Far and away the most exciting industry for the labor movement today is healthcare-and the air of historic change was in the San Francisco air this week as more than 1,200 registered nurses from across the country gathered to plan their coming merger…and to advance their patient advocate’s agenda of guaranteed healthcare on the single-payer model and of genuine labor law changes to allow every nurse to freely choose her union.  The RNs are members of the California Nurses Association/National Nurses Organizing Committee, and their guests from United American Nurses and Massachusetts Nurses Association.

The 1,200 nurses broke from their meeting to make a special house call to Dianne Feinstein, and deliver roses along with hand-written pleas for her to support the Employee Free Choice Act.  She’s in DC, but we’re sure she’ll get the message that we expect her to help nurses join unions and save lives.  That change alone will significantly improve our healthcare system.

Meanwhile:

In These Times reports on the coming RN SuperUnion and how registered nurses, together with the muscle of the AFL-CIO, will have the ability to inject a humane and pro-patient politics into our policy:

While lawmakers bicker and the public wades through a muddle of misinformation, the major nurses unions, particularly the California Nurses Association (CNA), are staking out bold positions on reform. Their efforts have culminated in a new union merger that seeks to align progressive nurses with other service workers as well as healthcare consumers.

As a critical link between physicians and patients, nurses occupy a pivot point in the reform debate. Alongside bread-and-butter campaigns on pandemic-flu preparedness and nurse-to-patient staffing ratios, the CNA has taken on universal healthcare as a labor issue, arguing that single-payer would not only serve patients’ best interest, but also make the entire system more economically viable.

The Wall St. Journal writes up how these pro-patient policies lead to nurses pushing Obama for better healthcare proposals:

At a conference for registered nurses in San Francisco, Geri Jenkins watched President Barack Obama’s televised speech with several others from the California Nurses Association. After the speech ended, the knot of nurses was left disappointed.

“You have to give him credit for standing up and trying to tackle the problem,” Jenkins said after it was over. “But it just needed to go a step further.”

Jenkins would have liked to see Obama’s plan place greater restrictions on how much insurance companies can charge consumers. Her 29-year-old stepdaughter, who was born with a heart condition, has gone without health insurance for a year because she could no longer afford the $7,000 annual catastrophic coverage.

Other nurses also felt the president’s proposals did not go far enough.

The San Francisco Chronicle let CNA/NNOC executive director sum it up:

“The problem with other solutions like the public option is that they leave in place the real problem: The insurance companies,” DeMoro told us.  

As the Washington Independent reports, those insurance companies are the subject of a new investigation by California Attorney General (and future and past Governor) Jerry Brown, after CNA/NNOC uncovered data that they reject on average 22 percent of all claims-and that jumps to 40 percent for the worst company, PacifiCare.

While the Christian Science Monitor notes the ongoing viability of the single-payer reforms nurses are dedicated to…it’s popular in the states and HR 3200 contains an amendment to empower states to that kind of experimentation:

The California Nurses Association was also instrumental in lobbying for an amendment, added by Rep. Dennis Kucinich (D) of Ohio to a House version of the federal healthcare reform bill, that would remove potential legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans from the federal Employee Retirement Income Security Act (ERISA)…. There are also strong prospects for single-payer healthcare in California, where the legislature has twice passed single-payer, only to have it vetoed both times by Governor Schwarzenegger.

Next week, we’ll be taking the fun to Pittsburgh where we will host the U.S. premiere of Michael Moore’s Capitalism: A Love Story at the national AFL-CIO convention, and use the occasion to throw a huge single-payer party

Check out more pix here.

(As a result of this report, Attorney General Brown has opened an investigation into insurance company practices.  Great, great work by the CalNurses. – promoted by David Dayen)

It’s time to stop talking about make believe death panels, and talk about the real ones.

Six of California’s biggest insurance companies have rejected more than one in five claims the past seven years — according to data the insurance giants, Blue Cross, PacifiCare, Kaiser Permanente, Health Net, Cigna, and Aetna report to the state Department of Managed Care.

Researchers from the California Nurses Association/National Nurses Organizing Committee analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six insurers rejected 45.7 million claims — 22 percent of all claims.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

Claims denial rates by leading California insurers, first six months of 2009:

• PacifiCare — 39.6 percent

• Cigna — 32.7 percent

• HealthNet — 30 percent

• Kaiser Permanente — 28.3 percent

• Blue Cross — 27.9 percent

• Aetna — 6.4 percent

As the news got out to the media, the insurance bean counters fell all over themselves digging up explanations, denials, and justifications for their unjustifiable behavior.

From the Los Angeles Times, the Sacramento Bee, and other reports, you can see them scrambling to shift the blame to the doctors, to the hospitals, to the nurses for daring to criticize them.

Left hanging in the air is a bigger question. If the private insurers are not paying for care, why do we have private insurers?

While not every denial results in patient death or injury, far too many do. As CNA/NNOC co-president Deborah Burger put it, “Care denials have a human face, a real patient enduring unnecessary pain and suffering.”  

Cigna, for example, gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself after protests organized by her family, her friends and community, CNA/NNOC, and netroots activists. Tragically the reversal came too late to save her life.

PacifiCare denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval.

At the time of denial, which she calls “insurance hell,” Kutcher notes she had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.

Why do they companies deny claims? Because it pays.

Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.

It’s also a reason why private insurers divert up to 30 cents of every healthcare dollar to overhead — much of it spent to support warehouses full of claims adjustors needed to deny care, to keep down their “medical loss ratio” or profits lost on approving claims.

So why aren’t these obscene, all too routine denials of claims — and ultimately care — more widely discussed in the national debate over proposed healthcare reform?  

The sad truth is there is little in the main proposals emanating from Congress and the White House to change these deadly practices.

Our nation remains the only one in among industrial nations to link access to healthcare to private profit.

That’s one reason for data like this:

Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.

One way to end this disgrace is to unhinge care delivery to profiteering by expanding Medicare to cover everyone. Isn’t that the best way to finally end this disgrace once and for all?

There’s a fundamental lesson in collective bargaining that seems to have been lost on the White House, and those in Congress who devised their failing strategy on healthcare reform:

Don’t make all your compromises before you walk in the room.  

For all those now wringing their hands over the apparent abandonment of the public option and like Rachel Maddow  dissecting the train wreck of the once promising opportunity for genuine healthcare reform, it’s time to ask:  what happened? who could have foreseen that semi barreling down the highway? and what do we do now?

To answer the first two questions, it’s worth noting the comments on Keith Olbermann’s show last night by Lawrence O’Donnell, a Democratic Party consultant and participant in Bill and Hillary Clinton’s failed healthcare plan of 1994:

Obama, O’Donnell aptly noted, “completely misjudged it, but so has the White House” in following the “convention wisdom of the leaders of his party in the House and in the Senate and his staff in the White House.”

“The lesson they don’t get here, is they compromised at the outset. They didn’t go for the best bill at the outset. The president said that if he was doing this his own way it would be single payer, it would effectively be Medicare for all. He would be with those 100 House members who want Medicare for all.”

“But he compromised right off the bat to go for something that would preserve the private health insurance industry, and tortured that thing into a shape that they thought would be acceptable to the middle of American politics, all in the fear if they went for Medicare for all they were terribly afraid of being called socialists.”

What did this strategy produce?

“Trying to go over in this direction into this tortured way of supporting an industry that doesn’t work. They are now still called socialists for having preserved the medical insurance industry.”

And stuck with a plan that was inferior from the outset, that is still widely denounced by the right, with further compromises being made to this half baked loaf every day.

After all the further concessions are made to attract one or two Republican votes and some of the conservative Democrats, what will be left? A plan that is not universal, that comes close only by forcing people to buy private insurance at whatever rates the insurers set. Sounds like another unpopular bailout in the making.

A plan that will be ineffective in controlling costs, especially after the shameful deal with the drug companies to remove the clout of the federal government to lower prescription drug price gouging. A plan, in short, that will fall far short of solving the healthcare crisis, and leave many Americans more cynical about government, and still facing healthcare insecurity and financial calamity if they get really sick.

O’Donnell concludes that Democrats learned the exact wrong lessons from the 1994 fiasco:

“My experience having failed at this kind of legislation in 1994, there’s a lot of people trying to blame Hillary Clinton for making different mistakes at different times. And she made all of those mistakes, but I don’t think it mattered. I think we were going to get nothing in the end because the basic concept of what we were trying to do was flawed.

What the Democrats should have been doing for the last 15 years after that defeat is selling Medicare for all. And maybe 15 years later, 15 years after that, maybe with the election of this president, Congress would be ready for a clean yes or no vote on that question, because that would be worth fighting for.”

So what should we do now? Well, that yes or no vote is still worth fighting for.

Ultimately, a final bill will be the one that comes out of a Senate-House Conference Committee process, and don’t we all look forward to the pleasure of watching the performance of Max Baucus and Chuck Grassley in that room?

Let’s go back to collective bargaining, lesson one. For the House to squeeze the best bill possible  out of the Conference committee, they need to walk in the door with their strongest bargaining stance possible. That would be the bill that would actually solve the healthcare crisis, not just tinker around the edges.

And, it ought to have a receptive audience. As Rep. Anna Eschoo put it today,  “There are those who view themselves as having already compromised on single-payer.”

No bill would give them more clout than passing a Medicare for all bill, and having that at the table when they meet with Baucus and Grassley.

On MSNBC this morning, Rep. Anthony Wiener talked about the value of a Medicare for all vote in the House in September. He’s right.

And Weiner already got the Energy and Commerce Committee to vote unanimously to preserve Medicare, including every Republican. Medicare – the bi-partisan solution to our healthcare crisis. As has been echoed by all those turning out to the town hall meetings demanding that the government keep their hands off their Medicare.

But Weiner should not be there alone. The left, the liberal constituency groups, labor, and everyone else who is dedicated to genuine, comprehensive healthcare reform, should join in, and work to make that the bill that passes the House.

Can you think of a better way to turn up the heat?

House HELP Passes Amendment to Allow State Single-Payer Experimentation

America’s registered nurses and other guaranteed healthcare activists are hailing the vote last night by House Education and Labor Committee to amend the national healthcare reform bill and give individual states the freedom to adopt single-payer, Medicare-for-All style reforms.

This bi-partisan vote affirms the best of American democracy.  The exemptions would life federal mandates on healthcare money and free states to act as the laboratories of democracy they are supposed to.  The vote is also an encouragement to progressives who are looking for paths to improve the parameters of the healthcare debate.

Here is Sen. Sanders discussing the Senate version of the amendment, which was recently voted down in the Senate Finance Committee.  And here Rep. Kucinich reports on the vote call.

In addition, nurses and healthcare activists cheer the vote because it gives hope for the kind of genuine healthcare reform that is not based on negotiating with the failed and heartless insurance companies who are the cause of our healthcare crisis-something they should not be rewarded for.

Introduced by Rep. Dennis Kucinich of Ohio, the amendment would remove the potential “ERISA” legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans.

The amendment passed on a bi-partisan vote of 25-19, with the support of both progressive, single payer Democrats and many Republicans who endorsed the ability of individual states to pass their own versions of health care reform.

“This is a historic moment for patients, for American families, and for the tens of thousands of nurses and other single payer activists from coast to coast who can now work in state capitols to pass single payer bills, the strongest, most effective solution of all to our healthcare crisis,” said Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee.

“There are many models of health care reform from which to choose around the world – the vast majority of which perform far better than ours. The one that has been the most tested here and abroad is single-payer,” said Kucinich in urging passage of the amendment.

“Under a single payer system everyone in the U.S. would get a card that would allow access to any doctor at virtually any hospital. Doctors and hospitals would continue to be privately run, but the insurance payments would be in the public hands. By getting rid of the for-profit insurance companies, we can save $400 billion per year and provide coverage for all medically necessary services for everyone in the U.S.,” Kucinich said.

The nurses noted there is a long road ahead for the amendment. It will still need approval from the full House and in a final version from the Senate. Nurses and other healthcare and community activists made numerous calls to legislators in support of the amendment, and will continue to press for its enactment in the final bill.

For those who have opposed the proposal, DeMoro called it “a very modest amendment that simply protects choice for residents of individual states who favor more comprehensive reform.”

Recent reports from both the Department of Health and Human Services and the prestigious medical journal Health Affairs have documented that compared to people with private insurance, Medicare enrollees have greater access to care, fewer problems with medical bills, and greater satisfaction with their health plans and the quality of care they receive.

The reason for improved access, quality, and lower costs under Medicare, said DeMoro, “is that under Medicare, insurance companies, whose central focus is profits for their shareholders not delivery of care,  don’t have the ability to deny care, limit coverage, or continually raise prices that endanger the health and financial security of patients.”

“The successes and standards of Medicare should be the model for reform for all Americans,” said DeMoro. “If the final national bill will not meet that test by establishing Medicare for all, then let’s give Americans the tools to pass it in individual states.”

Currently, if states were to pass single-payer laws, as California, for one, has twice, only to have the bill vetoed by Gov. Arnold Schwarzenegger, it could be subject to immediate legal challenge due to the federal Employee Retirement Income Security Act (ERISA) which applies to all employer-paid health plans. The Kucinich amendment would provide an ERISA waiver.

As our favorite politicos fall all over each other to see who can further erode the healthcare package likely to emerge from Congress, it’s worth recalling that there is another way.

But first, get a glimpse of the latest fiasco moving forward in the Senate Finance Committee, where Max Baucus is leading the charge to develop the all important “bi-partisan” reform bill.

Today’s news is that “everyone’s smiling” — says Kent Conrad, author of the embarrassingly weak proposal for “non-profit coops” as an alternative to the public option, much less the real reform, single payer.

Why? Because they’ve found a way to cut the price tag by $400 billion. How?

largely by reducing the amount of subsidies for low-income individuals to buy insurance

Well, thank goodness. At least that means less public money going into the pockets of the already gorged insurance giants.

Too bad it means more people are likely to go bankrupt or self-ration needed care when Congress passes a bill forcing everyone to buy insurance with no meaningful limits on what the private insurers can charge.

Is there another route? Yes, and it’s not a secret.

The rest of the world has figured it out, as T.R. Reid reminds us in the forthcoming publication of “The Healing of America. A Global Quest for Better, Cheaper, and Fairer Health Care.” (Penguin Press) Essentially it’s the print version of the acclaimed Sick Around the World PBS show from last year.

By now, most people have heard how the U.S. ranked just 37th in the World Health Organization’s overall scorecard earlier this decade. Or how the Commonwealth Fund listed the U.S. last year as last among 19 industrial nations in preventable deaths.

But how about this one.

When the WHO assessed 191 countries on the barometer of “fairness,” the U.S. stumbled in at a bare 54th, barely beating out the impoverished African nations of Chad and Rwanda, but still behind Bangladesh and the Maldives. Not exactly a badge of honor.

Can we do better? Of course we can, says Reid, just by learning from the experiences of the rest of the world, especially those other comparable industrial nations which all have some form of national healthcare system — one in which their citizens’ health is not held hostage by profit-making private insurance companies. He concludes:

most rich countries have been national health statistics — longer life expectancy, lower infant mortality, better recovery rates from major diseases” than does the U.S. And they also perform better in presenting patients “a greater choice of doctors, hospitals, and procedures

For those who say we should not taint our borders by emulating France or Germany or Canada, Reid offers this retort:

We have borrowed numerous foreign innovations that have become staples of American daily life: public broadcasting, text messaging, pizza, sushi, yoga, reality TV, The Office, and even American Idol

Apparently we consider our health to be less important.

Reid also provides a useful service in knocking down most of the myths about other national systems that are common grist for the likes of Fox TV and the conservative think tanks.

Such as “they ration care with waiting list and limited choices;” in fact the data varies widely among other countries, and if you want to see really hideous waits, rationing of care, and limited choices, check out most American ERs and insurance network restrictions.

If there’s one crucial difference between the U.S. and all the other countries he surveyed, says Reid, it’s the moral dimension.

Whether a society should guarantee health care, the way we guarantee the right to think and pray as you like, to get an education, to vote in free elections? Or is medicine a commodity to be bought and sold, a product like a car, a computer, or a camera?

Apparently that is what makes our system “uniquely American.” As Reid puts it, “all the developed countries except the United States have decided that every human has a basic right to health care.”

And, that “no other country relies on for-profit insurance companies to pay for basic health care.”

President Obama who in 2003 notably described himself as a single payer advocate, now says it would be too disruptive to the present system to do that now. Well, a lot of people believe our dysfunctional, profit-focused healthcare system needs some good disruption.

And, there’s plenty of examples abroad that you can remake your healthcare system, and make it better, as a number of industrial countries did in the wreckage after World War II.

There’s a more recent example, Taiwan, which in 1994 scrapped its own broken system and adopted a single payer approach similar to Canada.  

Almost overnight, Reid notes, every resident of Taiwan, in their new national single payer system, had complete choice of provider, cut administrative costs to a mere 2 percent, and experienced striking improvements in patient outcomes.

While Taiwan, like some other national systems, has some problems today, mostly with underfunding, it has a much more equitable healthcare infrastructure, and guarantees healthcare coverage for everyone.

With immensely more resources than other nations, there’s no reason we couldn’t learn from their successes, their mistakes, and adopt a national system that would be far more humane than the disaster we have now.