Health Care You Can Keep

US Senator Ron Wyden has a new video at his website, Stand Tall for America, promoting his Healthy Americans Act. Check it out:


  • Jack Sullivan (unverified)

    This is seriously funny stuff! Bravo!

  • Stephen Holland (unverified)

    Best political ad I've seen in a long time.

  • (Show?)

    This is hilarious. Brilliant.

  • (Show?)

    Ditto on what Charlie said.

    I love it.

  • (Show?)

    The people depicted in that ad seem awfully bitter.

    Seriously, though, I do have to wonder if this ad isn't misleading about the plan. Does anyone really expect any final version of this bill to provide health care if you quit your job? You don't even get unemployment insurance if you quit. I can't really imagine any legislation getting through Congress that would let you tell your employer to "take this job and shove it" while simultaneously making sure you can "afford a high-quality, private health plan." The impression the ad gives is that you'll be able to quit and keep coverage, despite the fact that you might not have any income (which you wouldn't unless you had another job lined up).

  • (unverified)

    And yet, that's exactly what the healthy Americans act, a bill already sponsored by 12 Senators, including 6 republicans, does. The cost of the coverage, coverage equal to what members of congress and their staff have, is based on your income, if you are not earning any income, your premiums are paid for you - yes darrelplant, even if you quit your job.

    This is a market based plan, clearly they believe that it's none of the government's damn business why you left your job (to go back to school, to go surfing, to go found apple computer or microsoft in your garage) just that the nation benefits when everyone has health coverage and the plan ensures that no one is without coverage at any time in a very efficient way. The benefits to the country of this system are far greater than the risk that a few folks might luxuriate in their free health care while avoiding income of any kind. Zonker Harris just aint that common a guy.

    This is one of the things that brought me to the this plan. The fact that it guarantees affordability - if you are not earning any money, you health coverage is free, if you're earning some money, you pay something, but always no more than should be affordable on a family budget, and if you're earning a lot, you're no longer getting a tax subsidy to buy luxury-level health coverage while 40 million people have nothing.

  • (Show?)

    The whole point is that your employment and your health insurance have been divorced.

    Businesses like it, because it means that they don't have to continue to deal with all the hassles of being the one to provide health insurance - the cost of the premiums, mailing and providing info about sign up, etc. And for those businesses that have unions, health insurance will no longer be something they have to wrangle over come contract time. How many employers have lost a great potential employee because another company was offering better insurance?

    People like it because they're no longer tied to their job for their insurance. Lots of people would love to move to a different job, but can't afford the break in insurance. There's the worry about what if something happens in the interim - a serious illness, unexpected surgery, etc.

    Not to mention the decreases in costs that go along with a system like this.

    There's a lot to like about Wyden's plan. It may not be the best plan possible, but it is wayyyyy better than what we have now, and is a huge step in the right direction.

  • (Show?)

    I'm in favor of the Healthy Americans Act. I'm not in favor of this ad. Too weird, too many negative messages. I'm bitter and I don't like this ad!

  • Health care is a right (unverified)

    Too bad elitists like Ron and Hillary (and pathetic suckup wannabes like Jenni and the editors at Blue Oregon) think we are too stupid to not understand that all they propose is forcing us to generate huge profits for private health insurance companies and giving us no control over our health care system. Ron can only get Republicans and corporate Democrats to support his plan to rip-off working people. A public health insurance system like the Canadians have is the only moral defensible worker friendly plan, private health insurance companies have no place in our health care system, and anybody who advocates a corrupt plan like Ron's and Hillary's should have no welcome in the Democratic Party.

  • (Show?)

    Actually, my preference is a single payer system that gets our health care out of the private insurance companies' hands.

    Does that mean I am going to oppose a plan that is much more likely to make it through Congress? A plan that will cover millions of Americans without insurance, bring down the costs for those of us who have insurance, etc. No way.

    People without insurance die all the time because they don't have insurance. They don't get the early checks that would have allowed them to get cancer treatments earlier. They don't have access to expensive treatments. They can't afford medications that help with major medical ailments.

    Do I want to condemn thousands of people to die because I reject something better than we have now that isn't the optimal plan? No.

    I understand that sometimes things have to be done in steps, whether I like it that way or not.

  • (Show?)

    And I should say that this is coming from someone who is far from being elitist.

    As it is, if our insurance cost goes up anymore, we're going to have to drop our coverage. Even with my husband's work paying for a portion of his insurance, just the premium costs us about 17% of my husband's annual income. Not to mention $30 copays for a generic doctor's visit, $45 for an Ob/Gyn visit, $150 for an ER visit, and only a 80% payment from the insurance after we meet the several thousand dollar deductible.

  • Health care is a right (unverified)

    And by the way r. scot. The plan doesn't guarantee affordability of health care, only affordability of private health insurance and profits for private health insurance companies. Over time, our health care will continue to be substandard since insurance companies will need to continue to drive down care to insure their financial returns. In the spirit of full disclosure, why doesn't Ron report on his website how much campaign funding he gets from business sectors connected with the health insurance and health care industry?

    By the way, what is not disclosed here is that Mandate Media, Kari's company says on their website as part of their sales pitch that "We publish two popular and influential blogs - BlueOregon and Western Democrat." They list Senator Ron Wyden as a customer and take credit on the "Stand Tall for America" website (which in the fine print says is copyright by the Wyden for Senate organization) as "producer". Blue Oregon has always just been a marketing channel for the things Mandate Media is selling. Everybody knows that, of course, but it needs to be pointed out whenever Kari and Carrie start attempting to blue-wash something for their paying customers like Ron was they carry water for corrupt corporate interests like the private health insurance industry.

  • Health care is a right (unverified)

    Jenni, elitism is a state of mind and you have it if you believe Wyden's plan is respectful and beneficial for working people. If you are dumb enough to believe you are going to get the quality and range of health services you need as our system is turned over even more to private health insurance companies, you have nothing intelligent to add to the debate. Get behind a public health insurance plan and tell Ron you'll vote against him and vote for a real Democrat in his next primary race if he doesn't support that instead of pushing his scummy plan to rip us off.

    For the rest who care about serious analyses:

    Lewin Group analysis of Sen. Wyden's plan (See "Comment" by Don McCanne, MD halfway down)


    Wyden's "Healthy Americans Act" is Wrong Model for Health Reform

    Note especially how Wyden's plan is based on the same elitist, pro-corporate health insurance industry idea of forcing working people to contribute to the profits of private health insurance industry as Massachussett's recently enacted plan. The MA plan already is facing economic failure even as elitist supporters talk about sticking it to working people again by charging them even more.

  • Health care is a right (unverified)

    Here's a proposal for commentators:

    Let's collectively us this thread to come up with a disclaimer we want to see on every Blue Oregon post talking about something one of Kari and Carrie's customers are trying to blue-wash. Any proposals?

  • (Show?)

    See, that's your problem. It can't be all or nothing.

    As much as I want to see a single payer system with no private insurance companies involved in it, we're not going to get it right now. It isn't going to happen. There is still too much of country that is not for such a system. I believe such a system has a much better chance once my generation takes over the government, since we're much open minded on such things than previous generations (which is typically the case on anything).

    And believe me, I am very far from being elitist - not in practice, mind, or anything else. I'm a realist and I understand what is possible right now and what isn't.

    From Wikipedia:

    "Elitism is the belief or attitude that those individuals like John McCain who are considered members of the elite — a select group of people with outstanding personal abilities, intellect, wealth, specialized training or experience, or other distinctive attributes — are those whose views on a matter are to be taken the most seriously or carry the most weight; whose views and/or actions are most likely to be constructive to society as a whole; or whose extraordinary skills, abilities or wisdom render them especially fit to govern [1]. Alternatively, the term elitism may be used to describe a situation in which power is concentrated in the hands of the elite." "The term "elitism" or the title "elitist" can be used resentfully [1] by a person who is not a member of an elite, or is a member but resents the elite position or uses it in a condescending or cynical manner in order to ridicule or criticize practices which discriminate on the basis of ability or attributes. Often, such as in politics, it used to describe persons as out of touch with the common people. The implication is that the "elitist" person or group thinks they are better than everyone else, and therefore put themselves before others. It could be seen as a synonym for snob. An elitist is not always seen as truly elite, but only privileged. This is use is often employed in politics in societies where social equality is valued, and the middle and lower classes have political power."

    Elitism is something that people like to throw around and use towards people, and often times it is completely incorrect.

  • rants are a right (unverified)

    Since you are seeing conspiracy everywhere, maybe you would like to explain how everyone else who posted Wyden's ad on their sites is also corrupt. Google Wyden's ad and you will find a variety of progressive blogs had stories about his video, just like BlueOregon -- DailyKos andEzra Klein (American Prospect) among them.

    And where do you get off calling good people like Sen. Stabenow and Sen. Inouye "corporate Democrats?"

    Single payer legislation has been introduced in Washington every single Congress since the end of WWII. Never once has it come close to passing in either house of congress. Please explain to us how 2009 will be the year. And if you are wrong, how many Americans will die because you are quite willing to continue to allow the perfect to be the enemy of the good?

  • (Show?)

    For the record, I had nothing to do with this post. I spent all day talking to bloggers about this video - but deliberately didn't post it here.

  • Health care is a right (unverified)

    Jenni, students who cite wikipedia are summarily flunked, as they should be. So maybe you are both ignorant and an elitist? Your "practical" argument is as full of BS as you are because Ron can only get a handful of sold-out Democrats like Stabenow and Inouye to support his plan. Be smart: it's apparent you don't have anything intelligent to offer, so just try to learn from how idiots like "rants' embarrass themselves.

    "rants are right", one never has to explain as a conspiracy that which is more easily explained by ignorance or lack of moral fiber. I don't care what other blogs do, only BO is published by Mandate Media that has Wyden as a paying client and is being used to blue-wash a fundamentally Republican plan. As far as Stabenow and Inouye, take a closer look at Stabenow's voting record, like how she voted against Dodd's amendment stripping immunity for telecoms from the FISA bill, where she's already proven she's not half the Democrat she campaigned as. And Inouye always has always been a member of the DLC, he even supported Lieberman over Lamont in the 2006 general election. So where I get off, you dishonest little worm, is by citing the facts and pointing out how you are really just playing a game in which you gamble that most people won't know the actual record of people like Stabenow and Inouye viz a viz corporate America.

    Notice also how sad little "rants" didn't deal with the substance of why Wyden's plan is about sticking it to working people? Instead we get an argument that is laughable on it's face. Wyden's plan doesn't have a prayer of gathering enough Democratic votes to pass either, even given the number of sold out and cowering Democrats, unless the insurance industry can buy a few more seats this time around. Wyden is selling a corrupt Republican plan that will fail just as the MA plan is failing now because he is more interested in helping insurance companies than his constituency. Jenni and "rants" are doing their best impression of a "dittohead" by just parroting empty talking points.

    In fact, it looks like Wyden is pushing his plan more for the benefit of his re-election campaign than anything else. He puts out intentionally deceptive information about the parts of his plan that are givens with any kind of public health insurance plan, sounding like he actually supports universal health care rather than mandatory universal private health insurance, knowing clowns like "rants" will deflect debate about how he is just fine screwing working people if it puts money in the pocket of the corporate interests he represents. That's why the BO - Mandate Media blue-wash scam is relevant to the debate.

    "rants", a lot of people aren't going to get the health care they need because people like you keep propagandizing for plans like Wyden's. These plans for providing orporate welfare on the backs of working people won't pass unless more elitist elected officials join the effort to ripoff us off by forcing us to pay what amount to a "living tax" to private health insurance companies and in exchange give us far less health care than we would get in a public health insurance system. So "rants", how many people are you will to allow to suffer unless we give into this extortion by you, Ron, and the industry? It's time to shame people like you, Jenni, and Ron right out of the public debate and the Democratic Party so we can start saving lives and getting people the health care they need and deserve in an affordable, sustainable way.

  • Katy (unverified)

    That made me really not want to go to work tomorrow morning. Great ad.

  • (Show?)

    Ok, since you won't accept the Wikipedia explanation, how about these, which are from sources that absolutely are accepted by schools, colleges, and universities:

    e·lit·ism [ i l tìzzəm, ay l tìzzəm ]

    noun Definition:

    1. belief in concept of superiority: the belief that some people or things are inherently superior to others and deserve preeminence, preferential treatment, or higher rewards because of their superiority

    2. belief in control by small group: the belief that government or control should be in the hands of a small group of privileged, wealthy, or intelligent people, or the active promotion of such a system

    3. control by small group: government or control by a small, specially qualified, or privileged group

    e·lit·ist noun, adjective Encarta® World English Dictionary


    Elitism, restricting powers and privileges in a society to members of one small, favored group, and the belief that this arrangement is justified by their superiority.

    "Elitism," Microsoft® Encarta® Online Encyclopedia 2007


    The only one around here who is acting like an elitist would be you, according to the definition of the word ("belief in concept of superiority: the belief that some people or things are inherently superior to others and deserve preeminence, preferential treatment, or higher rewards because of their superiority").

    You're the one going around saying everyone else's arguments must be wrong, that they must be ignorant or stupid, etc. Maybe you should look in the mirror.

  • Harry Kershner (unverified)

    Q: Who wants a single payer, Canadian style, private delivery, public health insurance system?

    A: Only a majority of the people, so it's politically unfeasible, since Wyden's corporate donors won't allow it.

    And only one presidential candidate will fight for what the people want. Guess who. (Hint: It's not Obama, Clinton or McCain)

  • Health care is a right (unverified)

    Jenni, what about that definition do you feel does not describe your position that working people should give welfare to private insurance companies? Aside from the fact, that is, that you are arguing for a plan that is contrary to the wishes of the majority of Americans, as Harry points out. If you actually believed health care is a right you wouldn't be arguing for a plan which is predicated specifically on rejection of that idea.

    You might try this one out specifically. By your own comments it is apparent you don't seem to understand the full meaning of the definition:

    "Elitism, restricting powers and privileges in a society to members of one small, favored group, and the belief that this arrangement is justified by their superiority."

    As in: You are elitist because you don't argue working people should be accorded the respect of a public health insurance plan. Instead you advance a patently nonsensical argument rationalizing your support for Ron's plan that explicitly says working people don't deserve anything more than being forced to pay a "living tax" to elite corporate interests who exercise enormous control over our public policy for their own benefit.

    As already noted, Wyden is no more going to get sufficient support for this plan than you allege single payer advocates will, yet you choose to advocate for his plan rather than criticizing him for it. That means you either aren't the sharpest tack in the box, or just like it for some reason other than it will actually come to pass, or finally that you actually believe it will pass despite the facts and have no problem that it would force working people buy over-priced private health insurance. Or maybe all three are the case (which is what I believe).

    If you really did have a brain in your head, you'd read the cites and try to criticize why they are wrong to justify why you think we should pay a "living tax" to private health insurance companies. No one can help it that you are elitist in your thinking, but maybe just aren't smart enough to get a cut of the booty. Pointing that fact out to you has nothing to do with elitism. Elitism is you believing no one has the right to point out to you the truth about Ron's plan and about you for supporting it.

    Harry: Ralph Nader. I like Nader, but wouldn't consider myself a Nader partisan and so no one should try to use my comments here to make an argument against Nader.

  • Missy (unverified)

    Someone needs some anger management:

    "So "rants", how many people are you will to allow to suffer unless we give into this extortion by you, Ron, and the industry? It's time to shame people like you, Jenni, and Ron right out of the public debate and the Democratic Party so we can start saving lives and getting people the health care they need and deserve in an affordable, sustainable way."

    As funny as Wyden's video is -- and it's Novick-quality funny (and no, I'm not saying Wyden is anywhere close to Steve's league when it comes to being funny; just his video) -- "Health Care is a Right" is much funnier. Jenni Simonis (I sure like her taste in Senate candidates!) is, according to you, dumb and elitist, and Jenni and Wyden need to be drummed out of the Democratic Party. That's brilliant stuff!

    Health care is a right - did you notice Kari's comment that he didn't post the item on Wyden? Kari obviously has a ton of Democratic clients. If BlueOregon refused to post anything at all on all of Kari's clients we wouldn't know what half of Oregon's elected officials and candidates are up to. PaleBlueOregon? That would be so sad!

    I have to ask you a teensy, tinesy favor: Will you PLEASE respond by calling me a "dishonest little worm?" That will make my day! Or come up with something new, just for me. Please! I've never been called a "worm."

  • (Show?)
    And yet, that's exactly what the healthy Americans act, a bill already sponsored by 12 Senators, including 6 republicans, does.

    r., you seem to have missed the part of my comment where I asked "Does anyone really expect any final version of this bill to provide health care if you quit your job?" There's often a great disparity between what gets proposed in a bill that goes into Congress' maw- and what comes out of the legislative end.

    I haven't seen anything in my reading about the bill that even justifies the claims that the bill as proposed will cover your plan no matter what your circumstances. Any citations for that?

  • Health care is a right (unverified)

    Little Missy, first thanks for quoting the most important point about how disrespectful Ron and supporters of his plan are of average folks who are already getting ripped of by our private health insurance system. And then providing your own personal example of that with deflecting comments that show you apparently don't have any substantive thoughts on the matter or concern for people. You do seem to respond well to PR tactics, though, something that makes you a very good and pliant follower.

    Why don't you take a shot at answering the critique of Wyden's plan in the cites, since you clearly can't defend the elitism in Jenni's comments? I'll even repeat the cites for you:

    Lewin Group analysis of Sen. Wyden's plan (See "Comment" by Don McCanne, MD halfway down)


    Wyden's "Healthy Americans Act" is Wrong Model for Health Reform

  • Health care is a right (unverified)

    nd I'll through in two about the MA plan mentioned in the second cite as being in the same category as Ron's plan. Make your best argument why these plans like these (and Hillary's and Bates/Westlund plan under SB-329 right here in Oregon) that force working folks to pay an extortionate "living tax" to fatten the profits of private health insurance companies and don't actually control health care costs, are what we want:

    Costs Soar for Mass. Health Care Law

    Doctors Give Massachusetts Health Reform a Failing Grade Poor Early Outcomes Raise Red Flags, Only Private Insurers Profit

    What was that elitist argument about Ron's Republican plan being blue-washed here because it was "practical"? MA's elitist solution: Shake down lower income people who smoke more than upper income people again by increasing tobacco taxes to give even more money to private health insurance companies without delivering any more health care, any more cost effectively. Sound familiar, like right from the mouth of our "I'll pretend to be a foodstamp recipient for week", elitist governor? No matter how condescending supporters of these Republican, corporations-before-people plans are towards average working people, we are smart enough to see what is going on here.

    darrelplant makes a good point that a final version is unlikely to contain even the minimal selling points Ron offers as his best argument. Beyond that, as the MA plan shows, even if some version of portability is included, those of us who lose our jobs will be increasingly forced to spend more than we should to profit private health insurance companies rather than to get cost effective health care.

  • Health care is a right (unverified)

    Shorter link for AP story (preview wraps the link, post doesn't):

    Costs Soar for Mass. Health Care Law

  • MCT (unverified)

    Yep. Funny.

    But who are we kidding? Keeping health insurance when you quit or lose a job is moot. You'd still have to pay for it. And without a job, even temporarily, you might have trouble meeting, and meting your bills. Especially for someone like a barista. Some bills might get put off, or paid late. That would lower your credit score.

    And as we know, in Oregon, that is STILL a free pass for insurance companies to raise all your insurance premiums...possibly beyond your reach. So you'd lose your insurance anyway. AND it's likely your credit card rates would jump sky high, too. And it could put your job hunt in jeopardy...some companies don't bother with drug and criminal background checks. They run a credit check, the thinking being that if your finances are sideways, you are not responsible enough to work for them.

    There is a sad irony in the fact that 1200 jobs were lost in Oregon last month. It's likely that some of the people who believed big insurance's lobby & lies on Measure 42, and voted against it....are now in a position to become victims of their vote.

    I truly hope our elected officials start looking at the bigger picture....and soon.

  • (Show?)


    No, no, no. You need to read Wyden's plan.

    Under the Healthy Americans Act:

    1) If you have no income, health care is free.

    2) In a given market (say, Portland) insurance companies will be required to offer EVERYONE the same exact rate. They can't raise your rates because of a pre-existing condition and they can't raise your rates because of your credit score. (Smoking, yes.)

    3) Insurance companies will be prohibited from denying anyone coverage. Period.

    Seriously, please read the plan. Or at least a few of the bullet points over at Wyden's plan is a far, far cry from simply making everyone get insurance in the existing market.

    Full disclosure: My firm manages Wyden's policy-promotion website, Stand Tall for America, but I speak only for myself.

  • trishka (unverified)

    it never ceases to amaze me the number of single-payer health care supportes who believe that the powerful insurance lobby is just going to up and disappear just because, well, they want them to, and darn it! it would be the right thing to do!

    once again i'm choosing to be happy over right. single-payer would be the right thing to do in this country. but it would make me happy to see a plan pass through the legislature that is a vast improvement over the mess we're in now. and once again i'm choosing to be happy rather than right.

  • (Show?)
    Under the Healthy Americans Act: 1) If you have no income, health care is free.

    Hardly anyone has no income. SSI, Social Security, pensions (for some folks), etc. I've looked at the plan, but I haven't found the part that specifies what would happen to you for the period between when, say, you quit a job, were living without income, and were looking for another job. That seems as if it would be dealt with by the state health provider agencies (HHAs) specified in the bill. I love the part about how people who aren't enrolled are fined for not purchasing mandatory health care (that you can keep!).

    Given the rather liberal interpretations possible in 50 different state agencies, color me skeptical. The wording in the section on subsidies, for example says that in the case of someone whose modified gross income is above 100 percent of the poverty line the HHA "may" provide a subsidy "equal to the part of the amount of any personal responsibility contributions applicable to such individual."

    That's not exactly a promise that someone making, say, $30K who quits their job (as portrayed in the ad) is going to get a single dime to cover their health care if they're out of work. It sounds like it's going to be up to the HHA, which might decide that they're doing well enough that they don't need a subsidy right off the bat. And if they miss a couple of months payments, they could end up getting fined by the HHA.

    once again i'm choosing to be happy over right. single-payer would be the right thing to do in this country. but it would make me happy to see a plan pass through the legislature ...

    These little happy (HAPI) acts always amuse me, but not in a good way. The whole "pass through the legislature" thing is where I wonder about this plan breaking down.

    I haven't run across anything about preventing profiteering from this system, either.

    Oh, and considering that the payment subsidies are based on a self-reporting mechanism, does anyone else think that this whole thing's going to become yet another stalking horse for Republicans nattering on about fraud?

  • MCT (unverified)

    Thanks Kari...I stand corrected. It does sound too good to be true, and somewhat of an administrative nightmare. What about self employed people, and commission only workers...folks who have fluxuating income? Like me, feast or famine? (Or more like catch up on all your bills, and famine again.)

    I'd like to believe this could pass, but I don't imagine big insurance lobbyists will agree without a mustering of forces. BTW does this plan cover dental and vision as well?

    As a lifer self employed person with pre-existing conditions (which have posed no further problems for nearly 25 years)my premiums shot up to nearly $600 per mo. years ago. Couldn't do it, after paying high premiums for years, I had to let it go. I've been flying without a net for 7 years now. Can't imagine what they would charge me now. But I am one of the fortunate OHP 'lottery' winners...just sent in my application for the Oregon Health Plan. If I get it, I probably won't be able to keep it more than the initial 6 months but at least I can have a thorough check up. At least I pray to God this economy doesn't crush me, and that I will have too much income to remain on the plan. My other choice is homelessness, but being able to stay on the Oregon Health Plan. Ain't that a kick in the pants? I have worked and paid taxes all my life. Still I am grateful.

    If Mr. Wyden call pull this off he's a hero. Can't happen soon enough.

  • (Show?)

    You bet, MCT. Banning forever the phrase "pre-existing conditions" would be an extraordinary thing.

    Darrel is right that there are lots of details yet to be worked out. Some will be in the legislation, some in the regulations. Wyden's bill is a way to start the legislative process, not end it.

    And Trishka is exactly right -- we've waited sixty years now since Harry Truman called for universal health care. We can either a few more decades for the single-payer advocates to marshal the support... or we can pass something now, give 47 million people health care, end pre-existing conditions, establish precedents for affordability and portability, and get it all done in one year. And then, once that's done, we can go back to working toward single-payer.

  • (Show?)
    And then, once that's done, we can go back to working toward single-payer.

    Kari, I'd like to believe that's the plan, but it seems a lot more like kicking the ball down the lane for a few more decades. Sort of like the plan to get out of Iraq or impeachment. It's too hard to do, so let's just not talk about it at all or try to split the difference.

    If this is a step toward single-payer, then the plan should be saying that up front. Congressional backers should be telling people why single-payer is the right thing to do and trying to convince the American public to support it.

    To me this looks like a jerry-rigged plan that has the potential to sour people on government-sponsored health care, with state agencies hunting people down for fees, potential for both user fraud (and bogus claims of user fraud) and insurance companies getting guaranteed payments from government coffers with no restrictions on profits. Halliburton for health care.

    I'm not some starry-eyed optimist who thinks that if the government ran the whole thing that there wouldn't be problems. But with this system, there are so many different levels -- patients, private health providers, insurers, state agencies, federal management -- that oversight would be a nightmare. The health care system isn't exactly well-policed.

  • Health care is a right (unverified)

    trishka, I know you're a typical clueless (Blue) Oregonian, but no single payer advocate I know believes "that the powerful insurance lobby is just going to up and disappear just because, well, they want them to, and darn it! it would be the right thing to do!" They quite realize it is the kind of tough political fight we've always had to fight as working people, for which smarmy, piggish people like you bear a large part of the blame.

    Kari, it's clear all you can do is serve the interests you've sold out to since all you can due is make vacuous arguments and spout talking points. So here's the reality: The PNHP squarely addressed the Lewin Group's analysis of Wyden's Republican plan to screw working people even further by forcing them to pay a "living tax" and increase the profits of private health insurance companies. You, on the other hand, are just a hollow propagandist who can't refute their substantive arguments and you don't even try. You, Wyden, and all of the supporters of this plan who claim to care about average folks are frauds, and no one here has an argument refuting that.

    The truth why your argument is pure BS is that Wyden's plan has even less chance of passing than single payer at this moment. That is unless he can line up more Republican support for what obviously is their kind of extortionate, pro-corporate, anti-working person plan because insurance companies can't manage to get more Democrats who'll whore from them like Wyden elected. Like I said to "rants", the real question is how many more people are you willing to force to suffer on behalf of those who pay you, because you won't instead work to shame and humiliate the Wydens in our party who have been the true obstacle to health care reform and who have no problem pushing down working people by forcing them to do whatever they can to get health care?

  • (Show?)

    Healthcare is a right, I suspect you of being an insurance industry provocateur. If not, you are just an idiot. You are harming the cause of government funded healthcare provision with your arrogant, elitist (vanguardist?) attacks on people who either are allies or who we need to become allies in seeking a real national health system.

    Let me put my agreement with some of Darrel's questions another way: I question the claim that Wyden's plan really is more achievable than HR 676 -- the Conyers almost single-payer bill (at least as it too would be changed by the legislative meat grinder). The attack on Wyden's plan from the National Review cited yesterday is just a piece of what will come. If even something as problematic as Wyden's plan is to pass, rather than being done down in the way that the Clinton plan was in the early 1990s, it will only be if and because there is credible mass backing of a single payer system. So all of you who say "I support single payer but don't think it's realistic" ought to nonetheless support it actively, rather than stressing its unrealism, even if you see Wyden's plan as a significant step forward that you would also support, a position I regard as reasonable.

    Fortunately for the prospects of fuller and fairer and less expensive healthcare access, organized support for HR 676, the main national single-payer vehicle, and for the underlying principle is growing. Last year the California legislature passed a state-single payer plan, which Gov. Schwarzenegger vetoed. John Conyers now has 88 co-sponsors in the House for HR 676 -- Jim McDermott (WA 7th) is the only one from Oregon or Washington.

    A listing of labor organizations in August 2007 named 27 state labor councils and said:

    As of August 3, 2007, HR 676 has been endorsed by 298 union organizations in 43 states. Endorsers include 81 Central Labor Councils and Area Labor Federations and 20 state AFL-CIOs.

    A similar listing maintained by Kate Tillow of the Nurses Professional Organization and the All Unions Committee For Single Payer Health Care--HR 676 was updated today with the statement

    HR 676 has been endorsed by 400 union organizations in 48 states including 103 Central Labor Councils and Area Labor Federations and 33 state AFL-CIO's

    showing rapid labor movement growth in the last 9 months.

    Endorsing state AFL-CIOs include Oregon and Washington. The Southern Oregon Central Labor Council recently joined the list of endorsers.

    The full list of endorsing states feds is: Alabama, Alaska. Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland-DC, Minnesota, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

    Interestingly, this list does not include a number of more liberal states or heavily unionized or industrial/rust-belt states, e.g. Massachusetts, Rhode Island, New York, New Jersey, Illinois and Michigan (despite UAW endorsement), which means that the growth of union support is very far from complete.

    As of August last year national/international unions endorsing included the American Postal Workers Union (APWU); California Nurses Association/National Nurses Organizing Committee; International Association of Machinists and Aerospace Workers (IAM); International Federation of Professional & Technical Engineers (IFPTE); International Longshore & Warehouse Union (ILWU; National Association of Letter Carriers (NALC; National Education Association (NEA; Office & Professional Employees International Union (OPEIU; United Association of Journeymen & Apprentices of the Plumbing & Pipe Fitting Industry of the United States & Canada (UA); United Automobile Workers (UAW); and United Electrical, Radio and Machine Workers (UE).

    In Oregon, as of last August only the National Association of Letter Carriers (NALC), Branch 82, Portland had endorsed, since joined by the state AFL-CIO and now the Southern Oregon Central Labor Council.

    In Washington, in addition to the state AFL-CIO, two councils endorsed as of last August: North West Washington Central Labor Council, Bellingham and Pierce County Central Labor Council, Tacoma, along with the Washington State Building and Construction Trades Council, Olympia.

    Endorsing locals or bodies of specific unions include American Federation of State, County and Municipal Employees (AFSCME), Retired Public Employees’ Council of Washington, Chapter 10; International Association of Machinists and Aerospace Workers (IAMAW), Washington State Machinist Council, District 160, Seattle (probably includes Boeing IAM workers); International Federation of Professional and Technical Engineers (IFPTE) Local 17, Seattle; Washington Alliance of Technology Workers (WashTech), (CWA), Local 37083, Seattle; and the Washington State Alliance for Retired Americans.

  • (Show?)

    P.S. to above: I say Conyers' bill is almost single payer because it would maintain the VA system (& maybe the military sytem?) separately at least for a while.

    Wyden's plan is neither the best thing since sliced bread nor as bad as the Massachusetts plan, though it shares some problems with the latter as has been pointed out. As Darrel points out, a version passed into law might be substantially different and probably weaker. An interesting question is whether a President Obama would veto it over individual mandates if it came to him. It probably would be more of a roadblock as a putative transitional plan to national single payer than Hillary Clinton's or John Edwards' plans, since it includes no publicly provided option operating in competition with private plans.

    The current crises of the healthcare system have a number of aspects, some of which Wyden's plan addresses better than others. Problems with the current system include: unaffordability to the point of lack of coverage for approaching 15% of the population, causing avoidable death and debility; rising problems of affordability for those covered through employment for both workers and employers; decreases in coverage and increases in exclusions and out-of-pocket costs as means to limit nominal premiums; cost inefficiency in actual care delivery due to high private bureacratic costs, corporate profits, inappropriate use of high-cost hosptital emergency services for primary care, and extra costs of delayed treatment; lack of transparency in pricing and costs along with inequitable distribution of costs due to unequal negotiating power among various parties; enormous fragmentation of the system among funders, payers, and providers; and raised coercion in industrial relations due to dependence on specific current employment to maintain insurance or avoid "pre-existing condition" exclusions (at least for a time) in moving to a new job.

    What Wyden's plan would address best would be complete lack of insurance, issues of transparency and inequity and "hollowed out" coverage for premium limitation (by providing strong floors on exclusions, requiring "actuarial equivalence" i.e. allowing plans to cherry-pick a healthier clientele, and restricting variation in coverages to a very small range -- features which also of course limit the differentiating operations of markets leaving the question of why retain a market-based system?), and detaching insurance from specific employment. Despite the reservations expressed on the latter in the context of the specfic claim of this ad, Wyden's plan would create dramatically greater freedom of movement and dramatically reduce risks due to loss of employment. As well or as simply as a tax-funded single payer plan? No. Better than at present? Much.

    These individual level effects would likely to some extent reduce overrall costs to the economy due to inappropriate use of expensive services and late interventions in preventable or manageable conditions.

    Wyden's plan would do something but not terribly much to reduce the fragmentation of the system. It is not entirely clear, but it seems likely that the restriction of the number of plans eligible for government subsidies to clients to two or three per state would increase consolidation in the health insurance industry, although other insurance for those not eligible for subsidies or for coverage beyond the basic plans would exist. What would happen to HMOs like Kaiser or Harvard-Pilgrim that are both insurers and providers is not clear and probably would vary by state. Medicare, the VA system and the military system clearly would continue to be separate; my memory is hazy about Medicaid/SCHIP, but it may be that some fragmentation might be reduced there.

    Costs to the system & economy from bureaucratic overhead might be somewhat reduced with reduction of the number of payers and greater transparency in pricing and billing and reduction of shifting of cost recuperation from service delivery to overhead charges. Bureaucratic costs to employers for managing employee insurance would be reduced (here it should be noted that Wyden's concern that single payer would lead to loss of employment actually applies to his plan too in terms of corporate HR employment -- it is an unfortunate fact that the high overheads of the current system go very largely to wages & salaries & that reducing them will mean cutting jobs any way you do it).

    But many of the current overhead costs related to private insurance bureaucracy would remain, and there would be some new ones associated with the new administrative agencies that would replace some current employer functions. Also, there would be some additional overhead costs to the system of adding 12-15% more people to it. Underestimation of such costs and unwillingness of state legislatures to pay for them has been a recurring problem in state level efforts to move toward universality, including the OHP and emerging again now in Massachusetts. Whether this would work differently with federal funding (which does not face the balanced budget requirements of the states) is not clear.

    Expansion of the number of insured persons may simply increase insurance company profits, as has been stated or claimed, but how much so is not entirely clear. In some respects Wyden's plan looks like it might result in something resemblinig the way private provision of public utilities is handled, though at worst it could end up looking like cost-plus defense contracting. In any case, the profits of the insurance companies would remain an increment of overall costs to the economy & system that are not going to healthcare provision.

    Costs to individuals in the forms of premiums and co-pays would go down for some people, although the subsidy scheme laid out is not as generous as that proposed for Oregon by the Oregon Health Policy Commission in its recommendations last spring that are informing the SB 329 process. Additional costs due to taxation remain opaque. Overall Wyden's approach does not seem likely to reduce the % of GDP that goes to healthcare and healthcare system management, which single payer certainly would do, for the same level of services.

    However, it actually ought to be a matter of debate in a different way than it is whether it is necessarily bad to spend 15% of GDP on the healthcare system -- if that were going to actual services that provided improved health, it could be entirely reasonable to say that's a national priority, in the same way that we accept (unfortunately) higher levels of GDP going to military spending than many other countries because we have made maintaining quasi-imperial military hegemony around the world a national priority.

    The problem is not necessarily the costs per se -- the problem is having the costs applied health-inefficiently.

  • Eileen Dover (unverified)

    Eliminate insurance companies and bring on the single payer system! This is a politically naïve suggestion—but one that resonates in the insular world of Blue Oregon. But even this approach is sure to fail if we don't address the underlying causes of health care cost increases. It’s not the evil insurance companies that are driving medical costs. The Oregon Insurance Department has compiled and published information on the major health insurers in Oregon. If you check the regulator’s own data, you’ll see that for Oregon’s eight domestic insurers, profits and insurer administrative costs are not the issue:

    Look at Medicare and Medicaid—both of these programs are effectively single payer systems for certain segments of the population. And both of these programs struggle with out-of-control costs. A health care system built on entitlement will never control costs.

    To be sustainable, we need a health care system with a focus on: • access for all (to eliminate the cost shift from the uninsured/underinsured); • personal responsibility to improve and maintain our own health (this may require incentives); • physicians, hospitals and other health care providers who are reimbursed based on the health outcomes they achieve for their patients; • the practice of evidence-based medicine that will help all patients receive the right care in the right setting at the right time—not too much and not too little; • timely and transparent comparative effectiveness analysis of new drugs, medical devices and procedures (we pay far too much for new technology that does little to improve outcomes); • full transparency of provider cost and quality; • an understanding that we can’t have it all.

    And those of us who demand health care services that only marginally improve outcomes above what medical evidence identifies as appropriate, we’ll need to pay for those services 100% out of our own pockets.

  • Tom Civiletti (unverified)

    Eileen Dover,

    Single payer might seem naive to someone who does not know how well it works in other nations, or to someone who does not know that most Americans support the idea, or to someone who does not know that Medicare is substantially MORE efficient at delivering healthcare than the private system.

    Which are you?

  • (Show?)
    And those of us who demand health care services that only marginally improve outcomes above what medical evidence identifies as appropriate, we’ll need to pay for those services 100% out of our own pockets.

    Like, who are those people? Not the people who can barely afford the procedures and drugs they get under their current health care plan. Not the uninsured. I'm in an HMO, they already don't do more than they think is appropriate. And for the most part, I've been pretty happy with them.

    The only people I know of who whine about their health care program not doing more are exactly the people who could afford to pay for their own health care already.

  • (Show?)
    If you check the regulator’s own data, you’ll see that for Oregon’s eight domestic insurers, profits and insurer administrative costs are not the issue:

    Someone has Gary Hart syndrome.

    If you do check the report cited in the link above, you'll see that:

    The top eight insurers [based in Oregon, and accounting for a large percentage of insured] all had medical loss ratios above 80 percent for the five-year period ending in 2005, meaning that they all paid out at least 80 cents of every premium dollar for claims. However, the not-for-profits tended to be in the high 80s while the for-profits tended to be in the low 80s.

    Medicare, on the other hand, spends about 2-3% of its revenue on overhead. There are people who dispute that figure, based on the number of people covered and the cost per patient being higher in Medicare, but even on a cost per insured basis, Medicare has less than half the operating costs.

    And none of the profits.

  • eileen dover (unverified)

    The solution to controlling rising health care costs is to eliminate private insurance and move to a universal, government-run health care system like Medicare. Medicare is doing a great job of controlling its costs. Check out this post from Reuters.........

    Medicare "drifting towards disaster": U.S. official Tue Apr 29, 6:34 PM ET

    Medicare is lurching toward disaster and it is too late for the Bush Administration and Congress to do anything about it, U.S. Health and Human Services Secretary Michael Leavitt said on Tuesday.

    He said the next administration will have to act to stop rising costs and get control of the $400 billion federal health insurance plan for the elderly, which now covers 44 million people.

    "Higher and higher costs are being borne by fewer and fewer people. Sooner or later, this formula implodes," Leavitt said in a speech to the right-leaning Heritage Foundation and American Enterprise Institute think-tanks.

    "There is serious danger here," he added. "Medicare is drifting towards disaster."

    Leavitt's speech echoes repeated warnings from other federal government officials who have noted that Medicare spending is projected to be 3.3 percent of gross domestic product in 2009.

    A separate report released on Tuesday from the National Cancer Institute estimated that Medicare spent $21 billion on cancer alone between 1999 and 2003.

    "The disaster is not inevitable. If we act now, we can change the outcome. In health care, the core problem is that costs are rising significantly faster than costs in the economy as a whole," Leavitt said.

    But the administration of President George W. Bush and the current Congress are out of time, Leavitt said.

    "So, given the strong possibility this won't get fixed in the next 266 days, I would like to add some general advice on the creation of a political construct for action and a general strategy to solve the problem," Leavitt said, saying he was speaking as a Medicare Trustee and not as a government official.

    Leavitt said paying for each medical action separately is wasteful and "it often results in bad referral decisions, sloppy hand-offs, duplications, fraud, and poor quality of care. The result is inappropriate care and unnecessary cost."

    Last week the Government Accountability Office blamed HHS in part for this, saying the agency had not used its powers to force hospitals to provide better care and less waste.

    "It troubles me that this matter is not receiving more attention in the presidential candidates' discussions. The next president will have to deal with this in significant part," he said.

    (Reporting by Maggie Fox, editing by Philip Barbara)

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