Health Care

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Sunday morning health care and basketball

I’m like about 90% of the country (including the President) waking up to find out that Kansas really did lose.   I watched the game, but still hoped it would be different this morning.  Yesterday was a disaster for my bracket:  I lost both Kansas and BYU from my final four and the only reason I haven’t lost Duke and Kentucky is they haven’t had their games yet.  March Madness a few years ago was like this:  upset after upset.  Great games, but hell on one’s picks.  At this point, I’m just watching to see what happens next.

And we are also watching health care to see what happens next.  The Republican/Tea Party folks must know they are going to lose.  Yesterday they showed their true colors.  The story in the Washington Post by Paul Kane begins

Members of the Congressional Black Caucus said that racial epithets were hurled at them Saturday by angry protesters who had gathered at the Capitol to protest health-care legislation, and one congressman said he was spit upon. The most high-profile openly gay congressman, Rep. Barney Frank (D-Mass.), was heckled with anti-gay chants.

Republican members of Congress addressed the crowd both before and after the incident.  Where were they to control their followers?

Democratic leaders and their aides said they were outraged by the day’s behavior. “I have heard things today that I have not heard since March 15, 1960, when I was marching to get off the back of the bus,” said House Majority Whip James Clyburn (D-S.C.), the highest-ranking black official in Congress.

Between race (I believe that the opposition to anything proposed by President Obama and the wanting to see him fail is simply because the Republicans can’t stomach having a black man in the White House.) and abortion (The opposition to a woman’s right to choose stems, I think, from a deep seeded belief that women are incapable of having their own religious convictions or of making a rational decision), I worry what happens during the fall campaigns.

So I have to turn to Paul Krugman’s column earlier this week to remind myself what we are trying to do.

So this seems like a good time to revisit the reasons we need this reform, imperfect as it is.

As it happens, Reuters published an investigative report this week that powerfully illustrates the vileness of our current system. The report concerns the insurer Fortis, now part of Assurant Health, which turns out to have had a systematic policy of revoking its clients’ policies when they got sick. In particular, according to the Reuters report, it targeted every single policyholder who contracted H.I.V., looking for any excuse, no matter how flimsy, for cancellation. In the case that brought all this to light, Assurant Health used an obviously misdated handwritten note by a nurse, who wrote “2001” instead of “2002,” to claim that the infection was a pre-existing condition that the client had failed to declare, and revoked his policy.

This was illegal, and the company must have known it: the South Carolina Supreme Court, after upholding a decision granting large damages to the wronged policyholder, concluded that the company had been systematically concealing its actions when withdrawing coverage, not just in this case, but across the board.

But this is much more than a law enforcement issue. For one thing, it’s an example those who castigate President Obama for “demonizing” insurance companies should consider. The truth, widely documented, is that behavior like Assurant Health’s is widespread for a simple reason: it pays. A House committee estimated that Assurant made $150 million in profits between 2003 and 2007 by canceling coverage of people who thought they had insurance, a sum that dwarfs the fine the court imposed in this particular case. It’s not demonizing insurers to describe what they actually do.

Beyond that, this is a story that could happen only in America. In every other advanced nation, insurance coverage is available to everyone regardless of medical history. Our system is unique in its cruelty.

And one more thing: employment-based health insurance, which is already regulated in a way that mostly prevents this kind of abuse, is unraveling. Less than half of workers at small businesses were covered last year, down from 58 percent a decade ago. This means that in the absence of reform, an ever-growing number of Americans will be at the mercy of the likes of Assurant Health.

So what’s the answer? Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies.

Or to put it another way, you end up with something like the health care plan Mitt Romney introduced in Massachusetts in 2006, and the very similar plan the House either will or won’t pass in the next few days. Comprehensive reform is the only way forward.

Krugman concludes

Can you imagine a better reform? Sure. If Harry Truman had managed to add health care to Social Security back in 1947, we’d have a better, cheaper system than the one whose fate now hangs in the balance. But an ideal plan isn’t on the table. And what is on the table, ready to go, is legislation that is fiscally responsible, takes major steps toward dealing with rising health care costs, and would make us a better, fairer, more decent nation.

All it will take to make this happen is for a handful of on-the-fence House members to do the right thing. Here’s hoping.

Are you rethinking your position Stephen Lynch?  And what about you, Rick Boucher in Virginia?  Do either of you really want to be the vote that kills Health Care Reform?

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One day before the House votes on health care

It is Saturday afternoon.  The Tar Heels won their NIT game, my NCAA bracket is doing so-so. and the Sox won.  There is a lot going on including the all important countdown to 216 votes in the House.

A couple of things have happened.  President Obama has made his “remember why you are a Democrat” speech (or maybe it is live up to Abe Lincoln) before the House Democratic Caucus.  There are sufficient votes in the Senate for the bill as it will be amended by the House and it looks like Nancy Pelosi will get to 216 sometime before tomorrow’s votes if she is not already there.  The picture and the quotes that follow are from the New York Times Prescriptions blog.

President Barack Obama met with House Democrats on Capitol Hill to discuss health insurance reform legislation, Saturday, March 20, 2010 in Washington

“You have a chance to make good on the promises you made,” Mr. Obama said. “This is one of those moments. This is one of those times where you can honestly say to yourself: ‘Doggone it, this is exactly why I came here. This is why I got into politics. This is why I got into public service. This is why I made these sacrifices.’ ”

“Every single one of you have made that promise not just to your constituents but to yourself,” he added. “This is the time to make good on this promise.”

He had opened his speech by quoting Lincoln

“I am not bound to win but I am bound to be true,” he said.

I have to believe that once the bill is passed and signed and benefits begin to kick in there will be support for the bill.  I really liked the President’s characterization of the the Republican’s trying to get Democrats to vote no.

“I notice that there has been a lot of friendly advice offered all across town,” he said. “Mitch McConnell, John Boehner, Karl Rove — they are all warning you of the horrendous impact if you support this legislation.”

He continued, “Now, it could be that they are suddenly having a change of heart, and they are deeply concerned about their democratic friends. They are giving you the best possible advice in order to ensure that Nancy Pelosi remains speaker and Harry Reid remains leader and all of you keep your seats — that’s a possibility.”

Mr. Obama chuckled at himself, and lawmakers in the audience laughed.

“But it may also be possible that they realize that after health reform passes and I sign that legislation into law, it’s going to be a little harder to mischaracterize what this legislation has been all about,” he said.

So with all this, what is going on the Representative Stephen Lynch?  Lynch represents the part of Boston not represented by my Rep, Mike Capuano, who is voting “yes”.  Lynch has announced that he is voting “no” because the bill does not do enough to control the cost of insurance.  There is a lot of pressure on him by the local unions, include SEIU of which I am a member.  According to the Boston Globe

More than 20 Massachusetts labor leaders made a last-ditch appeal to US Representative Stephen F. Lynch late yesterday, urging him to “do the right thing’’ and vote for a national health care overhaul.

In a letter delivered to Lynch’s South Boston office, the group suggested a vote against the bill would damage his standing with their membership.

Lynch, a former president of Ironworkers Local 7, declared Thursday that he will vote against the health care bill. He said the current bill does not do enough to force insurance companies to reduce costs.

“Congressman, we will not be able to explain to the working women and men of our union why you voted against their interests,’’ the letter states. “We have stood together time and time again and you have made an enormous difference.’’

“It takes courage to make history,’’ they wrote. “We know that you have always had the courage to do the right thing — national health reform is the right thing for Massachusetts families. Please stand with us once again and do the right thing.’’

It looks like he will join Senator Scott Brown in being the two “no” votes from Massachusetts.

Another Republican objection disappeared this afternoon when the House Rules committee decided against “deeming” and will now hold two votes.  As explained in the Washington Post

Rep. Chris Van Hollen (D-Md.) said the House will take three votes on Sunday: first, on a resolution that will set the terms of debate; second, on a package of amendments to the Senate bill that have been demanded by House members; and third, on the Senate bill itself.

Van Hollen, who has been working on the issue with House Speaker Nancy Pelosi (D-Calif.), said House leaders concluded that that order — approving the amendments before approving the Senate bill — makes clear that the House intends to modify the Senate bill and not approve the Senate bill itself.

“We believe this is a better process,” House Majority Leader Steny Hoyer (D-Md.) said of the vote strategy. “We determined we could do this. . . . We believe we have the votes.”

This is all possible because Senator Reid has done his head count and has the votes to pass the reconciled bill.

I think we will know who the 216 votes will be by tomorrow morning.

And before I retire to watch basketball (do you believe that St. Mary’s beat Villanova?! ) here is a link to the amendments the House will be making to the Senate bill.

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Union negotiations and health care benefits

Next week my bargaining unit will have an all employee meeting to prepare for bargaining for a new contract.  Our current contract, like a lot of city contracts, ends September 30.  So what will be the most contentious issues:  Wages and Health Care.

Last year, we narrowly voted to support the Mayor by putting off a scheduled 2.5% raise what was to be effective at the beginning of the current contract year.  What will happen to that raise?  We gave up money under the general threat of layoffs – a ridiculous proposition in my unit which is about 95% federally funded and with stimulus funds to hand out, we are swimming in money compared to general funded agencies like the libraries, police and  schools.  The teachers and police, by the way, voted against a freeze and no one was laid off – at least not yet.  I judge our changes of getting any kind of COLA to be slim to none – except maybe that elusive 2.5%.

So that leaves health care benefits.  I admit we do have a great deal.  The employee paid part is low and the co-pays small but it does cost the city a bundle.   This is a chart from the Boston Globe.

Looking at the chart it makes sense that we would agree to joing GIC.  And certainly retirees whould join Medicaid.  (My bargaining unit agreed to that last year for future retirees.)  But here are the political problems.

Sean Murphy, in his series of Globe articles, writes

Public employee unions are leery of changes to municipal health care plans.

Brad Tenney, secretary-treasurer of the Professional Fire Fighters of Massachusetts, an umbrella group of local unions, said his members are willing to “sit down with leaders on Beacon Hill and in the municipalities to reach a meeting of the minds.’’

“We recognize the significant cost of health care,’’ he said. “But we feel it is unfair to look at health insurance in a vacuum. Members gave up pay raises or accepted smaller pay raises through the years for the health care benefits they have.’’

Public employee unions and retiree groups, which make generous donations to the treasuries of many state officer-holders, are well-connected on Beacon Hill.

In brief interviews on Monday, House Speaker Robert DeLeo and Senate President Therese Murray expressed little desire to strip union employees of long-held collective bargaining rights. Murray also said she did not believe the GIC was capable of accepting cities and towns without increasing its staff.

The GIC provides health insurance for about 300,000 state employees, retirees, and elected officials, including employees and retirees of numerous independent authorities. State law allows the GIC to adjust the amounts subscribers pay in premiums and copayments without union negotiations.

I think that last sentence is at the heart of why a lot of unions, including mine, are reluctant to endorse the move to GIC, but I think it will be a big part of the bargaining this year.  I also think Tenney has it right that health insurance isn’t something to be looked at in a vacuum.  I was on the bargaining team last round and we worked very hard to make sure that the combination of wage increases and health care costs did not result in a negative amount for any employees.

Kevin Cullen sums it all up in his column in the Sunday Globe

In the case of cities and towns, we taxpayers are the owners, and we’ve got no gun. Taxes come out of a spigot we can’t shut off. And if we don’t pay taxes, we’ll be escorted to jail by some guy whose health plan we’re paying for. The idea that taxpayers are forced to underwrite health care plans that the vast majority of us can only dream about is more than galling.

But aside from being good doobies, and in some cases averting layoffs, what’s the incentive for the unions to give up their benefits?

Before you go bashing the unions, which is irresistible in this case, would you, short of having that gun to your head, give up benefits?

After Murphy’s stories ran, the Boston Foundation put out a report saying that the only way we can stave off the financial ruin of many cities and towns is for the Legislature to stand up to the vested interests and change the law, forcing municipal employees to shoulder more of their health care costs. The report also urged mayors and other municipal executives to force retirees onto Medicare at 65.

So the financial solvency of many cities and towns rests on the premise that politicians will do the right, as opposed to the expedient, thing by going after two of the most politically active demographic groups in the state, the unions and retirees.

God help us.

Murphy’s stories have caused understandable anger. But they should also cause everybody to pick up the phone and tell the pols in Washington they have to put aside the ridiculous charade that has passed for debate and produce something that will improve the way health care gets doled out and, just as important, rein in runaway costs.

It is hard to say what will happen with municipal unions.  I have a feeling that since we can’t strike, we will be working without a contract for a while.  But there is some hope.  The workers from one of the largest supermarket chains have announced just a short while ago that a strike had been avoided.

Grocery workers this morning approved a new contract with Stop & Shop Supermarket Co., ending months of tense negotiations and averting a threatened strike.

A day after reaching a tentative agreement with the supermarket chain, some 2,000 union members agreed to a three-year deal that will boost wages and preserve benefits, said a spokesman for the area branch of the United Food and Commercial Workers.

“Through the hard work of negotiators, we were able to reach an agreement that maintained our great health and pension benefits and provided general wage increases,” said Jim Carvalho, a spokesman for UFCW Local 1445, which represents 36,000 Stop & Shop employees in southern New England.

So maybe there is hope.  And the bottom line is everyone should have access to the kind of benefits government workers have.

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Passing health care

It seems pretty obvious that neither the Blair House summit nor the inclusion of some of the Republican suggestions have gained health care reform any Republican votes.  So how exactly can the bill pass?

Here is a diagram from today’s Washington Post

The President never used the term reconciliation in his remarks presenting his plan, but I think it was pretty clear what he meant.  According to the New York Times story

Wednesday’s remarks, made to a group of sympathetic medical professionals, many of them clad in traditional white lab coats, marked Mr. Obama’s entry into the end game of Washington’s long and divisive health care debate. With Republicans unified in opposition to the measure, Mr. Obama used his appearance to make the case to the public that while he is willing to accept Republican ideas, starting over, as Republicans are demanding, does not make sense.

He called on Democrats to stick with him.

“This has been a long and wrenching debate,” Mr. Obama said, adding that while health care “easily lends itself to demagoguery and political gamesmanship,” that is no reason “for those of us who were sent here to lead to just walk away.”

The President’s proposals would be shaped into legislation and then included in the bill by the House Rules Committee, but I guess that Representative Boehner doesn’t understand how the process works because he is now complaining that the President’s bill is “too short.”   I know that Representative Cantor thinks the bills passed by the House and Senate are too long.  Guess the Republicans will complain no matter what the length of any Democratic bill or Democratic proposal.

The health care bill is not going to make everyone 100% happy,  (Where’s the public option?) but the important thing is to make a start.  We are still tinkering with Social Security, Medicare and Medicaid and we can do the same with health care reform.  And one final thought:  I think the Democrats will do much better in the fall elections if they have an actual bill they can explain and sell – especially if they pass it with no Republican support.

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Christmas and Health Care

This was posted this morning by Mark R., NY as a comment on the New York Times Prescriptions blog.  Thank you to you, Mark.

‘Twas the day before Christmas
And they passed a bill
Despite the considerable
Republican chill.

The Senate was finished
At last for this year
But the right wing continues
Their campaign of fear

So when the time comes
To sit down with the House
I wonder if Boehner
Will still be a louse

The minds of the people
They claim to have known
And they continue to harvest
The seeds they have sown

If at the end of this all
We can get our reform
It will probably be
When again it is warm

Let’s get that public option
Back on the table
With the donkeys together
And graze in their stable

Let’s hope that they can get
This health care bill right
So that everyone’s covered
And can sleep at night

And may the Republicans
Who can only say NO!
In two-thousand-ten
Be voted to go

So we can finally craft it
To be single payer
Like every other industrialized
National player

So despite this bill being
Quite a bit watered-down
There’s still hope for the future
Despite the tea-bagging clowns.

So we say to our Reps
On this Christmas Eve
Just make it affordable
And don’t you deceive

May two thousand and ten
Bring you all lots of cheer
A lot more of together
And a lot less of fear.

Happy Christmas!

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A first look at the Senate Health Care Bill

Lester Feder has a good short summary of the most contentious points in the Senate Bill that will pass tomorrow at 7 am.  I think that the House version is, except for the very restrictive language on abortion, a better bill and the efforts at reconciliation will be very interesting.

1. Affordability. The House generally does a much better job of helping low- and moderate-income Americans afford coverage. For the very poor, it opens the Medicaid program to individuals who earn less than $16,245 per year, whereas the Senate makes the program available only to those earning less than $14,404. The Senate offers more subsidies than the House to help the middle class buy coverage. But the Senate’s subsidized insurance offers weaker coverage than that mandated by the House and leaves these Americans far more exposed to out-of-pocket costs

2. Enforceability. The Senate would have insurers sell policies in state-based exchanges, relying on state officials to police the market. The House, on the other hand, sets up a national exchange, and many believe the federal government can do a much better job of protecting consumers than state regulators. There are also questions about whether the Senate’s legislative language protects consumers’ right to go to court if insurance companies violate the new regulations.

What’s more, there’s a minor provision in the Senate bill that could undermine one of health reform’s most important regulations. On paper the Senate bans underwriting–the practice of charging higher premiums to those with pre-existing conditions. The Senate, however, allows for the creation of “wellness incentives,” which are theoretically designed to encourage people to do things like quit smoking or exercise by reducing premiums for those who engage in healthy behaviors. But the Senate includes virtually no limits on the “wellness” indicators an insurance company can measure and allows for huge variations in premiums. This could mean people who have been pregnant, have high blood pressure or are HIV-positive could be hit with thousands of dollars in extra premiums.

2. Enforceability. The Senate would have insurers sell policies in state-based exchanges, relying on state officials to police the market. The House, on the other hand, sets up a national exchange, and many believe the federal government can do a much better job of protecting consumers than state regulators. There are also questions about whether the Senate’s legislative language protects consumers’ right to go to court if insurance companies violate the new regulations.

What’s more, there’s a minor provision in the Senate bill that could undermine one of health reform’s most important regulations. On paper the Senate bans underwriting–the practice of charging higher premiums to those with pre-existing conditions. The Senate, however, allows for the creation of “wellness incentives,” which are theoretically designed to encourage people to do things like quit smoking or exercise by reducing premiums for those who engage in healthy behaviors. But the Senate includes virtually no limits on the “wellness” indicators an insurance company can measure and allows for huge variations in premiums. This could mean people who have been pregnant, have high blood pressure or are HIV-positive could be hit with thousands of dollars in extra premiums.

3. Financing. The House bill is funded primarily through a progressive income tax on families earning more than $1million; it also requires employers to either cover employees or pay into the system. The Senate, on the other hand, imposes a poorly designed tax on “high cost” plans and an awkward alternative to an employer mandate, both of which could wind up hurting many of the Americans who most need help from this legislation.

As the process moves forward it will be interesting to see where President Obama lands.  Right now, he appears to be simply encouraging everyone to put something in a bill and pass it. 

The New York Times quotes from his interview on PBS

Unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion into the health care system.

In an interview with PBS, Obama signaled he will sign a bill even if it lacks the provision.

”Would I like one of those options to be the public option? Yes. Do I think that it makes sense, as some have argued, that, without the public option, we dump all these other extraordinary reforms and we say to the 30 million people who don’t have coverage, `You know, sorry. We didn’t get exactly what we wanted?’ I don’t think that makes sense.”

I’m waiting for the conference bill before I decide whether the  bill is a good one or not.

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Bureaucracy and health care

I have to admit that when I hear people say they are opposed to the public option in health care because they don’t want their medical decisions made by a “government bureaucrat” my blood pressure begins to rise.  Who exactly makes decisions for those with private insurance?  A blue cross, healthsouth, wellpoint, or harvard pilgrim bureaucrat. 

When you call up and ask a question about your coverage does it matter if you get put on hold by someone who is a government employee or an insurance company employee?  Both enforce and interpret regulations.  After all one definition of a bureaucracy (OK it is definition #3 after people who work for the government) is “a system of administration marked by officialism, red tape, and proliferation.” [ Webster’s New Collegiate Dictionary]  Isn’t this when companies deny you for a pre-existing condition – like having been pregnant?  I’ve always had private insurance and have been put on hold almost every time I call about a payment or coverage.

So brought to you by Congressman Anthony Weiner, are the names of the Republican Congresspeople who are on medicare, but oppose the public option.

Rep. Ralph M. Hall
Rep. Roscoe G. Bartlett
Rep. Sam Johnson
Rep. C.W. Bill Young
Rep. Howard Coble
Sen. Jim Bunning
Sen. Richard G. Lugar
Rep. Don Young
Sen. Charles E. Grassley
Sen. Robert F. Bennett
Rep. Vernon J. Ehlers
Sen. Orrin G. Hatch
Sen. Richard C. Shelby
Rep. Jerry Lewis
Sen. James M. Inhofe
Rep. Ron Paul
Rep. Henry E. Brown
Sen. Pat Roberts
Sen. George V. Voinovich
Sen. John McCain
Rep. Judy Biggert
Sen. Thad Cochran
Rep. Harold Rogers
Rep. Dan Burton
Rep. Howard P. “Buck” McKeon
Rep. Frank R. Wolf
Rep. Michael N. Castle
Rep. Joe Pitts
Rep. Tom Petri
Sen. Lamar Alexander
Rep. Doc Hastings
Rep. Cliff Stearns
Rep. Sue Myrick
Rep. John Carter
Sen. Mitch McConnell
Sen. Jon Kyl
Rep. Phil Gingrey
Rep. Nathan Deal
Rep. John Linder
Rep. Kay Granger
Rep. John L. Mica
Rep. Walter B. Jones
Sen. Jim Risch
Rep. Ed Whitfield
Rep. F. James Sensenbrenner
Rep. Virginia Foxx
Sen. Kay Bailey Hutchison
Rep. Ginny Brown-Waite
Sen. Saxby Chambliss
Sen. Michael B. Enzi
Rep. Elton Gallegly
Rep. Donald Manzullo
Rep. Peter T. King
Rep. Ander Crenshaw

These are the 54 Republicans who don’t want government bureaucrats making health care decisions.

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Dr. Bones Explains Health Care

This past Sunday, the back page of the Boston Globe “Ideas” section was a great cartoon by Dan Wasserman.

And I’m still disappointed about the public option, but I’m not quite ready join Howard Dean and dismiss the entire bill.  [An update:  soon after I first published this Howard was on the Rachel Maddow show saying he is now not going to oppose the bill due to some additional changes that had been made.]

For more from Wasserman use the blogroll link for Out of Line.

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The Recession Effect

Two stories in today’s papers, one in the Boston Globe and the other in the New York Times, combined with a sudden flurry of foreclosure activity at the office reminds me that the lagging  job creation numbers are not just statistics for economists and government agencies to toss around.  The effects are real and are clearly taking their tolls.

This from the Boston Globe this morning

Requests for reduced alimony and child support payments have surged, and the emotional toll of lost jobs, slashed pay, and uncertain futures appears to be driving an increase in other family problems.

“People are increasingly agitated, and it’s incredibly emotional,’’ said Paula M. Carey, chief justice of the Probate and Family Court. “They are out of work, struggling to keep their homes, and all of that takes a toll. Every day, in every court, you can see it.’’

The same economic turmoil that has prompted more families to seek judicial relief has also made courts less equipped to provide it. Steep budget cuts have left the family courts roughly 40 percent understaffed. There have been cutbacks in court-appointed guardians and probation officers who try to mediate disputes before they are brought to judges, increasing judges’ caseloads and creating delays. Financial constraints have forced more clients to represent themselves, which has tended to further slow proceedings.

You have to worry about the impact on children and teenagers.

One day last week in Courtroom 2 of Boston’s Edward W. Brooke Courthouse, more than 50 cases came before Judge Joan Armstrong – an unrelenting succession of single mothers pleading for more support, some fathers saying they can’t pay, and couples grimly agreeing their marriages were beyond repair. Some had lawyers with expensive suits and leather briefcases by their side; others stood alone. Most traded accusations. Few found common ground.

Looming over nearly every case was the heavy weight of financial distress, and parent after parent described for the judge an economic situation hanging by a thread. As the day began, stacks of thick folders were piled high on the judge’s desk, and in quick succession a mother won permanent guardianship of her daughter, a 19-year-old with Down syndrome; an elderly woman in a shawl, after gazing imploringly at the ceiling as though for guidance, won her motion to extend by a year a restraining order against her former husband; a woman requested a hearing on reducing her child support payment.

What I really fail to comprehend is the Republican position that we can’t increase the deficit to create jobs and to fund a jobs program.  Don’t they understand that putting people back to work not only helps reduce the stress on them, but also means that they help support the economy by paying taxes?  Putting funds into the Highway Trust Fund and other transportation projects as my congressman, Mike Capuano, has proposed would allow states to proceed with infrastructure programs and hire people.  The current stimulus programs are a start, but much more is needed.

More than half of the nation’s unemployed workers have borrowed money from friends or relatives since losing their jobs. An equal number have cut back on doctor visits or medical treatments because they are out of work.

Almost half have suffered from depression or anxiety. About 4 in 10 parents have noticed behavioral changes in their children that they attribute to their difficulties in finding work.

Joblessness has wreaked financial and emotional havoc on the lives of many of those out of work, according to a New York Times/CBS News poll of unemployed adults, causing major life changes, mental health issues and trouble maintaining even basic necessities.

These are the results of a new poll announced today in the New York Times.

With unemployment driving foreclosures nationwide, a quarter of those polled said they had either lost their home or been threatened with foreclosure or eviction for not paying their mortgage or rent. About a quarter, like Ms. Newton, have received food stamps. More than half said they had cut back on both luxuries and necessities in their spending. Seven in 10 rated their family’s financial situation as fairly bad or very bad.

But the impact on their lives was not limited to the difficulty in paying bills. Almost half said unemployment had led to more conflicts or arguments with family members and friends; 55 percent have suffered from insomnia.

This graphic illustrates some of the results.

And of course many of the long term unemployed can’t afford health insurance – even the COBRA payments – so they are unable to take care of the health issues resulting from the stress and anxiety creating even more stress. 

Nearly half of respondents said they did not have health insurance, with the vast majority citing job loss as a reason, a notable finding given the tug of war in Congress over a health care overhaul. The poll offered a glimpse of the potential ripple effect of having no coverage. More than half characterized the cost of basic medical care as a hardship.

I realize that the Obama administration is trying to talk banks into lending to small businesses which create jobs, but without a real public jobs program to put people to work so they can begin spending and paying taxes I am afraid that foreclosures will continue increase, domestic violence will rise,  and the overall level of violence will continue to increase.

One very interesting result of the poll was who got the blame.

In terms of casting blame for the high unemployment rate, 26 percent of unemployed adults cited former President George W. Bush; 12 percent pointed the finger at banks; 8 percent highlighted jobs going overseas and the same number blamed politicians. Only 3 percent blamed President Obama.

Those out of work were split, however, on the president’s handling of job creation, with 47 percent expressing approval and 44 percent disapproval.

The Republicans may seem to have forgotten who allowed the economic crisis to happen, but it appears that the unemployed have not.  But clearly, the Obama administration and Congress need to act quickly.

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So what is really in the Health Care Reform Bills? One Progressive Analysis

I ran across this very interesting piece by Maggie Mahar who works for the Century Foundation.  The Century Foundation was founded in 1919 and  is “committed to the belief that a mix of effective government, open democracy, and free markets is the most effective solution to the major challenges facing the United States.”  1919 places it with the progressive movement and so it remains.

Mahar writes “Why Congress’ Health Care Bills are better than you think” posted on AlterNet on November 6. (Before the vote and before the Stupak amendment which is upsetting and a backdoor way of extending the Hyde amendment, but now is not the time to kill reform. Repeal of the Hyde amendment is a fight for another day.)  I have sampled a few of her observations, but the entire piece is very interesting, particularly her comments on the Congressional Budget Office which could be a blog on their own.

Many progressives are expressing deep disappointment with the health reform legislation now moving through Congress.

Some suggest that some legislators made deals with lobbyists and let them write the bills. Others complain that both the subsidies and the penalties are too low. Still others don’t like the fact that states can “opt out” of the public insurance option and decide not to offer “Medicare E” — Medicare for everybody.

Finally, many ask: “Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why can’t they roll out universal coverage next year?”

Normally, I would be among the first to critique the bills. By temperament and training, I’m both a skeptic and a critic.

But in this case, I think it is important to recognize that we cannot expect this first piece of health reform legislation to be anything but wildly imperfect. In fact, I’m impressed by the progress Washington has made in just 10 months.

I’ve been watching the struggle for health care reform since the early 1970s, and compared to what has happened over the past 39 years, this is mind-boggling.

Mahar cites gains in three main areas:  affordability, no denial of coverage, and a realignment of Medicare.

On affordability

For example, under the House bill, a family of three making $32,000 a year would pay $1,360 in annual premiums for good, comprehensive coverage; under the Senate Finance Committee bill, that family would be asked to lay out $2,013. Today, without reform, if that family tried to buy insurance, it would find that the average plan costs $13,500. For this household, the current legislation makes all the difference.

Too often, the press suggests that such a family would be expected to pay $10,000 out of pocket to cover co-pays and deductibles. That just isn’t true.

Even if the entire family were in an auto accident and racked up $200,000 in medical bills, at their income level, the House bill caps out-of-pocket expenses at $2,000 a year. Under the Senate Finance bill, the family would have to pay $4,000.

Moreover, under both bills, there are no co-pays for primary care. Even private insurers cannot put a $25 barrier between a family and preventive care.

Moving up the income ladder, a median-income household earning roughly $55,000 would pay premiums of $4,300 to $6,500 — depending on whether the Senate Finance bill or the more generous House bill sets the terms.

Without legislation, they too would face a $13,500 price tag — and that is if they could get a group rate. If they are buying insurance on their own, coverage could easily cost $16,000

No denial of coverage

House Speaker Nancy Pelosi’s health care reform fact sheet offers two outrageous examples of just how easy it is for insurers to deny coverage today:

  • Peggy Robertson: The Colorado mother of two was denied health coverage because she had a C-section in 2006. The insurance company told her if she got “sterilized” she would be eligible for coverage.
  • Christina Turner: After being sexually assaulted in Florida, Turner followed her doctor’s orders and took a month’s worth of anti-AIDS medication as a precautionary measure. She never developed an HIV infection. Months later, when shopping for new health insurance coverage, Turner was repeatedly denied coverage because of the precautionary anti-HIV treatment she received after being raped.

Realignment of Medicare which has the Republican opposition literally foaming at the mouth.

What many reformers don’t seem to understand is that when the public plan begins to negotiate fees with providers in 2013, Medicare fees for some very expensive services will be significantly lower than they are today, while reimbursements to primary care doctors will be substantially higher.

Medicare already has announced plans to cut fees for CT scans and MRIs by as much as one-third and has proposed trimming fees to cardiologists by 6 percent next year. Meanwhile, it would hike fees for primary care physicians by 4 percent.

…

Over the next three years, Medicare will be realigning financial incentives to reward preventive care and management of chronic diseases, while reducing payments for overly aggressive tests and treatments that have no proven benefit — and penalizing hospitals that don’t pay enough attention to medical errors. In the process, Medicare will be conserving health care dollars while protecting patients from needless risks.

As President Barack Obama has promised, Medicare cuts can make health care safer and more affordable for everyone — including the upper middle class. Because most private insurers will mime Medicare’s efforts to reduce overpayment, the cost of care will come down for everyone.

Mahar makes a couple of other interesting points about the new legislation including this on the Senate opt-out.

…even if the Senate’s opt-out provision for states remains in the final health care reform bill, states will not opt out. It would be too difficult for politicians to try to explain to voters why they cannot have access to a government plan that will be able to offer comprehensive insurance for less than what they pay for private insurance.

She concludes

If there ever was a time to avoid the traps of perfectionism, it’s now. As the old saying goes, don’t let the perfect be the enemy of the good.

And there’s a lot that’s good in the bills coming out of the House and Senate. No, they’re not perfect, but they offer a path to even better reform in the future while improving the lives and health care outcomes for millions of Americans. And that is all to the good.

We need to encourage Harry Reid and the other Blue Dog Senators to get a backbone.  One way to ease re-election fears might be to have some provisions kick-in sooner rather than later.  Mahar doesn’t talk about time tables and I know that the health exchange and public option are set for 2013.  I think some more research is in order.