Arnold Supports Health Care Reform - Just Not In California

One of the enduring takeaways of the Schwarzenegger era is just how much latitude he is given on the national level as some kind of transformative post-partisan leader, when those same reporters know that California is crumbling into dust under, and in many cases because of, his leadership. We witnessed this again today as national media types heaped praise on the Governor issuing a letter about the Obama health care reform plan:

“As Governor, I have made significant efforts to advance health reform in California. As the Obama Administration was launching the current debate on health care reform, I hosted a bipartisan forum in our state because I believe in the vital importance of this issue, and that it should be addressed through bipartisan cooperation.

“Our principal goals, slowing the growth in costs, enhancing the quality of care delivered, improving the lives of individuals, and helping to ensure a strong economic recovery, are the same goals that the president is trying to achieve. I appreciate his partnership with the states and encourage our colleagues on both sides of the political aisle at the national level to move forward and accomplish these vital goals for the American people.”

I love the phrase "significant efforts," by the way. Others might call them "failed efforts," but YMMV.

But this "praise" for health care reform is just a piece of paper. One would think that the national media would seek to know the actions of the Governor on health care - one would be wrong, but one would still think that. And it would take about 10 seconds of Googling to figure out that the Governor has vetoed key elements of the legislation working through Congress. Last year he vetoed AB1945, which would have banned rescission, the insurance industry practice of dumping sick customers for technical violations on their applications like typos the moment that they try to use their policies for treatment. He vetoed SB840, the universal health care bill, on multiple occasions in the past. He vetoed SB1440, which would have mandated that insurance companies spend 85% of premiums on medical care. He vetoed SB973, which would have created a public insurance option by linking local and regional measures. He vetoed AB2, expanding the state's high-risk pool for people with pre-existing conditions.

He basically has vetoed many of the same provisions to be found in the current health care bill. And he is threatening to veto every bill on his desk this year, including another bill to ban rescissions so that customers who have paid insurance premiums for years aren't left to die when they want to use their policies. Anthony Wright notes some of the other bills:

* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender.

* AB 2 (De La Torre): INDEPENDENT REVIEW, to create an independent review process when an insurer wishes to rescind a consumer's health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.

* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services.

* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses.

Dan Walters calls these bills "nothing of cosmic importance". Well sure, he's not going to have a kid, and women are charged more than men by insurance companies anyway! To an entitled white man with a good-paying job, he doesn't have to worry about losing his policy or not getting comprehensive medical coverage. But to a woman who can't afford to lose her job to have a baby, or someone with a mental health problem who can't get relief for his suffering, or someone with an individual policy living constantly in fear that his or her insurance will get revoked precisely when they need it, these are issues of "cosmic importance." Anyone saying otherwise is ignorant.

And yet the Governor will have no problem holding these bills, and these people, hostage. His buddies at the Chamber of Commerce probably don't want him to sign them at all. So he writes a pretty letter supporting health care reform, while denying the very same measures to his own constituents. And national media types call him a "bold leader."

Why We Need Hearings On Insurance Industry Practices

Some weak-kneed Democrats aren't so keen on seeing Henry Waxman grill the insurance industry over their immoral policies of denying care. They probably don't want to jeopardize their campaign contributions. But Waxman and others aren't listening to them, and will move forward.

“It’s completely fair to talk about profits and reserves and compensation and how they make their decisions,” said Rep. Jan Schakowsky (D-Ill.), a leader of the Progressive Caucus. “Let them come and make their case.” [...]

Regardless, Waxman and the House Energy and Commerce Committee appear to be heading forward.

Rep. Bart Stupak (D-Mich.), chairman of the Investigations subcommittee, said Tuesday that most of the nation’s 52 largest insurance companies met Monday’s deadline to submit documents on their profits and compensation to executives and board members. He also said a hearing is being put together.

“We will be doing hearings on different aspects of the insurance industry, including this,” Stupak said. “I hope that by the end of this week we’ll have a schedule set … I’d like to do another one of these, at least one or two, this month.” [...] “Blue Cross Blue Shield, which is the insurer of last resort in Michigan, they’re raising their rates 22 to 40 percent,” Stupak said. “How do you justify that when inflation is basically zero? Where is the money going? Is it going for healthcare? Or executive compensation?”

“I think it’s part of the mix, in that our committee needs to look at it,” said Rep. Gene Green (D-Texas). “I remember a quote from Sen. [Charles] Schumer [D-N.Y.] sometime this year … he said that some of those healthcare CEOs’ packages would even make Exxon-Mobil blush.”

Just so it's clear, here are the types of policies that Blue Dog Dems would rather not have discussed publicly in Congress in the middle of a debate over health insurance reform:

• The South Carolina Supreme Court ordered Assurant to pay 10 million dollars for rescinding the policy of a 17 year-old after he tested positive for HIV.

• Several insurance companies in the individual market consider pregnancy optional and don't cover maternity care. What's more, others refuse to cover any woman who has had a Caesarian section, considering it a "pre-existing condition".

That's really the tip of the iceberg. The stories of runaway profits, lavish lifestyles for CEOs and denials of care causing suffering and death have been chronicled over and over at Sick For Profit. The public ought to know about them, at least as much as they think they do about death panels, and if Congress can find a way to raise attention, all the better.

CIGNA Denies Cancer Patient Care, CEO Makes $120 Million

(I am a blogger fellow with Brave New Films on their Sick For Profit campaign. Visit us on Facebook.)



Today Brave New Films released their second installment in the Sick For Profit series, taking a look at the corrupt practices of CIGNA, denying care to their customers while their lead executives rake in millions and lead lavish lifestyles.

Meet Jo Joshua Godfrey. She had cancer without knowing for over a year.

"I would go to CIGNA and they would tell me I had bronchitis and give me medicine and send me home. No matter what medicine they gave me I wouldn't get better. Then the CIGNA Director called me up and she told me that there was nothing wrong with me at all. I called the doctor, and I came with my film and my CAT scan and he just put it in, it took exactly thirty seconds. He told me, 'You have cancer,' and he said the reason CIGNA did not want to give you your records is they've known right way back for years that you have cancer and they're not going to treat you."

CIGNA took in $19.1 billion dollars in revenue last year, with a $292 million dollar income. That doesn't include the salaries given to people like CEO Ed Hanway. He made a cool $12 million last year, and over the past five years he took in $120 million. Hanway has $28 million in unexcercised stock options. The company corporate jets, also not seen in profit statements, cost $68 million. This money is gained, as former communications director Wendell Potter says in this video, through denying claims and dumping the sick, enhancing the value of the company for Wall Street investors. The effect on people's lives, meanwhile, is tragic. Nataline Sarkysian, featured in the Americans United For Change advertisement, lost her life after CIGNA repeated denied her a liver transplant, despite the family having full coverage.

Meet Stephen Coddington, the wife of Marian, a stroke victim:

The case manager at the nursing home called me in and was really upset, and she said, "CIGNA is wanting to discontinue therapy with her. The doctors called and appeals were denied." It has been a day-in and day-out fight. Every talk that I've had with them, it's been, how can we wiggle off this hook.

This is the human cost for an insurance company's existence, for the record profits and supreme lifestyle of their executives. Welcome to the American health insurance industry. Instead of helping policyholders attain the health security they need for their families, big insurance companies get rich by denying coverage to patients. Now they're sending lobbyists to Washington, DC to twist the arms of lawmakers to oppose reform of the status quo. Why? Because the status quo pays.

CIGNA is not a special case in the insurance industry. It's perfectly normal and expected for a corporation to maximize profits. The difference with insurance is that the profit comes at the expense of your health care, and frankly, all the regulations in the world won't substantively change that. The best way to fight back is through exposure, a juxtaposition of the human luxury paid for by human misery.

So help us shine this spotlight. CIGNA's advertising tagline is 'A Business of Caring.' We think they ought to come up with something more appropriate for their actual practices. If you come up with one, post it on our Facebook page. Here are some examples. We'll send the best over to CIGNA. In addition, Jo Joshua Godfrey will join SEIU Healthcare 775NW outside the CIGNA corporate offices in Seattle, Washington today as they demand quality and affordable health care for every American as a fundamental right and not a privilege. If you're near 600 4th Ave in Seattle around 12:30 PT today, head down and show your support.

And send this video to your friends. Everyone needs to know what's at stake in health care reform. This kind of denial of coverage can happen to anyone under the current system.

Moment Of Truth For Schwarzenegger As Legislature Passes Anti-Rescission Bill

I mentioned this yesterday, but California lawmakers gave final approval to a bill that would ban the practice of rescission, where insurance companies drop coverage for policyholders after they try to use it based on alleged technical inaccuracies in their application form. Here's what AB2 would do:

AB 2 would require:

• Individual health care service plans to be subject to an independent external review before denying or rescinding coverage.

• The state to establish standard information and health-history questions to be used on policy applications.

• That intentional misrepresentation be shown before an individual health care service plan can be rescinded.

This language basically complies with what would appear in federal legislation before Congress banning rescission.

Now Arnold Schwarzenegger has a choice to make. Does he side with people who are denied coverage after paying premiums for years? Or does he side with his usual pals in the Chamber of Commerce who will push for anything, no matter how immoral, to maximize profits?

Everyone should know that Schwarzenegger vetoed a similar bill to this last year. He's always been a Chamber of Commerce sock-puppet and I don't expect him to change now. However, Schwarzenegger has been an alleged proponent of health care reform at the national level, and in a recent letter endorsed the concept of guaranteed issue of insurance, which obviously conflicts with allowing insurers to rescind policies. He also supports continued state regulation of the insurance industry.

Well, here's his chance. The Legislature has acted to ban what I call insurer-assisted suicide, and Arnold can make his decision by either signing the bill or vetoing it.

Legislature Home Stretch Update

There's lots of significant news in the Legislature's last week regarding various bills, and it's extremely difficult to keep up with it all, probably by design. I should point out that, while the legislative calendar has an end date, there's no actual reason for some of the forced bottlenecks that result in hundreds of bills being passed at the last minute. It creates a shroud of secrecy in which special interests rule, and saps the public trust. A Democratic leadership actually interested in positioning government as somewhat decent would remove these forced bottlenecks from the internal legislative rules and allow bills to be approved on a rolling basis. That said, this is the system we have now, and here's a bunch of news about various bills:

• A new bill would exempt non-General Fund workers from furloughs. This would reverse one of the dumbest provisions in the budget bill, the practice of forcing furloughs on workers not paid by state government, saving almost no money and depriving people of needed services. Of course, the Governor will probably veto this one, because he hates admitting how wrong he is.

• Democrats on that vaunted water committee have decided against floating a bond to pay for any restoration or overhaul of the Delta. This means Republicans won't vote for it, and very little will come of this very important committee thrown together at the last minute. Some conference committee reports are here, but a deal looks remote, as it would need votes from some of the empty chairs in the Yacht Party.

• One bill that has cleared both chambers would set up "Education Finance Districts", "in which three or more contiguous school districts can band together to try to increase local taxes." This is a small step to make it easier for districts to pass parcel taxes to fund schools, but at this point every little bit helps. The 2/3 rule for approving such taxes would remain.

• With all the talk of health care reform, it's notable that an anti-rescission bill has once again passed the legislature. The bill would also simplify insurance forms. Last session, Arnold Schwarzenegger vetoed it. There's something you don't hear much about from the Democratic leadership - Arnold Schwarzenegger vetoed a bill that would have banned insurance companies from dropping patients after they get sick. He sided with the forces of insurer-assisted suicide. This is your modern Yacht Party on this issue:

"Any of those who have read the various exposés in the Los Angeles Times and others . . . is aware that health insurers have admitted and acknowledged they engaged in a form of post-claims underwriting," said Sen. Mark Wyland (R-Escondido). "It is unethical and, considering what some of these people have endured, it really borders on the immoral."

However, Wyland said he would not vote for the bill because the Department of Insurance has proposed new rules to solve the problem, and he wants to see how they work.

Hey, give 'em a chance to see if the immorality stops! If not, we can think it over.

• The Legislature may extend a homebuyer's tax credit passed in a previous budget agreement that was nothing but a bailout for developers. It only credited new construction, and was structured only to benefit high-income households who could afford new construction. By the way, sales of new units have fell since this was enacted, so it's not even meeting its intended purpose. But it's a giveaway to a special interest, so off the money may go, even though we cannot afford it at this time.

• A bill to ban bisphenol A (BPA) from children's products was delayed after the Assembly couldn't muster 41 votes. The debate in the Assembly last night was pretty fierce.

• Cities and counties reacted angrily to a proposed bill to slow local government bankruptcies until vetted by the California Debt and Investment Advisory Commission. On the merits this looks to be a bill that would install more control on locals from Sacramento, although there are arguments on both sides. But mainly it's about the fate of union contracts in local bankruptcies, I don't think either side would deny that.

• A roundup of other bills passed yesterday can be found here.

Insurer-Assisted Suicide

The Washington Post today becomes yet another media outlet to detail the practice of rescission, whereby insurance companies go through your application form with a fine-toothed comb and look for any excuse to drop you from your coverage - but only after you try to use it to get treatment. They're perfectly fine with what they call "medical fraud" as long as you're just paying them your premiums. It's when you want to receive health care that fraud becomes the greatest threat facing the Republic.

The problem is that rescission just isn't a snappy enough description of the actual circumstance. I prefer "insurer-assisted suicide":

The untimely disappearance of Sally Marrari's medical coverage goes a long way toward explaining why insurance companies are cast as the villain in the health-care reform drama.

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

By the time she filed a lawsuit in 2008, she also got a diagnosis of pancreatic cancer and her debts had swelled beyond $200,000. She was able to see a specialist by trading office visits for work on the doctor's 1969 Porsche at the garage she owns with her husband.

"I've had about 10 visits," Marrari said of the barter arrangement that has proved more reliable than her insurance. "The car needs a lot of work."

And where would Mrs. Marrari be if she didn't have a garage that could work on Porsches?

Nobody knows how much money has been saved through insurer-assisted suicide; three insurance companies admitted in a hearing this summer that they've cancelled 20,000 over five years at a savings of $300 million dollars. Given that amount of money, the fact that California's five largest insurers have paid around $19 million to deal with rescissions seems like a drop in the ocean. Here's something that's not in the article: when Anthem Blue Cross challenged the fine placed on them for rescinding policies, state regulators never even tried to file suit because they figured they would be outgunned in court.

"This is probably the most egregious of examples of health insurers using their power and their resources to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous activity on the part of the insurers." [...]

In the only case to go to trial in California, an arbitration judge awarded $9 million to a beautician who had to stop chemotherapy for her breast cancer after Health Net dropped her policy. Company officials declined to comment.

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. Blue Shield officials said they would not comment on a pending case.

You might be wondering whether there's a mechanism to stop rescission in the current plans on the table. The President and Democratic leaders would certainly tell you that's the case, if only by banning the refusal of coverage for pre-existing conditions. However, as seen from the paragraph above, the fines they may incur as a result will either be seen as the cost of doing business or a fine that will never be enforced. In addition, there are plenty of additional ways to evade responsibility.

If federal health-care reform bars companies from screening for preexisting conditions, insurers note that cancellations will no longer be an issue. But Melinda Beeuwkes Buntin, an economist at the Rand Corp., said that unless for-profit companies are compensated for taking higher-risk patients, the firms will continue to look for ways to unload them.

"They wouldn't be able to overtly kick you out, but that doesn't mean that they might not put, for example, more onerous preauthorization requirements on services that people who are at risk might need, and that might discourage you from re-enrolling next year," Buntin said.

As long as insurers' incentive to make a profit diverges from caring for their customers, insurer-assisted suicide will always be a reality. And as we've seen, balkanizing the enforcement to the state level instead of having a federal regulator cracking down on this will put the enforcement at the mercy of fragile state budgets and haphazard state regulators. Here is the entire enforcement mechanism, as far as I see it, in the Baucus draft plan from the Senate Finance Committee:

Ombudsman. In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets. Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.

Yay, the states get an ombudsman! And he or she can only be tapped if individuals "exhaust internal appeals"; that is, beg their insurers to stop cheating them. And since the states will be establishing the office themselves, they'll set the budgets and choose the staff - meaning that we'll potentially be leaving enforcement of insurance regulations in Texas and South Carolina, for example, to Rick Perry and Mark Sanford.

Ultimately, those fighting for a public option are fighting for some way out of this Chinese box, where insurers have control over the health care you receive, and can just as easily deny your coveage as they can allow it. All of the regulations in the world won't mean a thing without proper enforcement, and this won't cut it.

The Waxman Book Report Continues

Henry Waxman must be coming up with one hell of a document about the insurance companies. He's been researching them since at least July, and yesterday he requested even more information. This time, he's investigating the extension of the rescission process to the small business arena.

"I began looking into the practices of the health insurance industry in the last Congress and was deeply disturbed by what we uncovered," said Chairman Waxman. "As part of our ongoing investigation, we are now looking into the practice of health insurance companies terminating the coverage of small businesses when their employees become ill and their health insurance claims increase. We need to better understand how widespread this harmful and destructive practice has become, and how it is impacting small businesses and their employees across the country."

"As we continue our investigation into business practices in the health insurance industry, the treatment of small businesses remains a concern," said Chairman Stupak. "We have documented examples of insurance companies raising small business premiums by an unsustainable amount or canceling a policy once it is discovered a covered employee is sick. Much like rescissions in the individual market, this practice is alarming. To better understand how prevalent this practice is and precisely how many small businesses are impacted, we are asking some of the largest insurers to provide information on their small business policies."

The Committee is requesting information and documents for small group policies, including their renewal rates, factors used to determine premium rates, and the maximum premium rate increases.

Because insurers basically guarantee issue to the businesses with whom they deal, the only way they can punish - and hopefully force to drop - a business from continuing to work with them is by unsustainably raising the premiums. You cannot do this with a large company like a Wal-Mart, but small businesses are essentially just a step removed from the individual marketplace in terms of their leverage. So insurers can afford to price those businesses out of the market, if they have employees on their books who actually need to use their health insurance.

That's an incredible admission by the insurance companies that they simply cannot afford to maintain their profits and pay for anyone's health care. So they engage in terminating coverage whenever humanly possible, even when the individual gets it through an employer, to avoid that payment.

Waxman typically engages in slow, deliberate investigations that gradually extract a maximum of damaging information out of the opponent. In this case, he's asked for all of these materials in a rush, and some of the deadlines coincide with Congress' return to Washington. I think he's writing a book - the definitive study of how the health insurance business really works, to be delivered at precisely the moment when Congress reaches the final stages of debate on health insurance reform.

Stop Me If You've Heard This One Before

The health insurance industry maximizes their profits by delivering as little care as they can legally get away with, or for that matter, illegally.

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.

The report was part of a multi-pronged assault on the credibility of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It came at a time when Rockefeller, President Obama and others are seeking to offer a public alternative to private health plans as part of broad health-care reform legislation. Health insurers are doing everything they can to block the public option.

At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."

The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.

Wendell Potter is the name of the star witness, a former VP for corporate communications at insurance giant Cigna. His testimony was devastating, as he offered a step-by-step tour into how the insurance industry works to increase their profits. This is the system that Republicans and conservative Democrats want to hold a monopoly over your health care, in a forced market where you have to sign up with them.

What drove Potter from the health insurance business was, well, the health insurance business. The industry, Potter says, is driven by "two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits."

Think about that term for a moment: The industry literally has a term for how much money it "loses" paying for health care.

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of a healthy person's dollar on medical care because he or she won't need much medical care. And the insurance industry accomplishes this through two main policies. "One is policy rescission," says Potter. "They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment." [...]

Potter also emphasized the practice known as "purging." This is where insurers rid themselves of unprofitable accounts by slapping them with "intentionally unrealistic rate increases." One famous example came when Cigna decided to drive the Entertainment Industry Group Insurance Trust in California and New Jersey off of its books. It hit them with a rate increase that would have left some family plans costing more than $44,000 a year, and it gave them three months to come up with the cash.

The insurers simply follow the profit motive. Under the current system, there is no profit in offering people care, only denying them it. And so competition in the marketplace, or more to the point competition on Wall Street to increase share price (because most insurance markets in this country are limited), depends on coming up with new and exciting ways to either deny care or off-load costs onto customers. Like this ingenious little bit, from the WaPo article:

Many Americans pay higher premiums for the freedom to go outside an insurer's network of doctors and hospitals. When they do, insurers typically pay a percentage of what they call the "usual and customary" rates for the services. How insurers determine the usual rates had long been opaque to consumers and difficult if not impossible for them to challenge.

As it turns out, insurers typically used numbers from Ingenix, a wholly owned subsidiary of the big insurer UnitedHealth Group. Ingenix had an incentive to produce benchmarks that low-balled usual and customary rates and shifted costs from insurers to their customers, the report said.

Ingenix got its data from the same insurers that bought its benchmark information, the report said. Insurers that contributed information to Ingenix often "scrubbed" their data to remove high charges, and Ingenix further manipulated the numbers, removing valid high charges from its calculations, the report said.

Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said. A dozen insurers have reached settlements agreeing to change their practices; UnitedHealth agreed to the largest payment, $50 million, to help a nonprofit organization set up a new database to replace Ingenix.

I'm convinced that polls showing large numbers of people happy with their health insurance stems from the fact that most people at any given moment don't have occasion to use it. When they do, the horror stories roll in.

These insurance industry groups claim that a public insurance option would dismantle their business. The goal of it would actually be to reverse those incentives. With millions of new customers entering the market, the profits have the potential to soar. But with a public option in competition, as long as there are strong regulations available so insurers cannot cherry-pick the healthy, suddenly they would have to compete on offering the best price or the highest quality plan. The arguments that government can deliver insurance with lower administrative costs, better economies of scale, etc. would be a feature and not a bug, and I don't think the public will react unfavorably to better-quality coverage at a lower price.

The last time that Congress featured the truth about the insurance companies, it went uncovered in the major media. Democrats and especially the President have the ability and the imperative to turn the spotlight on the industry and their practices, and the goal of reversing the incentives in a better fashion for businesses large and small, government and consumers.

Paul Begala Calls Out The Media

Yesterday I wrote about the shocking video of a Congressional hearing where health insurance CEOs, having admitted to canceling customers after they turn in claims for treatment, refuse to stop doing so. I'm pleased to report that we got up to 11,644 views as of this morning, and the video is already the #30 top rated of the week in the News & Politics section of YouTube. Keep going, keep retweeting, keep using Digg and Reddit to vote it up, use the Health Care for America Now page to email it to your friends. We can get this out.

And we have an ally in Paul Begala.

It's unusual for Begala, a longtime commentator for CNN and a member of the traditional media, to excoriate his own industry so forcefully for failing to inform the public. But he does exactly that here, in writing about this specific hearing, and the relative lack of attention paid to it.

You probably have never heard of Robin Beaton, and that's what's wrong with the debate over health care reform.

Beaton, a retired nurse from Waxahachie, Texas, had health insurance -- or so she thought. She paid her premiums faithfully every month, but when she was diagnosed with aggressive breast cancer, her health insurance company, Blue Cross, dumped her.

The insurance company said the fact that she had seen a dermatologist for acne, who mistakenly entered a notation on her chart that suggested her simple acne was a precancerous condition, allowed Blue Cross to leave her in the lurch.

Beaton testified before a House subcommittee this week. So did other Americans who thought they had insurance but got the shaft [...]

It was as dramatic as congressional testimony gets. Yet it got no airtime on the networks, nor, as far as I can tell, on cable news, although CNN.com did run a story. Time's Tumulty was all over it, as was Lisa Girion of The Lost Angeles Times. But the story did not make The New York Times.

Nor The Washington Post, which found space on the front page the morning after the hearing for a story on the cancellation of Fourth of July fireworks in Shippensburg, Pennsylvania, but not a story on the cancellation of health insurance for deathly ill Americans who've paid their premiums.

I know the right wing is outraged by ABC News airing a health care town hall meeting with President Obama next week, but isn't the real outrage that such prime-time coverage is the EXCEPTION and not the RULE? Shouldn't we have lots and lots of news and information from the biggest megaphones about a domestic policy issue that faces every single American? Shouldn't everyone have access to that debate, and all the perspectives contained therein? Since when is the fact of a television network allowing an hour of coverage on the issue that means life or death to everyone in the country something to be reviled?

And that's basically Begala's complaint here. The media is failing in their job. In a way, so is the Administration, because they need to bring the spotlight to their most important domestic issue. Robert Reich argues the same thing, that Obama needs to drop as much as possible and focus like a laser on health care in order to get it done.

Put everything else on hold. As important as they are, your other agenda items -- financial reform, home mortgage mitigation, cap-and-trade legislation -- pale in significance relative to universal health care. By pushing everything at once, you take the public's mind off the biggest goal, diffuse your energies, blur your public message, and fuel the demagogues who say you're trying to take over the private sector.

You have to win this.

But I cannot let the media completely off the hook here. The story of rescission makes the health care issue personal. It exposes the mission of insurance companies, the "murder by spreadsheet" dedication to profits over people. And until their incentives are changed, until they need to compete on price and quality instead of competing on how to get out of paying for medical care, absolutely no reform can possibly work. But that requires the facts to be delivered by a media simply resistant to them.

Fortunately, we live in an age of two-way media, where citizens can force discussions into the national conversation. And that starts with you making everyone you know aware of this video exposing the agenda of the insurance industry. I recognize that it lacks a certain amount of context; I am working on a project this weekend to provide that additional context. But I think it does make its point well enough. And when you send this to friends, you can explain it even more.



Let's keep working on this. Let's go viral.

We need 10 million views of this YouTube by next week

I mentioned earlier John Dingell bringing up the hearing in the House on rescission, the practice of insurers dropping people the moment they get sick, sometimes for technical violations on their applications like misspelling their name.

I know a fair bit about rescission, because in California, it's become a major issue. Former LA City Attorney Rocky Delgadillo has doggedly pursued those companies, like Blue Cross, who have engaged in the practice, and to date insurers have agreed to pay over $37 million dollars in fines. Another case is about to go to trial. Blue Cross encouraged this with performance bonuses for employees who found a reason to cancel coverage for the sick.

Now check out what these insurance CEOs said after being confronted with all of these examples of them denying coverage to sick people.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period [...]

Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives:

"No."

Rep. John Dingell (D-Mich.) said that a public insurance plan should be a part of any overhaul because it would force private companies to treat consumers fairly or risk losing them.

"This is precisely why we need a public option," Dingell said.

Here's the YouTube of that hearing. It should have 10 million hits by the end of next week.



Here's a Splicd version of the moment where they all refuse to commit to stop rescinding people when they get sick. In the above YouTube, that comes in around 4:47.

TEN MILLION VIEWS.

Here's the Twitter message I put up about this.

Health insurance CEOs refuse to stop screwing their customers: http://splicd.com/_29CCVI1ao4/288/371 please RT! #publicoption

Email this to everyone you know. Retweet. Put it up on Facebook. Do whatever you can to get this in front of people's eyeballs. Without a public option, we give our health care future over to people who have vowed not to cover you if you're sick. Politicians can stand with people, or with these insurers.

Thanks.

...Health Care for America Now has a page up with this incredible video. You can forward an email to a friend with the video using their page.

Let's Not Give The People What They Want

Blanche Lincoln just can't get behind a public option in health care.

U.S. Sen. Blanche Lincoln, D-Ark., says she prefers private insurance cooperatives to a government-run provider that would compete with the private sector in reforming the nation’s health care system.

“We want to keep what works in the private industry and make it better,” Lincoln told Arkansas reporters in a conference call today. “There’s a lot of discussion about what else we might need that we can’t get from the private sector.”

The senator left the door open to supporting a government-option, though she acknowledged she has reservations.

“One of our biggest concerns is that it doesn’t need to be a government plan that usurps that ability to compete in the marketplace, which I’m concerned that a totally government-run option would do,” she said.

This really doesn't make any sense, other than in the sense that Blanche Lincoln values corporate contributors over her constituents, and doesn't feel that the public can hold her accountable as long as she raises enough money. Because the public plan is wildly popular. In most cases, a wildly popular issue would be precisely the one that could yield bipartisan support. But if that issue is in any way progressive, suddenly, public opinion doesn't matter anymore.

And not only is the idea of a public option popular in the abstract, the inclusion of a robust public option would save a lot of money and thus allow the congress to minimize its reliance on unpopular measures like tax increases. But suddenly here public opinion becomes irrelevant. You never hear a Blue Dog say “my seat is so vulnerable that I can’t afford not to back a super-popular public plan.” Ben Nelson’s not talking about how if Democrats want to stay viable in red states they need to robustly back a 70-20 issue like the public plan. The WSJ doesn’t run a headline saying “Opposition to Public Option Spells Political Trouble for Republicans.” Public opinion, in other words, can be a reason to eschew sound progressive policy but never a reason to enact it.

Exactly. There are these etched in stone "political realities," designed by elites, that say you just cannot cross corporate power. And so we hear nonsense about "fiscal responsibility" as a means to deny the most fiscally responsible option. And we hear that we "have to protect the free market" while denying the choice that would strengthen that market. The public option is nothing so much as trust-busting. And the elites want to keep together the trust.

Meanwhile, the three committees working on this in the House have really stepped up. They released a discussion draft based on the work of all of the relevant Chairmen, which includes a robust public option to keep insurers honest and allow for experimentation in the marketplace. Initially, the plan utilizes Medicare bargaining rates to ramp up, and then will use cost control plans to provide better coverage and more effective care.

I would prefer a single-payer system. But this actually is a significant step, and worth fighting for: a health care plan that offers lower costs, higher quality and better choice. During the press conference (on C-SPAN 3, not cable, because who gives a crap about health care, right?), John Dingell brought up the hearing in the House on rescission, the practice of insurers dropping people the moment they get sick, sometimes for technical violations on their applications like misspelling their name.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period [...]

Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives:

"No."

Rep. John Dingell (D-Mich.) said that a public insurance plan should be a part of any overhaul because it would force private companies to treat consumers fairly or risk losing them.

"This is precisely why we need a public option," Dingell said.

Here's the YouTube of that hearing. It should have 10 million hits by the end of next week.



Here's a Splicd version of the moment where they all refuse to commit to stop rescinding people when they get sick.

TEN MILLION VIEWS.

Biting The Good Poll Numbers That Feed Them

To follow up on Tom Daschle's big fold on the public option, which is setting minds in Washington as we speak, the timing is truly impeccable. Not only did the WSJ and NBC come out with a poll finding 75% support for a public option in any reform, but an additional poll - put together by foes of health care reform - found even more support.

The poll — which was just released by the Employee Benefit Research Institute, a D.C. policy think tank — finds that a majority (53%) strongly back the availability of a public plan, while another 30% “somewhat” support it. That’s a total of 83% in favor of a public plan — a staggeringly large majority.

Even more interesting, guess who paid for the poll? From the release:

This survey was made possible with support from AARP, American Express, Blue Cross Blue Shield Association, Buck Consultants, Chevron, Deere & Company, IBM, Mercer, National Rural Electric Cooperative Association, Principal Financial Group, Schering-Plough Corp., Shell Oil Company, The Commonwealth Fund, and Towers Perrin.

Not exactly a band of raging lefties. The American Association of Retired Persons and Blue Cross Blue Shield were among the opponents of HillaryCare in the 1990s.

Meanwhile, instead of looking at those numbers and seeing that the public option must be preserved, Daschle and the Village thinks these guys must be preserved at all costs:

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

....Late in the hearing, [Bart] Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives: "No."

Rep. John Dingell (D-Mich.) said that a public insurance plan should be a part of any overhaul because it would force private companies to treat consumers fairly or risk losing them. "This is precisely why we need a public option," Dingell said.

Rescission is a serious problem. Here in California, Blue Cross and its parent company HealthNet have settled to the tune of about $37 million dollars in a variety of rescission lawsuits.

But no, private insurance must be preserved because it's so efficient. After all, that's why we pay twice as much for health care with worse outcomes than most of the industrialized world! (P.S. I know that doctors ordering up unnecessary treatments and tests contribute to this as well - our system's lack of integration provides perverse spending incentives.) And by the way, all of this is happening despite the fact that the Progressive Caucus has vowed to vote against any health care reform that does not have a robust public option. It's just assumed that they can be steamrolled.

Instead, we have this spectacle of so-called "centrists," supposedly concerned with fiscal responsibility, fighting against reform tooth and nail, even though that would be the only way to reduce cost.

The House's two most conservative caucuses, the Blue Dogs and New Democrats, are banding together to come up with shared principles on healthcare and counter a process many see skewing to the left.

The two groups, which combined have 131 members — more than half the House Democratic Caucus — have been holding meetings to see where they can agree on a healthcare plan [...]

There is concern among centrists in the caucus that the draft bill, to be released Friday, will reflect some of the more liberal ideas in the caucus, although leadership has already rejected the idea of a single-payer system. It is being put together by the House Education and Labor, Energy and Commerce and Ways and Means committees.

"You have a bunch of crazy liberal chairs and their crazy liberal staffers, and they want to lay down a marker," said a senior Democratic aide.

Crazy liberals, wanting to replicate the rest of the industrialized world's policy of less spending and greater effectiveness in health care!

It's really sad to see the Washington consensus just run like a truck over meaningful health care reform. Especially because the public won't buy anything without a public option as real reform, period.

UPDATE: Russ Feingold on the Senate floor:

Frankly, I am disappointed that this has become the topic of so much controversy, because it is such a fundamental part of making sure we provide the reform that my constituents, and all Americans, deserve.  Some have even suggested scrapping a public option in the interest of passing a bill with bipartisan support.  I want to pass health care reform and I hope very much we can do so with bipartisan support.  But I am not interested in passing health care reform in name only.  I am not interested in a bill that allows us to somehow tell our constituents we have done something but doesn’t really address their concerns.  We need real reform, and real reform means a strong public option.

And Americans want a public health insurance option.  According to a recent poll by NBC and the Wall Street Journal, over three fourths of those polled said they would like the ability to choose between public and private health insurance plans.  Providing a public health insurance option that does not discriminate against those with pre-existing conditions and illnesses will significantly improve the ability of people to access health care.

Health Care Bills Advance In CA Assembly

The Senate Health Committee held its first hearing on SB810 (Leno), the single-payer health bill. While I've made my belief in the inevitable problems of states trying to fund health care when they cannot deficit spend well-known, if I was on that committee I'd go ahead and vote for it. But I recognize the need to strengthen the broken health care system on all fronts, given the political realities that the Governor has vetoed single-payer multiple times in the past, and that the Republicans will never sign off on the funding, and so even if by some miracle the Governor put pen to paper we would have to wait until 2010 for full passage, and another year for implementation. In the interim, a number of very interesting health care reforms have cleared the Assembly Health Committee already, and progressives should take notice of them. Anthony Wright has some of the details.

The Assembly Health Committee on Tuesday approved a number of key health consumer protections. The measures would expand guarantees of coverage to Californians who are underinsured, uninsured or, in some cases, just plain inadequately served by their health care providers.

One of the bills would sharply increase civil fines in response to the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. Another would address a vast, and quickly expanding, demographic of the uninsured--young adults transitioning between school and careers that offer financial stability and benefits.

Yet another would require insurance brokers and employees to reveal their financial interests–such as paid commissions – in selling certain health care policies. One measure would require private providers to cover more of the costs of doctor-ordered medical equipment, something Medicaid and MediCal already do.

See the post for the full details on AB1521 (insurers revealing their commissions), AB730 (big fines for rescissions), AB29 (raising the age limit for dependent coverage from 19 to 26) and AB214 (requiring health plans to cover durable medical equipment). All 4 would have an immediate and tangible benefit for Californians, and all are common-sense reforms. Fining rescissions would attack the inequities in the system and prevent fraud, as would the agent commission rule. Raising the age limit would provide stability for those young people transitioning from college to starting a career, and adding protections for what is insured also adds stability (the fact that people can be made to pay for their own wheelchair is kind of nuts). None of these deal with the long-term cost drivers that bust state and federal budgets, and none deal comprehensively with the crisis of the uninsured. But all of them help, and we need to press forward on all fronts right now.

Health Care Policy And California

One of the worst elements of the current budget crisis is that it crowds out all of the other urgent problems facing the state. Nowhere is this more true than in health care. When the Nunez/Schwarzenegger overhaul failed last year, the problem never went away. And there are a host of other issues with health care delivery that linger. Fortunately, we're seeing a little progress and a few good ideas that can set a course for the future.

First, the state reached an agreement with Blue Cross to reinstate 678 patients who were wrongly removed from their insurance plan in a practice known as "rescission". Basically, the insurer waits until a patient files a claim and then invents a reason to cancel their policy.

The insurer has agreed to reimburse the subscribers for any out-of-pocket medical expenses and create a third-party process to review policy cancellations.

Blue Shield faces up to a $5 million fine if it does not take corrective action, said Darrel Ng, insurance department spokesman.

Between Jan. 1, 2004, and May 31, 2008, Blue Shield improperly dropped 678 subscribers, the agency said.

Obviously, the state meeting its responsibilities to protect California consumers is helpful, but it doesn't solve the big problems of health care delivery. One of the most pressing concerns how to get quality care out to rural areas, where there is a dearth of doctors and facilities. Fortunately, John Garamendi has a plan to recruit new doctors to rural health centers.

State Lt. Governor John Garamendi is proposing an ambitious fast-track medical school at University of California-Merced in an effort to create more doctors for the San Joaquin Valley, one of the most physician-poor regions in the state [...]

Entering freshmen — recruited from San Joaquin Valley high schools, with family ties to the region — would study at UC-Merced and local community colleges, then train in existing medical centers and clinics, instead of at a pricey research-oriented hospital.

They would be encouraged to train as primary care physicians and learn the challenges of practicing medicine in this vast region, where 130 languages are spoken and many residents suffer from chronic ailments such as diabetes, heart disease and respiratory ailments from dust, diesel-burning farm equipment and wood-burning stoves.

And then there are the macro issues with rising costs and the uninsured in general. Recognizing the dire needs in this area, foundations and nonprofits are stepping up in this area with advocacy that will hopefully bring more attention to the issue.

Overall, while the budget is obviously the pressing concern, we cannot overlook these burgeoning crises throughout California public policy. There is sadly no magic fix for them, even if a budget is someday signed.

State Legislative Update

Technically, the session is over in Sacramento, but of course, with no budget, the work will go on. More on that in a moment, but let's take a look at the bills that have passed thus far.

Hundreds of bills passed through their respective houses and made their way to the Governor's desk. Among those passing:

• AB 1945, which cracks down on insurance company rescission policies
• SB 1301, the California DREAM Act, allowing children of illegal immigrants to access financial aid for college
• SB 375, a major land use bill that would improve transportation planning and reduce urban sprawl (this is a real coup)
• AB 583, the Clean Money pilot project bill that would make the 2014 Secretary of State election a Clean Money race.

Among the bills that failed:

• SB 1522, a health care reform bill which would have standardized the individual health care market and made it easier to comparison shop, as well as set a floor for basic minimum care. That those who most strongly pushed for comprehensive health reform would fail to pass this common-sense fix makes no sense to me.

• SB 110, which would have created an independent sentencing commission to review and revised sentencing guidelines and parole standards. Another failure of leadership in our prison crisis, as lawmakers refuse to loosen their grip on the rules which they've abused and led to this disaster.

As for the budget, now the legislature, out of session by constitutional mandate, must work on nothing else. Sen. Perata has called the bluff on the Republicans, asking them to formally submit their unspeakably cruel budget plan so that the whole state can see their priorities for what they are.

There was a strange colloquy near the end of yesterday’s Senate session (Republican Senator Jim Battin is pictured at right), where the Republicans were clearly caught flatfooted, flustered in their responses like school kids admonished for not doing their homework, and having a hard time coming to grips with what Perata told them. This is a reprise of what Perata did last year when Senate Republicans held the budget up and when he asked them to come up with their own proposal.

Perata: Right now, the bill that I brought up yesterday is kind of an orphan. You have your opportunity to present a bill that you outlined today in your press conference. I appreciate the fact that there is a substantial amount of work to be done on that bill. We know, because we started ours 8 months ago. So you’ve got a lot of work to do. But we’re very confident you can do it. Every day we will be here to see how we’re doing [...]

Republican Senator Jim Battin: I just want to make sure I understand what your expectations are. So what you want from our caucus is a full budget document, is that correct?

Perata: Yeah. A budget.

Battin: And every day we are preparing that, you want to meet.

Perata: Yeah. You know what I don’t’ want to do is to be caught in that position where people are getting confused whey we don’t have a budget. Now every day we meet, we can say, “you’re working on it.”

Battin: And you also want to have the trailer bills as well?

Perata: Yeah. A budget.

Battin: You would actually allow us to bring it up for a vote on the floor?

Perata: You betcha.

Battin: So my expectation is that it will fail…And then what?

Perata: Let’s not prejudge. You may come up with a piece of work that will knock our socks off. So let’s see what you will do.

It's a neat trick, and good for political purposes. I don't know how it gets us closer to a budget. Schwarzenegger still wants the sales tax hike, Yacht Party Republicans are still dead-set against it, and Democrats are trying to compromise and on the edge of cracking. But they seem to believe, this time around, that the budget can be blamed on Republicans in November and there's a benefit in campaigning on the issue (I think that's why Perata wants a real plan).

So nobody knows how this ends. And the victims are the public employees, the long-term care workers, the schools, the health clinics, the everyday Californians that did nothing wrong and don't deserve this anxiety.

Wahhhhhh!!!!

Arnold Schwarzenegger will turn this car around right now!

Gov. Arnold Schwarzenegger said Wednesday he will refuse to sign any bills that reach his desk until the Legislature sends him a budget agreement.

"At this point, nothing in this building is more important than a responsible budget to fix our broken budget system," he said at a hastily called afternoon press conference. "So until the Legislature passes a budget that I can sign, I will not sign any bills that reach my desk."

Schwarzenegger acknowledged that his decision "means some good bills will fail." But he said with a cash crisis looming, the late budget takes on even greater urgency.

He's signaling here that his little state employee wage cut gambit didn't work. It didn't produce the kind of compromise he wanted and it sent him tumbling in the polls as he attempted to cynically hold innocent bystanders hostage in an unrelated fight. So he had to cut off all bills instead. Maybe now, he thinks, the legislators will take notice.

But let's understand what he's doing here. Yesterday, as a culmination of four years of work, Alan Lowenthal's bill to clean up the ports of Oakland, LA and Long Beach passed the State Senate. Eliminating the toxic pollution at the ports would save 3,700 lives annually according to the California Air Resources Board. The bill would enact a $30 container fee on every import, using that money ($300 million annually) for investment in reducing pollution and improving freight rail. It's a milestone bill that is sorely needed to improve the air quality of these communities.

It's not an exaggeration to say that Arnold's latest stunt will actually kill thousands of people from reversible diseases.

There's a bill pending in the Senate Appropriations Committee authored by Fiona Ma (AB 2716) which would deliver guaranteed paid sick days to all California workers. This bill has the support of 73% of the public and would make the state the first in the nation to provide this to their residents. Arnold would rather stamp his feet and issue ultimatums than improve the lives of Californians and do the bidding of the overwhelming majority of the public.

On health care, while we cannot expect a comprehensive plan to come out of this legislative session, there is a deal coming together that would improve health care for those who have insurance by mandating some strict rules for the industry:

In the final weeks of the legislative session, they are negotiating measures that would limit insurer profits on individual plans, require plans to provide a minimum set of benefits and restrict insurers' ability to cancel policies retroactively [...]

Three million Californians buy health insurance on their own rather than through employers. Insurers keep premiums low -- and profits high, their critics say -- on some individual policies by limiting the services they cover. Such plans may exclude prescription drugs and maternity services, for example; others may cover only hospital visits.

Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.

The game-playing by Arnold on the budget means that, in all likelihood, these rules will not go into effect, and individual consumers of health insurance (like me) will remain incredibly vulnerable to the vicissitudes of the insurance industry, which has shown already a penchant to deny coverage and jack up premiums. That too will put the lives of Californians at risk.

There's a human cost to the bullshit that Terminator Boy isn't accounting for. His head is in the clouds, and he thinks he can bully the legislature liked he bullied people in scripted movies for decades. But the recklessness will cost money, pain, suffering, and even lives.