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I don't think Judge Andrew Napolitano yesterday gave Neil Cavuto quite the response he was looking for when he asked him about Arizona Gov. Jan Brewer's predictably bad decision to make hers the first official police state in the country for immigrants.

See, every other paid Fox News Analyst that day had been sturdily defending the bill. Not the Judge:

Napolitano: She's gonna bankrupt the Republican Party and the state of Arizona. Look at what happened to the Republicans in California with the proposition --

Cavuto: What happens?

Napolitano: Ah, Hispanics -- who have a natural home in the Republican Party because they are socially conservative -- will flee in droves. She's also gonna bankrupt her state, because no insurance company will provide coverage for this. And for all the lawsuits that will happen -- for all the people that are wrongfully stopped -- her budget will be paying for it. Her budget will be paying the legal bills of the lawyers who sue on behalf of those that were stopped.

This will be a disaster for Arizona -- to say nothing of the fact that it's so unconstitutional that I predict a federal judge will prevent Arizona from enforcing it as soon as they attempt to do so. That will probably be tomorrow.

Judge Napolitano is an interesting mixed bag of an analyst. Sometimes he's just a flat-out nutcase. At other times, he's a sharp and insightful guy. This was definitely one of the latter occasions.

I think what Arturo Venegas, Jr., former chief of the Sacramento Police Department and project director of the Law Enforcement Engagement Initiative, had to say bears repeating:

“The passage of SB 1070 in Arizona is a catastrophe for community policing, with repercussions that will be felt by law enforcement officials across the country. The actions of the state legislature and Gov. Brewer are an unfunded mandate to Arizona police and are clearly rooted in concerns over politics, not public safety. No police officer should have to put arresting an undocumented immigrant over catching a violent criminal to avoid a lawsuit, and no victim or witness of a crime should be afraid to report it because he or she will be deported if he or she speaks to police.

“This law will drive a wedge between police and the immigrant and Latino communities not only in Arizona, but around the country. Trust between law enforcement professionals and the communities they serve is the cornerstone of community policing, and departments across the country have been working for decades to develop strong relationships with the community. Latinos and immigrants across America have been watching Arizona with fear, and will retreat deeper into the shadows now that this bill has become law.

“Today is a very sad day for the majority of us in law enforcement who believe that effective policing is based on community trust. I hope the federal government will heed this wake-up call and take long-overdue action for comprehensive immigration reform to protect our communities, and I am deeply disappointed in Governor Brewer and the Arizona legislature for passing this dangerous, costly, and ineffective law.”

It's important to understand that this kind of approach means that real violent crime is going to increase in Arizona. That's certainly what has happened in Maricopa County, under the regime of Crazy Sheriff Joe Arpaio, whose approach to emphasizing immigration enforcement has served as the inspiration for this bill. As the conservative Goldwater Institute found [PDF], such an approach meant skyrocketing rates in real crime:

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Salon's Cary Tennis is one of my very favorite writers. He's on hiatus from his "Since You Asked" advice column there, where he's written quite movingly of his journey toward sobriety. Instead, he's been blogging about his cancer fight.

Now he faces an even bigger battle: one with Blue Shield, and he needs our help:

I've been recovering from cancer surgery and waiting for the insurance company to approve the next course of treatment, which is eight weeks of proton beam radiation therapy at Loma Linda Hospital in Southern California.This treatment is what my surgeon, Dr. Christopher Ames of UCSF, calls the standard of care for sacral chordoma.

Today I learned that the insurance company has denied the request for this treatment. Dr. Ames is a noted expert on spinal tumors. That's Ames in the ABC7 News video below -- taking four vertebrae out of a woman's neck and ... well, just watch the video. This is the guy who operated on me:

Dr. Ames says that 8 weeks of proton beam radiation therapy at Loma Linda Hospital is the standard of care and I believe him. So I called Blue Shield. They told me to fill out this grievance form.I put the grievance form PDF on my Web site, where you can download one, too. Maybe if a few hundred, or a few thousand, of these forms were filled out and mailed to Member Services Grievances, Blue Shield of California, P.O. Box 272540, Chico, CA 95927-2540, well ... maybe it would get some attention. Or maybe if you called (800) 424-6521, which is the number that people with grievances are supposed to call, maybe that would get some attention. On the back of the form are instructions about how to contact the California Department of Managed Health Care. Their phone number is 888-HMO-2219.

Sacral chordoma is a very rare cancer, and proton beam radiation therapy is not a well-known course of treatment. Plus it is expensive. So naturally an insurance company is going to carefully review a request for such treatment.

But Blue Shield wouldn't deny me needed care, would they?I don't want special treatment. I want the same treatment anyone else would get. I just want treatment.

Our very own Murray Waas broke the story:

In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.

Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.

So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.

But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.

In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy. In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.

By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.

It turned out that Fortis/Assurant had a policy of targeting every customer with an HIV diagnosis for a fraud investigation where the company would search for any pretext to drop the policy.

Rescission--or the practice of dropping insurance policies at the time when customers need them, namely, when they become ill--is widespread and insurance companies are unapologetic for doing so.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Nevertheless, the judges involved in this case called Assurant/Fortis' actions in targeting specifically HIV patients "reprehensible." It is also a policy that will end with the health care reform bill.

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Seems that Sarah Palin isn't the only right-winger out there trying to convince the world that the "death panels" actually exist. Indeed, as Media Matters notes, there's a whole bandwidth of wingnuts out there trying to revive the notion.

One of these is the Troll Who Lives Under the Bridge And Sucks Your Toes, aka Dick Morris, who was on The O'Reilly Factor earlier this week with fill-in host Monica Crowley:

Morris: Look, Monica, it's one thing to load a big bill with pork. That's what the stimulus package was. But to load a health-care bill, where Americans are seriously worried that this is gonna destroy the health care their parents get, that this is gonna lead to government-imposed euthanasia, where they'll say, 'No, you can't have this annual mammogram, because I know it might save your life, but it costs too much.' 'No, you can't have this drug for colon cancer, because the drug we're going to let you take isn't as good as this one, but we can't afford it.' When we come to those kind of euthanasia-like decisions, to learn that the reason the Senate approved this was some little bitty payoff that went on to some insurance company that gave you a campaign contribution -- that kind of tawdry stuff for this kind of magnitude of deformity on the system is enough to drive people crazy -- me included.

I've always said that anyone who takes Dick Morris's advice deserves everything they get, because the man is such a font of misinformation. That includes a lot of intentional disinformation, promoting provably false "facts" that unhinge the people who absorb this crap. As we can see.

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(h/t David)

David Axelrod discusses the healthcare bill on This Week with George Stephanopoulos:

STEPHANOPOULOS: And, David, the public seems to have questions as well. We did a poll this week, ABC News/Washington Post poll, that showed that 53 percent of the public think their own health care will cost more if this passes, 55 percent think the health care system overall will cost more, and only 37 percent think their own quality of care will be better.

In the face of this kind of skepticism, is it wise to ram through legislation like this, such a huge piece of legislation on a party-line vote?

AXELROD: Well, I would say a few things, George. First of all, you say this is what people think, I think when people see what actually happens after these reforms are passed, those concerns are going to be allayed, and they're going to realize that if they have insurance, they're more secure in their relationship with their insurance company, their costs are going to go down.

If they don't have insurance, they can get it at a price they can afford. It's going to reduce our deficit. It's going to extend the life of Medicare. Medicare recipients are going to get a better deal on prescription drugs and better care. So the reality I think will trump polls numbers in the dead of winter as this debate is going on.

In terms of ramming it through, we've been talking about this, we've been debating it and considering it for eight months. The Republican Party has spent a month engaged in parliamentary maneuvers and dilatory tactics to try and prevent and vote.

Understand, the big question here isn't whether or not we're going to get a vote, whether this will pass or not, the big question is whether the Republican Party will allow a vote. A majority of senators support this reform, and the Republican Party wants to prevent it from coming up for a vote. I think the American people are entitled to a vote.

If you are a person with pre-existing conditions, if you're a small business person who can't afford health care, if you are a person who became seriously ill and was thrown off your insurance -- their insurance because of that, if you're going bankrupt because of out-of-pocket expenses, you need the United States Senate to act.

STEPHANOPOULOS: But most of the changes, even if the bill passes won't be instituted until after the next presidential election, so you're asking people to take an awful lot on faith.

AXELROD: George, that's not really true, almost all of these insurance protections, the things that will protect people in terms of out-of-pocket costs, the pre -- children...

(CROSSTALK)

STEPHANOPOULOS: (INAUDIBLE).

AXELROD: The day the president signs the bill, children with pre-existing conditions will now be -- an insurance company can't keep them from joining their parents' insurance policy. People with pre-existing conditions will have a catastrophic plan they can join.

And then, of course, when the thing goes fully into effect, everyone will be on insurance, insurance companies can't ban anyone with pre-existing conditions. But there are number of insurance protections that go into effect as soon as the president signs the bill. And not to mention, will begin reducing that gap in Medicare prescription coverage. So there...

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Just got off another blogger conference call, this time with Howard Dean, former CIGNA exec Wendell Potter, and Mike Lux.

Dean announced the results of a DFA poll that is "really quite stunning," he said. (You can read the results here.) The Senate cloture vote is scheduled for 7:30 p.m. on Christmas Eve, he said.

Democracy for America's "No Option, No Mandate" campaign to contact Harry Reid clocked 7000 calls in four hours, too, he said.

Dr. Dean opened the call by saying "this bill has always been a giveaway to the insurance industry, but we were willing to compromise" to get the public option.

He recapped all the compromises we made: "We wanted single payer, but that was taken off the table early on. That was a mistake. We had to get to the place where we had health insurance for all Americans." But now, he said, there's no public option, and no Medicare option.

"You're forced to pay money to an insurance company or get fined $750 by your government, while 27% of your money goes to CEOs who are flying around in these private jets," he said.

He talked about the compromises made for pre-existing conditions, the most disturbing one the ability to charge you 300% more, merely for being older. "It's guaranteed issue, but if you’re making $65,000 a year for a family of four and you’re paying $20,000 for insurance, how is that reform?"

He said the real bad stuff in the Senate bill was

"hidden in the weeds, so you can’t find it."

Dr. Dean brushed aside the "Get a bill, any bill" mentality in Washington. "Any legislation passed will have a huge impact on American healthcare. If they can’t fix it, it shouldn’t pass."

Wendell Potter, former CIGNA executive and reform activist, said the insurance industry got "every single thing they wanted" in the Senate bill.

"There's no individual mandate, no public option. There's also three words, 'benefit design flexibility' in Senate bill – that means the freedom to design plans that will pass more and more of us into ranks of the underinsured - and charge up to 22% of income if someone gets sick," he said.

In Massachusetts, they have a 2 to 1 premium ratio, "and they're already having trouble finding affordable, adequate insurance. The industry wants to shift even more costs to individuals and families, having the government pay them half a trillion dollars. The Senate bill meets every one of their requirements," Potter said.

"They will continue to shift the cost burden to consumers and get around not using preexisting conditions by charging for certain factors like high cholesterol."

Dr. Dean pointed out the House bill "is the compromise, we didn’t think it was right to take the option of an employer-based system away if people liked it."

In Vermont, he said, you can't be charged more than double the lowest premium.

Dean listed some more of the insurance company wish list the Senate was so eager to fill. "Getting rid of the anti-trust provision. This contributes to the predatory effect of the insurance companies – they're essentially unregulated. We need to get the provision in, get them regulated.

Wendell Potter talked about something you often hear pushed from the Republican side: "Just let us sell across state lines and let the market decide." As he points out, insurers would go to the states with least regulation.

Paul Hogarth from Daily Kos asked them to address criticism that if the bill is killed, "there's no reform and we’re worse off, the momentum is gone."

"I don’t know that we’ll be worse off," Dr. Dean said. "We ought to strip down this bill and get rid of the mandate. It should have been done by reconciliation."

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(h/t Heather.)

First of all, I'd like to reiterate that yes, a bill without a public option can serve the same purpose as the public option: namely, to force efficiency and competition. So yeah, I do see this as a win - and so does Nate Silver. And I don't buy the insurance company "we won" mantra just yet, because the Medicare buy-in proposal is a real threat to them. After all, the 55+ group is very profitable for them.

It seems clear the most important component of a plan lacking a public option is a mandated medical-loss ratio. But here's the most important detail of a requirement that companies spend 90 percent of each premium dollar on care: Who will be responsible for enforcement? In order to work, it's got to be the feds.

This is the most important part of the argument, because insurance companies (and their PACs) have enormous influence in state markets - and in state legislatures. State insurance commissioners are usually (not always) hired from the ranks of the industry, and are famous not only for rubber-stamping rate increases, but for far too often turning a blind eye to insurance company abuses.

What we want to watch in the Medicare buy-in is, are they going to take premiums (subsidies, whatever form it finally takes) into the Medicare trust fund? Believe it or not, it would be a very good thing if they did. A younger, healthier population would actually lessen the strain on the Medicare system. But I'm betting Republicans will shamelessly present it as "an assault on Medicare."

We also have to look at who gets to buy in - and why. Under the current proposal, people 55+ get to pick Medicare through the new exchanges in 2014. But what do we do until then? Well, they plan to allow them in starting in 2011.

Is this only for high-risk patients? Because it would really be a drain on the Medicare system (if the premiums went into the same system) if it was. It would be a bad idea anyway, because it would be too difficult to sustain if it was all people with pre-existing conditions.

Will the new Medicare members be charged the full cost? At 65, you're heavily subsidized for most of the cost, paying about $100 a month. The real cost is closer to $500. So will there be subsidies to purchase Medicare? Definitely, in 2014.

In the meantime? Not clear. This is one of the areas on which you want to lobby Congress.

You probably already know the problems with triggers - namely, that they're usually written in such a way as to make it highly unlikely they ever kick in. (That's why Queen Olympia loves them.)

As you might expect, we'll be watching closely.

Former CIGNA executive Wendell Potter says one of the most important things we can do to reform health care is to control the medical loss ratio - something Al Franken, Jay Rockefeller and other senators are attempting to do:

Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.

Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.

Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.

The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.

Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American

patients and their doctors, according to the industry's trade group.

And they do this by finding every excuse in the book not to pay a claim, even if it means

canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging."

In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main

consideration.

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.

The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.

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h/t David

From This Week with George Stephanopoulos, Republican Rep. Marsha Blackburn and Democratic Rep. Debbie Wasserman Schultz get into one of those discussions over this week's breast screening recommendations in which the Republican simply constructs an alternate reality:

BLACKBURN: ... Debbie is right when she says they forgot about people. Indeed, they did. But we have to realize, this group that made this recommendation, this isn't some outside group. This is a part of HHS. And when you look at the...

WASSERMAN SCHULTZ: It's an independent group. That is not accurate.

BLACKBURN: ... 118 -- when you look at the...

WASSERMAN SCHULTZ: It is not a part of HHS.

BLACKBURN: No, it is a part of HHS.

WASSERMAN SCHULTZ: No, it is not.

BLACKBURN: And when you look at what is going to happen with these 118 new bureaucracies with 62 directives that are given by the health choices commissioner on what insurance can be offered in this country after 2013 and what is going to be paid, you know that this is the bureaucrat in the exam room. This is how it's going to happen.

WASSERMAN SCHULTZ: Marsha...

BLACKBURN: And this is the first step.

WASSERMAN SCHULTZ: Marsha, there's an insurance company bureaucrat in the -- in between the patient and her doctor right now.

BLACKBURN: This is breast cancer. Well, and people don't like that, and we need to get rid of...

(CROSSTALK)

WASSERMAN SCHULTZ: And your bill -- your -- your alternative...

(CROSSTALK)

BLACKBURN: We need to get rid of all of those insurance bureaucrats.

WASSERMAN SCHULTZ: ... does nothing to...

(CROSSTALK)

STEPHANOPOULOS: I'm going to have to -- I'm going to have to stop this right now.

Yes, George. Because your job is to provide a showcase. You're not supposed to confront the guests when they make things up.

If they're already admitting to causing deaths, why should they care about a little girl's hearing?

What more do we have to do to fight back against these horror stories? What will it take to get these insurance companies to see the inherent immorality of focusing on the bottom line to the exclusion of all else? Think Progress:

One of the worst abuses of the private health insurance industry is its practice of denying claims to pay for necessary care for patients. This practice has become so rampant in the industry that a recent study by the California Nurses Association found that a whopping 21 percent of all insurance claims filed in the first half of 2009 in the state of California were denied by insurers.

As the story of six-year-old Madison Leuchtmann of Franklin County, MO, demonstrates, even children are victims of this insurance company abuse. Madison was born with bilateral atresia, which means she lacks ear canals in both ears. In order to hear, she wears a special device on a headband that allows her to make out sounds. Despite her disability, Madison is at the top of her kindergarten class and is slowly learning to read.

Yet Madison, due to her growth, will soon require a new hearing implant to be able to recognize sounds. Her hearing and speech therapist warns that “if she doesn’t get her implants by age seven, she’s not going to be able to blend her words. … She won’t be able to hear herself [talk].” Madison’s pediatrician, Dr. Randall Clary, also insists that without the implant, the girl may never be able to hear again. Unfortunately, the Leuchtmann’s family insurer, Cigna, has issued "one denial after another,” flatly refusing to cover the $20,000 bill for the implant. In a written statement to the local news station Fox 2, Cigna explained, “It is not unusual for commercial benefit plans to exclude hearing assisted devices,” prompting Dr. Clary to angrily respond, “This is obviously medically necessary. You have a child that has no ear canals!” Dr. Clary also told Fox 2 that he sees these sort of denials “on a weekly basis.”