The American Underground

http://www.ynetnews.com/articles/0,7340 ... 75,00.html
Son of Israeli immigrant accepts Obama offer to serve as chief of staff.

Democratic Rep. Rahm Emanuel served in IDF (Israel Defense Forces ), speaks little Hebrew. George Stephanopoulos: Obama told associates that Emanuel would 'have his back'
Yitzhak Benhorin
Latest Update: 11.05.08, 21:42 / Israel News
WASHINGTON - Illinois Democratic Rep. Rahm Emanuel, the son of an Israeli immigrant and an American Jew, has accepted US President-elect Barack Obama's offer to serve as White House chief of staff, Fox News reported Wednesday.
Chicago-born Emanuel, 49, served in the Israel Defense Forces and even speaks a little Hebrew. His father, Benjamin, is an Israeli-born doctor. His mother, Martha, is an American Jew who works for a Chicago civil rights organization.
As a child, Emanuel received a Jewish education at a conservative school and spoke Hebrew with his father at home.
According to ABC News, "the sharp-tongued, sharp-elbowed, keenly intelligent veteran of the Clinton White House is said to have ambitions to some day be Speaker of the House, but he also has a keen sense of duty."
ABC's George Stephanopoulos was quoted as saying that Obama likes the fact that Emanuel "knows policy, knows politics, knows Capitol Hill" and has told associates that Emanuel would "have his back."

http://libertariannation.org/a/f12l3.html
How Government Solved the Health Care Crisis

Medical Insurance that Worked — Until Government "Fixed" It

by Roderick T. Long

Today, we are constantly being told, the United States faces a health care crisis. Medical costs are too high, and health insurance is out of reach of the poor. The cause of this crisis is never made very clear, but the cure is obvious to nearly everybody: government must step in to solve the problem.

Eighty years ago, Americans were also told that their nation was facing a health care crisis. Then, however, the complaint was that medical costs were too low, and that health insurance was too accessible. But in that era, too, government stepped forward to solve the problem. And boy, did it solve it!

In the late 19th and early 20th centuries, one of the primary sources of health care and health insurance for the working poor in Britain, Australia, and the United States was the fraternal society. Fraternal societies (called "friendly societies" in Britain and Australia) were voluntary mutual-aid associations. Their descendants survive among us today in the form of the Shriners, Elks, Masons, and similar organizations, but these no longer play the central role in American life they formerly did. As recently as 1920, over one-quarter of all adult Americans were members of fraternal societies. (The figure was still higher in Britain and Australia.) Fraternal societies were particularly popular among blacks and immigrants. (Indeed, Teddy Roosevelt's famous attack on "hyphenated Americans" was motivated in part by hostility to the immigrants' fraternal societies; he and other Progressives sought to "Americanize" immigrants by making them dependent for support on the democratic state, rather than on their own independent ethnic communities.)

The principle behind the fraternal societies was simple. A group of working-class people would form an association (or join a local branch, or "lodge," of an existing association) and pay monthly fees into the association's treasury; individual members would then be able to draw on the pooled resources in time of need. The fraternal societies thus operated as a form of self-help insurance company.

Turn-of-the-century America offered a dizzying array of fraternal societies to choose from. Some catered to a particular ethnic or religious group; others did not. Many offered entertainment and social life to their members, or engaged in community service. Some "fraternal" societies were run entirely by and for women. The kinds of services from which members could choose often varied as well, though the most commonly offered were life insurance, disability insurance, and "lodge practice."

"Lodge practice" refers to an arrangement, reminiscent of today's HMOs, whereby a particular society or lodge would contract with a doctor to provide medical care to its members. The doctor received a regular salary on a retainer basis, rather than charging per item; members would pay a yearly fee and then call on the doctor's services as needed. If medical services were found unsatisfactory, the doctor would be penalized, and the contract might not be renewed. Lodge members reportedly enjoyed the degree of customer control this system afforded them. And the tendency to overuse the physician's services was kept in check by the fraternal society's own "self-policing"; lodge members who wanted to avoid future increases in premiums were motivated to make sure that their fellow members were not abusing the system.

Most remarkable was the low cost at which these medical services were provided. At the turn of the century, the average cost of "lodge practice" to an individual member was between one and two dollars a year. A day's wage would pay for a year's worth of medical care. By contrast, the average cost of medical service on the regular market was between one and two dollars per visit. Yet licensed physicians, particularly those who did not come from "big name" medical schools, competed vigorously for lodge contracts, perhaps because of the security they offered; and this competition continued to keep costs low.

The response of the medical establishment, both in America and in Britain, was one of outrage; the institution of lodge practice was denounced in harsh language and apocalyptic tones. Such low fees, many doctors charged, were bankrupting the medical profession. Moreover, many saw it as a blow to the dignity of the profession that trained physicians should be eagerly bidding for the chance to serve as the hirelings of lower-class tradesmen. It was particularly detestable that such uneducated and socially inferior people should be permitted to set fees for the physicians' services, or to sit in judgment on professionals to determine whether their services had been satisfactory. The government, they demanded, must do something.

And so it did. In Britain, the state put an end to the "evil" of lodge practice by bringing health care under political control. Physicians' fees would now be determined by panels of trained professionals (i.e., the physicians themselves) rather than by ignorant patients. State-financed medical care edged out lodge practice; those who were being forced to pay taxes for "free" health care whether they wanted it or not had little incentive to pay extra for health care through the fraternal societies, rather than using the government care they had already paid for.

In America, it took longer for the nation's health care system to be socialized, so the medical establishment had to achieve its ends more indirectly; but the essential result was the same. Medical societies like the AMA imposed sanctions on doctors who dared to sign lodge practice contracts. This might have been less effective if such medical societies had not had access to government power; but in fact, thanks to governmental grants of privilege, they controlled the medical licensure procedure, thus ensuring that those in their disfavor would be denied the right to practice medicine.

Such licensure laws also offered the medical establishment a less overt way of combating lodge practice. It was during this period that the AMA made the requirements for medical licensure far more strict than they had previously been. Their reason, they claimed, was to raise the quality of medical care. But the result was that the number of physicians fell, competition dwindled, and medical fees rose; the vast pool of physicians bidding for lodge practice contracts had been abolished. As with any market good, artifical restrictions on supply created higher prices — a particular hardship for the working-class members of fraternal societies.

The final death blow to lodge practice was struck by the fraternal societies themselves. The National Fraternal Congress — attempting, like the AMA, to reap the benefits of cartelization — lobbied for laws decreeing a legal minimum on the rates fraternal societies could charge. Unfortunately for the lobbyists, the lobbying effort was successful; the unintended consequence was that the minimum rates laws made the services of fraternal societies no longer competitive. Thus the National Fraternal Congress' lobbying efforts, rather than creating a formidable mutual-aid cartel, simply destroyed the fraternal societies' market niche — and with it the opportunity for low-cost health care for the working poor.

Why do we have a crisis in health care costs today? Because government "solved" the last one. D

Fact Sheet: The Truth About the Health Care Bill

The Firedoglake health care team has been covering the debate in congress since it began last year. The health care bill will come up for a vote in the House on Sunday, and as Nancy Pelosi works to wrangle votes, we've been running a detailed whip count on where every member of Congress stands, updated throughout the day.

We've also taken a detailed look at the bill, and have come up with 18 often stated myths about this health care reform bill.

Real health care reform is the thing we've fought for from the start. It is desperately needed. But this bill falls short on many levels, and hurts many people more than it helps them.

While details are limited, there is apparently a "Plan B" alternative that the White House was considering as recently as two weeks ago, which would evidently expand existing programs -- Medicaid and SCHIP. It would cover half the people at a quarter of the price, but it would not force an unbearable financial burden to those who are already struggling to get by.

Congress may be too far down the road with this bill to change course. But before Democrats cast this vote which could turn "ban the mandate" into "gay marriage" for the GOP in 2010, they should consider the first rule of patient safety: first, do no harm.

Myth 1: This is a universal health care bill.

Fact: The bill is neither universal health care nor universal health insurance. According to the Congressional Budget Office:


* Total uninsured in 2019 with no bill: 54 million

* Total uninsured in 2019 with Senate bill: 24 million


Myth 2: Insurance companies hate this bill.

Fact: This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009.
The original Senate Finance Committee bill was authored by a former Wellpoint vice president. Since Congress released the first of its health care bills on October 30, 2009, health care stocks have risen 28.35%.

Myth 3: The bill will significantly bring down insurance premiums for most Americans.

Fact: The bill will not bring down premiums significantly, and certainly not the $2,500/year that President Obama promised during his campaign.

Annual premiums in 2016: status quo / with bill:
Small group market, single: $7,800 / $7,800
Small group market, family: $19,3oo / $19,200
Large Group market, single: $7,400 / $7,300
Large group market, family: $21,100 / $21,300
Individual market, single: $5,500 / $5,800
Individual market, family: $13,100 / $15,200

(The cost of premiums in the individual market goes up somewhat due to subsidies and mandates of better coverage. The CBO assumes that cost of individual policies goes down 7-10%, and that people will buy more generous policies.)

Myth 4: The bill will make health care affordable for middle class Americans.

Fact: The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can't afford to use.

A family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income -- out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible.

Myth 5: This plan is similar to the Massachusetts plan, which makes health care affordable.

Fact: Many Massachusetts residents forgo health care because they can't afford it. A 2009 study by the state of Massachusetts found that:


* 21% of residents forgo medical treatment because they can't afford it, including 12% of children

* 18% have health insurance but can't afford to use it


Myth 6: This bill provides health care to 31 million people who are currently uninsured.

Fact: This bill will mandate that millions of people who are currently uninsured purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties. Some will be assisted with government subsidies.

Myth 7: You can keep the insurance you have if you like it.

Fact: The excise tax will result in employers switching to plans with higher co-pays and fewer covered services.
Older, less healthy employees with employer-based health care will be forced to pay much more in out-of-pocket expenses than they do now.

Myth 8: The "excise tax" will encourage employers to reduce the scope of health care benefits, and they will pass the savings on to employees in the form of higher wages.

Fact: There is insufficient evidence that employers pass savings from reduced benefits on to employees.

Myth 9: This bill employs nearly every cost control idea available to bring down costs.

Fact: This bill does not bring down costs and leaves out nearly every key cost control measure, including:


* Public Option ($25-$110 billion)

* Medicare buy-in

* Drug re-importation ($19 billion)

* Medicare drug price negotiation ($300 billion)

* Shorter pathway to generic biologics ($71 billion)


Myth 10: The bill will require big companies like Wal-Mart to provide insurance for their employees.

Fact: The bill was written so that most Wal-Mart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage.

Myth 11: The bill "bends the cost curve" on health care.

Fact: "Bends the cost curve" is a misleading and trivial claim, as the U.S. would still spend far more for care than other advanced countries.


* In 2009, health care costs were 17.3% of GDP.

* Annual cost of health care in 2019, status quo: $4,670.6 billion (20.8% of GDP)

* Annual cost of health care in 2019, Senate bill: $4,693.5 billion (20.9% of GDP)


Myth 12: The bill will provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition.

Fact: Access to the "high risk pool" is limited and the pool is underfunded. Only those who have been uninsured for more than six months will qualify for the high-risk pool. Only 0.7% of those without insurance now will get coverage, and the Centers for Medicare and Medicaid Services report estimates it will run out of funding by 2011 or 2012.

Myth 13: The bill prohibits dropping people in individual plans from coverage when they get sick.

Fact: The bill does not empower a regulatory body to keep people from being dropped when they're sick. There are already many states that have laws on the books prohibiting people from being dropped when they're sick, but without an enforcement mechanism, there is little to hold the insurance companies in check.

Myth 14: The bill ensures consumers have access to an effective internal and external appeals process to challenge new insurance plan decisions.

Fact: The "internal appeals process" is in the hands of the insurance companies themselves, and the "external" one is up to each state.

Ensuring that consumers have access to "internal appeals" simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an "external appeals process," as there is neither funding nor a regulatory mechanism for enforcement at the federal level.

Myth 15: This bill will stop insurance companies from hiking rates 30%-40% per year.

Fact: This bill does not limit insurance company rate hikes. Private insurers continue to be exempt from anti-trust laws, and are free to raise rates without fear of competition in many areas of the country.


Myth 16: When the bill passes, people will begin receiving benefits under this bill immediately

Fact: Most provisions in this bill, such as an end to the ban on pre-existing conditions for adults, do not take effect until 2014.

Six months from the date of passage, children could not be excluded from coverage due to pre-existing conditions, though insurance companies could charge more to cover them. Children would also be allowed to stay on their parents' plans until age 26. There will be an elimination of lifetime coverage limits, a high risk pool for those who have been uninsured for more than 6 months, and community health centers will start receiving money.

Myth 17: The bill creates a pathway for single payer.

Fact: Bernie Sanders' provision in the Senate bill does not start until 2017, and does not cover the Department of Labor, so no, it doesn't create a pathway for single payer.

Obama told Dennis Kucinich that the Ohio Representative's amendment is similar to Bernie Sanders' provision in the Senate bill, and creates a pathway to single payer. Since the waiver does not start until 2017, and does not cover the Department of Labor, it is nearly impossible to see how it gets around the ERISA laws that stand in the way of any practical state single payer system.

Myth 18: The bill will end medical bankruptcy and provide all Americans with peace of mind.

Fact: Most people with medical bankruptcies already have insurance, and out-of-pocket expenses will continue to be a burden on the middle class.


* In 2009, 1.5 million Americans declared bankruptcy

* Of those, 62% were medically related

* Three-quarters of those had health insurance

* The Obama bill leaves 24 million without insurance

* The maximum yearly out-of-pocket limit for a family will be $11,900 (PDF) on top of premiums

* A family with serious medical problems that last for a few years could easily be financially crushed by medical costs


Real health care reform is needed. But this bill falls short of that on many levels.