Using Stark Language

Leave it to Pete Stark to tell it exactly like it is.

Moderate Blue Dog Democrats ''just want to cause trouble,'' said Rep. Pete Stark, D-Calif., who heads the health subcommittee on the tax-writing Ways and Means Committee.

''They're for the most part, I hate to say, brain dead, but they're just looking to raise money from insurance companies and promote a right-wing agenda that is not really very useful in this whole process,'' Stark told reporters on a conference call.

Most of the legislative process involves posturing. The Blue Dogs want something for their districts, liberals want to represent their constituents, et cetera. When someone like Stark cuts through the posturing and lays out its consequences, it's quite revealing. He's one of the few people who can say this. He also in the same interview called co-ops the equivalent of a "medical unicorn".

Limits Of The Imagination

There was a fairly amazing article in yesterday's Washington Post that I think hits on many of the features of this newfound effort to worry about the deficit and entitlements precisely at the moment when a Democratic President enters office facing a huge crisis requiring major public spending. The basic thrust of the story by David Brown, a doctor and science reporter, is that health care spending will inevitably expand forever, and there's nothing we can do to control costs, and pretty soon we're going to face a crossroads between wanting to live longer and healthier lives and being able to afford it. This was not in the opinion section.

This difficult truth, which has emerged over the past half-century, is leading the United States and the rest of the industrialized world into a new era of humankind [...]

Last year, 16 percent of the nation's gross domestic product went for health care, about $7,600 per person. In terms of human effort, health care is the new food. By 2016, when it reaches 20 percent of GDP, it will be the new shelter. If it grows at its present rate through the first three-quarters of this century, it will consume 38 percent of GDP by 2075. It will then be the new food and shelter.

This isn't a mistake. If it were, we might have a chance of stopping it. It's success -- the way things are supposed to be, and the way we want them to be.

"At the end of the day, when it comes to controlling health care costs, the enemy is us," said Drew Altman, head of the Henry J. Kaiser Family Foundation. "Americans want the latest and best in health care technology, and we want it down the street, and we want it now."

It sounds so simple, doesn't it? Americans greedily want to be healthy, and they demand the latest and greatest, and the costs skyrocket.

Now, nowhere in this analysis is any explanation of the method of delivery of the US health care system, and how its inefficiency may just be, I don't know, the source of the problem. I'm trying to remember when I barged into a doctor's office and insisted on an artificial heart because the guy down the street just got one. No, what happens is that I pay thousands of dollars in premiums to a for-profit insurer, and when I try to use my coverage, I barter with some customer service rep for hours on end trying to get them to sign off, and she gets paid along with a whole staff to keep treatment costs down, and her salary and the salary of the marketing team at the insurance company and the PR guys and the pharmaceutical reps bringing in free lunches for the doctors and the CEO's private jet all fall under that big number of "health care spending."

Also, health care spending grew at its lowest rate in a decade last year, mainly because the economy started slowing down, people started using CHEAPER generic drugs (I thought Americans wanted the best and they wanted it now?), and because of lower rates of growth for administrative costs in - wait for it - Medicare, the public not-for-profit alternative health care delivery system.

Now, it would be simply gauche to point out that the current health care delivery system sucks up all kinds of money for insurance industry profits and admin costs, and that the high cost of premiums force 47 million people to go without health care and use emergency rooms as their personal physician, jacking up costs prohibitively. That couldn't possibly explain all that growth in spending.

Except consider the current series of health care bills before Congress, and recognize that the plan which would cover the most uninsured and the plan which save the most money are THE SAME PLAN. Matt Yglesias has the charts to prove it, from this Commonwealth Fund report. As Yglesias notes, because that DFH Pete Stark wrote the bill that combines reducing the most uninsured with saving the most money, it's deeply unserious and outside the boundaries of conventional Beltway debate.

Stark’s is the best again. And yet there’s no chance whatsoever that we’ll actually do this because his plan, though the most practical, is also the most left-wing. Far too left-wing for the United States of America

Some folks, of course, will oppose the Stark plan because they’re right-wingers who don’t want to expand health care coverage. And some folks, will want to focus their energies on other, worse, plans because those plans have a better chance of passing. But what’s incredibly frustrating is that a lot of people who claim to want to change public policy to expand health care coverage and better control health care costs will nonetheless fail to embrace Stark’s plan or anything similar for no real reason other than ideological posturing. It just can’t be the case, as a matter of centrist dogma, that the best solution is actually the most left-wing solution. It’s a far more ideological stance than anything you’ll ever hear from Pete Stark or from me. But the people hewing to it will insist on being called pragmatists.

Pragmatists like David Brown, who says that we're all going to have to live with the costs of better medical care and drugs, and if it costs too much to save someone's life, well we just have to grapple with that Malthusian Spectre. It can't possibly be that bringing America's health care costs in line with every other industrialized nation on the planet would both help to fix the deficit and entitlement concerns AND deliver better quality and more affordable health care to every American.

That just cannot be. If it's such a good idea, why wouldn't we have thought of it by now?

This all reflects a very ideological problem, where the case for liberal government has either not been made or drowned out by the right for the past 40 years, and so the Very Serious People in Washington view that case as a pollyanna scenario. And in the exchange, we all suffer.

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.

Yes, Having A Democrat Running A Democratic Committee Would Be A Catastrophe

Howie Klein notes that the next in line for the powerful House Ways and Means Committee, should Charlie Rangel succumb to his ethical struggles, is progressive Pete Stark. This has many on Capitol Hill in a tizzy: including those who should have the loudest voice in determining Democratic chairmanships, anonymous operatives and industry lobbyists.

Next in seniority to Rangel is Ways and Means Health Subcommittee Chairman Fortney (Pete) Stark, D-Calif., who is given virtually no chance. "The conventional wisdom is he would have a tough time getting elected chairman," said a Democrat close to leadership. From suggesting Republicans were sending troops to Iraq to die "for the president's amusement" to referring to a former GOP lawmaker as a "little fruitcake," Stark is prone to gaffes, sources said. "The guy behind [Rangel] is just not tenable. Republicans would have a field day," an industry lobbyist said, while noting the business community would "go nuclear. It would just be open warfare." A more viable pick might be Ways and Means Trade Subcommittee Chairman Sander Levin, D-Mich., who is next in seniority, although sources cautioned the cerebral Levin may be too deliberate for the high-profile job. Levin also appears to relish his duties at the helm of the trade panel. He is also seen as very much in tune with the labor movement, although industry sources said Levin was someone they could work with, as opposed to Stark. Also, the Democratic Caucus still largely respects the seniority system, the Democratic strategist said. "If you make the decision that Stark is too out there, then I don't see how you go over Sandy," he said. "He's been a loyal member, and nobody would doubt he's got the intellectual and legislative expertise for the job."

As Matt Stoller notes, there are NINE anonymous sources in this article. You'd think the people who presume to control Congress and who gets selected for particular committees wouldn't be so cowardly, would you? But of course, they just want to be behind the curtain, impervious to political pressure.

As a contrast, Pete Stark is open and honest about his views. He has paid his dues and he's next in line for the job. His "radical" policy ideas include making health care accessible and affordable for every American and opposing a giveaway to the financial services industry.

Howie explains the double standard at work here:

Do you recall any of the Inside the Beltway types viewing a Republican appointee to any job thru the lenses of how that person might be accepted by working families or by organized labor? Or did I miss the issue where CongressDaily suggested that Elaine Chao might be the world's absolute worst Labor Secretary because she loathes working people and doesn't recognize their aspirations as legitimate or worthy of her attention?

Did anyone ever question whether one of Congress' biggest corporate shills on environmental issues, Dirty Dick Pombo, would be unqualified to be Chairman of the House Natural Resources Committee because he was unanimously loathed by every single environmental group in the country? And what about that issue of CongressDaily-- or any other daily-- that pointed out that maybe Joe Barton (R-TX) shouldn't be chairman of the House Committee on Energy and Commerce because the $1,315,660 in legalized reported bribes he's taken from Big Oil over the years is far more than any other member of the House, more even than notorious Big Oil puppets like Don Young (R-AK- $964,763), Steve Pearce (R-NM- $804,815), Tom Delay (R-TX- $688,840), and Pete Sessions (R-TX- $582,264), and that all the green energy groups feel that Barton is an integral part of the energy problem in our country and decidedly not part of the solution? No, I must have missed it too.

Indeed. This might be a good time to contact the Speaker and tell her that Democrats up for Democratic committee chairs shouldn't be subject to a veto by industry.

This Is Such A Set-Up

When I saw that bipartisan press conference claiming that the contours of a deal has been reached, I noticed that the Republican representative from the Senate side was Bob Bennett, not the ranking member of the Banking Committee Richard Shelby. Well, sure enough, Shelby just showed up on MSNBC, and sure enough, he's absolutely opposed to the bill. He was waving around a piece of paper from top economists opposing the bailout, calling it a giveaway to the same Wall Street corporations that created the problem. He also said it bails out foreign banks, which I thought was taken out of the bill.

Shelby isn't wrong, not to my knowledge. As James K. Galbraith says today, the need for this bailout is extremely suspect. Certainly there are better ideas out there than the crappy Paulson plan. And in many ways, lawmakers and the Bush Administration are trying to fix a problem that doesn't have a fix - the housing market hasn't hit bottom, and it'll drag down the economy regardless (though a new Home Owners Loan Corp. would help).

But the politics of this are clear. Right after Dodd and co. announced a bipartisan deal, John Boehner said no dice. They are going to try to stick the Democrats alongside with Bush on this bailout.

I don't know if that will totally work. Pete Stark is calling B.S. on President Paulson's irresponsible talk about bank runs and depressions. Brad Sherman says his office calls are running 300 to 2 against. The results are the same across the country. I think a good portion of Democrats won't go along with this. But the Blue Dogs, those supposed stewards of fiscal responsibility, will, and they'll put Democrats in the situation of being on the side of the largest bank bailout in American history. At that point, the details will be irrelevant. This is Lucy with the football, and if the Democrats manage to blow this one they actually don't deserve to be a political party.

...the other option here is that House Republicans are holding off until McCain "convinces" them, showing how much of a post-partisan leader he is. That's a possibility, but anyone who votes for this piece of crap bill, absent some really enticing language, is in trouble in 2010.

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.

Roy Hobbs In The Bottom Of The Ninth

On a sad day for civil liberties in this country, there is one shining bright spot - Ted Kennedy is back in the Senate.

Sen. Edward M. Kennedy, battling a brain tumor, walked through a wall of applause into the Senate on Wednesday and cast a stunningly unexpected vote on long-stalled Medicare legislation.

"Aye," the 76-year-old Kennedy said in a loud voice, and he made a thumbs-up gesture as he registered his vote.

Spectators in the galleries that overhang the chamber burst into cheers — a violation of decorum that drew no complaints.

The vote in question was on whether to overturn the Bush Administration's edict to reduce Medicare payments to doctors, which would almost certainly result in doctors and hospitals refusing to treat patients on Medicare. It's financed by reducing payments to Medicare Advantage, which has become something of a racket for insurance companies. Democrats tried to push this before the July 4 break, and came within one vote of getting cloture. Once Kennedy triumphantly showed up and bellowed, "Aye," cloture was assured, so a bunch of cowardly Republicans, who earlier voted proudly to kick Medicare patients out into the street, in a manner of speaking, flipped their votes, and cloture passed by 69-30.

Here's Pete Stark (D-CA), chairman of the Ways and Means subcommittee on Health, on the vote:

"Today, with a veto-proof majority, the Senate joined with the overwhelmingly bipartisan majority of the House to pass legislation that averts a 10 percent pay cut for physicians, makes modest beneficiary improvements to Medicare, and is financed by reining in the Medicare Advantage program. H.R. 6331 is the minimum that we should do to protect and maintain Medicare. America's senior citizens and doctors helped reluctant Republican Senators understand that as well.

"Senator Kennedy managed to make it back from treatment for cancer, but Senator McCain couldn't be bothered. Senator McCain, who wants to be our next President, has skipped this vote three times now. Clearly, he'd rather hide than face up to the insurance industry. You can do that when you're in the U.S. Senate, maybe voters should leave him there."

But forget the particulars. Seeing Ted Kennedy return to the Senate and hearing the roar from the gallery is enough to cheer me up today. His care and treatment was not as important as the care of some elderly man or woman of more modest means. He's a fighter for the common man no matter what. There are still a few of them left.

UPDATE: Obama on this vote:

“Today, the U.S. Senate took a major step forward in addressing the needs of seniors and military families all across this nation. At a time when doctors are facing double digit increases in the costs of providing care, I am proud to have joined with my colleagues to stop a devastating cut in physician reimbursement that would have caused them to shut the door to many Medicare and Tricare beneficiaries. John McCain has said that he would have opposed this bill, demonstrating yet again that he’s more than willing to put the interests of the health insurance industry over our nation’s 44 million seniors and 9 million uniformed service members,” said Senator Barack Obama.

UPDATE II: Think Progress has the video and a statement from Teddy:

I return to the Senate today to keep a promise to our senior citizens and that’s to protect Medicare.

Win, lose or draw, I wanted to be here. I wasn’t going to take the chance that my vote could make the difference.

Dying For Coverage

Advocacy group Families USA has put out a shocking report (PDF), "Dying For Coverage," detailing how Californians are impacted by a lack of health insurance. The number "47 million" that designates Americans without health insurance is too abstract and detached from meaning. Californians are dying because of their inability to afford or acquire insurance.

• Families USA estimates that more than eight working-age Californians die each day
due to lack of health insurance (approximately 3,100 people in 2006).

• Between 2000 and 2006, the estimated number of adults between the ages of 25
and 64 in California who died because they did not have health insurance was
nearly 19,900.

•Across the United States, in 2006, twice as many people died from lack of health
insurance as died from homicide.

The factors that lead to death include: 1) a lack of preventive care and screening, 2) unnecessary delays for medical care because of affordability concerns, 3) no access to care outside an emergency room, and more.

Some of our Democratic members of Congress have commented on the report.

"This new Families USA study highlights a sad statistic that more people in our country died from lack of health insurance than from homicide between 2000-2006," U.S. Rep. Pete Stark (D-CA) said today. "In California alone, nearly 20,000 people in that time frame died because of being uninsured."

"Our nation has more people in jail than anywhere else in the world in its effort to combat crime," Stark said. "Yet, we allow 47 million people to go without health insurance-which translates into going without needed medical care-each year. It's time to take action and combat the real killer in our country-the lack of universal health care."

"It is appalling and irresponsible that more than eight working-age Californians die due to lack of health insurance each day," U.S. Rep. Hilda L. Solis (D-CA) said today. "In California , 60 percent of the uninsured are Latinos, which means that nearly five Latinos die each day because we cannot ensure access to quality, affordable health care."

"I am fighting in Congress to improve the health of communities of color and strongly support improving access to health care for all populations," Solis said.

When Republicans talk about "cost control" in medical care, they want a world very much like this. They believe that the problem with health insurance is that people have too much of it. They would rather it be limited and used only when necessary, and they would rather Americans hold out and comparison shop when they are ill or infirm. In other words, the conservative vision of health care aligns with the for-profit insurance company vision which directly leads to 8 dead Californians every single day.

As we pick up the pieces from the failure of health care reform from earlier this year, this powerful report shows the dire need to repair the broken system and ensure affordable care for everyone.

Head Banging Against Table

So the conservative noise machine threw a hissy fit about Rep. Pete Stark's comments the other day that the President was sending troops to Iraq for his own personal amusement (hey, it's a theory, and it holds up better than "they had WMD"). They held a censure vote in the House today. It failed, but then like all good little boys, Stark apologized.

"I want to apologize to my colleagues, many of whom I have offended," Stark said. He also apologized to "the president and his family" and "the troops."

"I hope that with this apology, I return to being as insignificant as I should be," he finished in an emotional, breaking voice.

I'm puzzled. This sounds like someone with battered wife syndrome, eager to please his Republican masters and not fall out of their good graces again. Why is he apologizing for the manufactured outrage of others? Why does he declare himself to be "insiginifcant"?

Probably because the leadership in the House mau-maued him to death. This is what is done when anyone shows a modicum of fire in the Democratic Party. They are silenced by the squishes and the suits. This is exactly why the Party has such an image problem.

Pete Stark is accountable to his constituents, not the fake comity of the House or the imperiousness of the leadership. His apology connotes weakness, which has characterized the entire term of Congress in this session. How depressing.

Baby Party Blues - And Their Enablers

It's a familiar pattern: the Republicans are on the absolute wrong side of an issue, wildly out of step with the American people. So to distract from that reality, they whine about someone saying something mean to them. I wonder if this does nothing but end up reinforcing in the public mind that Republicans are a bunch of babies who can't take words of any kind without heading for the fainting couch. Here's the problem, though: Democrats actually help along this crap.

His words will live on as part of the congressional record, but Rep. Pete Stark's comments about President Bush gaining "amusement" over deaths in Iraq have been condemned by House Speaker Nancy Pelosi.

In a statement released Friday evening, Pelosi called the comments of her fellow California Democrat "inappropriate."

"While members of Congress are passionate about their views, what Congressman Stark said during the debate was inappropriate and distracted from the seriousness of the subject at hand -- providing health care for American children," Pelosi said.

What's inappropriate is you having so much as a word to say about it. Rush Limbaugh makes a comment about "phony soldiers" and the entire Republican Party rallies around him, and he auctions off a letter signed by 41 Democrats for $2 million dollars. Pete Stark makes a bold statement in the midst of a heated debate, and Democrats have to denounce and distance. It's just horrendously bad politics. How about discussing how Republicans can't stop whining and crying and fainting about talk instead of action?

The Sadness Of SCHIP

So today the House GOP is going to set an explosion inside their own caucus by voting to ignore the American people and sustain a veto on children's health insurance expansion. They even have visual aids.

For those with bad eyes, Mr. (Iowa Rep. Steve) King has created a chart claiming the S-CHIP really stands for “socialized Clinton-style Hillarycare for Illegals and their Parents.”

Guys, you’ve done outdone yerselves on this one. Please, please, please keep insulting middle-class families who can’t afford health insurance. I guarantee that it will launch you right back into power.

With whom are the American people going to associate themselves? A callous liar like Steve King, or Pete Stark?

First of all, I'm just amazed they can't figure out, the Republicans are worried we can't pay for insuring an additional 10 million children. They sure don't care about finding $200 billion to fight the illegal war in Iraq. Where ya gonna get that money? You going to tell us lies like you're telling us today? Is that how you're going to fund the war? You don't have money to fund the war or children. But you're going to spend it to blow up innocent people if we can get enough kids to grow old enough for you to send to Iraq to get their heads blown off for the President's amusement. This bill would provide healthcare for 10 million children and unlike the President's own kids, these children can't see a doctor or receive necessary care. [...]

But President Bush's statements about children's health shouldn't be taken any more seriously than his lies about the war in Iraq. The truth is that Bush just likes to blow things up. In Iraq, in the United States and in Congress.

In the end, the Democrats will press this issue, House Republicans will not be able to take the pressure, and this bill will be made law, maybe with a cosmetic change here or there. But the pain of this vote will resonate all the way to November.

"What will happen is they’ll lose the override. They’ll make cosmetic changes and our guys will cave," Rep. Tom Davis (R-Va.) said Tuesday during an appearance at the National Press Club. "And at what cost? Our guys will get beaten up ... SCHIP is a dumb fight."

No wonder Davis is talking down a Senate run and sounding increasingly like a baby about it. His party is throwing itself in the lake and nobody seems to want to stop it. I agree that the right can't let up on health care because Democrats will actually be seen as protectors of the middle class, collapsing their coalition. But that's happening right now, anyway. It's a hole that will take a generation to crawl out of. Today the House will witness the beginning of the permanent Republican minority.

UPDATE: The final vote was 273-156, 16 votes short. The Republicans had almost nobody flip from the initial vote. Down the drain they go.

A-A-R-P Spells HMO

This is the equivalent of the Sierra Club buying an oil company:

WASHINGTON, April 16 — AARP, the lobby for older Americans, announced Monday that it would become a major participant in the nation’s health insurance market, offering a health maintenance organization to Medicare recipients and several other products to people 50 to 64 years old.

The products for people under 65 include a managed care plan, known as a preferred provider organization, and a high-deductible insurance policy that could be used with a health savings account.

When the new coverage becomes available next year, AARP will be the largest provider of private insurance to Medicare recipients. In addition to the new H.M.O., AARP will continue providing prescription drug coverage and policies to supplement Medicare, known as Medigap coverage.

William D. Novelli, the chief executive of AARP, said, “In launching these initiatives, we are driven by our mission to create a healthier America.”

I suppose it's to be expected that the AARP, a major power broker with a keen interest in seeing responsible health care legislation coming out of Congress, would step into the breach with the failure to pass that legislation. But once you put this interest group into the insurance industry, it's going to be phenomenally hard, next to impossible, for them to be a part of any health care solution that marginalizes or removes the insurance industry.

Pete Stark preferred to look on the bright side:

Representative Pete Stark, Democrat of California and chairman of the House Ways and Means subcommittee on health, welcomed AARP executives to the Medicare managed care market. “If they provide quality care at a fair price,” Mr. Stark said in an interview, “they could be a wonderful addition.”

But Judith A. Stein, director of the Center for Medicare Advocacy, a nonprofit group that counsels people on Medicare, said, “The new arrangements with insurance companies create a tremendous number of potential conflicts for AARP, which is a powerhouse, perceived as the most important voice for older people.” [...]

“AARP will not be perceived as a truly independent advocate on Medicare if it’s making hefty profits by selling insurance products that provide Medicare coverage,” Ms. Stein said. “AARP’s role in this market could give a big boost to the privatization of Medicare.”

The conflicts of interest here are enormous. The insurance industry has a definitive interest in their own survival. Yet we know that a for-profit manager of health care is always going to be more concerned with profit than caring for patients. In fact, the AARP tipped their hand within the article, saying that they would not be able to deny coverage to everyone between the ages of 50 and 64 (that should read "We won't cover really sick people"). Kevin Drum writes:

One of the great arguments among universal healthcare advocates is whether to press for a system that continues to make use of private insurance companies or to press for a purer single-payer system that gets rid of insurance companies altogether. The argument for working with the insurance industry is a political one: if we try to eliminate a role for insurance companies they'll fight us tooth and nail, and that's the last thing we need. Universal healthcare has enough powerful enemies as it is. The argument for pure single-payer is mostly (though not exclusively) economic: in our current system, healthcare administration uses up about 30% of all healthcare dollars, compared to 10% or less in countries with national systems [...]

I think they'll fight national healthcare just as hard no matter what the plan is, because the private health insurance industry is so big that even a reduced role means an enormous loss of revenue for them. What's more, I think they'll also judge (correctly) that even a reduced role is just the camel's nose under the tent that will eventually lead to the end of private insurance entirely.

So trying to make nice with the insurance industry is a mug's game. They just aren't ever going to be on our side, and frankly, I don't blame them. All that said, however, the fight against the entrenched interests of the insurance industry gets a lot harder when an organization that might have provided significant lobbying muscle for a single-payer system is depending on a private insurance business line for a big chunk of its revenue. It's definitely not pleasant news for the good guys.

Obviously, the AARP as an entity cannot be stopped from forming a corporation and making a profit. And generally they've been good on health care. But you can't very well act to change the system when you're part of the system. Also, because they're such a political force, lawmakers are going to be a little more wary of shutting down the HMO of such a big benefactor.

The Atheist Hordes

I expect the Christian conservatives to go as apeshit over this as they did over Keith "Muslims are taking over Congress" Ellison, but we'll see:

There is only one member of Congress who is on record as not holding a god-belief.

Rep. Pete Stark (D-Calif.), a member of Congress since 1973, acknowledged his nontheism in response to an inquiry by the Secular Coalition for America (www.secular.org ). Rep. Stark is a senior member of the powerful House Ways and Means Committee and is Chair of the Health Subcommittee.

Although the Constitution prohibits religious tests for public office, the Coalition’s research reveals that Rep. Stark is the first open nontheist in the history of the Congress.

Stark represents CA-13 in the East Bay on the other side of San Francisco (map), and he's been in office over 30 years, so one wouldn't expect this to damage him politically. But it's a little amazing to me that atheism is having this kind of "coming out" moment in 2007. In fact, there are at least as many secular voters as there are regular church-goers. There are approximately 15 times more atheists and agnostics nationwide as there are Jews, and worldwide that increases to 60x (worldwide there are almost as many atheists as Hindus). Only 26% of this country attends religious services once a week. Those who do are free to practice their religion; such freedom is a bedrock fundamental tenet of American life. But those who don't, a significant portion of the population, ought not to have had to wait 230 years before one of their political leaders dare say that he's one of them.

The media only addresses this divide in one direction - Democrats have a God problem. But in fact, that may not be nearly as crucial as the conservative problem with secularism:

Lots of ink has been spilled about how Democrats and liberals suffer from a "religion problem" -- a perceived hostility towards Christianity and religion in general. But Pew Research Center exit poll data from the 2006 midterm elections shows the opposite.

Democrats crushed Republicans among secular voters, broadly defined as those who attend church seldom (favoring Democrats 60% to 38%) or never (67% to 30%). Republicans retained strong support among those who attend church more than weekly. But among those who only go weekly -- the larger portion of the religious vote -- the Republican lead shrunk from 15 points to 7.

In short, Republicans failed to be competitive among secular voters, while Democrats were at least competitive among regular churchgoers. And since the secular vote is roughly equal to the regular churchgoing vote, according to the last several national election exit polls, that means Republicans and their conservative base have a far bigger secular problem than their rivals have a religion problem.

My personal view on religion hews closely to George Carlin's bit about it being like a lift in your shoes.

If you need it for a while, and it makes you walk straight and feel better - fine. But you don't need it forever, or you can become permanently disabled. Religion is like a lift in the shoe, and I say just don't ask me to wear your shoes. And let's not go down and nail lifts onto the natives' feet.

"I don't care if you have it, I don't want to take it away from you, just don't give it to me" is essentially my credo. I have a strong belief in morality and ethics, I use the faith in which I was brought up (Judaism) as a blueprint for my moral and ethical life, and I respect those who get strength from their faith to advance moral causes, but I don't demand that everyone think the same way I do. And most people with such a view get very touchy when they see fundamentalist Christians trying to impose their beliefs on every aspect of American life. They call it "defending the free exercise of faith," but they actually do the opposite by demanding that their faith be ensconced into law. This is why the GOP has a real problem with secular voters, who perceive that the Christianists have hijacked the party.

I'm glad Pete Stark has "come out" as an atheist but it's really no big deal, just as it wouldn't be if he came out as a Methodist or a animist or a Zoroastrian. I'm glad when anyone is allowed to give full expression to their beliefs without fear of reprisal. The religious right should be happy for that as well.