Step 1: Sell health insurance to healthy people.

Step 2: Deny them when they get sick.

Step 3: Profit!

Well, maybe it's a slightly different version of the same old story, but it is the same old story. And AHIP's release of their new health care plan is a just repackaging of the same old story.

The insurance industry has awoken to the fact that nobody likes them. It should come as no surprise when nearly every insured person in America experiences insurers as the people who denied care or services  when they really needed it, including the president-elect of the United States. Now, they have decided  to try to re-market themselves as the reformed good guy, who really wants you to get health care, with just a few *tiny* exceptions:

• When you get a chronic disease
• When you are a woman of child-bearing age
• When you are old
• When you are already sick

Richard Kirsch, HCAN National Campaign Director, summed it up saying, "AHIP’s plan still lets insurers charge higher premiums for older and sicker people and for women. Their proposal pushes high-deductible plans and still lets insurance companies decide whether or not to approve the care your doctor says you need. " Read Richard's full statement.

They plan to stick taxpayers with the bill of the people they don't want to pay for. For example, the health insurance industry’s solution to medical bankruptcy isn’t to give people good health coverage but to have the government bail-out families who go bankrupt because they have lousy health coverage. In his response the AHIP announcment, Richard asks, "How can the health insurance industry propose reform which still lets families go bankrupt and expect to be taken seriously?"

The truth is the health insurance industry tried this before, and it didn't work. They had their chance. We need reasonable regulation of the health insurers and a choice of a public plan that provides quality, affordable care to everyone. They will never reform until they compete on a level playing field that puts people's health first.

When it comes to the AHIP's health care plan, there is only one thing we have to remember:

“We will not sacrifice profitability for membership.”
-  Angela Braly, WellPoint CEO in a conference with investment analysts, April 2008

• Controlling costs: Health plans are urging Congress to set a bold target of reducing the future growth in health care costs by 30 percent over the next five years.  Based on the current projected growth rate of 6.6 percent, this could produce a cumulative savings of more than $500 billion over five years.
• Helping consumers and purchasers: Health plans propose that a new portable health plan be available to individuals and small businesses in all states.  This affordable "essential benefits plan" would provide coverage for prevention and wellness as well as acute and chronic care.  To maintain affordability, the essential benefits plan would not be subject to varying and conflicting state benefit mandates.
• Achieving universal coverage: Health plans propose guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate.  To help working families afford coverage, advanceable and refundable tax credits should be available, phasing out as income approaches 400 percent of the federal poverty line.
• Adding value: Health plans commit to streamlining administrative processes and propose making targeted investments in our public health infrastructure.  The plan also calls for refocusing our health care system on keeping people healthy, intervening early, and providing coordinated care for chronic conditions; adopting uniform standards for quality, reporting, and information technology; and investing more in research to better understand which treatments and therapies work best – for the nation as a whole and for specific patients.

Tax credits? Insurance across state lines? More pledges that the industry can self-regulate? A lot of this seems really familiar. A lot of this was part of John McCain's health care plan.

Doesn't the insurance industry realize John McCain was crushed in a large part due to the money Obama spent promoting his health care plan and demonizing McCain's? The fact that one month after a landslide election the insurance industry would come out with a proposal containing large parts of a roundly defeated health care plan show that they are hopelessly out of touch.

I thought this argument was over. I thought America rejected McCain-style health care. But I guess we have to go over it one more time.

First, tax credits don't work.

Second, while we at Health Care for America Now are for a standard benefits package, the question is who gets to decide those benfits. And that brings us to the next point.

Third, the insurance industry can't self-regulate. Insurance costs are skyrocketing. The ranks of the uninsured are growing. The industry keeps making more and more money. They never have and never will look out for the public's best interest. In fact, this proposal is simply a way of making more money. As Igor Volsky at Think Progress points out:

AHIP is all for “affordable” coverage on the government’s dime. That is, rather than agreeing to end premium discrimination based on age or sex, it wants the government to issue tax credits and cap total health expenditures for lower-income individuals to protect Americans from bankruptcy. The plan calls on the government to ensure affordability, while protecting industry profits.

And that's the truth, right there.

Now, over here at Health Care for America Now, we're pretty sure what AHIP's plan will include based on their past statements. At online forums around the Democratic and Republican conventions, Karen Ignagni, AHIP's CEO, repeated her support for McCain-style health care reform heavy on tax credits and light on actual solutions to high costs, low enrollment, and high administrative overhead. Then, even though AHIP recently said they would start accepting customers with pre-existing conditions instead of denying them needed insurance, they still steadfastly resist competing on a level playing field with a public insurance plan that is affordable and open to all. (And they say nothing about controlling costs.)

Given that AHIP's plan will likely be long on rhetoric (universal coverage, affordability) and short on actual solutions to any of those problems, we have 10 questions we're hoping members of the media will ask Karen tomorrow morning at the National Press Club in Washington, DC when AHIP presents their plan:

1. Will you continue to charge people more for health coverage based on age, gender, and medical condition, and will you raise rates on business and individuals after they or their employees go through costly medical care or become chronically ill?
2. You say that with universal coverage you will accept everyone, regardless of pre-existing medical conditions. Are there any qualifiers on that?
3. Will you continue to support high-risk pools which transfer the cost of the most expensive people to the public? If so, why are such pools needed if you are accepting all comers?
4. Will you support the federal government requiring that all health care plans include defined health benefits?
5. The Congressional Budget Office has found that Medicare is paying private insurers 13% more than it costs Medicare’s public plan to provide the same benefits. Will you support giving people a choice of public insurance? And if not, why not?
6. Does your plan require you make your rules – the rules you use to decide whether or not to provide care - public and easily understood?
7. Does your plan limit the amount that insurers may spend on administration, marketing, and profit?
8. Insurance premiums have been rising four times faster than wages while health insurance profits rose more than 1000% from 2001 to 2006. Given this, why should we trust you to control health care costs?
9. The average health insurance company CEO earns $8 million. In recent years, the Aetna CEO earned $57 million, the CIGNA CEO earned $42 million, and executives at WellPoint made more than $150 million in gains. Will you agree to limit CEO compensation as part of your health insurance reform proposal?
10. How much of the money you make from health insurance premiums are you spending now or planning to spend on lobbying and other efforts to influence the debate on health care?

We've sent reporters these questions, so they have them on hand. I'll be down at the National Press Club tomorrow, live-blogging and listening to see if the media steps up to the plate, does their job, and questions the industry's spin. It should be a fun morning.

Healthcare group spent $250K lobbying in 3Q - Associated Press

Healthcare Leadership Council spent $250,000 lobbying federal government in third quarter

Measuring the Value of Public Health Systems: The Disconnect Between Health Economists and Public Health Practitioners - American Journal of Public Health

The value of governmental public health systems may seem obvious in light of progress in public health over the past century. The reality of chronic underfunding of these systems suggests that the general public is unaware of public health's value. It is thus essential that governmental public health systems demonstrate measurable contributions to improving the population's health. On a conceptual and practical level, however, measuring the payback from public health spending is a challenge. As public health officials battle for resources in constrained fiscal environments, the manner in which they measure and communicate the value of programs-both internally in budget discussions and externally to the public-is critical. We examined how researchers and public health practitioners have defined and measured the value of services provided by governmental public health systems. First, we discuss the health economics literature on value measurement in public health. Next, we present the results of qualitative interviews we conducted with leading public health officials and practitioners. Finally, we examine ways to bridge the gap between economists and practitioners and discuss opportunities for the future.

Is 2009 the Year We All Get Health Care? - Esquire

Nearly fifteen years after the Clintons tackled America's health care crisis, a new group called Health Care for America Now may just tip the tide, scaring the bejeezus out of Conservatives.

New fault line forms in health care fight - Politico

A new fault line is forming in the health care reform debate that could prove to be just as bruising as the conservative-vs.-progressive battles: the schism between single-payer and public-private advocates.

OPINION

What the Baucus Health-Care Reform Entails - Max Baucus

Regarding your Nov. 20 editorial "The Obama Health Plan Emerges": The Health Insurance Exchange envisioned in my reform will not involve oppressive regulation, but will simply preclude insurers from discriminating against those who are sick.

Medicare’s Too Costly Private Plans - New York Times

Private health insurance plans were supposed to bring better care and lower costs to elderly patients covered by Medicare. Instead they have increased the cost and complexity of the program without improving care, according to new analyses published by the respected journal Health Affairs. Congress clearly has more work to do to remove unjustified subsidies that prop up many of the most inefficient private plans.

Presidential Rx for Health - The Health Care Blog

Past U.S. presidents have provided innovative leadership that shaped the landscape for our national health and science institutions.

Dive Right into Health Care Reform - Huffington Post

The pundits have been speculating on how and when President-elect Obama will tackle health care reform. Will his approach be evolutionary, going slowly seeking incremental change, or revolutionary, going full bore with bold policy strokes? Whichever approach he takes, it seems like things are beginning to move quickly– with the imminent nomination of former Sen. Daschle as HHS secretary, who wrote on Huffington Post last March, "The time is now for us to take this [health care] challenge head-on;" with the introduction of a health care bill this month by Sen. Max Baucus; and with Sen. Ted Kennedy's expected roll out of his own proposal.

American Health Care: The Staggering Costs of the Status Quo - Think Progress

Right now, the American health care system spends too much on the wrong things for too few people. This status quo is getting very, very expensive.

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.

This Trust For America's Health report from October, 2008 focuses on better ways to spend health dollars:

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.

U.S. 'Not Getting What We Pay For' - Washington Post

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

Reporter's Notebook: Why is single-payer health reform not viable? - Billings Gazette

When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money.

Health Care: It's Time for a Major Overhaul - Alternet

A huge coalition of progressive and union forces is gearing up for political battle on the health care front.

Consensus emerging on universal healthcare - Los Angeles Times

The prospect of bold government action appears to be accepted among players across the ideological and political spectrum, including those who opposed the idea in the 1990s.

OPINION

Health Care Reform Must Start Now - Real Clear Politics

This would seem a heckuva time to unfurl a national health plan. Washington has big fires to put out in the financial markets. Taxpayers, meanwhile, face a zillion-dollar bill for economic stabilization on top of already soaring deficits. Can we afford a big new government program right now?

Column: Baucus maps out health care reform plan - Missoulian

Sen. Max Baucus' ambitious health care reform plan, released two weeks ago, contains some good ideas and laudable goals. But we should be clear about what it's not, and what it does not do.

Why Big Reform Should And Could Happen In 2009 - Think Progress

In a post titled ‘Why big reform won’t happen in 2009,’ Joe Paduda of Managed Care Matters responds to our argument that the economic crisis demands health care reform. While recognizing, to some degree, that Congress cannot help American families or address the economic woes “in a lasting, meaningful way without health care reform,” Paduda argues that a lack of cost containment measures render comprehensive health care reform unaffordable.

Recession And Children's Health Care – A Revisit - Daily Kos

Ten months ago, we wrote this piece because we were concerned about what might be coming down the road. Like hurricanes and pandemics, recessions are inevitable, and preparing for them makes more sense than ignoring them. But how to prepare?

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.

So how do they do it? Well there are four basic models for health care in the world. There is The Beveridge Model, originally created in the U.K. and was also adopted in Spain, most of Scandinavia, and New Zealand. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library. Cuba represents the world's purest example of government control.

The second is The Bismark Model, this system of providing health care would probably the smoothest transition from the American system. It uses an insurance system — the insurers are called "sickness funds" — usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; though tight regulation gives government much of the cost-control clout that the Bismark Model provides. The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The third is the National Health Insurance Model. This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices. The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

Lastly there is the out-of-pocket model. Only the developed, industrialized countries — perhaps 40 of the world's 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.

The sort of pioneer spirit I mentioned before served our forefathers well in creating a foundation for this country based on what they felt was unjust, but it is not serving us, or the current leaders of our country, to be too cavalier to learn from nations that are serving their people well.  It's no secret anymore that our market based health care system is not working, with medical bills being the number one cause of bankruptcy in the nation I think it's clear that the market doesn't inherently take care of itself, and more importantly can't take care of us. Right now with government and lobbyist relationships under the public eye more than they have been in years, it's the perfect time to not only learn from the mistakes of the past, but also pay close attention to what has been proven to work, hopefully creating a new heath care system that serves everybody.

What worries you most about the healthcare system in our country? - The Obama Transition Team

Our policy teams will be sharing new developments with you, the American people, and asking for feedback. It's up to you to respond. Watch the latest video, and join the discussion below.

Fewer young uninsured, more poor - Boston Globe

The number of American children without health insurance declined by about 6 percent last year, according to a new report by Families USA, a nonpartisan organization representing healthcare consumers. But that's largely because the child poverty rate increased, so more children qualified for government-sponsored insurance, the report found.

Orszag Will Be Director of OMB - Washington Post

Not long ago, the men and women minding the federal budget were pure number crunchers. But in choosing Peter R. Orszag to run the Office of Management and Budget, President-elect Barack Obama indicated yesterday that the job will have a more expansive portfolio in his administration.

A Fall Through Insurance-Coverage Gap - The Philadelphia Inquirer

Phil Venezio worked for 30 years selling laboratory equipment to schools and industry. He supported a family, paid taxes, saved what he could.

Foundation Starts Health Policy News Service - New York Times

Seeking to fill a niche left by the decline of the traditional news media, the Kaiser Family Foundation is starting a news service to produce in-depth coverage of the policy and politics of health care, both for an independent Web site and in collaborations with mainstream news organizations.

OPINION

BLANKLEY: Obama's health-care czar - New York Times

As President-elect Obama's apparent choice for Health and Human Services Secretary and as White House health care czar, it is a fair guess that Tom Daschle's view on health-care legislation may be decisive.

THE POLICY REALIGNMENT OF UNIVERSAL HEALTH CARE. - Ezra Klein

The evidence suggests that people like government-run health care systems. Medicare has much higher satisfaction ratings than private insurance. Americans are much less satisfied with their health system than they are in other countries. And the differences are significant.

Obama's Health Care Team: They Mean Business - Jonathan Cohn

Today the Obama transition office will announce its health care policy team. As expected, Tom Daschle will be leading it. According to sources closes to the transition, he'll be joined by a set of analysts including Lauren Aronson, Mark Childress, Dora Hughes, and Jeanne Lambrew. Harvard economist David Cutler will be serving as a part-time, outside advisor, reprising a role he served during the campaign. Among the other outside advisers are Jonathan Blum, Rahul Rajkumar, Terrell McSweeny, and Jenny Backus.

Small Businesses Open To ‘Any Kind’ Of Government Intervention In Health Care - Think Progress

Bob Laszewski points to an article by John Sinibaldi, a “well-respected health insurance agent in St. Petersburg, FL , [who] has become prominent in Florida’s broker community.” Sinibaldi argues that many small businesses would now accept some sort of government intervention in health care.

Health Care Game-Changer Underway? - David Sirota

America is a decidedly center-left nation, especially on the issue of health care. Obama now has a budget imperative to reform it immediately.

Saving on health care costs by crossing borders - Feministing

An article in Newsweek chronicles a new phenomenon: outsourcing US health care to Mexico. People have been going abroad to save money on cosmetic procedures for quite some time (Brazil is an infamous destination for this) but this is something different.

I'm told that dozens of the heaviest hitters from the health care reform world met for a private retreat in Virginia last week and spent two days girding for a major battle with the insurance industry, hashing out specific messaging, discussing organizing goals and planning a major fundraising drive to blanket the airwaves with ads next year.

At the retreat — which was organized by Health Care For America Now, the major umbrella group of unions, reform advocates and providers — the group agreed that they were aiming to start next year with at least $25 million for ads and field organizing, with the hope of raising many millions more.

Lots of elements of health care reform and how to win were discussed, but one of the most important was taking on the opposition. Specifically, if we want to win health care reform, we have to not only prove the insurance industry and the right-wing of this country wrong, we have to make them untrustworthy.

Case in point, as I wrote yesterday, conservatives and the industry will use all their resources to "kill" health care reform to preserve their own interests:

As this debate moves forward, keep a close eye on who's making arguments. If it's the insurance or pharmaceutical industry, you can bet their argument helps or protects their bottom line. If it's conservatives, you can bet it helps their political viability. Don't ever assume these groups have the public's interest at heart.

Having arguments is one thing, and yes, reasonable people can disagree on issues like health care. But it's important that the general public understand who's pushing arguments like "We can't afford health care in an economic crisis" or "big government health care is not the solution we need" and why they are pushing those arguments. As conservatives are making clear, they aren't against health care for ideological reasons so much as for partisan reasons:

Amidst the usual scary phrases like "government takeover," "Marxist," and "Obamacare" (what does that even mean?), Pethokoukis comes clean about his real problem with health care reform - people will like it and they'll like Obama for making it happen. Michael Cannon of the Cato Institute agrees. His message to Republican lawmakers: Blocking Obama's Health Plan Is Key to the GOP's Survival.

The country needs to understand why the right-wing is against health care reform. You can help make that happen.

SEIU has put together an online letter writing tool for folks to write letters to the editor to their local paper. All you have to do is input your zip code and write a letter and it will be automatically submitted to all the local papers in your area.

So, please take a moment and write a letter to your local papers. Expose the reasons why conservatives oppose health care reform. Make their arguments untrustworthy. That way, we'll be able to win quality, affordable health care for all in 2009.

Facing a Choice Between Home And Health Care - Wall Street Journal

Housing Rout Cuts Off Source of Funds to Pay Medical Bills; Chemo, and Then Foreclosure

Medicare’s private insurers await impending cutbacks - The Hill

Congress and the incoming Obama administration are poised to slash subsidies to private insurers under Medicare, a move that could significantly change the landscape for health plans in the entitlement program — and their beneficiaries.

Health Care CEO Council Roundtable - Wall Street Journal

The U.S. spends $2.3 trillion per year on health care — almost twice as much per person as other industrialized nations — but we aren’t getting what we pay for. Studies show that fully a third of spending is wasted on treatments, drugs, and tests that don’t improve Americans’ health outcomes and that adults receive recommended treatments for many illnesses only 55% of the time.

OPINION

Rising Hope For Fixing Health Care - David Broder

Things are looking up for substantive reform of America's troubled health-care system.

The health care promise Obama is bound to break - USA Today

Presidential candidates make many promises that, when circumstances change and political realities intrude, get modified or broken. Just ask George H.W. Bush or Bill Clinton. Here's one campaign promise President-elect Barack Obama is virtually guaranteed to break: He'll cut health insurance premiums by $2,500 a year.

Health care costs are crippling small businesses - The Health Care Blog

I've got news for the folks doing the International Foundation of Employee Benefit Plans' survey: Smaller businesses, especially those defined as true small businesses with two to 50 full-time employees, are strapped beyond belief when it comes to paying ever-higher premiums for health care.

Why the Economic Crisis Shouldn't Mean Putting Off Health Care - Monica Sanchez

Many have speculated that the health care reform promised during the election will have to be put off in the face of our severe economic crisis. Others warned that comprehensive reform will be impossible given the budget gaps and believe piece-meal reform is the most we can hope for. Still others believe the new president will not be able to tackle comprehensive health care reform in his first year for political reasons.

Cato: GOP Survival Depends On Blocking Health Care Reform - Daily Kos

Basically, the argument is that universal health care would be so popular that Republicans would lose their grip on social conservatives. Michael F. Cannon makes the case.

The Health Care Death Blow - Booman Tribune

One election factoid conservatives keep mentioning is the relative popularity of conservative self-identification versus liberal self-identification in the exit polls.

Can Wyden’s Call For The Elimination Of Employer-Based Coverage Survive New Congress? - Think Progress

On Friday, the 13 co-sponsors of Sens. Ron Wyden’s (D-OR) and Bob Bennett’s (R-UT) Healthy Americans Act wrote a letter to President-elect Barack Obama outlining their shared principles for reform.