The Dialogue of National Health Care From Nixon to Now

http://www.youtube.com/watch_popup?v=iGKkPEvD2OM 

How amazing that the dialog has changed so very little from Nixon's term until now. The monetary figures have inflated a great deal, the two men who spoke on this issue are both gone now, but the needs of the nation remain relatively unchanged. The private insurance companies still accuse the unions of undermining private enterprise. The pseudo fiscal conservatives remain steadfast in their assertions that liberals are giving away the nation's wealth. Too many Americans still need affordable health care. Not much in this conversation has changed. 

But one undeniable element in this conversation that has changed are the ever increasing numbers of Americans who desperately need affordable, life saving health care. Shall we spend another two decades muddling through making do with a tiny band-aid on a fiscal wound that threatens to drain the coffers of our government, small and middle sized businesses, the family and the individual or do we re-initiate the conversation and insist that a cure be found, not merely a means to mask the symptoms. 

Once again, to Senator Murkowski, I submit that this issue has been discussed at great length, in great detail by men and women some long dead since the conversation began in earnest so many decades ago. We will respect you more if you simply admit that the band-aid must, at some point in the healing process, be removed, and the air let in to heal the wound. Yes, removing the band-aid will be painful. Any mother knows that a quick yank is preferable to a prolonged tug.

End of Life Counseling is Not Death Counseling - Huckabee and Palin Are Wrong

http://blogs.abcnews.com/george/2009/08/death-panels-and-the-politics-of-death.html

So far I have chosen not to directly address the repeated accusations of right wing, conservatives that President Obama and Progressive Democrats support death care, death panels, euthanasia or any number of other words and phrases meant to arouse fear in citizens.

What comment by whom has finally drawn me out? Mr. Huckabee has chosen to join Sarah Palin and others in attacking "End of Life Counseling" and twisted it into some sick form of "death panels." These accusations, ridiculous and without merit, threaten to place an undeserved black mark on a program that has provided comfort to and assuaged the fears of thousands of Americans who have had the misfortune of losing a loved one to a terminal illness. The infamous page 425. What does it mean? What does it propose to do?

First here is the link to H.R. 3200.

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

This is the house version of what has now been titled the "America's Affordable Health Choices Act of 2009." A similar version of this bill has been introduced in the Senate.

http://help.senate.gov/BAI09A84_xml.pdf

The section of H.R. 3200, much maligned by some right wingers, SEC. 1233., is Titled "ADVANCE CARE PLANNING CONSULTATION." So much has been said by those who claim to understand what "end of life care" means, and all of it has little if any root in truth.

I will give you my personal experience with "end of life counseling." I hope it helps to clarify the importance of such counseling, and dispels the myths and fears surrounding this section of the bill.

My father was diagnosed with Esophageal cancer on October 14th. For many months, my brothers and I hoped with all our might that my father would have the edge on this disease. As many of you know, my partner and I joined my father in Lynchburg,and even as we celebrated the inauguration of our 44th President, we clung to the belief that my father would beat the cancer. He was so strong, so viking, so seemingly indestructable.

Cancer does not respect genealogy. It cares not for the form and function of DNA and RNA as it was intended to exist at conception. It invades the cell, manipulates the RNA, reorganizes the organic factory, and reforms it to serve its own needs. Organs that were intended to live for decades, succumb to a lesser life span. The affected cells grow and multiply destroying the delicate homeostatic balance of life.

Chemotherapy, radiation, proper diet and other treatments are all attempts to counteract the growth of cancer, but sometimes, no matter how hard science tries to intervene, cancer wins, vital organs are crowded out. The body tries to protect itself by accumulating fluid putting further pressure on the organs. Eventually the body cannot maintain the balance of life. The heart, the lungs, kidneys all begin to wear themselves out in an attempt to adjust.

My father called me on a frosty day in early February. I sat in my office as he told me that his doctor had informed him his cancer had gone terminal. His body could not cope. The chemo could no longer stop the cancer. He was dying. I collapsed in a heap, and I wept. I allowed myself to grieve. Then, as my father lived, so went I and every moment thereafter was dedicated to his wishes.

My father drew up a living will. My step brother served as his executor. All of his children were given copies of his will. In this will he stated that he did not wish to be revived. I inserted in his will a DNR (do not resuscitate) clause. He did not want to be kept alive through artificial means after his brain had ceased to function. Nor did he wish to have his body sustained artificially after it had lost its capacity for self sustenance: no feeding tubes, no I.V. drips.

Cancer is a nasty condition. As it progresses, its growth begins to redirect precious resources away from normal body functions to feed the growth of the tumor(s). As the cancer grew in my father's body, he grew thin. What nutrients he was able to take in were immediately absorbed my the cancer. Because the tumor pressed against the other organs of the body, fluids began to collect around his vital organs in an effort to protect them from the pressure much as a blister forms on a foot to protect it from damage. I watched my father deteriorate. For those who have witnessed this, I apologize with all my soul if I revive painful memories. I do so only because I do not wish to see future generations deprived of end of life counseling.

End of life counseling for our family consisted of several key parts.

1st - My father paid a lawyer to draw up a will laying out specific instructions to his executor and designated "caregivers" as to his final wishes. Having determined that his cancer was terminal, he did not wish to be resuscitated should his heart fail. A copy of this directive was kept on his person at all times. A copy was also registered at his hospital. End of life counseling would give people access to such wills.

2nd - My father elected to enroll in local Hospice care. His wish was to die at home under the care of a hospice nurse. Hospice provided him access to twenty four hour own call care, support for his caregivers, and would act as an intermediary with the funeral home at his death. H.R. 3200 would afford people the option of participating his hospice care.

3rd - My father arranged for his designated caregivers to participate in end of life counseling with hospice. The counselling was intended to prepare his family for his death.

End of life counseling: This phrases can raise fear in the hearts of those who have no experience with it, and comfort in the hearts of those who have benefited from its care. My father chose the care of hospice. He wanted to die in his own home on his own terms. It was his wish, and he had discussed his intentions with his family. He was lucky enough to have the financial resources to draw up a living will, and a family willing and able to be with him as he prepared to die. It is one thing to say you are prepared to face the death of a loved one and quite another to face it. End of life counselling helped to prepare me for what I was about to face. During the first day of counseling, my brothers and I met our hospice counselor. She explained to us the function of hospice, which was to provide the in home medical support my father would need to cope with the many symptoms and complications of end stage cancer. She explained in detail the various stages that might be expected at the end of my father's battle with cancer. We were given my father's emergency medications to be used only when his pain became unbearable. We were instructed in pain management. We were given a 24 hour number with which to reach on call nurses who would answer our questions. We were given literature to read to help us transition as our father transitioned from life to death.

Imagine if you will, a man capable of running 5 to 8 miles day, reduced to struggling for breath as he made his way to the bathroom. Imagine your brother, all five foot ten of his massive frame, trying to help his father off the toilet without breaking ribs. The literature we were given helped us overcome those obstacles. Everyday presented a new set of obstacles. Our counselor and nurses from hospice helped us through every step. This is end of life counseling. This is reality.

No one told us to cut cords, disconnect respirators, refuse my father food. When my father's body could no longer take food, the counseling helped us understand the biological mechanisms involved as his digestive system shut down. When my father could no longer take fluids, they showed us how to prepare little sponges dipped in ice water to wet his lips. The nurses helped ease the awful fear in my chest that I was not trying hard enough to ease his pain. When his pain became unbearable, they reassured us as we administered the painkillers, because there is no more nerve wracking worry than that you might give someone too much painkiller. And, during those final hours, the counseling helped me recognize the signs that my father was letting go. I understood the breathing patterns, the way my father appeared to speak with loved ones no longer with us, that he could hear us even if he could no longer respond outwardly to our words. We read from the Bible, played Frank Sinatra, talked to our father, and told him he could let go. Hospice volunteers called us frequently to ask if we needed help washing dishes, preparing a meal, all the little things you take for granted when all your time and attention is centered on your loved one.

Please forgive any pain I may inadvertantly caused to those who have suffered the death of someone close from a terminal illness, but I feel compelled to talk about my experiences because the comments of Mr. Huckabee, Mrs. Palin and others who threaten the future of what I consider to be a very important program. I cannot imagine facing my father's death without the help offered by hospice, and the end of life counseling it provided. Because my father planned for his death, because he had the finances to do so, my brothers and I were able to be with my father in his final hours. He enjoyed a peaceful passage from life to death on his terms, but I know that many in this country do not receive this gift. I had the unbelievable privilege of holding my father's hand as he drew his final breath. He was able to die in the house that he loved surrounded by the memories of his departed wife and the family he loved.

I want people to have access to this program who do not have the financial resources my father enjoyed. He would have wanted that for them. That H.R. 3200 provides others access to end of life counseling is amazing. That the political posturing surrounding this bill threatens to sour people's view of this program is appalling.

Emotions should compel us to rise above our stations in life to make life better for others. They should not drive us to deprive others of better care, and access to a better quality of life or even death.

Who Will Stand in the Lion's Place? We Will Stand Where the Lion Once Stood!

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

The lion of the Senate has passed. Who will take his place? Who will roar as passionately? Who will take up the fight for the health and welfare of the pride? Who will give up so much for so many? Who will show their underbelly, and suffer the slings and arrows of the enemy?

We will stand for the lion! We will continue his roar! We were lost, but he never ceased his roar! We followed the sound! We have come home, and now we stand to protect the pride! Our coats of many colors unite, and we honor the Lion's passion for humanity!

Stand fast! Throw back your heads, and roar! Beware, enemy, beware! The pride has awakened!

Keith Olberman on United Health Group

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

I have to share this piece aired today on Keith Olberman's, Countdown. The many research tools and resources available to Mr. Olberman were leveled at United Health Group, one of the health insurers rated in the American Medical Association's, 2009 National Health Insurers Report Card.

I sometimes feel so inadequate in my attempts to highlight what I think sits at the core of health care reform - a broken, oft times corrupt multi-payer, private, for profit health insurance system that has, through extensive lobbying efforts, been allowed to gain control of the American Health care system strong arming medical providers and policy holders alike. The preponderance of evidence now points to the fact that some health insurers have been ripping off their clients for years. Mr. Olberman's and his team of researchers and writers did a wonderful job with this piece.

The big guns have picked up the ball on exposing corrupt health insurers. Now perhaps we can move forward and pass legislation that would close the loopholes in current health insurance regulation. H.R. 3200 is long and complicated, but the laws that regulate private health insurers are long and complicated. Changes will have to be made to the Public Health Service Act, the Social Security Codes and Federal tax codes among others.

Cleaning up health insurance regulations will protect those of us fortunate enough to have health insurance from being taken advantage of, but what about those who cannot afford health insurance? It remains to be seen what will be the final language of H.R. 3200, which takes many steps to reintroduce much needed regulation on health insurance, but, in a revised form, may not adequately meet the needs of the uninsured who cannot afford it. What are the alternatives? Can those alternatives coexist alongside H.R. 3200? We might do well to take a very close look at H.R. 676 (United States National Health Care Act or the Expanded and Improved Medicare for All Act)now currently in committee. As Laz wrote in a blog last week, this is a straight forward bill to create a pubic health care system based on the current system of Medicare. The bill is currently in committee, and has been since January 29,2009, but that doesn't mean it is dead.

What matters most in our efforts to achieve health care reform is that we remain steadfast when we say we want affordable health care. At some point we simply have to resign ourselves to the fact that the legislators will have the final headache of drafting the correct language. We are fearful of having a herd of sheep wool pulled over our collective eyes, but the final act of legislation belongs to Congress. We elect them and pay them to know what they are doing. If they do not, we vote them out. The end product of health care reform will be the proof of their actions. That is why the democratic process will always be ongoing, and there will never be a magic fix. I am deeply suspicious of anyone offering the quick fix.

The more immediate concern today is the spin factor. There is already an attempt to spin proposed funding for health care reform into another scare tactic aimed at seniors. President Obama explained that some of the funding for reform would come from cutting out the portions of Medicare that are wasteful and do not work. The right has already begun disseminating information telling seniors that the President wants to cut funding to Medicare. They of course fail to mention that conservatives themselves were the original arbitrators of deep cuts to Medicare under the Bush administration. To illustrate this point I would like to share this Statement of Congressman John D. Dingell, Chairman Committee on Energy and Commerce, dated February 28, 2008.

I attended and spoke at our district meeting for the Anchorage Democrats in Muldoon yesterday. It was a small but very knowledgeable group of people including our own Senator Bill Wielechowski. I would like to share some of their comments.

Senator Wielechowski shared his views on what got his attention in an email. He felt that personal, well stated arguments that demonstrated the persons passion for the subject as well as their knowledge were the most effective. Of course, the elected official must demonstrate a capacity to care about their constituents.

One woman was born and raised in Germany. Her family still lived there. She fielded many questions about the quality and quantity of German health care. She spoke of a niece who is receiving excellent treatment of Hodgkins Disease. We discussed the fact that Germans passed passed insurance laws in the 1600's right around the same time as they passed their brewery laws (Germany is a wonderful country).

A gentleman suggested that we encourage our state and US Congress folk spend some time actually interviewing the health officials in countries with national health care programs. First hand knowledge is the best. We are all sick of propagandizing of the right wing "think tanks," and the informative but sometimes agonizingly detailed (I hang my head) accounts from progressive sources can be confusing. Having someone who operates the system explain it might be the best solution.

If you haven't already done so, I highly encourage you to attend a house party on health care. If no has hosted one, contact Organizing for America, the Alaska Democratic party, the Anchorage Democrats, or any affiliation of your choosing and offer to host one. See if your district Representative or Senator will attend. If they can't, have them recommend someone who might be able to speak on the subject of health care reform. If they don't have anyone to recommend, ask them why they don't know anyone? I am not trying to be mean, but this is a very economically important issue, and one would hope that they have at least given it some thought. If they haven't, be the cattle prod. Learn, learn,learn and share,share, share.

My Depiction of What Obama Faces During his First Term as President

I started writing this story in a letter to a friend, and liked it enough to post on this blog. The content does not directly address the issue of health care, but does address the larger, more critical issue of reclaiming our government. Since the days of Reagan, the conservative right has deliberately set about dismantling our government in an attempt to fulfill their self proclaimed prophecy that all governments fail. They have tried for over twenty years to destroy the public belief in government. They will fail. Our government is alive and well, and with time and a lot of input from the public will recover and thrive.

Here is my allegorical depiction of what Obama faces during his first term in office.

President Obama, his Chief of Staff, and the Secretaries of each department in government walk into the White House, and into each building of each Department: Defense, Justice, Health and Human Services, Agriculture, etc. They can hear the sound of people working, but cannot see what they are doing. The rooms are all dark, and no one can find their desks. The wall switches don't work, their are no batteries in the emergency exit lights, the flashlights don't have light bulbs. When the President, his Chief of Staff and the Secretaries go down to the service areas of each building, they discover the circuit breaker panels have locks on them, and they cannot flip on the breakers. When they manage to find light bulbs for the flashlights (every department contracted from a different company and therefore each required a different bulb), and the key to the lock on the circuit breakers, they find to their dismay that the circuit panel legends have been scratched out. They flip the first breaker only to realize there is no power. The President calls the power company and is informed that the generators are broken. When the President asks the power company what they did with the money the government paid them, the power company mumbles that it suffered losses, and whines about global competition, and unstable markets. The President calls the Federal Reserve and asks them to cut a check to give to the power company to pay to fix the generators. With a jolt the first light flares to life. Through a painful session of trial and error, the President and his crew map out what circuits turn on the lights to each room in each building.

Finally, the legends are redrawn, and the President and his Secretaries are finally able to see what work transpires inside the once dark government buildings. They notice that the people in the various Departments have worked for so long in the dark, it takes time for their eyes to adjust. They have learned to move around the rooms by feel, and even when the darkness has been lifted, they tend not to "see" what actually surrounds them. They move from place to place by habit. The President and Secretaries move the offices around just to force personnel to recognize their environment. The people grumble. Some cannot adjust and leave the buildings, while others begin to thrive and interact. Just as the whole affair begins to operate smoothly, the power company calls the President and tell him its time to pay the bill.

People, who have come from their homes far away, gather outside Washington. They can see the flickering of lights inside the city. They catch glimpses of the magnificent buildings for an instant before the city returns to darkness. Slowly, each monument, the museums, the Mall, and the Departments lights up one after the other, until after fits and starts, we see the city brightly illuminated. The people see the bustle of movement within the Department buildings. The President had told the people that the city would shine once more, but to actually witness the event... The people call the Congress, and begin asking questions. "Why were the lights turned off for so long? Why did not the city have lights before today? How long will this last? What do we need to do to keep the lights on?"

The Congress, unused to hearing from the people outside the city, call the President. The tell him that the public likes what it sees in Washington. The President says he already knows. The President tells Congress that the power bill is due, and the Federal Reserve is nearly tapped out. The power company had failed to upgrade their systems over the years, and the President had to use the money in the Treasury to repair the generators. The Congress panics. They blame the President. The President reminds them that he just walked into the city and found it dark. They tell the President that the people will never go for sending more money to the government. "No," says the President, "they will not go for spending more money if it will be wasted." The President assures Congress that he will see to it that the new generators produce clean, reliable power, and that everyone he and his Secretaries supervise uses the energy wisely and efficiently. He gently reminds Congress that they alone have the responsibility of correcting the mistakes of the power company, and for finding the money to the pay the power bill.

The Congress, caught between two forces eager to see change, the President and the people outside Washington, must now adjust. For years the power company has been telling Congress what to do. They assured Congress and the people that they would make care for the generators and protect the city, but instead they spent the money they were given recklessly. To insure that no one asked questions, the power company made certain that at least one generator remained in good repair and that the lights in Congress were always turned on, but the rest of the city and those surrounding it were allowed to sink into darkness. Whenever certain members of Congress, concerned by the darkness within the city, wanted to see the generators, they offered them a job at the plant. If those certain members of Congress kept asking about the generators, the power company threatened to cut off the lights back home.

All this was possible because the last President liked working and living in the dark. The former leader so reviled the light, that whenever any light shown for even a brief instant, he fled to his home far away, and let the power company deal harshly with any would dare to bring the revealing rays of light into the city. To make certain no one working for him accidentally turned on the lights, he made certain his Secretaries were unable to distinguish a wall switch from a stem cell. His minion, and friend in the shadows, the Vice President, set about wrecking the circuit breakers in hopes of eradicating the light forever. While some members of Congress held the man in great esteem, others prayed for an end to his reign, and in silence planned for the future.

Time passed and the future arrived. Now the President knows the power company lied. The people know the power company lied. The people want the city to be illuminated. They want the people in the buildings to bustle about doing their work, but they don't want the power company to once more take over the city. Congress tries to find a way to pay the power bill, keep the power company in check, and keep the people happy. Meanwhile the President, his Chief of Staff and the Secretaries continue to train the people working in the Department buildings. The President tells the Congress that they will have to do their jobs and find a way to pay the bills to keep the buildings lit. Some Congressman have faith that the President will keep the power bills low by running his offices efficiently, and they tell the people that their money will be well spent.

Other Congressman continue to heed the voice of the power company in hopes that the city will be plunged back into the cradle of all concealing darkness. The power company tells these Congressman and the electorate they serve that the power was turned off in the Department buildings because the people in them were wasteful. "These people," the power company confides, " sucked up all the power, and refused to turn off the lights, and conserve electricity." The power company tells Congress that the money should be paid directly to the power company with no questions asked just as they have always done. Then the leaders of the power company hire some of the people who once worked in Congress, and some of the people who couldn't adjust to working in the light, and instruct them to talk to the people outside the city, and tell them that if the power is turned back on in the Departments, there will be no power back home. The government will waste the power. Worse yet, the surge from all the wasteful overuse will destroy the power stations back home. To further fan the flames of fear, they explain to the people that, if they send their money to the government, the government will use the money to buy up all the power and then ration it out to the people. Some might die. Only the power company can manage the distribution of power. They want power to flow straight from the plant to the people. Some of the people grow fearful and continue to support the power company. Those people turn on the others and attempt to spread their fear.

But the majority of the people refuse to believe the people paid to speak for the power company. They ignore the fearful wailing of those who do believe. Instead they seek truth. They question Congress. "The city has been dark for years, and yet we have been paying you to pay the power company? Where is our power? We can see it in the bright lights on the hills around the city, and in the mansions in the cities, but every time we tap into it, the grid collapses. Why are the generators always broken, and why are we expected to pay to fix them when they could have been fixed using a portion of the profits? We have to fix our houses, our cars and ourselves using only what we take home in a paycheck." The questions keep coming, and Congres begins to fear the people more than they fear having their lights turned off. "Why do the people in the brightly lit buildings in the hills around the city pay less, when we continue to pay the same for less?" Finally the people realize that the power company is the problem. "We will pay for the power. You provide that and deserve to be paid, but you can't control its distribution. If a smaller power company wants to offer us a better price, we don't want you running them off."

The Congress legislates the will of the people, and the power company can no longer do as it pleases. Meanwhile, the President, the Chief of Staff, and the Secretaries have spent their time wisely restaffing and retraining the people in the buildings of the Departments. One by one, the Departments begin to function efficiently, and the people begin to receive their power. The power company dissolves once more into many companies, and more jobs become available. The generators are no longer housed in one building, under one management, but have popped up all over. No one company can threaten to shut off the power to so many again.

Still, on a beltway, just outside the city, heads are bent together in discussion, and they plan...

National Health Care Reform with President Obama

This national forum was presented by Organizing for America (OFA). This is the same group, led by Jonathan Teeters and Sarah Howe, that hosted the press conference August 10th outside the Peterson Towers. I will let the video speak for itself adding only this quote from Jeremy Bird, Deputy Director, Organizing for America. This quote came from an email I received Friday.

On Thursday, an astounding 280,000 Organizing for America supporters gathered online to huddle with the President at our National Health Care Forum. With Congress about to return to Washington to make historic decisions on health insurance reform, the President chose this critical moment to speak directly to the OFA community. He reminded us of how far we've come and what we can accomplish together:

And as for our President's view on a public option...

Thursday, the President made the stakes of reform crystal clear. He talked about how, with health care costs rising three times faster than wages, the cost of inaction is simply too high.

He explained how reform will guarantee competition and choice. He described the Insurance Guarantees that will protect every American from discrimination against pre-existing conditions, exorbitant charges, and arbitrary denials or reductions in coverage just when we need it most.

And he made plain his stance on the public option: "So let me just be clear: I continue to support a public option, I think it is important, and I think it will help drive down costs and give consumers choices."

Senator Murkowski's Opinion of Health Care Reform Remains Unchanged

I was very disappointed yesterday when at four o'clock p.m., I realized the window installers had a made a mistake that would need to be corrected immediately. I had to wait for them to come and fix the problem. They never showed up, and I missed the Town Hall meeting.

A good friend of mine, Mrs. "B", attended the meeting, and has kindly agreed to share with me her notes. In addition to "B"s notes, I also read several news accounts and have included several quotes taken from KTUU's coverage of the Town Hall meeting.

From what I learned, it doesn't appear that Senator Murkowski's views on health care reform have changed at all since her last town hall in Fairbanks, or from what is published on her website. Senator Murkowski still thinks the "bill" (note the singular form of the word) before Congress is "to costly and ineffective." Mrs. "B" said the Senator did not discuss in any great detail how and why she believes the health care plan is too costly and ineffective. Costly and ineffective compared to what: the current situation with multi-payer, for profit, health insurers who have a 35% (AETNA) and 65% (Blue Cross) control of the health insurance market in Alaska? What is the comparison between the 1 billion spent in Alaska on Medicaid to the $200 billion wasted by the health insurers through "ineffective" administrative costs (AMA 2009 National Health Insurers Report Card). How many years does it take for $200 billion to add up to one trillion?

Apparently, at one point during the meeting, a young woman of high school age, stood up and commented that people didn't seem as inclined to protest the cost of the Iraq war, and no one seems to want to discuss how the debt from the war will impact future generations. And, yet, she noted, people all over the country keep talking about the trillion dollar cost of health care reform and the burden it will place on the youth of America. "B" said the audience gave the young lady a nice round of applause after she finished speaking.

The Senator did remark that "she agrees changes do need to be made" to the current system of health care, but had nothing much to say about the Republicans plan to make those changes. Mrs. "B" reported that members of the audience made comments both in favor of and against Medicare and Medicaid. Senator Murkowski explained that she believed that both of these programs are inadequate to meet health care needs of Alaskans. The Senator did not discuss the chronic lack of funding for these programs, and its impact on the ability of the programs to retain the services of medical providers.

Contrast this with the Chamber of Commerce meeting on August 10th. Senator handed out several very well organized fliers at his meeting. They were ripe with facts and figures, as well as credible sources to back them up. Those very same facts, figures and links to helpful informational sites can be found on his website. Senator Murkowski's site contains roughly the same information she presented at the town hall meeting last night and earlier in Fairbanks.

KTUU reported that, "The forum was pretty tame compared to last week's held by Sen. Mark Begich where a large crowd turned out to shout down the plan. On hand Thursday were people on both sides of the debate."

This does not surprise me in the least. Progressive Alaskans came to hear what the Republicans have to offer the people of America. To effectively listen one must remain quiet. In addition, "B" mentioned that the members of her group chose to spread out in the audience so that they could discuss their opinions with folks who were open to doing so. Contrast this approach with the tactics of "teabaggers" who push to the front of audiences to make their numbers appear larger. Take that you "big oaf."

I truly apologize for not having attended. Despite my criticism of our senior Senator, I refuse to develop a political callous on my liberal heart, and discount the possibility that our presence and voice might not yet convince her to rethink her position. My belief in the power of rational discussion is what compelled me to remain after the press conference earlier this month, and attempt to talk with protesters.

Here is my comment to a news article on the Channel 2 website (link provided above), which sums up my feelings about what Senator Murkowski had to say at the Town Hall meeting:

Bottom line - the goal of health care reform is to make health care more available and affordable to the public. Health insurance is merely a means by which we pay our medical debt. For those of us who can afford it, we purchase a health insurance policy that will pay the most toward that debt. We expect insurers to honor their contractual obligations. Mounting evidence says that this is not always the case. Policies have become overly complicated, riddled with exclusions, and patients and medical providers alike are fed up. The primary culprit in the current mess surrounding health care is the multi-payer, for profit, health insurance system. According to the American Medical Association (AMA), "The inefficient and inconsistent claims process adds as much as $200 billion annually to the health-care system." Private health insurers must either bow to stricter regulation and place the needs of the premium holder above those of the shareholder, or move over and let the government find a solution. If the definition of socialism is the unequal redistribution of wealth, than having the profits from my premiums divvied up at the end of the year for redistribution to shareholders of the company qualifies my private insurer as a socialist institution. I invite anyone who doubts that statement to take a look at the year end financial statements for their health insurance company.

I have to agree with a blog that Celtic Diva posted on her website earlier today. Republicans don't seem to want to do anything to change health care. Indeed, they appear to be in the midst of developing new strategies to further delay reform. The basic Republican message is, "Let them eat 0g transfat, low carb, no preservative, organic, low sodium cake!"

To illustrate this final comment, I present this link from last night's Rachael Maddow show.

Discrimination Does Exist in Anchorage

I found this comment in the Anchorage Daily News today, August 20, in the letter to the editor section. This person was responding to Mayor Sullivan's recent veto of AO 64, also known as the Gay Rights Ordinance.

• 
  
  GoBadgers wrote on 08/19/2009 04:57:29 PM:

  I like to know why we don't tax this GL lifestyle. It doesn't matter if you are obese or a heavy smoker, gays, especially gay men, have a shorter life expectancy and are a grave health care risk. Yet we discriminate against smokers, heavy people are being targeted, but gays with their disgusting lifestyle and all the ailments that goes with it are immune from inclusion in this serious debate.
  I think it is incredibly bizarre that people actually want to encourage others to live hopeless, unhealthy lives and even more, dictate to everyone else that it is a reasonable decision! Thank you Mayor Sullivan for giving us a little breathing room before these logic-challenged liberals raise their stupid ordinance again.

Gays, lesbian, bi-sexual and transgendered people experience this level of discrimination on a fairly regular basis. Yes, I said discrimination and not "poor treatment." An attempt was made to explain this to the Anchorage Assembly. Four members still insist that no evidence of any real discrimination exists. Well, here is my first submission of evidence.

If this fellow were allowed to do so, he would tax gay men because he believes they "are a grave health care risk." He has no shred of evidence to back up this statement (nor did the several other people who accused gays of this during the hearings), and yet, if he were to have a seat at some level of government, he would single gay men out for taxation. He attempts to justify his treatment of gays by saying that they "live hopeless, unhealthy lives..."

I fully expect bullies like the fellow above to make it a point to go out of their way to let gay people know that they lost, that they will be discriminated against in future, and that nothing can be done to stop it. No ordinance. No equal protection under the law. The council on discrimination will continue to round file complaints of sexual discrimination because, according to Mayer Sullivan, Dan Coffey, Debbie Ossiander, Chris Birch and Bill Starr, such discrimination doesn't exist. NEXT!

Where Are the Health Insurance Reserves?

In a statement yesterday, August 16, the associated press reported that President Obama's administration might be leaning towards a compromise with the Republicans who, along with some conservative Democrats, are pushing progressive Democrats to drop the public option for health insurance. I am not at all certain if I am ready to accept the validity of this statement. I will wait for a direct quote from the President himself. I do however, have a question regarding another statement in the report, and the answer to this question might well negate any need for a single payer or public option in health care reform, at least for now.

Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate.

With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates but independent of the government. They still would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.

"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."

Where are the financial reserves that the "private companies are required to keep in case of unexpectedly high claims?" I have pored over the financial reports from several of the biggest companies, and I see no evidence of the existence of any reserves. I certainly did not see evidence of any reserves in AETNA's, 2nd Quarter Financial Report of 2009. If a reserve did exist, it does not appear to have been adequate enough to cover an 18% increase in the medical costs from 2008 to 2009 that AETNA reported. AETNA reported a flat line growth in premium membership. AETNA reports "Sequentially, second-quarter medical membership remained essentially flat at 19.052 million..." If memberships didn't grow, how does AETNA explain how premium revenues increased 12%, as reported below in an excerpt from their report. I have chosen to discuss AETNA's financial report because they hold a 35% share of the health insurance market in Alaska.

Health Care business results
Health Care, which provides a full range of insured and self-insured medical, pharmacy, dental and behavioral health products and services, reported:

• Operating earnings of $336.0 million for the second quarter of 2009, compared with $430.9 million for the second quarter of 2008. The decrease in operating earnings reflects an 18 percent increase in medical costs partially offset by an 11 percent increase in revenue.
• Revenues for the second quarter of 2009 increased by 11 percent to $8.0 billion from $7.2 billion for the second quarter of 2008. Premium revenues grew by 12 percent primarily from membership growth and rate increases for renewing membership. Fees and other revenue increased 7 percent in 2009 primarily driven by membership growth.
  Aetna/4
• Medical benefit ratios ("MBRs") for second-quarter 2009 and 2008 were as follows:

It would appear that AETNA was unable to produce a 10% profit margin without raising individual and group premiums 11-12%.

The statement by AETNA that, "medical membership remained essentially flat at 19.052 million," conflicts with another statement that,

Fees and other revenue increased 7 percent in 2009 primarily driven by membership growth.

If premium revenues increased 11-12% (depending on which interpretation of the numbers you choose), plus the additional 7%, that should have covered the 18% increase in medical costs. These figures beg the question, if there had been a reserve, why then did AETNA need to raise premium rates so drastically? Is not the purpose of insurance to provide a pool of reserves from which to draw during difficult times?

In my state of Alaska, insurance premiums have risen much more sharply, and are projected to continue to rise over the next decade. These increases are further discussed in a report by FamiliesUSA.org.

Alaskans have been paying health care premiums for years, there seems to be little to show in the way of reserves as this statement from the FamiliesUSA report points out.

In that eight-year period, family health care premiums rose by 73.6 percent, while median earnings rose by only 13 percent.

In the eighties, the health insurer's membership benefit ratios (MBRs - the cost of medical expenses paid out in relation to premiums) were in the mid ninety percentile, and premiums were remarkably consistent during this period. How does one explain that today, when membership to benefit ratios are in the mid eighties, premiums keep skyrocketing up and up. If my logical thinking skills have not failed me in my middle years, the relationship between membership benefit ratios, and increased medical expenses should be a direct one. If medical costs increase, the MBR increases. If medical costs decrease, the MBR decreases. If the MBR increases, premiums increase, and vice versa. The total amount paid in premiums wouldn't affect the MBR because it is a percentage. One can see the direct relationship between medical cost and the MBR in AETNA's figures: the MBR for 2008 was 80.5% and 85.9% in 2009. Medical costs increased, therefore the MBR increased. If MBRs have dropped since the 90's, why then have premiums continued to soar?

If a reserve exists, then one would expect to evidence of it in the form of a buffer on rate increases. However, AETNA reported that from 2008 to 2009, the MBR increased just over 5%. Why then was it necessary to raise the premiums rate by 11%.

More information on how health insurers use and potentially misuse MBRs when determining premium rates can be found in this link to a report written by James C. Robinson.

http://content.healthaffairs.org/cgi/reprint/16/4/176.pdf

So again I ask, "Where are the financial reserves mentioned in the article by the Associated Press?" I believe the White House has more than a sneaking suspicion, and this knowledge in part compels the Obama administration to place a higher priority on health insurance reform than on creating a public option or single payer system. If abuses by health insurers lies at the core of this debate, then we can be hopeful that a swift kick in the butt of private, for profit, health insurance companies and their parent corporations by Congress will go a long way to reforming health care. I support Obama administration in their efforts. Numbers have meaning for me, and the numbers posted by the health insurance companies make no sense whatsoever.

Protesters at health care reform meeting at Bernard Middle School in Mehlville, MO

Yesterday, while waiting for my hair appointment, I decided to do a bit of window shopping, and walked over to one of my favorite stores. Yes, it was a box store. Guilty as charged, but they had those plastic popsickle makers I remember from my youth.

As I entered the store I found nearly all of the staff assembled near the front registers. I distinctly heard one of the male associates say, "Maybe we shouldn't even try to discuss health care." A female employee saw me, and greeted me with, "How are you today?" "Fine," I replied, "until I heard the word health care." Embarrassed smiles crossed a few faces, but they relaxed when I laughed and said hello.

"No," I continued. "We should all keep discussing health care. It is very important. We just need to do so without treating one another disrespectfully." Suddenly, I found myself answering question after question about health care. Only later did it occur to me that someone had recognized me from my little jaunt on tv. One young woman approached me as I ogled the vast array of stainless toiletry items and thanked me. Apparently the discussion had grown a bit heated.

A question that popped up several times, was one that I have struggled with for the past several weeks. Not because I don't suspect I know the answer, but because putting that suspicion into words that make sense to the average person is so very difficult.

Talking to this group of people helped me find a few more words, a few phrases that helped me and them make a bit more sense of the angry reaction of groups of people across America in town halls and other public meetings.

First, economically, the profits generated by private, for profit, health insurance companies account for a sizable percentage of many investment portfolios. Many senior citizens, whose retirement earnings have already been impacted by the current economic crisis, see another cut to their retirement earnings as a definite cause for worry. Should people opt out of their current insurance policies in favor of a public option, their dividends will most likely be impacted by the loss in profits. I believe those losses will be minimal, and will be offser by the security of knowing you will not face medically related bankruptcy, but I will discuss that further in another post.

During my lifetime, I have seen and experienced the way reasonable fears lockrf down in our subconscious can, if not dealt with, balloon into larger, more outrageous concerns and worries. I sadly admit that I have gone off on rants against a loved one, employer or friend for some offense that seemed improbable all because I couldn't express my feelings regarding another issue. If I was lucky, the recipient of my ire treated me with patience, and we were able to work through my fears to reach a mutual solution.

Is it possible the dynamics of this misplaced aggression have found their way into the debate over health care reform?

Older Americans seem to make up the bulk of those who come out to protest health care reform. Perhaps beneath the apparently inexplicable fears of government sponsored euthanasia and the imminent rise of socialist rationing of medical care, is a more understandable fear that has become deeply entrenched in their psyche: a fear that they have difficulty expressing because, in our culture, we believe that good Americans do not get into financial predicaments, and we certainly do not discuss such things with strangers. Charity is for poor people, not for the middle class, even when they are perched precariously on the brink of financial ruin.

Since the early two thousands, the average investment portfolio has peaked and plunged in value with frightening regularity. Not a promising state of affairs for someone who seeks to retire in five or so years. Because of losses suffered in the stock market, many Americans have put off retirement. News agencies every where have, at some point in recent years, hosted news stories covering the plight of the struggling retiree. Then around 2003, the housing market surged, and it seemed investment/retirement portfolios might rebound.

Unfortunately, the housing bubble burst, and once again stocks plunged. Worse still, the decision by many investors to move their money from high risk, high earning, investment funds to safer, lower risk retirement friendly funds, served to further slow the economy. Those hoping to retire at this point, were forced yet again to reevaluate their plans for the future. They dutifully, and quietly hunkered down, cut expenses and prepared for some rough times.

So here sit our now not so hopeful retirees and retiree want-to-bes. They spent a lifetime working hard, having kids, paying their dues and living the dream for better or worse only to face the reality of work after sixty.

Even as the attitudes of this group have gone through a major makeover, so also has the makeup of the investment/retirement portfolios they cling to with continued hopes of retirement. Since the collapse of the housing market, and the plugging up of the credit market, investment firms have been working to reorganize the structure of their investments. Non essential, poorly performing options were heaved in favor of more traditional, dependable ones.

So where does health insurance, and health care fit into this equation? They play a vital role in the new strategies, so vital in fact that the big investors have come out swinging in defense of what they perceive to be major underpinnings of their assets and earning potentials.

Let me pause to say, I am in no way an expert on the subject of capital investment, but I am quite competent to understand a financial firms investment report, and the message embedded within them is simple. The profits from health insurance and health care are sizable enough to compel investors to fight for their continued existence and to encourage them to maintain current profit margins. They must do this if they are to continue to provide the dividends that their clients have come to expect. Many of those clients may very well have elected to take up the cause, and head to the the town hall to do battle with government.

The Hartford Mutual Fund reported the following in its most recent semi-annual report for 2009. Here are the figures for medical and health insurance from the table on Diversification by Industry: Percentage of Assets of of April 30, 2009 (Hartford Mutual Funds Semi Annual Report 2009)

Health Care and Equipment Services 5.7%
Insurance 6.2%
Pharmaceuticals, Biotechnology and 9.1%
Life Sciences

Only a few assets ranked higher in percentage of assets that comprise the earnings of the fund:

Energy 9.5%
Capital Goods 7.1%
Software and Services 9.4%

Artio Global reported the following in percentage of assets in their recent semi annual report (Artio Global Investors: Semi Annual Report April 30, 2009):

US Artio
U.S. Microcap Fund
Healthcare 16.3%

*This number most likely includes all the above groups assets that have been separated out in the Hartford report.

The point to be made here is that any losses to profits related to health care reform could very well mean losses to investors. So it isn't hard to imagine how those Americans who depend on investment/retirement income might come out swinging in defense. And it is not hard to imagine certain unscrupulous elements of the health care and investment industry capilizing on those fears. Those who would would manipulate their worried clients have found clever ways to redirect the legitimate fears into other outlets. They do this because they know the White House and Progressive Democrats do indeed have answers and solutions to the legitimate fears. It therefore becomes necessary to fan the fears of clients to such an extent that reason is overcome by paranoia all in an effort to direct the discussion away from the original issue.

To allay their fears, I recommend we ask our law makers and policy enforcers the following questions:

1. If Americans opt of out coverage under private, for profit health insurance, how will this impact my retirement earnings? An answer to this question might also ease the fears of small to medium sized businesses who augment profits with investment income (practice which I believe ultimately can harm a business if income from investments becomes a crutch).

2. How will negotiations with big Pharm, Medical Equipment and Biotechnology impact the earnings of those industries, and can I expect those losses to impact my retirement income from investments related to them?

When entering into any discussion one must first define the topic of the discussion, then those points upon which the participants disagree and agree. I hope that this last posts helps to clarify what I hope are some of the more deeply felt concerns of our pre-retirement and retirement community. If anyone chooses to take on this discussion, I caution you to be ready to absorb the anger that may likely be directed at you. If you can remained calm and composed, and approach the conversation with an attitude of non confrontation, it is possible to move past this initial anger and begin a true conversation. These conversation are extremely rewarding.

Having made this point, I would like to clarify that while I have the utmost respect for the concerns of those individuals who are approaching or are of retirement age, I have far less patience with the younger group comprised of people in their early to mid forties upward who posses the capability to work until the established age of retirement. I am rather perplexed by the notion that these individuals have the right to be angry at the government because the recent economic downturn has forced them to give up early retirement. They seem to operate under the all to common belief that a lifetime of investing guarantees one the right to a life of ease and freedom from worry. Investing is risky business. A good investment firm will take great pains to emphasize and explain the risks. Heck, Suzi Orman will be happy to explain the risks via several public mediums. So it is improbable that anyone not living in a cave (no dig at our neanderthal brothers and sisters) would be unaware of the downside to dabbling in the stock market.

Why do I think that a fear of further loss of income might be behind the less reasonable fears loudly voiced in town halls across America? How could this former fear be lesser than the latter fears? We are Americans, and older Americans especially were taught to hunker down and keep ones financial worries to oneself. Americans make do. We don't like to accept charity. With this in mind, it is conceivable that it would be easier for a person laboring under the burden of such concerns to find it easier to redirect their worries and attack parts of health care reform that seem impossible for some of us to understand.

The ability to fan the flames of fear into righteous anger is a well known and much discussed tactic of the conservative right. It pains me to watch these pitiless arbitrators of chaos take advantage of people who have genuine concerns, and who, under better circumstances would be able to voice those concerns in a way that would bring about solutions to the problem of health care reform. So, while I know that many of the sign waivers and slogan shouters may well be the hired hands of the health care industry, I am mindful that there may well be those who struggle to find answers in the face of what for them may be near crippling fear. For them, I labor to find the truth.

Senator Begich’s Comments on Health Care Reform a the Dena’ina Center

Someone (I think it was his wife) once described Senator Begich as a wonker: someone who gets very engrossed in the details of a subject. That may not be the technical definition, but it works for me. That was the first time I had heard that term used. Being something of a wonker myself, I appreciate this trait in both my President and Senator Begich, especially when it helps to dispel the myths surrounding health care reform. In true form, Alaska's junior Senator passed out several informational flyers to attendees before his speech Monday at the Dena’ina Center. I thought I would share a couple of them.

The first flyer outlines the Senators case for health insurance reform and includes specific figures related to the cost of current and future health care in Alaska. It is of no small significance that the title of the flyers is "Time for Action: The Case For Health Insurance Reform" as opposed to simply "Health Care Reform". The latter cannot happen without the former.

These numbers speak volumes, and I need not add further comment save to say that figures similar to these have been posted and discussed (civilly when possible) in town hall and Chamber of Commerce meeting throughout the United States.

The second flyer lists the benefits to be had with Health Insurance Reform. How much more clearly can a Senator state their case?

All over the country people have come forward to testify to the widespread prevalence of the practices of health insurers listed in this flyer. With these examples in mind, one can sit down and review their insurance policies, and perhaps identify potential problems with coverage. Many of us have actually dealt with some or all of the problems listed in this flyer at some point in our lives. Mr. Begich's figures seem to indicate that, in Alaska at least, this is the case.
I have heard the argument stating Americans are already protected by provisions in Title XXVII (Requirements Relating to Health Insurance Coverage) of the Public Health Service Act (TXXVII PHSA). However, the evidence of both personal experience and testimonials from thousands of people across the United States seems to conflict with that argument.
For instance, in the matter of discrimination of pre-existing conditions, TXXVII, PHSA states only that an insurer offering group coverage cannot deny an individual within that group a policy because of a pre-existing condition. It does not, however, prevent that insurance company from denying coverage for a pre-existing condition within that policy.
On the matter of gender discrimination, yesterday, Randy Rhodes had a quest on her show, a former CEO with Cigna Health Insurance, who spoke of the practice of health insurers whereby they required companies to disclose how many of their employees were female, then adjusted the premiums up or down based on those numbers. As of today, I have not been able to locate a provision in the PHSA that prohibits gender discrimination as it occurs in the above example. If it does exist, it has not been properly enforced. Either way, the problem needs to be addressed in some version Health Care reform.
Senator Begich addressed an assemblage that included some of the top business leaders in Alaska. His point was clear that Health Insurance Reform would directly benefit small businesses in Alaska. Medical practices comprise a portion of those small businesses. Here is a link to a document released by the America Medical Association regarding benefits of reform to medical practitioners:
http://www.ama-assn.org/ama1/p...
I apologize if the images may be to small to read. They can be read if they are printed. I believe that copies of these flyers can be obtained on Senator Begich's website.
http://begich.senate.gov/public/
Although the end of the Congressional recess is drawing closer, there is still ample time to contact Representative Dong Young, http://donyoung.house.gov/, and Senator Lisa Murkowski, http://murkowski.senate.gov/pu... and learn more about their views on Health Care reform. Although the outcome of their decisions may already have been decided, we should not count them out. Mr. Young did not win by a landslide, and we may still be able to capitalize on those numbers. Senator Murkowski also may be vulnerable to poor result at the polls in the next election. For your vote to count at the polls, you must exercise your first amendments rights today, and we need to be clear when we say, "Reform Health Care now or we will find Congressfolk who will!"

HR 3218 - The Republican Version of Health Care Reform

The following is a link to thomas.loc.gov bill H.R. 3218. This bill is being touted nationally as the Republican health care reform bill. Representative Don Young supports this bill and is a co-sponsor.

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3218:

In addition to a tax credit that would be offered to insurance policy holders, this bill would allow states to create Individual Membership Associations or IMAs. The most identifiable weakness with this bill is that it basically duplicates a system that already exists under Title XXVII (Requirements Relating to Health Insurance Coverage), section 2745 of the Public Health Service Act (PHSA). The section of this act provides the structure and funding that currently allows states to create High Risk Pools to be used to provide health insurance to high risk individuals whose insurance rates are 150% higher than the standard in the state. The provisions in H.R. 3218 seem to mirror what is already covered under Title XXVII, section 2745. There is even a similarity in the mechanism of funding between the proposed house bill and the PHSA. The only addition seems to be the actual formation of the IMAs. The funding and structure for High Risk Pools already exist, and many of these High Risk Pools are already in place. Why then would there be a benefit in creating these IMAs? Conservatives generally tend to frown on excess government, so this bill makes little sense, unless one realizes that the IMAs will be run by private enterprise. Can we assume this bill merely serves the purpose of apportioning yet more out to the private sector? Health insurers already make a healthy profit from our premiums? Must we now provide profits for yet another corporation whose lobbying interests in Washington take precedence over the financial needs of the citizens of America?

Here is a section from H.R. 3218 that outlines the purpose and structure of the proposed IMAs.

SEC. 3101. DEFINITION OF INDIVIDUAL MEMBERSHIP ASSOCIATION (IMA). `(a) In General- For purposes of this title, the terms `individual membership association' and `IMA' mean a legal entity that meets the following requirements: `(1) ORGANIZATION- The IMA is an organization operated under the direction of an association (as defined in section 3104(1)). `(2) OFFERING HEALTH BENEFITS COVERAGE- `(A) DIFFERENT GROUPS- The IMA, in conjunction with those health insurance issuers that offer health benefits coverage through the IMA, makes available health benefits coverage in the manner described in subsection (b) to all members of the IMA and the dependents of such members in the manner described in subsection (c)(2) at rates that are established by the health insurance issuer on a policy or product specific basis and that may vary only as permissible under State law. `(B) NONDISCRIMINATION IN COVERAGE OFFERED- `(i) IN GENERAL- Subject to clause (ii), the IMA may not offer health benefits coverage to a member of an IMA unless the same coverage is offered to all such members of the IMA. `(ii) CONSTRUCTION- Nothing in this title shall be construed as requiring or permitting a health insurance issuer to provide coverage outside the service area of the issuer, as approved under State law, or requiring a health insurance issuer from excluding or limiting the coverage on any individual, subject to the requirement of section 2741. `(C) NO FINANCIAL UNDERWRITING- The IMA provides health benefits coverage only through contracts with health insurance issuers and does not assume insurance risk with respect to such coverage. `(3) GEOGRAPHIC AREAS- Nothing in this title shall be construed as preventing the establishment and operation of more than one IMA in a geographic area or as limiting the number of IMAs that may operate in any area. `(4) PROVISION OF ADMINISTRATIVE SERVICES TO PURCHASERS- `(A) IN GENERAL- The IMA may provide administrative services for members. Such services may include accounting, billing, and enrollment information. `(B) CONSTRUCTION- Nothing in this subsection shall be construed as preventing an IMA from serving as an administrative service organization to any entity. `(5) FILING INFORMATION- The IMA files with the Secretary information that demonstrates the IMA's compliance with the applicable requirements of this title. `(b) Health Benefits Coverage Requirements- `(1) COMPLIANCE WITH CONSUMER PROTECTION REQUIREMENTS- Any health benefits coverage offered through an IMA shall-- `(A) be underwritten by a health insurance issuer that-- `(i) is licensed (or otherwise regulated) under State law, `(ii) meets all applicable State standards relating to consumer protection, subject to section 3002(b), and `(B) subject to paragraph (2), be approved or otherwise permitted to be offered under State law. `(2) EXAMPLES OF TYPES OF COVERAGE- The benefits coverage made available through an IMA may include, but is not limited to, any of the following if it meets the other applicable requirements of this title: `(A) Coverage through a health maintenance organization. `(B) Coverage in connection with a preferred provider organization. `(C) Coverage in connection with a licensed provider-sponsored organization. `(D) Indemnity coverage through an insurance company. `(E) Coverage offered in connection with a contribution into a medical savings account, health savings account, or flexible spending account. `(F) Coverage that includes a point-of-service option. `(G) Any combination of such types of coverage. `(3) WELLNESS BONUSES FOR HEALTH PROMOTION- Nothing in this title shall be construed as precluding a health insurance issuer offering health benefits coverage through an IMA from establishing premium discounts or rebates for members or from modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention so long as such programs are agreed to in advance by the IMA and comply with all other provisions of this title and do not discriminate among similarly situated members. `(c) Members; Health Insurance Issuers- `(1) MEMBERS- `(A) IN GENERAL- Under rules established to carry out this title, with respect to an individual who is a member of an IMA, the individual may enroll for health benefits coverage (including coverage for dependents of such individual) offered by a health insurance issuer through the IMA. `(B) RULES FOR ENROLLMENT- Nothing in this paragraph shall preclude an IMA from establishing rules of enrollment and reenrollment of members. Such rules shall be applied consistently to all members within the IMA and shall not be based in any manner on health status-related factors. `(2) HEALTH INSURANCE ISSUERS- The contract between an IMA and a health insurance issuer shall provide, with respect to a member enrolled with health benefits coverage offered by the issuer through the IMA, for the payment of the premiums collected by the issuer. `SEC. 3102. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS. `State laws insofar as they relate to any of the following are superseded and shall not apply to health benefits coverage made available through an IMA: `(1) Benefit requirements for health benefits coverage offered through an IMA, including (but not limited to) requirements relating to coverage of specific providers, specific services or conditions, or the amount, duration, or scope of benefits, but not including requirements to the extent required to implement title XXVII or other Federal law and to the extent the requirement prohibits an exclusion of a specific disease from such coverage. `(2) Any other requirements (including limitations on compensation arrangements) that, directly or indirectly, preclude (or have the effect of precluding) the offering of such coverage through an IMA, if the IMA meets the requirements of this title. Any State law or regulation relating to the composition or organization of an IMA is preempted to the extent the law or regulation is inconsistent with the provisions of this title. `SEC. 3103. ADMINISTRATION. `(a) In General- The Secretary shall administer this title and is authorized to issue such regulations as may be required to carry out this title. Such regulations shall be subject to Congressional review under the provisions of chapter 8 of title 5, United States Code. The Secretary shall incorporate the process of `deemed file and use' with respect to the information filed under section 3001(a)(5)(A) and shall determine whether information filed by an IMA demonstrates compliance with the applicable requirements of this title. The Secretary shall exercise authority under this title in a manner that fosters and promotes the development of IMAs in order to improve access to health care coverage and services. `(b) Periodic Reports- The Secretary shall submit to Congress a report every 30 months, during the 10-year period beginning on the effective date of the rules promulgated by the Secretary to carry out this title, on the effectiveness of this title in promoting coverage of uninsured individuals. The Secretary may provide for the production of such reports through one or more contracts with appropriate private entities. `SEC. 3104. DEFINITIONS. `For purposes of this title: `(1) ASSOCIATION- The term `association' means, with respect to health insurance coverage offered in a State, an association which-- `(A) has been actively in existence for at least 5 years; `(B) has been formed and maintained in good faith for purposes other than obtaining insurance; `(C) does not condition membership in the association on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee); and `(D) does not make health insurance coverage offered through the association available other than in connection with a member of the association. `(2) DEPENDENT- The term `dependent', as applied to health insurance coverage offered by a health insurance issuer licensed (or otherwise regulated) in a State, shall have the meaning applied to such term with respect to such coverage under the laws of the State relating to such coverage and such an issuer.

In additional to being rather duplicative in its structure, the IMAs created by H.R. 3218 do little to help the under insured. The language of the bill does not clearly define what criteria will determine who can apply to the IMA. If the bill is based on the concept of the High Risk Pool, only those individuals whose rates are 150% higher than the standard rate for each state would be given the option to join the IMA (if I have misinterpreted this section of H.R. 3218, I would appreciate any input). The following excerpt outlines the funding for the proposed house bill.

H.R.3218 Improving Health Care for All Americans Act (Introduced in House) SEC. 301. FEDERAL MATCHING FUNDING FOR STATFEDERAL MATCHING FUNDING FOR STATE INSURANCE EXPENDITURESE INSURANCE EXPENDITURES. (a) In General- Subject to the succeeding provisions of this section, each State shall receive from the Secretary of Health and Human Services an amount equal to 50 percent of the funds expended by the State in providing for the use, in connection with providing health benefits coverage, of a high-risk pool, a reinsurance pool, or other risk-adjustment mechanism used for the purpose of subsidizing the purchase of private health insurance. (b) Funding Limitation- A State shall not receive under this section for a fiscal year more than a total of 50 cents multiplied by the average number of residents (as estimated by the Secretary) in the State in the fiscal year. (c) Administration- The Secretary of Health and Human Services shall provide for the administration of this section and may establish such terms and conditions, including the requirement of an application, as may be appropriate to carry out this section. (d) Construction- Nothing in this section shall be construed as requiring a State to operate a reinsurance pool (or other risk-adjustment mechanism) under this section or as preventing a State from operating such a pool or mechanism through one or more private entities. (e) High-risk Pool- For purposes of this section, the term `high-risk pool' means any qualified high risk pool (as defined in section 2744(c)(2) of the Public Health Service Act). (f) Reinsurance Pool or Other Risk-adjustment Mechanism Defined- For purposes of this section, the term `reinsurance pool or other risk-adjustment mechanism' means any State-based risk spreading mechanism to subsidize the purchase of private health insurance for the high-risk population. (g) High-risk Population- For purposes of this section, the term `high-risk population' means-- (1) individuals who, by reason of the existence or history of a medical condition, are able to acquire health coverage only at rates which are at least 150 percent of the standard risk rates for such coverage, and (2) individuals who are provided health coverage by a high-risk pool. (h) State Defined- For purposes of this section, the term `State' includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

I am not 100% certain at this time (my eyes are watering), but the following section of the bill might potentially provide less funding for each state than is currently provided under Title XXVII.

(b) Funding Limitation- A State shall not receive under this section for a fiscal year more than a total of 50 cents multiplied by the average number of residents (as estimated by the Secretary) in the State in the fiscal year.

My gut feeling is that H.R. 3218 does not adequately address the following key concerns of many Americans who seek true health care reform.

1. It does not address the way in which insurance companies determine when and how much will be paid out in the event of an actual claim. According to Title XXVII, section 2701, protections already exist that stipulate an insurance company offering group insurance cannot deny anyone a policy. However, nothing within Title XXVII prevents an insurance company from excluding coverage for a pre-existing condition within that policy. In addition, I am not certain that the above protection includes individual insurance policy holders.

2. It does not help those who are currently under insured whose premiums do not meet the requirement of 150% above the standard for each state. As I mentioned above, I am not certain that the PHSA protects the individual policy holder from being denied a policy, and it certainly does not preclude an insurer from denying specific coverage within that policy.

(ii) CONSTRUCTION- Nothing in this title shall be construed as requiring or permitting a health insurance issuer to provide coverage outside the service area of the issuer, as approved under State law, or requiring a health insurance issuer from excluding or limiting the coverage on any individual, subject to the requirement of section 2741.

The language in this bill does little to limit the ability of the insurer to pick and choose what coverage will be available to the insured within each policy. Thus, if an insurance company decides not to cover a portion of the medical bill, the insured is still left with the responsibility of paying a potentially large bill. According this section from the bill, the IMAs claim no liability for payment of such charges. This bill does nothing to reduce the risk to the insured of bankruptcy due to financial strain caused by an unforeseen injury or illness.

(C)
NO FINANCIAL UNDERWRITING- The IMA provides health benefits coverage
only through contracts with health insurance issuers and does not
assume insurance risk with respect to such coverage.

3. It does nothing to address the current practice of unregulated adjustment of insurance premiums by health insurance companies. If anyone knows of any current act or law regulates the manner and extent to which an insurer can raise premiums, please reply to this post. As I have pointed out in my previous posts, premiums rates fluctuate in sync with the profit margin of the health insurance company. It might even be argued that the average cost of premiums per state may relate more to the earning potential of that state, than to the actual number of individuals within a coverage area.

4. It does not address the need for more efficient administration of health care costs. In fact this bill adds yet another layer of administration to an already complicated process. The AMA made the following statement in their 2009 Health Insurers Report Card.

The inefficient and inconsistent claims process adds as much as $200 billion annually to the health-care system.

For me, H.R. 3218 cannot stand alone as a solution to health care reform. It does not directly address what I consider to be the root of the health care problem - private, for profit, health insurance procedures and practices. It remains to be seen if bills supported by democrats will do better, and I fully intend to explore those bills as well. This bill has passed through committee, and has been formally introduced on the floor of the House. This tells me that, for the most part, Republicans are happy with its content. I am not, and I have stated my reasons. I welcome any and all comments.

For reference, and for those who would like to know how the government regulates our health insurance, I am pasting the link to "The Compilation of Selected Acts Within the Jurisdiction of the Committee on Energy and Commerce: Health Law."

http://energycommerce.house.gov/images/stories/Documents/PDF/publications/109_health.pdf

I must sleep now, but I part with "take that you big oaf."


Our Family Faces Reality

In Honor of Mr. Roland Shanks and the Others Who Testified At the Press Conference

Mr. Shanks testified, or rather tried to testify, at the Press Conference in Anchorage on Monday hosted by Organizers for America. I am ashamed to say that I did mistake him for a woman. I apologize for my error from the bottom of my heart. The ring of rabble rousers prevented me from either seeing him or hearing exactly what he had to say. It was for this reason that I felt compelled to confront "the big oaf." I never got a chance to talk with any of those who gave testimonials. Mr. Shank sent this letter, and I would like to post it here on his behalf.

Hi I'm the person Jeannette idenified in her post as the women with an oxygen bottle on her shoulder. I'm actually a man, I thought after the chemotherapy took my ponytail I wouldn't have that problem anymore, but I guess it didn't help. I don't blame her things were a little confusing out there. I was diagnosised with Lung Cancer 3 and a half years ago, and have been dealing with the health care industry in Anchorage since. I also want to set the record straight on a couple of other nonfacts that were getting thrown around by some of our noisy friends. I don't work for a union, I work for a small nonprofit, we provide technical assistance to communities on environmental issues. Nobody paid me to be there, in fact I took annual leave, so there would be no question of who I was representing. I was representing me, myself and I and that is all. I do also do volunteer work on Health Care Reform with the Alaska Chapter of the American Cancer Society, but I was not representing them yesterday, just me, myself and I. Nobody wrote my speech for me, in fact anybody who bothered to notice would have seen I didn't have any prepared comments. My friends in the Native community have taught me that if you have something important to said just open your mouth and let your heart speak the truth, and that is what I was doing yesterday. Yes, we met with Senator Begich and Senator Murkowski's staff. We called and ask for an appointment and they scheduled a time. I'm sure that anybody who wants to meet could go through the same process. I can assure you I have no special connection to Senator Murkowski's office, and I didn't make the appointments the Democratically based Organizing for America did. I became involved in this debate because I've seen the problem with the system from close up and I want to do what I can do to make it better for the people who will have to deal with this issue in the future. I don't really expect to get much benefit from the reforms, most will probably take effect after my cancer and I have finished our dance, but I want the next generation to have it better. I want cancer patients in the future to be able to concentrate on fighting their illness and not fighting the system and the insurance companies. I suspect that most of the people who are happy with their insurance have never tried to use it for any serious illness. Among the people at meet at cancer events I most hear horror stories. I really appreciate all the effort you put into making Alaska a better place to live, Thank You.
> Roland Shanks
> For as long as space exists
> And sentient beings endure,
> May I too remain,
> To dispel the misery of the world

Mr. Shanks, you and the others who spoke deserved better than what you received at that press conference. Would that I could have done more to quell the noise from the tea baggers who selfishly tried to drown you out. I am so sorry I could not, and I am sorry that I didn't get the chance to speak to you. You will be heard, and what you have done will help the next generation. Your dance is one we all would rather avoid, but ultimately some, like my father, must face.

I cannot adequately express my gratitude to the hospice people who helped my father, my brothers and I deal with our dad's journey from life to death. The night before my father died, when his pain was greatest, and I felt so terribly useless, I was able to call a call a hospice nurse. She helped me cope, and her guidance eased my father's pain. My father had the resource and support system to plan for his death. He was a pharmacist, and understood what he would face in the end. He was lucky. I cannot possibly imagine anyone having to face cancer alone fighting with the insurance company for every procedure and possible drug. Thank you, Mr.Shanks, for sending this letter. I will do my best to spread this letter and its message to as many folk as will listen.