Health Care reform: What Has Been Won and What Has Been Lost So Far

As we near the final version of THE PATIENT PROTECTION AND AFFORDABLE CARE ACT it is time to take full measure of just what has and has not been accomplished. Most importantly what has not been accomplished is a so called public option or early Medicare buy in to pressure the health care insurance industry to lower their premiums. Instead, these protected monopolies, will get roughly 30 million new customers with few restraints on what they can charge for their "product". If that isn't enough to demonstrate the immense lobbying and influence peddling of the giant health care corporations take a look at this article from Huffington Post. Here is an excerpt:

Reuter's [business] noted a big bump Monday morning, after the bill passed the first critical test in the Senate:

"All in all, relative to the last version of health reform issued by the Senate, things have turned out pretty well for the health insurance industry," said Carl McDonald, an analyst at Oppenheimer. "In particular, all versions of a government-run health plan have largely been eliminated."

Thanks to Lieberman's threat, health insurers dodged a major competitor that could have lowered margins, siphoned off customers and impacted profits.

And for those who would argue that the free market is the best way to supply health insurance to the public let me say this. That concept would be a little more palatable if just making a profit was the goal. But these companies are traded on the stock market and any corporation that has stock holders must show not that it is profitable but that it's profits GROW each year. In other words more and more of the money poured into health care through these companies is dedicated to profits every year, not patient care.

In fact denying patient care is their job. So in the long run we have to have a government run single payer system to lower the costs in our health care economy, which is one sixth of our national economy.

This is not to say the insurance companies got off scott free.

• They will no longer be allowed to drop your coverage because you forgot to tell them about a skin tag that was found on you 5 years ago or other such nonsense
• They can no longer impose life time limits which run out when you are fighting an overwhelming disease or disorder
• They can no longer deny you or your children coverage because of a pre-existing condition.
• Insurance companies will be required to spend a preset amount of their premium incomes (80-85%) on providing health care to their beneficiaries.
• Will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost sharing requirements in public and private insurance coverage.

The Senate Finance Committee has posted an extensive list of the provisions of the current bill that will begin as soon as it is signed into law, immediately benefiting consumers. According to Salon very informal discussions will begin between staffers of the pertinent House and Senate committees.

One of the Shames of Being a Texan

The old saw that "everything is bigger in Texas" is sometimes a dumb brag. One area we are the biggest in is the number of uninsured children. One in five children in this state is uninsured. These are not the children of people on the welfare roles as a recent Families USA report shows.

The Families USA report, titled “Left Behind: Texas’s Uninsured Children,” spotlights the following facts about uninsured children in the state:

• 1.4 million children are uninsured in Texas—more than one of out five, or 20.5 percent of Texas’s children. These numbers place Texas first in the nation for the number of uninsured children, and first nationally for the percentage of children in the state without health insurance.

• The number of uninsured children in Texas increased by nearly 33,400 between the three-year period 2003-2005 and the three-year period 2005-2007, and is likely to continue to grow due to the financial crisis.

• Texas’s uninsured children come from working families. In Texas, the vast majority of uninsured children (89.5 percent) come from families where at least one parent works, and nearly three-quarters of uninsured children—or 73.9 percent—live in households where at least one family member works full-time, year-round.

• Nearly two-thirds of Texas’s uninsured children, or 65.7 percent, come from low-income families (families with incomes below twice the poverty level, or $35,200 for a family of three in 2008) who are likely eligible for Medicaid or CHIP.

The majority of Texas republicans seem to think this situation is fine. Our illustrious governor and jaded legislature have turned down federal matching funds for increasing the expansion of CHIP repeatedly. I once discussed this subject with a top aid to one of our local State Senators when the legislature passed new rules that they knew would discourage parents form enrolling their children in the State CHIP program. He basically said that if the parents weren't willing to jump through these new hoops, like re-registering their children every six months, then they didn't deserve the aid. To which I replied "That logic would stand if the parents were getting the health care benefits but it is their helpless children who will do without the health care that their parents don't sign them up for". This type of thinking leads to further refrains such as those who say that these children will get good care in our emergency rooms. That is true in our pediatric hospitals emergency rooms and in those associated with academic medical centers but those are also the most expensive places to obtain any medical care. What could be dealt with in a $75 dollar office visit instead costs a minimum of $1500-$2000. Parents tend to wait until their children are much sicker before they take them to the E.R. and now a new study has shown that this has dire consequences in children.

"According to the Hopkins researchers, the study, to be published Oct. 30 in the Journal of Public Health, is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States....Using more than 23 million hospital records from 37 states between 1988 and 2005, the Hopkins investigators compared the risk of death in children with insurance and in those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying independent regardless of their medical condition, the study found. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of non-insurance could be even higher.

"If you are a child without insurance, if you're seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance," says lead investigator Fizan Abdullah, M.D., Ph.D., pediatric surgeon at Hopkins Children's.

Thus it follows that if 17,000 children die needless deaths a year because of lack of insurance then Texas has the greatest number of such deaths per capita in the United States. That is a number Texan's should be ashamed of.

The Insurance Companies vs the Public Option

The House That Private Insurance Built

From The Washington Post's Ezra Klein
Following the old adage to never stop digging when you've created such a nice hole for yourself, AHIP is now touting a report (pdf) released by one of its member insurers: the Blue Cross Blue Shield Association. Like AHIP's report, Blue Cross Blue Shield finds that premiums will shoot into the sky with health-care reform. Like AHIP's report, Blue Cross Blue Shield leaves out little things like the insurance exchanges, the excise tax, the delivery system reforms and pretty much everything else in the bill. Like AHIP's report, Blue Cross Blue Shield argues for a stronger individual mandate, which makes policy sense, even if the conclusion is presented dishonestly. Like AHIP's report, Blue Cross Blue Shield does not present any options for funding a stronger mandate.

But what's interesting about the BCBS report is how clearly it shows that insurers have gotten themselves into this mess. Essentially, they've spent so long pricing the sick and the old out of the individual market that they don't really know what to do when they're allowed back in. Consider this paragraph from the analysis:

Insurance reforms alone will substantially increase claims costs in the individual market. The individual market “risk pool” will be less healthy than today and will drive higher insurance premiums. We estimate the average medical claims for the uninsured are 20 percent higher than claims in the current individual market. In addition, certain segments with high medical utilization who are now insured through other arrangements will enter the individual market as a result of guaranteed issue and modified community rating requirements. This includes people enrolled in state high-risk pools, people on COBRA through their former employers’ coverage, and other group conversion policies.

Or this one:

In most parts of the country today, insurers in the individual market are permitted to underwrite and design benefit plans with a variety of price points. This flexibility enables a stable, competitive insurance market. Perhaps most importantly, it offers the greatest affordability to attract younger and healthier members and helps encourage wider enrollment in health insurance.

This is the house they've built: an insurance market where plans are written for the healthy and all legal efforts are made to exclude the sick. That's meant premiums are somewhat lower than they'd otherwise be, but only because the people who most need health-care insurance aren't able to afford it, or in some cases, aren't able to convince anyone to sell it to them. Now that arrangement is ending and they're scared that they can't provide an affordable product to the people who need it. They may be right, but it's evidence of how deeply perverse their business has become, not of what's wrong with health-care reform. When they say that the individual market would be cheaper in the absence of health-care reform, they're saying the individual market would be cheaper if they could continue refusing to sell affordable insurance to people who need health-care coverage.

This isn't an argument against health-care reform. This is proof of its necessity.

Sick For Profit

Health Care That Works

By NICHOLAS D. KRISTOF

Here’s a paradox.

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.

So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care.

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effectiveelements in the American medical establishment.

A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals “received consistently better care across the board, including screening, diagnosis, treatment and follow-up.” The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole.

“If other health care providers followed the V.A.’s lead, it would be a major step toward improving the quality of care across the U.S. health care system,” Rand reported.

As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial.

But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.

A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days — and after that, she will lose her employer health insurance.

She can keep her insurance if she makes Cobra payments on her own, but she can’t afford this. In her case, her company will voluntarily help her — but I just don’t understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work.

On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States.

Let’s hope we won’t miss this chance. A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.

•

HHS: Insurance Companies Encourage Employees to "Revoke Sick People's Health Coverage"

From: The Washington Post/Daily Dose
By David S. Hilzenrath
You might have known that insurers can deny health coverag based on preexisting medical conditions, but here’s something else to worry about:
They can take away the coverage you thought you had when actually need it, the government says. The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”
“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said. The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims. At least one insurer included such savings in an employee performance evaluation. “Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said. The research compiled recently for a House hearing included more detail.
WellPoint and Assurant told the committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and becoming pregnant with twins, the committee staff wrote.
In November 2006, after a Texas resident was found to have a lump in her breast, Wellpoint investigated her medical history and concluded that she had been diagnosed previously with osteoporosis. The insurer rescinded her policy and refused to pay for treatment of the lump, the committee staff wrote. Today’s HHS post, which draws on a variety of studies going back as far as 2001, shows how the Obama administration is trying to give people reasons to support an overhaul of health care even if they are satisfied with their existing coverage. It also reflects a stepped-up focus on health insurers, which are increasingly being cast as bogeymen in the debate.
Under the current system, something as relatively simple as seasonal sneezing can jeopardize your financial security, HHS argues, citing a 2001 study for the Kaiser Family Foundation.
“Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage,” HHS said.
By Eric Rich | August 11, 2009; 5:50 PM ET

August 24, 2009 Death Panels, Palliative Care, and the Dangers of Modern McCarthyism

From: The Health Care Blog
by: Bob Wachter

It’s time to fight back. The “death panel” nonsense is not a harmless and amusing political canard – it is modern McCarthyism: the shameless, heinous use of lies and distortions to scare and confuse people. The tide will only turn if all of us begin speaking up for the truth.

Read NY Times piece on palliative care, and you get a sense of the power and beauty of the modern movement to provide patients and families with information and support at the end of life. The piece chronicles the decline and ultimate death of Deborah Migliore, a former topless dancer from the Bronx, from metastatic carcinoid, and the efforts of palliative care specialist Sean O’Mahony to support the patient and her husband through her painful final weeks. more

Health Care as a Civil Right

Newsweek 8/15 Jonathan Alter

Obama needs to reframe the debate.

"The United States has two parties now—the Obama Party and the Fox Party. The Obama Party is larger, but it is unfocused and its troops are whiny. The Fox Party, which shows up en masse to harass politicians, is noisy and practiced in the art of simplistic obstruction. As the health-care debate rages, it's the Party of Sort-of-Maybe-Yes versus the Party of Hell No! The Yessers are more lackadaisical because they've forgotten the stakes—they've forgotten that this is the most important civil-rights bill in a generation, though it is rarely framed that way.

The main reason that the bill isn't sold as civil rights is that most Americans don't believe there's a "right" to health care. They see their rights as inalienable, and thus free, which health care isn't. Serious illness is an abstraction (thankfully) for younger Americans. It's something that happens to someone else, and if that someone else is older than 65, we know that Medicare will take care of it. Polls show that the 87 percent of Americans who have health insurance aren't much interested in giving any new rights and entitlements to "them"—the uninsured.

But how about if you or someone you know loses a job and the them becomes "us"? The recession, which is thought to be harming the cause of reform, could be aiding it if the story were told with the proper sense of drama and fright. Since all versions of the pending bill ban discrimination by insurance companies against people with preexisting conditions, that provision isn't controversial. Which means it gets little attention. Which means that the deep moral wrong that passage of this bill would remedy is somehow missing from the debate." more

The Republicans Want to Leave Insurance Company Bureaucrats In Charge of Your Health Care

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How much an alternative plan would save in premiums required

Enough of The Mob!

Republicans Propagating Falsehoods in Attacks on Health-Care Reform

By Stephen Pearlstein Washington Post

"The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems."

Health-Care Reform: How the Bills Stack Up

Click on this link to see the health care bills compared in the House and Senate.

Enough of The Mob

Washington -- The Democratic National Committee today released a new web ad "Enough of the Mob" highlighting the angry mobs of a small number of GOP and special interest backed rabid right wing extremists who are disrupting thoughtful discussions about the future of health care in America taking place in Congressional Districts across the country.
"It's become clear that Republican leaders, having lost every major legislative battle on Capitol Hill, the confidence of the American people and two consecutive national elections, would rather incite angry, special interest funded mobs and disrupt and drown out legitimate discussion of the issues instead of working for real solutions for the American people,” said DNC Communications Director Brad Woodhouse.
“This activity is reminiscent of the manufactured, Republican Congressional staff protests during the Florida election dispute in 2000 and the more recent displays of right wing extremism at McCain-Palin rallies in last year’s election. These acts of mob rule are a direct result of and are being encouraged by Republican leaders who have vowed to ‘break’ the President for political gain and who have said that they hope that the President fails. This is the very type of anger and extremism that cost Republicans dearly in 2008 – and it is bound to back fire again.”

The "spontaneous" crowds at health care reform rallies

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Organizing for Health Care Reform

Why do we need health-care reform? Everything is fine just the way it is.

What’s Not to Like?

Reform? Why do we need health-care reform? Everything is just fine the way it is.
By Jonathan Alter | Newsweek Web Exclusive

Jul 31, 2009

Go ahead, shoot me. I like the status quo on health care in the United States. I've got health insurance and I don't give a damn about the 47 million suckers who don't. Obama and Congress must be stopped. No bill! I'm better off the way things are.

I'm with that woman who wrote the president complaining about "socialized medicine" and added: "Now keep your hands off my Medicare." That's the spirit!

Why should I be entitled to the same insurance that members of Congress get? Blue Dogs need a lot of medical attention to treat their blueness. I'm just a regular guy and definitely deserve less.

I had cancer a few years ago. I like the fact that if I lose my job, I won't be able to get any insurance because of my illness. It reminds me of my homeowners' insurance, which gets canceled after a break-in. I like the choice I'd face if, God forbid, the cancer recurs—sell my house to pay for the hundreds of thousands of dollars in treatment, or die. That's what you call a "post-existing condition."

I like the absence of catastrophic insurance today. It meant that my health-insurance plan (one of the better ones, by the way) only covered about 75 percent of the cost of my cutting-edge treatment. That's as it should be—face cancer and shell out huge amounts of money at the same time. Nice.

I like the "lifetime limits" that many policies have today. Missed the fine print on that one, did you? It means that after you exceed a certain amount of reimbursement, you don't get anything more from the insurance company. That's fair.

Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.

Yes, the insurance company status quo rocks. I learned recently about something called the "loading fees" of insurance companies. That's how much of every health-care dollar gets spent by insurance companies on things other than the medical care—paperwork, marketing, profits, etc. According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in "loading fees." Even good insurance companies spend close to 30 percent on nonmedical stuff. Sweet.

The good news is that the $8,000 a year per family that Americans pay for their employer-based health insurance is heading up! According to the Council of Economic Advisers, it will hit $25,000 per family by 2025. The sourpusses who want health-care reform say that's "unsustainable." Au contraire.

And how could the supporters of these reform bills believe in anything as stupid as a "public option"? Do they really believe that the health-insurance cartel deserves a little competition to keep them honest? Back in the day, they had a word for competition. A bad word. They called it capitalism. FedEx versus the U.S. Postal Service, CNN versus PBS—just because it's government-backed doesn't mean you can't compete against it. If they believed in capitalism, the insurance companies would join the fray and compete.

I'm glad they don't. I prefer the status quo, where the for-profit insurance companies suck at the teat of the federal government. Corporate welfare's what we've got, and it's a damn good system. Through a wonderful program called Medicare Advantage, the insurance companies receive hundreds of billions of dollars in fees to administer a program that the government is already running. Don't touch that baby. You'd be messing with the handiwork of some fine lobbyists.

You know what part of the status quo I like best? It's a longstanding system for paying doctors called "fee for service." That's where doctors get paid for each procedure they perform, as if my auto dealer got paid separately for the steering wheel, brakes, and horn instead of for the car. Fee-for-service is why the medical care at that doc-in-a-box at my mall is so superior to the Mayo Clinic or Memorial Sloan-Kettering Cancer Center, where the doctors are on salary. Who would want to mess with that?

OK, if you really press me, I'm for one change. It's the one that Republicans trot out to prove they're "reformers," too. We could save our whole system if we just capped malpractice awards. Two of our biggest states—California and Texas—did it a few years ago and nothing has changed there, but who cares? It sounds good.

So tell your congressmen and senators when they're home for the summer recess that it's too soon to address this issue. We've only been debating it for 97 years, since Theodore Roosevelt put national health insurance in the Bull Moose Party platform of 1912. We've only had 745 congressional hearings on the subject (I made that number up, but it's got to be close). That's not enough! Let's study this problem more before we do anything about it.

Did I say "problem"? Who said there was a problem? Not me. I like the status quo.

Find this article at http://www.newsweek.com/id/209817

© 2009

There may be hope yet for a public plan

Tapped: The Group Blog of The American Prospect

July 28, 2009



IS IT HEALTH CARE PANIC TIME?

Like Dana, I'm extremely dismayed by what I see coming out of the Max Baucus committee. But TAP alum Ezra Klein cautions that this isn't the final version of the bill and that there may have to be some concessions for liberals to go along too:

The question is whether Baucus's final product will matter. Rockefeller and the other Democrats on the committee have felt excluded from the negotiations and will want major changes before they can sign onto the final product. Then the Finance bill will have to be reconciled with the more liberal legislation built by the HELP Committee. Then it will have to go to the floor, where it will need the support of people like Russ Feingold and Bernie Sanders and Sherrod Brown just as much as it will need Ben Nelson and Evan Bayh. And then, if it passes those tests, it will have to be reconciled with the House's legislation.
It's frustrating to see this group of conservative senators having so much influence on the health-care bill, not only because the states represented make up a tiny proportion of the population relative to their influence but also because their political interests lie in making reform as ineffective as possible in order to ensure reform doesn't pay political dividends for their opposition. But Klein adds some useful context to think about as Baucus and friends strip almost everything useful out of the finance committee's version of the bill.

-- A. Serwer

Posted at 11:57 AM | Comments (1)

MUMBLINGS ON THE FINANCE COMMITTEE HEALTH BILL.

The AP has an anonymously sourced report on the compromise health-reform legislation emerging out of the Senate Finance Committee. It isn't looking good. Some features of the bill:

No government-funded public-insurance option, and no national health-insurance exchange. These features of the House tri-committee and Senate HELP bills are intended to bring down costs by fostering competition on the largest scale possible. Instead, Finance is suggesting regional health co-operatives in which private insurers compete without government intervention. This is likely to lower premiums somewhat, but the smaller size and geographic reach of the co-ops will make them far weaker than a national exchange. And no for-profit company is likely to offer a plan as inexpensive as national public insurance.
An individual mandate to buy health insurance, but no employer mandate. This is regressive. Large employers that refuse to offer health coverage to their workers will have to reimburse the federal government for part of the cost of subsidizing those workers' coverage....
BUT Finance also drastically reduces the number of people eligible for subsides, to only those within 300 percent of poverty ($32,490 for an individual or $66,150 for a four-person family). Senate HELP subsidizes those within 500 percent of poverty and the House bill subsidizes those within 400 percent. Those plans are far more supportive of middle-class families and the self-employed.
Like the House and HELP Committee, Finance would prevent insurers from denying coverage or charging higher premiums because of pre-existing conditions.

House moderates -- like the Blue Dogs -- are likely to grasp on hard to whatever the Finance Committee suggests and run with it, calling it the only politically viable compromise. That's why Finance's proposal is so important. We don't know yet whether Finance, like the House and HELP, will aggressively expand Medicaid coverage. But probably the most worrying aspect of this compromise is how drastically it weakens competition, by asking insurance companies to compete only on a regional basis, and only with one another. This is a plan that leaves employers and insurers in the power seats, while giving consumers far less support than either of the other reform proposals on the table.

--Dana Goldstein

Public Says It's Smarter Than Congress on Health Care

While almost half of Americans believe they have a good understanding of the issues involved in proposals to overhaul the health care system, two-thirds do not believe the same about the lawmakers who will vote on them, according to a Gallup poll conducted July 26.

Would you say that you/members of Congress have a good understanding of the issues involved in the current debate over national health care reform, or not?



Fifty-eight percent of Republicans say they personally have a good understanding of the issues but only 20 percent believe that's true of Congress. Forty-seven percent of Democrats regard themselves as knowledgeable on health care with 34 percent saying they believe Congress understands the issues too. Forty-one percent of independents say they know the issues, but only 26 percent say Congress does.

Dear Mr. President- No Government-Run Health Care

From Daily Kos:

Dear Mr. President
by Hunter
Sat Jul 25, 2009 at 02:20:04 PM PDT

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.


But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all. Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.


I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Study Links Rise in Health Care Costs to Job Losses

Business Week July 23:

In a first-of-its-kind study, the non-profit Rand Corp linked the rapid growth in U.S. health care costs to job losses and lower output. The study, published online by the journal Health Services Research, gives weight to President Barack Obama’s dire warnings about the impact of rising costs if Congress does not enact health care reform.

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of “excess” growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP.

For example, the study estimated that a 10% increase in excess health care costs would reduce employment by about 0.24 percent in the motor vehicles industry, where 80% of workers are covered by employers. The retail industry, however, where only one third of workers are covered, saw only a 0.13% percent drop in employment. Economy-wide, a 10% increase in excess health care costs growth would result in about 120,800 fewer jobs, $28 billion in lost revenues, and $14 billion in lost GDP value.


This study provides some of the first evidence that the rapid rise in health care costs has negative consequences for several U.S. industries,” said Neeraj Sood, the study’s lead author and a senior economist at RAND. “Industries where more workers receive employer-sponsored health insurance are hit the hardest by rising health care costs.
To rule out the possibility that the economic effects were caused by some other industry-wide factor, the researchers compared U.S. industries with their counterparts in Canada, which has publicly financed universal health care. They found no similar percent change in employment in the corresponding Canadian industries over the 19-year study period.

The rate of growth in U.S. health care costs has outpaced the growth rate in the gross domestic product (GDP) for many years. In 1940, the share of GDP accounted for by health care spending was just 4.5%. By 1990, it had reached 12.2%, and 16% in 2005, when health care spending totaled nearly $2 trillion, or $6,697 per person, far more than any other nation. This year health care spending is on track to equal 18% of GDP.

RAND researchers underscore that their findings do not necessarily mean that rapid growth in health care costs results in large job losses in the overall economy, since losses in industries that cover most of their workers are at least partially offset by gains in those industries that don’t insure. Of course, the workers themselves may not find those jobs equivalent.

The study was partially funded by Bing Center for Health Economics at RAND and the U.S. Department of Health and Human Services.

Republicans Motivated by Partisanship In Resisting Health Care Insurance Reform

Health care reform makes progress and republicans try to stop it.

The mainstream media is taking their dictation this week from the mega-healthcare corporations that have been spending $1.4 million a DAY to block any change to our national health care system. They are feeding the Republican lie machine with the money they are spending. Who is our lobbyist up there in the capital? The answer is: President Obama.

Did you know that 4 million Americans have lost their health care coverage since 2008? Are you happy with your coverage? Really? How much have your co-pays and deductible risen in the past two years? Do you know how much you are paying in health care expenses a year?

President Obama is committed to enacting health care reform that lowers costs, provides choice- including a public option, and ensures all Americans access to quality, affordable care.

The President supports the creation of a health insurance exchange - a one stop shop, where people can compare and contrast plans and pick the one that’s right for them. A public option in the exchange will increase competition and keep insurance companies honest, expand consumer choices and keep costs low.

To keep preserve what’s best about our system, we have to fix what’s broken and build on what works. No matter how we reform the system, if you like your health care plan, you will be able to keep your health care plan.

This week, GOP leaders in Washington have made it clear that they have no intention to help fix our broken health care system.

In fact, Republican leadership is openly encouraging members to engage in “every activity” to slow down reform.
– South Carolina Senator Jim DeMint (R) called health care President Obama’s “Waterloo” and said it would “break him.”
– The GOP is playing politics with our health.
– Instead of siding with America’s families and businesses, they are protecting the mega-healthcare corporations in Washington, DC and doing everything they can to maintain the status quo.
– Instead of fixing our broken health care system, the GOP would rather score political points and prevent millions of Americans access to quality, affordable care.

Insurance Companies
– President Obama does not think the government can or should run health care. But he also doesn’t believe health insurance companies should be able to do whatever they want.
– Health care reform will rein in insurance companies and put an end to unscrupulous health insurance industry practices that bankrupt families and undermine American businesses.
– A public option will increase competition and keep insurance companies honest, expand consumer choices and keep costs low.
– Health care reform will end the worst practices of the insurance industry.

Insurance companies will not be able to:
· Deny people coverage because of a pre-existing condition
· Set yearly or lifetime caps.
· Drop people from their plan when they become ill.

When I hear local people contend that they like the health care system like it is I am amazed. Being a physician I know their tricks and their motives. For health insurance companies it isn't just about making a profit, it is about making ever-increasing profits. That is what their stockholders expect and they don't care one whit about the financial burden that they have to shift on to the backs of their policy holders. Without legitimate reform more and more people will go uninsured and seek care in our publicly funded emergency rooms, driving the cost of care even higher. Premiums will continue to out pace inflation and co-pays will continue to increase at a frightening rate. We can cover everyone in this country. We can also afford it. In fact, without health care reform Medicare and Medicaid alone will bankrupt this nation. We need real change NOW!

What it Costs Doctors to Fight Insurance Companies to Get Paid

What Does It Cost Physician Practices to Interact with Health Insurance Plans?

Synopsis
A national study of nearly 900 U.S. physicians and medical group administrators found that physicians spent on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 on average per physician, per year.

The Issue
Administrative costs are high in health care. While those incurred by physician offices are a contributor to overall administrative costs, very little information has been available regarding the costs physician practices incur when they interact with health insurance plans. The authors surveyed a national sample of physicians and medical group administrators to ascertain how much time physician practices spent interacting with health plans on prior-authorization requirements, pharmaceutical formularies, claims, credentialing, contracting, and quality data. The study examines in depth the extent of such interactions, generating both time and dollar value estimates for such administration.

Big Questions About Deals Whitehouse is Making with the Big Players in Healthcare

White House, health industry deals raise questions about quid pro quos for private sector.
In a front page story, the New York Times (7/8, A1, Herszenhorn, Stolberg) reports, "The deals, trumpeted loudly by the White House, would each help pay for a sweeping overhaul of the healthcare system." But the promises by health industry groups, drugmakers and hospitals to save the government billions in healthcare costs, hailed as "historic" by the White House, have come with almost no discussion of "what the industry groups will be getting in return for their cooperation, whether or not the promised savings ever materialize." But in spite of the White House's deal making, "some lawmakers said the deals, while seemingly helpful, could raise false expectations by obscuring how much the industry is demanding for its concessions." A rumored deal in the works with doctors "could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements."

Lobbyists Descend on Congress to Do the Bidding for Corporations

Washington Post

Familiar Players in Health Bill Lobbying
Firms Are Enlisting Ex-Lawmakers, Aides

The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

The push has reunited many who worked together in government on health-care reform, but are now employed as advocates for pharmaceutical and insurance companies.

... public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate, and that it further illustrates the problem posed by the "revolving door" between government and private firms.

"The revolving door offers a short cut to a member of Congress to the highest bidder," said Sheila Krumholz, executive director of the Center for Responsive Politics, which compiled some of the data used in The Post's analysis. "It's a small cost of doing business relative to the profits they can garner."

Senator Ask's Aetna Why Texas Man With Insurance Owes $200,000

New York Times July 2nd.
Late last week Senator Charles Grassley sent a letter to Aetna insurance to ask why a policy they sold a Texas man didn't cover his hospital expenses.

"The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis.

Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December.

Senator Grassley, the ranking Republican on the Senate Finance Committee, has also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold.

“I remain concerned about health insurance plans that may appear to offer more coverage than they do and the effect subsequent underinsurance may have on the health care system as a whole,” Mr. Grassley wrote to Aetna’s chief executive, Ronald A. Williams."

In an article in the NYT last Tuesday entitled "Insured, but Bankrupted by Health Crises" Reed Abelson describes the specifics of Mr.Yurdin's case:

"...One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital...
"..“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
"...Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there."

Frontline: Sick Around the World

Health Insurers Have Cheated Consumers Out of Billions of Dollars

On Tuesday the Senate Commerce Committee released a report showing that health insurers have cheated consumer's out of billions of dollars. Though that amount seems astounding, most of us have experienced the methods used by these giant corporate criminals to extort that money from us. If you have ever had a claim denied on the basis of a clause in your policy that you didn't even know about then you have been a victim of these cold hearted bastards. Have you ever read the fine print in your health insurance policy? Most people who aren't lawyers haven't. According to testimony in the hearing the policies are written to confuse consumers on purpose.

According to the Washington Post article:

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

"...Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged..."

In New York State Attorney General Andrew Cuomo has discovered that health insurers bilked consumer's out of millions of dollars by underpaying for out-of-network physicians and hospitals. The accomplished this by using rates determined by a database OWNED by United Health Care called Ingenix. The AG asserted in court that this database was routinely "scrubbed" of justifiably higher rates and "low-balled usual and customary rates and shifted costs from insurers to their customers.."

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

We desperately need to have a reasoned debate about the reform of health care and I know that everyone involved in delivering health care has contributed to the burden it places financially on everyday Americans. Cuomo's findings just proved what most of us have known for a long time. This hearing was a shot fired across the bow of the ship of the insurer's who have been playing hard ball to undermine real reform of the system they profit by. Many more salvos are to come and the debate seems to swing back and forth. It isn't easy to figure out what will work better than the crazy quilt of a system we now have. Don't be mislead by easy answers because they are the ones that will leave us stuck with a dysfunctional result.

New Poll: Majority of Americans Support Public Health Insurance Option

This past week the republican lie machine has aimed it's magic words against any true reform of our broken health care system. All they have had to do to delay reform is to invoke the word's "government run" "socialized" "bureaucrats" "expensive" and "between you and your doctor" and the MSM (mainstream media) have panicked. Practically all you heard about the, still being debated, proposals was that the "public option" was dead. The public option was the plan to give Americans the option to enroll in a government sponsored non-profit making health insurance plan.

Of course when the republicans heard non-profit they knew instantly that it was a communist plot and a covert plan to turn our democracy into a socialist dictatorship, and I am not exaggerating!

Never doubt the power of a lie told often enough to become the "truth". The fact is that there is nothing a public plan would do but provide an option of a lower cost plan to poor Americans. Of course it would also pressure insurance companies to lower their prices and compete for customers. As it is the only customers the giant health insurance companies have competed for are the young and healthy. If you were sick, old or cost them a lot in claims they dumped you. If you ONCE had an illness they dumped you. For years now these greedy money mongers have had all of the power and few competitors. Because of that dynamic they have dictated the terms of coverage, co-pays, deductibles, which doctors we could see, which hospital we could go to and which procedures were medically necessary. In other words, if you want to see what it would actually be like for someone to stand between you and your doctor, just think about your health insurance company's rules.

Ralph Hall brings the Republican Lie Machine to a "Town Meeting"

On May 27th I witnessed one of the slickest displays of marketing I have ever seen. Marketing is that skill the Bush white house used so skillfully to first confuse voters and then later to fill their heads with propaganda. And for most of the past eight years it worked to further a Reaganistic vision of big bid'ness first and the hell with the rest of society. War was the answer to all international conflicts whether they were real or not. Wall Street was allowed to run hog wild and every other regulatory agency was turned into a frat house for Bush's incompetent buddies. Anyway, back to the meeting. It was titled "Americanize US Health Care Not Socialize". Ignoring the lack of proper grammar, we got the point. It turned out to have been sponsored by the Dallas Association of Health Underwriters-basically insurance sales people who sell plans to employers.

I had never seen Congressman Hall speak and I was impressed. His entire biography was read out loud as his introduction and from most of the folks attending he received a greeting appropriate for a hero. Then he feted Bush who he felt was a "great" President and trashed Obama. That got the crowd aroused with feelings of righteous indignation and anger. Then he turned folksy and went into what I can only describe as a Will Rogers mode telling funny jokes on himself and others just to show he wasn't really a mean person. When he finally spoke at all to the issue at hand, Health-Care Reform he began to paint it as essentially a back door approach to introducing a communist style of socialism to America. A woman behind me stood up to shout that "this isn't a communist country!".

It was at the point that I spoke out loud to interrupt the flow of jingoism and misinformation that was emanating from the stage. I shouted that I objected to the whole premise of calling it a community forum to share information about the details of the coming Health-Care Reform legislation with only representatives of the insurance industry allowed to present. In turn I was shouted back at by the audience and I must say that the congressman was polite. When I asked why other stakeholders in the process of reform weren't invited he just didn't respond to my question. Then several more democratic activists stood up to speak with more direct criticisms, like the perception that the insurance brokers were just afraid of losing their jobs and they were willing to destroy the mission to provide insurance to the poor to save them. Chaos ensued for a short while then the next speaker was introduced.

Reid Rasmussen, a former citizen of Canada, was next to speak. There wasn't much he said that wasn't a distortion of the facts. He intimated that when Hillary Clinton proposed over hauling health care that "he heard" "someone" suggest that her proposal was simply to adopt the Canadian model of a government run health care system. Then without a skip in his rapid fire banter he inferred that President Obama was proposing the same thing. In fact no such thing has been proposed by Obama and no such proposal has been considered in either the Senate's Finance or Health, Education, Labor and Pensions Committees where the legislative proposals for heath care reform are being considered.
A proposal has been made to offer a public plan option as part of a wide range of health insurance programs.

In the time I was there the only constructive information I heard was from the second speaker, Ron Dobervich. He spoke about ways in which consumers can be more assertive and informed about their care. He advocated that people keep a copy of all of their medical records, shop for lower prices for procedures and negotiate with physicians about their fees. He gave a very accurate map of the wide variance in prices for health care within a given city. I left at this point but many more brave democrats spoke out that night after me. So what started out to be a marketing plan by insurance salespeople actually turned into a real town meeting.

The Laws Broken by the Bush Administration's Office of Legal Oversight

Visit msnbc.com for Breaking News, World News, and News about the Economy

Why the Torture Memos Matter

Despite the claim of Shepard Smith on Fixed News that "We are America! We don't f--king torture" we did and there is a record of the memos that lead to the legal opinions that supposedly justified it. Dank Is Back on Daily Kos put together a detailed summary of the timeline involved in manufacturing the memos. Five days after 9-11 Dick Cheney went on Meet The Press and basically endorsed torture being used to interrogate suspected terrorists. In less than a month they sent former CIA director James Woolsey to England "In search of evidence connecting Iraq to the 9-11 attacks.." This obsession with proving the non-existent link between the 9-11 hijackers and Saddam Hussein was THE driving force behind the use of torture. To date there is simply no evidence that torture ever prevented an attack on the U.S. What it did do was ruin the whole worlds image of who we are as a nation.
When a President and Vice President talk lawyers into writing memos ignoring Common Article 3 of the Geneva Conventions and using transparent semantic tricks to label acts of torture as something else, it was not only wrong, it was a criminal act.
And like all of the criminal acts of the Bush-Cheney administration they acted against the best advice of experienced councils like Colin Powell and Richard Clarke. They made these decisions in secret, without the consent of congress and the American people as though they were a monarchy. They didn't order a study of interrogation methods and their effectiveness, they didn't ask the military what they thought and they ginned the memos to cover the CIA folks who knew they would be hung out to dry by the next administration. In other words, like everything else their administration did they displayed a contempt for the rule of law, treaties and civil liberties. That is why the torture memos must be pursued to their source and the perpetrators tried in a court of law.