Health Care Secrets

Opponents of health care reform, including Senator Chuck Grassley, have been fond of citing a study by the Lewin Group (see "Grassley's Talking Points").

Grassley, along with other Republican Congressmen, chose to focus only on the Lewin Group conclusion that 119 million Americans would opt for a public option, if it were available. I suppose they'll need to update their talking points, since the Lewin study has updated their study based on a more recent bill, the American Affordable Health Choices Act of 2009.

For the benefit of Senator Grassley and others, the new talking point is 103.4 million people opting for a public option. It's hard to tell why this is such a terrible thing, and it doesn't explain why so many people would choose a public option, or how much this would cost.

You won't hear the reason from Republican opponents of health care reform, but the latest report has some interesting findings:

"Family premiums under the public plan would on average be about $2,148 less for families (about 20 percent lower) than comparable private insurance."

"Assuming the exchange is opened to all firms, we estimate that the number of uninsured people would be reduced by 32.6 million people."

"Reductions in the cost of covering workers would result in higher net income which would be subject to taxation. The available research indicates that over time these savings would be passed back to workers in the form of increased wage growth, resulting in increased personal income and payroll tax payments."

"We estimate that these tax effects would result in increased federal tax revenues of $48.2 billion over the 2010 through 2019 period if the exchange is open to firms of all sizes."

And my personal favorite:

"If all firms are eligible for the exchange, and therefore the public plan, national spending would increase by about $1.3 billion. Thus, the Act would reduce the number of uninsured by 32.6 million people without significantly increasing national health spending."

No, that's not a typo. It's an increase of $1.3 billion, not $1 trillion. $1.3 billion is the combined cost of individuals (who will see insurance premiums decline) and the government (that will have higher costs dues to subsidies to cover many who are now uninsured). $1.3 billion is about a $100 for each taxpayer.

So we have 32.6 million more people insured, health insurance premiums going down by 20%, and higher income for workers, at a total cost of $100 per taxpayer. Sounds terrible, doesn't it?

As things now stand, we won't be getting a public option for health care, but at least when you get "health insurance reform" instead of the public option proposed in this legislation (which is what's likely to happen), you'll at least know what your missing out on.

You might also ask Senator Grassley and other Republicans who oppose the public option why they don't include this information in their talking points.

Grassley's Talking Points

Our own Senator Chuck Grassley should be a little more careful about the company he keeps, and whose talking points he uses.

In his July 23 editorial in the Des Moines Register, "Health-care reform should work for you," Grassley gives us a dire warning of what will happen if there's a public option for health care:

"I caution those who favor driving 119 million Americans into a government-run plan. The federal government is an unfair competitor and would run private insurers out of business, leading to a Canadian-style health-care system."

Setting aside the question of why private insurers could not compete with a government run system, the estimate of 119 million represents about 70% of individuals who now have private health insurance, and is far higher that any other estimates, including those provided by the Congressional Budget Office. Where did this figure come from?

It turns out this comes from a study published in April by a company called the Lewin Group. Senator Grassley describes the Lewin Group as a "think tank," but there's far more to the story. Grassley's just one of the many Republican Congressmen citing the Lewin Group as an "objective" source to bolster their argument against a public option for health care:



So who is this Lewin Group, and how objective are they? Well, at one time they actually were an independent research and consulting firm. They were purchased two years ago by Ingenix, the nation's largest provider of health-care billing information to companies like Aetna, UnitedHealth and CIGNA.

Ingenix made headlines earlier this year when they agreed to pay $400 million to settle lawsuits alleging that they distorted data to keep ("reasonable and customary") reimbursement rates artificially low, thereby reducing the payments owed by the insurance companies who use their data. Of course, this also means patients were forced to pay the difference.

By any measure, $400 million is a large settlement. But Ingenix is owned by UnitedHealth Group, one of the nation's largest health insurers, and they can afford it.

Senator Grassley should be a bit more careful about who he allows to put words in his mouth.

Birth of a Political Party

It's difficult to keep up with the right-wing these days. Even after reading about the reservist refusing orders to be mobilized to active duty a few weeks ago, I gave little thought to the conspiracy theories regarding President Obama's citizenship.

I recall when the issue came up before the election, after rumors surfaced that Obama's middle name is really Muhammed, causing the Obama campaign to post a copy of the original birth certificate on their website. As with any good conspiracy theory, each answer raised new allegations and demands for more information.

When I heard the rumor again a month or so later, I took a look at the documentation provided on several sites (including FactCheck.org), and forgot about it. But when I read recently that the fringe element clinging to this theory had been given a name ("Birthers") by the media, I realized the controversy would never die.

It's not surprising that those who make a living feeding ignorance have continued to keep this alive. Questions about Obama's citizenship raised by many media conservatives before the election live on with a more elite group of "trash for cash" media personalities. Even Lou Dobbs has decided to join the Rush Limbaugh/Sean Hannity crowd. Inside sources say Lou has been thinking about making a change ever since he heard about the eight year $400 million contract Rush signed last year. There's money to be made here.

Still, I object to elected officials pandering to fringe groups to score cheap points, and possibly pick up a few votes and/or donations. On the surface, there's nothing wrong with Congressman Bill Posey's (R-FL) amendment (H.R. 1503) to Federal Election Campaign Act of 1971, requiring that a presidential candidate provide a birth certificate. I'm all for it.

But while Posey and the bill's nine co-sponsors may claim this "has nothing to do with Obama," the truth is that it's intended to cater to the Birthers, and imply that Obama's presidency isn't legitimate.

It's by no means clear that Republicans can control the fringe elements they've created. Just ask Congressman Mike Castle (R-DE), who recently lost control of a town hall meeting to a Birther. If you haven't seen the video, it's worth viewing (click here), if only to get an advance preview of the Republican party of the future.

Maybe this will all give "birth" to a new political party... to replace the party that seems so determined to destroy itself.

Real Money

“A billion here, a billion there, and pretty soon you’re talking real money”
________________ Illinois Senator Everett Dirksen (deceased)

It's been nearly impossible to keep track of all the government programs intended to avert a total meltdown of our financial system. The overuse of acronyms such as TARP, TALF, PPIT, and TLGP doesn't help, except when making a rough estimate of the total ($100 billion for each letter is a good rule of thumb).

A few financial journalists have attempted to keep up with the potential liability resulting from all these programs. Most gave up as the total went over $10 trillion late last year. The federal government hasn't made this easier, since the information (when it's even available) is scattered over a dozen or so websites.

Apparently, no one in Congress thought to ask "what does all this add up to?" But a new report released by the special inspector general overseeing the $700 billion TARP bailout will make it difficult to avoid the question.

Special Inspector General Neil Barofsky will be testifying today before the House Committee on Oversight and Government Reform and has made it clear that the Treasury Department and Federal Reserve aren't disclosing enough information about how taxpayer money is actually being spent. He's estimating that the total potential taxpayer liability of all these programs adds up to a cool $23.7 trillion.

How much is $23.7 trillion? Well, it's enough to buy every stock traded on the U.S. stock market...twice. It's enough to buy every taxpayer a quarter of a million dollar home. It's enough to pay off the entire national debt, and still have $12 trillion left over. It's also enough to pay for Obama's health care plan for 200 years.

It's important to note that the government hasn't fully utilized many of these programs, so it's more useful to think of this as how much the government was willing to spend to avert a financial crisis. It's also an indication of how severe last September's near-meltdown really was.

The good news is that the amount of the $23.7 trillion the government has actually had to use has come down in recent months, and the report shows a current balance of $3 trillion, which is the lowest it's been since late last year.

As you watch Congressmen reading talking points from health insurers and drug manufacturers posturing about how health care is "too expensive," you might wonder where they've been over the past year.

Cheney's Silence

After coming out of his secret hiding place and showing up on every talk show except Oprah in recent months, former Vice President Dick Cheney must have seen his shadow. Maybe he felt he had sufficiently frightened the American public with predictions of another terrorist attack on American soil, and was able to declare "mission accomplished" and go back into hiding.

Or perhaps he got wind of Panetta's plans to visit Congress, and wisely decided to keep quiet for a few weeks. Last week's revelation that the CIA had failed to inform Congress of a covert "program" in violation of the National Security Act of 1947 was compounded by news this past weekend that this was under direct orders from former Vice President Dick Cheney.

CIA Director Leon Panetta didn't learn about the program until he was in office for almost 5 months, and within 24 hours notified both the House and Senate subcommittees. Panetta and members of the Senate and House intelligence committees have not said what the secret program actually was, although there has been widespread media speculation that the program in question involved the creation of groups whose mission was to assassinate al-Qa’eda operatives.

Much of this speculation has been fueled by current and former CIA employees that claim such a program was "on again-off again." But none of them can actually say with certainty that this was the program that caused Panetta to rush over to Congress with such urgency.

If this is actually what the "secret" CIA program was about, I can only say that the lack of curiosity inside the beltway is astounding. It's not like George Bush didn't make his intentions clear. A Washington Post article published shortly after 9/11 (CIA Weighs 'Targeted Killing' Missions) described the steps Bush took to authorize exactly such a mission. And in numerous public statements, Bush made his plans very clear.

At least up until now, there has been bipartisan agreement on this objective. Even Obama, in effect, sanctioned assassination in the October 7 Presidential debate: "We will kill bin Laden. We will crush al Qaeda. That has to be our biggest national security priority."

Given all this, wouldn't you think Congressional intelligence committees would have asked about this at some point in the last eight years? Wouldn't you think Panetta would have looked into this after a few days in office? The CIA has said the al-Qa’eda program never went beyond "brainstorming," so what was it that Cheney wanted to be kept secret?

Cheney's silence is telling us that we haven't heard the whole story.

A Congressional Visit to Wise County

With speculation growing that Congress will not be able to pass health care legislation before they recess in August, you might be tempted to think this is the result of partisan bickering, or perhaps the lobbyists who are spending millions to make sure this legislation gets stalled out.

But Republican Senator Judd Gregg has a more creative explanation: "the calendar doesn’t work.’’ Apparently there's just not enough time to play politics with the confirmation hearings of Supreme Court nominee Sonia Sotomayor, and still work on health care. And, since Congress didn't invent the Gregorian calendar (which, apparently, is broken), we can't hold them accountable.

Of course, we also can't expect Congress to shorten it's month long August "recess" just to deal with a problem that affects 75 million adults (42 percent of the under-65 adult population) who are either uninsured or underinsured in America.

They could better spend their time visiting this year's free medical clinic in Wise County, Virginia, Last year's clinic treated more than 2,500 people at the Wise County fairgrounds over a three day period, but thousands that came from surrounding states were turned away. It's sponsored by Remote Area Medical, a remarkable organization that provides free medical services, thanks to the efforts of medical professionals who volunteer their time. It's a no-frills event, with patients being treated in tents and cattle stalls.

It was a visit to the Wise County medical clinic a couple for years ago that led Wendell Potter to leave a well-paying job and speak out against the industry he had been a part of. Potter had been the head of Public Relations for CIGNA (one of the nation's largest insurers), but came to realize the fundamental untruth behind the lies he helped create.

In a recent interview with Bill Moyers on PBS, Potter explained how his trip to Wise County changed his views on the health care industry he had been a part of:

"It was absolutely stunning. It was like being hit by lightning. It was almost --what country am I in? I just it just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me."

"But when you're in the executive offices, when you're getting prepared for a call with an analyst, in the financial medium, what you think about are the numbers. You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations. That's what you think about, at that level. And it helps to think that way. That's why you--that enables you to stay there, if you don't really think that you're talking about and dealing with real human beings."

Although Wendell Potter testified before the U.S. Senate last month, Senator Gregg's feeble excuse suggests they have yet to really understand the problem. Imagine what would happen if you explained to your boss that you didn't do the job you were hired to do because "the calendar doesn’t work."

You might find yourself unemployed, and standing in line for health care in Wise County.

Transparency Redacted

It looks like there's been another delay in the release of a classified 2004 report on the CIA’s interrogation and detention program. The report was supposed to be released on June 19, was delayed until June 26, and was then delayed until July 1. Then White House spokesman Robert Gibbs told reporters that the report would not be released until this week.

For those who aren't aware of this report, it has been described as the "Holy Grail" of torture-related documents. Completed by former Inspector General John Helgerson in May 2004, it was released reluctantly and in heavily redacted form by the Bush administration in May, 2008. (click here to view the redacted version)

The Obama administration agreed to declassify the document following a lawsuit brought by the American Civil Liberties Union (ACLU). The report is based on the most comprehensive study of CIA torture practices ever completed, and is based on more than 100 interviews, a review of the videotapes, and 38,000 pages of documents.

We already know much of what's likely to be contained in the report, but it contains important information on recent claims made by former Vice President Dick Cheney. News reports have suggested that it will further contradict Cheney's claims torture of "high-value" detainees produced valuable intelligence, and saved "hundreds of thousands of lives."

Some have suggested that the delay is designed to protect the CIA from further embarrassment, rather than for reasons of national security. Whatever the reason, the CIA has now said that release of the report will be delayed (for a fourth time) until August 31. The ACLU's response makes it clear they aren't happy about the latest delay:

"It is apparent that the CIA report is not being delayed for legitimate reasons, but to cover up evidence of the agency's illegal and ineffective interrogation practices. It is time for the president to hold true to his promise of transparency and once and for all quash the forces of secrecy within the agency. The American public has a right to know the full truth about the torture that was committed in its name."

All of this is getting lost in the political theater behind CIA Director Leon Panetta's recent disclosure of an intelligence program that was hidden from Congress for eight years. Of course, we have no information on the program, because it's a secret. A former top Bush administration official (anonymously, of course) assures us that it's no "no big deal," but doesn't explain why it's been a secret since 2001. This gives plenty of room for both sides to play politics.

I must admit, the first time I heard the word "redacted," I had to look it up. But I know what "transparency" means, and this isn't it.