Neil deMause: The Website

In reading this AP story about the removal of the last remnants of a public option from the health reform bill, it occurred to me: Do journalists intentionally avoid explaining certain issues because if they did, one side would sound, you know, stupid? Take a section like this:

Many Democrats say they’d like to see a plan like Medicare to give consumers affordable choices. Republicans and some moderate Democrats fear private companies wouldn’t be able to compete. The search for a middle ground has been difficult.

That doesn’t actually explain anything, which is a bad thing in an article claiming to explain “key issues in the health care debate.” But think about how it would look if the writer had actually tried to describe what’s going on:

Many Democrats say they’d like to see the government provide health insurance, because, like Medicare, it’d be cheaper than private insurance. But Republicans and some moderate Democrats say that the only way we can have private insurance is if it stays expensive, and no one will buy expensive private insurance if there’s a better option. The first group knows this is crazy, but can’t say it out loud because then Joe Lieberman will lock himself in the Senate chamber and hold his breath until he turns purple.

Indeed, the search for a middle ground is difficult. In journalism doubly so.

As if landing the Olympics wasn’t trouble enough already, now it could come with the requirement of passing newly expanded police powers:

Countries could be barred from hosting the Olympics, starting with the 2018 games, if they don’t have laws that empower police to raid and investigate those suspected of helping athletes use performance-enhancing drugs.

Of course, that’s pretty much par for the course when it comes to the Olympics.

Meanwhile, as if the health reform bill wasn’t trouble enough already, an op-ed in today’s New York Times by the former head of Texas’ health insurance exchange spells out why such “pooling” plans, one of the few pieces of the Obama reform plan that hasn’t been gutted by the Senate, are likely to be worthless:

Private insurance companies, which could offer small-business policies both inside and outside the exchange, cherry-picked relentlessly, signing up all the small businesses with generally healthy employees and offloading the bad risks — companies with older or sicker employees — onto the exchange. For the insurance companies, this made business sense. But as a result, our exchange was overwhelmed with people who had high health care costs, and too few healthy people to share the risk. The premiums we offered rose significantly. Insurance on the exchange was no longer a bargain, and employers began backing away…

It would be smarter for Congress to revisit the idea of creating a public plan that could provide an attractive choice for consumers and real competition for private insurers, to give them the incentive to offer good coverage at affordable prices.

It’s a point I’ve alluded to before, but it’s nice to hear it from the horse’s mouth.

It’s swine flu season, which means all thoughts turn to what to do when your job won’t let you call in sick:

As the H1N1 swine flu virus starts its second major sweep through the U.S., business owners are bracing for the impact of a worse-than-usual flu season on their workforces. That’s reviving debate on a contentious issue: What kind of sick leave should companies offer employees — and should it be mandated by law?

“On the one hand, you have all of our top officials saying, ‘Do the responsible thing. If you’re sick, stay home,’” says Debra Ness, president of the National Partnership for Women and Families, a Washington, D.C.-based advocacy group that is pushing for paid sick leave laws. “You have advice from the Centers for Disease Control on exactly how many days you should stay home, and how many days we need to keep kids at home. And at the same time, we have a country where almost half the workforce doesn’t have a single paid sick day.”… [read more]

I’ve only scratched the surface of the 220 pages, but here are some lowlights:

• No public insurance option, of course. Looks like not even a trigger for a public option to be created if private insurers don’t bring their premiums down.
• The New York Times is reporting that Baucus “envisions middle-class American families having to pay” 13 percent of their family income “in health insurance premiums before co-payments, deductibles and other cost-sharing.” That’d be $1200 a month in premiums alone for a couple making $100,000 a year combined. Worse yet, what the bill actually says is that “individuals between 300-400 percent of [the federal poverty line] would be eligible for a premium credit based on capping an individual‘s share of the premium at a flat 13 percent of income.” If I’m reading that right, that means that insurers could still charge even more than 13 percent of income — just if they do, the government will pay anything above that limit. This is cost reduction?
• The standards for health plans would be divided into Gold, Silver, Bronze, and (I am not making this up) “Young Invincible” levels, with varying degrees of coverage required for each. This is apparently based on Massachusetts’ Commonwealth Connector plan, and I’m still not clear how it’s supposed to represent real standards: If your plan doesn’t cover 90% of the average person’s health costs, for example, all that happens is that it gets tagged as Silver instead of Gold. Not that any of it is likely to matter anyway, as in Massachusetts nearly half of all Connector participants are choosing the cheapest Bronze plans, with a mere 7% coughing up for Gold — no surprise, given that insurance premiums there are still sky-high.
• Even with the plan watered down to near-tincture levels, Baucus still couldn’t get a single Republican co-sponsor. This is working so much better than trying to pass a real reform bill in the first place.

UPDATE: Just saw that CJR has another good article up today on the failures of the Massachusetts plan and what it means for the nation as a whole if a Baucus-type plan passes. Required reading.

Health Savings Accounts, the Bush-spawned health insurance plans that have been derided as a mere tax dodge for the rich, are either in danger of being phased out under health reform, or likely to carry on unimpeded. You make the call:

While Washington wrangles over health care, the nation’s last big reform innovation faces an uncertain future. Health Savings Accounts, the hybrid of flex spending accounts and IRAs that President Bush created in 2003, are an afterthought in the current proposals on Capitol Hill — with strenuous debate over whether their demise would be a disaster or a welcome end to a program that never lived up to its promise…. [read more]

I wrote recently that I was worried that without a public insurance option in a health reform bill, “we could be left with a system that ’solves’ the health care crisis by guaranteeing everyone access to expensive, crappy coverage.” Now Rolling Stone’s Matt Tiabbi has explained in terrifying detail why this is exactly what will happen. For example, check this out:

If your employer does not offer acceptable coverage, you then have the right to go into one of the state-run insurance “exchanges,” where you can select from a number of insurance plans, including the public option.

There’s a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance “exchange.” In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their shitty plans protected by a grandfather clause. Which means …

“If you have coverage you like, you can keep it,” says Sen. Sanders. “But if you have coverage you don’t like, you gotta keep it.”

Extra bonus points to Tiabbi for summing up the Republican argument that a public plan would be unfair to private insurance companies because they need to lard up their premiums enough to rake in a profit: “This is a little like complaining that Keanu Reeves was robbed of an Oscar just because he can’t act.”

If none of the options in the health reform debate strike you as particularly appealing, maybe that’s because one of the most popular options has been ruled off-limits by for consideration:

While Republican types freak out about the idea that government reform of health care will somehow involve government — economist Arthur Laffer’s “Just wait till you see Medicaid and Medicare run by the government!” was a classic of the genre — most people I know seem to be heading in the opposite direction. Why, they ask, is Congress spending so much time and money patching a system that is fundamentally broken?… [read more]

More on the public health insurance debate, this time on the faceoff between small business groups over whether it’s a great idea that will increase choice and lower premiums, or an unnecessary government intrusion into the private market:

As Congress prepares to do battle over health reform, a parallel dispute is shaping up among small-business groups that are staking out opposing positions on a key element of reform proposals: whether Uncle Sam will take on a bigger role in offering insurance coverage or leave the field to the private market.

The so-called “public option,” backed by President Obama and many Congressional Democrats, would set up a government-backed health insurance plan that would compete with private plans. Though details remain fuzzy, the proposal already has critics on both sides of the aisle decrying “government-run health care.” The American Medical Association and private insurers oppose any public option…[read more]

Why we need a public health insurance option, in 360 words or less:

When my friend was laid off recently, she was happy to learn that, thanks to Obama’s stimulus package, she’d get to keep her family health insurance at a cost of $330 a month.

OK, maybe “happy” is pushing it… [read more]

The San Francisco Chronicle’s Carolyn Lochhead — never my favorite reporter on social issues — has a long piece today on health reform that asserts:

It will mean higher taxes and, potentially, lower benefits for many people. It will mean putting the brakes on how doctors and hospitals practice medicine. It may require employers to provide health insurance and individuals to buy it.

None of these things will be popular. Cost containment, identified by the White House as a key objective, never is.

So let’s see: Taxpayers will have to share the pain, the insured, doctors, employers … anyone left out? Oh yeah, insurance companies. Nowhere in 1,600 words does Lochhead find room for the notion that insurers might have to take a cut in their soaring profit margins — though she cites the National Coalition on Health Care as calling for “short-term restraints” on costs, she fails to mention that one of the restraints they’re calling for is a cap on insurance premiums.

On the bigger picture, meanwhile, Lochhead’s article is murky on the question of exactly which problems health reform is supposed to fix. (This is a common problem in health care coverage, which has quickly come to resemble “horse race” style election stories: all about which side is winning, not whose policies would do what.) While she cites both rising costs and rising numbers of uninsured, these aren’t exactly unrelated trends — aside from those who can’t get insurance because of pre-existing conditions (which would, thankfully, be dealt with by many of the Congressional plans), the uninsured are mostly uninsured because they can’t afford it.

Since there are only two ways to enable people to afford something — make it cheaper, or give them money to pay for it — both problems would seem to require the same solution in the end: Reduce the amount of money flowing to the people who make money off of health care (insurers, doctors, and makers of the machines that go “ping!”). The alternative would be a system that solves a social ill by pumping government money into rich people’s pockets, and surely that’d never fly with … er, never mind.