insurance, John McCain has destroyed Republican credibility on health care so utterly that his fellow Republicans won't touch it:

A reporter tries hard to see whether Sen. Norm Coleman's spokesperson will acknowledge that his boss supports Sen. John McCain's health care plan.

It's an obvious question, given that Democratic candidate Al Franken spent the day praising Barack Obama's plan and even sent out a press release asking "With McCain's Health Care Plan Coming Under Scrutiny, Franken Asks: Would Norm Coleman Vote For It?."

Coleman spokesperson Luke Friedrich won't say. Four times. Turning routine tit-for-tat into something more damaging for Coleman.

Even business groups are wary of McCain's plan because taxing health benefits would impact their balance sheets negatively, and dropping coverage would potentially decrease their ability to attract a solid workforce and stay competitive with those companies who retain benefits.

McCain is trying to shock the system. He wants to throw people onto the individual market without any infrastructure for them to navigate it successfully. Meanwhile, Senator Obama, who recently signed on to the progressive principles of Health Care for America Now, wants to create that infrastructure through a public option and cost controls to make insurance more affordable. This would gradually move us away from the employer-based system in the right way.

For years, conservatives railed against "socialized medicine" through fear. But with their own ideas now so discredited, it's hard for them to argue against something different.

Health Care Reform Partners

This happened a few days ago, but John Conyers has teamed up with Health Care For America Now, which is a big deal. Conyers is carrying HR 676, the single-payer health care bill. When HCAN was announced, it was criticized from the left for being a sellout in terms of their principles for a solution to the health care crisis, which was insufficient for single payer advocates. I always considered HCAN as an attack dog against the insurance companies, which would mobilize to try and kill any meaningful change to the health care system. HCAN's policy prescriptions didn't seem to me to be that germane. And now, with Conyers' backing, it seems like he considers it that way too.

"I am proud to join HCAN’s broad progressive campaign to raise awareness about the need for true universal health care reform. The HCAN coalition and I are united by our belief that the current non-system of health care run by profit hungry insurance companies is unsustainable and inhumane. It will take a monumental effort to defeat the entrenched special interests that benefit from the status quo. I remain firmly committed to the passage of my single-payer universal health care bill, H.R. 676, and believe that private insurance will never provide the kind of guaranteed affordable health care America needs. However, I agree with HCAN that a true policy debate in the Congress can only begin when there is broad consensus that the sham reform trumpeted by the industry is off the table."

HR 676 and HCAN are indeed compatible. In fact, spokesman Jacki Scheckner has explicitly said so:

A properly designed single-payer system could meet our principles, but it’s one of many approaches that would meet our principles.

We appreciate the passion and commitment of the single-payer movement and hope they will work with us in opposing the health insurance industry and health care reform plans that benefit the industry by leaving us alone to fend for ourselves in the unregulated, bureaucratic insurance market.

What's most important here is the team concept. Conyers and his allies can work inside the system to get the best bill out of the Congress. HCAN can work outside the system to beat on the insurance companies and win in the court of public opinion. And both of them can make sure that John McCain's principles in health care are never allowed to see the light of day.

• McCain's health care plan will increase taxes on employer-based insurance, and kick 20 million people off the rolls.

• McCain's plan will throw you into the individual market, where the same plan your employer offered will cost $2,000 more, and you can be refused care because you were sick 10 years ago.

• McCain's plan will shift costs onto the sick.

That would be mutually distasteful to anyone who seeks health care reform.

The Inside/Outside Strategy On Health Care

I know that the Democratic platform, which will be ratified this week in Denver, is a worthless piece of paper, in many respects. But the movement that led to the language change in the platform - with Democrats asserting a guarantee of health care for everyone - is very much worth considering. Clearly, the movement progressives made it impossible for Democrats to ignore them on this issue:

If one thing came through in the platform hearings, it was that Democrats are united around a commitment that every American man, woman, and child be guaranteed affordable, comprehensive healthcare. In meeting after meeting, people expressed moral outrage with a health care crisis that leaves millions of Americans–including nine million children–without health insurance and millions more struggling to pay rising costs for poor quality care. Half of all personal bankruptcies in America are caused by medical bills. We spend more on health care than any other country, but we’re ranked 47th in life expectancy and 43rd in child mortality. Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar is spent on prevention and public health.

The American people understand that good health is the foundation of individual achievement and economic prosperity. Ensuring quality, affordable health care for every single American is essential to children’s education, workers’ productivity and businesses’ competitiveness. We believe that covering all is not just a moral imperative, but is necessary to making our health
system workable and affordable. Doing so would end cost-shifting from the uninsured, promote prevention and wellness, stop insurance discrimination, help eliminate health care disparities, and achieve savings through competition, choice, innovation, and higher quality care. While there are different approaches within the Democratic Party about how best to achieve the commitment of covering every American, with everyone in and no one left out, we stand united to achieve this fundamental objective through the legislative process.

As Paul Krugman noted a couple weeks ago, this was put front and center in the platform because the party listened to the desire for change. The middle class is overwhelmingly open to national health care, as they see that the current system is fundamentally broken.

Americans are struggling to pay medical bills and are accumulating medical debt at an increasing rate, according to a survey released today.

"A perfect storm of negative economic trends is battering working families across the United States," said the survey by the Commonwealth Fund, a private foundation that supports independent research on health care [...]

Two-thirds of the working-age population was uninsured, underinsured, reported a medical bill problem or did not get needed health care because of cost in 2007.

More than two in five adults in the 19-to-64 age group reported problems paying medical bills or had accumulated medical debt in 2007, up from one in three in 2005. Their difficulties included not being able to afford medical attention when needed, running up medical debts, dealing with collection agencies about unpaid bills, or having to change their lifestyle to repay medical debts.

It's clear that there's a movement toward revamping the health care system, and it's being achieved with an inside/outside strategy. On the inside, grassroots Dems with an assist from Rep. John Conyers got the health care guarantee in the platform. From the outside, Health Care for America Now has been putting extreme pressure on Congress through an avalanche of phone calls, getting 188 members on the record on whether they support the guarantee. They've also been blasting the insurance industry and their front groups by exposing them and their tactics to block change and reinforce the status quo. There's even been a new-wave resumption of the Harry and Louise ads, with the difference being that they now understand the need for fundamental reform.

There is no doubt that enacting a universal health care plan would be immensely popular. Here's Krugman:

I know that’s not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program — you may have heard of it — called Medicare. It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.

There’s every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular. Consider the case of Massachusetts, which passed a state-level plan for universal coverage two years ago.

The Massachusetts plan has come in for a lot of criticism. It includes individual mandates — that is, people are required to buy coverage, even if they’d prefer to take their chances. And its costs are running much higher than expected, mainly because it turns out that there were more people without insurance than anyone realized.

Yet recent polls show overwhelming support for the plan — support that has grown stronger since it went into effect, despite the new system’s teething troubles. Once a system of universal health coverage exists, it seems, people want to keep it.

Obviously, the biggest barrier to this is making sure John McCain isn't elected. He literally wouldn't insure more than 5% of the currently uninsured with his health care plan, and by charging health care benefits from employers as income, his plan would massively raise taxes on the middle class. But Barack Obama's plan, as currently constructed, wouldn't get us to universality either. And he hasn't been raising the issue in a progressive way on the campaign trail, either. He has talked in the past about supporting single payer, but that was in a different context, one he doesn't see as politically possible right now.

Obama can't argue that he's a centrist on health care with no plans for increased government involvement because he likes to say things like “if I were designing a system from scratch, I would probably go ahead with a single-payer system." Other campaigns notice him saying those things, and they send the quote to reporters. On the other hand, he can't extract the maximum political advantage from his universal health care plan because he doesn't have a universal health care plan [...]

His plan manages to occupy an uncomfortable middle space where it's neither liberal enough to really fit into the sharp liberal argument nor centrist enough to protect him from attacks of being a traditional liberal. And that's not a point of abstract logic: In the primary, he got slammed for not being liberal enough, and now he's getting slammed for being too liberal. it's almost no surprise that Obama doesn't really seem interested in making health care a defining issue. It's not really worked for him thus far.

So how do we tease out Obama and make sure he leads on health care? Jon Cohn's piece is a nice one, and suggests some tea leaves to read about Obama's priorities.

Does Obama grasp this? There are good reasons to think he does--starting with the fact that the platform language was strong even before the activists introduced their amendments. The original platform, whose principal author was veteran Obama advisor Karen Kornbluh, specified that everybody should have health coverage on a par with what members of Congress have. That's no small matter, since members of Congress get relatively generous coverage. It's the right thing to do: without a promise of sufficient benefits, universal coverage is meaningless. But following through on this promise would require passing a bigger, more expensive reform. If Obama wanted to downplay his commitment to health care, he wouldn't have made this vow so explicit.

The same goes for another potentially controversial element of his health care proposal: Making sure everybody has the option of enrolling in a public insurance plan that looks something like Medicare. A viable public plan would help keep private insurance plans honest, by setting a benchmark for affordability, benefits levels, and responsiveness. And if a public plan proved to be more efficient than private alternatives, it might eventually lure most Americans as enrollees, effectively becoming a single-payer plan by acclamation. That's why liberals love the idea--and conservatives hate it. If Obama were going to back away from some of his primary-race promises on health care, that's another place where he might do so. But the public plan, like the promise of generous benefit levels, was always in the platform--again, even before the amendments in Pittsburgh.

Most striking of all, perhaps, is the sheer amount of attention--and apparent priority--health care gets in the platform. Health care is the first policy issue the document takes up in depth. No other platform in recent memory dealt with health care so prominently--or in such detail. Even in 1992, the last year in which a Democratic nominee seriously proposed universal coverage, the platform relegated health care to lesser status: It appeared ninth in a long list of measures to improve economic security. Priorities like deficit reduction, public investment, and agriculture all came before it.

The goal for activists is to continue with an inside/outside strategy, one that keeps the current broken system in the minds of the public to overcome their fear of the unknown, pressures Obama and Congress to act, and build support everywhere. I do think it's possible, more than at any time since 1992.

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.

SCHIP, Baby

Doesn't winning feel good?

After watching Republican opposition to a Medicare bill crumble in the Senate this week, emboldened Democrats are considering whether to force a new vote on expanding a children’s health insurance program.

Lawmakers, aides and lobbyists say House Democratic leaders may schedule a vote in September on an expansion of the State Children’s Health Insurance Program (SCHIP), a priority for Democrats since they took over Congress last year.

It's called "daring your opponent to make bad votes." SCHIP is a great political issue and an important policy, so having GOP lawmakers in threatened seats vote on it over and over again is a very good idea. And with the HCAN coalition and a possible jumping of the fence to Democrats by doctors, we have the outside muscle to get this done.

People don't really remember the SCHIP vote from last year. It's time to remind them.

(Unfortunately, eventually Democrats figure this stuff out on domestic policy; if it has to do with foreign policy they run scared. Which is completely sad, and harms their chances of taking back the White House.)

The Health Care Reform Moment

Paul Krugman has a really good column today about the consequences of the Democrats' victory on stopping Medicare cuts (Bush has vowed to veto, but the votes will in all likelihood be there to override) by halting the creeping privatization of the system. More than anything it was a tactical victory:

This year, the Democratic leadership decided, instead, to link the “doctor fix” to the fight against privatization and offered a bill that maintains doctors’ payments while reining in those expensive private fee-for-service plans. Last month, the Senate took up this bill — but Democrats failed by one vote to override a Republican filibuster. And that seemed to be that: soon after that vote, Senators Max Baucus and Charles Grassley had another bipartisan fudge all ready to go.

But then Democratic leaders decided to play brinkmanship. They let the doctors’ cuts stand for the Fourth of July holiday, daring Republicans to threaten the basic medical care of millions of Americans rather than give up subsidies to insurance companies. Over the recess period, there was an intense lobbying war between insurance companies and doctors.

And when the Senate came back in session, it turned out that the doctors — and the Democrats — had won: Senator Kennedy was there to cast the extra vote needed to break the filibuster, a number of Republicans switched sides and the bill passed with a veto-proof majority.

If the Democrats can win victories like this now, they should be able to put a definitive end to the privatization of Medicare next year, when they’re virtually certain to have a larger Congressional majority and will probably hold the White House.

More than that, however, advocates of universal health care, like Health Care for America Now, the new group headlined by Elizabeth Edwards, have to be very encouraged by this week’s events.

Absolutely, especially considering that HCAN will be in the exact attack dog position that the AMA was over the Fourth of July holiday. The AMA ran ads in Republican districts and broke them down to finally change their vote. As Ezra Klein notes, if physicians can be brought into a coalition on health care reform, that could be a tremendous asset.

Now there's been a lot of controversy to the launch of HCAN, particuarly from single-payer advocates who think that HCAN will perpetuate the for-profit insurance industry. Now, what they actually favor is a public option being given the ability to compete with private insurance, making gradual the transition to a national health care plan, along with strict regulation on insurers so they have to compete on price and quality. But overall, I think that these single-payer evangelists misunderstand HCAN's role, which is to relentlessly push back on insurance companies and wayward legislators rather than any kind of policy role. And the AMA/Medicare Advantage situation shows how that can work to reform the system in a progressive direction.

I thought Ezra's other post about the bind single-payer advocates are in was particularly good.

On the one hand, there will never be the political will for single payer without effective and determined advocacy. So single payer supporters need to engage in that advocacy, and point out problems in competing proposals. On the other hand, barring a seismic political shift, single payer isn't passing the US Senate any time soon, and so dogmatically insisting that the only way forward is single payer is basically dogmatically insisting that there won't be health reform because you'll oppose achievable compromises. At times, this attitude has killed health care reform, as when Democrats refused Nixon's proposal in the 70s -- a proposal far more radical than anything being offered today. So it's tricky. The policy is possible, and simply requires political will. The will is absent and requires advocacy. But the advocacy, if conducted too dogmatically, can stand in the way of reforms that would help the 47 million uninsured and get us a step closer to single payer.

I think that the goal ought to be single payer, but anything that helps 47 million people get health care is positive. And both Physicians for a National Health Care Plan and HCAN have roles to play in that goal, if they could only work together. But you have to acknowledge that tension.

UPDATE: Jon Cohn has more on the burgeoning coalition of Democrats and doctors.

If Ever Anyone Needed Watching

Today marks the launch of Health Care For America Now, a national coalition which plans to organize millions of Americans at the grassroots level to advocate for quality, affordable health care for everyone.

We're bringing together community organizers, nurses, doctors, small business owners, faith-based groups, organizations of people of color, and seniors who believe it's time we had an American solution that provides quality, affordable health care for everyone.

We're offering a bold new solution that gives you real choice and a guarantee of quality coverage you can afford: keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.

We're also calling for regulation on health insurance companies. We need to set and enforce rules that quash health insurance companies' greed once and for all.There is a huge divide between our plan and the insurance companies' plan for healthcare reform. We want to make sure you have the quality coverage you need at the price you can afford. They want to leave you alone to fend for yourself in the unregulated, bureaucratic health insurance market.

Our plan is affordable for people and business. Their plan is profitable for them. With no regulation, health insurance companies can and will charge whatever they want, set high deductibles, and continue to drop coverage when you get sick. Now is the time to pick a side. Which side are you on?

Elizabeth Edwards is one of the high-profile faces of this coalition, but it's fairly broad, including AFSCME, Americans United for Change, Campaign for America’s Future, Center for American Progress Action Fund, Center for Community Change, MoveOn.org, the NEA, National Women’s Law Center, Planned Parenthood, the SEIU, the UFCW, and USAction. Today they are running live launch events all over the country, including two in California. One is happening at this hour in Los Angeles, featuring Lt. Governor John Garamendi. There's another event in San Francisco on the steps of City Hall at 11:30 featuring Mayor Gavin Newsom. The names shouldn't surprise you - they're both two of the most high-profile advocates for universal health care in the state, and they'll both use the issue as a springboard for their 2010 gubernatorial campaigns.

What I'm more interested in is HCAN's strategy to work inside Bush Dog districts to hold them accountable should they prostrate themselves for the insurance industry.

The work of Health Care For America Now was first made public late last week. But the group, with Elizabeth Edwards as a figurehead, offered expanded insight into the details of its campaign during a meeting on Monday. In addition to spending $40 million -- $1.5 million of which will be put behind an initial ad buy (national TV, print, and online) -- the group will be sending organizers to 52 cities, blasting out emails to 5 million households, airing spots on MSNBC and CNN and submitting op-eds to major papers (officials hinted at the New York Times piece to come).

In addition, the campaign is going to take advantage of Moveon.org's massive data files to reach out to like-minded supporters and officials promised to work in Democratic and Republican districts alike.

"We'll have an organizer in the district of every Blue Dog Democrat," said HCAN campaign manager Richard Kirsch of the conservative Democrats.

"The focus of the campaign," he added, "is on national legislation. "This year, however, it is also a referendum: do you support quality, affordable, health care for all, or an alliance with the private insurance industry?"

Right on. These Bush Dogs need constant pressure and the threat of job loss in order to do right by their constituents. I don't know how successful HCAN will be, but they certainly have the right strategy.