RIP Teddy

Whatever my opinion of Ted Kennedy's political history, I am saddened by this news. I have had a family member die of the same kind of cancer and know how terrible it must have been for him and his family. My heart goes out to them.

I think the best memorial we can offer to this man, respecting his political service and offering amends for any political follies, is to enact, in its own right and without any other riders, exceptions, additions and/or emendations, his Medicare for All Act.

Now.

Anglachel

Crossroads

It looks like the Spousal Unit's company is going to go with Kaiser Permanente and drop Blue Shield. Susie Madrak posted about being between a rock and a hard place (or, rather, a lack of insurance and a lack of payment options) on needed dental work. And Paul Krugman writes up the cynical "fuck you" from Blue Cross/Blue Shield in his latest column Blue Double Cross.

SU and Susie are examples of the reason why the current avaricious state of private health insurance and and beyond-dysfunctional state of health care delivery need to be uprooted and replaced with something that actually works. Krugman gets into what it takes to do so. First he points out the non-clothes of the insurance emperors by talking about a Blue Cross ad in the works (my emphasis throughout):

"We can do a lot better than a government-run health care system," says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.

The point of the scare tactics is to take choice off the table. Period. These companies do not want people to even have an option of not being screwed over. Then Krugman, rightly, puts the screws to Obama, pointing out what it will take to end the insurance industry's campaign of terror (my emphasis throughout):

Back during the Democratic primary campaign, Mr. Obama argued that the Clintons had failed in their 1993 attempt to reform health care because they had been insufficiently inclusive. He promised instead to gather all the stakeholders, including the insurance companies, around a “big table.” And that May 11 event was, of course, intended precisely to show this big-table strategy in action.

But what if interest groups showed up at the big table, then blocked reform? Back then, Mr. Obama assured voters that he would get tough: “If those insurance companies and drug companies start trying to run ads with Harry and Louise, I’ll run my own ads as president. I’ll get on television and say ‘Harry and Louise are lying.’ ”

The question now is whether he really meant it.

The medical-industrial complex has called the president’s bluff. It polished its image by showing up at the big table and promising cooperation, then promptly went back to doing all it can to block real change. The insurers and the drug companies are, in effect, betting that Mr. Obama will be afraid to call them out on their duplicity.

It's up to Mr. Obama to prove them wrong.

The problem here is not so much that we're dealing with the insurance industry, but that we have a political leader who does not believe in forcing choices onto people, and most especially not forcing them onto white collar corporate interests. I wrote about this in the context of health care and retirement savings almost exactly a year ago today, in my post Libertarian Paternalism, where I looked into the intellectual environment Obama lives in and where his philosophical inclinations lie. My key point has to do with having a certain conept of what politics and government is for:

The aspect of Obama's economic approach that had always bothered me was a curious absence of any philosophy of the state as a constructive force, coupled with a stance that focused on "choice" for the isolated and abstract individual of classic economic theory. In short, there is no theory of power.

Why does this matter? If your focus is on the abstract individual and structuring choices for the individual, then you are not addressing the larger environment in which the structuring takes place...

There is, if only in the negative, a theory of government in this approach, which is that there really isn't a role for it in people's lives if it results in a requirement rather than an option for individuals. From a liberal democratic viewpoint, the purpose of government is to regulate relations of power such that those who are disadvantaged in society are not simply exploited by those who are. Our civil rights are the foundation of this regulation, but it reaches into things like workplace safety, disease control and environmental protection. Individual choice is meaningful only if the individual has some say in how those choices are structured, enabled and defended...

Choice requires context, and it is the context that is wrong in Obama's economic proposals. As in health care, he appears more concerned with maintaining the illusion of choice than addressing the environment in which acceptable choices about insurance can occur. Cassidy asks a question I have asked myself in several ways: "But for what policy purposes are the masses to be mobilized?" Just what is the vision for the society and the nation that Obama intends to put into practice? There isn't one; it is fractured into small buckets of choices here and there, with neither a philosophy of governance nor a coherent plan for transforming the steaming pile left behind by the Republicans into a strong, liberal government.

The Democratic candidates' foundation of political economy is in Keynsianism for the simple reason that it works far better than any other approach when the overall well being of the society is the central concern of government. That the libertarian paternalists equate the Clean Air Act with totalitarian government is telling. They cannot accept that government is needed to counteract concentration of power to the detriment of the citizenry, and their conceit that they will be among the winners in an unregulated society is not a hypothesis the rest of us really want to test.

This is why, for all the specific proposals, Obama's economic policies simply do not convince anyone who actually wants things to change.

What Krugman is asking, what I have asked for over a year, what anyone who actually listened to what Obama said should have been asking, is whether Obama is capable of mobilizing the power of the state for the benefit of the citizens in a way that actually forces an unwelcome outcome onto an unwilling power player.

There is no vision of what the long-term role of the state should be in improving the lives of its citizens who are not lucky enough to be counted among the upper middle class winners of the four decade class war conducted by the Movement Conservaties against the nation. We have already had five months of pandering to the interests of the financial industry in lieu of real reform, complete with the media trashing of Elizabeth Warren for not agreeing that everything is for the best in the best of all possible economic worlds.

Obama is at the crossroads. The domestic political and economic circumstances are such that he can choose to be the President and use his political capital for something that will materially improve the lives of millions of people for generations, or he can be the Preznit and posture about his wonderful inclusive hopey-changey powers while millions more citizens are immiserated. I have said for more than a year that he will deliberately go with the easy path, the one so heavily traveled the last few decades, and side with the socio-economic winners.

Prove me wrong, Precious.

Anglachel

14%

That's the amount of increase in the Spousal Unit's Blue Shield of California health insurance premiums this time around. His doctor's medical group is no longer in the Blue Shield network. The monthly premium goes up but the amount of coverage goes down. The hospital deduction went from $200 per day to a few dollars short of $800. One week in the hospital jumped from $1400 to $5600 overnight.

Of course, that assumes you get admitted in the first place.

At a time when there is no inflation, when California is suffering massive unemployment, and when businesses of all sizes are struggling to stay open (we'll worry about solvency later), private health insurance is jacking up the prices by 14%. And that's after negotiations.

The Spousal Unit is a healthy guy, aside from his failing eyesight. His only health problem, a bad back, was cleared up years ago by some physical therapy and an ergonomic office chair.

We bought the chair ourselves because the company couldn't afford it. They do pay 100% of health insurance premiums. On the other hand, his last paycheck, which should have been deposited on the 15th, is sitting in his wallet waiting for when there is money in the bank. This is often the case for small businesses, even in the glamorous world of high-tech; the trade off for the smaller environment is a willingness to be flexible about when the paycheck goes in.

Of course, the paycheck would go in a lot sooner if it weren't for the price gouging of the health insurance industry.

As if knowing our personal news of the day, Mark Thoma of The Economist's View links to Robert Reich's latest article, The Health Care Cave-In:

The Health Care Cave-In, by Robert Reich: "Don't make the perfect the enemy of the better" is a favorite slogan in Washington because compromise is necessary to get anything done. But the way things are going with health care, a better admonition would be: "Don't give away the store."

Many experts have long agreed that a so-called "single-payer" plan is the ideal... Not surprisingly, insurance and drug companies have been dead-set against a single payer for years. And they've so frightened the public into thinking that "single payer" means loss of choice of doctor (that's wrong -- many single payer plans in other nations allow choices of medical deliverers) that politicians no longer even mention it.

On the campaign trail, Barack Obama pushed a compromise -- a universal health plan that would include a "public insurance option" resembling Medicare, which individual members of the public and their families could choose if they wished. This Medicare-like option would at least be able to negotiate low rates and impose some discipline on private insurers.

But now the Medicare-like option is being taken off the table. Insurance and drug companies have thrown their weight around the Senate. And, sadly, the White House -- eager to get a bill enacted in 2009 rather than risk it during the mid-term election year of 2010 -- is signaling it's open to other approaches. ...

It's still possible that the House could come up with a real Medicare-like public option and that Senate Dems could pass it under a reconciliation bill needing just 51 votes. But it won't happen without a great deal of pressure from the White House and the public. Big Pharma, Big Insurance, and the rest of Big Med are pushing hard in the opposite direction. And Democrats are now giving away the store. As things are now going, we'll end up with a universal health-care bill this year that politicians, including our President, will claim as a big step forward when it's really a step sideways.

Sideways? I could deal with sideways. How about backwards? I don't yet know what is going to happen to my health insurance premiums this round. I pay part of them and I will pay a larger part this year because of a 6% cut in payroll and benefits imposed on my company.

I wonder if more than 14% of the population is completely secure in their health insurance? Between falling wages, lagging employment and the-sky's-the-limit insurance costs, what portion of the population is not a pink slip - or a slip on the sidewalk - away from health care ruin?

Since he won't be able to keep his doctor anyway, the Spousal Unit is probably going to switch to Kaiser. He's lucky he has that option. I'm lucky I work for a company so short-staffed that they can't afford to let me go if I get sick. I'm also lucky my bout of flu last month didn't turn into pneumonia, something I'm at risk for due to a congenital lung deformity. We're lucky that we could probably cough up the extra cash if one of us became seriously ill.

Basic health care should not be a matter of luck.

Anglachel

PS - If you care about health care, throw some dollars at the indefatigable DC Blogger whose blog on Corrente is a must-read to know the sorry political state of affairs of health care.

Hillary on New Stimulus Boost

Hillary has sent a letter to Bush, Harry Reid, Robert Byrd and Daniel Inouye pushing them to act now and start new stimulus spending for Main Street and not sit on their butts for almost three months until the Golden Calf is installed at the White House for us all to worship. She prioritizes New York's stimulus needs, as is to be expected, but the letter is more general. She does her usual job of combining hard facts, common sense and political zingers for an enlightening read. A few highlights:

We are in a recession which demands decisive action. I believe that in order to stimulate this economy, we need to get people working, earning, and building – not just spending. We have borrowed hundreds of billions that have gone to banks and financial institutions and borrowed tens of billions more to energize the economy, yet the economic downturn has continued and the financial turmoil has worsened. What is clear is that any action we take – especially as we borrow more money to do so – must pay off in the near and long term. That is what America does best: we can address this crisis while preparing for our future.

However, we do have immediate needs that cannot wait between now and when the next Congress and the next President takes office. And although your Administration has voiced skepticism about the need for a stimulus bill, I believe that the current conditions call for a coordinated response now.

Good little zing about the Wall Street give away, though she's not too sharp as New York is a financial capital, and a delicious slap to Bush with"not just spending" as a solution to sustantail financial problems. zHer next paragraph, though clearly taking Bush to task, strikes me as aimed more at the current Senate leadership than at the lame duck in the White House. No, you can't just sit on your hands until after the Inauguration. You need to set expectations now and get the ball rolling.

Hillary then goes on and identifies specific programs - Unemployment Insurance, SNAP, Medicaid - that will immediately help her constituents who are facing jobs losses. She goes into some detail about Medicaid:

In the midst of one of the greatest fiscal crises to hit our states, an increase in the Medicaid FMAP rate would help prevent further and deeper cuts to health care and other essential services like education, child care and public safety. Rising demand for health insurance coverage through Medicaid due to increasing job loss is straining state budgets, and the federal government should act to help ease this growing burden on our states.

This is something that the Spousal Unit is very keen on, the Feds supplying the money for social service programs to ensure that the states to not rob Peter to pay Paul, or steal the kids' lunches to pay for their vaccinations. One of the biggest dangers of a protracted economic downturn is that states cut services to the weakest and must vulnerable parts of the population. A city park may endure a lawn brown from lack of water, but a child will not survive a winter with no food and no heat. Her mention of this is also an implicit criticism of the decision to deny her a formal leadership role in the crafting of health care policy and initiatives.

She goes on to discuss infrastructure investment, noting that this long term improvement "serves the dual purpose of modernizing our country’s deteriorating roads, bridges, and transit systems while stimulating the economy," and thus provides tangible benefit to the public, unlike throwing money at Wall Street, especially when the funds are disbursed without provisions for accountability. Hillary returns to a topic she has discussed for months, the mortgage crisis, and warns that there is more bad news waiting for us, but that we have the power to proactively address the problem:

The next wave of foreclosures looms, and we should address it immediately. It is critical that we modify unworkable mortgages into clear and stable terms if we are to prevent the bottom of the housing market from falling even further. I have proposed HOME, the Home Owners Mortgage Enterprise, based on the successful program enacted during the New Deal which not only saved one million homes but also turned a profit for the Treasury. We should continue focusing on initiatives large and bold enough to meet the scale of the challenges presented by the faltering housing market.

As I've said before, home prices have to come down in alignment with wages, so I disagree with Hillary about the bottom of the housing market falling even further. That must happen. I think she knows it (mostly because she's waaaay smarter than me) which is why she so consistently pushes the HOME program, which would purchase mortgages at cut rates from the toxic pool, rework them when possible by reducing principal and adjusting rates, and end up providing a controlled devaluation of the house market.

This stands in juxtaposition to the announcement just today from Fannie Mae and Freddy Mac (h/t, Calculated Risk, FHFA Modification Program Details), where they do not wish to reduce outstanding principal in order to make a loan be affordable (no more than 38% of gross income). The press release is contradictory in that the first answer in the Q&A section states "It may include a change to the product (an ARM to a fixed rate mortgage), interest rate, amortization term and maturity date, and/or unpaid principal balance," which would seem to indicate that reducing principal is an option, but the answer to the question about benchmark ratios does not include changes to an unpaid principal balance among its options, "Once the affordable payment is determined, there are several steps the servicer can take to create that payment – extending the term, reducing the interest rate, and forbearing interest." The key here is that a HOLC/HOME style program can easily perform this action because of taking the mortgage back from investors (who eat the loss, which is the downside of risk) and issuing a sustainable rather than a profitable loan.

In the midst of the general celebration and self-congratulation over the elections, Hillary reminds the power brokers and the pundits that ordinary people are hurting and delays are unacceptable. My own Congress Critters are heading in the right direction, but have said nothing since before the election on these matters. Sen. Feinstein did find time to issue a press release on the theme for the Inauguration, bless her heart.

Hillary's overall message is Think Big, which is just what the good professors Krugman, Roubini and Galbraith all advocate when addressing the financial meltdown, and to do it now.

There's some change I can believe in.

Anglachel

PS - I found that I kept writing "reduced principle" instead of "reduced principal" when discussing the GRE press release. I am fully confident that the Bush Treasury can reduce their principles without limit.

Opportunity Emperiled

Last February, I riffed on a Krugman column in my post It's the Missed Opportunities, Stupid. In it, I wrote about the difference between an election victory and taking advanatge of political opportunities:

What the campaign lacks, however, and why it cannot achieve what Bill Clinton did, is an unswerving dedication to bettering the lives of ordinary people. It is trading on the most shallow of all political impulses (Oh, please, stop arguing about stuff and making me feel uncomfortable! Stop with the partisan bickering! Won't somebody think of the children?) and deliberately sidesteps the tough work of coalition building. Saying that you will seek common ground with the right - who wants no such thing - builds no coalition to promote progressive causes. It just gets you an inside track with David Broder and the Blogger Boyz who all want to become the next Tim Russert. Getting a bunch of college students with free time to swarm caucuses is not building a coalition, either, btw. ...

Movement Conservatism has been thoroughly discredited by the Bush II administration, but that doesn't mean the liberal cause has an open road ahead of it. The radicals on the right are entrenched in government, they command popular media, and they have no compunction against using the most crude and visceral attacks they can conjure up to sway public opinion. To take back the nation, the Democrats are going to have to mount their own concerted attack, doing right by ordinary citizens and insisting on accountable, rational government. That means deploying effective policies despite the entrenched right wing hacks, appointing liberal judges, and getting significant legislation passed over determined opposition.

Today, I see two posts, one on Suburban Guerilla, one on Corrente, where the Obamacans are signaling as hard as possible that they have no intention of straying very far from the economic policies of the Bush crowd. From the link to Dick Polman on Suburban Guerilla:

But just because Americans want something different, that doesn’t mean the nation is trending leftward; indeed, as top Obama strategist David Axelrod remarked in Newsweek the other day, “I think right now people are in a pragmatic mood, not an ideological mood.” In other words, Obama is well-positioned to win not because of his liberal profile, but in spite of it.

This year, Obama - mindful that contemporary America is slightly right of center - has been talking up tax cuts, invoking God and traditional values, and voicing his determination to kill terrorists. Meanwhile, he sidesteps the traditional liberal issues. He tries not to utter the phrases gun control or gay marriage. He defends abortion rights when asked to do so, but stresses his desire to reduce the number of abortions. He defends capital punishment. And he steers clear of the liberal camp's concerns about post-9/11 government surveillance.

Obama's caution suggests that he is attuned to the dangers of overreaching, that he and Axelrod are keen not to mistake a solid win for a sweeping ideological agenda. Barring an unforeseeable landslide (60 percent of the popular vote, more than 400 electoral votes), victory would present Obama with an opportunity, not a mandate. Swing voters would be entrusting him to govern competently, using good ideas from both sides of the aisle. No longer would he be judged favorably in contrast to McCain or Bush; that's the easy part. Within a year or two, Obama (and the Democratic Congress) would be judged solely on the size of the gap between promise and performance.

Some liberal commentators, citing demographic trends, have long been predicting a major party realignment that would benefit the Democrats. For instance, Ruy Teixeira and John Judis contended 17 months ago that a new Democratic president, working with a Democratic Congress in 2009, would have the opportunity to lock in Democratic dominance for years to come, by enacting “popular landmark legislation. The passage of Social Security legislation (in 1935) helped keep New Deal Democrats in power for decades. The creation of an effective national health insurance program (in 2009), despite Republican opposition, might do the same for today’s Democrats.” But they cautioned that such an achievement would not be easy, since even Democrats would “have difficulty agreeing among themselves on new, large government programs that may require higher taxes.”

Nothing new. No "over-reaching". Nothing daring or visionary. Just a rewarmed, cautious, bland version of the worst of the watered down policies Bill Clinton was trying to get past the Republican controlled Congress in 1999, but actively seeking out Republican approval desoite having a legislative majority. This is not the stance of someone who sees an opportunity, such as the ability to get UHC passed (craft it in 2008 & 2009, use it to sell electoral gains in 2010) , but someone who intends to follow The Village's lead and be an ever so Serious Person. Look at the Villager spin in the sentence "mindful that contemporary America is slightly right of center". Uh, NO, there is no proof of that. There is plenty of proof that the High Borderists occupy that political landscape, but rank and file voters want some good old fashioned FDR New Deal kinds of deals - starting with mortgage relief and guaranteed health insurance.

Then, on Corrente, Lambert takes on a deeply dishonest op-ed by Robert Rubin that tries to lay the ground work for undermining and dissolving Social Security. Lambert notes the presence of code words for Social Security and the absense of anything hinting at UHC:

What problem is Rubin solving here, exactly?

Every child among us knows that “individualized account” is focus-grouped code for the Village’s dream of gutting Social Security and latching onto a new revenue stream from the commissions on the individual accounts. And gawd knows Wall Street needs a new revenue stream.

How, at this point is anything private going to provide more “security” than Social Security? It won’t.

And the dog that didn’t bark in the Op-Ed?

Health care.

Rubin’s completely silent about it, when Medicare is in real trouble, unlike Social Security, and we can’t afford not to go to single payer

So, as usual with finance guys like Paulson, Rubin, et al, it’s all about the fees. Not us.
Oh, and the last paragraph is priceless:

We have no choice but to move beyond such false dichotomies and toward a balanced pragmatism whose goal is broadly shared prosperity and increased economic security.

See? No shock at all. You won’t feel a thing. It’s balanced pragmatism. With a big fat infestment banker’s thumb right on the scales.

NOTE Rubin’s sketchy scheme is not a carve out or a clawback, where Social Security revenues are diverted to individual accounts; that’s why he says “appropriate revenue measures. Rather, like Medicare Part D, it’s a private system in parallel to a public one. That undermines the social contract behind the system ...

UPDATE The increasingly valuable James Galbraith called his shot on this one back in 2006. In The Guardian, of course:

Rubin is the leading light of an initiative called The Hamilton Project
…
Deficit-fetishism also underscores and bolsters a long standing insider campaign to cut and partially privatize the Social Security System. The Hamilton Project strategy document doesn’t mention Social Security by name. But it is riddled with codewords about the “long term entitlement problem” which, it avers, can only be solved by a “bipartisan commission” acting on well-known options, behind closed doors.

The Hamilton Project’s promise to deal with these issues by “bi-partisan consensus” behind closed doors is a promise to exclude the voices of labour, the elderly, the poor, and loudmouths like me. I will resist. The correct policy toward Social Security is, and remains, what the late Robert Eisner always recommended: leave it alone.

There you go. Unity has to be good for something.

This is the combination of policy timidity and vagueness combined with overt contempt for the lower economic (and cultural) classes that has plagued The Precious since day one.

The Spousal Unit and me were talking this over on our way to Costco today (yes, we really do have conversations like this while out shopping), and SU said he thinks that while this is the desire of the Obamacan Unity Democrats, to be the ruling party of The Villagers, that events may be in the saddle because of the severity of the economic crisis, and they may not have a choice about taking advantage of the "opportunities" that total systemic collapse drops in their lap. I am not as optomistic.

What I do know is that the Unity Democrats are moving solidly away from the traditional base of the party and shedding even the pretense of defending liberal causes and institutions.

And they haven't even moved into the trashed frat house yet.

Anglachel

Girls Have Cooties

The NYT has a front page article, Women Buying Health Policies Pay a Penalty, on the significantly higher premiums private health insurance carriers charge woman. It appears that trying to remain healthy is a reason to charge higher premiums because the users "consume" more of the "product".

Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers.

Some insurance executives expressed surprise at the size and prevalence of the disparities, which can make a woman’s insurance cost hundreds of dollars a year more than a man’s. Women’s advocacy groups have raised concerns about the differences, and members of Congress have begun to question the justification for them. ...

In general, insurers say, they charge women more than men of the same age because claims experience shows that women use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy group that has examined hundreds of individual policies, said: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

The women most likely to be purchasing individual health care are those least likely to be employed and/or married to someone who has employer based health care. The women most likely to have lower household incomes and greater health risks due to the demands of work (possibly needing to do two jobs, leaving little time for self-care) and the structure of food pricing, where the least nutritious is the cheapest. This group of women is also likely to have dependents who are also significant "consumers" of health care.

One of my first thoughts was childbirth and attendant medical complications were factored into the premiums. After seeing what a friend of mine went through to have an "uncomplicated" ceasarian, I can see there would be some significant expenses involved. But that's not necessarily the case:

Insurers say they have a sound reason for charging different premiums: Women ages 19 to 55 tend to cost more than men because they typically use more health care, especially in the childbearing years.

But women still pay more than men for insurance that does not cover maternity care. In the individual market, maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.

Crystal D. Kilpatrick, a healthy 33-year-old real estate agent in Austin, Tex., said: “I’ve delayed having a baby because my insurance policy does not cover maternity care. If I have a baby, I’ll have to pay at least $8,000 out of pocket.”

So, it's not because the dames are popping out sproglets. That would be an additional expense. The "but you might get pregnant" argument is the same as what was used for years to deny access to education and good paying jobs. Your biology isn't male, thus, we're going to charge you. How big are these disparities?

Humana, for example, says its Portrait plan offers “ideal coverage for people who want benefits like those provided by big employers.” For a Portrait plan with a $2,500 deductible, a 30-year-old woman pays 31 percent more than a man of the same age in Denver or Chicago and 32 percent more in Tallahassee, Fla.

In Columbus, Ohio, a 30-year-old woman pays 49 percent more than a man of the same age for Anthem’s Blue Access Economy plan. The woman’s monthly premium is $92.87, while a man pays $62.30. At age 40, the gap is somewhat smaller, with Anthem charging women 38 percent more than men for that policy. ...

Thomas T. Noland Jr., a senior vice president of Humana, said: “Premiums for our individual health insurance plans reflect claims experience — the use of medical services — which varies by gender and age. Females use more medical services than males, and this difference is most pronounced in young adults.”

In addition, Mr. Noland said, “Bearing children increases other health risks later in life, such as urinary incontinence, which may require treatment with medication or surgery.” ...

In Iowa, a 30-year-old woman pays $49 a month more than a man of the same age for one of Wellmark’s Select Enhanced plans. Her premium, at $151, is 48 percent higher than the man’s.

So, women and men engage in sex, but women get pregnant and might have complications. That men, statistically more likely to have more partners, are at a higher level of risk for STDs and (since they are less likely to seek treatment) are more likely to suffer the long term effects of a disease like herpes and to spread that disease to other partners doesn't come up. Can we also talk about the propensity for male "young adults" to engage in risky behavior and end up requiring extremely expensive treatment for injuries? A friend of mine is recently out of ICU because of bashing in his own skull in a fall while trying to skateboard while drunk, for example. Are these accidents being factored in to male insurance premiums? Is it really the case that a woman is 48% more expensive to insure, or is it that the insurers know that men don't use medical services enough to make any money off them?

At the same time as women are being charged more because of they might get pregnant and they might make more use of the doctor, the fundamentalists are trying to remove access to effective birth control (in part by trying to force states to drop requirements that birth control be covered by insurance) and discourage use of health care that is aimed at reproductive health, such as pap smears, vaccines and and non-hormonal birth control, especially if provided by clinics that also provide abortion services. Where are the men of the Left in this battle?

Then there is the argument of health care over time. Women use health care earlier in their lives when it will pay out greater benefits in long term health. Men do not. The article did not offer a comparison of health care consumption after 40. Are men actually costing more long-term? The actuarial people warn against sharing the risk:

Cecil D. Bykerk, president of the Society of Actuaries, a professional organization, said that if male and female premiums were equalized, women would pay less but “rates for men would go up.”

Mr. Bykerk, a former executive vice president of Mutual of Omaha, said, “If maternity care is included as a benefit, it drives up rates for everybody, making the whole policy less affordable.”

Um, wouldn't it make the whole policy more affordable to the people most likely to need the health care? Instead of women, and the most vulnerable groups of women, having to bear a premium for the ordinary health needs of life, why don't we spread it around and make it a little more expensive here but a lot less expensive there? In short, why don't we use insurance the way it is supposed to be used, to reduce cost by recognizing the social benefits as well as the individual risks? Some people have their heads on straight:

Mila Kofman, the insurance superintendent in Maine, said: “There’s a strong public policy reason to prohibit gender-based rates. Only women can bear children. There’s an expense to that. But having babies benefits communities and society as a whole. Women should not have to bear the entire expense.”

The cost of poor maternal health as a whole is greater than just the considerable burden on the mother and her children. Of course, one answer I hear even on the Left is that women who can't take care of themselves (i.e., cannot afford health insurance plus the maternity rider) have no business bearing children anyhow. And they shouldn't expect to have contraception to save them, either. They can just keep their knees together and stop being such welfare queens and trailer park trash. Besides, the world is overpopulated and we don't need more people who are just going to reproduce their pathological culture as well as extraneous children.

Hmm, what's familiar about that picture? If you view women primarily as breeders, and then you divide them into the well mannered breeders who limit their reproduction and deserve to be treated like men and the undeserving breeders who have babies to stay on welfare or who are just sluts who fuck until they "have" to get married, well, you don't really have to look at the social benefit that accrues to men whose medical needs are no less than women's, but which follow a different pattern.

There is something profoundly wrong treating human reproduction as a disease peculiar to women.

Anglachel

Hillary on Healthcare

Statement of Senator Hillary Rodham Clinton on Report Finding Health Care Premiums in New York Rising Much Faster than Earnings

WASHINGTON, DC – Senator Hillary Rodham Clinton made the following statement after the release of a new report by the consumer health organization Families USA comparing increases in health care premiums and earnings in New York.

“The findings of this new report underscore the urgent need to reform our health care system. Over the eight years of the Bush Administration, New Yorkers have seen their health insurance premiums rise more than seven times as fast as their earnings. Across our country premiums are outstripping earnings, but New York has been particularly hard hit, with premiums rising more than 80 percent while earnings only increased by 11 percent. Workers in New York, especially employees of small businesses, are facing higher deductibles and receiving fewer benefits. In short, New Yorkers are paying more for less. Health care costs are consuming a larger and larger portion of family budgets at a time when so many New Yorkers are struggling to put food on the table and put gas in their tanks and the credit crisis threatens our entire economy. And even as health care costs have soared, so have the ranks of the uninsured. More than 2.5 million New Yorkers under age 65, about 15.4 percent, are now without health insurance. These are not just statistics. These are real people facing real and mounting challenges. It is now clearer than ever that we urgently need major reforms to reduce health care costs and ensure quality, affordable care for every single American. We cannot afford to continue down the path of the last eight years. I will continue fighting for this goal until we have the health care system that Americans deserve.”

On my agenda: universal health care, privacy rights, reversing declining incomes for middle income and lower wage earners, and battling misogyny.

Anglachel

Privacy Rights and Equal Treatment

Not only is Hillary on top of the financial crisis, she is front and center on defending our right to privacy and equal treatment before the law.

Hillary and Cecile Richards, president of Planned Parenthood, have an op-ed in the NYT today, Blocking Care for Women. It is a short peice, so please click through and read it all. For me, the key paragraphs are these:

The rule would also allow providers to refuse to participate in unspecified “other medical procedures” that contradict their religious beliefs or moral convictions. This, too, could be interpreted as a free pass to deny access to contraception.

Many circumstances unrelated to reproductive health could also fall under the umbrella of “other medical procedures.” Could physicians object to helping patients whose sexual orientation they find objectionable? Could a receptionist refuse to book an appointment for an H.I.V. test? What about an emergency room doctor who wishes to deny emergency contraception to a rape victim? Or a pharmacist who prefers not to refill a birth control prescription?

The Bush administration argues that the rule is designed to protect a provider’s conscience. But where are the protections for patients?

It is not just abortion. That is the wedge. It is having a right to receive all medical care available and not have procedures, medications and options preemptively withheld because someone else decides that A) it is their business to investigate your medical history and B) it is their right to infantalize you and substitute their desires for yours. This is another reason why UHC is vitally important - it empowers the person seeking treatment to be able to abandon medical providers who seek to coerce or punish.

I've argued before that the crucial civil right missing from the Constitution is an explicit right to privacy. The attack on Roe, and before Roe on Griswold, coming from the Right has precious little to do with moral questions. On the part of the foot soldiers, it has to do with removing one of the most important powers a woman has in modern society, which is to be in control of her pregnancies. It's part and parcel of the misogyny we've seen on parade for the last year. Among the power brokers, who probably do want to control the fertility of the women around them, the true issue is preventing people from claiming privacy against the intrusion of institutions, corporations and the state.

When medical providers are exempted from providing medical services based upon their opinion of what is acceptable, moral, appropriate, etc., then they are given a material, legally defensible property claim on your body, if only to exclude your physical form from being treated equally with other forms. The power to prohibit is the flipside of the power to compel, and both are coersive.

The Democrats cannot fight a battle for privacy rights solely on defense of specific procedures. The Republicans have shown that they will reduce and restrict any procedure, from abortion to contraception to simply receiving full information, until there is nothing left. It has to be done on broader grounds, not restricted to a subset of women's health procedures, and with the clear understanding that the overarching goal is privacy for the individual citizen.

Anglachel

Turn Tables

I'm working on the party post which is proving difficult to pull together, so I thought I'd toss out something I said to the spousal unit while we were making dinner.

The problem with the Obamacan response to Palin is that it did nothing to bring the debate back to Democratic friendly ground. It wallowed in cultural class resentment. A more sophisticated response would have been personally sweet-as-pie to the entire Palin family while blasting holes in the Republican platform. Something like:

Bristol is expecting? Our best wishes for a healthy pregnancy and a safe delivery. By the way, how does Ms. Palin get her health insurance? Through her mother's coverage? That should be good coverage, considering all the great care Gov. Plain must have received while carrying a special needs child. What are the Republicans doing to ensure that all American mothers-to-be get the prenatal care they need? What is their stand on health insurance for all just as good as what Gov. Palin can provide to her family?

Oh, Ms. Palin is getting married to her child's father? Our congratulations to the young couple for their upcoming nuptials and bundle of joy. Being a young couple starting a new family is a very scary proposition in these bad economic times. What can Republicans offer young families trying to get established in careers, buy a house, start their family, and so forth? Aren't young couples facing reduced prospects compared to their parents? Reduced funding for education, a deregulated market that allowed insane toxic mortages to be made, reduced job opportunities for blue and pink collar workers, especially those new to the labor market. The Republicans have ruined a previously strong economy, and this hurts young families.

And after Ms. Palin has her baby, will she be continuing her education? Will she be employed outside the home? These are crucial needs that young families struggle to fill. Child care, women completing college degrees, flexible workplaces, paternal as well as maternal leaves - these are all things that can mean the difference between a comfortable life and a struggle to put food on the table. Just what are the Republican plans to provide these goods and services?

Lather, rinse, repeat. It's really not that hard to be both nice and politically tough. Of course, it's a lot easier to do if you actually defended women's rights, UHC, strengthening education, expanding workplace programs to be family friendly, subsidizing child care and so forth.

If you run on a platform of vague and generically liberal propositions, you rob yourself of tools to use to your advantage when specific situations arise.

Anglachel