[Aurora, Colorado; December 1. Image via Getty]

AURORA, CO - DECEMBER 01: An immigrant from Mexico holds her four day-old son during a newborn care class at a community health center for low-income patients on December 1, 2009 in Aurora, Colorado. The Metro Community Provider Network (MCPN), which has 11 health centers in the Denver area, has seen a 138 percent increase in patients during the last year of recession. Non-profit community health centers such as MCPN could play a major role nationally if health care reform is passed, with increased subsidies from the federal government as well as millions of newly-insured low-income citizens seeking care. Health coverage for immigrants remains a contentious issue in the reform debate. (Photo by John Moore/Getty Images)

Worried about the passage of the health care bill and unable to pull the party together over the abortion issue, Pelosi and other Democratic leaders decided to allow a vote on an amendment introduced by anti-choice Democrat Bart Stupak of Michigan that would, according to Congressional sources who spoke to The Washington Post, "prohibit a new government-run insurance plan created by the health-care bill from offering to cover abortion services. It also would block people who received federal subsidies for the purchase of health insurance from buying policies that offered coverage for abortions," if passed.

Democratic leaders hope that the move will help them being anti-choice Democrats and Republicans (Republican Rep. Joseph Pitts of Pennsylvania is also a sponsor of Stupak's amendment) on board so that they can ultimately pass the health care bill itself, but the move is not a popular one with many pro-choice Democrats, including Rep. Diana Degette of Colorado, who tells the Wall Street Journal: "If you say the public option cannot be used for a medical procedure, you are greatly restricting a choice compared to current law. That is not acceptable to me."

House Holds Rules Debate On Health-Care Legislation [WashingtonPost]
Abortion Fight Erupts In Health Care Debate [NYTimes]
House Starts Debate On Health Bill [WSJ]

Adfreak, in its coverage of the campaign, writes:

The NWLC says 25-year-old women have been charged as much as 84 percent more than their male counterparts for health plans that don't even offer maternity coverage … all things I honestly didn't know until I saw the ad. With the mild uproar over last week's suggestion by Sen. Jon Kyl (R-Ariz., moron) that as a man he shouldn't have to pay for a plan that covers maternity care, NWLC's little campaign is getting extra press-and will no doubt spawn more campaigns as other women's non-profits rally around the call. And around Sen. Debbie Stabenow (D-Mich.), who pointed out to Senator Kyl that while he may not need maternity insurance now, his mom probably did.

The following Oh Snap attack is brought to you by Senator Debbie Stabenow:

If you want to tell off Senator Jon Kyl (or just email your senator reminding them how much you support the public option, or if you want to encourage Olympia Snowe not to filibuster and to stop holding up the process with this ridiculous trigger idea, or if you want to tell Nancy Pelosi to keep hope alive), you can use this cool little form to do so.

Official Site [A Woman Is Not a Pre-Existing Condition]
New ads turn healthcare into a gender issue [AdFreak]
Snowe Also Says ... [TPM Editors Blog]
Snowe Says She Won't Back Any Immediate Public Option (Update1) [Bloomberg]
Exclusive: Nancy Pelosi lacks votes for most sweeping public option [Politico]

The Washington Post clearly lays out the content of the Finance Bill:

The Finance Committee's bill is the only legislation on the table that meets Obama's objectives of providing coverage to the uninsured and barring insurance discrimination based on sex and preexisting conditions, among other factors - all for less than $900 billion over 10 years, and without adding to the deficit.

Many liberal Democrats, however, view the panel's effort as too meek in key areas, something they say is a reflection of three months of negotiations with Republicans and the moderate leanings of many Democrats on the committee.

The measure does not mandate that businesses provide coverage to their workers. Committee members defeated two versions of a government insurance option. And the bill would tax high-value policies that, to the dismay of many liberal lawmakers, could affect some union households.

Time further explains:

The bill includes consumer protections such as limits on copays and deductibles and relies on federal subsidies to help lower-income families purchase coverage. Insurance companies would have to take all comers, and people could shop for insurance within new state marketplaces called exchanges.

Medicaid would be expanded, and though employers wouldn't be required to cover their workers, they'd have to pay a penalty for each employee who sought insurance with government subsidies. The bill is paid for by cuts to Medicare providers and new taxes on insurance companies and others.

Unlike the other health care bills in Congress, Baucus' would not allow the government to sell insurance in competition with private companies, a divisive element sought by liberals.

Last-minute changes made subsidies more generous and softened the penalties for those who don't comply with a proposed new mandate for everyone to buy insurance. The latter change drew the ire of the health insurance industry, which said that without a strong and enforceable requirement not enough people would get insured, and premiums would jump for everyone else.

Olympia Snowe is widely expected to be the game changer in these debates.

One big question that will be answered with Tuesday's Finance Committee vote is whether Sen. Olympia J. Snowe (Maine) will remain at the table as the sole GOP negotiator involved in shaping the legislation as it moves forward. Snowe, a moderate, is promoting a plan that would create government coverage if private insurers do not offer affordable premiums. White House officials have indicated support for her approach, and Obama raised the issue during a phone conversation with the senator on Thursday, while prodding her about her vote. "He definitely was fishing," said Snowe, who remains noncommittal.

Snowe lives and breathes noncommittal. Every time I do a health care post, I ignore the news on Snowe, because it's always some variant on "let's wait and see." However, the Politico is reading the political tea leaves and has provided a guide to Snowe's potential votes and the possible outcomes:

—SNOWE VOTES "YES": Clearly the outcome Baucus is rooting for, as he made a lot of concessions to bring her onboard. The bipartisan nod Snowe brings to the bill strengthens Baucus' hand as he, Reid and Dodd merge the Health and Finance committee bills. Snowe's buy-in makes it easier for Baucus and Reid to sell reform to moderate Democrats – think Landrieu, Ben Nelson, Bayh – who are arguably more conservative than Snowe. And it positions Snowe to grab a bigger seat at the decision-making table as Reid crafts a bill to send to the Senate floor. Not to mention, the headlines all laud Baucus for landing a Republican vote and give Democrats the big mo. Look for Republicans to push back hard against any narrative that suggests one GOP vote makes the bill bi-partisan.

—SNOWE VOTES "NO" – This will be written as a SETBACK for Democrats. For Baucus, this one stings because he put so much time and effort into wooing Snowe for naught. He doesn't get the hero's welcome or a carrot to entice moderate Dems. And the failure to win Snowe's support in Finance will raise questions about whether Baucus and Reid can win her support on the floor. Remember, Sen. Ben Nelson has said he won't vote for an all-Democratic bill and other mods could be jittery without the bipartisan cover she provides. As for the Maine senator, she may find herself with a less influential voice moving forward as Democrats begin to question whether she's really serious about passing reform. The headlines may be the biggest problem for Dems as they'll slow the ‘mo and cast doubts on what should be a very big day for Baucus and reform.

—WHAT SHOULD SHE DO? Two schools of thought: a) If she votes against, she preserves her leverage as it goes to the floor. Otherwise, Reid takes her for granted and moves on to Susan Collins. b) White House argues: "She gets her greatest leverage by voting for it in committee, because then she's a part of the discussions to merge the bill, because once you have her in committee, you have to keep her for the floor. Because now you've committed yourself to a 60-vote track. If she wants to be for something in the end, the worst thing she could do is vote against it in committee, and then allow there to be a sense that it's headed to reconciliation, and the progressives are going to push incredibly hard for a bunch of things she's uncomfortable with, like a full public plan."

—CAVEATS – Snowe has left herself enough room that no matter how she votes today she'll be able to change it later. A no today can become a yes tomorrow as Snowe continues using her leverage to shape the bill. Conversely, a yes today can switch overnight if she feels leadership stepped all over her concerns while shaping the legislation. As Democrats' last best hope at winning a GOP vote, Snowe will continue to hold a good deal of sway. If she votes no, some observers may start ringing the reconciliation bell – a rookie mistake, according to some insiders.

So essentially, Snowe will vote the way she wants to, and has left room open to change her mind. Skillful!

Finally, some unexpected good news from an unlikely source. The insurance companies have finally tipped their hand, releasing a report which threatens a rise in rates if reform is passed. While the ad was intended to squelch support for reform, it actually renewed animosity toward the industry:

The spot is designed to amplify the message - perhaps best delivered yesterday by Congressman Anthony Weiner - that the insurance companies made one of the strongest cases yet for a public option by essentially vowing to raise rates. The report also makes it easier for reform proponents to argue that the industry, which had been making nice with the White House, is a bad-faith actor not to be trusted.

It seems like a potentially big tactical error by the insurance industry, and it'll be interesting to watch how proponents of the public option capitalize on it to pressure the White House and Senate leadership to put a public plan - or some form of it - into the final Senate bill that's being negotiated this week. The public option lives!

We'll know more later. Until then, enjoy this ad created in response to the insurance industry's scare tactic.

As Panel Votes Today, Democrats Look Ahead [Washington Post]
Senate Committee Set For Health-Care Vote [Time/AP]
Snowe 'Aye' Or 'Nay' Today Will Drive The Fall - What She Should Do Tp Preserve Leverage... [Politico]
New Bill Would Raise Rates, Says Insurance Group [Washington Post]

The poll asked the following,

Do you think the health care reform plan being considered by President Obama and Congress creates "death panels" which have the authority to subjectively determine whether or not a gravely ill or injured person should receive health care based on their "level of productivity in society"?

43% don't believe this, which we guess is encouraging. But 26% do (interestingly, about the same percentage who believe Obama isn't a real American citizen). And 31% aren't sure, meaning a majority — 57% — of Republicans can't say for sure whether our President plans to hold their parents and children up to Nazi-style productivity standards before allowing them to waste away. Of course, what we have now is a system where the sick and injured often can't get coverage, but those who deal in "death panel" fear-mongering don't have much regard for the facts, or for people who can't afford health insurance. In today's Washington Post, Richard Cohen compares Sarah Palin, major proponent of "death panel" lunacy, with Sen. Joseph McCarthy. "With Palin," he writes, "the subject is health care, which in many ways is the Red Menace of our day and lends itself to a kind of political pornography." He continues,

The most depressing aspects of McCarthy's career were not just the excesses of the man himself but the refusal of others — mainly his fellow Republicans — to either rein him in or defend his victims. Now we are seeing something similar with Palin. Say what you will about any of the health-care proposals, not one of them suggests a "death panel" empowered to withhold medical services from the aged or those with disabilities. [...] Yet, you can beat the bushes to a fine powder and find only two Republicans of note — Sens. Johnny Isakson and Lisa Murkowski — who had the courage or the decency to tell Palin that she doesn't know what she's talking about. Certainly, this was not the case with Newt Gingrich, the former House speaker, who in fact virtually seconded Palin's charge. This is not just because Gingrich himself can be casual with the facts but also because his urge to be politically expedient often overwhelms his convictions.

Cohen calls out not just Gingrich, but also Sens. Charles Grassley and John McCain, both of whom have failed to challenge her obviously false rhetoric. It may be true that, as Cohen says, Palin "rarely knows her facts" — but not every Republican in Congress is so blind to basic truth, and their failure to criticize her ridiculous assertions likely has more to do with what is "politically expedient" than with what is right. Sadly, Palin and her ilk have been successful, killing not only harmless and optional end-of-life counseling, but now the public option as well.

Despite his influence over the culture of 1950s America, Sen. McCarthy's "career was mercifully short," reminds Cohen. Perhaps the same will be true of Palin, whose approval rating has dropped from 57% when she joined the McCain campaign to 39% now. Unfortunately, crazy abhors a vacuum, and there will be more to rush in and fill her place. Like Michele Bachmann (pictured, right behind Palin), who previously informed us of liberal "reeducation camps" for young people and internment camps based on US Census data. In a disturbing McCarthyite parallel, she also called for a media investigation into anti-Americanism in Congress, and she shares enough awesome traits with our favorite lipsticked pit bull that one Minnesota State Senator called Palin "Alaska's Michele Bachmann." Bachmann says she'll run for President — if God tells her to. Specifically, she says,

If I felt that's what the Lord was calling me to do, I would do it. When I have sensed that the Lord is calling me to do something, I've said yes to it. But I will not seek a higher office if God is not calling me to do it. That's really my standard.

If I am called to serve in that realm I would serve but if I am not called, I wouldn't do it.

Apparently the Lord has repeatedly called her to mislead her constituents with baseless accusations against the government. Let's hope He keeps quiet about the Presidency.

Michele Bachmann: Many Are Called, Few Are Chosen [La Figa]
Palin's Red Menace [Washington Post]
Exclusive: New Poll Finds Majority Of Republicans Either Believes Or Isn't Sure About "Death Panel" Claim [The Plum Line]
This Is Reform? [NYT]
Bachmann Election Challenger: Sarah Palin Was Alaska's Michele Bachmann [Huffington Post]
Birthers And Deathers — The Same People? [Talking Points Memo]

Earlier: Palin "Wins", Or, The Power Of Misinformation On Health Care Reform
Sarah Palin Claims "Death Panels" Will Kill Son; Gingrich Agrees

[Inglewood, California; August 11. Image via Getty]

INGLEWOOD, CA - AUGUST 11: People await their turn to enter the Forum arena for a free health clinic on August 11, 2009 in Inglewood, California. Hundreds of people, most without health nor dental insurance, waited outside much of the night for the first day of the clinic. From August 11-18 the non-profit Remote Area Medical (RAM), is holding the nation's largest free healthcare clinic. Hundreds of doctors, dentists, optometrists and nurses volunteered to serve uninsured and underinsured people. With a limit of 1,500 patients per day, the organizers expect to see as many as 10,000 people during the 8-day clinic. (Photo by John Moore/Getty Images)

[Walsenburg, Colorado; August 5. Image via Getty]

WALSENBURG, CO - AUGUST 05: Robert Pacheco comforts his daughter Danielle, 5, after she received two vaccination shots at the Spanish Peaks Outreach Clinic on August 5, 2009 in Walsenburg, Colorado. Pacheco said he works fulltime as a clerk, but his job offers no health insurance, so he brings his children to the low-cost clinic. The Spanish Peaks Regional Health Center treats rural Coloradans who come for medical care from throughout southern Colorado, where hospitals and clinics are scarce. The outreach clinic is designed for patients with little or no health coverage. (Photo by John Moore/Getty Images)

[Aurora, Colorado; July 28. Image via Getty]

AURORA, CO - JULY 28: Joselyn Mejia, age 4, suffering from a stomach ache, has her vitals checked at the low-cost Rocky Mountain Youth Clinic on July 28, 2009 in Aurora, Colorado. Her mother Jessica Mejia said she has health insurance through her employer, but finds the clinic cheaper than paying the deductible to have her children cared for by a family practicioner. Funded primarily through donations and grants, Rocky Mountain Clinics treats mostly children of uninsured parents, those on medicaid and others who's parents cannot afford to pay the high deductibles charged by many health insurance policies. (Photo by John Moore/Getty Images)

First off, Dean thinks that bipartisanship on health care reform is bullshit.

I think it's a very good thing [that the Democrats might not get bipartisan support for their bill]. I think the Republicans have correctly diagnosed that the way to stop Obama is to stop the health-care bill. They're determined not to have a bill. In the long run, we're going to have to do this on our own.

In other words, since the Republicans have now announced their intention to kill the bill for political reasons regardless of what it contains, fuck 'em. They had their chance.

Besides which, if Obama wants to take credit for it in 3 years when he's running for reelection — let alone the House and Senate members who are up for reelection next year — they've got to be able to have something to show to their constituents that they, and they alone, are responsible for. And Dean's got the best idea this underinsured freelancer's heard all year.

Put in guaranteed issue and community rating at once, so people cannot be turned down for insurance in the private sector, nor can they have their insurance taken away because of an illness. He'll get huge credit for that and there's no budgetary cost.

It's so rare that constituents' personal interests and legislators' political interests align so nicely.

Dean's got another suggestion that I would have loved when I was just a tiny bit younger.

You say the federal government should provide free coverage to everyone under 30. That's pretty radical.
It's incredibly cheap. Statistically, only two expensive things happen to people under 30: one is a malignancy and the other is an accident. Everything else is mostly preventive maintenance and it's very inexpensive. But this is not what's going to be passed.

Sigh. Guess that's what we get for not voting as much as the oldies.

Anyway, although Dean doesn't use the word "market failure" to counter all the Republican arguments about how the free market ought to be allowed to "work" in the case of the health insurance market, he's got a pretty good handle on why it never will.

Everybody talks about preventive medicine, but almost nobody does it because there's no payback. A private practitioner invests money in preventive care and the hospital benefits. They're not connected. Second, pay people - particularly primary-care providers - for taking good care of patients without rewarding doctors for doing more and more and more. That's what the system is currently based on. The more you do, the more you get paid, which is an incentive for inefficiency.

In other words, the market that functions the most efficiently in terms of cost-incentives functions the worst in terms of caring for people's health. That's because the health insurance market has become the de facto health care market, rather than an addition to it.

In a speech to Campus Progress, Dean offers a potential — but politically untenable, which is why he's so beloved — solution to the market failure problem. Bonus: it's one the government has already implemented in other industries and which, until relatively recently, was the model the health insurance companies were often forced to abide by on the state level until they successfully lobbied for full privatization.

If you ever want to save costs, it can never happen in the private sector. ... Switzerland and Netherlands treat their private insurers like regulated utilities. Our private insurers are not going to want to do that.

No kidding! Providing health care to their insurance customers might cut into insurance companies' profit margins... and they wouldn't want to do that.

Howard Dean On The Politics Of Health-Care Reform [Times]
The Ever-Quotable Howard Dean [The New Republic]

Related: GOP Focuses Effort To Kill Health Bills [Washington Post]

In a new interview with Esquire scribe John H. Richardson to promote his new book Howard Dean's Prescription for Real Health Care Reform, Dean places the blame for our fucked-up health insurance system on the private sector and its government enablers.

For starters, Dean takes on the idea that the marketplace is more efficient than government in providing health care.

ESQ: Boil it down, if you would. Why isn't it working even if you do have insurance?

HD: Because it's too expensive. The private sector can't manage costs. Health care is one of the few places - defense is another - that the government works more efficiently and more effectively than the private sector. That's just a fact.

ESQ: Why is that?

HD: Because there is no feedback in the private health-care system. When I was practicing medicine, nobody with substernal chest pain ever got off my examining table and said, "The guy down the street does it for $2,000 cheaper, I'll see you later." That's why we've had 40 years of costs that increase between two and three times the rate of inflation every single year. It's breaking our economic system.

In effect, Dean is arguing that because there's no competition at the provider-level, the "health care" market already isn't a true market. Republicans have argued that the solution to that problem is more provider information and programs like Health Savings Accounts that force people to keep track of health expenses (as though health insurance companies aren't price-setting); Dean is suggesting that health care, like national defense, is a social good that will never properly be accounted for by the market because its intrinsic value is borne by too broad a segment of the population. Market failures  like the poor valuation of social goods like defense and education  are accounted for in economic philosophy by having government provide them to people by spreading the costs as widely as the benefits.

Dean then ascribes the business opposition to the public option to one of two things: political ideology; and lack of foresight.

Then there are lots of businesses that aren't particularly ideological but genuinely believe that if they keep doing the same thing, they'll somehow get a different outcome. That's human nature. They think they can manage health-care costs even though it's been 40 years since any of them ever have. That's why I think Obama's plan is so great: If you like what you have, you can keep it.

Dean, obviously, believes that both businesses and their employees will end up preferring the public option  and that despite Republican fears of that, that's not a terrible thing.

He also thinks that the polls back him up that most Americans agree with him  and that the Senate should stop fucking things up.

ESQ: But still, even you say you expect 65 million people to enroll in the public option, and a study by a health-care company put the number at 117 million. That's a lot of people.

HD: It is.

ESQ: But isn't that a threat to the insurance companies? Especially at a time when we want to keep businesses healthy and people employed?

HD: This is one of the many problems the Senate is now having. They are focused on anything but the American people. But the insurance companies will be fine. It won't happen overnight, and they'll make plenty of money. But this is not a matter of making the insurance companies happy. This is a matter of making the 72 percent of the people who want a public option happy, including the 50 percent of Republicans who want a public option.

ESQ: Fifty percent of Republicans want a public option?

HD: Yeah. That's in a Kaiser poll and in a New York Times/CBS poll last week. The Senate is in the process of self-destructing. They are talking about managing health-care reform to make sure that a relatively small sliver of American industry is satisfied at the expense of 72 percent of their constituents. That's unbelievable.

Can you tell the man doesn't have to worry about getting a bunch of Senators re-elected any more?

Dean also takes on Republican tropes that the public option will result in rationing and "a bureaucrat standing between you and your doctor"  which is a hilariously ironic thing to say to any American who's ever dealt with a health insurance company.

But we ration in America today. If you are one of the 47 million people who don't have insurance at all or if you're someone who has a lousy plan because you can't afford a good one, that's rationing by price. I'll tell you who rations. It's the private insurance groups. This ridiculous nonsense that the right-wingers are talking about, that public insurance will put a bureaucrat between you and the doctor - that goes on every day in the system we have. But only in the private sector. It doesn't happen in the public sector. I have never had, in my 10 years of practicing medicine, a Medicare bureaucrat call me up and say, "You can't do this and you can't do that." But that used to happen every day with the private insurance companies. You'd beg to have your patient have this drug or that procedure.

In fact, Dean cites the insurance companies' bureaucracy  and CEO salaries  as one of the reasons they're so economically inefficient.

I'm going to use Medicare as an example because it is a public plan. About 4 percent of every dollar that goes into Medicare is spent on administration. In the private sector, that number is between 12 percent and 50 percent. That's because of return on equity, very high CEO salaries, advertising, and general administration. But you don't have return on equity in a public plan, and there doesn't have to be advertising, and the people who run it aren't going to be making $20 million a year. They are probably making less than $200,000 a year. And that's before you get to cost controls.

Return on equity is a fancy way of saying that most health insurance companies are public companies, and so there are profit-pressures and dividend-pressures and stock-price-pressures for them to contend with before they get around to providing people health care  which, in fact, isn't their mission: it's to insure their customers.

In somewhat-related news, the health care reform bill will likely be the center of this year's abortion debate: NARAL President Nancy Keenan says they're aware that anti-abortion Senators plan on introducing a range of anti-abortion amendments to restrict women's access to insurance coverage for (at the least) abortion services; and 19 House Democrats (full listing here) have sent a poorly-worded letter to House Speaker Nancy Pelosi asking her to keep abortion out of the health care reform altogether. Since that reform comprises both public and private coverage, it could mean they've asked their own party to restrict or prohibit private insurance companies from covering abortion services. Fab.

Howard Dean: Private Health Care Is Breaking Our Economy [Esquire]
NARAL Pres Nancy Keenan On Health Reform And Abortion Rights [American Prospect]
Anti-Choice Dems Trying To Keep Abortion Out Of Health Care Reform [Feministing]

You'll recall, no doubt, that even when you take out the cost of pregnancy care, women pay more for health insurance in states that don't prohibit insurers from charging more. Insurers say that this is because women are more likely to engage in preventative care.

In interviews last fall, insurance executives said they had a sound reason for the different premiums: Women ages 19 to 55 tend to cost more than men of the same age because they typically use more health care, especially in the childbearing years. Moreover, insurers said women were more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Of course, if health insurance companies were operating on a long-term framework with regards to their customers the same way that their customers are operating in regards to their own health, it wouldn't be an issue, since preventative care is less expensive than emergent or traumatic care. However, given that insurance companies are most often motivated by short-term profits and shareholder value rather that the health and safety of their customers and because  particularly in this economy and given insurers' right to terminate our coverage for having the audacity to utilize it  they don't expect to be your health insurance company by the time preventative care pays dividends, they charge women more than men.

Anyway, the reason they're now willing to even contemplate equitable coverage costs for women is that part of Barack Obama's health care reform package calls for the establishment of a government-run health insurance program for middle- and lower-income Americans priced out of the private health insurance market to  in Obama's words  "keep private industry honest." Insurers have already agreed to stop terminating coverage when people use it and to insure even Americans with pre-existing conditions if Obama makes everyone either buy health insurance or get into Medicaid and Medicare  but they really, really don't want you to have the option to buy into government health insurance intended to compete with private plans because they don't want the competition. They'll even "accept" more regulation. Just try to trust that they won't fuck you over!

"We are not asking people to trust us, we are asking people to trust government," Karen Ignagni, president of America's Health Insurance Plans, told a Senate panel that is crafting sweeping legislation to overhaul the nation's $2.5 trillion health care system.

Yeah, that's big business which, by and large funds Republican candidates and causes, telling Americans to trust the government. Go ahead. You can laugh now. That government health insurance idea is starting to sound more and more like a good idea.

Health Insurers Agree to End Higher Premiums for Women [NY Times]
Health Insurers Ask Gov't To Police Their Industry [Associated Press]

Earlier: Ma'am, That Uterus Will Cost You Extra

• Barack Obama gave yet another prime time press conference to beat back critics of his budget, his tax plans and the deficit those things might or might not create. [Politico, Washington Post]

• Oh, look, Obama finally got himself a confirmed Commerce Secretary. Guess he buried those bodies really deep. [NY Times]
• Everybody loves Hillary Clinton these days. [CNN]
• Little-loved Louisiana governor Bobby Jindal doesn't want everything Obama does to fail, just most things. That's the only way he can win in 2012, after all. [Huffington Post]
• A bunch of conservative Catholics are complaining about the President of the United States giving a commencement speech and getting an honorary degree from Notre Dame because apparently to get a degree from a Catholic university is to agree to agree with everything the Pope ever says on everything. Makes me really not regret my decision to go to BC. [Washington Post]
• One of the people complaining is the twice-divorced and about-to-be-Catholic Newt Gingrich, because while telling your cancer-ridden wife that you want to marry your mistress at your wife's hospital bedside is a Catholic value, striving to reduce the incidence of abortion through education and economic empowerment while keeping it legal is not. [Media Matters]
• Arlen Specter hasn't yet decided to run for re-election as an Independent, so he's bowing to business interests and fucking over the labor unions that endorsed him over the Democratic candidate in 2004 by opposing the Employee Free Choice Act, known to conservative interests at "card check." It's so hard being the swing vote, you know, he can't just do what he thinks is right every time. [The Hill]
• He's already trailing in primary polling against the more conservative Republican that took him on in 2004. [Huffington Post]
• Health insurance companies promise to stop fucking you over if Barack Obama promises to make you buy their insurance. [LA Times]
• Under the Bush Administration, if your boss refused to pay you, you were on your own, asshole. Luckily for us, the people that felt that way were career bureaucrats who can't be fired. [NY Times]

In fact, in a health care system that financially rewards doctors for emergent care more than intermittent preventative care, encouraging people to seek preventative care regularly is better for the financial and physical health of everyone involved. You'd think that the people in charge of pricing your health insurance would know that. But as today's New York Times reports, you'd be wrong.

According to a study by the Times, women in the individual insurance market  the one McCain wants us to get our health insurance from if he becomes President  pay significantly higher premiums throughout their working lives than men do. In cases from Colorado to Florida to Ohio (swing states all!) women could expect to pay between 22 and 49 percent more than their male counterparts. (Note that the federal government currently does not allow employer-sponsored health insurance  the kind McCain wishes to wipe from the map  to distinguish between men and women when pricing.) And, according to insurers, there's one basic reason: women use preventative care.

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.

Oh, the same insurance company apologist try out the whole load of shit that it's about the expenses of being the ones that push out the babies, but even in states that allow women to opt out of pregnancy coverage, women still pay significantly more. Like a woman in the article, in fact, I don't have medical coverage if for some reason my multiple birth control methods fail:

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.'

Marcia D. Greenberger, co-president of the National Women’s Law Center, also points out that, the differential in pricing based on gender, McCain's tax credit for purchasing health insurance  $2,500 for you single ladies out there  will actually erode in value faster for women than men.

In the meantime, insurance professionals have one good reason not to make insurance pools gender-neutral:

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."

Oh, well, gosh, Cecil, we wouldn't want to deny men the benefit of really low-priced health care just so our health insurance, that covers of the furtherance of the species, is remotely affordable or obtainable! Have to keep that Viagra cheap for you! Luckily, the head insurance regulator in Maine  probably through her use of preventative care  has a few more brain cells functioning than old Cecil:

Mila Kofman, the insurance superintendent in Maine [where they prohibit gender discrimination in the individual insurance market], 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."

In fact, I'll go further than that. The whole purpose of insuring pools of people is to spread the costs across many  you know, sort of like roads and schools and shit. And so taking out the lowest cost group of people increases the cost of those who remain, undermining the fucking purpose of pooling risk.

In addition, as I noted above, preventative care does cost more at the outset than never going to the doctor. The difficulty is that, from a long-term perspective  which these insurance companies obviously lack as they pursue quarterly profits and stock prices to to exclusion of their business  is that foregoing preventative care ends up being far more costly when easily preventable problems turn into emergent care. Getting a Pap smear every year might cost your insurance company $150 and treating early cancer that said exam might find might be more expensive, but it's all fucking cheap compared to a hysterectomy with hospital stay and months of chemotherapy and then a lifetime of follow-up care. Of course, in the individual market they can just tell you to fuck off after a year and not renew your coverage, so I guess it might not be that expensive for an insurance company after all. The insurance companies  for all their rationalizations about post-childbirth urinary tract complications late in life being expensive, which is what one spokesman actually claimed as a reason for gender differentials in the Times piece  aren't interested in long-term cost lowering. They are interested in short-term profit maximization and figure that, by the time you're old, they probably won't be your insurance company anyway and, if they are, they can just easily boot you off their rolls.

Women Buying Health Policies Pay a Penalty [NY Times]

Related: Health Insurance And The Single Girl [Glamocracy]

Earlier: Elizabeth Edwards Talks About Issues Unrelated To Infidelity
Before First Pitch, Obama Hits One Out Of The Park

On the one hand, Elizabeth acknowledged that part of the willingness of people to pay attention to her on health care policy now stems from her post-election admission in 2004 that she had cancer  and I think both she and Gawande implicitly acknowledged that some in the crowd were there to gawk at the cuckolded lady as much as to hear why tort reform won't solve the problems in our health care system or why morbidity costs are such a drain on the system. That's probably why, as his final question, Gawande asked Edwards to address the problem of giving speeches like this when the audience was going to ask about her personal life. In addition to quoting Gawande's book (from a scrap of paper she pulled from her bra strap, which I loved), she said "I don't think that I lead a perfect life. And I think that's what makes me able to speak to people, that there's a recognition of my imperfection," and added that her ability to focus on her work for health care reform was a refuge.

(Which of course prompted someone around my age to get up and ask her about how her kids were coping with the fact that he's husband's a cheat. Seriously. If you were that girl and you are reading this, as a member of your gender and a woman your age, it was truly disappointing to watch you get to ask the last question and ask something that was personally painful for her and incredibly off-topic when the 4 other people in line  like the 5 people before you  probably had something interesting to ask about the topic at hand.)

Anyway, Elizabeth Edwards had some advice for Barack Obama and the Democrats about tying health care costs to the current economic crisis so that people view it as part and parcel of the problem rather than annoyance that the government can get around to as some unspecified later point. She mentioned that a lot of people who were struggling with medical expenses were (prior to the mortgage crisis and stock market meltdown) using their equity to pay for health care costs... and now have little or no equity, if they even have their house. Catastrophic health care costs are real, they tug at voters heart strings and all McCain's got on his agenda to help that is Health Savings Accounts, which is basically a big "fuck you" to people that can't afford to save money because they're already in debt from mortages and medical bills. Well, she didn't say that last part, that's me, but the point remains the same.

But the big, important this she said is that fixing this problem requires leadership  and it will require sacrifice. She said, "We have to change what we're willing to sacrifice to change things." If you want reform, if we want reform, we have to be willing to reform ourselves. It's not a matter of sitting back and letting someone else do it for us. Elizabeth Edwards is sacrificing her privacy and her ability to not be publicly confronted at every turn by some wannabe do-gooder who wants to know how she's holding up being married to a cheat in order to talk about and push for the kind of reform she wants to see. What would you be willing to give up for your pet issue?

Caring For Your Health, Caring for Her Health [New Yorker]
Elizabeth Edwards Has 'Passion' For Health Reform [MSNBC]

But, in that absence of a record  and as the Vice President on a ticket headed by John McCain  his stances are now basically her stances, or at least the policies she'll be called upon to defend. And, like her position on abortion, his stances on a range of issues important to women are not exactly progressive.

Abortion Rights: On abortion, they're clearly alike (now). McCain used to support an exception in cases of rape, incest or risk to the life of the mother but reversed himself this year. Glamour reports that he didn't support overturning Roe V. Wade in 1999, then he did and that he was kind of a dick when the magazine's editors asked for further clarification. He's definitely all excited about the 2-3 Supreme Court vacancies expected "by the people who decide these things," since that'll give him a chance to appoint justices that will see Roe v. Wade as a "bad decision" the way that he does.

Equal Pay For Equal Work: Moving onto pay equity, something else that Sarah Palin's said nary a word on. McCain's said plenty, including that he's "all for pay equity" but not for the Ledbetter bill because it would lead to, you know, women using the courts to enforce said equity. Of course, he's also said that we could solve pay equity by giving women better job training, which sort of pisses Lilly Ledbetter off. Nonetheless, the official position of a McCain-Palin administration would be "no" to any bill that attempted to resolve the issues in the law that allowed the Supreme Court to fuck over Lilly Ledbetter.

Women At War: McCain's somewhat more progressive on women in combat, telling Glamour:

I think this policy needs to be reevaluated constantly.... We have more and more evidence of greater abilities of women in combat. Also...this conflict is everywhere; we have had a large number of women wounded and killed in Iraq and in Afghanistan. I'm for integrating women as much as possiblewith one exception: For example, in Baghdad today, a male combat infantryman puts on 50 pounds of body armor, then another 40 or 50 pounds of military equipment. I want to make sure that women are able to also do that. Now, I'm not saying women are physically weak. Some of the strongest [people] I have ever known in my life are women.... I just want to make sure that they're able to carry out these missions in the most effective fashion.... Women have proven to [everyone's] satisfaction as pilots, as combat medics, in any other role they've been in, that they're perfectly capable, and in some ways not only capable but superior.

Of course, that's a little bit different than what he said back in 1991, but even old dogs can learn new tricks. Is flip-flopping a doggie trick? Anyway, he'd "reevaluate" constantly, sort of like he already has, but I would say it's iffy whether he and Palin would reverse the women in combat decision; I doubt they'd be spearheading any women-in-combat initiatives  let alone any reversal of don't ask, don't tell, despite its disproportionate effects on feamles.

Sex Education: While, as I've previously mentioned, Sarah Palin's record on abstinence-only education is sketchy at best, McCain's positions are more robust. He supports teaching abstinence in schools and is less supportive of birth control education. In fact, he's said that he opposes eliminating the proved-ineffective abstinence-only education programs currently on the books, while leaving wiggle room on giving teenagers some information that there are ways to avoid pregnancy if you ignore the abstinence thing. He did vote against an 2005 family planning bill and, when asked to explain by Glamour first said it was because it have provisions on funding abortion (it didn't) and then clarified that it was because it had provisions relating to Plan B, which doesn't exactly make it better.

In the end, when it comes to women's issues, there may not be a ton of information out there on where Sarah Palin stands, but  like every Vice President before her  she's not going to have any choice but to stand by her man... who hardly stands by many of the women in this country on the issues outlined above. McCain thinks women should nonetheless vote for him because he wants to keep taxes low (not that he's actually correct about that) and make sure that when his plan goes through Congress, the (magical) markets will keep prices low.

Interestingly, McCain's economic adviser, Carly Fiorina thinks women shouldn't be voting just based on abortion, and that issues likes taxes and health insurance are important to women too  issues on which, as I've just noted, McCain is actually worse on. So tell me again how is McCain's candidacy is supposed to be about the issues?

For these reasons and undoubtedly many others, the National Organization for Women Political Action Committee today endorsed Barack Obama and Joe Biden for the Presidency and Vice Presidency  one of the very few times the organization has ever made a general election endorsement. But even NOW's President, Kim Gandy, admitted on NPR that this would be controversial among some of their members despite the significant differences between Obama-Biden and McCain-Palin on the issues supposedly of importance to women. Bethesda, MD psychologist Lynette Long, a lifetime Democrat, probably knows a little about why  she's not voting on the issues, just on the gender that she shares with Sarah Palin. For all Fiorina's (and McCain's, and Palin's) posturing about the elections being about the issues (and about issues other than abortion), the McCain camp wants a lot of women like Long to completely ignore the issues, not choose between them.

Palin's Record on Women's Issues Questions [UPI]
Palin: Unserious About Sex Crimes and Domestic Violence [Shakesville]
Palin On Abortion: I'd Oppose Even If My Own Daughter Was Raped [Huffington Post]
McCain Poised to Flip on GOP Abortion Platform [ABC News]
Is McCain the Nostradamus of the Supreme Court? [CBS News]
McCain Opposes Equal Pay Bill In The Senate [Huffington Post]
John McCain [Glamour]
Women's Combat Roles Likely To Be On Next President's Agenda [LA Times]
McCain: Gay Troops "Intolerable Risk" [Gay.com]
John McCain Campaign to Brody File: Eliminating "Abstinence Only" Programs is Wrong [CBN News]
Health Insurance And the Single Girl [Glamocracy]
Tax Plans And the Single Girl [Glamocracy]
National Organization for Women PAC Endorses Obama-Biden [NOW]
National Organization For Women Endorses Obama [NPR]
In This Election, Putting Gender First [Baltimore Sun]

In fact, the most reliable applause line of the night  from Texas Railroad Commission Chairman Michael Williams to Sarah Palin  was any reference to abortion, or, in Republican terms, "respect for life." It is striking, in retrospect, how many times the speakers genuflected in the direction of embryos last night, as though there was any doubt that too many people in the room support reproductive rights.

Carly Fiorina has been stalking Hillary supporters for a while now trying to lure them with the false assertions that McCain is supportive of birth control coverage and not really all that opposed to abortion. In fact, one could even assert that she's the leading proponent in the McCainosphere pushing his "liberal" credentials on these issues, even as she's telling women they "aren't"  meaning, shouldn't be  one issue voters.

On the other hand, where is the women's agenda at the RNC? Pay equity is a Democratic issue, as is increased child care funding, as is universal health coverage. McCain's got increased child tax credits to go along with his insistence that he'll try to stop you from ever having an abortion and that your insurance company shouldn't have cover birth control, but I'd hardly say that's an agenda for women on a par with equal pay or equal rights. If I'm voting on more than "drill, baby, drill," the surge, McCain's torture-iffic past and letting businesses keep their tax breaks to keep prices low, what am I supposed to vote for when it comes to the daily issues in my life? The Dems may get my ear because of the Republican's insistence that abortion is as evil as "Islamic terrorism," but they keep it because they keep talking about things that I believe in. Women aren't one-issue voters, Carly, but John McCain is wrong on more than one issue.

Fiorina: Dems 'Hold Women Hostage' To Abortion Issue [The Hill]
Carly Fiorina's Fuzzy McCain-Speak [LA Times]

Because  as EMILY's List's Ellen Malcolm notes  Sarah Palin is hardly the latter. She opposes reproductive choice and marriage equity. She's a member of the group "Feminists for Life," which is dedicated to eliminating reproductive choice in this country. She is a big promoter, like McCain, of so-called "consumer-driven" health care, in which the government would eliminate the tax breaks companies get for offering health insurance (and thus your company's financial incentive to pay for yours)  despite the fact that, as Gloria Steinem pointed out, women are far and way the larger users of our health care system. No one yet knows if she supports the Lilly Ledbetter pay equity bill, but she certainly hasn't spoken about it in the last year and, given that the head of her ticket opposes it, it's a fair bet to say she wouldn't fight for it.

But the newspapers are all full of speculation that McCain chose her to try to win over the Clintonistas still upset about Hillary Clinton's loss  and her speech today in which she recognized the contributions of Geraldine Ferraro and Hillary Clinton despite not mentioning how politically different they are, makes it clear that it is certainly on the campaign's mind. But while getting one woman to a top position is a great symbolic victory for women, is it worth giving up other things for which we've fought really hard just to get a symbolic victory?

Palin Tough Target For Obama To Hit [Politico]
The Ticket: McCain Palin [Politico]
McCain To Announce Alaska Gov. Sarah Palin As His Vice Presidential Pick (Updated) [Think Progress]
McCain And Palin: Promoting Failed Consumer-Driven Health Care [Think Progress]
Deep Thought [Cogitamus]
McCain Chooses Palin as Running Mate [NY Times]

The major anecdotes cited all revolve around one thing: the unknowable, which is the purpose of insurance. Oh, sure, it's great to have insurance for the Pill and strep throat, but the health crises that sink people and families aren't at that level. The Times article talks about cancer, renal failure and liver failure as being motivating factors for people to consider making marital moves they wouldn't otherwise contemplate (putting off divorce, marrying, and getting divorced, respectively). Other couples moved up their wedding dates or eloped to qualify for insurance or to change insurance plans that became suddenly too expensive for them to bear, even with employers paying a portion of the premium.

This is the system that too-little oversight and too-small a safety net has wrought  a system in which health insurance, let alone health care, is a major financial undertaking for some families on a par with buying a house (or not, since many of these people aren't wealthy). Are there Republicans listening? People are getting married and divorced based on their ability to get or maintain health insurance in a system that John McCain says can be fixed with a few individual tax breaks, some increased competition within the current framework and a lot of promotion of things like computers and the "availability" of programs to help you quit smoking. So while my friends and I are contemplating what could be different after the elections because of a significant health care reform, we're not just blowing liberal hot air. We're talking about what major, important life choices that people will be free to make or undertake when they're not stuck wondering whether to pay the insurance bill, the hospital bill or the mortgage this month. That's a freedom of choice too many people lack.

Health Benefits Inspire Rush to Marry, or Divorce [NY Times]

"Our egghead actuaries crunched the numbers based on all the data we have about healthcare," explained Tom Epstein, a Blue Shield spokesman. "This is what they found."

But once you exempt pregnancy, what do men and women do significantly different? Men die young more often, and women seek preventative care (which is supposed to lower the cost of health insurance in the long term). Naturally, that's a problem.

See, the thing about insurance is it is technically supposed to be about risk pools, not usage statistics. So, if you're a young single woman on birth control who goes to the doctor when you have a mild case of bronchitis instead of going to the emergency room if it becomes pleurisy (a real disease! my friend had it last year) or pneumonia, then you're supposed to be in better shape price-wise because you're being cost-efficient. But if insurance companies are pricing insurance based on if you use it  as has happened in other insurance fields, such as homeowner's insurance  then any usage, even if it's efficient in the long-term, will ratchet up your costs over time and discourage you from utilizing the very insurance you're paying for. Gotta love a market failure!

But what does this mean? According to Elizabeth Edwards, it means that if John McCain has his way and eliminates the tax preference for employers to provide health insurance in favor of an individual tax preference, we ladies will all be paying more for our health insurance than the men. Matthew Yglesias thinks that more and more plans will be designed for and marketed to men, if for no other reason then than 29 percent of women are dependent on someone else's insurance and only 13 percent of men are, while men are twice as likely to buy their own insurance even today. In fact, fully half of men are primary insurance holders, while only slight more than a third of women are  meaning even if they're less than half the population, they're the population for whom insurance plans will most likely be design and to whom those plans will most likely be marketed. And then they'll just charge us extra for all that stuff that guys aren't using, and because they can.

So even if you're not technically using it, just having that uterus will cost you extra, and I'm not just talking about cramps, either. While John McCain's "reforms" aren't going to do much for us single types, though, my analysis says the other President candidate's plans might actually help. Plus, I think we all know which guy is more likely to push for legislation making health insurance coverage gender neutral, and it's probably not the guy who called his wife a cunt.

Gender Can Cost You In Individual Health Insurance [LA Times]
Elizabeth Edwards On The Inequitable Individual Market [ThinkProgress]
Gender and Insurance [Matthew Yglesias]
Women and Health Insurance Coverage [Kaiser Family Foundation]
Health Insurance And the Single Girl [Glamocracy]

They're getting caught giving bonuses to employees who can find ways to boot sick people off their rolls. Because, see, health insurance is only profitable for companies when they can sell it (and the fear of really large medical bills you can't pay) and they don't have to actually, you know, help you pay those bills.

So, in California, the law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions. This leetle tidbit of legal information apparently passed over the heads of some people at Health Net Inc., who openly praised and provided bonuses to one of their underwriters for her excellent work in rescinding the insurance policies of sick people, claiming she was an underwriter, not a claims adjuster. Between 2000 and 2006, the company avoided paying $35 million in medical expenses through the work of this underwriter and her colleagues. Um, yay? The information is all coming out because one of the people whose policies they rescinded  a 51-year old hair salon owner  is suing to get her chemo for breast cancer covered after they rescinded her policy.

Like, great job health insurance companies! You wonder why people think even the government can do a better job than you, despite the fact that nearly every poll shows we regard large swaths of our government with contempt? It's because you do shit like this all the time. Everyone knows someone who's been screwed by a health insurance company, everyone has gotten dicked around at least a little by a health insurance company and, frankly, everyone is paying out the ass anyway for health insurance (except for the 47 million Americans who don't have any). So, maybe, you should take some of the $1 billion dollars you and your insurance compatriots spent on just lobbying the federal government (and God only knows what untold gobs of money on your army of lawyers) and try spending that on patient care, mmkay? I'll bet it might actually cost you less than figuring out ways to screw us all over.

Congress OKs Expanded Kids' Health Care [ABC News]
U.S. Health Care Politics [CBS News]
Health insurer tied bonuses to dropping sick policyholders [LA Times]
Lobbying Spending Database [Opensecrets.org]