Now that the big “debate the bill” vote is passed, we have a week for pundits on both sides of the aisle to misinform the public about what the future of the health care reform bill is. There are two tunes, one theme, and melodies underneath both. There’s an unsung chorus or two in there, too.

The Progressive Theme: Reconciliation

Progressives are pressing ahead with petitions, blog posts, and swarms to advance the idea that health care reform — or more specifically, the public option — should pass using the arcane and somewhat unrelated escape hatch of reconciliation to force a vote which requires only a majority to pass.

Proponents argue that reconciliation does an end run around the filibuster and takes the ball to the goal. And it does, in a strange, stripped-down way. Here are some examples of reconciliation legislation in the past:

1. Bush Tax Cuts Because they were passed via the reconciliation process, they expire at the end of 2010. Not particularly helpful to health care reform to have provisional reform that is not permanent.
2. COBRA the last attempt at health care reform that was ultimately diluted to something that screwed laid-off and terminated workers more than not having insurance at all.
3. TEFRA – The Tax Reform Act of 1986 It had something for everyone, but again, no meaningful social legislation and certainly nothing that had a deeper impact than the bottom line of form 1040.

It’s been suggested to me that the purpose of putting the full court press on reconciliation is to let Reid in on the worst-kept secret of our time: The public option matters to progressives and they believe it is the magic amulet to force insurers and providers to keep costs down. More rebuttal to that in my Unsung Chorus sections.

I think pressure is good. I think engagement is good. What I don’t think is good: signalling desperation to one’s opponents. There are other, better ways to work this through the process.

The Conservative Theme: Everyone hates health care reform

This is the current media and pollster theme. Everyone hates it, it’s not popular, so Congress should drop it. I could argue with their logic or foundations for making a statement like this, but it would be a waste of time. Nevertheless, this will be what we will hear from now on — that we, the people do not want health care reform. That we really, really like being denied by insurers, excluded from coverage altogether, or losing everything we’ve worked hard to save and own, like our houses.

Think about that next time you hear the theme. The press wants you to scrap any possibility of equalizing access to health care, because a pollster (and a conservative one at that) is telling us that we really hate ourselves enough to leave the status quo.

That’s logic worthy of Sarah Palin and Glenn Beck. Oh wait! They’re probably the lead singers.

And yes, there is a nod to tort reform, which is such a comprehensive topic it should not be contained in a bill about health care reform. Still, it acknowledges that it’s been suggested as a possible cost-saver in the larger scheme of things.

The Lieberman Riff: It’s all about me

Joe Lieberman. In his quest to get whatever it is Joe wants that he doesn’t have right now, he is standing tall for…Joe. I’m guessing a few more vigils like this one won’t make a huge difference, but ultimately Joe will get what Joe thinks he wants, until Joe gets tossed out of office by constituents who overwhelmingly disagree with him.

Unsung Chorus #1: Conference Committees matter

Back in September, the President held a conference call with progressives where they composed a strategy. The song went like this:

1. Get the bills out of the committees. Check.
2. Get the bills onto the floor of the House and Senate. Check.
3. Pass the House bill. Check.
4. Pass the Senate bill, even if it means adding triggers to the public option. Half a check for opening debate. Let’s see if Snowe introduces an amendment calling for triggers. If she does, it gets a full check.
5. Pass the Senate bill with 60, where one of the 60 is Snowe or Collins. Bill has triggers for public option.
6. House/Senate bills go to conference committee for merge. In Joint Committee, trigger is stripped from public option by House progressives on the committee. Conference report goes back to House and Senate, needs 51 to pass the Senate and we’re done.

Unsung Chorus #2: The whole is greater than the sum of its parts

While progressives’ intone the chorus that without a public option, health care reform is no reform at all, the truth may be something different. What the public option clearly does (and why it’s being fought tooth and nail by moderates and conservatives) is open the door to a single payer system somewhere down the line. Otherwise, it’s another choice bundled with other choices, only a public choice as opposed to a private one. I’ve seen arguments that suggest it will be the only choice that will offer a patient-centered approach, but I really think that’s idealism. Under one administration it may be something different than it would be under another. We’ve seen that with Medicare, and there’s nothing that convinces me it wouldn’t be true with a public option.

That doesn’t mean I’m against it. It just means I want everyone to step back and look at the larger picture.

The more delicate and complex melody lurks underneath the sound and fury; namely this: the entire package makes such fundamental changes to the system that it is indeed major reform that will bring the cost of health care down, with or without a public option, with or without triggers for a public option, with or without opt-outs for a public option.

No, I did not blaspheme.

Consider the analysis done by Tim Jost over at the Health Affairs blog. His evaluation is striking in its clarity:

This year’s health reform legislation has often been criticized for being health insurance reform rather than health care reform, and for not doing enough to control the cost of health care. Those who offer these criticisms have obviously not read the bills or even tried to understand them.

Jost goes on to outline how, between the two bills, just about every viable suggestion by credible sources and/or studies has been incorporated into the bill. Outcomes-based payment systems, payment bundling, quality reporting, electronic health records, patient-centered outcomes research, etc, etc. The list goes on.

These are not provisions contained in the consumer protection section of a nine-section bill. They are part of the other facets, which when put together create a new and wonderous thing. Here are the nine facets of health care reform addressed in the Senate bill.

• Title I – Quality, Affordable Health Care for All Americans
• Title II – Role of Public Programs
• Title III – Improving the Quality and Efficiency of Health Care
• Title IV – Prevention of Chronic Disease and Improving Public Health
• Title V – Health Care Workforce
• Title VI – Transparency and Program Integrity
• Title VII – Improving Access to Innovative Medical Therapies
• Title VIII – CLASS Act
• Title IX – Revenue Provisions

There are some comprehensive and major paradigm shifts in this bill. That list of nine facets adds up to something greater than the presence or absence of a public option. This is what is being lost in the public debate over, and over, and over again. The finer cuts in each of those facets are the best ideas — regardless of the party who introduced them — for reforming the entire system.

It’s easy to fixate on one cut of one facet and think you’ve heard the whole mix, but it’s a little like pointing to “Yellow Submarine” as the seminal Beatles work of their career while ignoring masterpieces like the White Album. President Obama is a man of long strategies, not short-term end runs.

Let’s sing this song, loudly. If we don’t, it won’t matter what passes. It will all play out as some sort of loss for President Obama and the Democrats when in fact, it will be a huge win for each and every person who lives in these United States.

(cross-posted from odd time signatures)

I spent the day at Health 2.0 conference in the Bay Area. This is the third year of the conference, and it has grown from a fringe group of early adopters and application developers to a bona fide e-patient movement, probably spurred by the broken health care system.

Health plans already know that whatever versions of Obama’s reform plan are passed, they will be dealing more with consumers and less with employers in the future. They are are investing in the tools to do a more subtle form of medical management than they did in the ’80s, when the HMO movement became known for the dreaded “gatekeeper” concept of denying care. During the heyday of this concept, health care costs escalated about 25% over a decade.

However, consumers became so angry that in 1999, one of the largest payers, UnitedHealth Group, said it would do no more medical management. All other plans had to follow suit, and with no effective medical management, health plan costs exploded 60% between 2000 and 2007. 20% of all commercial plan enrollees have been priced out of coverage, and now health plans have decided to be proactive again and turn back to management. But this time, they are trying to shift the paradigm and get the patient to be the manager.

Health Innovation’s Jerry Reeves, the medical director for union plans across the country, says hospitalizations are no longer the key drivers of rising costs. Costs are now being driven by ambulatory settings like ERs, outpatient settings, imaging centers, and the outsourcing of diagnostic activities outside the physicians office. A doctor visit would be the low cost solution, but people are not getting access to physicians’ offices, and wind up in the ER, which costs 13x as much to deliver the same services. In addition, Reeves said people are not getting lifesaving treatments and things they really need, because the system is so broken. He is trying to move to value-based health care.

Mohan Nair is a serial entrepreneur now with Regence BCBS, a four-state plan that has been working for last 6 years to help the system change. Regence is trying to invoke a vision of health care as everyone’s community asset: the consumer has to recognize that it’s his money and his future. Although there’s plenty of blame to go around in the health care industry, rather than trying to find someone to blame, Nair says, insurers have to change, and change quickly, altering their centers of gravity to the consumer and helping the consumer make better decisions, balancing medical management with consumer engagement. Of Regence BC/BS’s 3 million members, 30% are already actively engaged in online communities.

Over the past two years, CIgna’s 8.5 million domestic” lives” have already seen a transformation from their old school insurance company to a customer-centric universe Focused on what people actually want from this system, Cigna participates in Facebook, Twitter, Second Life, Eliza, and Intuit (Quicken Health). Cigna patients can download all their claims information in Quicken Health and see what’s been paid, what hasn’t been paid, and what their responsibility is. The application both tells people how much is actually being covered by their insurance, and explains why things are not covered — in plain English. Cigna patients have seen their information made transparent and delivered to them through many interactive channels. However, merely making information available does not necessarily encourage people to change their behavior. You need to have a motivated patient that’s willing to act on the information.

But at least the new system invites the patient in, which the current health system does not do.

Nathan Moracco, St of Mn Management and Budget supports the employer group for the state of Minnesota, and has devised for the state a tiered product with care systems ranked on a cost and quality basis, layered on top of incentives for members to seek the right care at the right time. The state is doing quality management around diabetes and depression care right now, because veryone knows that 5 chronic diseases account for 70% of the health care spend.

Chris Ohman of Kaiser (8.5 million members, ten states,) says they are putting finishing touches on installing their health IT system throughout the enterprise with an emphasis first on clinical care management, and second on the customer experience. Kaiser, too, knowing the numbers, is making big steps forward in chronic disease management, delivering what they feel are better benefits at lower costs.Engagement of consumers is related to this and Kaiser patients are filling prescriptions, making appointments, getting test results on the web, and then engaging with the physician.

Dear Senator Kerry,

Your reported call for “lies” about health care reform to be refuted is essential and requires an urgent response. To that end, may we – British health professionals and patients – respectfully expose those “lies” which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

Continue reading to see the full letter.

PATIENT CHOICE: There is NO “death panel” in the UK NHS or anywhere else in the UK health care sector.
-Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.
-Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it. It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing voluntarily to make their own arrangements for their future, medically and physically.
-Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.
CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems – they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.
CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.

CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.

FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.

INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.
THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.

BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.
The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions. Importantly it gives freedom from fear of the financial consequences of illness.
Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.
The NHS has shown itself to be open to – and often the source of – innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here

Yours sincerely,

Sir George Alberti MD, PhD, PRCP
Past President of the Royal College of Physicians
Dean of Newcastle School of Medicine

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
Professor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK
Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP
Consultant Rheumatologist, UCH
Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men’s Health Forum and member BMA Council

Professor Eileen O’Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy
Health Policy Unit,
Dept Public Health & Policy,
LSHTM, Keppel Street,

Professor Rosalind Raine

Reprinted from Gary Schwitzer’s blog (one of the pre-eminent health journalists and teachers)

The Lie

Investor’s Business Daily’s latest salvo comes in the form of an editorial claiming that private insurance is eliminated.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

Unfortunately, IBD was just a little bit incorrect about the analysis and the reporting. I suppose, though, that characterizing it as an editorial might exempt them from actually reporting facts.

The Truth

Background: Page 16 defines what coverage will be considered “grandfathered coverage”; that is, coverage in existence today which would not be in compliance with new standards imposed by the law.

What it says: Any individual insurance policy (as opposed to a group insurance policy) that is in effect today will be permitted to remain in effect; however, any new policies issued after the law becomes effective will be required to comply with the standards set out in the section relating to policies offered via the new Health Insurance Exchange.

What it does: The purpose of the provision is to bring policy offerings into line with the minimum benefit tiers and provisions required under the new law. Here are those requirements:

1. Must offer “Basic Plan Benefits”, which means the following: No pre-existing condition exclusions, covers hospitalization, outpatient hospital and outpatient clinic services, physicians visits, supplies, equipment, prescription drugs, rehabilitative services, mental health and substance abuse treatment, preventive services, maternity, well baby and well child care, vision and dental for children under 21.
2. Has co-payments and deductibles not more than $10,000 per year, indexed for inflation.

On page 19, the bill clarifies the grandfather provision further by specifying that any individual health insurance coverage that is NOT grandfathered (e.g. products introduced after effective date of the law), will have to conform and be offered as an exchange-eligible plan.

This is all the grandfather provision does. Nothing more, nothing less. It allows existing products to die a natural death while requiring new products to conform to the basic standards. Those products are still offered by insurers. The public plan that has them all in an uproar is simply one among other offerings.

Why the lie? This provision effectively forces the insurers to sit down and craft policies that compete with each other and the public option in terms of benefits and accessibility. Recissions will be far more difficult and subject to three levels of review. Pre-existing conditions will be a dead term. All of this is great for individuals covered, but for insurers, it shuts down their gravy train. They’ll actually have to use one risk pool instead of tiered risk pools.

They don’t want to do that. They like making record profits while the rest of us are bankrupted. They understand that there will be reform; they just want it to be reform that benefits them instead of the rest of us. To that end, they recruit publications friendly to their cause like Investors’ Business Daily to publish ‘editorials’, which can then be spread via social networks and blogs to scare you into opposing ANY reform.

Now you have the facts. Straight out of the proposed legislation, from a person who has read the actual text of the legislation — all 1,018 pages of it — twice, and has a strong background in how these laws are shaped and come into being.

Do not let them scare you. Arm yourself with the facts.

The full text of the House Bill can be downloaded here. (PDF)

Americans have always loved freedom fighters. After all, it’s in our DNA — our story of the land of the free bought with the spilled blood of our forefathers who rebelled against oppression to create the most powerful nation in the world is a heady and exhilarating ideal. It’s hardly a surprise that so many would be captivated by events in Iran, particularly when viewed through the prism of our own election process and leftover baggage from the 2000 election outcomes.

Inside American idealism, there is a hope – a small burgeoning hope – that Iran will shake itself out from under the rule of the fundamental Muslim clerics – the mullahs — and become a true democracy. As Tom Regan points out, that dream is unlikely to come true, though some nominal change may indeed come to Iran as a result of the unrest over their elections. However, Americans are allowing themselves to become distracted and embroiled in the Iranian dream at the expense of their American dream.

We have our own totalitarian mullahs here in the US. They rule in the form of bankers and insurance company executives, the shadow actors who broker our health at a profit to serve Wall Street and investors while robbing us of the ability to run businesses, get health care at a reasonable cost, and force us to ignore very real health issues for fear of having them become ‘pre-existing conditions’ or causing us to be uninsurable.

If you think we’re free in this country, you’re wrong. We haven’t been free since we bowed down and let our lives and our health be sold at a profit for the benefit of Wall Street, who has not been as forthcoming about sharing the wealth. Make no mistake: If we aren’t healthy, we aren’t free. We become slaves to claim forms and ‘managed care’, we’re made to feel guilty for circumstances which may or may not be within our control, while insurers cover Viagra but leave smoking cessation to the means of the insured.

This isn’t news. Everyone has a story, knows someone with a story, or fears they will become a story. Despite the fact that 3 in 4 people support a public health plan option as part of comprehensive health care reform, the press and the Republicans are successfully trumpeting erroneous numbers released by the CBO (Yes, a failure to factor in the cost savings of competitive pricing in a public plan is a clear and large error) as proof positive that health care reform cannot include a public option.

Without a public option, there is no reform. Repeat that after me: Without a public option there is no reform. The public option is how we remove the health insurance mullahs’ power. There is no other way.

The timid Democrats in the Senate, led by Max Baucus (who has been well-financed by health insurance companies) bowed to the CBO report without so much as a question and removed the public option. House Democrats have included it as the center of their reform bill, which has been negotiated, considered and debated for 6 months.

Here’s the problem: Health insurance mullahs understand that they wield power by making large contributions to friendly politicians like Baucus. They then use the mainstream media as an amplifier to play the “it’s too expensive to have a public option” tune, and pretty soon, real reform dies.

This is how they killed it in the 90′s. It’s how they propose to kill it in 2009. They can do it. They know they can, just like the Iranian mullahs understand the power of religious totalitarianism, control of the message and the police.

When they own the message, they own the outcome.

They don’t have to own the message. We don’t have to let them. But as long as Americans remain focused on events in Iran and continue to romantically tilt at the Iranian mullahs, all power is abrogated to the American Insurance mullahs who wish to control our present and our future. In other words, we’re not watching what’s going on here because we’re focused on what’s happening there, where we have absolutely no power to change what has been set in motion.

Here are some facts. Consider them as powerful as Neda’s death broadcast from Iran on YouTube and now on all the major media outlets. Consider the stories of people dying every single day for lack of access to or ability to pay for health care to be as powerful as the story of one beautiful Iranian woman who was killed for simply being in the wrong place at the wrong time. Consider the suppression of these stories to be how they control the message.

Let this be a challenge and a warning: If we continue to tilt at Iranian mullahs, health insurance mullahs will win. It is time for the 3 in 4 Americans who support the public option to be heard. Here are some ways to take control:

1. Get the message out.  Next Saturday, June 27 has been designated as a National Health Care Day of Service. Click that link. Find a local way to participate and raise awareness.
2. Use the hashtags #hcan #hcr on Twitter, Friendfeed and other social networks. (Yes, I still hate hashtags but understand the value they bring for this moment.)
3. Write the editor of your local paper. Most newspaper websites have an online form you can use to compose your email. Write it. Do it. Don’t self-edit, tell your story.
4. Make signs. Handwritten signs. Put them in your window, write the message on t-shirts. Just like we did with the 2008 election, this is an opportunity to raise awareness by simply wearing, saying, displaying the message. Signs telling neighbors and passers-by to pay attention, to investigate the facts, understand all of the issues, get involved.
5. Call your representatives. Do not underestimate the power of your voice. They may not respond. They may not even listen personally. But your voice is heard, nevertheless. Midterm election campaigns are gearing up. Incumbents who shy away from real health care reform should not be confident of re-election. Hold them to the fire, make them accountable.

Yes, we can. We can depose the insurance mullahs, but not if our heads are turned away from the urgency of now. Now is more urgent than ever. Electing Barack Obama was an affirmation of participatory democracy, on and off line. It wasn’t an end. It was a beginning. Now, more than ever, each and every voice must be heard. We must hold the cowards in the Senate to the promise of actual health care reform. It will not happen if we don’t participate. Please. Participate.

cross-posted to Bipartisan Report

The Obama administration is serious about health care reform and about getting support for it. This was in my Inbox this morning from Jenny Backus, probably because I held a health care meeting in my home and signed up on the health care reform site.

A Special Video Message for You on Women and Health Reform from Secretary Sebelius

Dear Friend,

We know that the health care crisis impacts every American, but our mothers, daughters and sisters are paying a particularly heavy price. Today, 21 million women and girls are uninsured. Women who try to purchase insurance find that the private market is often stacked against them. Premiums in the private market for young women are often higher than they are for men. In some states, insurance companies can legally discriminate against women, and leave them with higher health care bills or inadequate coverage.

Today, in honor of National Women’s Health Week, Secretary Kathleen Sebelius and the HHS Office of Health Reform are releasing a report, Roadblocks to Health Care, that shows how our current system is leaving too many women without the care they need. You can watch a special message from Secretary Sebelius about the report by clicking here. (Nope. There wasn’t a link to the video –ed/_

To read the report visit www.HealthReform.gov.

Later this morning, Secretary Sebelius will join local women business owners in Washington DC’s historic Barracks Row neighborhood for a roundtable discussion. She will be joined by Tina Tchen, Director of the White House Office of Public Engagement and Executive Director of the White House Council on Women and Girls, to discuss the unique challenges facing women when it comes to health reform, especially women small business owners. We’ll have pictures of the event on www.HealthReform.gov later this afternoon.

We know America’s women can’t afford to wait for comprehensive health reform. Roadblocks to Health Care reports:

* In the individual insurance market, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
* In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men.

Health reform can’t wait. We must act soon to reduce the crushing cost burden that is overwhelming family, business, and government budgets.

Thank you for all your work to help make health reform a reality. Every day, we are moving closer to achieving this important goal.

Sincerely,

Jenny Backus

PS – We need everyone working together for reform. Don’t forget to sign the statement of support for comprehensive health reform this year and tell your friends to sign it too. Visit www.HealthReform.gov to show your support today!

I’ve just read a Huffington Post article on the issues surrounding women’s health and what’s needed in health care reform. The author pointed to the fact that nearly one in five women lacks health insurance, and therefore delays care. The article, of course, is meant to draw the attention of the Obama administration to the plight of women just as we sit down to discuss reform.

Uninsured Americans are more likely not to comply with medication regimens, seek needed care, or incur further debt if they can possible help it. They are also more likely to take jobs they may not be suited for and don’t like, and hang on to these jobs “for dear life,” to use an old turn of phrase, just because of the medical benefits.

When they are laid off, they lose their insurance, and very often since they are heads of households, their children lose, too.

Trust me, this is not a woman’s problem, however. You can skew the statistics any way you like, but men have the same problem, and in this recession men are being laid off faster than women. Last month, 663,000 more people lost their jobs. I see them in every Blueprint for Survival workshop, and their first issue is always health insurance. And if it isn’t, I make sure to bring it up because it should be.

When this recession is over, we will be confronting a profoundly changed America. We may have different kinds of jobs in different kinds of companies. Who knows whether the very companies we want to create “green” jobs, most of which are small and innovative (and not rich) can afford to pay benefits? Why should they have to?

I worry about how much of what has trickled out about Obama’s reform plans still depends on the old industrial economy with its big companies (that are now going under because of their health insurance costs) and employer-sponsored benefits. Putting it back on the employer just won’t work anymore. Nor will mandating that unemployed people buy health insurance.

There’s no way I want the health care system nationalized. There’s no way I want people to stop making a living. But I do want health care made into a social enterprise, perhaps even with non-profit status. Remember when we had non-profit hospitals? Church-run hospitals? It wasn’t on the backs of the government, nor was it on the back of the employer.

The way insurance companies and drug companies have been profiting at the expense of their customers is insane and unsustainable, and is no better than the banks.

We’ve seen where greed got the banks. Greed has gotten the health care industry into the same “pickle.” Like the small community banks, we need small, non-profit community health centers. Wouldn’t that drive down the cost of health care? Can’t we treat it like a public utility?

Let’s at least discuss this — here, on Friendfeed, anywhere you want — and get some new ides on the table.

As Obama prepares to take office amid a raging recession and America’s demands for more accessible and affordable health care, the London Daily Mail has this ad: “Save hundreds of pounds on health bills.” The paper offers to pay for a year of private health “cover” for five lucky readers if they call in before January 15th. The value of the insurance is said to be about 250 pounds a month, more than $380.00, and the contest says the insurance is subject to availability and the terms and conditions of the health care provider.
Britain’s National Health Service is not looked at fondly by its citizens, but as rather a last resort. In the boom years, many people had started buying PMI (private medical insurance). Now, with the economy in the tank, they’re spoiled, so the Daily Mail ran a this long article on how to have your cake and eat it too:

1. Remember that private health insurance is a luxury not a necessity. Most people buy it because it allows immediate treatment of non-urgent problems. But it doesn’t cover GP routine checkups.
2. Don’t buy insurance; pay privately as you go,or start a special savings account. Banks in the UK give higher interest on HSAs.
3. Check to see if you have employer-based coverage. Some employers do provide it.
4. Comparison shop. PMI plans are compared at moneysupermarket.com, and rates for a single person range from 13 pounds to 249 pounds per month.
5. Downgrade. This seems to be like catastrophic insurance — covers only things for which treatment is not available from NHS within a specified period.
6. Exclude mental health, certain tests and scans, as well as complementary therapies.
7. Accept fewer hospital choices
8. Take a no claims discount (which can bite you in the butt if you DO have a claim). It’s like promising not to use the insurance.
9. Take a shared responsibility policy, in which you are incentivized to keep costs down.
10. Pay premiums all at once.
11. If you are self-employed, “club” together and get group coverage
12. Increase your deductible.
13. Stay healthy.
14. Opt for a health care cash plan, which pays a fixed amount for certain services, after which you take over.
15. Shop for new insurance every year.

It’s interesting how many of these tips seem familiar to us in the US. However, there is ONE BIG DIFFERENCE: PMI is a choice for Britons, not a necessity. If they can’t afford it, they are not without access to health care.

I was impressed with how thorough the suggestions were for the Daily Mail’s readers. Most of us in America, who depend on private health insurance, don’t know all these angles. We need to become more educated immediately, no matter what Obama does.

And one more thing: the Daily Mail has a free month’s supply of antioxidants for you, too. That paper will go to any lengths to keep its readers:-)

NPR:

• How Obama Can Heed Clinton Health Reform Failure

  As President-elect Barack Obama prepares to take office and confront the problems with the nation’s health care system, some people in Washington are feeling a sense of deja vu.

  In 1993, Bill Clinton had just become president, and his party was in the majority in both the House and Senate. There were tens of millions of people without health insurance and high hopes for change.

  That health reform effort crashed. The policy experts involved in that initiative say the Obama team will have to do things differently if they want to make change this time.
  Podcast

• CNN’s Dr. Gupta May Be Next Surgeon General

Health Affairs Blog

• Health Spending Slows, But Still Outpaces Economy Slowdown

  Health care and the economy. Health spending growth overall outpaced the slowing economy and consumed a larger portion of gross domestic product in 2007, reaching 16.2 percent, up from 16 percent in 2006. Although prescription drug spending slowed significantly in 2007, reaching its lowest rate of growth in 45 years, most other health care services grew at about the same rate or faster from 2006 to 2007, the government said. Writing in today’s New York Times, Robert Pear noted: “In recessions, when the economy contracts, health spending usually continues to increase. So federal economists and statisticians said that health spending probably accounted for an even larger share of the nation’s economic output in 2008.”

• The Surgeon General: A Partner In Health Reform

  But over the past 50 years, even as these valiant efforts and life-saving programs saved countless lives and raised awareness, our health care system has fallen apart – and more recently, the Surgeon General’s voice has been muted. Now that President-elect Barack Obama has proposed Tom Daschle and Jeanne Lambrew to lead his new health reform team, it’s time for us to redefine the Surgeon General’s role as someone who can not only diagnose what’s wrong with our health care system but work with us, as a team, to fix it.

Just over a year ago, US Senator Barack Obama spoke these words:

One year from now, we can stop campaigning on the outrage of 47 million uninsured Americans and finally start doing something about it.

That time is NOW. Yes, the economy is in the tank, Israel is bombing Gaza, we have troops in Iraq and Afghanistan is looking gloomier by the day. Still, the true foundation of the ‘fierce urgency of now’ is reforming our health care system and opening access to all citizens of this country without regard to employment or pre-existing conditions.

As employees are laid off and jobs outsourced to foreign countries, more and more people are faced with this choice: Go bankrupt paying for health insurance or go bankrupt paying for health care. I know this from personal experience. I am a self-employed person who was also a full-time employee with health insurance benefits until December 31st, when I also made the layoff list.

The fierce urgency of now means that I must maintain my health insurance for me and the family no matter what the cost, because of pre-existing conditions which require that I have continuous coverage in order for them to be covered in the future. Did you follow that? It’s an important distinction for many, many Americans facing layoffs and looking for new jobs.

The cost for me to continue this insurance is exhorbitant. It costs twice what I can get as an individual, except that if you are an individual and you have COBRA continuation available, you must exhaust the COBRA coverage first. That means that I will pay $1,300 per month instead of $650 per month for similar coverage as an individual.

Or, I can go without coverage and take the risk that no catastrophe strikes our family before I find another job with insurance. That would also mean we would be forced to wait six months before getting any coverage for pre-existing conditions, which could be a catastrophe in itself.

I’m one of the lucky ones. Other families have no means with which to pay for health coverage and have to rely upon good luck and Medicaid, which means they are less likely to focus on wellness, much more likely to wait until a condition becomes an emergency, and ultimately become the responsibility of the government.

On the business side of things, profit margins drop with every new enrollment period. Employers shave away benefits without dropping them completely in order to stay afloat.

Health care is not optional. When George Will rather sneeringly suggests that the issues surrounding Medicare are a function of overutilization, price-fixing, and — gasp! — recipient ignorance about the cost of goods and services being furnished to them while ignoring the fact that the patient is a captive audience, he misses the larger and far more urgent picture: People die without health care. If they can’t pay for it, the government picks up the tab. This is because health care is as urgent a need as shelter, food, and warmth, and it is slipping from our grasp in real time.

I have paid (or my parents, their employer and my employers have paid) for health insurance since the day I was born. After 50 years, I do not wish to be told that I am responsible for a drain on the national budget or a spike in the national debt. Amortize what has been paid by me and on my behalf for 50 years and it will surely exceed the average lifetime cost of health care that has been provided to me, even with the birth of three children on that tab.

This is it: the future of our country in real time. ‘Bankrupt or bare’ are not viable options. Health care reform has to be on the agenda at the very first Cabinet meeting on January 21st. President-elect Obama has asked for our stories, suggestions, and solutions to the problem. Let’s be ready to serve them up on the first day of his Presidency.

Here are my suggestions for the first steps to take:

• Establish baseline federal standards for health care that override the widely varying current state-to-state standards.
• Begin an immediate public audit of the payor/payee system, beginning with insurers and related entities. There should be full transparency as to actuarial assumptions used to calculate premiums, criteria for claims processing, administrative fees and costs, as well as any profit-taking from related companies. In particular, examine the relationships between Pharmacy Benefit Managers and Insurers, which appear to me to be rather incestuous in some cases. This audit must be undertaken in public, in real time, either via streaming video, webcam, or on CSpan so that the public will have the opportunity to follow and participate.
• Give immediate education financing incentives to qualified pre-med and medical students to enter the field of general medicine rather than specializing.
• Streamline and consolidate medical records. Electronically, of course.
• As a stopgap measure, open enrollment in the Federal government plans to private citizens at the same rates (as candidate Obama promised) so that laid off, unemployed and self-employed individuals have the opportunity to buy health insurance at a cost that won’t bankrupt them and get coverage that will be meaningful when needed.

These are my first-blush ideas. We have 2 weeks until Barack Obama’s inauguration. I hope you’ll add your ideas, thoughts, suggestions and stories in the comments. As more voices rise, so will the best ideas rise, answering the urgency, the absolute need of NOW.