(derekbaker)

Schumer, Gillibrand & Rangel

o I sent the following letter earlier tonight to Chuck Schumer, as well as a similar version to Kirsten Gillibrand and another to Charlie Rangel. They represent me in Congress.

The Honorable Charles E. Schumer
757 Third Avenue, Suite 17-02
New York, NY 10017

Dear Senator Schumer,

I am writing you for two purposes. The first is to ask you to vote AGAINST any healthcare plan that does not include a "public option" for people to buy healthcare coverage.

A healthcare plan that relies on state or regional co-ops to somehow bring healthcare costs under control and yet have a large enough pool of currently healthy participants to pay for any currently unhealthy participants -- as every insurance organization needs, whether for-profit, nonprofit, or governmental -- is nearly akin to telling people that if they don't like their choices among private insurers, they're always welcome to go start their own insurance company. As fellow New Yorkers, we both know that lip-service programs (such as "No Child Left Behind" and "Don't Ask, Don't Tell, Don't Pursue") ultimately do more harm than good. A collection of small insurance co-ops across the country will be similarly destined to fail. Please vote against any healthcare plan that does not include a "public option."

Second, but even more important, I am also writing you -- as my senator, as the vice-chair of the Joint Economic Committee, and in your roles on the Healthcare Subcommittee and the Securities, Insurance and Investment Subcommittee -- to ask you to consider a bill should the healthcare plan fail to include a public option. In that event, I'm hoping you and your fellow leaders in the Senate would work to save Medicare by introducing and passing a "Save Medicare Now" Act.

As we know, Medicare will be insolvent within a decade. Medicare is one of the most popular government programs today, and its bankruptcy would be disastrous to the many older Americans who depend on it for covering their healthcare costs. With the aging Baby Boomers, more and more Americans will be entering the age of Medicare-eligibilty, even as less funds are paid into the program by fewer younger, working taxpayers.

A Save Medicare Now Act would allow U.S. citizens not yet eligible for Medicare to buy Medicare coverage for themselves and their dependents by paying an annual fee (in addition to the contributions they already make via payroll withholding) perhaps equal to a flat 6% of their adjusted gross income. In addition, individuals and families with incomes less than two-times the poverty rate should be provided Medicare coverage as if they were already eligible at age 65.

Not only would such a simple-to-explain and simple-to-execute plan introduce a much larger potential pool of younger, healthier, paying people -- including many self-employed people and small business owners -- into the Medicare program, righting its finances, such a bill could be politically popular for a number of reasons:

• Medicare needs to be solvent, and America's seniors will be enthusiastic for Congress to save it.


• Medicare is universally popular; in surveys, over 60% of Americans think that saving Medicare from bankruptcy is a priority.


• By making it a flat fee, it could garner support from libertarians and those who normally oppose progressive taxation plans.


• By making it a bill to save Medicare, it could be more palatable to senators from states with a high percentage of older citizens. And particularly popular for senators from states with a high number of people approaching Medicare eligibility who may be very glad to have Medicare as an option if they were to lose or have lost their job so late in their career.


• Many employers, particularly small business owners, will be enthusiastic for the program, because it would allow them to finally get out of the healthcare business and focus their employee costs on their business strategies.


• Finally, a Save Medicare Now Act avoids introducing any new "public option" or "single payer" idea into the debate -- and at this point, the less said with those two terms, the better, regardless of their meaning.

And, as I know you are aware, because the purpose of the Save Medicare Now Act is to provide financing for a popular but increasingly insolvent federal program, it is a budget bill, and cannot be filibustered according to Senate rules.

I thank you for your consideration of such a bill, or a similar bill. I am also writing to Senator Gillibrand and Congressman Rangel with this request. I am proud to have the three of you representing me in the U.S. Congress, but I am troubled by the current direction the healthcare debate is taking and thus urge your support of a Save Medicare Now Act -- for the physical health of our senior citizens, the economic health of our medical system, and the moral health of our country.

Sincerely,
Derek A. Baker

Now, I recognize that Chuck Schumer is partially to blame for the mess we're in right now. He was chairman of the Democratic Senatorial Campaign Committee, and as such, convinced a lot of "centrist" (or even right-wing) Democrats to run for Senate in Republican-friendly states ... which is why we have so many "Blue Dog" Democrats today who are resisting a public option in healthcare reform. On the other hand, I don't doubt that Schumer wants the right thing for America and if he could convince all those Blue Dogs to vote for an expansion of Medicare, he would. So perhaps my letter gives him at least one voter's permission to try.

And, as the letter says, I also wrote Senator Gillibrand and Cong. Rangel. Slight wording changes to reflect their chambers, committees, etc., but otherwise, the same proposal.

I'm not stupid, and I've seen Congressional staffers up close. I fully expect that one or all three of these letters will get summarized as "public option: yes; Medicare expansion: yes" and the rest trashed. But given that at least two of the three people who represent me in Congress carry some weight there, despite the fact that I fully expect them to vote for the betterment of the country whether I write them or not, I figured it couldn't hurt and, if they want yet another letter to wave on the floor of the House or Senate, they had it.

Oh, and I printed those three letters, personalized by address, salutation, and detail for each recipient, in Courier New, and handwrote the envelopes. Given that I'm legitimately an individual constituent and no one prompted me to write these letters, I figures it doesn't hurt to make it obvious that I'm a lone wolf (albeit regular voter and occasional contributor). If others take my letters as a format for their own activism, I would consider it an honor, but they'd do just as well to write their own version. Form letters count for less than constituent engagement, anger, and a threat to spread the word to neighbors.

Labels: healthcare, politics

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Nationalized Healthcare Kicks Our Butt

ome people have asked three questions which, taken at face value, are legitimate questions. What would the public option do to (a) reduce the overall cost of healthcare, and (b) improve the quality of my healthcare; and (c) what will the effect be on the deficit? The Congressional Budget Office estimates $1 trillion-plus. So how do we pay for that?

To take the last item first, the CBO analysis didn't factor in what could be saved by the public option, or by best-practice incentives, or by competitive price pressure on the private insurers. By the same rationale, fluorescent lightbulbs make no sense, because they're so much more expensive than incandescents. Except, of course, that they use less energy, so electricity bills go down, and they last much longer before needing to be replaced.

And in terms of cost going down (a), this is exactly what the insurance companies are fearful of: that an affordable, public alternative will prove a competitive cost pressure on their own premium prices. In fact, the insurance companies are so convinced that these would be the economics of their industry with a public option, they are fighting tooth and nail (and campaign contribution) to keep it from happening. So maybe we should ask them?

Also in terms of cost going down: the cat is out of the bag in terms of doctor-owned medical facilities and the scam that is pay-per-service medical care. The New Yorker article by Atul Gawande helped a great deal there, especially the examination of how some of the most successful (in terms of health, not necessarily profit) healthcare institutions are less expensive than most of the less successful ones. Add this to the efficiencies of electronic healthcare records, best practice education and incentives, and other cost-savings that we could implement today, without a single new drug or device being invented, and you've got a huge amount of savings.

As an aside, it's worth pointing out that the people screaming that a public option will be too competitive against private options should be screaming instead at the people who think the public option will be too slow and incompetent, a la the DMV. They can't both be true, after all. But cynically, the insurance companies, with the first fear, are financing much of the "outrage" over the second fear.

In terms of quality with the public option (b): the short answer is that it won't affect it, because you'll still have the same doctors and specialists you use today. But in truth, I can't answer that about the quality of YOUR healthcare. That's because I don't know what the quality of your healthcare currently is. You could have a gold-plated healthcare plan provided by your employer, and there is no reason why you can't continue to have such quality, just as today, when wealthy people will pay out-of-pocket for elective surgery or high-end specialists.

The real question therefore is: Would it improve the health of the nation overall, and thereby be the rising tide to raise all our boats? The evidence indicates that it would. Or, at least, that a public option has no connection with decline in quality, at any rate, so that there is no real economic argument against it and there IS a moral argument in favor it.

The U.S. currently spends more as a percentage of its GDP than any other country on healthcare (13.7%) -- but ranks 37th in the world in terms of its health system's performance (e.g., life expectancy, responsiveness, etc etc), and ranks 54th in the world in terms of the "fairness" (i.e., a closer relationshp between an individual's costs and an individual's income) -- behind Australia (7.8% GDP, 32nd in performance, 12th in fairness), Canada (8.6% GDP, 30th in performance, 17th in fairness), and the UK (5.8% GDP, 18th in performance, 8th in fairness).

I picked those three countries as comparisons because they're the ones that get mentioned most often, probably due to English as a common language. But among all the countries whose healthcare systems outperform the U.S.'s, 92% have more government contribution toward healthcare than we do (only Cyprus, UAE, and Morocco have less); 78% are more "fair" (e.g., fraction of average household spending minus food that goes to healthcare); and as already stated, 100% spend less overall as a percentage of GDP on healthcare than the U.S. does.

All of which is to demonstrate that we have the most expensive (than even France, Switzerland or Germany, yet all still outpeform us), among the more unfair (Oman and Portugal are only slightly less fair, yet again, still outperform the U.S. overall in healthcare), and among the less efficient (we're behind Costa Rica in performance, but, hey, we outrank Slovenia!) systems.

Now, will making our healthcare system look even marginally closer to that of the more developed countries among the 36 whose systems outperform ours mean that it will automatically bring costs down and quality up? No, there isn't a simple formula that will show that. And it's important to say that the public option ALONE won't accomplish this. That, I think, is where the question (how will the public option bring my costs down and my quality up?) ultimately fails in its sincere attempt to find some clarity in all this noise. It's asking for a 1-to-1, arithmetic relationship between the public option and personal cost or personal quality, and that will be different for each individual. If you get great medical care today, you probably won't see a lot of improvement in the quality; if you get bad or no care, you should see an improvement. If you or your employer spend a lot of money now on healthcare compared to others, you should end up paying less. If you or your employer spend very little now but you (somehow) get great care -- I dunno, maybe your sister is an internist -- then it'll probably end up costing you more.

But I would also turn it around on those who say the public option will make health care more expensive or less effective: What is the proof, math or argument that keeping the public option off the table will "keep costs down" (even though ours are higher than anyone's) or "keep quality high" (even though 36 other countries do a better job there, too)?

Labels: healthcare, politics

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Lies, Damned Lies, Yet No Statistics

I keep trying to start a blog post that aims to refute all the lies, idiocy and misinformation that the right-wing (Grassley, Boehner), ignorant ("Keep the government's hands off my Medicare!"), and downright evil (Palin, Beck, etc. etc. etc.) are putting out there about health insurance reform and health coverage. But every time, I end up realizing it would be full-time job that should have started over a month ago. And then, today, I read two column that help put a lot of the bad information out there into perspective.

The first was Steven Pearlstein's look back at the 20th century and how the right-wing loses its mind every time a liberal (even a nominal liberal) gets into power. It froths at the mouth. It takes two opposing thoughts ("socialism! fascist!") and says they're the same thing. It basically makes stuff up, and the more bizarre the better. That's what gets attention, at least.

The second was Paul Krugman's column about the "Swiss menace." In it, he lays it out more clearly than anyone has yet so far. (This is why he wins Nobel Prizes, and I start blog posts only to abandon them in a sputtering mess of exasperated fury.) The summary of his summary is this:

• Every wealthy country other than the United States guarantees essential care to all its citizens.


• In Britain -- with a system much maligned here, but much appreciated by Britons -- the government runs hospitals and employs doctors. The shorthand for this kind of healthcare is that it is "nationalized" healthcare; even "socialized medicine." Such a thing is totally alien to what we believe here in the United States, and is nowhere in the plans being put forth by the Obama administration, with this one caveat: Obama intends to maintain and improve the Veterans Health Administration, which is another example of "socialized medicine." So not so alien a system after all, I guess.


• In Canada and France, the government doesn't own the hospitals or employ the doctors, but it pays the bills. This is a "single-payer" system. This makes health insurance a public service, but keeps medical care a private industry. Of course, such a thing is also completely alien to the U.S. and even suggesting a single-payer system is an assault on American freedoms. Until you reach the age of 65. Because Medicare is, of course, a single-payer system and receives higher favorability ratings from its "customers" than private insurance companies, on average, do,


• Finally, there's the system they have in Switzerland. This is where everyone, by law, must have an insurance policy, but the government subsidizes people who can't afford it on their own. They buy those policies from private insurers, who aren't allowed to discriminate based on medical history or pre-existing conditions. Again, not so alien to the U.S. after all, according to Krugman. This is the system currently in place in Massachusetts.

To be clear: the "public option" that, until the last couple of days, was the stated goal of the Obama administration and the Democratic leadership in Congress (and hopefully will be again), exists between the Medicare model and the Massachusetts model. Rather than the government being the sole payer of medical bills, the government would provide an insurance option for people who can't afford or don't want to buy private insurance -- though they and their employers would still be able buy private insurance if that was what they wanted.

This is the extent of the "socialism," the "fascism," and the "un-Americanism" behind the public option, and public health insurance and public healthcare in general. That's it. And yet, all that lying and distortion now looks like it will keep the Blue Dog Democrats from supporting a public option.

I just called my congressman's office (Charlie Rangel, definitely not a "Blue Dog") to urge him to vote against any final healthcare proposal that doesn't include a public option. Because America's healthcare system is the most expensive in the world, but ranks 37th in terms of its effectiveness (World Health Organization). Not coincidentally, U.S. citizens receive less government support for their health than any of the other industrialized countries ahead of us. Perhaps more on this later.

Labels: healthcare, politics

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