OurFuture.org Blogs: Roger Hickey

A Momentous Step

Roger Hickey — Mon, 09 Nov 2009 08:10:39 -0800

The following statement was released by Roger Hickey and Diane Archer

The Campaign for America's Future declares our strong public support for the "Affordable Health Care for America Act of 2009" (H.R. 3962).

While we would’ve preferred stronger provisions in some key areas, this legislation constitutes a momentous step toward making a guarantee of quality affordable health care a reality for all Americans. And we hope that it serves as a model for action by the Senate.

The bill calls for shared responsibility by individuals, employers and government. It retains and strengthens employer-sponsored insurance, which currently provides the majority of Americans under the age of 65 with health coverage. It provides progressive financing and promotes good health policy by requiring employers to share responsibility for health care costs and the wealthiest one percent of Americans to pay their fair share instead of taxing health care benefits.

The Campaign for America’s Future is particularly supportive of the provisions in the bill that make health insurance and health care services more affordable, and those that make health insurance companies more accountable.

The inclusion of premium assistance, reduced cost-sharing, an annual out-of-pocket limit and comprehensive benefit packages, will help ensure that low- and middle-income individuals and families with health insurance will no longer have to file for bankruptcy when they have a medical crisis.

In addition, the inclusion of a public health insurance option will increase competition and set a benchmark for transparency and efficiency that will help lower the current unsustainable health care cost curve. Stronger federal regulations, including repealing the antitrust exemption for health insurers, as well as complementary federal oversight and enforcement of insurance regulations, will also assist in keeping insurance companies competitive and more responsive to the needs of their members over those of Wall Street.

Support for the Public Option Keeps Getting Stronger

Roger Hickey — Mon, 26 Oct 2009 03:44:36 -0700

“New Life for the Public Option” is the headline of Dan Balz’s excellent article in Sunday’s Washington Post. It’s not an accident that this powerful idea has made yet another comeback. And it is not surprising that public and Congressional support, always strong, has surged again, just as the insurance industry has ham-handedly tried to manipulate the choices of key decision-makers in the US Senate. In the crucial next few days – and in the weeks to come – advocates of the public option will be arguing that the principle of majority-rule democracy should be allowed to work. And the insurance and drug industries (and Republicans) will be basing their strategy for stopping the public plan on undemocratic procedure called the filibuster.

The public option has been part of the national health care debate since January 2007, when the Economic Policy Institute published Jacob Hacker’s Health Care for America plan. From that moment to this, many in the media and the pundit class have periodically dismissed its chances. But that was also the moment that Hacker, Diane Archer and I started having discussions with three essential audiences: leaders of activist citizen organizations, Congressional leaders, and presidential candidates. (For a record of that early organizing, click here.) Our message: a public insurance option is crucial to the success of real reform in America’s mixed system of private and public health insurance – especially if our government agrees to the demand of insurance companies that all Americans must be forced to buy insurance.

Those early conversations and the primary election campaign debates produced a consensus in favor of a public option, as first candidate John Edwards (in February 2007), then Barack Obama (in May), and (in September) Hillary Clinton all came forward with health reform plans based primarily on preserving employment-based health insurance for those who have it and reforming and expanding private health insurance for those who don’t. And all three Democratic presidential candidates called for a public insurance plan, like Medicare, that would give Americans choices – and give the private insurance companies real competition that could control health care premiums.

Even though some progressives were committed to a pure single-payer plan, leaders of many of the major organizations representing millions of Americans – unions, community networks, civil rights groups and health advocates – realized that private insurance companies would not soon be put out of business. Drawing on Hacker’s work, these groups came together around a plan for reforming the worst practices of the insurance companies, requiring all but the smallest firms to cover their employees, guaranteeing affordable coverage to everyone through an insurance exchange, and offering a public insurance option as one of many choices in the exchange. The Health Care for America Now! coalition, now representing 1,000 citizen organizations and millions of people, was built around these principles – and HCAN has consistently insisted that if you take away one part of the plan -- whether it is affordable coverage, insurance reform, or the public option – and the whole enterprise of building reform on a mixed system might just collapse and end up throwing money at the insurance and drug companies without achieving real reform or universal coverage.

HCAN also formalized outreach to Members of Congress and candidates for House and Senate in the buildup to the 2008 elections – though thousands of town meetings and local accountability sessions. By the time of the election, over half of the new Congress had publicly embraced the HCAN health reform principles. And two candidates for executive office, Obama and Biden had also signed on to those principles. The growing support for the public option in Congress reflects HCAN’s steady and creative organizing – writing the new textbook for a citizen majority overcoming some of the most powerful special interests in America.

Support for the public option in the Congress has grown steadily as Members focused on the healthcare debate, and many single-payer liberals realized the public plan is the closest they can conceivably come in today’s Congress. But the latest surge of support has come from moderate Democrats and even Blue Dogs, who have come to the realization that if they are going to vote to force their constituents to purchase health insurance, they had better make sure they have a lot of choices – including an affordable public option. And they are realizing that if a public option can keep insurance premiums down, then the Federal government can afford to free up more subsidy funds to keep premiums reasonable for middle-class constituents, while keeping the overall cost of the health reform bill under a trillion dollars in the first 10 years.

As he overcame his conservative hesitations (and a lifetime of caution) and prepared to cast his vote for the historic 1964, Republican Senator Everett McKinley Dirksen quoted Victor Hugo: “Nothing can stop an idea whose time has come.” And that helped get enough “moderate” votes to overcome a filibuster by Southern Democrats and conservative Republicans. Today Republicans are marching almost completely united in the opposite direction as historic reform. But, as the growing support for the public insurance option demonstrates, Democrats will find a way to unite in the Senate in support of the rule of democracy against the filibuster, and a strong and progressive health reform bill will pass the Senate with considerably more than a majority.

Once again, it is time to make history.

The House Will Make Sure the Senate Includes a Robust Public Option

Roger Hickey — Mon, 19 Oct 2009 07:32:10 -0700

This is the moment when Senate Finance Committee Chairman Max Baucus and Majority Leader Harry Reid (and President Obama) should make history by producing a Senate health reform bill that

makes health insurance truly affordable for all Americans,
creates a strong public option to give private insurers real competition,
and doesn’t destroy Democratic re-election hopes by taxing hard-won middle class health benefits.

Last week the Finance Committee became the last of five Congressional committees to pass a health reform bill —this one by far the weakest of all the bills. Almost immediately, a small group of senators—Reid, Baucus, and acting Health, Education, Labor and Pensions Committee Chair Christopher Dodd—huddled with a White House team led by Chief of Staff Rahm Emanuel to begin the mysterious process by which the more progressive HELP committee bill will be melded with the product of Baucus’s mostly fruitless negotiation with Senate Republicans, only one of whom, Maine Senator Olympia Snowe, deigned to vote for the final Finance bill.

Reid and even Baucus say they personally support a public option, but they repeatedly point to the so-called “moderates” in their own party whose support is necessary to get to the 60-vote majority needed to overcome a Republican filibuster and pass a health reform bill in the Senate. With a smart legislative strategy, the 60 Democratic votes (which with Snowe would total 61) could be called upon just to overcome the filibuster, clearing the way for a 50-vote majority to pass a strong health reform bill—while letting more conservative Democrats vote against it. [More on this anti-filibuster unity strategy in columns to come.]

Most importantly, Reid and Baucus need to realize that even “moderate” Democrats are rethinking their positions on health reform right now. Concentrating their minds is the realization that they are about to vote to force every American over the age of 25 to purchase health insurance. Moderate Democrats are the ones most receptive to the demands of the insurance industry, and the price the insurance industry is demanding in exchange for insurance reform (like preventing companies from discriminating against people with preexisting conditions) is the “individual mandate” – which means voters are forced to buy insurance, whether they can afford it or not.

At this moment, all Democratic politicians, even the most conservative, are realizing that their voters will blame them, not the insurance companies, if the policies the voters are required to buy are so expensive that premiums consume over 20 percent of those voters’ annual incomes. Suddenly, more generous tax subsidies to cover middle-class premiums seem like a good idea. And if the public option can bring down the cost of premiums those subsidies have to pay for, then the overall size of the reform price tag can be kept under control – a long-time demand of moderate Democrats.

Everyone knows that the three House bills contain more ample subsidies, two of the three have a strong public option, and none of them tax hard-won worker health benefits. On Friday, the Congressional Budget Office reported that the most progressive of the House bills produces more affordable premiums, while coming in around the 10-year cost of $900-billion goal set by moderate Democrats and President Obama. Here’s the headline on Lori Montgomery’s story: CBO Estimates House Health Bill at $905B or Less

On the Health Care for America Now Blog, Jason Rosenbaum does a nice job of teasing out the implications of these findings at this moment when moderates are figuring out how to achieve their fiscal goals, while avoiding being blamed for bad outcomes:

As a refresher, the bill being considered in the House is a much better bill than what Finance passed on Tuesday. It has a public health insurance option, it asks employers to pitch in their fair share, it is fairly financed, and it has much more generous subsidies (read: tax credits) to make health care affordable for everyone.

So, why, with all that good stuff in there, does it look like the CBO will say the House bill still covers millions more people and costs just as much, while remaining deficit neutral? Because things like employer responsibility, fair financing, and the public health insurance option save money.

That's right. The public option saves money. The CBO has said so before, and it looks like they're saying it again.

Combine that with raising money by taxing households that make over $350,000 per year instead of the middle class, and asking employers to chip in for their employees health care, and you've suddenly got a lot more money to work with. Which means you can give middle class people more generous subsidies than the anemic Finance bill. Which means you and I won't be on the hook for 16.5% of our income paid towards health care costs, the level a typical middle class family would have to pay under the Finance bill.

Reid and Baucus (and the White House) should step up to the plate and borrow the strongest parts of the HELP bill to write the final Senate health reform legislation. If they don’t, the House of Representatives, led by Nancy Pelosi and the Progressive Caucus, will force them to strengthen their bill in conference committee. But if the Democratic leaders in the Senate dare to lead, the House will back them up—and even the most moderate Democrats will support them as they make history by winning affordable health care for all.

President Obama: Make Sure Families Can Afford the Insurance They Are Forced to Buy

Roger Hickey — Tue, 08 Sep 2009 08:59:19 -0700

When President Obama speaks before the Congress on Wednesday night, he will tell the nation in more specific detail what he wants to do to make the health care system work for everyone.

He’d had better pledge to make sure good health insurance is affordable for all Americans – because he’s already made a deal to force all of us to buy insurance. And if that insurance is not affordable, he could get a bill out of Congress, but there will be hell to pay later – not from “the left,” but from working Americans.

A good way for President Obama to start is to get clear about big deals he – and Democrats – have already made with the insurance industry. All the pundits are talking about the bipartisan agreement that we should force the insurance companies to sell insurance to everyone who wants to buy it. No more denying people coverage because of a preexisting condition or because they are too old, or dropping people from coverage if their conditions cost the insurance company too much money. The pundits call this an easy and important reform to pass, because it is popular and the companies have already agreed to it.

But the insurance companies think they’ve already gotten something big in return: the federal government will require everyone in America to buy health insurance. It’s called an “individual mandate.” Most of the pundits and policy wonks assume President Obama has already agreed to it, even though he steadfastly refused all through the presidential campaign – despite huge pressure from then-Sen. Hillary Clinton and many “experts” – to endorse requiring people to buy insurance. His argument at the time was that rather than use the power of federal law to force people to buy insurance, government should make sure that health insurance was so easily available – and affordable – that people would want to buy insurance for themselves and their families.

Apparently, Obama is now willing to give the insurance companies what they wanted all along – a mandate that will force 47 million people who don’t have insurance (and everyone who loses their job or their employer-sponsored insurance) to quickly buy an insurance policy. In exchange, the companies will allow Obama and the Congress to pass laws that try to stop their discriminatory sales practices. The policy wonks encouraged this deal, saying the companies can’t be expected to sell insurance to people only when they get sick. But requiring all those millions of people to buy insurance will mean a massive windfall for the insurance companies.

What do Obama and the Democrats get? They had better make sure the insurance industry sells decent insurance policies that are affordable for those millions of people who are going to be forced to buy them. If that doesn’t happen, they could get a populist backlash that blows up in the Democrats' faces – after health reform is passed.

OK, so Obama has done the “easy part” – agreeing to a windfall for the insurance companies. How does he make sure people are happy with the quality and cost of the insurance they are going to be forced to buy?

Well, that’s where the public option comes in – giving the private insurance companies price competition from a nonprofit insurance company that sells good insurance at affordable prices, and giving us all some transparent benchmark information about how cheaply a company can sell insurance with good, reliable health benefits.

That’s also where the “insurance exchange” comes in – setting strong standards that assure buyers that they can count on the quality of benefits of insurance policies sold through the exchange by private insurance companies – and by one public insurance company.

That’s where the subsidies for poor and working class families come in – to assure they can afford insurance policies.

Conservative calls to “cut back” health reform can backfire – on Obama.

These essential parts of reform – affordability, decent benefits, and the public option – are the very elements that would disappear if President Obama and the Democrats agree to the conservative calls to “cut back” on the overall scope and cost of the health reform we’ve been talking about.

Cut back on affordability? Some conservative lawmakers (including Democrats) want Obama to “cut back” the cost of his overall bill to a ten year cost of $700 billion dollars. Most experts think that if you don’t spend at least $1.2 trillion over that decade-long period, you won’t be able to keep premiums and out-of-pocket costs affordable for most of the millions of people who will be forced to buy insurance.

Cut back on the insurance exchange? Other conservatives want Obama to “cut back” on the package of health benefits that private companies will be allowed to sell in the exchange. What good are insurance policies that don’t cover the treatments people need when you get sick – or require that you pay expensive co-pays?

Cut back on the public option? And as we have seen, other conservatives want to get rid of the public option. They say we can trust the insurance companies (and the free market) to keep prices affordable. Don’t worry that most insurance markets are dominated by only one or two big companies, they argue.

Now that the conservatives have managed to get Obama and the Dems to buy into the deal that will force millions of us to buy health insurance, they are demanding that Obama “compromise” by getting rid of all of the elements that Democrats have devised to make sure families can afford the insurance they will be required to buy.

On Wednesday night, President Obama should explain the deal he’s already made – and then explain the deal he proposes to make with the American people to make sure we can all afford good, high-quality health care.

Let's Pass Ted Kennedy's Health Plan

Roger Hickey — Mon, 31 Aug 2009 07:15:05 -0700

Let’s get a few things straight:

Until last year, Senator Edward M. Kennedy’s health care bill (co-authored with with Rep. John Dingell) was a bill known as Medicare for All. Not expensive private insurance for some, but Medicare [a public insurance plan] for All.
Senator Kennedy encouraged candidate and then President Obama to make health care for all his first priority -- during the campaign and as he took office.
And Ted Kennedy remained in charge as his HELP (Health, Education and Labor and Pension) Committee wrote -- and then passed -- a new health care bill with a strong public insurance option for those who want it.

I feel the need to remind people of all this because conservatives, and especially Republican Senators, are trying to promote the idea that if only Ted Kennedy were still actively involved in the health care reform effort, he could have gotten the Democrats to fold and embrace a weakened “bi-partisan” compromised health reform strategy. And some are urging that the best tribute we could construct to the great man’s memory is to pass such a watered-down health bill that could win the support of a large number of conservative Republicans.

Media Matters has done a good job of tracking and responding to the crocodile tears of Republicans, keying off of a Politico obituary that repeats the conservative spin that “without Kennedy, Democrats were less willing to make the concessions needed for true [health care] compromise.” But whatever Politico’s role, their journalism certainly picked up on the boldly outrageous statements of important conservatives. One by one, Media Matters’ quotes Republicans from Orin Hatch to John McCain, lamenting that Kennedy’s passing has deprived them all of a “reasonable” Democrat who would have won Republican votes by getting rid of the public plan or making the cost of “reform” dramatically smaller.

Let’s get another thing clear:

Republicans don’t want a deal. They want to kill health reform.

Democrats, especially a few in the Senate Finance committee, have for months been reaching out to Republicans with the hand of hopeful bi-partisanship. And in recent months, conservative Republicans have made it clear that if Democrats (like Finance Committee Chair Max Baucus) are going to continue to reach out the hand of compromise, they are ready to bite it off.

As cable television covered this weekend’s memorials to Ted Kennedy, when the talk got around to health care, there was almost always one pundit (usually one without much expertise about health care), who could be counted on to repeat the conservative talking points: “It will take somebody with a liberal reputation like Teddy Kennedy to negotiate a deal with Republicans -- and convince the liberals to accept the compromise.”

When someone occasionally reminds the discussants that even the Finance Committee Republicans, like Grassley and Enzi are refusing to make a deal -- as pollster Geoff Garin did in Sunday’s Washington Post -- one of these all-purpose pundits, like Cokie Roberts, quickly shift the arguments from Republicans to conservative Democrats. Newsweek’s Jonathan Alter, who professes to personally support single-payer heath care, has regularly gone on MSNBC programs to tell liberals they need to give up on the public insurance option if they want to get the support of enough Democrats to pass health reform without Republican support. The generic pundit argument is that liberals need to learn to compromise -- by cutting back the total cost of the package and ditching the public option in order to get the insurance reforms -- like requiring insurance companies to cover all applicants -- and the great step forward of requiring everyone to have insurance.

Let’s get a few more things straight:

The public insurance option is consistently very popular in every poll, including the most recent ones, when you ask if people should have the option of choosing a public plan which competes with private insurance companies (which are very unpopular).
The public insurance option is popular even among the supporters of conservative Democrats.
The House will pass a very progressive health plan -- with a strong public option and enough funding to make health insurance affordable for most Americans.
Support for a public plan is growing, not shrinking, in the US Senate. Most Democratic Senators, including members of the Finance Committee -- like Baucus (yes, see his White Paper), Bingaman, and two of the strongest supporters of the public option, Rockefeller and Schumer -- have already endorsed a strong public plan. Additional Senators would not vote against it. And Baucus and the rest of the Finance Committee Dems are about to acknowledge the reality that the Republicans have rejected bi-partisanship. That means Democrats can pass a bill like Kennedy’s HELP bill.

OK, but aren’t conservative Democrats worried about the high cost of health reform -- and won’t they demand a smaller, cheaper bill? And won’t they oppose a public plan?

Let’s get a few more things straight:

Individual mandates are the key demand of the insurance companies. Without that part of the deal, they will fiercely oppose the insurance reforms the pundits say are easy to pass -- the prohibitions against discriminating against people with pre-existing conditions, for example.
But without subsidies that make insurance policies affordable – for middle class voters as well as the poor -- Democrats (even conservative Democrats) don’t want to require their voters to buy health insurance if those policies are not affordable. Without that part of the package likely to disappear if the whole package is cut -- everybody involved in passing health reform will suffer voter backlash.

Once fiscally responsible Democrats realize they don’t want to make large cuts in the size of the program, they start to understand that the public insurance option is their best tool for keeping the total costs of the program under control.

Blue Dog Democrats in the House have already made a deal that accepts a pretty large health reform plan -- and a public option. Senate Democrats are coming together around a health reform program that is big enough to do the job. And they are embracing a public insurance plan that controls costs -- and keeps the private insurance industry honest.

In other words, Democrats are coming together around the kind of health reform very much like Senator Ted Kennedy’s HELP bill.

Don't Tax Benefits

Roger Hickey — Mon, 13 Jul 2009 06:17:29 -0700

Americans are demanding health care reform that guarantees them quality, affordable insurance, reduces the burden of health costs on employers and individuals and provides backup coverage through a public health insurance option.

But the suggestion that we pay for these needed reforms by taxing the health benefits that millions of us get through our employers is very unpopular — Americans fear that it could undo the one part of our health care system that now works (sort of). And we worry about new tax burdens on people who have worked hard to get and keep decent health coverage. If Democrats want to avoid a serious reaction against their important reform efforts, they should heed these concerns.

America’s health insurance system has evolved over the decades since World War II, when companies began offering health insurance — untaxed as income by government policy. Today, around 160 million of us get our health insurance from employers. And in these difficult times, millions of workers have repeatedly given up wage increases in order to keep their health benefits.

John McCain, when he was running for president last year, proposed taxing all employer-provided health benefits. Were we to do that, some 20 million Americans would lose employment-based health insurance, according to some estimates. And many employers would stop contributing to group health insurance — forcing their workers into the more expensive individual insurance market.

While many health experts acknowledge that taxing all benefits would cause chaos, some share the conservative view that a lot of people are getting “too much” insurance coverage from their employers and are pushing to get new revenues by taxing plans that are more expensive than average. But several recent studies find that it is almost impossible to design a tax that doesn’t overburden workers in firms with older or low-income employees or companies in regions with higher-than-average insurance premiums.

The Communications Workers of America looked at one proposal (to tax all employer-paid health benefits worth over $13,000 for a family) and found a typical member of its union in Pennsylvania with a working spouse and one child would pay $3,165 more in taxes in the first year, and $27,949 more over eight years. The issue is heating up. The Senate majority leader, Harry Reid, has told colleagues that they should not tax health benefits. But the debate continues.

It is dangerous for politicians to focus the government’s taxing power on the hard-won benefits of middle-class families. Fair and progressive income and wealth taxes are a better way to pay for health reform — and keep workers feeling as though they have a positive stake in achieving good health care for all.

This commentary originally appeared in the The New York Times.

I Pledge to Buy a Made-in-U.S. Car

Roger Hickey — Mon, 18 May 2009 14:27:48 -0700

I pledge that soon I will buy a new, fuel-efficient car—built in America by United Auto Workers members.

I'm asking YOU to take this pledge with me and get others to do so, too.

If enough Americans take this pledge—and pass it on—we can revive our country's auto and manufacturing industries. And we can give a big boost to the workers and communities—and to our country—that depend on those crucial industries.

Click here to take the American auto revival pledge. On that page you can pledge that:

Your next car will be manufactured in America.
It will be more fuel-efficient than my last one.
It will be made by UAW workers.
You will only consider foreign cars built in the U.S. if the UAW represents their workers.

You can also pledge to sign the Petition for Auto-Supply Chain Jobs sponsored by the Alliance for American Manufacturing, the Mayors and Municipalities Automotive Coalition, and the United Steel Workers.

In this disastrous economic meltdown, the workers in the auto and supplier plants and dealerships of our country are losing jobs by the hundreds of thousands. And the proud UAW has made painful yet patriotic wage concessions in an effort to save America's most important industry.

I want Barack Obama's plan to save the industry and revive manufacturing to succeed—so I'm stepping up to do a small thing: I pledge that my next car will be made in the good old U.S.A.

Now, I know that for some of us, buying American may feel like a sacrifice. But a Malibu matches the quality of a Honda these days. And even Americans lusting after a BMW will be amazed at the performance of today's small Cadillac. And the Ford Escape hybrid gets mileage comparable with the Prius. If we all do this together, we can make American cars cool again—and give American companies the time to invest in a new generation of fuel-efficient competitive automobiles.

This recession is a national emergency—as serious as 9-11. Back then no one was asked to do anything—except our soldiers. This time, it is our economic future that's at stake.

GM, Ford and Chrysler sold 6.3 million domestically-produced cars and light trucks in 2008, two million fewer than in 2007. Auto analysis expect that sales will drop to 4.4 million this year.

A typical assembly plant can build about 250,000 vehicles and will employ about 2,500 workers. If we collectively bought 1 million additional vehicles this year, that would save the equivalent of about four assembly plants and the jobs of 10,000 workers.

In addition, every job in Big Three domestic auto assembly creates an additional nine jobs in supplier industries and communities. So, if 1 million new buyers purchase domestic vehicles, it would create or save an estimated 100,000 jobs, based on data from the UAW and independent research groups.

We all have to step up. If you agree, take the pledge, and then, if enough of us do it, we can revive America.

After a nationwide bus tour, a Capitol Hill Teach In on Auto Jobs on May 19 will feature national economists, labor and business leaders, Members of Congress, local elected officials and everyday workers. MSNBC's Ed Schultz will lead off discussion of principles for revitalizing the auto industry by supporting American jobs and communities. To learn more about how the auto manufacturing industry impacts local communities, visit www.americanmanufacturing.org.

A personal note: At 6 a.m. one day last week I was sitting in the DMV auto inspection line, hoping my 1990 Plymouth Laser would make it through one more inspection. Other people in the line complained about how slow it was moving. They're laying people off here too, one guy explained. And those layoffs, as in every city and state in America, are due to lowered tax revenues due to growing unemployment and the deepening recession.

As I sat idling in the DMV line I knew that, even if it passed inspection, my old car (which has no air bags or anti-lock brakes), was putting more carbon dioxide and other pollutants into the air than it did when it was new. I realized that my frugality in nursing along this old car (which has served me well) was not only likely to kill me, it was helping to kill the planet and the economy.

Amazingly, my old Plymouth passed. But I drove to work that morning grateful to have a job to go to—and resolved that it was time to buy a new car. And the car will be made in the U.S.A.

Don't get me wrong. I didn't make the decision out of altruism. Like most Americans, I really enjoy getting a new car. Some of my green friends try to pretend they don't need a car. But they all have at least one, maybe more. And most of us—even the greenest of greens—really enjoy driving a new car, especially when circumstances push them over the edge. Many of my friends with kids who have left the nest, for example, have been thrilled to graduate back from their minivan to anything that doesn't feel like driving a bathtub. Like them, I had just handed myself the excuse to start car shopping.

As many of us who can, let's pledge to buy a new, fuel efficient car made by the UAW.

A Public Plan is Healthy Competition

Roger Hickey — Wed, 08 Apr 2009 08:02:44 -0700

Jacob Hacker’s 2006 book, The Great Risk Shift, helped politicians understand the economic pressures on the average family — including the rising costs and increasing loss of health insurance — or the threat.

And in his Health Care for America plan for health reform, published in early 2007 by the Economic Policy Institute, he outlines the concept of Public Insurance Plan Choice — the idea that all Americans be guaranteed

the right to keep the insurance they currently have, or
choose either from competing private insurance plans — OR
a public insurance plan — like Medicare for the not-yet-elderly.

Today we are releasing an important report by Dr. Jacob Hacker.

It is entitled HEALTHY COMPETITION: How to Structure Public Health Insurance Plan Choice to Ensure Risk-Sharing, Cost Control, and Quality Improvement.

The report is being published jointly by our Institute for America’s Future and the Center for Health, Economic & Family Security of the U.C. Berkeley School of Law where Dr. Hacker is Co-Director.

I just want to remind you that Jacob’s EPI plan has been incredibly influential. His public insurance proposal is central to Barack Obama’s health care plan – and to the health proposals of the other main Democratic presidential candidates -- Edwards and Clinton.

It was embraced by Senate Finance committee chair Max Baucus in his recent Health Reform White paper, by the Chairmen of the key Committees of jurisdiction in the House, and by Gov. Kathleen Sibelius, Obama’s candidate to lead HHS.

And it has been echoed by the work of others, like the health proposals from the Commonwealth Fund.

The public plan is also central to the principles of the large activist coalition called Health Care for America Now!

And as a result this growing consensus, some people — including some special interests — are starting to question or even oppose the public plan.

In a previous paper published in December by IAF and the Berkeley Center, Jacob argues that the public plan (in the context of a mixed system) is crucial to controlling costs and assuring quality. And President Obama has insisted that a crucial test of health reform is whether it can reorganize the health system to “bend the cost curve” downward. I urge reporters to ask proponents of other approaches a basic question: How does your proposal for expanding coverage also control costs in the health care system?

Now that the debate about public insurance choice has really been joined, lawmakers and journalists have been asking fundamental design questions:

How would the public insurance plan work? Who would be covered? How would it compete with private insurance plans? How can we guarantee competition will take place on a level playing field?

Earlier versions of Hacker’s new memo have been read eagerly by key Administration and Congressional staffers. This new version benefits from their comments and questions.

I’m sure this new paper will be just as influential as his earlier work as the health care debate goes forward.

An Election, a Budget, and Two Summits = A Bold Obama Strategy for Health Care Change.

Roger Hickey — Sun, 08 Mar 2009 18:30:20 -0700

Like most participants in President Obama’s Health Care Summit last Thursday, I was thrilled to be invited to the White House for the big public meeting on health care. At the Summit, the President did what the leaders and activists of the 800 organizations in our Health Care for America Now coalition have been urging:
he announced his determination to reform the country’s health care system -- to cover everyone and to control health costs -- in this first year of his presidency.

I brought CD’s with 300,000 signatures and emails collected by MoveOn, HCAN and my organization. The message to Congress: “Don’t let conservatives and special interests block health care for all.” By challenging all participants to control health costs as well as coverage, Obama is setting up the coming debate to demonstrate that the conservatives and special interests are bankrupt when it comes to real health reform – because they and the interests they represent are part of the problem, not part of the solution.

Obama signaled he was serious about health care with his first budget documents, released before his February 24 speech to Congress, containing a $640 billion “down-payment” on the cost of health reform in the next 10 years. And he set up the rationale for the urgency of going ahead with health care at the February 23 Fiscal Responsibility Summit, where Obama and his OMB director Peter Orszag argued that the only serious way to “bend the budget toward balance” is reorganize the health care system to control costs in this sector of the private economy that is also responsible for runaway growth in the Federal budget.

At a time when he has gotten the Congress to spend hundreds of billions to revive the economy and unfreeze the banking system, the President took on the concerns of conservatives and Blue Dog Democrats about growing deficits to set up the following equation: “When the economy recovers, the number one factor pushing up deficits will be Medicare and Medicaid spending. But these Federal programs is driven by rising costs in the entire health care system. So it is imperative that we reform the whole health care system to reduce inflation that is driving growth in Medicare and Medicaid spending.”

But the important point that I want to emphasize today is that on Medicare and Medicaid, in particular -- which everybody here understands is the 800-pound gorilla -- I don't see us being able to get an effective reform package around those entitlements without fixing the underlying problem of health care inflation. If we've got 6, 7, 8 percent health care inflation we could fix Medicare and Medicaid temporarily for a couple of years, but we would be back in the same fix 10 years from now. And so our most urgent task is to drive down costs both on the private side and on the public side, because Medicare and Medicaid costs have actually gone up fairly comparably to what's been happening in the private sector what businesses and families and others have been doing. That's why I think it's so important for us to focus on costs as part of this overall reform package. http://www.whitehouse.gov/the_press_office/Closing-Remarks-by-the-President-at-White-House-Forum-on-Health-Reform/

What is truly impressive is President Obama’s ability to reach out to deficit hawks who disagree with him fundamentally on the budget – or insurance company executives who have a very different approach to health care – and make them (and the media) feel as though they have been consulted, heard, and at least partially agreed with. Sooner or later, many of these forces will break with Obama, and he will have to assemble a majority in the Congress who support his approach -- and he will need the power of a powerful progressive movement to help him win. But for now this public openness works.

The new team has gotten this domestic policy summit thing down: Fill the East Room with a couple hundred Congresspeople and Senators and policy and organizational leaders from across the political spectrum. Give the President the microphone and let him impress us with his mastery of the issues – and then send us off for two hours of wonky “break out sessions” where Congressional leaders dominate but others also get to weigh in. Finally, bring us all together to hear the President summarize the discussions (from reports from his staff) and declare his intentions -- to bend the arc of the budget toward balance (in the case of the Fiscal Summit) and (at the Health Summit) to reorganize the health care sector to cover everyone in a way that controls the main cause of long term budget imbalance, the spiraling costs of health care.

These gatherings are designed to do a number of things at once: to dominate the hourly cable and talk-radio programs and the daily and weekly news; to make a large number of elected officials and citizen leaders feel they have had an opportunity to advise the White House and posture in public, and to convey to the voters who elected him that he has a plan to achieve what he said he would do if he got to the White House. And on each occasion the President sent off the participants with the admonition to work together for progress – and the implication failure to work together is a betrayal of the common good.

The good news is that many of the participants now feel pressure not to oppose the President directly. On health care, for example, the groups that wielded the knife that killed the Clinton health plan, the health insurance lobby and some groups claiming to represent small and big business, attended the Health Summit and pledged to help this time. Karen Ignani, who runs the insurance company association, now called America's Health Insurance Plans, declared to the President. “We hear the American people about what's not working. You have our commitment to play, to contribute, and to help pass health care reform this year.” Dan Danner, representing the National Federation of Independent Businesses, the group that produced the Harry and Louise ads against Hillary Clinton’s health reform, replied to Obama, “I'm honored to be here representing small business . . . and for them, cost is still the top issue. And we very much look forward to finding a solution together that works for America's job creators.” http://www.whitehouse.gov/the_press_office/Closing-Remarks-by-the-President-at-White-House-Forum-on-Health-Reform/

But how does the insurance industry meet President Obama’s challenge to control health insurance costs, now bankrupting companies and experienced by you and me in rising premiums, growing out-of-pocket costs, and just plain inability to afford decent coverage? Here’s Karen Ignani’s answer, conveyed in the breakout session I was assigned to: She suggested that every player in the health system – insurance companies, doctors, hospitals and other providers – all get together and promise to voluntarily reduce their costs in the coming year by at least 1 percent. That’s it. That’s the best this representative of America’s Health Insurance Plans could come up with! Voluntary price restraint! Bernie Madoff should try making this promise of volunteerism when he finally goes to trail. (“Members of the jury, if you don’t send me to jail, I will voluntarily give back the money and do real investments, not ponzi schemes for the rest of my life.”) When American health consumers, like the Madoff jury, hear this offer, they are likely to look for another solution.

In his concluding remarks at the Health Summit, in what may have been a feint to confuse everyone, President Obama declared “I'm talking to you liberal bleeding hearts out there. (Laughter.) Don't think that we can solve this problem without tackling costs.” Well, it turns out that it is the liberals who have been promoting the most effective strategy for tackling costs that has so far been proposed: giving everyone the option of enrolling in a public health insurance plan, like Medicare for the non-elderly. The Lewin group estimates that something like half the population would enroll in such a plan, creating a very important benchmark and competitor for the private insurance industry. The Commonwealth Fund Commission found that a public health insurance plan will have premiums averaging 20% less than private insurance. And recent polling by Celinda Lake has found that 73% of Americans favor a choice of private or public health insurance over having just one or the other.

The public insurance option is controversial among some of the same people who, like Ronald Reagan in the 1950s, called the prospect of Medicare for seniors “socialistic.” But the real impact of a public insurance plan would be to bring to bear some good old-fashioned competition in the health insurance market, which is dominated by a few firms in most states. According to a study in Health Affairs, in 40 states the top three carriers account for between 60 and 100 percent of the market. By now, everyone should know that Medicare is more efficient than private insurance, with fewer overhead costs like advertising – and much simplified billing and other procedures than private companies. And it is just this kind of simplified nation-wide administrative structure that would allow a public insurance plan for the rest of us to institute cost-saving and quality-improving reforms.

Everyone talks about the virtues of Health Information Technology in controlling costs. A unified system (like a Medicare for the rest of us) would be able to deploy IT system-wide more easily that a whole lot of private firms, each with their own administrative, billing and reporting systems. And the real cost saving potential for health IT comes when linked with a new system of “comparative effectiveness research,” so that over time, the health system builds up a huge database of what works and what doesn’t work in health treatments. Senate Finance Committee Chairman, Max Baucus, in his highly-regarded White Paper called Call to Action: Health Reform 2009, which proposes creation of a public insurance plan similar to Obama’s, argues that the public plan, by virtue of its size and non-profit national charter, would be able to reorient America’s health care delivery system toward services and activities that improve patient care and “bend the curve” of growth in national health care spending.

Study after study has endorsed the importance of a public insurance plan as a very effective mechanism for controlling system-wide costs, spurring competition and innovation in the private sector, and improving the quality of health care.

And yet, the conservative ideology dominates one part of the political spectrum. At the White House Health Summit, after he called on Senator Baucus, President Obama graciously gave the microphone to Baucus’s minority party ranking member in the committee, Sen. Grassley, who thanked the President and then laid down the gauntlet on the public insurance option: ”So the only thing that I would throw out for your consideration -- and please don't respond to this now, because I'm asking you just to think about it -- there's a lot of us that feel that the public option that the government is an unfair competitor and that we're going to get an awful lot of crowd out.”

So the only time the public insurance option was seriously discussed with the President in the room, it was for the highest ranking leader of the Republicans at the Summit to try to rule it off the table, because – it would represent unfair competition with the private insurance companies.

President Obama didn’t respond conclusively, but he correctly summarized the case for the public insurance option: “The thinking on the public option has been that it gives consumers more choices, and it helps give -- keep the private sector honest, because there's some competition out there.”

So the debate has finally been joined. The President is in favor of competition and choice to bring down costs. And the Republicans, echoing the insurance industry, are afraid of competition and have no other real answers to the problem of rising health care costs. Sound like a good fight to me.

###

I also attended the February 23 White House Fiscal Responsibility Summit and I was brought face-to-face with the reality that Republicans and some Democrats do have a proposal for dealing with Medicare and Social Security costs. They want an independent Commission on Entitlements that would propose caps on overall entitlement spending and automatic cuts to those programs when spending exceeded the caps. The Commission would devise the specifics and then present them to the Congress for an up or down vote – dispensing with the democratic niceties of debate or amendments.

Prior to this first summit I had worked with allies to urge the White House NOT to have Peter G. Peterson, the notorious budget hawk and advocate of such a commission, speak at the Summit – and to urge them not to announce a White House task force on Social Security. Perhaps to punish me for this successful pre-Summit agitation – or perhaps to let me see what they were up against, the White House assigned me to the Budget Process break out session that was dominated by Senators and Congresspeople -- like Judd Gregg and Evan Bayh and Kent Conrad – who made an entitlements commission the subject of the session. Their focus was on capping and automatically cutting Social Security and Medicare -- the very opposite of health care reform that takes on the drivers of health care inflation, the insurance companies.

I got only one opportunity to speak in a session dominated by Senators and Congresspeople, but I am especially proud of the small section (page 44) devoted in the official report to the dissenters:

Still others – for example, Representative Obey, Representative Van Hollen, and Roger Hickey – stated express opposition to a commission.

• Representative Obey stated that he believed a commission would thrill the policy wonks but nobody else, and that in the end nothing would be accomplished. “Cound me among the strong skeptics,” he said.

• Representative Van Hollen’s central concern with a commission process was his belief that Congress should not outsource the key fiscal policy decisions on health care, taxes, and Social Security to someone else. In his words: “Huge policy issues cannot be subcontracted.” He feared that a commission would be viewed as undemocratic and and abrogation of congressional responsibility.

• Roger Hickey believed that “an extraordinary procedure” has already been employed in the past year, to great effect – namely, the presidential election. He argued that the American people had spoken in favor of expanded health care and a fairer tax distribution, and also for greater honesty and transparency from their government – not in favor of handing over decisions on fundamental issues such as taxes, health, and retirement to a closed group of insiders.

My moment of glory at the Fiscal Responsibility Summit.

Sound The Alarm! Peterson Foundation Assault On "Entitlements"

Roger Hickey — Thu, 05 Feb 2009 08:14:38 -0800

At a press conference today by Wall Street mogul Peter Peterson, he and his invited speakers informed Americans who are losing their jobs and homes in record numbers that our nation’s biggest problem is the national deficit—and that the solution is to cut Social Security and Medicare.

We don't need this campaign. What the nation needs right now is an increase in the federal deficit to stimulate economic recovery and to create and save jobs. Yes, President Obama inherited a large budget deficit and national debt due to George W. Bush’s reckless tax cuts for the very wealthiest Americans, like Peterson. Economist Dean Baker has pointed out that Peterson and his partners made a fortune running a Wall Street private equity fund, much of which he was able to shelter from normal taxation through the "fund managers" tax break.

PODCAST: Countering A "Misplaced" Budget Debate

Miles Rapoport, the president of Demos, argues that what the nation needs is a debate on how to build a "high road to fiscal responsibility" based on government investment for the public good. He explains how.

Does anyone remember Peterson (or the others at his press conference) warning of the fiscal dangers of those massive tax cuts to the wealthy? Did they warn us about the speculative bubble economy and the irresponsible and dangerous financial deregulation of their industry, that allowed them and their cronies to make huge fortunes, while the banking system eventually collapsed under the weight of its own greed?

Now that the bubble has burst and the economy has collapsed, not only does Peterson give support to those who want to water down the recovery investments, he comes to D.C. to present a set of solutions that completely ignore how we got here and would place an enormous burden on the middle class and the poor. He wants Congress and President Obama to agree to a commission to slash Social Security and Medicare—which he calls "entitlements"—and undoubtedly to cut other important social spending.

Sound the alarm! The people who got us into the financial and economic mess that is currently costing American jobs and businesses have launched a campaign to jeopardize our retirement security and the one part of our health care system that works. The American people rejected their attempts to privatize Social Security, and they should reject this latest, ill-timed campaign.

Join Roger Hickey and Miles Rapoport February 11 in Washington and online for the "Thinking Big, Thinking Forward" conference, featuring New York Times columnist Paul Krugman and experts from The American Prospect, Demos and the Economic Policy Institute. Learn more »