Your Comments on Health Care Reform

1. Your Comments: This Just In From Paula and Dan – Feinstein Warns Senate

2. Your Comments/Question Answered on Dental (Kind Of)

3. Your Comments/Question Answered on Maternity Benefits

4. Your Comments: Isn’t This Where Feinstein Was Headed?

5. Your Comments: A Lawyer Responds to Feinstein’s Proposal

6. Your Comments: Is it True that Obama Once Supported Single Payer?

7. Your Comments: A Doctor Weighs In On Our Direction

8. Your Comments: Theron Stands Up for the Public Option

9. Your Comments: A Petition from J

10. Your Comments: What’s Going On?

1. Your Comments: This Just In From Paula – Feinstein Warns Senate

Feinstein Warns Senate: If We Don’t Deliver on Health Care “We’ve Got A Problem.”

You gotta give the old girl credit once in a while...

2. Your Comments/Question Answered on Dental Coverage

Question:

“Perhaps it’s slipped through the cracks, but I’ve not seen a response on the issue of whether dental coverage belongs as part of the health care insurance debate.”

Sorry! I called Mike Graham, Managing Director of Governmental Affairs at the ADA (American Dental Association.) He said:

"The way Sen Reid, Baucus and Dodd put the two committee bills together allowed for stand-alone dental benefits in the exchange. A stand-alone dental plan means that if you are eligible to go into the exchange, then you can buy both health care insurance and a separate stand-alone dental benefit."

(Note: I subsequently received an interesting response on that and will share in a less packed newsletter.)

3. Your Comments: Question Answered on Maternity Benefits

I got a question about maternity coverage some time ago. I received only vague answers from the experts, so last week I asked Debbie Leveen to weigh in. She responded:

“Maternity benefits are mandatory as part of the "essential benefits" in both bills. However only the House clearly requires ALL insurance plans to conform to the new requirements within 5 years; with the Senate bill I need to get clarity on the extent of grandfathering-- indiv and small group plans have to conform but I'm not sure about the others--it's a little fuzzier, hence weaker.”

I'll send an email later this week with Debbie Leveen's new write-up of what's in the Senate. As always, it's excellent.

4. Your Comment/Article: Isn’t This Where Feinstein Was Headed?

Some rough consensus is emerging about the primacy of a regulatory authority if the public option is as weak as it looks now, but the public option isn't dead yet.

5. Your Comments: A Lawyer Weighs In On Feinstein’s Rate Authority

"Eva: As you know, I am in support of a rate authority in the event that a public option is not obtainable or not strong enough. What could the gang of 4 object to (in) the rate authority since the public sector would not be providing the insurance---I am sure Lieberman would come up with some other excuse to be against it.

"Two thoughts about what is proposed. I think the rate authority should have the right to go in and demand decreases, too. Their only authority should not be with respect to increase in premiums. I don't want to get into a situation where they bump up rates in anticiaption of the bill taking effect, and then we can't force them to decrease them (i.e. the credit card companies). Also, I think a national authority which regulates rates on a state by state basis makes most sense. Some states have much lower health care costs, and if we peg it to a national rate, it would probably be the higher end, not the lower end of the rates in the states."

6. Your Comments/Question Answered: Why Do People Keep Saying Obama Supported A Single Payer System?

My answer: Because of articles in mainstream publications such as this. So give them some credit; they’re at least partially right.

7. Your Comments: A Doctor Weighs In On Our Direction

I spoke with one of our East Bay Physicians who wants to make sure we follow up on Feinstein’s three-point plan, as outlined earlier (rate authority + capping of medical loss ratio + elimination of anti-trust exemption for insurers.) I’ll speak with her office on Monday and follow up with you later this week.

8. Your Comments: Feinstein 1200’er Theron Stands Up for the Public Option in “Inc.”

Here's the article, with a note from Theron:

"One part that did not make the cut because the reporter was looking for pithy sound bites was my description of my sister. Briefly, my sister has worked on a job for a long time that she hates and which numerous health related issue can be attributed to in one way or another... ulcers, colitis, etc., resulting in surgeries and discomfort of all kinds.... Why has she stayed in this job for well over 25 years that causes her health problems? Because they offer good medical coverage! True... How can someone be held hostage in an unfulfilling job, one that not only minimizes positive feelings on so many levels but also eliminates the possibility of having a happy productive employee enthusiastically contributing to the company that employs her? The individual loses, the company loses, society loses...

My other sister has several ovarian cysts, a second occurrence. she will have them removed next month. she has decided to have a hysterectomy as well. why? because the company where she works will be shutting down in march. healthcare will cease and if the cysts reoccur later she is concerned she will not have sufficient - or any healthcare coverage (preexisting condition) to take care of it. Hence, hysterectomy while she has insurance that will pay for it. Wild, huh? Insane, immoral, outrageous...

One more part to this story, by the way. sister number one is against healthcare reform, sister number two is in favor. will take more time to discuss this part, but i have pitched numerous times to sister number two... Problem? She and her daughter (my niece) are Fox TV viewers."

9. Your Comments: A Petition From “J”

J asks that you sign here....

10. Your Comments: What’s Going On?

A simplified answer provided here.

A Physician Asks: How Are You Doing This?

I had a follow-up call with a physician after the health care rally this Wednesday (I am still waiting on pix from PRCH – it was an impressive rally in many ways, especially in getting young people out.)

The physician asked, “How are you doing this… this ‘Feinstein 1200’ stuff?”

I replied that I wasn’t sure what she meant.

She repeated, “I said, how are you doing this?”

Me: “With a laptop? And a cellphone?” (And a bunch of you who write in?)

Doctor: (unimpressed) “But who’s funding you?”

I'll admit I was nonplussed by this notion. Why would anyone think this requires funding?

Doctor: “You have no funding?”

Me: (laughing) “Absolutely not!”

Doctor: (impatiently) “What are you – what are you connected to? What’s your affiliation?”

Me: “Affiliation?”

And so on...

Following this call, I’d like to remind you (and clarify for others) that The Feinstein 1200 has no funding or “proper” affiliation – it’s a grassroots organization, not a non-profit business. Like the somewhat misunderstood Diogenes (the poor man’s Socrates!), I’ll continue to carry my lamp in the daytime streets, looking for an honest policy. Unlike Diogenes, I’ll continue to keep you in touch with your fellow F1200’ers through an email newsletter.

(Full disclosure: I received approximately $180 in ones and fives and tens and twenties in the donation box on the night we ran our seminar last September. It didn’t cover the costs, but in this case, seriously, it was the thought that counted. I’ll happily stay in the red in this endeavor, and not without reason.)

Update and Event

Dear all,

I'm sorry that I'm behind in newsletters. I have a treasure chest of "Your Comments" and some excellent articles (including an article that features one of you!) but it's going to have to wait until the weekend.

Sadly, I have some other work and volunteer responsibilities that have taken away from my F1200 time.

I will also admit that I was gobsmacked by the President's speech on Tuesday evening, and since that time have been feeling honestly defeated.

I can't and won't speak at this time for anyone else in the group with regard to our adventures abroad.

But personally, as someone who could only be wedged out of New York by 9.11 (my old office at Deutsche Bank was 'collateral damage'), I couldn't justify President Bush's decision to send troops to Afghanistan, even as I and other New Yorkers were inhaling smoke and particulate from the towers weeks and months after the bombing.

So it is even more difficult for me to envision how an escalation - after we have arguably made things worse in Afghanistan over the past eight years - would actually help either the US or Afghanistan. And yes, I had friends who were stop-lossed or re-upped.

I understand that the President campaigned on expanding our military presence in Afghanistan, but I would have expected him to consider that the economic crisis that arrived after his campaign-era formulations for Afghanistan might have had some bearing.

I would have expected someone as intelligent as President Obama to consider more carefully the resignation letter of Matthew Hoh, and the warnings of British soldier and diplomat Rory Stewart.

So again, please accept my apologies for the delay on the newsletter. I'll have a catch-up newsletter for you this weekend. There is, in fact, a great deal of news and progress with regard to HCR, and you deserve to know about it, as well as to read comments from your fellow F1200'ers.

In the meantime, please consider attending the December 6 fundraiser for EQUAL Health. You can meet not only Ellen Shaffer but Deborah Leveen at this fundraiser. Also, thanks to those of you who attended the rally at City Hall yesterday, it was good to see you there.

Many thanks for your patience,

Eva Chrysanthe

Clarification of Senator Feinstein's Position on Health Care Reform

On Monday evening, some of you may have received or had forwarded to you an email from a local OFA coordinator that read as follows:

"In speaking to Dianne Feinstein’s office today, our OFA Regional Field Director quoted her staffer as saying, 'She's not sure yet how she will vote on the bill'!! On further questioning, the staffer said specifically, 'She is in favor of a public option'. Also, while she is pro choice, she has 'not taken a position' on anti-abortion wording, e.g. as in the Stupak amendment. In general, she has not decided how she would vote on the bill if it was called for tomorrow. The staffer did say that they are receiving '700 calls per day', but did not say whether they were pro reform calls or opposition calls. Bottom line…keep the pressure on Feinstein! I don’t know what else she has to base her position on except the desire of her constituents. So, let her know what that is!!"

The message did not come directly from the OFA Regional Field Director referenced in the email, but from an OFA coordinator. Nor did the email name the Feinstein staffer who provided the information.

It's important to know that the email was sent in good faith, but that some of the information provided by the Senate staffer is clearly mistaken. And I am intentionally withholding the name of the OFA coordinator who sent the email because it's certainly not their fault that there was a miscommunication.

When I contacted one of the two OFA Regional Field Directors for Northern California, he confirmed that the other OFA Regional Field Director had indeed been given this information by Senator Feinstein's office, and he recommended that I circle back with Feinstein's office the following day to see if I received a different response.

I did, and will take the points one-by-one:

1) “She's not sure yet how she will vote on the bill!!" This is not quite the story I was given on Tuesday morning when I asked Feinstein's staff whether Feinstein knows how she will vote on the bill. Instead, I was told that Feinstein will not say how she will vote until she sees the final amendments. Given that the final amendments will likely deal with reproductive rights, it may be entirely reasonable that Senator Feinstein has taken this position at this time.

2) "Also, while she is pro choice, she has “not taken a position” on anti-abortion wording, e.g. as in the Stupak amendment." This was quickly refuted by Feinstein's office today, which sent me the following official message from Feinstein on the Stupak Amendment:

"I am disappointed that the House bill includes major new restrictions on women’s reproductive rights. Health insurance reform should not be used as an opportunity to roll back health care options for women. The House bill is a step back in this regard. It would force private health insurance plans to choose between offering full coverage and accepting people who purchase coverage with new subsidies. Any reform bill in the Senate should discard this flawed approach."

I was also able to find links through Planned Parenthood's website that indicated Feinstein's opposition to the Stupak Amendment.

3) "The staffer did say that they are receiving '700 calls per day', but did not say whether they were pro reform calls or opposition calls." This generated some puzzlement from the staffer I spoke with today, so we'll leave it as unconfirmed.

4) "Bottom line…keep the pressure on Feinstein! I don’t know what else she has to base her position on except the desire of her constituents. So, let her know what that is!!" You'll have no argument from me on that one. The question is how much pressure? If you've been reading Senator Feinstein's website regularly, or this email newsletter, you know that since October 23, 2009, Feinstein has not only come out in strong support of the public option, but has generated several interesting ideas of her own.

*****

Which brings us to... Dianne Feinstein's appearance this past Sunday on "Meet The Press." As a public option supporter, what I found noteworthy was that Feinstein seems willing to trade (an admittedly weak) public option for a rate authority.

GREGORY: So would you vote for a plan, a bill that did not include the public option?

FEINSTEIN: Well, I would vote for it if it had a rate authority to be able to control the increase in premiums, at least to keep it to medical inflation.

Now this is important. The public option currently on the table is weak, and it wouldn't go into effect until after 2012, possibly not until 2014. In the meantime, what do we have? Well, Feinstein herself has proposed three intermediary ideas that would have a greater immediate impact than the weak public option we're looking at.

(Bear in mind that neither Germany nor Switzerland nor the Netherlands has anything resembling either single payer OR a public option, but they do have a strictly regulated and strictly non-profit insurance industry, and it appears that this is the direction Feinstein might be highlighting with these three "back-up" ideas:)

1) Medical Rate Authority in every state: (from Feinstein's Oct 23 statement: "It would regulate premium increases in the state’s market. Companies would not be permitted to increase premiums more than the rate of medical inflation unless they received permission (by majority vote) of the Rate Authority.") Personally, I'd prefer if that specified a "National Rate Authority with a presence in every state" but it's a start.

2) Capping of medical loss ratio: (from Feinstein's Oct 23 statement: "I also believe we must restrict a plan’s medical loss ratio, which measures how much is spent on health care, and how much is spent on profit and overhead. According to Health Care for America Now, insurance companies, on average, spend only 81% of premium dollars on medical care. This number has decreased from 95% in 1993. There is no reason for a plan’s administrative expenses to exceed 10%, and this cap should be included in any legislation.")

3) Elimination of the existing Anti-trust exemption for insurers (including health insurers.) No explanation necessary.

Why should you trust Senator Feinstein's ideas? That answer is up to you. Perhaps those of you who continue to say you deeply distrust Feinstein can take Cato's words in support of Pompey, that the same men who do great evils know best how to cure them.

Have a Happy Thanksgiving weekend, rest up, and get ready to dial some senators when you return. Not just Feinstein, who has earned both praise and a strong reminder of what she's promised, but the more troublesome "Gang of Four" - Landrieu, Lincoln, Nelson and Lieberman.

Best holiday wishes,

Eva Chrysanthe

The Feinstein 1200

P.S. I'll list events in an upcoming newsletter - but in the meantime please mark December 2 for an anti-Stupak Amendment rally organized by a group of reproductive health physicians and December 6 for the EQUAL Health fundraiser, where you can meet not just Ellen Shaffer but Deborah Leveen.

November 16 Newsletter

Local Hero Edition

1. Local Hero Deborah Leveen Explains It All For You

2. Your Comments: Another Local Hero Sends Link to Rabbi's Efforts to Get Joe Lieberman to Support HCR

3. Your Comments: Pharma Industry Raises Prices in Advance of Reform

4. Get Out Your Handkerchiefs!

5. More Tomorrow

1. Local Hero Deborah Leveen Explains It All For You

I promised that I would send Deborah Leveen's synopsis of gains in the House bill as soon as I got permission. If you're not on the email list and would like the attachment, please contact me at this email address:

thefeinstein1200newsletter@gmail.com

2. Your Comments: Another Local Hero Sends Link to Rabbi's Efforts to Get Joe Lieberman to Support HCR

Alyssa is one tireless HCR advocate, attending and speaking at rallies, and combing through details of the legislation with a fine-toothed comb. Today, Alyssa sent this video from firedoglake, which highlights a Connecticut rabbi's brave effort to get Senator Joe Lieberman to get in touch with his conscience. Nice Hillel quote in the firedoglake coverage. Rabbi Fish appears in the second video in the link; the first video is of a Unitarian Universalist Minister.

3. Your Comments: Pharma Industry Raises Prices in Advance of Reform

Several of you sent this article on pharmaceutical companies raising prices, and one included this comment which sums up the feelings of many in our group: "Dear Eva - Did anyone think that the drug companies would NOT do this? Our lawmakers and deal cutters are incompetent. We need a third column in the part(y)(ies.) A column of people who are not bought, and who stay that way!" What most amazed me is that the pharma industry is doing this in advance of expectation of closer scrutiny - because I didn't think there was that much scrutiny coming forward. So maybe it's an indication of what Maggie Mahar predicted: that pharma and insurers know the gig is up - our country simply does not have the money to keep their merry-go-round going.

4. Get Out Your Handkerchiefs!

This one's a tearjerker - love the portrayal of the doctor in New Orleans. I hope Ms. Deavere Smith brings the show to the Bay Area.

5. Many More of Your Comments In The Coming Days

Trying to get answers to some of the questions you sent through me. Keep 'em coming, please!

November 15 Newsletter

1. Your Comments: T.R. Reid On The Medicare Scare

2. Your Comments: Give ‘Em Hell, Harry!

3. Your Comments: A Professor Emeritas Explains It All

4. Your Comments: A Doc Writes: Pragmatism Is The Name of the Game

5. Your Comments: A Pediatrician Diagnoses the Problem

Your Comments: Journalist T.R. Reid on the Medicare Advantage Cuts and a Silver Lining

There was a big, enthusiastic response to the radio interview with journalist T.R. Reid on the passage of the House bill, provided in yesterday's newsletter. (Who doesn't love T.R. Reid, the creator of the Frontline documentary "Sick Around the World"?) The radio interview with T.R. Reid is only 23 minutes long, but if you're having trouble downloading it, I made a partial transcript of some of the essential points covered in the interview, especially Reid's comments on Medicare Advantage cuts.

Interviewer: “Do you know what the cuts to Medicare Advantage would mean? Why would those be cut?”

T.R. Reid: “They would be cut, and people with Medicare Advantage now would pay a little more in premium, and that’s because all the rest of American taxpayers are subsidizing those plans. Those plans were set up to prove that the private insurance companies could be just as efficient as government. Initially, the law said that their fees could only be 95% of the standard Medicare fees, because they were going to be 5% more efficient than government…”

Interviewer: “They were basically competing with standard Medicare, right? People could sign up for standard Medicare through the government or sign up for these Medicare Advantage plans.”

T.R. Reid: “That’s right and you get it through one of these insurance companies. And initially they (the insurance companies) said ‘Hey, this is going to be a good deal, we’re going to save the government money, provide the same care for 5% less because we’re so efficient.’ As it turned out, they (the private insurance companies) weren’t efficient enough to do that, so they keep coming back to Congress for subsidies from the taxpayers. You and I pay for peoples’ Medicare Advantage. It now costs 14% more – they cost 114% of what it would cost to provide basically the same coverage through Medicare. So Congress said ‘Why should we pay 14% subsidies to insurance companies that take about 20% out of every dollar to pay for their administrative costs?’ They (Congress) cut that to save money and it’s definitely true – people who are now getting subsidized by other taxpayers for Medicare Advantage will have to pay more out of their own pocket.”

A few more points made by journalist T.R. Reid in that essential interview:

1. He points out that cuts in the wasteful Medicare Advantage program are going to subsidies to help uninsured people get coverage.

2. He breaks down who will benefit from the House bill, and who will be left out.

3. He doesn’t see the possibility that employers will dump employees into the public option as a downside.

4. He reinforces the fact that universal coverage provides the political will and the leverage to do the tough cost-cutting that is necessary.

5. Lastly, he saw an upside to an imperfect bill:

T.R. Reid: “I have good news for that caller who said she had thought we were going to cover everybody and was surprised that we don’t. I think this is going to lead to universal coverage in this way: I think a lot of state legislatures are going to see that Washington fell way short. I mean, the bill improves some things, but it doesn’t cover everybody. I think in January there are going to be bills in 25 different legislatures trying to set up some kind of state program to get to universal coverage. A couple of states, three or four, will make it work, the rest of us can watch them and copy it, and we’ll get there state by state. And the reason I say this is in my book I list some countries that got to universal coverage on a province-by-province basis. Or a state-by-state basis: one state makes it work and the others see it and say, ‘Hey, let’s try that.’ So I think this is going to lead to local experimentation that will get us to universal coverage. That’s my bet.”

Your Comments: Give ‘Em Hell, Harry!

Following on T.R. Reid’s ideas on cost-cutting, Pat sent Friday's important message from Robert Reich, which urges Senate Leader Harry Reid to push for reconciliation first, and she included this note:

“Of course you must have received tons of links to the Reich letter to Senate Leader Harry Reid (I don't think I missed it in your earlier newsletter), but I gotta say I love the "Give 'em hell Harry" diatribe, and wouldn't it just be something? It even leads me to view the prospect of an "opt out" option in a positive light. If only!”

Your Comments: A Professor Emeritas Explains It All

Yesterday I promised a synopsis of the House bill, and I’ve found an excellent, highly readable one by Professor Leveen. I need to check with her on one small point, and will send it to you ASAP, but no later than tomorrow morning. In the meantime, I am including a brief note that arrived from her after the passage of the House bill.

“I believe there are some remarkable provisions in the House bill that are by no means guaranteed in the Senate bill and are worth fighting for. Two of these include:

1) The Exchange is really intended to play a strong role, with authority to reject premiums or premium increases that are too high.

Indeed 3962 has a new title --Title I--with "immediate reforms" which include Sec 104: "Sunshine on price gouging by health insurance issuers"--and the Manager's amendment provides more details re: this process as well as $1B in grants to help establish this process. And it starts in 2010. The issue of premium increases has really received much more attention than in the original bill.

2) Eligibility for the exchange has been expanded: from business with 10/20 employees, and more permitted, in the original bill, to 25, 50, and 100, required, and then more permitted. With additional expansion partly determined by "excess of premium growth outside the Exchange..." . there is a lot to build on here!

Affordability may not be ideal, but there is a mininum benefits standard with limits on cost-sharing, no annual or lifetime limits on spending, and it will apply to ALL plans... there will be no "junk insurance."

31 million people will gain coverage! And since only 10% of the uninsured have incomes over 400% FPL, 90% should be eligible for subsidies. And since median family income is about $70,000/year (household income is about $50,000), that means more than half of our families will qualify for some subsidy: it phases out at $88,000 for family of four.

And once those subsidies are in place, and with employers forced to pay 65-72% of premiums, there will be even more political pressure to stop "price gouging". and I personally am impressed that the term "price gouging" appears in the legislation itself. All those who have worked so hard to bring attention to the abuses by private insurance have had a huge impact. I believe we have a lot to build on, and a lot to fight for!"

Your Comments: Pragmatism Is The Word of The Day!

Doctor Tom wrote this cautionary note with regard to the Stupak-Pitts Amendment:

“The most critical need here is to get a health care reform act on the President's desk. If abortion is a deal breaker for a few critical Democrats (or, for that matter, Republicans), and we run the risk of losing the whole bill because of it, then I would advocate opting for an imperfect bill now with the expectation of improving it over time, as has happened with many other pieces of important legislation in past.... Pragmatism is the word of the day!”

Your Comments: A Pediatrician Sends an Article Showing What We’ve Been Up Against

…and unfortunately, it’s not just the GOP who took the lobbyists’ money:

“Statements by more than a dozen lawmakers were ghostwritten, in whole or in part, by Washington lobbyists working for Genentech, one of the world’s largest biotechnology companies. E-mail messages obtained by The New York Times show that the lobbyists drafted one statement for Democrats and another for Republicans.”

The same pediatrician included his personal note regarding our Congress:

“One has to have some level of self-imposed ignorance or misinformation to think we do not already have ‘socialized medicine.’ Many of those opposed to health care for other US citizens are already receiving government administered “socialized medicine” from Medicare, Medicaid, or the Veterans Administration. Millions of Americans have government subsidized health insurance because they work for some branch of the school systems, city, county, state, or federal government.

It is both immoral and shameful that members of our Congress would continue to deny adequate health care to so many of our citizens.

The Republican solution was recently voiced by Representative Cantor (R,VA) when he told a woman facing massive bills for her cancer treatment that she should “spend down” her assets to try to qualify for Medicaid and/or look for charity.

Maybe it is now time for the "Blue Dog" Democrats to join this pseudo compassionate, pseudo conservative political party. Considering that the late Strom Thurmond's former “Dixiecrats” are now in control of the Republican Party, former respected members of the party such as Abraham Lincoln, Nelson Rockefeller, Everett Dirksen, and Barry Goldwater must be rolling over in their graves.”