December 19, 2009

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."

He said there were "some good things in this bill – money for community health centers," and other project. But he rejected the idea that killing the bill is the same as stopping reform.

"The idea that the legislation won’t pick this up for another 20 years is ridiculous. It’s a different time, we're in a crisis," he said.

The doctor said "Democrats aren’t tough enough. Use reconciliation like George Bush did - they used it 23 times."

McJoan from Daily Kos asked about the Stupak amendment. Dean predicted it wouldn't be passed. "I think the bill’s dead if Stupak’s in it. I can’t believe the women of the House will let it go through."

I asked about the plans to increase state authority to regulate insurers that were discussed in Wednesday's White House call, and both Dr. Dean and Potter cautioned against it.

"You have to ask this question: What would George Bush do in this situation? Nobody’s thinking about what will happen 15 years from now," Dr. Dean said.

"Who will be writing the regulations? How will this be handled when there’s a Republican administration?" Potter said.

Unintended consequences – having to buy insurance, have to have the ability to market products to keep people underinsured. Have to buy products they don’t want to buy, often for inadequate coverage.

John Odom asked: "Looking at the rhetoric of the past few days, how much is driven by egos and pure pique?"

Dr. Dean said the press attitude is "one of the reasons why I stay completely out of the personality stuff. The press would like nothing more, and it doesn’t get us to a better health care bill. It's heading us in the wrong direction."

"I’d never speculate on anyone’s motives," Potter said. But, he said, "There is a very little understanding of how the commercial insurance industry operates."

"It's a lot less about personality than it is about lobbyists being successful in driving the agenda here," Mike Lux added.

If we stripped the bill, what’s salvageable?

"Recissions, preexisting conditions, accountability, more information about how companies operate, awareness of what we’re buying – can’t shift costs onto consumers," Potter said.

"Real community rating, restore restrictions on cost control, insure by 2012, pay more of Medicare share, not the states, expanding Medicaid to everyone under 26. Make sure any federal regulations – the tougher regulations of the home state take precedence," Dr. Dean said.

We ended with a discussion of Medical Loss Ratio, the amount of each premium dollar spent on medical care. "It's dropping and dropping," Potter said. He said we want a mandated amount, "or we will continue to see companies shifting premium dollars to investors."

Dr. Dean reminded us the MLR's "not in there, the CBO ruled you can’t do that."

Can you require that any insurer in the exchange meet a minimum MLR? I asked.

Dr. Dean said no. "But what you can do is Kerry’s amendment: It gives state exchange managers the authority and the duty to look at highest MLR for consumers."

"Or at least require them to disclose it under standard definitions," Potter said.

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