Just Trust Us

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

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

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

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

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

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

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

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

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



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

That Baby Should Learn About Personal Responsibility

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

Rocky Mountain Health Plans, an insurance company in Colorado, has denied coverage to a four month-old child on account of "obesity." How dare the kid not moderate his portions!

By the numbers, Alex is in the 99th percentile for height and weight for babies his age. Insurers don't take babies above the 95th percentile, no matter how healthy they are otherwise.

"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

" 'Your baby is too fat,' she told me," Bernie said.

Rocky Mountain Health Plans' alibi is that as long as everybody denies coverage for a pre-existing condition, they will too.

So essentially, the insurance industry is telling this family to starve their child as the only way to get him health insurance.

That, or the baby should learn some personal responsibility and take care of himself better. Maybe push-ups.

UPDATE: A happy ending on this one. Rocky Mountain Health plans relented and will no longer consider an infant's added heft a pre-existing condition. Unfortunately, there aren't enough newspaper articles in the world to help everyone abused by the insurance industry.

The Non-Existing Condition

Valerie Scaglione's story is almost comical:

Monthly premiums for Blue Cross coverage for them and their three daughters have soared over the years to almost $2,000, Scaglione says.

She estimates that in the past six years, the family has spent more than $140,000 on premiums and co-payments.

Yet when she tried to switch from the family's expensive individual insurance to a Blue Shield group plan that's more affordable, she said, she and her oldest daughter were denied coverage. She said neither of them has the medical conditions that were listed as reasons for being denied - bronchitis and a skin ailment.

"I have three children," said Scaglione, 47. "We have to have insurance. Stitches may be required. A broken bone may have to be set. We have no chronic diseases. We're a normal family. This is crazy."

Consumer advocates consider their story emblematic in many ways of complaints that plague the entire health insurance industry.

"We've seen people denied for things as minor as heartburn," said Anthony Wright, executive director of Health Access California, a statewide health advocacy coalition. "It gets to the point where living is a pre-existing condition.

Mrs. Scaglione's health insurance coverage costs three times as much as the family's MORTGAGE. And she can't get out of it and into a group plan, because Blue Shield flat-out invented reasons to deny the coverage. She has demanded to see the medical records that show her daughter having bronchitis and her having a skin condition called rosacea, but the health insurer refused the request.

As the debate continues, the Scagliones remain among California's 3 million consumers in the pricey individual insurance market.

"I wonder how many other families are like ours," Scaglione said. "What's the option, to be uninsured? This forces me to stay with our same plan. Premiums will go up and up and up. What, do we not feed the kids? It gets to the point of being absurd."

Blue Shield of California can be reached at (866) 256-7703. You might want to ask them what health care ailments they think you have of which you're unaware.

Tom Campbell's Kind-Of-Interesting But Just-A-Mask-For-Friedmanism Health Care Proposal

Tom Campbell, among all the Republicans in the gubernatorial field, has at least been willing to lay out detailed plans for how he would fix the state. Typically this manifests itself as the same old Hooverism. But his health care plan at least gets points for creativity.

GOP gubernatorial hopeful Tom Campbell released a unique health care proposal Thursday that would redistribute $42 billion in federal and state funds already spent on health care in California to buy private health coverage for everyone in the state who's "involuntarily" uninsured.

Under the former congressman's plan, the funds would cover an estimated 2 million such people in addition to the 7.6 million already receiving public health coverage under the state Medi-Cal and Healthy Families programs.

"The astounding conclusion," Campbell writes in his proposal, "is that, using only the money already being spent by the federal and state governments for health care in California, we could buy free market health insurance currently available and cover all involuntarily uninsured in California, and still have more than $700 per person left over!"

Instead of dedicating funds to services for the poor or children, Campbell would split the state into regions, and allow insurers to bid against one another to cover everyone in that region who earned below a certain level, along with everyone denied coverage for a pre-existing condition. Insurers wouldn't bid on price, but quality of coverage - the money would be fixed, and insurers would bid against each other based on what they would cover and at what rate.

I'm wondering why any insurer would bid for this right. They deny people with pre-existing conditions because they are more likely to use health care, increasing their medical loss ratio. And the poor are more likely to need health care treatment based on lifestyle and environment. And the kicker to Campbell's plan is, if nobody bids, the status quo would remain in place for that geographical area. So basically, Campbell is touting a big plan that would do... nothing. And he wouldn't embark on it if the federal government enacts their own plan.

Mavericky!

Really, that interesting, if impossible (try getting a federal waiver to set it up and face Congressmembers with interests in protecting SCHIP and Medicaid), proposal is a cover for Campbell's apparent agenda - to permit the interstate sale of insurance and to bring up the canard of tort reform as a panacea. Medical malpractice is an insignificant percentage of total health care costs and states which have embarked on major medmal reform, like Texas, have seen no change in health inflation. As for the interstate sale of insurance, you can do it now - only you're responsible to comply with the laws of the state in which you sell. This proposal would allow insurers to only be responsible to the regulations of the state where they are based. Tom Campbell wants to do for the health insurance industry what this kind of proposal did for the credit card industry - send all insurance companies to a small state with no regulation, and gut all state-based regulation in the process, leaving California's insurance customers at the mercy of the laws of South Dakota or Mississippi.

To his credit, Campbell wants to remove the anti-trust exemption on the insurance industry. But really, that's a means to an end here. However, there is a point of consensus between conservatives and liberals to do away with the McCarran-Ferguson Act, that offers that anti-trust exemption. Bills to this effect were just introduced in Congress. If Campbell wants to talk them up to the California GOP delegation, go ahead.

Jon Kyl - Objectively Pro-Discrimination

Under current law, health insurance companies can deny you coverage if they decide you actually might use a doctor. They can discriminate against broad classes of Amercians based on what they call in insurance-speak a "pre-existing condition." They can even go back after you turn in a claim and find some typo in your medical history form that allows them to dump you from the coverage rolls.

Jon Kyl, the #2 Republican in the Senate, thinks this is all fine and dandy.

The distance between the parties' leaders on health care was made clear on Tuesday when the No. 2 Republican in the Senate held a conference call with reporters.

Asked by ABC News about a package of insurance market reforms that have been endorsed not only by President Obama but also by the insurance industry, Sen. Jon Kyl came out against all three proposals.

In particular, the Arizona Republican signaled that he opposes requiring insurance companies nationwide to provide coverage without regard to pre-existing conditions; requiring them to charge everyone the same rate regardless of health status; and requiring all Americans to carry health insurance.

"One of the concerns I have about the approach of the Democrats ... is an assumption that there has to be a national mandate on all insurers to do various things," Kyl told ABC News when asked for his position the three issues.

"Those are techniques that states can, and some have, used in the past with fairly disastrous consequences," he said.

Part of what community rating would ban is allowing companies to charge women more money for health insurance, because they may use more care. And actuarial statistics show that the poor have a higher propensity for sickness due to environment and food choices, which means that they are discriminated against at a higher proportion in the insurance market. That's the system Jon Kyl wants to keep in place - a segregated system where large segments of society cannot even have the option of health insurance.

Even the insurance industry supports guaranteed issue and community rating. They want that along with a forced-market monopoly, with no competition from a public insurance option, so that the government can subsidize their businesses and turn people who cannot afford health insurance into criminals. But that would be LESS RADICAL than what Jon Kyl is proposing.

These are the people with whom we must engage in bipartisanship, or so it is told.

Baucus' Move

There's been a lot of ink spilled about the failure of Clinton-era health care reform, but certainly legislators inside the Democratic caucus, particularly Blue Dogs and moderates, had a hand in sinking the proposal. Maybe it was because they felt cut out of the negotiations, or because they just didn't believe in the scope of the problem. Well, the best indication that 2008 is different is that Max Baucus, not a progressive, has boldly sketched out a universal coverage plan just a week after Barack Obama's election. There is good reason to be skeptical, however.

Here's the birds-eye view of Baucus' plan:

Without waiting for President-elect Barack Obama, Senator Max Baucus, the chairman of the Finance Committee, will unveil a detailed blueprint on Wednesday to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare, and requiring most employers to provide or pay for health benefits [...]

The proposals are all broadly compatible with Mr. Obama’s campaign promises. But Mr. Baucus’s 35,000-word plan would go further than Mr. Obama’s in one respect, eventually requiring all people — not just children — to have coverage.

“Every American has a right to affordable, high-quality health care,” Mr. Baucus said. “Americans cannot wait any longer.” Far from being a distraction from efforts to revive the economy, he said, “health reform is an essential part of restoring America’s economy and maintaining our competitiveness.”

Mr. Baucus would create a nationwide marketplace, a “health insurance exchange,” where people could compare and buy insurance policies. The options would include private insurance policies and a new public plan similar to Medicare. Insurers could no longer deny coverage to people who had been sick. Congress would also limit insurers’ ability to charge higher premiums because of a person’s age or prior illness.

People would have a duty to obtain coverage when affordable options were available to all through employers or through the insurance exchange. This obligation “would be enforced, possibly through the tax system,” the plan says [...]

In his plan, Mr. Baucus makes these proposals:

¶People age 55 to 64 should be able to buy Medicare coverage if they do not have access to a public insurance program or a group health plan. More than four million people in this age group are uninsured.

¶Medicaid would be available to everyone below the poverty level, providing at least seven million more people with access to the program. In many states, adults with incomes well below the poverty level — $17,600 for a family of three — are ineligible for Medicaid.

¶The State Children’s Health Insurance Program would be expanded to cover all uninsured youngsters in families with incomes at or below 250 percent of the poverty level ($44,000 for a family of three). This would raise the income limit in about half the states.

You can read the white paper here. This is basically the generic Democratic health care plan, not much different from what Obama campaigned on. Obviously, the big difference here is that the plan would include an individual mandate to buy health care, which was part of Hillary Clinton's plan during the primary but not Obama's. I don't think Obama is unaware of that fact - his chief of staff during the general election campaign, James Messina, held the same position for Baucus. And Obama has said that Congress should take the lead on this issue.

And there would be a public option to compete with the insurance companies. Jon Cohn has this:

It look a lot like the plan Barack Obama touted on the campaign trail: Expanded Medicaid and S-CHIP for the poor; a pooling mechanism that allows individuals and the uninsured to buy coverage at group rates; a new public insurance plan, modeled vaguely on Medicare, that would be available to people buying coverage through the new pool; subsidies to offset the cost of insurance coupled with efforts to restrain the cost of medicine in the long term; and regulations that force insurers to sell to everybody, regardless of pre-existing condition.

I think a lot of this may be a matter of jurisdiction. If Baucus comes out first with a big proposal, it becomes the spine for the eventual legislation. The Committee on Health, Education, Labor and Pensions would presumably have some control over this as well, and right now that's chaired by Ted Kennedy. The good news is that Kennedy has come out with praise for Baucus' effort. But we have no idea what's going on behind the scenes, where it matters.

These sorts of jurisdictional battles can be damaging. And they have real effects. HELP is a liberal committee that could pass a fairly pure bill that might have problems on the floor. Finance has a moderate, bipartisan history and would probably pass a heavy, consensus-oriented bill that will be built to smoothly pass once brought to the floor. I've heard talk, in the past, of setting up a special Committee of some sort that would include members of HELP and Finance (and probably Clinton and some others) to build health reform, but so far as I know, that's not gone anywhere. Then there's the wild card of Kennedy's health. WIthout Kennedy, HELP has nothing.

I'm not sure we should all cheer Baucus' outline, although the addition of universality and the recognition that we need reform is very important. First, the good. Fixing health care is the fiscally conservative thing to do. The only entitlement program with the potential to bust the federal budget is Medicare, and that's directly attributable to out-of-control costs. We currently spend more than any country in the industrialized world per capita on health care and achieve less results. The insurance and pharmaceutical industries have gamed this system for decades and the horror stories are legion. What's more, business is coming to the realization that they can't compete without government relieving the health care burden that makes it impossible for them to succeed. Despite the neo-Hooverist cant that Obama has to go slow on things like health care until the economy is sound, the fact is that expanding health care would provide an immediate stimulus for individuals and business. In addition, the unions are in full support of the measure and willing to spend on crafting public opinion. Politically speaking, those are a lot of allies in our corner. And by attacking this early, you get the sense of a "liberal shock doctrine," with progressive ideas used to combat a looming crisis.

Now, the bad. Mandates can be a forced market for insurance companies - in fact, they favor it in exchange for health care reform. Baucus' proposal is not a single-payer system. He came right out and said today that "I don't think a single payer health care system makes sense in this country, we are America, we will come up with a uniquely American health care system that's a combination of public and private." That kind of exceptionalism just makes no sense against economic reality. If the insurance industry can pawn off the sick onto the public plans, those costs will rise while insurers take in record profits. There is a clause in the proposal that "Private insurers offering coverage through the (Health Insurance) Exchange would
be precluded from discrimination based on pre-existing conditions," which is great, but insurers have used other means, like recsission (retroactively kicking people off the insurance rolls when they file a claim because they "lied on their forms"), to get out of paying for treatment. There also doesn't appear to be any language that insurers must spend a significant portion of their premiums of actual care. As for the cost controls, there's this clause, "The plan also considers careful reforms of medical malpractice laws that
could lower administrative costs and health spending throughout the system, while ensuring that injured patients are compensated fairly for their losses," which sounds like another round of tort reform to me.

It's hard to fully trust Baucus. He wrote the first Bush tax cut and he helped shepherd the Medicare Part D prescription drug bill which was a giveaway to industry. But Baucus also helped stop the Social Security privatization scheme and outflanked Republicans to get a Medicare fix passed this summer. His record is mixed at best, and that's not the greatest profile to have when you're the point man on universal health care:

His appetite for pork -- and his skill at wresting it for his state -- is so legendary that The Washington Post branded him a "High Plains grifter." As one former Baucus staffer put it to me, "He's like the city councilman for the state of Montana." And, he's well known for his tendency to break with the Democratic Party. In 2001, he was so instrumental in passing Bush's tax cut that he stood behind the president at the bill-signing ceremony, a visual that featured prominently in his 2002 campaign ads. (In 2003, however, Baucus voted against the second round of tax cuts.) He voted to repeal the estate tax and earned a 70 percent approval rating from the Chamber of Commerce.

Also helpful is the fact that Baucus never enters an election underfunded. "One of the rewards I was told about before I selected the committee," says Durenberger, "was someone said, 'You have to run for re-election. This is the best place to raise money.'" Much of Baucus' cash comes from the industries most affected by his committee's legislation. According to the Center for Responsive Politics, this cycle has seen Baucus raise almost $800,000 from securities and investment firms, $565,000 from the insurance industry, and $462,000 from the pharmaceutical industry. Ninety percent of his funds have come from out of state. In total, he's raised more than $10 million. (Some of which has gone to the Democratic Senate Campaign Committee; Baucus bragged to me that he had more than doubled the target contribution set by Sen. Chuck Schumer.) [...]

When I meet with Baucus at the City Grille in Denver, he is eager to emphasize this chapter in his story. "When Reid put me in charge of stopping the privatization of Social Security, man that was fun. That was the right thing to do," he says. "I remember President Bush came to Great Falls, Montana, and I set up a meeting with seniors at the same time, just across town, just right in his face. I relished the opportunity just to beat down privatization flatly and squarely." His message is clear: I can fight.

Unbidden, Baucus then launches into a retelling of his fight in July to block the 10.6 percent cut in Medicare physician reimbursement. Here too, the message is clear. "I walked away from Senator Grassley," he says. "I tend to work with Senator Grassley. But there comes a time when you just gotta say, 'Sorry.' These things get watered down too much, it's just not right, so I just broke with him on that and pushed through a Medicare bill that finally got 60 votes. We had to work hard to get those 60, because Grassley didn't agree, but that was the right thing to do. So when Ted Kennedy walked on the floor to cast the 60th vote, that's a moment I'll always treasure."

I'll take Baucus at his word that he is serious about the health care crisis. But a new reform must be the right kind of reform - it can't be a watered-down giveaway to industry that keeps them alive for no significant reason. I recognize that conservatives have bashed "socialized medicine" for so long that there needs to be a lot of education around the issue before you frontally assault it. But if you waste this moment once again, and create a system that rewards insurers more than people, all of the trust built up in this historic campaign will fade away.

It's crucial that we make perfectly clear that health care should be at the top of the agenda for the incoming Democratic majority. But it's not enough to demand its presence - we have to actively shape the reform itself as well. This legislation is by no means final - in most areas it's deliberately vague. Sen. Baucus is trying to control the pathway through which health care must travel. We the public must get a tollway on that path as well.

More Health Care And The Campaigns

Obama actually released a second ad on McCain's Health Care Tax today.



While this is definitely effective, it treats McCain's tax as a tax, when if you fully explain it out, it's worse than that.

In year one, you'll have to pay that tax, and the tax credit will roughly offset it. But the tax credit grows with inflation. Health spending grows much more quickly. By year five, your tax credit will have shrunk. Sharply. But health spending will be up, and so your tax increase will have expanded. Substantially. With every passing year, you pay more in taxes and receive less from the tax credit. The plan's savings -- minimal already -- are frontloaded and its costs are delayed. It's a pretty dirty trick.

That's the perfect Republican squeeze play. And if you have a pre-existing medical condition - forget it. Go sign up on a long sheet of those hoping to get the state to help you with your coverage. McCain's plan is a disaster.

What I didn't realize is that Obama released an ad about his own health care plan this week as well.



I know I'm not the target audience for this spot and that it's designed for swing-state independents, but it infuriates me. It shows that Obama is committed only to tinkering around the edges on health care. Eliminating pre-existing conditions would be a big step forward, as would mandating that a high percentage of premiums go to treatment. And preventive care is nice and all. But this keeps us very firmly in the status quo, with the insurance industry and its army of lobbyists in the lead. "Bring down costs" is thrown in there but cost control is not explained or even presented in his plan. And the public option, which is what I'm hanging my hat on in Obama's plan, goes unmentioned, which is a tell that it could go away.

This gives me little hope of Obama's seriousness about this issue, and Congress will have to take the lead here. I know there's a bias toward people liking what they have in health care, but I don't even know how true that is anymore. And his "common sense" solution makes little sense at all.

Ugh.

This Is Why McCain's Avoiding The Press

Because whenever he says anything out loud it's an embarrassment.

The Politico looked into his claim that 300 economists support his budget plan. They, um, don't.

Upon closer inspection, it seems a good many of those economists don’t actually support the whole of McCain’s economic agenda. And at least one doesn’t even support McCain for president.

In interviews with more than a dozen of the signatories, Politico found that, far from embracing McCain’s economic plan, many were unfamiliar with — or downright opposed to — key details. While most of those contacted by Politico had warm feelings about McCain, many did not want to associate themselves too closely with his campaign and its policy prescriptions.

Howard Beales, an economist at George Washington University, explained that he signed the letter as "an expression of support for [McCain], not necessarily each and every detail of his plan, which I may not have had time to study closely." [...]

Constantine Alexandrakis, a professor at the University of Massachusetts-Dartmouth, expressed second thoughts about signing.

"I would describe myself as an Obama supporter," he explained. "Maybe I shouldn't have rushed into signing the letter."

(I'm signing up for Prof. Alexandrakis' class at B-school, sounds like he doesn't read the papers too closely.)

The New York Times looked at McCain's health care plan and found that sick people are pretty much left out.

If Senator John McCain’s radical plan for remaking American health care is to work, he will have to find a way to cover people like Chaim Benamor, 52, a self-employed renovator in this Baltimore suburb. Mr. Benamor never found it necessary to buy insurance before having a mild heart attack last year and now, 13 years shy of Medicare, has little hope of doing so.

In late April, Mr. McCain, Republican of Arizona, announced that if elected president he would seek to insure people like Mr. Benamor by vastly expanding federal support for state high-risk pools like Maryland’s, or by creating a structure modeled after them. But as Mr. Benamor’s case demonstrates, even well-regarded pools have served more as a stopgap than a solution.

Though high-risk pools have existed for three decades, they cover only 207,000 people in a country with 47 million uninsured, according to the National Association of State Comprehensive Health Insurance Plans. Premiums typically are high, as much as twice the standard rate in some states, but are still not nearly enough to pay claims. That has left states to cover about 40 percent of the cost, usually through assessments on insurance premiums that are often passed on to consumers.

(His pre-existing condition plan is really disaster capitalism at its best - or worst.)

The AFL-CIO looked at his veterans record and found that he doesn't much give a damn.

He wants us to keep spending $10 billion dollars a month in Iraq, just like Bush... he even took sides with Bush against increasing health care benefits for veterans.

The Democratic Party again took a look at his ad buys and noticed some illegal coordination:

The short-story is this: on July 2, the McCain campaign placed $1.5 million in advertising in the Virginia area. The next day -- July 3 -- the McCain campaign canceled that media buy. On the very same day -- July 3 -- the outside group made a large media buy in the same region, filling the gap created by the McCain campaign's cancellation.

It's possible this was all just a coincidence, but given the close connections between the McCain campaign and this particular group (Vets for Freedom, also known as VFF), I have my doubts. In May, VFF attacked Barack Obama with swiftboat style ads. This created a bit of controversy, because at the time both Lindsay Graham and Joe Lieberman were on VFF's board of directors. Each has since quit the group, but it's hard to imagine that the McCain campaign has cut ties with the outfit altogether.

And Republican economic hack Larry Kudlow took a look at his energy policy, and was delighted to report that any meaningful step to combat climate change has been totally eliminated, in a sop to the right-wing.

I went back last evening and carefully read his 15-page policy pamphlet called “Jobs for America.” Here’s what I found: There is no mention of cap-and-trade. None. Nada. There is a section about “Cheap, Clean, Secure Energy for America: The Lexington Project.” But that talks about expanded domestic production of oil and gas, as well as the need for more nuclear power and coal along with alternative sources. Then it has the $300 million battery and flex-fuel cars. But nope, no cap-and-trade.

So I picked up the phone and dialed a senior McCain official to make sure these old eyes hadn’t missed it. Sure enough, on deep background, this senior McCain advisor told me I was correct: no cap-and-trade. In other words, this central-planning, regulatory, tax-and-spend disaster, which did not appear in Mac’s two recent speeches, has been eradicated entirely — even from the detailed policy document that hardly anybody will ever read.

So, like I said, no wonder he's ducking the press. Although, I doubt they'd have much to ask him beyond how awesome it was to have served his country and "Would you like another donut?"

Obama's First 100 Days

As Digby mentioned, Barack Obama at a fundraiser said that a priority of his first 100 days would be to scrutinize all executive orderspassed by George Bush and overturn those which he and his advisors deem unconstitutional. This is crucially important - as The Poor Man notes, the Cheney Administration has set little traps and landmines inside the government to ensure that radical executive power survives, and an Obama Administration, in order to be successful, will need to at least partially root out the garbage and the rot that will crop up to undermine his Presidency.

But Obama had another answer to the question of how he would fill out his first 100 days. He said that he'd get his health care plan moving. "We need a bill...by March or April to get going before the political season sets in."

That's particularly astute, as Ezra Klein notes. One problem with the Clinton health care debacle was that it took so long to get around to it, while the Administration had their honeymoon period tied up with NAFTA and gays in the military. Obama appears to recognize the need to act quickly on the potential mandate for change in the biggest domestic policy challenge facing the country.

For those of us into the politics of this issue, that timetable is big news. Doing health care quickly is crucial. You can't lose your momentum. You can't get bogged down in the endless unknown events and unexpected crises of a presidency. You need a strategy and you need momentum and in order to preserve those things, you need to move [...]

That time spent dithering was time that enemies of the plan spent organizing. The rest, as they say, is history. Last night, Obama said he's uninterested in repeating it.

I know that a lot of people have concerns about Obama's plan, and I share them to an extent. But acting quickly and getting a plan through that goes a good bit of the way toward reform is far better than waiting around and ending up attaining nothing. Like Obama, I believe that if we were starting from scratch, single payer would absolutely be the way to go, and any reform movement ought to see whatever is passed as part of a gradual shift to that goal, mindful of the fact that dislocating a major industry of 3 million people and their jobs is not something that can be done with a snap of the fingers without a major shock to the economic system. And I think that Obama is willing to let the process play out and have the lawmakers who will craft the bill get the leeway they need to improve upon his program within the broad goals that he's set out - lower costs, mandating all children with coverage, and an affordable option for everyone without pre-existing conditions.

The entire country wants this, make no mistake. A recent survey in Nebraska - Nebraska - showed that 94% favor affordable, quality coverage for all and 75% would agree with mandating coverage, because they've experienced the current system and they really don't like it:

Other findings published in “Nebraskans on Health Care Issues”:

* 31 percent of the people surveyed said they had postponed or skipped medical services in the past year to save money.

* 31 percent said they had problems paying for medical services in the past year, including 26 percent of insured Nebraskans.

* 18 percent spent at least $5,000 on health care last year.

Among the state’s more than 200,000 uninsured people:

* 76 percent had trouble paying for a medical service last year.

* 66 percent postponed or skipped care to save money.

* 40 percent were denied health care coverage.

There is a real desire to reform the health care system, which I believe can be translated into a bottom-up movement that any member of Congress who wants to keep his job will have to listen to. This is a hopeful time but it's going to take a lot of hard work, not to mention that little election in November. And if Obama does get in, he'd better hope he has his evangelist Teddy Kennedy in the well of the Senate helping him close the deal.

This Happens Every Day

Either John McCain has the worst advance people in the world, or his policies - and Republican policies in general - are so decidedly aristocratic that they can't help tripping all over themselves.

At his health care policy event yesterday at the H. Lee Moffitt Cancer Center & Research Institute in Florida, Sen. John McCain (R-AZ) was introduced by the institute’s chairman, former Republican senator Connie Mack. But, as Hotline reports, Mack is more than just a chairman. He’s also a registered state lobbyist “advocating for health insurance companies“.

(By the way, Mack just married Rep Mary Bono (CA-45). Surely that will come up in her re-election campaign.)

This has happened at virtually every McCain appearance recently. Last week he rode on and praised a ferry which was created with an earmark. He went to Youngstown, Ohio and praised NAFTA at a factory that was closed after NAFTA was enacted. Reality keeps getting in the way of McCain's Presidential hopes.

The funny part here is that the McCain camp tried to deep-six the story:

According to Hotline’s Jennifer Skalka, “the McCain campaign lobbied On Call feverishly to tank” its reporting on Mack’s role as a lobbyist, calling the story “ludicrous, absurd and ridiculous.”

I guess Ms. Skalka didn't get any of that yummy BBQ, or she would have known her place.

Later in the day, McCain blamed the Minnesota bridge collapse on runaway spending and earmarks - not that Republicans have gutted infrastructure spending at all - then was presented with an earmark that, gosh, saved lives.

On the same day, McCain was confronted with an earmark he did consider worthy. During a forum at Lehigh Valley Hospital, he met a woman with ovarian cancer who was treated in a clinical trial funded with $80 million in congressional earmarks.

The hospital was showing off an electronic medical records system that is virtually paper-free.

McCain insisted he was not trying to have it both ways and said that deserving projects can get money through regular channels.

"It's the process I object to," he said. "I'm sure that I can give you a list of projects the Mafia funds, and they would probably be good projects. But I can't give you a justification for the Mafia. I can't give you a justification for the corruption that's been bred which has sent members of Congress to the federal prison," he said.

I'm sure the Republicans who turned the earmark process into their personal favor factory in the 1990s are going to be so eager to campaign for McCain now. You know, after being compared to the Cosa Nostra and all.

On top of that, McCain has gone from a position against spending to a position against the technical process by which spending is achieved. That's going to really bowl them over on the stump. McCain wants to make himself the grand poohbah deciding what spending is OK and what spending isn't. The problem is that when he is put to the wall, he can't come up with more than a scattered few projects that are verboten. And he doesn't dare touch that sacred cow, the military budget, which is responsible for about 100 times the wasteful spending as earmarks.

McCain has put himself in a terrible position. Plenty of earmarks provide tangible benefits for people. Every campaign stop, he's going to be confronted by someone. And he'll have to say "Well, when I say cut spending, I don't mean THAT," and this is why his trillions and trillions of dollars in tax cuts for the wealthy and new spending will never be brought into balance. He is dangerous and fiscally irresponsible.

Also, his health care plan will bankrupt a lot of sick people.

McCain is offering people like (Elizabeth) Edwards what he calls a "Guaranteed Access Plan." But unlike all those awful big-government entitlements the Democrats are promising--you know, the ones that (supposedly) make you wait in long lines and cut off access to high-technology treatments--McCain says his plan will let the states handle the problem by working hand-in-hand with private insurers to offer insurance for people with pre-existing conditions [...]

It all sounds very lovely--unless you know something about health care policy, in which case it sounds absolutely preposterous.

More than 30 states already have programs almost exactly like the one McCain just sketched out. They are called "high risk pools," and the idea is pretty straightforward: Private insurers agree to sell policies directly to individuals, even those with pre-existing medical conditions, as long as the state helps to subsidize the cost.

But the whole reason conservatives like McCain prefer this approach to liberal schemes for universal coverage is that it involves minimal government regulation. As a result, private insurers have enormous leeway in dictating the terms of coverage. And one place they use that leeway is by setting high prices. A few years ago, a Commonwealth Fund study found that, on average, state high-risk pools offered coverage that was two-thirds more expensive than regularly priced coverage. In some states, the high-risk coverage was actually twice as high as regular coverage.

At those prices, you might think the coverage was spectacular. Not so. While private insurers in high-risk pools are willing to accept people with pre-existing conditions, they're not generally willing to cover expenses related to those pre-existing conditions--at least not right away. Nearly all the plans surveyed had waiting periods of between six months and a year, during which the insurers would not cover care for prior medical problems.

Between out-of-pocket expenses, deductibles, cost-sharing, and treatment not covered by high risk pool plans, someone like Elizabeth Edwards, with her breast cancer, would probably have to pay around $100,000 under McCain's plan. She has it; most cancer patients don't.

Someone's going to ask him about that on the trail, too. And it'll be another embarrassment. In fact, the only way McCain's bankrupt domestic policies will not cause one misstep after another is if he confines himself to whistle-stop tours of gated communities and medieval castles.

McCain's Terrible Health Care Plan

(Part three of a two-part series!)

In a weak moment not focused entirely on random black preachers from Chicago, MSNBC's "Race For The White House" took a minute to focus on John McCain's health care policy. Eugene Robinson had to concede, "It's not much of a plan - it does nothing for the 47 million people without health care. Increasing walk-in clinics? People can't walk right now! They'll have to add ramps to them."

Actually, increasing access would be a good thing, but of course McCain's plan is far more hurtful than that. His central tenet on health care is that people have too much insurance.

This is truly amazing: McCain and his handlers knew they had to say something about health care. So they turned to their friends (and financial supporters) in the health care industry and the conservative think tanks. And they have adopted the most extreme right-wing ideological approach, premised on the idea that the big problem in health care is that Americans have too much insurance – in their words, we don’t have enough “skin in the game” – and that only when we have to buy health care with money that comes directly out of our own pockets will consumers force doctors, hospitals and insurance companies to become more efficient [...]

So McCain wants to tax workers’ health care premiums that are paid for by employers. Ask any expert, conservative or liberal, and they will tell you the result will be companies will stop providing health care as an employee benefit. Fortune Magazine quotes one of their experts on the impact of McCain's plan: “I predict that most companies would stop paying for health care in three to four years,” says Robert Laszewski, a consultant who works with corporate benefits managers.

Now keep this in mind: McCain and his corporate advisers don’t dispute this. The massive upheaval that would result – millions of families losing their health coverage on the job and then having to try to find an insurance company that would sell them a new policy that would cover their families—that’s not an unintended consequence of his proposal. That chaotic loss of health security is exactly what McCain intends to happen. He wants us all to buy insurance not as part of a group—like an employee group or a co-op—that can negotiate for better coverage at lower premiums, but as individuals, at the mercy of the private insurance companies.

The only benefit to individuals who will be scrambling for new coverage is a tax credit that is completely insufficient to cover the current cost of healthcare by a factor of about 2:1.

And it's a tax credit, which means the actual benefit is substantially less than the numbers he states (maybe 30%), because it's simply factored into deductions. And if you are so poor that you don't pay anything in taxes, guess what? You don't get the tax credit, because it would be a deduction from zero. And so the people most at risk, the most likely to be uninsured, get nothing from McCain's plan.

I need to tweak this section a bit. The tax credit is effectively a cash payout, but at $2,500 for individuals and $5,000 for families it remains woefully insufficient to cover anything but the most bare-bones care, and in most cases not even that - the average health care bill is twice as much. Also, assuming that this tax credit will come in with your normal refund, families will essentially have to lay out the funds year-round for this and wait until April for reimbursement - which is not only an opportunity cost but actually an impossibility for a lot of folks.

Oh, and don't even get me started on Health Savings Accounts, which is what McCain wants you to do with any excess money if you find a cheap insurance plan. Simply put, they're abominable, and under McCain's plan they're designed to drain your cash out for trips to the doctor since you're stuck with high-deductible, low-coverage insurance.

In the end, the individual who does qualify for the credit will be paying more for health care
than corporations do now, CONTRIBUTING to rising costs, not the opposite.

I don't actually have a huge problem with severing the employer-based relationship to healthcare, but only if individuals could pool their risk to keep costs down and be able to bargain for coverage - you know, like a single-payer system would do. McCain's option simply leaves individuals out on an island with no bargaining power. We'd be in far worse shape than we are now.

But that's not the worst part.

And get this: McCain wants to abolish the regulations that currently exist in most states that require companies to insure people with pre-existing conditions, provide benefits that don’t exclude some medical conditions, and prevent them from charging huge premiums for crumby benefits. How would he do this? By “giving people the freedom” to buy insurance in other states with weaker regulations. You can bet that most of the big insurance companies are now shopping around for the state that wants to become the corporate headquarters state for the new deregulated health insurance industry – if President McCain wins. Delaware? Mississippi? Arizona?

UPDATE: McCain talks vaguely about "working with governors" to create non-profits that would backfill the cost to insurers to cover high-risk patients, creating yet another middleman! There are little if any specifics on this part, and it's highly dubious that it would work.

By eliminating state-created mandates to insure individuals for a variety of maladies, McCain would really end up hurting the sick and chronically ill, leaving them with no insurance. An unregulated market would simply refuse to insure people by the millions in an effort to maximize their costs by insuring only the healthy. You know, the way it is now - only worse, because the states would be unable to look out for their own citizens, and insurance companies would start a race to the bottom, bribing states with their business in exchange for lax regulation. The McCain campaign's response to this? Let the market sort it out!

Steve Bernard was talking about treatments for his 9-year-old son, Jake, who was born with a cleft lip and palate. Jake has already undergone numerous surgeries with more to come. Bernard described his battle to get insurance coverage for speech therapy. “Every time they say, `No, speech therapy isn’t covered,’ and we say, `yes it is covered.’ As a matter of fact in the state of Florida there are specific statutes that were created by other parents of kids with clefts that will protect those kids.”

He ended his comments with a plea to McCain, whose adopted daughter, Bridget, also had a cleft palate: “If there’s ever going to be somebody in leadership position who is going to know it, it’s going to be you, and we’re hoping you understand that,” Bernard said.

Left unsaid was that McCain’s health plan is designed to weaken state regulations like the one in Florida that, like 14 other states, mandates that insurance companies cover treatment for cleft palates. McCain says that mandates like this one drive up the cost of insurance, and he would allow people to buy coverage across state lines. Many experts predict that under this system, insurance companies would simply gravitate to the states with the fewest rules.

Asked about the contradiction between the family on the stage and the McCain policy, McCain senior policy adviser Douglas Holtz-Eakin said that the marketplace will fill the void. If there is a demand for this kind of coverage, he said, some insurance company will offer it. “There are boutique products in every other market,” he said.

McCain's laissez-faire stance makes George Bush look like Michael Moore. He offers nothing but double talk on the subject of health care, and fails on virtually every level - to lower costs, increase coverage, and reduce the power of the insurance industry. He's had government-run health care for his entire life, and his meager gruel offered to those who do not suggests that Elizabeth Edwards is right - on health care he's completely out of touch with reality.

Progressive Leaders

Elizabeth Edwards is a godsend. Seeing that the Clinton/Obama pie fight has prevented anyone of stature from focusing on John McCain, she came out with a broadside against McCain's useless health care plan, which wouldn't cover anyone with a pre-existing condition - like McCain, or herself:

ARLINGTON, VA. -- Elizabeth Edwards, the wife of former Democratic presidential contender John Edwards, said she and John McCain have one thing in common: "Neither one of us would be covered by his health policy."

Edwards lodged her criticism of the presumptive Republican presidential nominee's proposal Saturday at the annual meeting of the Assn. of Health Care Journalists.

Under McCain's plan, insurance companies "wouldn't have to cover preexisting conditions like melanoma and breast cancer," she said [...]

Douglas Holtz-Eakin, senior policy advisor to McCain, said Saturday that Edwards' comments were disappointing and that they revealed she did not understand the comprehensive nature of the senator's proposal.

Holtz-Eakin said McCain's policy would harness "the power of competition to produce greater coverage for Americans." Because McCain's plan would lower the cost of healthcare through competition, Holtz-Eakin said, it would reduce costs for consumers with or without preexisting conditions.

Which is the biggest non-answer you can get. Responding to "your plan wouldn't cover me," Holtz-Eakin says "but that non-coverage would be cheaper!"

Well, Edwards didn't stop there, she took to the Wonk Room to respond to Holtz-Eakin. It's good and comprehensive and allows Holtz-Eakin with no wiggle room, mocking McCain, who has absolutely no interest in health care or the problems of regular people.

I am not confused about your reputation: you are the straight-talker, you like to say. This is about health care, Senator McCain. Doesn’t the American voter deserve some straight answers to these questions? As one of those with a pre-existing condition, I sure would like some straight talk.

We live in a time where doctors, who ought to know, support a universal health care plan by a wide margin. But without the moral authority from someone who's been through the health care system, a progressive leader smart enough to know the policy inside and out and bold enough to call out the liars, progress will always falter. If Sen. Obama wants to outsource his health care policy, he can do worse than Elizabeth Edwards. But that won't happen. In fact, New York Magazine reports that it was the health care policy that caused a big fight between Elizabeth and Obama and ended up ruining any chance for a John Edwards endorsement. You know I think we'd be better off right now with Sen. Edwards fighting for the nomination. Maybe a progressive leader like Elizabeth can help hold whoever makes it to Denver and the White House accountable.

The Best Health Care System Money Can't Buy

According to Rudy 9iu11iani and the rest of the Right's Field, the American health insurance marketplace is clearly superior than a system of "socialized medicine". Gubmint-run health care will force Americans into long lines, rationed care, and stunted innovation. Interesting how they haven't learned from their own experiences with the US health care system. This of course is because most of them are rich enough to get the best care possible. They're simply unconcerned with the plight of the unwashed masses.

When Rudolph W. Giuliani was diagnosed with prostate cancer in the spring of 2000, one thing he did not have to worry about was a lack of medical insurance.

Today, the former New York mayor joins two other cancer survivors in seeking the Republican presidential nomination: Arizona Sen. John McCain has been treated for melanoma, the most serious type of skin malignancy, and former Tennessee Sen. Fred Thompson had lymphoma, a cancer of the immune system.

All three have offered proposals with the stated aim of helping the 47 million people in the U.S. who have no health insurance, including those with preexisting medical conditions.

But under the plans all three have put forward, cancer survivors such as themselves could not be sure of getting coverage -- especially if they were not already covered by a government or job-related plan and had to seek insurance as individuals.

McCain and 9iu11liani had government-run health care at the time of their illnesses. Fred Thompson is covered through the Screen Actors Guild. They simply aren't in touch with what most Americans who actually have to navigate the insurance system have to face. They want to depend on the ravages of the private market when they don't even depend on it themselves. The truth is that nobody with a pre-existing condition is going to come close to their wonderful market-driven health insurance. You'll either be denied off the bat or you won't be able to afford it.

The candidates "can't sit there and say they understand what people are going through, because they've got healthcare," (cancer patient Susan) Brown said. "We went through the same illness, however [they] don't understand what it's like not to have health insurance."

This would require the foreign concept of empathy.