Beat the Drum Slowly

True to his promise, President Bush vetoed the bipartisan State Children’s Health Insurance Program (SCHIP) legislation sent to his desk last week, and even though I guess I expected it, I was still shocked, SHOCKED that it had come to this. And furious, too, because I just didn’t understand how the cadre of Republicans who voted against extending the program could do that, if it was true, as widely reported, that over 70% of the American people supported the bill.

Locally speaking, I’ve had a hard time squaring Congressman Joe Barton’s opposition to expanding the program since, according to an April report in the Houston Chronicle, “Texas has the highest rate of uninsured children in the nation."

It seemed to me that, if so many citizens wanted SCHIP expanded, then the offices of the 6th Congressional District, which includes Ellis County, should have been flooded with calls and emails and faxes and regular old letters; and you’d think that knowing that his constituents cared about the issue would have persuaded the congressman to respond to the people’s wishes.

Of course, it’s possible that most folks in the 6th District did NOT want the program expanded, in which case Joe did the right thing. That must be the case, because I just can’t believe his loyalty would be to President Bush rather than to his constituents!

Then another possibility occurred to me: Could it be that the public didn’t know the facts?

Look, I admit to being a news junkie, one of those people who live and breathe current events, and I’m lucky that my work from home makes it easy for me to keep informed. So let me pass on just a few items that you may not know:

Item: Our own Joe Barton was the Republican Floor Leader for the opposition to the SCHIP bill; it was his job to lead the fight against the bill, to keep fellow congressmen from defecting to the support side, and presumably to make life difficult for those who chose to support it.

Item: The President vetoed the bill, claiming, among other things, that expanding the Bill to bring the number of children covered to 10 million from the present 6 million, would (a) cost too much, (b) lead inevitably to “socialized medicine,” and (c) make it possible for “adults making $83,000 a year” to be covered. Item (a) is a judgment call (think Iraq); (b) and (c) are simply not true, and I challenge any reader to offer irrefutable evidence to the contrary.

The funding the President said he would agree to not only did not provide for expansion but would actually cause children to be dropped off the program. Again, I’m not going to bother you with details here, as I have written about them before, but I challenge any reader to prove me wrong.

Item: The legislation expanding SCHIP passed the Senate by more than enough votes to override the presidential veto; the House vote, 273 to 156, was just 13 votes shy of where it needed to be. Thanks, Joe.

Item: The supporters of the legislation were aided by a family whose 12-year-old son was a beneficiary of SCHIP. Standing before the microphones, the child spoke in public to urge Congress to expand the program so that other children would benefit as he had.

Graeme Frost, the 12-year-old, had been critically injured, as was his younger sister, in an automobile accident, and SCHIP stepped in when the family resources ran out. He was in intensive care, in a coma, and in rehab for months. He still has partial paralysis.

The attacks began almost immediately, and thanks to emails from the office of Sen. Mitch McConnell, the Republican Minority Leader, news outlets were contacted and told that the Frosts were very wealthy, that their home was in a neighborhood of half-million-dollar homes, that the two children were in an expensive private school, that they were well able to buy their own insurance, and so on and on. One blogger went so far as to publish the Frosts’ home address.

The truth is that the Frosts’ combined income was less than $45,000 a year; they had paid $55,000 for their home back when the neighborhood was run down; the only insurance available to them before the accident was $1200 a month, not an amount a family with four children could have paid, and none was available after; the children were in private school on scholarships. After the facts came out, Sen. McConnell confirmed their truth, but the damage was done.

Item: After the Frost incident, one of Joe Barton’s websites published a page using The Simpsons characters for graphic effect, entitled “Children’s Health Fact of the Day.” The page, officially a Press Release for the “House Energy and Commerce Committee Republicans, Joe Barton, Ranking Member,” ridicules the idea of a child speaking out for SCHIP.

“Quimby here says he knows a bunch of low-income nobodies who are ripe for the picking.” After which “a restive crowd of backdrop-toddlers who’d been rented by MoveOn for the photo-op” were run out of town by hounds: “The 37 rental children fled and were not seen again, but the arf-arf-arfing of their pursuers could be heard well past sunset.”

Thanks, Joe.

Well, I’m sorry to keep on beating this drum, but I just wanted to make sure that people who might not have the time or opportunity to be news junkies got the whole, sordid story.

The good news is, the program has been extended until mid-November so there is time to make this right. Joe Barton’s number in Washington is 202-225-2002.

Can Anyone Give Me An Answer?

OK, it’s time for me to come right out and ask a useful question here:

As you know, I’ve spent some ink in this space in support of the States Children’s Health Insurance Program (SCHIP) presently apparently headed for Presidential veto. And a host of Washington politicians have suggested that expanding that program would be the absolute end of everything we hold dear, or words to that effect.

Senator John Cornyn (R – TX) last week stood up in front of Congress and made such outrageous statements that a couple of his fellow Republicans saw fit to chastise and correct him, right there in front of everyone.

Congressman Joe Barton (R – Arlington TX) has made it clear over and over again that he’s opposed to SCHIP. I won’t go into his interesting claims, having done so in the past. (I hear ‘n tell he wasn’t too happy with that, but I also note he didn’t write to correct me.)

They both insist that expanding SCHIP would send us down the slippery slope to “government-run” health care or, worse, “socialized medicine.”

Well, given that at least they both seem to agree that there are lots of totally innocent children who are without health insurance (this is true, even though President Bush famously suggested a few weeks back that everyone has access to medical care because they can go to the emergency room), let’s just dissect that frog and see if we can understand what, exactly, is wrong with universal health care.

I defy any opponent of universal health care to answer honestly WITHOUT resting their argument on certain phrases, such as “government-run” or “socialized medicine”; if they feel they just can’t live without them, I demand that we agree on definitions. Global warming is only made worse by the red-button rhetoric of the Washington folks.

Remember, my goal here is to get an answer to the question.

Let’s just take a look at a couple of examples of government-run medical services.
Start with Medicare. Anyone out there want to give it up?

Here’s who I think might be willing to do that: A retired corporate executive whose benefits include lifetime medical coverage, for whom Medicare is only a nuisance that he doesn’t really need; with both Medicare and private coverage, he’s in the catbird seat.

You could say that about airline pilots and union members, except that you can’t because their former employers are forever going bankrupt or cutting their benefit packages in order to cut costs. So it’s not likely these folks will give up Medicare benefits because they might need them!

The Federal Employees Health Benefits Program. Senator Cornyn and Congressman Barton would likely be quite willing to give up Medicare, because they will retire with the excellent health insurance available to federal employees, said to be even better than Medicare. Like Medicare, it’s a government run program.

Both FEHBP and Medicare provide universal health care to their populations: Medicare to seniors, the federal employees’ insurance plan to former and present federal employees, in each case with the government picking up about 75% of the premium and the insured picking up the rest.

Now, how about the Veterans Health Administration? Here’s what Phillip Longman, author of Best Care Anywhere, wrote:

And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals.

And here’s what Ezra Klein, writing for American Prospect, said:

What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction.

Anyone got a problem with the Veteran’s Health Administration?

So, you can see that the term “socialized medicine,” which simply means “the providers are government employees,” is SUCH a bugaboo!

So, if we do away with the terms “socialized medicine” and “government-run health care,” as I’ve shown they don’t describe something to be afraid of, what are we left with?

Oh, SCHIP opponents are also worried about the cost, they say. This is a red herring. Leaving children uninsured drives them to emergency rooms, as acknowledged by our President, where their care drives up the costs for the rest of us or, worse, leaves them without care, so their strep infection can go untreated and infect the whole class and from there their families, and from there their parents’ co-workers, all with lots of folks missing work because they are sick. NOW you can start counting the costs.

But you know what? You don’t make decisions about children’s health based on the cost. Do you?

And what about the assertion that some States would allow coverage to children of families with incomes up to three or four times the poverty level, causing some “rich” families to sign up instead of keeping their existing insurance. The poverty level is $20,650 for a family of four; you can do the math and see if the answer you get is “rich.”

Our own Senator Cornyn told a fib when he said incomes as high as $82,000 a year could qualify (he was talking about New York’s application to the Bush administration for a waiver to allow that increase, and it was denied) thus allowing some people who don’t need it to drop their private insurance and join up.

But consider the cost of living in New York, and then the cost of private health insurance, and do the numbers again.

You know what? I think a few “rich” kids (define “rich” — have you looked at the cost of living in New York?) getting coverage, so that over 4 million uninsured children can, it’s not a bad tradeoff!

So, it’s not the cost, “socialized medicine” is not always bad, and “government-run health care” can work pretty well. So, what?

Would someone please offer a convincing, fact-filled argument against SCHIP – or, for that matter, universal health care for all Americans?

Question: What does Bush have against little kids?

Answer: Nothing, really. It just looks that way.

This week the committee that meets to work out differences between House and Senate legislation came up with a final version of the SCHIP bill, renewing and expanding the program that makes health care available to children whose parents cannot afford to purchase private medical insurance.

The next step is to submit the bill to the House and to the Senate separately for final passage by each body.

After that, the bill goes to the President for veto.

Now, the President famously doesn’t veto very often, but he says he feels very strongly that continuing to provide medical insurance for 6.6 million poor children at the levels established ten years ago is bad enough, but he sure doesn’t want another 4 million added to the program.

Nosiree, Bob. I mean, that would SO offend the health insurance industry – you know, the good folks who brought us Harry and Louise back in the 20th century – no doubt they would much prefer to have poor families who can’t afford to buy insurance just go away. Or go without medical care. Or take their petty little fevers and broken bones to the emergency room and drive up the cost of care for the rest of the population (but don’t worry, your insurance company will just increase your premiums to cover this).

What? I shouldn’t pick on the insurance companies, those warm and caring folks you just love having to beg for treatment approval?

Well, how about Big Tobacco, then, who would be just as offended, in this case by the mere IDEA of raising the tax on cigarettes to pay for the expanded SCHIP program. (Interestingly, raising the cigarette tax would tend to discourage some people from smoking, thus eliminating quite a bit of emergency room traffic.)

Republican opponents of SCHIP have objected, saying that “Everyone knows that a cigarette tax hike would disproportionately affect the poor.” Translation: More poor folks smoke (smoking relieves stress). Get it?

Must be those compassionate conservatives. You think?

Why would Big Tobacco object to reducing smoking? After all, they spend lots of money telling us smoking is hazardous to your health even while they are sending people to the doctor. You don’t suppose they are still making money, after all that effort? Could it be all about the money? Please, say it isn’t so!

To be fair to the President, however, he’s not said anything about any obligation to either the insurance companies or Big Tobacco.

What he has said is that he thinks SCHIP is too expensive, and so he has proposed funding levels of only a third of what the program is projected to need, with restrictions that would not only prevent expanding coverage to more children but would take it away from some of those presently served.

But don’t think this is all about saving money – after all, if saving money were really important . . .

No, it’s bigger than that. According to the Atlanta Journal-Constitution, “Bush has vowed to veto any SCHIP bill that greatly expands funding, saying it was a move toward socialized medicine.”

Ah.

Paying for private insurers to insure kids is NOT government-run health care, as the President claims. And directing eligible families into Medicaid does not involve government-run health care because Medicaid, like Medicare, pays private doctors chosen by the patient.

SCHIP is different from Medicare because the States use the funds to buy insurance rather than to pay medical bills. Makes you wonder why the insurance companies are so opposed, doesn’t it?

This is where I tell the funny story I heard from one of the candidates for President: When he was talking about his plan for universal health care a lady in the audience stood and asked him to promise that he “won’t let the government get its hands on my Medicare!”

As I’ve written before, “socialized medicine” is really nothing more than a slogan designed by an advertising agency back around 1950, but lately some reasonable writers — Ezra Klein jumps to mind — have nicely distinguished “socialized” from “single-payer”: “Socialized” would describe the health system in England, where doctors are hired and paid by the government; “single-payer” would describe the Canadian system, where folks go to whatever private doctor or hospital they choose and the bill gets paid by the government.

Just like Medicare, actually.

Both the British and the Canadian systems provide universal health care, which means, at its most basic, that everyone gets coverage and emergency rooms are reserved for emergencies.

So, why can’t Medicare, which provides universal health care for seniors in a single-payer structure that is not socialized medicine, be the model for the rest of us?

That would make SCHIP totally unnecessary and save the President all this angst!

Bush hates little kids?

Once again it’s recess, and once again Bush plans to have his way despite that silly old Congress . . .

As reported in the New York Times, in a letter sent out at 7:30 p.m. last Friday, the Compassionate Conservative-in-Chief went around the House and Senate to forestall expansion of the SCHIP program just authorized by Congress.

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. ...

Kinda makes you wonder why we bother to have a Congress at all, doesn’t it? I mean, think of all the money we’d save!

Just one more question, Congressman

Last week I joined a roomful of citizens gathered to hear Congressman Joe Barton (R-Arlington) report on recent doings in the U.S. House of Representatives. Health insurance for poor children didn’t seem to be a key concern for the folks there, but it was included on an official handout that covered immigration reform (1 page), Iraq (2 pages), and energy (3 pages). SCHIP got 2 pages.

Listening and reading, I learned that the Congressman still likes lignite coal and believes in keeping your tires inflated properly to save gas. He told us the Trans Texas Corridor would not be all that different from I-35, and assured us that “it’s not going to be 12 lanes wide, after all!”

Well, I guess that’s true in a way. But since the TTC is planned to be 1200 feet wide, you have to wonder.

That’s a whole different column, though, from the one I want to write today, because some pretty outrageous things are being said and believed about the SCHIP legislation, beginning with Barton’s handout. I don’t think there’s room here to talk about them all, so I’ll just hit the high points.

Item: Well, of course the Congressman’s first concern is the cost. He worries that federal funding will increase by more than $88 billion over ten years; to put that in perspective, the Pentagon is presently spending $6 billion a DAY in Iraq alone.

Shoot, just two weeks out of Iraq and we've got SCHIP paid for!

Item: Barton claims that the legislation would “remove seniors out of private healthcare plans in Medicare Advantage … and greatly increase the number of people eligible for Washington-controlled, bureaucrat-run healthcare.”

Leaving aside for the moment his characterization of Medicare and SCHIP, try as I might I couldn’t find anything to support that. But even if in fact he were right, here’s what they’d be losing, according to the official Medicare website:

In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
… In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

But wait! According to MedicalNewsToday.com, the new legislation will:

Increase Medicare benefits for preventive care and mental health care, raise the value of assets low-income seniors can have and still qualify for the Medicare prescription drug benefit and cover more out-of-pocket Medicare costs for lower-income elderly beneficiaries.

And, get this: It will “eliminate co-insurance and waive the deductible for current preventive benefits covered by Medicare.”

Sounds like Mr. Barton and the insurance companies anticipate that a lot of folks, offered these extra benefits, may abandon Big Insurance for Medicare.

And as for that bit about “Washington-controlled, bureaucrat-run healthcare” — give me a break! Both Medicare and SCHIP are fee-for-service programs where you choose your provider and the provider of your choice sends the bill to the government.

You want to talk about bureaucrats? Ever dealt with a private health insurance company?

Item: But worried as he is about the evils of government provided health care, Barton is really, really worried about what he calls “cuts” in Medicare. The thing I find even more exasperating than outright dishonesty is the sin of omission, making a thing appear bad by not telling the whole story.

In this case, the so-called cuts are really reductions in reimbursements to the Medicare Advantage program by eliminating EXCESS payments. No doubt the insurance companies are going to miss them, and that’s the truth!

In addition, the legislation would delay cuts to physicians proposed over the next two years and instead INCREASE payments by .5% in each of those years.

Item: The Congressman, referring to a 2005 HHS report, claims that “the Democrat [sic] Majority’s SCHIP proposal” provides health care to illegal aliens.

Well, according to an item in the Houston Chronicle, that’s just not so.

Actually, the SCHIP legislation bars illegal immigrants from joining. [There is] a provision that let states change rules on required documentation. This was deemed necessary because many of the applicants, largely poor whites and African-Americans, couldn't find original birth certificates and don't have passports. In any case, Social Security numbers will still be required.

Item: In a section quaintly entitled “The Ills of Universal Health Care,” the good Congressman worries about our health care becoming too much like “the national care systems found in Canada and the United Kingdom.” He tells us that both systems “are rationed-care oriented which leads to lower quality care and long waits.”

Here’s what I found in the April 2007 American Prospect:

A 2003 study in The New England Journal of Medicine found that the United States spends 345 percent more per capita on health administration than our neighbors up north. This is largely because the Canadian system doesn't have to employ insurance salespeople, or billing specialists in every doctor's office, or underwriters. Physicians don't have to negotiate different prices with dozens of insurance plans or fight with insurers for payment. Instead, they simply bill the government and are reimbursed.

And Barton quotes from an article by a Canadian doctor to suggest that Canada’s wait times are horrible and deadly, though he doesn’t offer any fact whatsoever to show that we are any different.

Again citing the American Prospect:

A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn't count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can't see a doctor in the first place, you never have to wait for treatment.

Couldn’t say it any better.

I have to end this for now, but while I continue my research for the next round, let me just say I would really like to hear the Congressman’s answer to this:
What exactly would be the “ill” in universal health care?

Joe, You Didn’t Tell Us the Whole Story

The other day Congressman Joe Barton, of Arlington, Texas – whose District covers a good swath of north central Texas and includes Ellis County — had an article in our local paper about health care for low-income children.

It talked about the existing program that helps to fund medical insurance for low-income children and the upcoming vote to re-authorize that program. It appears he doesn’t like the way some States are using federal funds under the existing program, under “circumstances” he doesn’t define, and that he doesn’t care for the way others are using (similarly undefined) “waivers” to cover adults — all of which he naturally lumps under one of his favorite words: “abuses.”

And he objected to the bill to re-authorize and expand the program because, he said, a family with an income of $200,000 “could” qualify for help — but he doesn’t say how.

Still, the reader comes away with the impression that good ol’ Joe just loves to help poor kids get medical care and there are just a few tiny details to work out.

Well, last week he voted against it in the House.

I’ve been following this story for awhile, my interest in universal health care being one of the reasons — after all, if SCHIP (the acronym for the State Children’s Health Insurance Program) and Medicare both make folks so happy, can relief for folks in the middle become an idea worth looking at?

Another reason for my interest in the story is kind of contrarian: the President says he intends to veto the legislation. Yup, put the kibosh on it, stick a knife in it. And when the President is hot to kill legislation, I just can’t help wondering why.

Both bills would expand coverage to another 3.3 (Senate) to 5.5 (House) million children and some pregnant women. This would be done by allowing in families with twice the poverty level, around $43,000 per year for a family of four (which the Heritage Foundation sweetly calls “wealthier families”).

The proposal is to pay for the expansion by cutting excess payments to insurors and increasing taxes on cigarettes.

Now, anything that will help me quit smoking is fine by me! Anyone got any problem with that?

While the Congressman was all a-twitter worrying about how other States choose to treat their citizens, a whole gaggle of spinners hit the talk shows to inform us that the legislation included — gasp, horrors! — cuts to Medicare! “It will take from our senior citizens and probably send them to the poorhouse, or at least take away their insurance!”

Well, folks, then I received an email — addressed to me personally, since I am one of them — from AARP. You know, the organization that stands like a pitbull on behalf of the senior citizens of America. And y’know what? They LOVE this legislation!

“AARP applauds those Members of Congress who voted for the CHAMP Act. These lawmakers put the needs of older Americans and low–income children ahead of special interests.“

Seems that the Republicans who objected to the bill’s “cuts to Medicare” were in fact objecting to eliminating overpayments in the subsidies paid to insurance companies who cover Medicare recipients; it was discovered they had been paid 12% OVER what was due to them!

Between the tobacco companies and the insurance companies the pressure must have been unbearable.

And still another horror: This legislation will “expand government-run health care” and put us “on the path to socialized medicine”!

Oh, good grief! That old canard. Why would they haul that out? Because, sad to say, it still works with some people.

First of all, what government-run health care are they talking about? It’s help with INSURANCE, you idiots! Oh, sorry. I’m sure they are not idiots. But if they are not, and they are still saying this, what does that make them, exactly?

Likewise, the bit about “socialized” medicine. It’s not “socialized medicine.” What England has can be called “socialized medicine,” perhaps, because its hospitals are owned by the government and its doctors are government employees.

Whether it’s a single-payer system or Medicare, doctors in private practice and privately-owned hospitals send their bills to the government and get paid. Private. Choice. Not “government-run.”

In the case of SCHIP, just consider the name: State Childrens Health INSURANCE Program. We provide funds to help pay for insurance coverage for poor kids and in some cases their parents (a matter that obviously chafes the Congressman).

Why should we care? What if we don’t feel a twinge of pity for the poor, nor particularly care if they get to see a doctor, because we have other things to worry about? Well look at it this way: If your kid goes to school with a child who can’t afford to see a doctor for the preventive care that might have kept him from coming down with the flu, guess what he’ll bring home?

Of course, the “mark-up” meeting to work out differences between the House and Senate versions of the bill is still to come, so it’s not final yet. But since the Senate also passed a bipartisan version, I’m optimistic.

The fact that this legislation was passed with bipartisan support may not matter to the President, although when he counts the votes perhaps he’ll have an attack of reason. Protective reason. Other battles may become more important.

Meantime, if you have any thoughts about this, the Congressman will be in town this week, and I’m sure he’ll love to hear from you.