Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.

Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.

Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo -- leading to further compromises by both Obama and the leading Democrats.

This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying "I want us to be mindful we may need to take less than a full loaf."

But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.

Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.

What's left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.

In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.

Barbara Kennelly, a former Democratic congresswoman from Connecticut who now heads the National Committee to Preserve Social Security and Medicare: "To some people, it might not be a big deal. But to seniors, especially with their health care costs, it is a big deal."

"More than 32 million people are in the Medicare prescription drug program. Average monthly premiums are set to go from $28 this year to $30 next year, though they vary by plan. About 6 million people in the program have premiums deducted from their monthly Social Security payments, according to the Social Security Administration."

"Advocates say older people [,typically on fixed incomes,] face higher prices because they spend a disproportionate amount of their income on health care, where costs rise faster than inflation. Many also have suffered from declining home values and shrinking stock portfolios just as they are relying on those assets for income." --HuffPost

CONGRESSIONAL HEALTH CARE PLANS: Knowing that Medicare itself faces a financial crisis, many older Americans object to Congress’s tapping the program to help pay for coverage of the uninsured. They say they do not believe that all the Medicare savings will come from eliminating waste and inefficiency, as Mr. Obama says.

“Medicare is nearly broke,” said James P. Ivey, 66, of Deer Park, Wis. Mr. Ivey predicted its financial problems would grow as the ratio of beneficiaries to workers increased in coming years.

In effect, Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries.......In the past, insurers reacted to such cuts by increasing premiums, reducing benefits or pulling out of the Medicare market, and beneficiaries complained loudly....

Medicare officials recently proposed changes that could increase payments for some primary care services but reduce payments to many specialists. Cardiologists would be especially hard hit, with cuts of more than 20 percent in payments for electrocardiograms and 12 percent for heart stent procedures.

“Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients,” said Dr. John C. Lewin, chief executive of the American College of Cardiology.

--NYT

According to an NBC News poll released this week, 76 percent of Republicans believe that the health care plan will lead to a government takeover of the health care system; 70 percent believe it will allow the government to make decisions about when to stop providing medical care to the elderly; and 61 percent believe it will allow the use of taxpayer dollars for abortions.

According to a report on Wednesday by OpenSecrets.org’s Center for Responsive Politics, health services and H.M.O.’s increased their campaign donations by 37 percent from the first to the second quarter this year. Republican and conservative advocacy groups increased their contributions by a whopping 237 percent over the same time period. For comparison, donations by Democratic and liberal advocacy groups declined. --CHARLES M. BLOW

A backlash in the progressive base — which pushed President Obama over the top in the Democratic primary and played a major role in his general election victory — has been building for months. The fight over the public option involves real policy substance, but it’s also a proxy for broader questions about the president’s priorities and overall approach....

On such fraught questions as torture and indefinite detention, the president has dismayed progressives with his reluctance to challenge or change Bush administration policy. And then there’s the matter of the banks. I don’t know if administration officials realize just how much damage they’ve done themselves with their kid-gloves treatment of the financial industry, just how badly the spectacle of government supported institutions paying giant bonuses is playing....

On the issue of health care itself, the inspiring figure progressives thought they had elected comes across, far too often, as a dry technocrat who talks of “bending the curve” but has only recently begun to make the moral case for reform....The idea of letting individuals buy insurance from a government-run plan...was picked up by John Edwards during the Democratic primary, and became part of the original Obama health care plan....The public option offered a way to reconcile differing views among Democrats. Until the idea of the public option came along, a significant faction within the party rejected anything short of true single-payer, Medicare-for-all reform, viewing anything less as perpetuating the flaws of our current system....

It seems as if there is nothing Republicans can do that will draw an administration rebuke: Senator Charles E. Grassley feeds the death panel smear, warning that reform will “pull the plug on grandma,” and two days later the White House declares that it’s still committed to working with him. It’s hard to avoid the sense that Mr. Obama has wasted months trying to appease people who can’t be appeased, and who take every concession as a sign that he can be rolled.

Indeed, no sooner were there reports that the administration might accept co-ops as an alternative to the public option than G.O.P. leaders announced that co-ops, too, were unacceptable....Nonprofit co-ops, is a sham. That’s not just my opinion; it’s what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers....So progressives are now in revolt. Mr. Obama took their trust for granted, and in the process lost it.

Forget about a crackdown on price-gouging drug companies and predatory insurance firms. That’s not happening. With the public pretty well confused about what is going on, we’re headed — at best — toward changes that will result in a lot more people getting covered, but that will not control exploding health care costs and will leave industry leaders feeling like they’ve hit the jackpot.

The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)

Insurance companies are delighted with the way “reform” is unfolding. Think of it: The government is planning to require most uninsured Americans to buy health coverage. Millions of young and healthy individuals will be herded into the industry’s welcoming arms. This is the population the insurers drool over.

This additional business — a gold mine — will more than offset the cost of important new regulations that, among other things, will prevent insurers from denying coverage to applicants with pre-existing conditions or imposing lifetime limits on benefits. Poor people will either be funneled into Medicaid, which will have its eligibility ceiling raised, or will receive a government subsidy to help with the purchase of private insurance.

If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan — well, that’s reform the insurance companies can believe in.

The White House, for its part, agreed not to seek additional savings from the drug companies over those 10 years. This resulted in big grins and high fives at the drug lobby. The White House was rolled. The deal meant that the government’s ability to use its enormous purchasing power to negotiate lower drug prices was off the table. ...Robert Reich, who served as labor secretary in the Clinton administration, wrote that the deal struck by the Obama White House was very similar to the “deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry.”...

While it is undoubtedly important to bring as many people as possible under the umbrella of health coverage, the way it is being done now does not address what President Obama and so many other advocates have said is a crucial component of reform — bringing the ever-spiraling costs of health care under control. Those costs, we’re told, are hamstringing the U.S. economy, making us less competitive globally and driving up the budget deficit.

Giving consumers the choice of an efficient, nonprofit, government-run insurance plan would have moved us toward real cost control, but that option has gone a-glimmering. The public deserves better. The drug companies, the insurance industry and the rest of the corporate high-rollers have their tentacles all over this so-called reform effort, squeezing it for all it’s worth.

Meanwhile, the public — struggling with the worst economic downturn since the 1930s — is looking on with great anxiety and confusion. If the drug companies and the insurance industry are smiling, it can only mean that the public interest is being left behind.

What will determine the success or failure of reform? Above all, the success of reform depends on successful cost control. We really, really don’t want to get into a position a few years from now where premiums are rising rapidly, many Americans are priced out of the insurance market despite government subsidies, and the cost of health care subsidies is a growing strain on the budget.

And that’s why the public plan is an important part of reform: it would help keep costs down through a combination of low overhead and bargaining power. That’s not an abstract hypothesis, it’s a conclusion based on solid experience. Currently, Medicare has much lower administrative costs than private insurance companies, while federal health care programs other than Medicare (which isn’t allowed to bargain over drug prices) pay much less for prescription drugs than non-federal buyers. There’s every reason to believe that a public option could achieve similar savings....Yes, the perfect is the enemy of the good; but so is the not-good-enough-to-work. Health reform has to be done right. --Krugman, June 25, 2009

Look, it is possible to have universal care without a public option; Switzerland does....To have a workable system without the public option, you need to have effective regulation of the insurers. Given the realities of our money-dominated politics, you really have to worry whether that can be done — which is a reason to have a more or less automatic mechanism for disciplining the industry. --Krugman, August 17, 2009

Paul Krugman, in an Aug. 17 New York Times column, likens health reform to the reforms Switzerland instituted in 1994: “[E]veryone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.” But there’s a significant difference. In Switzerland, private insurers are required to provide basic health coverage on a nonprofit basis. Under Obamacare, private insurers will continue to seek profits, and it’s quite possible that the new regulatory restraints imposed on them (take all comers, don’t punish the sick with higher premiums, don’t seek out fine-print reasons to cancel policies after policyholders get sick, etc.) will inspire them to find ever-more-ingenious ways to avoid payouts. --Tim Noah, August 17, 2009

As for the public option, HHS Secretary Kathleen Sebelius said that the plan to federally run a national insurance plan in competition with private insurance plans is "not the essential element": "I think there will be a competitor to private insurers," she said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing. We need some choices, we need some competition." However, critics of the co-op plan note that, while federally funded, it would not be national, nor would it be run by the government, and it would not be a network, making it a toothless alternate to the public option, not able to hold down present health care costs or negotiate future prices as a group.

Hiding behind the skirts of Health Sec. Sebelius, Obama has delivered the bad news that corporate money runs his administration, since he has received the most campaign money handed out by the health care industry, more than John McCain, more than the the other members of Congress, Republicans and Blue Dog Dems, more than Max Bacaus, whose moderate-conservative Senate Finance Committee with combined states representing less than 2% of the American people is favored by Obama. When it comes to Obama, actions speak louder than words, and his actions show which side he's really on, lending truth to what we said during the Dem primaries: When Obama speaks of change, it's the change in your pockets, left after he keeps your dollars for himself and his corporate backers. --Jerry Politex, JoeBama Watch

Behind the scenes...Mr. Obama and his advisers have been quite active...negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric....

Some Democrats and industry lobbyists now argue that, in negotiating deals through Mr. Baucus’s [Senate finance committee] with powerful health care interests, the White House was tacitly signaling as early as last spring that it might end up accepting something more modest than the government insurer the president has said he prefers....The Finance Committee, for example, appears to be coalescing around the idea of nonprofit insurance cooperatives instead of a government-run plan. ...Cooperatives are likely to have less leverage over health care prices....Industry lobbyists and moderate Democrats in both chambers, though, argue that the White House’s actions behind the scenes show a recognition that the finance panel’s anticipated compromise is the most likely template for any final legislation.

Lobbyists for the drug and hospital industries say that, as early as June, White House officials directed them to work out cost-saving deals with Mr. Baucus’s committee. Drug industry lobbyists said they negotiated a deal to contribute $80 billion over 10 years toward the cost of an overhaul with Mr. Baucus, under White House supervision, before taking it to the president for final approval. House lawmakers have said they were caught by surprise when it was announced. Hospital industry lobbyists, speaking on the condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said. Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services.

Mr. Obama and his top aides have immersed themselves in the Senate Finance Committee process. The president talks to Mr. Baucus several times a week, people briefed on their conversations say. Mr. Obama has also held a few calls with the panel’s ranking Republican, Senator Charles E. Grassley of Iowa. In addition, Mr. Obama invited both senators to a private lunch at the White House early in the summer and met with six panel members for another White House session last week. White House advisers have held long evening and weekend meetings with Finance Committee staff members.

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Three Health Care Strikes. Will Obama Will Be Out? (August 11, 2009) , Huffington, NYT, Politex

1. and 2. The White House has now shown itself willing to cave on the two essential elements of real health care reform -- drug price negotiations and having a public option. Giving us health care reform without those key ingredients is like serving a PBJ sandwich without the peanut butter or the jelly. This white-bread-only reform makes no sense practically -- or politically. Health care reform that doesn't contain costs is destined to fail -- arming the GOP with a powerful "I told you so" cudgel to swing in 2010 and 2012. --Arianna Huffington

3. To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills’ cost. The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. --NYT

Presently, many doctors and clinics either do not accept medicare patients or limit their number, because medicare does not pay as much for services as does private insurance companies. There is nothing in the various bills to stop this practice, or to prevent such paractices fron increasing, or to pass on the greater uncovered costs to medicare patients. Further, the White House has encouraged the drug industry to believe that it will not insist on Medicare negotiations of drug prices. --Jerry Politex

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Riot At Tampa Town Hall On Health Care: Violent Protesters, Some With Racist Signs, Say They Had Been Spurred On By Conservative Activist Group, Fox News Host, GOP E-Mails (Video, August 7, 2009) , HuffPo

Police officers were called to calm down an unruly crowd outside a health care reform town hall meeting in downtown Tampa, Florida on Thursday evening, according to local news reports. Angry protesters screamed, yelled and banged on windows as officers hurried to guard the entrances to the facility, where U.S. Rep. Kathy Castor was trying to discuss the various health care reform proposals being debated in Congress. One photojournalist said that a fistfight broke out inside the building, reports WTSP....The spectacle...sounded more like a wrestling cage match than a panel discussion on national policy, and it was just the latest example of a health care meeting disrupted by livid protesters.

The Tampa Tribune reports that some protesters carried racist caricatures of President Obama and added details of more fights and scuffles: "Several of the protesters' signs bore an image of Obama with his face painted as the Joker, an image that drew protests of racism locally when it appeared on a Web site thought to be associated with the Pinellas Republican party."

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Right Disruptions Of Health Care Forums Recall Bush Bullies During Florida Recount, Nixon Racism (August 7, 2009) , Krugman

Robert Gibbs, the White House press secretary, has compared the scenes at health care town halls to the “Brooks Brothers riot” in 2000 — the demonstration that disrupted the vote count in Miami and arguably helped send George W. Bush to the White House. Portrayed at the time as local protesters, many of the rioters were actually G.O.P. staffers flown in from Washington.

But Mr. Gibbs is probably only half right. Yes, well-heeled interest groups are helping to organize the town hall mobs. Key organizers include two Astroturf (fake grass-roots) organizations: FreedomWorks, run by the former House majority leader Dick Armey, and a new organization called Conservatives for Patients’ Rights. The latter group, by the way, is run by Rick Scott, the former head of Columbia/HCA, a for-profit hospital chain. Mr. Scott was forced out of that job amid a fraud investigation....

There was a telling incident at a town hall held by Representative Gene Green, D-Tex. An activist turned to his fellow attendees and asked if they “oppose any form of socialized or government-run health care.” Nearly all did. Then Representative Green asked how many of those present were on Medicare. Almost half raised their hands.

Now, people who don’t know that Medicare is a government program probably aren’t reacting to what President Obama is actually proposing. They may believe some of the disinformation opponents of health care reform are spreading, like the claim that the Obama plan will lead to euthanasia for the elderly. (That particular claim is coming straight from House Republican leaders.) But they’re probably reacting less to what Mr. Obama is doing, or even to what they’ve heard about what he’s doing, than to who he is.

That is, the driving force behind the town hall mobs is probably the same cultural and racial anxiety that’s behind the “birther” movement, which denies Mr. Obama’s citizenship. Senator Dick Durbin has suggested that the birthers and the health care protesters are one and the same; we don’t know how many of the protesters are birthers, but it wouldn’t be surprising if it’s a substantial fraction.

And cynical political operators are exploiting that anxiety to further the economic interests of their backers. Does this sound familiar? It should: it’s a strategy that has played a central role in American politics ever since Richard Nixon realized that he could advance Republican fortunes by appealing to the racial fears of working-class whites.

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Obama's Secret Deal With Drug Industry Nixes Price Negotiations (August 6, 2009) , NYT

Drug industry lobbyists reacted with alarm this week to a House health care overhaul measure that would allow the government to negotiate drug prices and demand additional rebates from drug manufacturers....Speaker Nancy Pelosi said the House was not bound by any industry deals with the Senate or the White House.... In response, the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul. The Obama administration had never spelled out the details of the agreement....As for the administration’s recent break with the insurance industry, [lobbyist Billy] Tauzin said, “The insurers never made any deal.”...

The new attention to the agreement could prove embarrassing to the White House, which has sought to keep lobbyists at a distance, including by refusing to hire them to work in the administration. The White House commitment to the deal with the drug industry may also irk some of the administration’s Congressional allies who have an eye on drug companies’ profits as they search for ways to pay for the $1 trillion cost of the health legislation.

But failing to publicly confirm Mr. Tauzin’s descriptions of the deal risked alienating a powerful industry ally currently helping to bankroll millions in television commercials in favor of Mr. Obama’s reforms. The pressure from Mr. Tauzin to affirm the deal offers a window on the secretive and potentially risky game the Obama administration has played as it tries to line up support from industry groups typically hostile to government health care initiatives, even as their lobbyists pushed to influence the health measure for their benefit.

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Ten Ways To Tell Obama Has Caved On Health Care (8/1/09), Bruce Dixon

1. The plan doesn't cover the uninsured till at least 2013.
22,000 Americans now perish each year because they can't get or can't afford medical care, and this year three quarter million personal bankruptcies will be triggered by unpayable medical bills. Why this president and these Democrats are in such a hurry to pass health care now that doesn't take effect till two elections down the road doesn't make sense in any kind of good way....Congress passed Medicare in 1965 and president Lyndon Johnson rolled out coverage for millions of seniors in eleven months, back in the days before they even had computers.

2. The "public option" isn't Medicare, won't bring costs down and will only cover about 10 million people.
The "public option" was sold to the American people as Medicare-scale plan open to anybody who wants in that would compete with the private insurers and drive their costs downward. But in their haste not to bite the hands that feed them millions in campaign contributions each hear, the president and his party have scaled the public option back from a Medicare-sized 130 million to a maximum of 10 million, too small to put cost pressure in private insurers, [and delinked it from Medicare bargaining]. Worse still, the president and his party are playing bait-and-witch, not telling the public they have reduced the public option, to nearly nothing.

3. The president's plan, as well as those of Democratic "blue dogs" and Republicans, are to be funded in part with cuts in Medicare and Medicaid.
Private insurance companies have always hated Medicare because it is far more efficient than they are. Medicare's administrative expenses are under five percent, as compared with the one third of every health care dollar taken by the for-profit insurance companies for their advertising, bad investments, billing and denial machinery, executive salaries and bonuses. Private insurers have, over the years, purchased enough influence in Congress and previous White Houses to restrict Medicare's payment rates and partially privatize it. But president Obama's plan, perhaps the most friendly to Medicare and Medicaid, calls for over $300 billion in cuts to the programs that now provide medical care to those with the fewest options, while failing to guarantee that care will come from elsewhere. In Massachusetts...the prototype state for the Obama plan...hospitals are turning away poor people they used to be able to provide care for because funding that used to go to those institutions is now plowed into the state's "individual mandate" system.

4. The president and his party have already caved in to the drug companies on reimporting Canadian drugs, on negotiating drug prices downward and on generics.
This explains why Big Pharma, the same people who ran the devastatin g series of anti-reform "Harry and Louise" ads to spike the Clinton-era drive to fix health care are spending $100 million to run Obama ads using the president's language about "bipartisan" solutions to health care reform.

5. The president and his party have received more money from private insurers and the for-profit health care industry than even Republicans, with the president alone taking $19 million in the 2008 election cycle alone, more than all his Repubican, Democratic and independent rivals combined. (Source)
Democratic senator Max Bacaus got $1.1 million in 2008. Democratic senators Harkin, Landreau and Rockerfeller each got over half a million, and Senator Durbin got just under half a million. Other Democratic senators got a little less. Four Democrats in the House, Rangel, Dinglell, Udall and Hoyer got over half a million apiece in 2008, with other Democrats not far behind.

6. The president's plan, and those of Republicans and Democratic blue dogs too, will require families to purchase health insurance policies from private insurers.
This is something the policy wonks call an 'individual mandate", under which Individuals will be "mandated" to purchase affordable insurance, though companies would not be required to offer it. In Massachusetts, the prototype state for the Obama plan, a family with an income of $33,000 can be required to spend $9,000 in deductibles and out-of-pocket expenses before the insurance company is obligated to pay a dime. As in Massachusetts, public money is used to purchase private insurance for the very poorest citizens. With the revenues of insurance companies on the decline, individual mandate programs are a welcome bailout for the private insurance industry.

7. The president's plan, and those of Republicans and Democratic blue dogs too, could force you to buy junk insurance.
Think about an insurance policy that costs a lot, but is full of loopholes, exceptions and steep deductibles and co-payments. That's junk insurance, and for many it's the only insurance companies offer. Even more pernicious is the widespread practice among insurance companies of "recission" in which claimants are routinely investigated and disqualified in the event that they finally make a claim. [A significant portion of your insurance dollar pays for such practices. See #3.]

8. The president, with the cooperation of corporate media and the Republicans is trying to make the argument about himself instead of a discussion on the merits of his policy.
The president and his critics are happy to talk about whether this will be "his Waterloo", or his Dien Bien Phu, as if that matters more than the 22,000 Americans who die each year from lack of medical care, or the three quarter million who will go bankrupt because of unpayable medical bills....If the president were not afraid of his own supporters publicly examining the merits and demerits of his proposals, he would mobilize those 13 million emails and phone numbers collected during the campaign. The reason he has not sone so already is that most of his own supporters favor a Medicare-For-All single payer health care system, HR 676.

9. The president and his party, and the corporate media have spent more time and energy silencing and excluded the advocates of single payer health care, mostly the president's own supporters, than they have fighting blue dogs and Republicans.
But no matter how diligently the spokespeople for single payer are excluded from media coverage and invitations to Obama's policy forums and round tables, no matter how many times the White House cuts their questions from transcripts and video of public events, the calls, emails and letters keep pouring into Congress and the White House demanding the creation of a publicly funded, everybody-in-nobody-out system, a Medicare-for-All kind of single payer health care plan.

10. Despite the president's own admission that only a single payer health care system will deliver what Americans want, he and the leaders of his party insist that Medicare For All, HR 676, us utterly off the table.
Before he became a presidential candidate, Barack Obama identified himself as a proponent of a single payer health care system. All we had to do, he told us, was elect a Democratic congress and senate, and a different president. Now that this has been done, he insists that "change" is just not possible, and we have to settle for less. The president continues to admit that only a single payer health care system will cover everybody, but insists that America just can't handle that much change....It's what we deserve. It's what we voted for.

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Corporate Health Care Plan: Top Ten Positions (7/31/09), Ewe E. Reinhardt

Keeping in mind that "currently projected health spending will chew up 40 percent or more of the nation’s economy by 2050, American governments at all levels will go broke, and American companies will be uncompetitive in the global marketplace or slide into bankruptcy, like General Motors...here is just a short list of the design parameters that an acceptable health reform proposal would have to incorporate" in order to conform to the goals of the helath care industry, the industry-paid members of Congress, and the Wall Street Journal:

1. Only patients and their own doctors should decide what clinical response is appropriate for a given medical condition, even if that response involves unproven clinical procedures or technology.

2. Neither government bureaucrats nor private insurance bureaucrats should ever refuse to pay for whatever patients and their doctors have decided to do in response to a given medical condition. An insurer’s refusal to pay for a medical procedure is tantamount to rationing health care.

3. Rationing health care is un-American.

4. Cost-effectiveness analysis should never be the basis of any coverage decision by public or private third-party payers in health care, for to do so would put a price on human life — which, in America, unlike everywhere else, is priceless.

5. Government should not require individuals to purchase health insurance. Such a mandate would violate the constitutional rights of freedom-loving Americans.

6. Americans have a moral right to life-saving and potentially highly expensive medical care, should they fall critically ill, even if they are uninsured and could not possibly pay for that care with their own financial resources. (Why else would God have created hospitals and their emergency rooms?)

7. Government should stay out of health care. Specifically, government should not control health care prices, nor should it increase its spending on health care, which is out of control.

8. Even small reductions to the future growth of Medicare spending — called “cuts” in Washington parlance — unfairly burden the elderly, along with the doctors and hospitals that serve them and the manufacturers of health products, lest the pace of technical innovation be impaired.

9. To be acceptable in America, health reform should not create winners or losers, but only winners.

10. "Common sense" will be able to come up with such a plan.

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Health Care Failure: Obama's Top Ten Goals Will Not Be Met (7/30/09), Politex

Obama's health care plan will fail because he is not saying at town meetings what it needs to succeed:

1. Without a public insurance option future costs, obfuscated by non-competitive private insurance companies, will not be kept down. Underfunded and non-networked, co-ops will not solve the problem.

2. Without mandated employer insurance many Americans will be left adrift to fend for themselves in a sea of red tape created by their employers to avoid payouts.

3. Up to 67% of the cost of the plan will be put on the backs of our medicare-protected elderly citizens, and our highest wage earners will not be surtaxed. The health care industry lobbyists and their paid helpers in Congress have voiced that all funding for the healt care plan should come from the money that is presently being used for health care. That's like rearranging deck chairs on the Titanic.

As he takes his case to the people at forums and town hall meetings and in interviews and press conferences, Obama is silent on these three points. His other goals, according to his aides, while admerable, are not enough to make a plan that works, even if they're not being watered down or eliminated by health care industry lobbyists and their paid helpers in Congress:

4. No discrimination for preexisting conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

5. No exorbitant out-of-pocket expenses, deductibles or co-pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

6. No cost-sharing for preventive care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

7. No dropping of coverage for seriously ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

8. No annual or lifetime caps on coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

9. Extended coverage for young adults: Children would continue to be eligible for family coverage through the age of 26.

10. Guaranteed insurance renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick

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Senate Health Care Plan: "Tyranny of the Tiny White States" (7/29/09), various

The "Gang of Six" that put this plan together consists of industry darling Max Baucus and "Olympia Snowe, Mike Enzi, Chuck Grassley, Jeff Bingaman and Kent Conrad. In a Senate of 60 Democrats and 40 Republicans, the health care reform bill is being written by three centrist Democrats, one centrist Republican, and two conservative Republicans. And until last week, Orrin Hatch was in the room, too. --Ezra Klein

"In the Senate...vast power is being wielded by people who, in a democratic system of government, would have almost no power. We’re talking, after all, about Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico, Susan Collins of Maine, Mike Enzi of Wyoming, and Chuck Grassley of Iowa. Collectively those six states contain about 2.74 percent of the population, less than New Jersey, or about one fifth the population of California. The six largest states, by contrast, contain about 40 percent of Americans. --Max Yglesias

The states represented by the 6 senators (Iowa, Maine, Montana, New Mexico, North Dakota and Wyoming) have a total of 13 representatives so the committee consists of half of the senators from states with 13 representatives and corresponds to 6.5 representatives, that is, less than 1.5 percent of the house and roughly 1.5 percent of the population. --Nathan Newman

It turns out that a majority of the gang of six — Senators Baucus, Snowe, Conrad, and Grassley — hail from states with extraordinarily concentrated health insurance markets. As Catherine Arnst of Businessweek reports, “such market concent ration has become a potent argument for supporters of a public insurer,” which would especially benefit consumers in those states. So guess what the Gang of Six has immediately taken off the table in reform talks? [Guess why.] ... They’ve also dismissed an “income surtax on high earners” — because, hey, once you’ve already voted to give away $250 billion to the very wealthy in estate tax cuts, how could you possibly ask mere millionaires to chip in for health care? --Frank Pasqule

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Update: Congress Tears Obama Health Care Plan to Shreds (7/28/09), Politex

House Speaker Pelosi: "We need to see the direction that the Senate is going,” she said, “so that we can do as much work in advance of September, so that when we come back, when we go to conference, we’re a good way down the road.” NYT

Senate Bill: Being formed by the Senate Finance Committee under the direction of Max Bachus, who has been given millions by the health care industry. The rest of the committee consists of three Republicans and two Democrats, Kent Conrad, called "out in right field" by Krugman, and Jeff Bingaman, a Centrist.

Predicted Result: "If the three Democrats and three Republicans can pull off a grand bargain, it will have to be more conservative than the measures proposed by the House or the left-leaning Senate health committee. And that could force Mr. Obama to choose between backing the bipartisan deal or rank-and-file Democrats who want a bill that more closely reflects their liberal ideals [and, according to polls, the wishes of most Americans.]" NYT

Obama's Defeat: Baucus claims that what will come out of his committee, will represent Obama's goals,covering the uninsured and slowing down health care expense. Thus far, his committee's solutions place a band-aid on a severed arm. Here are the Obama goals that the committee has eliminated to date:

1. No government-run insurance plan.

2. No coverage by employeers.

3. No surtax on the wealthy.

What the committee has not eliminated isaccounting for 67% of the cost of the health care plan by paying doctors and hospitals less for those patients covered by medicare or medicaid. To make up their loses, doctors and hospitals will most likely pass these added costs on to those patients.

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Health Care Winners and Losers (7/27/09), Editorial

Update: Baucus' Senate Finance Committee to Drop Gvt. Insurance, Employer Coverage, Wealthy Surtax

It's been our experience that by the time one waits for House and Senate versions of a bill to be passed and sent to joint committee, it's too late to do much to change the result, unless the President decides to veto it and start all over again. This will not be the case with the Obama health bill, which has yet to pass in either branch of Congress. We call this the "Obama" health bill, because he's willing to accept whatever's presently being discussed in Congress and call it a "victory," no matter how far it is from his supposed original intentions.

We supported Hillary during the Dem presidential campaign because she wasn't much different than Obama on most of the issues, but her position on health care was more progressive than Obama's. Other than that, Obama was more personally attractive as a candidate than Hillary, and he sold himself as representing "change" and "hope," powerful, vague generalities that typical politicians use to get elected. Just ask Hillary's husband. As for McPalin, they were just more Bush, and the majority of the voters didn't want that. Bush's idea of health care was to send those who couldn't afford insurance to emergency rooms in hospitals.

Meanwhile, since the primaries, the health care industry--the American Medical Association, hospital groups and the insurance lobby--, seeing the writing on the wall, have been pouring billions into the coffers of the politicians in control of the final bill, from Obama on down. The Washington Post reports, "Obama "received more than $2 million from the insurance and pharmaceutical sectors during his record-breaking presidential campaign....The health-care sector has long ranked with financial services and energy interests as one of the most powerful political forces in Washington, and it spent nearly $1 billion on lobbying in the past two years alone." Obama's largest total campaign contributions came from the financial services industry.

"Overall, health care interests invested $126.8 million in lobbying over the first three months of this year....Spending has spiked since the beginning of last year, particularly among deep-pocketed organizations with a major stake in the health care debate....Health care lobby groups have been generous with their campaign contributions, too, particularly to Democrats....Democrats also enjoy close ties with influential players in the health care lobbying world, particularly those lawmakers sitting on committees with a key role in the legislation [like Dem Max Baucus, who is in charge of health care reform in the Senate and has been given over $3 million between 2003 and 2008]....The parade of health care lobbyists visiting the White House also moved into the spotlight last week...." (See specifics at Health Care Industry Unleashing Big Money.

As a consequence of the symbiotic relationship between politicians and the health care industry, it's now looking unlikely that the final health care bill that Obama signs will contain a federal health insurance plan, additional taxes on those earning $250,000 plus per year, and workable methods of preventing health care costs from rising. Instead, as Obama has made clear at his press conference last week, up to 67% of the cost of the plan will come from paying doctors and hospitals less for medicade and medicare patiets: "The biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid....We've estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs....We...want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis." [MedPac is already in place, but it has no power.] Right now, due to present fees, many doctors don't accept medicare patients, and some clinics limit the number of medicare patients they will treat. There's nothing in the 4 plans in Congress that specifically addresses this obvious problem, and things will ge worse as the cost of Obama's health care plan will be placed on the backs of our seniors.

While Obama, under pressure from Repubs, Dems, and the health care undustry, insists that most of the money from his plan is in available federal funds, Paul Krugman warns, "We really, really don’t want to get into a position a few years from now where premiums are rising rapidly, many Americans are priced out of the insurance market despite government subsidies, and the cost of health care subsidies is a growing strain on the budget.

"And that’s why the public plan is an important part of reform: it would help keep costs down through a combination of low overhead and bargaining power. That’s not an abstract hypothesis, it’s a conclusion based on solid experience. Currently, Medicare has much lower administrative costs than private insurance companies, while federal health care programs other than Medicare (which isn’t allowed to bargain over drug prices) pay much less for prescription drugs than non-federal buyers. There’s every reason to believe that a public option could achieve similar savings."

But writing in THE NATION, John Nichols, says a federal health care option is not going to happen:

"A robust public plan, with the quality and flexibility that is required to make it appealing to all Americans, would wipe out its insurance-industry competitors in short order. Why would anyone opt for more of the profiteering, restrictions and actual denials of needed treatment -- especially for people with pre-existing conditions -- that the insurance industry uses to make money rather than provide Americans with the medical care they require? And why would any employer choose to subsidize the stock value of health-care conglomerates when it is possible to opt for the better care and controlled costs of a public plan?

"The powerful insurance and private health-care lobbies, which fear honest competition as the vampire does the stake, are going to do everything in their power to accomplish three things:
1. Scare Americans with hypocritical talk about the hefty price-tag for getting a robust public plan off the ground.
2. Undermine the structural supports for a public plan so that it cannot compete -- effectively turning it into a sub-standard "alternative" that will appeal only to those who have no other options.
3. Fiddle with the overall "reform" so that most of the taxpayer money that is expended streams into the accounts of private firms.

In the state of confusion created the industry's lobbying and advertising campaigns, chances are that the scaremongers and the profiteers will come out ahead."

Which would lead, Krugman concludes, to defeat, not victory: "Reform isn’t worth having if you can only get it on terms so compromised that it’s doomed to fail. Above all, the success of reform depends on successful cost control."

And tht's why the D.C. politicians in power are having million dollar paydays, courtesy of the health care industry. --Politex

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Obama's a Wuss (7/21/09), Politex, Brooks

Most everyone likes Obama. I know I do. Personally. But when it comes to politics, he's a wuss. We knew this for years, and we've written about it. He's presently being eaten alive by the D.C. politicians on both sides of the aisle. He's unwilling to get tough enough to do the heavy lifting. He now knows that his dream of bipartisanship doesn't move Republicans one iota, and he allows the Republicrats in his own party to do business as usual. His pretty words to the contrary are hot air. He's weak and ineffectual.

By giving too much power to a Republicrat-controlled Congress, he is willing to sacrifice the needs of the people for hollow "victories." That's why his poll numbers are going down. He asks, "Can't we all just get along?" and the Republicans and Republicrats just keep beating on him. He's a wuss. --Politex, JoeBama Watch

Here's David Brooks' take:
"Months ago, it seemed as if Obama would lead a center-left coalition. Instead, he has deferred to the Old Bulls on Capitol Hill on issue after issue.

"Machiavelli said a leader should be feared as well as loved. Obama is loved by the Democratic chairmen, but he is not feared. On health care, Obama has emphasized cost control. The chairmen flouted his priorities because they don’t fear him. On cap and trade, Obama campaigned against giving away pollution offsets. The chairmen wrote their bill to do precisely that because they don’t fear him. On taxes, Obama promised that top tax rates would not go above Clinton-era levels. The chairmen flouted that promise because they don’t fear him.

"Last week, the administration announced a proposal to take Medicare spending decisions away from Congress and lodge the power with technocrats in the executive branch. It’s a good idea, and it might lead to real cost savings. But there’s no reason to think that it will be incorporated into the final law. The chairmen will never surrender power to an administration they can override."

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Stimulus, Environment, Health: Why Obama Ends Up With Weak, Half-Way Results (7/1/09), Brooks

Republican Senators And Dems Like Nelson and Conrad Make Citizens Sick (6/22/09), Politex, Krugman

Obama's First Choice For Health Sec. Urges Him To Drop Fed. Public Health Care Plan.
Disappointing Daschle Is Now A Well-Paid Health Corporation Shill (6/19/09), Huffington

Obama To Daschle: Don't Worry, Tom, I Have Your Back (6/19/09), Huffington

Since Key Members Of Congress Have Holdings In/Ties To The Industry,
Can We Expect Meaningful Health Care Reform?, WP

Almost 30 key lawmakers helping draft landmark health-care legislation have financial holdings in the industry, totaling nearly $11 million worth of personal investments in a sector that could be dramatically reshaped by this summer's debate.

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