47 Health Policy Experts (Including Me) Say, “Sign the Senate Bill”

[babylonsister]

http://www.tnr.com/blog/the-treatment/47-health-policy-experts-including-me-say-sign-the-senate-bill


47 Health Policy Experts (Including Me) Say, “Sign the Senate Bill”
Harold Pollack

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.


At a low moment of the Second World War, a breathless young aide barged in on Winston Churchill to report some bad news. Showing the aplomb one fully achieves only within the pages of one’s own memoir, Churchill quotes himself responding: “I’ve heard worse.” That’s the resilience Democrats need.

Treatment readers already know that many health policy experts across the political spectrum support House passage of the Senate bill, with an accompanying fix of the bills various shortcomings through the reconciliation process. Like Paul Krugman, Jonathan Cohn, Ezra Klein, and Jacob Hacker, Tim Jost and I very much agree that this is the best approach.

Yesterday, Tim and I crafted a simple letter (shown below), which we emailed other health policy experts we know. Some are progressives who identify with a single-payer approach. Others are more politically moderate economists, sociologists, and political scientists. Still others identify with organized labor, medicine, or public health.

Within several hours, many outstanding scholars, activists, and practitioners signed on. Signers include Henry Aaron, David Cutler, Jon Gruber, Theda Skocpol, Paul Starr, and many others, including Anna Burger, Secretary-Treasurer of SEIU.

Some people we contacted could not sign on, but reported that they are seeking the same goal through more private means. Virtually no one we contacted disagreed with this letter on either political or policy grounds. Our letter represents a broad consensus of those supporting health care reform.

We are so close to enacting a historic reform. Now is the time for calm and resolute Congressional action. The Massachusetts election was a setback. Democrats still have large majorities in both the Senate and the House. We’ve heard worse. It’s time to act.

22 January 2010

Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515

Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515

Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515

Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515



Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:

For nearly three-quarters of a century, Presidents and Congressional leaders have tried to enact legislation that would make health care accessible to Americans. Although pieces of this dream have been realized—health care for the elderly, the disabled, and children in low-income families—universal coverage itself has proved beyond reach.

We are now on the cusp of realizing this goal. Both houses of Congress have adopted legislation that would provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American. These bills are imperfect. Yet they represent a huge step forward in creating a more humane, effective, and sustainable health care system for every American.

We have come further than we have ever come before. Only two steps remain. The House must adopt the Senate bill, and the President must sign it.

While the House and Senate bills differ on specific points, they are built on the same framework and common elements—eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness.

Some differences between the bills, such as the scope of the tax on high-cost plans and the allocation of premium subsidies, should be repaired through the reconciliation process. Key elements of this repair enjoy broad support in both houses. Other limitations of the Senate bill can be addressed through other means.

The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.

With the loss of Edward Kennedy’s Senate seat, Democrats no longer enjoy a filibuster-proof Senate majority, though they still enjoy the largest Senate majority any party has achieved in the past generation. The loss of this one vote does not require Congress or the President to abandon Senator Kennedy’s life work of health care reform. A year of political infighting, misleading debates about death panels and socialized medicine, and sheer inaction has left Americans exhausted, confused, and disgruntled. Americans are also bearing the severe consequences of deep recession and unemployment. Still, a majority of Americans support the elements of the Senate bill.

The House of Representatives faces a stark choice. It can enact the Senate bill, and realize the century-old dream of health care reform. By doing so, it can achieve a historic milestone while freeing itself to address other national problems such as joblessness and mortgage foreclosure that affect millions of Americans. Differences between the House and Senate bill can be negotiated through the reconciliation process.

Alternatively, Congress can abandon this effort at this critical moment, leaving millions more Americans to become uninsured in the coming years as health care becomes ever less affordable. Abandoning health care reform—the signature political issue of this administration—would send a message that Democrats are incapable of governing and lead to massive losses in the 2010 election, possibly even in 2012. Such a retreat would also abandon the chance to achieve reforms that millions of Americans across the political spectrum desperately need in these difficult times. Now is the moment for calm and resolute leadership, pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with negotiations to produce a less comprehensive bill. From the perspective of both politics and policy, we do not believe this is a feasible option. We doubt that the American public would welcome more months of partisan wrangling and debate. We doubt that the final product would match what has already been achieved. Indeed we doubt that any bill would reach the President’s desk should congressional leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different perspectives. Some of us are long-standing advocates of progressive causes. Some of us are nonpartisan or identify as political moderates.

From these differing perspectives, we agree on one thing: the current choice is clear. Pass the Senate bill, and improve it through reconciliation.



Sincerely,

Henry J. Aaron, The Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, Secretary-Treasurer, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Jonathan Oberlander, University of North Carolina at Chapel Hill
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
William Terry, Brigham and Women's Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU

(Institutional affiliations listed for identification only).



cc. Senator Harry Reid

President Barack Obama

[akel21]

1. why

would we pass the senate bill, it is corrupt. It was written the the bought and sold congress. We need to use the "Nuclear Option"

[CreekDog]

2. i thought regulating insurance companies was a good thing

as is expanding medicaid.

as is helping people afford coverage.

as is preventing people from being denied coverage for preexisting conditions.

as is preventing older people from being charged more than 3 times what younger folks pay (on average they pay 11 times more).

as is preventing differential pricing based on one's health.

there are things that are no doubt, corrupt, within that bill, but they pale in comparison to what the bill accomplishes.

and not passing it leaves all the people this bill would help, out in the cold --and there's nothing else in the wings to help them.

[Raineyb]

5. For starters

Medicaid is not health insurance and the government will hound you for your financial information semiannually waiting for you to make a dollar over the limit so they can demand you pay them back.

Secondly, forcing people to buy insurance but allowing outrageous co-pays and deductibles that people can't afford doesn't get them health care. It gets them broke and still not seeing a doctor.

Third of all, This bill allows the insurance companies to charge older people triple what younger people pay. There is nothing stopping the insurance companies from charging higher prices based on past conditions. In addition, there's nothing to say that they can't charge outrages prices for pre-existing conditions. Not to mention, they still allow insurance companies to rescind policies based on "fraud." What difference would it make to the insurance compares if they were forced to cover everyone, without discriminatory pricing, regardless of condition, if you forgot to mention you had acne as a 12 year old?

You can polish it all you want but it's still a turd.

[CreekDog]

6. and bankruptcy and no care is better?

i want single payer, but i'll take any step in the right direction if it's what i can get.

[subterranean]

9. They will NOT be able to charge more based on pre-existing conditions.

From Section 2701 of the Senate bill:

With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--

(A) such rate shall vary with respect to the particular plan or coverage involved only by--

(i) whether such plan or coverage covers an individual or family;

(ii) rating area, as established in accordance with paragraph (2);

(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 2707(c));

(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and

(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).

[Lydia Leftcoast]

13. But you can BET that they will set their base rate higher

to ensure profits, even while covering pre-existing conditions.

Also, the part about charging older people 3 times as much is outrageous. No civilized country does that. If the charges vary, they vary on the basis of INCOME.

[subterranean]

15. I can't argue with you there. n/t

[karynnj]

23. The status quo is that in some states they now can charge 20 times as much

[Lydia Leftcoast]

24. But why settle for three times as much?

Individuals don't get to dictate what laws they are willing to obey. Why should corporations?

I can just see it. Congress goes to a maximum security prison, and the serial killers say, "We should get off with probation if our victims don't suffer too much." And Congress says, "OK."

[karynnj]

25. Watching the Finance committee

It seemed it was hard to get it to 3:1. When Baucus started writing the bill, it was 5:1, Kerry, who wanted 2:1 was able to get it to 4:1 before the mark up. In committee, he argued for that to be lowered, but was unable to get the committee to agree. One concern was that it would make the costs too high for younger people. It was lowered to 3;1, which was the ratio in the HELP bill in the final bill.

[Lydia Leftcoast]

27. Congress is under no obligation to ensure a private company's profits

Private business is supposed to be a gamble. If the insurance companies can't handle equal rates, then they're greedy and not very clever.

[karynnj]

28. Business? I didn't say anything to suggest that

Of course insurance companies can set a single rate and set it to be profitable. That is likely the easiest model for them - especially when people are mandated to buy insurance.

My point was that many Senators were not in agreement with that because as young people typically are cheaper to carry, an equal rate means that they actually would be asked to pay a higher rate than they as a group cost. Here there were ideological differences - ie Kerry was ok with that, all the Republicans and some conservative Democrats weren't. (Most Democrats on teh committee were quiet.)

[bornskeptic]

30. Insurance companies don't care what the ratio is

as long as an individual mandate and subsidies exist to guarantee the size of the pool. They are oing to get theirs anyway. That's what actuarial science is all about. With a 3:1 ratio they get more from older people and less from younger people. With no age discrimination they get more from younger people and less from older people. Either way they have to cover benefit costs and administrative costs, and then they will tack on whatever they can as profit depending on market conditions.

The situaton under the status quo is completely different, because a company which charged a uniform premium rate now would have to charge more than its competitors to younger people in order to cover the benefit costs of older people, and lose younger customers as a result. Then premiums have to be raised again, and because of that more people drop out. Eventually the premiums would be so high that nobody would remain. Thats why, under the current conditions, a company which wants to remain in business has to charge older individuals more than younger ones.

[Lydia Leftcoast]

31. ...and lose the older customers as a result or gouge them

Then why can national or even heavily regulated privatized health systems in other countries get away with charging everyone the same?

[karynnj]

21. Note that Jacob Hacker, father of the public option is here

This really says that there is enough good for these experts to feel it should be signed. It is, in fact, landmark legislation that the RW FEARED would pass - that's why they fought it and distorted it from day one.

[Pirate Smile]

3. K & R

[Cha]

4. We'll see what happens..

always something to keep us on the edge of our seat.

[Oregone]

7. Pass it. We will fix it after we fix NAFTA

[Capn Sunshine]

8. yeah. Pass the goddam thing.

It does a lot of good, especially the "no prexisting conditions" thing. That alone has the industry shaking it it's boots. So much so, they have paid squadrons of fake progressives screaming online about how it's a corrupt bill, and nothing is far preferable.

[Lydia Leftcoast]

34. FAKE progressives? EXCUSE me!~

I stood outside in below zero weather with union members in 1982 protesting a visit by Ronald Reagan.

I was active in the anti-intervention campaign against the wars in Central America.

If I'm a "fake" progressive, then I've been faking it for a long time.

[Knight Hawk]

10. Not going to happen

Anyone even slightly in touch with the zeitgeist of the country knows this is not going to happen.The country is TIRED of the debate on health care.We have a better chance of getting something decent passed if we step back and reload.

[IndianaGreen]

11. Tally Sheet: Where House Dems Stand On How To Move Health Care Reform Forward

Pass the Senate bill: (1)

Walz, Tim (MN)

Pass the Senate bill with separate amending bill: (12)

Capps, Lois (CA), Clyburn, James (SC), Dingell, John (MI), Frank, Barney (MA), Grayson, Alan (FL), Holt, Rush (NJ), Hoyer, Steny (MD), Kennedy, Patrick (RI), Pelosi, Nancy (CA), Sestak, Joe (PA), Van Hollen, Chris (MD), Watson, Diane (CA)

Pass a bunch of small bills: (8)

Arcuri, Michael (NY), Blumenauer, Earl (OR), Delahunt, Bill (MA), Grijalva, Raul (AZ), McDermott, Jim (WA), Tanner, John (TN), Woolsey, Lynn (CA), Yarmuth, John (KY)

Start over: (2)

Weiner, Anthony (NY), McCarthy, Carolyn (NY)

Noncommittal: (27)

Andrews, Robert E. (NJ), Becerra, Xavier (CA), Bishop, Tim (NY), Brady, Robert (PA), Capuano, Mike (MA), Cooper, Jim (TN), Davis, Susan (CA), DeGette, Diana (CO), DeLauro, Rosa (CT), Ellison, Keith (MN), Garamendi, John (CA), Hill, Baron (IN), Hodes, Paul (NH), Kind, Ron (WI), Lee, Barbara (CA), Lujan, Ben (NM) Maloney, Carolyn (NY), McDermott, Jim, (WA), Moran, Jim (VA), Neal, Richard (MA), Pallone, Frank (NJ), Pomeroy, Earl (ND), Rush, Bobby (IL), Schakowsky, Jan (IL), Speier, Jackie (CA), Stark, Pete (CA), Waters, Maxine (CA)

Unknown:

Everyone else.

http://tpmdc.talkingpointsmemo.com/2010/01/tally-sheet-where-house-dems-stand-on-how-to-move-health-care-reform-forward.php?ref=fpb

[cherokeeprogressive]

12. You're one of the 47 signatories? I didn't see your name on the list...

47. Is that like saying "1 out of 5000 health care workers recommend..."?

My sister works for Scripps Health (a NON-PROFIT health care system), and no one there is happy about ANY part of the Senate bill.

[Lydia Leftcoast]

14. Note that they're all affiliated with large universities

If you want good benefits, a large university is the place to be. I had fantastic benefits when I worked for a large university and even when I worked for a small college.

These experts work with numbers and graphs and are insulated from the results of the bill. They will have excellent access to health care no matter what.

[Better Today]

16. NO, NO NO! Look at NAFTA, look at the lack of trust when

senators make promises, re: Joe Liberman, Nelson, others to follow I'm sure.

DO NOT PASS the Senate bill or we are screwed with a complicated, useless, and delayed startup bill, that may never be altered.

[DailyGrind51]

17. And do it NOW! It's the closest we are likely to get for the next 20 years!

[Lydia Leftcoast]

33. O ye of little faith

There is nothing in the Constitution or the laws of the land that say that you can deal with health care only once every twenty years.

Some people have internalized the DLC's list of deceptive and industry-coddling talking points.

It's the DLC equivalent of the Bushie's shouting, "You have to do something about Saddam Hussein NOW!"

[Irish_shark]

18. Hey look, Jonathan Gruber is on the list, indentified as "MIT professor"

Which is true. And it's also true that he's a consultant for the government. I guess they forgot to include this part. He's earning his money allright.

[Name removed]

19. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Irish_shark]

22. His Mr. Jacob Hacker a consultant for the administration? n/t

[jesus_of_suburbia]

20. I agree. Pass the Senate Bill. It's not what I wanted, but it's a start.

[backscatter712]

26. START by signing the Senate bill.

We can improve on it with the reconciliation sidecar bill with the agreed upon modifications between the House & Senate.

And if the Dems want to actually get some enthusiasm from the base and reverse the plunge in the poll number, they should put a public option in the reconciliation sidecar. That would actually make the Senate bill almost decent.

[Lydia Leftcoast]

32. Once private insurance is set in stone in the Senate Bill,

the bribed members of Congress (the majority) will somehow find a way never to get around to fixing it. Something else will always take priority, just as it has with NAFTA, Welfare Reform, etc.

Unless you are quite affluent, kiss your disposable income good-bye if the Senate bill becomes law.

Don't be such a good little subject that you're willing to settle.

[backscatter712]

36. The way the arrangement's going down,

with the Senate bill plus reconciliation sidecar, the sidecar will have to be passed as a condition for the support of the progressives in the House, before they'll agree to the Senate bill.

In fact, the reconciliation sidecar bill may be passed by the Senate before the House votes to pass the Senate bill.

[jeanpalmer]

29. Having just dealt with a private insurance company

I can state private insurance is not the answer. Their goal is to harrass people into not seeking treatment, to increase their bottom line. There's no way that private insurance can be the start of anything. It will be a dead end. Mr. Pollack wants to enshrine an inefficient system that makes Americans pay twice as much for healthcare as people in other countries. And all because our politicians are in the hip pocket of big pharma and big insurance. Before you buy insurance, you are attractive to an insurance company as a potential revenue source for them. But once they have you on board, you and your healthcare needs become an obstacle to their maximizing profit. That's not a system to be expanded. It's one to be shut down.

[izzybeans]

35. Paul Starr and Theda Skocpol are big names for me.

Paul Starr's book The Social Transformation of American Medicine is a classic that should be read by everyone. Theda for any of the reasons listed here: http://books.google.com/books?as_auth=Theda+Skocpol&source=an&ei=gbtdS4WGO8qe8AbbroD_BA&sa=X&oi=book_group&ct=title&cad=author-navigational&resnum=9&ved=0CCYQsAMwCA