If you haven't already, read Atul Gawande's piece on health reform in the New Yorker, largely centered around McAllen, Texas, the community in America with the highest health care costs. It's hard to quote the heart of the article, because it's so good, so I'll just quote the conclusion:

Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.

In El Paso, the for-profit health-care executive told me, a few leading physicians recently followed McAllen’s lead and opened their own centers for surgery and imaging. When I was in Tulsa a few months ago, a fellow-surgeon explained how he had made up for lost revenue by shifting his operations for well-insured patients to a specialty hospital that he partially owned while keeping his poor and uninsured patients at a nonprofit hospital in town. Even in Grand Junction, Michael Pramenko told me, “some of the doctors are beginning to complain about ‘leaving money on the table.’ ”

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future.

And he's right. If we don't get health care costs down, health reform will not work. People will still go bankrupt, we will still ration care based on ability to pay, and we will still have a health care crisis. And when you get down to it, health care costs are about how much and what medicine your doctor orders for you.

Conservatives will accuse those in favor of health reform of taking the easiest way out, in a sense. Health care costs are up? Ok, let's ration care and drive those costs down. But that's not what we're proposing. And, as Gawande so eloquently points out, driving down health care costs and increasing the quality of that care actually can be one and the same. So that's some pretty good news.

One thing about this article leaves me puzzled, though. Gawande seems to set up a conflict between advocacy for a public health insurance option and what he apparently considers "real" health care reform, which is setting up incentives for doctors to provide better care, not just more care. Maybe he's just reacting to the media coverage around health care reform, which has been largely centered around a public health insurance option. And maybe I'm biased, seeing as I've been working to shape that media battle. But I really don't think it's either/or. Actually, I think Gawande's point makes the public health insurance option more critical.

I agree with Gawande that we could end up with a public health insurance option that doesn't foster the right incentives to control costs, and that wouldn't be a big victory. But while Gawande is proposing some kind of outside board to control these incentives, I wonder if the public health insurance option isn't the place where these reforms are put into action.

Think about it: One advantage to a public health insurance option is that it is transparent. Private insurance doesn't tell you what they pay for services, how often these services are used, and whether these services have improved patient outcomes. A public health insurance option could make that data available and work with it to improve care and control costs. This data would put the public health insurance option in the perfect position to figure out why some places in America cost so much more and why their outcomes aren't any better, and how to fix that.

We must get costs down, that much is clear. We need the tools to do it. I'm pretty convinced the public health insurance option can be at least a crucial part of that toolset.

Watch this video from Think Progress:

ThinkProgress Video Report Exposes Profits-Driven Ideology And Scandal-Plagued History Of Leading Right-Wing Health Reform Opponent Rick Scott

In the United States, the majority of people get their health insurance through their job or that of a family member’s. For many workers, that means staying in a job they don’t like just to keep the health benefits they and their families depend on. Ensuring they cannot be denied coverage if they leave their job is not enough to free them from this ‘job lock’ to become entrepreneurs or move on to more satisfying and lucrative work. They have to know they will be able to afford the coverage and that the coverage they get will cover the care they need. To accomplish that we need a public health insurance plan option.

Read more…

Via Politico:

Progressive health care reform groups demanded on Thursday that Washington’s NBC television affiliate refuse to air a 30-minute infomercial funded by a conservative group opposed to creating a public insurance.

The Service Employees International Union sent a letter to NBC4, arguing that the station has a responsibility to pull the documentary-style commercial paid for by Conservatives for Patients’ Rights. The ad, set to run Sunday after “Meet the Press,” “will be false, deceitful, and a distortion,” the union’s attorney wrote in the letter.

…

If the ad is aired and does contain falsehoods, CPR could face a fine from the Federal Communications Commission, said Levana Layendecker, the online campaigns director for Health Care for America Now, a coalition pushing to create a public insurance plan.

The coalition, Democracy for America and the SEIU e-mailed their supporters, asking them to sign on to another letter that urges NBC and “Meet the Press” to refuse to air the infomercial. The groups plan to send another e-mail Friday to Washington-area supporters, rallying them to call the station with the same message.

Sign on to the letter and pressure NBC and Meet the Press to get Rick Scott's lies off the air.

And, while you're at it, call the NBC Washington station directly and let them know they'll be liable for FCC fines if they air these lies: (202) 885-4000.

NEWS

Obama: Now or never for health reform - Associated Press

President Obama warned Thursday that if Congress doesn't deliver health care legislation by the end of the year, the opportunity will be lost, a plea to political supporters to pressure lawmakers to act.

Groups urge NBC to pull health care ad - Politico

Progressive health care reform groups demanded on Thursday that Washington’s NBC television affiliate refuse to air a 30-minute infomercial funded by a conservative group opposed to creating a public insurance plan.

Kennedy's Health-Care Measure To Require Employers to Chip In - Washington Post

Sen. Edward M. Kennedy (D-Mass.) is circulating the outlines of sweeping health-care legislation that would require every American to have insurance and would mandate that employers contribute to workers' coverage.

Nelson Now Open To Public Health Care, Baucus Will Fight For It - Huffington Post

The push to include a public health care option as part of a system-wide overhaul benefited from two major boosts Wednesday. Sen. Max Baucus (D-Mont.), the chairman of the Finance Committee and lead health care negotiator, is "fighting tooth and nail to include that in any final deal," his chief of staff John Selib said at a town hall meeting in Montana, according to the Billings Gazette.

The Doctor Will See You—In Three Months - Business Week (old but good)

In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn't clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August. "I completely freaked out," Susan says. "I couldn't imagine spending the summer with this hanging over my head." After many calls to five different facilities, she found a clinic that agreed to read her existing mammograms on June 25 and promised to schedule a follow-up MRI and biopsy if needed within 10 days. A full month had passed since the first suspicious X-rays. Ultimately, she was told the abnormality was nothing to worry about, but she should have another mammogram in six months. Taking no chances, she made an appointment on the spot. "The system is clearly broken," she laments.

Jacob Hacker at Campaign for America's Future laid out the case for a Medicare-like public health insurance option:

A Medicare-like public plan would be much more stable and secure than other approaches. It would provide the broadest possible choice of doctors. It could be offered throughout the nation on the same terms. It would have the lowest administrative costs. And its bargaining power and large risk pool would allow it to offer the most affordable possible premiums and most effectively restrain costs while upgrading the quality of care.

Joe Paduda disagrees, arguing that the savings Hacker sees from Medicare are overstated. Instead, he proposes a different model for the public health insurance option:

I could go on, but the point is clear - Medicare's supposed administrative and medical cost advantages are not real. That does NOT mean a public plan option isn't viable. In fact, there is a government plan that is kicking the collective private health plan industry's rear end. It's the Veteran's Administration, and rather than Medicare, i'd base a national plan on a dramatic expansion of the VA.

Who's right? Well, both - or neither.

First, I should take issue with one of Paduda's assertions. Medicare does indeed hold down health care costs. It's costs are growing slower than private insurance. Now, that doesn't mean costs aren't growing - they are. If we don't control health care costs, Medicare will indeed break the bank. That's why we need the public health insurance option.

To analyze which type of public health insurance option will work best, I think it helps to understand the goal of the public health insurance option. First and foremost, the public health insurance option should exist to provide people with a place they can go to get quality health insurance if and when their private insurance fails to provide them with what they need. People should always have a choice to get out of the private, monopolistic system if they want.

This choice will lead to increased competition. (I'm not sure why Paduda says it "may" lead to more competition, it seems to me that increased competition is pretty much a guarantee.) The public option should be able to bargain with providers for lower rates, and with less overhead, it will be able to provide services for at least nominally less than private insurance right off the bat. This, combined with an insurance program designed to protect people's health and not a corporate bottom line, will make the public health insurance option a strong competitor. Private insurance will be forced to respond.

This competition between public and private seems to me to be the main driver of lower costs and better outcomes. Private insurers will likely get creative finding ways to out-deliver and undercut public insurance. And public insurance, with access to a vast pool of data and government transparency regulation, will be able to really understand costs in the health care system in a new way, and derive further solutions from that, solutions like the ones Atul Gawande has proposed in this must-read article in the New Yorker.

So, in a way, it doesn't matter much if the public health insurance option is Medicare-like or VA-like. As long as it provides people with quality health care and peace of mind, it will be popular. And as long as it is a strong competitor, it can adapt down the line to ratchet down health care costs even further.

(originally posted at Campaign for America's Future)

NEWS

Health Overhaul Fails Without U.S. Plan, Rangel Says (Update2) - Bloomberg

An overhaul of the health care system won’t pass the U.S. House of Representatives unless it includes a government-financed insurance plan for consumers, the head of the House’s tax-writing committee said.

Warring Sides on Health Care Carry Their Fight to TV and Radio Ads - New York Times

The battle over the future of health care has taken to the airwaves, with interest groups spending hundreds of thousands of dollars on television and radio advertisements supporting or attacking legislation they expect to emerge from Congress.

Massachusetts, Model for Universal Health Care, Sees Ups and Downs in Policy - New York Times

Despite a weakening economy, Massachusetts continued to measure gains in the share of residents who reported having a steady source of health care in 2008, its second year of near-universal coverage, a new study has found.

U.S. group finds insured paying more for uninsured - Reuters

U.S. families with health insurance are paying an estimated $1,017 more in annual premiums to compensate providers for healthcare to the uninsured, a report released on Thursday said.

Californians crossing border to Mexico for health care - McClatchy

Nearly a million Californians, perhaps hundreds of thousands more, cross the border to Mexico every year because they cannot afford the rising cost of health care in the United States, according to UCLA researchers.

Insurer offers ways for U.S. to save on healthcare - Reuters

The U.S. government can save $540 billion in healthcare costs in the next decade by taking 15 steps, such as pushing use of high quality, cost-efficient doctors, a major health insurer said in a report on Wednesday.

Health insurers bulk up 1Q spending on lobbying - Associated Press

Big health insurers have punched up lobbying spending this year as the debate over a potential overhaul of the nation's health care system heats up in Washington.

I just love how all of these opposition groups to President Obama's health care plan front like they're real, grassroots organizations. AHIP's Campaign for an American Solution? Fake! Rick Scott's Conservatives for Patients' Rights? Funded with his ill-gotten gains. And now there's Patients United Now.

As I noted yesterday, Patients United Now (or PUN for short!), is a front group for Americans for Prosperity, a group behind the lobbyist-funded tea parties last month. Igor Volsky at Think Progress has put together some of the history of Americans for Prosperity. Even though on PUN's website they claim that they are "people just like you," they are actually just corporate-funded lobbyists:

After orchestrating and funding the so-called Tea Parties movement, Americans for Prosperity — a nationwide front group founded and funded by the right-wing polluter Koch Industries — is launching an ad campaign characterizing President Obama’s effort to reform the health care system as a government take-over that will ration care and care and deny treatments.

Americans for Prosperity is notorious for its fake grassroots efforts, funneling millions of dollars into conservative campaigns designed to undermine Democratic initiatives. As Lee Fang put it, “AFP is a professional AstroTurf machine”:

• Hosted ‘Drill Baby, Drill’ rallies around the country.
• Financed Joe the Plumber’s tour against the Employees’ Free Choice Act and other anti-EFCA rallies.
• Started NoStimulus.com, “a grassroots website that we hope will be a focal point for the widespread frustration ordinary Americans feel at the runaway government growth that we see during good economic times and bad.”

Now we've got Joe the Plumber's backers against health care - oh noes!

I guess these groups have no choice but to astroturf. It's not popular right now to represent these groups' real constituencies - corporations. So they have to front like real people are behind them. They're not, of course. As Media Matters Action Network points out in their point-by-point factcheck of PUN's ad, health care reform is seen as a necessity by Americans, and they want the plan Obama is proposing.

So, good luck with the astroturf, PUN, you're going to need it!

Turns out, the voluntary agreement by insurance companies (and drug and device manufacturers and hospitals) to hold down health care costs might be illegal:

President Obama’s campaign to cut health costs by $2 trillion over the next decade, announced with fanfare two weeks ago, may have hit another snag: the nation’s antitrust laws.

Antitrust lawyers say doctors, hospitals, insurance companies and drug makers will be running huge legal risks if they get together and agree on a strategy to hold down prices and reduce the growth of health spending.

It's not terribly surprising that there are anti-trust concerns in the health care industry. We've known for a while that the industry is more collusive than competitive, with 94% of markets in this country near-monopolies. I'm not sure why anyone was surprised when these corporations got together and offered up more collusive behavior.

Now, I never believed that the insurance industry would actually make good on their pledge. And in fact, they've backed away from their promises themselves. However, as it turns out, the only way to make these near-monopolies hold down costs is to, you know, make them hold down costs. By writing regulations into law and passing a public health insurance option to force competition.

NEWS

WellPoint Institute of Health Care Knowledge Releases Report on Health Care Costs - PRNewsWire

The WellPoint Institute of Health Care Knowledge today released a report detailing the primary drivers of increased health care services and health insurance premiums, dispelling the notion that insurer profits are fueling spiking costs. The May 2009 Institute report, titled "What's Really Driving the Increase in Health Care Premiums?," compiles research from sources such as PricewaterhouseCoopers, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Bureau of Labor Statistics and the Congressional Budget Office.

BCBS adjusts answer to Obama - News and Observer

Blue Cross and Blue Shield of North Carolina is moving ahead with plans to take on President Barack Obama's health-reform plan despite mounting criticism about the insurer's internal strategy that leaked out this month.

Antitrust Laws a Hurdle to Health Care Overhaul - New York Times

President Obama’s campaign to cut health costs by $2 trillion over the next decade, announced with fanfare two weeks ago, may have hit another snag: the nation’s antitrust laws.

Conservative Groups Fault Health-Care Agenda - Wall Street Journal

Conservative groups are stepping up the battle against Democrats' proposed health-system overhaul with advertising campaigns contending that the changes could result in long waits for surgery and difficulty obtaining prescription drugs.

Wyden Open To Public Health Care Option If His Plan Stalls - Huffington Post

Sen. Ron Wyden, an Oregon Democrat, is a key player in the health care debate, the sponsor of the only bipartisan health care bill in the Senate. Backers of the major Democratic plan, which would allow patients to buy into a public plan, see Wyden's bill, however, as an obstacle preventing centrist Democrats from fully jumping aboard the public-option train.

The Cost Conundrum - The New Yorker

What a Texas town can teach us about health care.

Drug CEOs Switch Tactics on Reform - Wall Street Journal

Drug-company executives are aiming to prevent steep cuts in prescription prices by joining the effort to overhaul the U.S. health-care system.