health care reform

The House Public Plan: Yes, It's Worth It

Jacob S. Hacker — Fri, 06 Nov 2009 09:54:28 -0800

with Diane Archer

How short memories are in Washington. A few weeks ago, when it looked possible that Nancy Pelosi could marshal enough Democratic support to create a “robust” public insurance option with rates tied to Medicare’s, everyone was talking about the big savings and reduced premiums that a series of estimates by the CBO showed this option could create. Then, the concern was that the public insurance plan would put private insurers out of business by using the government’s bargaining power to drive too hard a bargain with providers, creating an “un-level” playing field.

Now, however, the punditocracy is abuzz about the latest CBO estimates that show that the public plan eventually embraced by Pelosi--one that would negotiate rates with providers, rather than base them on Medicare’s--might actually charge higher premiums than the average private plan. No matter that the CBO estimates clearly state that the higher projected premiums reflect its expectation that the public plan will disproportionately enroll less healthy Americans--which might be seen as a virtue, since these are folks private insurance tends to serve most poorly. And no matter that a subsequent CBO letter to the House stated that even a public plan with negotiated rates would still place “downward pressure on the premiums of private plans.” Suddenly, in the commentariat, the public plan isn’t a fearsome predator. It’s a complacent kitten. Initially not worth having because it would be too strong, it’s now, according to critics, not worth having because it would be too weak.

In truth, both the initial fears and current dismissals are overblown. The CBO’s declining estimates of savings certainly make a strong case for having the public plan use modified Medicare rates, as we have long argued. It’s a shame the House will not be considering a bill that shows how substantially a public plan can contribute to freeing up federal dollars to help Americans afford coverage. But we should keep in mind that the prime argument for the public plan has never been about a particular payment formula. It has been that a public insurance plan is vital as an institutional check on private plans, its role evolving to reflect the emerging weaknesses (or strengths) of regulated private competition. Put simply, health reform is much more likely to succeed with a public health insurance option, even one with negotiated rates, than if private insurers are left to run the show.

Let us start with the obvious: No one knows for sure the exact role that the public option will play. CBO may be correct that the public plan will attract a less healthy pool of enrollees, and that risk-adjustment (paying plans with higher-cost patients more) will not fully compensate for this. And it is surely correct that the public plan will have lower administrative costs than private plans. (It should be emphasized that if the public plan has higher premiums primarily because it’s attracting less healthy enrollees, then it is still reducing average premiums and hence federal subsidies for premiums. That’s because average premiums would be even higher if the people enrolled in the public plan enrolled in private plans. That’s what the CBO’s more recent letter discussing “downward pressure” on private premiums implies.) But while the CBO estimates are rightly the authoritative source for Congress, they are by no means infallible. CBO has made clear that an unusually high level of uncertainty attaches to its analysis of the public plan.

Take the CBO’s projections that the public plan would pay the same rates as the private sector. Nothing in the bill requires this. The Secretary of Health and Human Services, empowered to negotiate rates for the public plan, is simply barred from paying more than private plans do. The Secretary may end up being able to negotiate lower rates than the CBO projects. (When this issue was being debated in the House Energy and Commerce Committee, Secretary Kathleen Sebelius actually suggested that she could get better rates than Medicare, which raised more than a few eyebrows.) If the public plan is able to obtain more favorable rates, it will not only lower its premiums and increase its membership. It will also, through competition, bring down private plan rates. Private insurers overpay preferred providers at least in part because it’s a way for the insurers to keep competitors out of the market. But if a public plan is now in the mix, the game changes, and insurers may finally feel pressure to drive greater efficiencies.

The same uncertainties surround the CBO’s prediction that the public plan will attract just one in five Americans within the health insurance exchange because of its higher projected premiums (down from earlier estimates of one in three). After all, the price of coverage is only one reason why people choose a health plan. The vast majority of older and disabled Americans enroll in the public Medicare plan--even though by choosing (excessively subsidized) private Medicare private plans, many can get broader benefits for less than they pay for Medicare plus supplemental insurance. By the same token, nonelderly Americans--even healthy non-elderly Americans--might be willing to pay a little more for a public plan if it offers the same transparency and accountability the public Medicare plan offers. Healthy people might choose the public plan because they will have the security of knowing that if they get sick or injured and need costly care, their plan will not be conjuring up ways to deny them needed coverage. (To be sure, if the private plans were required to be transparent about the services they covered and the rates they paid, it might be a different story. But the current congressional bills do little to require they disclose this data to enrollees.) And, of course, the more healthy people join the public plan, the more bargaining power the public plan will have and the more public plan rates will come down.

The public plan is also critical to reform as a cost and quality benchmark, one that is particularly crucial if private premiums accelerate upwards. The insurance industry has threatened that premiums will skyrocket if an individual mandate is not tough enough. It may be an idle threat, but if a final reform bill ends up looking more like the Senate Finance bill than the House bill, it might not be. In most local markets, competition is likely to be anemic, and regulation of insurers inadequate. There will be little to prevent insurers from raising rates as they have threatened.

Having a public plan in place should also help keep down the rate of growth of health insurance premiums over time. Over the past twenty years, the public Medicare plan has had a substantially slower rate of growth than private insurance. The CBO report on the House bill states that private insurers are better at controlling utilization than a public plan would be. But, to date private insurers have failed to prove their value at cost control and demonstrated they have strong incentives to delay and deny needed care rather than drive efficiencies in the system.

And remember: If the private plans continue to misbehave, drive up costs excessively, and otherwise engage in practices that are detrimental to our health security, Congress can later decide to strengthen the public plan and give it greater leverage to rein in costs and serve as a check on private insurers. Creating a public plan down the road is not realistic; that's one reason we seriously doubt any proposal to trigger the public plan would really work. Strengthening an existing public plan would be a far more likely prospect, especially if the public plan is proving its value in the market, as we believe it will.

What’s more, as far as payment and delivery system innovations are concerned, the public plan is really the only tool available for testing and implementing reforms in the market for the non-elderly. Private plans are notorious for keeping their innovations private--when they have them--and have little financial incentive to improve health care if it will not increase their bottom line. Yes, we can continue to rely on the public Medicare plan to test innovations. But working families have somewhat different needs, and it seems appropriate to pursue delivery and payment reforms more broadly, through both Medicare and a public plan focused on those younger than 65.

In short, it’s no time to be despondent about the fate of the public insurance option. For sure, pegging rates to Medicare and obligating Medicare providers to accept these rates would be far preferable, and a public plan with negotiated rates may do less to keep the insurers honest and drive down costs. But it’s still immensely valuable to give Americans an out--another choice--to let the insurers feel the heat of not being the only game in town. The fierce and continuing opposition of the insurance industry suggests that they think that a public option will prove a serious counterweight in an increasingly consolidated private market. The overwrought pessimism of the pundit class should not aid them in their cause of protecting themselves from a public-spirited competitor.

This article originally appeared in The New Republic.

Progressive Breakfast: The Net Domestic Product

Isaiah J. Poole — Fri, 30 Oct 2009 06:30:34 -0700

The daily Progressive Breakfast serves up what progressive movement members need to know to start their day. Bill Scher is traveling; he will return Monday.

Thursday's news that the nation's gross domestic product grew at an annual rate of 3.5 percent in the third quarter comes with a lot of asterisks. A few of them:

*The Wall Street Journal reports that the White House recovery plan will claim responsibility today for creating or saving 650,000 jobs with a bit less than half of the $339 billion in recovery funds spent through September 30. "The White House sees the data as proof that its $787 billion American Reinvestment and Recovery Act of 2009 will meet its goal of creating or saving at least 1 million jobs," the WSJ writes.

*John Authers of the Financial Times critiques what helped drive the GDP increase:

Household disposable incomes actually fell during the quarter, by 3.4 per cent, but consumer spending rose, also by 3.4 per cent. This is not a pattern that can be sustained for long, and it is inconsistent with the need for US families to pay down their debts.

Consumption rose largely because of a huge increase in expenditure on durable items, led by motor cars. Government subsidies through the “cash for clunkers” programme, removed before the quarter had ended, largely explain this.

Meanwhile, tax credits for homebuyers, which helped revive activity in the housing market, are due to be withdrawn later this year. The question now is whether higher consumption can be sustained without government support.

... Thursday’s new data on initial claims for unemployment insurance confirmed that the rate of the rise in joblessness has slowed significantly – but the jobless rolls are still rising faster than at any time this decade, before the financial crisis took hold.

*At BusinessWeek, Michael Mandel sees in the numbers evidence "that companies are robbing the future to pay for short-term profits," and if we measured economic growth to take into account the impact of these business decisions, we'd find GDP growth to be significantly lower:

...[T]he official statistics are not designed to pick up cutbacks in "intangible investments" such as business spending on research and development, product design, and worker training. There's ample evidence to suggest that companies, to reduce costs and boost short-term profits, are slashing this kind of spending, which is essential for innovation. Without investment in intangibles, the U.S. can't compete in a knowledge-based global economy. Yet you won't see that plunge reflected in the GDP and productivity statistics, which are still too focused on more traditional sectors, such as motor vehicles and construction.

... Over the past year, U.S. employment of scientists and engineers—the people who create the next generation of products and make the U.S. more competitive over the long term—has fallen by 6.3%, according to a BusinessWeek tabulation of unpublished data. Yet overall employment has fallen only 4.1%. "There are really bright people who are struggling to find a job," says Josh Albert, managing director at Klein Hersh International, an executive search firm for life scientists.

*Bloomberg News reminds us that the future prognosis is for anemic growth:

The economy will likely grow at a 2.4 percent annual rate from October through December, the median forecast in a survey

earlier this month showed. GDP will also grow 2.4 percent next year and 2.8 percent in 2011, the survey showed, compared with an average of 3.4 percent growth over the past six decades.

*In Olathe, Kansas, a suburb of Kansas City, a side effect of the economic downturn is playing out that is happening around the country. From The Olathe News:

The Olathe Salvation Army Food Pantry continues to see an increase in people needing help during these difficult times. The need, however, has changed in recent months.

“We’re seeing people we normally don’t serve,” said Mindia McManness, volunteer coordinator for the Olathe Salvation Army. “They call us not knowing even how to get help because they’ve never needed it before. They don’t know where to begin.”

They’ve lost their jobs or are experiencing other difficulties because of the floundering financial markets.

“They’ve run out savings or maxed out credit cards, something that usually helped them through short-term difficulties in the past,” McManness said.

This recession has gone on much longer than expected, and the impending recovery will take even longer, leading to a new pool of people needing assistance.

Shelves once filled with canned corn, spaghetti noodles, chili, pork and beans or peanut butter and jelly are empty more frequently, and tight food supplies have become the rule, not the exception, all around the metro area.

Health Care: House Moves Ahead

House Democrats unveiled the long-awaited health care reform legislation Thursday that will be up for debate on the House floor, and the best that can be said about it, at least according to a headline this morning on Politico, is that "liberals don't bolt" from it:

...[T]he bill [House Speaker Nancy Pelosi unveiled Thursday includes big pieces of what the most liberal members of her party wanted — most likely setting up a serious battle when negotiators try to merge it with the far more moderate Senate legislation.

The public option stays, even if it’s not the same one the House speaker preferred. So, too, does the so-called millionaire’s tax to help offset the $894 billion price tag. Individuals will be required to own insurance. Most employers will be legally mandated to offer it.

And in return, the House speaker won assent — if not complete agreement — from the liberals in her caucus, as well as a surprising amount of support from Democratic moderates who have long railed against some of these provisions.

Liberals expressed frustration that the speaker bowed to political reality by allowing doctors and hospitals participating in the public option to negotiate payments directly with the Department of Health and Human Services, and some promised to request an amendment that would allow them to scrap the current plan for one tied to Medicare. But few pledged to vote against the bill.

Adele Stan at AlterNet says that at least the House bill is "almost (dare we say it?) progressive" when compared to what's pending in the Senate:

So, okay, it isn't the "robust" public option promised to AlterNet readers by Ways and Means Committee Chairman Charles Rangel, D-N.Y., this summer, but it doesn't include that silly opt-out plan. Unlike the lonely Harry Reid, who stood alone to face reporters on Monday, Pelosi was surrounded by members of her caucus, all smiles. Implicit in her timing was a message to the Senate: Keep noodling all you want, but here's a bill, a decent bill -- the bill we're gonna pit against yours in a conference committee if you ever get around to passing one. So, you might want to hop to it. And the more yours looks like ours, the easier it's gonna be for all of us.

As for the compromises in the House bill...

The deficit neutrality of the House bill presumably wins the support of the White House, while the less-than-robust public option seems to have passed muster with the big labor unions, who are surely influenced by another important distinction between the House and Senate bills: the House bill helps pay for itself through a new tax on the nation's most well-off citizens, while the yet-to-be-finalized Senate bill will likely pay for part of its cost by taxing high-priced, fully-loaded health-care plans -- like the plans many unions have negotiated in lieu of salary increases (and even as trade-offs for give-backs) by their members. Within hours of Pelosi's unveiling, both the AFL-CIO and the Service Employees International Union (SEIU) released statements praising the House bill.

Some ConservaDems are still refusing to get behind the House bill, reports McClatchy's David Lightman, claiming they need to hear from constituents:

"The plan on the table has some good points and some bad points. I want to look at it," said Rep. Lincoln Davis, D-Tenn.

Blue Dogs wanted to hear from constituents, many of whom are more conservative than those represented by most Democrats. "I have both sides of the health care debate well-represented in my district," said Rep. Allen Boyd, D-Fla.

... Blue Dogs and some party moderates have been concerned about the plan's cost, as well as its impact on small business and expansion of government. Those concerns remain.

But Pelosi thinks that there's already been so much debate on the merits and impact of all aspects of the legislation that she wants the nearly 2,000-page bill to face an up-or-down House vote without a lengthy amendment process. Ryan Grim at The Huffington Post:

House Speaker Nancy Pelosi said Thursday that there's been plenty of time for amendments already, so neither her caucus nor members of the minority party should expect a chance to amend the health care bill when it gets to the House floor.

"I've considered all of that input as our amendment process," Pelosi said on a conference call with bloggers, citing "probably 78 caucuses on this subject where we've listened to members [and] 2,000 town meeting on this subject."

A stinging rebuke of one feature of the House health-care bill comes from FireDogLake's Jane Hamsher, who says as a breast-cancer survivor she felt "tremendous disappointment" that the bill places higher hurdles the marketing of generic versions of biologic anti-cancer drugs:

Nancy Pelosi made a choice with regard to the lifesaving biologic drugs I took when I was in chemotherapy that will cost many of my fellow breast cancer survivors everything they own, and quite possibly their lives. ... Thanks to Representatives Anna Eshoo and Joe Barton, there will be no generic versions of these drugs. At least not for 12 years, if the House health care bill announced today passes. And because of an “evergreening” clause that grants drug companies a continued monopoly if they make slight changes to the drug (like creating a once-a-day dose where the original product was three times per day), they will never become generics. Instead of the Waxman-Deal amendment that granted much more reasonable terms to biologic patent holders, Speaker Pelosi chose the Eshoo-Barton amendment. And we could all be paying for that choice for the rest of our lives.

Hamsher is helping to organize with Public Option Please "treat, not trick" Halloween-themed protests at 3 p.m. at the Russell Senate Office Building, the Baltimore office of Maryland Sen. Barbara Mikulski and the offices of Rep. Sen. Kay Hagan and Rep. Anna Eshoo.

'Too Big To Fail' Reform Too Bad To Work?

The Obama administration's plan to change the rules for so-called too-big-to-fail financial institutions so that taxpayers will not be compelled again to prop them up when they engage in reckless gambles is receiving significant criticism on Capitol Hill. The Washington Post:

Under legislation unveiled this week by the committee chairman, Rep. Barney Frank (D-Mass.), in close coordination with the Obama administration, an oversight council of regulators would act as a monitor of systemic risk throughout the financial system and impose tougher regulatory standards on the largest companies. Compared to an earlier draft put forward by President Obama's team, the current bill expands the role of the council, entrusting it to identify risks to the system. The Fed would be the enforcer of the council's recommendations.

But that structure came under fire from Sheila C. Bair, chairman of the Federal Deposit Insurance Corp., who argued the new council should be headed by an independent chairman rather than by the Treasury secretary, and that the council should have greater authority.

Bair also joined both Republican and Democratic lawmakers in questioning the government's plan to pay for the cost of winding down large, failing financial firms. The plan calls for companies with more than $10 billion in assets to be assessed fees only after a large collapse, rather than contributing ahead of time into an insurance-like fund. [Treasury Secretary Timothy F.] Geithner and Frank have said the intent is to shift the burden of such failures from taxpayers to the financial industry itself, but Bair argued for the insurance approach.

The Washington Independent also details the objections that Treasury Secretary Timothy Geithner faced when he testified before the House Financial Services Committee:

“Mr. Secretary, I’m not a man that fears this administration or you,” Rep. Paul Kanjorski (D-Penn.) told Geithner. “But I do fear the accumulation of power exercised by someone in the future that can be extraordinary.”

Rep. Brad Sherman (D-Calif.) echoed those concerns, arguing that the bill represents “the most unprecedented transfer of power to the executive branch to make decisions about both spending and taxes in history — all without congressional approval.”

... [S]ome lawmakers are attacking the proposed bailout tax on large institutions, arguing that it should be collected beforehand as a type of insurance fund, rather than imposed after a competitor went under.

“No more TARP. No more bailouts,” said Rep. Luis Gutierrez (D-Ill.). “Let them [the companies] create the fund, the systemic risk fund, that will guarantee that the American taxpayer will no longer have to be involved should they cause such a crisis ever again.”

Progressive Breakfast: Hope For The Public Option

Isaiah J. Poole — Fri, 02 Oct 2009 04:14:38 -0700

Despite Sen. Max Baucus's best efforts to pronounce it dead, the public option keeps refusing to die in the Senate.

Senate Majority Leader Harry Reid told constituents late yesterday that "we are going to have a public option before this bill goes to the president's desk," reports the Las Vegas Review-Journal.

"I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us," he said.

It's the latest sign that, as Jon Walker writes on FireDogLake, "progressives have successfully entrenched the demand for a public option." Walker specifically cites the number of public option compromises floating around the Senate, including the idea—reported by Politico—from SEIU chief Andy Stern that states should be allowed to opt out of a public option. (Mcjoan at Daily Kos critiques some of the not-so public-option variations.)

Chris Bowers warns progressives to not get too excited.

...Remember that Harry Reid has previously described his favorite public option in a way that sounds awfully like a co-op.

Here at Open Left, we are not going to take this for granted. Today, we joined with CREDO Action on a petition to President Obama demanding that the public option be included the bill sent to the Senate floor. Remarkably, we are already well over 37,000 signatures today.

There is also Reid's fuzzy language captured by Politico:

"Remember, a public option is a relative term," Reid said. "There's a public option, there's a public option, and there's a public option. And we're going to look at each of them."

Meanwhile, the Senate Finance Committee finished work on its bill after 2 a.m. Friday morning. The Hill summarizes:

The bill would establish state and regional health insurance exchanges for individuals and small-business employees. People with incomes from 133 percent of the federal poverty level and 300 percent of poverty would receive tax credits to help pay for insurance and people below 133 percent would receive Medicaid benefits. The bill would require a total of about $900 billion in new federal spending that would be offset with Medicare and Medicaid spending cuts and new tax revenue.

Snowe and Sen. Chuck Schumer (D-N.Y.) teamed up to offer an amendment, adopted with Minority Whip Jon Kyl (R-Ariz.) as the lone dissenter, to relax the financial penalties in the bill for people who do not abide by the individual mandate to obtain health coverage.

One person to watch next week when the committee is expected to vote on its bill is West Virginia Sen. John D. Rockefeller. Despite his vow to not vote for a committee bill that does not include a public option, he did win a number of concessions that could earn his vote, including exemptions on the excise tax on so-called "Cadillac" health care plans for older workers and those in high-risk jobs.

Other provisions, per the Associated Press:

A new commission designed to wring savings from Medicare to recommend cuts in federal subsidies paid to low-income seniors who have prescription drug coverage under the program.
Exemptions for millions of people from a requirement to purchase insurance that is currently in the bill and reduce the penalties on millions more who defy the mandate.
Permission for states to negotiate for coverage for individuals and families with incomes slightly higher than the cutoff for the Medicaid programs that provides health care for the poor.

Side dishes

The latest Obama administration official to come into the crosshairs of the right is Kevin Jennings, the openly gay man heading the Department of Education's Office of Safe and Drug-Free Schools. Fox News said that he has "promoted homosexuality" in schools and did not report to police an incident in which an "underage student"—Keith Olbermann said on the "Worst Persons" segment of his program Thursday that the student was actually 16 and thus at the legal age of consent—had sex with an older man. Think Progress has the lowdown on this smear, and Emily Douglas tells a personal story about Jennings at The Nation.

Fans of Glenn Beck conveniently ignore, or perhaps are unaware, of the racist beliefs of Beck's idol, W. Cleon Skousen. Skousen's writings about slavery, and his conclusion that "the slave owners were the worst victims of the system," have been excavated by Pam Spaulding on Pandagon.

Right-wing Sen. Jim DeMint is planning to head to Honduras today, in defiance of U.S. policy, to back the military coup that overthrew the elected government of Manuel Zelaya. The AP reports that Republicans Aaron Schock and Peter Roskam of Illinois, and Doug Lamborn of Colorado are heading there with him. Steve Clemons makes what's happening plain: "DeMint is acting on behalf of, in cahoots with, and against the foreign policy of the United States of America in encouraging post-coup Honduran government officials defy the United States. He is encouraging a political leadership which has no legitimacy and which not recognized by other democracies in the region -- while the ousted President makes cell phone UN General Assembly statements from a couch-bed in the Brazilian Embassy in Tegucigalpa." On MSNBC Thursday night, Rachel Maddow asked if the appropriate word for this "begins with T and rhymes with 'reason'."

Bill Scher will return Monday.

Stacey Ritter Lost Everything. CIGNA's CEO Gets Another House

Jason Rosenbaum — Thu, 01 Oct 2009 10:27:49 -0700

Meet Stacie Ritter. She's a hardworking mother of twins who lives in Pennsylvania.

Her daughters, now 11, were diagnosed with leukemia when they were four. They both needed stem cell transplants and other cancer treatments. The twins survived, but the glands controlling their growth were damaged beyond repair from the treatment. To continue growing, they needed doctor-recommended growth-hormone injections regularly.

Stacie's husband's company switched to CIGNA health insurance, and CIGNA refused to cover the hormone shots. Each time Stacie takes her daughters to the doctor for the shots, it costs her $440. Between the cancer treatment and the denied care, Stacie and her husband had to file for bankruptcy.

Meet Ed Hanway. He's the "hardworking" CEO of CIGNA, a leading health insurance company.

Last year, Hanway made $12.2 million. That's $5,883 an hour, enough to cover 12 of the treatments Stacie's daughters need every hour. He has $28 million in stock options. He owns a beach house in New Jersey worth $13 million, one of many mansions he possesses.

Hanway runs CIGNA, which made $7 billion dollars in the last eight years [pdf]. How does CIGNA make money? By denying claims from people like Stacie. You see, if they had to pay for treatment like what Stacie's daughters need, they couldn't make anywhere close to $7 billion dollars.

This isn't right.

It isn't right that Hanway can make more money than the average American family every hour, and Stacie has to go bankrupt trying to care for her daughters. And it isn't right that a company in America can base their business off of hurting and bankrupting other people, denying them needed health care.

Stacie isn't taking this sitting down. Watch:

Today, Stacie is off to one of Hanway's mansions in Pennsylvania. She's going to ask him to put her up, so she can afford the treatment Hanway's company denies her. And she's not going to take no for an answer.

Stacie lost everything, while Hanway made even more money. Hanway won, Stacie lost, but she's fighting back.

You can help spread the word about Stacie's story at www.sickofit.net. And check back soon for updates on how Stacie's confrontation went.

On the Death of My Older Brother, Jeremy, and Ted Kennedy

Mike Elk — Wed, 26 Aug 2009 04:32:02 -0700

In the coming days, many great eulogies of Ted Kennedy will be written. Many will offer personal anecdotes in the coming days about what a great man he was. I do not intend to write one here.

I have no great anecdotes or personal stories to tell about how Ted Kennedy directly touched my life. I meet the man once briefly in passing while walking in the U.S. Capitol.

I did however lose an older brother, far too young, much as Senator Kennedy did. Anyone who has ever lost an older brother understands the intense pressure that the surviving younger brothers to live up to the legacies of their older brothers. Its an inescapable burden.

Not a day goes by that I don't think about my brother. I find myself wondering often what my brother would do if he were still alive. He died at the young age of twenty one of leukemia far before he could develop into the type of activist that I am today. He never got the chance to fight for working people the way that I so luckily have.

Ever since I have turned twenty-one, I have treated every day like it was one extra day and cherished it. It has made me want to get up in the morning and worker harder and be smarter because I feel so lucky to be alive. I feel that to not work as hard and diligently as I possibly could would be a disservice to my brother's legacy. My brother's legacy serves as a constant source of inspiration for some of the darkest hours and toughest fights.

Senator Kennedy cited his brother's legacy too in passing health care reform with a public option out of his committee earlier this year. In his statement he said:

This room is a special place. In this room, my two brothers declared their candidacy for the presidency. Today, the nation takes another major step toward reaching the goals to which they dedicated their careers, and for which they gave their lives. They strived, as I have tried to do, for a fairer and more just America -- a nation where every American could share fully in the promise of quality health care.

America has lost an older brother in the death of Ted Kennedy. We must all be fortunate that we are still alive. and around to fight for a public health insurance plan available for all Americans that Ted would have loved to fight for. We must work harder for the things that we believe in. If Ted were still alive today, he would be fighting like hell for the public health insurance option that he considered a fundamental human right.

Lets fight for my brother too. He died tragically and far too young. His death shocked my family. Fortunately, my father was a member of a union and the union provided us with excellent health care. In the closing days of my brother's life, we did not have to worry about medical bills. We spent them enjoying the company of my brother, Jeremy.

Every American deserves the same type of high quality health care that my brother, Jeremy, had in the closing days of his life.There is no reason why the richest country on the planet that people should have to suffer because their only crime was being too poor to afford quality health care.

Let's fight like hell for the public health insurance plan that Senator Kennedy so dearly fought for in the closing days of his life.

My deepest condolences to the friends and family of Senator Kennedy.

I hope that Ted is in heaven now finally reunited with his brothers as I hope to someday be reunited with mine.

Co-Op Proposal An Effort To Kill The Public Plan

Jacob S. Hacker — Thu, 06 Aug 2009 09:35:18 -0700

The Senate Finance Committee today has unveiled a health care reform plan that does not include a public health insurance option. It instead proposes the creation of health co-operatives. At a media teleconference, I explain why this will not work and should be seen for what it is: an effort to kill what would be an effective competitor to the private insurance market.

A public health insurance option would provide a cost and quality benchmark for private insurers, a backup for people who could not get access to private insurers and a cost-control backstop that would drive innovation and efficiencies that private insuers could use. A co-operative would not have the reach necessary to fulfill these functions successfully in a market dominated by a a few large players.

Ellen Shaffer

Ellen Shaffer — Fri, 31 Jul 2009 14:24:54 -0700

Honoring Paul Wellstone: Fighting Like Hell for Health Care Reform

Mike Elk — Tue, 14 Jul 2009 08:42:25 -0700

I had the rare privilege of meeting one of my heroes, Paul Wellstone, shortly before his death in 2002 when I visited Washington as part of a conference for high school students interested in politics. We had the opportunity to meet several senators during our time in Washington, but Paul Wellstone treated us differently—more like we were friends coming over for a cup of coffee than a bunch of nerdy high school students on a trip. He insisted that we not call him "senator," but instead simply Paul.

While other senators were going on and on about their accomplishments or telling corny jokes, Paul went around and asked what issues were important to us and what we were doing currently to advocate for these policies. He suggested ideas about how we could become more involved, more effective, and what other issues we might want to get involved in. He encouraged us "to go out and fight because that was the only way change has ever been achieved." Paul's faith in my ability to achieve social change inspired me so much that I spent the rest of my summer volunteering full time to help elect Ed Rendell as governor in Pennsylvania.

A few months later. I was in tears as I listened to the news over NPR that Paul Wellstone and his loving wife, Shelia, had died in a plane crash on their way to a funeral of a steelworker in Northern Minnesota. Paul Wellstone, a tireless champion of the working class served as an inspiration to a generation of activists during the dark days of a decade long Republican reign. For the last seven years, I have kept a photo of Paul Wellstone and me on my desk as a source of inspiration for when the times get tough.

Paul came to the United States Senate under the most unusual of circumstances. He was a college professor who had been arrested protesting with union workers and had previously spent most of his career organizing welfare mothers and poor farmers. No one had expected him to win his first campaign for Senate against an incumbent Republican Senator as he was outspent nearly seven to one. Paul had a secret weapon though his ability to inspire regular people to get out and organize. Unemployed, single mothers held bake sales to help fund his campaign, youth not old enough to vote spent hours volunteering for him. He formed a grassroots army of thousands of ordinary folks and trained them in community organizing.

When Paul Wellstone was elected to the Senate, he never forgot the thousands of ordinary folks that put their hopes and their dreams in him by working to get him elected. He summed up his philosophy about why he was in the Senate by saying, "I don't represent the big oil companies, the big pharmaceuticals or the big insurance industry. They already have great representation in Washington. Its the rest of the people that need representation."

Many Senators had referred to Paul as "The Conscience of the Senate." Only 5 feet 4 inches tall and walking with a severe limp, Wellstone would stand on the floor of the U.S. Senate and rail against corporates interests with the tenacity of the All-American wrestler that he was once. And then he would go back home on the weekends and teach those people how to community organize and fight against the powerful interests that were ruining their lives. Its unknown how many people Wellstone inspired, but to this day you can still see thousands of green bumper stickers in Minnesota with the phrase "W.W.W.D. - What Would Wellstone Do?"

Last week, Al Franken, a friend of Paul's who had been inspired to run for office by Paul's death, took back Paul's old seat from Republican Norm Coleman. After reading, I found myself wondering of what Paul would be doing now if he was still a U.S. senator. Paul had spent the majority of his career in the minority party in the Senate. In his book "Conscience of a Liberal," Paul admitted that in his time in the U.S. Senate he spent nearly 85 percent of his time defending against Republican attacks on working families and he never had the opportunity to fight for things like the big reform measures that he craved. I thought about how Paul would be down on the floor of the Senate to talk about the 20,000 people that die every year due to a lack of health coverage, or to talk about how his access to quality health care as a United States senator allowed him to continue having a productive life despite his semi-debilitating multiple sclerosis.

While Paul spent the most of his career in the minority, he did indeed spend a very brief time in the majority in 1993-1994 when Democrats had the opportunity to pass a health care reform. However, Democrats caved to the insurance companies' lobbyists and no comprehensive health care reform was passed. As Mike Lux, a top Clinton aide at the time argued in his book "The Progressive Revolution," Democrats were then swept out of power for their inability to stand up to special interests. Democrats would remain in the wilderness for the rest of Wellstone's tenure in the Senate.

If Democrats fail to deliver on a strong public health insurance plant that an overwhelming 76% favor according to the Wall Street Journal, they too will fail as a party. Reforming health care is about standing up to the big special interests that are spending $1.4 million every day on an army of lobbyists so that they can continue to deny people the health care they need.

Furthermore, health care reform is literally about saving lives. Democrats should avoid looking for some easy compromise on health care with the insurance industry that would deny some people care in order to score a quick legislative victory.

As Wellstone said, "Politics is not about power. Politics is not about money. Politics is not about winning for the sake of winning. Politics is about the improvement of people's lives. It's about advancing the cause of peace and justice in our country and the world. Politics is about doing well for the people."

Beating the insurance industry is going to be one of the toughest fights we as a movement have ever engaged in. Unfortunately, we don't have Paul Wellstone around to fight for us anymore. However, we do have the people that Wellstone believed in the most—ourselves. So I say its about time that we ask ourselves, What Would Wellstone Do?

Let's fight like hell. Let's win one for Paul!

Some Choice Words for 'The Select Few'

Bill Moyers — Mon, 13 Jul 2009 08:11:05 -0700

with Michael Winship

If you want to know what really matters in Washington, don't go to Capitol Hill for one of those hearings, or pay attention to those staged White House "town meetings.” They’re just for show. What really happens – the serious business of Washington – happens in the shadows, out of sight, off the record. Only occasionally – and usually only because someone high up stumbles -- do we get a glimpse of just how pervasive the corruption has become.

Case in point: Katharine Weymouth, the publisher of The Washington Post – one of the most powerful people in D.C. – invited top officials from the White House, the Cabinet and Congress to her home for an intimate, off-the-record dinner to discuss health care reform with some of her reporters and editors covering the story.

But CEOs and lobbyists from the health care industry were invited, too, provided they forked over $25,000 a head – or up to a quarter of a million if they want to sponsor a whole series of these cozy get-togethers. And what is the inducement offered? Nothing less, the invitation read, than “an exclusive opportunity to participate in the health-care reform debate among the select few who will get it done.”

The invitation reminds the CEOs and lobbyists that they will be buying access to “those powerful few in business and policy making who are forwarding, legislating and reporting on the issues…

"Spirited? Yes. Confrontational? No." The invitation promises this private, intimate and off-the-record dinner is an extension “of The Washington Post brand of journalistic inquiry into the issues, a unique opportunity for stakeholders to hear and be heard.”

Let that sink in. In this case, the “stakeholders” in health care reform do not include the rabble – the folks across the country who actually need quality health care but can’t afford it. If any of them showed up at the kitchen door on the night of this little soiree, the bouncer would drop kick them beyond the Beltway.

No, before you can cross the threshold to reach “the select few who will actually get it done,” you must first cross the palm of some outstretched hand. The Washington Post dinner was canceled after a copy of the invite was leaked to the Web site Politico.com, by a health care lobbyist, of all people. The paper said it was a misunderstanding – the document was a draft that had been mailed out prematurely by its marketing department. There’s noblesse oblige for you – blame it on the hired help.

In any case, it was enough to give us a glimpse into how things really work in Washington – a clear insight into why there is such a great disconnect between democracy and government today, between Washington and the rest of the country.

According to one poll after another, a majority of Americans not only want a public option in health care, they also think that growing inequality is bad for the country, that corporations have too much power over policy, that money in politics is the root of all evil, that working families and poor communities need and deserve public support if the market system fails to generate shared prosperity.

But when the insiders in Washington have finished tearing worthy intentions apart and devouring flesh from bone, none of these reforms happen. “Oh,” they say, “it’s all about compromise. All in the nature of the give-and-take-negotiating of a representative democracy.”

That, people, is bull – the basic nutrient of Washington’s high and mighty.

It’s not about compromise. It’s not about what the public wants. It’s about money – the golden ticket to “the select few who actually get it done.”

When Congress passed the Helping Families Save Their Homes Act, "the select few” made sure it no longer contained the cramdown provision that would have allowed judges to readjust mortgages. The one provision that would have helped homeowners the most was removed in favor of an industry that pours hundreds of millions into political campaigns.

So, too, with a bill designed to protect us from terrorist attacks on chemical plants. With “the select few” dictating marching orders, hundreds of factories are being exempted from measures that would make them spend money to prevent the release of toxic clouds that could kill hundreds of thousands.

Everyone knows the credit ratings agencies were co-conspirators with Wall Street in the shameful wilding that brought on the financial meltdown. But when the Obama administration came up with new reforms to prevent another crisis, the credit ratings agencies were given a pass. They’d been excused by “the select few who actually get it done.”

And by the time an energy bill emerged from the House of Representatives the other day, “the select few who actually get it done” had given away billions of dollars worth of emission permits and offsets. As The New York Times reported, while the legislation worked its way to the House floor, “it grew fat with compromises, carve-outs, concessions and out-and-out gifts,” expanding from 648 pages to 1400 as it spread its largesse among big oil and gas, utility companies and agribusiness.

This week, the public interest groups Common Cause and the Center for Responsive Politics reported that, “According to lobby disclosure reports, 34 energy companies registered in the first quarter of 2009 to lobby Congress around the American Clean Energy and Security Act of 2009. This group of companies spent a total of $23.7 million – or $260,000 a day – lobbying members of Congress in January, February and March.

“Many of these same companies also made large contributions to the members of the Senate Environment and Public Works Committee, which has jurisdiction over the legislation and held a hearing this week on the proposed ‘cap and trade’ system energy companies are fighting. Data shows oil and gas companies, mining companies and electric utilities combined have given more than $2 million just to the 19 members of the Senate Environment and Public Works Committee since 2007, the start of the last full election cycle.”

It's happening to health care as well. Even the pro-business magazine The Economist says America has the worst system in the developed world, controlled by executives who are not held to account and investors whose primary goal is raising share price and increasing profit – while wasting $450 billion dollars in redundant administrative costs and leaving nearly 50 million uninsured.

Enter "the select few who actually get it done." Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll – more than 350 of them – and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.

Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.

President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel – the insider del tutti insiders – indicated that a public plan just might be negotiable, ready for re-engineering, no doubt, by “the select few who actually get it done.”

That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change – nothing – until the money lenders are tossed out of the temple, the ATMs are wrested from the marble halls, and we tear down the sign they’ve placed on government – the one that reads, “For Sale.”

Bill Moyers is managing editor and Michael Winship is senior writer of the weekly public affairs program Bill Moyers Journal, which airs Friday night on PBS. Check local airtimes or comment at The Moyers Blog at www.pbs.org/moyers .

Don't Tax Benefits

Roger Hickey — Mon, 13 Jul 2009 06:17:29 -0700

Americans are demanding health care reform that guarantees them quality, affordable insurance, reduces the burden of health costs on employers and individuals and provides backup coverage through a public health insurance option.

But the suggestion that we pay for these needed reforms by taxing the health benefits that millions of us get through our employers is very unpopular — Americans fear that it could undo the one part of our health care system that now works (sort of). And we worry about new tax burdens on people who have worked hard to get and keep decent health coverage. If Democrats want to avoid a serious reaction against their important reform efforts, they should heed these concerns.

America’s health insurance system has evolved over the decades since World War II, when companies began offering health insurance — untaxed as income by government policy. Today, around 160 million of us get our health insurance from employers. And in these difficult times, millions of workers have repeatedly given up wage increases in order to keep their health benefits.

John McCain, when he was running for president last year, proposed taxing all employer-provided health benefits. Were we to do that, some 20 million Americans would lose employment-based health insurance, according to some estimates. And many employers would stop contributing to group health insurance — forcing their workers into the more expensive individual insurance market.

While many health experts acknowledge that taxing all benefits would cause chaos, some share the conservative view that a lot of people are getting “too much” insurance coverage from their employers and are pushing to get new revenues by taxing plans that are more expensive than average. But several recent studies find that it is almost impossible to design a tax that doesn’t overburden workers in firms with older or low-income employees or companies in regions with higher-than-average insurance premiums.

The Communications Workers of America looked at one proposal (to tax all employer-paid health benefits worth over $13,000 for a family) and found a typical member of its union in Pennsylvania with a working spouse and one child would pay $3,165 more in taxes in the first year, and $27,949 more over eight years. The issue is heating up. The Senate majority leader, Harry Reid, has told colleagues that they should not tax health benefits. But the debate continues.

It is dangerous for politicians to focus the government’s taxing power on the hard-won benefits of middle-class families. Fair and progressive income and wealth taxes are a better way to pay for health reform — and keep workers feeling as though they have a positive stake in achieving good health care for all.

This commentary originally appeared in the The New York Times.