The Healthcare Report

By NYCeve (Eve Gittelson)

As members of the United States Senate and the House of Representatives stand on the floors of each chamber debating the relative merits, and the extent and cost of healthcare the American people may or may not be entitled to, keep in mind, these people have healthcare and other benefits, the rest of us can only dream about.

Though we have fifty million Americans without any access to healthcare, and many additional millions dangerously underinsured, those we elect to do our business, have the finest and most affordable healthcare available in the United States. Why this fact is not part of the debate is beyond me.

Benefit consultant Watson Wyatt is forecasting a bitter 2010 open enrollment period for Americans not blessed to have the FEHBP.

In a word, higher costs, higher out-of-pocket costs, higher deductibles, more and greater costs shifted onto the shoulders of recession battered Americans.

This is what we have, and the healthcare reality for most Americans going forward.

What=2 0can U.S. workers expect when they receive their fall open enrollment benefit packages for 2010? In short, higher costs. But through research, global consulting firm Watson Wyatt has identified a few financial rewards trends in health benefits plans for next year.

Employees might find their 2010 employee benefit packages include financial rewards for promoting healthy lifestyles, full coverage for preventive services, closer scrutiny of dependent and spousal coverage, and greater use of consumer-directed health plans (CDHPs), according to benefit experts at Watson Wyatt.

“Faced with an uncertain economy and rising health care costs that show few signs of slowing, many employers have made changes to their health benefit plans for 2010,” said Tom Billet, a senior consultant with Watson Wyatt. “While next year’s benefits will reflect these higher costs, workers can also expect employers to continue their commitment to encourage employees to lead healthy lifestyles.”

Without a public option to act simply as a cost stabilizer and competitor to for-profit insurers, middle class families will continue to see huge chunks of their wealth fly out the window as healthcare costs continue the inexorable upward spiral.

On the other hand, our elected officials have what is known as the Federal Employee Health Benefits Plan. It is heavily taxpayer subsidized, with the taxpayers picking up approximately 72% of the costs of th e premium.

For many years, the Cadillac benefits our elected officials avail themselves of, has been a huge issue for me and many Americans—but as I said, the national debate is strangely silent on this point.

When you receive a huge volume of emails from Americans in desperate need of healthcare as I do, you’ve got to wonder why the citizen taxpayers of our country agree to such an outlandish and unfair arrangement?

Kaiser Health News peels back the curtain on these deluxe benefits which as federal employees, members of the House and the Senate receive.

Children and dependents are covered.

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

FEHBP insures 8 million federal employees, retirees and dependents. This means that long after we have voted an elected official out of office, they=2 0hang onto these cherished benefits.

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the President, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Choice, choice and more choice.

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Nationwide, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up207 percent. The year before, the annual premium increase was just 2.1 percent.

And what do the diabetic friends of Toni do?

Those kids who are either uninsured or dangerously underinsured. Toni learned this summer at a camp for diabetic children. They re-use their insulin needles—and dull needles really hurt.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

The French think the debate we’re having in the United States is “surreal”, they spend a fraction of what we do, and have a longer life expectancy.

France spent about $300 billion for the health needs of its 64 million people in 2007, the last year for which reliable statistics are available, the OECD reported. That amounted to about 11 percent of gross domestic product for a system covering an estimated 99 percent of the population, well below what Americans pay for a system that leaves out tens of millions of people.

On a per capita basis, France also ranked well below the United States in health expenditures. It was eighth on the OECD list, while the United States ranked at the top.

Spending less apparently has not lowered the quality of health care. Despite their reputation for guzzling red wine and eating fatty cheese, French people have for years enjoyed a longer life expectancy than their counterparts in the United States, currently at 80.98 years compared with 78.11.

The situation in America is no longer a crisis, it’s a catastrophe. How do the politicians sleep at night?

By NYCeve (Eve Gittelson)

First, a huge shout out to Howard Dean for telling the truth about the Baucus Insurance industry Protection Bill.

Howard Dean, former Democratic National Committee chairman, minced no words about Sen. Max Baucus‘s healthcare proposal, unveiled to the public this morning. "The Baucus bill is the worst piece of healthcare legislation I’ve seen in 30 years," Dean said last night at a healthcare town hall and book signing in Washington. “In fact, it’s a $60 billion giveaway to the health insurance industry every year,” he said. “It was written by healthcare lobbyists, so that’s not a surprise. It’s an outrage.”

So what exactly are we going to do about the garbage legislation from the Senate Finance Committee?

First we have to deal with the “just pass anything” crowd.

Jay Rockefeller is emerging as an uncompromising healthcare warrior. He’s worried and so am I. Will Democrats redefine down the meaning of reform, snatch an easy victory and present the American people with unacceptable legislation?

Are Democrats dialling down expectations on what can be acheived under the banner of healthcare reform this year? Sen. Jay Rockefeller (D-W.Va.) seems to be concerned they are.

Rockefeller emerged from the Senate Democrats’ weekly luncheon Tuesday afternoon, which featured an appearance by President Barack Obama’s communications guru David Axelrod, wondering aloud (perhaps rhetorically) whether the White House’s get-it-done message to Congress wasn’t bold enough.

“David’s in there — Axelrod — saying we’ve got to try to get ‘something.’ So, the new benchmark is, ‘Well, if we can do something, if we can do anything, then we can say we did healthcare reform,’” Rockefeller said.

If this is the plan then, as Dr. Dean has advised, we’ll have our fifty (with Biden), or fifty-one good Democrats, use reconciliation and deliver the American people from this healthcare evil.

The Baucus bill leaves out some of the president’s goals for healthca re reform, such as the controversial public option. While more palatable to Senate moderates, the Baucus proposal also drew criticism from Sen. Jay Rockefeller, a Democrat from West Virginia, who said yesterday he would not vote for it in its current form. “I’m glad Senator Rockefeller is not going to vote for it. I wouldn’t vote for it at all under any circumstances,” Dean added. Instead, Dean said Senate Democrats should and would end up using the reconciliation process to pass a plan with the public option. “It can be done, and that’s how it will be done,” Dean said, pointing out that a majority of Senate Democrats still support a more robust bill.

Americans are dying because for-profit insurers are out-of-control, and getting in what may be their last licks. The refusal to honor contractual obligations has reached epidemic proportions. In California claims denials are running as high as 40%

Just ask the family of 17 year-old Emily Gomez, if we need a public option.

Emily Gomez is fighting for her life, as her parents are fighting with their insurance company to pay for her treatment.

It’s estimated that eleven million Americans suffer from eating disorders, a condition that initially plagues, then kills. Emily Gomez is one of these young Americans dealing with this deadly illness.

Emily started passing out in school and several times she wound up in the hospital. Her doctor said something had to be done — and fast. “Her doctor would look at me and say, ‘You have got to do something and quick. … This child is extremely sick, and if you don’t do something immediately, you’re going to find her dead on the floor,’” Leigh Gomez said.

A team of pediatricians said outpatient care wasn’t enough. They said Emily needed long-term residential treatment.

But that treatment is expensive, ranging from $750 to $1,000 a day. Because Emily was so sick, her parents assumed the treatment would be covered by their insurer, but they were wrong.

“Each time I called, they just said I’m sorry, there’s nothing we can do for you,’” Leigh Gomez said.

Like millions of us, survival for the Gomez family comes in the form of a public option. Nothing else matters, nothing else will do.

By NYCeve (Eve Gittelson)

As they say, a picture is worth a thousand words.

This chart is a picture worth 1000 words.

It’s a sobering look at where we’ll be in ten years without healthcare reform. If we get the “pass something” reform the political class wants to label reform, and this “something” doesn’t include a public option, President Obama will “own” (his words), a terrible concept which will do nothing to bend the cost curve.

Health insurance premiums for a family could rise to $30,000 within 10 years.

Here are some more numbers worth remembering.

The average cost of a family health insurance policy in 2009 was $13,375.

Over the past ten years, premiums have increased by 131 percent, while wages have grown 38 percent and inflation has grown 28 percent.

If health-care costs grow as fast as they have over the past five years, the average premium for a family policy in 2019 will be $24,180. If they grow as fast as they have over the past 10 years, premiums in 2019 will average $30,803.

Our healthcare system is on life support. Without a public option, we have accomplished exactly nothing, other than nationalizing Romneycare.

Speaking of Romneycare. The front page of the Boston Globe this morning should be a grim warning about the consequences of making Romneycare the law of the land.

The Massachusetts catastrophe situation is what happens when you mandate people purchase for-profit junk insurance without offering a public option. Costs are spiraling upward, and employers are shifting more and more of the financial burden onto the shoulders of employees. People in Massachusetts are paying much more for much less—they’re buying bare bones junk insurance.

Skyrocketing premiums and the inability of Americans to even afford what amount to high deductible junk insurance has profound real world consequences just ask Los Angeles pediatrician Alex Blum.

In a heart wrenching and deeply disturbing opinion piece in the Los Angeles Times, Dr. Blum describes a very young patient destroyed for life simply because the family could not access affordable healthcare.

Along with every other pediatrician I know, I have seen far too often the unconscionable consequences of children not having healthcare coverage. One case still haunts me.

In the middle of one night during my training at a county hospital outside of Los Angeles, a 12-year-old boy arrived at the emergency room. He was having a seizure. From a brain scan, we made the terrible diagnosis: He had suffered a massive stroke. At best, he would be severely disabled for the rest of his life.

When I sat down with his mother to tell her the bad news, she told me that he had been a happy, healthy child through most of grade school. But there had been one other trip to the hospital. When he was 7, he’d had a stroke from which he recovered quickly and completely. His mother had been instructed to take him to a specialist to find out what was wrong so he would not have another stroke. But she was the family’s sole provider and simply could not afford the expensive out-of-pocket bills.

Dr. Blum is correct, we have a healthcare catastrophe.

Until the system changes, health catastrophes like this will continue to be commonplace in America. Until we reform the system, Americans will continue to be forced to choose between feeding their families and taking them to the doctor.

And it is not only the destitute who need change. In my clinic, I have quietly comforted countless parents who are jobless and struggling to pay hundreds of dollars in monthly COBRA payments. The reality for most Americans is that your insurance is only as secure as your job. And in this economy, that’s not much comfort.

If the “pass something” crowd is successful, and we don’t have a public option as part of healthcare reform, we will continue the terrible slide—no American should have to choose between food and healthcare.

Shame on this great country.

By NYCeve (Eve Gittelson)

A just released poll of U.S. doctors shows overwhelming support for a public option. 63% of the doctors surveyed said they favor giving Americans a choice of public or private health insurance.

I wonder why?

Could it be because physicians are on the front lines, and see the human destruction wrought by our broken system. Small and trivial details like skyrocketing premiums which cause 14,000 Americans to drop their insurance every day.

A new nationwide poll found that a large majority of doctors support a public option.

“Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance,” NPR reports. “In addition, another 10 percent of doctors say they favor a public option only; they’d like to see a single-payer health care system. Together, the two groups add up to 73 percent.” The researchers found strong support among all types of doctors: primary care providers, specialists, both urban and rural doctors and among members of the American Medical Association, which has opposed the public optio n. The survey was published by the New England Journal of Medicine.

Dr. Salomeh Keyhani, one of the researchers, says doctors already have experience with government-run health care, with Medicare. “And she says the survey shows that, overall, they like it.” Keyhani adds that “physicians have sort of signaled that a public option that’s similar in design to Medicare would be a good way of ensuring patients get the care that they need” (Shapiro, 9/14).

If you’re still wondering why we need a public option, read on.

Meet Rick Colby.

When Columbus, Ohio, health care lobbyist Rick Colby writes his monthly check of $2,556 for his family’s health insurance, his hand trembles.

“It’s a staggering amount of money and there’s nothing I can do about it,” the 49-year-old Colby says. His insurance rates soared over the past decade after his daughter, Lauren, was diagnosed with a brain tumor and his wife, Trish, developed breast cancer.

After his daughter died at age 8 in 2007, his rates dropped by a few hundred dollars a month — but then shot up by 20 percent the following year, he said.

But Rick Colby is far, far from alone.

Blue Cross of Michigan requested a stunning 56% rate hike on individual polices, the insurance commissioner approved a 22% increase.

31% rate hike from Catamount Health in Vermont.

And in Utah:

The Utah employer’s average annual share of family premiums was $4,861 in 2000, and it rose 97 percent to $9,594 in 2009, the report notes. It is based on data from the U.S. Census and the U.S. Department of Health and Human Services.

The amount of coverage Moynahan’s family can afford has continued to dwindle. Last year, they found a plan with a $2,000 annual deductible, which required them to continue to pay 30 percent of all costs after paying that amount. But when the insurer contacted them in June after three years of 20 percent annual increases, they got desperate.

Indignity heaped on indignity.

Beleaguered citizens of Utah (and everywhere), are forced to pay much more for bare bones health insurance coverage—what we call junk insurance. Then they scramble some more to pay escalating medical bills (depite being insured). How odd that their senator Orrin Hatch proudly proclaims, Republicans won’t even support the really bad bill Max Baucus and the Senate Finance Committee is crafting.</a&g t;

It’s time to throw the Republicans under the bus. It’s time for reconciliation.

Max Baucus can twist himself into a pretzel and give away the store, but Republicans won’t ever support making healthcare a right in the richest country on the planet.

By NYCeve (Eve Gittelson)

There is no place for triggers when it comes to the public option and healthcare reform.

The insurance industry has had sixty years to become simply decent corporate citizens—not good or exemplary models of corporate beneficence, just law abiding. Compassion isn’t a part of their corporate playbook. At our most vulnerable moments, this parasitic industry cemented at the heart of our healthcare system, unleashes terror in the form of denials begetting financial ruin against sick and injured Americans. All in the pursuit of profit.

Equally appalling, across the nation, insurers have been sanctioned by civil and criminal authorities for repeated and egregious consumer abuses. Still the political class is hard at work trying to figure out how to give this industry more time to mend its deplorable business practices. This is the rationale for applying a trigger mechanism to the public option.

Triggers=the death of the public option.

David Sirota makes the point that a “trigger mechanism”, is a means by which politicians kick the policy can down the road—maybe forever, and end up, ultimately doing nothing.

The giveaway to the pharmaceutical industry known as Medicare D, is a case in point. It was designed to allow the importation of drugs from Canada if certain “triggers” were met. They never were.

As with today’s public option surveys, polls on importation showed strong national support for the concept. So rather than murder the drug legislation outright, congressional leaders joined the Clinton and Bush administrations in backing a “compromise”: Importation bills were passed, but only those that gave the secretary of Health and Human Services the power to trigger – or not trigger – final implementation. Specifically, the secretary would have to first certify that imported medicines were “safe” (drug companies promote the lie that Canadian medicine is mortally dangerous – prompting Republican Gov. Tim Pawlenty, an importation proponent, to ask, “Where are the dead Canadians?”).

Sirota’s take home message is as true today for triggering a public option, as it was when the nonsensical Medicare D triggers were hatched.

This trigger provision, of course, was lobbyists’ poison pill – and it worked as they planned. Importation has never been implemented, as no HHS secretary has pulled the trigger. Hence, Americans are still barred from wholesale importation of lower-priced medicine – and pharmaceutical industry profiteering continues.

The moral of the story is that triggers are just another version of the old Blue Ribbon Commission trick. They are designed not as good public policy, but as devious political tactics to help dishonest lawmakers look like they support popular measures – all while guaranteeing those measures never become reality.

In a September 3rd interview, Representative Lynn Woolsey makes the identical point. Trigger=death of the public option.

The White House is now floating the idea of passing health care reform with a so-called “trigger,” as proposed by Sen. Olympia Snowe. Could progressives support a plan like that? Well, I can’t. And no, we can’t, because it will actually delay what we know is the most important part of health care reform, which is offering choice and competition, and we need a robust public health care plan immediately, not when the private health insurers prove once again that they either can’t or won’t solve the health care reform needs in this country.

Rep. Woolsey:

So, in your view, it would just be postponing what needs to happen for a few more years?

Rep. Woolsey: Well, if they even pull the trigger. We have Part D Medicare as our example. There’s a trigger that was the compromise in that legislation, and it’s never been pulled, and there are all kinds of problems with Medicare Part D, and we’ve never pulled the trigger so that there could be a public plan in that.

So even if legislation with a trigger is passed, there’s no guarantee that the trigger would get pulled?

Rep. Woolsey: Right. I mean we have to just look at Medicare Part D. It should have been pulled and it never has been, and I doubt that it ever will be.

Is there any way that the trigger mechanism could be set up in a better way than it was with Medicare Part D?

Rep. Woolsey: No. It’s a phony way to—you know, I don’t think Olympia Snow is phony, but for the subject of health care reform, it is putting off what we should be doing in the first place, and putting it off, probably, in perpetuity.

How many more chances, and how many more years do we give the for-profit insurance industry? How many more Americans need to die? As Nicholas Kristof writes in his blog in the New York Times, “the most compelling argument for reform isn’t improved productivity or efficiency, but simply that the present system is morally offensive.”

By NYCeve (Eve Gittelson)

There’s been discussion lately about yet another mechanism—a trigger—as a way to make healthcare reform more palatable to the insurance industry. Such a scheme is ludicrous. The private insurance industry has had fifty years to rein in its egregious and predatory business practices. Have they responded? Of course not.

This year, small businesses across America are facing some of the most onerous renewals of the last decade. Kind of like the insurance industry is getting in its last licks before an ax of some sort falls on them. Small business owners are responding to unaffordable rate hikes by downgrading employee benefits to dangerous high deductible policies, also known as junk insurance.

Ask any small business owner how bad life has become.

Just recently, I received notification of yet another health insurance premium increase of 19 percent. Colorado small businesses like mine cannot sustain such sizeable increases much longer. The time for health care reform is now.

. . .Employers are now increasingly purchasing group plans with high deductibles or few benefits; insuring only their employee and ending dependent coverage for kids and spouses; or dropping coverage altogether. This is a collectively short-sighted approach, because we as a state are not only protecting our current workforce, but are failing to invest in the health and development of our future workforce, leaders and clients.

The insurance premium death spiral is unsustainable even in Arizona, John McCain’s back yard.

Your benefits may be secure today. But what happens if you lose your job? Try shopping for health insurance on your own and discover the expense. If you have just about any type of serious medical condition, insurers will deny coverage or issue a policy that doesn’t pay for the medical conditions you face.

If you come down with cancer or a brain tumor, insurers may scrutinize your medical history. If they find that you misrepresented or forgot details of your medical history, they may retroactively cancel your policy. It’s called rescission.

So your coverage is great, your employment is secure and you’re in perfect health? You’re still going to pay to compensate for the system’s weaknesses.

Studies indicate that companies and employees who have health coverage get charged more to help absorb providers’ costs related to the growing ranks of the poor, elderly and uninsured.

Any way you might concoct a trigger, it would be a mortal blow for millions of small businesses across the United States. The small business premium increase death spiral is unsustainable, this yearly rite of passage has morphed into a death watch for beleaguered and desperate small businesspeople.

Ask any small business owner, if they can tough out another six or eight years of frightening premium rate hikes and woefully inadequate coverage? How much more destruction do we need to experience before the government steps in?

Think about it. What would the trigger be for the public health insurance option? Skyrocketing prices? Already there. No choice or competition? Already there. Denying care? Already there. As has been proven time and time again, we have a health care crisis now. Trigger conditions have long since been met.

So, proponents of a trigger are in effect saying, “Wait! The health care crisis needs to get worse. The insurance industry should be more concentrated and premiums should be higher before we give America relief.”

And to that, any reasonable person would shake their head. Because we know the health care crisis isn’t some far-off hypothetical, it’s real and it’s happening now. Every 30 seconds, another person goes into bankruptcy because of health care costs. If that’s not the definition of a crisis that needs to be resolved now, then I don’t know what is.

The trigger idea might have been a good one ten, twenty, or thirty years ago. But now it’s too late. Trigger conditions have been met. We have a health care crisis, and those who say we should let it get worse without implementing a public health insurance option to give you and me choice and affordability deserve the ridicule they get.

It’s so old and tired to make the point again, but I must.

The US has by far the most expensive and least effective health care system in the industrialized world. We spend double per person what Japan spends. Drugs in the US cost 40-50% more than in other counties, and Americans cross the Northern and Southern borders to secure by any means available less expensive alternatives. Employers are scaling back or dropping employee health benefits entirely.

Our life expectancy is near the bottom. We are the only industrialized nation without some kind of universal coverage. The system is rigged to allow the insurance industry to profit from our misfortune. And of course they have huge lobbies to shape the laws, distort the news and frighten the American people. In short Americans are under siege.

It can’t possibly get any worse than it is now. Well, I guess it could. We could face the prospect of “reform” without a public option, or with a public option hijacked by a trigger.

It’s also time to wake up and rise up America.

By NYCeve (Eve Gittelson)

Sixteen years ago, President Clinton stood before a joint session of Congress and spoke about making healthcare available to all Americans. That speech was not just about healthcare, it was about our country and its core set of values. I remember as he held aloft a card and said that the little document would be a gift of life and certainty to all Americans. I breathed a deep sigh of relief, thinking how comforting, I’ll never have to worry about being uninsured or not having access to healthcare.

Alas, it was a short lived dream.

Even in those days, premiums were skyrocketing and there was always the possibility that each renewal might be the end of the road. Our healthcare lives were littered with worry, fear, anxiety and ever present bills. Back then, healthcare was a privilege, not a right, and it still is.

It was difficult in those days, but the system was still chugging along in some fashion. Back then, I had some surgery, and the day I entered the hospital, I was asked to write a check for $3500.00. I remember that moment like it was yesterday.Here I was going into a major American hospital to get help, but before I could access that care, I was required to make a large payment. I wondered, what happens to people who don’t have the financial wherewithal?

President Clinton didn’t lose the battle for Health Care Reform because he was over-reaching or because Hillary Clinton attempted to grab too much power, or cloak the legislation in a veneer of secrecy. We lost sixteen years ago due to a lack of political ambition and corporate greed—just like today. The American people lost because of lies, fears and manipulation.

Like all Americans, Paul Krugman is anticipating which road President Obama will take tonight. He is very clear, that without a public option, we’re still in the 1993 mindset.  Americans fearing each premium renewal and wondering—always wondering, will this be the year that I just can’t afford it any longer? Will this be the year the healthcare of my family gets the ax.

But what is one to make of the practical, political argument from the likes of Ezra Klein, who argue that any public plan actually20included in legislation probably wouldn’t make that much difference, and that reform is worth having even without such a plan?

There are three reasons to be suspicious of that argument.

The first is that I suspect that Ezra and others understate the extent to which even a public plan with limited bargaining power will help hold down overall costs. Private insurers do pay providers more than Medicare does — but that’s only part of the reason Medicare has lower costs. There’s also the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients — and even with community rating, some of that will still go on. A public option would probably be able to attract clients with much less of that.

Second, a public option would probably provide the only real competition in many markets.

Third — and this is where I am getting a very bad feeling about the idea of throwing in the towel on the public option — is the politics. Remember, to make reform work we have to have an individual mandate. And everything I see says that there will be a major backlash against the idea of forcing people to buy insurance from the existing companies. That backlash was part of what got Obama the nomination! Having the public option offers a defense against that backlash.

What worries me is not so much that the backlash would stop reform from passing, as that it would store up trouble for the not-too- distant future. Imagine that reform passes, but that premiums shoot up (or even keep rising at the rates of the past decade.) Then you could all too easily have many people blaming Obama et al for forcing them into this increasingly unaffordable system. …

Let me add a sort of larger point: aside from the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats — the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. And sooner or later Democrats have to take a stand against Reaganism — against the presumption that if the government does it, it’s bad.

The public option is also a reaffirmation from democrats that affordable healthcare is a right which citizens of the richest country on the planet can no longer be denied.

Worry, anxiety, and  fear is what we all experience from a dreaded medical diagnosis.  Never again should these toxic emotions arise from not having access to healthcare in the first place.

By NYCeve (Eve Gittelson)

As President Obama addresses the nation on Wednesday evening, please remember Army Specialist Greg Missman who gave his life in Afghanistan, in an attempt to access healthcare for his family. This is yet another tragic and instructive piece of our uniquely American healthcare catastrophe.

CNN Transcript

ROBERTS: Welcome back to the most news in the morning. How far would you go to get good health insurance? One man who lost his job and medical benefits reenlisted in the Army just to get his family covered and then he paid the ultimate price. This is a story that you’ll see only here on CNN.

Jim Acosta joins us now from Washington for the heart-wrenching report. It’s unbelievable story, Jim.

JIM ACOSTA, CNN CORRESONDENT: It is terrible, John. The story of Greg Missman as you mentioned is not just about a soldier’s sacrifice in the intensifying war in Afghanistan. It’s also about a father’s sacrifice to his family, when that family has no health insurance.

(BEGIN VIDEOTAPE)

ACOSTA (voice-over): Army Specialist Greg Missman was only on the ground in Afghanistan for one month.

JIM MISSMAN, FATHER OF ARMY SPC. GREG MISSMAN: My son’s convoy had been ambushed.

ACOSTA: In July, his father Jim got that knock on the door.

J. MISSMAN: A chaplain and a master sergeant showed up. So it was – it was not a pleasant day.

ACOSTA: It was an abrupt end to what was actually Missman’s second stint in the Army. He left the service 11 years ago, but last year, he lost his job as a computer consultant.

(on camera): He lost his job?

J. MISSMAN: Um-hmm.

ACOSTA: And became unemployed.

J. MISSMAN: Became unemployed. Lost his health insurance.

ACOSTA (voice-over): Missman says his son reenlisted to see to it his family had health insurance.

J. MISSMAN: See you in a year.

ACOSTA: He was full of confidence on the day he left for Afghanistan.

J. MISSMAN: So he said, you know, I’m going to go back in the Army and make sure Jack has — his son Jack would have health insurance. That was really the motivating thing to have him go back in.

ACOSTA (on camera): Greg Missman grew up in a community that’s already lost two of its sons in the war of Iraq. Greg made it three, only in Afghanistan.

(voice-over): Keith (INAUDIBLE) son, Matt, is one of the other fallen soldiers.

(on camera): Do you think we’ll see more cases like Greg Missman?

UNIDENTIFIED MALE: No doubt about it. We probably will. You know, I was going to say hope it isn’t from here, but I hope it isn’t from anywhere. But it will happen again.

ACOSTA (voice-over): Jim Missman looks at the letters he has received from the president and military leaders and worries about the future.

J. MISSMAN: I’m a gold star parent because of my son’s sacrifice, and I would rather not see any other Gold Star parents.

ACOSTA: But this Gold Star parent doesn’t have the answer on how to fix the nations’ health care system.

J. MISSMAN: He made quite a sacrifice. Health care is – it’s going to be a tough one.

ACOSTA: These days he’s remembering a son who sacrificed to country and family.

(END VIDEOTAPE)

ACOSTA: And a Pentagon spokesman said there is no way to count how many soldiers have joined the armed services to get health care benefits. As for Greg Missman, his son will continue receive military health insurance so this soldier’s sacrifice will live on, John.

ROBERTS: What a shame. What a story. Jim Acosta for us this morning. Jim, thanks so much.

Click here for full transcript: http://transcripts.cnn.com/…

But Greg Missman’s story is by no means unique. Meet a few other Americans. These people are also citizens of the richest country on the planet, but they too find huge barriers to accessing healthcare. This is because in the United States healthcare remains a privilege not a right.

Jose and Flora Ana Granado need a public option.

Jose Guevara and Flora Ana Granado, Mount Rainier, Md.

When Jose, 49, or Flora, 40, need to see a doctor, they rely on La Clinica del Pueblo, a community health clinic in the District, which charges patients on a sliding scale. Jose and Flora pay $20 for an office visit. They don’t have coverage for hospitalization. Jose says he’s not optimistic that proposals in Congress would do much to help families like his. “What I’m hearing is, the only benefit is for the people who are already earning a lot,” he says. Lawmakers, he says, should “help the people who need it the most, the poor people.”

Christine and Gerald Duncan need a public option.

Christine Duncan and Gerald Duncan, Denver

In July, the Duncans, who run a small drafting firm, dropped health insurance coverage for themselves and their 20-year-old son after their insurer raised premiums to $766 a month from $706. The increase came amid a severe downturn in the couple’s business, which has been hit hard by the recession.

“We had nothing coming in during July,” says Christine, 53, who says the couple earned about $50,000 last year but will make much less this year.

In the 15 years they have been buying their own insurance, the Duncans have seen their premiums rise by 300 percent, she says. The July increase left them with a stark choice: Paying the mortgage or paying for insurance.

“We’re praying we don’t need any medical care,” she says.

David and Debbie Sherry need a public option.

David Sherry and Debbie Sherry, Green Bay, Wis.

Four years ago, David Sherry, now 59, took early retirement after working for the city of Green Bay for 34 years. He and his 57-year-old wife, whose job doesn’t offer insurance, decided to stay on the city’s health plan for retirees. They pay a premium of $1,025 a month.

Before the plan fully covers their medical care, they each must shell out $2,600 a year in deductibles and co-payments for hospital and doctor bills. All told, their premiums, deductibles and drug costs will total at least $18,400 this year. That’s about 28 percent of their $65,000 in income from Debbie’s office job, David’s pension and his part-time job at a car dealership.

The Sherrys had trouble paying their $5,200 in deductibles and co-payments last year, so they started a payment plan under which they paid $300 a month. But some providers threatened to report them to a collection agency, so they sold one of their remaining financial assets – some stock – to pay off the bill.

Late last year, David received a diagnosis of bladder cancer, and his wife is scheduled to have surgery on her parathyroid gland this month. Because of those health problems, the couple expects to confront the full deductible again this year.

“What are we going to sell off next year to pay our $5,000?” David asks. “The only way I’ll get a little reprieve is if I live until 65 and go on Medicare. Then my premium won’t be as much. Maybe I should have stayed working until I died.”

Mr. President, I could go on all day.There are tens of millions just like these three families. What a tragedy that our fine volunteer army could become a repository for desperate Americans needing healthcare.

Americans need a robust public option available on day one. No triggers. No co-ops. Just a straight up public option.

By NYCeve (Eve Gittelson)

I received a phone call the other day from a close friend. He owns and runs a small business. We Americans are told that small business is the backbone of the U.S. economy.

He wanted my advice about his health insurance. He had just received the annual renewal notice. His voice was as subdued as I’ve ever heard. He began by saying, “this can’t be correct, it’s got to be an error.” But I knew better, I knew it was accurate.

“They’re hitting me with a 22% increase”, he stammered.

“So what’s the number?” I asked.

“Over $1800.00 a month for me, Marianne and Marc”. He chuckled, “I thought Obama was going to help us, what the hell is going on? When will we see some relief?”

Most Americans are dangerously underinsured with junk insurance.

So I laid out his really bad options.

I told him to increase the deductible, increase the co-pays, and lower the reimbursement for out-of-network providers, and he could probably reduce the premium increase from 22% to around 10-12%. I also explained that by doing this, he’d be moving deeply into the land of the dangerously underinsured.

He laughed some more. “Only a 10% increase, how lucky, but business is down 30% this year”.

When the dreaded annual premium renewal arrives, scaling way back on health insurance, and going to what amounts to a bare bones policy, has become the only path most Americans can take. The choice is to become dangerously underinsured or drop insurance entirely.

My friend received this bad news as we’re learning that the White House may be in negotiations with Republican Senator Olympia Snowe, to either abandon the public option entirely, or subject it to “triggers”. How many more triggers do we need, to know that the for-profit insurance industry has no intention of being a responsible corporate citizen?

Last night at the Bill Pascrell town hall which I attended at Montclair State University, Congressman Pascrell asked Kelly Conklin a small business owner to address the gathering.

He too had just received a renewal premium. The unruly crowd actually stopped screaming for the few minutes Conklin spoke. He said, every year, he offers his employees more meager health benefits, and now he’s at the breaking point. He made the point that he is a business owner, who has been forced to make life and death decisions for his small band of employees.

Life and death decisions? When the day arrives that he can no longer afford the skyrocketing premiums, he will be forced to cast his employees into the dangerous world of the uninsured. This is a monumental life and death decision.

Ask Kelly Conklin and other small business owners about triggers.

Unless a robust public option is a part of healthcare reform, Kelly Conklin and millions of other small business owners will really have to pull the trigger. They will pull the trigger and give up entirely on employee health benefits. They’ll have no choice, you can’t pay for something you can’t afford.

By NYCeve (Eve Gittelson)

Wendell Potter spent most of his professional life spinning tales on behalf of his employer, the health insurance giant, CIGNA.

Several years ago, Mr. Potter had an epiphany, and left this massive killing denial machine. Now he works for the Center for Media and Democracy and has become an outspoken advocate for healthcare reform.

Mr. Potter is not a garden variety advocate. By speaking out, and subjecting the industry to the withering scrutiny of an insider, he provides the most intimate look yet of for-profit insurance which is at the epicenter of the U.S. healthcare system.

As you listen to this courageous man, remember that denial of healthcare, denial of claims, denial of benefits, and denial of service, is critical to maintaining a robust bottom line. This is what Wall Street investors demand, and it’s the glue which binds together our for-profit system.

Potter’s recent blog post on the Center for Media and Democracy web site, seems to me, to be among the most profound indictments I’ve seen of the for-profit insurance industry. Yet despite reform, it will remain at the center of the revamped U.S. healthcare system.

You need to wonder about our dysfunctional political system, and the corrupting influence of money in politics when you read stuff like this. Recognize that a day after we have “reform”, the American people will still be in the death grip of this industry.

Even with a public option, for-profit insurance stays in place.

I would like to begin by apologizing to all of you for the role I played 15 years ago in cheating you out of a reformed health care system. Had it not been for greedy insurance companies and other special interests, and their army of lobbyists and spin-doctors like I used to be, we wouldn’t be here today.

I’m ashamed that I let myself get caught up in deceitful and dishonest PR campaigns that worked so well, hundreds of thousands of our citizens have died, and millions of others have lost their homes and been forced into bankruptcy, so that a very few corporate executives and their Wall Street masters could become obscenely rich.

The political class has been well briefed by Mr. Potter and others. Yet despite his dire warnings about the egregious behavior of his former employer, our government continues to center reform around this discredited industry. Indeed, the individual mandate will amount to a government sanctioned transfer of American wealth, from middle class families to the pockets of for-profit insurers.

Mr. Potter warns, but those we elect to do our business, ignore him.

But It was only during the last few years of my career that I came to realize the full scope of the harm my colleagues and I had caused, and the lengths that insurance companies will go to increase their profits at the expense of working families.

As I told the Senate Commerce Committee two months ago, the higher up the corporate ladder I climbed, the more I could see how insurance companies confuse their customers and dump the sick – all so they can satisfy those Wall Street masters.

I described for the senators how insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers, and how they make it nearly impossible to understand — or even to obtain - information consumers need.

I also told the Committee how the industry has conducted duplicitous and well-financed PR and lobbying campaigns every time Congress has tried to reform our health care system - and how its current behind-scenes-efforts may well shape reform in a way that benefits Wall Street far more than average Americans.

As we head to the final rounds of this historic struggle, the end game, if you will in the battle for healthcare, keep Wendell Potter’s admonitions square in your mind. When you hear elected officials talk about “death panels”, also remember these are talking points manufactured and distributed by the well-oiled PR spin meisters hired to replace Mr. Potter.

The status quo stays in place as long as the insurance industry is able to distract the attention of the American people from the urgent realities facing the country. Tragically, the media has been a willing enabler.

“Video Wallpaper”

The eruption of anger at town-hall meetings on health care, while real and palpable, became an endless loop on television. The louder the voices, the fiercer the confrontation, the more it became video wallpaper, obscuring the substantive arguments in favor of what producers love most: conflict.

As a postscript, I should add that I’ll be interviewing Wendell Potter on Thursday, when I attend Congressman Bill Pascrell’s town hall in Montclair New Jersey.

By NYCeve (Eve Gittelson)

Buried deep in an article in the Washington Post about the concerns of hospital executives on healthcare reform, is an extraordinary statistic.

What if new policies reduce revenue and increase demand? What if existing doctor shortages grow worse? What if some of the most vulnerable and expensive patients continue to have no coverage, like the nine people who made 2,678 visits to local emergency rooms in one six-year stretch and soaked up $3 million in expenses?

This is about $1100 per ER visit!

Imagine, if these nine people had health insurance and access to healthcare. Imagine if they could see a doctor before a small problem became a big and expensive problem. Financial incentives exist for treating people when they get sick, these incentives should be available for keeping people healthy!

Imagine if that mild cold or flu got treated before it morphed into expensive bronchitis or pneumonia?

So let’s talk about skyrocketing costs, an issue which seems to be one of the biggest concerns (ahem) of health reform obstructionists. Take a look at what happens when an uninsured American needs to access healthcare.

ER visits cost from $300 up, while doctor’s office visits usually run less than $100.00.

It’s estimated that 46 million persons a year walk into emergency rooms simply because they don’t have doctors or are indigent. Who pays for this? You and I—the ER bills of the uninsured are being paid by Americans with insurance. It is a hidden tax in the form of sharply higher premiums for those of us with insurance.

Unlike other areas of health care, federal law requires hospital emergency rooms to see patients even if they cannot pay. The American Medical Association estimates that, on average, more than half of treatment delivered by doctors in the emergency room is uncompensated.

The problem has worsened as the recession has led to an increase in the number of people without health insurance. More people are seeking treatment in emergency rooms for routine medical needs and a growing number of those admitted have serious health problems that have gone untreated because of a lack of preventive care.

Paradoxically, since healthcare is not a right in in the United States, as it is in all the other industrialized nations of the world, we have the highest costs (sicker uninsured making multiple ER visits), and we don’t get the best medical outcomes. All too frequently Americans are forced to use the ER as a primary care physician—the most expensive healthcare, simply because healthcare is unavailable for so many.

Bending our unsustainable cost curve is a critical component of reform. We can’t do this if we don’t provide affordable health insurance options for everyone.

And it goes without saying that a public option also addresses the other huge issue of healthcare reform. Americans utter contempt for the private insurance industry, which has proved itself over and over, to be an untrustworthy steward of the health of the nation.

There is overwhelming public support for the public option.

All: 79 percent favor/18 percent oppose
Democrats: 89 percent favor/8 percent oppose
Republicans: 61 percent favor/33 percent oppose
Independents: 80 percent favor/16 percent opposed

Throw the private insurance industry under the bus.

Americans don’t accept that people go bankrupt and face financial ruin though insured.

Americans don’t accept that they dutifully pay premiums to for-profit insurance companies, only to see claims denied in the name of increased profits.

Americans don’t accept that healthcare remains a privilege not a right in the richest country on the planet.

And Americans certainly don’t accept the horror that 18,000 Americans a year die as a direct result of not having health insurance.

The half a loaf strategy which for some includes throwing the public option under the bus, is simply unacceptable. The only way we cut costs is with vigorous competition. We assure robust competition with a public option. It is the only mechanism which will force private insurers to reconsider and amend their predatory and egregious business practices.

The political facts of life don’t change: Democrats remember the huge price they paid when Bill Clinton’s legislation failed in the early 90s, and they cannot allow that to happen again. The consequences of failure are simply too enormous, from both a political and moral standpoint.

In 2008 we bought the hope. In 2009 we need the audacity.

By NYCeve (Eve Gittelson)

I receive more messages from Americans being savaged by our broken healthcare system than I care to tell you about. They are heartbreaking and a constant reminder of what this fight is all about.

The other day, I was sent an email making the rounds on Capitol Hill. It’s about Republican deceit. But this is not garden variety Republican deceit. For many of us, this time, on this issue, deceit = death. We lose 18,000 Americans every year because they don’t have health insurance and are unable to access urgent medical care. So as Republicans ramp up their sleigh-of-hand on healthcare reform, keep this tragic and deadly reality in mind.

America’s Affordable Health Choices Act is a comprehensive reform of our health insurance system, and includes the creation of a public health insurance option – to provide competition to private insurers who virtually monopolize the market in some parts of the country. Independent analysts project only 3% of Americans will choose it—but polls show Americans are broadly supportive of its creation—understanding the role it will play in keeping private insurers honest.

Astonishingly, opponents to this government-run option, now claim to be defenders of Medicare. According to the Kaiser Family Foundation, Medicare is “federal entitlement program that provides health insurance coverage to 45 million people, including people age 65 and older, and younger people with permanent disabilities, end-stage renal disease, and Lou Gehrig’s disease.” Now that we have defined what Medicare is, let’s take a look at some recent comments by Republicans embracing this government run health insurance program.

Republicans Embrace Government Run Healthcare

Rep. Joe Barton (R-TX) Energy & Commerce Committee Ranking Member: “My mother would not be alive today if it weren’t for Medicare[a government run health insurance program]. She had a heart condition several years ago that was very difficult to treat. She went to Houston to the Hermann Hospital heart center and underwent a two-part surgical provision that basically replaced her aorta, and it was very complicated. It cost over $100,000; she paid out of pocket less than $500 because of Medicare [a government run health insurance program].” [Energy and Commerce Mark-up, 6/30/2009]

Michael Steele, Republican Chairman: “First, we need to protect Medicare [government run health insurance program].” [Washington Post, 8/24/09]

Senator John McCain: “I think we will be able to succeed because your program is typical of so many millions and millions of Americans who like their health care plan, who like their Medicaid [government run health insurance program], who like their Medicare [government run health insurance program], who want to keep it…. We’ve got to preserve your health care, Medicare [government run health insurance program], Medicaid [government run health insurance program], Social Security.” [Townhall, 8/25/09]

Congressman Mike Pence, House Republican Conference Chairman: “I support Medicare [a government run health insurance program].” In an interview with Andrea Mitchell, Rep. Pence said, “Oh, no, I support Medicare [a government run health insurance program], and have supported the program.” [MSNBC, 7/29/09]

Senator Lindsey Graham: “We’re not going to get rid of Medicare [a government run health insurance program] and there’s no reason to get rid of it. We just need to be sure it’s a well-run program and we can afford it.” [Washington Post, 8/8/09]

Here’s John Mccain today:

MCCAIN: I don’t know if they feel any better. I hope that all of us, including me, gains a better understanding of the issues and challenges that they face, that a public option, which is really government option, is not something that will do anything but lead to a government takeover of health care in America.

They are very concerned, of course, about many aspects of the issue, but the, quote, “public option,” and I use quotes because it really is the government option, I think people are really very concerned about.

VAN SUSTEREN: Is there any way you would vote for a health-care reform plan that had a government/public option in it?

MCCAIN: No, I could not do that.

Paul Krugman makes a hugely important point this morning about deficits, healthcare and the deceit and deliberate misinformation lies debasing the entire national healthcare debate.

The truth is more complicated and less frightening. Right now deficits are actually helping the economy. In fact, deficits here and in other major economies saved the world from a much deeper slump. The longer-term outlook is worrying, but it’s not catastrophic.

The only real reason for concern is political. The United States can deal with its debts if politicians of both parties are, in the end, willing to show at least a bit of maturity. Need I say more?

… So is there anything to worry about? Yes, but the dangers are political, not economic.

As I’ve said, those 10-year projections aren’t as bad as you may have heard. Over the really long term, however, the U.S. government will have big problems unless it makes some major changes. In particular, it has to rein in the growth of Medicare and Medicaid spending.

That shouldn’t be hard in the context of overall health care reform. After all, America spends far more on health care than other advanced countries, without better results, so we should be able to make our system more cost-efficient.

But that won’t happen, of course, if even the most modest attempts to improve the system are successfully demagogued — by conservatives! — as efforts to “pull the plug on grandma.”

So new budget projections show a cumulative deficit of $9 trillion over the next decade. According to many commentators, that’s a terrifying number, requiring drastic action — in particular, of course, canceling efforts to boost the economy and calling off health care reform.

The beginning, the middle and the end of the so-called debate about healthcare reform, involves saving, improving, and enhancing the lives of people who happen to be citizens of the richest country on the planet.

Another wake up call report, this time from the Urban Institute. How many of these reports do we need before we, the American people wake up to the reality that we have the most expensive health care system in the world, but not the best? The take home message from this new study could not be any clearer. The entire report is available here.

While the evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S.health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

… Many Americans would be surprised by the findings from studies showing that U.S.health care is not clearly superior to that received by Canadians, and that in some respects Canadian care has been shown to be of higher quality.

We Americans are indeed best at something. We’re the most expensive. Hats off to us, even when it comes to the health of the nation, we rely on the free market, and unfettered capitalism.

But we know the truth. We know conclusively that our health care system isn’t the best in the world, only the most expensive. The statistics don’t lie.

In 2008 health care spending in the U.S. was $2.4 trillion and is projected to reach $4.3 trillion by 2012. Yet we are far from the top (not even in the top 25) countries in terms of overall life expectancy or in preventing infant mortality.

So what’s meant by “best?” Most profitable, perhaps?

Insurance companies have spent millions of dollars promoting what they laughingingly call, “bipartisan reform”, but in reality, they’re doing their level best to kill the “public option.” Why are they so intent on requiring all Americans to buy private insurance? Simply to bring more customers into the pay or die U.S. healthcare system? Do you imagine for a second that they care about your health?

Let’s ask Gary Diego whether he thinks in a medical crisis, the insurance company is there for us. Gary made a terrible error, and he’s close to bankruptcy because of it. As his wife lay dying before his eyes, he was supposed to find out whether the nearest hospital was in or out of network! Think you’re insured, think again!

On the evening of March 1, 2008, Gary Diego was relaxing with his wife, Ellen, when she abruptly lost her hearing, began repeating herself, and seemed to be losing her grip.

Alarmed, Diego rushed her to his insurance company’s in-network hospital, near his home in Truckee, Calif. Unable to handle what was determined to be bleeding in the brain, the hospital quickly transferred her to Renown Regional Medical Center in Reno, Nev., where she spent 17 days in intensive care. While recovering, she caught pneumonia and died.

A few weeks later, a still-grieving Diego learned from his insurer, Health Net, that he owed the Reno hospital $75,462.77. The reason? The hospital was not in his approved network.

… As Diego’s bills continued to arrive, he discovered that he also owed money to out-of-network doctors and testing laboratories for services not covered by insurance. “It’s amazing how many individual doctors and test labs are involved,” he said.

All of this was on top of a $14,000 deductible he had chosen to keep his premiums down.

Yesterday it was Gary Diego, tomorrow it’s you or me.

Insurance companies are making record profits. The average employee contribution to his premium has increased 120 percent since 1999 and the benefits have decreased. Because of the frightful unreimbursed out-of-pocket costs, otherwise know as, leaving the American people holding the bag, medical bankuptcies are at an all time high.

Over sixty percent of all bankruptcies are at least in part the result of medical expenses that regular Americans, many of whom thought they were well insured, can’t pay.

Always remember, when you’re facing huge medical bills, after dutifully paying premiums year-after-year, that for-profit insurance companies are massive denial machines—they are in business to maintain profit and they accomplish this by denying care and not paying claims.

By NYCeve (Eve Gittelson)

A frightening chronicle from the land of for-profit health insurance.

How can the government mandate people purchase private health insurance, a commodity that is simply unaffordable?

Well the government can’t. Mandating that all Americans purchase private health insurance, without offering a public option, when health insurance premiums have increased 95% since 2000, while wages has gone up a pitiful 17.5% is simply an untenable non-starter.

According to Families USA, a Washington nonprofit group that advocates for affordable health care, between 2000 and 2009 the cost of a family premium provided by an employer increased 95.2 percent while median income went up just 17.5 percent. To make matters more galling, workers get fewer benefits plus higher deductibles and co-pays for the extra money.

The organization blamed the higher prices on the rising cost and increased use of medical treatments, inadequate oversight of insurance companies, lack of competition among insurers in many markets, and cost-shifting from the growing numbers of uninsured to the insured.

The higher prices have also made it more difficult for people to get insurance through their jobs. Nationally, 63 percent of U.S. companies offered health insurance to employees in 2008. That is down from 69 percent in 2000.

All this grim information is contained in a startling and urgent new report from Families USA. If there is anything macabre about this data, it’s that the American people don’t need yet another report to know how badly they’ve been sucker punched by the insurance industry for the last decade. Though Congress certainly needs to do plenty of studying. Those we elect to do our business, have shielded themselves very successfully from the harsh realities we face. And sadly, we have allowed them to accept generous and heavily taxpayer subsidized benefits, while 14,000 Americans a day lose their insurance and access to healthcare.

Now, what would happen, if we were mandated to buy private insurance and there was no public option? We’d get Romneycare the Massachusetts disaster writ large.

Massachusetts which enacted a system of universal healthcare, but failed to include a public option, has the highest premiums in the country. If you go on the web site of the Commonwealth Connector, and input a local zip code and your date of birth, you can judge for yourself whether what is being offered in Massachusetts is affordable and comprehensive. It’s neither. It’s junk insurance, with high premiums, high deductibles and high out-of-pocket costs.

Then do yourself a favor and go to the Familes USA web site and take a look at how for profit insurance premiums have skyrocketed in your state. Without a public option, there is no reform, only a mandate to buy (“think you’re insured, think again”) private insurance which won’t be there when you get sick or are injured and need it.

So what’s an American to do?

A new study cites financial concerns as a significant cause for early, medically unwise hospital departures. Because Americans fear medical bills, despite being insured, some patients choose to leave the hospital before it is safe.

Tomorrow, we’ll look at the huge rise in premiums in states of the co-op champions: Montana (Max Baucus), North Dakota (Kent Conrad), and Wyoming, the state of health care reform killer, Mike Enzi.

Yes, I know, we don’t need a public option to give the American people an alternative, because the for-profits are doing such a good job of keeping costs down and being the guardians of the nation’s health.

We will miss Senator Ted Kennedy as a nation, and I will miss him as a human being. Over the next few months, as we debate his life’s passion, which was Universal Health Care, we will feel his presence everywhere. He will be in the Senate Chamber, in the committee rooms, in the White House, and in the minds of most of the reporters old enough to have witnessed the trajectory of this extraordinary generation of America’s First Family from it’s beginning. Much has been written about Ted Kennedy already. He was indeed extraordinary. My mother, who was a solid Upper East Side Republican until 2004, once happened to sit next to him at a wedding of a mutual friend. She had never met him before. I’m sure the exchange was lively, and being a Dean, I doubt my mother gave him much quarter. A week later, a beautiful, kind, and very personal handwritten letter arrived from Ted Kennedy. My mother, like so many other Americans, was hooked by the Kennedy charm and grace.

Ted Kennedy was a man with a long career of determination as well as charm. When President Obama signs a Health Care Reform bill late this year, Ted Kennedy may not be standing there next to him, but his presence will be deeply apparent in the Oval Office as the President’s pen moves across the page.

Governor Howard Dean, MD