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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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I agree with Julian Sanchez about the alleged astroturfing behind the angry town hall crowds:

Manifestly, there are groups like FreedomWorks trying to catalyze or corral opposition to Obama’s policies, but it hardly sounds as though they’re in control—at most, it seems like they’re providing focal points for the kind of genuine, strong sentiment you can’t fake… and that I’d think few political operatives would want to fake.

You can certainly shake your head about Dick Armey, Rupert Murdoch, and Howard Phillips — a report in Alternet by Adele Stan illuminates their roles well.  But I think it’s a false sense of superiority to call the right wing participants in these events “fringe” or “astroturf.” No more so than Obama supporters turning out by the hundreds and more for campaign rallies — called there by e-mail, text message, and spiffy web sites. Sanchez continues:

That said, I think the sharp line between “grassroots” and “astroturf” will probably make less and less sense in the emerging media environment. The Platonic form of a grassroots campaign is, say, a bunch of ordinary parents in Peoria, largely unconnected with and certainly undirected by any larger political entity, banding together to agitate for some change or other. And the Platonic form of astroturf is when Peoria Parents for a Brighter Future turns out to be three bachelors  in a K Street office with some letterhead and a fat check from McDonalds or something. But the lines between local and national politics are much blurrier when all the organizing and reporting are taking place online.

In a comment, he concedes a reader’s point that “the “genuine, strong sentiment ” you [applaud] is authored by deceit,” and so do I — see Re: Fw: SENIOR DEATH WARRANTS below.  But it does no one any good to bemoan that.  Freedomworks et al have been out-organizing Obama’s people, and by a considerable margin. Why is that?  I have a few theories.

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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.

Kathy — can I call you Kathy? great! — I’ve been a little upset about the story in Politico last week about how you and the Washington Post were going to hold pay for play issue “salons”, where companies could pay anywhere from $25,000 to $250,000 to have off the record discussions with top of the line, elite journalists and government policy makers.

Now obviously this was mishandled from the start; these “salons” — heck, let’s just call a spade a spade and call ‘em policy brothels — are a great idea, but the product rollout was terrible.  Like you told your loyal servant Howie Kurtz the day the story broke, “This should never have happened. The fliers got out and weren’t vetted. They didn’t represent at all what we were attempting to do.”

But I still accept your abject weekend apology in the Washington Post.  Like you wrote, this was a venture that just “went off track,” – kind of like a dog that slipped its leash; I mean, who’s really to blame for that?

After all, how could you be blamed for some business plan by some guy you employ to hold a policy brothel in your home? Sure, the Washington Post business vice president guy — Charles Pelton — said that “newsroom leaders, including Brauchli, had been involved in discussions about the salons and other events,” but seriously: who’s going to believe a guy who can screw up a nice racket like this one?

For my part, I can’t wait for whatever it was you were attempting to do.  Like the flyer said — “Spirited? Yes. Confrontational? No.” I’m sure I speak for most captains of industry when I say now that’s the way I like my journalists, all shy and respectful, in the “intimate and exclusive” privacy of your own home.  I don’t know which of the talent in your stable you were “inviting” to these “salons,” Kathy, but I tell you what: you take a fresh young fella like Ezra Klein, why, it’d be a crying shame not to try to make a little money off him.  You brought him in off the mean streets of the blogosphere, you gave him a nice home — you have an investment to recoup! I’m sure there’s many an “underwriter” who’d gladly pay for even just a kind word from him.

For his part, Ezra still seems to hope that “salons could be profitable after all”; as long as everything’s on the record the way you (now) agree it should be.  So he’s not against the “pay to play” part — tough as that might be on little papers that can’t attract the high rollers, or the little nonprofit citizens groups who either can’t afford to get past the doorman, or won’t suck up to the “underwriters.”  Not his problem — and not ours either, Kathy!

Kathy, like you, I think there’s got to be some “legitimate way to hold such events” — there’s too much money at stake for there not to be!  However the events eventually do work, you’re right to want to“review the guidelines for them with The Post’s top editors and make sure those guidelines are strictly followed.” As long as those “guidelines” have 3 or 4 zeroes at the end of ‘em, I’m sure old Fred Hiatt will play ball — heck, just a couple of zeroes would probably get you some of the, you know, less discriminating boys.  Am I right or am I right, Jackson?

I’ve been saying for a long time that the way the Post and the Times do journalism only makes sense if you figure they’re doing it for the influence, not for the readers.  Thanks for proving me right, Kathy — it might have been better if you’d piled up some board memberships instead, but now that it’s out in the open, go make it profitable!

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EDIT, 7/7: D’oh. Weymouth, not Graham.
UPDATE, 7/20: prompted by Nell, I lay a figurative flower wreath at the Internet Archive link to Media Whores Online, 2000-2004.
UPDATE, 7/26: In an e-mail, eRobin went “policy brothels” one better with “message parlors.”  Also, on his July 10 “Journal,” Bill Moyers delivered a homily for the ages on the subject. Among the many good parts:

Remember, 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. The “stakeholders” in health care reform in this case 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, a bouncer would drop kick them beyond the beltway.

The clip to the right, from a June 16 Congressional hearing, is via Christy Hardin Smith (at “firedoglake”), who joins Howard Dean and others in advocating a “public option” health care reform, and points to the “firedoglake” Public Option Whip Count Tool to help do so.

It is no doubt true that we’ve been gamed within an inch of our lives by a political process that took “single payer” off the table from the start — a tactic now regretted by one of its primary enforcers, Senator Max Baucus (D-MT). From David Herszenhorn’s NYTimes article (Baucus Grabs Pacesetter Role on Health Bill) of last week:

[Baucus] conceded that it was a mistake to rule out a fully government-run health system, or a “single-payer plan,” not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama’s proposal of a public health plan to compete with private insurers as the most liberal position.

Even without details available, Obama’s “public option” notion is no silver bullet, as Harvard’s David Himmelstein* argued on the Bill Moyers Journal in May:

…most of the cost savings [Obama]’s talking about are really illusory, I think. And my research group has done most of the research work on administrative costs in health care. And the administrative costs he’s talking about saving are a tiny fraction of the potential savings under single-payer. ‘Cause hospitals have to keep their bureaucracy, if you’re dealing with hundreds of different plans. And doctors have to keep the bureaucracy in our office. You don’t actually get the streamlining that you get from having one payer that has one set of rules and can pay lump sum budgets to hospitals. But more than that, we’re worried that the public plan actually becomes a dumping ground for the unprofitable patients.

…because private insurors use tricks like second-floor or otherwise hard to get to signup locations to weed out the elderly or infirm from their lists. That said, were “public option” to become the insurance of choice, it might become a de facto single payer system, one that was able to achieve the savings in the long run that it can’t in the short run. Then again, it might not get that far. For more justifiable skepticism about Obama’s “public option” idea as compared to a “single payer” system, read Lambert or Avedon Carol (also here) and follow their links.**

But a public option might at least be free of the kinds of abuses Ms. Robin Beaton (the woman in the video) suffered through — worse even than so-called “rescission” for a nondisclosed prior condition, in that Beaton faced delay of benefits for a condition discovered after coverage began — while facing malignant breast cancer:

In May 2008, I went to the dermatologist for acne. A word was written on my chart and interpreted incorrectly as meaning pre-cancerous. Shortly thereafter, I was diagnosed with Invasive HER-2 Genetic Breast Cancer, a very aggressive form of breast cancer. I was told I needed a double mastectomy. When the surgeons scheduled my surgery I was pre-certified for my two days hospitalization. The Friday before the Monday I was scheduled to have my double mastectomy, Blue Cross red flagged my chart due to the dermatologist report. The dermatologist called Blue Cross directly to report that I only had acne and please not hold up my coming surgery. Blue cross called me to inform me that they were launching a 5 year medical investigation into my medical History and that this would take approximately 3 months.

Naturally, it got worse: Ms. Beaton testified that Blue Cross canceled her insurance; it was only thanks to the intervention of her Congressman that her coverage was reinstated — after having to wait for 4 months for surgery, while her tumor grew from 2-3cm to 7cm in size.  If her cancer returns and cannot be cured, it won’t be an exaggeration to say her health insurance killed her.  How many other Robin Beatons are there? How many couldn’t get their coverage back?

Whatever its shortcomings, it seems possible a “public option” could be a (relatively) abuse-free, predictable, transparent alternative to monstrous situations like Ms. Beaton’s — a safe harbor, not a dumping ground, for Americans who want reliable health coverage when major illness or injury strikes.

One reason for thinking so is that the health insurance business turns out to be massively concentrated; a recent Health Care for America Now! (HCAN) report shows that “[i]n the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets but haven’t delivered on promises of increased efficiency. According to the American Medical Association, 94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries.” (Via TPM).

One of the best ways of losing clients — if there were actual competition to lose them to — would be to subject them to the kind of thing Ms. Beaton experienced. While I’d very much prefer a single payer plan, it seems to me a “public option” could have real value, too, in preventing the kind of “pseudoinsurance” issue Ms. Beaton’s case illustrates.

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* Dr. Himmelstein is author of the study referred to in the prior post, showing that over 60 percent of bankruptcies in 2007 were attributable to medical expenses.
** OTHER persuasive single-payer over public option articles or resources: AZ League of Women Voters comparison; Robert Reich, though he prefers public option to the regional coop idea that has been floating around.

This is a cheap post — just an embedded video, a bit of transcription,  and a big “thank you” to eRobin who’s working hard on this issue.

Dean is great at turning the debate around to where it needs to go: a public option offers freedom of choice and builds the American economy. He also subscribes to the notion that single payer can evolve from the “public option,” rather than insisting on going directly to “Go” and collecting the savings that would result that way. Great quotes:

This is about the future of the American economy. We’re not just losing jobs to China, we’re losing jobs to Canada because their health care system is better for business than our health care system is. [...]

You can sign up for a public plan like Medicare or you can sign up for a private plan. You get the choice. You get the choice. And that’s … why the Republicans are in trouble here. They want to keep the choice for themselves, they want to make the choice for you, but we think it’s time now that the American people get to make the choice themselves. [...]

The only way we’re going to get to a single payer is if that’s what the American people want. … Look we had some health insurance companies leave our state when we forced all the insurance companies to issue health insurance regardless of the health of the individual and when we forced them to not charge more than 20% more for their sick patients than for their healthiest patients. And the bad ones left the state. And that was a good thing! We need to get some of these health insurance companies to behave themselves, and the best way to do it — the only way we’ve discovered in 40 years — is to offer an option. Let the American people choose. That’s all the Democrats are asking: let the American people choose. [...]

I understand why the insurance companies are against this, because they would have to clean up their act. But I don’t understand why the Republicans are against it. I thought the Republicans were interested in giving *more* choices to the American people, but apparently they’re not, and that is wrong, and if we have to pass this thing with 51 votes we should do it…

They may be on the sidelines, relatively speaking, but if worthwhile health care reform happens it will also be thanks to Howard Dean, and to all the activists and organizers like Robin who’ve been working so hard and so long towards this goal.

UPDATE: It occurs to me to mention a Prosperity Agenda item by Kevin Zeese that I posted on Facebook a few days ago, via which I found  Medical Bankruptcy in the United States, 2007: Results of a National Study (.PDF), an article by David Himmelstein, Deborath Thorne, Elizabeth Warren,  and Steffie Woolhandler in the American Journal of Medicine.  From the results section of the abstract (emphases added):

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

As I wrote at the time,* the outlines of this outrage were already apparent to these authors back in 2005. But despite their research and outreach at the time, a Dickensian bankruptcy bill (sponsored by Joe Biden) was passed that made no allowance for these kinds of undeserved financial disasters.  Clearly the health care and financial security of average Americans generally take a back seat to the care and feeding of financial CEOs. I hope this time will be different; perhaps the bankruptcy bill was all part of Joe Biden’s elaborate ten-dimensional chess strategy to achieve single payer health care.

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* The titles, “Bankruptcy Bill Hackery” and “Bankruptcy Bill Hackery: The Sequel,” refer to a critic of the study, not to Himmelstein et al.