I have said that the Senate health bill caps out-of-pocket expenses in the individual market at 10% of income or $5,950 for individual plans, whichever is less.  It came to my attention that while not far from the truth, it is not entirely the case, although there are absolute caps of $5,950 for individual and $11,900 for family plans for those with income over 400% of the Federal Poverty Level.  I will explain in a minute what had me confused, but let me actually set the record straight on the numbers first.

Here are the actual out of pocket limits, straight from the horse's mouth (Senate Democratic Policy Committee analysis of bill as passed):

Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans. The standard out-of-pocket maximum limits ($5,950 for individuals and $11,900 for families) would be reduced to one-third for those between 100-200 percent of poverty, one-half for those between 200-300 percent of poverty, and to two-thirds for those between 300-400 percent of poverty. The plan’s share of total allowed costs of benefits would be increased to 90 percent for those between 100-150 percent of poverty (i.e., the individual’s liability is limited to 10 percent on average) and to 80 percent for those between 150-200 percent of poverty (i.e., the individual’s liability is limited to 20 percent on average). The cost-sharing assistance does not take into account benefits mandated by States.

Now, keeping in mind that Medicaid will cover people up to 133% of poverty under the Senate bill, here are actual individual caps (family in parentheses) in the individual market.  I have used the midpoint in each of 100-200%, 200-300% and 300-400% of Federal Poverty Level.  Above 400% of FPL, of course, the limits are $5,950 or $11,900.  So for the last number, I have used 450% of FPL, which does not have subsidies, just to be consistent with a 100-point jump in the rest of the table.

% of FPL	150	250	350	450
Income (first line = individual, second line = family of 4)	$16,245 $33,075	$27,075 $55,125	$37,905 $77,175	$48,375 $99,225
Out-of-pocket cap (first line = individual, second line = family of 4)	$1,983 $3,967	$2,975 $5,950	$3,967 $7,933	$5,950 $11,900
Out-of-pocket cap as percentage of income	12%	11%	10%	12%
Premium cap* as percentage of income	4.6%	8.1%	9.8%	N/A
Worst case scenario cost as percentage of income	17%	19%	20%	N/A

Dollar amounts rounded to the nearest dollar, percentages rounded to two significant figures.
For FPL, the Federal Poverty Guidelines from 2009 were used.

*Premium caps taken from both this table prepared by the Center for Budget and Policy Priorities, and from Kaiser Family Foundation's subsidy calculator.  If you choose the Senate-passed bill on the KFF calculator, and try out numbers, one of the lines you see will be "Cap on premium as % of income."

As you can see, roughly, it does not change the bigger picture a whole lot.  At the end of the day, it still establishes caps where there are none under the status quo, dramatically expands coverage, and saves lives.  In addition, there are a couple important thing that might get lost in the above four sections that no one should forget:

First, the above table does not change, and is not related to the fact that one is not subject to the individual mandate to obtain insurance under the Senate bill if one does cannot find comprehensive coverage for under 8% of income in their portion of premiums.

Second, insurance companies are not allowed to discriminate based on income.  That means, for example, that if an insurance company wants to make sure a 40-year old healthy non-smoking individual making 450% of FPL, or $48,375 a year and buying in the individual market is subject to the legal mandate to buy coverage (which has a threshold of 8% of income), they have to offer that individual a policy with an annual premium of roughly $3,900.  That means they have to offer the same policy to every 40-year-old non-smoker in the exchanges.  The Kaiser subsidy calculator will tell you how much your premium will be and how much of it you will pay and how much the subsidies will be, if any.

I have been getting the misconception from this article on Bloomberg, which states,

[The Senate bill] would increase to 10 percent the threshold for deducting out-of-pocket medical expenses for most people in 2013.

I took the "10 percent threshold for deducting" to mean 10 percent deductible.  I apologize for the confusion.  It turns out that what they meant was this: the Wall Street Journal explains it better:

In the past, relatively few people have been eligible to take the deduction because it allows no write-off for expenses equal to the first 7.5% of adjusted gross income. (The Senate Finance Committee has voted to raise this hurdle to 10% next year.)

I want to thank the commenter jim bow on a Daily Kos thread for pointing this out.  I have updated all the posts I can find about this, and continue to believe that the Senate bill is still a pretty good bill.

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A big debate is raging on the progressive blogosphere on health care. Do we have the votes to pass the Senate bill as-is in the House? Does the Senate have the votes to pass through reconciliation the things that most activists pushing for reconciliation want? What will the political consequences be if the Democrats pass nothing? What will those be if only the Senate bill passes? Hell, can a progressive vote for the Senate bill as is and not be assailed as a sellout?

That's a fine debate to have. It's great to say that because the Senate bill expands the private system of coverage without giving people the option to choose a public, government-run plan, it is so outside of one's principle that one is willing to take a principled defeat rather than compromised victory. But for 47 million Americans without health insurance coverage, millions of Americans who are losing their homes and filing bankruptcy because of medical costs despite having health insurance, seniors in the Medicare donut hole who are cutting their pills in half or choosing between a meal and prescription medication, the working poor who do not have a Community Health Center close by or a free clinic close by, the status quo is deadly.

For Nataline Sarkisyan, the status quo was deadly. So damn popularity, and damn politics. Damn the bloviating. Damn the political warnings. Let's look at people. Let's look at the enormous human tragedy of the status quo that is our current health care system and let's look at what the Senate bill does to at least treat this societal ailment that is crippling America. Let's look at why, at the minimum, we must at least pass the Senate bill.

COVERAGE AND CARE

Status Quo: By 2019, 57 million Americans will be uninsured if we do nothing. Right now, one out of every thousand Americans without health insurance dies every year due to the lack of health insurance. If that statistic holds, and there is no reason to believe it will not if we change nothing, by 2019, 57,000 non-elderly Americans will be dying every year because they do not have health insurance. The situation is made worse by the fact that those who lack insurance find it a daunting task - and mostly impossible - to find affordable care.

Senate Bill: The Senate-passed bill fails to eliminate that number, but it sure as hell cuts it down. In 2019, it will reduce the number uninsured to 23 million - still a shame, but better than 57 million uninsured, don't you think? Even more will have access. Community Health Centers are not just a great investment in the health of our people, but an incredible leverage to find additional funding for delivering access to care. In fact, the government tells us that only 20% of the total funding for Community Health Centers are federal funds. That means for every dollar invested in Community Health Centers by the federal taxpayers, we get $5 worth of medical access and service. Community Health Centers currently serve 20 million people every year. That is less than one-half of the number uninsured. Sen. Bernie Sanders says that the House's $14 billion CHC funding will expand that access to 45 million. The Senate bill's funding for CHC's is $10 billion. Doing the math, the Senate bill bill will expand access to 38 million Americans through Community Health Centers. Watch what happens when you combine these numbers. For the first time in history, Community Health Centers will have the capacity to serve a total number of people greater than the total number of uninsured once the Senate bill kicks into gear (23 million uninsured, enough capacity to serve 38 million people in Community Health Centers). I repeat: this is unprecedented in American history.

Status Quo: Insurance denials if you have a pre-existing condition (including, mind you, acne), denial of coverage when you get sick, jacking up your insurance premiums when you get sick, and no limit to how much your insurance company can make you pay send-of-pocket. If you cannot afford coverage, no one will help you obtain it. No restrictions on how much what they make in premiums insurance companies must spend on providing care. Your coverage might not include mental health parity or substance abuse care

Senate Bill: Comprehensive coverage, including mental health and substance abuse care. No more denials based on pre-existing conditions once the exchanges start in 2014, and no denials based on pre-existing conditions for children beginning immediately. No more rescission when you get sick, no more jacking up your premiums when you get sick. Premium assistance through the exchange for those who have trouble affording coverage, up to 400% of Federal Poverty Level (and no requirement to get coverage if your portion of the premium costs more than 8% of income). Sure, the assistance could be more generous. But are we really going to throw away whatever assistance is provided?  Out-of-pocket expenses are limited on a sliding scale (as are premium caps) for people up to 400% of poverty, and above that, to $5,950 for individual plans and $11,900 for family plans.  And remember that's the individual market only; in the small group market, deductibles over $2,000 for an individual plan and over $4,000 for a family plan are prohibited.  No out-of-pocket expense for regular checkups and preventive care. In the group market, insurance companies must spend 85% of your premiums on care, or cut you a check at the end of the year. A patient's bill of rights on steroids, according to President Obama.

Status Quo: Medicare donut hole is making seniors choose between food and medication, between cutting a pill in half and paying their heating bill. Letting insurance companies rip off Medicare recipients by making them pay extra copays and ripping off taxpayers by charging 14% extra in "Medicare Advantage" (talk about Orwellian framing) to the government.

Senate Bill: Advantage subsidies for big insurance cut by $118 billion. Over time, the Medicare "doughnut hole" is closed completely. This won't just save our health care system money and provide more efficient care. It will stop millions of seniors from having to make those heart-wrenching choices between medication and food, or prescription drugs and fixing the roof.

COST

I will cover costs in greater detail in the next few days, but here is a summary rundown of what happens to cost in the status quo vs. the Senate bill.

Status Quo: Well, let me draw you a picture:



By 2019, we will be spending nearly 20% of our GDP on health care if we do nothing. By 2014 alone, Medicare and Medicaid spending will be at nearly a trillion dollars. That's a Trillion with a T. And that's for that one year alone.

Senate Bill: Kick out the Medicare Advantage subsidies, find efficiencies and cost savings in Medicare, streamline, and save $483 billion in Medicare over 10 years. Cost of uncompensated care will decrease dramatically as coverage increases and as Community Health Centers expand. The Community Health Centers play a rather significant role in reducing the cost of uncompensated care. As Sen. Sanders puts it,

the emergency room will treat you for the common cold and charge $600 to $1,000, and the community health center will cost $100. If we spend on community health centers, you actually save money.

The CBO estimates that the Senate bill will shave $132 billion off the top of the budget deficit over the next decade, and by over $1 Trillion over the following decade. Cost containment measures within the health care system itself also includes the 85% Medical Loss Ratio (MLR) requirement, the excise tax on high-cost plans (but not necessarily more effective plans), streamlining medical billing and electronic medical records, etc. A diverse coalition of groups ranging from the SEIU to the American Medical Association to PhRMA have pledged, in writing, to produce a $2 Trillion saving in the system, but also said that that would only be possible under restructuring of the system and improving health of the population under comprehensive reform. Realizing even half of that would be a small miracle. None of those health improvements or systematic streamlining can take place quickly if we pass nothing. The Senate bill does put investments and incentives in place for all of these things, even if you think (as I do) that it doesn't go far enough in squeezing health insurance companies.

Folks, the status quo is deadly. And we must break it by passing the Senate bill as is in the House, and following it up with a reconciliation bill to improve it even more (but we have to be careful about what can be expected in such a reconciliation vehicle).

So, ultimately, that's the context in which we are talking about health reform. We're talking about a choice between the deadly status quo and the Senate bill which goes a long way towards treating our health care ailments. That's what I'm talking about when I ask if one can, in good liberal conscience, kill the bill. That's why I was so encouraged when news came this morning that President Obama has scheduled a half-day televised meeting with Democratic and Republican Congressional leaders on health care for February 25 (mark your calenders, people!). Indeed, it seems Obama is ready to accelerate health care reform following that meeting. And that's why you need to call Congress at (202) 224-3121 and ask for your member of Congress, and demand that they pass the Senate bill and follow it up with a reconciliation fix.

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No, that wasn't a typo.  Last night, Sarah Palin, the former half-term governor of Alaska and serious foreign and domestic policy feather-weight, was the featured speaker at the Tea Party Convention in Tennessee.  I don't usually go around listening to Teabaggers or to Sarah Palin for that matter, but for kicks, I wanted to hear what she's sayin' this days.  Of her many insanities, a few drew my attention.  Because I find incredible value when right wing lunacy accompanies comedy, I was rather amused to hear her say, amidst taking other run-of-the-mill potshots at President Obama's foreign policy about 14 and a half minutes into her speech:

...around the world, people who are seeking freedom from oppressive regimes wonder if Alaska is still that beacon of hope for their cause.

But more importantly, is Sarah Palin still Lady Liberty?

I don't know, Sarah, why don't you ask your husband, a former member of the separatist Alaska Independence Party?  You know, the secessionists whose convention you greeted as governor?  Was it a Freudian slip on Palin's part?  Who knows.  Palin has never been particularly keen on the idea of American diversity; this much we know.  To hear her father tell it, she left Hawaii because there were too many Asians and Pacific Islanders there.

Of course, Sarah I-don't-know-why-there-are-two-Korea's Palin's attacks at the President's foreign policy did not either begin or end there.  Before she ever got to her Alaska-as-liberty-island slip, Palin excoriated the President and his administration for trying and questioning the Christmas day underpants bomber under the civilian court system instead of treating him as part of the enemy in the war on terror.  There was 50 minutes of questioning, said Sister Sarah, and then we read him his rights.  That's not all.  He then "used his right to remain silent."  Umm.  About that, I know you read a lot of newspapers, Sarah - any of them, all of them that are put in front of you - but did you miss a story?  Abdul Mutallab not only gave the FBI a lot of good intelligence before he was, you know, read his rights, right now, FBI tells us that he is singing.

But of course, what good conservative undermining of American jurisprudence would be complete without mocking Obama's knowledge of Constitutional law?  What convention of people proclaiming their undying love for the American Constitution wouldn't want to hear about how silly it is to apply the Constitution?  About a minute or so before her Alaskan Beacon of Hope^TM flap, Ms. What-does-the-VP-do-everyday quipped,

We meed a Commander in Chief, not a professor of law.

Yes, God forbid we have a president who used to teach the Constitution to university students rather than running around having "youthful indiscretions" at age 40.  But even more importantly, Sarah Palin does not understand a basic tenet of American democracy: the President is Commander in Chief of the US Armed Forces by the virtue of being President, not the other way around.  Our country believes in and our Constitution codifies civilian control of the military, not military control of the civilian government.  Although, given Sarah Palin's understanding of what the Vice Presidential job description, it's not exactly a surprise that she is clueless about the President's job description as well.

You see, Sarah Palin is famous for her foreign policy credentials.  So much so that she learned all that stuff n stuff about foreign policy without even having a passport until 2006.  And that's not all.  She's also a domestic and tax policy guru.  As such, she told her worshipers how small businesses should get tax cuts to create jobs.  I am left wondering, though, that nobody told her about the big amounts of tax breaks that small businesses got under the Recovery Act.  She also did not seem to know or care about the President's plan to redirect $30 billion TARP (bank bailout) money for a small business loan program administered through community banks.  The new jobs bill, likely to land in the $100-150 billion range, is also poised to deliver major small business assistance and tax credits, including a $5,000 tax credit for every new job created by small business.  The House jobs bill, already passed, delivers permanent estate tax relief for small business, and provides $354 billion for small business loan guarantees through the Small Business Administration.  Sarah Palin, are you paying attention?

As the resident domestic and economic policy dittohead and Leader of The People, she demanded consequences for bankers who were bailed out by taxpayer dollars and are now paying bonuses t themselves.  Well, I guess that means she is signing on with the President's proposal to slap a fee on the largest banks so we can get all our money back.  I mean, there were even more indications for it in her speech.  She bragged about how when the "good ol' boys" were making backroom deals that were benefiting the oil companies, she punished them.  Well it turns out that at least part of that punishment was a windfall tax on oil companies that allowed Palin to cut a $1200 check to every Alaskan (aka socialist redistribution of wealth Reaganite capitalism).  For some reason, though, I can't find her statement Facebook post pushing for this bank fee.  Nor did she pitch it in her speech to the Torch and Pitchfork Crowd.  But maybe she'll write a book about it, and Newsmax will give it away for free.

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As you can see, I have been busy giving The People's View a new look. I think I like the way it looks. You can now easily share the contents of this site to all your social networking places - Facebook, Twitter, MySpace, to your heart's content by using the AddThis 'Share' bar that' follows every entry, and is also available on the top of each page. There is an 'about' section, and you can even use the 'contact' link above to contact me! You can click the little twitter bird on the right to follow me on Twitter.

So, what do you think of the new look? I think I like it!

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I usually don't do short posts, and I am not terribly fond of political predictions.  Not this far ahead of an election, at any rate.

However, I do have something in mind that I think needs to be said.  A lot of Democrats seem to be afraid that that they are damned if they do and damned if they don't on health care.  I want to make the short point that Democrats are more damned if they don't - at least in their base - and at least pretty well off in the long run if they do.  How so?

Right now, the Democratic base is somewhat divided on health care.  At least it appears so if you are counting the loudest ones.  One side believes that the Senate health bill is the Second Coming of Satan and that there is no way in hell it should pass as is.  They want a reconciliation bill to fix the bill go first.  The other side, my side, believes that the Senate bill is actually a pretty good bill for all its flaws, and should be passed forthwith by the House and sent to the President for a signature.  It can later be followed up with a 'fix.'

Let me tell you why going with my side will give Democrats a political advantage within the base, and likely within the larger American public.  First of all, if you do not pass any bill - which would be the position of the other side if a reconciliation bill doesn't go first - Democrats are screwed in both parts of their base.  My side, 'pass it and fix it later' crowd will abandon Democrats (in intensity, if not in votes) because they wouldn't get anything done.  Please don't fool yourself and think that the 'kill the bill' side of the base will suddenly come to the Democrats' rescue.  Democrats will have lost them as well, since they will not have delivered anything for them.  Their perception that the Democrats are just a bunch of wimps who have no spine will not change.

If Democrats pass the Senate bill first, my side of the base will be with them.  If they are then able to put together a satisfactory reconciliation package, the other side can be pacified - although I suspect they won't be, since they will accept nothing short of a public option, and there does not seem to be any way to pass one through reconciliation.  However, a reconciliation bill will bring some of them on board, and others will take a step back and realize, hey, we got something done!  Success has its followers.  There will still be some who will decide to be grumpy and stubborn, but at least Democrats will not have lost all, or even most of their base.

Now within the general American public, the same story will play out.  If we pass the Senate bill and explain to Americans what's in it for them and our values behind it - as the President is already doing - we will do just fine among American voters.  As Ezra Klein said, the American people don't hate the specific parts of the bill, they are misinformed and they hate the Congressional process.  Once the process is over, success will bring its own followers, and we can put the misinformation to rest.  If we pass nothing, however, the American people will believe two things: first, that the health care bill was a terrible idea and all the misinformation about it were true - and Democrats came up with it!  Second, Democrats are incapable of governing, so stop giving them the power to.

So, yeah.  Pass the damn bill.

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You can throw a dart at the left-ideological blogosphere and if you aim it roughly for health care reform, chances are you are going to hit a post about how the Democratic party is violating its own platform with the Senate bill.  Horror!  Of course, you can look at the right wing lunatic blogosphere and they are screaming about Socialist Communist Kenyan (TM) takeover of health care reform.  But I'm planning on examining the claims of this serious violation of the Democratic platform today.  After all, Democrats are in power in the White House, the House and the Senate.

First let me introduce you to the 2008 Democratic National Platform.  As you will see, it divides each policy area into subsections about what the Democratic platform says about that policy area.  I am going to list them and assign points based on a rather simple idea: I wasn't at the platform discussions.  I don't know what was given the most weight and what was given the least.  So each goal under the main health care umbrella will get the same amount of points assigned, and each sub-goal within it will divide up those points equally.  Sound fair?  Ok.  So let's find out how the Senate health care bill stacks up against those goals.

Before I go on though, because I'm a Democrat, I'd like to begin with a reminder to my fellow Democrats about this President and this Democratic Congress' commitment to health care and children.  The platform, in the health care section, starts off this way, highlighting the importance of health care reform among Democratic delegates:

If one thing came through in the platform hearings, it was that Democrats are united around a commitment that every American man, woman, and child be guaranteed affordable, comprehensive healthcare. In meeting after meeting, people expressed moral outrage with a health care crisis that leaves millions of Americans – including nine million children – without health insurance and millions more struggling to pay rising costs for poor quality care.

The President and the Democratic Congress moved swiftly after Obama's inauguration to drastically reduce this number.  On February 4th, 2009, the President signed into law a big expansion of SCHIP, covering 4 million additional children, cutting the number of children uninsured by nearly half.  That is in addition to 7 million children previously covered, bringing the total number of children covered by SCHIP to 11 million.

Work on health care indeed began before the current legislation.  The Recovery Act dedicated more than $145 billion to investments and reform of health care systems, including $87 billion to states in just the next couple of years to maintain Medicaid programs, $25 billion to help laid off workers buy COBRA, $19 billion for Health Information Technology (HIT) deployment, and $10 billion in additional funds for the National Institute of Health.

Now let's move on to the particular sections for health care in the 2008 Democratic platform.  Each category, except one one-liner, will be worth 20 points.  First up:

I. Universal coverage and insurance options - 20 points possible.

Covering All Americans and Providing Real Choices of Affordable Health Insurance Options. Families and individuals should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan. Coverage should be made affordable for all Americans with subsidies provided through tax credits and other means.

From here, point distributions:

Coverage, 10 points possible (100% coverage possible)
The Senate achieves 94% coverage, so it gets a 9 (House bill would get a 10, with 96% coverage).

Health care choices: 10 points possible - 5 for public plan, 5 for affordable choices.
Senate bill does not have a public plan.  Zero for that.  Health insurance choices are alright, costs are largely a wash with the House bill, although it could always get more subsidies.  So it gets 4 out of those 5 points.  So 4 out of 10 here.  (House bill would get a 9).

Category I Score: 13/20.

II. Shared responsibility - 20 points possible.

Shared Responsibility. Health care should be a shared responsibility between employers, workers, insurers, providers and government. All Americans should have coverage they can afford; employers should have incentives to provide coverage to their workers; insurers and providers should ensure high quality affordable care; and the government should ensure that health insurance is affordable and provides meaningful coverage. As affordable coverage is made available, individuals should purchase health insurance and take steps to lead healthy lives.

The platform sure sounds to me like it's at least quite open to a mandate.  Given a whole lot of delegates (Clinton and Edwards delegates) were pledged to candidates who openly campaigned for a mandate, this is a reasonable assumption. The Senate bill has a mandate - an affordable one, as I have discussed before - with a hardship exemption.  The Senate bill provides employers with incentives to provide coverage, with small business tax credits for health insurance going into effect immediately.  The Senate bill does as good as the House bill to ensure high quality care - with both reforms in care delivery and defined minimum benefits.  It puts an onus on the insurers to come up with coverage with value given the 85% Medical Loss Ratio (MLR) requirement - i.e. insurers spend that much on health care or cut you a check at the end of the year - coupled with an excise tax on high-premium employer plans discouraging unnecessarily expensive but not necessarily more effective policies.

I give Shared Responsibility on the Senate bill its full 20 points.

Category II score: 20/20.

III. End Insurance Discrimination (pre-existing condition) - 20 points possible

An End to Insurance Discrimination. Health insurance plans should accept all applicants and be prohibited from charging different prices based on pre-existing conditions. They should compete on the cost of providing health care and the quality of that care, not on their ability to avoid or over-charge people who are or may get sick. Premiums collected by insurers should be primarily dedicated to care, not profits.

The Senate bill eliminates discrimination (all discrimination, including in price, not just in acceptance) based on pre-existing conditions, although not until 2014, when the exchanges start.  Pre-existing condition discrimination against children is banned immediately.  The Senate bill ends recessions if you get sick or injured, and bans annual or lifetime caps (lifetime caps for existing policies are grandfathered, but you can switch easily since no discrimination is allowed based on health conditions when you choose a new plan, and new policies are forbidden from having a cap).  The Senate bill also allows insurance companies to charge older people 3 times as much.  That'll cost some points.  Largely because of this, I'm giving it a 15 in this category.

Category III score: 15/20.

IV. Insurance Portability - 10 points possible

Portable Insurance. No one should have to worry about losing health coverage if they change or lose their job.

I know I said 20 points each.  But this is pretty bare knuckle and short.  Not any components.  10 points is good enough for this.  Portability is basically achieved through the exchanges, which are present in the Senate bill.  Some will quibble that insurance on a national exchange is more portable than insurance on state based exchanges, and even though I disagree, I don't want to belabor the point.  Fine.  9 points.

Category IV score: 9/10.

V. Meaningful Benefits - 20 points possible.

Meaningful Benefits. Families should have health insurance coverage similar to what Members of Congress enjoy. They should not be forced to bear the burden of skyrocketing premiums, unaffordable deductibles or benefit limits that leave them at financial risk when they become sick. We will finally achieve long-overdue mental health and addiction treatment parity.

Well, the Senate bill's minimum coverage isn't quite what Congress has, but the basic package is modeled after it.  No junk insurance.  Affordability and cost control measures include the exchange (marketplace), the ability of state and federal regulators to monitor premiums and kick out insurers from exchanges, the 85% MLR requirement and the excise tax only for high-priced for group plans, dis-incentivizing costly plans that don't deliver better insurance.   Mental health is covered.  Premium assistance is available for people up to 400% of poverty; Medicaid is extended to people up to 133% of poverty.   Out-of-pocket expenses are limited on a sliding scale (as are premium caps) for people up to 400% of poverty, and above that, to $5,950 for individual plans and $11,900 for family plans.  The mandate is inoperative unless you can find insurance that will costs you 8% or less of your income in premiums.

But both the Senate and the House does a disservice in terms of abortion coverage - although the Senate bill is lesser of the two evils on that.  I do believe abortion is a "meaningful benefit."  Although this next point is not considered in grading, I do caution you that Vice President Biden's Violence Against Women Act is up for re-authorization next year.  Do we want Republicans be in control of Congress for that?

So, take a few points off the top for the imperfections (lack of abortion coverage, mainly), 17.  That's a B.  Sounds fair to me.  The House bill would lose more points on abortion coverage, and stand at about a 15.5 for me.

Category V score: 17/20.

VI. Prevention and Wellness - 20 points possible

An Emphasis on Prevention and Wellness. Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension. Chronic-care and behavioral health management should be assured for all Americans who require care coordination. This includes assistance for those recovering from traumatic, life-altering injuries and illnesses as well as those with mental health and substance use disorders. We should promote additional tobacco and substance abuse prevention.

This thing is on steroids in the Senate bill - what can be done as part of a health insurance package is, anyway.  Preventive care is free after your premium - i.e. no copay or deductible for preventive care.  Since pre-existing condition is gone, people with chronic care will be able to get health insurance and get proper care.  The Senate bill (being set apart from the House bill) also allows employers to provide employees with premium discounts, reduced cost sharing or additional benefits when an employee participates in a wellness program and meets certain health related standards.  To ensure it does not unfairly leave people behind, employers must provide alternative standards for those for whom it's unreasonably difficult to meet those standards.  This reward initially reaches up to 30% of cost of coverage, and may be increased to 50% in appropriate cases.  (Source: KFF - check 'Senate bill' in the top box, and then 'Wellness' in the bottom one, and then click 'generate comparison.')

Mental and behavioral health are included, including substance abuse care, as noted above.    Electronic medical records will help make you not go through the same test five times.  And let's not forget the $10 billion Community Health Center expansion in the Senate bill, thanks to Sen. Bernie Sanders, something he characterized as revolutionizing primary care (which is also preventive care).  Sanders has also already increased funding for CHC's in the Recovery Act.  Women's preventive care is well-covered.

This bill does as well as can be done with legislation on prevention and wellness.  Full marks.

Category VI score: 20/20.

VII. Modernized system that lowers cost and improves quality - 20 points possible

A Modernized System That Lowers Cost and Improves the Quality of Care. As Americans struggle with increasing health care costs, we believe a strengthened, uniquely American system should provide the highest-quality, most cost-effective care. This should be advanced by aggressive efforts to cut costs and eliminate waste from our health system, which will save the typical family up to $2,500 per year. These efforts include driving adoption of state-of-the-art health information technology systems, privacy-protected electronic medical records, reimbursement incentives, and an independent organization that reviews drugs, devices, and procedures to ensure that people get the right care at the right time. By working with the medical community to improve quality, these reforms will have the added benefit of reducing the prevalence of lawsuits related to medical errors. We should increase competition in the insurance and drug markets; remove some of the cost burden of catastrophic illness from employers and their employees; and lower drug costs by allowing Medicare to negotiate for lower prices, permitting importation of safe medicines from other developed countries, creating a generic pathway for biologic drugs, and increasing use of generics in public programs.

We don't know how much families will save with this bill.  It's not entirely clear.  But consider this: in 2008, the average family health plan cost $12,298, or about 18% of the median income for a family of 4 that year, $67,019.  If you are a median family, with let's say the primary policy holder about 45 years old, the Kaiser Health Reform Subsidy calculator estimates your premium to be $11,080 under the Senate proposal.  You would be eligible for subsidies, and the federal government would pay $4,512 of that cost.  That leaves your family with $6,568 in premiums.  So to you, the drop in cost is well over the $2,500.  (This is obviously if you are purchasing coverage in the individual market and not obtaining through your employer.)  But it might not be as much for families that aren't eligible for subsidies.  Overall though, with the help of the subsidies, that goal is pretty much met.

Electronic medical record and technology upgrades?  Check, a whole lot was already there before the debate even started, in the stimulus bill.

Independent board to find out what works best and the most effective care?  Check, at least for Medicare (waiting for Sarah Palin to start screaming 'Death Panel!' anytime now).

Removing cost burden of catastrophic illness?  Sure, if you consider most people will be required to get coverage, widening the pool and thus spreading out the cost of catastrophic illness.  Until the exchanges open, here is also a high risk pool set up in the Senate bill.

Now the Senate bill doesn't let Medicare negotiate drug prices, and points are coming off because of it.  But, it does, over time, completely close the Medicare drug benefit donut hole.

The Senate bill also fails to allow for drug re-importation.  Something will be taken off the top here.  I will note that the White House has promised to work with Sen. Byron Dorgan to enact a separate drug re-importation measure.

The Senate bill protects brand-name biologics drugs for 12 years, but in fairness, so does the House bill.  The Senate bill, however, slaps $2.3 billion in annual fees on brand name biologics makers.  So it might actually be doing better in this respect than the House bill.

Overall, I'm giving this modernizing system to improve cost and quality category a C.  That's a 15.

Category VII score: 15/20.

There are a few other areas of the health care platform, but legislatively, they are generally addressed in different areas, and thus would not make sense to include here.  These are:

• Building a strong health care workforce through incentives and training (primarily addressed via education policy and legislation. A quick note that Sen. Bernie Sanders, through the Recovery Act and this bill, also secured the largest increases for the Health Services Corps, in addition to the CHC's.)
• Commitment to eliminating ethnic, gender, sexual and other discrepancies in health care (can't be addressed in direct insurance coverage legislation, primarily addressed through access in existing programs, and of course, the Senate bill outlaws discrimination based on any of those factors.  The thing to work on now is regional discrepancies, since markets vary, and so does the customer base's makeup.)
• Public health and research (primarily funded through NIH and CDC).

So from the 7 areas above, I don't think I have been particularly generous in scoring.  As you saw, a total of 130 points were possible: 6 areas with 20 points each and one with 10.  My scores, in those 7 areas, total 109 points.  That's 84%.

In other words, we are getting about 84% of the Democratic health care platform in the Senate bill.  84%.  That's pretty damn good!  Maybe that's why two staunch proponents of the public option, House Majority Whip Jim Clyburn and Sen. Al Franken agree that the Senate bill is a 'very good' bill.  Now we can sit here and squabble about the other 16%, we can hold or we can make sure that we get this bill passed and get the 84% of the health care platform of the Democratic party - and possibly more!

To do that, you need to make a few calls - even if you have already made those calls.  First, call the Capitol switchboard and ask for your member of the House.  Tell them politely but firmly that you expect your member to vote for the Senate health care bill as is so that it can be signed by the President.  Then urge them to follow up with a reconciliation bill to fix it (or find your member at House.gov).  Call the Capitol switchboard back and ask to speak to your Senators (you can also find your Senators on Senate.gov).  Tell them you expect them to follow through on the House's reconciliation bill.  Call Harry Reid also if you like, as well as Speaker Pelosi.  Here are the toll-free numbers:

• 1-866-338-1015
• 1-866-220-0044
• 1-866-311-3405

Finish the job on health reform.

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There has been a big push by some on the ideological left (and I do not, at all, use the term negatively) about a reconciliation bill to "fix" the Senate bill before the House passes the Senate bill as is.  A big part of the push, though, has come from those who consider a public option sacrosanct and believe that a reconciliation bill is the way to push it through.  Indeed, some are positively giddy about the prospect of the public option (PLEASE NOTE: The link leads to a Google Docs spreadsheet form, and I have no idea where your information goes once you put it in, so I am not recommending you use it to sign, but just as an example) being revived now that any fix going through the Senate must do so by reconciliation and thus only require a majority vote.

However, those who are cheering on a "Reconciliation first" strategy simply or primarily because of the possibility of having the public option should take a breather.  Speaker Pelosi - who yesterday said that the Senate has no obstacle to move to reconciliation (and thus elated the supporters of the 'Reconcile First' strategy) - today poured cold water over the idea of a public option being included in a reconciliation package.  In no uncertain terms: "The Senate never supported the public option."

There was talk that there would be 51 votes for it, but it never passed on the floor of the Senate. It did pass in the House and, of course, I think it would be the way to go. But it isn't the way that the Senate went. And so I think that what you might see coming out of some reconciliation would be those areas of agreement that all three--the White House, the Senate and the House--had already agreed to...more than two weeks ago.

The Speaker is correct.  According to the Washington Independent's count on Nov 12, the public option had 51 likely supporters in the Senate.  However, many of these Senators, including Jim Webb and Claire McCaskill, who will not support comprehensive reform done through reconciliation (read: public option).  As it is, there are more than enough Democratic (and Democratic-caucusing) Senators on the fence to derail reconciliation altogether.  Some sort of reconciliation is still possible, but only given some of these Senators' willingness to pass narrow measures through reconciliation, not broad measures like a public option.

Narrow measures such as, as Pelosi said (and Ways and Means Chairman Charlie Rangel backed up), what was going on 'more than two weeks ago,' specifically, before Scott Brown was elected President of the United States the 41st Republican Senator.  The idea that a public option would be part of it was always, at best, a pipe dream.  Things the White House, the House, and the Senate all, as the Speaker says, already agreed to were: a national exchange (instead of state based ones), a supposed fix/temporary exemption for unions of the Cadillac tax and combining it with a millionaire's tax as a revenue mechanism, closing the Medicare donut hole faster, and a deal on federal subsidies and federal Medicaid assistance to the state (i.e. fixing the great 'Nebraska Compromise').  No, I did not make this up.

Harkin (D-Iowa), who attended healthcare talks at the White House, said negotiators were on the cusp of bringing a bill back for final votes in the Senate and House.

Harkin said “we had an agreement, with the House, the White House and the Senate. We sent it to [the Congressional Budget Office] to get scored and then Tuesday happened and we didn’t get it back.” He said negotiators had an agreement in hand on Friday, Jan. 15.

Harkin made clear that negotiators had reached a final deal on the entire bill, not just the excise plans, which had been reported the previous day, Jan. 14.

Harkin said the deal covered the prescription-drug “donut hole,” the level of federal insurance subsidies, national insurance exchanges and federal Medicaid assistance to states.

While the Speaker has said, more than once, that she wants the Senate to push through a reconciliation package in order for the House to act on the Senate bill as is, we now know with a pretty good deal of certainty that even she does not believe that a public option can be part of such a side car.  And the Speaker as well as House Democratic leaders have said previously that yes, they can pass health care legislation through the House without a public option.

House Majority Whip James Clyburn, a big supporter of the public option, said in no unequivocal term that he himself would vote for a bill without the public option.  In fact, he went further.  He said that the Senate has produced a very good bill:

"I believe that both the House and Senate bills make tremendous contributions toward bending the cost curve," the congressman from South Carolina said. "I think they do a great deal to bring more people into the system. I think though that the House bringing the 36 million additional people, the Senate bringing 31 million additional people, I think that the more the merrier in this instance. So I do believe that the Senate has done a very good bill. But I think that the House has done a very good bill as well."

So to be sure, the belief that a sidecar fix should go along with the Senate bill through the reconciliation process is not at all in conflict with the belief that the Senate bill, stand alone, is of itself a very good bill.  Sen. Al Franken agrees.

Majority Leader Steny Hoyer said in December that the House can pass a bill without the public option.

And Pelosi has today, for the second time, reminded us of the reality that a public option will not be going through the reconciliation process.

I should remind everyone here that Nancy Pelosi has done incredible work in passing the public option through the House, and I am not going to let anyone speak ill of her leadership on health care reform.  She is, in my book, a health care hero.  But Speaker Pelosi is not alone in her assessment that a reconciliation bill will not, in fact, include a public option.  Congresswoman Lynn Woolsey, Co-Chair of the House Progressive Caucus, agrees.  In fact, she goes further, saying that a public option not only does not have votes, but that it does not fit under budget reconciliation.

"I don't believe it fits in the reconciliation," said Progressive Caucus co-chair Lynn Woolsey (D-CA). "All that is is budget."

Today, Woolsey released a letter with Rep. Grijalva, seemingly contradicting her position and calling for a public option in reconciliation.  However, I will simply note that wanting something in reconciliation and acknowledging it's not possible is, not a complete contradiction.

So, just two recap - two of the hardest fighters for health insurance reform and for the public option do not believe that a public option can be included in budget reconciliation - both for counting-the-votes reason and for the restrictions on what can be included in a budget reconciliation bill according to the rules.  In other words - and I hate to say this - the public option is dead this go-round.  It's not coming back.  When you make your calls demanding reconciliation (and I'm all for demanding reconciliation), keep that in mind.

The choice before us, then, is rather stark.  When you clamor for a reconciliation bill, you must realize that it will not include your (and my) favorite thing: the public option.  It might include, to repeat myself:

• a national exchange (some progressives, including Howard Dean happen to think state based exchanges are better when a bill like the Senate bill is the underlying bill; see my comparison for detail)
• closing the Medicare prescription drug donut hole faster (although the Senate bill, as is, does eventually close it also)
• adjusting subsidy levels (which I pointed out might be considered a wash between the Senate and the House bills, but the House bill does have more money devoted to subsidies - hence the greater coverage) 
• "fixing" and exempting unions from the excise tax for a period of time ("fix" that wouldn't solve any of its underlying problems)
• giving all the states the Nebraska deal on Medicaid.

That's it.  These are the "fixes" you get in a 'sidecar' reconciliation bill.  To me, they seem like smoothing out what the House considers are rough edges - but not big titanic policy issues that should, in the alternative, stop the biggest expansion of social safety net since Medicare (those are Paul Krugman's words, not mine).  To be sure, these might all be good fixes.  Now, I want you to ask yourself this: even if you support the House's position on all five of the above, are they so important that you want to hold the underlying Senate bill hostage to a sidecar bill?  Must these fixes hold up what James Clyburn has called a 'very good bill'? Or do you think that while the Senate should certainly act on a reconciliation package to address these concerns, the House should make history by enacting historic health reform into law, by its passage and consequently, the President's signature?  The sidecar isn't derailed if the House passes the Senate bill as is, rather, in my judgment, momentum is created with final success and enactment into law of the Senate bill.

So, I need to pick up the phones again.  You need to call your member of the House and your Senators - even if you have already called.  First, call the Capitol switchboard and ask for your member of the House.  Tell them politely but firmly that you expect your member to vote for the Senate health care bill as is so that it can be signed by the President.  Then urge them to follow up with a reconciliation bill to fix it (or find your member at House.gov).  Call the Capitol switchboard back and ask to speak to your Senators (you can also find your Senators on Senate.gov).  Tell them you expect them to follow through on the House's reconciliation bill.  Call Harry Reid also if you like, as well as Speaker Pelosi.  Here are the toll-free numbers:

• 1-866-338-1015
• 1-866-220-0044
• 1-866-311-3405

Don't walk away from reform.  Not now.

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Today, Congress is holding a hearing on the Don't Ask, Don't Tell policy that lets gay and lesbian Americans serve in the armed forces of the United States only if they hide their sexual orientation.  The President promised to repeal this law, most recently in his State of the Union address.



As a gay American, I am glad to see Congress moving forward on this, and I am pleased to see the President pushing for it.  Today, in some more encouraging news, Adm. Mike Mullen, the Chairman of the Joint Chiefs of staff supported the repeal of the Don't Ask, Don't Tell policy, saying:

"No matter how I look at the issue," Mullen said, "I cannot escape being troubled by the fact that we have in place a policy which forces young men and women to lie about who they are in order to defend their fellow citizens." Noting that he was speaking for himself and not for the other service chiefs, Mullen added: "For me, it comes down to integrity — theirs as individuals and ours as an institution."

I think that sums it up.

But the injustice done to young men and women in uniform who happen to fall in love with someone of the same gender has cost them, and our country, dearly.  Since the enactment of this policy that forces our profiles in courage to be cowards about their sexual orientation and their families, over 13,500 brave Americans have been discharged for the crime of laying their lives on the line to protect their fellow citizens while gay.  At the last year's Netroots Nation, I went to meet Dan Choi and a Bill Clinton rally broke out!  Lt. Choi is one such brave American, a West Point graduate and Iraq veteran, whose discharge is now pending.

The cost has been great of this unfair policy - to LGBT Americans, to our military, to our security, and to our treasury.  So what is the dollar cost?  A Blue Ribbon Commission, made up of professionals with sterling credentials in defense policy, both civilian and uniformed was founded in 2005 in response to a GAO study requested by Rep. Marty Meehan about the cost of the Don't Ask, Don't Tell (DADT) policy.  The Commission concluded thusly:

In February 2005, the Government Accountability Office (GAO) released a report titled, “Financial Costs And Loss Of Critical Skills Due to DOD's Homosexual Conduct Policy Cannot Be Completely Estimated.” GAO found that the costs of discharging and replacing service members fired for homosexuality during the policy’s first ten years, from fiscal year 1994 through fiscal year 2003, totaled at least $190.5 million.

However, oversights in GAO’s methodology led to both under- and overestimations of the financial cost of implementing “don’t ask, don’t tell.” By correcting these oversights, and after careful analysis of available data, this Commission finds that the total cost of implementing “don’t ask, don’t tell” between fiscal year 1994 and fiscal year 2003 was at least $363.8 million, which is $173.3 million, or 91 percent, more than originally reported by GAO. Given that we were not able to include several cost categories in our estimate and that we used conservative assumptions to guide our research, our estimate of the cost of implementing “don’t ask, don’t tell” should be seen as a lower bound estimate.

 Why the discrepancy?  What did the Blue Ribbon Commission look at that the GAO did not?

As we discuss below, the appropriate cost measure for the policy is not the cost of replacing those fired, but rather the value of service years lost from each premature firing.

So, as it turns out, the taxpayers lose $36.4 million every year because of this policy.  The financial cost to our nation is the value of the years lost from the premature firing.  The security cost?  Immeasurable.  The military has discharged 800 mission critical troops and at least 59 Arabic and 9 Farsi linguists at a time when we are fighting terrorist who tend to communicate in, you know, Arabic, Farsi, Urdu, etc.  This is happening at a time when our military and other intelligence agencies are hurting for the lack of professionals who can speak, read and write those languages.  How badly are we hurting?

On September 10th, 2001, the United States government intercepted two phone calls placed from Afghanistan between Al Qaeda operatives. "Tomorrow is zero hour," said one of the voices. "The match is about to begin," came another ominous line. The National Security Agency intercepts millions of messages every hour, but these calls came from sources deemed to be high priority. They were, of course, spoken in Arabic, so they made their way to a translator's queue, waiting to be interpreted. Unfortunately, in the fall of 2001 our government did not have enough Arabic linguists to translate the messages quickly. The phone calls were not translated until two days later, on September 12, 2001. It was two days too late.

Our enemies speak English.  So when insurgents and terrorists hack into our $12 million drones, they know what the instructions in it say.  And we, the country that spends more money on Defense than the rest of the world combined, fire our military Arabic linguists because of who they love.

So let's count the costs of this policy by the numbers, shall we?

• 13,500 troops discharged for being gay.  Support our troops?
• 13,500 families punished for a loved one's willingness to die for his or her country.
• Many more have had their careers threatened. 
• Countless brave Americans who would not join the military in the first place because they refuse to live a closeted life inside the institution that is supposed brandish honor and integrity.
• At $36.38 million a year, it cost our military, in 16 years, over $582 million.  That's over half a billion dollars.
• 800 mission critical troops discharged.
• 59 Arabic linguists discharged, at least.
• 9 Farsi linguists discharged, at least.

And possibly, though it might be a stretch, the events of 9/11.  Could we have the message translated in time if we didn't kick all these people out of the military?  Who knows.  The NSA isn't the military, although its head is a high ranking military officer.  But our resources surely would be better invested in more linguists who speak the language of our enemies than in homophobia.

I'm gay.  I'm an immigrant.  I am an American.  I love this country with all my heart.  Is it so wrong for me to want to be a full citizen?  Is it wrong of me to demand that equal justice under law not be just a slogan?  Is it so wrong for Americans brave enough to give their lives in the service of their country to be also brave enough to love openly?  The first wounded American soldier was Staff Sgt. Eric Alva, a gay soldier who did almost lose his life in the service of our country.  Why do we live in a country that allows a gay soldier to be wounded in a war but not celebrated for his love?

We should not allow such policies to stand.  Stand with the President.  Stand with members of Congress who want to repeal this policy.  Stand with Eril Alva.  Stand with Dan Choi.  Contact your member of the House and your Senators.  Contact the House Armed Services Committee and the Senate Armed Services Committee.

I leave you with Lt. Dan Choi's reaction on NPR to the President's announcement.  Hear the voice of a soldier, an activist, an American.

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That's what Ezra Klein said Saturday at a forum sponsored by Families USA.  He was referring to the fact that for Democrats, there is no way to move backwards on this.  There is no going back on this.  There is no smaller piecemeal legislation.  Democrats can run on this bill and the success of it having passed, or they can run on a caricature of this bill and the failure of it.  Either way, Democrats are tied to it.  If we let health reform fail now - if we don't pass it quickly now - the failure will doom the Democratic party.  It's this bill, or everybody dies.  Not having health care reform will spell political and policy disaster for the Democratic party.  Not to mention, Ezra reminded the audience, this bill will save real lives.  Failing on this means more real people will continue to die.

Click here to see Ezra Klein make this point succinctly.

There are plenty of people running around in the Democratic party saying that health care reform has to be put on a back burner while Congress works on a jobs bill and so on and so forth.  There are two problems with that.  As I have pointed out before, the House is already ahead of the game, having passed its massive jobs bill back in December.  And secondly, Congress can do more than one thing at a time.  We cannot let health care reform lose steam just as the President is picking up steam and exposing the Congressional Republicans for the phonies that they are.

And "this bill" has to start with the House passing the Senate bill first.  If for no other reason, because the House can move faster than the Senate - even when the Senate is operating under reconciliation rules.  As Jonathan Cohn, Senior Editor of the New Republic points out in the same forum, even while a bill is moving through the reconciliation process, the Republicans can still obstruct and take up time, even though they won't be able to stop it ultimately.  Passage of the Senate bill through the House while reconciliation starts in the Senate (but is not completed) and the current Senate bill is signed into law will create momentum.

So, it's time again.  You need to call your member of the House and your Senators - even if you have already called.  First, call the Capitol switchboard and ask for your member of the House.  Tell them politely but firmly that you expect your member to vote for the Senate health care bill as is so that it can be signed by the President.  Then urge them to follow up with a reconciliation bill to fix it (or find your member at House.gov).  Call the Capitol switchboard back and ask to speak to your Senators (you can also find your Senators on Senate.gov).  Tell them you expect them to follow through on the House's reconciliation bill.  Call Harry Reid also if you like, as well as Speaker Pelosi.  Here are the toll-free numbers:

• 1-866-338-1015
• 1-866-220-0044
• 1-866-311-3405

There is absolutely no excuse why we shouldn't be able to get this done.  In fact, we are incredibly close, if Robert Gibbs is to be believed.

"We’re one vote in the House of Representatives from making health care reform a reality," the White House press secretary said, positing a scenario where the House passed the version of the bill already passed by the Senate which President Obama would then sign into law.

We are one vote shy.  One vote that millions of lives depend on, and that means that it's time to set aside the detractors, the endless back-and-forth, and get it done. If at this point you are unconvinced that this bill will worth passing, I will ask you one more time, can your conscience live with killing the bill?
It's this bill, or everybody dies.

Let's also talk about what this reconciliation everyone is demanding might include.  It would be great if a  public option can get in, and I'm still going to push for it.  A reconciliation bill is only being talked about because Democrats no longer have the 60 votes in the Senate, but the overall parameters of the House-Senate negotiations may not have changed.  Recall that prior to the election of Scott Brown to the Senate, the House was demanding fixes to the Senate bill - and those fixes did not include the public option.  Those negotiations were directing to these possible demands from the House: a national exchange (instead of state based ones), a supposed fix/temporary exemption for unions of the Cadillac tax and combining it with a millionaire's tax as a revenue mechanism, increasing the subsidies for low-income Americans in the exchange, fixing the Nebraska compromise to give all states the same treatment as Ben Nelson got for Nebraska in terms of Medicaid payments (having the federal government take over 100% of payments rather than sharing it with the states) and ending the anti-trust exemption for health insurance companies.  Whatever the Senate was unlikely to give the House before January 19, it is probably not likely to give it now, at least not right away.  The reconciliation bill is still taking shape, and this one will likely skip the public option.  So the basic question for those of us pushing for a public option in reconciliation is this: are we willing to kill health reform if - as is likely - a reconciliation bill does not include a public option?  I am certainly not willing to do that.  I am willing to get whatever we can of the rest of the fixes in reconciliation.  And once again, I believe that the House should not wait until the reconciliation process is complete to pass the Senate bill - it will only delay the bill without any sense of success or accomplishment to fuel the rest of the path.

Sen. Al Franken has begged the House to pass the Senate bill if the Senate will promise to fix it through reconciliation.  I think he put it best:

"I know that there are elements of the Senate bill that are distasteful to many members of the House of Representatives," Franken said.  "Believe me, there are a few elements in our bill that I’d like to see improved.

"But If we in the Senate pledge to fix those elements through reconciliation — a budget process that requires only 51 votes,  the House of Representatives should pass the Senate bill," he said. "Big pieces of legislation often need to be fixed and improved after passage.  Health care would be no different.  But we have to stop letting the perfect — and everyone has different definitions of perfect — be the enemy of the very good."

I am with those who believe the Senate bill should be fixed through a reconciliation process, and I will continue to push my Senators for it.  But this cannot be an excuse for letting the underlying Senate bill wither on the vine or die.  Insisting that the reconciliation bill must not just begin but pass the Senate before the House can act is delaying health care reform, and potentially derailing it.  Besides, if anyone believes that whatever can be pushed into a reconciliation package are the only fixes this bill is ever going to need, I have a very nice bridge in Brooklyn that I would like to sell you.  The process of improving this law will begin the moment the President signs the legislation, and will most definitely not end once a reconciliation bill is also signed into law.  It is going to take much longer term commitment both for us advocates and for Congress.  So let's pass the damn bill, and commit to seeing it improve not just in reconciliation but by any means necessary in the coming years.

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Spain has pulled a fast one and taken politics to the arena of academic competition, refusing to let Israel's Ariel University Center - a university with both Israeli and Arab students - participate in Solar Decathlon 2010, after the Ariel U team already qualified for the finals.  Spain is the host of the Solar Decathlon 2010 - the goal of which is to build the best solar house.  According to one of this year's Solar Decathlon Europe's (the first year Europe is hosting it) official web site (click on Solar Decathlon Europe menu, then History),

The Solar Decathlon is a competition organized by the U.S. Department of Energy in which universities from across the globe meet to design and build an energetically self-sufficient house that runs only on solar energy, is connected to a power grid, and incorporates technologies that maximize its energy efficiency.

In the final phase of the competition, teams will assemble their prototypes in the so-called ‘Solar Village.’ The prototypes designed by the participating teams will then ‘compete’ in a set of ten contests (Decathlon) in order to demonstrate the self-sufficiency and energy efficiency of each house.

It is an academic competition, and it is wrong to exclude students that have worked hard and already qualified for the finals.   I believe that it is contrary to academic freedom, detrimental to the spirit of open competition and most importantly, counterproductive to the goal of the Solar Decathlon - which is to find the best group of student scientists that can produce a solar house and provide a model for the world's clean energy future.  That is why I am asking everyone reading this to sign the petition to Spain to have this decision to inject politics in academics reversed, and if they won't, ask the US Department of Energy to rescind its sponsorship of the event.

Spain has expelled the Ariel University Center of Israel from this competition on the premise that the university is located in the West Bank and that Europe does not recognize the Israeli settlements in the West Bank.  It is rather curious that Spain only noticed the location of the university after the Ariel U team qualified for the finals, with the rather ridiculous excuse that they did not come to know of the university's physical location until recently.  I smell something rotten.  Anti-Israeli and anti-Semitic sentiment is on the rise in Spain, and it is being taken out on students.

If Spain won't rescind its decision and let the Ariel University Center team in, then the United States must stand for academic freedom and stand by one of our best allies in the world, Israel.  The Department of Energy, which started the Solar Decathlon and is a main sponsor of it this year, must condemn Spain's behavior and at once, end its sponsorship of this year's event.  I signed the petition, because I agree, wholeheartedly, with this:

Political extremists have launched yet another Boycott, Divestment, and Sanctions (BDS) campaign targeting Israel. They pressured Spain into abruptly expelling Ariel University Center (AUC) from the 2010 Solar Decathlon, an international competition for building a self-sustaining solar house, even though Ariel’s team was chosen as one of 20 finalists. The U.S. Department of Energy created the first Solar Decathlon in 2002, agreed in 2007 to have Spain host the competition in alternating years, and is co-sponsoring the 2010 event.

BDS’s goal of spreading the 60-year-old Arab boycott against Israel violates all standards for international cooperation which call for transcending political grievances in joint research that will advance human knowledge and benefit humanity. BDS activists oppose and threaten those ideals. Spain has capitulated to their demands.

This is an academic event, not a political one.  Aspirations of students and the future of our planet are intertwined.   It's time to stop giving into the hostile campaigns against Israel and uphold the ethics of academic freedom.  Watch the video of Israeli and Arab students speaking out against this unjust campaign:



Please sign the petition.  After you do that, you might want to leave a note to the President at the White House, as well as contact your members of the House and the Senate.

By the way, if you would like to see the incredible work the students at Ariel University Center have already done on this project, check out their project web site.

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President Obama went to the House Republican Policy retreat today to talk to them and answer questions one-on-one.  The President mesmerized with intellect, honesty, mastery of policy and sincerity with no talking points or teleprompter during the Q&A session.  The White House insisted on televising both the President's speech and the Q&A session be televised.  So of course, like the cowards they are Fox Noise ran from the coverage in the middle of the President speaking.  Watch:



Luckily, MSNBC happens to have the whole thing on tape, so you can watch it.  I could tell you that the President delivered a smackdown, disarmed and schooled the Republicans, and give you my analysis.  But that's just not going to do in this instance.  So you are going to need about an hour and a half and watch this yourself.  Watch and marvel at the intellectual prowess and the ability of the President to drive the point home for the American people.

Here's the President's speech:



And here is the question-and-answer session:



This is why I am so proud to call this man my President.

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So homophobia lives on in the world of sports, and in the Superbowl.  News just trickled in that CBS has rejected an ad from a gay dating site.  Yes, the ad had the audacity to show two men kissing.  I wonder, are there going to be ads showing heterosexual kissing during the Superbowl?  Given Online Booty Call's recent tweet about what team their followers want to see at the Superbowl, I'm assuming so.

Football can certainly be homophobic - but does it have to be?  There are plenty of lesbians and gay men who love sports, are football fans and will be watching the Superbowl.  I don't know that this will do any good, but you can contact CBS corporate and demand an explanation for this.

CBS Television
51 West 52nd Street
New York, NY 10019
Or use this form to wrote them

If you receive a response, and it's that CBS had problems verifying the company's credit status, that's likely bullshit, since the company says it offered to pay cash.

Here is the YouTube video of the ad from ManCrunch.com, the group whose ad was rejected:

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In his State of the Union address to Congress on Wednesday night, President Obama urged Democrats not to run for the hills.  And of course, our darling Congressman Dennis Kucinich (D-OH) runs for the hills.  Appearing on MSNBC's The Ed Show yesterday, Kucinich presented the idea that Congress should hit the pause button on health care, seeming to say that Congress can only tackle jobs or health care, but not both simultaneously.

I will let you watch first, and then discuss.



Let's start with what Kucinich starts with.

In my own personal opinion, Ed, the Senate bill is a non starter. 

Well, thank you very much for your concern about the Senate bill, Dennis. If the Congressional record is correct, the bill that the House passed was also a non-starter for you.  You voted against it.

We should pay attention to what happened in Massachusetts, take a deep breath, take a step back, create millions of jobs, regain the confidence of the American people, and then come back with a bill that the President apparently asked for last night, which is Medicare for All.  And I think that we need to take this step back, though.  If we go forward into the breach here, we're risking further loss of confidence of the American people.

So the lesson from Massachusetts is to "take a step back."  Not to redouble our efforts, not to push through our agenda so people can see who is on their side, but to "take a step back."  Never mind that Dennis thinks MA was a referendum on the health care bill (supposedly, the MA voters hated the Senate bill so much, they made sure that the House has to pass that bill to get any reform at all).  Never mind that the small business tax credits immediately available through the Senate health care bill will help those workers get health insurance.  Has Congressman Kucinich forgotten that health care costs are one of the factors that squeeze small business and keep them from creating new jobs?  Never even mind that according to Speaker Pelosi, the health care bill will create 4 million jobs.  A lot of that, I reckon, would be due to the massive expansion of the Community Health Centers ($10 billion worth) thanks to Sen. Bernie Sanders of Vermont.  Congressman Kucinich has this bizarre notion that if Congress is to work on jobs, it cannot also pass a health care bill.  And that's not true.  Congress can, and must, walk and chew gum at the same time.

You know what will lose us more confidence of the American people, Congressman?  If we give up when the going gets tough, that will tell the American people that the Democrats don't have the guts to govern.  If we give up on health care after coming so close because MA elected a Republican, that will tell the American people we don't deserve to govern.  Never mind the loss of confidence of the American people.  If we back down or turn our attention elsewhere, indeed, we will have proven that we are too cowardly to stand our ground.

I'll say it again, Ed.  In this political climate, I think we have to be aware of what happened in Massachusetts, and it's demonstration that the American people fell that this bill is too complex, and it was not representing their interests.  Let's pull back, pass a big jobs bill, and then come back with a health care bill that really would represent a challenge to established insurance companies here.  I think people would support it.  But first they want to see, can we deliver on jobs?  And we should be able to do that.

Ahem, Dennis, the House has already passed a $174 billion jobs bill.  I'd say that's a pretty big jobs bill.

I don't understand why Massachusetts has got Dennis Kucinich, the supposed fearless leader of the Real Left (TM) so spooked.  Snap out of it, Congressman!  We should put health care on the back burner because of Scott Brown?  Is that it?  I remind you once again that the House has already passed a jobs bill.  Another jobs bill, if need be, can be pushed through with relatively little time in the House.  But health care is proving to be far more difficult, and Congress needs to stay on it until it's done.   And speaking of political realities, Congressman, putting health care on the back burner now is the political equivalent to signing its death warrant.

Let me also say that I find this practice of pitting jobs against health care - presenting them as one at a time choice - abhorrent, anti-liberal, divisive, and most assuredly a right wing talking point.  For the whole of last year, Republicans have accused the President of losing focus on jobs and working on health care instead.  They have disregarded the Administration's efforts on behalf of the American people to save jobs through the Recovery Act, to stabilize the financial markets and salvage American auto industry - all of which kept us from an economic cataclysm.  This frame of arguments - pitting Americans who are going bankrupt because they can't pay their Medical bills against Americans who are losing their home because they lost their jobs - is a divisive conservative right wing tactic, and now Dennis Kucinich has adopted that meme.  Shameful.

But when we understand that this bill that we were looking at coming out of the Senate would have taxed people's health care plans, would have created a monopoly for insurance industries, gave them protection against anti-trust laws, this is wrong.

Oh, so you don't like the Senate bill because it has the Cadillac tax, does not create a government-run option for people to buy into so they don't have to buy insurance from the private market, and because it doesn't repeal the anti-trust exemption of the health insurance companies.  I see.  So remind us again why you voted against the House bill that did not have a Cadillac tax (it had the millionaire's tax), had a public option so the insurance companies wouldn't be the only entities one can buy insurance from, and repealed the anti-trust exemption?  Once again, thanks a lot for your concern.

We cannot give up on, scale back, or delay health care reform.  So once again, a call to action: Call your member of the House.  Tell them politely but firmly that you expect your member to vote for the Senate health care bill as is so that something can be on the President's desk to sign.  Then urge them to follow up with a reconciliation bill to fix it (find your member at House.gov).  Then call your Senators (find your Senators on Senate.gov).  Tell them you expect them to follow through on the House's reconciliation bill.  Call Harry Reid also if you like, as well as Speaker Pelosi.  Here are the toll-free numbers for the Capitol Switchboard (call and ask for your member):

• 1-866-338-1015
• 1-866-220-0044
• 1-866-311-3405

I don't mind us working on other items as well. But we cannot put health care on the backburner. Pass the damn bill!  Don't walk away from reform now:





Before I finish, yes, I am aware that apparent Dennis Kucinich agrees with Rahm Emanual. Two observations about that: first, I have never thought much of Rahm Emanuel. Never liked him, and disagree with him on this. Second, at least the White House isn't yammering about how we have to look at the MA loss as a referendum on health care and thus trade lightly.

And lastly, for all of you that think Kucinich is just such a principled guy, I will just remind you a couple of things:

• This guy used to be anti-choice until he ran for president in the 2003-04 cycle.
• This is the same guy who, in 2004, made a deal to have his Iowa caucus goers join those of John Edwards, at the time the most fervent defender of the Iraq war among the Democratic contenders for President that year.

So much for principle.

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I want to start today with some good news.  The California State Senate just passed SB 810, a single payer health insurance bill, sponsored by the great Mark Leno.  The bill now goes to the Assembly.  Yes, Gov. Schwarzenegger has promised a veto, but he is not going to be governor for too much longer.  If the momentum keeps building, the next governor, in all likelihood a Democrat, will sign it and make California the first state with single payer health care in the nation!

Sen. Mark Leno made a statement on this, saying:

Leno argued the state-run plan would replace the $200 billion Californians already pay for their health care while eliminating insurance companies' share. He previously said the system could use existing state and federal money and a payroll tax, coupled with increased efficiencies from a government-run system.

"We are spending $200 billion currently," Leno said. "It is the same $200 billion used in a more efficient, cost-effective fashion."

So here is my challenge to every liberal and progressive that want us to move towards a single payer model - after all, that is at least one reason we all want the public option, right?  You want real health care reform and not just health insurance reform, right?  Well, you are going to have to invest in this fight a little bit.  You are going to have to hunker down.  First, we need to build momentum.  The best way to destroy our momentum is to let the federal health care bill fail just because you didn't get this or get that.

ACTION ITEM 1: So, first, call the Capitol switchboard and ask for your member of the House.  When you get their office, tell them politely but firmly that you expect your member to vote for the Senate health care bill as is so that something can be on the President's desk to sign.  Then urge them to follow up with a reconciliation bill to fix it (or find your member at House.gov).  Call the Capitol switchboard back and ask to speak to your Senators (you can also find your Senators on Senate.gov).  Tell them you expect them to follow through on the House's reconciliation bill.  Call Harry Reid also if you like, as well as Speaker Pelosi.  Here are the toll-free numbers:

• 1-866-338-1015
• 1-866-220-0044
• 1-866-311-3405

ACTION ITEM 2: Once you have done that, if you are really interested in long term health care reform in this country rather than just short term shouting contests on blogs, you need to look up if there are any single payer or other similar health care reform efforts going on in your state legislature.  As I have noted above, California is already moving towards it with full stream ahead (despite facing the gubernatorial veto pen twice on this before).  So if you are in California, I need you to pick up your phone one more time.  Call your Assemblymember's office.  If you don't know who it is, look them up.  Call their office and tell them you want them to push Leno's single payer bill through.  SB 810.   Don't forget.

ACTION ITEM 2.1: If you are in California, call Gov. Arnold Schwarzenegger's office at 916-445-2841.  Tell him to sign SB 810 when it reaches his desk.  Will he listen?  Maybe not.  But we need to give him hell anyway.  You can also email the governor.  Actually, you should call Schwarzenegger's office even if you are not in California.  He needs to hear from out of state that migration of talent to California will be helped by single payer in California.  He needs to hear that he can give California businesses a competitive advantage by bringing talent into the state.

I don't think anyone would dispute that Sen. Mark Leno, the sponsor of California Universal Health Care Act (SB 810) is a health care hero.  And Mark Leno does not believe we should give up on federal health care reform, as it will work as a catalyst for change in the states.

As California faces another year of skyrocketing health care costs, many of us have followed the developments of federal health care reform with anticipation. Even though I recognize that federal health care reform in 2010 will bring positive and worthwhile changes, it was disappointing to see the insurance industry succeed at scaling back reform. However, we should not be discouraged. Underneath this historic step forward is a true groundswell of support for universal health care. Across the nation, Americans are coming to the conclusion that private insurance companies have failed in their obligation to administer health coverage, and polls show that strong majorities support a Medicare for all model of health care.

If we don't pass the federal legislation for any other reason - we should pass it for this reason.  It is providing impetus for states to act.  It is giving steam to debates across the states, and it's providing encouragement to brave legislators like Mark Leno to advance reform at the state level.  Reform isn't going to be easy, and we have to push everywhere - including the states - to get reform.  We're going to have to be in this for the long haul.

Want to do more on CA? Go to California OneCare's website and find out what more you can do (from Daily Kos comment by Pris from LA on Thu Jan 28, 2010 at 03:24:19 PM PST). They have great resources.

STATE BY STATE ACTION: Here are a few other states that have a single payer or other progressive health care reform legislation under consideration.  If you live in these states, you need to call your legislators.

• Illinois - HB 311.  Illinois has a Democratic governor.  Call the governor's office too, at 217-782-0244.
• Pennsylvania - HB 1660/SB 400.  Another state with a Democratic governor.  Ed Rendell, (717) 787-2500.
• Massachusetts - HB 2127.  Can you guys in the Bay State do a little in-you-face-Scott-Brown?  Gov. Deval Patrick (D), 617.725.4005.
• Maine - LD 1365. Gov. John Baldacci (D), 207-287-3531.

I'm sure I'm missing plenty of states.  Please let me know in the comments section (State, bill number, at the least, and any other information you can provide).  Here is a partial list from 2007, but I need lists that are more updated.

Remember that jeopardizing or holding hostage the federal health insurance reform to any single demand will discourage the people fighting in the trenches in the states to make those states little laboratories in public and public assisted health insurance.

So pass the damn bill and let the states lead!  Don't walk away from reform now:

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Last night, President Obama delivered his first State of the Union address to Congress. With an estimated 90 million Americans watching, the President spoke directly to the American people as well as to Congress.  You can view the full address on the White House web site, but here are some of my favorite moments:

Here is my single most favorite moment from the debate.  The president called out the Supreme Court's recent decision to let corporations spend, without limit, advocating for or against federal candidates in elections - essentially, letting domestic and foreign corporations buy our elections and sell our democracy.  Here is that awesome, awesome moment.  Watch:



Justice Alito (Bush appointee), you will notice, blurts out something in protest.  I'd call that a guilty conscience, but Alito is probably guilty of not having a conscience at all.  Supreme Court justices are not to react to the President in a joint session of Congress.

President Obama had a more substantive message for the Democrats.  Don't let the loss of Ted Kennedy's seat cower you into the corner.  The American people expect us still to solve problems, and not run for the hills:



But he has not forgotten that it's the Republicans in the Senate who have been forcing a 60 vote threshold to get anything done at all. If they insist on it, then the responsibility to govern falls on them, too, the President reminded them. "We were sent here to serve our citizens, not our ambitions," Barack Obama told Congress.



He laid out a full agenda before the American people for this year:

• Pass a jobs bill to invest in jobs for Americans
• Pass financial regulatory reform and recoup our money from the banks
  
• Finish health insurance reform
• Repeal Don't Ask, Don't Tell
• Blunt the force of the Supreme Court's "corporations can buy your elections" ruling with legislation
• Pass comprehensive energy legislation, focus on clean energy

He explained to Americans last night that while no one likes the bank bailouts, but those were needed to stop the economy from falling off a cliff.  But now that banks are giving out big bonuses again, we need to recover all of our money.

The President is fighting.  The President is fighting for jobs, for financial regulatory reform, for health care, for civil rights, for the people's right to elect our leaders (and to prevent giant corporations from taking that right away), for a cleaner planet, a greener energy and more American jobs.  He is not backing down.  Neither am I.  And neither should Democrats in Congress.  This is no time to give up.  This is no time to run for the hills.  This is time to show the American people that they made the right decision when they gave control of Congress to the Democrats and sent President Obama to the White House.

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