One of the enduring takeaways of the Schwarzenegger era is just how much latitude he is given on the national level as some kind of transformative post-partisan leader, when those same reporters know that California is crumbling into dust under, and in many cases because of, his leadership. We witnessed this again today as national media types heaped praise on the Governor issuing a letter about the Obama health care reform plan:
"As Governor, I have made significant efforts to advance health reform in California. As the Obama Administration was launching the current debate on health care reform, I hosted a bipartisan forum in our state because I believe in the vital importance of this issue, and that it should be addressed through bipartisan cooperation.
"Our principal goals, slowing the growth in costs, enhancing the quality of care delivered, improving the lives of individuals, and helping to ensure a strong economic recovery, are the same goals that the president is trying to achieve. I appreciate his partnership with the states and encourage our colleagues on both sides of the political aisle at the national level to move forward and accomplish these vital goals for the American people."
I love the phrase "significant efforts," by the way. Others might call them "failed efforts," but YMMV.
But this "praise" for health care reform is just a piece of paper. One would think that the national media would seek to know the actions of the Governor on health care - one would be wrong, but one would still think that. And it would take about 10 seconds of Googling to figure out that the Governor has vetoed key elements of the legislation working through Congress. Last year he vetoed AB1945, which would have banned rescission, the insurance industry practice of dumping sick customers for technical violations on their applications like typos the moment that they try to use their policies for treatment. He vetoed SB840, the universal health care bill, on multiple occasions in the past. He vetoed SB1440, which would have mandated that insurance companies spend 85% of premiums on medical care. He vetoed SB973, which would have created a public insurance option by linking local and regional measures. He vetoed AB2, expanding the state's high-risk pool for people with pre-existing conditions.
He basically has vetoed many of the same provisions to be found in the current health care bill. And he is threatening to veto every bill on his desk this year, including another bill to ban rescissions so that customers who have paid insurance premiums for years aren't left to die when they want to use their policies. Anthony Wright notes some of the other bills:
* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender.
* AB 2 (De La Torre): INDEPENDENT REVIEW, to create an independent review process when an insurer wishes to rescind a consumer's health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.
* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services.
* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses.
Dan Walters calls these bills "nothing of cosmic importance". Well sure, he's not going to have a kid, and women are charged more than men by insurance companies anyway! To an entitled white man with a good-paying job, he doesn't have to worry about losing his policy or not getting comprehensive medical coverage. But to a woman who can't afford to lose her job to have a baby, or someone with a mental health problem who can't get relief for his suffering, or someone with an individual policy living constantly in fear that his or her insurance will get revoked precisely when they need it, these are issues of "cosmic importance." Anyone saying otherwise is ignorant.
And yet the Governor will have no problem holding these bills, and these people, hostage. His buddies at the Chamber of Commerce probably don't want him to sign them at all. So he writes a pretty letter supporting health care reform, while denying the very same measures to his own constituents. And national media types call him a "bold leader."
Tom Campbell, among all the Republicans in the gubernatorial field, has at least been willing to lay out detailed plans for how he would fix the state. Typically this manifests itself as the same old Hooverism. But his health care plan at least gets points for creativity.
GOP gubernatorial hopeful Tom Campbell released a unique health care proposal Thursday that would redistribute $42 billion in federal and state funds already spent on health care in California to buy private health coverage for everyone in the state who's "involuntarily" uninsured.
Under the former congressman's plan, the funds would cover an estimated 2 million such people in addition to the 7.6 million already receiving public health coverage under the state Medi-Cal and Healthy Families programs.
"The astounding conclusion," Campbell writes in his proposal, "is that, using only the money already being spent by the federal and state governments for health care in California, we could buy free market health insurance currently available and cover all involuntarily uninsured in California, and still have more than $700 per person left over!"
Instead of dedicating funds to services for the poor or children, Campbell would split the state into regions, and allow insurers to bid against one another to cover everyone in that region who earned below a certain level, along with everyone denied coverage for a pre-existing condition. Insurers wouldn't bid on price, but quality of coverage - the money would be fixed, and insurers would bid against each other based on what they would cover and at what rate.
I'm wondering why any insurer would bid for this right. They deny people with pre-existing conditions because they are more likely to use health care, increasing their medical loss ratio. And the poor are more likely to need health care treatment based on lifestyle and environment. And the kicker to Campbell's plan is, if nobody bids, the status quo would remain in place for that geographical area. So basically, Campbell is touting a big plan that would do... nothing. And he wouldn't embark on it if the federal government enacts their own plan.
Mavericky!
Really, that interesting, if impossible (try getting a federal waiver to set it up and face Congressmembers with interests in protecting SCHIP and Medicaid), proposal is a cover for Campbell's apparent agenda - to permit the interstate sale of insurance and to bring up the canard of tort reform as a panacea. Medical malpractice is an insignificant percentage of total health care costs and states which have embarked on major medmal reform, like Texas, have seen no change in health inflation. As for the interstate sale of insurance, you can do it now - only you're responsible to comply with the laws of the state in which you sell. This proposal would allow insurers to only be responsible to the regulations of the state where they are based. Tom Campbell wants to do for the health insurance industry what this kind of proposal did for the credit card industry - send all insurance companies to a small state with no regulation, and gut all state-based regulation in the process, leaving California's insurance customers at the mercy of the laws of South Dakota or Mississippi.
To his credit, Campbell wants to remove the anti-trust exemption on the insurance industry. But really, that's a means to an end here. However, there is a point of consensus between conservatives and liberals to do away with the McCarran-Ferguson Act, that offers that anti-trust exemption. Bills to this effect were just introduced in Congress. If Campbell wants to talk them up to the California GOP delegation, go ahead.
Last week I discussed the legislative fixes being made to save half a million kids from being dropped from the Healthy Families rolls. This fix would push more costs onto the families, making the program less affordable and the coverage stingier, and would extend a gross premiums tax on insurance companies, which was set to phase out in October, at a lower rate than they are now paying. Keeping that tax at the same rate would have spared families from increased premiums and co-pays.
But saving the program is saving the program, and yesterday the State Senate took the first step.
State lawmakers pushed forward Wednesday with a $196-million plan to keep nearly 700,000 children from being yanked off a government health insurance program for the working poor.
The state Senate passed a measure to create a new tax on insurance companies and bring in federal money to rescue the decade-old Healthy Families program, which had been cut deeply in recent months as lawmakers scrambled to balance the state budget.
Assembly officials expressed confidence that they would garner the needed two-thirds vote in the lower house, where the bill is expected to be taken up today. Administration officials said Gov. Arnold Schwarzenegger would sign the measure.
Again, not quite right. The "new tax" on insurance companies is an extension of an existing tax at a lower rate than before. This is why the insurance companies support the bill; they're getting taxed at a lower rate, keeping 600,000 kids on their insurance rolls, getting the families to pay more, and being credited with saving the program. It's a neat trick. Not only that:
The new tax would replace an existing 5.5% levy set to expire in October, prompting some lawmakers to quip that the new levy is actually a tax reduction. It would expire at the end of next year, and the insurers would be reimbursed for most of their cost.
"Of course the insurance companies want this -- it won't cost them a penny," Aanestad said.
Keeping the premiums tax in place does net $97 million in federal matching funds, which certainly helps matters. And keeping the program alive helps children in tangible ways. But this is a very strange conception of "shared responsibility," when the families participating in the program will have to pay more for premiums and co-pays, with less coverage overall, and the insurance companies get a lowered tax, which they will get reimbursement for down the road.
And the craziest part of all of this is that Sam Aanestad of the Yacht Party, while admitting this is a lowered tax and that insurers will not pay anything in the final analysis, voted against the bill because it "raises taxes on California business."
"Who pays is the bottom line here," said state Sen. Sam Aanestad (R-Grass Valley), who voted against the bill.
Sam Aanestad in this paragraph should read Sam Aanestad from the other paragraph.
...the Assembly passed this today without a no vote. The Governor will sign. Insurers will get their tax cut. Huzzah.
(Disclaimer: I have been hired as a blog fellow for Brave New Films and their Sick For Profit campaign, exposing billionaire health insurance CEOs and their profiting off of denying care. Join the campaign on Facebook)
It's a little shocking that the story of health insurance CEO largesse hasn't been told, by and large, by the Congress in the debate over health care reform. The debate has covered public options and "death panels" and Nazi comparisons and cost curves without addressing the fact that for-profit health insurance companies add almost nothing of value to access or quality of care and exist only to skim off the top and keep as much of their premiums as possible. And they rake in giant profits at the same time. Now Henry Waxman, no stranger to Congressional investigations, wants to put a dollar sign on those profits, specifically what money goes where.
Two powerful House Democrats have sent a letter to insurance companies asking them to provide detailed information about their conferences and retreats, executive pay, and other business practices [...]
The Waxman-Stupak letter asks companies to provide, by mid-September, the compensation packages of any employee or officer who made more than $500,000 in any year from 2003 to 2008. It also asks the companies to list all their board members and their compensation.
The congressmen also want information "listing all conferences, retreats or other events held outside company facilities from January 1, 2007, to the present."
In addition, the letter demands more basic information, such as the companies' total revenues, net income, and total dividend payments, as well as premium revenue, sales expenses and profits.
It seems like, especially considering the prominence of the subject of health care over the past few months, this should be public information. Here's the full letter.
We already have a pretty good understanding of the profits of the insurance companies, as well as the rewards of their CEOs, in salary, options, and additional perks. That was the subject of Sick For Profit, which in the first installment exposed Steven Helmsley, the CEO of United Health Group, and his $13.2 million in compensation in 2007, his $6 million dollar home in Minnesota, and his $744 million in unexercised stock options ($127 million of which he exercised in 2009). But Waxman asking for this information puts it into an investigation. And that gives it a different feel. He can use subpoena power. He can haul the CEOs before the committee. He is in the best position to contrast the 47 million people without health insurance, and the 40 million who are underinsured, with these obscene profits.
This week, Remote Area Medical, an organization that got its start providing health care services to the impoverished in the Third World, descended on Inglewood to provide those same services to the most disenfranchised group, from a medical care standpoint, in the industrialized world - the uninsured and underinsured in America.
They came for new teeth mostly, but also for blood pressure checks, mammograms, immunizations and acupuncture for pain. Neighboring South Los Angeles is a place where health care is scarce, and so when it was offered nearby, word got around.
For the second day in a row, thousands of people lined up on Wednesday - starting after midnight and snaking into the early hours - for free dental, medical and vision services, courtesy of a nonprofit group that more typically provides mobile health care for the rural poor.
Like a giant MASH unit, the floor of the Forum, the arena where Madonna once played four sold-out shows, housed aisle upon aisle of dental chairs, where drilling, cleaning and extracting took place in the open. A few cushions were duct-taped to a folding table in a coat closet, an examining room where Dr. Eugene Taw, a volunteer, saw patients.
These were not only uninsured patients, over 1,500 in the first day alone, but underinsured patients who cannot get the services they need with their coverage.
No cable news outlet discussing health care reform and the town halls around it ever get around to mentioning this reality. In the poorest areas of this country, health care access is so nonexistent that people will wait around for days in their cars, driving for sometimes hundreds of miles, to find a volunteer clinic that they now use as their primary care physician. South Los Angeles lost one of its only health care providers when King-Drew Medical Center shut down a couple years back, and really nobody, outside of Remote Area Medical, has filled the breach. This is an absolute tragedy, and at the end of the day, it costs our medical system far more than it would to cover everyone, because nagging problems only served by free clinics every couple years eventually find their way into the emergency room. And the disconnect between this circumstance and those right-wingers yelling and shrieking across the country is striking.
The enormous response to the free care was a stark corollary to the hundreds of Americans who have filled town-hall-style meetings throughout the country, angrily expressing their fear of the Obama administration's proposed changes to the nation's health care system. The bleachers of patients also reflected the state's high unemployment, recent reduction in its Medicaid services for the poor and high deductibles and co-payments that have come to define many employer-sponsored insurance programs.
Somebody should leak to one of the astroturf groups activating the right about these town halls that there will be a major Congressional event over at the Forum in Inglewood, and then sit back and watch their face sink when they show up to protest and instead encounter the horrors of this broken system.
John Garamendi has been seeking votes in California for well over 30 years. He first took a run for the Governor's mansion in 1982, and was set to do so again in 2010 until the seat in CA-10 opened up, and he was inspired to return to Washington, where he served in the Clinton Administration in the Department of the Interior. He has the most diverse record of anybody in the race, with stints at the federal level, the state legislature, and in two statewide offices, as the Insurance Commissioner and now Lieutenant Governor. In our interview, we discussed health care, lessons learned from regulating insurance, No Child Left Behind, saving the NUMMI plant in Fremont (more on that from Garamendi here), and foreign policy in Iran. I found Garamendi to come at issues in a very comprehensive and thoughtful way, and you can see this for yourself below. A paraphrased transcript follows. (flip it)
The Senate Health Committee held its first hearing on SB810 (Leno), the single-payer health bill. While I've made my belief in the inevitable problems of states trying to fund health care when they cannot deficit spend well-known, if I was on that committee I'd go ahead and vote for it. But I recognize the need to strengthen the broken health care system on all fronts, given the political realities that the Governor has vetoed single-payer multiple times in the past, and that the Republicans will never sign off on the funding, and so even if by some miracle the Governor put pen to paper we would have to wait until 2010 for full passage, and another year for implementation. In the interim, a number of very interesting health care reforms have cleared the Assembly Health Committee already, and progressives should take notice of them. Anthony Wright has some of the details.
The Assembly Health Committee on Tuesday approved a number of key health consumer protections. The measures would expand guarantees of coverage to Californians who are underinsured, uninsured or, in some cases, just plain inadequately served by their health care providers.
One of the bills would sharply increase civil fines in response to the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. Another would address a vast, and quickly expanding, demographic of the uninsured--young adults transitioning between school and careers that offer financial stability and benefits.
Yet another would require insurance brokers and employees to reveal their financial interests-such as paid commissions - in selling certain health care policies. One measure would require private providers to cover more of the costs of doctor-ordered medical equipment, something Medicaid and MediCal already do.
See the post for the full details on AB1521 (insurers revealing their commissions), AB730 (big fines for rescissions), AB29 (raising the age limit for dependent coverage from 19 to 26) and AB214 (requiring health plans to cover durable medical equipment). All 4 would have an immediate and tangible benefit for Californians, and all are common-sense reforms. Fining rescissions would attack the inequities in the system and prevent fraud, as would the agent commission rule. Raising the age limit would provide stability for those young people transitioning from college to starting a career, and adding protections for what is insured also adds stability (the fact that people can be made to pay for their own wheelchair is kind of nuts). None of these deal with the long-term cost drivers that bust state and federal budgets, and none deal comprehensively with the crisis of the uninsured. But all of them help, and we need to press forward on all fronts right now.
On Monday morning the final regional White House forum on health care reform will be held in Los Angeles and at satellite sites throughout California, in San Diego, Oakland and Clovis. Details can be found at HealthReform.Gov. California certainly figures as a good place to talk about health care reform; a study released today by Families USA shows that 37% of all Californians were without health insurance during all or part of 2007 and 2008.
About 12.1 million Californians, or 37% of non-senior residents, were uninsured for at least one month during 2007 and 2008, Ron Pollack, executive director of Families USA, a Washington, D.C.-based group, said Thursday.
Most of them were uninsured for at least six months, Pollack said, and more than 80% of them were in working families. Minorities were more likely to be uninsured; 53% of Latinos and 38% of blacks were uninsured during the two-year period; for whites, 25% were uninsured.
They were among the 86.7 million U.S. residents who went without insurance for at least one month during the same two-year period, according to the organization's count.
The legislature is working to make sure this number doesn't get any larger. They passed a bill yesterday, AB23, allowing workers laid off from small businesses with under 20 workers to apply for the same health insurance subsidy that workers in larger firms can to retain COBRA, as part of the federal stimulus package. Of course, that would impact 60,000 to 100,000 Californians, which is a drop in the bucket given these latest numbers.
Our broken health care system does not merely have an effect on the margins. A near-majority of Californians face this crisis in a very direct way. And with the recession only getting worse here, and slipping into Depression in some areas, something must be done as soon as possible to remedy this, both for fiscal reasons and reasons of basic humanity.
With this epic FAIL maneuver on the budget, Arnold Schwarzenegger signaling here that his little state employee wage cut gambit didn't work. It didn't produce the kind of compromise he wanted and it sent him tumbling in the polls as he attempted to cynically hold innocent bystanders hostage in an unrelated fight. So he had to cut off all bills instead. Maybe now, he thinks, the legislators will take notice.
But let's understand what he's doing here. Yesterday, as a culmination of four years of work, Alan Lowenthal's bill to clean up the ports of Oakland, LA and Long Beach passed the State Senate. Eliminating the toxic pollution at the ports would save 3,700 lives annually according to the California Air Resources Board. The bill would enact a $30 container fee on every import, using that money ($300 million annually) for investment in reducing pollution and improving freight rail. It's a milestone bill that is sorely needed to improve the air quality of these communities.
It's not an exaggeration to say that Arnold's latest stunt will actually kill thousands of people from reversible diseases.
There's a bill pending in the Senate Appropriations Committee authored by Fiona Ma (AB 2716) which would deliver guaranteed paid sick days to all California workers. This bill has the support of 73% of the public and would make the state the first in the nation to provide this to their residents. Arnold would rather stamp his feet and issue ultimatums than improve the lives of Californians and do the bidding of the overwhelming majority of the public.
On health care, while we cannot expect a comprehensive plan to come out of this legislative session, there is a deal coming together that would improve health care for those who have insurance by mandating some strict rules for the industry:
In the final weeks of the legislative session, they are negotiating measures that would limit insurer profits on individual plans, require plans to provide a minimum set of benefits and restrict insurers' ability to cancel policies retroactively [...]
Three million Californians buy health insurance on their own rather than through employers. Insurers keep premiums low -- and profits high, their critics say -- on some individual policies by limiting the services they cover. Such plans may exclude prescription drugs and maternity services, for example; others may cover only hospital visits.
Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.
The game-playing by Arnold on the budget means that, in all likelihood, these rules will not go into effect, and individual consumers of health insurance (like me) will remain incredibly vulnerable to the vicissitudes of the insurance industry, which has shown already a penchant to deny coverage and jack up premiums. That too will put the lives of Californians at risk.
There's a human cost to the bullshit that Terminator Boy isn't accounting for. His head is in the clouds, and he thinks he can bully the legislature liked he bullied people in scripted movies for decades. But the recklessness will cost money, pain, suffering, and even lives.
Dan Weintraub has a stupid column about single-payer health care that uses the same rhetoric that has locked us into a broken status quo for the history of the Republic. He claims that a new legislative analyst's report of the costs of SB840, if implemented today, would leave the state $40 billion dollars in the red after just one year. That's true, but as Sheila Kuehl explains, that's because health care costs have soared while wages remain stagnant, and thus the numbers from the original assessment of the bill are completely out of date. Weintraub then achnowledges this, but asserts that only 50 percent of the deficit can be attributed to a run-up in health care costs.
Of course, that's $20 billion dollars. And one element that Weintraub refuses to consider is cost control, which is the only way any fundamentally new health care system will survive, be it single payer or a collective-responsibility plan like that rejected by the State Senate last year. Weintraub never tries to factor in cost control. He never manages to analyze whether or not a system that takes middle men out of the process and removes the profit driver might be able to reduce the price of quality care. In the same way he never considers whether mandating that insurance companies spend a high percentage of premium revenue on treatment and care would reduce those costs he sees as fixed.
Spending on health care is out of control because there is a patchwork quilt of delivery services, diced up between insurers, hospitals, managed-care organizations, and other elements who add cost without impacting quality. It's, in short, an efficiency problem; the United States is grossly inefficient in its delivery of services, and despite superior technology and high spending has a life expectancy which trails 30 other countries and has the highest rate of underweight babies in 40 years, to cite just two examples. Subjecting a fiscal analysis of a system that would eliminate or sharply reduce the fiscal burden of this quilt to the old rules, and the old costs, makes no sense whatsoever. It's like doing an fiscal analysis in the 21st century of the naval budget, factoring in the effects of ships falling off edge of the world.
There's also the moral argument that we have over seventy million uninsured and underinsured Americans in a country which lists "life" as a fundamental inalienable right. But I'll shove that aside for a moment to deride Weintraub's limiting analysis.
There actually are some things going on outside the primaries, here's what's piqued my interest the past few days:
• Matt Stoller has more on the Barbara Boxer/climate change bill debacle. What hurts the most is that she shut down any debate on the left flank, called progressive groups like Friends of the Earth "defeatists," and pressed forward with a muddled bill that rewards polluting industries without doing the work necessary to provide pushback from the inevitable corporate-funded conservative narratives. I wish she'd just pull it before she causes lasting damage; we'd be in a much better position next year to get something legitimate passed.
• Here's a very good profile in The Nation of almost-a-Congressional candidate Lawrence Lessig and his "Change Congress" movement. I'm kind of waiting for the innovative steps to get this done, but Lessig is a sharp guy. He's giving the keynote address at Netroots Nation next month.
• There's an LA Times exploration of the various health care-related bills moving through the legislature. They're all fairly small-bore but I think they will improve the situation out here, by eliminating rescission, mandating that insurers spend 85% of premium revenue on treatment, and including more procedures in baseline coverage, like maternity. As long as we have the insurance system, we need to do what we can to make sure it's not as thieving as possible.
• There's a new Field Poll on Arnold and the legislature out today that is a cavalcade of bad news - the right track/wrong track numbers are 22/68, the Governor's approval rating is down to 41%, and the legislature is at 30%. Californians don't like their government right now. Some leadership might solve the problem.
• The salmon are dying in the Sacramento/San Joaquin Delta because of ammonia runoff from sewage treatment plants, and purifying the Delta could cost up to $1 billion.
• Here's another personal story of how the foreclosure crisis is hurting individuals, this one in the Central Valley town of Merced. It's impacting practically the entire economy of the town. Just another example of the mess we're in from over-speculation and lax oversight of the financial industry.
Speaker Pelosi on the recent revelations by Scott McClellan:
''This war is a big lie. It was a lie to begin with..and it continues to be a lie..at some point, maybe the lies just got to be too heavy for him to carry.'' (SF Chron Blog)
Congratulations to Fiona Ma and the Assembly for passing Ma's AB 2716, paid sick leave. Business interests howled that it would break them after SF passed mandatory sick leave by initiative. It didn't, and SF is better for it. California will be better for it if the Governor signs the bill.
Note: I do some web work against 98. Not a whole lot of people are coming out in support of Prop 98, while nearly every newspaper, elected official, and interest group opposes it. You have labor, business, good government, environmental, tenants, and the list goes on and on. On the other side, you have, well, apartment owners and Howard Jarvis' corpse that they keep dragging out.
Today, environmental leaders got together in SF to decry the measure for the potential harm it could do to environmental safeguards. And today, Protection and Advocacy, Inc, a lobbying group for disabled Californians came out against Prop 98 and in favor of Prop 99. Poor Jon Coupal must be crying that even with millions of dollars of landlord money, they still can't catch a break by fooling voters and keeping progressive voters from turning out.
A couple more from Dave:
I found someone who supports Prop.98: Jeff Denham! In fact, he'd rather put abolishing rent control on its own ballot. Another reason to vote yes on the recall.
More bills are facing their fate this week, the last to move bills out of one house. And Republicans blocked the bill put together by a federal receiver and supported by the governor, to build additional medical facilities at our overcrowded prisons. The prisons should be less crowded, and there are plenty of steps to be taken, but this is a human rights issue. Prisoners are dying from lack of adequate care, and without implemented some basic standards there is no way the state will avoid a federal takeover of the entire system. That must be just what those big-government conservatives want.
Anthony Wright has the scoop on some other health care bills, outside the prisons, that did manage to pass through one chamber of the legislature. These are some good, sensible proposals, including a mandate that 85% of premium money go toward patient care (SB1440), independent reviews before insurer rescissions (AB1945), expanding the requirement on insurers covering mental health services (AB1887) and maternity services (AB1962), and SB1522, which standardizes insurance and simplifies the process, in effect eliminating "junk" insurance.
Advocacy group Families USA has put out a shocking report (PDF), "Dying For Coverage," detailing how Californians are impacted by a lack of health insurance. The number "47 million" that designates Americans without health insurance is too abstract and detached from meaning. Californians are dying because of their inability to afford or acquire insurance.
• Families USA estimates that more than eight working-age Californians die each day
due to lack of health insurance (approximately 3,100 people in 2006).
• Between 2000 and 2006, the estimated number of adults between the ages of 25
and 64 in California who died because they did not have health insurance was
nearly 19,900.
•Across the United States, in 2006, twice as many people died from lack of health
insurance as died from homicide.
The factors that lead to death include: 1) a lack of preventive care and screening, 2) unnecessary delays for medical care because of affordability concerns, 3) no access to care outside an emergency room, and more.
Some of our Democratic members of Congress have commented on the report.
"This new Families USA study highlights a sad statistic that more people in our country died from lack of health insurance than from homicide between 2000-2006," U.S. Rep. Pete Stark (D-CA) said today. "In California alone, nearly 20,000 people in that time frame died because of being uninsured."
"Our nation has more people in jail than anywhere else in the world in its effort to combat crime," Stark said. "Yet, we allow 47 million people to go without health insurance-which translates into going without needed medical care-each year. It's time to take action and combat the real killer in our country-the lack of universal health care."
"It is appalling and irresponsible that more than eight working-age Californians die due to lack of health insurance each day," U.S. Rep. Hilda L. Solis (D-CA) said today. "In California , 60 percent of the uninsured are Latinos, which means that nearly five Latinos die each day because we cannot ensure access to quality, affordable health care."
"I am fighting in Congress to improve the health of communities of color and strongly support improving access to health care for all populations," Solis said.
When Republicans talk about "cost control" in medical care, they want a world very much like this. They believe that the problem with health insurance is that people have too much of it. They would rather it be limited and used only when necessary, and they would rather Americans hold out and comparison shop when they are ill or infirm. In other words, the conservative vision of health care aligns with the for-profit insurance company vision which directly leads to 8 dead Californians every single day.
As we pick up the pieces from the failure of health care reform from earlier this year, this powerful report shows the dire need to repair the broken system and ensure affordable care for everyone.
It looks as if the Foundation for Taxpayer and Consumer Rights is planning on going to the ballot in 2010 with a proposal to basically do to the health insurance industry what Proposition 103 did to the auto insurance industry.
"We are going ahead with this," said Jamie Court, president of the Santa Monica-based Foundation for Taxpayer and Consumer Rights. "The only thing that would block this is if the single-payer (universal health care) folks want to go ahead and go to the ballot, or if a new president wants to do something more ambitious. In that case, we would back off." [...]
The plan would remove HMOs from the regulatory authority of the state Department of Managed Health Care, which is headed by an appointee of the governor, and place them in the California Department of Insurance, which is run by a publicly elected commissioner. It would order HMOs and others to get their rates approved in advance by the state and force them to justify those rates; rates judged to be "arbitrary or capricious" would be thrown out. Rescinding coverage after an illness sets in would be outlawed. Extra costs for special services, the so-called "out-of-pocket maximums" - would be capped, as would prescription drug costs. Patients would not be penalized for changing doctors or care plans. The HMOs and others would be required to submit detailed financial information to state regulators, who would have the authority to penalize companies for violations and seize and operate companies whose fiscal condition was suspect. There would be language making it easier to sue HMOs and others, and those who bring lawsuits in furtherance of the initiative would be compensated for their time - as in Proposition 103.
This would spark maybe the most expensive initiative fight since Prop. 87 in 2006. In general, if you're going to remain with a for-profit health insurance system, then regulating it to provide for the fairness of California citizens seems apt. Prop. 103 has somehow not left Californians without car insurance. This is a valuable market for that industry, and the same with health insurers.
Health care reform in California is in stall mode right now, and with each passing day the price tag for gathering signatures rises. But between the twin fundraising efforts of the Speaker and the Governor, as long as they cancel travel for a month they should be fine.
What's working against the proponents of health care reform, in my view, is the continuing tragedy of Nataline Sarkysian. By November 2008 this will be out of the headlines, but within weeks the State Senate will be debating the merits of a reform measure that keeps the insurance companies in business to do this:
A Friday funeral was set for the Northridge teenager who died last week after her insurer refused to pay for a liver transplant and then reconsidered. Meanwhile, the girl's health plan stood by its initial decision Monday.
Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.
This is definitely a time to be citing statistics.
CIGNA clearly makes decisions based on corporate profit and lawsuit threats. They decide what treatments are "experimental" based on flowcharts and spreadsheets, not by looking into their customer's eyes. And their complete lack of empathy proves that they're willing to let this continue.
Just the other day, a state appeals court ruled that insurers cannot play the game of canceling coverage because of faulty applications only when the patient actually needs to use their health care.
California health insurers have a duty to check the accuracy of applications for coverage before issuing policies -- and should not wait until patients run up big medical bills, a state appeals court ruled Monday.
The court also said insurers could not cancel a medical policy unless they showed that the policyholder willfully misrepresented his health or that the company had investigated the application before it issued coverage [...]
The decision came in a closely watched case involving Steve Hailey, an Orange County small-business owner whose coverage was canceled by Blue Shield of California after he had a disabling car accident. The ruling in favor of Hailey sends the case back to the lower court for trial and requires Blue Shield to pay Hailey's appellate costs.
The types of tricks of the trade employed by CIGNA and Blue Shield are a nationwide trend. Legislation and lawsuits have yet to stop them. They'll claim that they can't do business without this kind of chicanery. At some point, government must grant their request.
Let me clear out my Inbox and set you on your weekend way:
• The Megan's Law website apparently is being used as a hit list and may have led to at least one death. This is the downside of a "what about the children?" über alles mentality.
• I'm not entirely certain about this claim that state lawmakers could have solved the mortgage crisis back in 2001 by cracking down on predatory lending practices. It's a boilerplate story, a typical "they bought off the politicians" frame. But the problem, as Paul Krugman notes today, is that home prices lowered, leading to negative equity for homeowners. Not sure what the lawmakers could have done about that. This is a national crisis that required federal action. And what action could be taken on the state level is in the purview of the Attorney General. Jerry Brown is investigating home loans from Countrywide Financial for improprieties, particularly forcing buyers with good credit into subprime mortgages.
• For all the talk about Steve Poizner, he is doing his job in suing Blue Shield for their loathsome practice of dropping patients retroactively after they seek coverage. Blue Shield's response?
The state's interpretation of laws governing policy cancellations "is simply wrong."
Stupid state, not knowing their own laws as well as a private entity!
• Nancy Pelosi is under fire for saying that Republicans like this war. Juan Cole is right to slam her for assuming that Republicans would act in good faith and help to end the war after the 2006 elections. What Republican Party was she talking about?
• Anthony Wright has the new amendments released to the public on the new health care reform. I should have a lot more on this over the weekend.
• I know that I didn't execute a House roundup in November, but honestly there wasn't a whole lot going on in the races. So I postponed it and will have a December roundup in the next few days.
• And finally, I would be remiss if I didn't mention the California Democratic Party buying three grand in French wine from Fabian Nuñez, who's now a wine salesman, I guess. I have to acknowledge Kevin Spillane (two Republicans in one day, I know) from the No on 93 campaign for the funny move of sending a bottle of Two Buck Chuck to Nuñez' office. It is an award winner.
This is the benign face of the industry that will undeniably get richer in a forced-market "universal" health care approach:
One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.
Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.
The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.
Cancellation GOALS. That's right. One man's catastrophic medical and financial situation is another man's new boat.
This is of course nothing new. It's standard practice for most insurers. When you get sick and put in a claim to actually use your health insurance, your file is immediately sent to the cancellation department and people review it for the slightest rationale to dump your coverage.
The greatest concern in the post-wildfire landscape of California is the insurance situation. Obviously there are going to be thousands of claims, and how the insurance companies handle them will deserve great scrutiny. John Garamendi, the former Insurance Commissioner and current Lieutenant Governor who has been all over the media this week (building a profile for an attempted 2010 Governor's run - hint hint), has talked a lot about the insurance industry's desire to limit payouts to their customers after the 2003 Cedar Fire.
LT. GOV. GARAMENDI: The first commandment of the insurance industry is, "Thou shalt pay as little, as late, as possible." And then you get the reward. You go to financial heaven if you can carry out that commandment.
BRANCACCIO: California lieutenant governor John Garamendi, a democrat, served twice as the state's insurance commissioner. A total of eight years battling with the industry over the many ways he says it tries to avoid high payouts where there's been a total loss.
LT. GOV. GARAMENDI: I'm telling you, the insurance industry, prior to the fire and probably even to this day, is purposely misleading their customers.
Garamendi was actually pretty relentless in forcing insurers to honor their commitments. Now we have a Republican in the Insurance Commissioner's position. While Sara Nichols wants Steve Poizner to honor his supposed environmental credentials, I'm worried that he will let too many insurers off the hook. Plus, with fires wrecking the landscape around homes and making them more vulnerable to mudslides, the ability of those homeowners to get insurance for those potential disasters is a major concern.
All of this is mad possible by the revolving-door manner in which top Democrats have shuffled statewide positions in recent years, leaving us with maybe the worst Democratic candidate possible for Insurance Commissioner in 2006, Cruz Bustamante. He was crushed, not only because Poizner outspent him, but because he was a horrible, ethically compromised candidate. But Insurance Commissioner was available to him, so that's were he went. This musical chairs in these top seats ends up having a major impact in times like this.
So after being peppered with criticism from both term limits groups and the California Nurses Association, the Speaker's office has chosen which group to strike back at: the nurses, of course, using the exact same standard of judgment that they called a "smear job" when it was used against Nuñez.
This is an argument over improving the delivery and cost of health care, and there's plenty of ideological rigidity to go around. What started as a promising "year of health care reform" has devolved into putative allies arguing about how much money the other spends on hotel rooms. Behind the mere gaining of political points is a serious debate about how to best allow all California citizens, not just the ones with full-time employment (us freelancers need health care too), the highest quality affordable health care they can manage. And the real truth of the matter, the one that nobody really wants to talk about, is that none of these state-based plans, by definition, have any hope of working and have serious potential consequences, besides. I think that's why everyone's getting so mad at one another, because it's easier to do so than to face the facts.
We've got all these great universal bills passing at the state level, and I'm here to tell you that, well, they are pretty great, but they're not going to work. It didn't work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn't work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state's revenues dropped. It didn't work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.
The plans fall for a few small reasons, and one big one. The big one is that states don't have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don't exist the state can't borrow the money. So they dismantle the program. It's happened time and time again -- in some states, like Oregon, more than once.
Moreover, you don't really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access - it's actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don't have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don't trust them to fundamentally reform the system.
California is obviously one state that has the size, and certainly could float ever more bonds to spend the necessary money. But we're almost certainly on the cusp of a new recession, and the combination of massive debt passed on to grandkids and a pay-to-play system that still reigns supreme in Sacramento is unpalatable to reform.
I repsect the efforts of groups like Physicians for a Naitonal Health Plan, who have studied the issue and recommended some of the best possible solutions. But that word "national" is hard to get around; it's the only way to create the real economies of scale and managed risk necessary for a solution. I believe in health care for everyone, not simply in red states or blue states. As Ezra Klein notes,
You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the "laboratories of democracy." But there's another Brandeis saying that I think is more applicable: "If we would guide by the light of reason," he said, "we must let our minds be bold." And that's what I'm asking: Be bold. Because nothing else will, in the long term, work.
I've been watching the debate in the Congress over expanding S-CHIP (the State Children's Health Insurance Program) today while waiting for my plane travel to Yearly Kos, and I'm reminded of how dishonest Republicans are on this issue. They created the block grant program to give states the ability to cover children, and now when it's become popular and successful, and state governors want to expand it more, they suddenly want to stop it. And they're using the familiar "this would let illegal immigrants get free health care" canard to try and submarine the bill (incidentally, it doesn't).
It's important to chronicle this, because it's the opening salvo in the battle to change the health care system in this country. In California we're gearing up for health care reform, and today The California Budget Project and the UCLA Center for Health Policy Research released a joint report that ably shows the consequences of maintaining the broken status quo on health care as the Republicans want to do:
