How Obamacare Helped Me

In April 2008, I stopped drinking alcohol. When Mimi left her job, and her group health insurance plan, in November 2009 I suddenly became one of the 50 million uninsured Americans. But thanks to the Affordable Care Act – or “Obamacare” if you’re of a particular political persuasion – I now have health insurance coverage.

I have a family history of alcoholism and in 2008 decided I wanted to stop drinking. But it was harder than I thought. So I decided to visit my primary care physician and she prescribed Lexapro, an anti-depressant medication. After one dose, I lost my craving for alcohol. After thirty days, I stopped taking it and haven’t had a drink since.

Good news, right? Not if you want to purchase health insurance on the open marketplace. When we gave up our group health coverage, our insurance company declined to cover me citing my past history of “substance abuse and anxiety.” Fortunately, I was able to continue coverage through COBRA temporarily; that company dropped me after a payment was 3 days late.

For the last 18 months I’ve been without any health insurance coverage. After much prodding, our health insurance company did eventually offer me a policy that cost $1,500 per month with a $10,000 out-of-pocket deductible. I declined, hoping that the health care reform law passed by Congress in 2010 would kick in before I suffered any grave medical problem.

And that’s exactly what happened. This summer, I learned about the Pre-existing Condition Insurance Plan (PCIP) that was created as part of the health care reform law. Organized by the states and federal government, it provides coverage to someone like me who’s had difficulty getting coverage in the past. It’s not free, but at $168 a month it’s affordable.

I’ve worked in health care for nearly 20 years. During that time I’d heard from many people with diabetes, epilepsy and cancer and the difficulties they’d faced in obtaining health insurance. But losing my health insurance because I stopped drinking alcohol? I never thought in a million years my life would be at risk for making the (seemingly) right decision about my personal health.

So the next time you hear people decry “Obamacare” and how it’s taking away your personal liberties, think again. You just may be in my shoes some day.

Statement on Health Care Reform & “The Summit”

Regretfully, I see tomorrow’s much ballyhooed Health Summit as a big waste of time.

The GOP has been obstreperous all year.  And what happens?  They win Ted Kennedy’s Senate seat.  So now we think they’re ready to compromise?  Get Real.  Minority Whip Cantor’s already said the Obama bill is a “non-starter.”

Where can they possibly go from there?

The White House should lean hard on Speaker Pelosi and House Democratic Leaders.  They should just hold their noses and vote for the Senate bill, warts and all, and get it to President Obama’s desk.  No matter how much you hate doing it.  It’ll sure taste bad going down, but will do the patient a world of good.

This is an historic opportunity.  Fix the problems later, get the bill enacted now.  Waiting until the last minute is not a good idea, it’s an even-numbered year after all.  Reconciliation is a bad strategy and trying to blame Republicans, when you’ve had majorities in both chambers, is an Election Day disaster in the making.

Listen to me Online: Tuesday @ 11am EST

Listen to me Tuesday at 11am EST on the Sheer Balance internet radio show where we’ll talk about health care reform.

You can listen to the show live or download the podcast at

http://tinyurl.com/yfr5mql

And call me with a question at (347) 857-1289!

The Decline of Organizing in the Obama Era

I am constantly frustrated by the lack of resources organizations dedicate to political organizing and grassroots communications.  And after reading a recent article in BeyondChron, San Francisco’s Alterntive Online Daily, I realize I’m not alone in feeling that way.

How bad is it?  Consider health care.  According to a 2007 survey by the National Health Council, fewer than 1% of people affected by a chronic disease (e.g. diabetes) are advocates with a patient advocacy organization (e.g. American Diabetes Association).

Rather than organizing millions of patients to speak out, many patient groups dedicate significantly greater resources to political lobbying.  Lobbyists can be instrumental in the success of a political campaign.  But the strength of a patient organization lays in its members.  Without their active involvement, success is extremely difficult.  One need look no further than the once-again failure of health care reform.

Political organizer, author and BeyondChron editor Randy Shaw sees an overall decline in grassroots organizing since President Obama’s election in 2008. “The reasons range from sharply reduced funding for organizers,” Shaw writes, “to complacency after Democrats’ sweeping 2008 victories, to labor unions being forced to focus on protecting current workers…than organizing new members.”

As a result, grassroots organizing is being replaced by ineffective “email campaigns and other short-cuts” with potentially dire consequences for Democrats in the November, 2010 mid term elections.  “Investing in organizing and winning real change for people now is also the best strategy for success in November,” Shaw writes.  I couldn’t agree more.

The Cost of Failure is Very, Very Expensive

The Wall Street Journal published an essay today examining what might happen if Democrats fail to enact health care reform.  It’s not a pretty picture.

Unlike 1994, the last time health care reform failed, no one wants the status quo.  But that’s exactly what will happen if President Obama and Democrats in Congress don’t get their act together.

Think of it as the health care death spiral: More people will go without coverage, fewer employers will provide it, and it will get more and more expensive.

How expensive?  Take Medicare and Medicaid for example. This year those two programs alone will cost $725 billion, which is 50% more than Congress provides for all domestic programs.  That figure is expected to rise to $950 billion by 2014.  According to Congressional Budget Office Director Peter Orszag, “the fiscal course we’re on is…unsustainable.”

For a complete copy of the article, please click here.  An Urban Institute report on this issue is also available online by clicking here.

Statement on Health Care Reform

“House Democrats have an incredible opportunity before them,” said  consultant Joseph LaMountain.  “They have the power to ensure enactment of the most far-reaching health care reform legislation since Medicare in 1965. This would be one of the party’s most significant achievements in the last 50 years.”

“While the Senate bill is not their cup of tea,” LaMountain said, “they really have no choice but to accept it.  The longer this process drags on (13 months and counting) and the closer we get to the November elections, the tougher it becomes to strike a deal.  The clock is ticking, Republicans aren’t cooperating and you can’t wait another 15 years for this moment to return.”

Statement on Massachusetts Senate Race

“This is a disaster for Dems,” says Joseph LaMountain, a political consultant based in Alexandria, Virginia. “It doesn’t get worse than losing Ted Kennedy’s seat to a Republican. It reminds me of the GOP takeover in 94,” he said. “Health care reform was again the issue. Clinton recovered, enacted bipartisan welfare reform and was easily reelected.  This is Obama’s chance to pivot and become a real game changer.”

Economist: “America’s Dysfunctional Politics”

The Economist published an interesting article last week on the health care reform battle that’s consumed Washington for the last year.  Calling the battle “unedifying,” the magazine declared the “drama in Congress itself… no prettier.” The author then highlights the following four defects of American democracy that have been visible throughout the debate:

1. The Undemocratic Senate – Every schoolchild is taught why the Senate has two senators from every state, regardless of population. But that does not make the representative consequences less perverse. The system theoretically allows politicians representing around a tenth of the population (ie, 41 senators from the 21 smallest states) to block any bill.

The constitution says that when the Senate is equally divided, the vice-president may cast a deciding vote. But the chamber has operated for decades under rules that were designed to overcome filibusters but are now used to require a 60-vote supermajority for most important bills. Since the Democrats have “only” 58 of the 100 senators, this gives exceptional power to any Democrat threatening to break ranks, and to the two independents who caucus with the Democrats. One of these, Joe Lieberman of Connecticut, administered the death blow to the “public option” (a government-run plan to compete with private insurers), one of the biggest ideas contained in the House bill and an early draft of the Senate’s.

2. Extreme Partisanship – In a legislature of rugged individualists, the supermajority rule might at least force the majority to seek a broad consensus—no bad thing when far-reaching laws are proposed. But if the minority votes strictly on party lines the rule cannot work this way and becomes something less defensible in a democracy: a way for the minority to thwart the majority’s wishes.

And that is what nearly happened in the health debate. When the Senate voted on health on Christmas Eve, the Democrats reached their magic 60 but not a single Republican voted in favour. (In the 435-seat House only one Republican broke ranks.) Each side blames the other for the absence of compromise. Republicans say a Democratic party in hock to trial lawyers ignored Republican ideas, such as reforming the tort laws that drive up health costs. Democrats say the Republicans were never serious about reform and cared only about inflicting a defeat on the president.

Whichever side deserves more blame, the partisanship on display in the health fight followed a well-established trend. In its 57th annual study of voting patterns, published this week, Congressional Quarterly reported that Congress was more partisan than ever in 2009. More than seven out of ten Senate votes were what CQ calls “party-unity” votes, pitting a majority of one party against the majority of another. Cross-party coalitions of the sort that created Medicare and Medicaid in 1965 have become virtually extinct as politicians have deserted the middle ground.

3. Lobbying – Senator John McCain memorably called the 2003 energy bill the “no-lobbyist-left-behind” act. But the Centre for Responsive Politics, a non-partisan think-tank, expects that the amount spent on formal federal lobbying by the health and health-insurance industries (some $425m in the first nine months of 2009 alone) will break all records. And this is just a fraction of the two sectors’ total spend on television advertising and other efforts to influence the debate.

The fact that health reform is likely to pass in spite of this wall of money does not mean that Congress is impervious to the power of special interests. Much of the spending was designed to shape the bill, not to defeat the reform altogether.

Indeed, many industry groups lobbied in favour of reform—but only after cutting a series of pre-emptive deals with the White House. Mindful of the defeat of the Clintons’ health-reform effort of the 1990s, the Obama team worked hard to buy off potential foes in advance. The pharmaceuticals business was promised that reform would not cost drugmakers more than $80 billion over the next decade. Hospital bosses were told that reform would shave their revenues by no more than $155 billion—mere coppers in light of their gargantuan profits. The health-insurance industry accepted the inevitability of tighter regulation—in return for scooping up millions of healthy new customers compelled to buy insurance on pain of a fine.

Backstage bargains like these kept the plan afloat, but at the price of extinguishing some of the best ideas for reducing costs. The White House is unapologetic. “Let’s be honest,” said Rahm Emanuel, Mr Obama’s chief of staff: “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.” That attitude, shot back Bill Galston, one of the slighted think-tank’s senior fellows, all but guaranteed that Congress would duck the hard issues.

4. Pork – When every vote counts, lawmakers who fail to bring a fat wedge of pork home to their district are in danger of looking like wimps. Most blatantly, Ben Nelson, a Democrat from Nebraska, withheld his support for the health bill long enough to force Harry Reid, the Senate majority leader, to promise that Nebraska alone would not have to bear any of the cost of future expansion of the Medicaid programme. Mr Reid dismissed the ensuing furore. “That’s what legislating is all about,” he said. “It’s compromise.” It may be no coincidence that two out of three Americans tell pollsters they disapprove of the way Congress does its job.