Tag Archives: health care reform bill

Kucinich Explains His Yes Vote on Health Care Reform

Following is the full statement issued on March 17 by Dennis Kucinich on his decisions to vote for the health care reform bill in the House. Even readers who are angry with the vote may want to read this for some of the broader comments Kucinich makes, in the last few paragraphs, on the current political scene. 

Each generation has had to take up the question of how to provide for the health of the people of our nation.  And each generation has grappled with difficult questions of how to meet the needs of our people.  I believe health care is a civil right.  Each time as a nation we have reached to expand our basic rights, we have witnessed a slow and painful unfolding of a democratic pageant of striving, of resistance, of breakthroughs, of opposition, of unrelenting efforts and of eventual triumph.

I have spent my life struggling for the rights of working class people and for health care.  I grew up understanding first hand what it meant for families who did not get access to needed care.  I lived in 21 different places by the time I was 17, including in a couple of cars.  I understand the connection between poverty and poor health care, the deeper meaning of what Native Americans have called “hole in the body, hole in the spirit”. I struggled with Crohn’s disease much of my adult life, to discover sixteen years ago a near-cure in alternative medicine and following a plant-based diet.  I have learned with difficulty the benefits of taking charge personally of my own health care.  On those few occasions when I have needed it, I have had access to the best allopathic practitioners.    

As a result I have received the blessings of vitality and high energy.  Health and health care is personal for each one of us.  As a former surgical technician I know that there are many people who dedicate their lives to helping others improve theirs.  I also know their struggles with an insufficient health care system.

There are some who believe that health care is a privilege based on ability to pay.  This is the model President Obama is dealing with, attempting to open up health care to another 30 million people, within the context of the for-profit insurance system.   There are others who believe that health care is a basic right and ought to be provided through a not-for-profit plan.  This is what I have tirelessly advocated.

I have carried the banner of national health care in two presidential campaigns, in party platform meetings, and as co-author of HR676, Medicare for All.   I have worked to expand the health care debate beyond the current for-profit system, to include a public option and an amendment to free the states to pursue single payer.  The first version of the health care bill, while badly flawed, contained provisions which I believed  made the bill worth supporting in committee.  The provisions were taken out of the bill after it passed committee.  

I joined with the Progressive Caucus saying that I would not support the bill unless it had a strong public option and unless it protected the right of people to pursue single payer at a state level.  It did not.  I kept my pledge and voted against the bill.   I have continued to oppose it while trying to get the provisions back into the bill. Some have speculated I may be in a position of casting the deciding vote.   The President’s visit to my district on Monday underscored the urgency of this moment.

I have taken this fight farther than many in Congress cared to carry it because I know what my constituents experience on a daily basis.  Come to my district in Cleveland and you will understand.

The people of Ohio’s 10th district have been hard hit by an economy where wealth has accelerated upwards through plant closings, massive unemployment, small business failings, lack of access to credit, foreclosures and the high cost of health care and limited access to care.  I take my responsibilities to the people of my district personally.  The focus of my district office is constituent service, which more often then not involves social work to help people survive economic perils.  It also involves intervening with insurance companies.

In the past week it has become clear that the vote on the final health care bill will be very close. I take this vote with the utmost seriousness.  I am quite aware of the historic fight that has lasted the better part of the last century to bring America in line with other modern democracies in providing single payer health care.    

I have seen the political pressure and the financial pressure being asserted to prevent a minimal recognition of this right, even within the context of a system dominated by private insurance companies.

I know I have to make a decision, not on the bill as I would like to see it, but the bill as it is.   My criticisms of the legislation have been well reported.  I do not retract them. I incorporate them in this statement. They still stand as legitimate and cautionary.  I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

However after careful discussions with the President Obama, Speaker Pelosi, Elizabeth my wife and close friends, I have decided to cast a vote in favor of the legislation.   If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform.  We must include coverage for those excluded from this bill.  We must free the states.  We must have control over private insurance companies and the cost their very existence imposes on American families. We must strive to provide a significant place for alternative and complementary medicine, religious health science practice, and the personal responsibility aspects of health care which include diet, nutrition, and exercise.
The health care debate has been severely hampered by fear, myths, and by hyper-partisanship.  The President clearly does not advocate socialism or a government takeover of health care.  The fear that this legislation has engendered has deep roots, not in foreign ideology but in a lack of confidence, a timidity, mistrust and fear which post 911 America has been unable to shake.
This fear has so infected our politics, our economics and our international relations that as a nation we are losing sight of the expanded vision, the electrifying potential we caught a glimpse of with the election of Barack Obama.  The transformational potential of his presidency, and of ourselves, can still be courageously summoned in ways that will reconnect America to our hopes for expanded opportunities for jobs, housing, education, peace, and yes, health care.
I want to thank those who have supported me personally and politically as I have struggled with this decision.  I ask for your continued support in our ongoing efforts to bring about meaningful change.  As this bill passes I will renew my efforts to help those state organizations which are aimed at stirring a single payer movement which eliminates the predatory role of private insurers who make money not providing health care.   I have taken a detour through supporting this bill, but I know the destination I will continue to lead, for as long as it takes, whatever it takes to an America where health care will be firmly established as a civil right.

Senator Ron Wyden: Public Option Now Meaningless

I have recently argued that the public option is now so weak and diluted that it really doesn’t amount to much. Trudy Lieberman of the Columbia Journalism Review, among the few writers to find her way through the blizzard of misleading press accounts on the subject, has done an interview with Oregon’s Senator Ron Wyden that includes his own takedown of the current public option. Here is what Wyden says:

The House public option would cover six million people and the Senate three to four million—roughly one out of eight people. United Healthcare has seventy million policyholders. Why haven’t the American people been told that under ten million would be eligible? How can six million people hold United Healthcare accountable? You never see the press writing how virtually nobody would be eligible…. I think people will be flabbergasted by the idea that the typical person is going to be virtually defenseless against the insurance companies.

The battle over the public option Wyden says, has become a meaningless political exercise, promoted by the media’s inadequate coverage of health care reform. “It’s all about the horserace and a lot of the rest is about personalities….[The press’s] idea is liberals for and conservatives against. It’s the clash on Capitol Hill over the public option. The public hasn’t been informed.”

Wyden thinks this pitched battle has distracted attention from the real issue, which is that for the “typical consumer,” health reform will change things “very little.” He believes that even if a reform bill is passed, millions of people will still not be able to afford decent insurance–with or without a public option, and with or without the proposed federal subsidies. This is because lawmakers are unwilling to seriously regulate the costs incurred by insurance companies and the rest of the profit-driven health care industry. So the entire “reform’ is ending up as a subsidy to the insurance industry. Wyden says this:

RW: If you don’t have cost containment, you can’t get affordability. Lack of cost containment flows from an unwillingness to make the special interests hold the costs down. If you don’t have real cost containment and just tell the special interests we’re going to guarantee markets and subsidies, you’re in a vise. The [comprehensive] benefits are not there.

TL: Will people still be underinsured when illness strikes?

RW: Nobody has guaranteed all Americans good quality, affordable health care. There’s no question that, under the bill, underinsurance will remain a very substantial problem. Bankruptcies will still continue. People will be paying nineteen percent of their income out-of-pocket on health care—even people with subsidies. This is going to take a toll when you’re falling farther and farther behind every year. I’m very, very concerned with the issue of underinsurance.

How the Baucus Plan Screws Older People

As I wrote yesterday, there are aspects of the Baucus health care reform plan that don’t bode well for Medicare recipients. But the people who stand to get screwed most by the plan are those who aren’t old enough to qualify for Medicare, but are still old enough to be discriminated against by insurance companies.

For several months, the Columbia Journalism Review has been publishing analyses of the Massachusetts health care system, which in many ways serves as a model for the current national health care reform–a “canary in the coal mine” for the rest of us. The state mandates that all residents have health insurance or face a tax penalty. And while it does provides some regulation of private insurers, it doesn’t bar them for “age rating”–setting different premium rates based on age. This doesn’t apply to most working people who are covered by group plans through their employers, at group rates. But for the self-employed and early retirees–who numbers are growing since the recession began–the costs can be devastating. CJR cites reporting by Kay Lazar in the Boston Globe, which found:

State law allows insurers to charge older people up to twice as much as younger people for the same coverage. In other states, the disparities can be even greater. One result is that more older people choose less comprehensive plans. Data from the Commonwealth Choice program, which offers state-approved private insurance, show that as enrollees grow older, more choose cheaper and less comprehensive coverage.

The main solution that’s been proposed for this problem is to make it “easier for self-employed people and retirees who are 50 to 64 to be exempted from a stiff tax penalty if they can’t afford insurance.” So rather than force insurance companies to stop discriminating on the basis of age, the state may begin “allowing” 60-year-olds to live without health insurance. So much for the great Massachusetts universal coverage model.

All of the major health reform plans that have been floated in Congress allow age-rating, and the Baucus plan endorses disparities even higher than those in Massachusetts. As the New York Times reports:

Under Senator Baucus’s plan, insurers would be permitted to charge older people five times more for their health insurance premiums than younger people. That proposal, first circulated in a Finance Committee policy options paper last spring, is a significant departure from the approaches put forth by three House committees and the Senate Health, Education, Labor and Pensions Committee. Those bills would only allow insurers to charge older people twice as much as younger ones….

According to AARP, the lobbying organization for older Americans, the number of uninsured adults between 50 and 64 grew to 7.1 million in 2007, an increase of 36 percent over 2000. Among the main reasons for the increase: higher premiums demanded of older, sicker people seeking coverage in the individual insurance market.

Supporters of the Baucus plan and the other half-measure Congressional health reform proposals made a big deal of the fact that insurers won’t be able to turn people away, or charge them more, because they have pre-existing conditions. In other words, they can’t discriminate against sick people. They also, of course, cannot discriminate on the basis of race, ethnicity, gender, and the like. This means that the only form of discrimination that will remain legal is age discrimination.

This is, of course, another sop to the insurance industry, which worries about the effect on its profit margin if it has to insure everyone. As the Times notes:

By allowing insurers to charge so much more for older, often sicker people, “You’re just using age as a proxy for health status,” said Uwe Reinhardt, an economics professor at Princeton University. He estimates that Senator Baucus’s age-rating plan would allow insurers to cover roughly 70 percent of the additional risk they’d take on by being required to accept all comers, regardless of health.

A Banner Week for Big Insurance, Part II: Medicare Advantage

The so-called Baucus bill is a gift to the insurance industry in more ways than one. As I wrote earlier, it hand-delivers to the private insurance companies a whole new customer base that is government-mandated and government-subsidized. And if offers no competition in the form of a public option.

In addition, the Baucus plan preserves the Medicare Advantage program, which is one of the insurance industry’s most overt rip-offs of the public purse. As most Unsilent Generation readers will know, Medicare Advantage (MA) plans offer managed care run through private insurers, paid for by the federal government. In recent years, MA plans have come under increasing fire for their hard-sell tactics to elderly Medicare recipients, shoddy coverage, and rip-offs of the Medicare system. “Competition” from the private plans was supposed to reduce growth in Medicare spending–but in fact, they cost the government more. Recent estimates say that the government pays 14 percent more for those enrolled in Medicare Advantage vs. those in traditional Medicare. Eliminating these overpayments could save the government $177 billion over the next ten years.

Republicans (and at least one Democrat, Bill Nelson of Florida), are already complaining about the Baucus plan’s proposed cuts to MA plans. But the Baucus plan doesn’t eliminate Medicare Advantage, and might not even do it much harm. It simply introduces a new formula for calculating payments to private insurers who offer MA plans. As Tim Foley writes:

Medicare Advantage plans–private HMOs paid for by the feds at 114% the rate for a regular Medicare beneficiary but with no better health outcomes–would keep their overpayments until 2014, at which point they’d be paid the “weighted average” of all the Medicare Advantage plans combined. In layman’s terms, they’d still be getting paid more than traditional Medicare, albeit possibly less than the 14% extra they get now.

This change is rendered even more meaningless by the fact that the Obama Administration had already announced, back in April, its plans to begin incrementally cutting back on overpayments to Medicare Advantage–something it doesn’t need legislative approval to do.

Nonetheless, the insurance industry is pulling out all the stops to protect every cent they make through Medicare Advantage plans. They spent the spring and summer trying to plant astroturf on the issue by luring old people to “community meetings” (with free lunch and door prizes) where they were encouraged to “join the fight” to save the plans.

Now the insurance industry lobby group AHIP (America’s Health Insurance Plans) is offering up reports claiming that Medicare Advantage plans are especially helpful to the poor and people of color–an idea that has already been widely debunked. Cuts to MA, the report says, will hurt the most vulnerable elders.

In response, Pete Stark, (D-CA), chair of the House Ways and Means Health Subcommittee, issued a statement:

AHIP’s reports attempt to portray taxpayer overpayments to MA plans as indispensable for low-income, minority Medicare beneficiaries, when the opposite is true. These overpayments to private insurers increase premiums for all Medicare beneficiaries to pad the pockets of insurance companies….

Any report commissioned by Jay Gellert – the CEO of HealthNet and Chair of AHIP – should be taken with a healthy grain of salt, especially one claiming that beneficiaries are being helped.  Under his leadership, HealthNet has been fined hundreds of millions of dollars for illegally rescinding people’s health coverage when they get sick.

A Banner Week for Big Insurance, Part I: Mandating Profits

This is turning out to be a very good week for the private health insurance companies (or as I like to think of them, the bloodsucking middle-men whose only role in the health care system is to squeeze some profits out of human illness and suffering). Yesterday, AP/Forbes reported on the uptick in insurer stocks, which jumped from 3 to 6 percent in a single day:

Shares of health insurers jumped Wednesday after an key Democrat released a much anticipated Senate version of a health care reform bill that excluded a government-run insurance option.

The so-called public option had been a contentious issue with health insurers, with the industry viewing it as unfair competition. Instead, Sen. Max Baucus released a proposed bill that would require every American to obtain health insurance, which would be a financial boon for the health insurance industry.

It doesn’t take Einstein to figure out why this is great for the insurance industry: If there’s no public alternative to compete with private insurance companies, guess where all those people will have to go to buy their government-mandated insurance? As for the touted co-ops and exchanges, all they are ultimately likely to offer is better access to private insurance. And people of limited means will get government subsidies, mostly in the form of tax breaks, to buy private insurance–which means a transfer of funds from the taxpayers to private insurers. We might as well be writing our checks directly to United Healthcare, Wellpoint, and Humana, instead of the the IRS.

As Mark Karlin pointed out on Buzzflash yesterday, taxpayer subsidies are the only way to solve the “issue of how for-profit insurance can co-exist with the goal of reducing medical costs.” Karlin continues:

This isn’t a ‘free market’ solution; it’s socialized support of “profits”–basically a shakedown. It’s the only way– under the myth of Big Insurance providing enhanced “value,” which it doesn’t–that for-profit insurance companies can survive, because they are…unnecessary (essentially, a expensive redundancy) except for the explicit purpose of enriching a select few: the executives and shareholders.

We saw this happen under Medicare Part D, which was written by Big Pharma under the Bush Administration.  Seniors got a reduction in prescription costs, but without the government being able to negotiate the costs of the prescriptions. It was a multi-billion dollar socialized medicine gift to Big Pharma.

Karlin is right to compare what’s going on now to the Medicare Part D scam, which I’ve written about often. For decades, the drug companies had opposed the idea of a Medicare prescription drug plan. But at a certain point, they realized that if the plan was constructed the right way, it stood to reap them huge rewards in the form of government-subsidized profits, without the onerous burden of too much government control. That’s how we ended up with the convoluted, overpriced, privatized system that is Medicare Part D, instead of the comparatively simple and efficient structure of original Medicare.

The insurance companies also cashed in on Medicare Part D, since the whole program is financed by the government but run through them. So when health care reform came up this time, they were prepared: From the start, they showed a willingness to support health care reform, as long as it was the right kind of health care reform–i.e. one that expanded, rather than threatened, their role in the system, and thus their profits. As Robert Pear wrote in the New York Times last week:

While the White House has struggled to define its position, insurance companies have never wavered. Starting two weeks after the 2008 election, they have said they would accept greater federal regulation of their market practices if Congress also required everyone to have health insurance.

These may have been tactical concessions, to abate public wrath, but they were well received in Congress. While making these offers, the industry conserved its resources for the bigger battle over a public option.

In other words, so what if the law says that private insurers have to accept some people with pre-existing conditions, or stop cutting them off when they get sick, as long as the law also provides them with a huge set of new, government-subsidized  customers–and absolutely no competition.  It could hardly have worked out better for the insurance industry if they’d written the plan themselves.

Baucus Bill: No Public Option

As expected, Senator Max Baucus released the full text of a health reform bill that was noteworthy primarily for what wasn’t there: the bill is minus a public option. As long predicted here, the legislation includes “co-ops” and “exchanges,” which are similar to the federal health employees health care plan. And Medicare Advantage stays, albeit at lesser rates.

And in return for this sellout on the most meaningful planks of health care reform, the Baucus plan has gotten…so far, not one single, solitary Republican vote.

Kaiser Health News provides a concise summary:

Senate Finance Committee Chairman Max Baucus today unveiled a health care bill that would require most individuals to have health insurance. Insurance companies could not deny health coverage based on a pre-exisiting medical conditions or place yearly or lifetime limits on coverage.

People who earn as much as 133 percent of the federal poverty level ($14,440 for an individual, $29,400 for a family of four) would be eligible for Medicaid, the government insurance program for the poor. The measure includes a health insurance ‘exchange’ where people could buy insurance and a system of health care “co-ops” rather than a government-run health insurance plan. Subsidies would help low-income workers purchase health insurance and small businesses would receive tax credits to help offset the cost of providing coverage.

The bill is projected to cost $856 over 10 years. It would be paid for with an excise tax on high-end health insurance policies, lower payments to the Medicare Advantage program and with fees on medical device manufacturers, clinical labs, drug makers and health insurance companies. Baucus negotiated the plan with five other finance committee members – including three Republicans – but no one in the GOP has endorsed the package.

Obama’s Health Care Speech: Too Little,Too Late

As the summer has waned in an atmosphere of misinformation and recrimination, so too have hopes for real health care reform. Many people have by now sadly come to the conclusion that the moment for such reform has come and gone. In this context, Obama’s inspiring speech tonight was simply too little and too late.

It may just be that Obama, using the Democratic majority as a hammer, can achieve some limited change for the better. If so, that change most likely will be built on a base set forth by the Baucus plan announced yesterday, further embellished and/or weakened in the joint House-Senate conference that will draft a final bill. That final bill will be such a study in compromises that most people in America won’t notice any change at all–which is pretty much the point, as Obama himself admitted tonight.

Obama tonight eloquently defended the need for a public option, only to kick it to the curb, insisting that it is “only one part of my plan”–and one open to further tinkering and dilution. He promised the American people: “If you can’t find affordable coverage, we will provide you with a choice.’’ The “choice,’’ however, could be any one of a number of things—co-ops or exchanges accompanied by tax breaks, with special subsidy programs or perhaps expanded Medicaid to pick up the slack for the poor. One thing is clear: It won’t be a challenge to the private insurance industry. Obama said flatly, “I have no interest in putting insurance companies out of business.”

Giving the speech was brave. But its politics remains a muddle. The core problem here is the Obama administration’s inability to project a vision for real change or take an ideological stance that might have some populist appeal. The only time Obama reached toward that ground tonight was when he quoted Teddy Kennedy’s belief that health care is a human right–something the president himself apparently couldn’t bring himself to say in his own words. Instead, the administration has dawdled in a swamp of tehnocratic mumbo jumbo, leaving ideology, once again, to the Right.

In the end, the model here is not the lawmaking carried out by Teddy Kennedy–or Teddy Roosevelt, John Dingell’s father, Harry Truman, LBJ, or anyone else Obama cited tonight. The model is Obama’s own wishy-washy credit card legislation enacted earlier this year, which sands down some of the freemarket’s hard edges by outlawing its most outrageous abuses, and otherwise lets business go on as usual. This approach seems destined to become the hallmark of the Obama administration–and as I predicted months ago, the final health care reform bill will undoubtedly bear this stamp:

Under a propaganda blitz heralding sweeping reform, we get legislation that reins in some of the very worst abuses, while making no significant change at all to the underlying flawed system. So, for example, we may see insurance companies required to provide coverage in spite of pre-existing conditions–something Obama referred to in his AMA speech, with moving references to his mother’s own battle with cancer. We might see what the President called “more efficient purchasing of prescription drugs,” which presumably means more power to haggle with Big Pharma over drug costs, as well as speeding up approval of generics. We will see health care providers given incentives for more cost-effectiv–and, we can hope, better–treatment. These things are not meaningless, and they will provide a modicum of help to some struggling Americans. But they do virtually nothing to strike at the basic American system of health care for profit. And at the same time, they offer only a fraction of the savings a single-payer system could offer.