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My son, who worked as a DC intern, has told me about what it was like to have access to areas of the Capitol that the public never sees. He was especially taken by the lower regions far below where the tourists walk every day. There the air is musty with the scent of history made pungent by narrow, cave-like hallways and ghost-like lights.

In these corridors are doors that look like no one has opened them for half a century, signs in aged fonts at least a century old, and wall hangings that probably belong in a museum. My son said that had he decided to open one of the doors he would not have been surprised to see Henry Clay or Daniel Webster walk out.

It has long been speculated that ghosts haunt the Capitol, both in a real and a metaphorical sense. After all, John Quincy Adams literally died at his desk in the House and Preston Brooks beat Charles Sumner within an inch of his life in the Senate.  In the past few weeks a restless spirit seems to again be walking the corridors of the Capitol, something it has done with some regularity in the past few years.

Certainly the spirit was there when Jim Bunning conducted a half-hearted filibuster that had Democrats apoplectic. Bunning’s filibuster was half-hearted because back in the day when a filibuster was really a filibuster–that is before the Senate rules were changed–the person conducting the filibuster actually had to physically hold the floor.

But that all ended when Harry Byrd put in place “dual tracking,” which allows the Senate to conduct business on several matters at once instead of one bill at a time.  Essentially, the Senate can set aside whatever is being debated on the Senate floor and move immediately to another item on the agenda.  Hence the filibuster can continue ghost-like while other discussions continue on the floor.

Before dual tracking once you stopped talking someone else could capture the floor and end the filibuster.  That is why in the famous filibuster scene in Mr. Smith Goes to Washington; James Stewart has to keep talking until he drops from exhaustion.  Barry Friedman and Andrew Martin have proposed ending dual tracking because it would force the current crop of Republican road-blockers to literally put up or shut up.

The ghost would have agreed with that. He would have found Bunning wimpy for not being able to conduct a real filibuster. That is because the ghost once held the record, going nonstop for 24 hours and 18 minutes.  He prepared for the event like a prize fighter, sweating in a steam bath so he wouldn’t need a bathroom break, downing a sirloin steak and stocking up on throat lozenges and malted milk tablets. Just in case, a staff member waited on the edge of the Senate chamber with a pail just in case a bathroom break was needed.

The ghost also surfaced this week when it was proposed that there be federal standards for education common to all states in order to receive education stimulus funds.  No doubt a few people heard the ghost shrieking about that one since he had long been opposed to any federal intervention in education.

The place I really noticed the ghost was when I watched the Health Care Summit, which was conducted not at the Capitol but Blair House, where there was an assassination attempt on Harry Truman.  I definitely heard him speaking through the mouths of several Republicans. The ghost’s name is Strom Thurmond.

It was Tom Harkin of Iowa and to a lesser extent Louise Slaughter of New York who pointed him out to me. Harkin finally put the healthcare debate in terms everyone can understand by referring to it as segregation, with a small “s.” What Harkin meant was that the existing system discriminates as rigidly unjustly and callously as Jim Crow. As Patty Murray so eloquently pointed out, it even kills people.

I deliberately put segregation with a small “s” because some might see Harkin’s remarks as themselves a bit racist, since Segregation with a capital “S” was a system that dictated every aspect of the lives of African Americans from where they could get a drink of water, eat a meal, go to school, use the bathroom, and even be buried. Health-care segregation is not cultural in the way racial segregation was and still is.

Harkin might have better chosen the word discrimination, but he chose not to. Still, the point Harkin zeroed in on is that the health care system parallels segregation in that people do not choose to be ill. One very stupid and callous Republican reminded me of this when he blamed most people’s health care problems on bad habits such as smoking, overeating and lack of exercise.

That was pure Thurmond. This was the Senator who for most of his life defended Segregation as a system. While he was never as off-the-wall as race baiter Theodore Bilbo, Thurmond thought Segregation as necessary because this man, who it turns out fathered a child with an African American woman, did not believe in mixing the races.

Discrimination is actually a very real part of the health care debate because a majority of the uninsured in this country are people of color or single mothers. The Republicans don’t want you to know it and the Democrats seem reluctant to play the race card. Even Barack Obama has said nothing about it.  So when the Republicans blame the uninsured or those denied insurance or their own problems it has both a racist and sexist tone to it.

Now it is important to point out that there is a difference between those who voluntarily refuse to have coverage and those who cannot get it. A study by June and Dave O’Neill has shown that 43% of the so-called uninsured actually have the income to purchase insurance but choose not to do so. Of course when these people end up in the emergency room guess who pays for their refusal to carry insurance? The American tax payer.

So who are the uninsured? The largest group are single mothers.  Over half are female and 58% are people of color. The more startling data are which states have the largest percentages of involuntarily uninsured. The top five are Texas, New Mexico, Louisiana, Florida and Arkansas. Dixie rises again.

Besides segregation the other part of Strom Thurmond’s ghost that entered the room was state’s rights. After the Brown v. Board decision, Thurmond and 19 Southern Senators and 81 Representatives issued the Southern Manifesto which accused the Supreme Court of treading on the rights of the states.

We decry the Supreme Court’s encroachment on the rights reserved to the States and to the people, contrary to established law, and to the Constitution…At the expense of our children and families, they make up laws, invent new rights, free vicious criminals, and pamper felons in prison…The sound principle of judicial review has turned into an intolerable presumption of judicial supremacy.

In essence Thurmond was saying if states want to keep the races separate by force if necessary then they had the right to do so. As George Wallace would later demonstrate by symbolically blocking the door of the University of Alabama to prevent James Hood and Vivian Malone from registering, the federal government had no right to question what Thurmond and the others felt were the “domestic relations” and “regional culture” of the South.

Today the same doctrine of state’s rights is also the real heart of the health care debate. Ronald Reagan taught the Republican Party not to use the phrase state’s rights which by 1980 had become a code word for racism. Instead he cleverly changed it to “big government.”

But the message coming from the Republicans is the same as Thurmond’s — government ought not to be messing with the states. The Republicans have made it clear too many times during the debate over health care they want to leave it to the states, which is exactly what Thurmond said in a different context.

Of course leaving healthcare to the states means the lowest common denominator wins. It means that preventing the discrimination Tom Harkin referred to is up to the states, just as Strom Thurmond wanted to leave racial discrimination to the states.

Mississippi has a health care system on a par with that of Third World countries. If Mississippi wants to offer Third World health care than that is Mississippi’s right just as it was their right to have Jim Crow laws. The National Center for Health Statistics points out:

Mississippi’s health consistently ranks dead last among states in annual tallies produced by the United Health Foundation. It has the highest rates of obesity, hypertension and teen pregnancy in the country, with about 20 percent of its population lacking health insurance.

So what unlikely source did Mississippi enlist in trying to improve its health care system? Not the United States, not even some European Country, but that nation at the top of America’s demonology list, Iran.  The Center for Health Statistics gives an answer as to why Mississippi would enlist Iranian experts:

In Iran, preventive care is a priority and special attention is paid to high-risk groups such as mothers and children. Health care workers are chosen and trained within each community. Preventive and curative programs are integrated seamlessly. The system is decentralized, which encourages regional facilities to become self-sufficient and empowers local communities.

In contrast, Mississippi has a fragmented ad-hoc system of hospitals, health clinics and individual medical practices.

Healthcare discrimination as practiced by states like Mississippi means that if you have the misfortune to live there you will live in a state with higher infant mortality and lower lifespan expectancy than if you live in Minnesota. Yet somehow the Republicans have managed to convince a significant number of Americans that it is okay that someone in Mississippi faces a greater likelihood of dying than someone in Michigan.

That in a nutshell is the difference between the two parties and has been ever since the Republicans took up the Thurmond Manifesto, first with the Goldwater campaign and then with Richard Nixon’s Southern Strategy.

As Barack Obama pointed out several times during the Summit — and frankly could have done a better job doing — there are times federal solutions are the only just ones, the only ones that keep the playing field level. We gave up allowing states to regulate things like food and drug laws because frankly some of them were not doing a very good job at it. Americans accept that as a legitimate role of the federal government.

That we do a better job of regulating meat than we do health care is a national disgrace. Person after person at the Summit trumpeted the fact that we have “the best health care in the world.” No one chose to challenge that false statement. According to the World Health Organization we do not have the best health care in the world if by that you mean a system in which all citizens fare well.

According to one WHO study, the United States ranks 37th in the world, tied with Slovenia and one hundredth of a point above Cuba on the index used to compute the rankings. Above us are Morocco, Columbia, Saudi Arabia and virtually every Western European nation.

Yes we have places like John’s Hopkins and the Mayo Clinic, which most concede are the best in the world, but most of us do not have the good fortune of being able to access Mayo Clinic-class healthcare. I say this because the Mayo Clinic saved my life, but only after a bitter battle with my insurer in which my doctor finally made it clear that if I did not have access to Mayo’s experimental procedure he would hold them personally responsible for my fate.

Similar stories told by many at the Summit made it abundantly clear that this has got to end. In a famous speech that caused a walkout at the 1948 Democratic convention and Strom Thurmond’s Dixiecrat run for the presidency, Hubert Humphrey said it was time “to get out of the shadow of states’ rights and walk forthrightly into the bright sunshine of human rights.”

The same also holds true for health care.

My son, who worked as a DC intern, has told me about what it was like to have access to areas of the capital that the public never sees. He was especially taken by the lower regions far below where the tourists walk every day. There the air is musty with the assent of history made pungent by narrow, cave-like hallways and ghost-like lights.

In these corridors are doors that look like no one has opened them for half a century, signs in aged fonts at least a century old, and wall hangings that probably belong in a museum. My son said that had he decided to open one of the doors he would not have been surprised to see Henry Clay or Daniel Webster walk out.

It has long been speculated that ghosts haunt the Capitol, both in a real and a metaphorical sense. After all, John Quincy Adams literally died at his desk in the House and Preston Brooks beat Charles Sumner within an inch of his life in the Senate. Listening to the Health Care Summit, which was conducted not at the Capitol but Blair House, where there was an assassination attempt on Harry Truman, made me think of those ghosts, for one of them had decided to a company the Republican delegation and where it hung over them for the duration of the meeting.

At times I thought I could almost see that specter. I definitely heard him speaking through the mouths of several Republicans. His name is Strom Thurmond.

It was Tom Harkin of Iowa and to a lesser extent Louise Slaughter of New York who pointed him out to me. Harkin finally put the healthcare debate in terms everyone can understand by referring to it as segregation, with a small “s.”

What Harkin meant was that the existing system discriminates as rigidly unjustly and callously as Jim Crow. As Patty Murray so eloquently pointed out, it even kills people.

I deliberately put segregation with a small “s” because some might see Harkin’s remarks as themselves a bit racist, since Segregation with a capital “S” was a system that dictated every aspect of the lives of African Americans from where they could get a drink of water, eat a meal, go to school, use the bathroom, and even be buried. Health-care segregation is not cultural in the way racial segregation was and still is.

Harkin might have better chosen the word discrimination, but he chose not to. Still, the point Harkin zeroed in on is that the health care system parallels segregation in that people do not choose to be ill. One very stupid and callous Republican reminded me of this when he blamed most people’s health care problems on bad habits such as smoking, overeating and lack of exercise.

That was pure Thurmond. This was the Senator who for most of his life defended Segregation as a system. While he was never as off-the-wall as race baiter Theodore Bilbo, Thurmond thought Segregation as necessary because this man, who it turns out fathered a child with an African American woman, did not believe in mixing the races.

Segregation is actually a very real part of the health care debate because a majority of the uninsured in this country are people of color. The Republicans don’t want you to know it and the Democrats seem reluctant to play the race card. Even Barack Obama has said nothing about it.

So when the Republicans blame the uninsured or those denied insurance or their own problems it has both a racist and sexist tone to it.

STATS

Besides segregation the other part of Strom Thurmond’s ghost that entered the room was state’s rights. After the Brown v. Board decision, Thurmond and several Southern congressmen issued the Southern Manifesto which accused the Supreme Court of treading on the rights of the states.

QUOTE

In essence Thurmond was saying if states want to keep the races separate by force if necessary then they had the right to do so. As George Wallace would later demonstrate by symbolically blocking the door of the University of Alabama to prevent James Meredith from registering, the federal government had no right to enter into what Thurmond and the others felt were the “domestic relations” and “regional culture” of the South.

Today the same doctrine of state’s rights is also the real heart of the health care debate. Ronald Reagan taught the Republican Party not to use the phrase state’s rights which by 1980 had become a code word for racism. Instead he cleverly changed it to “big government.”

But the message coming from the Republicans at the Summit is the same as Thurmond’s — government ought not to be messing with the states. The Republicans made clear too many times during the Summit that they want to leave health care to the states, which is exactly what Thurmond said in a different context.

Of course leaving healthcare to the states means the lowest common denominator wins. It means that preventing the discrimination Tom Harkin referred to is up to the states, just as Strom Thurmond wanted to leave racial discrimination to the states.

Mississippi has a health care system on a par with that of Third World countries. If Mississippi wants to offer Third World health care than that is Mississippi’s right just as it was their right to have Jim Crow laws.

Still healthcare discrimination as practiced by states like Mississippi means that if you have the misfortune to live there you will live in a state with higher infant mortality and lower lifespan expectancy than if you live in Minnesota. Yet somehow the Republicans have managed to convince a significant number of Americans that it is okay that someone in Mississippi faces a greater likelihood of dying than someone in Michigan.

That in a nutshell is the difference between the two parties and has been ever since the Republicans took up the Thurmond manifesto, first with the Goldwater campaign and then with Richard Nixon’s Southern Strategy.

As Barack Obama pointed out several times during the Summit — and frankly could have done a better job doing — there are times federal solutions are the only just ones, the only ones that keep the playing field level. We gave up allowing states to regulate things like food and drug laws because frankly some of them were not doing a very good job at it. Americans except that as a legitimate role of the federal government.

That we do a better job of regulating meat than we do health care is a national disgrace. Person after person at the Summit trumpeted the fact that we have “the best health care in the world.” No one chose to challenge that false statement. According to the World Health Organization we do not have the best health care in the world if by that you mean a system in which all citizens fare well.

STATS

Yes we have places like John’s Hopkins and the Mayo Clinic, which most concede are the best in the world, but most of us do not have the good fortune of being able to access Mayo Clinic-class healthcare. I say this because the Mayo Clinic saved my life, but only after a bitter battle with my insurer in which my doctor finally made it clear that if I did not have access to Mayo’s experimental procedure he would hold them personally responsible for my fate.

Similar stories told by many at the Summit made it abundantly clear that this has got to end. In a famous speech that caused a walkout at the 1948 Democratic convention and Strom Thurmond’s Dixiecrat run for the presidency, Hubert Humphrey said it was time “to get out of the shadow of states’ rights and walk forthrightly into the bright sunshine of human rights.”

The Summit reminds us that the same also holds true for health care.

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Posted by: liberalamerican | 25th Feb, 2010

The Health Care Summit Who Was Really at the Table?

The Health Care Summit represented an unprecedented event in American political history: never before has a President sat at a table with the Congressional leaders of both parties and carried on a discussion of a major issue before live television cameras. What emerged was in part scripted performances, the usual political posturing, and some overacting, but what also emerged was a clearer picture of the differences between Republicans and Democrats, some meaningful discussion and some sharp exchanges. What did not emerge, to the credit of all who attended, is the ill-mannered bickering that has characterized this Era of Bad Feelings.

While I have criticized Republicans in the past about their conduct, which has spilled over even into the President’s appearances before Congress (remember the shout of “Liar!), for this meeting they were on their best behavior. While I disagree with some of their points and more fundamentally with their philosophy (which I will write about next), their tone throughout the long hours before the cameras was measured and respectful.

If nothing else comes from this event, my hope is that both sides can at least agree to conduct their public business in an equally civil manner, laying aside the talk-radio style rants. If that alone would happen maybe I could then stop writing about the Era of Bad Feelings.

Who Was There

One of the fascinating takes on the summit, which was broadcast live over the White House web site and dozens of newspapers, blogs and others who picked up the feed was a site run by the Sunlight Foundation. It also did something unprecedented, for as each speaker said their piece, the site would show that person’s major campaign contributors in a sidebar. This was to provide some idea of what might be motivating their positions.

Their data came from the best source on the net–Open Secrets, a site if you do not know about, you should.  During the Presidential campaign I published a great deal of finance data from their site and found it to be accurate and easy to access. If you want to know who is backing someone in Congress or someone running for Congress you need to go to Open Secrets. It even has a database on state legislators.

Sunlight’s data was interesting, but when I checked it against the actual Open Secrets data I found it incomplete and because of that somewhat misleading. Perhaps in the interest of readability the site only published the top ten lifetime contributors to each person. Open Secrets publishes the top twenty. Adding ten more contributors to the list gives you a much more complete picture.

The second data issue concerns their choice to run lifetime contributors versus 2009-2010 contributors. A lifetime list can be misleading in that for someone who has been in Congress for some time, it gives you aggregate data when what is really needed for analyzing this issue is recent contributions. Senator X may have taken donations from health care insurers ten years ago but what have they taken in this year?

The First Elephant in the Room–The Insurers

Using this year’s data, it is possible to construct charts of who else was in the room during the summit, the major contributors to each Senator and Representative.  It is a bit like pulling back the curtain to see what is really going on behind the scenes. What follows are a series of tables presenting these data which I think you will find fascinating.

We start with the insurers. What follows below is a table with the names of the major HMOs and insurers, how many contributions they made and which party who received them.  I have included life insurance companies in these data because in a sense they also have a vested interest in what emerges from the health care debate.

As the chart details, Blue Cross was by far the major player in the summit, especially with Republicans–although they also contributed to some Democrats just to keep their options open.  The degree Blue Cross was involved in the debate provides an interesting perspective on remarks made by several Republicans about the California Blue Cross rate hike that has angered so many Americans, including the President.  As major recipients of Blue Cross dollars the GOP made sure to defend their contributor.

What is also interesting is the number of total insurance contributions to Republicans rather than Democrats. You can make up your own mind about whether you think this is contributing to the GOP’s intransigence on this issue, especially their continued insistence that “the market” be allowed to regulate itself.

Clearly if any Democratic leaders happen to be reading this essay there is ammunition here to nail the Republicans.

The Second Elephant in the Room–The Physicians

If you managed to catch part or all of the Summit you heard a great deal of talk about medical malpractice.  It has come up over and over again when health care has been debated, with physicians asserting that malpractice insurance costs are too high and malpractice settlements too generous. The GOP wants to cap malpractice claims at $250,000 which to me is frankly a ridiculous amount to put on a human life, especially in this day when middle level managers in some big corporations make more than that in a year.

Significantly the American Medical Association, which has long fought health care reform, has not spoken out against the health care bill and is on record for the first time favoring reform.  But listening to the Republicans at the Summit you would think most physicians hate the bill.

Just as with insurers we can track this elephant in the room by examining contributions by associations representing physicians. The table for this is a bit long as there are a number of them, but again the pattern is striking.

The first thing you notice is all the contributions went to Republicans, which may be why they are fighting so hard for so-called “tort reform.” Now admittedly the major recipients of many of these contributions are also doctors such as Charles Boustany, a Louisiana cardiovascular surgeon.

The second interesting finding in the chart is which practices are contributing to those who attended the Summit. Among the different medical areas, cardiology and orthopedics rank high. The first is obvious–if a cardiologist makes a mistake, there is a good chance the patient is dead. If an orthopedic surgeon makes a mistake there is a good chance someone is permanently disabled.

So there is a certain logic in these professions seeking some relief from malpractice costs, but the $250,000 is patently absurd.

Again, the Democrats have some ammunition here.

The Third Elephant in the Room–The Drug Companies

A major player–and major villain in the health care debate is the drug companies. Here is their chart:

By now you should be seeing a pattern: again the Republicans at the Summit raked in considerably more cash than their Democratic counterparts.

The Bottom Line

The grand total of all three charts of contributions from insurers, physicians and drug companies is an astounding 71 to 21 in favor of the Republicans!  Clearly in terms of their financial contributions, the campaign contributors to those attending the Summit stand to gain more if we follow the Republicans’ recommendations for incremental change than if we overhaul the entire system. In the Democrats’ bills all three major players will suffer.

Deep Throat in All the President’s Men said follow the money and nowhere is that more borne out than when we examine the campaign contributions to those who attended the Summit.  What is even more disturbing is that several key Republican players including Marsha Blackburn, Mike Enzi, and John Boehner are heavily supported by contributions from the health care industry.

I hope that as you follow the health care debate you will keep these numbers in mind when you wonder why the GOP is digging its heels in about health care reform and why it wants to start over. I also hope that when you see some of these people on talk shows or news reports that you will imagine these charts out to the side and weigh their words along with what is flowing into their pocketbooks.

They say money talks, but in this case it seems to be roaring. The real tragedy would be if it could buy what it is paying for–no meaningful health care reform.

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Economists have had fun with off-the-wall theories like the skirt length economic predictor which says that shorter skirts herald economic good times and long skirts bad ones.  Despite its sexist outlook this theory has largely held true through the 20th century, allowing hundreds of professors teaching beginning statistics courses to deliver lectures on the difference between correlation and causation.

In the interest of giving them something else to add to their courses I propose the reality TV theory.  It suggests that during depressions we see more reality shows.  Since we didn’t have television before the 1950s, the counterpart of reality TV were shows on the radio and in local theaters featuring amateur performers.

Today network and cable television are dominated by reality shows, whether the latest weirdo to seek counseling from Dr. Phil, the newest villain on Survivor or the would-be star who feels the sting of Simon Cowell’s signature comments. You would think they would be running out of Americans willing to make fools of themselves in front of millions of people but that does not appear to be the case.  Jerry Seinfeld must be short of cash because the man who once starred in one of America’s best sitcoms has signed on to be a marriage referee.

Amateur Shows in the Great Depression

During the Great Depression there were also a lot of reality shows most of which enticed people not with the promise of 30 seconds of fame but the hope earning a few extra bucks. There were the amateur hours that inspired American Idol that appeared on local radio stations and the national networks. Local ballrooms and theaters sponsored their own contests.

The most notorious of all were the dance marathons in which couples endeavored to stay on their feet for days at a time.  The contests began in the late 1920s, but took off during the Depression. Dance marathon historian Carol Martin reports that nearly every American city of 50,000 people or more hosted at least one endurance dance marathon.  According to Martin dance marathons were the number one public entertainment of the Great Depression’s early years. If you want to know what they were like rent a DVD of the film They Shoot Horses, Don’t They.

The trick was to perfect the art of switching off sleeping on your feet as your partner literally held you up while trying to make it appear both of you were awake.  With some of the contestants half starved when the ordeal began, bodies would drop in heaps as the hours ground on until only one couple remained to take home the prize money. Some contestants went from contest the contest, especially the ones adept at the little tricks you needed to know to stay on your feet.

Historylink quotes June Havoc’s attitude towards the marathons, one that sounds strangely descriptive of today’s reality shows:

Our degradation was entertainment; sadism was sexy; masochism was talent.

Amateur Night in Two Eras

As Havoc suggests, there is in the reality contests of both eras a willingness of the contestants to publicly debase themselves for the chance at fame and fortune. More germane is the big picture which tells us that the harder the times, the more people are willing to do anything to grab the brass ring that holds out the possibility they might just be able to pull out of an impending crash.

There are also differences.  The contests of the Great Depression were trials of endurance. Being able to stay your feet for days represented the situation too many Americans found themselves in during those turbulent times.  Today’s contests have a different dimension.  If the Depression’s contests demanded endurance, the reality shows of what some are calling the Great Recession require an all or nothing gamble. The odds of winning American Idol are infinitesimal; the reward immense.

Health Care Bill Realities

This brings us to health care.  Like the contestants in contemporary reality shows the various sides in the health care debate seemed engaged in an all or nothing gamble.  There is talk of reconciliation, the nuclear option and filibusters.

As someone who has read the entire telephone book-thick bill and as a person living on disability, to me the most important part of the health care initiative has always been the section on preexisting conditions. The insurance companies actually fear this more than they do a public option which is why they continue to fight the bill even with the public option removed.

Here is what they are fighting:

‘SEC. 2705. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’’

With respect to the premium  rate charged by a health insurance issuer for health insurance coverage offered in the individual or group market—
‘‘(1) such rate shall vary only by—
‘‘(A) family structure;
‘‘(B) community rating area;
‘‘(C) the actuarial value of the benefit;
‘‘(D) age, except that such rate shall not vary by more than 2 to 1; and

‘‘(2) such rate shall not vary by health status- related factors, gender, class of business, claims experience, or any other factor not described in paragraph (1).

The Devil Is In the Details

It is a simple but revolutionary change.  The problem with this relatively straight-forward language is that with the insurers whispering in their ears, politicians, pundits and bloggers are purposely trying to make the issue more complicated than it needs to be. They ask: how do we define a preexisting condition (did they read the bill)?

Then comes the “this provision will bankrupt us” argument.  Insurers whine that if they have to accept sick people that it will saddle them with massive costs even as insurers raise rates and rake in record profits. This prompted the inclusion of the notorious “everyone has to have insurance” provision to the bill, the idea being that if you broaden the pool of the insured that spreads the risk.  The insurers and their allies cry this is “socialized medicine” and “big government.”

The problem with this argument is that you don’t hear people whining about having to carry auto insurance.  Why should health insurance be any different? Right now there is a cohort of the uninsured that is essentially young and healthy. They don’t carry insurance because they don’t think they need it. Then they show up in the ER after a car accident. The argument that people should not have to have health insurance because they are healthy is about as specious as my arguing I shouldn’t have to carry auto insurance because I am a safe driver.

The Importance of the Preexisting Condition Clause

A preexisting condition clause is revolutionary for two reasons.  The first one is obvious, the second has been little noticed.  Its power lies in the fact that this marks the first time the government has dictated fundamental terms to insurers. Once the precedent of eliminating the preexisting condition provision is established (and watch the insurers take this straight to the Scalito Supreme Court) it will open the door for the government to dictate other terms.

The problem is that like contestants in a dance marathon the Democrats seem to be running out of steam.  With the heat being turned up to include a public option, the preexisting condition section has become an afterthought for some and a bargaining tool for others.

Are They Going to Scuttle the Preexisting Condition Clause?

There are reports there is some movement to drop the preexisting provisions section or restrict it only to those under 19.  Gutting this portion of the bill would be a tragedy. Then the bill would be truly meaningless.

Blogger John Aravosis was the first to alert everyone to a change in the language being used by the Democrats. He put it plainly:

The only reason to specify that children under the age of 19 won’t be denied coverage is because you plan on letting everyone 19 and over BE denied coverage for pre-existing conditions. Even the lousy Senate and House bills outlawed that. But here’s the rub.

Joe Sudbay, his colleague on AMERICAblog, followed up with an essay that did as good a job as I have seen at defining what is at stake:

Hard to imagine how the Democrats can convince the American people that health care has been reformed if insurance companies aren’t reined in on the pre-existing conditions issue. Only people living in an out-of-touch bubble would think that’s a good political move.

The Consequences for Obama of Weakening the Preexisting Condition Clause

As Sudbay and others remind us, getting rid of the preexisting condition clause was right at the top of Barack Obama’s to-do list.  Under the heading Make Health Insurance Work for People and Businesses — Not Just Insurance and Drug Companies the very first bullet point states:

Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.

The implication is clear: if the final health care plan does not include this provision or slices it into meaninglessness, the Obama Administration will have lost all credibility and along with it what is left of its base.

Staying On Your Feet

If I were the Obama Administration I would position the thousand plus pages of the health care reform bill  very simply — the bottom line is preexisting conditions.  This will smoke out the insurance companies and put the Republicans in a tough spot for next fall. Any Republican who votes against eliminating the preexisting condition clause will find that vote hard to defend.

There is a lesson here we can learn from the dance marathons of the Great Depression: it’s not about winning a million to one shot or getting yourself on TV, it’s about staying on your feet.

If the Administration can successfully paint the Republicans into a corner over the preexisting condition provision, then it can perhaps increase its majority rather than lose it.  Framing the debate around preexisting conditions is also a win/win for the Obama Administration.  It can grab the high ground it has lost with its thousand-plus page nightmare by standing firm on eliminating the preexisting condition clause.

Obama’s Press Conference Bombshell

Unfortunately the proposal released this morning by the Obama Administration does not follow this path. Preexisting conditions are mentioned only briefly and cryptically.  It states:

It will end discrimination against Americans with pre-existing conditions.

And then says nothing further about how it will do that, only adding fuel to the fire of rumors about modifying the provision.

I waited to post this until the briefing by White House Press Secretary Robert Gibbs. It was ominous enough that the briefing was delayed a half hour. Either you have your act together or you don’t.  Thirty minutes will help even less than last-minute cramming for a college exam.

A key moment came early in the briefing when Gibbs was asked what the President would not compromise on. Tellingly he left preexisting conditions and the public option off this list. His answers to other questions resembled the staggering motions of an over-fatigued marathon dancer.

Then came the bombshell. After an hour of wobbling on his feet, Gibs was asked about the reports that the preexisting condition clause would only apply to children. He answered that the provision would go into effect immediately for children but would be phased in for adults. He did not go into detail about the phasing or what would be phased.

If this is the Administration’s new position it means the game is over. Barack Obama has backed off from what he said was his number one priority. Without a meaningful preexisting condition clause this bill deserves to go down as a failure.

Gibbs’ Press Briefing as Dance Marathon

There were moments in a dance marathon where the combination of lack of sleep, inadequate food and being on their feet for days would cause contestants to lose touch with reality. They would babble incoherently or see things that weren’t there or break out in frenzied movements.

Press Secretary Gibbs seemed on the verge of that today. The change he seemed to indicate in the preexisting condition provision suggests either he or others at the White House have lost touch with reality and with their own principles.

The Public Option

Gibbs also all but ruled out the public option, meaning that the two provisions that made the original plan a genuine reform have vanished.  The public option was always a bit of a stretch, but the President and Congress had the courage to put it on the table.

Last fall five Democrats on the Senate Finance Committee voted against the public option defeating the provision before it even reached the floor. Meanwhile in the House the Blue Dogs have also been noticeably cool to the public option.

Do we give up the fight for the public option? Of course not.  Why? The 2008 report of the World Health Organization states:

The health sector can take significant actions to advance health equity internally. The basis for this is the set of reforms that aim at moving towards universal coverage, i.e. towards universal access to health services with social health protection.

The 2009 WHO statistical report shows the mediocre performance of the American health care system. Our under five mortality rate ranks with that of Slovakia and below almost every European country, Thailand, Singapore, Korea, Japan, Canada and, yes, Cuba.  This is inexcusable and falls squarely in the laps of America’s HMOs and other insurers.

If this situation is allowed to continue this country will be in deep trouble.

Abortion

BTW it is interesting how many so-called liberal bloggers seem willing to leave abortion restrictions in the bill as long as they get a public option.  Sorry, but a public option with the Stupak Amendment is not a public option for American women.  Eliminating the abortion restriction is right up there with eliminating the preexisting conditions clause as a no compromise issue.

I was appalled that no one asked Gibbs about the Stupak Amendment during the press briefing. It was a question that demanded to be asked.

The Need for Action

With the White House and Congress looking like fatigued contestants in a dance marathon, it now comes down to whether each of us are willing to do the hard work it will take to save health care. That means writing op ed pieces, letters to our Congressional delegations (and the White House), jamming the phone lines and email boxes, and, above all, talking to our neighbors.  If each of us would talk to five people that might help to turn the tide.

There is little question that most Americans are fatigued by this marathon health care dance.  This is causing many to consider dropping out. That would be wrong.

We need to make this President get some backbone and stand up for his own principles. It is the future for our children that is at stake. Do we want them to grow up under a health care system that is worse than Cuba’s?

To the Readers:

If you are a regular reader of this blog you probably wonder what has happened over the past few weeks. You also know that this blog believes in people taking action. All talk with no action will get us nowhere. So in the past few weeks I have been trying to walk my own talk by testifying before a legislative committee about school funding, working on an environmental grant project with a state agency, helping to try to save my local school district, serving on a community commission and seeking grant funds to reinvigorate my community. The draft of the follow-up to Strange Death has also reached a critical point.

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