On My Last Weekend, Or, Wanna Save A Few Trillion On Health Care?

So I disappeared for a full week, right in the middle of what should have been a busy writing schedule, and I have to claim some “personal days” to cover the time we missed here at the blog – but it won’t be time entirely wasted.

Instead, I’m going to jump into my own personal life for today’s story, and I’m going to do it so that we can stimulate some thinking about where we really need to go to if we ever hope to make some sense out of the crazy way we deliver health care in this country.

Since this appears to be the weekend that a lot of decisions are either going to be made about the future of our “social safety net”…or they wont; we’re entirely unsure…let’s talk about how it actually works for a lot of us – and how it could work a lot better.

But the worst part of the Industrial Revolution – and the part that has never been documented – is what happened to the role of managers. The owners of factories realized they needed a layer of insulation between themselves and the people they were exploiting. They needed the type of people who were incapable of understanding the workers’ pleas for common sense, decency, and safe working conditions. The owners wisely chose managers for these roles.

--Scott Adams, from the book “Dogbert’s Top Secret Management Handbook”

So as most of you know, I am a blogger, and that means, for better or worse, that this is how I’m trying to make a living – and as a result I, along with about 50,000,000 other Americans, find myself on the DGS Health Plan (never heard of DGS? It’s the “Don’t Get Sick” Health Plan).

So what do I do? The same as a lot of you: I don’t get sick.

And up ‘til now, it’s worked out surprisingly well, even though I weigh more than I should and I have a coke addiction that can see me consuming as much as 2 liters in a single day…but by last Friday I had one of those tooth twinges building up that you know is not going to end up well.

By Friday night things were getting bad enough that I had to tell The Girlfriend that we were very likely to be going to an Emergency Room, if not that night, certainly by morning – unless things cleared up on their own, which, if you’re an optimist, could happen.

So much for optimism.

Midday Saturday we’re in downtown Seattle and I’m waiting in line to be seen by an intake clerk, then a triage nurse, and then a financial counselor, because there’s no way I can really take on a big medical bill.

I’m lucky that Washington State has a “Charity Care Law”; that law requires Washington’s hospitals to accept all comers at the Emergency Room, regardless of ability to pay – and there’s been a considerable increase in demand over the past four years.

(The Department of Health reports that $591 million in such care was provided in ’07, and in the last year for which numbers are available, ’09, the same cost had run up to $846 million; that’s a 43% jump in just two years. The odds are pretty good that the ’10 and ’11 numbers will also show an increase that’s well above the rate of inflation.)

Anyway, after that they showed me to a sort of mini-Emergency Room facility, I was examined by a Medical Student and his Instructor, and they decided that maybe a CAT scan would be a good idea, just to determine exactly how badly and how widespread this infection might be.

I rode the ride, an assessment was made, and it time to offer up my various elbows to my Medical Student, which left me with a couple of bruises that are still healing, and him with a couple of experience points.

More assessment followed the return of the lab results; as a result I was given a prescription of a rather unpleasant antibiotic that I’ll be taking for a few more days, but all in all, for me, things worked out pretty well.

That said…imagine if I lived in Canada.

First thing, I waited longer than I should have with this infection, and if I had a General Practitioner with whom I had an ongoing relationship, I would have gone there at least a day sooner.

That delay imposed a few costs: I had that CAT scan, took up ER time and a mini-ER suite; instead I could have made an office visit, and probably walked out with a prescription for the same antibiotic with a quick exam or just a blood test.

There is no financial counselor in Canadian healthcare – instead, you present your Provincial insurance card, and that’s that. For those not aware, Canadian healthcare, for the most part, works like American care, except there’s only one insurance company, and that’s each Province; they also collect taxes to fund the services.

That means providers only deal with one insurer, and all of that cuts a lot of administrative expenses out of the system. It also means patients never have to worry about whether their provider will be “in the network”.

(Fun Fact: bankruptcy is now a big part of the American medical system. In 1981 8% of bankruptcies were related to medical costs, but by 2007 that number appears to have grown to 62%, all this according to the Journal of the American Medical Association. Three-quarters of that 62% had medical insurance.

Canada does not have a medical bankruptcy problem of statistical significance.)

When you add all this together, it begins to explain how it’s possible that Canada can insure all their people for about 11% of their 2009 Gross Domestic Product (GDP) when we pay about 17% of GDP and still leave a huge portion of the population either completely uninsured or unable to pay for care even if they have insurance, due to what won’t be covered when the bill comes in at the end of the month.

(Fun Fact #2: Sweden, Switzerland, France, Germany, Iceland – in fact, any country that you can name on the face of the Earth – pays less than we do for their health care.

By a lot.

When it comes to the cost of health care, the USA is #1.)

So it’s not all skittles and beer, up there in Canada. You might have to wait a while to get some types of care, and it appears that there’s an element of “rationing by waiting period”, which is a constant source of complaints up there. (The counterargument is that rationing of some sort is required in any medical insurance scheme; otherwise, you’ll have folks at the doctor’s for no reason at all, and that’ll quickly drive a system broke.)

There are co-pays, for some services, and no coverage for others, depending on your Province, (nonemergency dental and vision are often not covered) and that can lead to some out-of-pocket, but for the most part taxes cover the bills.

And just as we in the USA are struggling to pay for medical care, so is everyone else: controlling medical costs are hard, for a variety of reasons, including the cost of paying medical professionals to do work in a dangerous environment that can often be hard to automate.

Dangerous, you say?

In healthcare, back injuries, frequently caused by overexertion, occur at a very high rate. Healthcare industry workers sustain 4.5 times more overexertion injuries than any other type of worker…According to national statistics, six of the top 10 professions at greatest risk for back injury are: nurse's aides, licensed practical nurses, registered nurses, health aides, radiology technicians, and physical therapists.

So the other reason I’m having this conversation today is because I was having a talk with a very nice gentleman just about 48 hours ago who is a bit more Conservative politically than I, and he wondered how I felt about “Obamacare” (formally known as the Affordable Health Care Act).

I’m not a big fan of that plan, I’m not, and that’s because I’d much rather do something like expand Medicare to everyone, or “go all Canada”; either choice seems simpler and easier and doable at far lower administrative costs than any plan that relies on private insurers, as the Affordable Health Care Act does.

So there you go: that’s how I spent the weekend, and a couple of days after to boot, and if we were living in Canada I could have had the same problem, but it would have cost the healthcare system a whole lot less money – and when everyone gathered at the White House today, I wish that’s what they had been talking about.

On Honoring A Legacy, Or John Edwards, We Need To Talk

So it has come to pass that Elizabeth Edwards has died.

Despite having more things thrown at her than anyone I’ve ever had the chance to support in my entire political life, she managed to represent, in her very presence, a sense of grace and kindness and concern for those who were looking to have a better life than the one they had now, and I don’t know that I could ever live up to the quiet courage she showed as her life came to an end.

And, bless her heart, it appears that she took the time to make sure that her kids knew her, and that she helped them put away enough “past” to, hopefully, ease some of the pain of the future.

But now the time has come to look beyond death, and, John...that’s why I want to talk to you today.

Fish say, they have their Stream and Pond;
But is there anything Beyond?
This life cannot be All, they swear,
For how unpleasant, if it were!
One may not doubt that, somehow, Good
Shall come of Water and of Mud;
And, sure, the reverent eye must see
A Purpose in Liquidity.

--From the poem “Heaven”, by Rupert Brooke

I am required to start this story with a great big “Full Disclosure”: I was very much a John Edwards supporter during 2007, for reasons I laid out after seeing him in a small room in May of that year, and I was a contributor to the Edwards campaign website’s “blogging community”. I did not, and do not, contribute money to candidates, including Edwards—and that’s so that I can write more dispassionately when it comes time to consider the endgame.

That said, let’s move on.

One of the reasons I supported Edwards was because his campaign was the one that was, in a big way, talking about making poor people into middle-class people. Remember the “Two Americas” messaging? If you don’t, he’s famously quoted from his 2003 stump speech in which he describes a country where we have...

"...One America that does the work, another America that reaps the reward. One America that pays the taxes, another America that gets the tax breaks. One America that will do anything to leave its children a better life, another America that never has to do a thing because its children are already set for life."

In fact, I have often suggested that conversations like this from the ’08 Edwards campaign forced both the Obama and Clinton ‘08 campaigns farther to the left than they would have been otherwise—and I would further suggest that the effort to “grab” Edwards voters after he dropped out led Obama to say things about the reforms that he wishes he could walk away from now.

In addition to operating the campaign’s web presence, the Edwards folks also provided the Internet “organizing ground” for OneCorps, which was intended to be a way for supporters and friends to do “politically agnostic” good works for the public good.

Sadly, as the Edwards campaign wound down, so did much of the inertia of OneCorps.

And so has much of the interest in doing something about those “Two Americas”.

And that’s what I want you, John Edwards, to come back and do something about.

Here’s the thing, John: while you might see your personal troubles as something that keeps you from being a public figure, I don’t.

I see what’s happened to you as liberating.

You aren’t running for anything anymore, and you have Elizabeth’s legacy to advance—and you no longer have to suck up to the Paul Begalias and Ed Rendells and Donna Braziles of the Democratic Party...and you damn sure don’t have to suck up to any Republican legislative leaders or the Doug Feith crowd to advance an agenda in a lame-duck session.

You are free, Mr. Edwards, and if you want to start doing some work to help broke people get organized again, or if you want to start asking hard questions about why banks and billionaires need subsidies and why those who are neither have to cover the bills...or if you want to do something that combines the civility aspect of “No Labels” with the energy of OneCorps and the policy direction of “Two Americas”...this is your chance.

In fact, by having no interest whatsoever in running for office, you may actually be in the best political situation of your life: you have a chance to be one of the few truly “honest brokers” in American politics, you have a chance to do truly good work, at a time when America truly needs the help, and you have the chance to do it in a way that bypasses both political establishments and taps directly into the giant well of “unrepresented” that is out there in every city and town in the Nation.

There are millions of Americans who want to see jobs coming back to this country, who are afraid that Social Security is looking more and more like a giant pot of money to be sold to the highest bidder, and who are worried that their kids won’t be able to do better in life than they did—and you are now in a position to do them a lot of good by getting out there and telling some hard truths about who’s winning and who’s losing—even when it’s Democrats who are having to endure some of the truth telling.

Beyond that, you can help to advance a legacy that I know means more to you than you could ever say—and it would give you and the kids a chance to honor someone that I know you miss more than you could ever say.

Look, I know you screwed up...badly...but this is America, the land of the second chance—and if you approach this as a chance to perform a public service, and ignore all the “professional” politicking that will pop up as we move forward, you could do something truly great.

Hold our politicians accountable.
Demand action on “Two Americas”.

Use your insight to point out exactly how the hustle is going down—and, once again, be the voice that stands up for those who want more from this country than just getting trickled on.

This is your chance to do right by someone you cared very much for, and a chance to do right by an entire Nation, both at the same time—and if I were you, I might just make this my New Year’s resolution.

On Assigning Blame, Or, “So, You Think I’m Retarded?”

LANGUAGE WARNING: Today’s story is uncharacteristically blunt, and from this moment forward we will be using lots of inappropriate language in making our points.

Gentle Reader, you have been officially...warned.

With that in mind, if you take offense when confronted with language strong enough to knock a fuckin’ buzzard off a shitwagon, please stop reading now.

It is by now fairly well known that Rahm Emanuel, President Obama’s White House Chief of Staff, had a bit of a blow-up with liberals who were ready to start running ads against “blue dog” Democrats who were working very hard to shut down the health care reform effort.

Now we’re not gonna get in the middle of that argument today; instead, since we’re finally getting a chance to talk, I figured me and Rahm could get a few other things out of the way that have been on everyone’s mind for the past year or so.

“...What the ancients called a clever fighter is one who not only wins, but excels in winning with ease.

Hence his victories bring him neither reputation for wisdom nor credit for courage.

He wins his battles by making no mistakes. Making no mistakes is what establishes the certainty of victory, for it means conquering an enemy that is already defeated.

Hence the skillful fighter puts himself into a position which makes defeat impossible, and does not miss the moment for defeating the enemy...”

--Sun Tzu, “The Art of War”

So...Rahm, buddy...here’s the thing:

In January of 2009 you came into the White House having just beaten down both the Republicans and Hillary Clinton, and baby, y’all were on a roll.

Reforming health care was the top priority of 59% of the population, you had a 75+ seat majority in the House...and of course, to quote your boss, there was that “largest Senate majority in a generation”.

Y’all were appointing smart people to take over agencies, and the President gave that speech in Cairo—and even though people had their misgivings about the way the bailout and the stimulus came together, we were still right there with you.

And then, in May...remember when y’all promised to get a heath care vote done by August? If I recall correctly (and I do), the President said:

"...We've got to get it done this year. Both in the House and the Senate. We don't have any excuses. The stars are aligned."

And then for some reason, you decided it would be a smart idea to spend a couple of months letting Ben Nelson and Charles Grassley, who were both happy to let you know they were against this thing from the beginning, run the show.

“...When you engage in actual fighting, if victory is long in coming, then men's weapons will grow dull and their ardor will be damped. If you lay siege to a town, you will exhaust your strength.

Again, if the campaign is protracted, the resources of the State will not be equal to the strain.

Now, when your weapons are dulled, your ardor damped, your strength exhausted and your treasure spent, other chieftains will spring up to take advantage of your extremity. Then no man, however wise, will be able to avert the consequences that must ensue.

Thus, though we have heard of stupid haste in war, cleverness has never been seen associated with long delays.

There is no instance of a country having benefited from prolonged warfare...”

--Sun Tzu, “The Art of War”

“...and then the C.H.U.D.S. came at me...”

--Homer Simpson

And then came the Tea Parties. For a solid month we were bombarded with images of uninformed people carrying signs demanding we protect Medicare while at the same time demanding Government stay out of health care, people who see Obama as the new Hitler, and people who apparently think Socialism, Fascism, Communism, and Vegetarianism are all different flavors of the same political junk food.

In other words, fuckin’ retards.

And just to make things perfect, the Republicans couldn’t wait to jump on the retard train: Sarah Palin quit being a Governor so she could turn her interest in “Death Panels” (and her desire to never be a quitter...) into a gig at Fox—and Rick “Goodhair” Perry, the Governor of what might be the most “Rah Rah America!” state in the Nation, suggested that making Texas into its own country might be the smartest way to save these United States.

I loved it.

I knew what was about to happen: the classic “pincer move”, where you let the enemy race into the trap, and then slam the door behind them, locking them in a box from which they cannot escape.

And the best part was, they had made it so easy that a politician with even a moderately high degree of mental acuity could spring the trap. All the President had to do was to go to the States where these politicians live, stand up on a platform, with cameras running, preferably in the early part of the daily news cycle, and do one of these two things:

--Either put his arm around [insert politician’s name here]’s shoulders and tell the giant crowd how the President and [again, insert name] are going to fight the insane Republicans and the evil insurance companies together, “No matter how much they try to stand in our way...”

--Or go to the same podium and give this speech: “I’m going to fight for you, all the way, and I want you to call [insert name here] and demand that they join the fight, too.”

For extra effect, you could have sent him to one of those free clinics the viewers of Keith Olbermann’s “Countdown” were paying for.

Repeat this process a dozen times or so, and the next thing you know you own the news cycle, and the enemy is crushed and disorganized.

This is Politics 101, and it’s just as effective at moving along reluctant Democrats as it is reluctant Republicans.

But that never happened, Rahm, did it?

Instead, as far as I can tell, you let the fuckin’ retards kick your ass for the past eight months.

You didn’t even really try to organize your friends: for example, where was the coalition-building process while all of this was going on? Did it ever occur to you to try to get gay activists and youth activists and healthcare activists together to help move this process along?

Had you been on the ball here you could have organized a “Counter Tea-Party” for every single one of those stupid “patriotfests”...and now, when you need support to move issues that matter to the gay community, you haven’t built up the kind of trust that would have been enormously helpful in keeping the GaYTM open and available, as it was in 2008.

Only in the past ten days or so have y’all finally figured out what Alan Grayson seems to have known all along: an aggressive, in-your-face Democrat will not only survive, but thrive—even in Florida.

And that’s the part I don’t get: you came in here enormously popular, with every advantage, with Republicans who were falling all over themselves to make your life easy, with the facts on your side, and a public who wanted to go along with the program.

And despite that, you let yourself get beaten down by idiots, you failed to spring the obvious trap, you never tried to really engage with your friends at critical times, and now you find yourselves in a tough election environment having to play catch-up, when it’s the Rs who should be running for cover while your guy is pulling a 65% approval rating, or something similar, and Democrats expand that Senate majority to 63 or 64 seats.

And if all that wasn’t enough, now you have to sit here and listen to people like me, the proverbial “overfed, long-haired, leaping gnomes” of politics, tell you something you should have known all along.

Which finally brings me to the part I really don’t understand: how did our situation get so turned upside down that you are viewed as the big-time highly-paid political genius...and somehow, the people who thought you would be easily digest the pre-chewed political snack food that was being served up to you on a silver platter became the fuckin’ retards?

It’s a question I can’t answer, Rahm...but you better figure it out, and fix it—quickly—or the next three years are going to suck a lot more than this one did.

On Health Care, Vegas-Style, Or, Figure It Out In The Ambulance, Chump

I was supposed to begin the long-delayed series of PTSD stories I’ve been planning, but before we begin, I need to tell y’all about something that just happened in my house.

For us it wasn’t a matter of life or death, but it is the kind of story that explains, perfectly, why we need to reform the health care system we have today—and for that matter, it’s also a great explanation of why a single-payer system would be a giant step forward for everyone in this country, whether you’re insured today or not.

It’s also hilarious and sad and frustrating, all at the same time—which makes today’s story a pretty good allegory for the current American way of doing health care.

So follow along, have a good laugh…and at the same time, take a minute to consider what could be, and how much less irritating things should be.

“There was never any thing by the wit of man so well devised, or so sure established, which in continuence of time hath not been corrupted.”

--Charles Pratt, 1st Earl Camden, “Concerning the Service of the Church”

Several things have been happening over the past couple of months to prevent me from writing as much as I would like; among those a series of quite painful medical events that caused The Girlfriend to have to visit the emergency room three times.

Nothing life-threatening, as I mentioned above, but painful nonetheless.

She is a State employee, so she has insurance; the emergency room benefit calls for a $50 co-pay for an ER visit.

The bill has now come in…and much to our surprise, the “patient responsibility” is a bit over $300…for only one of the three visits.

As you can imagine, a phone call to the insurer followed…and this is where the story gets weird.

The customer service rep told us that the emergency room cost is, indeed $50, as we expected—but the services of the ER doctors are not paid at all.

How is this possible, you might wonder?

The customer service rep explained that while the ER itself is “part of the network”…the physicians who work in that ER are not a part of the network.

It takes a minute to make sense of that, so if you want to pause to allow the whole thing to sink in, I’ll understand.

Ready to move on?

The Girlfriend asked the obvious next question: how are you supposed to know, on your way to the emergency room, exactly who might be in the network and who might not?

The customer service rep came back with the obvious answer: there is no way to know…you just wait for the bill, and then you find out.

Our reaction, as you might expect, was something like this:



As of this moment we do not know how this is all going to turn out, but here’s the point:

It doesn’t have to be this way.

Canada manages to get patients in the front door and through the billing process with far fewer administrators, far less hassle, and at far lower cost than the system we have here—and that was the big attraction of a “near single-payer” approach before it was driven out of the reform discussion. (To be technical, a “Medicare for all” system could accomplish the same thing.)

Of course, it’s not just our family that would benefit from reform.

Think about what a hassle keeping track of all of this is for employers.

The State of Washington has an entire corps of workers who do nothing but manage the insurance coverage for State workers…and I suspect your State does as well.

In a time when every State is trying to put as many dollars as possible into maintaining basic services (such as keeping the State Patrol fully operational), wouldn’t it be nice to redeploy some of that money to someplace like the Office of Support Enforcement or Adult Protective Services?

Private employers would obviously benefit as well, as their own no-longer-required health insurance administrators could also convert to jobs that are “bringing revenue in the door”—just as they have done in Canada and the UK and…well, everywhere else in the developed world, more or less.

And that’s today’s story: a moderately serious problem has led to the kind of absurd situation that causes wolves’ eyes to nearly explode; in the process, however, we’ve had a chance to think about how health care reform could make things much better, not just for those who have no insurance, but also for everyone who has insurance, for every one of our employers…and, on a larger scale, for the Nation as a whole.

Unless, of course, you’re lucky enough to have the mythical health insurer whose approach to business truly incorporates the motto “the customer is always right”, in which case you may go ahead and ignore all of this and return to your normal low-altitude recreational hang gliding over the cactus fields.

On Learning To Love Homegrown, Or, Baucus' Fundraising Considered

So we are now finding out the answers to some of our questions about which members of Congress actually represent We, the People...and which ones represent, Them, the Corporate Masters.

We have seen a Democratic Senator propose a policy that would put people in jail for not buying health insurance and a Democratic President who has taken numerous public beatings from those on the left side of the fence for his inability to ram something through a group of people...and yes, folks, the entendre was intentional.

But most of all, we’ve been asking ourselves: “why would Democratic Members of Congress who will eventually want us to vote for them vote against something that nearly all voting Democrats are inclined to vote for?”

Today’s conversation attempts to answer that question by looking at exactly how money and influence flow through a key politician, Montana’s Senator Max Baucus—and in doing so, we examine some ugly political realities that have to be resolved before we can hope to convince certain Members of Congress to vote for what their constituents actually want when it really counts.

“The idea of covering even the early stages of the cynical and increasingly retrograde campaign has already plunged me into a condition bordering on terminal despair, and if I thought I might have to stay with these people all the way to November I would change my name and seek work as a professional alligator poacher in the swamps around Lake Okeechobee.”

--Hunter S. Thompson, “Jimmy Carter and the Great Leap of Faith”

Now any normal person trying to analyze last year’s election would have said something like “the fact that Obama was promoting a new type of politics—and that a large majority of the public liked what they were seeing—should have meant that politicians would finally do what the public wanted”...and if you’re as cynical as I am, you might have thought that the fact that Obama is the most successful fundraiser in the history of politics would have made other candidates figure that supporting Obama, politically, would be the easy way to put more cheddar in their own pockets.

But here’s the thing: Senator Baucus has been in Washington, in the same job, since 1978, which is about three years short of half of his entire life (and he spent those three years in the House), and unless he wakes up dead one morning or Montana secedes from the Union he’s pretty much guaranteed to be there until at least January 2015.

In those three decades he’s been able to create, and then “outsource”, his own independent fundraising operation—and he’s been so good at doing this that he can donate money from his own Political Action Committee (Glacier PAC) to other Democrats, which is the Congressional version of acquiring really cool “Magic: The Gathering” cards now in an effort to both control votes today and become a more powerful player later on.

He did it by cultivating people in his own office who later went on to become lobbyists. At least 24 of ‘em. Since Baucus now runs the Senate Finance Committee and every bill in the Senate that needs money has to pass through his Committee for approval, all those hard working lobbyists now lobby...wait for it...their former boss.

This creates a fundraising “virtuous circle”: “Baucus-affiliated” lobbyists sell access to Baucus...and part of the price of that access is donating to Baucus...which, since “the fix is in”, creates legislative successes that lead to more people wanting more access for bigger favors...which makes the prices all go up, creating more power and influence for Baucus and his orbiting constellation of homegrown lobbyists.

And now that the enterprise has reached the point where the entourage has gone on to have their own entourages, Obama’s vision of “change you can believe in” is sounding more like a promise to screw up a perfectly good hustle than it is a way to run a country.

So how does all this influence the healthcare debate?

At the moment, Baucus could literally coach a basketball team of former staff members who now lobby Baucus on behalf of health care clients:

--David Castagnetti of Mehlman Vogel Castagnetti, Inc. is the vertically integrated busy beaver of the group, representing drug powerhouses Abbot, AstraZeneca, and Biogen, device manufacturers like GE Medical, service providers like Humana and the American Clinical Lab Association, and AHIP, the trade association of health insurers, among others.

--Jeff Forbes, who is currently self-employed, is representing drug maker Roche Group, Manor Care (who provides long-term care services in nursing homes and other environments), and the Advanced Medical Technology Association (AdvaMed), a group which includes many of the big players in the medical business.

--Roger Blauwet (he of DC’s Canfield and Associates), is representing Wyeth and Pfizer (two more major drug manufacturers), the Association of Financial Guaranty Insurers, who are the “reinsurers” who help carry risk for other insurers (in return for a piece of the action), and the Rx Benefits Coalition, which reports that it represents companies that support “market solutions” to make prescription drugs available.

Some clients feel that their needs require more than one “Baucus alumnus” on the payroll, which is why Scott Olsen and Jeff Forbes are working for biotech giant Amgen (along with about 150 other lobbyists), David Castagnetti and Angela Hofmann are slogging it out for Wal-Mart, and Roger Blauwet and Castagnetti are both hoofing it for the Pharmaceutical Research and Manufacturers of America (PhRMA), who is, literally, the “Big PhRMA” that everyone talks about.

Drug manufacturer Merck hired three of the anointed: Forbes, Blauwet and Castagnetti.

All of this effort is working—and working well. According to OpenSecrets.org, somewhere in the range of $4.5 million has been donated to Baucus during his career by insurance and healthcare interests.

It isn’t just health care, either. Because somewhere around two dozen former Baucus staffers turned lobbyists are “home on the Washington range”, no matter what is being debated in Congress, Baucus gets paid (two quick examples of his Committee’s jurisdiction: changes in tax policy and financial industry regulation—or the lack of it).

In truth, “Baucus gets paid” is probably a bit too cynical.

What I really should say is that Baucus has been exceptionally successful in listening to all points of view when considering ways to make the lives of every American all they can be, that the people who get listened to are exceptionally grateful for this attention, that millions and millions of dollars worth of gratitude have been funneled to Baucus over the years because he’s such a good listener, and that, from now until at least 2015, if you need a Senator to support “status quo you can believe in” you might want to try launching a great big brick of cheddar into the Senator’s constellation.

So the next time someone asks you how “change you can believe in” could have possibly morphed into “buy insurance or we’ll put you in jail”...well, now you know—and given the choice, wouldn’t you rather watch someone make sausage?

On Fighting The Madness, Or, Send This To A Deather

We are coming down to the home stretch on healthcare, and we have seen the results of the first couple of rounds of crazy that have been sent forth in an effort to stop the process.

In addition to the Town Halls, opponents are flooding the email inboxes of America’s “low information” voters with no end of lies. Those emails are getting passed around and around and around, and by now some of them have probably appeared in your inbox.

But it’s summer...and who has time to respond to this stuff?

Well, guess what, Gentle Reader: I’ve already done the hard work for you.

Today’s story is an email response that you can send right back to your “inbox friends”. It’s a reminder of some of the frustrations that we all share in this country and some explanations of what’s being proposed...and a few words about socialism, to boot.

So get out there and copy and paste and forward and reply, and let’s see if we can’t fight the madness, one email at a time.

There is a whole lot of talk about health care reform these days, and a lot of it is designed to be confusing, instead of helpful.

To cut through some of that confusion, let me ask you a simple question: is your health insurance stressing you out more than it should?

If you worry about paying for drugs you might not be able to afford, if you don’t go to the doctor as much as you should because you recently pawned your last gold bar to cover a margin call on your AIG stock...or if the odds of getting your insurer to take care of what you thought they’d cover are lower than hitting 13 on a double-zero roulette wheel...we need to talk.

This conversation won’t be about death panels or secret camps or black helicopters or any of that silly stuff. Instead, let’s talk about a few things that we’re probably all worried about, and then let’s talk about some ideas that might make things better.

So first off, why do we even need reform?

How about because we pay about twice what the rest of the word pays for health care—and we don't get good value for the money.

The US spends almost three times as much as the UK, and twice as much as Canada, per person, for health care—and of the top 50 countries in life expectancy...we come in 45th.

Canada, the UK, Cuba...and 40 other countries...also have lower infant mortality rates than the US.

That is not good; and over the long term it's killing businesses and, by extension, the larger economy. Not to mention, as consumers, we deserve better.

We also want to provide for the nearly 50 million Americans that have no coverage at all, for a couple of reasons:

First, it's extraordinarily expensive to have uninsured people showing up at the emergency room. For a good example, consider the cost of treating a relatively simple cholesterol problem with drugs instead of a paramedic response, an ambulance ride, and heart surgery followed by a stay in the hospital.

The average family with health insurance is today paying about $1000 a year in extra premiums that they wouldn't be paying if we could find a way to cover those 50 million people—and if my guess is correct, there are a lot of families that could use the extra $1000.

And for what it's worth, not having insurance is already killing about 18,000 Americans every year.

So that's the uninsured...but what about the insured?

Right off the bat, here's something you should think about: we can expect the cost of the average family's health insurance premium to double by 2020 to roughly $23,000 a year...which is almost $2,000 a month.

If we can't slow that rate of growth, there's going to be a whole lot fewer people getting health care through work—and for several years now employers have been trying to get workers to bear a larger portion of their health care costs.

Plus, insurance companies are increasing profits by looking for more and more ways to cut off policyholders, or by refusing to renew insurance for those clients who do file claims.

And once you get cut off, no one else is likely to allow you to purchase insurance...which means the number of uninsured is growing all the time.

We have also seen the cost of deductibles go up (with $5000 to $10,000 deductibles looking like the wave of the future)—and all of this means that insurance companies are doing great, while the customers are getting the short end of the stick.

Did you know that more than 60% of the Americans who filed for bankruptcy in 2007 did so because of medical bills? That's not all: more than ¾ of those 900,000 or so newly bankrupt families had health insurance when they went broke.

What about this whole "putting bureaucrats between me and my doctor" thing?

How many people have health insurance that requires pre-approval for procedures or pre-approval to see specialists, or drug formularies that charge different prices for generic and brand-name drugs?

All of those things exist because of insurance company bureaucrats that at this very moment sit between you and your doctor.

So those are some of the problems.
Here are some ideas about how to make things better:

—We could tell health insurers that they can't use "preexisting conditions" to deny people coverage, and that they can't just cut people off for the crime of needing care. This allows more people to have access to health care, and it also reduces bankruptcies, since insurers wouldn't be allowed to simply deny coverage when claims come in, leaving families to pay both the health insurance premiums and, later, the medical bills.

This is the least controversial part of the reform plans before Congress today.

—There are proposals to create more competition among insurance providers, the idea being to use market forces to keep private insurance companies from drawing so much money out of the system as profit. This would be in the form of one or more insurance plans, operated by some new entity, for which members of the public would be able to "buy in" and get coverage that they can't get today.

The idea here is to create a large new pool of insured persons, which allows the insured group to negotiate for better prices on drugs and procedures and office visits and medical equipment—and if you allow anyone to sign up it can force private insurers to either match the price of the "public option" or lose customers.

Businesses would be required to either pay for coverage for their workers or a tax if they don't. Small businesses would be exempt, but we are not sure how small exactly "small" would be as of today.

This public option proposal is very controversial, and insurance companies are spending over a million dollars a day to shut the idea down before it gets out of Congress.

—The most controversial reform proposal is to create a "single-payer" system, which is what Canada has today. At the moment, this is not likely to be part of the program that comes out of Congress, if any program does.

In the Canadian system, people keep their own doctors and the Province where you live becomes the insurance company. You go to your doctor, who then bills the Province. Everyone is entitled to an insurance card, which means everyone has coverage. All of this is paid for with tax dollars.

That's also how Medicare works, and there are people who suggest the best way to do healthcare reform would be to simply enroll everyone in Medicare.

The catch would be how to control costs while providing care for all, and that's the last thing we'll talk about here.

Right now it looks like it would cost about $1 trillion, over ten years, to provide coverage for roughly 50 million people.

Remember the conversation we had about how treating high cholesterol problems with drugs is cheaper than treating heart attacks? It turns out it's so much cheaper that about $700 billion of that $1 trillion can be found with that change and other similar changes, like treating people before they have diabetes instead of dealing with the disease later.

That leaves us roughly $250 billion short. In 2003 we gave a substantial tax cut to people with especially high incomes, and Obama has proposed ending that tax cut. This would cause people making more than $1.2 million a year to return to the same tax rates they had from the 1990s until 2003.

If the public option is made widely available, the insurers tell us, private industry could never compete...but that's not as certain as insurers would want you to believe.

Consider the electricity market: in Washington State, Puget Sound Energy, a private company, operates side-by-side, literally, with "public options" like Seattle City Light and Snohomish PUD, and seems to be doing just fine—and they've been doing just fine for roughly a century.

A final point: there is a lot of talk about how government providing health care is "socialism".

Maybe it is.

But you know what? In America we also have socialized police and firefighting and EMS, and socialized streets and roads and libraries and sewers and airports and Post Offices...and socialized National Defense.

And if you really want to talk about the Founding Fathers and socialism, consider this: among the original 13 Colonies were the Commonwealths of Massachusetts, Pennsylvania, and Virginia.

Add in the Commonwealth of Kentucky, and four of the 50 stars on our flag today represent places that are known not as States, but instead as "Commonwealths"...which, oddly enough, is both about as American and as socialist as you can get.

How's that for a lot of stuff to digest?
To finish, let's summarize what we have.

There are a lot of reasons we want to do some sort of reform:

—we pay more than anyone else in the world for health care, but lots of other countries have longer life expectancies and lower infant mortality rates.

—we need to do something about the nearly 50,000,000 Americans who have no access to care outside of the emergency room, both for moral and for economic reasons.

—in 10 years the cost of health insurance will be somewhere around $2,000 a month for the average family. Businesses cannot afford this, so as time goes on more and more people who now have coverage through their jobs...won't.

—if nothing changes those who are able to keep their insurance at work should expect their employers to move to plans with $5,000 to $10,000 deductibles.

—every year, almost 900,000 American bankruptcies are related to health care costs. 3/4 of those people had insurance, but their insurers refused to cover their medical bills, and they went broke.

—if you have a significant claim, or you lose your job, you stand a good chance of losing your insurance, which means you are not very likely to be insurable again.

We talked about some reform ideas, with protections against "preexisting conditions" and cutting people off for having claims being the most likely reforms to be turned into law, a "public option" being less likely, and "single payer" being highly unlikely.

There is money available to pay for this. Roughly 2/3 would come from treating the uninsured in cheaper ways than we do today, and the other 1/3 could be raised by letting a tax cut for very wealthy people expire.

The good news here is that lots of other countries are doing better than we are, and spending half the money we are doing it; which means there are solutions available that do work and do save money.

If we can put some of those solutions to work here, it would probably help us, too.

On Disarmament, Or, How Congressman Larsen Made A "Town Hall" Work

We’ve all been hearing the “Town Hall Meeting” stories the past few days, and the images presented have been of gatherings where you might see some current or former official “death panel” for the benefit of the crowd, where the few people who shout the loudest bully the rest into silence, and where threats of physical intimidation are part of the debate.

I attended one of these meetings, and based on what I saw I’m here to tell you that it is possible to hold an event that features none of the images previously described.

Instead, what I say was an event where people asked their questions, the Congressman answered—and from time to time the angry members of the audience got their shout on, too...but not in a way that was able to ever take control of the venue.

There were helpful lessons that can be applied by others who want to have these meetings, and today’s conversation examines what can be done to make them work for you, too.

Let’s start by meeting the players:

Rick Larsen is the Member of Congress representing Washington State’s Second District. A Democrat, he first won his seat in the 2000 election, and in 2008 he defeated former Snohomish County Sheriff Rick Bart by a 62-38% margin.

The (mostly rural) Second District is bordered by Puget Sound on the west, British Columbia to the north (Vancouver is just a short drive from the I-5 border crossing at Blaine, Washington), the Cascade Mountains to the east, and Seattle’s northern suburbs to the south.

From south to north, major cities include Everett (former fishing, lumber and harbor town), Mount Vernon (the largest town in a region known for tulips and eagles and agriculture and formerly, commercial fishing and lumber), and Bellingham (college town, and, again, former fishing and lumber town). All three towns grew substantially as a result of the Alaska Gold Rush of the 1890s.

There are numerous Indian Tribes within the District, as well as two significant military installations: Naval Air Station Whidbey Island and Naval Station Everett.

Larsen had held a previous Town Hall in Mount Vernon that attracted a crowd that was several times the capacity of the venue, so at the last minute Everett Memorial Stadium was booked for this event.

(Fun Fact: this stadium is the home of the minor-league Everett AquaSox, one of the few sports teams to ever take the field in tie-dye uniforms.)

By my count, roughly 2500 were present—but there was an interesting distribution: it appeared to me that the “Diamond Club” seats right behind home plate, and the two sections on either side, were thickly populated with supporters of reform, with opponents “flanking” them to the left and right. The main entrance is on the third base side, and the seats filled up from that side as well, with the seats out past first base being the most empty.

It was not “high summer”, by any means, and at “game time” (5 PM) we had a cloudy sky and a temperature of roughly 65 degrees.

Larsen stood on the field near home plate, and as soon as he started speaking you could see he had three advantages: the large outdoor venue meant that no single person could shout down the meeting, Larsen’s access to the PA system meant that he could always be heard even if a group tried to “chant out” the meeting, and his use of “runners” to take the microphone to each questioner meant no “in your face” screaming matches were going to take place.

Another smart move: Larsen limited his discussion to one specific bill (HR 3200), which allowed him to avoid having to speculate as to what might or might not be in any other possible proposal.

Beyond that, he made it clear in his opening remarks that he would be willing to spend up to 2 ½ hours to answer questions and that the microphone would be getting to every section, in turn, as much as needed; this seemed to remove much of the concern that people would be shut down and left unable to ask questions.

Additionally, he was more than willing to challenge those with whom he disagreed, as evidenced by his answer to one question from the crowd:

“I’ve got facts on my side and you’ve got Glenn Beck on your side...”

At the same time, he was able to use the PA and personal attention to his advantage during questioning. The “runners with mic” system made sure that all questions, from supporters and opponents, could not be drowned out, and by giving real attention to each questioner and presenting a “non form-letter” response (the PA assuring that his answer also could not be drowned out), Larsen was able to show that this was indeed a conversation and not a shouting match.

The crowd also acted as a moderating influence. A number of the questions came from people who seemed as reasonable as they could be, and when some extremist language was presented, the crowd exerted its own influence.

Here’s an example: a questioner asked the Congressman and the crowd to try to come up with one example of Government ever doing anything right, or words to that effect. The crowd offered some supportive cheers.

A couple of questioners later, a man stood up and told the crowd that he did not appreciate the last 20 years of his life being disrespected. He pointed out that the United States Navy, in which he serves, is the finest military force of its kind on the planet (this, in what is today very much a Navy town)...and all of a sudden, the “Government can’t do anything right” supporters, many of whom appeared to be military retirees (based on their age and choice of hats), found themselves...moderated.

About 90 minutes in Larsen called for a “7th inning stretch”, but much of the crowd took that as an invitation to leave, particularly as it was beginning to get cold, and it was starting to rain. Within a few minutes roughly 1500 of the original 2500 people had left.

The event, all in all, was kept under control, and those who came to disrupt were unsuccessful in creating an environment where that could happen...and a lot of that was because of the efforts of Larsen and his staff.

The goal of this exercise is not to go through all the questions and answers and crowd reactions, but I will tell you that I heard a woman behind us asking out loud about what would happen to senior citizens if the Government ever took over Medicare, which I found both profoundly humorous and profoundly sad.

So what can we make from all of this?

First off, a large venue makes it much tougher for any individual or group to take over the event.

Getting your people into a cohesive group near the center of the action is also quite helpful.

Ensuring that the PA is loud enough to always overpower any “disrupters” is vital.

Making sure the crowd understands that nearly everyone who wants to will get to ask questions matters—and it also matters if you appear to be giving reasonable answers to reasonable questions.

Be a bit of a parent, and call the kids out when they deserve it.

Finally, if a questioner says Government can’t do anything right—ask ‘em why they want to disrespect the brave men and women of our Armed Forces. If you’re in Texas...or North Carolina...or California...or Florida—ask ‘em twice.

If you are going to have to campaign for office every two years (and as a Member of Congress, you do), creating a positive image that transcends electoral cycles can be a great thing. These Town Halls offer that opportunity—and if you do it right, you’ll be able to say that you “listened to the voters” and “stood up for the People” and “made the tough decisions”, despite the efforts of special interests to “hijack the process”, for years to come.

And that, Future Candidates, is not a bad image to take on the campaign trail.

SPECIAL NOTE: We note today the recent passage of Les Paul. Many will remember him as the man who made the electric guitar famous, and still others will remember his work with Mary Ford...but if you have ever stood behind turntables or made a mix or a mashup, you should know that everything you’re doing today also came straight from the mind of Les Paul, who was just about the only person on the planet Earth making 24-track overdub recordings all the way back in 1951.