So after being peppered with criticism from both term limits groups and the California Nurses Association, the Speaker’s office has chosen which group to strike back at: the nurses, of course, using the exact same standard of judgment that they called a “smear job” when it was used against Nuñez.

This is an argument over improving the delivery and cost of health care, and there’s plenty of ideological rigidity to go around.  What started as a promising “year of health care reform” has devolved into putative allies arguing about how much money the other spends on hotel rooms.  Behind the mere gaining of political points is a serious debate about how to best allow all California citizens, not just the ones with full-time employment (us freelancers need health care too), the highest quality affordable health care they can manage.  And the real truth of the matter, the one that nobody really wants to talk about, is that none of these state-based plans, by definition, have any hope of working and have serious potential consequences, besides.  I think that’s why everyone’s getting so mad at one another, because it’s easier to do so than to face the facts.

We’ve got all these great universal bills passing at the state level, and I’m here to tell you that, well, they are pretty great, but they’re not going to work. It didn’t work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn’t work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state’s revenues dropped. It didn’t work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, “I say to you with a clear heart that I’ve tried everything. There is no big lump of federal money that will make the problem go away.” Similar plans failed in Oregon, in Massachusetts, and many other states.

The plans fall for a few small reasons, and one big one. The big one is that states don’t have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don’t exist the state can’t borrow the money. So they dismantle the program. It’s happened time and time again — in some states, like Oregon, more than once.

Moreover, you don’t really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access – it’s actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don’t have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don’t trust them to fundamentally reform the system.

California is obviously one state that has the size, and certainly could float ever more bonds to spend the necessary money.  But we’re almost certainly on the cusp of a new recession, and the combination of massive debt passed on to grandkids and a pay-to-play system that still reigns supreme in Sacramento is unpalatable to reform.

I repsect the efforts of groups like Physicians for a Naitonal Health Plan, who have studied the issue and recommended some of the best possible solutions.  But that word “national” is hard to get around; it’s the only way to create the real economies of scale and managed risk necessary for a solution.  I believe in health care for everyone, not simply in red states or blue states.  As Ezra Klein notes,

You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the “laboratories of democracy.” But there’s another Brandeis saying that I think is more applicable: “If we would guide by the light of reason,” he said, “we must let our minds be bold.” And that’s what I’m asking: Be bold. Because nothing else will, in the long term, work.

I’ve been watching the debate in the Congress over expanding S-CHIP (the State Children’s Health Insurance Program) today while waiting for my plane travel to Yearly Kos, and I’m reminded of how dishonest Republicans are on this issue.  They created the block grant program to give states the ability to cover children, and now when it’s become popular and successful, and state governors want to expand it more, they suddenly want to stop it.  And they’re using the familiar “this would let illegal immigrants get free health care” canard to try and submarine the bill (incidentally, it doesn’t).

It’s important to chronicle this, because it’s the opening salvo in the battle to change the health care system in this country.  In California we’re gearing up for health care reform, and today The California Budget Project and the UCLA Center for Health Policy Research released a joint report that ably shows the consequences of maintaining the broken status quo on health care as the Republicans want to do:

…many families spend a substantial amount on health care premiums and out-of-pocket costs, and could face financially devastating medical expenses if they are not adequately protected.  The report, “What Does It Take for a Family to Afford to Pay for Health Care?” (available at www.cbp.org and www.healthpolicy.ucla.edu) recommends that health care reform proposals – such as those proposed by the Governor and Democratic legislative leaders – ensure that families can realistically afford premiums and out-of-pocket costs, such as copayments and deductibles.

The report recommends that proposals fully subsidize health care coverage for those who earn up to 200 percent of the poverty line ($41,300 for a family of four) because the cost of housing, food, and other necessities leaves these families with few or no resources to contribute toward health care costs.  The report also determines that families need incomes near 300 percent of the poverty line ($61,950 for a family of four) just to afford typical health care costs.  Because some families face much higher out-of-pocket health care costs, the report recommends that policymakers consider providing subsidies for families with incomes higher than 300 percent of the poverty line.

This is EXACTLY what the expansion of S-CHIP would do, and yet Roadblock Republicans and the Bush Administration are concerned with defeating it solely on ideological grounds.  They don’t want America to see a health care system managed in a public way that works.  They fear people will see the differences between a system that gives people the choice for affordable care and a private for-profit system that values limiting care above everything, and opt for the former.  They don’t want government to work, and they will do everything in their power to make it malfunction.

(I do take issue with the idea that “the governor’s proposal,” which has no cap on affordability or any floor on coverage, would necessarily help needy families.)

Here are some of the key recommendations of the report:

Limiting families’ out-of-pocket costs.  Some insured families have very high health costs because they have very high copayments, deductibles, or other out-of-pocket costs.  Some of these costs are predictable (for example, if a family member has a chronic illness), but some can be unexpected (for example, as the result of an accident or unexpected illness).  Placing limits on out-of-pocket costs is as important as premium subsidies in ensuring affordable health care.

Taking into account expenses families face, such as housing and child care, when determining how much families can afford to pay for health care.  Because families face very different costs, such as housing and child care, income alone is an imprecise measure of what families can afford to spend on health care.

An average adult with private health coverage pays almost $800 a year on premiums; a family of four spends $1,800.  Poor families cannot cope, and forget about it if they actually want to USE their coverage.  We know that almost half of all bankruptcies are due to health care costs.

Californians need to send a strong message to Congress and the President to wholeheartedly support the continuation of S-CHIP.  And they need to send the message to our Legislature that we need real health care reform that allows working families to have the peace of mind of medical coverage while also being able to survive financially.

The public hearing scheduled for July 19 about Blue Cross of CA and its deceptive, anti-consumer practices will now be held on August 7.  Not only are they angering their subscriber base by going out of their way to deny claims and cancel policies for “discrepancies” as trivial as typos, but they’re starting to piss off hospitals as well.

Blue Cross of California’s latest antidote to rising healthcare costs isn’t going down very well with physicians. The state’s largest for-profit health plan is set to roll back its payments for about half the services and procedures provided by physicians next month.

And many of the 53,408 physicians in Blue Cross’ preferred provider organization (PPO) networks say that’s a prescription for disaster.

Doctors say the health plan imposed the new rates unilaterally. In most cases, they say, Blue Cross will get its way because it controls the lion’s share of their patient base. But other physicians say they’ve had it with Blue Cross. More than 300 of them have sent notices threatening to dump the insurer if the rates take effect as scheduled Aug. 6. Some say the new rates won’t even cover the cost of supplies. ‘I don’t know how anybody can afford to stay in practice and accept Blue Cross rates,’ said Dr. Charles Fishman, a San Luis Obispo dermatologist who sent a letter telling Blue Cross he would drop its contract if his rates were not improved. A spokeswoman for the insurer described the level of complaints over the new rates as routine, and she said the number of termination notices from physicians over the issue was negligible – less than 1% of the doctors in its PPO networks.

Surely, this will come up in the August 7 hearing, to be held at the Carmel Room Auditorium at the Junipero Serra Building, 320 West 4th St., Los Angeles, from 10 a.m. until 3 p.m.  And It’s Our Healthcare is amping up the pressure by demanding that Blue Cross return to the state millions in excess profits:

This year alone, Blue Cross has sent almost a billion dollars in profit out of California to its corporate headquarters in Indiana.

Blue Cross is able to amass such a profit because it currently relies on business practices that harm millions of Californians, such as:

–Spending less of California’s premium dollars on patient care than other larger insurers
–Denying coverage for pre-existing conditions?and instead seeking to insure only the healthy
–Selling insurance designed to provide limited benefits, coupled with high deductibles and co-pays
–Raising rates however and whenever it chooses

We urge the state enact meaningful reform to stop these practices and we urge the state to order Blue Cross to return the hundreds of millions of dollars in excess profit to California.

We, the undersigned Californians, ask the state to make Blue Cross reform its business practices to start putting people ahead of profits and stop using California as an ATM.

Blue Cross has already settled out of court on some of these issues, but there is no indication that they have curtailed their practices and cleaned up their act.  Blue Cross has also taken the lead in torpedoing meaningful health care reform in the state.  It is maybe the most unconscionable company in the state, and I don’t know what it takes to get a corporate charter revoked, but theirs ought to be.

At any rate, you can keep the pressure up by signing the petition.

(I added the video of the Perata/Nunez presser after the flip – promoted by Brian Leubitz)

So, as expected, the leadership in the state legislature has agreed to combine their bills on health care reform.  The significant number is that the bill would require businesses to spent a minimum of 7.5% of payroll on health care.  But this newest proposal doesn’t come close to being universal.

Most significantly, they agreed to drop the Senate plan to require that Californians with more than modest incomes get insurance. That was intended to be the middle ground between Schwarzenegger’s insistence on universal coverage and the Assembly’s rejection of any requirement that people have insurance.

Senate President Pro Tem Don Perata (D-Oakland) and Assembly Speaker Fabian Nunez (D-Los Angeles) also agreed to apply the business requirement to every enterprise except the self-employed. The Assembly plan had carved out large exemptions for businesses with only one employee, those with payrolls of less than $100,000 and those that had been in operation for three or fewer years.

The Governor held a press conference today as well, and pretty much said that you need an individual mandate, and that nothing the Legislature passes matters, that he’ll work it all out in secret.  Now THAT’S transparency in government!

I do think that somewhere down the line, an individual mandate does make some sense because it spreads the risk pool.  And I think this new bill strengthens the tying of health care to employment, when that really should be severed.  But putting in an individual mandate without regulating the insurance companies to any major degree, or setting any ceiling on affordability or floor on coverage, seems like nothing more than shoveling billions of dollars to the for-profit healthcare industry.  So I’m not particularly jazzed by any of these proposals outside of SB 840, which of course will be vetoed.  The Perata/Nunez plan looks to me to be insufficient, though I’ll wait for the release of details.

The fact that Blue Cross of California is leading the insurance company effort to stop any reform in the state’s health care system makes me smile broadly.  There couldn’t be a more reviled corporate entity around these parts than Blue Cross, the team who systematically tried to throw any sick person off their rolls and reduce any effort to get them to actually pay for medical treatment, which after all is their entire job.  Health Access picked up on this and noticed that Blue Cross tried to use the Enron energy crisis as a scare tactic (“Unintended consequences do happen”), when in fact nobody is more like Enron than… Blue Cross.

Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.

BlueCross’ ad campaign may backfire with the public. They won’t believe BlueCross, and they will make it clear to Californians what we can win with health reform.

I don’t think it’s may, I think it’s will.

Nobody’s going to buy this for a second.  That’s why the campaign is only in Sacramento and not statewide.  If our leaders in this state are anything like Democratic national leaders, they’ll immediately drop all health care reform plans for fear that Blue Cross will continue to be mean to them.  But having Blue Cross argue about responsible health care policy is like having Tony Soprano argue about gun control.  And it’s up to us constituents to let the politicians know that.  If Blue Cross is the face of health care status quo, I’d say change is a-comin’.

Elizabeth Edwards’ acknowledgement of the recurrence of her breast cancer (which I hope is not more serious than the Edwardses made it out to be, but which I fear is) was but one story of cancer attacking prominent political figures.  Tony Snow will have surgery for a small growth under his abdomen; he had colon cancer two years ago, so we hope that it’s nothing more serious.  And most tragically, conservative commentator and blogger Catherine Siepp succumbed to lung cancer.  Cancer is not a disease that picks between political affiliations for who it afflicts, that much is clear.  And so a problem affecting everyone must be solved with a universal solution.

Before she died, Catherine Siepp wrote about her experiences with Blue Cross of California.  It was a bit shocking to hear a committed conservative talking about the failures of our health care system in such a frank and direct manner, but when a health insurance conglomerate acts so dishonestly, anyone in that position would be offended regardless of their politics.

over…

By law, insurance companies aren’t allowed to adjust your monthly premiums just because you get sick. But they can raise the out-of-pocket cap for all of their members anytime they like, which amounts to the same thing because it affects only the unvalued sick members. (And, of course, getting sick means that even while one’s medical costs go up, the ability to pay goes down — earnings potential is curbed when life becomes a series of treatment appointments.)

Lucky you, if you don’t know what your out-of-pocket cap is. And if you’re like every single healthy person I’ve queried, you probably don’t. But you should know, because the out-of-pocket cap is the most important part of your policy, meant to stave off financial disaster in case of catastrophic medical expenses […]

Another thing working in insurance companies’ favor is that cancer patients rarely have the energy to argue about such nickel-and-diming. I recently managed to spend a morning forcing my way through multiple disconnects and transfers on the Blue Cross 800 number, but I was eventually told that the company would probably reimburse me for the extra $90 a month I was paying for that weekly anti-nausea drug if I filled out the right forms. My far bigger worry is that out-of-pocket cap, which is essentially what insurance is for. To drastically raise it seems the definition of bad faith.

Or so I thought — until I began getting letters from Blue Cross in February announcing that it was retroactively disallowing the anti-cancer drug Avastin treatments it had been paying for since October, at $5,000 a pop every other week. It seems Blue Cross decided this new and expensive targeted therapy is experimental. (It looks as if Blue Cross is not asking to be repaid for my relatively unexperimental chemo, which had been costing about $2,500 every single week, but who knows?)

To decide after a therapy has proved beneficial that it’s merely “investigational” and therefore should not be covered — that, actually, seems the definition of bad faith.

Today, the LA Times reported that Blue Cross of CA is being fined a million dollars for illegally dropping the policies of sick clients for trumped-up reasons.  Recission is harsher, but generally of a piece with what Siepp had to put up with near the end of her life.  That fine is embarrassingly low (they made three billion last year) and won’t make a dent in Blue Cross’ policies.  But at least the state of California has publicly stated that this health insurer is motivated solely by greed and will gladly let their customers suffer rather than carry out their responsibilities.  As an individual policyholder with Blue Cross, exactly the profile that they dishonestly drop as a matter of routine, this scares the heck out of me.

I am truly sorry for Catherine Siepp and her family, along with any other family out there who has had to deal with the scourge of cancer.  We need to ensure that these families get the best medical attention and all the support they need; it ought to be an inalienable right of this country not to have to suffer due to some corporate balance sheet.  The current insurance system will never get us to such a goal.