Saturday, June 20, 2009

Editorial A Public Health Plan NY TIMES

As the debate on health care reform unfolds, no issue has caused such partisan rancor — and spawned such misleading rhetoric — as whether to create a new public insurance plan to compete with private plans.

The nation already has several huge public plans, including Medicare for the elderly (once reviled by conservatives, it is now only short of the flag in its popularity) and Medicaid for the poor.

Now the issue is whether to establish a new public plan to encourage more competition among health insurers and provide Americans with an alternative.

Most Democrats and some Republicans have already accepted the need to create one or more health insurance exchanges where individuals without group coverage and possibly small businesses could buy insurance policies. Some proponents hope that big businesses could enroll their workers as well.

An exchange would give the government (federal or state) a lot more power over insurers that choose to participate in order to tap a vast new market of previously uninsured people. It would determine the range of benefits that all participating plans would have to offer. It would presumably require those plans to accept all applicants, regardless of “pre-existing conditions.”

What Republicans are adamantly opposed to is the idea of adding a public plan to that exchange. They portray it as a “government takeover” of the health care system, or even as socialized medicine. Those are egregious mischaracterizations.

There is no serious consideration in Congress of a single-payer governmental program that would enroll virtually everyone. Nor is there any talk of extending the veterans health care system, a stellar example of “socialized medicine,” to the general public.

The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we.

A public plan would have lower administrative expenses than private plans, no need to generate big profits, and stronger bargaining power to obtain discounts from providers. That should enable it to charge lower premiums than many private plans.

It would also provide an alternative for individuals who either can’t get adequate insurance from private insurers or don’t trust the private insurance industry to treat them fairly. And it could serve as a yardstick for comparing the performance of private plans and for testing innovative coverage schemes.

Unfortunately, many Senate Democrats are so desperate to find a political compromise with Republicans — or so bullied by the rhetoric — that they are in danger of gravely weakening a public plan, or eliminating it entirely. That would be a mistake.

Here is a look at the main proposals now under consideration:

THE MOST ROBUST This approach, favored by many analysts, would allow the new public plan to piggy-back on the rate-setting powers of Medicare. As a result, it is the one most feared by Republicans, the insurance industry and doctors and hospitals. Any doctors who wanted to participate in Medicare, as virtually all do, would also have to participate in this plan and would have to accept the same payment rates as Medicare provides.

With lower costs, it would be cheaper for consumers, charging its members premiums as much as 20 to 30 percent lower than premiums for comparable private coverage, a boon to hard-pressed families.

It would also shave hundreds of billions of dollars from the amount needed to cover the uninsured — a crucial advantage as Congress scrambles to finance the reform effort.

The risk is that if this plan, given its power, were too stingy, it might drive some financially stressed hospitals into bankruptcy. The hope is that the downward pressure on reimbursements might force them to innovate and find big savings.

Republicans and private insurers fear, with some reason, that such an inexpensive public plan would entice or drive tens of millions of Americans away from private insurance, especially if big employers were allowed to enroll their workers in an exchange. The challenge is to craft rules to discourage employers from simply dropping their own subsidies entirely.

The prospect of competing with a government plan terrifies the private insurers. But in our judgment, if that many Americans were to decide that such a plan is a better deal for them and their families, that would be a good thing. Innovative private plans that already deliver better services at lower costs would survive. Inefficient private plans would wither.

In an effort to address some of these fears, Senator Jay Rockefeller has introduced a bill that would use Medicare provider payment rates for only the first two years and let doctors opt out after three years while remaining in Medicare. That would get the new public plan off to a good start, after which it would compete on its own.

LIGHTER VERSIONS Other proposals are circulating that would level the playing field with private plans. They would require the public plan to hold the same reserves as private plans and sustain itself from premium income without drawing on the federal treasury. It would probably pay providers higher rates than Medicare but lower rates than most private plans. Its administrative costs would be far lower, allowing it to offer lower premiums. These more modest versions could be worth having, but they would save individuals and the health care system far less money.

STATE-BASED PLANS A bipartisan group, led by three former Senate leaders — Republicans Bob Dole and Howard Baker and Democrat Tom Daschle — has proposed leaving it to states to create public plans if they wish. The federal government would be able to step in after five years if a state has failed to establish an exchange with affordable insurance options. That looks like a formula for delay and inaction.

COOPERATIVES Propelled by a belief that no public plan could survive a Republican filibuster, Senator Kent Conrad, Democrat of North Dakota, has proposed instead setting up private nonprofit cooperatives — run for the benefit of their members rather than stockholders — to compete with profit making insurance plans.

The presumed advantage of this approach is that cooperatives might be able to charge lower premiums because they would not have to earn large profits. Their performance, too, would be a yardstick against which to measure whether profit making plans are charging fair premiums.

Health care cooperatives have existed at the local or regional level for decades in this country. Many have gone belly up. A few still provide high quality care at reasonable prices. Given sufficient size, seed money and negotiating power, a cooperative organization could help transform the health care system. But Republicans seem unlikely to accept a strong national organization, so creation of cooperatives is apt to be local and spotty. They would be unlikely to deliver as much savings as a large public plan.

TIGHT REGULATION Right from the start of the debate, some experts have suggested that much tighter regulation of the new insurance exchange could achieve many of the goals of a public plan.

Regulators could insist that insurers not exclude people with pre-existing conditions or charge them higher premiums. The exchange could offer customers a menu of private plans and be modeled on the federal program that serves Congress and other government personnel. Several European countries, including Germany, provide better health care at lower cost than the United States without relying on a public plan. And the near-universal coverage in Massachusetts was achieved without a public plan option.

We continue to believe that a public plan would be desirable. Surveys by the Commonwealth Fund have found that Medicare beneficiaries report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher satisfaction with their coverage than do workers insured by private employers.

If Senate Republicans block a public plan, much tighter regulation will be essential to guarantee affordable private coverage for millions of Americans.

Media Matters weekly update.

The jagged little pill that is health care coverage

Rush Limbaugh believes that there is no health care crisis in America. And he's not alone. With the right wing's relentless onslaught against any attempt to reform health care in America just getting started, the need for honest reporting on the issue is greater than ever. (David Goodfriend's honest comments on CNBC were refreshing, but unfortunately, they represent the exception, not the rule.)

This week, the Congressional Budget Office released a partial analysis of the Senate health committee's draft health care reform bill. And immediately, Glenn Beck, Sean Hannity, David Brooks, USA Today, The New York Times, and ABC's Jake Tapper all misinterpreted its findings, claiming that the legislation would cost a trillion dollars while still leaving nearly 40 million Americans uninsured. When House Majority Leader John Boehner advanced similar fallacies on The Situation Room, he wasn't challenged by Wolf Blitzer.

CBO Director Douglas W. Elmendorf actually explained his agency's findings in a letter to Sen. Ted Kennedy. He wrote that those considering the analysis should know that "[t]he draft legislation released by the HELP [Health, Education, Labor and Pensions] Committee ... indicates that certain features may be added at a later date." Furthermore, the draft legislation evaluated didn't include "a 'public health insurance option' and requirements for 'shared responsibility' by employers. Depending on their details, such provisions could ... have substantial effects on our analysis." In other words, withhold final judgment, because that's what we are doing. But that's not what was done in the press. At least Robert Reich was paying attention.

The other piece of health care news making the rounds this week involved President Obama's speech to the American Medical Association. A bit of background: While the AMA is a powerful lobbying force for the medical industry, it claims only 29 percent of America's doctors as members. Despite this, NBC's Savannah Guthrie and CNN's Kitty Pilgrim both claimed that it represents "the nation's doctors."

It should also be noted that the press often ignores the group's sponsorship by the pharmaceutical industry.

While usually opposing changes to the status quo (the AMA opposed the creation of Medicare in the 1960s, for example), the organization has signaled a willingness to consider a public health insurance option. But in two separate articles this week, Sheryl Gay Stolberg, Robert Pear, and Jackie Calmes of The New York Times continued to report that the group is resolutely against such an idea, repeating an omission from the previous week. The aforementioned errors -- overstating the degree to which the AMA speaks for doctors and ignoring its corporate sponsorship -- were also in effect.

Following the pattern, The Washington Post's Ceci Connolly described the AMA as being "the nation's largest physician group" without noting that there are 800,000 doctors in America or that the AMA gets at least 20 percent of its budget from drug companies.

With everything Frank Luntz is doing to undermine health care reform in America, the last thing the public needs is more misinformation on the issue.

Other major stories this week:

Media just can't get it right on Obama, economic polling (MOE +/- 0%)

Five months into his tenure, Obama and his administration remain broadly popular. But in an attempt to generate drama, multiple news organizations interpreted new polling data this week on the economy in the most negative light possible.

ABC's The Note -- yet another liberal product of the "All Barack Channel" -- cited a New York Times/CBS News poll noting that 57 percent of the public had a favorable view of the Democratic Party, as opposed to only 28 percent who thought well of the Republicans. The Note's Rick Klein spun that unambiguous outcome thusly: "The new polls have little good news for Republicans -- unless you count worrisome news for the president as good news for his opponents." Most administrations wouldn't consider support from nearly six in 10 Americans as "worrisome news," but Klein apparently does.

Klein summarized his analysis by writing, "Either something or somebody gets dragged down when a popular president pushes unpopular policies." It was a sentiment echoed by The New York Times, which managed to misrepresent its own survey. The Times article on the poll said, "A majority of people said his [Obama's] policies have had either no effect yet on improving the economy or had made it worse." But omitted from the story were several important numbers; among them, the 57 percent of the public that approved of Obama's handling of the economy and the 32 percent who felt that his policies had improved the country's economic condition -- more than twice the number of those who thought they had hurt it. Forty-eight percent of respondents believed that so far, no effect had been felt. The Times grouped that number with the 15 percent who thought Obama's policies had hurt the economy in order to produce the supposed "majority."

Over at Congressional Quarterly, an article on the same poll (and an NBC News/Wall Street Journal poll) headlined "Honeymoon Over: It's on Obama's Watch Now" commented that while Obama had once enjoyed "a grace period when the public saw the nation's problems as ones he inherited," there was now "public concern ... over the size of the deficit."

It isn't wrong to note that people are concerned about budget deficits. But the article ignored yet another key finding from the NBC/Journal poll: that 6 percent of the public currently blames Obama for the budget situation, while 46 percent blame President Bush. That might not be something worth reporting for Sean Hannity, but it should be for a CQ journalist.

Speaking of deficits, conservative commentators have, of course, used much ink and airtime to attack Obama on that and other economic issues. Media coverage has, by and large, given them free rein to do so, in the process helping to promote the idea that neither the public nor responsible economic commentators will tolerate increased deficits. This was the narrative advanced by the Journal, NBC's Nightly News, the CBS Evening News, and the Times this week.

While a majority of the public does want the administration focused on deficit reduction (52 percent in the Times/CBS poll, 58 percent in the NBC/Journal poll), the reports, being so eager to portray the tide of opinion as turning against Obama, failed to note that prominent economists have disagreed with the idea that reducing the deficit should be the administration's most important priority at the current time, Nobel Prize winner Paul Krugman and Moody's chief economist Mark Zandi among them.

Hey, Fox News. Jealous much?

So, what happened when ABC News announced plans to broadcast a June 24 prime-time special called "Questions for the President: Prescription for America," a town hall meeting on health care reform with Obama, from the White House? Fox News and media conservatives went absolutely nuts.

That's right: To say that Fox News hosts and guests have been critical of ABC News would be putting it mildly. One host, for example, agreed with a Republican National Committee complaint that ABC's special "will become a glorified infomercial" for the Obama administration. But in expressing concerns about the ABC News broadcast, those on Fox News did not make any attempt to distinguish -- or even mention -- the extraordinary access Fox News had to Bush, Vice President Dick Cheney and other high-ranking administration during the Bush years -- using those opportunities to lob softball questions and provide an uncritical platform for administration talking points -- from the ABC event.

In a flashback of sorts, Media Matters for America noted that just last year, Fox News was boasting about its "unprecedented" access to the Bush White House. Who could forget their moving "George W. Bush: Fighting to the Finish" tribute?

Some Fox News hosts and guests have also suggested a "conflict of interest," pointing to the fact that former ABC News correspondent Linda Douglass is now communications director of the Department of Health and Human Services' Office of Health Reform. Again, Fox News' concern over the ABC News special is noteworthy given Fox's history. In 2006, Tony Snow, then a Fox News anchor and radio host, left Fox to serve as Bush's White House press secretary.

One highlight of Fox's weeklong whine-fest was how hosts and guests attempted to explain away their own network's rightward tilt. On Special Report, Charles Krauthammer actually acknowledged that Fox News is the "voice of opposition in the media," while Fox & Friends co-host Steve Doocy laid it on rather thick, saying that "here at Fox we still do journalism" and that "when you watch the other channels ... you don't hear a lot of the criticism."

Perhaps Eric Boehlert, a senior fellow here at Media Matters, said it best appearing on Fox News when he said: "I think conservatives are confusing being in the minority with being victims of liberal bias."

Walpin: They'll turn this into a scandal or die trying

Since Gerald Walpin was fired from his position as inspector general at the Corporation for National and Community Service last week, conservatives and Fox News hosts have claimed that he was removed for investigating an Obama ally. The White House has since provided a list of reasons for Walpin's termination, including but not limited to the corporation board's concerns over Walpin's behavior and conduct, as well as a complaint filed by acting U.S. attorney for the Eastern District of California Lawrence G. Brown regarding Walpin's actions during his investigation into the misuse of AmeriCorps grants given to a nonprofit organization in Sacramento, California.

Fox & Friends aired on-screen text this week asserting as fact the claim -- disputed by the Obama administration -- that Walpin was "fired for protecting taxpayers." Other graphics that aired throughout the report asked whether Walpin was "dismissed for doing his job" and if there was a "cover-up at AmeriCorps."

As has become standard operating procedure, Fox's Glenn Beck took things to the absurd, stating that Walpin was dismissed because he "wouldn't sit in the last row of seats; he wouldn't get up from the counter." Get it? Walpin's firing equals the struggle for civil rights.

Walpin attempted to mount a defense this week by taking to the conservative airwaves with appearances on Glenn Beck and Fox & Friends as well as Laura Ingraham's radio program. In each of his appearances, hosts failed to note or ask Walpin about Brown's allegations. Specifically, that Walpin and his staff "did not include" or "disclose" relevant information regarding the case involving the misuse of AmeriCorps to Brown's office; that Walpin repeatedly discussed the case in the press after being advised "under no circumstance was he to communicate with the media about a matter under investigation"; and that Walpin's "actions were hindering our investigation and handling of this matter."

SOURCE: MediaMatters