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Archive for the ‘health care reform’ Category



Consumer Group: Calbuzz Blew It on Health Care

Monday, December 28th, 2009

WrightBy Anthony Wright
Special to Calbuzz

I’m confused. Calbuzz has become indispensible reading on topics, from the governor’s race to California Forward, for its veteran analysis that is informed, policy wise and politically savvy. But all that was lacking is the anti-Obama, anti-health reform rant earlier this week.

The post didn’t describe the policy, bungled the politics, neglected the process and didn’t even pretend to stand on principle.

In the entire screed, readers only get two actual critiques about the actual content of the health reform.

One policy critique is that the bill is “framed and defined” by a “transfer” of money to the “rapacious private insurance industry.” Well, not quite. Of the $800+ billion cost of the bill over 10 years, about half is an expansion of public coverage through Medicaid. The other half is composed of subsidies to low- and moderate-income families, providing a guarantee that coverage won’t cost more than a certain percentage of their income.

That’s not the only sea-change. It’s also a radically different insurance market, where the existing business model — called “underwriting,” “risk selection,” or avoiding anybody who actually needs care — is made illegal.

The other policy criticism is that there is no longer a public health insurance option. We’re angry and disappointed that a handful of senators bucked the will of the majority of the House, Senate and public in blocking it from being in the Senate version of health reform. My organization has been leading organizing efforts all year with that as a top priority. (California should be proud that all California Congressional Democrats — including our two senators and even our seven Blue Dogs in the House — voted for a strong health reform that included a public option. Too bad such efforts was not as successful in a few other states.)

But the public health insurance option, as important as it is, isn’t the only priority. We worked for Medicaid expansions, filling the donut hole in Medicare, affordability subsidies to help families up to four times the poverty level, exchanges with the power to bargain for group rates, standards for basic benefits, the abolition of underwriting and denials for pre-existing conditions, requirements on premiums dollars being used for patient care rather than administration and profit; investments in prevention and other cost containment efforts, and much more. We won all these elements, lost others and we’re still fighting on many fronts.

In the comments, Mark Paul gave a spirited defense of the bill on the specifics. As head of a group dedicated to engaging people to advocate on health issues, I believe it should be possible to be honest — agree with many of his points, and still be clear and active about the significant gaps and problems that need to be fixed in conference committee and beyond.

On the politics, the analysis only makes sense if passing health reform is a routine event that the President flubbed. One could write a completely different take — that President Obama is on the verge of passing a reform more far-reaching than any of his predecessors, despite a century of stalled attempts, from Harry Truman to Bill Clinton. Closer to home, California has also been trying since Governor Earl Warren. The Calbuzz crew might remember just the past decade of attempts which I was actively involved — from John Burton’s pay-or-play measure to Sen. Sheila Kuehl’s single-payer proposal to Governor Schwarzenegger and Speaker Nunez’s compromise less than two years ago.

In other words, President Obama’s hands-off approach to let Congress get dirty in the details — a let’s-do-it-differently-than-the-Clintons strategy — could be seen as more successful. If there’s a critique, the president did place a few firm policy demands on the bill writers — like limiting the cost of the plan to $900 billion over 10 years, and they were geared at passing a bill, and not helpful in getting a better bill. Ultimately, they probably were redundant, given Congressional constraints.

And that’s the biggest failing of the Calbuzz post: Much of the critique of the president should better be directed at Congress, and particularly the rules of the Senate. Beyond the insanity of California having the same level of representation as Wyoming, Utah or Delaware, the 60 supermajority rule creates dysfunction and paralysis. Getting to a supermajority of 60 is a challenge. We in Sacramento know the insanity. As odious as they are, Ben Nelson’s demands for once-in-a-generation health reform are not in the same league as the constitional amendments and other requirements legislative leaders have accepted just to pass an annual budget.

What could have President Obama done on the politics? Sen. Lieberman disliked him enough already to make a big point of crossing party lines to endorse and actively campaign for his rival. It’s hard to see what lever he had with someone working from an ideology of pique.

What can a president do? President Obama spent over $100 million during the campaign on TV advertising on health reform, in order to build a mandate for reform. He put his presidency on the line, but focused on moving the process forward. Two years ago, Gov. Schwarzenegger made his own demands on health reform rather than focusing on what could pass the Legislature. He was the last to figure out he wasn’t going to get Republican legislative support, and ultimately neglected to build the coalition to pass the Democrats in the California Senate.

Finally, the Calbuzz critique isn’t even rooted in principle. The argument is that President Obama should have simply given up at the start. “If they couldn’t see a way to put the votes together, they should have taken on some other signature issue.” Sorry, 30 million uninsured. No luck, millions with pre-existing conditions. Too bad, those who find out too late their coverage actually doesn’t provide coverage when they need it. Not only should we not have passed these reforms that would help you — the President shouldn’t have even tried.

So what’s the endgame? Actually, Californians have a role to play. The negotiations between the House and Senate to reconcile the bill are just underway. Senate Majority Leader Harry Reid will be negotiating largely with Californians, from Speaker Nancy Pelosi on down, including key chairmen like George Miller and Henry Waxman. They’ll be listening to our 53 members, including chairs of key caucuses like Lynn Woolsey, of the Progressive Caucus, Barbara Lee of the Black Caucus and Mike Honda of the Asian Caucus.

Those House leaders need to be pushed to make the final legislation closer to the very good bill they passed in the House. They need the stronger affordability subsidies for low- and moderate-income people, especially important for those in high cost-of-living states like California; the stronger standards to limit of out-of-pocket costs; better benchmarks for employer-sponsored health coverage; more oversight on insurers; no undue exclusions for immigrants or abortion coverage; and to adopt the more progressive financing of the House bill.

This isn’t the end of health reform, but the beginning. Not acknowledging the nuances — both the positives and negatives of a reform — just breeds cynicism and disengagement. That’s not what we need, especially in the next few weeks and in the years ahead, as this debate comes back to Sacramento.

Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition, advocating for the goal of quality, affordable health care for all Californians.

How Obama Punted Away Real Health Reform

Monday, December 21st, 2009

ObamaHealthCareUpdate: Today’s Calbuzzer comments reflect a contentious debate raging in the blogosphere about the virtues, or lack thereof, of the Senate bill. While Calbuzz is triangulating like crazy – it’s a lousy bill but pass it anyway ‘cuz somethin’s better than nothin’ – others are whacking deep into the weeds on this.

If you care to join them, here’s a guide to the best arguments string: Jane Hamsher, founder of Fire Dog Lake, posted 10 reasons why the Senate bill should be killed, and was promptly attacked by the Washpost’s Ezra Klein,world’s leading authority on practically everything. Then Jon Walker of FDL attacked Klein’s attack, and we give the final world to Nate Silver,the smartest person in the world, who attacked Walker’s attack of Klein’s attack of Hamsher.

———-

In a case of life imitating art, comic blogger Andy Borowitz provided the most accurate and trenchant commentary about the Democrat’s misadventure on health care reform, as he offered a look at  details of his own, newly unveiled,  “CompromiseCare™” program“:

– Under CompromiseCare™, people with no coverage will be allowed to keep their current plan.
– Medicare will be extended to 55-year-olds as soon as they turn 65…
– A patient will be considered “pre-existing” if he or she already exists…
– You’ll be free to choose between medications and heating fuel…
– You will be entitled to natural remedies, such as death
.

And so on. The Borowitz Plan would be a riot if it didn’t come to so close to the truth.

The sad fact is that Barack Obama’s wimp-out on his signature issue has resulted in a legislative end game defined by a default bill in the Senate that’s godawful. Riddled with half-measures, the bill is framed and defined by the institutionalized transfer of hundreds of billions of public dollars to the same, rapacious private insurance industry that shaped the dysfunctional system supposedly being transformed.

Even its worthwhile nods to reform – efforts to end the industry’s disgraceful practices on pre-existing conditions, rescissions and lifetime benefit caps – are largely dependent upon regulatory enforcement by the states, woefully over-matched by the legal firepower of insurance companies, as David Dayen  argues most persuasively at Fire Dog Lake.

So now, Obama will be left holding the bag on weak, compromise legislation repellent to Democratic advocates on the left and Republican opponents on the right.

Worse, a new NBC/Wall Street Journal poll shows that less than one-third of Americans say that the stinky cheese that Obama now supports as “reform” is a good idea – a number that has steadily eroded since he jettisoned his support for the public option. Worse, more people, by 44-41%, say it would be better to do nothing than to pass the measures before Congress.

Yes we can!bidensmirk

The strongest argument for nose-holding passage of the health bill in its current form is made in a NYT op-ed by Vice President Joe Biden. But Biden’s take-whatever-we-can-get-and-declare-victory stance avoids the hard fact that the White House made one fundamental strategic error, followed by a series of tactical blunders.

Strategically, Mr. Smartypants Rahm Emanuel and the geniuses in the White House political shop should have counted noses at the start to determine if there was a threshold of support for a public option – which also should have called something more politically palatable, like “health insurance competition” or “consumer choice” – or an expansion of Medicare. If they couldn’t see a way to put the votes together, they should have taken on some other signature issue — jobs would have been a good one.

Instead:

–Obama frittered away his mandate. After stomping John McCain and leading the way to Democratic domination of both houses of congress, he retreated to a passive posture in which he uttered Yoda-like platitudes about reform while letting the food fight in congress shape the legislation.

–Obama quickly signaled the special interests were still in charge. About the only substantive moves by the White House were a) to dump, before they even got started, the progressive’s goal of a single payer system and b) to break his campaign promise of transparency by cutting an early, backroom deal to minimize the impact of any bill on the pharmaceutical industry.

–Obama shined on his political base in the name of pursuing “bipartisan” harmony with people whose only interest was sticking it to him. Back in August, when Obama began backing away from support for a public option, we warned that he was setting himself up for failure with his fetish Fairy_largefor fairy tale bipartisanship.

In the political fight of his life, Obama has been putting his energy and emphasis almost exclusively on the can’t-we-all-just-get along aspect of his message, in a desperate bid to pass a bill – any bill – that he can spin as an alleged victory, even if represents right-center policies and politics.

With Democrats in the rare position of controlling the White House and both houses of Congress, however, he needs to stop singing kumbaya and start busting some heads by fighting fiercely for the populist – and, yes, partisan – principles that led millions to support the progressive promises of his campaign. And that means taking on, not just the other party, but some of the obstructionist Senators in his own party…

Obama’s we’re-all-in-it-together action, in place of a principled fight, has simultaneously succeeded in emboldening his Republican enemies and alienating his progressive base, in the name of imaginary bipartisanship and placating the self-absorbed Lieberman-Nelson-Snowe “centrist” axis, whose members keep dumping on him from a great height for his trouble.

What’s even more troubling is the suspicion that Obama’s kumbaya strategy was timid by design, aimed at avoiding any effort to make real change in the status quo, viewing process as more important than  policy. As Rep. Anthony Wiener, the most articulate  champion of substantive health reform, told Politico:

This has been a fairly transactional presidency, and the president did nothing to insulate himself from the compromises — which were inevitable — by making it clear at the outset what his values were on some of these important issues. While being transactional may help you get through the days in Washington and get things on the scoreboard, it creates a weird disconnect that most people in the country don’t know what you want and don’t feel they should rally to your side.

In a pair of must-read pieces, here and here, Salon’s Glenn Greenwald makes the case that, after the massive Wall Street bail-outs, abdicating to Goldman Sachs and wimping out on credit card reform, Obama with health care has now fully revealed hiobamapostermself as a triangulating advocate of corporate power,  his soaring populist rhetoric be damned.

As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this — the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional “centrists.”

Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start — the one that is a huge boon to the health insurance and pharmaceutical industry.

So whether by incompetence or design, the White House has left health reform advocates (boy is Ted Kennedy missed) with little choice but to support badly flawed legislation, an argument summed up in Biden’s op-ed: “I share the frustration of other progressives that the Senate bill does not include a public option. But I’ve been around a long time, and I know that in Washington big changes never emerge in perfect form.”

Not exactly change we can believe in.

A Second Wave Attack on Women’s Health

Saturday, November 28th, 2009

By Susan RosSusan_Rosee
Special to Calbuzz

The official word from the federally funded U.S. Preventive Services Task Force –  that most women don’t need mammograms until the age of 50 — generated passionate responses from women, medical associations and advocacy organizations.

The task force, a panel of physicians, also recommended against teaching women to do breast self- examinations. For good measure, a new recommendation to limit the frequency of Pap Smear Tests further added to the confusion about women’s health care protocols.

The timing could not have been worse for the White House, as the Administration struggles to pass health care reform.

Following closely the House passage of the disastrous anti-abortion Stupak Amendment, the new controversy has outraged many women’s organizations, leaving the uneasy Democratic coalition in Congress shakier than ever.

Why are all these attacks against standard women’s medical health practices coming now? Is it time to trust my paranoia? Is this directly connected to health insurance reform? The debate over saving money in health care suddenly seems to be tilting in favor of cutting services that serve women and save their lives.

Expressions of opposition to the new recommendations were widespread,USREPORT-US-USA-HEALTHCARE as leaders like Nancy Brinker, founder of the Susan Komen Foundation, and influential women’s health author Dr. Judith Reichman pushed back at the task force report. Even the Obama administration backed away from the recommendations, leaving Health and Human Services Secretary Kathleen Sebelius to state that  “our policies remain the same.” Perhaps most important, the American College of Obstetricians and Gynecologists confirmed their continuing support for the practices of screening mammograms for women from the ages of 40 to 49, as well as self-exams that can detect palpable breast cancer.

In their defense, the task force qualified their findings, saying they should be applied by “individualized decision making to the specific patient or situation” and advising the recommendations do not apply to high-risk women.

Good. That will work for my two 40-something daughters because they have a family history of breast cancer.

My story is no different than the many I have heard and the thousands repeated around the country. I was 47 years old when I was diagnosed with breast cancer. I had been examined by my gynecologist who missed the lump. A few weeks later I found it myself while doing a breast self-exam (BSE). The tumor was very small and I proceeded with the recommended treatments. This year I celebrated my 20th anniversary as a breast cancer survivor.

But two years after the first diagnosis, a Pap Smear revealed another cancer site unrelated to the first. It was found early, and required no additional treatment. The BSE and the Pap Smear are tests I continue to use to this day.

The task force’s recommendations have major implications for insurance coverage. As the Senate begins its debate on health care reform, ongoing analysis of the Stupak Amendment makes it clear that women may well lose all opportunities for abortions covered by insurance, because there will be little incentive for companies to provide these services. With formal recommendations from a federal task force now calling for limits on screening mammograms, why should insurers continue providing coverage for these services either?

breastcancerribbonWomen have long been second class citizens in the history of medicine, ignored or treated differently than men. For many years, research on heart attacks was done on exclusively on men and the results then applied to women. Now scientists are looking at numbers of breast cancer diagnoses and deciding whether to provide women with preventive medical treatment. At what threshold are women worth being treated? We have moved from not being counted at all to being viewed only as statistics.

Scientific research and evaluation are important and the cost of health care needs to be managed, but there must be a way to do both without denying women basic medical services.

Advocates for the task force recommendations argue that they are about evidence- based medicine, and we should not mix science and politics. Perhaps, when gender equity is truly reflected in Congressional representation, we won’t have to fight these battles. Until then, we cannot separate out politics from science.

Susan Rose served 8 years on the Santa Barbara County Board of Supervisors and writes regularly about women’s issues for Calbuzz.

A Feminist’s Outrage at Abortion-Health Care Deal

Wednesday, November 11th, 2009

By Susan RoseSusan_Rose
Special to Calbuzz

Saturday night’s vote on health care reform was a disaster of mega proportions for American women.

Amid the legislative horse-trading that occurred to pass the bill, women lost big time: the House of Representatives cast 220 votes for health care – and 220 against reproductive health for women.

Between the Catholic Bishops lobbying and the Democratic Blue Dogs yelping we should have seen this coming months ago. We didn’t have a chance.

President Obama said he didn’t want to change the status quo (the existing policy embodied in the Hyde Amendment allows abortions for rape, incest or when a mother’s life is at stake) but that policy has been wavering for years – one vote away at the Supreme Court.

Now Congress has done the hard work for the Supremes. It has been 36 years since Roe v. Wade was decided and now women are about to lose access to safe abortion services. Women are the sacrificial lambs for health care reform and the Democratic Party led the way.

The weapon of choice was the anti-abortion amendment authored by Rep. Bart Stupak, D-Mich.

It cleverly blocks coverage of abortions from several directions: Private insurance companies participating in the new public health exchange would not be able to cover any abortions; women receiving tax subsidies could not use their own money to purchase private insurance that covers abortion, even if it is 100 percent of their own funds; low-income women who depend entirely on public health care would have no access to abortion and no alternative to care; other women would be forced to buy a separate insurance “rider” to cover any future abortions. With these restrictions squeezing out nearly all insurance for abortions, who would be left to provide such services?

The health care debate now moves to the U.S. Senate.

Even if Senators eliminate the offensive Stupak amendment, a final bill must, of course, satisfy both houses. As currently proposed, the health care reform bill would cause more women to have less access to comprehensive health care.

For more than 25 years, the Democratic Party has championed reproductive freedom for women. It has been a main plank in party platforms and all national political conventions. Women’s organizations like NOW, Emily’s List and The Feminist Majority have made choice a litmus test for their endorsements and, in return, have recruited candidates and raised money for their elections. The Democratic Party depended on this support.

nancy_pelosiThe Democrats had an excruciating choice: health care reform or reproductive rights for women. Under Speaker Nancy Pelosi’s leadership they chose health care. Perhaps the Speaker believes that this will be worked out in conference committee, but considering the firestorm now ignited on both sides of the debate, I doubt it. Once again women have been sent a message that they don’t count.

Women may hold up “half the sky” in the rest of the world, but in the US culture, not much has changed. The Equal Rights Amendment (ERA) introduced in 1972 still hasn’t passed, and CEDAW, the international treaty proposing the elimination of “all forms of discrimination against women,” has been ratified by 186 countries but not by the US. Rape and domestic violence exist in epidemic proportions and universal childcare is not available. Women still don’t matter.

A friend and longtime Democrat told me yesterday she is re-registering as an Independent. The Democratic Party has a lot at stake in this health care vote, not least the majority support of women voters.

Am I angry? You better believe it. The message from Washington D.C. is clear – our government will decide for women how and in what way we control our bodies. We have been hearing the debate for years but we are now much closer to that reality. It was the closing bell on Saturday night.

Susan Rose, a board member of the Planned Parenthood Action Fund, served 8 years on the Santa Barbara County Board of Supervisors and writes regularly about women’s issues for Calbuzz.