Yesterday's bipartisan summit marked a milestone, hopefully the last critical milestone, before the final vote is taken on comprehensive health reform. Under the President's auspices, Democrats and Republicans came together for a remarkable seven hours of adult health policy debate.
Given the nature of this event, health policy experts were not able to directly weigh in on the key issues in play. Yesterday evening, Timothy Jost and I sought to fill that gap by asking health policy experts in a variety of fields what they believe should happen.
Within 12 hours, we received responses from 80 of the most prominent health policy experts in the United States: Public option advocates Helen Halpin and Jacob Hacker, sociologists Paul Starr and Theda Skocpol, political scientists Ted Marmor, Mark Peterson, and Jonathan Oberlander, health economists Len Nichols, Jon Gruber, David Cutler, Henry Aaron, legal scholars such as Jerry Mashaw and Peter Jacobson, physicians and public health scholars such as Paul Cleary, Judith Feder, William Hsiao, George Kaplan, Gil Omenn, Phillip Pizzo, and Barbara Starfield, the leadership of SEIU. I have no doubt that we could get hundreds more. The dominant majority of people who have researched these issues or who spend every day serving patients in our increasingly-challenged health care system agree with this letter.
Some people on the list are single-payer advocates. Others are strong supporters of the public option. Still others are moderate economists or are practicing clinicians who do not identify with partisan affiliations. As expressed in the below letter, everyone on this list agrees that the time has come to enact comprehensive health reform.
As the letter put things:
“We commend the President's pursuit of bipartisan solutions. Yet the summit made plain that it is now time to move decisively and quickly to enact comprehensive reform. We believe that the only workable process at this point is to use the President's proposal to finish the job. After long debate, the House and Senate have passed two similar bills that do crucial things to improve US health care. All that needs to happen, if Republicans insist on blocking final improvements, is for the House and Senate to make the required adjustments and to pass these bills by majority vote in both houses.
Given the likelihood of a filibuster, this legislation will likely require the majority-vote reconciliation process. Reconciliation has been used by both Democrats and Republicans to enact welfare reform, Reagan and Bush-era tax cuts, the state children's health insurance programs (SCHIP), and other key legislation. Reconciliation is an appropriate and justified mechanism to secure an up-or-down vote on this critical bill.
Below is the final text and a list of signatories.
Update: We've added even more names that came in after the deadline, including another medical school dean (Jim Scott, dean of the The George Washington University School of Medicine and Health Sciences), health actuary Jim Toole, and distingushed health economists Willard Manning and Linda Blumberg.
February 26, 2010
President Barack Obama
Senator Harry Reid
Majority Leader
Senator Max Baucus,
Chairman, Committee on Finance
Senator Tom Harkin
Chairman, Committee on Health Education Labor and Pensions
Congresswoman Nancy Pelosi
Speaker of the House of Representatives
Congressman Charles Rangel
Committee on Ways & Means
Congressman Henry A. Waxman
Committee on Energy and Commerce
Congressman George Miller
Committee on Education and Labor
Dear Mr. President, Congressmen and Congresswomen
Our health care system is in crisis. America has higher per-capita medical spending than any other industrial democracy, Health care spending continues to increase, and is projected to reach $3.3 trillion by 2019. Health insurance premiums are rising rapidly, particularly within individual and small group markets. Meanwhile, the financial security traditionally offered by health insurance continues to erode, with rapid increases in out-of-pocket spending. Rising public health care program costs are driving large, ultimately unsustainable state and federal budget deficits. It is likely that more than 50 million Americans are now uninsured, with more losing coverage every day due to the twin challenges of deep recession and rising health care costs. Although this country has some of the best medical technology in the world, the quality and effectiveness of medical care often falls short of what every American deserves.
This week, the President put forth a proposal for finishing the job of enacting comprehensive health care reform with which Congress has struggled for the past year. Yesterday the President, House, and Senate leaders from parties spent much of the day in a nationally televised health care summit. This meeting identified areas of bipartisan agreement–many of which are already included in pending legislation. It also identified areas where future bipartisan agreement might be possible, such as malpractice reform. Yet the meeting also underscored the profound differences that separate the leadership of the two parties. Most notably, the President's proposal would cover 30 million people who would otherwise remain uninsured. The Congressional Budget office reports that Republican proposals would only expand coverage to 3 million.
We commend the President's pursuit of bipartisan solutions. Yet the summit made plain that it is now time to move decisively and quickly to enact comprehensive reform. We believe that the only workable process at this point is to use the President's proposal to finish the job. After long debate, the House and Senate have passed two similar bills that do crucial things to improve US health care. All that needs to happen, if Republicans insist on blocking final improvements, is for the House and Senate to make the required adjustments and to pass these bills by majority vote in both houses.
Given the likelihood of a filibuster, this legislation will likely require the majority-vote reconciliation process. Reconciliation has been used by both Democrats and Republicans to enact welfare reform, Reagan and Bush-era tax cuts, the state children's health insurance programs (SCHIP), and other key legislation. Reconciliation is an appropriate and justified mechanism to secure an up-or-down vote on this critical bill.
The President's proposal incorporates many of the best ideas proposed by Democrats and Republicans, patients, clinicians, and researchers. It combines and strengthens many elements of the House and Senate bills and repairs their deficits. It offers a strong foundation for comprehensive reform. Fully implemented, the President's proposal would:
• Cover more than 30 million people who would otherwise go uninsured.
• Provide financial help to make coverage affordable for millions of working families.
• Strengthen competition and oversight of private insurance through insurance exchanges and increased regulation of private insurers and their rates
• Provide unprecedented protection for Americans living with chronic illnesses and disabilities
• Make significant investments in community health centers, prevention, and wellness.
• Increase financial support to states to finance expanded Medicaid insurance coverage
• Eliminate the Medicare prescription drug “donut hole”
• Eliminate objectionable provisions such as special funds for Nebraska's Medicaid program
• Reduce the federal budget deficit over the next ten years and beyond.
• Provide a platform to improve the quality and economy of the health care system and to slow future growth of health expenditures.
We, the signatories of this letter, come from 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: After months of extensive debate, expert analysis, and the historic passage of House and Senate bills, it is time to pass a final bill. The President's proposal provides a foundation for finishing this work — and for future steps to build on this foundation..
It may be possible, as the President suggested, to incorporate proposals put forth by the Republican leadership. This proposal already incorporates many traditional Republican ideas for health reform, such as tax credits to help middle-income Americans pay for health care, organizing markets through health insurance exchanges, and creating a regulatory structure that allows insurers to sell coverage across state lines.
Time is short, however. If Republican leaders do not promptly offer constructive proposals in the context of comprehensive legislation that has already passed both the Senate and the House, Congress must move forward. It is time to act.
Sincerely,
Henry Aaron, Brookings Institution
Emily Abel, UCLA
Ronald Andersen, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia
Linda Bergthold, Independent Consultant and Health Policy Researcher
Linda Blumberg, Urban Institute
Peter Bourne, Health Policy Advisor, President Jimmy Carter
Richard Brown, UCLA
Anna Burger, Secretary-Treasurers, SEIU
Deborah Burnett, University of Chicago
Paul Cleary, Yale University
David Cutler, Harvard University
Stephen Davidson, Boston University
Linda Degutis, Yale University
Judith Feder, Georgetown University
Eric Feldman, University of Pennsylvania
Brian Flay, Oregon State University
Lawrence Gostin, Georgetown University
David Grande, University of Pennsylvania
Tim Greaney, Saint Louis University
Colleen Grogan, University of Chicago
Jonathan Gruber, MIT
Jacob Hacker, Yale University
Mark Hall, Wake Forest University
Helen Halpin, University of California, Berkeley
Bradley Herring, Johns Hopkins University
Diana W. Hilberman, UCLA
Jim House, University of Michigan
Jill Horwitz, University of Michigan
William Hsiao, Harvard University
John Jacobi, Seton Hall University
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University
Daniel Kahneman, Princeton University
Rosalie A. Kane, University of Minnesota
George Kaplan, University of Michigan
Jerome Karabel, University of California, Berkeley
Eleanor Kinney, Indiana University-Indianapolis
Mark Kleiman, UCLA
Gerald Kominski, UCLA
Karl Kronebusch, Baruch College, City University of New York
Paula Lantz, University of Michigan
Miriam Laugesen, Columbia University
Robert Leflar, University of Arkansas
Arleen A. Leibowitz. UCLA
Carol Mangione, UCLA
Willard Manning, University of Chicago
Wendy Mariner, Boston University
Ted Marmor, Boston University
Jerry Mashaw, Yale University
Timothy McBride, Washington University
Michael Millenson, Northwestern
Farideh Motamedi, USC
Fitzhugh Mullan, George Washington University
Jack Needleman, UCLA
Len Nichols, George Mason University
Jonathan Oberlander, University of North Carolina
Gilbert Omenn, University of Michigan
Alexander Ortega, UCLA
David Orentlicher, Indiana University-, Indianapolis
Kevin Outterson, Boston University
Frank A. Pasquale, Seton Hall University
Mark Peterson, UCLA
Phillip Pizzo, Stanford University
Harold Pollack, University of Chicago
Daniel Polsky, University of Pennsylvania
Ninez Ponce, UCLA
Marc Rodwin, Suffolk University
Victor Rodwin, New York University
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Jim Scott,, George Washington University School of Medicine and Health Sciences
Mark Schlesinger, Yale University
Steven Shortell, University of California, Berkeley
Theda Skocpol, Harvard University
Barbara Starfield, Johns Hopkins University
Paul Starr, Princeton University
Rosemary Stevens, Cornell University
Katherine Swartz, Harvard University
Donald H. Taylor, Jr., Duke University
William Terry, Brigham and Women's Hospital
James Toole, MBA Actuaries
James Tulsky, Duke University
Alexander Wagenaar, University of Florida
Rachel Werner, University of Pennsylvania
Celia Wcislo, SEIU
Joe White, Case Western University
Elizabeth Yano, UCLA
Fred Zimmerman, UCLA
(Titles and degrees omitted. Institutional affiliations for identification only)
President Obama's announcement yesterday began the final chapter in the 14-month war over health care reform. The decisive battle will obviously take place on the floor of Congress. But the most symbolically powerful battle may take place next week some miles from the Capitol, at the Ritz Carlton Hotel on the edge of Washington's tony Georgetown neighborhood.
That's where executives from America's health care industry will gather under the banner of AHIP (America's Health Insurance Plans) to plot – and then execute – a last-ditch attempt to defeat health insurance reform.
That's also where, on Tuesday, March 9th, thousands of demonstrators from Health Care for America Now (HCAN) and allied groups will mass to confront the insurance executives – and their attempts to effectively deny quality health care to millions of Americans.
The term “battle” is entirely appropriate. The insurance executives who run America's health insurance companies are, in fact, waging war on the American public. Their goal is the continued domination of the American health care system. They want to be able to continue to raise their rates more than three times faster than wages – and twice as fast as the underlying cost of health care – so they can continue to gorge themselves with record profits. They want to continue to siphon off the healthiest, wealthiest customers and deny access to insurance for anyone with a “pre-existing condition” or illness.
Just like all wars, their war on the American family costs tens of thousands of lives and untold suffering. Each year, the lack of health insurance costs 45,000 lives. In other words, each year we lose 80% as many Americas to insurance industry greed as died in the entire Vietnam War.
What's worse, these insurance executives don't get a first-hand look at the suffering and death that results from their policies, or their attempts to block reform. They manage their war from pristine office towers. They don't have to look into the eyes of a husband whose wife has just died of cancer that could have been cured if it were caught early – but went undetected because for financial reasons she had no insurance and kept putting off a routine check up.
They don't have to face the family who lost their home — and everything else — to bankruptcy because an uninsured medical emergency wiped out the fruits of decades of hard work.
They don't have to explain themselves to the millions of Americas who worry they are just one pink slip away from losing their insurance coverage and know that a spouse's history of cancer or heart disease or diabetes will prevent them from ever getting insurance again.
On next Tuesday, thousands of those Americans will demand to confront those executives in the lovely halls and conference rooms of the Ritz.
Like the mythical mobster Tony Soprano, the kids of these insurance executives think their parents have respectable jobs. In fact, just like Tony Soprano, they traffic in lives and suffering in order to make more and more money for themselves.
Time to rip off the patina of respectability.
Take people like Ed Hanway, the former CIGNA CEO who retired at the end of last year with a $73 million golden parachute – money he earned by denying coverage to people like Nataline Sarkisian. Nataline died in 2007, just before Christmas. She was 17. She died because CIGNA wouldn't pay for Nataline's liver transplant – even though she had health insurance.
The average transplant operation and hospital stay costs about $250,000. Ed Hanway's $73 million golden parachute would have bought 292 liver transplants. Nataline only needed one.
Or people like Wellpoint's CEO Angela Braly – who last year took down almost $10 million in compensation. Wellpoint's Anthem Blue Cross division just announced a 39% premium increase; it says it needs more money to meet its expenses – like Angela's $10 million salary. And by the way, Wellpoint's profits for the fourth quarter of 2009 skyrocketed to $2.7 billion – accomplished by actually providing health insurance to 185,000 fewer policy holders.
Or people like AHIP chief lobbyist, Karen Ignagni, who once worked to promote health care for average people at the AFL-CIO. She took her thirty pieces of silver and switched sides.
These people are coming to Washington to use their enormous economic power to prevent their fellow Americans from having secure, affordable health care. They cannot be allowed to succeed.
In fact, they should be greeted with the same enthusiasm with which we would greet the forces of an invading army. They should be met at National Airport and Union Station with signs declaring they are unwelcome in the nation's capital.
HCAN has sent letters asking the dozen speakers listed on their agenda to cancel their appearances. HCAN has demanded that these academics and consultants stop giving aid and comfort to the enemy – stop giving them the cover of respectability.
These insurance executives are not here to negotiate. They are not here to shape legislation. They are here to stop health care reform dead in its tracks. They will not be “convinced” to allow health care reform to pass the Congress. They must be defeated.
Robert Creamer is a long-time political organizer and strategist, and author of the recent book: “Stand Up Straight: How Progressives Can Win,” available on Amazon.com.