July 30, 2009

Q&A With Another Mendacious Hack

Over at Townhall.com, conservative performance artist and unintentional satirist Dennis Prager has a column entitled 10 Questions for Supporters of 'ObamaCare', that reads like a primer for dishonest right wing talking points.

Mr. Prager's "10 questions" are actually more like fifty, since he makes multiple queries in each one, but since his article encompasses many of the most popular assaults on President Obama's efforts to reform health care coverage, I thought it would be worthwhile to address them. What follows, then, is my own primer for responding to many of the major falsehoods propagated by opponents of a public health insurance option:
Question 1:
President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

No one - with the exception of dishonest Republican hacks - is talking about nationalizing health care. The issue on the table is a public option for health care COVERAGE that would compete against private plans, not government control over the practice of medicine.

Question 2:
President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

The legislation currently being crafted contains a mandate requiring all citizens to have health insurance. There will certainly be people who fail to comply with the mandate for coverage - just as there are people who fail to pay their taxes - but a well-crafted plan will account for some level of non-compliance. Increasing the pool of people paying into insurance in no way "spells the end of the concept of insurance"; just ask the citizens of pretty much every other developed nation on the planet.

Question 3:
Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

I don't know, but I bet it is not for the reason that Mr. Prager is conflating "coverage" and "care," which is clearly to create the impression that the current debate over health care reform could lead to government interference in the doctor-patient relationship rather than changing how we pay for treatment. In any case, this isn't germane to the debate at hand; again, no one is advocating nationalizing the practice of medicine.

Question 4:
No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

Simply put, there is no moral justification for the state rationing health care, just as there is no moral justification for rationing by private companies, which is what we have today. Neither governments nor corporations are required to justify their actions morally; just legally and ethically.

Question 5:
According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives - in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

First, in the modern era of direct-to-consumer marketing of drugs, it remains an open question as to whether sales of a given pharmaceutical correlate to efficacy. (It is also an open question - although much, much less of one - whether one should take at face value the word of a man who shamelessly shills for a conservative think tank, and who has been publicly humiliated for making misleading statements before Congress.) Second, just because pharmaceutical companies might set up shop somewhere besides the United States, that in no way means that Americans will be denied access to the drugs these relocated (or foreign) companies develop. As long as there is demand for treatment, someone will meet that demand. Finally, this is a question of pharmaceutical industry economics, and it has little to do with the need to reform health care coverage.

Question 6:
Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to – and given that a private enterprise must raise its own money to be solvent and a government option has access to others' money - i.e., taxes?

Certainly. Private insurance continues to be available to those who want it in countries that have public insurance, and there will remain ample opportunity to provide the same kinds of coverage even with a public option in America. At the end of the day, however, the survival of the private health insurance industry is completely irrelevant to the issue of health care coverage, and is again a matter of economics within a given industry.

Question 7:
Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

The United States spends far more per capita on health care than any other industrialized nation. Yet for all of that expenditure, the U.S. is just 37th in the most recent World Health Organization (WHO) rankings of the world's health care systems, slightly ahead of Slovenia and Cuba, but behind such dynamos as Costa Rica, Dominica, Chile, Colombia, Morocco and Greece. Further, the United States ranks 47th in life expectancy at birth; 29th in infant mortality (down from 12th in 1960); and 14th out of 26 developed nations surveyed for deaths from heart disease. Americans also wait as long or longer for care as people in countries with national health insurance. It is unclear, therefore, how this performance is related to "uniquely excellent care," but it is likely that these standings are at least partially reflective of the effect tens of millions of Americans without insurance have on both cost and aggregate success.

Question 8:
Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

Defensive medicine is not the sole reason for unneeded procedures; doctors and hospitals also order procedures for profit reasons, even in states with caps on medical malpractice awards. More important, however, is the fact that malpractice is only about 1 percent of health-care spending, even if defensive medicine is included. It is essentially a non-issue.

Question 9:
Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

Absolutely not. Not only are current inefficiencies in health insurance a serious drag on our economy that we would be well rid of, government spending to reform the system will act as significant economic stimulus. This is actually an excellent time for major changes, and viewed at a macroeconomic level from a long range perspective, health insurance reform is about cost shifting (private to public) and savings (elimination of overhead, reducing inefficiencies, broadening the pool of insured), not additional cost.

Question 10:
Contrary to the assertion of President Obama - "we spend much more on health care than any other nation but aren't any healthier for it" - we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?

Again, this question conflates health care and health care coverage, the first of which is not under discussion or debate. There is no plan in the bill for nationalizing health care (Anyone sensing a pattern here?), and the framing of this question - as illustrated amply by the statistics cited in the answer to Question 7 - is clearly and demonstrably untrue. We wait for care as long or longer than patients in countries with national insurance; no one excludes violent crime and automobile accidents from calculations of life expectancy; and while I was unable to find anything confirming or denying the assertion that "our life expectancy with virtually any major disease is longer," given the outright dishonesty in the other claims, I think we can charitably assume that it's a moot point, at best.
Far from being alien to our current debate on health care reform, the questions in Mr. Prager's column actually represent many of the arguments commonly used by those most loudly and stridently opposed to change. Understanding this, it is intensely illuminating to see the dishonesty and intellectual bankruptcy of these arguments, intended as they clearly are not to address the technical hurdles to productive reform, but instead to cloud the atmosphere with propaganda, fear-mongering and outright lies.

That being the case, it is clear that, for the right wing, this is a battle over ideology rather than an effort to solve a problem. Given that the stakes in solving the problem of health care reform are the lives and wellbeing of our fellow Americans, that is, frankly, despicable.

Be sure to check out this clip from Robert Greenwald, entitled 450,000 Doctors Can't Be Wrong:

July 25, 2009

Red Roof, Gloucester

I am lucky enough to have made some lifelong friends in high school, and every July, as many of us as can make it - and we all really try to make it - gather at a place called Red Roof, in Gloucester, MA. It's an annual rite of fun, relaxation and alcohol-aided silliness, a highpoint of the summer, and something to which I look forward every year.

Anyway, the point of all this is that there will be no post today, as I am wholly unplugged, chilled out, and not thinking about global, national, local or personal problems. Even we angry bloggers have got to recharge now and then!

Regular posting will resume later this week.

July 20, 2009

The AMA's New Position on a Public Option

Earlier this month, I wrote a post entitled The Health Care Oligopoly and the Real Weight of the AMA that discussed the lack of competition in our current, supposedly "market-driven" health insurance industry, as well as the shrinking constituency of the American Medical Association (AMA). In it, I quoted the AMA's stated position with regard to a public health insurance option as part of ongoing reform which was, at the time, as follows:
The AMA does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.
Later that day, I received a comment from someone at the American Medical Association declaring that I had completely misstated the organization's position, despite the fact that, in describing that position, I had used the AMA's very own words:
Your post is simply wrong regarding the AMA’s position on health-system reform. The AMA is committed to health reform this year that provides all Americans with affordable, high-quality health coverage. Over the last few years we have invested more than $15 million in our Voice for the Uninsured campaign to call attention to the uninsured crisis and lay the groundwork for health reform that gets all Americans covered.

The term “public plan” has so many different meanings that it confuses more than informs the debate. As the nation’s largest physician organization, we have made it perfectly clear that we welcome and will thoughtfully consider all proposals consistent with the principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.

Recently, the White House released a statement saying: "the AMA agrees with the President that enacting reform that drives down costs and expands choice and coverage is an urgent priority. We look forward to working with them as the process moves forward."
Confronted with what I'm reasonably certain was the work of a lazy summer intern in the AMA's public relations department, my low tolerance for this slipshod and deceitful feedback sort of, well... came out:
Wait, let me get this straight: Your contention is that, in directly quoting a statement from the American Medical Association, it was I who got it wrong? Are you seriously trying to make the case that I was incorrect in citing this statement from the AMA?:

"The AMA does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans."

Your comment is little more than one big strawman, rife with the tried and true technique of addressing something I never actually said. For example, you quoted a White House statement that reads:

"... the AMA agrees with the President that enacting reform that drives down costs and expands choice and coverage is an urgent priority. We look forward to working with them as the process moves forward."

This substanceless dreck clearly falls into the category of "Uh-huh. And?" and in no way addresses the contents of my post. Further, you may have "made it clear" that you will entertain all sorts of proposals, but per my quote above from YOUR ORGANIZATION, you have also made it clear you oppose a public option.

I work hard to maintain a civil tone and have intelligent and calm conversation on this site, but holy shit, your post is absolutely insulting in its craven, mealy-mouthed dishonesty. Whoever you are, feel free to engage with substance in a manner that actually speaks to what I wrote. Alternatively, if your sole intent is to cut and paste corporate PR statements into my comments section, go piss up a rope.
Anyway, as mildly entertaining as all that was, I am pleased to announce that, as of July 16th, the American Medical Association has endorsed the health reform bill that has been passed by the House of Representatives, and which includes a public option! For the record, this was NOT the case at the time of my post - the accuracy of which I maintain - but I think it is only fair to make mention of the AMA's new position, and I applaud the organization's decision.

Who knows? Perhaps they saw the comments below by Vermont Senator Bernie Sanders, who just flat-out gets it:

July 15, 2009

An Insider Lays Bare the Health Insurance Industry

In The Health Care Oligopoly and the Real Weight of the AMA, I highlighted Congressional testimony by Wendell Potter, the former head of public relations for health insurance giant, Cigna. Mr. Potter's comments were devastating in their very direct exposure and condemnation of standard insurance industry practices, which he made clear were focused on making a profit at the expense of providing quality health care to people who need it.

On July 10th, he sat down for an in-depth interview with veteran journalist Bill Moyers, and expanded on the points he discussed on Capitol Hill. It's a lengthy - but utterly gripping - conversation. Mr. Potter left Cigna after seeing firsthand the number of people - some of whom had traveled for hours - who came to a rural health care exhibition in Virginia for treatment they couldn't otherwise afford.

Anything but a disgruntled employee, Mr. Potter was happy, well-paid and well-regarded at Cigna, where he worked for 15 years and rose through the ranks. But when he saw the insurance industry gear up to block efforts to reform America's dysfunctional health insurance system, his memories of the exhibition in Virginia would no longer let him remain neutral. In his interview with Mr. Moyers, he matter-of-factly delivers a searing indictment of the perverse incentives that run-rampant throughout the health insurance industry.

The entire conversation can be viewed at the PBS website, here, and the full transcript is here. It is a lengthy interview, and while I strongly recommend viewing or reading it in its entirety - it is both infuriating and enlightening - highlights and clips are below. Please be sure to check it out.

On the role of so-called "centrist Democrats" in defeating reform:

MOYERS: This is fascinating. You know, "Build awareness among centrist Democratic policy organizations--"


"--including the Democratic Leadership Council."


Then it says, "Message to Democratic insiders. Embracing [filmmaker Michael] Moore is one-way ticket back to minority party status."


Now, that's exactly what they did, didn't they? They--


--radicalized Moore, so that his message was discredited because the messenger was seen to be radical.

On Michael Moore's movie Sicko, which examines the inequities of the health insurance system in America:

MOYERS: Was it [Sicko] true? Did you think it contained a great truth?

Absolutely did.

What was it?

That we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie.

On the ideological approach to health care taken by many conservative politicians:

MOYERS: I have a memo, from Frank Luntz. I have a memo written by Frank Luntz. He's the Republican strategist who we discovered, in the spring, has written the script for opponents of health care reform. "First," he says, "you have to pretend to support it. Then use phrases like, "government takeover," "delayed care is denied care," "consequences of rationing," "bureaucrats, not doctors prescribing medicine." That was a memo, by Frank Luntz, to the opponents of health care reform in this debate. Now watch this clip.
REP. JOHN BOEHNER: The forthcoming plan from Democratic leaders will make health care more expensive, limit treatments, ration care, and put bureaucrats in charge of medical decisions rather than patients and doctors.
SEN. MITCH McCONNELL: Americans need to realize that when someone says "government option," what could really occur is a government takeover that soon could lead to government bureaucrats denying and delaying care, and telling Americans what kind of care they can have.
SEN. JON KYL: Washington run healthcare would diminish access to quality care, leading to denials, shortages and long delays for treatment.
REP. JOE WILSON: How will a government run health plan not lead to the same rationing of care that we have seen in other countries?
REP. TOM PRICE: We don't want to put the government, we don't want to put bureaucrats between a doctor and a patient.
MOYERS: Why do politicians puppet messages like that?

Well, they are ideologically aligned with the industry. They want to believe that the free market system can and should work in this country, like it does in other industries. So they don't understand from an insider's perspective like I have, what that actually means, and the consequences of that to Americans. They parrot those comments, without really realizing what the real situation is.

On the revolving door between Washington and special interests:

MOYERS: Why is the industry so powerful on both sides of the aisle?

Well, money and relationships, ideology. The relationships-- an insurance company can hire and does hire many different lobbying firms. And they hire firms that are predominantly Republican and predominantly Democrat. And they do this because they know they need to reach influential members of Congress like Max Baucus. So there are people who used to work for Max Baucus who are in lobbying firms or on the staff of companies like Cigna or the association itself.

Yeah, I just read the other day, in The Washington Post, that Max Baucus's staff met with a group of lobbyists. Two of them had been Baucus's former chiefs of staff.


On the threat to profits represented by a public health insurance option:

MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

Compared to the industry's--

They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

On the pressure exerted on insurance firms by Wall Street to deny coverage in order to boost profits.

MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio. For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

That they're spending more money for medical claims.


And less money on profits?

Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.

On the ludicrous talking point that today's health care system is free of bureaucracy:

MOYERS: You know, there's an irony, because you hear the companies and their trade groups talking about how we don't want a public option that would put a bureaucrat between a patient and his doctor. But you've just described a situation in which a CEO is actually between a doctor and the patient,

It's true. And that same thing happened, in the Nataline Sarkisyan case. You had a corporate bureaucrat making a decision on coverage. So, they are trying to make you worry. And fear a government bureaucrat being between you and your doctor. What you have now is a corporate bureaucrat between you and your doctor.

Whose motive is profit. Understandably, naturally, profit.


On what likely tactics from the health insurance industry as reform legislation makes its way through Congress:

MOYERS: In other words, if the industry is able to kill reform, or the Democrats and the Republicans can't agree on a proposal, that's what the industry really wants.

Exactly. And it happened in '93 and '94. And just about every time there has been significant legislation before Congress, the industry has been able to kill it. Yeah, the status quo works for them. They don't like to have any regulation forced on them or laws forced on them. They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not-- you know, they'll not do anything after say this plan fails.

Say nothing happens. They're saying now what they did in '93, '94. "We think pre-existing conditions is a bad thing," for example. Let's watch and see if they really take the initiative to do anything constructive. I bet you won't see it. They didn't then.

Well, on the basis of the past performance, and on the basis of your own experience in the industry, can we believe them when they say they will do these things voluntarily?

I don't think you can. I think that they will implement things that make them more efficient. And that enhance shareholder value. And if what they do contributes to that, maybe so. But now, they do say, they are in favor of an individual mandate. They want us all to be insured.

For the government to require every one of us to have some policy.

Exactly. And that sounds great. It is an important thing that everyone be enrolled in some kind of a benefit plan. They don't want a public plan. They want all the uninsured to have to be enrolled in a private insurance plan. They want - they see those 50 million people as potentially 50 million new customers. So they're in favor of that. They see this as a way to essentially lock them into the system, and ensure their profitability in the future. The strategy is as it was in 1993 and '94, to conduct this charm offensive on the surface.

But behind the scenes, to use front groups and third-party advocates and ideological allies. And those on Capitol Hill who are aligned with them, philosophically, to do the dirty work. To demean and scare people about a government-run plan, try to make people not even remember that Medicare, their Medicare program, is a government-run plan that has operated a lot more efficiently.

And also, the people who are enrolled in our Medicare plan like it better. The satisfaction ratings are higher in our Medicare program, a government-run program, than in private insurance. But they don't want you to remember that or to know that, and they want to scare you into thinking that through the anecdotes they tell you, that any government-run system, particularly those in Canada, and U.K., and France that the people are very unhappy.

And that these people will have to wait in long lines to get care, or wait a long time to get care. I'd like to take them down to Wise County. I'd like the president to come down to Wise County, and see some real lines of Americans, standing in line to get their care.

July 10, 2009

Brian Kilmeade's Theories of Racial Purity

The term "eugenics" - which literally means "normal genes" - is one that rarely surfaces in the modern world, and with good reason. The aim of eugenics, after all, is to improve the human species through selective breeding. Although Robert Graham's attempt to create legions of baby geniuses through the mechanism of a sperm bank exclusively housing the genetic material of Nobel laureates is an example of (at least nominally) positive eugenics, "negative eugenics" such as the Nazi extermination of Jews, Gypsies, homosexuals, the physically handicapped and the mentally disabled during World War II, has been by far the preferred methodology.

No experiment in eugenics has ever been shown to measurably improve human health, and the forcible sterilization, incarceration, and killing of those carrying undesirable genetic material - all hallmarks of eugenics, even in the United States - have thoroughly discredited the field. Breeding some sort of master human race is, today, almost exclusively the province of racist whack jobs.

Unless, of course, you happen to be Brian Kilmeade, one of the hosts of the painfully moronic morning talk show Fox & Friends. Earlier this week, Mr. Kilmeade's mouth got rolling, and the world was treated to this deep thinker's theories on genetic purity, as well as his apparent categorization of Irish and Italian people as "other ethnics" if not - and I wish I were kidding here - "other species."

See for yourself the car wreck within the car wreck. In the immortal words of Hunter S. Thompson, res ipsa loquitor:

July 6, 2009

So Much for the Pitbull in Lipstick

[Click image to view at original size]

Alaska Governor Sarah Palin announced her resignation on Saturday, in what can only be described honestly as a painful and disjointed press conference, full of tortured basketball analogies and, as is her wont, stupefyingly suspect logic.

A day later, Mrs. Palin went so far as to have her lawyer threaten legal action against anyone spreading rumors of possible legal trouble for the governor, and the most conservative elements of the GOP were left to try and justify her abrupt abdication in terms that were pretty clearly hollow even to their authors. Their efforts were rendered even more hypocritical for anyone who recalled a scornful statement the governor directed at then-candidate Barack Obama when she was John McCain's running mate during the 2008 presidential election:
I guess a small town mayor is SORT of like a community organizer, except that you have actual responsibilities.

Of course, no one on the political right mentioned the much greater responsibilities Mrs. Palin is abandoning as she quits the executive mansion in Juneau, and we were treated instead to desperate declarations that her resignation is a brilliant political move. The lot of them looked ridiculous, frankly, in their apparent inability to accept that the country's appetite for taking willful ignorance, pettiness, arrogance, stupidity and corruption at face value pretty much exhausted itself - at least for now - with the presidency of George W. Bush.

In her resignation, Mrs. Palin widely employed the surreal, empty reasoning that has become her trademark, and essentially made the claim that by abandoning her post as Alaska's chief executive, she was somehow not only doing the right thing for her state, but helping the Republican Party. Perhaps that might be true in some fashion - so long as one ignores the fact the she is walking away from her responsibilities - if Sarah Palin were truly the political rock star she clearly envisions herself to be. Given the stunning dearth of qualification and intelligence she has displayed to date, however, it is probably much more fair to view it as an appalling dereliction of duty and an effort to set herself up for a presidential run that is deeply cynical, grandly delusional, or both.

It will be interesting to see whether Governor Palin's career travels the trajectory she seems to envision for it, or whether it will continue to die a slow death while continuing to choke the life from the GOP's aspirations of national resurgence. Whatever happens, though, two things are certain: Sarah Palin is the gift that keeps on giving to the Democratic Party; and whichever direction things move, she will be woefully incompetent and unprepared.

If you think the above evaluation is in any way spiteful, please take a moment to review some of Sarah Palin's greatest hits in the video below, and reflect on the fact that there are people in this country who honestly believe she would make a great President of the United States.

July 1, 2009

The Health Care Oligopoly and the Real Weight of the AMA

As the health insurance reform debate continues to simmer, there are a couple of important issues that have received scant attention. Specifically, any sort of in-depth examination of physician opinions on the various options for health care coverage; and the true level of market-based competitiveness that exists in today's private system.

In regard to the first, much was made of the fact that President Obama traveled to speak to a gathering of the American Medical Association (AMA) in Chicago, and headlines were grabbed when the AMA announced that, while its members recognized a need for reform, they would oppose any sort of publicly-funded health insurance program. The organization released the following statement:
The AMA does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.
At first blush - at least if one ignores the fact that the argument should be about the best way to provide health insurance to all Americans, rather than how best to preserve an industry that has failed to meet the needs of the public - this would seem to be a significant strike against any effort to advance a public option. After all, the American Medical Association represents the majority of U.S. doctors, does it not?

Actually, not even close. While the AMA claimed fully three quarters of all physicians in the United States on its membership roles in 1960, its share of representation has steadily dwindled, and today, it speaks for only 20% of America's doctors. With 250,000 members, it is still the largest single association for the medical profession in the U.S., but a number of other physicians' groups that do not align with the American Medical Association have gained strength in recent years.

The National Physicians Alliance (NPA), for instance, claims 20,000 doctors in its ranks, and supports a public health plan. The Physicians for a National Health Program (PNHP), with 16,000 members, wears its support for a public option on its sleeve. And the American Medical Student Association (AMSA) - which broke from the AMA over support for the launch of Medicare 50 years ago - has 62,000 members who are not only the next generation of doctors, but explicit supporters of a public health insurance option and, ultimately, a single-payer system.

Last year, the Annals of American Medicine updated a survey they first conducted in 2003 entitled Support for National Health Insurance Among U.S. Physicians [Note: PDF file]. In the 2008 edition, results indicated that support for a public plan has grown significantly among doctors, and that fully 59% backed some type of comprehensive, national, public option. This is not to say that the AMA's opinion is inconsequential, but it is important to recognize that equating the official opinion of the American Medical Association - which increasingly appears to represent higher-paid specialists - with that of the medical community as a whole, does our current debate a great disservice.

But what of the AMA's concern for the private health insurance industry? Should we be concerned about a public plan that causes people to abandon private insurers for a public plan? Perhaps the simplest answer to that question is another question (or more properly, two): If the private sector can provide service that is superior to that offered by the government - or at a minimum, the same service at a lower price - won't that problem solve itself? And if it can't, why do we need private insurers?

Beyond that basic query, however, lies an important truth. Namely this: the idea that the private health insurance industry is a vibrant, market-driven battleground is a complete sham. Health Care for America Now! (HCAN) released a report in May that uses data provided by the American Medical Association to demonstrate that 94% - more than 9 out of 10 - of the country's insurance markets meet the Justice Department definition of "highly concentrated," in relation to the potential for anti-trust action. So extreme is the level of consolidation, that HCAN has sent a letter [Note: PDF file] to the Justice Department's Antitrust Division, asking it to investigate the state of the health insurance marketplace.

The rest of the reports findings are every bit as striking:
  • In the past 13 years, more than 400 corporate mergers have involved health insurers, and the small number of companies that now dominate local markets haven’t delivered on promises of increased efficiency.
  • Shrinking competition has allowed remaining firms to charge higher fees, and premiums have gone up more than 87 percent, on average, over the past six years.
  • Meanwhile, profits at 10 of the country’s largest publicly traded health insurance companies rose 428% from 2000 to 2007, from $2.4 billion to $12.9 billion.
  • Consolidation of market share among a smaller number of insurers disproportionately disadvantages rural and lower population states. In Hawaii, Rhode Island, Alaska, Vermont, Alabama, Maine, Montana, Wyoming, Arkansas, and Iowa, the two largest health insurers control at least 80 percent of the statewide market.
  • The private health insurance industry invests more in buying back its own stock and rewarding its shareholders than it does in improving operations and service.
All of this would be bad enough if health insurers hadn't earned themselves a reputation for dishonesty and callousness that was confirmed to be well-deserved at a recent Senate hearing. There, a former senior executive for insurer Cigna named Wendell Potter made some very stark and very disturbing statements when he spoke before the Senate Committee on Commerce, Science, and Transportation:
[T]hey [health insurance companies] confuse their customers and dump the sick, all so they can satisfy their Wall Street investors... They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment... Dumping a small number of enrollees can have a big effect on the bottom line.
All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether.
Insurers know that policyholders are so baffled by those [explanation of benefit] notices they usually just ignore them or throw them away. And that's exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.
My comments are directed toward an industry that is really going in the wrong direction and taking this country in the wrong direction.
To be clear, there is nothing wrong with anyone making a buck by legal means, but this isn't - or shouldn't be - just about the almighty dollar, and if what Mr. Potter says is true, then insurers are treading in the realm of the unethical, if not the explicitly unlawful.

Private health insurance firms are thriving in what is anything but a dynamic marketplace, raking in enormous profits and enjoying the fruits of an anti-competitive oligopoly. Without significant change - a public health care coverage option - the number of uninsured Americans, which currently stands at 46 million, will only continue grow, and at an accelerating pace.