President Barack Obama held a summit on health care yesterday with about 150 politicians and experts in the field. This morning the White House followed up by announcing plans to hold regional forums on health care in five states, including Iowa. From the press release:

The Regional White House Forums on Health Care Reform will be hosted by the states’ Governors and will include participants ranging from doctors to patients to providers to policy experts.  They will be open conversations with everyday Americans, local, state and federal elected officials – both Democrat and Republican — and senior Obama administration officials.  The events will begin with a video recorded by the President, a summary of the findings from the Health Care Community Discussions that took place in December, and an overview of the discussion that took place at the White House Forum on Health Reform.

The meetings in California, Iowa, Michigan, North Carolina and Vermont will take place in March and early April.  Further logistical information about the forums is forthcoming.

Presumably Iowa was chosen because both of our senators will play an important role in drafting health care legislation. Chuck Grassley is the ranking Republican on the Senate Finance Committee, and Tom Harkin will be in charge of drafting the parts of the bill concerning disease prevention and public health.

Ezra Klein posted about an exchange between Obama and Grassley at the White House yesterday:

“Max Baucus and I have a pretty good record of working out bipartisan things,” said Grassley. “I think only two bills in eight years that haven’t been bipartisan.” (One of them, however, was the S-CHIP bill, and another was Medicare payment reform, so their record on health care is more contentious). Grassley then moved onto a more relevant sore spot: The public insurance option. “The only thing,” he pleaded, “that I would throw out for your consideration — and please don’t respond to this now, because I’m asking you just to think about it — there’s a lot of us that feel that the public option that the government is an unfair competitor and that we’re going to get an awful lot of crowd out, and we have to keep what we have now strong, and make it stronger.”

The question was no surprise: In recent Finance hearings, Grassley has clearly signaled his anxiety on this issue. What was a surprise was that Obama rejected Grassley’s plea to think it over and instead replied on the spot with a strong articulation of the case for a public plan. “The thinking on the public option has been that it gives consumers more choices, and it helps give — keep the private sector honest, because there’s some competition out there. That’s been the thinking.”

“I recognize, though, the fear that if a public option is run through Washington, and there are incentives to try to tamp down costs and — or at least what shows up on the books, and you’ve got the ability in Washington, apparently, to print money — that private insurance plans might end up feeling overwhelmed. So I recognize that there’s that concern. I think it’s a serious one and a real one. And we’ll make sure that it gets addressed.”

I love it when conservatives like Grassley drop the free-market-warrior act. David Sirota asks the right question: if what we have works so well, why are “Republicans insisting that Americans would overwhelmingly opt to be covered by a government-run health care program, if given the choice?”

Also, why are there 48 million Americans without health insurance, with 14,000 Americans losing their health insurance every day lately? Why do the uninsured have less access to basic care and even organ transplants?

And why do so many people who do have health insurance face financial ruin following a medical crisis?

There must be a public health insurance option for people too young to qualify for Medicare and not poor enough to qualify for Medicaid. Someone close to my family just got laid off this week and was diagnosed with diabetes within the last few months. What are his chances of finding good private health insurance coverage under the current system?

This thread is for any thoughts about the substance or the politics of health care reform. I’ll post more details about the upcoming White House regional forum when they become available.

President Barack Obama formally announced on Monday that he is nominating Kathleen Sebelius to serve as Health and Human Services Secretary in his cabinet. She should be confirmed with little trouble, as various Republicans have already praised her nomination.

After the jump I’ve posted my initial thoughts on the pluses and minuses of this appointment.

President Barack Obama will present his first budget request to Congress today.

Early leaks indicate that he will propose some tax increases on the wealthiest Americans as well as some spending cuts to help pay for health care reform.

Ezra Klein, an excellent blogger on health care, is excited about what’s in the budget regarding health care reform. Although there is no detailed plan, Obama is submitting eight principles that should define health care reform efforts. Klein believes the principle of “universality” is likely to lead Congress to propose an individual mandate to hold health insurance.

I support mandated coverate only if there is a public plan that any American, regardless of age and income, can purchase as an alternative to private health insurance. The public plan would work like Medicare, in that individuals would be able to choose their own providers. Unfortunately, the Massachusetts model of mandatory private insurance without a meaningful public option has left a lot of problems unsolved.

It is not clear how much Obama will do to roll back George W. Bush’s tax cuts for the wealthiest Americans. I am with House Speaker Nancy Pelosi and others who would prefer to start rolling back tax cuts for the top 1 percent immediately. Last month the president seemed to be leaning toward letting those tax cuts expire over the next two years rather than fighting to repeal them this year.

According to Bloomberg,

President Barack Obama’s first budget request would provide as much as $750 billion in new aid to the financial industry […]

No wonder Obama went out of his way to make the case for helping banks during his address to Congress on Tuesday night. I firmly oppose shelling out another $750 billion toward this end, especially since the bailout money we’ve already spent hasn’t accomplished the stated goals of the program.

According to AFP, today’s budget proposal will include a plan

to raise money through a mandatory cap on greenhouse emissions.

Obama’s budget director Peter Orszag earlier estimated that a cap-and-trade scheme could generate 112 billion dollars by 2012, and up to 300 billion dollars a year by 2020.

Cap-and-trade may be more politically palatable, but a carbon tax may be a better approach for reducing greenhouse-gas emissions.

In cabinet-related news, have calculated that expanding the food-stamp program

Interior Secretary Ken Salazar wasn’t the top choice of environmentalists, but I was pleased to read this post:

Interior Secretary Ken Salazar canceled oil shale development leases on Federal lands in Colorado, Utah and Wyoming and announced that the Interior Department would first study the water, power and land-use issues surrounding the development oil shale.

Meanwhile, Homeland Security Secretary wants to review US Immigration and Customs Enforcement raids and told Congress that employers should be the focus of raids seeking to enforce immigration laws at workplaces. Obviously, swooping in and arresting a bunch of undocumented workers does nothing to address the root of the problem if employers are not forced to change their hiring practice.

Yesterday Obama named former Washington Governor Gary Locke as his latest choice to run the Commerce Department. Locke seems like a business-friendly Democrat, which is a big improvement over conservative Republican Judd Gregg, who thankfully withdrew his nomination for this post.

Republicans have been freaking out because of alleged plans by the Obama administration to “take control of the census.” Of course the GOP wants to continue the practices that have caused millions of white Americans to be double-counted in past censuses while millions more Americans in urban centers (largely non-whites) were not counted at all. Click here for more on the political battle over the census.

This thread is for any thoughts or comments about Obama’s cabinet or budget.

One year ago today I was battling an ear infection that turned bad enough to put me in the hospital for a week.

What I went through then was among the worst experiences of my life. Yet looking back on the experience, I realize how lucky I was.

The rest of the story is after the jump.

Great news, everyone! Today the House of Representatives approved an expansion of the State Children’s Health Insurance Program (SCHIP). In Iowa, this program is known as HAWK-I, and it provides coverage for thousands of children whose families are not poor enough to qualify for Medicaid, but not wealthy enough to purchase health insurance:

The child health bill would provide $32.3 billion over four and a half years to continue coverage for seven million children who now rely on the program and to extend coverage to more than four million who are uninsured.

“This is a day of triumph for America’s children,” Speaker Nancy Pelosi of California said. “We put women and children first.”

After years of frustration, Democrats were exultant.

“Today is a new day,” Representative Dave Loebsack of Iowa. Representative Chris Van Hollen, Democrat of Maryland, said, “Passing this bill sends a very important signal that change has come to Washington as a result of the last election.”

Representatives Bruce Braley and Leonard Boswell joined Loebsack in voting for the bill, which passed by a comfortable margin of 289-139. But as you can see from the roll call, Representatives Steve King and Tom Latham voted no.

King has been a proud opponent of the SCHIP program for years. In the bizarro world he inhabits, this program is Socialized Clinton-style Hillarycare for Illegals and their Parents.

Gee, I thought it was for people like my friend, who owns her own business but couldn’t afford health insurance for her kids after her husband got laid off. With the enormous job losses of the last few months, more and more families will need this program.

Anyway, we’ve all come to expect this kind of vote from King.

I hope some Democrats who crossed over in the fourth district to support Latham will open their eyes now. Today’s vote should not surprise anyone, because Latham has voted against expanding the SCHIP program on several occasions.

Still, I doubt this is what most voters had in mind when they saw television ads touting Latham’s “trusted leadership” on health care.

The Senate will take up this bill within the next two weeks, and I doubt Republicans will be able to filibuster it. So, Barack Obama will have a major achievement on health care very early in his presidency. Let’s hope it will be the first of many.

UPDATE: In typically dishonest fashion, Steve King (who never met a tax cut for the rich he didn’t like) claims the SCHIP bill “provides new benefits to illegal immigrants and wealthy families at the expense of low-income children.”

From Daily Kos user rok for dean:

In 1950, the average pay of an S&P 500 CEO was less than 30 times that of an average U.S. worker; by 1980, prior to the “Reagan Revolution,” the average pay of the S&P 500 CEO was approximately 50 times higher than that of an average U.S worker.  But by 2007, the average pay of an S&P 500 CEO had soared to more than 350 times as much as that of an average U.S. worker.

This is both immoral and unsustainable in a democracy.  By way of comparison, in Europe, an average CEO only makes 22 times as much as an average worker, and in Japan, only 17 times as much.

If America wants to be competitive again, we need to reduce CEO pay to a level comparable to CEO pay in Europe and Japan.  I know exactly how to accomplish this feat.  The [United Auto Workers] should agree to immediately lower U.S. union worker pay to a level equal to the level paid by their non-union, non-American competitors.  In return, auto CEO’s must agree to permanently lower their compensation to only 20 times that of an average union worker.

Sounds fair to me. How many Republicans who’ve been beating the war drums about excessively generous pay to union workers would agree to those terms?

It’s true that union workers get paid more than non-union workers (though strong unions are associated with higher average wages even for non-union workers in the same area). But in a country where two-thirds of our gross domestic product depends on consumer spending, higher wages are not a bad thing.

In any event, unions are not primarily to blame for the auto industry’s current problems. Toyota is about to post its first operating loss in 70 years despite having an entirely non-union workforce. The tough economy has diminished demand for new cars.

American automakers also have to bear the burden of our broken employer-based health insurance system, but that’s a topic for another diary.

The same Republicans who claim they’d never raise taxes on Americans are only too happy to slash the wages of middle-class auto workers. As rok for dean says, let’s call their bluff and see if they would be willing to tie executive pay to a reasonable multiple of the average worker’s salary in the company.

Side note: my dad was a Republican, but it really bothered him when corporate executives would receive exorbitant salaries and bonuses even as they were driving their companies into the ground. Rewarding good performance is one thing, but paying incompetent managers obscenely high salaries is another.  

The Principal Financial Group lowered the boom on 300 workers in central Iowa yesterday:

Principal Financial Group laid off 550 employees Tuesday, including 300 in its Des Moines headquarters, the company said.

Principal, one of the area’s largest employers, has approximately 16,400 employees worldwide and 8,000 in the Des Moines area. […]

The Des Moines-based insurance and financial services company said the cuts are due to continued deterioration of U.S. and global markets.

Principal reported a net income of $90.1 million for the third quarter, a 61 percent decrease from $232.3 million in the same period a year ago. Principal also told a state development agency last month that it is no longer interested in receiving tax incentives in exchange for creating 900 jobs in Iowa.

The last day for most affected employees will be Dec. 31, and all affected employees will receive severance and career assistance, the company said.

It’s great that people will receive severance pay and career assistance, but they will be entering a very tough job market. Other local employers, including Wells Fargo Home Mortgage, have already laid off workers this fall. Finding a job with pay and benefits comparable to what Principal offered won’t be easy.

This isn’t just an issue for central Iowa. As nyceve writes in her latest diary, rising unemployment is expected to greatly increase the number of Americans lacking coverage for basic health care. Add that to the list of problems with our costly and inefficient employer-based health insurance system.

Doctors go through a lengthy period of education and training before they are certified to practice medicine.

So why are insurance company bureaucrats routinely able to second-guess or overrule doctors’ orders?

Rekha Basu’s column from the Sunday Des Moines Register provides another shameful example of this common practice. Last December, Angela Ira’s 18-year-old son Nicholas, who had a history of depression, severe anxiety and borderline agoraphobia, was suicidal.

Scared and desperate, she said she persuaded him to go with her to the hospital emergency room, though he fears leaving the house. The doctor threatened to have him involuntarily committed if he didn’t agree, said Ira. She finally talked him into it. But half an hour later, the doctor returned to say the insurance company refused to pay. […]

Magellan’s clinical director, Steve Johnson, said he couldn’t discuss individual cases. But in the letter to Nicholas mailed last Dec. 10, Magellan cited as reasons for the non-authorization:

– “You do not appear to be a danger to yourself or others, and you are capable of activities of daily living.”

– “The information provided supports that other services will meet your treatment needs.”

– “You no longer have the symptoms and/or behaviors you had on admission, and you have shown progress in meeting your treatment goals.”

How could the company determine, when Nicholas’ doctor was saying he was suicidal, that he was making progress toward goals? The letter said, “If we disagreed with your provider’s clinical decision, we consulted with a licensed psychiatrist or other qualified professional and recommended an alternate service.”

As if someone who hadn’t met or spoken to the patient could better understand his needs than the doctor treating him.

Conservatives love to demagogue about “government-run health care,” but I notice that they don’t seem bothered when insurance company employees deny access to treatment recommended by the patient’s own doctor.

Basu’s column is a reminder that even Americans who have private health insurance are often forced to go without medical care they need.

Barack Obama and the Democratic Congress need to stop insurance companies from substituting their judgment for that of doctors. This needs to be part of a broader universal health care package.

The Des Moines Register’s editorial board again called for single-payer health care reform in an unsigned editorial today:

Our view: What’s needed is a government-administered health-insurance program – similar to Medicare, which covers seniors and disabled people – available to all Americans.

A single system could reduce administrative expenses associated with facilitating thousands of different private health-insurance plans in this country. It could increase leverage for negotiating lower prices. It could facilitate the expansion of electronic medical records, which would streamline paperwork and help prevent costly medical errors. It would boost the country’s economy in the long run.

Every health care delivery system has its flaws, but on balance I agree that a Canadian-style single-payer system would serve this country well. A few days ago DCblogger chided me for my “defeatism” about the prospects for enacting single-payer. I stand by my assessment, though. Even if President Obama were fully committed to “Medicare for all,” getting HR 676 through Congress would be extremely difficult. But Obama has not endorsed single-payer and is not going to put his political weight behind it, even if 93 members of Congress have co-sponsored the bill.

This is an open thread for any comments related to health care or health care reform proposals.

UPDATE: The latest from nyceve continues to make the case for single-payer, with lots of statistics on the high cost of our for-profit health insurance industry. Naughty Max Baucus: “The only thing that’s not on the table is a single-payer system.”

I don’t expect to get everything I want from Democratic politicians in power. Probably liberals like me will have plenty of disappointments in the coming years. But if Barack Obama and the Democratic Congress only follow through on one big campaign promise, I hope it’s health care.

The many injustices of our current health care system have been thoroughly documented by nyceve, among others, but I want to add my two cents.

The 46 million Americans lacking health insurance represent one very large part of problem. Some can’t afford insurance, and others can’t find a private insurer who will sell them a policy for any price. You could spend all day listing the ways uninsured Americans get a raw deal on health care. They can’t afford preventive care and routine diagnostics, so they are more likely to be diagnosed with late-stage, incurable cancer. They are less likely to receive care for any number of chronic illnesses. They live with terrible, crippling pain. Few Americans without health insurance coverage are able to receive organ transplants, though many become organ donors after dying prematurely.

We need to get these people covered and get away from our broken employer-based health care system. Every day Americans who thought they had good benefits are joining the ranks of the uninsured–like my friend whose husband got laid off in October, right before his employer (a small manufacturer) went under. It turned out the boss had secretly stopped paying the health insurance premiums some time before. Or the retirees who worked at Maytag or at John Deere for many years and are now losing some of the health benefits they were promised.

Employer-based health care is also a huge drag on large corporations and our national economy, as clammyc pointed out in this recent diary.

In an ideal world, I’m for a Canadian-style single-payer system (also known as HR 676 or “Medicare for all”), but as a political compromise I would settle for something like what John Edwards and Hillary Clinton proposed during the primaries: mandatory health insurance, which would be portable with no exclusions for pre-existing conditions, and the option for any American to buy into a public insurance plan. Momentum is building in Congress for this kind of reform.

But getting Americans health insurance will solve only part of the problem. It’s shocking how many Americans with “good” insurance go without needed medical care. Only occasionally does a case makes national news, as when the teenager Nataline Sarkisyan was unable to get a liver transplant last year. A recent study found many Americans with chronic illnesses forgo medical care for cost reasons, even if they have insurance.

Then there are the “lucky” people who get the care they need for a medical emergency, but later face financieal ruin when their insurance company denies coverage. Medical bills are implicated in about half of all personal bankruptcies in the U.S.

When I had a medical emergency last winter, I got to the doctor relatively early, I received good care in the hospital, no lasting damage was done to my body, and my insurance company covered almost all of the costs (once we had exhausted our deductible). I remember our relief when the biggest bill arrived in the mail, for about $18,000, and our required payment was only $600. (I recognize that $600 would be a hardship for many families, but we are fortunate to be able to pay that without cutting back on any essentials.)

Yesterday I was reminded again of how things could have turned out very differently for my family. If you are a regular at Daily Kos, you may recognize the handle AdmiralNaismith. Among other things, he wrote a series of diaries about the political scene in all 50 states between April and October. The links to all of those pieces are here, and he wrote an interesting post-election wrap-up diary here.

AdmiralNaismith doesn’t write many personal diaries, but he recently discussed his own family’s “medical horror story”: Drowning in medical bills, despite insurance (another link is here).

He describes the sequence of events, including his wife’s life-threatening embolism, which left his family owing thousands of dollars for medical care–more unpaid bills than AdmiralNaismith earns in three months. He asked fellow bloggers to help pay down the three largest bills, which will otherwise be sent to collection agencies within 30 days. (He’s not asking anyone to send him money directly but provides contact details for the insurer, with name and account number.) A few hundred people paying $10 or $20 each would help enormously.

I will be calling to make a payment on Monday, and I encourage anyone who’s ever benefited from reading AdmiralNaismith’s informative diaries to do the same.

But equally important, I ask the community of Democratic activists, who did so much to elect Obama, to hold his feet to the fire next year on delivering the comprehensive health care reform he promised.

I haven’t been thrilled with Obama’s cabinet appointments so far. My number one hope for the new government is that Ezra Klein is right about what Tom Daschle as secretary of Health and Human Services means:

This is huge news, and the clearest evidence yet that Obama means to pursue comprehensive health reform. You don’t tap the former Senate Majority Leader to run your health care bureaucracy. That’s not his skill set. You tap him to get your health care plan through Congress. You tap him because he understands the parliamentary tricks and has a deep knowledge of the ideologies and incentives of the relevant players. You tap him because you understand that health care reform runs through the Senate. And he accepts because he has been assured that you mean to attempt health care reform.

Please share your thoughts or health care horror stories in the comments.

Jed L brought something remarkable to my attention over the weekend.

Michael Cannon of the conservative CATO Institute wrote a piece called Blocking Obama’s Health Plan Is Key to the GOP’s Survival. The idea is that if Obama gets universal health care passed, he will bring “reluctant voters” into the Democratic coalition. The Republicans must at all costs provent that from happening.

David Sirota and TomP both pointed out that conservative pundit William Kristol made the same case to Congressional Republicans during Bill Clinton’s first term. At first, some were afraid to be seen as obstructing the president’s health care reform efforts. But in December 1993,

Leading conservative operative William Kristol privately circulates a strategy document to Republicans in Congress. Kristol writes that congressional Republicans should work to “kill” — not amend — the Clinton plan because it presents a real danger to the Republican future: Its passage will give the Democrats a lock on the crucial middle-class vote and revive the reputation of the party. Nearly a full year before Republicans will unite behind the “Contract With America,” Kristol has provided the rationale and the steel for them to achieve their aims of winning control of Congress and becoming America’s majority party. Killing health care will serve both ends. The timing of the memo dovetails with a growing private consensus among Republicans that all-out opposition to the Clinton plan is in their best political interest. Until the memo surfaces, most opponents prefer behind-the-scenes warfare largely shielded from public view. The boldness of Kristol’s strategy signals a new turn in the battle. Not only is it politically acceptable to criticize the Clinton plan on policy grounds, it is also politically advantageous. By the end of 1993, blocking reform poses little risk as the public becomes increasingly fearful of what it has heard about the Clinton plan.

Getting back to Cannon’s recent piece for CATO, I am struck by how conservatives don’t even believe their own propaganda about the horrors of “socialized medicine.” Yes, I know that Obama isn’t proposing socialized medicine (which would work like the Veterans Administration, where the government employs the doctors and runs the hospitals), or even single-payer health care (as in Medicare, where patients choose the doctor but the government pays the bill). But for the moment, let’s accept CATO’s frame on this issue, which is that Obama’s health plan would turn into socialized medicine.

Obama’s plan would presumably allow Americans to buy into a state-run health insurance plan as an alternative to private health insurance, and would prohibit insurers from excluding people with pre-existing conditions. These measures would force the insurance companies to compete for customers by offering better coverage, as opposed to the current system, in which they try to maximize profits by denying care whenever possible, and sometimes refusing to insure people for any price.

I have a friend with a thyroid condition. At one point her husband was between jobs and they looked into buying their own health insurance. They could not find any company that would take their family. It wasn’t a matter of excluding coverage for anything related to my friend’s thyroid condition. They simply declined to sell insurance to this family at any cost. Fortunately, my friend’s husband got a job with good benefits. Otherwise, they would be uninsured to this day.

The benefit of giving families like my friend’s the option of buying into state-run insurance program is obvious. But let’s assume that conservatives are right, and that any state-run insurance scheme is bound to be expensive and inefficient. If that’s the case, wouldn’t it fail in the marketplace?

Obama’s health care plan could evolve in the direction of single-payer health care only if the government insurance plan provided superior coverage to consumers at a lower cost. CATO shouldn’t be worried about this, right?

Let’s go a step further. Conservative pundits are trying to tell us that Democratic health care proposals would be disastrous for the country and wreck the economy. If that’s true, then why is a CATO analyst worried that enacting Obama’s health care plan would cause a political realignment in the Democrats’ favor?

Cannon’s argument is also shocking on a moral level. He appears to believe that Obama’s health care plan would improve so many Americans’ lives that the GOP’s survival would be threatened. So, he urges Republicans to put their own political interests ahead of the interests of Americans currently lacking adequate health care.

Jed L thinks

Cannon has everything backwards: the GOP’s survival depends on Republicans being part of the solution instead of being part of the problem.

I have to admit that here I agree more with Cannon. Republicans would not get much credit for helping to pass Obama’s universal health care plan. Everyone would know it was a Democratic president with a Democratic Congress who delivered on that promise.

Obstruction with the goal of making Obama look like an ineffective leader in tough economic times is probably the Republicans’ best hope of making political gains.

I am cautiously optimistic that Congress will be more open to adopting Obama’s agenda than the Democratic-controlled Congress was for Bill Clinton in 1993 and 1994. We’ve got at least two things going for us: Obama’s Health and Human Services secretary will be Tom Daschle, who knows the inner workings of Congress, and Henry Waxman (not John Dingell) will be running the House Energy and Commerce Committee.

An earthquake hit Capitol Hill today, as the House Democratic caucus voted 137 to 122 to make Representative Henry Waxman of California chairman of the House Energy and Commerce Committee. He will replace Representative John Dingell of Michigan, who has served in the House for more than 50 years (after his father represented the same district for more than two decades).

Dingell has been the top Democrat on the panel for 28 years and is an old-school supporter of the auto industry. Waxman has complained that the committee has been too slow to address environmental issues like global warming.

“The argument we made was that we needed a change for the committee to have the leadership that will work with this administration and members in both the House and the Senate in order to get important issues passed in health care, environmental protection, in energy policy,” Waxman said after the vote.

“The next two years are critical,” said Rep. Jan Schakowsky, D-Ill., who spoke on Waxman’s behalf in the closed-door caucus. “It’s not personal. It’s about the American people demanding that we embrace change and work with the president on critical issues of climate change and energy and health care.”

This is more important than the Senate Democrats caving to Joe Lieberman on Tuesday.

It’s an excellent sign that the new Congress will be serious about progressive change. I had read yesterday that freshman Democrats were overwhelmingly for Waxman, while the Blue Dogs and Congressional Black Caucus were mostly for Dingell.

It’s unfortunate that Dingell has spent several decades trying to shield the big three American automakers from government regulation on fuel efficiency and other matters. If he had not “protected” them for so long, maybe U.S.-made cars would be more desirable for more consumers, and the automakers would not be on the brink of bankruptcy.

Of course, our employer-based health care system is another major drag on American manufacturers. With any luck we will be able to help uninsured Americans and major industry at the same time by passing universal health care reform.

Congratulations to Waxman for taking the first step in what will no doubt be a long slog.

UPDATE: A Siegel is encouraged by Obama’s speech to the recent bipartisan governors’ summit on climate change. Click the link for more details and the text of the speech.

Via nyceve at Daily Kos I learned about a new study called “Class and Race Inequalities in Health and Health Care.” The three authors found that very few Americans lacking health insurance receive organ transplants, although the uninsured often become organ donors.

Eve’s diary includes a link to the full report in pdf format and summarizes one of its findings:

Strikingly, lack of insurance was a stronger predictor of organ donation than was any hospital characteristic or demographic factor other than age (older people’s organs are more often diseased and unsuitable for transplantation).

Why are the uninsured more likely to become organ donors? Could it be that more of them are dying prematurely?

The authors explain in the introduction why they embarked on this research project:

   “In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy.

   The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.”

Yes, you read that correctly. The patient was rejected for a heart transplant in part because, lacking health insurance, he was deemed unlikely to be able to buy the immunosuppressing drugs he would need to survive with a new heart.

Republicans scream about “socialism” and “rationing,” as if health care is not rationed every single day in this country. Maybe one of my Christian conservative readers can explain why it was ok to deny this young man a heart transplant. If his job had provided health insurance, he might have gotten that heart and be alive today.

Speaking of health care rationing, I learned from this MyDD diary that the academic journal Health Affairs recently published a study comparing care for chronically ill patients in eight countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States).

Click here to read the study, which found that “Chronically ill U.S. patients have the most negative access, coordination, and safety experiences.” I’ve excerpted some passages:

Asked about experiences, U.S. and German patients were significantly more likely than patients in the other countries to report wasted time because of poorly organized care. […]

The United States stands out in patient costs, with 41 percent reporting that they spent more than $1,000 out of pocket in the past year. […]

U.S. chronically ill adults were by far the most likely to report forgoing needed care because of costs. More than half (54 percent) reported at least one cost-related access problem, including not filling a prescription or skipping doses, not visiting a doctor when sick, or not getting recommended care (Exhibit 2). […]

U.S. patients were significantly more likely than those in other countries to report that medical records or test results were not available during a scheduled visit or that tests were duplicated unnecessarily. One-third of U.S. patients reported at least one of these experiences–a rate 30 percent higher than in any other country. […]

U.S. uninsured adults were significantly more likely than those insured all year to go without care because of costs and to wait when sick. Remembering that all in this study have chronic (often multiple) conditions, a disturbingly high 82 percent of the uninsured did not fill a prescription, get recommended care, or see a doctor when sick because of costs. Uninsured chronically ill adults were also more likely than those with insurance to report errors as a result of higher rates of delays in hearing about abnormal lab tests and wrong-dose/ wrong-medication errors. Not surprisingly, given these experiences, the uninsured were also more negative about the U.S. health system than insured adults were.

Still, the experience of fragmented and inefficient care in the United States cuts across insurance status. Insured and uninsured chronically ill U.S. adults reported similarly high rates of coordination concerns (duplication and records/tests not available) and perceptions of excess care or time wasted because of poorly organized care.

Although insured U.S. adults fared better than the uninsured, they were still more likely than their counterparts in other countries to forgo care because of cost and to encounter poor coordination. Their perceptions of waste, patient-reported errors, and negative system views also remained at the high end of the country range. […]

Repeating patterns observed in earlier surveys, the United States continues to stand out for more negative patient experiences, ranking last or low for access, care coordination/efficiency, and patient-reported safety concerns. The percentage of chronically ill U.S. adults who reported access problems, errors, delays, duplication, and other symptoms of poorly organized care was two to three times the level reported in the lowest-rate countries in the survey (a 20-30 percentage point spread). Along with Canadians, U.S. patients were also the most likely to indicate a primary care system under stress–lack of rapid access, difficulty getting care after hours, and high ER use.

Americans spend a higher percent of our gross domestic product on health care than any other industrial democracy, yet we don’t get good value for money. It’s worst for the uninsured, but as the above study found, even chronically ill patients with health insurance reported more problems with health care access than comparably ill patients in other countries.

I hope Congressional Democrats are serious about making big changes to our health care system, because the status quo is immoral and unacceptable.

UPDATE: More evidence that our current rationing of health care is immoral can be found in this diary by nyceve: “Many uninsured Americans endure terrible physical pain.”

I’ve been consistently worried that Barack Obama would not set an ambitious domestic policy agenda if elected president. His post-partisan rhetoric has given me the impression that he would move toward compromising with the Republican position on various issues before negotiations with Congress have begun. Specifically on health care, I agreed with Paul Krugman of the New York Times that Obama’s proposal was not as good as the plans John Edwards and Hillary Clinton advocated during the primaries.

Obama hasn’t been sworn in yet, and the new Congress won’t meet for more than a month, but already there are signs of growing momentum for truly universal health care reform (and not just incremental progress toward that goal).

On Wednesday Senator Max Baucus of Montana, who chairs the Finance Committee, released a “white paper” on health reform. You can get the gist by reading this diary by TomP or this one by DemFromCT. Ezra “Momma said wonk you out” Klein dived into the details in a series of posts this week.

The key point is that Baucus embraced the concept of mandatory health insurance, but with a public plan any American could choose to join. So, if private insurers kept jacking up premiums while covering less and less medical care, people could “vote with their feet” by paying into a public plan that would work like Medicare (the patient chooses the doctor).

This story explains Baucus’ line of thinking:

Baucus, of Montana, chairman of the Senate Finance Committee, said in a health-care blueprint released today that only a mandate could ensure people didn’t wait until they were ill to buy health insurance, forcing up the price for everyone.

The 89-page proposal revives a debate from the Democratic presidential primaries about how to overhaul the U.S. health- care system. Obama supported requiring coverage only for children, saying adults would buy coverage voluntarily if it were affordable. Senator Hillary Clinton of New York said insurance must be mandated for everyone.

“Requiring all Americans to have health coverage will help end the shifting of costs of the uninsured to the insured,” Baucus said today in his plan. The requirement “would be enforced possibly through the U.S. tax system or some other point of contact between individuals and the government,” he said, without spelling out possible penalties. […]

Because of the urgency of health-care reform, Congress should move on legislation in the first half of next year, Baucus said at a press conference today in Washington.

“There is no way to solve America’s economic problems without solving health care,” he said. The $2.2 trillion health-care system “sucks up 16 percent of our economy and is still growing,” Baucus said.

It’s hard to exaggerate the significance of this development. First, as many others have noted, if Baucus runs health care reform through the Finance Committee there is a good chance it will be the kind of bill not subject to a filibuster. That means the Democrats would need only 50 votes (not 60) to pass it in the Senate.

Second, Baucus is among the more conservative members of the Senate Democratic caucus (check out his Progressive Punch ratings here). If he is ready for big, bold health care reform, the ground has shifted.

Third, this development could be very discouraging for Iowa’s own Senator Chuck Grassley, the ranking Republican on the Finance Committee. Traditionally, Grassley and Baucus have had a close working relationship. But this past summer Grassley was annoyed when Democrats rejected a deal he thought he had cut with Baucus on a Medicare bill, and Baucus denied having reached any prior agreement with Grassley.

This report from Wednesday quotes Grassley expressing skepticism about finding the money to pay for a big health care initiative.

If Baucus moves away from the habit of compromising with Grassley now that the Democrats will have a solid Senate majority, could Iowa’s senior senator decide to step down in 2010? We all know that Grassley’s seat is safe for Republicans unless he retires. He seems to like his job, but perhaps facing defeat after defeat in a Democratic-controlled Congress would diminish his desire to hang around for another six years.  

If you’ve been on the job market in the last decade or two, you may know how hard it is to find a job with good benefits.

A lesser-known fact of life in this country is that even if you think your employer provides great health care coverage, you could get shafted later. nyceve has written a book’s worth of diaries about “Murder by Spreadsheet,” when for-profit insurance companies find excuses to refuse to cover needed medical care.

Insurance companies are not always to blame, however. Corporations looking to cut costs sometimes yank promised health benefits from retirees who put in many years of work and in some cases gave up pay raises in exchange for better benefits packages.

The makers of John Deere machinery have provided the latest example of this travesty. In response, some 5,000 former employees of Deere & Co. filed a class action lawsuit this week

demanding that company officials reset the clock to 2007 and restore health benefits that court papers say were drastically cut back this year.

The lawsuit, filed in federal court in Des Moines, alleges Moline, Ill.-based Deere broke longtime promises to its employees when the company on Jan. 1 “eliminated, reduced and dramatically altered” benefits pledged under retiree health plans.

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Court papers say the company for more than 15 years promised lifetime health benefits to employees who vested in Deere & Co. pension plans, and Deere can’t now back out of that deal.

In July about 3,000 retired former Maytag employees learned that Whirlpool, which bought Maytag in 2005, is trying to reduce their health benefits as well.

The Des Moines Register reported today that officials from Iowa’s Senior Health Insurance Information Program have scheduled meetings in Newton on September 17 “to warn Maytag retirees about upcoming choices and deadlines in the wake of a decision by Whirlpool to reduce their health benefits.” Maytag retirees have filed a class-action suit in Michigan claiming that Whirlpool must honor Maytag’s contracts that promised “vested lifetime retiree health care benefits.” That lawsuit is pending, as is a separate case filed by Whirlpool, seeking to impose the benefit changes on Maytag retirees.

Speaking of our screwed-up health care system, today nyceve posted a wonderful diary contrasting a video of John McCain saying, “Like Most Americans, I go see my doctor fairly frequently” with footage of Joe Biden talking about health care on the stump. Click through, these videos are worth your time.

It’s no surprise that McCain is out of touch with the realities of health care in this country. After all, one of the authors of McCain’s health “reform” proposal thinks there are no uninsured Americans as long as sick people can go to the emergency room.  

MissLaura put up this front-page post at Daily Kos today about why unions matter. She linked to Change to Win, which has all kinds of useful statistics on its website. Click the link to find charts illustrating that “Union Workers Earn More,” “Union Members Have Better Benefits,” “Union Members Pay Less for Health Coverage,” and so on.

If Barack Obama becomes president, I hope he will follow through on promises to make it easier for workers to organize in this country. Replacing some of the corporate hacks George Bush has put on the National Labor Relations Board would be a step in the right direction. The Bush administration has used the NLRB to carry out a “systematic assault on workers’ rights.”

In the good news column, Shai Sachs reported in this post at MyDD that union membership appears to be slowly inching up, reversing a long decline.

But remember, just being in a union doesn’t guarantee that a worker will receive promised benefits. As I wrote a few weeks ago, Maytag retirees are probably going to lose health benefits guaranteed in their last contract. On the other hand, if they hadn’t been in a union, it’s a good bet they never would have had those benefits to begin with.

If you were negotiating an employment agreement, you might consider taking an outstanding benefits package in exchange for a lower starting salary or a wage freeze. How would you feel if many years later, in retirement, some of those benefits were taken away from you?

About 3,000 former Maytag workers and family members have received letters from Whirlpool this week informing them that they are about to get cheated. Here’s the background:

Whirlpool Corp. has filed a lawsuit in federal court seeking to cut the medical benefits of thousands of retired Maytag workers.

The lawsuit, dated July 24 and filed in U.S. District Court for the Southern District of Iowa in Des Moines as a class action complaint, names the international and local chapters of the United Auto Workers union and three retired Maytag workers as representatives of the class. […]

Whirlpool bought rival Maytag in 2006 for $1.7 billion and assumed the negotiated union contracts and related benefit plans. […]

Whirlpool said in the lawsuit that a contract negotiated between the union and Maytag in 2004 expires on July 31. Whirlpool said it plans to change the retiree medical benefits on Jan. 1, 2009, to bring the benefits in line with the same plan that more than 10,000 current employees, retirees and their dependents have.

I hope that Whirlpool’s lawsuit will fail, but unfortunately, the federal bench is so full of Republican-appointed judges that I don’t expect much in the way of protection for union members.

Barack Obama released this statement today in connection with the controversy:

Des Moines, Iowa – Below is a statement from Senator Barack Obama on the letter Whirlpool sent to Maytag union retirees this week about changes in their health benefits.

“In America, we believe that if you work hard, you should be able to build a better life for yourself and your family.  But today, this American dream is slipping out of reach for too many working Americans. Whirlpool’s decision to cut the health care benefits of 2,200 Maytag retirees is the latest sign that we need to change the broken system in Washington.  

“It’s not right that Maytag’s CEO walked away with a multi-million dollar buyout while the hardworking men and women who built the company lost their jobs and are now facing health care cuts. I’ve had the privilege of meeting with Maytag workers in Newton, and I know they negotiated those benefits in good faith, giving up pay increases and other benefits.  Now it is time for Whirlpool to show good faith to their former employees.  

“As President, I will fight for our workers every day because when our workers do well, America does well.  In the Senate, I’ve fought to protect pensions, and I will continue that fight in the White House.  I will make sure our workers get the fair wages, affordable health care, and secure retirement that they deserve.  And I’ll change our tax code so it rewards companies that create jobs here in the United States instead of companies that ship jobs overseas. I’ll be a President who looks out for Main Street, not just Wall Street and who fights to put the American Dream within reach for every American.”

I certainly hope Obama will work to strengthen labor unions and workers’ rights in this country if he gets elected.

But ultimately, Whirlpool’s action is yet another indictment of our health care system. Even Americans who have good employer-based health insurance can get screwed.

To get more informed about the failures of our current health care system and the benefits of moving to a single-payer “Medicare for all” model, read nyceve’s diaries at Daily Kos or the Guaranteed Healthcare group blog.

At Guaranteed Healthcare, you can also find a list of Democratic candidates for Congress who have endorsed HR 676, which would establish a single-payer health care system.

To everyone who worked hard toward the passage of a law expanding health insurance coverage for Iowa children, which Chet Culver signed yesterday.

To the Iowa Council for International Understanding, which has posted translations of Iowa voter registration documents on its website in light of a court ruling that bars the Secretary of State’s office from providing information in any language other than English.

To Senator Chuck Grassley for looking into the spending practices of six tax-exempt “media-based ministries,” despite a large-scale public relations campaign accusing him of “religious McCarthyism.”

To Iowa Independent blogger Dien Judge, who was just appointed to the Monroe County board of supervisors, a position he will hold for the next six months.

And to Iowa City Council member Ross Wilburn, the bicyclist who won Johnson County’s annual Bike-to-Work Week Bike-Bus-Car race.

Put up a comment if you know of someone else who deserves congratulations this week.

The wonderful nyceve caught this unintentional comedy from John McCain as he answered a question about his health:

“Everything’s fine,” McCain told reporters during a news conference. “Like most Americans, I go see my doctor fairly frequently.”

As nyceve points out in her latest diary, “most Americans” do not go see the doctor frequently, especially not if they are only covered through a Health Savings Account. That’s the centerpiece of McCain’s health care plan, but nyceve gives us a reality check:

If all you’re able to afford is High Deductible Junk Insurance which McBush is pushing as a solution to our healthcare catastrophe, then you don’t to go to a doctor “fairly frequently” as McCain does. You don’t attend to routine health problems because you can’t afford to. High deductible health insurance offers bare bones coverage and is insurance in name only.

So what do you do if you have junk insurance?  You wait and hope and pray that you recover. Some Americans even procure medicine from pet stores which often sell a variety of antibotics at low prices.

Her diary also included a link to this report:

More than a quarter of Americans have skipped or postponed an essential visit to a doctor because it was too expensive, a new MSN-Zogby poll says.

Nearly half (48%) say they pay more in health-insurance premiums than a year ago, and 37% say they pay more out of pocket for medical services or prescriptions.

The results of the poll of 9,765 adults suggest that medical expenses are becoming a heavier burden on household finances, even for middle-income Americans.

Go read the whole diary, which includes a video of a 33-year-old man who was uninsured when he was diagnosed with lymphoma. He describes the choices he had to make while undergoing cancer treatment without health insurance. Of course, no private insurer will sell him a policy now that he has had cancer, a problem McCain’s health care plan would do nothing to correct.

By the way, DemFromCT points out the inconvenient fact that McCain supported George Bush’s veto of Congress’s attempt to expand the State Children’s Health Insurance Program. When will the media stop calling him a maverick?

A few posts down I mentioned that Elizabeth Edwards has been going after John McCain for his totally inadequate health care reform proposal. As she has noted, both she and McCain could be excluded from his program because their cancer would be considered pre-existing conditions.

Instead of addressing her substantive arguments, McCain’s national finance co-chair, Fred Malek, whines that she should not be talking about cancer in a political context:

http://www.dailykos.com/storyo…

Finding a cure for cancer is a vitally important mission for this country. Supporting that mission should unite everyone – and should be off-limits from the political and partisan battlefield.

…I just hope that it doesn’t become a common occurrence on the campaign trail. The cancer conversation is best left to the experts, researchers, and doctors.

Yes, let’s all join together and find a cure for cancer, while not mentioning that cancer patients could be denied coverage under McCain’s health care plan.

Click the link to read diarist Dean Barker’s discussion of the highlights of Malek’s career. They include his work compiling a list of high-ranking Jews in the  Bureau of Labor Statistics for President Richard Nixon in 1971.

The indispensable nyceve put up this diary about a fantastic blog post by Elizabeth Edwards: Why Are People Like Me Left Out Of Your Health Care Proposal, Sen. McCain?

Just click the link and read the whole thing. We need to hammer McCain on this issue, because his health care reform plan is totally inadequate.

What do you know? Under John McCain’s health care reform plan, insurance companies could exclude pre-existing conditions such as his own recurrent melanoma. Of course, McCain doesn’t need to worry about this, because he has the Cadillac care provided to all members of Congress.

Elizabeth Edwards, who could likewise be excluded under McCain’s plan because of her history of breast cancer, has called McCain on his hypocrisy. Click the link above to read nyceve’s important diary on the subject.

On a related note, Dr.SteveB, who like nyceve advocates a single-payer health care system (that is, like Medicare, but covering every American), reports on a new study published in the peer-reviewed journal Annals of Internal Medicine. A nationwide survey of 2,193 physicians

showed 59% “support government legislation to establish national health insurance,” while 32% oppose and 9% are neutral. That’s a solid majority of American doctors, and up 10% from 49% in 2002 when a similar study was last done.

This is an excerpt from the article in Annals of Internal Medicine:

Support among doctors for NHI has increased across almost all medical specialties, said Dr. Ronald T. Ackermann, associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine and co-author of the study.

“Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy,” he said.

Dr.SteveB has more on the story if you click the link.

I laugh when I hear conservatives try to scare people with their talk of “socialized medicine” leading to “rationing” of health care. As almost anyone who has dealt with a private insurance company can tell you, health care is routinely rationed in the U.S. already.

I mentioned a particularly outrageous case recently, in which Pacificare was denying treatment to a 17-year-old cancer patient.

Well, after the story spread all over the internet and the phones started ringing, Pacificare reversed itself and authorized the treatment.

Let’s hope it’s not too late for this kid, like it was for Nataline Sarkisyan.

A few posts down I mentioned a report from Families USA about how many Americans die prematurely because they lacked health insurance. Someone from that organization was kind enough to send me the link to the full report referenced by the Des Moines Register (pdf file).

The press release that accompanied the report is after the jump. Here is a particularly depressing excerpt:

* Families USA estimates that nearly three working-age Iowans die each week due to lack of health insurance (approximately 140 people in 2006).

* Between 2000 and 2006, the estimated number of adults between the ages of 25 and 64 in Iowa who died because they did not have health insurance was more than 800.

* Across the United States, in 2006, twice as many people in that same age category died from a lack of health insurance as died from homicide.

Of course, the media coverage devoted to homicides far exceeds the coverage devoted to people who die because they lack health insurance.

Here’s hoping that when Hillary Clinton and Barack Obama have their next debate, journalists allow them to talk about health care and other issues.

Over at Open Left, fladem wrote this diary about the relationship between economic inequality and life expectancy in the U.S. Poor people don’t live as long as wealthier people for a lot of reasons, one of which is that they are less likely to have health insurance.

I totally agree with fladem’s take on the situation:

a more damning indictment of our health system I could not imagine.

The right always argues that socialized medicine will lead us to “ration health care.”  Of course, what they don’t tell you, and what this article makes clear, is that markets are rationing health care just fine on their own. No, I have never thought that conservatives mind health care rationing so long as they get their health care.

The Des Moines Register published this editorial a few days ago citing a report by Families USA about the number of Americans who die because they lacked health insurance. An estimated three Iowans die every week for this reason, though that cause is not listed in their obituaries.

This doesn’t surprise me a bit, as my scary run-in with an infection last month could have turned out much worse if I had delayed seeking treatment, as many uninsured people do. But as the Register noted, the cause of death in such a situation would never be listed as “lacked health insurance.”

The latest issue of Mothering magazine (no link, article not available online yet) had a harrowing story about the high rates of infant mortality and maternal mortality in the U.S., compared to other industrialized countries.

If you have the stomach to read them, nyceve’s series of diaries on “murder by spreadsheet” are essential reading for anyone who wants to understand the shameful inequities in our health care system.

Her latest piece is about how the for-profit insurance industry has denied limbs to many amputees. Absolutely horrendous stories in that diary.

Someday we will have a presidential nominee, and I hope that person will focus some attention on economic inequality and inadequate access to health care.

UPDATE: nyceve posted a diary today: Pacificare denies 17-year-old cancer patient lifesaving treatment. Read it and weep.

cross-posted at Daily Kos and MyDD

I am a healthy woman in my late 30s who rarely sees a doctor outside of regularly scheduled checkups. I have had two uncomplicated pregnancies followed by easy, midwife-assisted births.

Most years we pay far more in premiums for our family’s health insurance than our medical care would cost if we paid for everything out of pocket.

Not this year. Yesterday I returned home after spending seven days and six nights in the hospital. It might have been a lot worse if I were uninsured.