If you’re a reader of my blog then you probably already know that I’m a big fan of the concept of civil discourse,  both for practical and moral reasons.  And the decline in quality of our political dialogue stresses me more than pretty much anything else in the realm of politics right now.  I’m not just talking about recent events.  In many ways the anger, distrust, fear, misinformation, and outright hatred we’ve seen on display recently are just the natural result of several decades of steadily crumbling communities and increasingly isolated and individualistic lifestyles.  And quite frankly, new technological methods of communication that allow anybody with an internet connection to appear to be as credible as actual experts, that facilitate the specialization of news so that citizens can wrap themselves in a cocoon of their own perspective, and which enable people to say increasingly inflammatory things while hiding behind a veil of anonymity are just accelerating the degradation.

So can you imagine my delight to find that my church has chosen to speak out against this very problem.  The LDS church put out a press release a week or so go entitled “The Mormon Ethic of Civility” that I thought was well-written, insightful, and extremely relevant.  While it’s written by LDS leaders, it should be an interesting read for Non-LDS readers as well.  It can be found here on the original LDS newsroom website, but I’ve also posted the full text after the jump.

The Mormon Ethic of Civility

SALT LAKE CITY 16 October 2009

The political world is astir. Economies are faltering. Public trust is waning. Individuals feel vulnerable. And social cohesion wears thin. Meanwhile, stories of rage and agitation fill our airwaves, streets and town halls. Where are the voices of balance and moderation in these extreme times?

During a recent address given in an interfaith setting, Church President Thomas S. Monson declared: “When a spirit of goodwill prompts our thinking and when united effort goes to work on a common problem, the results can be most gratifying.” Further, former Church President Gordon B. Hinckley once said that living “together in communities with respect and concern one for another” is “the hallmark of civilization.” That hallmark is under increasing threat.

So many of the habits and conventions of modern culture — ubiquitous media, anonymous and unsourced online participation, politicization of the routine, fractured community and family life — undermine the virtues and manners that

make peaceful coexistence in a pluralist society possible. The fabric of civil society tears when stretched thin by its extremities. Civility, then, becomes the measure of our collective and individual character as citizens of a democracy.

A healthy democracy maintains equilibrium through diverse means, including a patchwork of competing interests and an effective system of governmental checks. Nevertheless, this order ultimately relies on the integrity of the people. Speaking

at general conference, a semiannual worldwide gathering of the Church, Elder D. Todd Christofferson of the Quorum of the Twelve Apostles asserted: “In the end, it is only an internal moral compass in each individual that can effectively deal

with the root causes as well as the symptoms of societal decay.” Likewise, Presiding Bishop H. David Burton emphasized that the virtues of fidelity, charity, generosity, humility and responsibility “form the foundation of a Christian life and are the outward manifestation of the inner man.” Thus, moral virtues blend into civic virtues.

The seriousness of our common challenges calls for an equally serious engagement with reasonable ideas and solutions. What we need is rigorous debate, not rancorous altercations.

Civility is not only a matter of discourse. It is primarily a mode of engagement. The technological interconnectedness of society has made isolation impossible. Of all the institutions in the modern world, religion has had perhaps the greatest

difficulty adjusting to the reality of give and take with the public.

Today, and throughout its history, The Church of Jesus Christ of Latter-day Saints continuously encounters the legitimate interests of various stakeholders in its interaction with the public. Rather than exempting itself from the rules of law and civility, the Church has sought the path of cooperative engagement and avoided the perils of acrimonious confrontation.

Echoing this mode of civil engagement, President Monson declared: “As a church we reach out not only to our own people but also to those people of goodwill throughout the world in that spirit of brotherhood which comes from the Lord Jesus Christ.” Speaking of civility on a personal level, Elder Robert D. Hales of the Quorum of the Twelve Apostles taught Latter- day Saints how to respond to criticism: “Some people mistakenly think responses such as silence, meekness, forgiveness, and bearing humble testimony are passive or weak. But, to ‘love [our] enemies, bless them that curse [us], do good to them that hate [us], and pray for them which despitefully use [us], and persecute [us]’ (Matthew 5:44) takes faith, strength, and, most of all, Christian courage.”

The moral basis of civility is the Golden Rule, taught by a broad range of cultures and individuals, perhaps most popularly by Jesus Christ: “And as ye would that men should do to you, do ye also to them likewise” (Luke 6:31). This ethic of

reciprocity reminds us all of our responsibility toward one another and reinforces the communal nature of human life.  Similarly, the Book of Mormon tells a sober story of civilizational decline in which various peoples repeat the cycle of

prosperity, pride and fall. In almost every case, the seeds of decay begin with the violation of the simple rules of civility. Cooperation, humility and empathy gradually give way to contention, strife and malice.

The need for civility is perhaps most relevant in the realm of partisan politics. As the Church operates in countries around the world, it embraces the richness of pluralism. Thus, the political diversity of Latter-day Saints spans the ideological

spectrum. Individual members are free to choose their own political philosophy and affiliation. Moreover, the Church itself is not aligned with any particular political ideology or movement. It defies category. Its moral values may be expressed in a number of parties and ideologies.

Furthermore, the Church views with concern the politics of fear and rhetorical extremism that render civil discussion impossible. As the Church begins to rise in prominence and its members achieve a higher public profile, a diversity of voices and opinions naturally follows. Some may even mistake these voices as being authoritative or representative of the Church. However, individual members think and speak for themselves. Only the First Presidency and the Twelve Apostles

speak for the whole Church.

Latter-day Saint ethical life requires members to treat their neighbors with respect, regardless of the situation. Behavior in a religious setting should be consistent with behavior in a secular setting. The Church hopes that our democratic system will facilitate kinder and more reasoned exchanges among fellow Americans than we are now seeing.

In his inaugural press conference President Monson emphasized the importance of cooperation in civic endeavors: “We have a responsibility to be active in the communities where we live, all Latter-day Saints, and to work cooperatively with other churches and organizations. My objective there is … that we eliminate the weakness of one standing alone and substitute for it the strength of people working together.”

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I found this comic (on PHDComics.com) the other day and just had to post it because it really hits the nail on the head.  While this process is easiest to identify in science news, where original sources are relatively easily available, I think this fear amplification and exaggeration process applies to most things you see reported in the news.  Drill down to original sources and actual data, and everything is always far more nuanced, moderate, and sensible than the story that’s delivered to media consumers.  Of course these days many people don’t even read the news, they get their information through the filter of opinion commentators, radio pundits, or cult-like internet personalities.  So perhaps the cartoonist could have made the cycle more complete by adding an additional step before the paranoid granny where radio/tv/internet pundits tell you that the government/big business/unions are secretly trying to slip “A” into legislation/biased media/your water supply.

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When protesters marched on washington a few weeks ago, one of the most common rallying cries was that congress was disconnected from the opinions of the American people.  They argued that Americans were outraged that congress was (among other things) shoving a healthcare bill down American’s throats that they don’t want.  I found this to be a curious charge, considering the bipartisan calls for healthcare reform that have grown louder over the last few decades.  But maybe the protesters had something there.  Perhaps it’s true that congress has become disconnected from what mainstream Americans want out of all this healthcare reform talk.  Fortunately, a few polls have been released recently which give us some insight into how the public feels about the public option , perhaps the most famous, most misunderstood, and most contentious element of the healthcare plans proposed thus far.

First up is an ABC news poll released Sept 14th, shortly after the president’s healthcare address.  The entire poll is interesting (found here) but in regards to the public plan the numbers were close but clear:

“On specifics in the health care plan, 55 percent support a so-called public option, with 42 percent opposed – slightly less opposition than in last month’s 52-46 percent division, but still shy of the initial reaction in June, 62-33 percent support.”

Notice the reference to numbers from earlier in the summer, when support for the public option started out strong, and then dipped significantly in popularity through July and August.  Clearly the townhall protests, the “death panels”, the abortion furor, and the numerous other healthcare reform myths had taken their toll.  So was the slightly aleviated opposition after Obama’s speech a blip on the radar or a sign of a turning tide?

If the recently released NYT/CBS poll is to be believed then the tide has turned indeed.  Here are their numbers on the public plan:

What surprises me most is that they threw “like medicare” into the language of the question which, in my opinion, makes the public option seem more socialistic than it actually is, and still the result was dramatic.  Perhaps some of this increase in support can be explained by a bloomberg poll, released in between the two afformentioned polls, which asked those surveyed to rate the validity of various claims they’ve heard about healthcare reform.  Here are the results:

While these wild charges were certainly making headway at first, it seems that the fact-checkers have caught up and most Americans have, by now, recognized them as non-issues.

While not representative of America as a whole, another poll released a couple weeks back asked America’s physicians what they thought of the public plan:

“When given a three-way choice among private plans that use tax credits or subsidies to help the poor buy private insurance; a new public health insurance plan such as Medicare; or a mix of the two; 63 percent of doctors supported a mix, 27 percent said they only wanted private options, and just 10 percent said they exclusively wanted public options.”

To clarify, the “mix” option refers to the public plan which would compete with private insurers, and the “new public health insurance plan such as medicare” refers to single-payer healthcare ala Canada.  This means that a full 73% of doctors support either a public option or something far stronger.  This is not surprising to me having come recently from a CMA conference in LA where I heard republican physician after republican physician extol the benefits of healthcare reform and lament the lack of competition in the private insurance industry.

So lest my tentative support of the Baucus bill confuse anyone, I count myself among the 65% of Americans who would support a public plan.  The co-ops of the Baucus Bill, while better than nothing, aren’t shaping up to be strong enough to have the negotiating power necessary to substantially lower premiums or lower long-term costs as efficiently as a public option.  While I’m nearly always in favor of political pragmatism, and I believe compromise is superior to partisanship even when one has the power to make their ideals law, I feel it should be noted that the public option was a proposal that came pre-compromised.  It was, in itself, an attempt to bridge the gap between the liberal and conservative theories of healthcare reform.  And as recent polls have shown us, it remains a mainstream, moderate choice.  And if these polls weren’t evidence enough, Bill O’Rielly came out in support of the public plan recently.  I’m not kidding! And when both Keith Olberman and Bill O’Rielly agree on a policy proposal, maybe that’s a sign we have found a reasonable compromise.

So perhaps the tea-party protesters were right in a way.  Maybe congress isn’t listening to the public on this one.  How else could we, with a democratically controlled congress, and a democratic president now be laying our hopes on a healthcare reform plan that does not include a public option, and thus lies to the right of the feelings of most Americans and the large majority of doctors?

Honestly I think it was a strategic issue more than anything else.  Had Obama come in pushing a more liberal plan we might be happily settling on a public option right now.  But, as he has on bills past, Obama attempted to bridge the gap first, then present the plan.  But I think we’ve learned that no amount of concessions prior to coming to the negotiating table will placate those who simply don’t want Obama’s presidency to succeed.  One of the things I liked about Obama during the election was that he consistently expressed a calm faith in the ability of Americans and congress to overcome partisanship.  Perhaps he gave us too much credit?  I hope not.  At the very least we’ve learned that acting as if we’re living in a post-partisan America, isn’t enough to make it so.

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Today the Senate Finance Committe (made up of both republicans and democrats) released their long-awaited “compromise” healthcare bill.  Since Obama’s healthcare speech last week (Read or watch the speech here) this seems to be the bill everyone’s been looking to as the hope for the future.  Some of that may be warrented but there’s still a long road ahead.  I’ve provided details and links after the jump

Links

For the full text of the bill (which seems to be formatted in an odd paragraph format) see here:

http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

For a brief but thorough official 18 page summary see here:

http://finance.senate.gov/press/Bpress/2009press/prb091609.pdf

For the Congressional Budget Office’s always excellent and always non-partisan analysis see here:

http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16-Proposal_SFC_Chairman.pdf

For a summary of the CBO analysis, from their blog see here:

http://cboblog.cbo.gov/?p=354

And for CNN’s description of the bill, which seemed to me to be the most balenced and informative of the major news outlets articles see here:

http://www.cnn.com/2009/POLITICS/09/16/health.care/index.html

Summary

So what does it contain?  Well it’s similar to many of the bills completed in the last few months in that it contains subsidies for those who can’t afford insurance, a mandate for individuals to purchase insurance, new regulations preventing insurance companies from dropping patients mid coverage or denying them insurance due to pre-existing conditions, mechanisms for eliminating waste from medicaid, and it creates a health insurance exchange.  But it’s also clearly designed to appeal to republicans and thus has some important differences from previous bills, specifically:

-It does away with the “public plan” (read more about the public plan) and replaces it with a series of co-ops (read more about healthcare co-ops)

-It includes more detailed provisions against providing funding for illegal immigration, adding stronger enforcement mechanisms

-It discusses abortion explicitly, reinforcing the old capp’s amendment, making clear that no tax dollars would be used to pay for abortions, except in cases of rape, incest, or immediate threat to the life of the mother, as it has always been in medicare and medicaid.  It also allows all state abortion regulations to stay in place

-Encourages tort reform, the details of which are to be decided by individual states

It’s also important to note that the CBO analysis was also released today and on the two big statistics everyone’s looking for the bill does decently well.  Ten years out the CBO predicts that the projected number of uninsured will be reduced from 54 million, to 25 million (pg 16), and the federal deficit will be REDUCED by 49 billion (pg 3)! That second number is significant because while Obama has always maintained that he would not sign a bill that wasn’t at least deficit neutral, this is the first completed bill I’m aware of that actually is.

Reception

The bill was received with optimism by the president, and by democratic leaders of the senate, but some democrats there have expressed concerns, namely Jay Rockefeller, who has come out in open opposition to it, and fellow finance committee member Ron Wyden.  In fact, as of right now, nobody on the Senate Finance committee aside from Baucus has endorsed the bill, and no republicans are committed to support it.  Not even the moderate Republican Olympia Snow who the white house has been working with extensively.  But the markup process will proceed for the next several weeks and it’s quite likely that a few republicans will be on board by that time.  Acquiring the support of at least a few senate republicans is a necessity since democrats do not have the majority necessary there to pass the bill on their own.  But moderating the bill wasn’t motivated purely by a desire to attract republicans, several moderate democrats were also somewhat uncomfortable with some of the provisions of the house bill and their support should also be more reliable with the Baucus Bill.

Unfortunately, widespread republican support on this, or any bill, cannot be expected.  Upon the Senate Finance Committee Bill’s release today, Mitch McConnel (R-Kentucky) released a statement saying “This partisan proposal cuts Medicare by nearly a half-trillion dollars and puts massive new tax burdens on families and small businesses to create yet another thousand-page, trillion-dollar government program.”  With all due respect to Mr McConnell, the first concern about cuts to medicare has already been widely debunked, there are new taxes for very few Americans but I think anyone looking at the numbers would say massive is a gross overstatement, the bill is not a thousand pages but is only 223 pages (almost half of which is just describing existing policies) and the CBO clearly predicts a gross cost of a bit over 800 billion dollars over ten years and a net cost of -49 billion.

But this kind of response was to be expected.  I tend to agree with Obama’s assessment in his speech last week that there are

“those who have made the calculation that it’s better politics to kill this plan than improve it”.

Back in July, Sen. Jim DeMint (R-SC) said in a conference call, “If we’re able to stop Obama on this it will be his Waterloo. It will break him”.  And since that time, I think, many republicans have committed themselves firmly to the idea that killing reform in the hopes that it will destroy Obama and get them more congressional power in 2010 is the best course of action.  The fact that republicans have yet to submit a proposal that is even halfway serious seems to support this theory.  Not that this is new behavior for congress.  It’s unfortunately common for one party to oppose good, moderate proposals simply for strategical reasons, especially when that party is the party out of power.  But I guess I had just hoped that with a healthcare crisis immediately looming, and with this being a subject that deals with the very life and death of American citizens, everyone would be putting forth a good-faith effort.

Anyway, this is important because it means that Democrats can really only hope to pick off a handful of republicans to support this bill, and they risk losing a corresponding number of liberals at the same time.  It’s a difficult task to balance.  And it’s beginning to upset liberals, Like Rockefeller and Wyden, who feel that Democrats “are being asked to support a bipartisan bill that doesn’t have bipartisan support.”  The compromise without the cover.  This same concern was present back in Stimulus days when extensive bipartisan talks resulted in a strikingly conservative final bill (with the final product being 42% tax cuts and 58% spending, nearly equaling Rush Limbaugh’s stimulus proposal in the WSJ of 48% tax cuts and 52% spending), but it still passed on a nearly party-line vote.

In the end will liberals say, “enough is enough” and push through a bill using a public plan with no republican support?  Will they use the controversial budget reconciliation method to do it?  Or will they stay on board with a compromise bill as it continues to be modified to meet republican needs to draw those precious few to their side?  Time will tell.  Personally, as much as I think a public plan would be a better choice, I think budget reconciliation is the wrong way to go at this point.  I think Americans prefer a bi-partisan bill, even if that bi-partisanship amounts to 57 democrats and 3 republicans.  And while I’ll reserve my final judgement for when mark-ups are finished, I think baucus’s bill looks decent so far.  Frankly, if it weren’t for the possibility of securing something “better” I think democrats would be thrilled with it.  I hope the liberal democrats realize that it would be silly if we took 0 steps forward because people were upset about taking 3 steps forward instead of 4.

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What is the Healthcare Co-op?

First off, it’s important to know that when we’re talking about co-ops, we’re not talking about the local health insurance co-operatives found in states like Wisconsin. CNN recently wrote an entire article while apparently operating under this misunderstanding, and pretty much all of the statements deriding co-ops that have come from Gov. Tom Pawlenty recently also fall into this category. We are talking about a single, national co-operative or small group of cooperatives, given special permission to compete nationally across state lines to provide competition to the overly-consolidated private health insurance markets. To fully understand this type of co-op, you should first go back and read “All About the Public Plan” if you haven’t already. Seriously, you won’t understand this article without it. I’ll wait… Okay, are you done? Do you understand what the Public Plan is? The Co-op is exactly the same, except administered by elected board members rather than government appointed officials. Literally, that is the only difference I have been able to come up with.

Disadvantages of the

Healthcare Co-op

Now I should clarify that the Co-op idea has the potential to be exactly the same as public plan proposals, and would likely function almost exactly like the public plan, but since no bill has actually been written up with a co-op component, we can’t say for sure yet exactly what it would be like. Sen. Kent Conrad, one of the first to propose co-ops in the context of the current healthcare reform debate has said that they could operate on a state level, a regional level, or a national level. It’s a national healthcare co-op that would function like a public plan. State or regional co-ops would probably be beneficial but would not have nearly the same strength in bargaining power as a national co-op or a public plan and thus would be a less formidable competitor to private insurers. So this remaining ambiguity is certainly one disadvantage to dumping the public option in favor of a co-op.

The only other reasonable argument I’ve heard against the healthcare co-op is that since administrators would not be appointed by the government, it’s not a guarantee that the co-op would remain dedicated to its original mission of lowering America’s insurance premiums. There’s not much to prevent the administrators of the co-op from pursuing the interests of their organization over those of the American people should they ever come into conflict. The primary situation in which that might occur would be if the co-op became too successful and threatened the fabric of our private insurance industry. In that situation, those not participating in the healthcare co-op would not have any direct input into its operations, while those who are members would have only an incentive to increase the size of their organization to grow their risk pool. Of course we’d still have some control over the co-op through legislation, but as we’ve seen that can be a slow and arduous process. In other words, a government administered program would theoretically give the American people (through our elected officials) somewhat more direct and time-sensitive control over how the plan operates.

Advantages of the

Healthcare Co-op

While I’ve stated several times in the past that I believe it to be very unlikely that a public plan would bankrupt private industry, it’s impossible to say that it could never happen. With that in mind a state or regionally based healthcare co-op plan would essentially eliminate that risk, which should ease the minds of conservative reform opponents.

But I think the primary advantage is political. It’s clear that, due to unfortunate naming, insurance company smear tactics, and the white house’s perplexing decision to sit back and let the wings define the debate for the first several months, the public plan has become a very, very controversial proposal. To many conservatives it has become synonymous with “Socialized medicine” and a “government takeover of healthcare”. If a strong, national, healthcare co-op would give us nearly the same result without the controversy then it seems like the logical choice.

I know some are frustrated with that option because they see it as a sign of giving in to misinformation. Yes it’s true that the Public plan has been unfairly smeared and is almost universally misunderstood. Yes it’s true that if it were abandoned, healthcare reform opponents would trumpet from the hilltops that they were clearly right all along and that their protests and screaming had succeeded in averting socialism. The liars would be gratified and the screamers would not learn their lessons, and that would be frustrating. But there will always be liars and there will always be screamers. One win or loss on one item of policy will not change that. Are we willing to accept no reform at all in place of a healthcare system with a strong national co-op, or even strong regional co-ops, for reasons that essentially amount to pride?

Unfortunately I’ve found that this is a frequent occurance in politics. Idealogues often get their way because they’re loud and more than willing to lie their faces off. But if anything is going to be accomplished then somebody has to compromise, and it won’t be them. And in the end, I think it’s less about who believes they won or lost and more about the end result for the American people. I think the most noble policy makers are those who pragmatically seek the best result for their constituents. They’re rarely anyone’s hero, they don’t often make the news, and they don’t have a rabid fan base since they’re not out there boldly and defiantly waving some ideological banner. But they’re the one’s we can thank for most of the positive change that has actually been enacted over the years.

Conclusion

So is the co-op the way to go? If that’s what we have to do to get a bill passed, then I say yes. And all signs from the Senate say that the public plan is a no-go there. I’m all in favor of a public plan, I think it’s the superior choice. But not by so much that healthcare reform is worthless without it. I think it’s wise to push the public plan as much as we can and fight the misunderstanding that’s out there. But when it becomes clear that it will not succeed, we need to accept the co-op and move forward as quickly as possible, before the next smear campaign has time to gain momentum. I really liked what Pres. Obama had to say about this subject in his healthcare address last week actually. and I’ll let his words close out this article.

“It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.”

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Visit msnbc.com for Breaking News, World News, and News about the Economy

For those who didn’t get to see it last night, I give you Obama’s healthcare speech, in both video form and text form (after the jump).  Frankly, it was better than I expected.  He effectively summarized the rational for many of the most controversial reform elements, and added in enough personal stories and emotional appeals to keep it from becoming too dense with policy details.  I also thought he did a fair job of criticizing some of the tactics that have been used by his opponents, while promoting cooperation.  I sincerely hope that the olive branch of tort reform Obama extended last night was in good faith, and that the republicans will actually become more cooperative as a result.  It would be nice if it felt like congress was actually trying to do what they thought was best for the country and not what they thought was best for their party or their political future.  Hit the read link to see the full text.

Madame Speaker, Vice President Biden, Members of Congress, and the American people:

When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.

As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is many months away. And I will not let up until those Americans who seek jobs can find them; until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we have taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink.

I want to thank the members of this body for your efforts and your support in these last several months, and especially those who have taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation.

But we did not come here just to clean up crises. We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future – and that is the issue of health care.

I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.

We are the only advanced democracy on Earth – the only wealthy nation – that allows such hardships for millions of its people. There are now more than thirty million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.

Then there’s the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren’t any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It’s why so many employers – especially small businesses – are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It’s why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally – like our automakers – are at a huge disadvantage. And it’s why those of us with health insurance are also paying a hidden and growing tax for those without it – about $1000 per year that pays for somebody else’s emergency room and charitable care.

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.

These are the facts. Nobody disputes them. We know we must reform this system. The question is how.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.

During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.

Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

The plan I’m announcing tonight would meet three basic goals:

It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it’s a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans – and yes, from some of my opponents in both the primary and general election.

Here are the details that every American needs to know about this plan:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

That’s what Americans who have health insurance can expect from this plan – more security and stability.

Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we’ve given ourselves.

For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it’s a good idea now, and we should embrace it.

Now, even if we provide these affordable options, there may be those – particularly the young and healthy – who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don’t sign up for health insurance, it means we pay for those people’s expensive emergency room visits. If some businesses don’t provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek – especially requiring insurance companies to cover pre-existing conditions – just can’t be achieved.

That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that’s been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I’d like to address some of the key controversies that are still out there.

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally. And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

My health care proposal has also been attacked by some who oppose reform as a “government takeover” of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly-sponsored insurance option, administered by the government just like Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly – by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.

Insurance executives don’t do this because they are bad people. They do it because it’s profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called “Wall Street’s relentless profit expectations.”

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public – and that is how we pay for this plan.

Here’s what you need to know. First, I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.

Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn’t make us healthier. That’s not my judgment – it’s the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.

In fact, I want to speak directly to America’s seniors for a moment, because Medicare is another issue that’s been subjected to demagoguery and distortion during the course of this debate.

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

These steps will ensure that you – America’s seniors – get the benefits you’ve been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That’s what this plan will do for you. So don’t pay attention to those scary stories about how your benefits will be cut – especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system – everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.

Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don’t believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It’s a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

Add it all up, and the plan I’m proposing will cost around $900 billion over ten years – less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Most of these costs will be paid for with money already being spent – but spent badly – in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.

This is the plan I’m proposing. It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed – the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.

I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death.

In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, and his children, who are here tonight . And he expressed confidence that this would be the year that health care reform – “that great unfinished business of our society,” he called it – would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that “it concerns more than material things.” “What we face,” he wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

I’ve thought about that phrase quite a bit in recent days – the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.

For some of Ted Kennedy’s critics, his brand of liberalism represented an affront to American liberty. In their mind, his passion for universal health care was nothing more than a passion for big government.

But those of us who knew Teddy and worked with him here – people of both parties – know that what drove him was something more. His friend, Orrin Hatch, knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient’s Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent – there is something that could make you better, but I just can’t afford it.

That large-heartedness – that concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people’s shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter – that at that point we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road – to defer reform one more year, or one more election, or one more term.

But that’s not what the moment calls for. That’s not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it’s hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history’s test.

Because that is who we are. That is our calling. That is our character. Thank you, God Bless You, and may God Bless the United States of America.

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In all my discussions with people about current healthcare reform proposals, by far the Public Plan is probably the most thoroughly misunderstood.  I have encountered very few individuals, amongst either reform supporters or opponents, who have anything close to a correct conception of what the “public plan” is or what it’s designed to do.  I read an article on the Huffington Post the other day in which the author admitted that until very recently, he had thought the public plan being debated was a “medicare style unrolled plan”.  This is probably the general public’s perception as well.  A part of me feels that there’s very little excuse for this since the bills and summary sheets have been available for months now, but I acknowledge that this issue has been so skewed and twisted by politicians, pundits, and the media that finding the truth can be difficult.  So here are the facts, as best as I can find:

What is the public plan?

The public plan is simply a health insurance plan, administered by the government, that has special permission to sell their plans nationally.  It will not offer free care to anyone.  It’s not a “medicare or medicaid style plan”.  It will not provide “universal healthcare”.  It will have premiums and co-pays just like any other plan which it will base on the market.  And perhaps most importantly, it will not be funded with tax-payer money and it will not be allowed to draw money from the general fund.  It will be self sustaining.  That last fact seems to be very difficult for many people to grasp and in conversations with healthcare reform opponents, many of them have admitted that they simply don’t believe me on that point.  So here are more references than you could possibly need to demonstrate this fact:

“Public option must be financially self-sustaining, as private plans are.  Public option will need to build start-up costs and contingency funds into its rates and adjust premiums annually in order to assure its financial viability, as private plans do.” - From the official bill summary

The House Bill will, “Finance the costs of the public plan through revenues from premiums.” - Kaiser Family Foundation (select tri-commitee bill and insurance pooling mechanisms)

“H.R. 3200 would require a public plan to be self-sustaining and independent of the federal treasury.” - The American Medical Association

“…but as long as the public plan charged premiums that covered its costs (as it is supposed to do under the proposal), those amounts would be offsetting…” - CBO Analysis

“Participants [in the public plan] would pay actuarially determined premiums set at levels required to pay the full cost of coverage under the public plan.” - Lewin Group Analysis

Public plan has “Reserves [and is] self sustaining w/o public subsidies” - ITUP summary sheet

“The secretary shall establish geographically-adjusted premium rates for the public health insurance option … at a level sufficient to fully finance the costs of health benefits provided by the public health insurance option; and administrative costs related to operating the public health insurance option… the Secretary shall include an appropriate amount for a contingency margin… Limitation on Funding – Nothing in this section shall be construed as authorizing any additional appropriations to the Account, other than such amounts as are otherwise provided with respect to other Exchange-participating health benefits plans.”  - HR 3200 pages 119-120

I really hope this puts this issue to rest.  There are no reputable organizations I have come across that are claiming that the public plan is subsidized by the government or is a “medicare-for-all” kind of plan.  This is not really a debatable issue so I feel I can speak strongly.  If you have heard someone claiming that the public plan is tax-payer funded than you can be sure that that individual is either uninformed, lying, or a delightful mixture of the two.  If it was publicly funded I would surely oppose it, as would the AMA, and most people involved in healthcare policy.

Once we have established that the public plan is self-sustaining, then many of the frightening myths about healthcare reform are invalidated.  Namely the ideas that this represents socialized medicine, that it will bankrupt private insurance, that abortion coverage by the plan would mean our tax dollars are paying for abortions, or that it would usher in long lines and rationing.  (See The Top 7 Craziest Myths about Healthcare Reform).

So Why is It Important?

The question remains, why would we need to have a government plan with these special privileges?  Well here’s my understanding of the issue and the explanation I’ve heard and read most often:

The problem this is meant to address is the issue of health insurance premium inflation. Everyone acknowledges that market forces are malfuctioning in the insurance market, primarily because there’s a lack of competition. In some rural areas there is only one insurance company available and in most places around the country there are only two or three. This means that patients are not able to shop around for insurance that offers them lower premiums for the same coverage and doctors aren’t able to drop insurance companies that don’t pay them enough for their procedures. Which is why insurance companies are raising premiums, paying doctors less, and simultaneously making record profits.   The AMA has an article about this problem here, Here’s one of the many studies on the subject here, And here’s an interesting case study about it here.

This problem is a big contributer to rising premium costs, and rising premium costs are a problem for everyone since the more uninsured people there are in the country, the more people we have getting free (and inefficient) care at the emergency room, and the more money tax payers have to shell out to hospitals for this uncompensated care.  In a study funded by Americas Health Insurance Plans in 2006, the insurance companies themselves acknowledged that market consolidation and the resultant artificial price inflation was a major contributer to rising premium costs.  They estimated that of the 8.8% yearly rise in premium prices, 1.1% of it was due to market consolidation.  Keep in mind that the goal is not to reduce premium growth to zero, but rather to reduce it until it’s equal with wage growth, which generally hovers around 5.5% in the US.  This means we only need to cut 3.3% off of our premium growth to make our nation’s financial future look a whole lot rosier and introducing competition to the scene would eliminate 1.1% or a third of what we need.  And keep in mind these are the Insurance companies’ numbers.  Other estimates are far higher.  So at the very least, if we can bust up these oligopolies and monopolies we could get a third of the way to solving a large part of the healthcare crisis and the benefits would likely be a lot greater.  Furthermore, premiums have been growing artificially higher for years and years.  Introducing competition to these consolidated markets would not only prevent future artificial growth but would also reverse years of unnecessary premium growth, leading to a very large initial drop in premium prices.

So one solution to this problem would be to deregulate the insurance industry, allowing them to sell insurance across state lines, thus increasing competition and lowering premiums. I have had many healthcare reform opponents suggest this to me and many republican politicians are pushing it as an alternative to the public plan.  The problem is that doctors and hospitals hate this idea. For two reasons. First, hospitals and doctors’ offices are already swamped trying to figure out which insurance companies cover what and filling out all the different forms each insurance company requires to ensure compensation.  It is not uncommon for a small practice to hire 5-6 employees solely for the purpose of managing insurance company calls and paperwork, and that’s when they’re only dealing with 3 or 4 companies. Imagine if there were hundreds. It would instantly bankrupt most private practitioners and many hospitals.  The second reason doctors and hospitals are opposed to this idea is because right now the only way doctors have a say in the insurance industry (since there are little to no functioning market forces) is through lobbying their state governments to regulate insurance companies. If insurance companies could sell across state lines then they’d all congregate in the state with the least number of regulations and physicians in all other states would have zero say in how the insurance companies in their area opperated.

So if we’re not going to deregulate the insurance industry the only other good idea for putting downward pressure on premium prices that anyone has come up with is what Obama is proposing, a nationwide public plan that anyone could buy into. It would give the insurance companies competition, even in rural areas, effectively forcing them to lower their prices to compete.  Despite the public perception this plan has as some kind of anti-capitalistic bastion of inefficiency, the public plan is designed to fix malfunctioning market forces, increase competition, and increase patient choice.  And analysis by the CBO, Kaiser Family Foundation, Lewin Group, and ITEP all say it will do just that.  The invisible hand can’t move us towards efficiency in the absence of choice and competition.  Healthcare reform opponents often talk about market-based reforms but reforms based on preserving current markets support a system that inhibits market competition.  We need to break the monopolies and the public plan is one of the only feasible ways of doing that.  In that sense it is one of the strongest “pro-market” idea out there.

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Ok, those who have been following the healthcare reform battle have surely noticed that things have gotten nasty in the last couple of weeks.  And I mean seriously nasty.  I’ll admit, I’m still young, and I’ve only been following politics with intensity for the last 5 years or so, but I’ve done a fair amount of research on controversies of the past and I feel I’m fairly informed about the history of American politics over the course of the last century.  But the healthcare debate that’s going on now seems to be shaping up to be among the most vitriolic policy battles of recent history.  And along with that vitriol has come a slew of misinformation and purposeful misrepresentations that have far exceeded anything I would have expected to see in modern America.  With the advent of the internet and increased access to original sources, it’s perplexing to me how these smears can spread so quickly, and maintain such staying power.

And the pervasiveness of these myths is likewise surprising.  I’ve been watching videos of town hall protesters lately and it is extremely rare to see a protester carrying a sign that isn’t littered with false claims about the healthcare bills.  And some of them are so shockingly confused as to deal a serious blow to my faith in humanity (A sign I saw recently reading “keep your government hands off of my medicare” comes to mind).  And in casual conversations I’ve had with others about the bill I have yet to talk to an opponent who has actually cited something that’s really in the bill as justification for their opposition.  Once again, to be clear, every single person I’ve talked to who opposes the bill, when asked about their reasons, has cited nothing but provisions that are not actually in this bill.

So for the last few days I’ve been working on this article:  a feeble attempt on my part to correct 7 outlandish myths that are out there about healthcare reform.  In reality there are several claims being thrown about that are probably more shocking than these, but I tried to pick 7 that were both blatantly false, and commonly held.  Even many of the moderates in the audience may be unaware that the things mentioned below are, in fact, untrue.  I’ve tried to cite original sources wherever possible.  And for those who aren’t familiar with the methods of internet bloggers, the underlined text indicates a hyperlink to a source for the underlined statement.  This article is quite long, but I believe its topic is vitally important.

In the interest of full disclosure I should also point out that I’m currently a voting delegate to the California Medical Association (CMA) and American Medical Association (AMA), and I hold positions on the CMA’s Council on Legislation and the AMA’s House Coordinating Committee.  While these positions have certainly helped increase my understanding surrounding this bill and healthcare policy in general, I am speaking purely for myself in this article and nothing I say should be construed as reflecting the positions of those organizations or committees.

Myth #7 – This Healthcare Reform Plan = Socialized Medicine

I’ll talk about this one first because it’s probably the most pervasive of all the myths I’ve heard so far.  And it isn’t all that crazy when you get down to it.  In the public mind the terms “universal healthcare”, “socialized medicine”, “public plan”, and “single-payer healthcare” are all kind of viewed as the same communistic policy but they are, in reality, very distinct and different ideas.  Let’s do a little bit of defining.

Socialized Medicine – a medical system in which the healthcare providers work for the government, healthcare facilities are owned by the government, and the government is the sole payer of healthcare costs.  There are actually few modern examples of true “socialized medicine” with the UK and Spain being two of the only industialized countries to employ such a system.  There are currently no groups in the US that are advocating for a system of this nature in the US.  Literally even the furthest left-wing healthcare reform advocates are shooting for Single-Payer, described below. (Definition at MedTerms)

Single-Payer Healthcare - a system in which healthcare facilities are privately owned, healthcare providers work for themselves or for hospitals, and the government is the sole insurance company.  This could alternatively be called a “socialized health insurance system”.  This type of healthcare system is more common and can be found in Canada, Australia, and Taiwan.  There are groups in the US, most prominently the PNHP, that advocate for single-payer healthcare, and Dennis Kucinich proposed such a system, but honestly these groups aren’t taken seriously by mainstream liberal politicians. (Definition at MedTerms)

Universal Healthcare - is just a general term for any system in which all or very nearly all of the populace in a given country has either private health insurance or government provided healthcare.  There are as many ways to achieve this as one can think of.  There are both market-based and regulation-centered reforms that could potentially lead the US to “universal healthcare”.  Most countries that ensure universal healthcare do so through a mixture of public programs and private industry.  Many of the best healthcare systems in the world are organized in this manner such as those in France or Greece.  The US is the only industrialized country in the world that doesn’t have some form of universal healthcare.

Public Plan – The public plan, as described in the House’s initial draft of their healthcare reform bill would not provide free healthcare to anyone and nobody would be required to use it under any circumstances.  It would compete with private industry in much the same way that the USPS competes with UPS, FedEx, and others in the package delivery business.  But unlike the Postal system it would not be funded with taxpayer dollars but would be required to be financially self sustaining.  Many countries with mixed public/private systems have a similar plan. (Fact Sheet on Public Plan)

Now that we have some basic definitions lets see which one’s apply to the reform plans currently in congress. Well, according to CBO predictions (pg. 13), the healthcare bill would reduce the number of Americans without health insurance by 37 million, leaving about 17 million uninsured and would have only a minor impact on the number of people currently using private insurance companies.  So it wouldn’t even provide universal coverage and since our healthcare insurance system would still stay predominantly private, it brings us no closer to single-payer healthcare and keeps us multiple levels away from anything resembling socialized medicine.

I suppose the argument remains that it’s a “socialized” plan because it moves us closer to the “socialism” side of the spectrum.  I would say that’s barely true, but then we’re just playing games with words.  By the same token I could label any deregulation proposal “anarchic medicine” because it’s inching us ever closer to anarchy and it would be equally valid.  One of the most basic ways that politicians and pundits try to influence the debate on an issue is through controlling the language used and opponents have done a very efficient job associating healthcare reform with socialism.

These ideas are reinforced by partisan news organizations who use headlines like “Would Americans accept socialized care?” or who put polls on their site asking “do you think American taxpayers should pay for universal healthcare?”, both of which are irrelevant questions when considering the healthcare legislation currently in congress.  I saw an example of this recently when a news organization featured an article discussing the merits and pitfalls of Canada’s system, implying that it had pertinence to the US healthcare debate, when in reality Canada’s system is nothing like the reform being proposed.  But they know that the more they make the association, the more ingrained that perception becomes.

In fact it’s probably already so ingrained that many of you probably have difficulty coming to terms with the idea that the impending healthcare reform bills do not represent anything close to socialized medicine, despite the clear and simple facts.  Which is a testimony to the power of “source amnesia” (discussed here) and a lesson in the importance of choosing information sources without an agenda, and who don’t attempt to manipulate your psyche.

Myth #6 – A Public Plan Would Crowd Out Private Insurers

This was one of the first criticisms of Obama’s initial healthcare plan, and it was first made way back before any bill-writing even began.  And at the time it was actually pretty valid.  In those days no one knew exactly what was meant by a “public plan”, only that it was to be designed to compete with private insurance.  If the public plan had been designed such that it was subsidized by tax funds, then it would be perfectly reasonable to worry that it would bankrupt private industry, since its competative advantage would be enormous.  Similarly, before projections were released regarding the impact the public plan might have, or the effects of the bill’s employer mandates, some fear regarding how big the public plan might become was warrented.

But thankfully we now live in more enlightened times and we’ve got enough information to falsify this claim several times over.  First of all, as addressed above, the public plan will compete as a non-profit entity with private insurance and will do so without help from taxpayers. They will have to stay in the black through setting and regularly adjusting their premiums like everyone else.  They will NOT be allowed to dip into the general fund.  Thus there’s no reason to think that the public plan would be able to draw a substantial number of currently insured people away from their private plans unless it were somehow able to provide far better services at a far lower price.  While part of its goal is to operate efficiently and thus create some semblance of a ceiling on premium prices, it’s not really reasonable to think they would have the ability to draw enough customers away from the large private insurance companies to put them in financial jeopardy.

Secondly, the CBO has already analyzed the situation and determined that while there would be some small amount of migration from private plans to the public plan, the vast majority of new public plan purchasers would be currently uninsured individuals. And ten years from implementation they show private industry with a slightly smaller market share, but still going strong and holding steady.

Finally, most of the people who make this claim now act as if that’s somehow the government’s secret plan all along; that this is some underhanded way to move us to a single-payer healthcare system.  As someone who used to be a supporter of single-payer healthcare, I can tell you that it’s really not very popular amongst democrats in congress and a large majority of them are actively opposed to such a system.  So that kind of shoots a hole in that conspiracy theory.  It is to nobody’s benefit to undermine private insurance.  The best healthcare systems in the world are those where public and private healthcare coexist in equilibrium.  If the make-up of the congress was as it is now and the public plan ever did threaten the integrity of private firms, I can nearly guarantee that they’d scale it down to give private insurance room to make new gains.

Myth #5 – The Healthcare Reform Bill Would Force You Onto the Public Plan and Ban Private Insurance

Ok, now we’re getting to the crazy stuff.  This claim first arose just a few days after the full text of the bill was released.  It started with an article on the site Investors Business Daily that made this claim (link here):

“It didn’t take long to run into an “uh-oh” moment when reading the House’s “health care for all Americans” bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.”

Now those of you who have attempted to read congressional bills on your own can probably testify that they can be confusing, but pages 16 and 17 of this bill are actually rather clear (relatively speaking) so it’s hard for me to understand how they could have come to this conclusion unless they were purposefully trying to distort its meaning (see the text of the bill here).  These pages talk about how all plans offered after the bill is enacted need to conform to the regulations laid out in the bill.  It does indeed say. “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of the year the legislation becomes law.”  But what they neglect to address is that “this paragraph” then goes on to describe the new regulations the bill applies to health insurance companies (no denying people for preexisting conditions or dropping them when they get a chronic disease etc) starting from page 19 onward.  So what the bill is saying is that any contract entered into before the date the legislation is enacted will continue in its agreed-upon form until its expiration, but any new contract signed after the bill becomes active must conform to the new regulations laid out in the bill.  Pretty standard boilerplate.  Politifact, The Kaiser Family Foundation, Rep Waxman, and even the conservative Heritage foundation all called them out on their misrepresentation.

A variant of this claim is sometimes made in which the offender says, “You will not be able to keep your current plan for more than a year after the legislation is enacted” or “if your employer drops your insurance you won’t be able to get your private plan back”.  These claims are even more deceptive because they’re just playing off of the fact that all private health insurance plans will change once the legislation is enacted so technically no plan that existed previous to the bill will continue to exist after the bill in the same form.  So yes, you’ll keep your plan, but technically, when your contract is renewed in the year following the enactment of the bill it would be a “different plan” because its provisions would have changed.  So it’s technically true that your “current plan” will be gone and unavailable, but what they don’t tell you is that it will be replaced by one that’s exactly the same but better.

As an aside, IBD had another embarrasing moment in their healthcare coverage when they claimed in a July 31st article, “People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”   Of course what they apparently aren’t aware of is that Stephen hawking was born, raised, and currently lives in the UK.  His response to the editorial was, “”I wouldn’t be here today if it were not for the NHS,” he told the Guardian. ”I have received a large amount of high-quality treatment without which I would not have survived.”  Indeed, the fact that Stephen Hawkings has survived longer than almost anyone else in history with ALS, all the while under NHS care, seems to demonstrate that IBD is just making things up, both when it comes to basic facts, and their health policy analysis.  It just goes to show that just because someone has a website, and an official sounding name, and an audience, it doesn’t mean they know anything about what they’re talking about.

Myth #4 – A Public Plan Would Lead to Rationing and Long Lines

This is another one of those myths that’s just out there in the ether.  There’s no part of the bill cited when someone makes this claim, and there’s no particular line of reasoning used to justify it that I’ve found.  The myth seems to be driven by a general association between healthcare reform, universal healthcare, socialized medicine, and rationing and long lines ala Canada.

Long Lines

The truth, if you want to call it that, behind this myth is that Canada does indeed have a single-payer, government-financed healthcare system. And they do indeed have longer wait times than we do on elective surgeries (though you rarely hear anyone comment on the associated implication that their wait times are shorter on essential ones).  And for some reason Canada has become the posterboy (girl?) for universal healthcare despite that fact that, once again, every other industrialized country in the world has some kind of universal healthcare.  And many of them have shorter wait times than we do in the US.  As an aside, all this complaining about Canada in connection with universal healthcare is really an impressive accomplishment in selective statistics considering many countries with universal healthcare beat us in nearly every important statistic relating to healthcare quality and healthcare outcomes.  The World Health Organization didn’t rank our system 37th in the world for nothing.  But I’m digressing here.

I suppose the reasoning goes, “Canada has socialized healthcare (single-payer actually but close), Obama wants to institute socialized medicine (not even close), Canada has long wait times (on non-essential surgeries), therefore this healthcare reform plan will lead us to longer wait times.”  It’s a simple line of reasoning and would make sense if not for the detail that every assumption along the way is factually flawed.

Rationing

As for rationing, I have heard some people cite the “comparative effectiveness research” provisions in the bill to support this idea.  Comparative effectiveness research (CER) describes studies that are done for the purpose of determining which procedures are most effective for a given condition. (definition from free dictionary) I think everyone should be able to agree that this is vitally important and it comes as a surprise to a lot of people to know that very little of this kind of research is done.  Obviously for a given treatment there is extensive research available that includes its effectiveness for a condition, but for treatments that address a problem in different ways, or when dealing with combination treatments, those studies aren’t always directly comparable.  So research designed specifically to compare treatment methods is important.

A subset of comparative effectiveness research involves determining which treatments or tests provide more effectiveness for the money.  In other words, in a given diagnostic situation an MRI might cost 20x more than a Chest X-Ray, and CER would be commissioned to determine whether that MRI gives you something like 5 times the accuracy, or a paltry 2% accuracy boost.  If it’s the latter then it would probably be a good idea to reserve that expensive MRI for only those situations in which that extra accuracy is of vital importance.  But it’s this kind of CER that some people say could lead to rationing since, now that they’d have info on which treatments are expensive, they’d refuse to allow the elderly, or otherwise infirm access to those treatments because they’re expected to die soon anyway and they wouldn’t be deemed important enough to waste all that money on.  Apparently this assumes that the American value system has also been drastically altered.

So obviously there’s a large logical leap between funding CER and that kind of heartless rationing.  And I don’t know anybody in the healthcare policy arena who is seriously concerned that CER could lead to something like this.  Both the non-partisan CBO and the Institute of medicine have released reports wholeheartedly endorsing CER and I would suggest that anyone interested in this topic read those two documents as a starting point.

But even if the unthinkable happened, and the public plan started only paying for certain procedures based on some formula that determined who was or wasn’t fit for care, then couldn’t you just change to a private insurance company instead?  Or couldn’t you just pay for the procedure yourself?  The answer is, of course, yes.  Yes you could.  So unless you assume that private insurance is also nonexistant (see myths #5 and #6) this could never really catch on.  And the bill is very clear that the CER findings will be available publicly, but that the information would not be used to force physicians’ hands.  But even if they wanted to, there’s just really no avenue in our current system for enforcing CER findings on physicians since they operate autonomously.

The only situation in which this apocalyptic prediction would be remotely plausible would be if we were in a system in which we had true socialized healthcare (see the definitions in myth 1) and as has already been discussed, there is zero chance of that happening anytime in the foreseeable future.

Myth #3 – This Bill Would Encourage the Elderly to Kill Themselves!

As far as I know, this claim started with Betsy McCaughey on the July 16th epidode of the Fred Thompson radio show.  This was her claim: “Congress would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.”  She says the language can be found on page 425 of the health care bill, Sec. 1233, labeled “Advance Care Planning Consultation”.  Once again, click here to read the bill yourself.  The claim was then parroted by Rush Limbaugh, and has since made its way around through conservative circles.  Notably, I don’t think I’ve heard any actual politicians repeat this one.

First some context, everyone should have in place a document describing their preferences for end-of-life care, a “living will” or “Advanced care directive”.  It should specify whether or not they want to be kept on ventilation, whether they want to be given artificial nutrition, whether they want to be intubated or resuscitated, etc.  And it should be reviewed regularly.  Of course most people do not have such a document. These decisions are not as easy as they might seem on the surface (why wouldn’t you want all possible treatments?).  Many people are concerned about the burden on their families if they’re left in a vegetative state or in an untreatable coma for years, they’re not willing to undergo the trauma of intubation or artificial ventilation, or some simply want to die in a bed surrounded by their families and not “full of tubes” with doctors pounding on their chest while their family watches from another room.  While an advanced directive detailing one’s preferred care is important for everyone to have, it’s especially important for seniors. These are critical issues that come up regularly in care of the elderly and it’s obviously difficult to ascertain the patient’s wishes on this subject once they are in a coma or otherwise incapacitated.

Of course these are difficult subjects to discuss (no one wants to sit down and dwell on their mortality or the possible method of their death) but it is generally agreed upon that it’s best for patients to sit down with their family doctor, who they are comfortable with, to discuss these things while still healthy.  Unfortunately, because medicare and most private insurance plans do not compensate doctors for time spent counseling patients on these issues, and because these kinds of visits tend to be long and FP doctors have crowded schedules, they are not done as often as they need to be.  This means that elderly patients are forced to make these complex decisions in the Emergency room, without time to thoroughly consider their options, or in the prep room immediately before facing surgery.  This adds a huge unnecessary burden to patients at a time when they need it the least and creates tension and uncertainty for families.  In fact many in medicine, especially those who work with the elderly, consider it a tragedy that so many of our seniors have to spend those moments running through a list of unseemly and complex questions about their possible death instead of spending that time with loved ones.

So for years the AMA has been lobbying for medicare to cover these counseling sessions so they can be done properly.  This bill finally gives medicare the power to compensate doctors for these counseling sessions once every five years per patient, or more often if the patient becomes very ill.  These sessions are absolutely NOT mandatory as this radio show suggests (the relevant portion of the bill is a modification of medicare, all of which is voluntary).  They are absolutely NOT designed to advocate for patients to “end their life” sooner or “do what’s in the best interests of society”.  They are for the patients’ benefit, so they can have the opportunity to make their wishes known about how they want to be treated.  They would NOT be performed with a “government agent” but with one’s family doctor.  The counseling sessions discussed in this bill are exactly the same as the counseling sessions that are occurring now, at your doctor’s expense, all across the country.  It’s just that now medicare will pay for them.

It’s worth noting that it was the AARP, amongst others, that lobbied for the inclusion of this provision and after this radio segment was released, this was the response of their national spokesman, “In no way would these sessions be designed to encourage patients to end their lives.”  And he said that McCaughey’s comments are “not just wrong, they are cruel.”  I agree.  While I’m often frustrated by the massive volumes of misinformation being propagated about the current healthcare bill this particular claim infuriates me more than most.  This is something that seniors, and those who advocate for them, have been fighting for for years and to use deceit to encourage fear surrounding this provision in the name of “protecting seniors”, as Betsy McCaughey does here, is pretty despicable.

Myth #2 – The Healthcare Reform Bill Would Force Taxpayers to Pay for Abortions!

Ok, this is a really sneaky one.  And it’s become quite popular amongst the furious town hall crowd (Regarding Healthcare Town Hall Protesters).  As far as I can tell, this rumor was started by the Family Research Council and Focus on the Family (this used to be their website but it seems to be partially taken down now) shortly after the first iteration of the house bill was released.  And it was quickly repeated by John Boehner and echoed in town halls across the country.  The argument goes like this, “sure, the House bill doesn’t contain any mention of abortion, but that’s just the trick.  Because it’s not expressly forbidden, those wily democrats are going to ensure that the public plan covers abortion on demand and then we’ll all be paying for these immoral procedures.”

Now that should come off as a bit of a stretch in and of itself.  But it’s shown to be an outright distortion when we consider the facts.  First off, I think Republicans often make the mistake of assuming all democrats are pro-choice, which is clearly not the case.  Democrats are not nearly as united on abortion issues as republicans are and even NARAL points out that despite the healthy democratic majorities in both houses, anti-abortion legislators still outnumber pro-abortion legislators in each.  So the assumption that Democrats are out to promote abortion at every opportunity is questionable to say the least.

But there are more problems with the assumption that the bill’s silence on the subject indicated a pro-abortion agenda.  In the finals days leading up to the production of the initial version of this bill, talk about what to include about abortion started to bubble up.  At the time Nancy Pelosi was quoted saying that they didn’t want to try to tackle abortion through healthcare reform and that their goal with that bill was to simply leave things the way they are now.  And Obama himself, in a CBS interview said, “As you know, I’m prochoice. But I think we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care. Rather than wade into that issue at this point, I think that it’s appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.”  Indicating pretty clearly that subversively introducing something as contentious as tax-payer funded abortions was not the goal at all.  It’s also worth noting that the federal employees health insurance program, which this reform is based on, does not allow tax dollars to be spent on abortion.

So we’ve established that the assumption that the bill’s silence on abortion was a signal of a coming abortapocalypse is a shaky one, but even if by some chance the public plan ends up covering abortion this myth still wouldn’t make any sense.  Because as I indicated earlier, the Public Plan, despite its name, is not funded with taxpayer money.  It’s self sustaining.  So whether or not the public plan covers abortion is irrelevant.

A “smarter” version of this myth was popular amongst republican members of the house and senate who were basically arguing that since tax credits would be given to millions of Americans to purchase healthcare, and some of those people will choose to purchase private insurance plans that cover abortion, taxpayers will end up funding abortion through that convoluted means.  The democratic response to this was to ask, “what about the grant money we give to students?  The tax credits for new home buyers?  The salaries of government employees?  Should we be monitoring these things to make sure none of that money is used to fund abortions?”  One democratic senator asked, with no small amount of sarcasm, “should we ban women from driving to abortion clinics lest our taxpayer-funded roads facilitate an abortion?”  The point being that there has to be a limit to how many levels out we can go while still labeling something “tax-payer funded abortion”.  I tend to agree that trying to ensure that nobody uses tax credits to purchase a private insurance plan that might pay for somebody’s abortion is going a little far.

But, as evidence of their moderation on abortion issues, the democrats in the House disagreed with me, and Rep. Bart Stupak, D-Mich. offered an amendment to the House health care proposal shortly after it was completed that would have prohibited the use of public money “to cover any part of the costs of any health plan that includes coverage of abortion.” The amendment was narrowly defeated.  But soon after, Rep. Lois Capps, D-Calif. introduced an amendment that did pass (found here).

From Politifact.com:

Under the Capps amendment:

* Abortion coverage would not be part of the required minimum benefits package. In other words, insurers would not be required to offer, or be prohibited from offering, abortion services in order to participate in the exchange.

* The public plan could include abortion coverage, but the cost of the additional coverage could not be paid through public subsidies (tax dollars), only through the premiums paid by the insured. And with private plans in the exchange, again, federal subsidies could not be used for abortion coverage.

* Public funding would only be permitted for abortions allowed under the Hyde Amendment — in cases of rape, incest or when the mother’s life is in danger.

* At least one plan in every region must offer full abortion coverage; and one must not.

* Any insurance plan participating in the exchange cannot discriminate against hospitals or other health care facilities (such as Catholic hospitals) that are unwilling to provide abortions.

* The plan will not pre-empt any state laws regarding abortion, such as parental notification laws.

It should be noted that the Hyde Amendment referenced there has been in place since 1976, and forbids federal funds from being used for abortions through Medicaid except in cases of rape, incest or when the mother’s life is in danger.  So the Capps amendment essentially ensures that nothing will change in regards to abortion and tax-payer funds.  Of course the House bill is still in flux, and will eventually be combined with the Senate bill.  But considering the fact that this amendment easily passed in the more liberal House, it’s hard to imagine it will not be included, or even made more restrictive in the final bill.

Of course the eventual passage of this kind of amendment surprised nobody, since this was the stated goal of DC leaders from the beginning.  But these organizations took advantage of the few days between when the bill was completed and the amendment was passed to present their forced and contradictory conspiracy theory, knowing that the general public would be immediately enraged.  It’s apparent that their goal is defeat of the healthcare reform bill for political reasons and they knew that by shifting the debate to something as contentious as abortion, they could rally their troops.  It worked wonderfully and now here we are, weeks after abortion foes have won the amendment they wanted, and posters claiming that healthcare reform will lead to federally funded abortion are still a mainstay of town hall protests.

Myth #1 – Death Panels

When I began planning this article I was going to make this whole “Death panels” thing a humerous bonus at the end.  You know, something so far out there that nobody would take it seriously.  But then it actually caught on!  It is thrown around now by elected officials!  This one was started by none other than Sarah Palin, in a rant on her Facebook page of all places.  She said:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,..Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.”

The first thing that should set off alarm bells here is her endorsement of Michele Bachmann.  Whether republican or democrat we should all be able to agree that Michele Bachmann is crazypants.  As far as I’m aware, she has the Politifact record for highest number of “False” or “Pants on fire” ratings at 6/6. And they haven’t even gone after some of her craziest ones like her claim that “The stimulus carries a provision that would force kids into reeducation camps”. I mean we talk about extremists making poor predictions, well she’s as extreme as they come and I have yet to see one of her predictions pan out in any form.

The second thing that should set off alarm bells is that it’s all obviously made-up.  Understandably, everybody seemed initially baffled when Palin put this out, and even conservatives didn’t react kindly.  David Brooks dismissed her comments as “crazy” adding that “the crazies are attacking the plan because it will cut off granny. That is simply not true, that simply is not going to happen.”  And GOP Rep Jack Kingston (GA) said “It’s a scare tactic, no question about it,” adding that there are clearly no death panels.  And Republican Senator Johnny Isakson called her assertion “nuts” in a washington post interview. But a few short days later Newt Gingrich endorsed this idea.  While he carefully avoided saying that he thought her statement was accurate, he expressed sympathy for the idea and encouraged a kind of generalized fear around anything government related.  Then Senator Chuck Grassley stepped forward endorsing the idea as well.  Once again, he didn’t want to go on record using the terms “Death panel” or anything like that but he defended Sarah Palin’s claim and told an audience, “you have every right to fear” in reference to end-of-life counseling.  That’s all it took to turn “Death Panels” into the new headline on certain news stations, to inspire several frothing-at-the-mouth death panel rants from Glenn Beck, and to turn the phrase into the new claim de jour on protestors’ signboards across the country.

After numerous fact checking organizations demonstrated that Palin’s statement was pure fiction (with the trusty politifact.org calling it “a Sci-Fi Scenario not based on reality”), Palin slammed her critics (as is her wont) in a new statement.  But this time made a different claim, stating that while it might not be in the bill, one obscure, misunderstood quote from someone on Obama’s staff validates everything she said.  Unfortuantely for her this claim is also demonstrably false.  And unfortunately for America, nobody in the mainstream media is bothering to correct her.

But her claim did get her a daily show clip based off of her comments, which ended up being pretty hilarious.  So I leave you with this clip as a conclusion, and as a reward for making it through this enormous mass of text.  Feel free to skip to 1:30 in the video if you want to skip right to the death panel discussion, and bypass some censured cursing:

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Of all issues in politics, this one is probably most dear to me.  No I’m not talking about healthcare, though that may be a close second, I’m talking about maintaining and improving the quality of our political dialogue.  For those who don’t know, healthcare town hall meetings have been held over the last week all across the country, and small groups of radical protesters have shown up at many of them with the express goal of “shouting down” their elected leaders.

To be clear, I have absolutely no problem with somebody being against the current healthcare bills being developed in congress.  If they’ve researched the issues thoroughly and have cut through the mists of misinformation and still come out thinking its not the best idea for America then more power to them.  I would welcome those people at a healthcare town hall and I would encourage them to go and speak their mind, even forcefully if they feel its appropriate.  But that’s not what this is.  This is just mobs of people screaming slogans and platitudes.  It’s people who are clearly unfamiliar with the content of the healthcare bill chanting things like “read this bill” for half an hour while their elected leader tries in vain to explain to them that they actually have read each and every iteration of the bill.  This news article, after the jump, will give you a picture of what’s going on:

From the St. Petersburg Times:  ”TAMPA – Bitter divisions over reforming America’s health care system exploded Thursday night in Tampa amid cat calls, jeering and shoving at a town hall meeting.

“Tyranny! Tyranny! Tyranny!” dozens of people shouted as U.S. Rep. Kathy Castor struggled to talk about health insurance reforms under consideration in Washington, D.C.

“There is more consensus than there is disagreement when you get right down to it,” Castor offered, immediately drowned out by groans and boos.  She pressed on, mostly unheard among the screams from the audience of more than 200.

“Tell the truth! Tell the truth!”

“Read the bill!”

“Forty-million illegals! Forty million illegals!”

The spectacle at the Children’s Board in Ybor City sounded more like a wrestling cage match than a panel discussion on national policy, and it was just the latest example of a health care meeting disrupted by livid protesters. Similar scenes are likely to be repeated across the country as lawmakers head back to their home districts for the summer recess.

Thursday’s forum/near riot was sponsored by state Rep. Betty Reed, D-Tampa, and the Service Employees International Union, who apparently had hoped to hold something of a pep rally for President Obama’s health care reform proposal.

Instead, hundreds of vocal critics turned out, many of them saying they had been spurred on through the Tampa 912 activist group promoted by conservative radio and television personality Glenn Beck. Others had received e-mails from the Hillsborough Republican party that urged people to speak out against the plan and offered talking points to challenge supporters…

She [Castor] left before the forum ended, which drew more boos. State Rep. Reed said she encouraged Castor to leave because nobody could hear her any way.”

Clearly shouting things like “tyranny!” and “tell the truth!” adds nothing to the debate.  And I’m still scratching my head about the “forty-million illegals” thing.  Are they under the impression that the bill would give free healthcare to illegal immigrants?  Because it specifically denies them healthcare subsidies.

Another important issue is the one brought up at the end of the article.  While some members of congress and certain partisan news organizations are trying to pass this off as a grassroots movement of citizens, it’s become clear that they’re nothing more than an organized group of traveling protesters, moving from town hall to town hall to create a public spectacle.  The conservative organization “Freedomworks” has already taken credit for several of the protests and has proudly posted a video of protesters shouting at a befuddled Arlen Specter, labeling it a “must emulate”.  They’ve also bragged about how their members have driven as much as 4 hours to disrupt town halls in other districts.  And the group “Conservatives for Patient’s Rights” has also admitted to being behind many of the protests, even going so far as providing lists of slogans and phrases for their members to shout out and encouraging people to interrupt and “drown out” their public servants.  Obviously there’s nothing wrong with organized protests, but it does irk me some when they then vehemently deny that they’re anything but regular ole town hall attendees.  Its very reminiscent of the Tea Parties that FoxNews and Freedomworks organized and promoted for months, and then covered as “an inspiring, spontaneous, grassroots call for liberty”.  But more than simply being dishonest, these shipped-in protestors deny the real constituents of that district their opportunity to participate.

To those who may be sympathetic towards these protesters, or who may be warming up their lungs for a town hall appearance of their own, I submit for your consideration this quote from one of our great founding fathers, John Adams:

“I fear that in every assembly, members will obtain an influence by noise not sense. By meanness, not greatness, By ignorance, not learning, By contracted hearts, not large souls.
There is one thing, my dear sir, that must be attempted and most sacredly observed or we are all undone. There must be decency and respect, and veneration introduced for persons of authority of every rank, or we are all undone. in a popular government, this is our only way”
–John Adams, from a letter to one of his constituents.

Is that really too much to ask?  While I was no fan of President Bush’s policies I always cringed when protesters would hold up signs comparing him to hitler, or when I’d hear someone call him an “idiot” or “ignoramous”.  And I cringe now that the tables have turned and it seems that in less than 6 months our country is already more comfortable disrespecting our elected leaders than we were 6 years into the Bush administration.  I mean seriously, when did we get to the point that a very friendly looking man like the one in the picture above feels comfortable being photographed while hanging his congressman in effigy at a town hall meeting?  Certainly this is not the direction our country should be headed in, and its not the kind of political discourse our founding fathers hoped we’d be engaging in 200 years later.  Whether you like your leaders or not, they were elected fairly and justly through the rules of representative democracy.  And whether you feel like their opinions mirror your own or not, to disrespect them to this degree is to disrespect the system laid down by our founding fathers.

Even pushing all that to the side, this kind of incivility is just plain stupid.  These protesters are complaining that their voice isn’t being heard and when they have the opportunity to make their concerns known directly to their elected leaders they opt instead to hurl insults and angry non sequiturs, missing an opportunity to contribute thoughtfully to the discussion and instantly identifying themselves as solution-less obstructionists.  Healthcare reform is an exceptionally complex issue, and the bills going through congress are actually impressively moderate.  There are certainly elements of them that are controversial, but as US Rep Kathy Castor tried to tell her incensed Tampa crowd, “There is more consensus than there is disagreement when you get right down to it”.  I think most people, including conservatives,  would find upon actually studying these bills that there is a lot to like.

So please, lets all calm down and take a deep breath.  If you’re concerned about healthcare reform then get educated using balanced and unbaised sources (this post: Some Basic Info on the House’s Healthcare Reform Bill  will get you started).  Then if you find that once you understand the bills circulating congress you still oppose them then by all means work to modify or even defeat them.  But please do so thoughtfully, with civility, sans fear-mongering and hyperbole, and with a healthy respect for those who disagree, and those your community has chosen to represent you.

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Well needless to say there’s a lot going on in the healthcare arena lately.  In case you missed it, the House of Representatives released their healthcare bill last week.  I’m planning on writing up my analysis of it but unfortunately I’ve got midterms early next week so you’ll all have to wait a week or so for that.  But in the meantime I thought I’d provide some basic information about what the bill contains since I’ve had several people recently express frustration to me that they don’t know where to get an objective description of the contents of the bill.  So I’ve provided some helpful links after the jump.

The text of the bill can be found here:

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Its 1018 pages. So they have prepared summary sheets of the most important points, broken down by topic:

Public plan: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-PUBLICOPTION-071409.pdf

Guaranteed Benefits: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BENEFITS-071409.pdf

The Health Insurance Exchange: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-EXCHANGE-071409.pdf

Making Coverage Affordable: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-AFFORDABILITY-071409.pdf

Paying for Healthcare Reform: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-PAYINGFORHEALTHCAREREFORM-071409.pdf

And finally, here’s the CBO’s (Congressional Budget Office) analysis of the bill. They’re a non-partisan research organization that does forecasting for congress:

http://www.cbo.gov/ftpdocs/104xx/doc10430/House_Tri-Committee-Rangel.pdf

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So California’s budget woes have been going on for months now but the time for action is quickly growing near.  Unfortunately, while everyone agrees that action is necessary, nobody can agree on what those actions should be.  We’ve got a 26.3 Billion dollar gap still to close and accomplishing that in a bi-partisan way is looking to be nearly impossible.  Of course listening to statements from either side makes it seem so easy, “Just cut out our wasteful spending already!” or “Just raise taxes on the rich to where they belong!”.  But when you find out that if we were to, for example, cut all state funding for the UCs and CSUs it would still only save us 1.5 Billion or that raising corporate income taxes would only net us 430 million, it starts to look a little more complex.  Obviously a mixed approach will be necessary, at least until the economy begins to recover and the state’s income returns to normal levels.

The LA times has a very interesting little program on its website that allows you to try your hand at solving CA’s budget crisis.  It can be found here:

You Balance the Budget – LA Times

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While politicians hammer out the details of healthcare reform legislation and debate some of the more “controversial issues” (which I put in quotes because they shouldn’t be as controversial as they are) surrounding healthcare reform, the administration is busy doing things that everyone should be able to happy about.  Of course good news doesn’t draw as many readers as doom and gloom so its easy to miss some of these developments if you’re just clicking through a news website or taking in a bit of CNN, so I’ve highlighted a couple of the recent positive developments after the jump.

Key Senator, White House Strike Deal With Drug Industry for Health Coverage

First up is an article from several weeks ago.  And I apologize for using partisan news sources but I’ve got one from each side of the aisle so I guess it balances out.  Basically, Senator Max Baucus was able to negotiate a deal with the Pharmaceutical industry whereby they will eat some of the cost of drug coverage for seniors on medicare who make less than 80-85,000 per year.  They’re expecting to subsidize about 80 billion dollars worth of care over the course of the next ten years.  Not too shabby.

Biden, Hospital Leaders Announce Pact To Help Cover Uninsured

Next up is an article from today.  Joe Biden announced that the nation’s hospitals had agreed to comp 155 billion dollars worth of medicare and medicaid care over the course of the next ten years.  Nice.

These developments, along with the pledge from leaders of the healthcare industry a few months back (Titans of Healthcare Pledge to Reduce Healthcare Costs) are good news for members of congress as they attempt to draft legislation that is “budget neutral”, they’re good news for the country since healthcare costs are the primary drivers of our dismal deficit projections, and its good news for average Americans, who for some time now have been dealing with healthcare costs that are rising at more than three times the rate of their wages.

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Well its been a while hasn’t it?  Sorry about that.  I’ll be posting with more regularity in the future.  As many of you know I recently got back from an AMA conference in Chicago and it was a surprisingly eye-opening experience in a lot of different ways.  There’s no way I can cover it all in one post so I’m just going to talk about one of the issues that was discussed at this meeting.  There is a now-famous article that was recently published in the New Yorker entitled “The Cost Conundrum” which analyzes some of the drivers of high healthcare costs.

Everybody was talking about this article.  The President of the AMA called the article a “watershed moment” for healthcare reform.  Supposedly President Obama had everyone on his healthcare team read the article.  So if you have even a passing interest in healthcare policy and reform, you should probably read it too.  So for your enjoyment I’ve posted a link to it after the jump.

But first, a quick warning.  While I think this article is extremely important and talks about an often-overlooked issue driving healthcare costs, we should keep in mind that it brings attention to this issue by focusing on an extreme case.  The behavior of the doctors in McAllen TX discussed in this article is in no way typical.  They are identified as an unusual case in the article but its still important to keep that idea in mind.  And the way this is portrayed as almost the sole driver of rising healthcare costs near the end is a bit misleading.  I don’t think very many people studying the economics of healthcare would speak quite so strongly.  And finally we should keep in mind that this is not a new problem, but has been talked about by organized medicine for years now.  There are plenty of physicians who support the principles laid out in this article.  In fact some companies, particularly in California (Kaiser), long ago embraced the capitated model recommended by this author (there’s even a mention of Sacramento as a “low-cost city”!)

So my point is, this article rips a lot on doctors.  Some of it is warranted but it uses extreme examples and a bit of hyperbole to make its case, without really acknowledging the work physicians have already been doing for a while to solve this problem.  With that said it brings attention to an important issue and makes recommendations that I (and many other students and physicians) wholeheartedly support.  So with no further delay, your article awaits.

The Cost Conundrum by Atul Gawande

ps – its really long.

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Breaking News!  Tomorrow morning Pres. Obama is expected to announce that he has chosen John Huntsman Jr., governor of Utah and moderate republican as the new ambassador to China.  And sources say Governor Huntsman has accepted the ambassador position.  He learned Chinese while serving a mission for the church in Taiwan and he has an adopted daughter from China.  He also served as Ambassador to Singapore under President George H.W. Bush and worked in the Reagan Whitehouse.  I’ve always liked Gov. Huntsman and he seems to be extremely qualified for this position.  And I’m pleased to see Pres. Obama reaching across party lines to appoint more Republicans to important positions.  The full article follows:

SALT LAKE CITY — President Barack Obama intends to name Utah’s Republican Gov. Jon Huntsman, seen by many as a potential GOP presidential contender, to be ambassador to China, a source close to the governor said Friday night.

The popular moderate governor has accepted the appointment, said the source, who would speak only on condition of anonymity ahead of a White House announcement expected Saturday. Repeated messages to Huntsman’s spokeswoman and other staffers went unreturned Friday. The White House would not confirm the nomination.

Huntsman, a two-term governor, is fluent in Mandarin Chinese from his days as a Mormon missionary in Taiwan. One of his seven children, Gracie Mei, was adopted from China in 1999 after she was abandoned in a vegetable market.  He made headlines recently for encouraging the Republican Party to swing in a more moderate direction if it wanted to bounce back from the 2008 elections, angering some conservatives.

Obama’s 2008 campaign manager, David Plouffe, said Huntsman is a Republican who “seems to understand the party has to adjust _ not stubbornly believe that everything is OK and it is the country that has to change.”  Huntsman’s positions on the environment and other issues have led some to consider him a potential contender for president in 2012.

He signed an initiative that would set a regional cap-and-trade effort to reduce global warming. In a 2006 speech at Shanghai Normal University, Huntsman spoke of the need for China and the U.S. to work together on environmental issues.  ”The United States and China must be good examples and stewards of the Earth. We must match economic progress with environmental stewardship. The effects of industrialization are felt worldwide,” Huntsman said then.

Throughout his tenure as governor, Huntsman’s background as a diplomat has been evident. He preferred to win over opponents in private meetings rather than using his bully pulpit to give rousing speeches.

One of his most significant achievements was loosening the state’s restrictive liquor laws over the objections of many in heavily Mormon Utah in an effort to make the state more appealing for visitors. It was a feat many here didn’t think would be possible in Huntsman’s lifetime.  However, Huntsman has drawn the most attention for stating he favors civil unions for gay couples even though he backed a state constitutional amendment passed in 2004 that prohibited same-sex marriage.  Huntsman’s comments on civil unions drew the ire of conservatives in his own state and elsewhere.

Officials in Michigan last month canceled a GOP county fundraiser where Huntsman was to speak; they said he had abandoned important party principles.

Huntsman’s career began as a staff assistant in the Ronald Reagan administration and he also served as ambassador to Singapore under President George H.W. Bush and as a deputy U.S. trade representative and U.S. trade ambassador under President George W. Bush.  Utah’s only Democratic member of Congress, U.S. Rep. Jim Matheson, said he was pleased with the appointment. “It’s a great bipartisan appointment by the president,” he said.

Before becoming governor in 2005, Huntsman made millions serving as chairman and CEO of his family chemical company.  If confirmed by the Senate, Huntsman will succeed Clark Randt as U.S. ambassador to China.

Randt, a classmate of former President George W. Bush at Yale University, served as Washington’s top envoy to Beijing from July 2001 until January, making him the longest-serving U.S. ambassador to China since the two nations established diplomatic ties.

Utah Lt. Gov. Gary Herbert would become governor until a special election in 2010.

-Huffington Post

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Well while I’m on the topic of the future of Healthcare here’s another one for you.  The CEO of the CMA, Joe Dunn, came and spoke at the UCD School of Medicine several weeks ago and he gave a great speech.  And now, through the miracle of technology, that speech is available to all of you!  His speech was directed towards medical students but it really has relevance to anyone who wants to get something done in politics.  Its long but he’s a very engaging and entertaining speaker and the speech really gets better as it goes along so if you have the time its definitely worth watching it through.  You would be hard-pressed to find a better primer on how things get done in government.

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