Free speech and hate speech

A friend of mine on Facebook posted links to two YouTube videos about some outrageous acts of right-wing incitement that have taken place recently. First is a video of the marvelous Rachel Maddow talking with former religious-right organizer Frank Schaeffer about the murder of Dr. George Tiller. Second is a video about anti-abortion vigilante Randall Terry encouraging people to burn Rep. Nancy Pelosi and Sen. Harry Reid in effigy this Hallowe'en because they will "burn in hell" for sponsoring health insurance reform legislation.

Watching these videos reminded me how tricky and complicated the issue of free speech is.

The right to free speech is not trivial. It is a right that needs to be used carefully and responsibly, because the pen, and the video camera, are indeed mightier than the sword. Legal words can inspire illegal actions that have terrible consequences. Just because you have the constitutional right to say something doesn't mean it is morally right for you to say it. If right-wing rabble-rousers describe their opponents as "murderers," and invite their supporters to symbolically burn them at the stake, they oughtn't express surprise if listeners take their words as the justification for real acts of violence. And it's really not fair for them to whine when commentators such as Rachel Maddow use their own free-speech rights to point this out.

I suspect that some folks would like to go one step further and make it illegal for evil-speakers like Bill O'Reilly and Randall Terry to spew their poisonous rants. I'm guessing these folks would say that it's okay to oppose abortion rights, and it's okay to oppose health care reform -- but you need to be moderate and responsible in the way that you do this. And if you're not, there ought to be some kind of legal penalty. We have to stop hate speech before it destroys us. To these folks, I would like to say, not so fast. Yes, we need to stop hate speech, but passing a law to do that is likely to have serious unintended consequences.

Back when I was in college, I took a course in constitutional law. This was maybe 30 years ago, so I apologize that I don't remember the names of all the cases that we studied. But here is how I remember the case law on free speech. Remember how you don't have a right to "yell `fire!' in a crowded theater?" Sounds reasonable, right? Well, it came from a case involving people resisting the draft during World War I. There was a law -- I think it was called the Espionage Act -- that said that if you encouraged people to avoid military service, you were committing a felony and could be sent to jail. (You remember World War I, right? That was supposed to be "the war to end all war," but all it accomplished was the humiliation and impoverishment of Germany -- which set the stage for World War II.)

Wait. I just had a brainstorm. Due to the miracle of Wikipedia, I don't have to dig through the stuff in my junk room to see if I kept those old notes from college. I can point you to an entry about the Espionage Act of 1917, which leads me to an entry about Schenck v. United States, the case in which the supposedly liberal Justice Oliver Wendell Holmes, Jr. penned the famous phrase about fire in a crowded theater. In case this isn't absolutely clear, I want to emphasize the Holmes wrote a concurring opinion for the court in upholding this act, which had such bizarre consequences as the following:

The poet E. E. Cummings and his friend William Slater Brown, then volunteers in the Norton-Harjes Ambulance Corps in France, were arrested on September 21, 1917. Cummings' "espionage" consisted mainly of his having openly spoken of his lack of hatred for the Germans.^[2] The two were sent to a military detention camp, the Dépôt de Triage, in La Ferté-Macé, Orne, Normandy, where they languished for 3½ months. Cummings' experiences in the camp were later related in his novel, The Enormous Room.

Publications which the Wilson Administration determined were guilty of violating the Act "were subject to being deprived of mailing privilege, a blow to most periodicals," according to Sidney Kobre's book Development of American Journalism. A section of the Act allowed the Postmaster General to declare all letters, circulars, newspapers, pamphlets, packages and other materials that violated the Act to be unmailable. As a result, about 75 newspapers either lost their mailing privileges or were pressured to print nothing more about World War I between June 1916 and May 1918. Among the publications which were censored as a result of the Act were two Socialist Party daily newspapers, the New York Call and the Milwaukee Leader. The editor of the Leader, Victor Berger, was sentenced to 20 years imprisonment after being convicted on a charge of conspiracy to violate the Act; this was later reversed on a technicality. Other publications banned from the mails were the Industrial Workers of the World (IWW) journal Solidarity, American Socialist, bohemian radical magazine The Masses, German-American or German-language newspapers, pacifist publications, and Irish nationalist publications (such as Jeremiah O'Leary's Bull).

I can also point you to a biography of the grand old socialist presidential candidate Eugene Debs, who was imprisoned under the Espionage Act for giving this speech. He compared the despotic rulers of Germany with the supposedly democratic rulers of the United States, and found that they ruled in just about the same way. The speech is as gentle as it is eloquent, but ya know, it certainly implied that the US government was illegitimate and ought to be replaced.

My point should be obvious. Laws restricting "hate speech," or laws restricting criticism of the government are just as likely -- or more likely -- to be used against progressives, feminists, and left-wing radicals than they are to be used against right-wing haters like Randall or O'Reilly.

Any feminist worth her salt has been accused of being a "man-hater." Advocates for the rights of people of color routinely accused of hating white people. Critics of US intervention in other countries are routinely accused of trying to destroy the United States.

As painful as it is to contemplate, in order for the right of free speech to be safe, it has to apply to the hateful and immoderate as well as to the thoughtful and responsible. We need to distinguish between hate speech and hate crimes.

There is a difficult but very effective way to stop the haters. We have to do what Rachel Maddow does. We have to speak out against them.

Free Market efficiency is a myth when it comes to health care

Our Bodies Our Blog has a great post on activism to pass a health-care plan. It includes this great little six-page document that summarizes the issues at stake.

Is this good news or bad news?

T r u t h o u t reports that Senate Majority Leader Harry Reid has announced that the health care bill that will be introduced on the Senate floor will include a "public option"--a government run plan that will compete with private insurers for the business of individuals and businesses not currently covered by insurance. The catch is that states will be able to "opt out" of the public option, and deliver their residents into the clutches of the health insurance industry.

Former Oklahoma legislator challenges bizarre new abortion law in well-publicized case

I think most folks would like to see a reduction in the number of abortions that take place. As a feminist, I support the right to choose abortion because it is sometimes the best solution to a bad situation, and because I support the right of women to make decisions about what goes on inside our own bodies.

If we want to reduce abortion, the most practical way to do that is to empower women to keep from becoming pregnant when they don't want to be pregnant. We might do everything in our power to make contraception and family planning services available. And -- call me an old school lesbian feminist if you like -- we might even work to overturn compulsory heterosexuality.

Instead, the Oklahoma Legislature takes the patriarchal approach of trying to bully and humiliate women who seek to end an unwanted pregnancy.

I first learned of this story in an e-mail update from the National Partnership for Women and Families. Their post relied largely on an online article in the Guardian of London, which linked to a piece on Salon.com about an off-the-wall new Oklahoma law that takes truly bizarre steps to interfere with the rights of women to have an abortion. The Salon.com piece linked to the web site of the Center for Reproductive Rights, and this is the best place to begin to read about this bizarre new Oklahoma law.

According to CRR, back at the end of September

former Oklahoma state representative Wanda Stapleton, along with Shawnee, Oklahoma resident Lora Joyce Davis, filed a legal challenge against an Oklahoma law that will impose a host of restrictions on women's access to abortion and cost the state over a quarter of a million dollars a year to enforce. The plaintiffs are represented by the Center for Reproductive Rights and argue that the state legislature overstepped its authority by enacting a statute that will both violate the Oklahoma's Constitution and waste taxpayers' money.

The Oklahoma Constitution requires that laws address only one subject at a time, but the new measure covers four distinct subjects, including redefining a number of abortion-related terms used in the Oklahoma code; banning sex-selective abortion; requiring doctors who perform abortions or treat patients who have had abortions to report extensive patient information to the state health department; and creating new responsibilities for the State Health Department, the State Board of Medical Licensure and Supervision, and the State Board of Osteopathic Examiners relating to gathering and analyzing abortion data and enforcing abortion restrictions. According to the legislature's own estimates, implementing the new reporting requirements will cost the state $281,285 during the first year and $256,285 each subsequent year.

Lynn Harris at salon.com has a chilling description of the new law :

The required questionnaire (see PDF of entire law), practically as long and elaborate as eHarmony's (and containing fishy questions such as "Was there an infant born alive as a result of the abortion?"), does not include the name, address or "any information specifically identifying the patient." But opponents argue that the first eight questions alone would be enough to out any woman in a town of 200 or smaller.

Also, doctors failing to provide this information would face criminal sanctions and loss of their medical license.

It isn’t unique for a state to post health data on its Web site. However, Oklahoma’s requirements are by far the most extensive as such. The law's supporters claim they want this information to be made public so it can be used for "academic research," but according to the Center for Reproductive Rights, its collection method makes it useless for that purpose. (If a woman sees more than one doctor concerning her abortion -- primary care and abortion provider, say -- the data, collected each visit, will appear to represent more than one patient.)

The good news is, thanks to CRR, the law -- originally scheduled to go into effect Nov. 1 -- has been stayed pending a Dec. 4 hearing.

Also, according to CRR, back in August

a state district court struck down a 2008 law that included, among other abortion restrictions, the most extreme ultrasound requirement in the country and a requirement that would have limited the availability of abortions performed with the medical abortion pill. The court in that case ruled that the statute included too many disparate topics and therefore violated the state constitution.

CRR is also challenging the current law on the grounds that it addresses more than one topic, in violation of the state constitution, which gives hope that the new law will also be overturned.

Tests are not always for the best

We've all heard that early detection is important to help prevent deaths from breast cancer--but sometimes the benefits of screening are questionable. The American Cancer Society, long a proponent of mammograms and prostate cancer screening, has started to take a more cautious approach towards these tests.

Feminist Peace Network (one of my very favorite blogs) has a thought-provoking post on this topic. Over-testing has the effect of causing women to undergo treatments that they don't really need, while not really helping to prolong lives.

It seems to me that health care reform means not just providing health insurance to everyone, but doing our best to make sure that treatments benefit patients, and not just the profit margins of health care providers.

Is insurance industry running scared?

Maggie Mahar at Health Beat asks Why are Health Insurers Launching An 11th Hour Attack on Health Care Reform?
and says, in a long but very interesting post, that it's because they know that a public option has a very good chance of making it into the final health care bill.

US banks still in trouble

Thanks to CommonDreams.org for picking up Paul Krugman's New York Times op-ed piece on the continuing troubles of US banks.

Krugman argues that "while the wheeler-dealer side of the financial industry, a k a trading operations, is highly profitable again, the part of banking that really matters — lending, which fuels investment and job creation — is not. Key banks remain financially weak, and their weakness is hurting the economy as a whole."

As if to prove Krugman's point comes the news of CIT Group's worsening condition. CIT is a lender to small and mid-sized businesses whose collapse could seriously threaten the chances of recovery in the real economy.

Reflections on Marriage

Melissa Harris-Lacewell has some really interesting Reflections on Marriage over at thenation.com.

Afghan women don't want more US troops, CodePink founder tells Obama at fundraiser

AlterNet has the story.

Earlier in the month, Evans recently visited Afghanistan over a ten-day period along with a group of CodePink activists, and she was clear in a recent AlterNet article about what she saw -- a humanitarian crisis: "The United States has spent a quarter of a trillion dollars in eight years of military action: what have we achieved? Most of the country is in worse condition, the bordering countries are less stable and death fills the air. According to the United Nations, Afghanistan is ranked 181 out of 182 countries for human development indices. Life expectancy has fallen to 43 years since the U.S. invasion. Forty percent of the population is unemployed, and 42 percent live on less than $1 a day."

What real reform looks like

Maybe, like me, you've received an e-mail from barackobama.com urging you to attend an Oct. 20 event designed to get folks to call their congress critters in support of the president's health care plan.

Maybe, like me, you've been concerned that the president doesn't really have a health care plan, but often seems eager to pass any kind of legislation that says "health care reform," just so he can claim it as an accomplishment.

If so, I think you will want to read a great post by John Nichols over at thenation.com, who says Here's What to Tell Obama, Congress About Real Reform.

How pilot lights work

Recently I re-lit my floor furnace. While I was at it, I took lots of pictures and posted them on Facebook, along with lots of little comments. One of the comments I made was that the pilot light of the floor furnace generates enough electricity to operate the thermostat. (In the event of an ice storm bad enough to cause a power outage, this is a handy little feature.) A viewer of this Facebook album asked, reasonably enough, does the pilot light really generate electricity?

Well, yes it does, it says so right in the manual for the floor furnace. But my manual doesn't say how this works. Fortunately the web site How Stuff Works seems to have the answer to this question.

Thermocouples generate electricity directly from heat. They take advantage of an electrical effect that occurs at junctions between different metals. For example, take two iron wires and one copper wire. Twist one end of the copper wire and one end of one of the iron wires together. Do the same with the other end of the copper wire and the other iron wire. If you heat one of the twisted junctions with a flame and attach the two free iron wires to a volt meter, you will be able to measure a voltage.

In a pilot light, one of the junctions of a thermocouple is sitting in the pilot light's flame. The electricity that is created runs to a small electromagnetic valve and holds it open. If the pilot light blows out, the thermocouple quickly cools off. It stops generating electricity and the valve closes.

Pretty neat, huh?

What will Congress do now that it has five health care bills?

Open Left has an interesting post describing how the five bills that have been passed by House and Senate committees will turn into one bill that becomes law.

Insurance industry bites hand that feeds it as finance committee votes on health care bill

Whoops. I've been so busy getting ready to write a novel next month that I started to lose track of the health care debate.

When last we visited this debate, three House Committees and the Senate Health, Education, Labor, and Pensions Committee had already voted on some version of a health care bill. Now it's the turn of the Senate Finance Committee, which is scheduled to vote today.

The Finance Committee is chaired by Montana Senator Mike Baucus, who is variously described as a moderate Democrat or an insurance industry toady, depending on who is doing the describing. Baucus's goal has been to create a "moderate" bill that Republicans and the for-profit healthcare industry can support. For Baucus, the key to gaining that support has been not to have even a very watered-down version of a public option -- a government-run plan that would compete with private insurers.

The problem is, the Finance Committee bill--like the other bills making their way through Congress--requires almost everyone to purchase health care insurance, and without a public option, that could be a very expensive purchase. According to National Public Radio, in order to address this issue,

Last-minute changes made subsidies more generous and softened the penalties for those who don't comply with a proposed new mandate for everyone to buy insurance. The latter change drew the ire of the health insurance industry, which said that without a strong and enforceable requirement not enough people would get insured, and premiums would jump for everyone else.

AMERICAblog points out the irony of the insurance industry attacking the Baucus bill, and in another post, links to this video of  New York Democratic Rep. Anthony Weiner explaining how the insurance industry's opposition to the Baucus bill makes the case for a public option:

Don't let states opt out of public option

Maggie Mahar over at Health Beat explains why its not necessary to allow states to opt-out of a public option in order to pass a health care bill--and why it's not right.

Fun with a floor furnace (Don't try this at home)

I have always thought that one should never expect anything from the weather. By its very nature, weather is ever-changing and unpredictable. Nevertheless, the recent cold and rain in Oklahoma City caught me by surprise. I wasn't thinking that I'd need to light my floor furnace for at least another month. Then I noticed that the temperature inside my house had started to drop to uncomfortable levels. Yesterday, it was 55 degrees inside. This morning, it was 50. Time to act.

Fortunately, last year when I bought my little house, I downloaded the manual for my floor furnace from the manufacturer's web site. So, after a delicious breakfast at the Red Cup, I got right to work.

First, I needed to clean the darned thing. This required me to get out my shop vac.

Then I had to put the cat away in the bedroom so she wouldn't get into the furnace when I opened it up to clean it. Next, I removed the register and the inner casing. Here's how it looked after the register was taken off, while the casing was still in place. I like this photo because you can see the controls over on the left, and how the whole thing fits together:

It took a while to vacuum out all of the accumulated dust, debris, and foreign objects. About two-thirds of the way through this process, I had to stop to clean out the vacuum. The hose seemed to be clogged with cat hair. Go figure. Once I finished with this step, I removed two of the vent covers from the house foundation so that the heater would be properly vented once it was lit. Then it was time to go under the house.

Here's what it looks like under the house as I crawled back toward the underside of the heater:

The chimney needs some repair, which you can tell when you crawl up closer to it. (I need to find a mason.) The furnace itself has a little bit of external rust, but it seems to be in good shape.

I inspected the furnace, all the fittings I could see, and the connections of the flue to the furnace and the chimney. I cleaned all the debris out of the debris pan. First I tried a little brush, and then a rag. Finally, I used some canned air, and that did the trick. You can barely see part of the debris pan in the photo above. Look for a little flat thing on the bottom middle of the furnace.

Here's where the flue enters the chimney:

This photo shows some of the other issues I need to resolve with the house. First, I need to dig (or, possibly, have someone dig) a French drain to keep water from dissolving the east wall and flowing under the house:

But I have a novel that I need to write in November, so that project may have to wait for spring.

I love to hang out under my house, but eventually it's time to get myself out from under.

And then it was time to go back indoors and light the furnace, following the instructions in the manual. At first I didn't see the part about holding down the gas control while I used the automatic spark switch, but it worked just fine with a match. Now my house is warm and cozy.

Some of that is due to the fact that my floor furnace is blazing away merrily, but I also had a lot of help from my friends in getting the house ready to move into. And when it's cold outside, having good friends keeps my heart warm.

And I still ain't satisfied

It is a beautiful gray October morning, and the inside of my head this morning is still gray and foggy, because of the weather, because I work nights and it takes me a while to get going in the morning. So I'm sitting at my desk with my front door open, and absent-mindedly browsing my blogroll, when I come across this post on Open Left. It's basically a link to this video:



Sometimes the sun burns through the clouds a little bit, and I think I'd like to sit out on the porch and play the harmonica, or maybe sit right here at my desk and re-write a few poems, or maybe do some day-dreaming and note-taking for the novel I'm going to write next month. But instead, here's this interesting and complicated issue about a domestic partnership referendum in Washington State sitting in front of me.

And for me, this could get really complicated. I'm an old-fashioned lesbian feminist with lots of reservations about the old-fashioned patriarchal institution of marriage. And thinking about this ignites the burning nostalgia for a time in which we were going to change the world, really change it, so that everyone was equal and free, and not just try to take our equal place in a fucked up oppressive system. Maybe nostalgia is the wrong word, because I try to live every day of my life to do my part to make that free and equal world possible.

I'm not talking about utopia. I'm not talking about a world free of sorrow or pain. I am talking about a world without the rulers or the ruled. I don't think it's easy, but I think it's possible.

I'm not explaining this very well. I don't know if I can.

So I will confine myself to a much more limited goal. I will give you links to a couple of Wikipedia entries to help you understand the situation in Washington State, and keep my ambivalence and my complicated feelings to myself.

The first entry describes domestic partner laws in Washington State, and the second entry explains Referendum 71.

The wind is still blowing and the sun is still trying to break through. I'm going out now to sit on the portch.

Abortion funding under health insurance reform

Jessica Arons has an interesting analysis at RHRealityCheck.org.

Health insurance reform -- read all about it.

Here are some reference links about the health care reform debate.

There are currently three bills making their way through Congress, being considered by five different committees. Three different House committees are working on versions of HR 3200. The Senate's HELP Committee (Health, Education, Labor, and Pensions) has its own bill, and the Senate Finance Committee is working on yet a different bill. The Senate will merge its two bills, and the House will pass a final version of HR 3200. After that, a conference committee will put together a final version of the bill.

Much of the debate around health care reform centers around the advisability of something called a public option. You can find a description of Jacob Hacker's original proposal for a public option here. (HR 3200 contains a much watered-down version of this proposal that would allow the public option as a choice only for those who don't already have some form of insurance coverage.)

The public option was originally conceived as a compromise that would not be as controversial as single-payer health insurance (sometimes called "Medicare for all.") You can read the text of HR 676 here. You can find more information about single payer on the site of Physicians for a National Health Program. I also wrote a recent post on a conservative version of single payer called balanced choice.

Some of my favorite sources for health care legislations news include

• Our Bodies Our Blog
• RH Reality Check
• Health Beat
• Ezra Klein's blog
• Healthcare Newsladder
• Common Dreams (a great site for all kinds of radical news and views)

Happy reading.

Battle over healthcare public option continues

On Tuesday, the Senate Finance Committee rejected an amendment that would have added a public option to their health care bill. John Nichols at The Nation thinks this is very bad news.

Maggie Mahar at has a very different analysis over at Health Beat.

We knew that the Senate Finance Committee would reject the public sector option. Now they have done just that.

This is not news. Nor is this a “fatal blow” for progressives.

Will the public option survive a vote on the Senate floor? Probably not—though it could happen. But this still does not mean that the public option is dead.

We know that the bill that emerges from the House will contain a MedicareE (for Everyone) alternative. The House bill and the Senate bill will then go to conference. This is the moment that matters. As a respected HealthBeat reader who knows Washington well recently told me, “Everything else is foreplay.” Much of what we are reading now is posturing--by some politicians ( Charles Schumer deserves an Emmy), by some pundits and by unnamed sources who want reporters to think that they know more than they actually know.

I would be happier if I thought both the Senate and the House bill would include a public option. But that isn’t necessary. All that is necessary is to get a bill through the House, and a bill through the Senate, with or without MedicareE. In Conference, where the two bills are merged, they can put the public option back in.

This all depends on the White House stepping up to support a public option. Mahar thinks that President Obama and his aides will do just this because their political survival depends on delivering health care reform that really works.

When Mahar refers to "MedicareE" it looks as if she's referring to a version of the public option that would allow everyone who wanted to do so to sign up for Medicare, even if they had not yet reached age 65. It would be very good news if this is so, but such a proposal is much stronger than anything in the original language of HR 3200. (I'm reading the darned thing, so I have some clue what I'm talking about.)

Meanwhile Iowa Democrat Tom Harkin insists that a bill including the public option could pass the full Senate by a "comfortable margin."

About Roman Polanski

AngryBlackBitch has said almost everything I would have wished to say on the subject.

A chance to reform the PATRIOT Act

The Electronic Frontier Foundation has a letter you can send to your senators to support the reform of the PATRIOT Act to curtail civil liberties abuses. It just takes a few minutes, and for Oklahoma residents, could be especially powerful, because our own Tom Coburn is a member of the Senate Judiciary Committee.

If our ultra-conservative senators are so suspicious of government and don't want it to curtail our liberties, maybe they'll support this. (Well, a person can hope.)

You can read the text of the JUSTICE Act here. The EFF explains the issues here.

Interesting, but not surprising

ProPublica talks about the incentive that Arkansas "Blue Dog" Democrat Mike Ross might have to oppose health care reform.

Arkansas Rep. Mike Ross -- a Blue Dog Democrat playing a key role in the health care debate -- sold a piece of commercial property in 2007 for substantially more than a county assessment and an independent appraisal say it was worth.

The buyer: an Arkansas-based pharmacy chain with a keen interest in how the debate plays out.

Ross sold the real estate in Prescott, Ark., to USA Drug for $420,000 -- an eye-popping number for real estate in the tiny train and lumber town about 100 miles southwest of Little Rock.

"You can buy half the town for $420,000," said Adam Guthrie, chairman of the county Board of Equalization and the only licensed real estate appraiser in Prescott.

But the $420,000 was just the beginning of what Ross and his pharmacist wife, Holly, made from the sale of Holly's Health Mart. The owner of USA Drug, Stephen L. LaFrance Sr., also paid the Rosses $500,000 to $1 million for the pharmacy's assets and paid Holly Ross another $100,001 to $250,000 for signing a non-compete agreement. Those numbers, which Ross listed on the financial disclosure reports he files as a member of Congress, bring the total value of the transaction to between $1 million and $1.67 million.

And that's not counting the $2,300 campaign contribution Ross received from LaFrance two weeks after the sale closed.

Holly Ross remains the pharmacist at Holly's Health Mart under USA Drug. Neither she nor her husband agreed to speak with ProPublica for this story. (Read Rep. Mike Ross's response to this ProPublica-Politico investigation.)

Republicans for Single Payer Care

This morning on Facebook, the Whole Foods Boycott Action posted a link to the web page of Republicans for Single Payer, who are promoting "Universal Health Care with Informed Choice." Exploring this site a little bit, I found a link to a plan for something called Balanced Choice Health Care which presents itself as the conservative version of single payer.

"Single payer" usually means HR 676 (unlike other proposals currently making their way through Congress, this bill is only 26 pages long, so its easy to just read the whole thing.)

Under HR 676, the system would be partly funded by eliminating paperwork and the bulk purchase of pharmaceuticals. Additional funding would come from "existing sources of Federal government funding for health care," from a tax on the top 5 percent of wage earners, from a modest payroll tax on workers, and from a small tax on stock and bond transactions. Private insurance companies would be forbidden to sell policies for any of the medically necessary procedures and medicines covered by the system. Patients would be free to choose their own doctors, and doctors would remain privately employed. There would be no deductibles or copays.

The Balanced Choice proposal has several differences.

For one thing, the funding is a bit different. It relies on current state and federal funding, on diverting current employer contributions into a trust fund, and also on what appears to be a payroll tax. The system would be managed by a private non-profit organization rather than by a government agency.

For another thing, patients would make some kind of out-of-pocket payment every time they went to the doctor. There would be two options. Under the copay option, patients would make a small co-pay most times they went to the doctor, and the rest of the payment would come from the system. The payment would be an agreed-upon amount, and the doctor couldn't charge more. Under the independent option, the system would make a basic payment to the doctor, and the patient would pay the difference between what the system provided and what the doctor charged. This would allow wealthy patients to pay more for premium services, and it would allow health care providers to profit by providing those services.

Finally, it seems that rather than having the government negotiate prices for drugs, the Balanced Choice proposal would use a different system that allowed patients, under their doctors' guidance, to choose medication that fit their needs and their budgets. (I'm a bit skeptical about this part of it, actually. It seems like a sop to the pharmaceutical industry, and I doubt it would do much to control costs.)

I think that the Balanced Choice program is an interesting idea. At first glance, it seems that it would do more to more to provide universal care and control costs than any of the plans currently under active consideration in the House and Senate. It would benefit workers, and also employers, who would be freed from the trouble of providing health insurance, and who would be promised cost savings over the current system. As I've noted above, it might make the pharmaceutical industry happy. It probably would make health insurance companies very unhappy, because it would put them out of business.

Furthermore, Balanced Choice is devised and promoted to answer the concerns that conservatives express about the kind of single-payer system envisioned in HR 676.

Providers have justifiably resisted the idea of a government-operated health care system. This is not an abstract ideological position, but one that is based on experience with government systems. Medicare has a history of unilaterally determining reimbursement rates that do not adequately reimburse some areas of health care. In the current system, providers can refuse Medicare patients because there are other sources of income. If there were only one system, it is natural to be concerned about having the profession crippled by misguided government policies. At times Medicare has also made heavy-handed threats of prosecution for fraud and huge fines when providers have made errors in following bureaucratic procedures. The Veterans Administration is known for bureaucratic inefficiency.

Balanced Choice is not this kind of government program. It protects providers from these abuses because it allows patients and providers to make choices. Providers are not locked into accepting the fee schedule and can use the Independent Option if the Copay Option reimbursements are insufficient. Balanced Choice would be required to distinguish between bureaucratic errors and fraudulent billing, and it would be prohibited from the heavy-handed threats of criminal prosecution that were used by Medicare. Balanced Choice is not a health care delivery organization; it is a payment system for independent providers of health care services.

Balanced choice might be a reasonable compromise between conservatives and progressives on the subject of health care. But given that the machinery of both the Democratic and Republican parties seem determined to protect private profit over the public good, I doubt it has much chance of gaining serious consideration.

What do you think?

Reform health care, not just insurance

Talking to Myself isn't really a health care blog, but it does seem that's most of what I'm blogging about these days. But this is an important issue, so here we go again. Over at Common Dreams, Randall Amster asks the thought-provoking question, Does Anyone in the Healthcare Debate Really Care About Health?

Amster argue persuasively that merely assuring access to the current system, with its emphasis on drugs and surgery, isn't going to make us any healthier.

What I'm suggesting may be difficult for some folks to accept. It has become convenient and comfortable for many people to rely on the current healthcare system. Prescriptions for painkillers and their ilk are glad-handed all over the country every day. Radical surgeries are performed routinely in non-life-threatening situations. Giving birth has been rendered an "illness" requiring hospitalization and, oftentimes, surgery if nature doesn't follow the predetermined clock precisely. Children are given full-spectrum vaccinations before they can even walk, and when they start to run are medicated psychotropically if they don't color within the approved lines. Emergency rooms are staffed by everyone except doctors (who still wind up billing you anyway) and are filled to the brim with people lacking true emergencies. And so on.

This is a sick system, and a sickening one too. Most of the reasons for entering the healthcare system could be attended to in myriad other ways that are healthier and more beneficial for individuals and society as a whole. Unfortunately, we've chosen to accept and subsidize in large measure one model of healthcare to the exclusion of competing options. How many plans in existence today provide coverage for midwives, naturopaths, nutritionists, masseuses, or the like? Even in the few cases where they might do so, how many people utilize these services in any event? Let's be real about this: our healthcare plans, and the ones being debated nationally right now, are overwhelmingly about the "pills and surgery" reactive version and hardly at all about proactive, natural options. The only talk even remotely along these lines is about preventive care, but even that becomes about screening and testing for conditions that then will likely require pills and surgery.

Amster describes health care systems in Japan and New Zealand, which he says work much better than ours. The entire essay is well worth reading.

Happy anniversary

Hat tip to the New Zealand blog In a Strange Land for linking to this post about the anniversary of women's suffrage in New Zealand. On Sept. 19, 1893, New Zealand became the first nation state to grant women the right to vote.

Finally, some common sense on the issue of health reform and "illegal immigrants"

Naomi Freundlich at Health Beat writes about Health Reform At The Expense of Immigrants.

“Under President Obama's plan, undocumented immigrants would not be allowed to enter the exchange. People who are lawfully present in this country would be able to participate in the exchange.”

That statement, which echoes a provision that is included in the newly-released Senate Finance Committee’s version of health reform, means that even undocumented workers who want to pay out of pocket for health insurance—with no government subsidy—will be denied access to the exchanges.

This is a short-sighted political move that is designed clearly to pander to the Conservatives who have dredged up the illegal immigrant issue (along with abortion and end-of-life counseling) in an attempt to block any version of health care reform. It won’t garner more support for reform legislation, it eliminates cost-savings and it moves us further from the stated goal of being a compassionate nation.

Freundlich points out that discouraging anyone from buying health insurance drives up the cost of health care for everyone by discouraging preventive care and encouraging expensive emergency room visits. Plus, the more stringent citizenship verification requirements in the Senate Finance Committee bill would drive up administrative costs.

I find myself wanting to quote a lot more of this clear-sighted and compassionate post. It's not very long. Why not read the whole thing for yourself?

Senate Finance Committee releases health bill

The Senate Finance Committee has released its much-anticipated version of the health insurance reform bill. Committee Chair Max Baucus created a bi-partisan "gang of six" to try to create a bill that would gain Republican support--by, for instance, taking away the public option that would give private insurers some competition. Baucus has received widespread criticism for being the darling of the insurance companies--but he wasn't able to get any Republicans to support his bill.

Here's a link to download Baucus's Americas_Healthy_Future_Act.

Meanwhile, Washington Post blogger Ezra Klein has an interesting analysis of the Baucus bill.

How to get the money to pay for health care reform?

One thing that would help a lot would be to join Feminist Peace Network in the campaign We Need An Exit Strategy For Afghanistan NOW.

The Feminist Peace Network is participating in a week-long effort to demand an exit strategy for Afghanistan. While certainly believing that there should be accountability for the bombing of the World Trade Center and the many lives that were lost that day, the Afghan people were not responsible for what happened and the United States’ unending campaign to destroy Afghanistan that has cost so many Afghan lives has clearly failed to destroy the Taliban and is unsupportable and needs to end.

As this blog has pointed out countless times, despite the use of the human rights of women in Afghanistan as part of the justification for our actions, the lives of Afghan women remain at extreme peril and the continuing militarism only exacerbates the everyday dangers that they face. It is time not only to get out but to substantively provide the Afghan people and especially Afghan women with the means to rebuild their country. Doing so would make us all much safer.

Singing (and marching) in the rain

An enthusiastic crowd of about 250 Oklahoma residents braved the rain to march on the state capitol today in support of efforts to reform our nation's out-of-whack health care system. The event was sponsored by the Oklahoma chapter of Organizing for America.

Speakers included Dr. Boyd Shook of Manos Juntas, 9-11 volunteer rescue worker Reggie Cervantes, the Rev. Jeff Hamilton, president of the Interfaith Alliance of Oklahoma, State Rep. Anastasia Pittman, State Sen. Constance Johnson, and the Rev. Robin Meyers of Mayflower UCC Church.

Boyd Shook told the demonstrators that the United States has the most expensive health care system in the world, but not the best. He said that US health care ranks 37th in the world in quality and value, and that a public insurance option would allow us to lower cost and increase quality.

Anastasia Pittman reminded her listeners that "sick children can't learn, and sick people can't earn." She said that Oklahoma ranks 10th in the nation in people without any health insurance, with 600,000 uninsured, and that 60 percent of bankruptcies were caused by medical expenses. Referring to the lack of support for health care reform by Oklahoma's US senators and representatives, Pittman asked, "Who are we voting for, and why are we voting for them?"

Everyone there seemed eager to jump into the difficult work of passing health care reform. Most seemed to favor a public option, and some signs supported the creation of a single payer system.

March for Affordable Health Care

Sponsored by the Democratic lobbying group Organizing for America, there will be marches nationwide tomorrow to support President Obama's health care reform proposals.

These rallies are meant, in part, to counter right-wing anti-reform rallies that were held today.

The MARCH FOR HEALTHCARE- OKC will take place on the south steps of the state capitol, starting at noon tomorrow. It's preceded by a march, starting at 11:15 from Stiles Park at 8th and Stiles.

According to the Oklahoman, after the pro-health care march, an anti-reform group will be holding a rally on the north steps of the capitol starting at 4:30.

What happens when corporations own our free speech?

Hat tip to Ezra Klein for this link to The Life and Death of Online Communities, by Phoebe Connelly at The American Prospect.

Connelly discusses the demise of GeoCities, an old school community of user-created web pages that was popular back in the 1990s. Its owner, Yahoo, has announced that it will close GeoCities on October 26.

Other online platforms began to spring up, and soon GeoCities became a fond memory for most users. Blogger was introduced in 1999 (and purchased by Google in 2003), making it easy for anyone to start a blog. MetaFilter, a community blog, was launched in 1999. The social networking site My-Space was founded in 2003. These services also marked the entrance of a very public form of socializing--where, unlike email or listservs, the conversation, and content, was accessible to those not part of the conversation. In offering a platform for creating online identities, GeoCities started a trend that has been replicated by companies ever since.

But once those online identities are created, are they the property of the users or the corporations that host them? David Bollier, author of Viral Spiral: How the Commoners Built a Digital Republic of Their Own, calls corporate-controlled spaces like GeoCities and Facebook, "faux commons." For him, true online community spaces are defined by users having control over the terms of their interaction and owning the software or infrastructure. Corporate spaces come with "terms of service" agreements that lay out the rules users must abide by and what control they agree to surrender in exchange for using the product. "Oftentimes corporate-controlled communities are benign, functional, and perfectly OK," Bollier says. "It's just that the terms of services those companies have or the competitive pressures of business may compel them to take steps that are not in the interest of the community."

As a user of both Blogger and Facebook, I found this piece a bit unsettling and very thought provoking.

Health care and consensus decision making

Last night I went to the beautiful Belle Isle Public Library to watch President Barack Obama address a joint session of Congress on the topic of health care reform. Call me a socialist if you will, but I really enjoy and appreciate this excellent government-run service (both the wi-fi in particular and the library in general). I sat there with my laptop and my earphones, and frantically took not-very-good handwritten notes. Which probably wasn't necessary, given that it's possible to read the transcript here or view the video here.

I need to start by saying that I have a lot of policy disagreements with the president about health care. I think we need single payer. I'm disappointed that the proposed public option is only open to those who don't already have health insurance. The version of the public plan originally proposed by Jacob Hacker would have covered anyone who wanted it, and would have done a lot more to control insurance costs. And despite the president's assurances, I'm worried that people without much money would be required to pay more than they could afford for the health care insurance that they'll be required to have. Senate Finance Committee Max Baucus's framework is particularly worrisome in that regard. And frankly, I think it's a bad thing that federal money can't be used to pay for abortion.

That being said, I think that it was a masterful speech by a masterful consensus builder. The word "masterful" makes me want to get out some Julia Penelope on the topic of patriarchal language, but that is a topic for a different time.

I do want to talk a little bit about consensus.

Watching the president, I was reminded of old meetings of, oh, say, the Oregon Women's Land Trust. If you've ever been part of a lesbian feminist organization that runs on consensus decision making, you will know that the US Congress has nothing on lesbian activists when it comes to getting into down-and-dirty political fights. The Senate, in particular, has rules that are very reminiscent of consensus decision making used by lesbian feminist collectives. Having a simple majority is enough to get something passed. While one person can't shut down the Senate (and I have more than once seen a single dissenter shut down a lesbian collective from taking any action), you need to have 60 votes to cut off debate in order to proceed with a bill.

By its nature, it's a conservative process. The way the Senate operates probably has most of the same advantages and disadvantages of consensus decision making. One big disadvantage is that a minority can bolix up the works and keep actions from being taken that have majority support. This is what's happening in the Senate right now. Especially after the death of Ted Kennedy, the president and the Democrats can't count on 60 votes to move forward without courting Republicans and conservative Democrats.

But the disadvantage is also an advantage. The truth is, if you have a substantial minority of the population that opposes a law that has passed, that law has much less chance of succeeding. It seems to me that the most successful movements of our times--the civil rights movements, the feminist movements--have been the most successful when campaigns to pass legislation were combined with campaigns to achieve popular support. Changing laws is not enough without changing people's hearts and minds. Sometimes the piece of legislation fails, but the change in popular attitudes that came about by fighting for it makes an enormous positive difference. I'm thinking of the Equal Rights Amendment here.

Okay, okay, I'll try to get back on track. Health care legislation is not the same as civil rights legislation, and to make a change, we do need to pass a law. I'm just trying to make the point that to pass the legislation and to have it succeed, President Obama needs to bring people together and build a broad base of support for it, including from moderate and conservative members of the population. And I think that's exactly what he succeeded in doing with his speech last night. He took the things that just about everybody agrees about, and used that as a basis for moving forward.

He gave an eloquent description of exactly how broken our current system is. How we are the only advanced democracy that doesn't offer universal health care. How people who don't have insurance--because they are self-employed and can't afford it, because they have a pre-existing condition that won't allow them to get coverage--can be just one accident or illness away from bankruptcy. How people who have insurance can find that their coverage has been dropped just when they need it the most. How we spend one and a half times more per person on healthcare per person without that making us any more healthy. How health insurance premiums are rising in cost three times faster than wages, and how this puts workers and businesses at a disadvantage. How increasing health care costs are putting "an unsustainable burden on the taxpayers."

When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.

What the president did with the first part of his speech was to demonstrate that we do have a national consensus about what is wrong with the way we pay for health care. What he did next was to address what we need to do to fix it. His strategy was to position himself as being what he always has been, a centrist.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's...where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.

(Oregon Democratic Senator Ron Wyden has also proposed a plan that would end employer-based coverage and retain a private market, and might have been surprised to hear himself classified as being "on the right," but I suppose that is also a topic for another time.)

At any rate, having established that there is widespread agreement about what is wrong with our healthcare system, Obama argued that there is also widespread agreement--within Congress, at least--about many steps that need to be taken to correct the situation. And he argued that there has actually been significant progress toward creating reform legislation.

We've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups, and even drug companies -- many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

According to the president, these points of agreement are:

• People who already have health insurance through an employer or through Medicare, Medicaid, or the VA, would get to keep what they already have. (Although, as Matt Taibbi points out, if the insurance you get through your employer now is really awful, you would still be stuck with it.)
• People who have insurance could not have their coverage canceled or "watered down." There could be no yearly or lifetime limits on coverage. There would be a limit on out-of-pocket expenses. Insurers would be required to cover routine checkups and tests such as colonoscopies or mammograms.
• Individuals and small businesses that don't currently have access to affordable insurance would have access to something called a health insurance exchange. Because all these people would be pooled together as one group, they would have (at least in theory) the kind of collective bargaining power that government and large businesses now have. Insurance companies would participate in this system because it would give them access to millions of new potential customers.
• Individuals and small businesses that still couldn't afford the insurance offered by these exchanges would receive subsidies based on their ability to pay.
• Large businesses would be required to provide insurance for their employees. Most individuals would be required to purchase health insurance. There would be hardship waivers for individuals who couldn't afford insurance, and 95 percent of small businesses would be exempt.

While I continue to have serious reservations about the health care policies he's proposing, I have to admire the way he is putting his experience as a community organizer to good use. His strategy here seems almost like a page out of Building United Judgment. I think he's absolutely correct that even most conservative Republicans already agree with much of what he's proposing. For instance, when I attended Mary Fallin's town hall meeting back in August, one thing that struck me was how many of the things she said she supported were actually in the one of the existing health care bills, whether she was aware of this or not.

After showing how much agreement Congress already has about health insurance reform, the president openly confronted the orchestrated right-wing backlash to reform that developed over the summer.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple. (Applause.)

There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally.

AUDIENCE MEMBER: You lie! (Boos.)

THE PRESIDENT: It's not true. And one more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. (Applause.)

The heckler in this excerpt was reported to be Republican Rep. Joe Wilson of South Carolina.

The president went on to confront claims that his plan represented a "government takeover" of health care. Here is where I had my most ambivalent feelings. I'm as skeptical of government as the next person, but I think there are some services that don't operate well as private industries, and I think health insurance is one of those. The president actually made a similar point in his defense of the limited public option that four of the five committees working on health care have included in their bills:

My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.

Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."

I don't think the limited public option in the healthcare bills before Congress does much to address the relentless profit-seeking of private insurers. It's only available to people who don't have insurance who are shopping for coverage through the exchange, and the president himself says that maybe five percent of people will be covered by it.

I think it's proper and necessary that some essential services--like health care--need to be made available for the public good, and not for the relentless profit expectations of Wall Street. I agree with Jeff Cohen that if Obama--or at least the liberal groups who are his allies--has started out pushing for a single-payer plan, we might have been able to win a strong public option that would have helped provide quality care at an affordable price. Now we are left with a situation in which Obama gives a ringing endorsement of a limited public plan, but says he's willing to trade it away.

Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. 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. (Applause.) 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. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. (Applause.)

Okay. There was more of the president's speech that I haven't addressed. I don't have a grand concluding statement. But I think I've gone on about long enough, and it's almost time for me to go to work. My reaction to the president's speech remains contradictory.

On the one hand, I have serious concerns about what the president has proposed, and don't think the final bill will address those concerns. I think if progressive groups had worked harder and smarter for a more far-reaching proposal, we would have gotten a better result.

On the other hand, there is the reality of powerful right-wing opposition to health care reform to deal with, and we can't ignore that or merely wish it away. The right wing in this country remains extremely powerful, not necessarily because of whatever popular support it might have, but because it is extremely wealthy, well-organized, and well-connected. Obama's plan may be a realistic way to deal with that. I was moved by his sincerity last night, and impressed by his skill. Maybe what we have here is a good starting place. He says he hopes he is the last president to deal with health reform, but I hope he's wrong. What we have is a good first step on a very long journey.

Senate Finance Committee releases proposed healthcare "framework"

Conservative Democratic Senator Max Baucus of the Senate Finance Committee has released a proposed framework for a health care reform bill. Baucus and his bipartisan "gang of six" have been working to create a plan that at least some Republicans could support.

The semi-liberal Ezra Klein thinks the bill isn't great, but isn't bad.

Insofar as the effort is aimed at filling in the cracks of the current system — making it more affordable, more transparent and less cruel — it's not a bad bill.

The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.

Over at Health Beat, Maggie Mahar is less favorably impressed:

Finally, if insurers can charge 50-somethings five times as much as they charge 20-somethings (who the Baucus plan refers to as “young invincibles”), a great many of them are going to need subsidies. More tax-dollars winging their way to Aetna.

But wait, there is a loophole here: “An exemption [from mandate that everyone buy insurance] is permitted if coverage is deemed unaffordable – defined based on a circumstance where the lowest cost premium available exceeds 10% of a person’s income.”  Okay, here’s the answer for 50-somethings that just can’t afford paying five times as much as younger customers: we excuse them from the program. No penalty, no mandate. In other words, we don’t cover them at all—at the point in their life when they are most likely to need heath care.

Somehow, this isn’t what I thought they meant by “universal coverage.”

Oh, and in case you wondered.  . . No, there is no public sector insurance option in the Baucus plan. The private sector insurance industry will have a monopoly on the millions of new customers who will be coming their way, tax subsidies in hand.

Meanwhile, Truthdig asks Does Max Baucus Represent Montana or Blue Cross? Certainly a reasonable question. If you'd like to formulate your own opinion, you can read the 18-page framework for yourself, or compare it to other versions of health reform making their way through Congress.

Cynical but accurate?

Thanks to the folks at the Facebook "Boycott Whole Foods" group for posting a link to Matt Taibbi's Rolling Stone blog post about the health care reform process. I've read some of Taibbi's writing before on AlterNet, and I'm not sure I trust him. In the past, my impression has been that Taibbi is something of an arrogant blowhard. Some of that arrogance comes across in this piece, but underneath his self-righteousness and bad language, this is also a comprehensive history of the health care bills making their way through Congress.

Here's a sample:

To recap, here's what ended up happening with health care. First, they gave away single-payer before a single gavel had fallen, apparently as a bargaining chip to the very insurers mostly responsible for creating the crisis in the first place. Then they watered down the public option so as to make it almost meaningless, while simultaneously beefing up the individual mandate, which would force millions of people now uninsured to buy a product that is no longer certain to be either cheaper or more likely to prevent them from going bankrupt. The bill won't make drugs cheaper, and it might make paperwork for doctors even more unwieldy and complex than it is now. In fact, the various reform measures suck so badly that PhRMA, the notorious mouthpiece for the pharmaceutical industry which last year spent more than $20 million lobbying against health care reform, is now gratefully spending more than seven times that much on a marketing campaign to help the president get what he wants.

So what's left? Well, the bills do keep alive the so-called employer mandate, requiring companies to provide insurance to their employees. A good idea — except that the Blue Dogs managed to exempt employers with annual payrolls below $500,000, meaning that 87 percent of all businesses will be allowed to opt out of the best and toughest reform measure left. Thanks to Harry Reid, Nancy Pelosi and Barack Obama, we can now be assured that the 19 or 20 employers in America with payrolls above $500,000 who do not already provide insurance will be required to offer good solid health coverage. Hurray!

The rest of the piece is a bit long, but I think this is necessary in order for Taibbi to do justice to a complicated subject. I would really be interested in any comments that you have afterward.

If you think health care reform is bad, consider the alternative

Thanks to Maggie Mahar at Health Beat for writing up a two-part post by Joe Paduda at Managed Care Matters. These two posts consider what the consequences are likely to be if health care reform fails to pass Congress.

Part One of "Your life without healthcare reform" is here. In this part, Paduda relies on a report at businessinsurance.com to predict what will happen to health care costs if we don't get a health care bill that includes strong cost controls. Paduda says:

When costs increase ten percent a year, they double every seven years. With current family premiums in the $15,000 range, employers and employees will be paying $30,000 per family in 2016. And that's not including deductibles and copays, which are sure to rise.

If you're relying on so-called consumer-directed health plans to stem the tide, good luck - their costs went up two points more than 'regular' HMO and PPO plans. Industry veterans aren't surprised, as new insurance products almost always have good experience in the first couple years and as the block 'ages', claims creep up. As I've noted previously, CDHPs are not a panacea, in fact they may well drive up costs due to delayed care. (That said, with substantial changes CDHPs could be a valuable tool in cost containment.)

Eventually the US will reform its health insurance and health care delivery 'systems'. Unfortunately I don't see it happening this year due to the failure of the Democrats to put forth a program that controls costs, make a cogent argument and control the debate, and the decision by the Republicans to remain nothing more than the 'Party of No'.

In Part Two, Paduda argues that

The past is a pretty good predictor of the future; over the last eight years cost have consistently increased more than ten percent each year, with most increases well above that level. Whether we are at the bottom of the cycle or cost inflation rates will continue to decrease is unclear, but what is clear is that the inflation rate will head back up at some point in the next few years.
Back to the real world impact.

• If nothing changes, the share of the nation's budget paid by the government will be greater than that paid thru private insurers.
• 178,000 small business jobs will be lost by 2018 as a result of health care costs
• If employee contributions stay at their current level (about 30% of premiums), workers will be paying $9000 per year, or $750 per month, towards their health coverage - not including deductible, copays, coinsurance, and services not covered
• General Motors' health insurance will add about $3000 to the cost of each vehicle - if it is still in business
• In my hometown of Madison, Conn., Town employee health insurance costs are paid for with property taxes; without reform the amount of tax revenue needed to pay those bills will double by 2016, forcing tax increases and/or significant serice cuts
• More Americans will have to rely on the kindness of others for their health care
• Because 65 million of us will be without health insurance

Unlike the distortions, misrepresentations, and outright lies being spread by McCaughey, Limbaugh, Palin et al, this is the real deal. So fight against reform if you wish, but don't complain later when you can't afford insurance, your employer can't afford insurance, your taxes are going up to pay for teachers' benefits, and our economy is sinking under the weight of health care costs.

Paduda thinks the right wing will win this battle but lose the war, because eventually, without health care reform, too many of us will be in too much pain to tolerate the status quo. For my own part, I am hoping that the battle is not lost, and that with luck and hard work, we can prevent the pain that Paduda predicts.

They hate government run health care, but they choose to use it

Sam Stein at the Huffington Post reports that GOPers Decrying "Socialized Medicine" Go To Govt. Hospital For Surgeries.

The Republicans in question are senators John McCain, (R-Ariz.), Senator Kit Bond (R-Mo.), Senator George Voinovich, (R-Ohio), and Rep. Roy Blunt, (R-Mo.) . All have chosen to receive treatment at Bethesda Naval Hospital--which members of Congress are able to do if they pay an annual fee.

As Stein points out:

To be strictly accurate, there is an important distinction between a government-run hospital and a government-run health insurance agency. The public plan, which is the focus of much of the GOP's ire, is the latter. Bethesda Naval Hospital is the former.

But conservatives have long used the notion of "socialized medicine" to defeat health care reform efforts -- even though when it comes to the flagship Naval Hospital just miles away, the worries about bureaucratic nightmares, low quality care, and long lines seem to be wiped away.