From mid December until the New Year, at the behest of President-elect Obama and Senator Tom Daschle, America talked about health care.
Health Care for America Now helped organize hundreds of these meetings across the country, and they were exactly what we (and the Obama transition team) were hoping for: Regular folks getting together and discussing this important issue, like these people from Alabama and California:
The news coverage of these events across the country was extraordinary, which gives me hope. Here's a small sampling.
The Institute for America’s Future and renowned health care and economics expert, Jacob Hacker, released a report today called: “The Case for Public Plan Choice in National Health Reform.” The report explains how the public plan option levels the playing field to allow for access and affordability by reducing costs, without reducing the innovation that can come from the private market. The Key Findings (pdf) of the report state:
A health care system that contains costs and drives value must include a good public plan if the broad goals of reform—universal insurance and improved value—are to be achieved. Private insurance and public insurance have distinct strengths and weaknesses, and thus should be encouraged to compete side by side to attract enrollees on a level playing field that rewards plans that deliver better value and health to their enrollees. Public insurance has a better track record at reining in costs, while preserving access; it has pioneered key quality and payment innovations that have often set the standard for private plans; it is essential to set a standard against which private plans must compete to drive value and can be a source of stability for people. Private plans are a source of new benefit options, and continuing pressure for innovation in benefit design and care management strategies.
HCAN Campaign Director, Richard Kirsch, voiced his support for the report’s conclusion: “Creating a high quality, affordable public plan alternative to private insurance is absolutely essential to achieving comprehensive health care reform solutions that will work for all of us in 2009.” Rep. Pete Stark stated his strong support for the choice of a public plan and HCAN agrees that a health care solution that does not include a public plan would be a non-starter. President-elect Obama also talks about the choice of a public option as a critical part of his plan, saying again and again in his speeches that every American should have a choice of a public plan similar to the health care that every Member of Congress gets.
However, we have seen signs that there will be debate on this issue. Advocates of real health care reform need to make sure that this critical part of the solution is not bargained away in a misguided attempt to placate those who see health care reform as a business opportunity, not a matter of the health of our families and our neighbors. This would be a tragic mistake.
This is an exact quote of what President-elect Barack Obama said in today's press conference when announcing the appointments of Senator Tom Daschle and Dr. Jeanne Lambrew:
The time has come – this year, in this new Administration – to modernize our health care system for the twenty-first century; to reduce costs for families and businesses; and to finally provide affordable, accessible health care for every American.
Not later. Not in 2013. Now. This is the year health care reform will finally be passed in America.
It goes without saying that this is exactly what Health Care for America Now hoped to hear from Obama. Why? Because we're ready for it, ready to get the job done this year. We've got grassroots support in 45 states. We've got a powerful coalition of over 500 groups working to build support for the Obama/Health Care for America Now principles of health care reform. We've got 160 Members of Congress who support our efforts. And we've got a President-elect who understands the urgency.
Obama also said:
The runaway cost of health care is punishing families and businesses across the country. It’s not something that we can put off because we are in an emergency. This is part of the emergency.
Forty-three states expect to see budget shortfalls in the coming year. And, while the federal government can run a deficit, most state governments are required to keep a balanced budget. As a result, 18 states and DC have already cut or are proposing cuts to their Medicaid and CHIP programs. Cuts in state Medicaid and CHIP eligibility and services pose a real threat to the very families and individuals who most need the help.
The report details how additional health care spending will help state economies.
The connection between the recession and health care isn't hard to see. DemFromCT has been gathering the news stories on this very subject for weeks. It's incredibly heartening to have a leader who understands this connection, and who makes it clear that the fix - real health care reform we can all count on - will come sooner rather than later.
So thank you for your commitment, President-elect Obama. We're looking forward to making it a reality.
The former Democratic senator from South Dakota urged today that Americans join in community discussions in the last two weeks of December to develop ideas for new national policies that will reduce health costs, boost the quality of care and get everyone coverage. The events are being organized through the transition team’s Web site, change.gov.
The last health care fight in 1993-94 made a lot of mistakes. A key mistake, however, was not involving Congress of the American people in the process. So far, Obama looks like he's changing that, starting with soliciting comments online, and now with Daschle's community discussions.
Here at Health Care for America Now, we're with SEIU. We will work closely with the transition team to make sure these community discussions are well attended, that real ideas get discussed, and that these ideas make their way not only to Barack Obama, but to Congress as well.
With their policy, their politics, and their tactics, Obama is most definitely not repeating mistakes that have been made in the past. And, judging by the movement of health care in Congress, in outside progressive groups and community organizations, and in the transition team, the prospects of passing health care reform in 2009 look good.
Remember, this is just the beginning. Covering kids through Medicaid and SCHIP will temporarily help kids (but not adults), and mask what's really happening as people lose insurance and can't get it back (that takes at least two years after a recession). When states start to hurt, eligibility will be cut back and/or new enrollment will be limited at the state level.
Even were it not for a recession, reforms in health care are badly needed. From TIME:
By too many measures, America is a lot less healthy than a developed nation has any business being.
Even though the United States spends more than $2 trillion annually on health care, tens of millions of Americans suffer from preventable diseases and major vulnerabilities exist in the nation's preparedness to respond to health emergencies.
If there's any doubt as to why health reform is at the top of the new Obama Administration's agenda, these numbers should put that to rest. A health disaster is staring us in the face, and "status quo" is far more tenuous than it appears. Covering the kids, important as it is, is only a piece of the puzzle.
Parents are more likely to take their children to the doctor regularly if they themselves have health insurance [pdf], not just their kids. And when those kids grow out of the Children's Health Insurance Program, they're still young, and still need coverage.
Children's Defense Fund Action Council knows better than anybody that SCHIP, while an important program, isn't children's health care, and they've joined our steering committee to advocate for quality, affordable health care for all Americans in 2009 - children included.
When I first started studying health care inequality as an undergraduate, one of the first facts I learned was that, "the U.S. is the ONLY major industrialized nation in the world without a universal health care system." I was shocked! How was it possible that in my twenty-three years of life I had never learned this fact? The more I studied the more I realized that the reason I never heard this … and worse yet, the reason that I took for granted that getting health care is difficult for everyone, is due to the same, out dated archetype that has been afflicting many other disparities upon this country; our overbearing culture of individualism, and the belief that the United States is too "unique" to model ourselves after other countries.
With all of these thoughts in mind, I was overjoyed when the PBS series Sick Around the World came out. Reporter T.R. Reid travels to five countries (the U.K., Japan, Germany, Taiwan and Switzerland) each democratic, each capitalistic, and each with very different health care systems. He specifically notes three major things: the positive aspects of the system, the negative aspects of the system, and what aspects could possibly apply to the United States.
The United States spend 17% of its GDP on health care (making it the most expensive system in the world, and yet everyone is not covered. This statement on it's own just seems like another statistic floating around about how much we consume. However, when you look at the fact that France (the country that is ranked the best health care system in the world by the World Health Organization, the United States is ranked 37th) only spends 9.6% of its GDP, that statistic seems a lot more drastic doesn't it? WHO's country rankings are decided by three main factors: attainment and performance, goodness and fairness, and goals and functions. Clearly if we are spending so much money more money on health care than nations that are providing access to everyone, we are doing something wrong.
As DemFromCT pointed out yesterday, the white paper Senator Max Baucus released yesterday leaves open the option of altering the current employer-based health care tax exclusion.
At first blush, altering or eliminating the employer-based tax exclusion sounds exactly like what Senator John McCain wanted to do, and exactly what we've been arguing against for months. So why is it ok when Baucus does it?
The current employer-based health care exclusion says that unlike some other employee benefits - which are taxed just like cash - any money your employer spends on your health care isn't taxed. So, for example, if your employer spends $100 every month paying for your health care plan that you get through work, that money is never taxed. If you had to buy health care yourself, you'd have to spend $100/month of your post-tax income on health insurance, which is more expensive. Not taxing the health benefits you get through work encourages employers to offer health insurance. Their money goes farther because it is not taxed and employees have to spend less. It's a win-win.
There's a problem, though, and it's that the tax exclusion is a regressive tax - it benefits the rich more than it does the poor. The rich pay a higher tax rate on their income than the middle and lower classes, but they get their health insurance through their employer tax free just like everyone else. So, $100 in tax-free benefits is worth more to the rich because at their higher tax rate, that $100 turns into much less if you convert it to post-tax money.
I.O.U.S.A. is a documentary that purports to explain why America is drowing in debt, both public and private. Unfortunately, it tells something of a one-sided story that leads viewers towards right-wing economic conclusions, as the Center for Economic Policy and Research points out, minute by minute.
The issue here for me is less the symptoms (though the facts used are, as noted above, one-sided), it's the solutions that are proposed and implied. I.O.U.S.A. presents the facts in such a way that huge cuts across the board to government programs and spending, coupled with intense privatization, seems like the only answer. And that's where I.O.U.S.A. gets way off base.
The enormous budget deficits projected for future years have the starring role in the documentary IOUSA (see CEPR's analysis of the film). However, the simple fact that the film conceals is that these scary deficits are driven almost entirely by projections of exploding private sector health care costs.
The government pays for approximately half of the country's private sector health care through programs like Medicare and Medicaid. Therefore, if the projections of exploding private sector health care costs prove accurate, then the government will face a serious deficit problem. However, if health care costs can be contained, then the budget problems are easily manageable.
Got that?
The huge budget deficit America is facing in the near future isn't caused mainly by the housing market's collapse, the plummeting dollar, the financial bailout, or programs like Social Security. It's driven primarily by rising costs of Medicare and Medicaid.
Make no mistake about it, yesterday's election was a mandate to enact legislation that will provide a government guarantee of quality, affordable health care for all. But to realize a promise of such historic magnitude, it will take our nation believing monumental change is possible. President-elect Obama announced last night his win was just the beginning saying, "This victory alone is not the change we seek. It is only the chance for us to make that change. And that cannot happen if we go back to the way things were."
When the Obama campaign decided to spend 86% of its October advertising on health care, it both recognized that health care was the most important issue to break through with swing voters on the economy and raised the expectation that health care would be at the top of the Obama agenda. Obama himself made it clear he sees health care as an essential plank for restoring the economy when he gave his major health care address in Newport News, Virginia on October 4, 2008. He rhetorically asked whether the nation could afford health care given the economic crisis and answered, "In other words, the question isn't how we can afford to focus on health care – but how we can afford not to. Because in order to fix our economic crisis, and rebuild our middle class, we need to fix our health care system too. So it's clear that the time has come – right now – to solve this problem: to cut health care costs for families and businesses, and provide affordable, accessible health insurance for every American."
Given that the economy is (rightly) the #1 issue for voters, that's where the focus of our politicians should be, right? And to a certain extent, it is. But a look at the advertising numbers tells a slightly different story. DDay picks up on the trend:
Obama has put a significant amount of money into talking about health care, with a whopping 68% of his TV ads devoted at least in part to the issue, including 86% in October. That shows you that the potential is there to make reform an urgent priority. Our health care crisis is tied to the economic woes of the country - US companies are less competitive than their counterparts abroad because they have to also be a giant HMO, skyrocketing costs are putting a giant hole in the federal budget, and treating the uninsured costs everyone in increased premiums.
As DDay explains, we shouldn't be surprised that Obama is spending his money and possibly winning this election because of health care. At its heart, health care is about healthy people, and healthy people are the engine of our economy.
…as unemployment increases, so does the number of people with no health insurance. The Kaiser Commission on Medicaid and the Uninsured found that a one-percentage-point rise in unemployment nationally results in 1.1 million more uninsured and 1 million more enrollees in Medicaid and the State Children's Health Insurance Program. The U.S. unemployment rate is already up 1.2 percentage points since January.
Declining job-based coverage is shifting costs onto state and local governments at the same time they face budget shortfalls due to the economic downturn. As more people lose their health insurance, they turn to government programs for assistance with their health care, which places increased demand on these governments that are already in the red. Additionally, if people go to emergency rooms because they haven't been able to afford to treat less- severe health conditions that then worsened, the burden of that more-expensive emergency care will be born by cities and states.
There is evidence that rising under- and un-insurance is directly contributing to the current financial crisis. A study recently published in a Case Western Reserve University journal of health law documented that medical crises contributed to a surprising half of all home foreclosures. It surveyed homeowners in California, Florida, Illinois and New Jersey who were on the brink of foreclosure, had defaulted on their home loans or whose lenders had initiated legal foreclosure proceedings. The researchers found that "if these patterns hold nationwide, medical causes may put as many as 1.5 million Americans in jeopardy of losing their homes each year."
Stabilizing or bringing down health care costs is a win for the economy. Keeping people healthy, productive and in the work force is a win for the economy. Giving people greater freedom to choose between jobs or to leave a job and start their own businesses is a win for the economy. Keeping people from losing their homes because of their medical bills is a win for the economy.
The fact that the economy is reeling from financial turmoil is not a reason to avoid doing health care reform; it's a reason to make health care reform a top priority.
The line that I emphasized is key. Fix health care and we fix our economy. Fail to fix health care and rising unemployment, falling wages, and skyrocketing health care costs make the economy worse.
Of course, there's another reason Obama is spending a lot to talk about health care. In the words of Jane Hamsher at Firedoglake, John McCain's health care plan is "full of shit." Here's John McCain' explaining his health care plan in his own words:
