Good news or bad news? Court upholds health law

So. According to this statement from the Oklahoma Policy Institute, it looks as if the US Supreme Court has upheld the Affordable Care Act. I was both surprised and relieved to read this when I opened up my e-mail just now. OPI's post provides a link to the entire decision. (It's almost 200 pages long, so I'll have to read that later.)

BBC News reports that the law was upheld by a 5-4 ruling, with Chief Justice John Roberts casting the deciding vote. Justice Anthony Kennedy, sometimes described as the key swing vote on the court, wrote the dissent.

OPI welcomes this decision as a step forward in the journey to bring quality healthcare at a reasonable price to all US residents, and calls on Oklahoma lawmakers to move forward on implementing the ACA:

The Supreme Court also upheld expansion of the Medicaid program, a provision that will particularly benefit low-income uninsured Oklahomans, paid for almost entirely by the federal government.

For the 1.7 million Oklahomans who are privately insured and happy with their plan, coverage is now more secure and comprehensive. Insurers can no longer deny their claims or drop their coverage without oversight. Their insurer will now cover routine preventive care, like immunizations and cancer screenings, for no co-pay or additional out-of-pocket cost.

The health law is already working to strengthen consumer protections and ensure that Oklahomans are getting what they pay for from their insurers and providers. It’s now up to state leaders, regardless of their personal political preferences, to move forward quickly to implement the Affordable Care Act.

That's an optimistic assessment about the ACA's effects. Others have less optimistic assessments. As Physicians for a National Health Program point out:

Although the Supreme Court has upheld the Affordable Care Act (ACA), the unfortunate reality is that the law, despite its modest benefits, is not a remedy to our health care crisis: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.

Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would provide truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

Some folks argue that the Affordable Care Act is merely the beginning of a process that will ultimately lead us to a single-payer system. Right-wing opponents of the law certainly made that case as the bill was making its way through Congress.

I would like to believe that the ACA will lead to a better system, but I'm not sure that it will. On the other hand, if the Supreme Court had struck down the law, this would have been a decisive blow against any kind of comprehensive national health insurance coverage. Thus, while I'm not particularly happy with the ACA, I am relieved that it wasn't struck down.

Michigan, the Oklahoma of the north?

Thanks to Kansas National Organization for Women for a link to this post from Jezebel about an extreme anti-choice bill that has since been passed by the Michigan House of Representatives. Among other provisions, the bill would ban all abortions for any reason after 20 weeks of pregnancy. There are no exceptions.Not even if the life or health of the pregnant woman is endangered by the pregnancy. Not even if the fetus has such serious problems that it will never be able to live outside the womb.

To add insult to injury, according to Jezebel, two pro-choice female legislators have been banned indefinitely from speaking on the House floor. One of these legislators, Democrat Lisa Brown, apparently gave offense by using the word "vagina" in her floor speech opposing the bill.

JOS of Feministing reports that the bill passed on June 13 by a vote of 70 to 39 after only 20 minutes of debate. The anti-choice Michigan Senate is likely to consider the bill in September

Besides the ban on all abortions after 20 weeks, the bill is what pro-choice advocates call TRAP legislation. According to the National Abortion Federation, the acronym stands for Targeted Regulation of Abortion Providers. The goal is to drive abortion providers out of business under the pretense of regulating clinics to make sure they meet proper medical standards.

According to Feministing blogger Chloe, the Michigan bill includes:

: state-mandated scripts for doctors that masquerade as faux concern for women who are being coerced into abortion, new TRAP laws to make insurance more complicated and expensive for providers, stricter regulations for clinics, new rules about the disposal of fetal remains that would affect women who have miscarriages as well as abortions, and a new measure requiring the presence of a doctor for a medical abortion in a state where many women rely on tele-med prescriptions because so few counties have a provider on the ground.

Chloe provided a link to the text of the bill, and recommended reading the ongoing coverage of the Michigan situation by Angi Becker Stevens at RH Reality Check. Robin Marty, also of RH Reality Check, wrote another excellent analysis of the bill.

Michigan state lawmakers seem to want to vie with the Oklahoma Legislature for the honors of producing the most extreme and ridiculous laws to limit women's lives and freedom. Of course, in Oklahoma, valiant and well-organized activists managed to defeat one of the worst anti-choice bills considered in the recent legislative session. Maybe our Michigan sisters will be able to do the same.

It's not about epistemology

You may wonder, gentle reader, what the heck is "epistemology," besides a funny looking big word that is fun to say in order to impress your friends? It is, very simply, that part of philosophy that is devoted to studying what we know and how we know that what we know is true.

This is a very important question. I think I know all kinds of things--that all people should have equal rights and power, that climate change is a serious problem and needs to be stopped, that US military intervention always makes things worse rather than better. There are large numbers of people who think I am exactly wrong about all of those things. How do I know that I am right and they are wrong?

Yes, that's an important question, but as you read in the title of the post, this is not about epistemology, so we'll take that question up at another time.

This post is actually about the Affordable Health Care Act, which has made its way to the Supreme Court. Right-wing opponents of the law have challenged its constitutionality, saying that the federal government doesn't have the right to require citizens to purchase health insurance. Liberal supporters of the law say that it provides a huge step forward in making health care available to all citizens.

As for myself, I just don't know. I expect that the law is constitutional, but I don't think it fixes what's broken about the US health care system. The US health care system is designed to allow private companies to make enormous profits by providing services that cost lots of money but may (or may not) improve anyone's health. Despite its name, I'm not sure the health care act will really make health care more affordable.

Robert Reich has written a blog post that expresses very well my reasons for ambivalence about the ACA. (You may recall that Reich served as secretary of labor under Bill Clinton. Reich is now a professor of public policy at UC Berkeley.)As Reich writes:

The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising.

Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large healthcare costs.

This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it.

But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.

Now Republicans are using this compromise in order to whip up resentment from far-right Tea Party supporters who don't want the government to tell them what to buy. Some of this resentment probably comes from people who, even with subsidies, cannot afford to buy health insurance or pay a fine for not having it.

It seems like a lose-lose situation. If the Affordable Health Care Act is struck down by the Supreme Court, we are left with the same broken system, with all of its skyrocketing costs and inadequate coverage. Plus, it's a big defeat for the whole idea of universal health care. If the ACA is upheld, more people have some kind of coverage, but most of the problems of the existing system are left in place.

Reich, however, sees a silver lining in the possible overturn of the ACA. He argues that no one objects to mandatory participation in Medicare by people over 65, because this is a government program that works well and is universally popular.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

I would like to believe that Reich is right.

I have only one minor quibble about what he has to say.

The court debate started off with an argument about whether this is the right time to hear this case. This was a procedural issue based on an interpretation of an 1867 law that says that you can't file a legal challenge to a tax until you've had to pay that tax. People who don't buy health insurance won't need to pay a penalty for several years. The Supreme Court spent the whole first day of argument considering whether the 1867 law applies to this case.

Reich describes this argument thusly:

Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Um, no. This procedural argument had nothing at all to do with epistemology, it had to do with the way the word "tax" is defined. Maybe Reich meant to use the word "etymological," which has to do with tracing the history of words.

If we had an epistemological discussion about the ACA, we would be discussing whether we have any reliable way of predicting exactly what its effects are going to be. This is not a "nicety," but a very substantial problem. Even big words have meanings, and you can't just throw them around at random to prove how smart you are.

Good news and bad news

Bad news first. The National Partnership for Women and Families reports that the US House has passed a draconian piece of legislation to drastically reduce both public and private insurance for abortion.Among other things, the report says that HR 3 would make permanent the Hyde Amendment prohibition on public abortion funding for poor women and prohibit the District of Columbia from using local funds to pay for abortions. Up until this time, the Hyde Amendment has faced renewal each year.

The good news is that House Republicans seem to have backed off on their plan to privatize Medicare. Thanks to Women's eNews on Twitter for pointing me towards that news item.

Deficit attention disorder

Over on AlterNet, Joshua Holland calls out President Obama for giving a deficit speech that was long on "flowery talk" and short on substance:

The reality is that while our private profit-driven health-care system is unsustainably expensive, the U.S. spends less on the public sector than almost every other developed country. We're running large deficits because we're maintaining costly military operations in several countries and the federal government collected less tax revenue in 2010 than in any year since 1961.

Progressives will no doubt celebrate Obama's deft dissection of the GOP's budget gimmicks and his full-throated defense of the welfare state. But it was ultimately some thin political gruel with unemployment remaining at 9 percent and the foreclosure crisis continuing unabated. When Obama's on, as he was today, it's easy to forget that our biggest national debate is little more than a distraction from the real issues plaguing our economy.

The big question on my mind is, how much, in the end, will Obama going to cave in to the extreme budget agenda of House Budget Committee Chair Paul Ryan. Dean Baker explains exactly how bad Ryan's budget proposal is. It will "leave the vast majority of future retirees without decent health care by ending Medicare as we know it. According to the Congressional Budget Office (CBO) analysis, most middle-income retirees would have to pay almost half of their income to purchase a Medicare equivalent insurance package by 2030." Baker also notes that:

he ostensible rationale for this attack is the country's huge budget deficit. This is garbage. As all the pundits know, the country has a huge deficit today because the Wall Street boys drove the economy off a cliff. If the government deficit were not propping up the economy, we would be looking at 11 or 12 percent unemployment, rather than 8.9 percent. Spending creates jobs, and at this point, it is not coming from the private sector, so the government must fill the hole.

Over the longer term, the projections of huge deficits are driven by the projected explosion in health care costs. President Obama's health care reform took steps toward constraining these costs, although probably not enough. Remarkably, Ryan's plan abandons these cost control measures, virtually guaranteeing that quality health care becomes unaffordable for all but a small elite.

Finally, former Labor Secretary Robert Reich points out how expanding Medicare could actually lower both health care costs and the federal deficit:

For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

Feminist abortion activist Jody Howard dies

Our Bodies Ourselves on Facebook has posted a link to the obituary for Jody Howard at chicagotribune.com. Howard was a co-founder of "Jane," the abortion service provided by the Chicago Women's Liberation Union before Roe v. Wade legalized the procedure.

According to the obituary, Howard became a feminist at Michigan State University,.After graduation, she moved with her husband to the Hyde Park neighborhood of Chicago. She became involved in a variety of progressive causes, including the Chicago Women's Liberation Union and the American Civil Liberties Union. She was diagnosed with Hodgkin's Disease while pregnant with her daughter. She needed an abortion for health reasons as the result of a later, unexpected pregnancy. In order to get a legal abortion, she was required to go through two psychiatric evaluations. This experience helped to inspire Howard to co-found Jane.

A forceful advocate for causes she backed, Ms. Howard "had a great deal of personal charisma and (at the same time) could offer a very nice analysis of the issue," [former Jane member Martha] Scott said.

With her daughters, Ms. Howard participated in a blockade of the Rock Island Arsenal to protest war. At an ACLU fundraiser at Hugh Hefner's Gold Coast mansion, she showed up with small pictures of naked men that she posted here and there.

"She was escorted out," her ex-husband said.

A commenter on Our Bodies Ourselves Facebook post pointed out that more information about Jane can be found at this page on the Chicago Women's Liberation Union herstory site.

Senate passes health insurance bill, capitalists cheer, patients mourn, progressive House Democrats fight back

As you've probably heard already, the US Senate passed its version of the health insurance reform bill today. The Associated Press (courtesy of msnbc.com) calls it an historic occasion:

WASHINGTON - Senate Democrats passed a landmark health care bill in a climactic Christmas Eve vote that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.

The 60-39 vote on a cold winter morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Vice President Joe Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."

The Motley Fool site, which offers stock investing advice, is glad to be "closer to capping off the long process that's weighed on health-care stocks this year. If it's made into law, the $871 billion bill will represent the largest expansion of health-care coverage since the creation of Medicare in 1965." Commentator Brian Orelli notes that

Someone has to pay for this thing, and it's been interesting to see who has the most clout in Washington. Pharmaceutical companies negotiated early. Medical-device companies like Boston Scientific (NYSE: BSX) and Medtronic (NYSE: MDT) looked like they were going to get a big hit, but managed to whittle down their tax considerably. And cosmetic treatments like wrinkle removers and breast implants made by Allergan and Johnson & Johnson (NYSE: JNJ) managed to get their proposed tax removed altogether. Tanning salons (and their customers) apparently don't have that great of a lobby; they've been slapped with a 10% tax, which will raise an estimated $2.7 billion over the next 10 years.

The only question now is whether the companies will end up being able to pass the costs along to consumers. Will investors have to pay for health-care reform with their portfolios or their pocketbooks?

Orelli doesn't know (or doesn't care) that there are vast numbers of us out here without stock portfolios who need access to health care. For us, the news is not very good. At CommonDreams.org, Donna Smith describes the Senate Bill as "a lump of Christmas coal all polished up with sparkling rhetoric. " She knows what she's talking about from personal experience.

I went broke while carrying health insurance, a disability insurance policy and a small healthcare savings account. And if I get sick under this mess of a plan, it will happen to me again. Little has changed except that millions more of my fellow citizens will join my ranks.

Smith describes exactly how this can happen, and her entire post is well worth reading.

Meanwhile, progressive Democrats in the House of Representatives are pushing back against the watered-down Senate bill, which lacks a public option. New York Democratic Rep. Louise Slaughter says that the Senate bill is so fatally flawed that it could not be successfully reconciled with the House bill passed earlier this fall. She calls for the defeat of health care legislation in its current form. And California Reps. Barbara Lee and Lynn Woolsey have mounted what politico.com calls "a full-throated defense of the public option."

Bad news from DC, good news from Oklahoma

Blogger Robin Marty tells all in a reproductive rights news roundup at RHRealityCheck.org. An Oklahoma law that would require women seeking abortions to answer more than 30 invasive questions has been blocked again for the time being. Marty also has more information on the abortion compromise that gained the vote of conservative Democrat Ben Nelson for the health insurance reform bill. This is the compromise that allowed Democrats to win a key procedural vote at one o'clock this morning, virtually guaranteeing passage of the Senate bill by Christmas Eve.

Feminists condemn Senate health bill compromise

Senate Majority Leader Harry Reid apparently has succeeded in cobbling together a filibuster-proof health insurance bill that can pass the Senate before Christmas. In the process, he has made a bill of questionable benefit even worse, according to John Nichols at thenation.com. Among the changes weakening the bill were concessions to right-wing Democratic Senator Ben Nelson of Nebraska.

To get Nelson's vote, Reid had to agree to restrict the availability of abortions in insurance sold in newly created exchanges.

"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson said of the anti-choice language. "But I would not have voted for this bill without these provisions."

The question now is whether supporters of abortion rights can -- or should -- back a bill that not only disrespects but disregards a woman's right to choose.

While President Obama made a bizarre statement Saturday about how he was "pleased that recently added amendments have made this landmark bill even stronger," the co-chairs of the Congressional Pro-Choice Caucus signaled deep disappointment with the Senate compromise.

The compromise has also angered mainstream feminist organizations that have supported the health insurance reform bill up until now. Groups opposing the compromise include the National Partnership for Women and Families, EMILY's List, and NARAL. The National Organization for Women has gone so far as to oppose passage of the health insurance bill if the anti-choice amendment remains.

Over at RH Reality Check, blogger Rebecca Sive is also calling for defeat of the health insurance bill in its current form:

If the bottom line in all this is that we won't be getting healthcare reform, but we might be getting healthcare finance reform, is it too much to ask that the Democratic women members of the House and Senate insist on eliminating any kind of two-tiered system for paying for abortions-one for the rich and one for the poor. Is it too much to ask that they say to do otherwise isn't reform of any kind; it's the same bad business as usual, and we won't have it?

I can understand someone who believes abortion is wrong and must be prohibited under all circumstances; hence, my respect for Senator Nelson. What I don't understand is women who are complicit in the use of government power to deny their poorer sisters access to the healthcare they, the richer sisters, get. This looks like what we used to call in the 70s "identifying with the oppressor." It's still a very bad idea.

So, here's this week's talking point for the Democratic women Senators:

Have the courage of your convictions: Stand-up, and say what Ben Nelson said: "There isn't any real way to move away from your principle on abortion, and we won't."

Update: Thanks to Feminist Peace Network on Facebook for linking to this explanation by Washington Post blogger Ezra Klein on how the latest anti-choice compromise is supposed to work:

The basic compromise is that states can impose the Stupak rules on their own exchanges, but the rules will not be imposed by the federal legislation. I've been assured that at least one plan in each state will cover abortion, but I'm still trying to get clarification on how that works (my hazy understanding is that at least one of national non-profit plans, and probably more, will include abortion coverage, and they'll be offered in all states).

Mammography not always a smashing success

Thanks to FeministPeaceNetwork on Facebook for a link to a commentary on the breast cancer screening controversy by the ever-wonderful Barbara Ehrenreich.

A federal government advisory panel recently proposed that women not receive routine mammograms before age 50, and to receive mammograms only every other year after that. These new proposals quickly became controversial, with many people, including feminist activists, charging that they were an effort to save money at the expense of women's lives. Ehrenreich argues that feminists should embrace the new guidelines, using her own experience as a cancer survivor to illustrate:

One response to the new guidelines has been that numbers don’t matter -- only individuals do -- and if just one life is saved, that’s good enough. So OK, let me cite my own individual experience. In 2000, at the age of 59, I was diagnosed with Stage II breast cancer on the basis of one dubious mammogram followed by a really bad one, followed by a biopsy. Maybe I should be grateful that the cancer was detected in time, but the truth is, I’m not sure whether these mammograms detected the tumor or, along with many earlier ones, contributed to it: One known environmental cause of breast cancer is radiation, in amounts easily accumulated through regular mammography.

And why was I bothering with this mammogram in the first place? I had long ago made the decision not to spend my golden years undergoing cancer surveillance, but I wanted to get my Hormone Replacement Therapy (HRT) prescription renewed, and the nurse practitioner wouldn’t do that without a fresh mammogram.

As for the HRT, I was taking it because I had been convinced, by the prevailing medical propaganda, that HRT helps prevent heart disease and Alzheimer’s. In 2002, we found out that HRT is itself a risk factor for breast cancer (as well as being ineffective at warding off heart disease and Alzheimer’s), but we didn’t know that in 2000. So did I get breast cancer because of the HRT -- and possibly because of the mammograms themselves -- or did HRT lead to the detection of a cancer I would have gotten anyway?

Ehrenreich also links to a post by noted breast cancer specialist Dr. Susan Love, explaining the new guidelines. Love notes that the guidelines don't say that no women under 50 should receive mammograms, but that the test shouldn't be done routinely. It should be an individual decision made by a woman and her doctor with an understanding of both the benefits and risks:

One key shift has been in our understanding of the biology of breast cancer. We used to think there was just one kind of cancer that grew at a steady pace; that when it reached a certain size, it spread to the rest of the body. As a result, it seemed to make sense that we could save lives if a screening test could identify the cancer while it was still "early," before it had spread. That's how we developed the notion of early detection. And it works, sometimes.

In the best of hands, mammographic screening in women over 50 will reduce a woman's risk of dying from breast cancer by 30%. That is a lot, but it is not 100%. Why? It turns out that breast cancers are not all the same. There are at least five kinds, with different growth rates and levels of aggression. Some are so aggressive that they will have spread before they are visible on a mammogram or form a lump. Some are very slow growing or may not even have the ability to spread, so there is no benefit from finding them early. This is because of the biology of the disease, not the limitations of screening.

One of the reasons that mammography is a less effective tool in young women is that they have a higher rate of these aggressive tumors. Younger women also have breast tissue that is more sensitive to the carcinogenic effects of low-dose radiation. Calculations by a research team in Britain published in the British Journal of Cancer in 2005 suggest that it is possible for women to develop cancer because of the cumulative radiation from yearly mammograms starting at 40 or younger. Finally, mammograms are generally less accurate in younger women who have dense breast tissue, which can mask a cancer. Thus the balance of risk versus benefit is not as clear.

Ehrenreich says, at the end of her post, that what we really need is a new women's health movement that is willing and able to ask hard questions about the causes and treatments of breast cancer, and not falling for the propaganda of what she calls "the cancer industrial complex." I wholeheartedly agree.

House health bill shortchanges women in many areas

As the Senate begins debate over Majority Leader Harry Reid's version of the health insurance reform bill RHRealityCheck.org reminds us that the House bill fails to cover many items necessary to women's health. In addition to the notorious Stupak Amendment limiting abortion coverage, the House bill also fails to cover such items as contraception, pelvic exams, and STD counseling.

As RHRealityCheck columnist Amanda Marcotte says:

I’m forced to suggest that the major factor is that our government is still mainly run by a bunch of middle-aged men who’ve been shielded from having to deal honestly and empathetically with women’s lives their whole lives, and therefore are prone to seeing women’s concerns as disposable at best, and at worst, as frighteningly alien and needing to be controlled. When you have that attitude, it’s easy to push aside all the ways you’ve personally benefited from contraception and abortion, and just assume the only women who need assistance in those areas are wayward sluts who need to be slapped down instead of given a hand. After all, I’m sure most of these men have had the benefit of women who quietly make sure that fertility control is taken care of, without bothering the over-privileged men in their lives.

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.

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.

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:

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."

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.

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.