George Bush has spoken: no guaranteed healthcare, not for kids, not for nobody.  Thank you Mr. Bush for putting your unpopularity behind the private insurance sector–just as their “individual mandate” laws in Massachusetts are running into trouble.  Bush’s veto provides the single-payer movement with the greatest strategic opening in memory.

All this and more in today’s Guaranteed Healthcare Update, cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize to make 2007 the Year of GUARANTEED healthcare on the single-payer model.

It was on ideological grounds that George Bush vetoed the expansion of Medicaid to more kids: “My concern is that when you expand eligibility . . . you’re really beginning to open up an avenue for people to switch from private insurance to the government.”

We have the least popular President in a generation putting his moral weight behind the private insurance companies—and opposing the idea of society guaranteeing healthcare to all kids, and adults.

In the words of Pink, thank you, Mr. President.  This is our opportunity to sharply frame the debate: throw patients to the insurance industry wolves or fight for guaranteed healthcare?  Trust in George Bush and Blue Cross…or the medical systems working in every other industrialized nation in the world?  The more nurses, patients, and other guaranteed healthcare advocates can point out the links between Bush and the private insurance industry, the better off our movement is.  It’s a tragic veto, but a strategic gift we should all exploit.

Speaking of wolves, count Ron Wyden in: “’We’re right at the cusp of an ideological truce on health care,’ declares a beaming Ron Wyden.”  His truce is a massive expansion of the role of private insurers through a legal mandate to become their customer.  In other words… to the ideology of George Bush and Mitt Romney and Arnold Schwarzenegger.

Ironically, the original individual mandate bill, RomneyCare in Massachusetts, is having trouble and legislators are rushing to tinker.  The big problem? “Massachusetts Senate President Therese Murray recently warned: ‘If we do not constrain health-care costs, the system we worked so hard to create and implement will collapse.’”  It is, of course, impossible to make the economics of healthcare work when you use 30% of care dollars to prop up an unnecessary private insurance sector middleman.  That’s why health care providers in Mass. are leading the fight against the program, with a petition saying, “the state is offering plans with skimpy coverage and little real health security…”

Elsewhere, Larry Summers shares a dark vision of how we’ll get to guaranteed healthcare: “Incrementalism is not enough, we need full and fundamental reform. But I suspect that Congress will do incremental reform for a while until it fails, and crisis forces radical change.”  Let’s work to skip the even-worse crisis part, because that’s a code word for patient suffering.

Finally, medical students are among the nation’s most committed healthcare reformers, and one drew up this great animation on single-payer.

To join the fight for guaranteed healthcare (with a “Medicare for All” or SinglePayer financing), visit with GuaranteedHealthcare.org, a project of the National Nurses Organizing Committee/California Nurses Association.

(wouldn’t you know it, Ezra Klein wrote an almost identical piece, albeit from a slightly different perspective, at TAPPED.  It’s very much worth a read.)

Last night we were treated to a health care “plan” that would reward those who have shitty health insurance, punish the middle-class union workers who’ve bargained for better health insurance, and keep the private insurance industry afloat in the process.  Ruth Marcus thinks that this actual reading of the evidence of the plan is unfair.

If George W. Bush proposes something, it must be bad. Such is the knee-jerk state of partisan suspiciousness that when the president actually endorses a tax increase — a tax increase that would primarily hit the well-off, no less — Democrats still howl.

….Listening to Democratic reaction to Bush’s new health insurance proposal, you get the sense that if Bush picked a plank right out of the Democratic platform — if he introduced Hillarycare itself — and stuck it in his State of the Union address, Democrats would churn out press releases denouncing it.

Kevin Drum and Jonathan Cohn do away with this nonsense so easily that it’s not worth taking an extra swipe, showing that Bush’s plan is actually an attempt to preserve the health insurance industry and allow it to offer less and less services to their customers.  But there is an important issue in here that needs to be addressed, that I seem to keep coming back to in this health care debate. 

Republicans who say the words “universal health care” do have the effect of pushing the debate in a more progressive direction, and setting out universal coverage as the desired goal.  But IT’S NOT ENOUGH for them to be lionized for doing something that human dignity and a basic belief in humanity demands. 

Catherine Siepp of the National Review makes this mistake, and throws in a nose-thumbing at all Democrats for good measure.

But for some reason, the only politicians pushing expanded access to health care right now are Republicans: Gov. Arnold Schwarzenegger of California and former Gov. Mitt Romney of Massachusetts, who’s just left his post to become a (mean old) Republican presidential candidate in 2008.

The name’s Wyden, Ron Wyden.  And Ted Kennedy.  And John Edwards.  And Barack Obama.  And Ed Rendell, who’s moving forward with his own health care plan in Pennsylvania, which (while marginally similar to Schwarzenegger’s in California) actually addresses cost-containment and quality of care, frankly the only issues that are going to make health care more affordable and more desirable.

So if you agree that the broad cross-section of the public, and the broad cross-section of the political spectrum want universal care (though the Democrats have been waiting for the Republicans to get there since 1994), it behooves you to actually take a look at the plans, and not give them a free pass because they kinda sorta seem like they want to help people.  Which is how Mitt Romney got so much praise for getting a plan through in Massachusetts that actually will slowly begin to bankrupt the uninsured:

Uninsured residents will have to shell out a quite a bit more than originally expected to get mandated health-care coverage, according to the group charged with introducing the coverage.
Monthly premiums to meet the state’s minimum coverage under last year’s universal health-care law would cost $380 on average and could cost up to $580 for a 56-year-old.

The plans are meant for roughly 200,000 uninsured Massachusetts residents who aren’t eligible for publicly subsidized insurance programs, said Bob Carey, director of planning and development at the Health Care Connector Authority. The group sent out requests for proposals to health insurance companies asking for the cost if they provided 60 percent of the benefits from an above-average health insurance plan. The cost ended up $100 higher than expected.

“This is bad news,” said member Jon Gruber. “We used to think it was going to cost $260.”

So it’s not enough to come up with some magical way to insure everybody.  Content matters, and some fundamental principles must be preserved.  I believe health care is a right and not a privilege for those who can afford it.  I believe in the importance of covering all children regardless of any other factor because it’s cheap, it promotes wellness throughout life, and it can prevent diseases which are more serious in children than adults.  I believe that trying to partner with the private insurance industry is like making a deal with the devil, and that the only market-oriented solutions that make any sense include things like guaranteed issue and community rating, so nobody is discriminated against for health care based on who they are.  I believe in baseline minimums for basic care that are far above what is typically considered in these plans.  I believe that forcing a marketplace through an individual mandate that doesn’t include a “Medicare for All” option does nothing but subsidize for-profit industry. I believe that health care with a huge deductible and giant co-payments is not health care.  And I believe that single-payer is the best way to keep down costs and keep the system efficient, and that anyone who studies the issue will come to the same conclusion.  Failing that I like Jacob Hacker’s solution from the Agenda for Shared Priorities.

A far better alternative was recently proposed by Yale Professor Jacob Hacker and the Economic Policy Institute. Employers would either have to provide good insurance, or pay a tax of six percent of payroll. People without insurance could buy into a public program much like Medicare, on a sliding scale. That same program would enroll people whose employers elected to pay the tax instead of providing insurance.

Hacker estimates about half of all Americans would soon be in the universal pool. Over time, the superior efficiencies of the public program would attract more people. The private health insurance industry, as a superfluous and inefficient middleman, would gradually dwindle. We’d eventually get universal and public coverage without the fragmentation.

Of course, the people who brought us HMOs will fiercely oppose it, but that’s not necessarily bad. Harry and Louise, the stars of the insurance industry commercials that helped kill the Clinton plan, have a lot less credibility these days. Reformers seeking universal coverage should recognize that the private insurance industry is less a credible partner than the prime obstacle.

For the Beltway punditocracy, their bretheren in the states, and people who don’t pay a lot of attention, having a health care plan means that you are a beneficent soul trying to improve people’s lives.  I don’t begrudge motives, but it’s not enough just to be FOR the general principle.  You have to support something that’ll actually work.

As I mentioned yesterday, nyceve has been doing incredible work looking into the crisis of healthcare nationwide.  Today, she highlights a disturbing LA Times story about how insurers in California pretty much refuse to cover potential consumers unless they’re Jack LaLane (and even then, Jack had better not have a pre-existing condition).

Frankly today I don’t know whether to laugh or cry. The stupidity. The abject stupidity. And Americans accept this as “normal”?

Perhaps something is wrong with us, with the citizens of the United States for tolerating this crap.

So without further delay, let’s end the year on a high note.

And once again, ask yourselves, if our elected representatives suffered these indignites, remember they serve us , how quickly the for-profit insurance industry scam might collapse.  Do you think they would tolerate such abuse?

In California, if you are say, self-employed (the backbone of the American economy, per George Bush), and you need to buy an individual health insurance policy, in a word. You. Better. Be. Healthy. Period.

This is what the Los Angeles Times is reporting this morning in a front page story. By the way, the reporter, Lisa Girion, deserves a Pulitzer for her ongoing and  extraordinary coverage of the corrupt, cherry-picking health insurance industry in California.

Scott Svonkin joined the Los Angeles County Commission on Insurance 10 years ago because he was concerned about an emerging problem: people losing health coverage. Since then, the ranks of uninsured Americans have swelled to more than 46 million.

Svonkin almost became one of them.

. . .As it turned out, Svonkin was rejected by not just one but three of California’s biggest health insurers, which cited his history of asthma, among other things.

“I couldn’t buy it at any price,” said Svonkin, 40, who lives in Sherman Oaks. “I remember thinking, ‘This can’t be happening to me.’ “

I want to interject here at this point, because I am in exactly the same position as those in this article.  I’m self-employed, living in California, and I have, in fact, a prior history of asthma.  I had to practically beg Blue Cross to take me in 2004 (when I fully went free-lance, and dropped the coverage I had with my employer), and since I have had Achilles tendon surgery since then, I pretty much have to stay with the greediest, sneakiest, most depraved insurer in the nation.  It seems like it’s only gotten worse since then.  As it is, I have high-deductible coverage that doesn’t cover routine things like MRI’s (which I paid completely out of pocket in the summer of ’04).  I can certainly afford coverage that’s better, but at this point, nobody would cover me.  This is well-known to anyone who has to arrange for their own insurance.  I’ve been turned down before, even by so-called “good guys” like Kaiser.  It’s this knowledge, that any prior history will cause rejection, that pushes people to fib on their forms, which Blue Cross uses to its advantage later by dropping people after they make a claim.  Blue Cross doesn’t mind if you lie a little on your form if you pay them; it’s only when you want something FROM them that they’ll drop you.

Consumer advocates see the practice as cherry-picking – a legal form of discrimination that is no longer tolerated in schools, public accommodations or workplaces – and a way to guarantee profits.

“The idea is to avoid all risk,” said Bryan Liang, executive director of the Institute of Health Law Studies at California Western School of Law in San Diego.

Jerry Flanagan, an advocate with the Foundation for Consumer and Taxpayer Rights, said it wouldn’t take much to be left out of the private-insurance market. “A minor asthma condition or a surgery 10 years ago that requires no further medical care is enough to get you blacklisted forever,” he said.

As a result, some people forgo treatment so as not to tarnish their health records. Others withhold information from doctors or ask them to leave details out of their records. For those who are uninsurable, healthcare often is the chief reason they stay in or take a certain job.

. . .Consumer advocates say out-of-date, ambiguous and even erroneous medical information can render people uninsurable. Sometimes the reasons can seem absurd. In a letter to an otherwise healthy recent college graduate, for instance, Blue Cross listed among the reasons it denied coverage a past bout of jock itch, “successfully treated with cream.”

. . .Blue Shield declined to discuss Svonkin’s case, citing patient privacy laws, as did the other insurers that subsequently rejected him, Blue Cross and PacifiCare. Although the rejection notices pointed to various problems – “expectant fatherhood” and swelling from a spider bite – all three blamed his history of asthma, a condition that affects more than 4.5 million Californians.

This is why we MUST have universal health care to prevent this kind of ruthlessness from happening.  For-profit insurance companies have a responsibility to their shareholders and their corporate boards, and the people have no part in that. 

Few mention this, but the American healthcare system is something of a mistake. It blossomed out of a World War II tax reform meant to guard against corporate war profiteering. Liberals, with their usual combination of good intentions and inadequate foresight, imposed massive marginal tax rates on corporations, effectively freezing their profits at prewar levels. But the law had a loophole: Corporations could funnel their wartime riches into employee benefits, such as healthcare, thus putting the cash to use within their company. And so they did, creating the employer-based healthcare system.

But healthcare was simpler in the 1940s, and far less expensive. In the 21st century, it’s not simple at all. Once a perk of employment, health insurance is now a necessity, and a structure that dumps such power, complexity and cost in the laps of employers is grotesquely unfair to both businesses and individuals. There’s no logic to an auto manufacturer running a multibillion-dollar health insurance plan on the side; it should stick to making cars. There’s no excuse for pricing the self-employed and entrepreneurial out of the market. And there’s no reason the owner of a three-employee start-up should have to go to bed with a heavy conscience because his coffee shop can’t pay for chemotherapy.

But health insurance is not only the inexplicable responsibility of business; it is a big business, which is why the system survives. The medical-industrial complex is a massive, remarkable beast, consuming a full one-ninth of the American economy and offering astonishing profits to many of the participants (indeed, Big Pharma was the most profitable industry in the U.S. from the 1980s until 2003, when energy companies wrested away the top spot). As with any lucrative industry, the winners are resistant to reforms, and they have a formidable army of politically lobbyists, PR specialists and image consultants helping to preserve their position, to preserve a mistake.

It’s unconscionable to keep the system the way it is, and I hope Ezra Klein is right, that change is around the corner.  But to go into the buzzsaw that is the present insurance industry is going to take an enormous amount of political will, as well as a grassroots movement to understand the nature of the problem, and why going single-payer is the most rational alternative.  I think Senator Wyden’s proposal, which uses community rating to ensure everybody pays the same price no matter their expected level of care, deserves serious support and scrutiny.  What will come out of California, which will certainly be a compromise, will go a long way to determining what will be acceptable to the nation at large.  We should not lay down our arms for universal health care before those negotiations even begin.  And we should not allow a system to continue where people who can afford quality care can’t get it – because the insurance companies don’t want to take the risk of paying even a dime to care for them.