Restating the Obvious

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There’s more commentary today on health insurance rescissions. Many are angry, but I’m not seeing anyone else state the obvious — the CEO’s insistence that they can’t stop recissions and make a profit; the implicit acknowledgment that they can’t insure people with preexisting conditions and make a profit; amounts to a confession that the private health insurance industry cannot solve the health care crisis. The “free market” is inadequate to the task of paying for modern health care.

And see Digby — the CEOs of the 23 top health insurance companies received $14.9 billion in compensation over a five year-period. You can provide a lot of health care for $14.9 billion.

What are the righties saying? So far the only reaction I’ve seen is from Erick Erickson of RedState. Taking his comments in reverse —

More damning, the White House cannot think of a single example of a single-payer system in the world that works.

Apparently White House spokesman Robert Gibbs was caught inexcusably flat-footed on a question about which single-payer system in the world “works.” I can answer that, but first let’s turn the question around — name a single nation in which 21st-century health care is being delivered by a “free market” system, at all.

{Cricket Chirps}

The United States is the only industrialized democracy that pretends to have a “free market” system, although in fact a large part of our health care costs are being paid by government, anyway. And the World Health Organization says ranks the U.S. at #37, behind Costa Rica, in terms of quality and fairness of our system.

In other words, there are 36 nations with some form of government-paid national health care system, several of which are single-payer, that are doing a better job than we’re doing in delivering health care.

Erickson also says,

Jay Rockefeller, Ted Kennedy, Barack Obama, and a host of liberal writers admit that the government will determine whether or not to treat you based on whether the government thinks the cost/benefit analysis makes sense.

Does anyone have any idea where Erickson got that idea? I’ve seen no such admission, and of course Erickson doesn’t provide a link.

Life as a Preexisting Condition

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The must-read new story today is by Lisa Girion of the Los Angeles Times. In “Health insurers refuse to limit rescission of coverage,” we find the clearest case yet why the private health care industry will never, ever, not in a million years, come even close to solving the health care crisis.

In a nutshell — yesterday three big insurance company executives — WellPoint Inc., UnitedHealth Group and Assurant Inc. — told the House Subcommittee on Oversight and Investigations that their business models depended on being able to cancel the health insurance policies of customers who cost them too much money. An investigation by the Committee had found that over a five-year period, these companies had canceled the coverage of more than 20,000 people in order to avoid paying more than $300 million in medical claims.

One of the execs claimed the rescissions — industry jargon for canceling coverage — were necessary to protect the companies from fraud. People lie about preexisting conditions on their applications, he said, and this drove up the cost of insurance for everyone else. I’ll come back to this point in a moment.

In practice, this means insurers target people with high-cost conditions such as breast cancer and lymphoma and direct employees to examine patients’ paperwork for any pretense to cancel coverage. People with innocent mistakes and inadvertent omissions; people who were unaware of a preexisting condition at the time they filled out the application because the symptoms hadn’t developed yet; people whose preexisting conditions were minor and had nothing whatsoever to do with the disease costing the insurer money — such people found themselves dumped out of the health care system at their time of greatest need.

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

Karen Tumulty at Time presents several other heart-breaking, and outrageous, examples.

Of course, you might remember that Michael Moore documented this practice quite nicely in Sicko. We all knew this was going on. Members of the House Committee feigned surprise.

But I want to go back to the part about rejecting people with preexisting conditions. Who above the age of 40 does not have a preexisting condition? For that matter, what percentage of young adults freshly cut loose from their parents’ policies find they cannot obtain insurance because they failed to get through childhood without a preexisting condition?

The insurance companies are saying they can’t make a profit unless they deny coverage to people with preexisting conditions. How is this not an admission the private health insurance industry is a big, fat FAIL?

Righties just love to tell us that the reason health insurance is so expensive in some states, like New York, is that those states have (Cue: “Fortuna, Imperatrix Mundi (O Fortuna)”) regulations. And what are those regulations? Chief among them are provisions that limit the insurers’ abilities to deny coverage to people with preexisting condtions.

So, in many states, a middle-aged person with no serious health problems who was once prescribed Lipitor for high cholesterol would be unable to obtain health insurance at any price. In New York, this person can get insurance. Yes, it’s so expensive most people can’t afford it, but it’s obtainable for those who can pay for it.

What this says to me is that relying on a private insurance industry to pay for health care costs is unworkable. A private insurance industry simply cannot do the job of paying for health care, because the only way a private company can make a profit is to deny coverage to people who are actually sick so that they don’t have to pay those bills.

My next question is, how obvious does this have to get before people see it?

I’m sure some people do lie on their insurance applications in order to obtain coverage. But in most industrialized democracies, this wouldn’t even be an issue. You’re a citizen, you get health care. Whether you once had acne treatments or took Lipitor or had a gallstone or even had a life-threatening disease, you get health care. Because the purpose of the health care system in most countries is delivering health care, not making a profit.

And for those worried about the cost to government of providing health care to sick people, let me present this handy chart:

healthcarecostsbycountry

This chart was adapted from a Canadian site calling for health care reform in Canada. The Canadian system has its problems, but I suspect seeing the mess we’re in persuades many Canadians to leave well enough alone. At least Canadians can get health care.

I believe the only way we’ve got a shot at lowering per-capita cost while delivering health care to everyone is to kick the insurance companies out of the picture altogether and going to a purely public system. At least a public health insurance plan would be a step in that direction.

Regarding the recently released CBO estimate of $100 trillion over ten years — see Extra Klein for why the CBO estimate is deeply flawed. See also “The Bright Side of the CBO Snafu.”

More Manufactured Outrage

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I don’t know what’s more amazing: that the powers that be on the Right would even think up a stunt like this, or that so many righties are such sheep — nasty blood-sucking sheep, but sheep nonetheless — that they unthinkingly go along with it.

Here’s the basic story — Wednesday next week ABC News will devote much of its program to the Obama Administration’s proposed health care policy. On that day, “Good Morning America” will originate from the South Lawn of the White House and will include an interview by Diane Sawyer with President Obama. That evening, President Obama will take part in a moderated discussion in front of a live audience on ABC. The moderators will be Charles Gibson and Diane Sawyer, and questions will come from the audience, according to ABC News.

One might say, Good for ABC! Unless, of course, you are a Republican.

The GOP officially complained that “opposing voices” will be left out, namely that they won’t be able to plant one of its usual trained goons next to the President to interrupt incessantly with absurd talking points so that no one can have a sensible discussion. ABC promises that people with diverse opinions will ask questions from the audience. One also hopes that Sawyer and Gibson will ask substantive and challenging questions.

Righties are screaming about an “ethical firestorm” because news will be “anchored” from inside the White House. A sampler of reactions:

This is the stuff of apparatchiks and Politburos, not a healthy, ethical free press. ABC will become the Obama network to sell his health care plan for an entire day. … [link]

Dr. Goebbels would be so proud… [link]

As far as I am aware this has never happened before in any administration – Democrat or Republican.

A free and independent press is one of the legs on which all representative governments rest. If we have lost it, The American Experiment’s remaining time is short indeed. [link]

One must ask, in what universe would news reporting from inside the White House, or a President taking questions from a live audience whose members he did not personally choose, be considered subversive of democracy? Beside Bizarro World, of course?

And the answer is, a world of people who think of the place from within the White House as enemy territory that must not be allowed legitimacy.

Update: See Bob Cesca at Crooks and Liars.

No Need to Be Civil

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In an op ed in today’s Los Angeles Times, Douglas W. Kmiec argues that the simple way to resolve the Proposition 8 controversy is to cross out “marriage” and substitute “civil union” in California statutes. I held a similar view years ago, but I’ve changed my mind. And I have two reasons for arguing that same-sex marriage should be marriage, period, not “civil” anything.

Unless there is agreement at all federal levels that “civil union” and “marriage” mean exactly the same thing under the law, California by itself cannot resolve some of the more intractable issues of same-sex marriage. These include whether “civilly unioned” couples are entitled to the same federal benefits, tax filing status, etc., as their married co-citizens. It also doesn’t tell us whether other states may recognize civil unions in any way.

But my larger objection is this: The word “civil” in this context means “Of or relating to citizens and their interrelations with one another or with the state.” It also means “Of ordinary citizens or ordinary community life as distinguished from the military or the ecclesiastical.”

In other words, by creating a dichotomy between marriage and civil unions, we are saying that marriage is something recognized and authorized by more than just the state. Marriage has the weight of ecclesiastical authority on its side, whereas civil unions are merely a legal contrivance. I argue that this dichotomy does not reflect reality.

First, marriages are not always blessed by clergy — judges and ship’s captains can do the job as well. Further, not all religious institutions are opposed to same-sex marriage. Some — a minority, I admit, but some — are just fine with it. And I argue that not recognizing same-sex marriages performed in those traditions as marriage is a form of religious discrimination.

The usual argument from religious institutions is that recognizing same-sex marriage would force them to perform such marriages, in violation of their beliefs. I would support language in the law that permits any religious institution to refuse to marry a couple for any reason. I believe they have that right now. I’ve often heard of priests and ministers refusing to perform wedding ceremonies because the engaged couple were not both of the same faith, or because the engaged couple were already living together. But if it makes everyone feel better, then fine; let the law clearly state that a religious institution can refuse to perform or honor same-sex marriages without penalty of law.

However, my understanding is that a few religious institutions have been performing same-sex wedding ceremonies for a while, and same-sex couples are recognized within that organization as being “married” in every sense of the word. These institutions include Unitarian Universalist fellowships and at least some Buddhist sanghas. I know American Zen priests who have been performing same-sex marriages for many years. Episcopalians may be heading in that direction also, and it wouldn’t surprise me if some Episcopal priests have presided at same-sex wedding ceremonies, even if they aren’t yet officially sanctioned by the church.

Yet the law does not recognize these couples as being married. On the other hand, some religious institutions are demanding the law reflect their sectarian beliefs opposing same-sex marriage, which to me clearly runs afoul of the establishment clause of the First Amendment.

I say the only way for the law to avoid religious entanglement and be free of religious discrimination is to recognize same-sex marriages but make it clear that a religious institution can refuse to perform them. We don’t need to be “civil” about it.

Update: I confess to being very tired right now, and I discussed the Los Angeles Times article without reading it through to the end. So I missed this paragraph:

The federal action was brought on behalf of two gay couples who were denied marriage licenses after the ruling that upheld Proposition 8. If such an action were instead brought in state court, California would have an opportunity to bring equity to both sides. The attorney general, in defending the state’s interest, could ask for a court order enjoining the state from using the terminology of marriage altogether. Instead, the state would give everyone — gay or straight — a civil union license and allow churches, synagogues, temples and mosques to say who can and cannot “marry” within their individual traditions. Religious freedom, a bedrock constitutional value of like importance to equality, would also be a winner.

That has some internal logic to it, although I don’t think it would fly. It still doesn’t solve the issue of federal privileges and protections. And what does this say to atheists? Surely there are atheists who would like to call themselves “married” but who, as a matter of principle, would not take part in a religious ceremony.

It occurs to me also that there are many circumstances in which a couple might be married under the law but not in a church. I understand that Catholics who have not had a first marriage properly annulled by the Church cannot be married in the Church, for example.

Iran: At Least They Care

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Reuters reports that tens of thousands of Iranians are demonstrating in the streets of Tehran in protest of the recent election results, which look fraudulent to just about everybody (more on the exception below). People are demonstrating in spite of an Interior Ministry ban on rallying, which I assume means people protest at some personal risk.

I admire the protesting Iranians. At least they give a damn. Here, politicians steal critical elections and we shrug our shoulders and pretend it didn’t happen.

Of course, we have our own version of the Iranian security police, which are the wingnut bullies in media and elsewhere who abusively shout down anyone who dares point out, you know, facts. We also have some pretense at a mediating process, meaning cases are sent to courts. But we know how that turns out.

It’s been, what, seven months since the November elections? And has Al Franken been seated in the Senate yet? The endless dispute has nothing whatsoever to do with determining the will of the people, of course. It’s about using the courts and anything else to block the will of the people and advance a minority, extremist agenda.

This shows our political system is about as corrupt as Iran’s. The only difference is that we’re a little more subtle about it.

The wingnuts are screaming because CBS republished a New Republic article that compared Mahmoud Ahmadinejad to George W. Bush. But if you read the article, I’d say the New Republic makes a good case for the comparison. In fact, I bet many of you can think of similarities between Ahmadinejad and Bush (rememeber when we used to call him “Bunnypants”?) without reading the article. And the similarities are getting more obvious all the time.

The Washington Post is running an article that suggests maybe the Iranian elections weren’t stolen, but I don’t think anyone is buying it. Juan Cole certainly isn’t.

DOMA Fury

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[UPDATE BELOW.]

I have to echo PZ Myers: Obama screws up, very, very badly.

The basic facts, as I understand them: The Justice Department moved to dismiss the first gay marriage case filed in federal court. The case was brought by a couple married in California, Arthur Smelt and Christopher Hammer. Smelt and Hammer brought a constitutional challenge to the Defense of Marriage Act, which says that the federal government and states without same-sex marriage don’t have to recognize the marital status of same-sex couples lawfully married in a state that provides for same-sex marriage. Smelt and Hammer argue that DOMA is in violation of the Constitution on several grounds, such as the Full Faith and Credit part.

The Justice Department argued (as I understand it; I admit this doesn’t make sense to me) that Smelt and Hammer had no legal standing to sue because the status of their marriage in California is not in question and punted the constitutional question. If anyone can explain this, please feel free to do so. I’m baffled.

Most of the Left Blogosphere is outraged, and the GLBT community feels betrayed. I’ll let Pam Spalding explain this POV.

There are a few defending the Obama Administration on the grounds that, while we may wish the law to be otherwise, the law is the law; see Sully. However, even Sully admits there is language in the DoJ’s brief that is outrageous and homophobic and inexcusable.

My understanding is that the DoJ is still largely infested with Bush appointees. While this is not an excuse, it might be an explanation. President Obama’s Attorney General should answer for this.

Update: Andy Sullivan writes that the DOMA brief was written by a Bush Administration holdover, which confirms my suspicion. “The harsh rhetoric, the gratuitous attacks on our relationships … they were written by someone who was given an award by Alberto Gonzales for his defense of the Partial Birth Abortion Act.” As I thought, but that doesn’t excuse the Justice Department for signing off on it.

Steve McMahon Is So Wrong

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I caught the segment in the video below on Hardball yesterday. If you don’t want to watch, it’s a discussion among Tweety, Democratic strategist Steve McMahon and Republican strategist Todd Harris. McMahon thinks the Democratic Party should cut the public insurance option from the health care reform package and pass a “compromise” bill without it.

McMahon thinks the health care package won’t pass with the public insurance option but could pass without it. He thinks it’s better for Congress to pass something it can call “health care reform” now rather than have the whole effort defeated because of the public insurance option. We have a window of opportunity to pass a health care reform bill, he says, and if we miss this window and pass nothing there may not be another chance for years.

My thinking is just the opposite. If Congress passes a bill without the public insurance option, it will confirm the darkest beliefs of Americans about government being irrelevant to their lives. I sincerely believe that the rest of the legislation might make some marginal improvements in the system. It might make a tangible difference for a few people. But it would do nothing that will make a big, tangible difference in the lives of most American citizens.

So if they pass this bill without the public insurance option, there will be a big whoop-dee-doo in media about how now everybody’s got health care reform. And the days and weeks and months will go by, and most people won’t notice that anything has changed.

This is, I think, the absolute worst thing that Congress could do. It would be better to let the whole thing be defeated, then go to the American people and say, look, we tried to get you this meaningful reform, but Republicans and Blue Dog Democrats blocked it. And, yeah, that’s a lame excuse. But I think rank and file Dems, and many Independents, are sick to death of these pathetic tweaks that Washington mistakes for accomplishments but which don’t make any real difference in the lives of Americans.

In the long run, whether a bill was passed with bipartisan support or not will mean absolutely nothing. If a bill passes that really does relieve many of our fears of losing our insurance and being dumped out of the health care system altogether, that bill will be very popular. Before long, politicians who didn’t support it will pretend that they did. There’s your bipartisan support.

On the other hand, a “compromise” bill passed with everyone in Congress holding hands and singing “Koom By Ya,” but which does not make a tangible difference in peoples’ lives, won’t mean a bucket of warm spit by the time the next elections roll around.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Why the AMA Is Selling Us Out

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We shouldn’t be surprised that the American Medical Association has come out against government-sponsored insurance plan. The AMA these days has many concerns other than medicine. It is a main proponent of “tort reform,” a vast right-wing conspiracy to enhance corporate profits by denying citizens’ 7th Amendment rights to sue for damages in court.

Although it still pretends to be the voice of American physicians, in fact it has been losing membership steadily for the past several years. The most recent information I could find says that about a third of American physicians are members. It has struggled financially with dwindling membership dues.

The AMA and the American Council of Engineering Companies are co-founders of the American Tort Reform Association (ATRA), which has turned into an umbrella group of special interests and astroturf organizations pushing for tort reform legislation. The ties of “tort reform” to the Right, via Karl Rove, are legendary.

Take, for example, the organization Citizens Against Lawsuit Abuse (CALA), which has chapters in several states actively pushing “tort reform” to state legislatures. According to SourceWatch, CALA is an astroturf organization commissioned by the Philip Morris tobacco company in 1995, and Philip Morris continues to fund and direct CALA through ATRA. SourceWatch says,

A “privileged and confidential” Philip Morris (PM) tort reform budget from 1995shows that PM spent over $16 million to instigate tort reform during that year alone, and that PM paid an international public relations firm called APCO & Associates (now known as APCO Worldwide) almost $1 million in 1995 to implement tort reform efforts behind the scenes.

ATRA promotes CALA on its website (scroll to bottom) as

… citizen activists fed up with the high cost and injustice in our legal system. They work actively within their communities to urge individual responsibility, safety, and to chronicle abuses of the legal system and to fight for civil justice reform.

Yeah, right.

It is ironic that the AMA, which 20 years ago stood up to the tobacco industry by calling for a ban on tobacco ads, is now in bed with it. They’re shacked up in a shabby off-the interstate motel hoping no one finds them, but they’re in bed just the same.