Forbes: Good summary of health debate

Conservative Forbes gives a pretty good summary below of what the various health care bills in Congress do and don't say. And although Forbes uses the term "Obamacare" incessantly, it admits that Obama has only laid out 3 broad goals for reform; and in response, the House and Senate have proposed several different versions of health care reform.

I understand why Republicans latched onto the term "Obamacare" -- because labelling Hillary's health care bill "Hillarycare" in the 90s really helped kill it. However, unlike Hillary, Obama never came up with a bill in secret, he never plopped a bill in front of Congress and said, "Pass this." He just laid out the goals.

Obama's laid-back approach, however, has probably been his undoing.

This $1 trillion figure (which included a public option -- which Obama has since caved on) from the CBO sounds like a lot, but as Forbes points out, that's only $3,333 for every man, woman and child over 10 years, or $333 per person per year. For many of us, $333 is less than the cost of one month's insurance premium. (It's less than half of mine). $1 trillion still sounds like a scary number, until you consider that the U.S. will spend about $2.5 trillion on health care in 2009 alone, accounting for 17.6 percent of GDP. By 2018, the annual cost of health care is estimated to more than double to $4.4 trillion. Over the last decade, employer-sponsored health insurance premiums have increased 119 percent. Today, the average employer-sponsored health premium costs $13,000 for a family of four, or $3,250 per person, and employees pay 30 percent of that cost, or $3,900 per year, on average. Does that $3,333 estimate over 10 years still sound so scary? Furthermore, the CBO (yes, the same CBO that gave us that scary $1 trillion figure that Republicans have pounced on) estimated that employer-based health costs for an average family of four will reach $25,000 per year by 2018.

Source: http://www.nchc.org/facts/cost.shtml

So, at the same time you're considering the cost of reform, weigh the intolerable cost of doing nothing. Oh, and by the way, conservative Forbes says that health cooperatives won't increase the number of people who get insurance. But co-ops probably will be included in the final bill. Sorry.

Health Care Checkup
By Brian Wingfield and David Whelan

August 18, 2009 | Forbes.com

Feeling a bit lost in the debate over health care reform? It's understandable.

America's health care system was already confusing even before Congress' ideas for changing it. Now, special interests have made things yet murkier. The White House has backed away from its initial support of a government-run insurance program; town hall meetings are brimming with scorn for the ideas on the table, and health care chatter has consumed the airwaves.

Lawmakers will determine this fall what's in the final bill, but as the debate rages this summer, here's a guide to help you get up to speed and back to the beach as quickly as possible:

What's been proposed?

President Obama wants to see reform that includes, among other things, coverage for all Americans, allows people to choose their providers and lowers the growth in health care costs. Congress has to figure out the dicey details.

In July, leaders in the House of Representatives proposed a bill that would create a government-run insurance plan, or "public option," to compete with private insurers. It requires individuals to have coverage and mandates that large businesses provide it or pay a tax to the government. To help pay for the public option, it would increase taxes on the wealthy. Several House committees have produced their own, slightly different, versions of this bill.

The Senate's health committee also proposed a plan in July, and it too includes a public option and individual and employer mandates. However, the Senate Finance Committee, which determines how to pay for the Senate proposal, is deliberating until at least mid-September.

For this reason, "ObamaCare" doesn't really have a formal definition. It's basically still a handful of proposals.

What's still on the table?

Technically, everything; but in fact, a lot has been cut out. Most recently, the White House has backed off from its support of a public option, the most expensive part of reform and an idea that might not pass the Senate. The idea of taxing the wealthy is also probably gone. And the president doesn't support the idea of killing a tax subsidy for employer-provided coverage because it might raise taxes on the middle class.

So what's left? Proposed cost reductions in Medicare, Medicaid and prescription drugs. Perhaps a plan for health insurance to be provided by nonprofit cooperatives instead of the government. The main thing that remains: the problem of figuring out how to insure an additional 46 million people without adding to the deficit.

What's likely to get done, if anything?

Democrats in control of Congress and the White House aren't going to walk away from this battle without being able to claim victory, so expect some type of health care reform to happen this year. Much depends on what the Senate Finance Committee determines.

Reform will most likely cost less than $1 trillion, paid for by entitlement savings and various tax increases. It will likely expand health insurance, though probably not as much as the president hopes. And it seems increasingly likely that it won't include a public option.

What's it likely to cost?

With a public plan, the bill is projected by the Congressional Budget Office to cost just under $1 trillion over 10 years. That's $3,333 for every man woman and child. Take out the public plan completely and that drops by $773 billion, so the administration will have more room to spend that money on other proposals, like health co-ops or expanding Medicaid eligibility, promoting electronic health records or comparative effectiveness research. Removing that cost could also allow the final bill to include fewer Medicare cuts to hospitals or doctors.

What would it mean to the way I get medical care?

If you are part of the demographic that right now is not well served by the private insurance market and you don't qualify for Medicaid, Medicare or S-CHIP--you could suffer without a public plan option. The public plan would be ideal for small businesses that can't afford double-digit annual premium increases or low-to-middle income individuals with preexisting conditions who, in many states, can't even find an HMO to buy a plan from.

Co-ops could provide another option for these patients, but where they already operate, there's no evidence that they solve the uninsured and under-insured problems.

If you work at a big company, have Medicare or qualify for Medicaid, likely your medical care will not dramatically change, though the long-term fiscal pressures on the government plans will likely lead to cost-cutting and tax increases down the road.

What happens next?

Supporters of the public plan will likely make a push to ensure it's in the final bill. If they succeed, the final passage will happen, but it will be a bruising battle until the end. Expect more angry town halls. And forget about beer and car ads during football season. It will be all health care all the time.

If they don't get it back in, it will be much easier to get congressional support from moderates and even Republicans--but the president and the original band of reformers will face criticism that they didn't accomplish what they set out to do.

Obama caves to GOP, nixes 'public option'

See? Why were you Repugs worried about Obama? All along, it's the liberals like me who should have feared he was a corporate sellout. And now it's happened (again). Money and power did their thing. Obama caved.

So, the compromise deal will probably include state health insurance co-ops. Once those fail, and if Obama is re-elected to a second term, then we'll have another shot at real reform. If Obama isn't re-elected, then we'll have to wait another 4-8 years. So, long story short, we're talking about a four- to 10-year delay of the inevitable "public option." Meanwhile, all you Repugs get to high-five each other for enraging and scaring the crap out of America; and you can rejoice in the continued millions of uninsured and their needless, avoidable suffering. And four to 10 years from now, we liberals will get to say, "I told ya so." Gee, sounds like a great deal.

Making legislative sausage aint pretty. The sight of it can even make you sick.

White House appears ready to drop 'public option'

By Philip Elliot

August 16, 2009 | (the George Soros-funded and controlled) Associated Press

Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers.

Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his core principles of reform.

Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.

With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.

"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."

Obama's spokesman refused to say a public option was a make-or-break choice.

"What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday.

A day before, Obama appeared to hedge his bets.

"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it."

It's hardly the same rhetoric Obama employed during a constant, personal campaign for legislation.

"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and assure quality is a public option that will force the insurance companies to compete and keep them honest," Obama said in July.

Krugman: 'Obamacare' based on successfull Swiss model

The Swiss Menace

By Paul Krugman

August 16, 2009 | New York Times

It was the blooper heard round the world. In an editorial denouncing Democratic health reform plans, Investor's Business Daily tried to frighten its readers by declaring that in Britain, where the government runs health care, the handicapped physicist Stephen Hawking "wouldn't have a chance," because the National Health Service would consider his life "essentially worthless."

Professor Hawking, who was born in Britain, has lived there all his life, and has been well cared for by the National Health Service, [and is still alive! - J] was not amused.

[Investor's Business Daily is the Right's answer to Pravda. It is a total throwaway of lies and distortions. Reading it will make you dumber. Seriously. - J]

Besides being vile and stupid, however, the editorial was beside the point. Investor's Business Daily would like you to believe that Obamacare would turn America into Britain — or, rather, a dystopian fantasy version of Britain. The screamers on talk radio and Fox News would have you believe that the plan is to turn America into the Soviet Union. But the truth is that the plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn't a socialist hellhole the last time I looked.

Let's talk about health care around the advanced world.

Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the doctors. We've all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.

The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That's how Canada and, in a more complex fashion, France do it. It's also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program.

Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can't discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some "Swiss" aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it's a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn't have chosen this route. True "socialized medicine" would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That's why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

After stimulus, Japan's recession ends

Japan emerges from recession

August 17, 2009 | CNN.com

Japan has joined the growing number of major economies that are back in black.

Japan's economy grew 3.7 percent on an annualized basis from April to June this year, the first time the world's second largest economy has seen positive growth in 15 months.

The announcement of preliminary figures by Japan's Cabinet Office comes after France and Germany surprised economists last week by posting 0.3 percent growth for the second quarter of the year.

The news that Japan has rebounded -- the hardest hit of the major economies because of its reliance on exports -- gives economists cautious optimism that the worst of the global recession is over.

"The economy has seen a bottoming out of global demand, which has pushed out net exports ... especially in high tech industries and basic materials, such as chemical, steel and so on because of Chinese demand," said Hiromichi Shirakawa, chief economist in Japan for Credit Suisse.

Japan's GDP grew just under 1 percent during the three-month period and trade increased 1.6 percent.

The uptick marks the end of the worst recession in Japan since the end of World War II. Japan's GDP fell at a record pace during the January-March quarter, when GDP was 15.4 percent lower than the same time period last year.

The Japanese economy was buoyed by a historic ¥15 trillion ($150 billion) stimulus package in May, which included unemployment benefits, aid to struggling companies, promotion of green industries and a variety of tax breaks.

"There are many times in the past when tax breaks and fiscal stimulus were offered and failed, but this time around, it worked," Shirakawa said.

Economists expect GDP to continue modest growth through the rest of the year, especially with an expected rebound in global auto sales this quarter. But whether the recovery can continue into the new year after the stimulus package runs its course remains a question.

"Japan's economy still is quite sensitive to global demand ... and for consumer demand to grow on a self-sustained basis still seems unlikely," Shirakawa said.

AdAge: How Obama lost control of health-care debate

PR Pros: Obama Lost Control of Health-Care Message

By Michael Bush

August 17, 2009 | AdAge.com

For a president and an administration that seemed to play the PR and communications game better than almost any that preceded them, President Barack Obama and his staff appear to have lost control of the messaging in the health-care reform debate, the first big policy test of his administration.

AP

A woman holds a sign as President Barack Obama speaks at a town hall meeting about health care reform in Portsmouth, N.H.

And according to a number of communications professionals, the irony in all of this is that the president's opponents have managed to define the issue and take control of the conversation with tools -- such as grassroots marketing and e-mail communications -- that he used to near perfection during the election. Lesson learned for the Republicans.

"The Republicans and industries lining up [to block] reform have been good about doing what Obama used to be good at, like getting people to attend town halls and forums," said Mark Hass, CEO and partner of MH Group Communications. "Everywhere the proponents of health-care reform go, they get into these shouting matches with people. The ability of the GOP to get people to attend these town hall meetings and shout has turned the news coverage into this chronicle of emotional debate. Republicans are doing what he did so well, using e-mail and grassroots organizing techniques around social networks effectively to get people out and to make this debate confusing."

No clear definition of bill
There are a number of issues at play that have put the administration in the unenviable position of having to scramble to regain control of the situation, according to the industry professionals who spoke with Ad Age. Foremost among them is that with three separate bills floating through Congress, there is no clear and definitive explanation of what the bill actually says. The administration essentially committed the biggest mistake it could from an issues-management perspective: It failed to define the issue before its opponent did.

"The Republicans have done a good job at capitalizing on the vagueness of the bill," said Nick Ragone, partner at Omnicom Group's Ketchum. "The administration made a little bit of a misstep in delegating the details to Congress. That's given the Republicans the ability to read into the bill what they want and communicate that to the broader public. You hear the president talk and it's very vague and uncertain, and that has worked against him."

Mr. Ragone said this "by far" has been President Obama's first major misstep. "He misjudged the country's mood and it's been too vague," Mr. Ragone said.

Eric Dezenhall, CEO and co-founder of Dezenhall Resources, doesn't necessarily believe the Republicans have been masterminds, but instead lucked into a misstep by the administration. "The Republicans are massively disorganized and are essentially lucking into Obama's recent troubles," he said via e-mail. "While Democrats would like to believe that all of this pushback is orchestrated, my sense is that it's largely organic and through nobody's genius."

Ame Wadler, exec VP-global health care at Interpublic Group of Cos.' MWW Group, said the administration has done a terrible job of explaining the package to the public. But she also lays blame at the feet of Congress, which she thinks will end up damaging the president in the long run.

A partisan approach?
"President Obama promised there would be a more bipartisan and less political approach to his presidency and the leaders of the House and Senate are communicating and demonstrating partisan approaches," she said. "There is a clear arrogance toward the constituencies they serve. In fact, it seems they've forgotten that they are public servants and that they are representative of what people want, not what they think people need. There's a clear paternalism to the congressional communications and, frankly, an approach that is dismissive of the American people and as a result, while I think he is somewhat of an island because of his charm thus far, this will ultimately have a negative effect on Obama."

Mr. Hass doesn't feel any of this has had any negative influence on the president yet, but if "he doesn't come out of this with some type of victory or something he can claim as a victory, it will affect his personal brand."

Ms. Wadler doesn't like what she's seeing or hearing in the shouting matches between congressional leaders and their constituents at town hall meetings. Some congressional leaders have called those speaking out at the meetings un-American and debates have broken out over "authentic" grassroots efforts vs. "Astroturf" efforts. "That's one way to take the focus off of the issue by calling people rude and un-American instead of answering their questions," Ms. Wadler said.

And while she thinks those citizens shouting at members of Congress could face their own backlash, she said if that's what it takes to get heard, then so be it. "If it requires that you shout to get heard, then get heard," she said.

The second factor is the notion that Mr. Obama and his administration were resting on the laurels of what was a largely overwhelming sentiment throughout the presidential run -- that health-care reform must happen.

Torod Neptune, global PR leader at Waggener Edstrom, said it's clear this "full-scale legislative fight" is new territory for a lot of people in the administration and they were caught off guard. "It's the difference between campaigning and governing," Mr. Neptune said. "The ability to understand how quickly public sentiment can change and then being able to pivot and stay in front of that public sentiment is the holy grail for those of us in issues management and public affairs."

Mr. Neptune said in "brass knuckles-type" Washington policy discussions, rhetoric will not carry a person through, and engaging in a policy-specific battle is new to this administration. "At some point, you have to establish and frame the rationale and benefit of that issue," Mr. Neptune said. "That's the jump that has not been made as clearly and quickly. But they are clearly trying to make it now. It's not a battle of rhetoric, which is what we saw in the campaign and the first couple of months of the administration. Now you're getting down to the brass tacks of a specific policy legislative battle."

Rush was a mistake
The other contributing factor in this is the president's desire to quickly get another major bill passed before the August recess. Some say this may have been one too many for the public, who so far have already watched the multibillion-dollar stimulus bill and bailout plans expedited through Congress earlier this year.

Mr. Dezenhall thinks this was an enormous mistake on the part of the administration and Democrats in Congress. "Not only does the administration appear ill-prepared, they also appear arrogant and entitled, which may be even worse," Mr. Dezenhall said. "It's as if they believed they were destined to pass health care by virtue of some kind of kingly mandate. Being known for walking on water is a huge asset until you start believing it."

Ketchum's Mr. Ragone said rushing it through has also made people uneasy. "People are nervous, and rightly so," he said. "The stimulus package was rushed through with seemingly little payoff -- it has not gone the way it should have, and their follow-up to that was to rush health care through. That was a tactical misstep."

MWW's Ms. Wadler said the lack of clarity in the communication of what the bill entails coupled with the rush to get it passed was a bad cocktail the public doesn't want to swallow.

"By trying to rush it through without making an honest attempt to outline what it would mean in terms of costs and care, they made the public skeptical," she said. "It looked as if they were trying to rush something through so that people couldn't ask questions and couldn't challenge their assumptions."