The health care debate has been crystallizing in my mind this past week – I’ve been suspicous of Senator Max Baucus. He’s holding the football and the regular Lucy’s are lining up. But what does he want? How does he intend to get it?

This morning I was visited by a ghost of Democrats past. It was eerie – he spoke with a drawl and had some charm and charisma and a thing for cigars. His name: Triangulation.

In the 1990’s, Bill Clinton enlisted the support of Democrats to advance various right wing causes, among them the deadly Iraq sanction regime, welfare “reform”, increased incarceration of blacks, the attack on Serbia, and privatization of Social Security. Democrats presumed that his rhetorical support for their causes meant he could be trusted to follow through. They didn’t apply force on him – odd thing about liberals – they do not threaten office holders. They merely trust them to carry out their will. Bill Clinton took them down his road.

As Mel Brooks reminds us, it’s good to be king, and Democrats like being in power. Once in power, they are like sheep lined up at the sheering wagon. With health care reform, it is Max Baucus holding the clippers.

The game is afoot. (I am one tall, handsome and balding mixed metaphor this morning.) First, Baucus took “single payer” off the table. Democrats were OK with that. Don’t let the “perfect spoil the good”, they were told.

Second, he’s making coverage mandatory. There’s some justification for that, though it seems heavy-handed. But the key to mandatory coverage, from the Baucus standpoint, is the so-called “public option”. With a true option, we will have a choice between private and public coverage. I was traveling down this path until I realized that Baucus does not intend us to have a real choice.

The “choice” will belong to his campaign contributors – the health insurance companies. They will get to “choose” who they cover. They will be allowed to cherry pick – healthy people will be required to purchase private coverage. Government will pay the premium for poorer people, but as with Medicare D (another Baucus product), there will be no price negotiation allowed.

The “public option” is really an “insurance company option” on who to cover. Anyone deemed unprofitable will be turned over to government. Since it will be by definition a high-risk pool, it will be expensive coverage. Those of us who are not poor and who do not qualify as healthy enough for private coverage will be forced to pay exorbitant premiums.

Who will manage the high-risk pools? Again, it will be private insurance companies. However, they will not be at risk. They will merely be paid a management fee, and will have a guaranteed profit.

We have such a plan in Montana, as I wrote about before. It’s called the “Montana Comprehensive Health Association“. It’s a high-risk pool, very expensive with high co-pays and deductibles, and a private insurer, Blue Cross Blue Shield of Montana, is paid to manage at no risk to itself. There are 77,000 uninsured Montanans. MCHA covers perhaps three thousand of them. If Baucus were in charge, all 77,000 would be required to purchase MCHA coverage.

So it’s time to sink the ship. There are conservatives out there who are opposed to any kind of health care reform. It is time to enlist their services. For once, those deceptive TV ads will be welcome. For my small part, I’ve written letters to the editor to newspapers in Missoula, Great Falls, Billings and Bozeman. In them I emphasize that Baucus wants to use the IRS to force people to buy private health insurance policies. That ought to rile up some libertarian and conservative feathers. (Last metaphor – I promise.)

The objective is to drown the Baucus plan in the bath tub. (Aye!) There’s tons of good energy out there right now for reform, but triangulation has reared its ugly head again. It’s time to triangulate on triangulation, progressives and conservatives alike taking aim.

Ready, aim, fire.

P.S. Strong Mike Dennison piece in today’s Gazette, perhaps all the Lee newspapers.

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Senator Baucus wants to have a hearing and wants to exclude the most prominent public point of view, and at the same time reminds them that he can’t hear all points of view unless he has his hearing from which he has excluded the most prominent public point of view. He cares so deeply – you can see the lines of concern on his forehead.

Other politicians are better at this sort of thing – acting, it is called. Max is so bad at it that it’s a wonder he has managed to fool so many Montana Democrats for so long. It says far more about them than him.

Senator Max Baucus is saying that he favors a “public option” in his health insurance proposal, but is not specific as to what that might be. I suspect that this is where he and the insurance industry are going to nail us – the devil will be in their details.

In Montana we already have a public option. We just don’t call it that. It’s called the “Montana Comprehensive Health Association“. There are something like 77,000 Montanans without health insurance, and MCHA picks up maybe three to four thousand of them. The reason it covers so few is that it is a horribly expensive high-deductible plan. But it is a “public option”.

Here’s the rules for qualifying for MCHA:

1)You have been rejected or offered a restrictive rider by two insurers within the last six months or have one of the listed specified illnesses (see this link – there’s a bunch); and
2) You are not eligible for any other health insurance coverage, or,
3) You have comparable coverage but are paying or have received a notice of a premium rate that is more than 150% of the average premium rate used to calculate MCHA premium rates.

In other words, you can go there only after the private insurance people have decided you are too high a risk for them.

Baucus and the insurance industry need to come clean on what they mean by “public option”, and soon. This could be a trap door, with Baucus holding the lever.

Footnote: Blue Cross Blue Shield administers MCHA, but has no risk – they merely collect a fee for use of their network. This is their idea of a “public service”.

Bill Moyers had an interesting show (see here for transcript) last Friday on single payer health insurance – a troubling insight came from guests Dr. David Himmelstein, on the faculty at Harvard Medical School, and Dr. Steffi Woolhandler, founder of the advocacy group Physicians for a National Health Program.

It has to do with the so-called “public option” that I and others have been advocating as the “good vs. perfect” solution to our health care problems. I like it because I believe that if people are given an option to buy in to Medicare or VA, that it will slowly crumble the foundations of the private insurance system that is the heart of our problem.

Speaking of the downside of a public option, the doctors spoke of a program called “Medicare Advantage”, which is supposed to offer superior private insurance care to seniors:

Himmelstein …we’re worried that the public plan actually becomes a dumping ground for the unprofitable patients. As it’s happening in Medicare. … the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. So, you put your signup office on the second floor of a walkup building. And people who can’t navigate stairs are the expensive people.

Wolfe …Get rid of the heart failure patients.

Himmelstein Or you have your signup dinners in a rural area at night, where only relatively healthy people are able to drive and stay up that late. So, there’s a whole science to how you sign up selectively healthier patients. And the insurance industry spends millions and millions of dollars on that. And would continue to as they’ve done under Medicare. Selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.

Insurance industry shill Senator Max Baucus and his sub-shills are saying that there is a public option on the table, but are not specific as to what it is. Since the Democratic wing of the Republican Party has already abandoned single payer, we will be stuck with either no public option at all, or one that is structured in such a way as to allow private insurance companies to continue to operate as they do now: Cherry-picking healthy clients, dumping everyone else on government.

Himmelstein and Wolfe maintain that we can only succeed if we do what Canada did in 1970 – kick the insurance companies out of business. If anyone suggested in Canada that they go back to their pre-1970 system, there would be a bloody revolt.

PS: By the way, Medicare Advantage is 1) subsidized, 2) costs 15% more than regular Medicare, and 3) with the program, insurance people are up to their old tricks, skimming the Medicare population for the healthy ones and avoiding the rest. It could be a foreshadowing of the Baucus public option.

Prison seems too kind.

I knew this was coming, but it pisses me off nonetheless:

ehealthinsurance.com

Dear Mark,

We regret to inform you that your application for health insurance coverage has been declined. BlueCross BlueShield of Montana will contact you directly to provide more information about their decision. eHealthInsurance has not been informed why your application was declined.

We understand this is not the result you had hoped for. If you don’t have an employer-sponsored health insurance alternative available, here are some other options you may wish to consider:

* Public Health Coverage and Assistance Programs. The Foundation for Health Coverage Education, a non-profit private organization, sponsors the U.S. Uninsured Help Line at 800-234-1317 and the Coverage For All website, where you will find a list of the options available in your state. Use their helpful tools and expert assistance to find and apply for a broad variety of state-sponsored health coverage and public assistance programs.

* Social Security and Medicare. If you have a disabling condition which has lasted or is expected to last 12 months or longer and you are unable to perform any work activity, you may be eligible. Contact Social Service Coordinators for an eligibility evaluation at no cost to you at 1-866-440-2983 or online at: http://www.sscdisability.com\ehealth

If we can be of any further assistance, please call us at 800-977-8860. We’re available Monday through Friday, from 5am to 8pm Pacific Time.

Gary Matalucci
Vice President of Customer Care
eHealthInsurance Services, Inc.

The #1 service to compare and buy health insurance

Note: 1) Matalucci doesn’t involve himself or his company in seeking to find insurance. That’s not his job. eHealthinsurance Services, Inc. is a private company contracted with the health insurance industry to sift through the population and find profitable clients. They are interested in making money, period.

2) This is precious – they suggest I find some sort of public assistance, Medicare or Social Security. That’s is the private insurance business model – to cherry-pick the best, and dump the rest on government.

Are there a more contemptible set of leaches than the private insurance industry? They are useless appendage – “lice on the body politic” (Koopman, circa 2005). The best we can do for ourselves is to find them a productive outlet for their talents. Maybe they can pack boxes and load freight cars down at the Styrofoam factory.

Anyway, this is what it’s like out in the real world.

Many thanks to Elizabeth Edwards, who was on the Daily Show last night (as if she is going to read an obscure Montana blog), for pointing out the obvious. I’m not going to show the clip, as this was but a small part of it, nor am I going to accurately quote her. I got the point, which I should have gotten from the beginning.

The recent initiative on the part of health insurance companies to cut back costs by $2 trillion was a response to the mere threat of a “public option” – of giving people an opportunity to join a public health insurance plan, like Medicare.

Imagine the savings if the threat became reality! Competition does that.

Imagine what it is going to cost us if the threat vanishes.

America’s health insurers have come forth with a new proposal for saving money – it is being trumpeted as being worth $2 trillion. For some reason it made me think of an old Letterman Late Night bit where the curtain rises, and some oddball does an act, like twirling several hula hoops or creating sparks with a grinding wheel against parts of a metal costume.

Letterman and Paul Schaffer then have to decide whether it is “something”, or “nothing”.

This proposal seems to have been thrown together like a late night sandwich, probably in response to public pressure for either single payer or at least a public option in health care insurance. But President Obama jumped all over it – an anonymous spokesperson called it a “game changer”, and Obama himself a “watershed event”. That smacks of cheerleading for the industry. Why?

Timing is everything. There’s nothing in the package that could not have been done last year or twenty years ago. But health insurance companies are hugely profitable, and therefore have seen no need to rectify problems like soaring costs or millions of uninsured. As long as investors were getting a good return, there was no talk of change.

But right now there is pressure for change, and they are under intense scrutiny. What better time for a grand and meaningless gesture?

The cost savings would be welcome, but as with ever-elusive future projected shrinking federal budget deficits, are probably not going to materialize. The gesture is most likely just some good political gamesmanship, a way of keeping the insurance industry in the health care game. It also offers political cover for Democrats as they work with the health insurance industry to preserve … the health insurance industry.

Health insurance companies are the problem. We need to get rid of them. They know this. This grand gesture is, in the end, not a “game changer” so much as a “bacon saver”.

I vote that it’s “nothing”. What do you say, Paul Shaffer?

Sen. Max Baucus is in the process of cutting a deal with the insurance industry, and of undercutting the movement for health insurance reform that has gathered so much momentum in these last four years. I don’t know what the final product will be – I only know that unless Democrats can mount severe and direct pressure on Baucus, he will not change his ways. That is, they have to threaten to hurt him.

They have never done this before. I doubt they will do it now.

First, a word about private health insurance: It is structurally incapable of offering universal care. It does a fairly good job of covering people in the workplace. This is because people in the workplace generally are not there because they need health insurance. Consequently, adverse selection is avoided. I have no doubt that, job insecurity aside, most people who have insurance through their job would like to keep it. I have had it myself, and coverage was very good.

Outside the workplace, it’s a different story. There are professional organizations, such as engineers or accountants or small business owners, who are drawn together for reasons other than health insurance. These groups sometimes offer health insurance to their members. But more and more these groups are denying insurance to members due to adverse selection – people joining solely to get health insurance. I was turned down for insurance by the Montana Society of CPA’s because of my preexisting condition. I no longer belong to that group.

Individuals trying to buy insurance on the open market are pretty much screwed. Either they are fairly well-to-do and healthy, or they will not be offered coverage. If they can afford insurance but have one of the hundreds of conditions that qualify as “preexisting”, they’re out of luck.

The health insurance companies are running a business. They have to do what they do, otherwise claims will skyrocket. Premiums will follow, and people will drop coverage, and eventually they’ll be left covering the already-sick at enormous cost. Health insurance companies are not run by bad people – these are smart people who are selling a product that simply cannot meet our needs. I don’t wish ill on any of them. I only want them to find a new profession.

Private insurance is heavily bureaucratic and expensive. They have to pay high commissions to sales people to sift through the population to find profitable clients. They have to generate a profit for investors. They have to avoid paying claims, requiring expert staff to justify the practice of formally denying benefits. And they have to dump their costs – on patients, hospitals, doctors, government, and other insurers.

But there two ways that private health insurance can both meet our needs and be profitable: 1) If coverage is mandatory; and/or 2) if government subsidizes it. But to demand that people buy their product is neither fair nor wise; to subsidize it is to institutionalize their inefficiency.

There is really only one solution in our diverse country: Single payer. But that won’t happen anytime soon. In the meantime, we need a mixed system, with private insurance operating in the employed workforce, and government insuring anyone who wants coverage (with subsidies for the elderly and the poor). This is called the “public option”.

Now comes Max. He’s already taken single payer off the table. Fair enough – it’s not going anywhere no matter what. But yesterday, he had doctors arrested for trying to butt into his private circle of friends. He’s really gotten to be an arrogant dick.

According to Open Secrets, Max’s top contributors, 2003 to 2008 are as follows:

Securities and investment ($1,003,018); Health professionals ($851,141); Pharmaceuticals and health products ($850,131); Lawyers and law firms ($791,004); and Insurance ($784,185).

I didn’t see a listing for “the uninsured and people abused by insurance companies”. So we’re screwed. We spend a great deal of time trying to analyze the impact of campaign contributions – do they influence a politicians vote? I can answer that: Duh. It’s worse than that – every dollar has the impact of two dollars: If Baucus doesn’t collect these dollars, they will go to a potential opponent. He too is a smart business man.

So what is coming down the pipe? Probably we are going to get some sort of universal plan with a mandate that people buy insurance from private companies. Unless 70 House Democrats prevail, there will be no public option. Insurance companies will be required to cover people with preexisting conditions, but this is key: They will be subsidized. Government will pay them to do so. Add one more layer of costs to our already-overburdened system.

Ordinarily a piece like this ends with the words “Write or email Senator Max Baucus. Tell him you want health insurance with a public option.” That’s bogus. First of all, emails are pointless – they are too easy to generate and submit en masse. And letters take weeks to get to him due to the anthrax scare. And anyway, he’s not listening.

Instead, I ask the following of Democrats:

Turn against Max Baucus. Punish him. Hurt him. Call his local office. Don’t even think about being civil. Write nasty letters to the editor. Organize groups to picket his offices, letting the newspapers, who generally support him, know what you are doing. (That way, they can ignore you too.) Vote for his opponent when you get a chance, even if that opponent is a Republican or a whack job. Above all, be nasty to him. Let him know he is a schmuck.

Max is extremely vain, and treasures his image. Tarnish it. Face him head on, tell him what you really think. Don’t stutter.

Max is not a sellout. He never had to sell out. He’s bought, from the very beginning.

It is my object here to write a short post. Here goes:

The private American health care system is dysfunctional because:

1) Insurance companies avoid people who might actually get sick. This would be the old and those with existing conditions.

2) Insurance companies avoid people who cannot pay premiums. This would be children and the poor and working poor.

3) Insurance companies are incentivized to deny claims. From their point of view, every claim paid dents the bottom line.

Doesn’t work. Can’t work.

State Senator Morgan Carroll of Aurora, Colorado, is a health care reformer. She has taken on the arduous task of introducing some transparency into doctors’ relationships with pharmaceutical companies. She introduced a bill in the Colorado legislature that would have banned drug companies from giving gifts to doctors or reselling patient prescription information for marketing purposes.

Carroll brought the bill before a committee of the legislature. The Democrats around her were a little stunned, and used procedural maneuvers to kill the bill. Here’s her words:

* the health care bill was assigned to a committee on business, not health
* President Groff refused even a short extension to consider amendments that may have achieved pharmaceutical / health care reform, effectively killing the bill on a deadline technicality.
* Chairwoman Veiga refused to even entertain a vote on an amendment — something I have never seen in 5 years, also effectively killing the bill on a flex of bald chairing power.
* Democratic Senator Heath indicated because he had Roche pharmaceuticals in his district he couldn’t vote for the bill.
* Democratic Senator Tochtrop said her concern was about samples, even though samples were exempted from the bill.
* Not one colleague could point to one provision of the bill or recommend one change. Normally, members of the same party will at least attempt to work with a bill sponsor. Here quite the opposite was true.
* The Senators left during the hearing intermittently to talk to the drug lobby outside the hearing, missing key testimony.

This is the usual procedure for killing good bills, and it is usually done behind the scenes. Since most of the Democrats who killed the bill also campaigned on reform of the health care system, they have to act quietly and don’t want any publicity.

Sen. Carroll has broken with etiquette, and written about the matter on her blog.

Democrats are outraged. Not about the bill. They meant to kill it. They are mad at Senator Carroll for talking out of school, about blogging about their activities.

Do we need any more evidence of the real problem we face? It’s not Republicans. They are what they are. It’s Democrats who are nothing more than beards for special interests while talking about reform.

Democrats are the problem. Democrats are the Problem.