Sarah Palin and Rush Limbaugh—reaching for socialized medicine

Usually, we try our best here to explain things. But there are some things we just can't explain. All we can do is link to the Wonk Room blog for reports of two similar events:

• A few days ago, Sarah Palin spoke in the Canadian city of Calgary. "We used to hustle over the border for health care we received in Canada," she said. "And I think now, isn't that ironic?" Wonk Room reported. Previously, as Wonk Room reminded us, Palin had said she and her husband, Todd, had "gone though periods of our life here with paying out-of-pocket for health coverage until Todd and I both landed a couple of good union jobs."
• Rush Limbaugh said he would leave the United States if health care reform passes. Wonk Room, which reported Limbaugh's comments, noted that "Limbaugh's announcement could very well inspire liberals to pass reform." Furthermore, as Work Room points out, "Costa Rica's hybrid government-private health care system provides comprehensive universal coverage to all residents - and even sells affordable policies to soon-to-be visitors like Limbaugh. The government owns several major hospitals and operates small clinics in almost every community. Workers are required to contribute 15% of their salaries to health insurance" and the government pays for care for the unemployed.

– 03/11/10

Obama: “Give the American people more control over their health care”

President Barack Obama called today for Congress to take a final vote on health reform in the next few weeks.

"I believe it's time to give the American people more control over their health care and their health insurance," he said. "I don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone."

Obama, who is supporting a compromise between the already-passed House and Senate reform bills, said there has been lengthy debate with all options have been on the table. A government-run single-payer system, he said, is "neither practical nor realistic." On the other hand, he rejected "those, and this includes most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry - whether it's state consumer protections or minimum standards for the kind of insurance they can sell…I'm concerned that this would only give the insurance industry even freer rein to raise premiums and deny care."

Obama said his plan would do three things:

• "End the worst practices of the insurance companies," including refusing or cancelling coverage, imposing unlimited out-of-pocket costs on patients, and "arbitrarily and massively" raising premiums.
• "Give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves - because if it's good enough for members of Congress, it's good enough for the people who pay their salaries." It would do this by creating a large insurance group and by offering tax credits to help families and small businesses afford policies.
• "Bring down the cost of health care for millions - families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care.... But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade."

The complexity of health reform "lends itself to demagoguery and political gamesmanship, and misrepresentation and misunderstanding," he said. "But that's not an excuse for those of us who were sent here to lead. That's not an excuse for us to walk away." The politics are not what's important, he continued.

This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has. This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and get a regular checkup once in a while, and have some security about their children if they get sick.

This is about what reform would mean for all those men and women I've met over the last few years who've been brave enough to share their stories. When we started our push for reform last year, I talked to a young mother in Wisconsin named Laura Klitzka. She has two young children. She thought she had beaten her breast cancer but then later discovered it had spread to her bones. She and her husband were working and had insurance, but their medical bills still landed them in debt. And now she spends time worrying about that debt when all she wants to do is spend time with her children and focus on getting well.

This should not happen in the United States of America. And it doesn't have to.

– 03/03/10

Want to keep the health coverage you have? Then you need reform

If health reform doesn't pass, that doesn't mean we get to keep things they way they are now. As a New York Times analysis points out, "health policy analysts and economists of nearly every ideological persuasion agree" that in the absence of reform, we can expect thinner benefits at higher premiums because of rising health costs.

The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.

“People think if we do nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. “In fact, what we will have is a substantial deterioration in what we have.”

Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone’s dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.

In the absence of reform, premiums for family coverage, now about $13,000 a year, will nearly double to $24,000 by 2020, according to the Commonwealth Fund. And the number of uninsured, now 46.3 million, will grow to as much as 65.7 million by 2020, [the Urban Institute projects].

And the number of uninsured, now 46.3 million, will grow to as much as 65.7 million by 2020, the Urban Institute projects.

– 03/01/10

Health care summit clarifies differences

I can't believe I watched the whole thing - seven hours of debate on health reform.

The White House's summit on health contained lots of speeches and few surprises. But it did show clearly the major differences between the Democratic approach, embodied in bills that have passed the House and Senate and the plan proposed this week by President Barack Obama, and the approach of Republican opponents:

• The Obama plan and the bills passed by the House and Senate would guarantee affordable coverage for those who don't have it, those who lose it because they lose their job, and those who can't get it because of pre-existing conditions. They would do this by offering subsidies to moderate-income families and to small businesses, and by expanding the Medicaid program for the low income. The Republicans didn't dispute that their own plan would extend coverage to only 3 million more people, compared to 30 million who would gain coverage under the Democratic bills. Republicans said that making sure more people are assured of coverage should come later, after the government has moved "step by step" to reduce costs. As The New Yorker's James Surowiecki wrote, "the Republicans are reasonably satisfied with what's currently in place. The fact that tens of millions of Americans don't have health insurance is not, in their mind, an issue that government should be trying to solve-at least not if it will cost any real money."


• The Obama plan would set standards for insurance companies: preventing denials of coverage for pre-existing conditions; limiting out-of-pocket costs for patients; specifying minimum benefit levels; banning yearly and lifetime coverage limits; and reviewing insurance company premium hikes. Obama said some government oversight is needed to protect consumers. For example, he said by way of comparison, food would be cheaper without federal meat inspection, but it wouldn't be safe. The Republicans generally rejected the idea of "deciding from Washington" on these issues, leaving them to the marketplace. In effect, they're saying, "Just get out of the way of the insurance companies and things will get better."

At the close of the day-long meeting, President Obama offered a challenge to Republicans. He said he would work with them on two issues they have been pushing - medical malpractice reform and insurance sales across state lines - if they would "do a little soul-searching" and see if they can support some aspects of expanding insurance coverage and setting minimum standards for insurance companies.

He said he was hopeful some consensus could be reached over the next month or six weeks, but indicated that, if there is no agreement, Democrats would move ahead.

"When I talk to the parents of children who don't have health care because they've got diabetes," the president concluded, "they don't want us to wait."

– 02/26/10

Obama offers health plan in advance of bipartisan summit

President Obama offered a health reform plan today that attempts to bridge the differences between bills already passed by the House and Senate. The plan will serve as a starting point for discussion at Thursday's bipartisan health summit.

This is the most specific proposal yet from the president, who has previously outlined general goals but left the legislative details to Congress.

Like both the House and Senate bills, the Obama plan would prohibit insurance companies from denying or cancelling coverage based on health problems, would expand Medicaid to cover more low-income workers and families, would offer premium subsidies to make insurance affordable for moderate-income families, would require individuals to maintain insurance coverage, and would take some steps to rein in health inflation.

The Obama plan doesn't include some key provisions from the CWA-endorsed house bill – among missing are a public health insurance option, a national health insurance exchange rather than state-level ones, and a "millionaire's tax." However, it does make several improvements on the flawed Senate bill:

• Although the Obama plan retains a tax on high-premium health plans, it has adopted the improvements negotiated with labor leaders and goes even further. The threshold for the tax would now be a premium of $27,500 for families and $10,200 for individuals, compared to $23,000/$8,500 in the Senate bill and $24,000/$8,900 in the agreement with labor leaders. That means the tax would hit far fewer working families. The agreement with labor delayed the tax until 2018 for collectively-bargained plans; the latest Obama proposal delays the tax until 2018 for everyone.
• The Obama plan junks the heavily-criticized special treatment for Nebraska's Medicaid costs, but adds more federal help to states to pay for Medicaid expansion (similar to the House bill).
• Following the House bill, the Obama plan closes the coverage gap – the so-called "donut hole" – for seniors on Medicare, meaning thousands of dollars a year in prescription savings to millions of seniors.
• While it doesn't require employers to offer coverage, as the House bill does, the Obama plan increases the penalties on companies whose workers end up on publicly-subsidized plans, to $2,000 per worker, up from $750 in the Senate bill.
• It adds new federal oversight on insurance companies that seek excessive premium hikes, a provision not in either the House or Senate bills. The proposal is in response to recent huge [increases sought by insurers such as Anthem Blue Cross], which is trying to raise individual premiums in California by as much as 39%.
• It adds new provisions to curb abuse and fraud, including some taken from three different Republican bills.

For more information, you can read the 11-page full text of the presidents' plan and see the White House's answers to what-does-it-mean-for-me questions. Also, the Wonk Room blog has a chart comparing Obama proposal to the Senate and House bills.

– 02/22/10

Voters tell Washington: Keep trying on health reform

By a nearly two-to-one margin, voters want both major political parties to keep trying to pass comprehensive health reform, according to a new Washington Post-ABC News poll.

In the poll, 63% said lawmakers should "keep trying to pass a comprehensive health-care reform plan," while only 34% said Congress should "give up." Voters were evenly split on whether President Obama was doing the right amount or not enough to reach out to Republicans, but, by a two-to-one margin, said strongly that Republicans were not doing enough to compromise with the president.

Meanwhile, the president is making another effort to bring the Republicans and Democrats together. President Obama has called a bipartisan health summit for Feb. 25. In discussing his plans, the president said that he was continuing to work toward the goals of controlling costs, ending insurance company abuses and making sure insurance is available and affordable for people. He's not willing to give up on those goals, he said, but will listen to all ideas about the best way to achieve them:

"When I was in Baltimore talking to the House Republicans, they indicated, we can accomplish some of these goals at no cost. And I said, great, let me see it. And I have no interest in doing something that's more expensive and harder to accomplish if somebody else has an easier way to do it.

"So I'm going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don't think makes sense and I don't think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there's a lot of posturing. Let's get the relevant parties together; let's put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don't get every single thing that I want.

"But here's the point that I made to [Republican Congressional leaders]: Bipartisanship can't be that I agree to all the things that they believe in or want, and they agree to none of the things I believe in and want."

– 02/11/10

Obama to Congress: “Don’t walk away from reform”

"Don't walk away from reform," President Barack Obama told Congress last night in his State of the Union address. While the politics have become more difficult, the need for health reform remains, he said. Here, from the official transcript, is the section of his speech dealing with health reform:

"And it is precisely to relieve the burden on middle-class families that we still need health insurance reform.  (Applause.)  Yes, we do.  (Applause.) "Now, let's clear a few things up.  (Laughter.)  I didn't choose to tackle this issue to get some legislative victory under my belt.  And by now it should be fairly obvious that I didn't take on health care because it was good politics.  (Laughter.)  I took on health care because of the stories I've heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who've been denied coverage; families -- even those with insurance -- who are just one illness away from financial ruin.

"After nearly a century of trying -- Democratic administrations, Republican administrations -- we are closer than ever to bringing more security to the lives of so many Americans.  The approach we've taken would protect every American from the worst practices of the insurance industry.  It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market.  It would require every insurance plan to cover preventive care.

"And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make kids healthier. (Applause.)  Thank you.  She gets embarrassed.  (Laughter.)

"Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan.  It would reduce costs and premiums for millions of families and businesses.  And according to the Congressional Budget Office -- the independent organization that both parties have cited as the official scorekeeper for Congress -- our approach would bring down the deficit by as much as $1 trillion over the next two decades.  (Applause.)

"Still, this is a complex issue, and the longer it was debated, the more skeptical people became.  I take my share of the blame for not explaining it more clearly to the American people.  And I know that with all the lobbying and horse-trading, the process left most Americans wondering, 'What's in it for me?' "But I also know this problem is not going away.  By the time I'm finished speaking tonight, more Americans will have lost their health insurance.  Millions will lose it this year.  Our deficit will grow.  Premiums will go up.  Patients will be denied the care they need.  Small business owners will continue to drop coverage altogether.  I will not walk away from these Americans, and neither should the people in this chamber.  (Applause.)

"So, as temperatures cool, I want everyone to take another look at the plan we've proposed.  There's a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo.  But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.  (Applause.)  Let me know.  Let me know.  (Applause.)  I'm eager to see it.

"Here's what I ask Congress, though:  Don't walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  (Applause.)  Let's get it done.  Let's get it done.  (Applause.)"

– 01/28/10

The more they know, the more people support health reform, poll shows

While Americans remain closely divided over health reform, people are not sure what's in the current bills.  And when they learn more about elements of the reform bills, their support increases, according to a new poll by the Kaiser Family Foundation.

Overall, 42 percent of people polled said they supported the current legislation, while 41 percent said they were opposed.  But when told about specific elements of the proposals - tax credits to help small business, health insurance exchanges, insurance companies not being able to deny coverage because of pre-existing conditions - they said that made them more supportive.

"It's one thing to talk about the public's perception of health care reform legislation, which right now is in some ways negative, but it's another to tell people what's actually in the bill, and when you do that people are more positive," said Drew Altman, president and CEO of the Kaiser Foundation.

Other examples of the-more-they-know-the-better-people-like-it cited in Kaiser's report: "Among the least known elements of the bills, those with the biggest potential to change minds include the fact that the Congressional Budget Office has said health reform would reduce the deficit (only 15% expect the legislation to reduce the deficit, but 56% said hearing that makes them more supportive) and that the legislation would stop insurers from charging women more than men (37% are aware that the legislation would do this, but 50% said this provision makes them more supportive)."

Seniors were one group that trended strongly against the reform proposals, but became much more supportive when they learned that the legislation would close the Medicare prescription "donut hole," reducing the costs of medications for seniors.

– 01/25/10

Mass. election raises more uncertainty for health reform

A Republican win in the special Senate election to replace Ted Kennedy in Massachusetts leaves an uncertain road for health reform. Without 60 votes in the Senate, the Democrats can't stop a filibuster, which could block action on a Senate-House compromise reform bill now taking shape.

It's unclear at this point how the Democrats will proceed. One suggestion is that the House could approve the version of the health bill already passed by the Senate, thus avoiding another Senate vote, then fix problems in the Senate bill later. That's a scary prospect for us, since the Senate bill contained a number of serious flaws, including the tax on high-premium health benefits.

We don't want to see the Senate bill passed with only a vague hope of fixing its problems.

Another suggestion is that the Democrats back off, on the belief that the Massachusetts results show the public doesn't want health reform. That's not good, either, and would represent a misreading of the vote.

The winning Republican, Scott Brown, supported the health reform bill which passed several years ago in Massachusetts, and which was similar to the bill being considered in Washington. What Brown argued during the campaign is that national reform wouldn't help Massachusetts, since the state reforms already meant less than 3 percent of the population there was uninsured.

Exiting polling by Rasmussen Reports doesn't support the idea that Brown's win was a referendum on health reform. While 56% of voters told Rasmussen that health reform was the most important issue in the election, Democrat Martha Coakley won among those health voters. Brown built his margin among voters who said the most important issues were the economy, taxes and national security.

Moreover, the Massachusetts election doesn't change the facts that make health reform necessary: Escalating costs. A system that leaves all of us a layoff from being uninsured. Medical bankruptcies when people – even insured people – get sick. Insurance companies that can deny coverage to people who need it. The highest health costs in the world, without the best results. Tens of millions without coverage.

"In the wake of Mr. Brown’s victory, the decision facing Democrats is not whether to start with a blank slate and try to write a bill based on both liberal health care ideas and conservative ones. They’ve already tried that," writes New York Times columnist David Leonhardt. "The decision is whether to expand insurance and try to control costs, despite the political risks, or whether that project will once again be put off until another day."

– 01/20/10

Health reform advances in Senate; benefits tax still at issue

A health reform bill won a procedural vote in the Senate early this morning.  While the Senate has a few more days of debate and a few more procedural votes before a final vote, expected on Christmas Eve, attention will now turn to a conference committee which will iron out the differences between the Senate and House bills.

CWA continues to work to block a tax on health benefits which is in the Senate version.

The so-called excise tax would slap a 40 percent tax on health benefits that cost more than $23,000 a year for families and $8,500 for an individual.  That would hit millions of middle-class families.  Employers say they would cut benefits to avoid the tax, meaning higher out-of-pocket costs for patients or skipped treatments.

While money is needed to fund health reform, CWA favors the House version of the bill, with a so-called "millionaires' tax," adding to the income tax of families making more than $1 million a year or individuals making more than $500,000.

The Senate voted to move ahead with its version of the bill on a party-line vote at about 1 a.m. - all 58 Democrats and two independents in favor, all 40 Republicans opposed.  The 60 votes were needed to overcome a Republican effort to kill the bill through a filibuster.

Assuming the other votes this week go the same way, the bill will pass the Senate before its members leave for the Christmas holiday.  Soon after, a committee made up of House and Senate members would meet to craft a combined bill, and the focus will move to the conference committee to try to get the best bill possible.  Then, both houses will have to vote again on the combined bill.

For a more detailed look at the differences between the Senate and House bills, you can check out a New York Times interactive graphic.

– 12/21/09