My answer: A little of both. Let’s start with an assumption that the rumors are actually true. It’s an assumption, subject to change later. (Update: Here’s the official release from Harry Reid with no details but also no eulogy for the public option. Update #2: Talking Points Memo has some sketchy unconfirmed anonymous details that seem to mesh with my thinking.)

Medicare Expansion Age 55-65

This is a great development for people in this age group. It’s far better than what they would have gotten under the public option on the table. Medicare-negotiated rates for services are just lower than they would ever have gotten with the public option from the House or the Senate.

Why does it work for everyone? First, because it opens an existing program, so there aren’t a huge amount of administrative startup costs. It also solves the cash flow problem by requiring those of us in that aging baby-boomer age group to pay premiums in order to buy in. That brings additional cash into the Medicare system on some sort of actuarially calculated basis, while buying time for some of the cost-saving reforms to kick in and push the solvency range even higher.

Non-profit co-ops with rates negotiated similar to FEHBP

This would be a plan offered by private insurers, but with the same terms that the Federal government gets on its rates. The insurer must be a non-profit entity and approved by the OPM (Office of Personnel Management). Insurers are paid a fee of up to 1%, and the rates are significantly less than what we’re paying for individual policies now.

Don’t forget who would be covered

The only people eligible for this would be those who aren’t covered by employer plans. This is the primary issue. Yesterday there was an admission by one Senator that they wanted to separate health care/health insurance from employment but couldn’t, because they couldn’t get any agreement from big business.

For someone like me who is unemployed/self-employed with one uninsurable child, one healthy, a husband 4 years older than me, our options would look like this:

• Husband buys into Medicare
• Uninsurable kid buys into national high risk pool, or we release him as a dependent and he is covered under Medicaid.
• Daughter and I go out to the individual market through 2013 when I turn 55.

It’s an incredibly piecemeal approach, but it would actually work for us.

Something to consider

One of the most-overlooked features of the reform packages is the standardization of benefit packages. It’s worth remembering this when evaluating the value of this bill. Right now, coverage is all over the place. Under the bill, there are minimums. Here just some of the main ones:

• Outpatient services, clinic, emergency room, lab, etc
• 100% coverage of preventative services
• Prescription drug coverage
• Hospitalization

Also, standardized out-of-pocket costs and maximums, which are also covered by subsidies for low-income families and individuals.

That’s a pretty substantial list of benefits, and is certainly more than what I was able to find when shopping individual (affordable!) policies early this year.

But..but…no public option?

Remind me when this bill has been signed to share my prediction back when the process began. Until it gets through the entire legislative process, I’m keeping my big yap shut. Not because I think the powers that be listen to me, but because I don’t want to start a firestorm among those who read what I write before I have water to fight it with.

When is a public option not a public option but it is a public option? When they call it something else, pull other ideas in that can be supported, re-use existing institutions to accomplish the goal, and they get 60 to agree to it.

After all, we can tilt after this thing called a public option and pound this bill into oblivion, guaranteeing that Democratic majorities in the Senate and House will be ground to dust, or we can step back, figure out the goal, and see if there is a pathway to the goal that makes something that looks like a public option but is really called a non-profit national co-op and Medicare expansion.

(Note: rumors of Medicaid expansion seem to indicate that it’s not going to happen, but the Medicare expansion looks to be gaining traction.)

Throughout this summer’s debate and under all the noise, there’s been a slow, steady drumbeat for single payer health care to replace the piecemeal reforms on the table.

I like single payer. I like the concept and I like the idea of paying a flat amount each year to know that if I get sick, I get treatment. If I were crafting a system from scratch, I’d surely start with single payer.

Health care reform could have been as simple as opening up Medicare to everyone with a corresponding payment via payroll deduction or other means, but if you think the public option was demonized, imagine what would have happened if this were the proposal on the table.

Here’s the problem: It’s idealistic to imagine that a national single payer system could be implemented in one fell swoop. Aside from the administrative nightmare, insurance companies would do their level best to kill it, and it would always be subject to the political whims of the party in power. (Witness the efforts of the Bush administration to privatize it via Parts C & D, as an example).

While I admire the single payer advocates for their passion and dedication to the cause (and have made contributions to them), I wish they’d be a bit more practical. The most pragmatic thinker around this concept is Dennis Kucinich.

Kucinich has proposed a state-by-state single payer system at the option of the states which, if adopted, would conform to the requirements for Qualified Health Benefit Plans under HR3200 and the HELP committee’s sister bill. The advantage to a bill like this is that it is a more self-determining type of approach, where each state can simply choose to allow insurers to cover health benefits or implement single payer models. Theoretically, as states opt for those models and they succeed, more states will implement them. This is what Canada did, and it’s why the Canadian system is now single payer nationwide.

One of the biggest misconceptions about single payer health care is that the payer is the government. That’s not necessarily true. Kaiser, for example, is an example of single payer health care. The best health care I ever received was via a single-payer medical group, subsequently acquired by HealthNet and made into an odious HMO with all of the for-profit insurance aspects that killed its usefulness.

What we’re going to get from Congress is piecemeal reform, and frankly, I think it’s probably the best we will get on the Federal level. My prediction is that we will see an end to pre-existing conditions exclusions, recissions, and cancellations when one becomes ill. What we won’t see is a meaningful competitor on the Federal level to force insurers to play on a level field.

This is where Kucinich nails the approach. Let reform pass Congress without a public option, and then push states to implement single payer. A few already have: Vermont is one example. As people, regardless of what party they belong to, begin to realize that access to insurance doesn’t guarantee affordability, they will push states to implement single payer reforms as their “public option”, and as those reforms take hold and succeed, there will be a push nationwide. This also remains consistent with the view of states-rights advocates, who oppose any form of Federal government involvement in health care.

President Obama’s speech tonight will not be the make-or-break that the media and other organizations (including certain members of Congress) think it is. I believe he’ll frame the initiatives and the issues, and push for resolution toward a bill which passes both houses. What passes will be imperfect, but it will open the door for states to initiate their own alternatives to the Federal plan.

Just for perspective here, President Clinton couldn’t even get bills reported out of committee and onto the floor of the House and Senate for a vote. Already, much progress has been made. Regardless of what happens with Congress, we should all be pushing our state governments to adopt the Kucinich approach and shift to the single-payer model.

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• White House: Public Option Still On Table (cbsnews.com)
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• Glenn Beck Explains The Failure Of The For-Profit Health Care System (bravenewfilms.org)

cross-posted to odd time signatures

As our health care debate has overheated, myths about the Canadian health care system abound. The Republicans and the media are using the Canadian system to criticize everything from the public option to breast cancer treatment as they continue to stonewall any reform. This video, and more like it, might finally change the debate by forcing the American media to get off their arses and go tell the truth about Healthcare around the world, and how it towers over the wretched mess we have in the United States. Too many lives are running out of time.

Why this video? Why now?

In the spirit of truth, my friend Matte Black (@Shoq on Twitter) and his brother took their video camera to Canada on vacation to interview Canadians about their health care system. When we talked about it, I asked him to try to get negative views with specifics for balance. Here is the result. It has been edited for brevity, but the negative views were not removed, because there were none. He could not find one Canadian who thought they should kill the system. These are everyday people. They have no agenda at all other than being patriotic Canadians.

Please watch it and share it with as many people as you can.

Click the button to follow Shoq:

Dennis Prager posed 10 questions to supporters of “Obamacare”¹ This post answers them in the order asked. I have endeavored to support my contentions with facts from sources which are non-partisan, but I will state up front that I am a supporter of comprehensive health care reform that includes a robust public option.

1. Question 1: “If Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to “pay for itself,” let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

   Answer: It goes without saying that Mr. Prager has posed 4 questions here, but since they’re related, I’ll tackle them as one. The fundamental question he appears to be asking is “Why should I believe government can do this right when they’ve done everything else wrong?”

   Mr. Prager’s premise is flawed. It assumes that the problems with Medicare and Medicaid relate to the government operation of those funds when in fact, the real problems stem from the so-called “Medicare Reform” and Medicare Advantage plans. Medicare Advantage Plans are a ‘Medicare Alternative” provided by private insurers; in essence, an effort to privatize Medicare. According to the Commonwealth Fund, payments to private insurers increased costs over what would have been paid had the Medicare system remained under public oversight.

   The Medicare Modernization Act of 2003 sharply increased payments to private Medicare Advantage plans. As a result, every plan in every county in the nation was paid more in 2005 than its enrollees would have been expected to cost if they had been enrolled in traditional fee-for-service Medicare. The authors calculate that payments to Medicare Advantage plans averaged 12.4 percent more than costs in traditional Medicare during 2005: a total of more than $5.2 billion, or $922 for each of the 5.6 million Medicare enrollees in managed care.

   A glance at insurers’ profit reports confirms this. From BusinessWeek’s report about United Healthcare’s record profits for the second quarter of 2009 on decreased enrollments:

   “We expect this year’s revenue growth in public and senior business to continue to more than offset the potential for further pressure from the employer market,” UnitedHealth CEO Stephen J. Hemsley said in a conference call with analysts.

   Further, VA hospitals (a government-run single payer system) consistently outperform private hospitals. (Washington Post)

   In other words, Mr. Prager, it isn’t the GOVERNMENT that’s running Medicare and Medicaid into the ground. It’s the for-profit insurance companies whose profits are earned on the backs of American taxpayers.

2. Question 2: [Re: Pre-existing conditions exclusions] But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? … The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick.

   Answer: This is why there is a distinction made between “access to health care” and “health insurance”. To be clear: Health benefits are a risk pool. They are not “insurance” like car insurance or life insurance. The premise behind life insurance is that an insured will live long enough that the premiums paid will cover the pure cost of providing insurance. The premise behind auto insurance is that drivers won’t have car accidents, but if they do, the insurance company will cover the damages attributable to their insured. If drivers don’t have accidents, the company wins. If drivers do have accidents, the company has the option to drop them or assign them to a more expensive risk pool. Now that auto insurance is mandatory in many states, however, all drivers must have access to insurance, and so state-mandated high-risk policies are available and required to be carried by high-risk drivers at, yes, a higher cost to them.

   Health insurance is entirely different. It is implicit that everyone will need health care at some point. The best outcome there is: a risk pool diverse enough so that premiums paid will cover benefits due in any given year. To raise their profit margins, insurers ‘purify the risk pool’ by denying coverage to anyone who might possibly develop a condition requiring treatment. By purifying the risk pool, claims are lowered and profits rise, which makes a healthy balance sheet and an unhealthy population.

   It is a fact that without health benefits, people avoid seeking treatment for conditions which, when untreated, can become life-threatening conditions. Preventive medicine is a cost-saving measure which is included as part of the House health care reform act and which benefits our society as a whole. Excluding people from access to health benefits because they have a pre-existing condition forecloses preventive care,  guarantees that at some point they will turn to the government for assistance because there is nowhere else to turn, and they will do so at the point where treatment costs are most expensive.

3. Question 3: “Why do supporters of nationalized medicine so often substitute the word “care” for the word “insurance?” it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care. ”

   Answer: See my answer to Question 2. It is somewhat disingenous to suggest that the government can’t manage health care benefits and then turn around and claim that everyone ultimately has access to health care. Anyone who has faced a serious illness, injury or condition which requires hospitalization, surgery, or chronic illness care knows that they only receive health care at the risk of losing everything they have worked for, including their home, their job, their savings and their livelihood.

4. Question 4: “No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration? ”

   Answer Health care is rationed now. Some people get it and others don’t. The ones who don’t are the ones with pre-existing conditions, the middle class, the self-employed, and the unemployed who cannot afford COBRA continuation benefits. Those who decide the rationing process are the for-profit insurers, who make their decisions based upon their balance sheets, rather than any moral, medical or social good. What Mr. Prager is asking us to accept is that corporations who have a duty to make a profit and distribute those profits to their shareholders will somehow make medical care decisions which are morally superior to public servants whose only duty is to the people they serve.

5. Question 5: “Given how many lives — in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats’ bill improve or impair Americans’ health?”

   Answer: Given that the price controls relate to established medications which have gone long past the patent expiration and are available as generics, it would appear that this argument is moot. Further, the price controls on drugs are controls agreed to by the pharmaceutical industry.

   Finally, Medicare is currently prohibited from negotiating drug prices under Medicare Part D, that ‘reform’ passed by the Republican Congress under George W. Bush’s watch, which has caused the costs of the Part D benefit to balloon in the past 5 years to double the original CBO score.

6. Question 6: “Do you really believe that private insurance could survive a “public option”? Or is this really a cover for the ideal of single-payer medical care?”

   Answer: This is the heart of the argument at last. Even insurance companies agree that everyone should be covered and pre-existing conditions exclusions should go away. However, they want that captive group — the 47 million uninsured who will now be required to buy insurance. Introduction of a public option means they cannot operate in a monopolistic fashion. They will have to compete.

   As demonstrated with Medicare Advantage plans, insurers have figured out how to be profitable and compete, provided they receive government subsidies. Administrative costs in private insurers’ plans are twice the cost of public Medicare costs. Insurance companies “save” by excluding those who might be a risk.

   One possibility for profit margins: Split the company. Make the company providing the basic benefits a not-for-profit company, and offer insurance through a for-profit company for ‘luxury benefits’. Insureds could hold policies with both. That’s just one idea. Trust me on this. Insurance companies always find ways to make profits. I have yet to see one who hasn’t. It just means they’re not quite as in control of things as they were before. Now they have a true competitor in the same market, something that has been sorely lacking.

7. Question 7: Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven’t the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

   Answer: Hospitals and pharmaceutical companies have agreed to these cuts, and have participated in the process and the dialogue. Presumably they have done so because they expect to benefit in other ways. As for doctors, it’s my understanding that there are still some open issues on how they will be compensated and what “outcomes-based” medicine means in terms of the final health care reform bill. I do think this question is valid and deserves a more specific answer, which may be forthcoming as the bills are reconciled in committee.

8. Question 8: Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn’t any meaningful “reform” of health care provide some remedy for frivolous malpractice lawsuits?

   Answer: Tort reform applies to many areas. Health care is only one. Shouldn’t tort reform be tackled as its own reform dealing with the different areas it touches upon, particularly given the coordination with state law?

9. Question 9: “Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn’t the state of the U.S. economy alone argue against national health care at this time? ”

   Answer: No. There is no question that the health of the economy is inextricably tied to the health of the population. Further, no one is proposing the expenditure of one trillion dollars. The President has said over and over again that he will not sign anything into law that is not deficit-neutral.

10. Question 10: Contrary to the assertion of President Obama — “we spend much more on health care than any other nation but aren’t any healthier for it” — we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?

    Answer: Mr. Prager is basing his assertion on what facts? These are the facts I see:

    1. In 2008, the US ranked last in rankings focused on preventable deaths due to treatable conditions.
    2. The US ranks last or next-to-last on a five-point ranking system of performance: quality, access, efficiency, equity, and healthy lives. It also shows a lag in adoption of IT and use of nurses for care coordination of chronic diseases. (Commonwealth Fund)
    3. The US performs best on preventive care, if patients have access to it. (Commonwealth Fund) See also the Kaiser Foundation report on Health Care and the Middle Class: More Costs and Less Coverage

    The facts point to the truth of President Obama’s assertion. Waiting less time for procedures and surgeries is only good if one has access to the procedures and surgeries. 47 million people don’t. Our life expectancy with any major disease is not necessarily longer, nor is the quality of life better. The problem is not with the practitioners of medicine in the US. The problem is getting access to practitioners.

A pattern and a message emerge from Mr. Prager’s questions. What they are intended to suggest to the reader is that we live in some kind of utopia where we have the best health care available, delivered by the best system in the world. In fact, we have great practitioners, but a growing group of the population has no access to those practitioners. If I had a dime for every person I’ve heard tell me they’re afraid they have some disease or condition but can’t go to the doctor because they don’t have health insurance, I’d have enough money to pay my COBRA continuation premiums for the rest of my life.

Mr. Prager is playing ‘head in the sand’ argumentation. I truly believe that he believes that if we close our eyes and say over and over “there’s no place better than the US”, our health care system will magically improve. The truth is different. Until we face the issues head-on and deal with them, with the understanding that there are just some things government really CAN do better than private enterprise, our economy and our health will continue to suffer.

¹ A term I object to since it politicizes a discussion which should be non-partisan and rationally addressed. Health care is an issue that affects each and every one of us, Republican or Democrat.

Updated post at 3:11pm to include VA reference and Medicare Part D reference

Single Payer – Not necessarily socialized medicine. Not even necessarily the government. Just means one set of uniform paper work to one entity with common standards. Could be very efficient.Would certainly drive costs down for providers, who wouldn’t have to employ nine clerical workers for one professional, just to bill insurance companies and collect. Could make claims processing faster, too. Would not necessarily change your choice of provider. Remember: the payer is not the provider.

Public Option – A plan run by an entity like Medicare, which could take all the people who couldn’t afford or get into private plans. Not necessarily cheaper, or worse. But a way to guarantee health care for people who can’t afford it. Doesn’t make paperwork more efficient, but gives people with pre-existing conditions or no employer a place to get affordable insurance.

Rationing – What we all think of when we think single payer or public option. But in actuality, what we have now in America, where if you can’t afford or qualify for insurance, you don’t get care. We have more “effective” rationing of health care in America than any other developed country. It’s just not rational rationing. Rational rationing involves letting the sickest go first, or the ones with the best future potential. In America, the old and the rich go first. Also the extremely poor. The middle goes last.

Pre-existing conditions – the way we ration now. Back problems, depression, asthma, epilepsy, diabetes, high blood pressure, arthritis are some of the most common pre-existing conditions. Let’s not even talk about cancer.

By age 50, most Americans have one of them, and many Americans have as many as three. Pre-existing conditions are used by insurance companies to stop people from qualifying for health insurance, or to limit the insurance to exclude pre-existing conditions (a “rider” attached to a policy), or to make the cost of insurance so high that entire families go bare.

Employer-sponsored coverage – this is what we have (had) now, which most uninformed people want to protect. What “low information voters” don’t realize, is that 1) the cost of health insurance is part of what drove GM into bankruptcy, and makes large employers so anxious to lay people off whenever the economy hiccups 2)that’s one thing that makes the cost of American goods more expensive than those produced elsewhere and has forced manufacturing offshore; 3)small employers are trying to duck it like the plague, because the cost of insurance makes hiring too costly for them.

Who likes employer-sponsored coverage? The health insurance industry, because it has found the deepest pockets to shift the costs to. Who doesn’t like it? Any small business. Anyone who works in a small business. Anyone who is laid off. Anyone who works for him/herself.

Now. Armed with this information, imagine yourself laid off, or with a
pre-existing condition and wanting to work for a small company, or
self-employed. What do YOU think you would want?

Sometimes it’s necessary to walk a mile in the other person’s mocassins, folks.

I don’t have a dog in this hunt, because I’m on Medicare, which is single payer. But I know what it’s like to be over 50 in a small business (my own) with employees I cared about and a hip that needed replacing. I never told anyone about it because I didn’t want a pre-existing condition to raise our rates. As a result, I was bone-on-bone in pain when I reached age 65, and collapsed in a heap in the orthopedic surgeon’s office, thanking God for Medicare.

OK. I’m officially freaked out by what is happening around health care reform after watching Bill Moyers’ Journal.

Single payer, which was implemented successfully by every other developed country in the world, has been dismissed as “too disruptive.” Instead, we are going to get some hodge-podge combo that will neither lower costs nor decrease paperwork in medical offices, but WILL preserve the insurance industry.

It you don’t like to click on video links (above), here’s the transcript from the first twenty minutes of the show, where a representative of the California Nurses Association, who was insured and had Aflack and a Health Savings Account, tells how she was bankrupted anyway by the illnesses of her family.

This doesn’t even include the testimony in the other half of the show from a representative of 16,000 physicians who are also in favor of a single payer plan, although the last time around it was the AMA that fought what it thought was “socialized medicine.” Now the doctors realize that the alternative is…NO medicine

BILL MOYERS: Welcome to the JOURNAL. Health care reform. It’s the talk of the town – if the town is Washington, D.C. But some possible reforms aren’t being talked about at all. Not officially, that is.

The White House and Congress have kept the lid on one of the most controversial but popular options, known as single-payer. It’s a story the mainstream press has largely ignored and that’s why we are covering it in this broadcast.

You don’t expect to see these people demonstrating in our nation’s capitol. You’ll most likely encounter them in the examining room, the operating theater, the clinic or the laboratory.

They’re doctors, nurses, and other health care professionals, unaccustomed to making themselves heard in the streets.

GERI JENKINS: People are fed up with seeing the process hijacked by the insurance industry. So, we have to keep the heat on. We have to keep putting the pressure on them to have the voice of the people heard and what people in this country really want is, which is a single-payer system, publicly funded, privately administered. And we’re going to keep pushing to make sure that message gets out there.

PROTESTERS: Single-payer! Single-payer! Single-payer!

BILL MOYERS: That’s exactly what brought them here. They want the White House and Congress to know they can’t do their job taking care of us under the health care system the way it is today.

DR. MARGARET FLOWERS:I wanted to take care of patients. And to have insurance companies and administrators that don’t know anything about medicine, telling us what we can and can’t do, was really ridiculous to me. You know, I couldn’t understand it.

DAN HENDERSON: Are we going to let insurance giants decide what’s best for Americans?

PROTESTERS: No!

BILL MOYERS:They’ve come here to tell policy makers how the life-and-death choices they make in caregiving are affected by decisions made in corporate board rooms and behind closed doors in Washington.

DR. PAT SALOMON:There were all these arbitrary decisions, which were not about people’s health care. They were about profits. How can I get away with the least amount of care offered to this person, so that their premium is going to give me the most profit? That’s not the way health care decisions should be made. It’s wrong. It’s wrong for us as a nation.

GERI JENKINS:We’re there around the clock. So we feel a real sense of obligation to advocate for the best interests of our patients and the public. You know, you can talk about policy but when you’re staring at a human face, it’s a whole different story. So I think sometimes people who define policy haven’t seen the human side up close and personal like we see it every day.

BILL MOYERS: What the protestors want is single-payer health care – a non-profit system that would remove the role of the insurance companies and unify the financing of the health care system under one entity, a government run organization, like Medicare, that would collect all health care fees, and pay out all health care costs.

DEANN MCEWEN:Single-payer is really the only solution. It’s the only way we’re going to be able to equitably distribute the resources that we have. It’s the best system that it can possibly be and serve the most number of people.

PROTESTERS: Health care! Not warfare!

BILL MOYERS:A day earlier some of these nurses and doctors showed up at the Senate Finance Committee where Democratic Chairman Max Baucus was holding hearings on health care reform.

SEN. MAX BAUCUS: Today we host the third of our three roundtable discussions on health care reform.

BILL MOYERS:To protest that no advocate of single-payer had been allowed a place at the table, some stood, turned their backs to the committee, then walked out.

Five stayed. Speaking out one by one, interrupting the proceedings.

PROTESTER: We want guaranteed health care. We want to see our doctors when we need.

SEN. MAX BAUCUS: Can we have a recess until order can be restored?

PROTESTER: We want a single-payer system.

PROTESTER: Health care should be for patients, not for profits.

BILL MOYERS: They were quickly gaveled down, escorted out, and arrested.

PROTESTERS: Free Deann now! Free Deann now!

BILL MOYERS: For nurse Deann McEwen it was worth a little jail time just to be heard.

DEANN MCEWEN:They’re our public representatives. You know? They’re supposed to represent us. And here they are, representing the interests of the corporations.

And it’s outrageous. And it’s almost like how dare you not listen to us? You know? We’re here to tell you what we see. We’re the experts, not you. You sit in that chair and you bring the gavel down on single-payer. You’re bringing the gavel down on democracy. And you know, not in my lifetime. Not on my profession.

BILL MOYERS: The next day, with several hundred reinforcements, they marched on Congress.

DR MARGARET FLOWERS: Guess what Senator Baucus? You need the police because you’re the criminals, we are not committing a crime, you are committing the crime of not listening to our voice and not being responsible to the American people.

BILL MOYERS: Two members of Congress spoke up in support. Freshman Representative Eric Massa from upstate New York, a Democrat…

REP. ERIC MASSA: Allow us to get President Obama on the right track, cover his back, give him the political cover he needs to make the tough decisions.

PROTESTER: Thank you Senator Sanders.

BILL MOYERS: And Vermont’s Independent Senator, Bernie Sanders.

SEN. BERNIE SANDERS: All over this place, there are thousands of lobbyists representing greed and short-term profits. And it’s nice to see ordinary people coming here to Washington fighting for the rights of their patients and all of our people.

Our current health care system is disintegrating. We need a new system. And what we need is a system not based on the profits of the private health insurance. We don’t need a system mired down in bureaucracy and waste.

We don’t need a system where CEOs earn all kinds of outrageous salaries. We don’t need a system in which companies are paying out huge profits to their stockholders. What we need is a single-payer, national health care system.

BILL MOYERS: After the rally, they fanned out through the halls of Congress, to make the case for single-payer. But they’re battling the odds – against deep pockets and swarms of highly-paid lobbyists for huge corporations that reap billions from health care profits. But, they say they’re not giving up.

DONNA SMITH: The people still matter. We do matter in this process, and it’s the only thing. If we give up, then we do hand it over to the corporate interests. No human rights struggle in the history of this country’s been an easy one. This is a human rights struggle. We’re going to win it, but we’re going to have to keep fighting and struggling and speaking out. There may have to be more people arrested. There may have to be more brave nurses out there speaking out, but we’re going to win this.

BILL MOYERS:Donna Smith is with me now. She works as a community organizer and legislative advocate for the California Nurses Association, whose 85 thousand members across the country were early champions for a single-payer program. Welcome to the Journal.

DONNA SMITH: Thank you very much, Bill.

BILL MOYERS: What’s going on that you have to take to the streets?

DONNA SMITH: They’re not listening. Congress is not listening to advocates of a single-payer system. In fact, they seem to be bent on one direction and one direction only.

BILL MOYERS: What is that?

DONNA SMITH: Expanding the broken system that we have now. We have so many insurance companies involved in making health care decisions in this country, and so many Americans suffering at the hands of those insurance companies, whether it’s through higher premiums and higher co-pays and deductibles, and all the things that American citizens deal with – not to mention 14 thousand of us losing employer-based health care benefits every day. So having-

BILL MOYERS: 14 thousand-

DONNA SMITH: A day, during this economic recession.

BILL MOYERS: Regular people?

DONNA SMITH: Regular people losing their employer-based system. And yet Congress, certainly the Senate, and certainly – as evidenced through Senator Baucus’s committee – seems to be just on the bee line to make a system where we all have to purchase that private health insurance product that has not been serving us very well as patients, and certainly as nurses and doctors, in this country for many years.

BILL MOYERS: So that moves you out to the streets? That says this is the only way we’re going to be heard?

DONNA SMITH: I think it’s the only way we can. So many formal requests have gone in to the, not only to Congress, but to the administration. President Obama set out to have White House forums on health care reform. He had his first one at the White House. Single-payer advocates had to really protest and get quite active and fax and call, and doctors and nurses threatened to go to the streets to be outside the White House advocating for single-payer, to be let into that discussion. And finally two representatives were invited into that White House forum. They didn’t speak, however, they were invited in.

BILL MOYERS: Now, you must have an opinion as to why that is.

DONNA SMITH: Because they’ve already made a choice. They’ve already made a choice, I think, to stay with the moneyed interest, the people who fund the campaigns, the people who fuel the government system as we know it now. You know, certainly where Senator Baucus is concerned, he’s the third highest recipient of donations from the health insurance and health care industry in general. The third. The highest Democratic recipient. And sometimes I feel so strongly that he ought to have to disclose that at the beginning of every single hearing that he chairs.

BILL MOYERS: But he says, of course, “That doesn’t affect my judgment. This doesn’t affect my decision.”

DONNA SMITH: I don’t think I’d buy that. And I don’t think there’s very many people in this country that would buy that. If you have someone who’s giving you money to insure that your position to stay in a very powerful role in the United States Senate – that’s a prime position politically.

BILL MOYERS: What is it you would like those folks to know, those regular citizens to know about this issue, about single-payer and why it’s important to them?

DONNA SMITH: I tell people, I always ask them to tell me if they understand single-payer and what it’s all about. It’s a great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery. And you put it together in one system that takes out the waste and the abuse that’s really happening, which is where all the money goes into the health insurance. Up to 30 percent of the costs have nothing to do with health care at all and everything to do with fueling the health insurance needs.

And I’ve had so many tell me, doctors and nurses who work in offices where doctors have had to spend hours of every day not in patient care but on the phone, hassling with insurance companies, trying to negotiate to get a patient a treatment. It makes it very difficult to deliver the right kind of care.

BILL MOYERS: I saw your testimony before Congress two years ago, 2007. And you were angry.

DONNA SMITH: Very angry.

DONNA SMITH AT SENATE HEARING: You left me broken and battered because you failed to act on health care reform. Just as I have come out of the shadows of economic ruin and shame, so, too, will others come forward to hold you accountable. Remember the hard-working people who elected you. Their bankruptcy shame, my bankruptcy shame due to medical crisis, really is your shame. You are the body that could have acted and has yet not done so.

BILL MOYERS: You had had cancer of the uterus, and while your husband was suffering from heart disease. And you went bankrupt even though you were insured?

DONNA SMITH: Yep. That’s why I was asked to testify. I tell people that our story, my husband’s and my story’s not unique. It’s not because we’re so unique that people talk about us because we’re not unique. So many millions of Americans do what all middle-class families do. You hang on. You watch your premiums rise over time and your benefits shrink. And as long as you’re healthy, you absorb some of that cost and you deal with it and you make decisions.

But if you get sick, you find out just how inadequate that insurance may be. And I tell people not only did I have health insurance, I had Aflac disability insurance and a health care savings account on top of that. So we were like the prime example of responsible people who try and keep ourselves covered. And yet when we got sick, there was no way the deductibles and out-of-pocket maximum exposure added up so quickly that we were buried very quickly financially.

BILL MOYERS: There are people who would listen sympathetically to that story and nonetheless say that to move to single-payer now would be disruptive of the health care system. That’s the term they use, disruptive.

Do you think that moving to a single-payer plan, even if it were politically feasible, would disrupt the health care system?

DONNA SMITH: What a great question. And you used some of my favorite words in that, “political feasibility.” I often answer that real quickly in saying I hear tell a year and a half ago that a man named Barack Obama, when polled against John McCain, would have lost in every state but Hawaií and Illinois. So political feasibility is all a relative thing, isn’t it?

And I trust that if he wanted to make single-payer happen, he could make it happen. Would it be politically difficult? Absolutely. I sat in a committee meeting with some staff members of Senate Finance some time ago. And somebody gave this argument, it’s not politically feasible to do single-payer. So many people who will say, “Don’t let the perfect be the enemy of the good.”

And I think, well, that’s an interesting analogy, acknowledging that the perfect may be single-payer but that you can’t do it ’cause it’s politically not feasible. So I sat there and I let this person talk. And he said, there’s a visceral reaction to single-payer.

And I let him talk for a minute. I said, “From whom? Who’s the visceral reaction from?” The Congress, he said, because elections are reality. These people have to run for new terms every so often. The money and the power that’s exerted in Washington on them from the health insurance and health industry lobbies is very powerful. It’s hard for them to break out of that loop. It takes an awful lot of nurses and doctors in the streets and being arrested, apparently, and more than 60 percent of the American public to say to them, “We’re behind this. This is what we want you to do.”

And in terms of disrupting the system, oh, my god, talk about disruption. I just saw Max Baucus’s white paper has just been released on what he envisions or what his committee, not just him, but his committee envisions for the future of health care reform financially in this nation. Wow. You talk about complexity and difficulty with what we’ll all have to deal with.

They envision mandates going into effect January 1st of 2013. But any insurance reforms or any tightening up of what happens to insurance companies would be allowed to phase in over a ten-year period.

BILL MOYERS: So what is your strategy? The clock is ticking. The President and Congress have said we want health care reform by the 1st of August. That’s just a few months away. What will you be doing between now and then?

DONNA SMITH: We’re going to stay very active. The nurses, of course, are going to stay in the streets wherever they need to, and very much on the minds of these folks to say this has not been an intellectually honest or policy honest discussion that we’ve had so far in this country. And don’t you think we owe that to each other to at least be intellectually honest about this discussion? And let’s put it all out on the table and argue on the merits. Let’s have a debate on the merits of single-payer on the floor of the Congress and see where it goes from there.

BILL MOYERS: You’ve been saying that, though, Donna Smith. You’ve been saying that, but last week during your rally, only four members of Congress showed up.

DONNA SMITH: You get louder. You get more insistent. You do what many of our nurses are doing. We’re going to do a little more action in California next week. You know, California’s passed single-payer legislation twice now. Governor Schwarzenegger has vetoed it twice. I suspect that California will continue to pass it until they have a governor who signs it.

There are some people who believe that passing single-payer will have to come through a state level first. And that once one of the major states passes it, that it will topple over into the rest of the nation. As people see it as the most cost-effective, smartest way to do it not only for governments but for American families.

BILL MOYERS: When we did a report on the Journal 12 or 15 months ago on the California nurses and the fight out there for single-payer, we were inundated with mail saying they’re socialists and you’re a fellow traveler. What do you say to people like that, who read into what you’re doing a call for state government-run socialistic medical care?

DONNA SMITH: I laugh a little bit in light of the last six months on how much money we’ve thrown into Wall Street and how much money we’ve thrown in keeping financial markets stable in this country. In three days, we were able to come up with three quarters of a trillion dollars to throw into Wall Street. So the argument about socializing things and making things government-run seems a little bit yesterday to me, just intellectually.

But I tell people, you know, look, don’t fear this. This is not- you’re not turning into a Communist red nation. Please don’t be afraid. Even in polling data where the words “socialized medicine” is used, even in that polling data, almost 50 percent of the American public say, “Okay. Do it.” And data where we just ask about a national health insurance system, and that’s through “The New York Times” and CNN and Yahoo! and a number of polls, 60 percent of the American public say we’ve got to have a national health program. We just have to do it. It’s the only way we fix this mess. It’s spun out of control. It’s going to bury us financially. It’s going to mortgage our children, and it kills people. It just is not working.

BILL MOYERS: Donna Smith, thank you very much for being with me on The Journal.

DONNA SMITH: Thank you so much, Bill.

Raise your voice, people. I already live under socialized medicine: Medicare. It’s fabulous, but it is going broke because the rest of the system is incentivized to send the oldest, sickest people to the government. You may not be sick now, and you may think you are insured now, but let me tell you that nobody gets out of this life alive:) It’s worth raising your voice for decent health care and not being sure the government will come to some kind of compromise, abetted by insurance industry campaign donations, that will protect you.