A Little Less Conversation and A Lot More Action: Join the Virtual March for Real Health Care Reform

If you follow me on Facebook, pieces of this post will sound familiar.

President Obama released his proposed health care reform legislation this week; you may find the proposal as well as highlights and summaries at whitehouse.gov. The hue and cry that President Obama's health care reform proposal doesn't include a public option began immediately following the release of his proposal. The public option has become both the boogeyman and the holy grail of health care reform.

Loud voices on the progressive left have repeatedly stated that they would rather see no health care reform than have reform without a public option (the holy grail of health care reorm). They've made the inclusion of the public option the litmus test of health care reform legislation. Loud voices on the conservative right, have demonized the public option and are just as vocal in asserting that they will not accept a public option.

The folks opposed to the public option and the supporters of it have both placed way too much emphasis on the exclusion or inclusion of that single piece of health care reform efforts to the detriment of getting some of the larger issues addressed.

So let's look at what the President's proposal includes:

(1) Provides federal authority to regulate insurance rates in direct response to the super rate increase attempt in California;
(2) Creates marketplace competition and consumer choice via the provisions for the exchange plan;
(3) Closes the donut hole in Medicare prescription drug coverage, which will provide immediate relief for seniors on Medicare;
(4) Increases tax credits for health insurance premium;
(5) Provides waivers for low income families and individuals regarding mandatory insurance;
(6) Prohibits denying health insurance to persons with pre-existing health conditions;
(7) Extends consumer protections against heath insurance practices; and
(8) Adds new protections that prohibit all annual and lifetime limits.

The above is not a review of all of the provisions of the President's proposal. I think that we are a nation with the attention span of a one-year-old. The Internet has made it possible for each of us to carefully review primary documents rather than rely on the news media to tell us what those documents say. Before you decide what you think of the President's proposal, READ IT! Once you get to the site, follow all of the links to ascertain what each proposed Title does.

When you're done, if you share my belief that we don't have the luxury of waiting possibly another decade for health care reform, then take action. MoveOn.org is conducting a Virtual March for Real Health Care Reform on tomorrow, February 24. All that you have to do is take less than three minutes to register for the virtual march and then indicate when you will call your Senators on tomorrow. MoveOn will send a fax to your senators from you (see photo to the left). I've checked out the participation numbers on the map on MoveOn (just roll your cursor over the map to see the numbers) and the numbers are pathetic. When you don't participate in telling government what you want, you can't complain about what it does. MoveOn is a progressive organization; this is our chance to drown out the voices of the tea party protesters. If we truly want change then we have to act; the campaign slogan was always, "Yes we can!"

Making Peace With The Senate Health Care Bill

To support the health care reform bill, or not to support it, that is the question being debated across the Internet. Now that Nebraska Sen. Ben Nelson (D) has agreed to support the Senate version of the bill, it looks as if the Senate has the 60 votes necessary to pass the legislation. The new question is, "What's in the Senate bill?" I think that this is the 9th edition of the bill and it's been changed more often than Madonna has reinvented her image. After scuttling around on the Internet, I think that I reasonably understand the current content with the most recent amendments that will be voted upon at one a.m. on Monday. Of course, this all may change by the time I finish writing this entry.

Costs
According to the Congressional Budget Office (CBO), the legislation, with the proposed changes that are being offered as an amendment to the Senate's version of the health care bill would cost about $871 billion over the first 10 years. Those costs would be offset by $483 billion in spending savings and $498 billion in revenues over the period. Factoring in tax increases and lower payments to doctors, the CBO asserts that the Senate bill would reduce the deficit by about $132 billion between 2010 and 2019.

What's Changed
Elin (Mrs. Tiger Woods) and the government run insurance option (the Public Option) are gone. She may come back but the public option isn't likely to return in time for Monday morning's vote. It has been replaced with a plan to create two national or multi-state health insurance exchanges (exchanges) to be run by the U.S. Office of Personnel Management (OPM). One of the plans is to be non-profit. The CBO has stated that it is unclear whether insurers would be interested in contracting with the OPM to offer these plans. A move to replace the public option with a plan to expand Medicare to provide coverage for uninsured Americans over 55 was stopped by opposition from Sen. Nelson and other alleged Democrats and the ever present Joe Lieberman.

The Medicare payroll tax increase is 0.9% (was 0.5%) for couples with an income of  $250,000 or more and individuals earning $200,000 or more. This is a revenue raising measure. To save money, the Senate proposal cuts federal government reimbursement rates to doctors by 21% effective in 2010.

Funding for abortions has been a lightning rod in the Senate's debate about this legislation. In spite of the legal right to choose to have an abortion within certain medical guidelines and provisions, the anti-choice contingency have latched on to the health care reform legislation as an opportunity to try to make inroads in their ongoing effort to undo Roe v. Wade. The bill now includes more restrictive abortion funding language that strengthens the prohibitions against the use of public money for abortion services. The bill now separates federal funding from private funding for abortion services on the exchanges, and lets states choose not to allow insurance companies to cover abortion on their health exchanges. This change has left both pro-life and pro-choice groups unhappy (I didn't take the time to read all the reasons that both sides are upset with these changes).

Under the proposed changes, more firms would qualify for the small business tax credit for health care coverage. The tax credit would be available in 2010, a year earlier than originally proposed. The income threshold would be increased so that the tax credit will be available on a sliding scale to firms with fewer than 25 workers and an average wages of less than $50,000. Employers with 10 or fewer workers and average wages of less than $25,000 can get the full tax credit.
 What Stays the Same
Insurance Reforms to health insurance stay the same as in the first Senate bill. This means that insurers will be prohibited from denying or stopping coverage based on the cost of care or the health of the customer, or in other words, denying coverage based on preexisting conditions.

The requirement that all individuals purchase health insurance by 2014 remains the same, as do penalties for employers who do not offer insurance to their workers; however, businesses with fewer than 50 workers are exempt.

The so-called 40 percent "Cadillac tax" on high-dollar insurance plans does not change and will go into effect in 2013.

The provision remains that provides that the federal government will subsidize the cost of insurance for families who make between 133 percent and 400 percent of the poverty level.

The bill also continues to include provisions offering new federal insurance for Long Term Care.

What's next
According to the knowledgeable pundits, now that Sen. Ben Nelson has agreed to support the bill, the Democrats will have votes from 60 senators and can defeat the Republicans' efforts to filibuster the health reform bill. If all goes as predicted, the Senate will move quickly through a series of procedural votes on the bill, beginning at 1 a.m. Monday morning, and likely finishing at 7 p.m. on Christmas Eve.

However, it isn't over until it's over. Assuming that the Senate passes its bill, Democratic leaders from the House and Senate will negotiate a compromise between their competing versions of health reform. Major differences remain between the House and Senate versions, with the most significant being the creation of a public option (the House does it, the Senate does not), and who will pay higher taxes to pay for the expanded coverage. The House raises taxes on the wealthy with a five-percent income tax increase on people making more than $500,000. The Senate increases the Medicare payroll tax and creates the "Cadillac tax," which could hit middle-class workers by taxing expensive health plans.

If the conference committee reaches a compromise, the House and the Senate will both vote on the new and final version of the bill. The goal of the Democrats is for President Obama to sign the measure before his State of the Union address at the end of January.

Why a watered down bill is better than no legislation
I offer this summary because I think that it's important in this emotionally charged climate to have a clear understanding of the substance of the House and Senate bills. People that I respect and like are split on this issue, with some advocating that progressives should make our displeasure known and withdraw support for any health care legislation that doesn't include a government funded or public option. Others believe that even if the final bill is watered down, including lacking a public option, that it's better to go forward with it than to get nothing. I happen to be in the second camp.

I think that while a lot of good things have been removed in the Senate version, a lot of good things remain, most notably, prohibitions against denying coverage to persons based on preexisting conditions or charging outrageous premiums to insure those people. Even more importantly, politics is a game. It's a pretty disturbing game because the rules aren't written down and they are constantly being amended. The constants in this game are negotiation and compromise. You always ask for the moon, but you know from the outset that you're not going to get it. You leave yourself some room for compromise and negotiation.

Maintaining a facade of civility is of prime importance, unless you have had years to hone your image as an eccentric maverick and you also have acquired power through a system of favors and debts owed to you. Arguably one of the least powerful offices in the federal government is that of the president; the drafters of the Constitution designed it that way in an effort to prevent this new government from ever having the power concentrated in the hands of any single individual.

It's easy enough to call for the president to simply tell the wayward Democrats in the Senate what to do; however, the reality is that he can tell them and if they don't acquiesce, what then? He can't throw them out of the party. He could perhaps refuse to help with their reelection campaign, but chances are that their constituents don't need or want the president's input. However, this issue isn't about the president; it's about beginning the process of reforming our health care system.

That's right, reform is a process. It doesn't happen in the blink of an eye. The Senate bill cuts away far too many pieces of this bill, but the House version isn't dead. The final bill will be a compromise of the elements of both versions of the bill. However, when it comes to legislation, final doesn't mean that it's forever written in stone. More than half of the bills submitted during any legislative session aren't brand new, but rather amended versions of existing law.

If this bill dies, then chances are good that it will be several administrations in the future before the issue even makes it on the table again. The battle will have to start all over from scratch, and there is no guarantee that it will meet with any more success eight or 12 years from now. Now is the time to pass the best bill possible under the reality of the opposition and start working on the drafts of the reauthorization of the health care legislation (federal law is ripe with reauthorizations of major pieces of legislation in every legislative session). The only way that health care reform dies is if we let our righteous indignation kill it.

Hobbes, Rousseau, and the Nature of Humankind

Somehow, two weeks have passed and I haven't written a single blog entry. I think that my brain has been suffering from an overload of "WTFitis." I watch the news, read Newsweek, and scroll through newspapers and news sites on the Internet, and like Evilene in The Wiz, I just want to scream, "Don't nobody bring me no more bad news!"

Of course, not hearing or reading bad news doesn't make it go away. However, it isn't just the bad news that disturbs me, it's the mindlessness of the general populace that makes me want to slap somebody. As engaging in acts of violence could land me in a jail cell, I've been refocusing my disgust on trying to understand what it is about human nature that can move us to engage in great acts of creativity but can also move us to engage in acts of great cruelty and destruction.

I've been rereading two of my favorite political philosophers, Jean-Jacques Rousseau (The Social Contract 1762) and Thomas Hobbes (The Leviathan 1651). Both works focus on an analysis of why government is necessary and the purpose of government. However, they have different takes on why it is that humans spend our time fighting and squabbling among ourselves.

They each speak of the "natural state" [aka state of nature] describing it as humankind without the conventions that we have come to call civilization. Hobbes views humankind in its natural state as focused on individualism to the exclusion of any concern for the well being of others; self-preservation and aggrandizement is the reason for existence. If we occasionally act in an altruistic manner it is motivated by self-interest and not any concern for others. In Hobbesian analysis, we are motivated by self-preservation in all of our actions. We see the possibility of our own misfortune in another's misfortune and offer assistance in anticipation that we may at some point need assistance.

In this natural state, if I want my neighbor's cow, I attempt to take it. Naturally, my neighbor resists. Whichever one of us is stronger or has more friends to help out in the fray, gets the cow. Of course, then the winner has to guard against some stronger person coming along and taking the cow away. It's an ongoing cycle and no one can be truly secure and all our energies are spent on survival. We are therefore in a perpetual state of war. Hobbes defines a state of war as the absence of peace, that is, living in a society where individualism reigns supreme and it's every man and woman for themselves.

Hobbes perceives this natural state as being the essence of human nature and that governments were implemented to save us from our baser impulses. According to Hobbes, without absolute government, life is "solitary, poor, nasty, brutish, and short."

Rousseau takes a more positive view of our natural state. He proposes that humankind in its natural state is essentially good. It is the development of society that has corrupted us. The advancements of civilization, while wondrous, have also corrupted us. Often Rousseau's philosophy is defined as promoting the image of the "noble savage." Humans living relatively solitary lives, motivated only by basic needs of food, clothing and shelter. In this state, there is no competition because there is no desire for power. The individualism that Hobbes sees as innate in human nature is an acquired trait in Rousseau's philosophy. For Rousseau, it's the development of society and all its trappings that has turned humankind into greedy, selfish beings focused on self preservation.

Both Hobbes and Rousseau propose that in this natural state, we have unlimited personal freedom, sort of like Cartman, citizen of South Park, who frequently declares, "I can do what I want!" In Hobbes viewpoint, a powerful central government is needed to check that personal freedom which is motivated only by self-interests. Rousseau argues that the people create government in a desire to promote harmonious interaction. The power of the government comes from the people, who voluntarily cede their personal freedoms to the collective group, not a single authoritative power, in order to promote the common good. For Rousseau, the people are the government, while Hobbes arrives at the conclusion that the people must cede their personal liberties to the control of a strong central government, an absolute government, to protect and promote the common good.

I tend to be Hobbesian in my beliefs about the nature of humankind. I think that self-interests are the norm and concern for humankind is the exception. At the heart of the arguments against any type of social welfare program is always a stated belief by the opposition that it is not the responsibility of those who have to provide for the have-nots. People stand in town halls and shout in trembling voices that their tax dollar should not go towards supporting any program for people that they deem to be undeserving. Those of us who express a belief that we are our brothers and our sisters keepers are dismissed as stupid, naive, un-American purveyors of socialism.

We are in such a constant state of war that many of us have come to believe that war is the norm, and there is no need to call for its end. I am so tired of seeing some sad parents or a sweet young woman with an infant bravely facing the television cameras, reciting the oft repeated litany, "He died doing what he loved. He died serving his country." As long as we continue to glorify dying in war, as if it is a noble loss of life, we will do nothing to put an end to war.

Where I part company with Hobbes is that I don't believe that selfish individualism is an innate quality. I think that Rousseau was on to something; perhaps we learn to elevate self-preservation to a religion because so much in society rewards and thereby reinforces selfishness. If that's true, then like Pandora's box, there is still a flame of hope that we have to fan into a fire. We can become better than we are.

If you are intrigued by the theories of government that influenced the development of the governing philosophies of the United States, click this link for a good place to begin with summaries of the political theories of Hobbes, Rousseau, John Locke, and Charles Montesquieu.

Health Care Plan: Battle Won But Not the War

It's always something. The U.S. Senate is making it perfectly clear that it has no intention of accepting the baton when it comes to running with health care reform. The primary Senate objection is to the government health insurance plan in the House bill passed on this past Saturday.

The party affiliation shape shifter Sen. Joe Lieberman (Independent) has declared , "... as a matter of conscience, I will not allow this bill to come to a final vote." South Carolina's Sen. Lindsey Graham (R) has proclaimed, "The House bill is dead on arrival in the Senate." In addition, a few moderate Democrats said to hold the power in the Senate, are opposed to the government health insurance plan included in the House bill.

The power in the hands of the few moderate Democrats is the power to stop a Republican led filibuster. Senate Majority Leader Harry Reid (D) needs 60 votes to start debate and 60 votes to end discussion and call the bill to a final vote. Those few moderate Democrats' votes are very important in the scheme of things.

The primary opposition to the government plan is that it puts the government into competition with private insurers. I feel as if I've missed something. Haven't the conservatives supported capitalism and its system of free market enterprise with cries of competition is good?

Lieberman asserts that his opposition to a public option arises from his belief that it could be a huge and costly entitlement program. Entitlement is a big buzz word, implying that a slew of undeserving persons will benefit from the public option. How do you deserve medical care? How can you be undeserving of medical care? In one of the most affluent nations in the world, how can it possibly be acceptable that some people don't receive health care because of exorbitant costs for medical care and/or health insurance?

I smell more compromise in the air. Already, Republican Sen. Olympia Snowe of Maine, who voted for a version of the Senate bill in committee, has provided the Democrats with a fallback position. She's proposing the "trigger" option which would allow a government plan as a last resort, if after a few years premiums keep escalating and local health insurance markets remain in the grip of a few big companies. Frankly, I think that the trigger has already been pulled, over and over again. Exactly how costly do premiums have to get and how extensive does the monopoly of the health insurance market by a few major players have to be before the need for a government plan is triggered?

There are other major differences between the House and Senate bills:

• The House would require employers to provide coverage; the Senate would not.
• The House would pay for the coverage expansion by raising taxes on upper-income earners; the Senate would use a variety of taxes and fees, including a levy on high-cost insurance plans.
• The House plan would cost about $1.2 trillion over 10 years; the Senate version would cost under $900 billion.

Sigh, I guess that I need to keep my senators on speed dial. In the words of Yogi Berra, "It ain't over till it's over."