The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Bipartisan Health Care Reform Summit Changes Health Care Reform Dynamic

Posted by Alan on February 8, 2010

In politics it’s often easy being in opposition to the party in control. Since your ability to pass laws is limited, at best, the goal shifts from legislating to point making. Minority parties tend to introduce bills to bolster their base and embarrass the majority. They get to rail against the inevitable hypocrisy that is a part of governing in a democracy while ignoring their own double standards back in the days when they were in charge.

In Washington this game is clear and obvious. The Democrats, control of both chambers of Congress and the White House, try to muscle through their priorities. The Republicans unanimously oppose them. In California the game plays out a bit more subtly. Democrats have large majorities in the legislature, but a Republican occupies the Governor’s office. This allows Democrats to shift between the role of the party in control and the opposition. The result: Democrats back a bill that would establish a $200 billion single payer program in the state, safe in the knowledge that it will never become law. If a Democrat becomes Governor next year single payer legislation will still be on the table, but it will be vetted and debated far more thoroughly than this year’s bill.

Now that Democrats have lost their filibuster-busting majority in the Senate, the dynamic in Washington changes substantially. Republicans have been unified in their opposition to the Democrats health care reform proposals. With 60 votes Democrats could ignore them. The debate was all within the Democratic caucus and took place between liberals and moderates. Reduced to 59 votes, Democrats face a new reality: Republicans matter.

President Barack Obama gets this. His appearance at the House GOP conference was a masterful stroke. The give-and-take can be viewed differently depending on the partisan glasses one wears, but the political picture painted at the event unarguably favored the White House. The mere presence of the Democratic president at a Republican meeting was a victory for the Administration. Most of his questioners read from prepared documents (one from a huge book). President Obama answers were note-free. This made it seem like the Republicans had mapped out how to trap or embarrass the President while President Obama was there to simply talk.

Worse, the Republicans could not help but couch their questions in loaded, political terms. (“When will you stop being a socialist” kind of thing). President Obama not only called them on this behavior, but focused his remarks on substance and the need for bipartisanship. Because the questions were politically laden, even when the President responded in kind he won – self-defense is a valid excuse in the eyes of most non-partisans. The best evidence the President benefitted from attending the event: Republican leaders admit, off the record, that televising the question and answer session was a mistake.

Now President Obama is taking the dialogue to a new level and Republicans are in danger of being cornered again. Think of it as the “Be Careful What You Wish For Gambit.” Republicans have been accurately complaining they’ve been excluded from negotiations concerning health care reform. That’s about to change.

On Sunday President Obama announced he would convene a bipartisan health care reform summit with legislative leaders to be televised live. The New York Times quotes President Obama as stating “I want to come back and have a large meeting, Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward.” The paper goes on to say that “Mr. Obama challenged Republicans to attend the meeting with their plans for lowering the cost of health insurance and expanding coverage to more than 30 million uninsured Americans.”

This move has the potential to actually move health care reform forward. Democrats could be forced to defend some of their more tenuous proposals. Republicans might have to explain how their reforms stack up against the Democrats’ ideas. Republicans could use the opportunity to pin Democrats down on some of their favorite ideas (e.g., medical malpractice reform) while Democrats could question their GOP counterparts on how requiring carriers to accept all applicants regardless of pre-existing conditions can work without requiring all Americans to obtain coverage. In other words, there’s an opportunity for a meaningful, substantive debate that would educate the public while identifying common ground among the Congressional combatants.

And then there’s the political theater of it all. If Democratic or Republican participants use the opportunity to score political points rather than solve problems it will be apparent for the world – and their constituents to see. You can bet that President Obama will avoid this mistake. Instead this is an opportunity for him to present himself to voters – especially independent, moderate voters – as a thoughtful, serious leader focused on finding solutions to serious problems. There’s no more politically potent place for a politician to stand than above politics.

Of course, there’s no guarantee this summit will take place. Republicans are insisting that the legislation passed by the House and Senate be shelved before they participate. While I appreciate their concern about giving credence to the Democratic plan, the reality is that any discussions need a starting point. And the Democratic legislation is what’s before Congress. Taking into account that many of the provisions of the bills are non-controversial, starting with the current bills makes sense from a practical standpoint. Further, politically it’s to the Republicans advantage to force Democrats to defend their proposals. Especially given rifts within the Democratic party within and between each chamber, defending the existing bills would put Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi in an extremely awkward position.

However, instead of turning the President’s summit idea into an advantage, Republicans seem to be deploying the tactics that made them a minority party in the first place. Consider Republican Representative Darrell Issa. According to the Associated Press he said that the first question Republicans should ask President Obama is “Did you lie about moving forward on malpractice reform?” Yes, this feistiness is red meat to the Republican base, but elections are won among moderates – and moderates are tired of politics-as-usual. Representative Issa could have made the same point by suggesting the first question be “How can the GOP help President Obama keep his promise to move forward on malpractice reform?” That’s the approach most independent voters are hoping to see. (Granted, some independents are well to the right or left of the mainstream, but the ones that decide elections tend to be moderates.)

President Obama’s call for a bi-partisan health care summit is subtle and significant.  At best it leads to passage of health care reform albeit at the political price of rewarding Republicans for being partners in reform. At worst the summit proves no health care reform is possible, but in the process shows that it is Republicans who are unwilling to take substantive action.

For President Obama this is a win-win situation. For Republican it is a dangerous one. If they rise above politics it could cement their standing as the alternative to the current Congress.  That’s their win. If they follow Representative Issa’s example, however, they’ll make their base happy, but undermine the electoral momentum they’ve gained in the past year. That would be their loss.


40 Responses to “Bipartisan Health Care Reform Summit Changes Health Care Reform Dynamic”

  1. I strongly disagree. I believe the President is doing this as a last resort. He should have in fact done this a lot earlier if he truly wanted bipartisanship.

    he should have aired the negotiations on C-span as he said he would during the campaign.

    I believe that going in now without really an open forum, instead using the actual plans being pushed by the Democrats is only a ploy.

  2. CHP said

    The Democrats, control of both chambers of Congress and the White House, try to muscle through their priorities. The Republicans unanimously oppose them.

    Why can’t we all just get along and actually enact some positive change, rather than jostling for power all the time? It’s frustrating to watch.

    • In my experience (over 40 years in politics, same in health insurance) whenever Congress is controlled by only one party, Ds or Rs, over both houses, there will be no “getting along”. If the Administration is controlled by the same party (absolutely no checks and balances) it is guaranteed that the party in control will bully their way through every legislative action taken. In this case, the Ds have full control and the evidence of complete arrogance and turning a deaf ear to the electorate, who they all are to represent, has been clearly apparent, unlike the actions of the Ds which we were promised would be transparent, but has instead been totally opaque.

      Hopefully, the “independents”, those who are moderates, centrists, and are “beholdin’ to no one and have no party to whom they feel loyal (none has earned that loyalty in decades), now that we are larger than either party singularly, will be able to exercise far more influence over who wins in 2010 and 2012 and in the process diffuse some of the arrogant “bird-waving” we have experienced from the Republicans and the Democrats.

      Our Administration and Congress should be working to represent the electorate, and the citizens, but thus far have only been representing their own self-interests.

  3. Sheila Marks said

    California USA has the worst health care system in the entire world. Due to a 1970s law Doctors and hospitals cannot be held liable for malpractice or wrongful death. This allows the victims and thier families not to be able to recover. This allows crime to take place big time in the funeral industry and with the stealing of property ect.. Spread the word world wide.

    • To Sheila Marks: I was going to comment, however…realizing the “off the charts” inanity of your post, Ms. Marks, will only comment as I did.

      Study, research, learn, become educated before uttering such uneducated comments, please.

    • Roxann Breazile said

      Ms. Marks: I can’t help but wonder what would motivate you to make what appear to be exceptionally inaccurate statements, without providing specific facts to support your assertion. For example – What legislation are you referring to — binding arbitration? Did you have a personal experience in which you felt that you could not pursue legal recourse for malpractice? Why would legislation regarding malpractice make the ENTIRE California health care system the worst in the world? And finally, what in the world does the funeral industry have to do with malpractice legislation?
      So, please back up your statements.

  4. Malcolm Cutler said


    Let me answer your questions. The client’s husband was a real cat with nine lives: Hodgkin’s lymphoma, heart attack, quadrupal by-pass, cancer in both kidneys, one repaired and one removed, three bouts of melanoma, and toxic shock. He survived all but his last round of melanoma. I just checked the Blue Cross maximum and did not find one.

    In California, insurance reform, created several years ago, created the large pools of small groups that cover pre-existing and guarantee issue for small employes (2+).

    Have good long weekend.


    • James S. Thornton said

      Well, I suppose I wouldn’t want to change places with him, now that you put it this way.

      Thanks, Malcolm, for providing a very concrete and specific example. I think California may be a bit more progressive than Pennsylvania when it comes to insurance regulations.

      Can I ask you how old the wife is?

      Also, you mention “struggling to find coverage for individuals with health problems.”

      I am wondering, from your personal perspective, if you have had clients for whom the insurance options, their medical history, and their financial situation have made coming up with an answer basically just impossible?

      If so, how does this effect you emotionally as a broker, one who seems (to me at least) genuinely concerned with helping his clients find answers?

  5. Malcolm Cutler said

    Response from Henry in California:


    Thank you for your inquiry on my client, who has been a client since 1987 and, since she lives on the Westside of town just received a 39% increase from Anthem Blue Cross. Since I am in the process of reviewing recommendations for her, I thought I would take you through the process with me.

    First off. as a long term broker is California, we experienced insurance companies such as Prudential and American National providing good product and then leaving the business and leaving us struggling to find coverage for individuals with health problems. Based upon this, our agency decided we would only offer individual coverage through Blue Cross or Blue Shied – separate companies in California. Like Gerbers, we felt that healthcare was their only business and they would be around.

    I just started to write about my client’s husband’s health issues and I realized I would be violating HIPAA rights and to list the 2 to 6 million dollar worth of medical expenses would take up to much space. But Blue Cross paid all bills and, since most years exceeded his $5,000 Stop Loss, most of the bills were paid at 100%. Her husband passed away a year or so ago.

    My client’s costs, with her renewal, are going from $872 to $1207 and two days ago I received a call from her saying she could not afford the increase.

    With the renewal, it appears that shifting from her $1,000 deductible, her current plan, to a $5,000 deductible reduces her premium from $1207 to $675.60, Though that sounds like a big deductible jump, doctor visits are paid at $40 and routine Pap and mammograms are not subject to the deductible. In making such a change, she is saving $2300 per year from her current premium and if she can save that for a little more than two years, she has the money for the deductible, if she is hospitalized.

    We will also show her a High Deductible Health Plan, which allows the establishment of a Health Savings Account, that pays 100% after a $3000 deductible for a cost of $950. We will need to review her prescriptions and general medical expenses, since the needed funding of the deductible leaves her at about her $1207 renewal cost.

    Another option is a no deductible 40% of expenses to $7500 out of pocket. The cost is $735 per month.

    So for this client it appears that the change in deductible will actually improve her monthly cash flow from where she was prior to the 39% increase, send a message to keep herself healthy so she does not have to incur the deductible, knowing she has the same strong catastrophic coverage that paid all of her husband’s.

    James, when I came into the health insurance business we paid our medical bills and purchased a major medical policy. It seems, as I have read this blog, that if we went to insured high deductibles for all and paid our bills, with government support for those who cannot pay their bills, we might make a big step toward needed HCR.

    James, I hope I have answered the question you raised.

    My best.

    HENRY- A California Broker

    Malcolm Cutler Jr.
    Century Benefits Group
    Pacific Unified Insurance
    15901 Hawthorne Boulevard, #200
    Lawndale, California 90260
    Phone (310) 370-5000
    Fax (310) 370-5454
    License #0670200

    • A fine example where a competent professional proves their worth…..
      We must constantly be reminded….INSURANCE is transferring a risk we can not afford to bear alone…..So, in terms of HEALTH INSURANCE….what are the “risks” we can not afford?
      Is it the annual exam? The routine blood work? Or, is it the cost associated with a serious illness or injury? Let’s say there was no insurance…what would happen? Surely, the vast majority of Americans can actually afford to pay for the routine office visit….flu and other immunizations…even X-rays, CAT Scans and MRI’s…though these may add up to several thousand dollars, they will not make one go bankrupt…..these “costs” can be borne by each of us. But let’s say the “tests” find a major heart condition or cancer and the course of treatment runs into the many thousands? NOW, most of us clearly see the NEED for INSURANCE. Now, whether with an HSA or with a high deductible co-pay plan…then, we may wake up to the reality that controllable factors like diet, exercise and proper rest have a direct impact on our quality of life….when WE pay get healthy, perhaps WE will realize it might be cheaper to STAY healthy in the first place.
      So, to the “clients” who experienced massive rate increases….we must review their current deductibles, etc….are too many of the “routine” costs shifted to the insurance carrier? When a carrier “handles” the billing for routine expenses, they will add three components….claims paid, operating costs, profit margin…if one wants the “convenience” of having a low deductible policy, they must be made aware of the “cost of that convenience”….and if they find the high deductible plan “REVOLTING”….then they should be motivated to commit to staying healthy.
      It is easy to condemn any carrier for increasing rates by 39%…but is it right? Many of our problems come from “people” receiving “health care” and “health insurance benefits” that someone else has been paying for (the employer, for example), and its true costs have been hidden…..Now that these costs are much more visible, they are seen to be ugly and offensive.
      So, to those of us who have to “explain” these rate increases, let’s remember to explain to the client our primary role is to protect our clients from the financial crisis associated with catastrophic loss….and if they want to also include “healthcare” benefits, as well, there are a myriad of plans and programs to do that too!

    • James S. Thornton said

      Thanks, Malcolm. This is precisely what I was hoping to find.

      For what it is worth, every broker I have dealt with personally has been extremely conscientious.

      Until I interviewed Alan for an article last year, however, I did not even know there was such a thing as a health insurance broker–I just thought you called up the local health insurance company (in my area, at least, there aren’t that many to choose from) and tried to get the best policy you could qualify for.

      Without giving away any specifics, I am curious how any individual can rack up $6 million in medical costs. I am pretty sure my current insurance has a cap that is lower than this, not that matters.

      I do understand the concept of insurance, and that the many end up subsidizing the few. Because the many, in this case, are the ones who are fairly healthy, and the few–like your client’s husband–are catastrophically ill, I certainly hope to remain in the “many” column for as long as possible.

      I also agree with Mike’s suggestion that most people have little idea how much their healthcare is really costing, because they don’t feel the direct pinch when an employer is helping to subsidize his or her premiums.

      What I continue to find difficult to understand is why:

      A) if spreading out the risk is the whole point of insurance, what would be so horrible about a way for self-employed and/or small businesses nationwide to collect themselves into one giant risk-spreading pool

      B) why these two “little guy” groups–i.e., the self-employed and very small businesses–are not provided the same protections given to those able to obtain group insurance

      It sounds like your client can afford to pay $675 a month, plus the vast majority of her out of pocket expenses. For many single individuals, however, this is a hefty chunk of their income.

      Perhaps spending $6 million on one person’s healthcare is part of the problem here.

      • “What I continue to find difficult to understand is why:
        A) if spreading out the risk is the whole point of insurance, what would be so horrible about a way for self-employed and/or small businesses nationwide to collect themselves into one giant risk-spreading pool
        B) why these two “little guy” groups–i.e., the self-employed and very small businesses–are not provided the same protections given to those able to obtain group insurance
        It sounds like your client can afford to pay $675 a month, plus the vast majority of her out of pocket expenses. For many single individuals, however, this is a hefty chunk of their income.
        Perhaps spending $6 million on one person’s healthcare is part of the problem here.”

        James: And you said you didn’t want to discuss anything “Political”. I quote: “Forget about politics just for a few moments. Forget about who is right, who is wrong, who is ruining the country, who is trying to save it, who is arrogant, etc. Forget anything and everybody who might be on TV.”

        Yet you just posted two glaring very political questions that are directly related to the Pro-HCR argument.

        Mean what you say, and say what you mean. You DO want to discuss the politics of HCR. That’s pretty disingenuous, James.

        • Roxann Breazile said

          I think James has some valid questions that many people are asking. I don’t find them glaringly political. It is thoughtful responses to these types of questions and a thousand others like them that will help us improve the current situation; where some people can’t get insurance at any cost and others can’t keep their insurance because of the cost.
          In response to A…because insurance carriers are regulated by the states–a nationwide pool will be a massively huge undertaking to “level-set” a standard across the country in terms of benefits, regulations, rates, guarantee issue status, etc. This would be health care reform on steroids.
          In response to B…If health care reform legislation directed more attention to cost containment, premiums like this could be reduced. Instead legislators seem to be content with making this mainly about health insurance reform.
          In the final analysis, someone has to pay for the care provided. The cliche of “no free lunch” is terribly apparent in the health care reform debate. By taking a two-prong approach to #1 finding effective, compassionate and fair ways to contain sky-rocketing costs AND #2 instituting ways to increase accountability while maintaining a chance for carriers to profit reasonably from the valuable service they provide…we have a shot at improving accessibility and affordability for everyone.

        • James S. Thornton said

          Thanks, Roxann, for your explanation.

          I did not intend for my questions to be political, but I suppose it is hard to disengage the political from the personal.

          I do hope that Spencer has good proctological care, because it appears–at least to this layman–that he has a severe pre-existing condition here.

          Like blind men examining an elephant, I know that my perspective on the health insurance situation in our country is parochial at best.

          For most of my life, I have been by most reasonable definitions a middle class person.

          This is starting to slip away with increasing alacrity, and it has not made me into what, by most reasonable definitions, could be called a better person.

          I feel for the first time in my life a very strong sense of prejudice and discrimination–feel free to laugh if you want, Spencer, but there you have it.

          When I decided to pursue my career as a magazine writer in the early 1980s, I knew that it would not be the easiest route to a secure life. I knew that I would have no employer to match my social security contributions, and hence have been paying 15 percent off the top of everything I’ve earned.

          I knew, as well, that I would have to pay for my family’s health insurance premiums.

          What I didn’t know then, and I am not sure anyone would have been able to predict this, is that

          * two of the most commonly treated conditions in the U.S.–depression and high cholesterol–would render both my wife and me uninsurable if we ever tried to change policies

          * that the policy we bought at the time, and found quite affordable when we were 31 and 27 respectively, now takes up 40 percent of our pre-tax income.

          This is the part of the elephant I am looking at, and I assure you, it is a very disgusting part indeed. You may want to write this off as a political rant, but I am telling you, I have spent the last year looking of options out of this, and the only possibilities I can find are to give up insurance altogether, or to try to lower my income to the point where we will qualify for a state-aided policy that is basically a welfare kind of thing.

          Spencer, you may have the luxury of getting all huffy about this in a political sense, but I am certain it does not effect you in a personal way. For one thing, if you are old enough to be retired, chances are you are sucking the socialist teat of Medicare already, the kind of socialism I suspect you independents with the little i’s rant against when it’s offered to anybody else.

          Again, I am slipping into ad hominem territory here, and I apologize. It’s just so damnably frustrating to have no way out and the responsibility of your family on your shoulders and a sense that the system is rigged against you.

          I apologize for suggesting you need a proctologist.

        • James,

          You owe me no apology. I was abrupt, harsh, and behaved, as my wife says on occasion, like an A$$hole.

          I apologize.

          I must run, I just found the number of a proctologist whose services I think I need. 🙂

  6. James S. Thornton said

    As a regular reader of Alan’s blog, I have the impression that many of my fellow readers are brokers, and perhaps more than a few are from California.

    From the tenor of many of the comments I’ve read, I would furthermore suggest that there might be a “free market” leaning in many of you, that those who are in favor of Democratic reform proposals are in a minority, and those in favor of “scrap this abomination and start over from scratch” are the majority.

    Forgive me if this is a mischaracterization.

    In any event, I am wondering if there are any Republican brokers specifically from California who have helped self-employed individuals buy coverage from WellPoint (see AP story )?

    If one of your clients, presumably someone who has been a good and faithful customer over the years, is now being dropped because they can’t afford to pay into the death spiral, what specifically do you advise to said client?

    I ask this, in part, because I am in a similar situation (though the lemon-dropping insurer in my case is BC/BS from another state.)

    I know it is very easy to become passionate about the Big Picture ideology of this debate. But what I would really like to know is how you explain this specifically to an individual customer you have worked with over a long period of time.

    Thanks for your replies.

    • SAL said

      James, my apology, I am not a CA Broker, though I did retire from my firm where we specialize in marketing and product development of Long Term Care policies. We have also been heavily involved with NAHU and the WA chapter of NAHU for many years, and have earned our bones fighting in the trenches for over three and a half decades. I did want to comment on yur post.

      All that you just mentioned for discussion can be resolved with “Insurance Reform”. Health Care Reform, as it has now become defined, was an attempt by the Obama Administration with the help of the House, under Nancy Pelosi’s leadership (and one of the most arrogant politicians I’ve seen in almost 40 years of being involved in politics, and the Senate, under the “threatening” leadership of Harry Reid (“Oppose me and you will lose your committee chairmanships!”, paraphrasing).

      I am a Centrist, a Moderate, an “independent” with a small “i”. I voted for Obama and have been deeply disappointed since he took office and has exhibited, IMO, no leadership qualities or abilities whatever.

      This whole mishigas (mess) could have been avoided if some required “Due Diligence” and research had been exhibited by those interested in throwing out the entire existing system, against the wishes of the vast majority of Americans. In fact, considering that the economy was in the toilet and we went from 5 Million Unemployed to 15 Million Unemployed in 2009 alone, it should be clear that Obama and Friends should have attacked this urgent issue first, and not tried to push through, jam down everyone’s throats, an expensive ($2Trillon in ten years?) plan that would break an already broke America.

      I repeat, “Insurance Reform”, badly needed and still not accomplished, or even being worked on, unless it too is being worked on behind the same closed doors, back-room cigar smoke filled, pork barrel loaded manner in which Obama and Friends operated for the entire year of 2009 (“NO! There will be NO coverage of our shady deals by C-Span!”).

      Insurance reform, last time, will solve the problems you suggest, and it is agreed need solving. Along with a very heavy dose of Tort Reform, badly needed and carefully avoided by an of the 40% of the Lawyers in the House, and 60% of the Lawyers in the Senate, for their own, very selfish and pecuniary reasons.

      It doesn’t matter who on this Blog is a Broker, Agent, Insurance company rep, Doctor, Lawyer, or Indian chief. It matters a great deal what those people who are writing on this blog think about having been ignored completely by the Democrats and the arrogance they have displayed over the last 12 months. This is not the way we are supposed to be represented under America’s form of democracy.

      • James S. Thornton said

        Sal, I appreciate your responding to my inquiry. However, I am still hoping that someone out there can address a very specific question I have.

        Forget about politics just for a few moments.

        Forget about who is right, who is wrong, who is ruining the country, who is trying to save it, who is arrogant, etc.

        Forget anything and everybody who might be on TV.

        And tell me specifically what you (a California broker) say to your client (a WellPoint individual insurance customer) if and when the planned yearly rate increase proves too much to endure.

        Again, there is no shortage of political, ideological, and assorted other Big Picture fodder for discussion ad nauseam.

        But I am not asking for this at the moment.

        Say you, the broker, are named Henry. And your client is named Jane.

        Henry sold Jane the WellPoint policy in, say, 1984. She has been paying regularly, and it has–thanks in large part to your recommendations– been a good product that has helped her manage health care costs for much of the past 25 years.

        During this time, Jane has developed a few chronic conditions, as people are wont to do as they age. Mild hypertension, for example. And perhaps some arthritis.

        In the last couple years, Jane’s premiums have begun to soar. Now, with the proposed increase of 39 percent, she simply CANNOT pay anymore. She does not earn nearly enough money; in fact, she has been borrowing against home equity over the last several years just to help pay for the pre-39% increase rates.

        What do you, Henry, say to Jane?

        Give me a thumbs down for this question if you want, but why won’t any of you brokers answer it?

        • Rick said


          More info is needed on Jane.

          Please provide her full background, assets v liabilities, along with annual income and an itemized list of her expenses in order to determine if this person is living within her income. We also need to know her exact occupation to determine if there are some ideas she might use to increase her income.

        • James:

          I think that Malcolm Cutter’s response was excellent, and appreciated Mike Breton’s comments.

          This is not being posted as an apology or as a defense. I would only like to correct a “mis-characterization” I believe you have made, perhaps more than one:

          Many of us may lean toward a “Free-market” system, certainly I am one. I believe in Capitalism, strongly, not in a Socialist philosophy, even though Medicare (my field) certainly is socialist in many ways. That does not mean that we are against HCR that has been properly researched, has the appropriate individuals “at the table” to work out a plan, and yes, that definitely includes what Hillary Clinton used to call the “Fox”, as in the hen-house. The vast majority of Agents and Brokers do an excellent, ethical job for their clients and place their clients first and foremost.

          Many of us who lean toward a “Free-market” system are not Republicans. Among us are Democrats, and a number of us represent what is now the largest voting bloc in the country, “independents”.

          You don’t want to discuss politics or any of the political “taint” representative of 2009, yet you use phrases such as ““scrap this abomination and start over from scratch”, and assign that language to “Many of you”, and imply that the “Many” appear to be Republican, you have just entered the world of politics. As might be heard in a “court of law”, “you opened that door, counselor.”

          Some of us are undoubtedly from CA, and from WA, TX, ND, SD, IL, WA DC, and all over the country.

          I will repeat what I said earlier…Insurance Reform can fix many of the ills we now face in the field of health care funding and its accessibility and affordability, and when the majority of the Electorate, and the myriad types of disciplines represented in Health Care and represented at the Health Care Reform table, then we can talk about HCR in a balanced manner.

          Now, just my opinion, but this blog was established by Alan as a Health Care Reform Blog for discussion of health care and health care reform issues, not for a discussion site to exclude all from the conversation except those in one discipline of Insurance for a discussion of conscience, sensitivity, empathy, and ethical marketing in that specific discipline only…any more than I would deliver thoughts regarding specific areas of Long Term Care insurance (Being discussed in HCR legislation, BTW) that are unrelated to the conversation of Health Care Reform (Rick’s post speaks to that far more briefly than mine; then again, perhaps I feel more shut out than Rick).

          Perhaps, if you were to have provided your email address with the comment, “Would a broker or agent who has dealt with Anthem BC please contact me”, instead of shutting the rest of us out, it would have been far more appropriate and less exclusionary. Most certainly these discussions will become political. This entire issue began as a political issue, originally raised by Barack Obama when he began his campaign in 2007.

  7. I remember an old axiom from my synical “college” days…..
    Those that can, do….those that can’t, teach!
    Of late, President Obama is acting more like a “professor” than a leader….he can’t get it done, so he’ll “lecture” and pontificate!
    Most people would appreciate a “problem solver” and could care less if that person is a Democrat, Republican, Independent or “Tea Party Conservative”.
    1. Pre-existing conditions causing elimination of coveratge or automatic decline.
    2. Protection from “adverse selection”….or applying only after condition/concern discovered.
    3. Malpractice Insurance costs and the tests they effective mandate, regardless of need.
    4. The fact that 30+% of the life-time spend on healthcare is in the last few months of life.
    5. Making people understant the need for making good “life style choices” and creating a system rewarding those that do and punishing those that do not.
    6. Finding a way to compensate Doctors and Hospitals for keeping us healthy instead of paying them to treat.
    These are neither conservative or liberal issues…these are ultimately fiscal issues….if we don’t find a way to solve them, we will simply not have enough money to maintain our Country….

    We keep borrowing to pay for our past sins and current problems…and mostly from the Chinese…we must remember….we can reasonably expect to be able to keep borrowing so long as the lenders believe we will pay them back with interest. Unless you’re a complete fool, you only lend money to people who you believe will pay you back…..and if we keep devaluing our currency and increasing our debt burden, we will soon reach a “tipping point” where lenders no longer believe their loans are safe…..then everything crashes.
    Healthcare is but the very tip of this iceberg…..and we’re all merrily rearranging the chairs on the deck of the Titantic.

    • James S. Thornton said

      A good comment in my opinion.

      I would, however, add a 3.5 item to the list. Though frivolous lawsuits do seem to encourage defensive medicine, there also needs to be some way to curtail practitioners who own the testing apparatus itself from mandating tests where it is not medically necessary.

      In the financial industry, I am all for bringing back the Glass–Steagall Act of 1932, which kept commercial and investment banks from merging.

      In the medical industry, I think there should be something equivalent to this, as well.

      Let’s face it: people defer to their doctors. If a doctor recommends you have an MRI, and your insurance will cover it, who among us is going to say, “Why don’t we wait a month and see if things improve before spending all that money?”

      If the doctor has a financial interest in the MRI machine (or whatever other testing device), and there is a gray area, he or she is likely to recommend the test anyhow–and claim it’s only “defensive medicine” because of malpractice attorneys, when part of his or her motive (conscious or not) is to make money from the use of the testing device.

  8. Allen H. said

    I think the HC summit is purely political posturing-window dressing on both sides of the aisle. Obama/dems want to say-we tried for bipartisanship, but those guys oppose everything. Repubs want to say we want HCR, but not this horrrble govt takeover thing.
    HCR in Washington has nothng to do with Health Care Reform. HCR has morphed into the following:
    Dems- How best do we get out of the mess that we created w/HCR-how do we save our jobs?
    Repub- Oppose HCR at all costs-if HCR fails, we will take back Congress.

    • SAL said

      “Dems- How best do we get out of the mess that we created w/HCR-how do we save our jobs?
      Repub- Oppose HCR at all costs-if HCR fails, we will take back Congress.”

      Allen H: The Rs won’t take back Congress, but history has shown that when the Administration is one party it is always best if Congress is not controlled 100% by the same party. When it is, we have no checks and balances. Instead we see what we have seen in 2009, a behavior that borders on “Dictatorial”, as we have seen from the behavior of the Ds. Having the Senate have a 60% majority of Ds closed the door on any chance at a bi-partisan solution to anything, and arrogance, of the highest and most shameful order, took hold. Were the Rs in control of the Administration and the Congress, to that same degree, we would see the same.

      We need balance in everything, and when only two parties control the political makeup of our governing bodies, balance is especially important, balance is essential to true democratic representation (that’s democratic with a small “d”). Should the Republicans take back either the Senate or the House in 2010 a good thing will have happened for the principles of democracy to work in America.

      Nothing should move forward in Health Care Reform, other than some Insurance and Tort Reform (the Lawyers) until that balance has been “reinstated”.

  9. Healthcare reform can start now with no high price tag

    Obama and Congress are taking the entirely wrong approach to healthcare reform. We can be doing so much right now to improve healthcare without suspicious price tags. There is nothing wrong with carrying out reform in two phases: the immediate and low price-tag phase, and the longer-term, let’s-find-the-money-first phase.

    What can be done now, with little public opposition:

    One group plan
    Everyone would have access to insurance if all insurance companies were required to offer a plan to individuals as though they were all in one large company group plan, with the same rate and no exclusions. There is no cost to taxpayers; premiums are paid by the insured.

    Guaranteed coverage and insurance market reforms
    Few would argue with such provisions. The health insurance industry has been such a Wild West that companies could promise anything and provide nothing. They suffered no bad consequences when they blatantly breached contracts with subscribers. Other than enforcement, there would be no cost to taxpayers.

    Essential benefits
    An independent committee would define an “essential benefit package” as a minimum quality standard. It would include preventive services with no co-pays or deductibles, mental health services, and oral health and vision for children. It would cap the amount that consumers have to spend per year, and cost taxpayers nothing. Insurance companies could add features to this basic package. Now they can get away with not paying for basic services because most people do not have a choice of plans, and insurance plans are far too complicated to easily compare.

    Individual responsibility
    It is time for the government to be honest about the lifestyle factors that cause many of our healthcare problems. According to an article at that is based on research reported in The New England Journal of Medicine, “preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs,” and “preventable illnesses account for eight of the nine leading categories of death.” This is the single most important factor in lowering healthcare costs and making people healthier. But in most ways it is not a role for government. It is up to individuals to change their habits. However, the federal government certainly shouldn’t be making the situation worse. That means telling the truth about the fast food and prepared food industries. And it means requiring that government agencies and contractors use part-time and telecommuting work arrangements so people have time to exercise and prepare food at home. A national campaign aimed at employers, encouraging them to use flexible schedules for workers, such as part-time and telecommuting, could do a lot of good, with the government itself taking the lead. Cost to taxpayers: nothing. In fact, there are potentially huge savings in lowered healthcare costs.

    Pushing for results
    It is time for ratings. Netflix movies are rated. EBay sellers are rated. This is established technology. It is time for a central web site that shows us ratings for healthcare providers. Some sites do this now, but there are too many with too few ratings and it is chaotic. An insurance company doing ratings of its providers is not an unbiased source. How good is that doctor / hospital / radiology lab anyhow? How effective? How organized? How long a wait? How polite? How accurate a bill? This costs little and offers so much in savings and making healthcare very effective quickly. No more money is wasted on ineffective providers. People get well much sooner. Providers change their methods to get better ratings. Cost to taxpayers: very little. Such a site would also reveal the really bad eggs . . . moving on to . . .

    Making sure healthcare providers really do their job
    States are supposed to enforce this now, but often don’t. According to a press release from Public Citizen’s Sidney Wolfe, MD, “Most state medical boards are doing a dangerously lax job in enforcing their state medical practice acts and adequately disciplining physicians.” In another article, Dr. Wolfe said that from 1990 to 2002, just five percent of U.S. physicians caused 54 percent of the nation’s malpractice lawsuit payments, basing his numbers on information from the National Practitioner Data Bank. A constant stream of reports show that hospitals are covering up mistakes. If states were doing their job, there would be little or no malpractice lawsuits. This is far more important than tort reform. With ratings, state regulators, properly funded and monitored, could spot and check on providers who are doing a poor job before they do something really really wrong. Such a practice would eliminate payments to incompetent providers and lower malpractice cost. Cost to taxpayers: very little.

    Emphasizing primary care
    Healthcare reform needs to enhance the partnership between patient and primary care doctor. The primary care doctor is the one who needs to be on top of what is happening with a patient, with whatever record-keeping system works best for him or her (usually a hybrid of paper and database. All-electronic record-keeping is not reliable yet). Primary care doctors need to be paid as much or more than specialists and be paid for phone call and record-keeping time instead of just doctor visit time. Many doctors are forced to use a more expensive visit when a phone call will do because they don’t get paid for phone time. Cost to taxpayers: nothing

    Looking close at hospitals
    Hospitals need to be very closely audited. Not only are there often bogus charges on bills, but the charges are far far beyond costs. No one really checks this, so they keep doing it. Employees wander around hospitals that don’t seem to be doing anything. Hospitals charge for unnecessary tests, with no one making sure that tests are based on research. Anyone who complains is ignored. Medical institutions are roach motels for our hard-earned dollars. Dollars check in but they don’t check out. Cost to taxpayers: very little.

    A simple little thing
    Refrigerator magnets can save millions. Yes, you read that right. A magnet can list the phone numbers, hours, and locations of urgent care centers that can be used during weekends and evenings instead of much more expensive emergency rooms. We now waste millions on non-emergency problems being treated in emergency rooms simply because people don’t know where else to go. Cost to taxpayers: very little.

    Another simple little thing
    Money is wasted on mailed Explanation of Benefits forms from insurance companies when this information could be provided for free via a secured web site. Cost to taxpayers: nothing.

    These no- or low-cost changes would greatly improve care and save millions. They are the first step. There is no reason to delay them in order to get a “comprehensive” healthcare reform. No reform can possibly work without them in place first.

    Patty Zevallos
    media producer – web, video, print

  10. CHP said

    Hopefully this forum will bring to light some of the better Republican ideas, like making health insurance portable and capping malpractice claims. If the public hears and agrees with particular sentiments, from either side, then Congress will hopefully be forced to implement good ideas, regardless of which side they stem from.

    • CHP,

      Your comments about capping malpractice claims is not just excellent, it is a serous understatement. We in America, are in need of serious Tort Reform, and have been for decades.

      There is absolutely no reason why Lawyers should be treated as a protected “endangered” species. In fact, just the contrary.

      Portability, Guaranteed Renewability, No Cancellation due to health history or claims history, Guarantee Issue (with pre-X requirements), and “TORT REFORM” legislation should be and can be passed into law in 2010, should the Democratic Party Leadership not fight it too hard, given the massive number of Lawyers among them (40% of the House, and 60% of the Senate).

      A push for Torte Reform in 2010 may afford us all a look at a different dynamic than we saw for health care reform, pushed without proper research, development and consideration for the wishes of the Electorate, in 2009.

  11. Roxann Breazile said

    Slightly off topic… but this link reports that “Congress joins call for Anthem to reconsider rate hikes” This is the latest in the rates controversy for Anthem Blue Cross CA. The CA insurance commissioner Steve Poizner requested a rate implementation delay pending an investigation and Kathleen Sebellius has also called for an investigation. Do you think this is a unique situation or an indication that Federal oversite in state-regulated insurance rates will be one of the first health care reform measures passed?

    • Roxann,

      As I understand it, not only is this an ongoing situation with Anthem (CA Blue Cross)regarding rate issues, but also with issues regarding Anthem canceling coverage due to claims history, and possibly other “Consumer unfriendly” actions.

      While a number of states have done a good job regulating the companies doing business in their states, a number have not; in fact many have been “AWOL” (Absent Without Leave).

      Given that we in the Agent Community often must do battle with the very insurance companies that encourage us to “write” their product, in order to provide our clients with the kind of benefits, ease of claims, and receiving reasonable rate hikes (Anthem’s request is ludicrous…it appears they simply want to “dump the book”) perhaps the best solution is to have the Feds take control of such regulation and oversight as the states, clearly, have done a really appalling job in not requiring uniformity in having companies apply the same standards in all states.

      The Insurance Companies’ cavalier attitude toward the consumer (and toward many in the Agent Community) in their zeal to make a (lot) of bucks, fairly “cries out” that strict, mandated Federal Regulations be followed, for the protection of the consumer and the agent community.

  12. Malcolm Cutler said

    I attended a seminar on healthcare reform and in the seminar, part of the panel referred to how many uninsured individuals would be covered if they simply elected to participate in available health insurance plans:

    College: 5 million

    Medicaid eligible: 11 million

    +75,000 income: ___________

    I am missing the 75,000+ income and want to verify college and Medicaid.

    Clarity of these numbers should help focus on the target, which from what I read is 3 million for the Republican plan and 52 million for the Democratic plan.

    Since a correct solution is what we are after, it makes sense to know what target we are shooting for and at what cost to hit it.

    Thanks for your help.


  13. Overall a good commentary, Alan.

    That said, and while I realize not yet a true “partisan party”, it isn’t just Republicans who matter, “independents” matter even more.

    Do “independents” hold political seats? No, not yet, but we will, sooner rather than later. It isn’t Republicans who elected Scott Brown to the Senate from massachusetts, it was the “independents”, and the independents are tired of being ignored, as exemplified by that unexpected vote. The GOP did nothing to help Brown win that seat, but the independents did much. The Democrats and the Republicans need to pay attention. 2010 will be the year that the independents in America will take their rightful place among “thinking” voters. And independents cannot be as easily bought as Rs or Ds. That why we’re called, “independents”.

  14. Mark said

    This isn’t necessarily on point but I thought it worthy of a post. Karen Callen, M.D. is an OB-Gyn who practices in San Francisco. To my progressive friends this is a bit of eye opening stats. This is a short op ed that appeared in this morning’s Marin Independent Journal.

    • James S. Thornton said

      Mark, I read your friend’s editorial in the Marin paper. She doesn’t cite her sources for the breast cancer survival data, so I did a search for this.

      One of the things that gives me a little pause is when a writer uses something clipped verbatim from a talking point of either side. In this case, her suggestion we need to scrap the current work and start over from scratch sounds like something you would hear Bill O’Reilly or Glenn Beck spouting.

      As far as mortality stats go, here are a couple links from peer reviewed studies:

      There are a total of nine nations
      with over 1,000 annual breast cancer
      deaths that have ASRs higher than that
      for the United States. On the other hand,
      the breast cancer mortality ASR for the
      United States is nearly three times that of
      Japan (7.1/100,000).

      Click to access 138.pdf

      Five year relative breast cancer survival rates from CONCORD study.
      Rank….Country….mean (95% confidence interval)
      1……….Cuba……….84.0 (82.9, 85.2)
      2……….US………….83.9 (83.7, 84.1)
      3……….Canada……82.5 (81.9, 83.0)
      4………Sweden……82.0 (81.2, 82.7)
      5………Japan……….81.6 (79.5, 83.5)
      6………Australia.. ..80.7 (80.1, 81.3)
      8………France……..79.8 (78.2, 81.4)
      22…….England……69.8 (69.5, 70.2)

      First thing to note here is that the differences between the top countries are very small. The CONCORD study report warns that the ranking of the countries maybe unstable. There are differences between these countries that cannot be controlled for, and aspects of statistical analysis that are imprecise. While the CONCORD study defends its methods and says that the resulting biases are small, it also warns that when the differences between countries are small, then a small bias might make a big difference in the ranking. So, the bottom line is that from these data and the warnings provided by the study itself, we do not really know whether Cuba, the US, Canada, Sweden or Japan is ‘the best’ at treating breast cancer.

      Note: it’s funny that her editorial failed to mention that Cuba currently has the best breast cancer survival in the world, or that ours is three times worse than Japan.

      What are we to make of this, I wonder? Emulate the Cuban and Japanese healthcare systems when we go back and start over from scratch?

  15. James S. Thornton said

  16. James S. Thornton said

    Why can’t the level of reason and reasonableness found in this blog post be replicated on the level of the powers-that-be?

    The only reason why politicians who claim to have the country’s best interest in mind would decline such a call for bipartisanship is if they are being motivated by something entirely different than what they claim.

    I think many Americans on all sides of this debate suspect that the parties really calling the shots here are using ideological arguments to obfuscate what’s really going on.

    I can’t speak to the fears of the far right, but the fears of the left-of-center person like me is that the current system benefits numerous players, and they are spending as much as they need to prevent any reforms that could affect their bottom lines.

    Their backers in Congress vote as they are told, and explain such votes via “free markets function best” or “socialism will ruin us” or “we just don’t have the money to pay for reform”–anything that has a veneer of reasonableness and can be sold to enough Americans in the form of fear-mongering to provide said politicians political cover.

    It reminds me of pro-tobacco Congressmen and Senators before defense of this became just too noxious to be associated with anymore.

    • Rick said

      “Why can’t the level of reason and reasonableness found on this blog post be replicated on the level of the powers-that-be?”

      The Democrats surely failed that opportunity by originally locking out, and demonizing, the opposition.

      • James S. Thornton said

        Mom, he started it!


        Rick, so you are saying that any attempt to reach a compromise is impossible because one group feels demonized by the other?

        Death panels? Socialism? These weren’t attempts to demonize the other side?

        What do you think the answer is, then? Do nothing till the Republicans, by some miracle, get back in control? And then you expect that the Democrats aren’t going to play by the same obstructionist playbook the Republicans are using now?

        This kind of thinking is why the Middle East is an intractable can of worms where nothing ever improves, just more bloodshed.

        Is the goal to “break Obama” so important that you are willing to break the country in the process?

        • Rick said

          “Mom, he started it!”


          “Rick, so you are saying that any attempt to reach a compromise is impossible because one group feels demonized by the other?”

          Jim, you get angry very easy. The answer to the above question is no. I simply said the Democrats failed by originally locked them out and demonized the opposition.

          “Is the goal to “”break Obama”” so important that you are willing to break the country in the process?”

          Obama appears to be doing that himself.

        • James S. Thornton said

          Republicans seem quite happy to urge us to “move on” from the Bush years and its tax cuts, two unfunded wars, an unfunded prescription drug benefit for seniors, and the massive bailout of “too big to fail” banks that had reached the brink of collapse in large part to deregulation.

          This deregulation was not entirely a Republican notion–the repeal of the Glass Steagall Act, for example, occurred in 1999 under President Bill Clinton.

          (To me, this was a triumph less of political ideology than relentless corporate erosion of one of the most effective levees separating us from financial disaster. The Glass Steagall Act was finally repealed after what Frontline calls “12 attempts in 25 years,” with “Congress finally repeal[ing] Glass-Steagall, rewarding financial companies for more than 20 years and $300 million worth of lobbying efforts.)

          If you look to the past for blame, there is no shortage of usual suspects to finger (though how 8 years of Bush-Cheney can be written off as an inconsequential trifle in our current woes by many current Republicans is beyond my comprehension.)

          In any event, I ask you again: what do you propose be done re: compromise and bipartisanship in health care reform?

          P.S. the “anger” argument you cite is kind of a cliche at this point, Rick.

        • Rick said

          Jim, you want a question answered regarding bipartisanship in health care reform, but start with partisan statements and bashing Bush & Cheney. I realize you guys have a lot invested in Bush & Cheney but then you want me to believe the ‘anger’ argument is a cliche.

          You want to limit the subprime mortgage crisis to financial companies but conveniently forget about Franklin Raines & the government sponsored entity Fannie Mae that lowered credit score requirements for mortgages purchased by Fannie.

          Your side has the majority, so why don’t you answer your own question for my review?

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