insurance rescissions ending next month

Politico:

The health insurance industry has decided to end its practice of cancelling claims once a patient gets sick next month, well before the new health care law would have required it, the industry’s chief spokesman said Wednesday.

"While many health plans already abide by the standards outlined in the new law, our community is committed to implementing the new standards in May 2010 to ensure that individuals and families will have greater peace of mind when purchasing coverage on their own," AHIP president and chief executive Karen Ignagni said in a letter to top House Democrats.
...
Congressional Democrats and Health and Human Services Secretary Kathleen Sebelius had pressured companies to end the practice early. The overhaul plan will ban the practice in September, except in cases of fraud or intentional misrepresentation, and subject it to a third party review.

White House health reform czar Nancy-Ann DeParle said the administration will be watching to ensure the industry does indeed institute the ban.

There was a lot of BS in the healthcare bill, and too many compromises were made with people who negotiated in bad faith, but at the end of the day the single worst practice in the American healthcare system is coming to an end. This is going to save lives.

Stupak retiring

There's a lesson here. It will be misinterpreted by myopic editorials as "the Tea Party is unstoppable!," but I think most people would agree that Stupak came under so much fire because he chose to grandstand and obstruct the president's signature legislation, his own party's electoral hopes, and the dire needs of millions of Americans ... and then back off.

What's funny about his decisions during the healthcare debate is that the bill that passed the Senate never did provide any financial support for abortions. In fact, the pro-Roe crowd was generally angry because it placed extra burdens beyond the Hyde amendment on women seeking abortions. There was a joke circling the internet after Stupak's meeting with the president and his reversal that Stupak couldn't bring himself to believe that the bill didn't fund abortions because it was female senators, women's groups, and nuns telling him so. Finally they all went to the president and told him Stupak won't believe it unless it comes from a man.

In a way, I suspect an element of truth here. My guess is that this had nothing to do with abortion policy. Stupak put his finger to the wind and guessed that this was going to be a major anti-Democratic wave election year, and he needed to get out in front of it. Grandstanding against HCR on behalf of the anti-Roe crowd gets him in the good graces of tea partiers, McCain voters, the US Chamber of Commerce (who will be doing the lion's share of PAC spending this year) and the Christian Right all at once.

Only things didn't work out like he'd hoped. He was probably told by the Speaker that he wouldn't be allowed to join the handful of red state Dems allowed to vote the other way to protect their own asses, so he recruited a bunch of other "pro-life" Democrats to his cause, hoping he could just torpedo the bill and Obama's loss would be his gain. He took a lot of the blame when HCR looked dead, and Democratic groups (and, ahem, voters) were furious.

And then he learned a hard lesson about leading an army of cowards. When it looked like the president was going to lose, they flocked to Stupak. When the conventional wisdom shifted, however, and people started talking about how, during the 1994 elections, centrist Democrats were slaughtered en masse by the GOP whether or not they supported HCR, and that passage of HCR was absolutely essential to the Democrats keeping Congress, knees all around him started shaking.

Then votes in Congress started flipping the Speaker's way, and the Stupakers became the last group left holding up HCR. They caught the angry eye of the Speaker, the White House, and the Democratic electorate at large. Rahm came knocking on their door with the message that the White House "is going to remember who stood in the way of this legislation." Democratic groups and unions start evaluating their support. Support for Stupak et al. among their own Democratic constituents started sinking.

I imagine at some point Stupak and his buddies gathered with their campaign advisors, looked at polls they had commissioned hoping that their gains among tea partiers, Christian conservatives, and Republicans were offsetting Democratic losses, and learned the ugly truth about triangulating your own party in the post-Clinton age: after so many bridges burned and so many allies spurned, Republicans said they supported Stupak et al. in larger numbers ... but still plan to vote for their Republican opponents in November.

Everyone wanted off this sinking ship, they were finished with Stupak's folly (including Stupak himself), but they needed some way to save face, and that's how the president's Executive Order came to be. It won't save them, as Stupak eventually figured out. Stupak made several serious miscalculations:

1. he badly misjudged how important his own party considered HCR


2. he relied on a cadre of cowardly, centrist congressmen to defend against the White House, congressional leadership, every Democratic/liberal interest group in America, and the vast majority of Democratic voters


3. he made a play for Republican and independent votes at the expense of Democratic ones (i.e., gave his own supporters a HUGE reason to stay home), and then tried to renege, effectively antagonizing all three groups

That last one is what gets the "centrists" every time. Research shows that most "independent" voters have amorphous, frequently changing political views, but nobody likes a waffler.

HCR already more popular

Remember what I said yesterday about how winning is a great deodorant? Here's the health care bill's new numbers.

optics

But while we're on the subject of the "optics" of the health care reform vote, I would like to point out that what people saw on their TVs this weekend was a black president and an Italian-American female Speaker passing this bill over the protests of mobs of white teabaggers shouting "ni66er" and "fa66ot."

On a simpler level, though, it's also worth remembering John Madden's dictum about unpopular players and coaches: winning is a great deodorant. I suspect we're going to see some movement in approval ratings over the next week or two.

Also, so much for the GOP's charge that Obama isn't doing anything. Are we going to the "too busy" or "too much change" arguments now?

Waterloo

Health care reform passes. There's a lot of obfuscation and a lot of posturing and a lot of mob mentality and groupthink about the politics of this decision, but here's David Frum, one rocksolid Republican with a lot of influence who calls it Waterloo... for the GOP.

He admits what we've all suspected and what has been maddening about the Democrats' approach, namely that the GOP decided at the very beginning to stonewall reform, to refuse any compromise, to "play for all marbles" as he put it. The GOP could have had a huge influence on this bill (they didn't as it is?), but because they opted for mere obstructionism, they failed and got nothing out of it.

There will be no repeal, even after the GOP gains in November. Frum writes:

Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage?

I'll take this a step further: this bill will never be repealed and the middle class will like it, and the failed attempt to preserve the infamous "doughnut hole" and insurance companies' right to cut you off at the critical moment will hang on the necks of the GOP like a millstone for a generation. The Democrats will be able to come back to those points again and again.

But, as I've been hitting on over and over in this debate, the politics of this don't matter as much because the policy is so important to the lives of all 300 million of us. This was the kind of thing you played all those politics for, the big play where a party and president leverage all that political capital to do all that world-changing they dreamed of doing when they first decided to enter politics. As Josh Marshall puts it, it's legislation like this that makes losing a majority worth it. Win or lose in November (or better put, lose or hold onto), the Democrats managed to pass the first major social policy legislation in 50 years.

Put another way: every majority ends eventually. The real difference is not how long they last, but which ones do something productive and which disappear with nothing to show for it. It's a lesson I'd like to see some of Bayh's agenda-less coalition (like my own mollusk of a congressman) reflect on.

This bill was thin gruel compared to the House bills of a year ago, but the regulations on the worst insurance company abuses alone are going to save lives. Plus, many, many families who would have been bankrupted by medical bills and the loss of health coverage will not be because of this bill. Furthermore, the execrable "doughnut hole" is now a footnote in history.

Let's remember what matters, people.

My argument against Tort reform via malpractice caps

A good friend of mine recently put up a pretty long facebook screed about the state of the healthcare thing, and I felt the need to respond. I addressed the entirety of it in an email to him, but since I did all this research re: tort reform specifically I thought I'd share it with the masses.

Here's the TLDR version:

• Its anti-states rights. Many states already have malpractice damage caps and all states could implement them if it suited them.
  
• It provably doesn't lower malpractice insurance premiums according to the biggest malpractice insurer.
  
• It doesn't even show a correlation between existence of malpractice caps and the price of healthcare - again, many states already have caps and the existence of those caps does not equate to lower heathcare costs.
  
• It doesn't remove the primary incentive for junk prescriptions and tests - payola. Industry spends billions each year directly influencing doctors.
  
• It gives away patients rights after they've been crippled by negligent docs, even if a jury agrees that they should have damages awarded.

Enjoy!

[Do] Tort reform.. ie the millions that are spent on protective medical practice that doctors spend on covering their ass against lawsuits.

Tort reform is interesting in just how little it would actually do to fix most of the major problems with the system and how much it would cost us as patients.

starting off-


Of course the first argument is that there's really nothing preventing the states of the union from enacting their own versions of tort law, and naturally each state handles it pretty differently. Here's a nice guide as to what the ground rules are in each state.

The federalist argument is of course that States should get to decide what they want and not have tort laws dictated to them by Washington, and that is the current status quo. This allows each state to set up laws according to their own unique constituencies and encourages competition between states for the most effective laws. I'll admit that I'm not much of a federalist when it comes to public safety (though I am in other areas), but I'm just pointing out that the tort reform argument runs counter to the principles of capitalists and federalists because it asks Washington to set the tort laws uniformly for all states while removing the ability of states to offer competitive legislation.




moving on-

When evaluating any potential change you have to honestly evaluate what the specific change is, and look to concrete data. Texas, for example has pretty tight medical malpractice lawsuit caps. Texas also kills a lot of people in hospitals. Texas healthcare is also not measurably less expensive than in a state like Arizona, which does not cap malpractice suits. Here's a fun map of per capita health care expenditures by state.

Relevant data (referencing links given above):

• Texas caps malpractice pain and suffering awards at $250k
• per capita cost of healthcare in Texas $1728 (in 2004, best data I could find)

• Arizona does not cap malpractice on pain and suffering awards (Constitutionally prohibited there)
• per capita cost of healthcare in Az is $1479 in 2004

• The existence of a tight malpractice cap in Texas can't keep healthcare costs below what they are in Az, which has no cap.
  

or, to look at it another way:

• DC is far and away the most expensive district in the union in which to receive healthcare: $4081 per capita in 2004
• Heathcare in DC costs almost 3x as much as it does in Arizona
  
• Neither state has malpractice caps
• Almost every other state in the union has per capita healthcare costs in between these two states.

When you look at the data, there just is no clear correlation between the existence of malpractice caps and the price of healthcare to the end user.




continuing -


The arguments roots extend to the price of malpractice insurance. IOW, if you cap malpractice awards, then the price of malpractice insurance will go down, allowing doctors to charge less to patients. The problem is that the nation's largest malpractice insurer doesn't see it that way. Here's a quote from that article (emphasis mine):

GE Medical Protective's finding was made in a regulatory filing with the Texas Department of Insurance (TDI),in a document submitted by GE to explain why the insurer planned to raise physicians' premiums 19% a mere six months after Texas enacted caps on medical malpractice awards.

In 2003, Texas lawmakers passed a $250,000 cap on non-economic damage compensation to victims of medical malpractice caps after Medical Protective and other insurers lobbied for the change.

According to the Medical Protective filing: "Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0%."

So what percentage of that 1% of insurance premiums do we expect the doctors to give back to the patients? Now given that we can certainly have a legit conversation about the state of malpractice insurance in this country, but the argument that capping malpractice awards does much for we the patients is pretty weak according the numbers provided by the insurers.

And then there's the reason for malpractice laws in the first place. If a doctor does a procedure on you and is grossly negligent, he can accidentally cripple you. In Texas there isn't much recourse if the doc you go to relieves you of your ability to use your legs. That gives lots of crappy docs lots of reason to come practice medicine here instead of in Arizona.




last one, I promise-


The last leg of the tort reform argument is that doctors are forced to practice defensive medicine in order to avoid lawsuits. I'll not argue that this doesn't exist, but I will argue that there are better ways to address the problem than capping malpractice awards.

What are the incentives for a doc to order a questionable test on a guy?

• minesweeping for anything he may have missed (science is hard)
  
• habit (dude has chest pain, lets get an ekg)
  
• fear of lawsuits
• and of course - money

Generally the point I'm going to make is that lots and lots and lots and lots of the money that pharmaceuticals and medical equipment manufacturers make goes to docs in the form of direct marketing. This means that the megacorp like Pfizer will send a rep to talk with a doc, usually by taking him out to lunch. He'll give him some free samples as part of a "clinical trial," and will encourage the doc to prescribe that drug to his patients in the future. Then he'll set up another meeting in 2 weeks. Oh yeah, and there are 1400 of these reps, doing this exact job, for every single doctor in this country.

Here's a fun exercise - Ask a doc when was the last time he bought lunch for himself. I'll put a couple of quick numbers in context (emphasis mine):

Currently, there are approximately 100,000 pharmaceutical sales reps in the United States^[7] pursuing some 830,000 pharmaceutical prescribers. A pharmaceutical representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200 physicians with 120 targets that should be visited in 1-2 week cycles.

The United States has 90,000 pharmaceutical representatives or 1 for every 6.3 physicians.^[3]

Pharmaceutical company spending on marketing far exceeds that spend on research.^[14][3] In 2004 in Canada $1.7 billion a year was spent marketing drugs to physicians and in the United States $21 billion were spent in 2002.^[4] In 2005 money spent on pharmaceutical marketing in the US was estimated at $29.9 billion with one estimate as high as $57 billion.^[3] When the US number are broken down 56% was free samples, 25% was detailing of physicians, 12.5% was direct to consumer advertising, 4% on hospital detailing, and 2% on journal ads.^[4] In the United States approximately $20 billion could be saves if generics were used instead of equivalent brand name products.^[3]

Currently, there are approximately 100,000 pharmaceutical sales reps in the United States pursuing some 120,000 pharmaceutical prescribers.^[28] The number doubled in the four years from 1999 to 2003. Drug companies spend $5 billion annually sending representatives to physician offices. Pharmaceutical companies use the service of specialized healthcare marketing research companies to perform Marketing research among Physicians and other Healthcare professionals.

What happens is that every doctor in every hospital in every state has every lunch and many dinners bought and paid for by the pharmaceutical and medical equipment industry. They are also legally allowed to accept gifts like junkets and even cash/real estate from these entities. In return, try to walk into a hospital, make up and complain of any ailment, and walk away without a prescription for something. I'll bet you can't do it.


So what happens when we remove the fear of lawsuit incentive from docs? Well, we've left intact the biggest motivator that they have to continue with the junk tests and prescriptions - the free lunch, all while removing the ability of patients to receive the resources needed to cope with getting crippled - even if a jury of their peers deems that type of thing appropriate. Tort reformists would prefer Washington to make those decisions. The net effect is that you get what you see with the states that already have caps - no discernible effect on healthcare costs.

a fool's errand

That's what it would be to draft a new bill to woo Republicans. Krugman:

So, House Democrats have a choice: do they pass the Senate bill, or do they go back to the drawing board and spend several months cobbling together a plan that’s worse in almost every dimension, generating thousands of stories about hapless Democrats — and almost surely find that Senate Republicans block the new plan, too.

The GOP is not interested in working with Democrats, only with subverting them. They've already said their strategy is obstruction, they've being using that strategy for 3 years now, and they believe they're winning with it. Why would they suddenly vote to fix healthcare now?

Reid's recent comment about Olympia Snowe's duplicity should be the lesson of the decade for Democrats. They gave her everything she asked for from weakening the mandate penalties to stripping the co-ops, the Medicare buy-in, and the opt-outs, even the public option itself, only to watch her vote to filibuster anyway.

Remember, one the GOP's main arguments against the public option was that it would be better than private insurance, and that's a bad thing:

Nevertheless, Republican senators argued that the public option would bankrupt the country and lead to a single-payer system. "Government is not a competitor. Government is a predator," said Sen. Charles Grassley (R-Iowa).

To the GOP, the worst thing that could happen is that something gets fixed while the Democrats are in charge.

giving up

Speaker Pelosi says she doesn't have the votes, and doesn't give any viable alternatives.

I think the Democrats have given up on healthcare reform.

It's being described in several places as "political suicide," which it is, sure. One wonders whom, exactly, Mary Landrieu is expecting will go to the polls for her (let alone donate and volunteer!) if she runs against a Republican and yet fought tooth and nail against having to make a decision on the defining Democratic project of the last 50 years. Who does she think is her base of support? Then again, of all the controversial parts of the various bills, the public option consistently polled better than anything else, and yet it the main thing conservative Democrats wanted out of the bill, so maybe that says something about the political instincts of the "waffling is conviction" crowd.

To call this "political suicide," though, misses the mark because it's still looking at politics as theater or sport, using the "horse race" rhetoric of election-year journalism that doesn't recognize the very real way that politics affects our lives. As Jon Stewart once put it, "This isn't a f**king game."

Giving up on healthcare reform isn't suicide; it's abandonment. It's abandonment of 50 million uninsured Americans, countless millions of others who are underinsured, overcharged, and one health problem away from bankruptcy. It's abandonment of everyone who's been or will be denied coverage because of "pre-existing conditions" or dropped when they get sick, and everyone victimized by the "death by spreadsheet" business model of American insurance companies. And it's abandonment of everyone who put their hopes in a new Congress, a new party, and a new president to finally make things right.

Yes, this means that Obama voters are going to stay home in November, and the blood of conservative and moderate Democrats will flow like a river down the steps of the Capitol, but the real "news" is that as many as 101,000 people will die needlessly in 2013 because Congress couldn't maneuver a health reform bill through a 59 seat majority. Which one of those massacres actually matters?

UPDATE: then again, this makes one wonder if the only bill Democrats ever stood a chance of passing was one that does more harm than good, anyway.

failure

Public option triggered out of existence in the Senate compromise. I really, really wish I were wrong about this.

Of course, we're all waiting to see what the CBO says about all this, even though they said the public option would save money. After all, if it isn't for wars, it's not free money!

Obama why?!

Protect Insurance Companies PSA from Will Ferrell

Funny.

so what's in the damn things?

Been looking online for any news source that bothers to tell us what's in the Baucus plan or the House ones, other than which ones are more "liberal," how much it costs, and whether or not they commit the cardinal sin of providing healthcare to illegal immigrants. After spending a little time finding the name of the Baucus bill (it's "America's Healthy Future Act," in case you were wondering), I found a copy of the early, layman's terms iteration of the bill, all 223 pages of it, which is a little long for a layman to read in his spare time, especially one who doesn't know much about the ins and outs of healthcare policy.

John Dingell's plan (America's Affordable Health Choices Act), however, is over 1000 pages. Pretty much all I can find about it is how much it costs and whether it funds abortions and euthanasia. This bill has been around at least July, when it was endorsed by the American Medical Association, and that's the full extent of its coverage. Great job, journos!

I found only a couple stories and posts that actually deal with the content of the bill: one here from RJ Eskew at the Huffington Post, one here from Ezra Klein on the CBO's quite positive assessment of it, and one here from Forbes. In fact, it looks like Ezra Klein may be the only person in the country repeatedly writing about what is in this bill.

From how it sounds from these stories, as well as what I've read elsewhere, it's really irritating how Baucus seems to look for every way possible to get money from the Treasury into the pockets of insurance companies. It's almost obsessive, like he's deeply apologetic over the slight of making them stop cutting off service to people right when they most need it and looking for ways to make it up to them.

back on topic, people

Yes, we all know that the outburst was highly irregular and a huge no-no for elected representatives. We all have a pretty good idea why President Obama was denied a basic respect granted to every other president in the history of the republic, and grasp the significance of that denial emanating from a representative of South Carolina. It was also not lost on most of us that a Louisiana congressman delivered the rebuttal from Strom Thurmond's old office.

But let's be honest: this is all just political theater. It's bullshit, easily digestible fluff that keeps us from having to talk about an issue that requires thinking.

You know what we don't know?

We don't know what kind of coverage Obama envisions the public option providing. Will it provide coverage for dental cleanings? Eye exams? Anyone have a ballpark estimate on the deductible? The copay? Will it be able to negotiate lower drug prices?

We don't know what the role of Medicaid will be under this new system. After all, Medicaid was created to handle precisely this problem of the poor lacking access to basic healthcare. Will it be scrapped, boosted, what?

We don't know who will be responsible for the public option. Will its administration fall under the federal Dept. of Health and Human Services? Will it be run by the states? A wholly new and separate entity?

We don't know how the Administration plans to enforce the individual mandate on buying health insurance. How will they check to see if we're covered? What happens if someone refuses to purchase it? Will they go to jail?

We don't know what measures, if any, will be taken to address the problem of astronomical premiums for malpractice insurance. Sure, Democrats and liberals are (rightly) suspicious of attempts to curb the ability of regular people to seek damages when they are significantly hurt, maimed, or killed, and apparently the number of lawsuits and amount of damages has been on the decline since the early '90's, but it is clear that high malpractice premiums and the overly common practice of defensive medicine are significant factors in the high cost of healthcare.

We don't know what measure, if any, will be taken to address the exorbitant and unmitigated cost of medical school. The NHSC is a great first step, but the vast majority of doctors are still starting out in the field hundreds of thousands of dollars in the hole from school loans, which undoubtedly affects the amount they have to charge for services.

These are pretty basic questions thought up by some wanker on the intarwebs with no inside knowledge of the medical field whatsoever, and yet here we are, past the time of debate and at the "time to act," and there have been (to my knowledge) no attempts even to ask these questions of our representatives, let alone answer them.

And why is that? Because every time the president spends an hour of primetime television trying to bring us back on topic, the conversation gets derailed even before he gets off the air onto Henry Louis Gates, and civility in the House, and death panels, and socialism, and abortion, and the stupidity of Republicans yelling to keep the government out of Medicare.

Obama's health insurance reform speech

The text here. Remembering the emotion of last year's squabbles between Democratic primary candidates on health care reform, it is notable that the current plan appears to be candidate Obama's insurance exchange plus Obama's subsidies for the poor plus Clinton's insurance mandates, with Edwards' method of enforcement. This is all, of course, leaving aside candidate Kucinich's health plan, Medicare for all, which is still the best plan, but that doesn't really matter at this point.

Judging from the president's words last night, it's pretty clear that the public option he envisions is an anemic thing, capable of providing care but not of providing it well enough to compete for customers who can afford to go elsewhere. That is a shame, and the Reaganites who believe government only works when it redistributes wealth upward will make some serious political hay out of it down the road. I know that sounds like politics rather than policy discussion, but it is in policy where we will pay dearly for this compromise.

Also, we heard it officially tonight: the president's plan will mandate that people purchase private health insurance, and use subsidies to help the poor afford it -- in other words, tax revenue funneled directly into the pockets of Wall Street health insurance investors. Free money for the bad actors who caused much of this mess in the first place. I still don't get this compromise. If you want to achieve universal coverage, why not just create a public option and sign everyone up for it? Then set it up so that the fees and services for the public option begin next year, and add a form to this year's taxes whereby people find out how much they owe for the public option, or can check a box to decline the option if they provide their alternative policy. No policy, no checking the box. No need for fines or other enforcement mechanisms than the IRS' current policies and staff. Universal coverage. Easy peasy.

How is forcing people to pay private insurance premiums preferable from either a political or policy standpoint?

On the other hand, there is this:

Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse.

It doesn't deal with the issues of millions of uninsured people, obscenely high malpractice insurance premiums, or of various other problems in the health care industry, and will only be as good as the organization charged with enforcing it, but this paragraph alone probably makes the bill worth signing. If the Democrats can't get a workable universal coverage/universal access bill out of the Senate, it would be worth their time to create a separate bill with these provisions alone to put an end to the most barbaric abuses in the system. I'm tempted to say I would prefer that even to universal coverage provided in the rest of the plan.

reporting politics, not policy

CBS released a poll showing that huge majorities of Americans don't understand the reforms Democrats are pushing on health care. Newspapers and TV networks have been giving us nonstop footage of the parade of crazy going on in town halls across the country. I've even seen some reports on Obama's/Democrats' inability to galvanize support being based on people's lack of understanding of what they're proposing.

So... eh... why don't you tell us? I've seen several online videos that explain the proposals clearly and concisely, often in cartoon form. Why can't the Nancy Snydermans of the various networks do something like that? Why are they all just waiting for an instructive voice to drown out the din on nonsense?

After all, apparently health care literacy is so low, even other journalists need a couple of basic lessons. It would be nice, for instance, for someone to tell Maria Bartiromo that Medicare isn't available to people under 65 (then again, judging from her Celebrity Jeopardy! performance, she might be a lost cause. Yes, CNBC hired this woman to tell you about financial news every day). Or tell other journalists that the public option does not establish a single payer system.

what the public option would mean for Michiana

According to the House Energy and Commerce Committee, passing the America's Affordable Health Choices Act would mean in the 2nd district of Indiana:

up to 13,500 small businesses could receive tax credits to provide coverage to their employees; 10,200 seniors would avoid the donut hole in Medicare Part D; 1,770 families could escape bankruptcy each year due to unaffordable health care costs; health care providers would receive payment for $104 million in uncompensated care each year; and 95,000 uninsured individuals would gain access to high-quality, affordable health insurance.

That would be the one with the public option. These numbers are pretty staggering.

Here's the one for TX-19 (Randy Neugebauer, R - Lubbock), and here for TX-32 (North Dallas, Pete Sessions). The rest of you can look your districts up here.

the case against welfare: health insurance companies

This is a conversation I would love to see. Atrios:

John Cole:

Hell, I can’t, for the life of me, figure out what value the insurance companies add at all. Seems like all they do is skim money off the top, add layers of paperwork, and then screw people when they get a serious illness.

This is correct. More than that, most of "health insurance" isn't really insurance at all, except for a bit of catastrophic insurance which they try to avoid paying out.

There really is no reason for them to exist.

It appeared on CNBC recently, as well, in this interview with Anthony Weiner. At about the 2:00 mark, he has to correct the newsmodel's conflation of the public option with "single payer" (an issue in itself: that's a pretty basic distinction to be f**king up this late in the game) and notes as a sort of throwaway line that he's not sure what private insurance companies are bringing to the table right now. It's a great interview, worth watching in its entirety.

Single payer plans give the government broad power to negotiate lower prices and power to consumers, who have some say over the system via their elected representatives, while dramatically streamlining the system. A public option can do these on a smaller scale, providing coverage to those who need it without discrimination and at minimal expense, while forcing insurance companies to compete with an entity that isn't interested in profits. Co-ops, so the argument goes, gives consumers a say in how their insurance organization is run and they share in the prosperity when/if it does well.

What is the advantage of private insurance? What do they offer? They are more expensive than public plans, less efficient, more capricious with their coverage, and less accountable. The only thing private companies offer, so far as I can tell, is that they will cover as much as you're willing to pay for. If you want a hospital room decked out like the Ritz, they will pay for it (for a price, of course). That's all I see, and that would still be available in most all public plans.

the bar is too high

Another point I'm glad to hear someone else making:

Big domestic programs (other than tax increases cuts) are nearly impossible. The Bush people went 0-for-2 on big domestic proposals. It’s difficult to turn immigration reform or Social Security privatization into a war against the worst enemy ever.

For all the talk about how Congress did whatever Bush wanted—and they did—he didn’t pass much of import domestically, aside from the big tax cuts (something else that’s always easy to pass) and (EDIT) Medicare Part D, a big corporate give-away (these are also relatively easy to pass). The last president to have success with ambitious domestic policy initiatives was probably LBJ.

Castigating Obama for not being another LBJ seems a little unfair to me.

Health care for all, comprehensive climate change legislation, cutting the military budget, and ending a war with anything other than total victory are probably the four most difficult things a president can attempt to do. As it is, Obama has had to put 3 of them at the top of his agenda. No matter what happens with the others, he will likely have to add the 4th as well.

It already looks like he will end a war, which is impressive enough. If he gets one of the others, he will be a model of successful legislating. Three would put him in the pantheon of great presidential lawmakers with the Roosevelts and Johnson. Four is impossible.

Barney Frank has had it with your bulls**t

From Yahoo! News:

DARTMOUTH, Mass. – Rep. Barney Frank lashed out at protester who held a poster depicting President Barack Obama with a Hitler-style mustache during a heated town hall meeting on federal health care reform.

"On what planet do you spend most of your time?" Frank asked the woman, who had stepped up to the podium at a southeastern Massachusetts senior center to ask why Frank supports what she called a Nazi policy.

"Ma'am, trying to have a conversation with you would be like trying to argue with a dining room table. I have no interest in doing it," Frank replied.

He continued by saying her ability to deface an image of the president and express her views "is a tribute to the First Amendment that this kind of vile, contemptible nonsense is so freely propagated."

I don't always like him, but he's a hoot to watch.

UPDATE: Oh joyous day! there's a video!

the Onion on health reform

Nice.

some good work on the current health care debate

Nate Silver is significantly more optimistic than I am on the benefits of a public option-less health reform bill, and has some good points to make. I like his point about how the bill still contains rules preventing insurance companies from denying coverage based on pre-existing conditions or current illness, but my worry is the possibility of loopholes that render these provisions meaningless (e.g., does it also bar them from raising that person's premiums/deductibles/co-pay to the point where they can't afford it?), and also the possibility of Republicans, lobbyists, and teabaggers to turn on those provisions after they prevail against the public option.

Also, Rick Perlstein on the nutball protesters as just the latest iteration of a long-standing national phenomenon.