Written by Martha Koester   

t least according to the cheerleaders for the Pelosi health care bill. They are perfectly right of course, in insisting that there are some things in this bill that are worth having. I just don't get the insistence that these things absolutely have to be tied to the forced purchase of a garbage product from private insurance thieves. It is exactly like insisting that expensive perfume MUST be dumped into a pile of used kitty litter instead of being kept in its own bottle. Or that you absolutely have to eat a poison ivy salad just because it's dressed with expensive balsamic vinegar.

Why not try to save only what's worth saving instead? I've read the numbered highlights that Pelosi put out, and have the following suggestions. (I've noticed that neither Pelosi nor any of the people hyping this press release have said a single thing about mandates, nor about the public option being more expensive and available to only 10%. I’m sure they are hoping that no one notices.)

Put all the useful parts of Medicare reform into one separate bill.
Include with 6-8 the Dicks/Inslee bill (Cantwell in the Senate) changing reimbursement to end the penalty against states which provide better results with less money now.
6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.


1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

Throw the above on the burn pile and start over. This is an area where incrementalism is witless. Pass one piece of legislation abolishing the entire donut hole starting now. And negotiate bulk prices with pharmaceutical companies while you are at it.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

Burn pile. A useless overpriced abortion, given that it would probably be like what high risk pools at the state level are now. Just let high risk people into Medicare early like we do with disabled people. Put the subsidy money into Medicare to take care of the extra expense.

Private insurance consumer reform bill. Another separate bill with 3, 4, 5 and 10
3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for benefits, except in the case of fraud.

5. INCREASE DEPENDENT AGE FOR POLICIES THROUGH AGE 26: Allows those through age 26 not otherwise covered to remain on their parents’ policies at their parents’ discretion

10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.


9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

Burn pile-- useless tripe, not unlike Conyers' sternly worded letters to Rove et al chastising them for refusing to answer subpoenas. If we have to work through private insurance, just cut the crap and regulate what they can charge and what they must cover like every other civilized country with privately insured universal care does.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

Burn pile. Useless to retirees with no access to such benefits. Put the $10 billion into Medicare, and allow retirees in this age group to join, as Senator Rockefeller has already proposed. Direct benefits to retirees should trump benefits to employers.

Each of the following could be separate bills.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

A note to single payer advocates

There is a really big constituency of partisan Dems out there who desperately want any bill at all so that Obama and the Dems don't look foolish after all the health care uproar. As a result, they have thrown away all capacity for logical analysis. We MUST come up with some bills that could pass, benefit at least some, and not permanently entrench murderers and thieves in power over us. Please use the above as a starting point for laying out some possibilities. Let's start with contacting members of the Progressive Caucus. Not suggesting that we quit on the Kucinich or Weiner amendments; just that we think ahead more.

There are also a lot of microconstituencies like parents of uninsured 20-somethings, affluent people who are now uninsurable and could afford outrageous premiums, etc, that will benefit from one provision in the existing legislation. It is tactically stupid to insist that Chanel #5 is bad and that they don't really want any. Better to point out that they have more productive uses for it than pouring it all over a pile of steaming cat shit.