Bringing Wellness to an Insurance Fight

Congress seems nervously eager to water down any form of public insurance option. Co-ops and triggers have been attacked as obvious gimmicks for sabotaging a robust public option. However, it is harder to find fault with promoting wellness and reducing obesity.

So, what could be wrong with encouraging Americans to eat more vegetables? Why not include wellness provisions in a health insurance reform bill?

For one, because the food industry is big business.

Read more at Campaign for America's Future ...

Not the Health Care Co-ops They Had in Mind

Here is one possibility we could see and, given the abandonment of single-payer and what looks like a systematic effort to sabotage the public option, a co-op that a growing number of Americans would gladly join:

Democratic Party Lays Plans for Insurance Cooperative

Democratic Party insiders have quietly begun laying plans for a national nonprofit insurance cooperative owned and operated for the benefit of its members.

Inspired by an idea suggested by Senate Budget Committee Chairman Sen. Kent Conrad, D-N.D., the proposed plan, code-named Trenton, would be open to all registered Democrats and their families.

Leaders from both major parties have declared a single-payer health care plan dead on arrival in the U.S. Senate.

This month, Rasmussen’s partisan identification survey estimated the number of Democrats at 39.4% (leading Republicans by 6.8 percentage points). Dr. Michael McDonald of George Washington University recently estimated the 2008 voting-eligible population in the U.S. at roughly 213 million.

By those estimates, nearly 83 million Democrats and their families would be immediately eligible, with another 60 million independents up for grabs. When launched, Trenton could attract the largest single pool of insurance customers in the United States.

“We’re looking at a pool with far more bargaining power for driving down costs than the VA," said an unidentified official.

The proposed Democratic insurance co-op would not deny coverage to patients with preexisting medical conditions.

It's not a headline many on Capitol Hill, in Big Pharma or Big Insurance would welcome, and certainly not the co-op Kent Conrad envisions. But it's one alternative frustrated Democrats have kicked around for years.

Read more at Campaign for America's Future ...

Setting a new tone

A friend put me on to this article in the New Yorker that explores how "the culture of money" among doctor who see themselves as entrepreneurs led to the overuse of medicine and significantly higher costs in McAllen, TX.

But I was struck by this paragraph about how key employers set the cultural tone for business in some areas:

Woody Powell is a Stanford sociologist who studies the economic culture of cities. Recently, he and his research team studied why certain regions—Boston, San Francisco, San Diego—became leaders in biotechnology while others with a similar concentration of scientific and corporate talent—Los Angeles, Philadelphia, New York—did not. The answer they found was what Powell describes as the anchor-tenant theory of economic development. Just as an anchor store will define the character of a mall, anchor tenants in biotechnology, whether it’s a company like Genentech, in South San Francisco, or a university like M.I.T., in Cambridge, define the character of an economic community. They set the norms. The anchor tenants that set norms encouraging the free flow of ideas and collaboration, even with competitors, produced enduringly successful communities, while those that mainly sought to dominate did not.

A friend observes the same thing about cities like Seattle. Where once it was Boeing, now Microsoft sets the economic tone.

Living in Western North Carolina with a withered textile/furniture manufacturing base - one that sorely needs reviving - the idea of attracting anchor-tenants as a way of setting a new tone for manufacturing investment deserves attention.

Greenville, SC had seen its textile-based economy wither in the late 1960s and early 1970s. Building on the strength of the statewide technical school system, Democatic Governor John C. West lured Michelin Tire Company to Greenville, SC in the early 1970s, "anchoring" the area's transition to a mixed manufacturing economy. Republican Governor Carroll Campbell built on that momentum in attracting BMW and Fuji Film to the area in the late 1980s.

Downtown Greenville, SC was boarded up and dying in the 1970s when Mayor Max Heller began promoting his plan to narrow Main Street, widen sidewalks and create a European-style downtown.



Heller convinced Hyatt to locate a new hotel at the north end of Main Street (rather than on a nearby interstate highway) to "anchor" the downtown redevelopment and set a tone that downtown was a place to invest. Decades later, downtown is thriving, lined with shops, restaurants and outdoor cafes. In the most Republican area of South Carolina, in downtown Greenville there stands a bronze statue of Austrian Jewish refugee, and Democrat, Max Heller.





The anchor-tenant concept could be used to revive manufacturing in Asheville/Buncombe. What name-brand company do we want to attract as an anchor-tenant?

Time to line up, sign up and enlist

Health care reform is going to be a helluva fight if the Dems don't surrender before the first shot.

What Digby said:

This is just beginning and a lot can happen, but I can't say that it's going very well so far. They took single payer off the table before they even began, so they are starting this negotiation with this public plan option as the leftward position to be bargained away in the inevitable "compromise." The way they're going we'll be lucky if we don't end up with "reforming" Medicare into a private, for profit insurance company.

Health Care Reform Is About Choices

Health Care Reform Is About Choices

Some people would rather keep things as they are. Some people would rather live in an America with a health care system ranked 37th in the world. Some people would rather America spend twice as much in GDP per capita for health care than industrialized countries with national systems. Some people would rather pay more and get less.

Read more at Campaign for America's Future ...

Reaping Privatization's Rewards?

Privatization advocates argue that the private sector runs a more efficient and cost-effective ship than the government. Small-government conservatives – the same people, often – argue that fighting wars and fighting crime are among the few constitutionally legitimate functions of government, yet they support turning over even those government functions to the for-profit sector.

You can’t let constitutional legitimacy get in the way when there’s money to be made.

Read more at Campaign for America's Future ...

We need a symbol

More of my comments from the CAF thread:

Every American has skin in this game. Our job is not to glaze their eyes with statistics and polls. It is to remind them how broken the system is and to show them a way out.

I’m not much for futile, symbolic gestures, and the further left progressives go, the more popular those wastes of time become. Still, symbols can be powerful persuaders if done right. Harry and Louise, for example.

Recalling Firedoglake’s 2006 rubber stamp campaign, I suggested to Christy Hardin Smith a symbol everyone could use to drive home the problem with the broken health care system: stacks of medical bills.

http://media.collegepublisher.com/media/paper1146/stills/403b7303951e1-9...

http://www.armyofmom.com/SPF%20xanax%20bills.JPG

http://blogs.babycenter.com/momformation/files/2008/09/bills.JPG

My sister died at 37 from a metastatic sarcoma (the same thing that got Ted Kennedy, Jr.’s leg). I watched her die, went to her funeral and, in mourning, went back to pack up her apartment and sift through stacks of medical bills, trying to figure out what she owed to whom and how we would get them paid. This doesn’t happen in most industrialized countries and shouldn’t happen here. It's a disgrace.

We need a symbol to stand in for our failed for-profit health care system, a symbol that a) every American recognizes; b) every American loathes; c) most people have touched and have in their homes; d) won’t disappear with a compromise reform plan; e) anyone can mail to, send to or throw onto their representative’s desk, or wave over their heads for the media; and f) that our representatives themselves can wave over their heads during debate.

I think stacks of medical bills are that symbol.

I attended a local organizing meeting pushing health care reform Thursday night, and was surprised to find that the activists there had the same reaction many progressives in the crowd at AFN had. They want single payer and they are ready to fight for it regardless of what the White House supports.

One woman recounted a terrible story about her six-foot-plus son dying of colon cancer (he had a congenital predisposition to it) because he had no insurance and couldn’t get a yearly colonoscopy until he had Stage 3 cancer and was down to 110 lbs. Obama’s OFA is reportedly collecting thousands of similar personal stories from across the country.

Great. But the problem is that too many among the general public will be sympathetic, but unable to connect those stories, faces and names to their own lives. Most everyone has dealt with medical insurance paperwork. Instantly recognizable. Universally hated.

There will be some kind of mass rally in D.C., I expect. I see a touch of "Meet John Doe" or "Mr. Smith" in thousands of people arriving in D.C. clutching sheaves of medical bills, and medical bills spitting out of Capitol Hill fax machines for days (with videos posted on YouTube). A little something our reluctant Smiths can use for show-and-tell in the wells of the House and Senate. I don't think they grasp the depth of anger and frustration out here. They just need a little educating.

If this fight comes down to a few progressive activists and congressmen vs. an extremely well-funded insurance industry, the American people lose. This battle can’t be won with polls and statistics. It has to be won with boots on the ground and symbols that capture the American psyche.

Weighing in on health care

This is my response to Bernie Horn's post on health care at Campaign for America's Future:

"This is Negotiating 101," David Sirota said at AFN last Tuesday. You don't start negotiating from where you expect to end up.

The Big Money Boys will work to beat us down from whatever we start out asking for. If we begin the process asking for some kind of public option, we may not even get that. In fact, you can see from some of the proposals floating around that Frank Luntz still has some influence - "trigger" provisions are meant to give the illusion of some kind of public plan without actually delivering one, just what Luntz suggests.

As you said, "even if a single-payer proposal starts out with a majority of Americans in support, it won’t hold majority support after the insurance industry clobbers it with ads." Maybe. Maybe. But that's my point, and Sirota's. That's where we have to start. We have to aim high if we expect to get in the end what we'd accept as a minimum. That's why pushing single-payer makes good strategic sense, not just good public policy sense.

Those who remember ClintonCare being shot down by the “Harry and Louise” ads are understandably gun-shy this time around. ClintonCare was an all-or-nothing proposition and we ended up with nothing. By pushing the public option, the gun-shy (the pragmatic, if you prefer) hope not to provoke the massive retaliation we all know is coming against real reform anyway. (A neighbor describes the coming health care battle as another Gettysburg.) But we don't have an all-or-nothing situation this time. There are various proposal floating around, and this time a public option allows people the comfort of keeping what they have. It's sellable. I get that.

But single-payer isn't politically viable? I'm not so sure. As I recall, Obama was unelectable. But he somehow managed to dispel preconceptions and stereotypes in winning the presidency. Politicians, they say, are always looking for a parade to run to the head of. That's what Obama seems to be doing behind the scenes with Organizing for America (OFA), trying to organize that parade. If a single-payer parade materializes, and if it is massive, just watch the pols run to get in front of it. If it doesn't materialize, single-payer won't either.

We're dealing with corporate entities happy to deny care to the sick and dying to save a nickel. Don't think they won't neuter any public option before implementation if it means extra shareholder value. We have to push hard for more than a public option if we hope to preserve a viable public option by the time the dust has settled and the bill is ready for signing.

Not meaning what they say it means

Once again the NYT doesn't quite get the story right:

U.S. Lawyers Agreed on Legality of Brutal Tactic

Well, in fact, not so much. The story is based on some leaked Jim Comey e-mails that say something else. The OLC was asking about whether the nasty interrogation techniques being considered were in compliance with 18 USC 2340-2340A, the anti-torture federal statute. Marcy has the dirt:

That is ... [the] OLC was clear that the advice did not extend to the Geneva Conventions or the Convention Against Torture. The question at hand was, did waterboarding and sleep deprivation comply with a law--2340-2340A, not whether it complied with all laws.

Follow the link.

"The concrete is being mixed..."

Robert Reich cautions that the Big Insurance and Big Pharma are already rolling out plans to sink the public option.

So they're pulling out all the stops -- pushing Democrats and a handful of so-called "moderate" Republicans who say they're in favor of a public option to support legislation that would include it in name only. One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they've been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers.

Isn't that right out of the Luntz playbook?

Olympia Snowe, Reich says, is pushing another unreachable "trigger" provision to protect the insurance companies from any immediate erosion of their profits. The same push is happening on the House side.

Reich:

This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers -- one that gives the public insurer bargaining leverage over drug companies, and pushes insurers to do what they've promised to do. Don't wait until the concrete hardens and we've lost this battle.

Kennedy lays down a marker

Sen. Ted Kennedy is still fighting his brain cancer and still fighting the good fight:

WASHINGTON — All Americans would have access to “essential health care benefits,” with no annual or lifetime limits, employers would have to contribute to the cost of coverage and the government would create a new public insurance program under sweeping legislation drafted by Senator Edward M. Kennedy and circulated Friday.

Under the legislation, the government would subsidize premiums for people with incomes up to 500 percent of the poverty level ($110,000 for a family of four), and private insurers would have to pay out a specified percentage of their premium revenues in benefits.

The new government-run program would pay doctors and hospitals at Medicare rates, plus 10 percent.

Mr. Kennedy’s bill would also establish a new insurance program to provide home- and community-based care for 10 million people with severe disabilities.

The Conyers HR 676 (a.k.a. Medicare for All) is up to 78 cosponsors so far. This is going to be the fight of a lifetime - another Gettysburg according to one friend.

Recalling Firedoglake’s 2006 rubber stamp campaign, I have suggested a symbol everyone could use to drive home the problem with the broken health care system: stacks of medical bills.

http://media.collegepublisher.com/media/paper1146/stills/403b7303951e1-97-1.jpg

http://www.armyofmom.com/SPF%20xanax%20bills.JPG

http://blogs.babycenter.com/momformation/files/2008/09/bills.JPG

We will need a symbol to stand in for our failed for-profit health care system, a symbol that targets insurance companies and that a) every American recognizes; b) every American loathes; c) most people have in their homes; d) won’t disappear with a compromise reform plan; e) anyone can mail to, send to or throw onto their congresscritter’s desk, or wave over their heads for the media; and f) that our congresscritters themselves can wave over their heads during debate.

I think stacks of medical bills are that symbol.

I attended the local Obama group’s organizing meeting on pushing health care reform Thursday night, and was surprised to find that the 30 Obama supporters there had the same reaction many progressives in the crowd at America's Future Now! had. They want single payer and they are ready to fight for it regardless of what Obama is supporting.

One woman recounted a terrible story about her son dying of colon cancer (congenital predisposition to it) because he had no insurance and couldn’t get a yearly colonoscopy until he had Stage 3 cancer and was down to 110 lbs. Obama’s Organizing For America is collecting thousands of personal stories from across the country.

Great. But the problem is that too many among the general public will be sympathetic, but unable to connect those stories, faces and names to their own lives. Most everyone has dealt with medical paperwork. Instantly recognizable. Universally hated.

There will be some kind of mass rally, of course. I see a touch of "Meet John Doe" or "Mr. Smith" in thousands of people arriving in D.C. clutching sheaves of medical bills, and medical bills spitting out of Capitol Hill fax machines for days (with videos posted on YouTube). A little something our reluctant Smiths can use for show-and-tell in the wells of the House and Senate. I don't think they grasp the depth of anger and frustration out here. They just need a little educating.

Lock and load.

Media on the ropes

The forum yesterday on the fate of the news media and its relationship to the blogs posed more questions than answers. Mostly of funding and legal issues. Marcy Wheeler raised the issue of how much we all count on the efforts of other - like the ACLU - to do the leg work of getting at government source material. Their lawyers do the work and we benefit.

Other notable comments were from a former reporter who noted that advertising losses have forces staff cutbacks and higher workloads which lead to lousy reporting. But it begs the question of which came first, the lousy reporting or the loss of revenue and readership.

Cheap hotel we're in has no wireless, plus the hour each way on the metro makes blogging while here more of a pain than it should be.

Sirota at America's Future Now! conference

One divide here is between passion and caution on health care reform. At several events, cries of "single payer" come up when health care is being discussed. They are the further-left, all-or-nothing folks who want single payer swept in now ... or nothing, I suppose. There's a real reluctance by the power players here to push hard for single payer. On Monday, Gov. Howard Dean explained it as more palatable (and salable?) to simply place a public option on a menu of choices Americans can choose from.

Their caution is warranted. In 1993, the Clintons pressed for sweeping change and got nothing. Obama is playing it closer to the vest and asking for something more incremental. But is that the right strategy?

It's time for progressives to press hard for single payer, David Sirota observed this morning. We can expect the change we will actually see from this process to be somewhat incremental - and perhaps including some kind of public option - so why push for less than what most Americans want? If we push hard Congress hard for more than we expect to get, that makes compromising for less more productive. That's something many Democrats and progressives don't seem to get, Sirota said, but it's time they learned. It's Negotiating 101.