Coverage

The fifth committee has spoken. The Senate Finance Committee led by Montana Democrat Max Baucus just passed its health reform bill, 14-9. All Democrats, liberals and moderates, backed the bill, along with one Republican moderate, Olympia Snowe of Maine.

As several of the committee members noted, this puts America closer to health reform than it's ever been in the nearly 100 years since President Theodore Roosevelt first demanded that we cover everybody.

Now, after the Finance and Senate HELP bill are melded (not an easy task we know, but none of this has been easy and we've come far) the full Senate will vote. And the House.

 As the director of New America's health policy program Len Nichols said, "America got better today."

When a lobby -- like AHIP, the health insurance lobby -- pushes out a report intended to inflict last minute damage on an important bill late on a Sunday on a three-day weekend, they may score a few points in the first wave of headlines but ultimately the truth wins out. Not only did the second-day headlines (like Politico's "Insurers Face Blowback") note the questions about the AHIP report’s veracity, even the consulting company that wrote the report, PricewaterhouseCoopers, basically said it was a meaningless exercise in the application of irrelevant assumptions. In other words, AHIP got what it paid for.

PricewaterhouseCoopers said:

The gloves are off in the fight for health reform, and the insurance industry has decided that it's time to start throwing analytically indefensible punches. Two recent cases in point: (1) the headline grabbing "report" entitled the "Potential Impact of Health Reform the Cost of Private Health Insurance Coverage," by PriceWaterhouseCoopers , for AHIP (the main health insurance industry trade group); and (2) the "Blue Perspective" entitled "Age Discounts ‘A Must' to Encourage Young Adults to Purchase Insurance," by the Blue Cross and Blue Shield Association. 

Thankfully the Urban Institute, in work funded by the Robert Wood Johnson Foundation, has recently released a thorough and devastating rebuttal to the Blue claims.  So my comments below focus mostly on the AHIP paper. 

In health care, everyone has a story, one that shows how our current system fails us and why the need for reform is so urgent.

There's the worried parent whose grown child doesn't have health insurance, either because they can't afford it or don't think they need it. There's the women whose preventive screening caught a chronic disease early, and whose premiums promptly skyrocketed. And then there's the mother who went to three different hospitals before her daughter was properly diagnosed, only to find that her insurance wouldn't cover treatments the company deemed experimental.

We heard all of these stories and more at health care roundtable this week hosted by Politics Magazine (read some of their coverage of the events here and here).

Our colleague Julie Barnes, deputy director of New America's Health Policy Program. moderated the panel on "the future of healthcare reform and public funding." With Sen. John Barrasso (R-WY), Rep. Michael Burgess (R-TX), former Rep. Martin Frost (D-TX), and former Rep. Nancy Johnson (R-CT).

In 1993-94, then Senate Minority Leader Bob Dole, a Kansas Republican who had presidential ambitions and a hankering to regain his position as Senate Majority Leader, helped kill President Bill Clinton's health reform initiative.

Fifteen years leader, he regrets letting politics trump policy, and he is urging fellow Republicans not to repeat his mistake.

"I want this to pass," he said. "I don't agree with everything Obama is presenting, but we've got to do something." He added that he expected to see a Rose Garden signing ceremony within months.

Dole joins a lengthening parade of prominent Republicans, including Bill Frist, in endorsing health reform. (They may not change many minds in a polarized Congress, but might be a help to centrists in both parties. Having Frist and Dole on board would make it easier for someone like Republican Olympia Snowe to vote yes... and harder for a moderate Democrat like Ben Nelson to vote no.)

I ran into an old friend the other night at an overpriced grocery store (slowing down the checkout out of anyone unfortunate to be in either of our lines), and as we chatted in the parking lot trying to catch up before our frozen food started to drip, he asked me whether he, a progressive, should be disappointed about health reform.

It depends on your perspective, I said, voicing some of the thoughts that had been clattering around in my brain recently. What's your starting point?

If you start from your most optimistic, sky's the limit moment, say last November 4 or January 20, expecting to get a $1.5 trillion deficit-oblivious bill that covered absolutely everyone immediately and had a robust public plan and completely rebuilt our health care system ... you know, all the things that some hoped for in the "happy talk" stage of reform when the stars were all aligned for change but none of the hard decisions had been made and the Republicans hadn't opted for the "try to beat'em, don't join'em Waterloo strategy.." well, then disappointment is understandable.

When the health care conversation heated up a year or so ago, a spate of articles focused on the Dutch health care system. In the Netherlands, everyone receives health coverage through a network of private insurers, and there is strict government regulation to ensure that everyone competes on a level playing field. We heard very little about the Dutch system for awhile -- but recently, there's been another round of reporting, including this piece from the NewsHour with Jim Lehrer.

The list of Republicans backing (or more or less backing, or a reasonable facsimile of backing) health reform efforts by President Obama and the Democratic-led Congress is growing:

California Gov. Arnold Schwarzenegger.

Former HHS Secretary and former Wisconsin Gov. Tommy Thompson (a Bush appointee).

Former CMS administrator and FDA Commissioner Mark McClellan (ditto).

Former Senate Majority Leaders Bill Frist, Bob Dole and Howard Baker.

New York City Mayor Michael Bloomberg (Democrat turned Repubilcan turned independent).

The Hastings Center recently published a series of articles on American values and health reform, including one on stewardship by New America's Len Nichols. Hastings has now created a related web site and blog, The Values and Health Reform Connection to expand the conversation. They invited me to write one of the inaugural essays, "Honest Debate - and Pragmatic Solutions." I wrote about values and politics (not as synonyms) and honesty and quality. (I think working moms by nature and necessity tend to find themselves pondering the practical side of things more than the ethereal and philosophical) I'm cross posting below. Other early contributors include Maggie Maher, "Dr. Val" Jones and William Sage. Hastings also invites your comments and contributions, as do we. 

Liberty. Justice, Responsibility, Solidarity.

These are some of the American Values highlighted in the Hastings Center's report on "Connecting American Values with Health Reform."

Watching health reform unfold here in Washington, however, that "Connection" is painfully elusive.  The debate is not a careful calibration of competing rights, values and obligations. It's a political moshpit. Instead of values, we have vitriol.

The Urban Institute has an excellent new analysis of variations in insurance coverage by congressional district.

Analyzing the latest data from the American Community Survey, the Urban researchers looked at rates of private coverage, public coverage, and uninsurance for non-elderly adults (under age 65). They also examined how these rates varied with poverty, producing the fascinating maps you see above (click to open in a new window) and the following conclusions:

1. Rates of private coverage are lowest in districts that have higher poverty rates, which tend to be concentrated in the South and West;
2. The needs in these high-poverty districts have led many to above-average rates of public coverage;
3. Despite these higher rates of public coverage, uninsurance remains most serious in districts with low rates of private coverage.

The underlying context of this analysis is to provide a clearer picture of the states and districts which will benefit the most from the passage of health reform. So let's take a look at some particularly interesting and politically relevant districts and states (NPR has an equally nifty map of the uninsured using the latest Census data):