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Without it, it’s a giveaway!

Via Real News Network and brought to you by Billionaires for Wealthcare.

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UPDATE, 10/25: Enthusiastic review by Rachel Maddow on MSNBC, hilariously pinch-mouthed writeup by Garance Franke-Ruta in the Washington Post.

I received an e-mail from Representative Chris Van Hollen (D-MD-8) today that updates my knowledge of where he stands in the health care debate.

As Van Hollen might write, I’m pleased to report that he makes repeated and positive mention of the “public option” in his remarks, which naturally center on HR 3200, the “American Affordable Health Choices Act.” From the e-mail:

The American Affordable Health Choices Act fulfills the promise of bringing real change to America through two key provisions: giving Americans the choice of a public health option and providing universal coverage to all Americans. [...]

One of the most significant elements of this bill will be the public health option. A public option is essential for creating choice for consumers and more competition for the insurance companies. The top 10 insurance companies have seen their profits increase 430 percent over the last seven years, yet the majority of Americans’ incomes have stayed flat while their insurance premiums have sky rocketed. A public option will keep insurance companies honest and bring health costs down for the American people.

This may or may not be a surprise to close watchers of the health care reform debate, but Van Hollen’s unequivocal emphasis — at least at this point — on the public option was welcome news to me.  Last year during the election he actually went further, endorsing a “single payer,” Medicare for all reform, but hasn’t opined on that since then as far as I know.

In an September 1 interview with Ezra Klein of the Washington Post, this is how Van Hollen handicapped the prospects for the public option:

Right now, you have Senate moderates saying they can’t pass a bill with a public plan and House liberals saying they won’t pass a bill without one. Is health-care reform between a rock and a hard place?

We need to let it play out more. In the House there’s a consensus in support of the public option, and people coming back from their districts continue to support a public option. Then we’ll have to see what the Senate does and where we go from there. As we come back, the White House will have to play a bigger role in this debate.

I wonder how he rates Obama on that score now; that’s somewhat less than a pledge to fight for a public option no matter what.  But given his continued support for a public option — a stance that is presumably in step with other House Democrat leaders — it’s important to support Baucus bill amendments like Jay Rockefeller’s that add the public option to the Senate bill.

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EDIT, 9/25: “Representative,” “(D-MD-8),” and link to the congressional web site added.

Click to  pledge that if incumbents vote against
both a “public option” and “single payer,” you’ll
work against them in 2010.  More here.

There’s a lot to unpack in Aziz Poonawalla’s post “Baucus bill follies: the public option is anti-progressive.” In it, he levels a blast at people like me who are insisting that at least a public option be part of health care reform, writing that the “public option” does “exactly zero” towards bringing affordable coverage to all Americans.  He bases this in part on the contention that

“…the public option would only be available to a small fraction of citizens who are either ineligible or unable to afford private insurance.…”

This isn’t entirely clearly written, so while Aziz and others may not disagree, let’s make sure: the public option* will eventually be available to anyone who can enroll for the “Health Insurance Exchange” risk pooling market, i.e., anyone who…

• is not a full time employee with a qualified employer health benefits plan (QHBP), i.e., affordable and meeting benefits and consumer protections standards, and
• is not “enrolled in another qualified health benefits plan or other acceptable coverage,” with”acceptable coverage” including things like Medicare, Medicaid, Department of Defense “TRICARE,” and approved state health benefits risk pools like (perhaps) the Massachusetts “Connector.”

Redrafting, then, “the public option will eventually be available to citizens ineligible for more heavily subsidized health insurance plans, and also not covered as a full time employee of a company with an adequate plan.”

The definition is convoluted, but as Medicaid recipients are for the most part unable to afford private insurance, and many full time employees are able to, the public option is clearly aimed at an “in between” financial situations.  However small its target groups turn out to be, they’re logically part of the puzzle of bringing everyone in to a health insurance system.  A public health insurance option also isn’t just “mopping up” the halt and the lame, as one commenter at Aziz’s post seemed to imply — a pool of the unemployed, the self-employed, and employees of small businesses would generally be about as healthy as the rest of the country.

Aziz concludes:

“So the scope of the public option is limited to begin with, and certainly will be constrained so heavily that it will never, ever be the stealth road to single-payer that most of the progressives who are intent on making it a litmus test seem to think it will.”

Now it’s true that I would have much preferred the public option to be available immediately, rather than by 2013, and I’d have preferred to be able to switch into it from my current employer based health insurance if I so desired.  Both improvements would have made the public option a much more direct competitor with private insurance companies instead of an indirect one I’ll only be able to choose if unemployed.  But Aziz’s prediction still combines at least two assertions I question.

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2010 Health Care Pledge for a public option or single payer health care system

Public option supporter, 9/13/09

The goal of this pledge is for Americans who support either a “public option” or a “single payer” health care system to motivate their representatives and senators in the strongest way possible: by withholding any support from candidates who failed to vote for a bill including either provision.

The pledge:

We, the undersigned, pledge not to support and to oppose *any and all* incumbents (Democrat, Republican, or otherwise) in the Senate or House in 2010 who

(1) voted against each of (a) a public option and (b) a single payer health care reform bill (HR 676) in the 111th Congress when the opportunity before the full House or Senate arose, or who
(2) demonstrably prevented the possibility of such votes (e.g., by voting to allow filibusters to continue), or
(3) who voted for a reconciliation bill that failed to incorporate either a public option or single payer option, or
(4) — if no such votes take place — who failed to co-sponsor such reforms or vote for them in applicable committees.

By “support,” we mean
(1) contributing money to,
(2) working as campaign volunteers for, or
(3) voting for such incumbents.

By “oppose,” we mean supporting suitable primary challengers to such incumbents whenever possible, and supporting suitable third party challengers in the general election whenever that is necessary to provide a choice for single payer or public option health care reform on the 2010 general election ballot.

By “public option,” we mean an immediate public option, not one “triggered” by future events (since experience shows Congress routinely ignores such triggers), and not a system of “regional coops” (since these are likely to create a “race to the bottom” state with the weakest health insurance legislation).

This petition is not affiliated with any organization, but those who sign it will have self-identified as people who will only support proponents of meaningful, structural health care reform, and should seek out such candidates.

Once health care reform situation is clarified by final votes or filibusters, I’ll do the following:

• Provide a list of “F’s on health care reform” — Senators and Representatives who have failed to meet any of the four conditions above, and where possible, a list of their primary and/or general election opponents.
• Notify suitable challengers (who do support single payer or public option) to these candidates of the possibility of petition signers’ support by directing them to the petition.
• Contact petition signers with an message seeking permission  to send occasional additional messages as the 2010 election campaign season proceeds, and suitable challengers to “F’s on health care reform” are found.  I will not provide any petition signer’s email addresses to any candidate.

This space will serve as a place for updates on the progress of the petition and the progress towards a public option or single payer health care system.

Public option rally, Sunday, September 13, 2009, north of the Capitol.
Organized by “Americans United for Health Care and Insurance Reform“

I joined about a thousand other people from around the country for a rally near the Capitol Building on Sunday.  I was impressed with how energized people seemed to be, at least compared to my own somewhat glum assessment of the situation after Obama’s speech last week. The slideshow above shows a sampling of the signs on display; my favorite was a young man whose signs bowdlerized biblical verses like Matthew 6:26 to “Look at the birds of the air; they do not pay taxes yet your Lord feeds them. … They must be SOCIALISTS.”

It was a reminder that optimism and humor beat pessimism when you want people on your side.  So maybe my fellow demonstrators had it right when they cheered speakers’ mentions of Obama’s speech; while I felt Obama artfully threw the “public option” under the bus, maybe I’m wrong about that after all, and what good does it do me if I’m right?

The rally was a true grass roots effort, bringing people from all over the country.  A woman from Asheville, North Carolina told the terrible story of her son’s death from colon cancer — and from the insurance companies refusal to pay for needed tests and treatments.  Another woman from Michigan told about holding down four jobs and not seeking medical help for an infected jaw — for four years.  A doctor from Texas told about how ashamed she was when an injured patient’s first reaction after regaining consciousness on respiratory support was to panic — and finally explain why by writing out the message “I can’t pay for this.”  These people came a long way to share their stories; they’re not giving up, and so neither will I.

Some of the recent political news isn’t great — e.g., Senator Harkin (Kennedy’s replacement for the HELP Committee saying dropping the “public option” isn’t a dealbreaker, Senator Snowe saying she’ll vote against it, Obama not meeting with progressive Congressmen and women.  But at least one analyst thinks it’s too early to count out the “public option”.  Writing in the Huffington Post, author and political consultant Robert Creamer points out that (1) it’s the push for a bipartisan deal that seems to be fading, (2) four of five congressional committees have reported out a “public option” in their bills, (3) Obama’s support for the idea matters, as does his support for holding down costs — and the Massachusetts model lacking a public option is seeing rising costs, and (4) likely 2010 voters favor a public option by 62 to 28 percent.  I’d take issue with Creamer’s description of HR 3200 as a “strong” public option, but that’s beside his point, which is simply that it ain’t dead yet.

Congressional progressives like Keith Ellison and Raul Grijalva don’t seem to be throwing in the towel, either, and are conducting a “whip count” to gauge the strength of their position that any reform must include a public option.  Ellison thinks 80 to 100 representatives will pledge to oppose any legislation that doesn’t include a “public option”; Grijalva thinks that’s a little high, and told the Huffington Post’s Ryan Grim the whip count will “send a message to the administration: don’t cut deals with some elements of our party or with some elements of the Republican Party without including the progressives in that discussion.” That kind of “deal cutting” formulation may or may not be a good sign, but obviously the higher the count the more insistent he and his allies can be.

Locally, Donna Edwards is a co-sponsor of HR 676 (Conyers single payer bill) and is among those insisting on a public option.  Meanwhile, my own representative Chris Van Hollen has been MIA despite pledging support for a single payer bill in last year’s election — leading Gordon Clark to ask “During this battle for  health care, where in the world is Chris Van Hollen?” It would be good if he got off the fence on this issue, at least.

The Obama plan both builds upon and improves our current insurance system, upon which most Americans continue to rely, and leaves Medicare intact for older and disabled Americans. The Obama plan also addresses the large gaps in coverage that leave 45 million Americans uninsured. Specifically, the Obama plan will: (1) establish a new public insurance program available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) make available the National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees; (4) mandate all children have health care coverage; (5) expand Medicaid and SCHIP to cover more of the least well-off among us; and (6) allow state flexibility for state health reform plans.

– from “Barack Obama’s Plan for a Healthy America” (PDF), via Jane Hamsher (”firedoglake”).

Thus, Obama specifically campaigned for what is now called the “public option”  –  and it wasn’t just the 8th of 11 bullet points in some forgotten speech in Cornstalk, Iowa, it was the very first specific element of his official health care plan.  It was positions like this one that helped convince me, after Edwards’s exit, that the health care issue was at least a rough tossup between Clinton and Obama in the primaries, and helped convince me that Obama was worth working for in the general election campaign.  I don’t seem to be the only one, judging by the Progressive Change Campaign Committee’s (PCCC) yeswestillcan.org site, which placed the ad to the right in the New York Times on Tuesday.

But the “public option” was a disposable afterthought — merely an “additional step we can take” — in Obama’s speech to Congress on Wednesday evening.  Even after noting that a majority of Americans “still” favor the idea, Obama continued:

But its impact shouldn’t be exaggerated — by the left or the right or the media.  It is only one part of my plan, and shouldn’t be used as a handy excuse for the usual Washington ideological battles.  To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it.  The public option — the public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. …

Wrong.  Having eschewed a single payer model for health care insurance, the public option is utterly necessary for meaningful health care reform. The separate “Health Insurance Exchange” market that Obama and writers like Ezra Klein put much of their faith in will only be as good for Americans as the best insurance provider within that risk-pooling and -adjusting exchange — not just in co-pays and premiums, but in accessibility and service.  Without a public option, the profit motive and shareholder pressures all but guarantee that private insurors will see such an exchange as just another regulatory framework to game — either by “innovatively” colluding and signaling industry-wide higher fees and premiums than necessary to eachother, by “innovatively” finding ways to cherrypick the healthiest clients within the exchange without appearing to do so, or both.

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As the health care “debate” lurches forward under the expert guidance of our Democratic leadership, my thoughts turn unbidden to the past.

How vividly I remember how we were counseled not to upset our sensitive Republican friends with any prospect of impeachment or subpoenas or prosecution, or of anything at all that might hold them or their chieftains even a little bit accountable for anything.

No, even though it was our most fundamental birthright to hold our rulers accountable when they break laws and break faith and break oaths, we were looking forward, not looking back.  And that was because we were looking forward to that “progressive place” Pelosi prattled on about once — serious liberal Democrats like Harold Meyerson and Chris Van Hollen and Eric Alterman nodding sagely at her side.  Well, Alterman came later, but I’m being allegorical here.

When we got there, she told us, there’d be a delicious yummy exit from Iraq and then! a delicious yummy climate change bill and then! a delicious yummy health care plan!  It was a wonderful story!  Instead of having to fight mean Mr. Bush and Mr. Cheney, we’d just wait for them to go away and we’d have a much easier time with all their friends.  Why, we might all look back on everything and just laugh at how silly we’d been!

So we gave away our birthright, and now I suspect that instead of getting anything delicious and yummy, we’re going to get the mess of pottage I understand you can expect when you do that.  Although there was nothing in the old story about the Iraq surge and FISA amendment and all the other sh*t sandwiches we got to eat first.  Which just goes to show those old stories never get it exactly right, but they can still get pretty darned close.

If so, I imagine people will be saying, “mmm! pottage!” or “you know, for a mess of pottage, it’s not half bad!” And they’ll say it with uniquely American Homer Simpson voices.  And I’ll be banging the desk with my head.

UPDATE, via Jed Lewison at DailyKos:

I got one of the health care e-mails that have been ricocheting around the Internet yesterday.  It was forwarded by a dear relative of mine, with the subject line “FW: SENIOR DEATH WARRANTS.” I’ve posted it on my Google Docs site — of course, without any identifying information, and without editing.  I want to respond to various claims made in that e-mail.

Throughout the discussion below, I’ll link to relevant parts of proposed legislation to back up what I’m saying.  I’ll usually be referring to the text of H.R.3200, also known as “America’s Affordable Health Choices Act of 2009″ — this is one of the main House bills.  The link leads to an “all about H.R.3200″ web page at govtrack.us that enables links to very specific parts of the bill.  However, readers with slow browsers or older computers may be better off consulting the text version of the bill.

Discussion
The email begins by recounting a conversation with a doctor:

REPLY: FALSE. This and other parts of the e-mail appear to misconstrue Section 1233 (”Advance care planning consultation”) of the bill.  As a fact sheet by Rep. Blumenauer summarizes,

The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.

REPLY: NOT RESPONSIVE. It’s true that the AMA has endorsed a health care reform plan; given the organization’s opposition to health care reform in the past, that’s big news.  The main reason, according to reporter Jeffrey Young of The Hill, is that the bill envisions a “permanent fix to a Medicare payment system that annually calls for doctors fees to be cut.”

This was potentially an expensive gift to doctors; so if the doctor is advocating keeping annual fee cuts intact, I’m right there with him.

REPLY: FALSE. First, while it’s too bad, no major health care reform bill advocates a health care system anything like England’s.  But second, the statement is flatly wrong. Factcheck.org actually contacted the U.K. Department of Health and and an English nonprofit group advocating for older persons about this claim:

[A spokesman] said medical procedures in the U.K. are not routinely denied for older people. The National Health Service, the U.K.’s public health care service, has a constitution which prohibits discrimination on the basis of age and other factors. “The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief,’ “ the spokesman said.

We also contacted a nonprofit group, England’s Age Concern and Help the Aged, which works to stop age discrimination in various facets of life, including employment and health care. Age Concern’s press office had never heard of any kind of prohibition on heart surgery for those 60 and older.

REPLY: SADLY, NO. First, it would be impossible to have a healthcare system “just like Canada’s and England’s” because they have different systems.  Canada has a “single payer” health care system, in which health care costs are negotiated between health care providers and the government or an independent agency — a kind of “Medicare for all” instead just for older persons.  Another country with a successful kind of single payer health care system is France — according to that left wing magazine Business Week.

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The health care is supplied by a worthy group, the Remote Area Medical Volunteer Corps. Their founder — none other than Stan Brock, once a star of the nostalgia favorite “Wild Kingdom” — said in another video clip I ran across that he got the idea from his days in the Amazon; after a serious injury, he was told he was 29 days on foot away from the nearest health care.  (Brock is careful in that interview to characterize health care as a “privilege.”)

The Amazon jungle — a reasonable model for those without health insurance in America.