Unsilent Generation

Catholic Bishops’ Faustian Bargain: “Burn Health Care Reform” to Advance Anti-Choice Cause

November 9, 2009 · Leave a Comment

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Ad from the U.S. Conference of Catholic Bishops

We now know that the U.S. Conference of Catholic Bishops, which in the end run reports to Rome, was intimately involved in the crafting and promotion of the Stupak Amendment, which turned a tepid health care victory for the Democrats into a serious loss for women’s reproductive rights. Jessica Arons, director of the Women’s Health and Rights Program at the Center for American Progress Action Fund, writes today that the measure “potentially goes farther than any other federal law to restrict women’s access to abortion” by effectively guaranteeing that virtually all insurance plans will refuse to pay for the procedure in the future.

Jon O’Brien, president of Catholics for Choice, despairs of what he calls the American bishops’ “obsession” with sex and sexual politics. In an interview today, he said these bishops are supposed to be dedicated to the sick, poor, and vulnerable, all of whom desperately need decent health care. Yet they have shown themselves willing “to burn health care reform” over the abortion issue–a postion that places them out of line with the majority of lay Catholics.

O’Brien points out that a recent poll, commissioned by the organization, shows that “while Catholic voters are split on President Obama’s ideas for healthcare reform, they do want to see costs lowered and overwhelmingly support a government plan that would make health insurance available to the uninsured.” In addition:

Catholic voters believe the US Catholic bishops are wrong on healthcare reform. Sixty-eight percent disapprove of US bishops saying that all Catholics should oppose the entire healthcare reform plan if it includes coverage for abortion and 56 percent think the bishops should not take a position on healthcare reform legislation in Congress.

Despite what many conservatives argue, Catholic voters are against refusal clauses for institutions that take taxpayer dollars. Sixty-five percent said that hospitals and clinics that take taxpayer dollars should not be allowed to refuse certain procedures or medications based on religious beliefs. In addition, 60 percent believe that hospitals and clinics that take taxpayer dollars should be required to include condoms as part of HIV prevention.

The poll also found that “large majorities of Catholic voters support health insurance coverage for abortions—either in a private or a government-run scheme” in order to protect the life or health of the mother, in cases of rape and incest, or when tests show a fetus has a severe abnormal condition. And they are evenly split, 50-50, on “whether insurance plans should cover abortion whenever a woman and her doctor decide it is appropriate.” 

pope 1What this means is that American public policy on health care and reproductive rights is being shaped not by a majority of voters or even a majority of Catholic voters, but by a bunch of celibate men in robes, and a reactionary 82-year-old German in the Vatican.

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Anti-Abortion Amendment Puts Church Before State

November 9, 2009 · Leave a Comment

It’s a little difficult to believe, but the shrieking anti-abortion Protestant nutcases seem to have had less influence over the current health care legislation than the the more sedate, no-nonsense bishops of the Catholic Church. The Stupak Amendment, which promises to limit access to abortion in ways the Hyde Amendment never could, was promulagated by a devout Catholic Democrat, who managed to persuade 63 other members of his party to vote along with him. Some were apparently willing to scuttle the whole bill unless they got their anti-choice measure included. According to a Politco report, the Conference of Catholic Bishops was very much involved behind the scenes:  

“Pelosi wasn’t the only one getting pressure on the amendment. As rumors spread that Republicans might vote ‘present’ in order to scuttle the entire bill, even Cardinal Francis George, archbishop of Chicago and president of the U.S. Conference of Catholic Bishops, called Republican leader John Boehner to make sure the GOP didn’t play any games with the Stupak (abortion) amendment, sources said.”  

Does this mean that in addition to the insurance industry, big Pharma, the doctors and hospitals, and the like, we must wait for His Holiness to weigh in?

While waiting for things to sort themselves out, it’s well worth reading the statement issued Saturday evening by Center for Reproductive Rights  in New York on the potential impact of the Stupak Amendment:

This evening, the House of Representatives voted for health care legislation that requires women who are insured through the Exchange to purchase riders for coverage of abortion services and eliminates abortion coverage in the public option altogether. Nancy Northup, president of the Center for Reproductive Rights, issued this statement in response:

Tonight’s vote in the House is a stunning assault on women’s health and rights. In a matter of hours, our elected officials have fallen hook, line and sinker for the anti-choice position, dispensing with a credible compromise on abortion and adopting a bill that would leave millions of women worse off than they already are today.American women demand that members of the Senate refuse the political bait which sullied the House vote and protect women’s health. Health care reform is supposed to provide affordable health care coverage to all Americans. Yet for women, this legislation gives with one hand and takes away with the other, forcing millions to buy insurance that does not meet all of their medical needs.

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Democrats Won a Health Care Battle—But Are Losing the War

November 7, 2009 · 2 Comments

On the House floor Saturday night, Nancy Pelosi managed to muster enough votes to pass a health reform bill, in what’s being widely celebrated as a great victory for the Democrats. (Pelosi herself has even compared it with the passage of the Social Security Act in 1935 and the Medicare Act in 1965.) But while Republicans may have lost this battle, they continue to take their shots in what’s clearly a larger war. Lindsay Graham has already pronounced the bill “dead on arrival” in the Senate. And in the House, as the debate wore on, one after another, GOP members of Congress rose to denounce the Democratic health care plan as a socialistic plot that will lead to government-run medicine and bankrupt the country. While they were at it, many also took the opportunity to blame Democratic policymaking for the rising unemployment figures and the continuing recession.

It’s the height of gall, of course, for Republicans to lay any of our economic woes at the feet of the current administration. The frenzy of deregulation and speculation that have left a reported 10 percent of Americans without jobs (and in reality, closer to twice that figure) can be traced directly to conservative policies, which got a leg-up during the Clinton years and flourished under Bush. So why can’t the Democrats seem to fight back? In part, perhaps, because they aren’t willing to engage in the kind of all-out, brazen, incendiary lying that’s become commonplace within the GOP. But there are other reasons, as well.

I know the prevailing opinon among the mainstream punditocracy is that Obama is in trouble because he is trying to do  too much, too fast. I think it’s the other way around. There’s no doubt that the president faces tough opposition, much of it fueled by the kind of ignorance and racism that nearly impossible to quell. But they still do, after all, control a majority, both in Congress and among the American public. What makes Democrats most vulnerable to conservative attacks is the fact that they have no compelling message of their own to offer—and nothing to match the soaring rhetoric of the Obama campaign. Instead, they tiptoe cautiously down the middle of the road, and wonder why no one feels terribly inspired to follow them. 

Take their health care legislation. When Obama addressed the Democratic caucus on the Hill this morning, they reportedly responded with “scattered chants of ‘Fired up, ready to go.” But fired up is exactly what reform supporters are not. There’s nothing in the bill to inspire any fervor on the left that could rival the tea parties. In fact, Republicans are partly right when they say that it won’t do much of anything but run up the deficit. The reason for this is not, as they claim, because it’s a socialistic big-government plot to take over the private medical system; the reason is that it isn’t any of those things–not by a long shot. The Democratic legislation is a costly, futile mess precisely because it refuses to rein in the industries that have been ripping off the American public year after year.

Obama and the Democrats have no real vision for a transformed health care system, so they’ve gone for a slightly modified version of business as usual. They’ve cut backroom deals that win a few meager concessions toward the public good, while at the same time ensuring the profits of the insurance companies, Big Pharma, and other health care profiteers by maintaining their basic control of the health care system and rewarding them with bigger assured markets and more and more money. (To make matters worse, at the last minute they also cut a deal with anti-choice members of their own party that will further undermine women’s access what was, when I last checked, still a legal medical procedure.) In other words, they’re doing what Democrats have done since at least the Clinton years–acting like kinder, gentler Republicans, rather than like the defenders of the common people.

A whole lot of Americans don’t like the current health care system, and a whole lot more hate insurance companies. The Democrats might have been able to translate that into some sort of populist support for real change. Instead, they dithered and compromised, and failed to invoke any compelling ideology. Health care ought to have nothing to do with profits. It should be a basic human right in a civilized society. But that’s precisely the kind of statement the Democrats are unwilling to make—so they end up saying nothing at all.

Likewise, the Obama White House has yet to take any strong, principled action against the forces responsible for wrecking the economy. And how could it, since it is staffed by the old Clinton economic team that set the financial debacle in motion a decade ago? At the root of the economic mess was the decision to rip down Glass-Steagall, the law that separated Wall Street from commercial banking. One of the men at the center of that endeavor was Larry Summers. And having been a prime cause of the recession, where is Larry Summers today? Ensconsed in the White House, running the Obama economic program.

There was a time, shortly after Obama took office, when a rising populist rage at Wall Street greed might have been harnassed to fuel some genuinely meaningful regulatory action. Instead, with men like Summers and Tim Geithner at the helm, we’ve seen Wall Street recover while Main Street continues to suffer. We’ve seen a large portion of the stimulus funds chanelled through the private sector, where they’ve yet to trickle down to the people who need help most. Obama says his goal is for every American who wants a job to have one. So why not start creating government-funded jobs, as FDR did in the early years of the Depression? Why not launch federal projects to create a new green energy industry, instead of waiting for the energy monopolies to come up with a way of making a killing off it?

Obama was elected because people took him seriously when he said sought real change. So why won’t he take bold action on any of these fronts? Is it because if he did, the Republicans would abandon him and crush his dream of bipartisanship? Or because he doesn’t want the Democratic party to lose electoral ground among the so-called swing voters? Or because he’s afraid of being branded a crazy maniacal socialist? Oh, wait—all those things have happened already. So what does the president have to lose? If he’s going to be called a radical when he’s acting like a timid moderate, why not be a little more radical (or mildly progressive, even) in service of the public good? Then he might actually bring about some change we could believe in.

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House Prepares to Vote on Health Care Reform

November 7, 2009 · Leave a Comment

Following are excerpts from an analysis by Dr. John Geyman, professor emeritus of family medicine at the University of Washington School of Medicine in Seattle and a past president of Physicians for a National Health Program, on the House bill up for a vote this weekend. Geyman acknowledges that the legislation will “introduce some limited reforms to the health insurance market, expand health insurance to some of the uninsured (primarily by expansion of Medicaid and by often-inadequate government subsidies to individuals and small employers for the purchase of private insurance); and help to address some other problems, such as the growing shortage of primary care providers.” But he nonetheless concludes that “the bill is not good enough to pass.”

• Although supporters of the new House bill claim that it would expand coverage for as many as 30 million uninsured, we are actually likely to see an increase in the number of uninsured in coming years for these kinds of reasons—as costs keep going up, many Americans will be forced to drop their present coverage because of inability to afford rapidly rising costs of premiums, deductibles and co-payments; there is no guarantee that the uninsured will be able to afford new private coverage (even with subsidies, which won’t kick in for another four years); and expansion of Medicaid will not take place until 2013 (many states are already pushing back with concerns that the their recession-strained budgets will not allow them to pay their share in adding to their Medicaid programs, potentially leaving millions of the poorest Americans uninsured.

• There are no effective cost containment mechanisms built into the bill, either for the costs of health insurance or for health care itself. As it whines about weakening of the individual mandate that will likely limit some of its big increase in the insurance market, the health insurance industry is already warning that sharp premium increases will result. The most the bill will do is to require disclosure and review of premium increases, without any regulatory teeth. Although the bill would set up a Health Benefits Advisory Committee to recommend a minimal essential benefits package (with four tiers), insurance industry lobbyists will argue for the most minimal levels of coverage, and we can anticipate an exponential growth in underinsurance. Moreover, there are no price controls to be applied anywhere in the system, except perhaps in authorizing the government to negotiate drug prices with manufacturers. But that provision will almost certainly not clear the Senate, where we can expect even less concern for affordability and prices.

• Although the public option has been the target of intense controversy, it will play a negligible role in health care reform. The CBO has concluded that it would cover no more than 6 million Americans, just two percent of the population, in 2013, and will cost more than private programs, mostly due to adverse selection in attracting sicker individuals and its inability to set reimbursement rates for physicians and hospitals as is done by Medicare. Moreover, middle-income families may be required to spend 15 to 18 percent of their income on insurance premiums and co-payments.

• HR 3962 will not result in making health care more affordable, despite allocating some $605 billion over ten years for subsidies to low- and middle-income Americans to buy insurance on Exchanges. We can count on continued increases in the cost of health insurance as far as the eye can see, together with less actuarial value of coverage.

• Buried in the fine print of this monster bill are many provisions that will benefit corporate stakeholders in the medical industrial complex on the backs of patients and their families. These examples make the point:

• Although medical loss ratios (MLR) (the proportion of premium revenue actually spent on medical care) are specified at a minimum of 85 percent, this loophole has been added–”while making sure that such a change doesn’t further destabilize the current individual health insurance market.” By way of comparison, the Senate Commerce Committee has found that the average MLR for the largest insurers in the individual market is only 74 percent, with 26 percent of premium revenue going to marketing, administrative overhead and profits.

• Although the bill would create a much-needed Center for Comparative Effectiveness Research, it would have no say over reimbursement and coverage policies. As the bill says, it “contains protections to ensure that research findings are not construed to mandate coverage, reimbursement or other policies to any public or private payer.”

In sum, this $1.055 trillion plan over ten years will not fix the major problems of cost and affordable access to health care in our deteriorating system, will add new layers of bureaucracy and complexity to the present system, is not fiscally responsible, and is not sustainable.

What to do now? Rather than accept an unworkable bill that is politically expedient, we would be better off to make a major course change. That vote could take place as early as tomorrow.

If that fails, shelving this bill would be the best option. Until a few days ago, I would have added that lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-Ohio) to allow states to experiment with single-payer plans, as a number of states would like to do (e.g. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania) . Although that amendment had already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee, it has been stripped from the bill.

The best first option would be to call for a floor vote, as originally promised by the House Speaker Pelosi, for the amendment proposed by Anthony Weiner (D-NY) to substitute HR 676, a single-payer proposal, for HR 3962. If that fails, shelving this bill would be the best option, but if that is not possible, lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-OH) to allow states to experiment with single-payer plans, as a number of states would like to do (eg. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania) .

That amendment has already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee. Whether a health care bill survives the end game in both chambers of Congress in this session is still up in the air. If a bill is finally enacted into law, however, it will be ineffective in remedying the big problems of cost and access to health care. We should be gearing up for an intense effort in 2010 to push for real health care reform–Medicare for All.

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Republicans Think We All Have Munchausen Syndrome: GOP Health Care and the Myth of “Overuse”

November 6, 2009 · 1 Comment

Earlier today I wrote about the Republicans’ claim that most Americans are “over-insured.” This, they say, is the real problem with our health care system, because it encourages people to have “unnecessary” and costly treatments.

This claim, in turn, points to an enduring myth about health care that has yet to be seriously challenged, even by Democrats, in the current debate. It’s the idea that if people had better access to health care, it would lead to “overuse,” and therefore increased cost. That’s why we can’t have single-payer or any other reform that gives people freer, cheaper access to health care services, conservatives argue—because without financial barriers, everyone would be running to the doctor every time they sneezed.

This myth treats medical procedures as if they were enjoyable leisure activities that everyone would like to partake of more often if only they were given the chance: “Gosh, I’ve got some free time today–I think I’ll go sit in my doctor’s waiting room” or “Wow, I’d love to have another colonoscopy this month” or “Hey, why don’t I have my hip replaced–after all, it’s free.” The overuse myth suggests that a large portion of the U.S. population is suffering from Munchausen syndrome—or at the very least, that we are masochistic hypochodriacs.

In reality, there’s scant evidence that better access leads to overuse–although the opposite is certainly true. And the meteoric rise in health care costs, beginning in the 1990s, has no apparent relationship to greater access. As Physicians for a National Health Program pointed out several years back:

[T]hose with interests in rising health expenditures will try to make sure the American public does not understand the real causes of the recent surge in medical inflation. Their loudest argument is that Americans overuse medical care and that such overuse would only worsen if all Americans were insured.

Overuse does exist, the evidence indicates. But so does worrisome underuse. And overuse cannot explain the latest burst in health insurance prices or the sharp rises in what drugstores and doctors charge. There is no credible evidence that Americans received a lot more medical care in the past few years. But the price of health care has skyrocketed nonetheless. That inflation is because of the market power of insurers, drug manufacturers, hospitals and other suppliers of medical services.

PNHP also argues that ”the expectation that patients (especially the sickest 20 percent of the population that account for 80 percent of health spending) should be able to distinguish between what care is ‘necessary’ and what is not is fantastical.” In other words, if people are having too many costly treatments, it’s not because they are choosing to do so; it’s because they are being told to do so by parties with a vested interest in making money off those treatments. 

The real myth is the notion that a system of medicine-for-profit can yield sound health care. In  the preface to his 1909 play The Doctor’s Dilemma, George Bernard Shaw (an early advocate of a publicly run health care system), described the internal contradiction inherent in this idea:

It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.

Scandalized voices murmur that these operations are necessary. They may be. It may also be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, no man’s neck would be safe and no man’s house stable.

Shaw’s words of advice for those approaching the health care system: “Treat the private operator exactly as you would treat a private executioner.”

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GOP to America: Get Real, You Are “Over-Insured”

November 6, 2009 · Leave a Comment

Going into the House health care debate and vote tomorrow, it pays to keep in mind what the Republican party has identified as the real problem with American health care. I’ve mentioned this before as a longstanding tenet of conservative thinking, but Steve Benen in the Washington Monthly sums it up succinctly one more time. They quote former Congressman Dick Armey, the guru of the tea party crowd, saying, “The largest empirical problem we have in health care today is too many people are too overinsured.”

There it is, the right’s philosophy on American health care in 17 words. Most of us think the problem with the existing system is that we pay too much, get too little, and leave too many behind. Dick Armey sees the existing system and thinks we’d all be better off with less coverage. Lest anyone think this is unique to Armey, the opposite is true. A few years ago, during Bush’s pitch in support of health saving accounts, the LA Times’ Peter Gosselin explained, “Most conservatives — including those in the [Bush] administration — believe that the root cause of most problems with the nation’s healthcare system is that most Americans are over-insured.”

Just two months ago, Reps. John Shadegg (R-Ariz.) and Pete Hoekstra (R-Mich.) had an op-ed in the Wall Street Journal making the same case. “When was the last time you asked your doctor how much it would cost for a necessary test or procedure?” they asked, making the case that consumers need more “control … over their care.”

It’s all premised on the notion that health insurance encourages medical treatments. If we have coverage, we might get tests and procedures that we wouldn’t get if weren’t so darned insured. Less coverage means fewer costs.

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Hip to Profits: The Sleazy Business of Medical Device Manufacturing

November 2, 2009 · 3 Comments

The latest issue of Mother Jones includes an article by Peter Stone on the shady dealings and inflated profits of the medical device industry. These companies makes things like artificial joints and heart valves, which are often needed by older people—and paid for by Medicare.

In recent months, these companies have launched a huge lobbying blitz  in response to provisions in the health care reform bills that would levy fees on their high-profit enterprise. The efforts apparently have not been wasted: In the latest versions of the legislation, the level of fees has dropped considerably (though that hasn’t stopped the manufacturers’ whining).

Compared with Big Pharma, the medical device industry has received relatively little media coverage or public attention, which makes this article worth reading in full. A few highlights:

We’ve been left jaded, after all, by the endless reports of drugmakers’ seducing physicians with golf and spa weekends, expensive gifts, and lucrative consulting contracts. Well, now that federal investigators have quietly turned their sights on the makers of medical devices—a $200 billion industry whose marketing practices have seen relatively little scrutiny—it’s becoming clear that implant companies are just as solicitous of doctors as Big Pharma has been.

Consider Minneapolis-based Medtronic, the country’s leading device maker, which hauled in nearly $15 billion in 2009 sales despite having become a repeat target for state and federal prosecutors. In 2006, Medtronic agreed to pay the feds $40 million to settle allegations that from 1998 through 2003 it had set up sham consulting and royalty agreements, trips to strip clubs in Tennessee, and other incentives to entice surgeons to use its spinal products….

Stone runs through cases that have led to hundreds of million in federal fines against medical device manufacturers in the last three years, including a $311 million settlement with the top five manufacturs of artificial hips and knees accused of giving doctors millions in kickbacks, often disguised as consulting fees.

Some effort to combat these practices has emerged from the Senate Special Committee on Aging, chaired by Wisconsin Democrat Herb Kohl, which held a “Surgeons for Sale” hearing last year, and in January introduced the Physician Payments Sunshine Act of 2009. This legislation, Stone writes, “would compel makers of medical devices, drugs, vaccines, and the like to publicly disclose any payment of more than $100 to a doctor; failure to report could result in fines of up to $1 million.”

Kohl is hoping the provision will become part of the final final draft of health care reform legislation. But the medical device manufacturers, in league with Big Pharma, will do everything they can to keep that from happening.

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The Late Ted Kennedy

November 2, 2009 · Leave a Comment

An especially insightful review of Ted Kennedy’s memoir True Compass appeared on The American Prospect over the weekend. It may be of interest to members of the Unsilent Generation, not only because so many of us grew up—and grew old—with Teddy, but also because it is a homage to the wisdom and fortitude that came to him with age. In a review titled “He Kept the Flame,” Harold Meyerson points out that Kennedy’s real achievements were made late in life, when he was bucking the dominant political tide. “The essential Ted Kennedy,” he writes, ”only truly emerged as he sought to keep the nation and his party from moving rightward”:  

For decades, the [Democratic] party had been losing the support of working-class whites (and gaining support among professionals). It had been complicit in the evisceration of American manufacturing and had generally grown more centrist in its economics. For Kennedy, however, the Democrats had an enduring compact with working Americans, one they had to renew every generation by enacting such policies as universal health care. Though the party moved rightward during the age of Reagan, Kennedy writes, “I maintained my conviction that the working-class majority forged by Roosevelt remained our best hope for justice and progress.” 



The appreciations of Kennedy’s achievements that followed his death this summer noted, of course, that he was the only one of the Kennedy brothers to be given a long career and that his list of accomplishments was, accordingly, a long one. But in measuring Ted’s work alongside that of Jack and Bobby, another key difference also emerges: His brothers were liberal political leaders during an age of liberalism. Ted was liberalism’s leading standard-bearer in a time of conservatism, a time when conservatism made inroads into his own political party. 



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Health Care Reform: What Would LBJ Do?

November 1, 2009 · Leave a Comment

In my last post, I compared the current Democratic leadership to Lyndon Johnson, and speculated that if LBJ were alive today, he might have been able to get a decent health care reform bill through Congress. I suspect he could have done it without at least some of the compromises and concessions to corporate interests, which have now made the Democrats’ legislation—including the public option—so weak that it is getting close to meaningless.

800px-Lyndon_Johnson_signing_Medicare_bill%2C_with_Harry_Truman%2C_30_July%2C_1965

LBJ signs the Medicare Bill in 1965, with Harry Truman by his side

This reminded me of a post about LBJ that I wrote nearly a year ago, as Obama prepared to take office with the promise that health care reform would be among his first priorities. It refers to Johnson’s successful effort to create the Medicare and Medicaid programs–the only single-payer health care this nation has ever known. Like a lot of LBJ’s War on Poverty programs, they were far from perfect. But compared with what today’s Democratic leadership is offering, they were something close to radical, and represented a triumph of political will on Johnson’s part. 

When it came to getting legislation through Congress, LBJ—both as Senate Democratic leader and as president—had skills that make Nancy Pelosi, Harry Reid, and Rahm Emanuel, along with President Obama, look like rank amateurs. But more than this, he had the level of commitment—and the spine—required to stand up to opposing interests when it came to a basic need like health care.

I’m going to run most of that post again here, since its relevance has only increased with each passing month.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

December 2008. An NPR story earlier this week included excerpts from Lyndon Johnson’s White House tapes, featuring his behind-the-scenes efforts to pass the bill that created Medicare and Medicaid in 1965.

The idea of a Medicare-type program for seniors had been debated for more than 20 years, ever since Harry Truman’s post-World War II calls for a national health care system. But it was Johnson, famous for his arm-twising skills, who finally succeeded in sheparding the legislation through Congress. He did so against the wishes of the American Medical Association and much to the chagrin of conservatives, who saw it as a step down the slippery slope toward socialized medicine.

The Oval Office tapes feature Johnson’s typically colorful language. As NPR describes it, “Just moments after [the] bill…got through a key House committee in March of 1965, Johnson sounds like he’s in no mood to celebrate. He gets on the phone to demand that legislators keep the bill moving”:

“You just tell them not to let it lay around. Do that,” Johnson barks. “They want to, but they might not,” he continues. “Then that gets the doctors organized, then they get the others organized. And that damn near killed my education bill. Letting it lay around. It stinks. It’s just like a dead cat on the door. When a committee reports it you’d better either bury that cat or get some life in it.”

The NPR story is based on an article in this week’s New England Journal of Medicine by David Blumenthal, who teaches at Massachusetts General Hospital and Harvard Medical School and served as an Obama campaign adviser on health care. Blumenthal thinks Johnson’s strategy could be instructive to the new president as he seeks to pass health care reform.

But what Johnson had going for him was not only his skill in dealing with Congress, but his  commitment to expanding Americans’ access to health care, regardless of the cost. In March 1965, he told Vice President Hubert Humphrey:

“I’ll go a 100 million or billion on health or education. I don’t argue about that any more than I argue about Lady Bird buying flour. You got to have flour and coffee in your house. And education and health, I’ll spend the goddamn money.”

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Ignagni v. Obama: Another Victory for the Health Insurance Industry

October 30, 2009 · 1 Comment

For months, even as other Democrats fell by the wayside, Nancy Pelosi has been saying she wouldn’t put through health reform without a “robust” public option. Instead, she this week agreed to a provision that would make any public plan weak to the point of meaninglessness.

In announcing the House Democrats’ health reform plan, Pelosi made it clear that she has abandoned any ideas that the public option’s payment rates should be based on Medicare rates, or otherwise standardized and set by the government. Instead, the government-run  insurance plan will negotiate rates with doctors and hospitals, just as the private insurers do.

What this means is that plan rates under the public option will be pegged to those of the insurance industry, eliminating any real chance that the public option will bring down health care costs by “competing” with the private companies. There is no waffling here. Just complete capitulation to private industry.

Pelosi apparently gave in under pressure from members of her own party. But the real winner in the health reform debate are not the so-called moderate Democrats, or the Republicans, and certainly not Obama or Pelosi or Harry Reid. It is Karen Ignagni, president and CEO of America’s Health Insurance Plans. She called the politicians’s bluff—and won.

She knew from the very beginning, as did most of Washington, that the profit-making industries who control the American health care system would emerge victorious. Billy Tauzin, mouthpiece for Big Pharma, whined about Obama’s duplicity but sat tight, knowing the drugmakers had in the end gotten a sweet deal. Ignagni, likewise, didn’t make threats. She waited, then executed her own double-cross and  amidst  liberal yelps ran right through the opposition without a scratch.

Could anyone have blocked Ignagni’s breakaway run? Not in this crew, that’s for sure. LBJ would have stopped her. Liberals scorn Johnson because of Vietnam. But LBJ had a domestic program that he never lost sight of, and that he refused to concede enitrely to the power of corporate America. It was Johnson, after all, who got the bill creating Medicare through Congress, over the objections of the AMA and a lot of other powerful interests. Neither Pelosi nor the  oh-so-clever Rahm Emanuel has Johnson’s dealmaking abilities–or his spine. 

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