By Peter Schrag
Sacramento Bee
Published Wednesday, January 31, 2007

Was it just imagination or were there unmistakable echoes of Arnold Schwarzenegger in President Bush’s State of the Union speech last week — health care, climate change, bipartisanship? Hadn’t we just heard this in the State of the State? Arnold wanted national influence: Is he getting his wish quicker than he thought?

Schwarzenegger and Bush got polite applause for touching on two subjects that not long ago had been unmentionable. Even last week, the closest Bush got to global warming was “global climate change,” no comfort to dispossessed polar bears, but at least getting warmer. His version of improved health care boiled down to getting 3 million off the rolls of the nation’s 47 million uninsured: the 6 percent solution.

The respective Schwarzenegger and Bush proposals on reducing use of fossil fuels and covering more people with health insurance have one principle in common: As advertised, neither would cost a dime in additional taxes for the average taxpayer. OK, so quibble about Arnold’s “fees” or about Bush’s proposal to tax high-cost employer-paid health insurance.

Can you track all those peas under all those shells? Since all this is supposed to be “revenue neutral,” who gains and who loses? You might think the Bush scheme to tax only gold-plated health plans would affect only corporate fat cats, but it’s likely to hit many ordinary workers, especially the public employees with lush health plans, even harder.

Schwarzenegger’s people put out a document last week comparing the Bush health plan with Schwarzenegger’s, which makes the two sound even more like Rube Goldberg devices than they probably are. But Arnold at least wants to go for the whole enchilada. Yet since both health plans have so many moving parts — a dump of responsibility by the state on the counties, big-bucks fiddles with Medicaid and Medicare, employer mandates, fees/cum taxes on doctors and hospitals — a lot of things will have to change before either plan becomes more than a puff in the headlines. Ditto for the global warming-energy independence proposals: higher motor fuel economy standards; ethanol, biomass, hydrogen, solar, nuclear, clean coal.

Given that the Bushies had been doing nothing for so long on fuel efficiency, just the mention of it was worth a nod. (If you watched the Bush speech, you might have also noticed the corny delight on the face of Sen. Charles Grassley of Iowa when the president mentioned ethanol.)

A lot of those new technologies are dubious or distant, or both. What would not be dubious is the quick efficiency gains and lowered demands resulting from higher taxes on carbon fuels. Schwarzenegger induced Californians to approve a mega-buck transportation bond issue last year — and may yet again — without a cent in additional fuel or other use taxes. Which is to say that even as we struggle with crowded, crumbling roads we do nothing to reduce demand, and so keep chasing our tail.

Because neither the health proposal nor the energy proposal asks for fundamental changes, either from taxpayers or from corporate interests, both rest on the rickety structures of the existing national health systems and energy policies, which are the source of the problems to begin with.

Schwarzenegger’s health plan ambitions are commensurate with the challenge of covering everybody (except maybe the state’s illegal residents who are adults). But his failure to attack the costly and inefficient private insurance system to which he wants to graft his fixes almost assures that the mess will continue. Still that beats Bush, who tinkers only at the margins.

As long as we have a profit-based health care system in which 21 cents or 22 cents — some studies say as much as 27 cents — of every dollar goes to the bureaucracies that manage it to protect industry profits, we’ll spend more for care and get less for it than any other modern nation.

The governor wants to force insurers to spend 80 cents of every dollar on actual care, which would be a marginal improvement. But it doesn’t get within shouting distance of eliminating the 3-to-1 difference in administrative costs between the United States and Canada, which, like most of the civilized world, has a single-payer system in which everybody is covered.

The governing message both in Washington and Sacramento is that the voters can have it all — energy independence, clean air, a thick ice cap, open roads, big cars, good health care (for some) and other quality public services — at no additional cost and, as in the Iraq war, no sacrifice or imposition on anyone except the troops.

According to the latest surveys of young Americans, 80 percent regard getting rich as their top goal in life. Nothing is being asked of them — or of their elders — except maybe in the future. We could be developing alternative energy technologies and an efficient single-payer health system. Instead, we tinker at the margins and pretend that we can fix it all for nothing. Won’t the kids be surprised.

By Pete Stark
USA Today
January 29, 2007

President Bush is to be commended for finally recognizing the needs of 47 million Americans denied health care for lack of insurance. His proposal would do little to help them. In a few years it would raise taxes for 160 million workers who receive group health insurance benefits.

The president’s plan would limit the tax deduction to $7,500 for an individual’s health insurance premium. The high rate of medical inflation would soon cause an income tax increase for most Americans.

Employers would cancel group plans. Workers could buy individual policies, which have higher costs and more limited access than group plans do. The suggestion that employers would pass on the group insurance savings in higher wages does not pass the smirk test.

Granted, the Bush plan would make the tax code more equitable. But so would eliminating the mortgage interest deduction. Who is to say home equity adds more to life quality than adequate health care?

There are many offsetting inequities in the Bush plan:

* Tax deductions are regressive and provide much greater benefit to the wealthy than to the poor. In Bush’s plan, a high-income person who is currently uninsured would receive nearly $6,000, while a low-income individual would receive $1,200.

* The individual insurance market discriminates against those who are sick or at risk of becoming so. Currently, employers cover both healthy and sick, spreading risk to reduce costs. Individuals, however, would be at the mercy of insurance companies that use family history, genetic indicators, age, occupation and illness as reasons to jack up rates — or exclude coverage altogether. Millions of Americans would therefore see their premiums increase substantially.

Much like Iraqi weapons of mass destruction, “gold-plated” health insurance is a figment of the president’s imagination. The problem with our health system is not that Americans can afford to use too much health care; it’s that too many can’t afford any.

Bush’s proposal would destroy the very system through which the vast majority of people get their coverage today and fail to replace it with an alternative means of obtaining quality care. It doesn’t deserve Congress’ consideration.

Rep. Pete Stark, D-Calif., is chairman of the health subcommittee of the House Ways and Means Committee.

A Colorado father journeyed to Washington to plead for health-care reform on behalf of his chronically ill son.

^{WEB EXCLUSIVE}

By Eve Conant
Newsweek
Jan 29, 2007

Thomas Wilkes at play.

Jan. 29, 2007 – President Bush’s State of the Union address may not have done much to improve his popularity. But it did succeed in jump-starting debate over one of the leading–and most contentiously lobbied issues–on his domestic agenda: health-care reform. In his speech, the president proposed offering tax subsidies to encourage more people to buy their own health insurance. The goal: to provide equal treatment to those who buy insurance on their own, and those who get it through their employers. Under the Bush plan, the administration estimates that 80 percent of workers with employer-based health plans would pay lower taxes–while 20 percent of those with more costly workplace plans (branded “gold-plated” by Bush) would see a tax hike, unless they decreased their coverage.

Democrats on Capitol Hill, along with labor unions and consumer groups, pilloried the Bush plan, arguing his proposal would do little to help America’s nearly 47 million uninsured–and could wind up hastening the demise of employer-provided healthcare. (In his weekly radio address, Bush called the criticism “reflexive” partisanship and called on Congress to cooperate with him to find a solution.)

But it wasn’t just folks in Washington who were upset. Nathan J. Wilkes of Greenwood Village, Colo., was so worried about the possible effects of Bush’s proposal on his ability to provide coverage for his chronically ill son that he decided to travel to the capital to make some noise. A computer network security expert who earns over $100,000, Wilkes works for a private firm outside of Denver which fits into the large-group insurance category and is allowed to shop around for different providers each year. But when his son Thomas, born with severe hemophilia, developed a resistance to treatment at age 1, Wilkes’s claims soared; his company’s insurance provider, Wilkes says, soon began hiking premiums 40 to 55 percent each year, and introduced a lifetime cap of $1 million for all employees and their families–including Thomas. Soon, Wilkes says, no other insurance companies would offer to cover the company. Worried he would no longer be able to provide coverage for his son, Wilkes turned to state and local groups for help. Physicians for a National Health Program took up his cause, and brought him to Washington, where he hoped to persuade Congress to reject the Bush plan in favor of universal health- care legislation. Wilkes spoke to NEWSWEEK’s Eve Conant about his trip. Excerpts:

NEWSWEEK: You have a good income and your employer gives you and your family comprehensive health insurance. So why are you so worried about coverage that you’ve come to D.C. to lobby for universal coverage?
Nathan Wilkes: Why am I worried? My son will no longer be insured in a month’s time. His claims have increased health-care costs for everyone I work with. My company is very socially responsible, but because of our high claims, no other insurance company will touch us. We’re trapped with the same provider, which keeps raising prices and last year introduced a $1 million lifetime cap on coverage. Even if my son has no injuries, we’ll hit that cap in the next one to three months. With hemophilia, the problem is internal bleeding. We know it’s happening if he complains of pain, or stops using one of his arms or legs. Even if we treat him at home the cost for medicine can run up to $3,600 every few hours. Because of insurance limits we’re often advised to delay treatment–to see if his injuries will clear up on their own–simply to avoid getting closer to the million-dollar mark. The aim of private insurance is to weed out high-cost patients like my son.

And what happens when you delay treatment?
Sometimes it works out fine. Other times he gets worse. Even at our most frantic we have to worry about the cap. We’re told he may have permanent nerve and joint damage because of the times we’ve had to delay treatment. We do everything we can, but he’s a 3-year-old, he wants to walk around and try to jump off the couch.

Did you watch the State of the Union? What do you think of Bush’s health proposals?
His strategy is to manipulate the tax code to make it appear as if you’re insuring more people, when in fact, you’re not addressing the real problems of the private insurance system: cost, access and the underinsured. Continuing with private insurance just feeds the monster. This won’t bring down the cost of drugs or reduce the overhead and profits taken in by the insurance companies. It only serves to free up more money in the consumer market to feed back into a broken system.

What will you do when your son’s insurance runs out?
The race has started; it’s like an hourglass with a finite amount of sand. We have to think of something else, but all our options would give us only a year at most. I’m told I can quit my job and try to join a larger company so my son’s chronic illness won’t be noticeable to their insurance company. But that might only buy a little bit of time. My wife could try to get a job, but that would mean the cost of putting three children in day care, including one who is ill and needs intensive supervision. I can’t get on Medicare or Medicaid because I make too much money. I’ve also been advised to divorce my wife, so that she and the kids might qualify. But that creates another set of bureaucratic problems. The best option is Colorado’s high-risk pool insurance (individual insurance for the uninsurable), but that also has a $1 million cap. That could last us a year, or, if my son has any bleeding in his head, could last a few days. One of my last options is to lobby for universal health care; I think I’m a decent example of what is wrong with private insurance in the U.S.

You’re one of those people with what Bush described as a “gold-plated” insurance policy, right?
I find that a pretty offensive term. Calling what I have gold-plated is just a way to shift attention away from real problems. My employer has done [its] best, so that we have minimum or no copay. But over the years, they’ve been forced to shift more of the burden on my co-workers and me. Gold-plated just means more attention on preventive care, which avoids the really costly problem of people only getting treatment in the emergency room. I’ve been insured my whole life, but we’re going to lose it because private insurance is about making profits, not keeping people healthy.

There’s a lot of political momentum on health coverage right now, but in the past that momentum has fizzled out. Do you think there’s a difference this time around?
My son has hemophilia and is immunosuppressed from his chemotherapy treatments [chemotherapy, in some extreme instances, is used to fight the immune system’s resistance to hemophilia treatment]. He’s the kind of person that is supposed to be first in line in the emergency room. Instead, we wait for hours in packed emergency rooms where the uninsured are piled in to get basic care. I think what we’re seeing in Washington now is a different momentum. If you keep piling snow on a mountaintop, there will eventually be an avalanche. This issue has been pushed under the rug before, but every other industrialized nation has some form of national health care. The system now is nothing short of an abomination. I think there might be enough political will now for a radical change.

URL: http://www.msnbc.msn.com/id/16874285/site/newsweek/

Minneapolis/St.Paul Star Tribune Editorial
Published: January 28, 2007

For Americans who hope the United States might one day have a health care system that makes sense, this is an exciting time. Massachusetts has adopted a plan to achieve universal coverage, and California Gov. Arnold Schwarzenegger has pledged to do the same in the nation’s most populous state. Last week President Bush committed himself to a radical overhaul of federal tax subsidies in a bid to hold down health care costs and expand insurance coverage.

Yet the closer you look at these ambitious plans, the more you see they are mere patchworks. In Massachusetts, which will require most residents to buy private insurance, policies are coming on the market with higher prices and less coverage than experts hoped. Economist and columnist Paul Krugman points out that the Schwarzenegger plan will require big new state bureaucracies to regulate insurance companies and police individual behavior. As for the president’s plan, even the White House admits it will cover only 5 million of the nation’s 46 million uninsured; that’s because it relies on tax deductions, which aren’t much use to low-income families who represent the bulk of the uninsured population.

It’s good to see political leaders think boldly. But the lesson is that they aren’t thinking boldly enough. It’s time for the United States to think about just making the leap to single-payer insurance.

This radical notion would seem unthinkable, except that every other civilized nation already has thought about it and embraced it — from conservative societies such as Japan and Australia to nanny states such as Germany and France. Every one of them covers more people, produces better medical outcomes, wastes less revenue on overhead and marketing, and spends less money than the United States.

The biggest argument against a single-payer system is it’s “politically unrealistic” in a free-market society like the United States. We think that gives too little credit to the impatience and common sense of American voters. But then we won’t know until a leader has the courage to find out.