From Fox News Sunday:

[CHRIS WALLACE]: What would you tell a woman patient with no particular history of breast cancer what she should do about getting mammograms?

DR. BERNADINE HEALY, FORMER HEAD OF THE NATIONAL INSTITUTES OF HEALTH: I think she should stick with the existing guidelines that come out of the medical professional organizations and have been in place for a long time, which is start your screening at age 40; if you are concerned about a risk, maybe a baseline of 35; and then — and then have it done every year in your 40s. You might go to every other year in your 50s.

And you and your doctor will decide for how much longer it should go.

WALLACE: So basically you’re saying ignore the [U.S. Preventative Services Task Force] recommendations this week.

HEALY: Oh, I’m saying very powerfully ignore them, because unequivocally — and they agreed with this — this will increase the number of women dying of breast cancer. Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients. You may save some money, Chris, but you’re not going to save lives.

Her opinion on the role/goal/composition of the Task Force:

This particular task force has been in existence for about 25 years and its focus is on public health, modeling of health policy and economics.

It does not have people who are experts in hands-on patient care, for the most part, and on oncology or even in breast cancer or cervical cancer. It gets information from those groups, but it ultimately comes up with models.

You know, Chris, there’s really been no new information here. It is a different way of looking at the same problem. Their perspective is if you can cut in half the money we’re spending on screening for breast cancer and lose only, you know, maybe 10 percent, 20 percent of the benefit, that’s a good tradeoff.

A doctor who is responsible ethically for their individual patient would not make that tradeoff.

…

This is not the voice that medicine has used that focuses on the individual patient rather than the good of society. And even if they included the other groups, like the obstetricians and gynecologists, and the oncologists, and the cancer society, that would be fine, but they didn’t.

The issue here is that we are listening to one voice. And unlike what the secretary said and Senator Stabenow just said, this is not just a recommendation. This is codified in law that this is the group that will be providing information.

The bolded sentences highlight precisely what I’ve been saying in discussions about this topic – and why I think the tradeoff supported by the guidelines are completely unacceptable.

I appreciate that overall, she did not allow Wallace to drag her into a politicized conversation about the topic.

For one senator, on one issue, the answer is clear. And even if you disagree with him, the honesty and brevity of that answer is refreshing, precisely because such answers seem so rare among a class of people known for obfuscation.

Political scientist Steven Taylor points to this piece in particular that asks the question. And Taylor — as usual — stands back and gives us his take on the issue, minus any talk show like rhetoric of the left and right. And it’s our political Quote of the Day:

However, what it is “telling” about is the nature of the Senate and the way that that rules have evolved over the last several decades. It is difficult to do business in the Senate, period. And the process of having have a debate and vote about where or not to have a debate and a vote is nothing new to Senate processes. Indeed, in the absence of unanimous consent agreement, it is the only practical way for major legislation to reach the floor. It other words: it is the kind of thing that is not a deviation from the norm but only seems like one because observers typically pay no attention to the process. I have written some about Senate procedures along these lines here and here, although there the process under discussion was judicial nominations more than general bills. In basic terms: bills are supposed to come off the calendar in the order in which they are placed on the calendar. This is an inconvenient way to do business, especially in terms of major legislation. As a result, a motion is needed to get the bill off the calendar and onto the floor. This is usually done for major legislation through a negotiated process between the majority and the minority leadership. However, the minority clearly did not want this bill on the floor, so a motion to proceed was needed and hence the debate. Indeed, one of the main reasons that controlling 60 seats in the chamber is a big deal is that it (theoretically, at least) gives the majority direct control of the calendar by providing enough votes for such motions without having to negotiate with the minority. Of course getting 60 votes even within the majority caucus is never a guarantee.

It is also “telling” about those making the observation (both York and “the source”) that they seem not to understand that, by definition, super-majorities are difficult to construct. Just because the Democrats have 60 seats does not mean that they have 60 automatic votes. The very nature of super-majority requirements is such that it empowers the minority and makes constructing the final vote a real challenge. It is difficult enough to cobble together a legislative majority in our system for major legislation, let alone for a 2/3rds vote (for any number of reasons, not the least of which being the regional variations in ideological perspectives around the country and the personalistic/candidate-centered nature of our elections).

And yes: this is major legislation not without any number of controversies associated with it. It would be shocking if there weren’t fights along the way, even within the Democratic caucus.

Taylor’s blog is required reading for political junkies. It’s reading a political scientist’s analysis on an issue versus reading something that sounds like you heard it on a right or left cable or radio talk show. It may not be the popular analysis to say, “Hey, just wait, take a deep breath and look at the actual facts” but with Taylor it’s always a classy analysis.

All Democrats and Independents voted Yes. All Republicans voted No.

Max Baucus flew in from Montana, where his mother is apparently very ill, to vote Yes. That deserves great respect and thanks, and my strongest hopes go to Sen. Baucus and his family for his mom’s recovery.

Debate will begin on the Senate floor the first day at work after Thanksgiving break.

Seizing on a quasi-government task force’s report this week recommending that annual mammograms start at 50 rather than 40, the GOP has gone into full outrage mode.

“This is how rationing begins,” warns Rep. Marsha Blackburn. “This is the little toe in the edge of the water. This is when you start getting a bureaucrat between you and your physician.”

Never mind that Secretary of Health and Human Services Kathleen Sebelius immediately made it clear that the US Preventive Services Task Force “is an outside independent panel of doctors and scientists who make recommendations” and who neither “set federal policy” nor “determine what services are covered by the federal government.”

“The task force has presented some new evidence for consideration,” she noted, “but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

In fact, the recommendation has provided a starting point, as it was intended to do, for debate of the issue, rather than a mandate, and has met heavy resistance from physicians and patients as well as the American Cancer Society.

Read the rest of this entry.

BREAKING @ 3 pm ET: Senate Democrats have secured the 60 votes needed to move the bill forward to floor debate. Details at Politico.

Here is a live streaming video feed of the Senate health care reform debate. The actual vote on whether to let the bill come to the Senate floor for debate and amendments is expected between 8 and 9 pm EST. This live video will remain at the TOP of TMV until after the coverage completely ends. Underneath the video you’ll periodically see some links to news stories and blogs of various opinions on the debte. So keep checking back. And here is the debate at this moment:

12:55 – Landrieu thinks something are wrong with the bill. First she thinks the tax credits for small businesses are too small and need to be expand. She wants more tax equity for those who are self-insured. She is rightly worried about the possibility of premiums going up between now and 2014. She is against the current public option. She wants a trigger, like the one promoted by Snowe.

12:50 – Landrieu begins by praising Wyden and his efforts to create the Wyden-Bennett plan that she co-sponsored. She says she will vote to let the debate move forward, but her vote is not a vote for the underlining bill. It is only a “vote to move forward.” She said it is clear that doing nothing is no longer an option. Landrieu plans to “stay focused like a laser” on bringing down cost for small businesses. Landrieu is pro excise tax on employer provided health insurance.

12:35 – Cantwell makes a strong case for her basic health plan and says she hopes to work to expand it. It is not a public option but it is basically how the health exchange should have been designed to begin with. The state creates the design of a good health insurance plan (co-pays, benefits, deductibles, etc). Insurance companies bid to offer this insurance plan to all the people in the basic health plan program. The state approves several of the lowest bids and individuals can choose from any of these approved insurance providers. Read more about the “basic health plans” here.

--THE CONSERVATIVE VIEWPOINT: Be sure to check in with Ed Morrissey who has “an open thread” (which reminds me I need to pick up my torn pants at the tailor’s) on the debate. Here is a small taste of what is up there as this is written:

Update (AP): The big question mark, obviously, is Blanche Lincoln, but it’ll be worth watching Nelson’s, Lieberman’s, Bayh’s, and Landrieu’s floor speeches too to see what demands they’re willing to issue publicly for their support going forward. As for tonight’s vote, it’s sort of a free kick for conservatives. Granted, 97 percent of Senate bills that pass this hurdle end up being enacted (so keep calling!), but most bills aren’t remotely as politically fraught as this one. Everyone expects Lincoln to cave and give Reid the 60 he needs — read Jay Cost’s excellent easy peasy three-point analysis for why it’s easy for Blue Dogs to say yes this time — but if she’s sweating now, she’ll be melting down before the final winner-take-all cloture vote a few weeks from now. Notes Cost, “The fact that these Democratic moderates are actually spending time ‘pondering’ whether to vote against starting debate is a sign that they are very skittish about this bill.”

Long story short, tonight is low risk and potentially huge reward. If Lincoln bugs out and the vote fails, it’ll be a nuclear humiliation for the Democrats and will have a lot of people suddenly believing that ObamaCare is un-passable.

Update (AP): Stressing that her yes vote today in no way guarantees a yes on cloture next time, Landrieu says she’s ready to proceed. All eyes on Lincoln now. The Louisiana purchase worked.

–New York Times: A Holdout Will Support Democrats’ Health Bill
–The Huffington Post plans to offer updates by Twitter. Check HERE to see when and if they are posted.
–Crooks and Liars has an open thread.
–The AP reports that now that Mary Landrieu is in and all 40 Republicans will vote against allowing the bill to go to debate and amendments, the sole holdout is…Nebraska’s Blanche Lincoln.
--Nate Silver:

Needless to say, it would have been very, very bad news for the Democrats if the motion to proceed to debate on their health care plan had failed tonight. But I’m not sure how newsworthy this really is. The potential hold-outs, like Lincoln and Ben Nelson, are going to have much greater leverage later on, when the bill nears its second major procedural hurdle: the cloture motion to proceed to the final vote.

And there’s some bad news for Democrats too: Lincoln has joined Senators Ben Nelson and Joe Lieberman in making a fairly explicit threat to filibuster a bill that contains a public option. Mary Landrieu, on the other hand, sounds a little bit more open to compromise. But this impromptu Gang of 3 — Lincoln, Nelson, Lieberman — could be a tough one for progressives to penetrate.

--Scared Monkeys:

Harry Reid obviously paid off the last two remaining Senators, as AP calls them, centrist Sens. Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana. Make no mistake about it America, that means you Arkansas and Louisiana, these two are not centrists. No centrist would ever have allowed debate to go forward on this 2074 page piece of trash bill. We all now that Landrieu was paid off with the $100 million provision on page 432 of Reid’s bill. Remember when Obama said he was going to change the way Washington, DC does things and usher in a new era of hope and change to the political process Inside the Beltway? Guess that can go down as one more lie as the quit pro quo payoff to Mary Landrieu for her vote can attest to that.

Landrieu and Lincoln, please do not lie to your constituents or the American people. Your cloture vote all but ensured passage of this healthcare bill that will subjugate Americans to a government controlled health care system.

–Daily Kos’ McJoan:

Of course, Lieberman could pull a Lieberman, and change his mind on this one just for the hell of it (and because he hasn’t been in the headlines very often lately), but for now there’s no drama left in today’s vote.

Now the real fight for a real public option. In agreeing today to continue debate on this bill, Lincoln vowed essentially to join a Republican filibuster.

For years, our medical system focused on the individual. The thinking was, even if only one life was saved, everyone should get tested. But the new studies show not everyone needs screening. In fact, too much screening can do more harm than good.

Dr. Louise Russell studies preventive care at Rutgers University. She says patients have to change their mind sets. Think about the odds of finding lethal cancer… She says patients need to trust the odds and not get screened if they’re not at increased risk — if they don’t, say, have a family member with cancer.

Doctor Otis Brawley is the chief medical officer of the American Cancer Society. He disagrees with the mammogram recommendations. He says even if one life in a thousand is saved, it’s worth it… A lot of patients feel the same way. They don’t care about the big picture.

Doctor Robert Aronowitz teaches the history and sociology of science at the University of Pennsylvania. He says it’s hard to change that way of thinking. But people can put themselves in danger. Unnecessary cancer treatment can cause anxiety and even death… Aronowitz says that applies to all kinds of preventive treatment — from screenings to drugs that are supposed to prevent disease.

There is reason for optimism.

Today the Senate is expected to hold a key health care reform vote. And if President Barack Obama has a bundle of political clout riding on this vote, so does Majority Leader Harry Reid.

Reid, in an increasingly tough (some pundits suggest seemingly fruitless) battle for re-election who was never a darling of the Democratic party’s liberal wing, could be in a weakened position unless when the votes are counted it turns out that he had gathered the needed 60 votes on a cloture vote. Eyes will be on him and Democratic centrists and — as always — on Connecticut Sen. Joe Lieberman, an independent who caucuses with the Demmies. But the question is going to be: did Reid do his homework or will the day end with him and Obama looking further weakened? One key Republican sounds as if he is betting that Reid has lined up the votes:

Senate Majority Leader Harry Reid (D-Nev.) will get exactly the 60 votes he needs to pass healthcare reform legislation through its first test [today], Sen. David Vitter (R-La.) said Friday.

Reid on Thursday scheduled a cloture vote on a motion to proceed yesterday. The vote is the first crucial test the healthcare bill will face in the Senate.

“My guess, that’s all it is, is that it would be exactly 60 to exactly 40 but we’ll see,” Vitter said on MSNBC this morning. “I think he probably does [have enough votes] for this first pivotal vote.”

Reid has refused to predict whether or not he will get the necessary votes to pass the measure. “We’ll find out when the votes are taken,” he said when asked on Thursday about his chances of success.

Vitter is a staunch opponent of the bill.

But the Hill also notes this:

Two others Democrats potentially could be absent from the vote on Saturday night. Senate Finance Committee chairman Max Baucus is currently in Montana tending to his ailing mother. Sen. Robert Byrd (W.Va.) has experienced health problems all year.

The Politico also thinks that — from Reid and Obama’s point of view — it is looking good:

Two Saturdays ago, Pelosi passed health reform on a squeaker of a House vote. Today, Reid can’t spare a single Democrat as the Senate decides whether to start debate. If not, President Barack Obama’s reform hopes suffer immeasurable harm.

That said, things were looking good at daybreak, as Reid can be reasonably confident of 59 votes, with Sen. Ben Nelson (D-Neb.) a yes vote and Sen. Mary Landrieu (D-La.) leaning yes. The holdout: Sen. Blanche Lincoln (D-Ark.), who has been a fan of reform generally but faces a tough 2010 re-election fight.

In theory, Reid’s job should actually be easier than Pelosi’s. The House voted on final passage. Reid is just asking the Senate to begin debate. But the vote is more than that – it’s a test lab for the ideas, arguments and battle tactics that both sides will carry into an epic showdown over health reform next month.

The debate runs all day with the vote scheduled for 8 p.m.

So is it a slam dunk? Hardly:

Democratic leaders are optimistic of success, but they need every Democrat and both independents to vote “yes,” and two moderates remained uncommitted ahead of the roll call, which is expected around 8 p.m. EST. The vote will determine whether debate can go forward on Majority Leader Harry Reid’s 2,074-page bill to dramatically remake the U.S. health care system over the next decade.

…..The two Democratic holdouts are Sens. Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana. A third centrist, Ben Nelson of Nebraska, announced Friday that he’d be supporting his party on the test vote, while cautioning that it didn’t mean he’d be with them on the final vote.

“It is not for or against the new Senate health care bill,” Nelson said. “It is only to begin debate and an opportunity to make improvements. If you don’t like a bill, why block your own opportunity to amend it?”

The Republicans are expected to vote as a solid block. Senate Minority Leader Mitch McConnell calls it a “monstrosity of a bill.” Reid insists everything is full paid for.

Ezra Klein sees an irony in this debate:

Little will illustrate the absurdity of the filibuster as neatly as tomorrow’s vote. This is not the vote to pass the bill. It’s the vote to begin considering the bill. Changing the bill. Amending the bill. Recall that the purpose of the filibuster is to protect debate and ensure that members can make their opinions heard and ensure they have an opportunity to add their ideas to the legislation. Tomorrow, however, 40 Republicans are expected to use the filibuster to close off debate and ensure that no more opinions are heard nor changes considered. The right to unlimited debate has become a tool for cutting it off.

ABC NEWS points to these five questions that will determine the ultimate fate of this bill.

The Washington Post’s editorial page editor Fred Hiatt argues that passing health care reform is not only vital to health care but to the overall success of the Obama administration — including how it is perceived by other countries abroad. Some excerpts:

Is American democracy in paralysis? That question emerged at a conference of big thinkers and experts in various fields organized last week by Foreign Policy magazine, our sister publication.

To an extent, the question reflects an America-in-decline-ism that becomes fashionable from time to time, especially when the U.S. economy is dragging. The United States always has turned out to be more resilient than the pessimists expect, while the supposed advantages of less democratic rivals (the Soviet Union in the 1960s, Japan in the 1980s) have been trumped by the rigidities of one-party rule. This decade’s juggernaut — communist China — also faces challenges that may become more evident with time.

Yet as health-care reform sputters and lurches toward an uncertain finish line, the question is understandable. Foreigners see a Democratic Party that supposedly is alarmed by climate change, that decisively captured the White House and both houses of Congress a year ago — and yet that will send an administration to a crucial conference in Copenhagen next month with little but hopes and promises. Now there is talk that cap-and-trade legislation will wait until not just next year but the next Congress.

He rattles off other problem areas: Obama has been unable to fill most judicial posts and has not even submitted names for many of them; labor law reform is on hold; immigration reform is in limbo; and Afghanistan policy awaits an official…policy:

Meanwhile, American power seems powerless to bend events in Iran, North Korea, the Middle East, Sudan, Congo or even tiny Honduras to our south.

Underlying all is the nation’s growing debt — to other countries and to future generations. The retirement system (Social Security) and health insurance for the elderly (Medicare) are headed for bankruptcy, with state and local pension funds and the federal pension insurance fund not far behind. Pretty much everyone understands that the government must spend less and tax more, but the system seems incapable of taking a first step in either direction.

And didn’t candidate Obama promise to fix the college football Bowl Championship Series?

He goes through a bunch of institutional, political and 21st century media reasons that might partially explain all of the above, then argues:

Whichever explanation appeals to you — and no doubt they all contain some truth — the perception of paralysis increases the urgency of passing health-care reform. Failure would damage the Obama presidency, and it would also deepen the fear, here and abroad, that America is stuck.

Paradoxically, though, it also increases the urgency of doing health-care reform right. If Congress and the administration manage only to extend expensive new benefits, without improving the health-care system or controlling rising costs, it will be an achievement — but not one that will long reassure anyone concerned about the U.S. ability to get things done.

Which means a lot of people are watching to see if Harry Reid did his homework. If he hasn’t then he and Obama could face political detention..

The cartoon by RJ Matson, Roll Call, is copyrighted and licensed to appear on TMV. Unauthorized reproduction strictly prohibited. All rights reseserved,

Ed is urging his readers to melt the phones and get their Senators to vote against this. I’m sorry to say, this is entirely wrong headed thinking. (Though I did call both of my Senators today to remind them of my opposition to the bill itself in its current form.)

Whether they be Republicans or moderate Democrats, I would urge a full throated yes vote tomorrow. To vote no on this action is to say, “No. We are, as you have suggested, nothing more than the Party of No. We have no ideas to present. We have no alternate suggestions. We just don’t want to talk about it.”

You have plenty of ideas and many valid objections to the bill as presented, and an open debate on the floor of the upper chamber is exactly where this should play out in full view of the voters, the press and the public. You should be pointing out that the proposed methods for paying for this plan are mostly fiction. You should be pointing out the across the board taxes which will be imposed. You should be pointing out the highly dubious constitutional basis of any mandate by the federal government forcing citizens to purchase a product from a private provider. You should be pointing out the damaging effect on a major private industry (along with all the jobs that entails) of any so called “public option.”

These are all valid, solid selling points for your argument. You need to make these points like adults and then move toward starting over with a new, leaner bill that accomplishes what so many Americans want in health insurance reform without all of the damaging side effects and costs. But if you vote no on even opening debate, none of this happens. You are simply the party of no. There will be time over the course of this debate to continue digging into the bill’s particulars and bringing these items to the attention of the public. If you vote no, you should be ashamed of yourselves and just get out of the way.

Her story represents the stories that I dread will become absolutely the norm and her story represents the stories that other women who are unhappy with the new guideline recommendations about breast cancer screening dread.  That, under the new recommendations, a 30 year old woman will either not perform self-breast examinations which otherwise would give her something with which she could go to a doctor and ask for more screening, or that if she does ignore the new guidelines (which argue against self-examination: “[the task force] discouraged doctors from teaching breast self-examination” – yes, you read that right) and go ahead and do self exams, that when they then go to their doctors and ask for the screening, the doctor will require some ridiculous threshold before he or she will approve or recommend the screening. And that even then, the woman’s insurance won’t cover it since the guidelines say that it’s imperfect and not recommended for women under 50.

That passivity will be approved and routine.  That women will not trust themselves to know their body, that they will not bother because the system does not want to bother – because the system is so concerned about the harm of anxiety and over-biopsying.

I’ve read the guidelines, the reports and the very carefully worded explanations written by people I trust and admire.

But I am trusting my instinct on this and I am telling you – disapproving of self breast-examination and suggesting that women will have to walk in with such a threshold of concern for what they’re feeling about their body absolutely makes me irate at the thought of what a set back this is for women – for humans, for patients – to be in control of their health.

And the utter disregard for the human toll these illnesses take on everyone around the one diagnosed with the breast cancer.

Anxiety sucks. I’ve been there done that for years with shadows on films and MRIs that required additional testing.  And while I have a “family history” we don’t have the gene – and a very small percentage of women do have the gene mutations currently known to be responsible for a very small percentage of breast cancer.  My Gale score isn’t high enough to get me into most clinical trials.

From the New York Times:

While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.

Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms.

Screening in the 40-49 decade results in a 15% reduction in fatalities? I’ll take that over reducing the harm of anxiety and overbiopsying anyday.

This is how health-care reform controls costs. It is, at its base, a grand bargain: The coverage expansion gets liberals to agree to, and even advocate for, cost controls they would never otherwise consider. A 6 percent growth target? A super-MedPAC — now called the Independent Medicare Advisory Board — that reforms Medicare to save money and whose recommendations are fast-tracked and protected from the filibuster? Hundreds of pages of changes to payment rates and experiments in value-based purchasing and coordinated care efforts? This stuff is very, very real, and it goes into effect very quickly. You may think it’s impossible for Congress to cut costs in Medicare and the government will just go bankrupt, but even you’d have to admit that this is what it would look like if the government was cutting costs in Medicare.

If this piece of the bill was passed on its own, it would be the most important cost control bill ever considered by the United States Congress. But you could never have passed it on its own. You needed the coverage to make the grand bargain work. Republicans like to call this bill a trillion-dollar experiment to expand the health-care system, and in some ways, it is. But it’s also a multitrillion-dollar experiment to cut costs in the health-care system, and it deserves credit for that, and support from fiscal conservatives. It’s easy to talk about cutting costs, but this is the chance for people to actually do it.

SOME NEW NON-DISCRIMINATION PROVISIONS

Some of the least controversial measures in both bills concern new limitations on discrimination by private health insurers towards those individuals with “pre-existing” conditions. Both bills require insurance companies to cover everyone no matter how sick, and in some cases they also prohibit discrimination based upon age, race and sex. The whole brouhaha over abortion coverage versus Viagra/Cialis coverage exposes some political and social inconsistencies. If readers determine that the proposals permit some other forms of discrimination, I would appreciate being informed of those situations as well.

Most annual and lifetime dollar limits would also be prohibited. But I do not know of all the other consumer protections and anti-discrimination provisions in both bills, many of them long overdue and quite laudable. They have been ignored by much of the senselessly disingenuous, false, vitriolic, angry, partisan and ideological debates we have conducted for most of this year. However, all provisions with respect to setting premiums will determine many important matters, particularly the public cost of providing subsidies to those who cannot afford health insurance.

The private health insurance industry has not vociferously opposed healthcare reform as they did in the past. Even with these new requirements of non-discrimination, every U.S. citizen and legal resident will be required by law to purchase private health insurance through their employers or directly with public subsidies based upon income. This mandatory requirement is fully constitutional but wholly unrelated to the states requiring drivers to carry automobile liability insurance. This will provide tens of millions of new policyholders to insurance companies paying whatever new premiums they are still essentially free to set.

Both bills will provide that public subsidies will pay for part or all of private health insurance premiums for individuals and families that cannot afford the rates that the private companies will determine themselves. Without a national standard for minimal health insurance coverage at a specified monthly cost, this might well become a financial boon for insurance companies at the public’s expense.

AUTO INSURANCE DISCRIMINATION MAY COME TO HEALTH INSURANCE

First, let’s turn to automobile insurance and how that is legally priced across the country with minor state deviations. The premiums for individual drivers are not just based upon a person’s driving history, but also upon several other factors. Most private auto insurance companies factor in a person’s credit history, their residential zip code, and sometimes income levels and unlucky involvement in accidents caused by other drivers. There are discounts for those who own their own homes (regardless of whether their mortgages are upside down or not) and renters do not receive such preferences.

Effectively automobile insurance rates are inversely related to a person’s income. The poor and unlucky among us generally pay far more for the same coverage as do wealthier and luckier individuals. To make such auto coverage affordable, the poor and unlucky opt for far less comprehensive coverage and much higher deductibles – all unaffordable in real life situations when an accident does occur.

While there are few published studies clearly linking how a person who has had a foreclosure is also a greater risk for causing an auto accident, insurance companies constantly discriminate on that basis and charge more for the same policy as a person’s credit rating decreases. Zip codes sometimes reflect overall income levels and crime statistics, so those living in poorer areas also pay more for the same auto policy coverage than those residing in more favorably-viewed zip codes, even though the factual linkage to poor drivers or auto theft is generally missing.

If a person is involved in any auto accident, even if he or she is completely not at fault, insurance companies in many states assess an “unlucky” surcharge. That connection is about as relevant as claiming a person who likes to eat bananas will more likely slip on a peal and injure himself than one who prefers apples. We may really need a national class-action lawsuit by consumers against auto insurance companies to rectify these massive coverage distortions.

POTENTIAL OVERCHARGING FOR POLICIES COVERED BY PUBLIC SUBSIDIES

Will future private health insurance premiums reflect discrimination against covered individuals based upon their credit ratings, zip codes and other unlucky factors? These are not clearly prohibited in current health reform legislation. If they are not prohibited, one can rest assured that insurance companies will use these differences to price policies accordingly. Since many poor people cannot afford health insurance already on the basis of current premiums, after healthcare reform is enacted, will those premiums be raised on such factors and will the public subsidies also be unnecessarily increased to cover such insurance discrimination?

Let’s compare two families, both with 2 working adults and 2 grade-school age children. The individuals are all about the same ages and both have 2 comparable cars, one is paid and the other is still being financed.

Family A has great credit as there have never been any job losses. They live in a wealthy zip code, and they have no history of any DUI convictions or at-fault auto accidents. There is one pre-existing condition in their background, a child with a congenital condition requiring more annual care than most other children but no frequent hospitalizations – only expensive treatments and medications. All the members of Family A are considered obese but that is irrelevant since they are covered under a Cadillac health policy sponsored by the most generous of their two employers. This type of coverage is highly favored by our tax code, essentially providing Family A with an indirect public subsidy for their relative good fortune in life so far.

Family B has lousy credit due to one spouse’s job loss last year and non-employment to date, resulting in the foreclosure of their home mortgage, and many other unpaid bills. A few months ago, while taking one child to see the doctor, they were hit by an uninsured driver and everyone required medical treatment that was paid by their auto insurance policy’s uninsured motorist coverage. A few months earlier, a neighbor’s dog bit the other child and fortunately the neighbor’s homeowner’s policy covered the medical and hospital bills. Family B has no pre-existing conditions and is in much better overall health than Family A. They have recently moved to a rental unit in a poorer zip code as a result of the foreclosure. The remaining spouse who continues to work does not get any healthcare coverage through employment. They also have not had any DUI convictions or at-fault auto accidents during the past five years.

Under a future healthcare reform, Family B shops around for health insurance but the cheapest they can find costs more than the Cadillac plan for Family A, even with far less coverage and higher deductibles and co-pays. The insurance companies all rated them higher risks than Family A because of their credit history, current residence, low household income, and those two unlucky occurrences. Family B’s auto and home-owners policies also increased their premiums as a result of their unlucky accidents, bad credit and new zip code residence. Fortunately, their needlessly high health insurance premiums for Family B will be fully covered by subsidies from the federal government.

The public financial subsidy for Family B would have been much lower, and the overall cost to the Federal budget for many more Family B’s would consequently be much lower, if health insurance companies were prohibited from discriminating against these poorer families across the country on the bases described above.

I strongly favor the public helping those who cannot afford health insurance. Every U.S. citizen and legal resident should have adequate health coverage – and illegal aliens and foreigners should be able to buy into coverage without subsidies. However, I am against insurance companies raping public coffers because they are not sufficiently regulated to prevent them from engaging in such surreptitious alternative forms of discrimination.

Whereas the annual out-of-pocket healthcare costs between Family A and Family B might be the same, or Family B might even be lower, the premiums collected may be artificially higher for Family B solely to increase insurance company profits – particularly since the public subsidies are based upon the ability to pay and not on the reasonableness of the underlying premiums.

FINAL THOUGHTS

It’s bad enough that our current national healthcare system is principally a bloated disease mismanagement operation that essentially caters to wealthy hypochondriacs. We really need an integrated healthcare system that fosters healthier lifestyles for all people and eliminates many unnecessary treatments, tests, paperwork and fraudulent excessive billings to our public Medicare system and private insurance companies. More than likely, we will have to reform our reforms a few more times in the future before we get our nation’s out-of-control healthcare system under some semblance of rationality or sanity.

I hope my concerns are unfounded but most of what I have read does not discuss or dispute these warnings on premium calculations. Left unchecked, they could easily gut all alleged healthcare savings under any final reform bill. Without some strict controls over how health insurance companies set premiums, the public will shell out far more money in subsidies to cover excessive private insurance premiums. This will further limit our society’s future flexibility to spend public money where we deem appropriate. Enriching private health insurance companies at public expense is probably not the wisest form of national economic or job stimulus.

Posted 11/19/09 by Marc Pascal who happily rants in Phoenix, AZ. Please note that I will discuss new job stimulus proposals in one of my future posts as I promised at the end of my last TMV posting.

On my trips abroad, I have rarely found an Indian restaurant that would satisfy my native taste buds. In the West, there has been a “curry” revolution and its impact has been the most in Britain. However, there is a growing realization that Indian cooking is not just meant to set your tongue on fire or titillate the palate, it actually mixes common sense with the ancient science of Ayurveda, gaining popularity as alternative medicine.

“Ever since the first British curry house opened its doors (the country now has an estimated 9,000 Indian restaurants) Indian food has become synonymous, in many minds, with the macho pursuit of tongue-bothering spice and fattening takeaway blowouts washed down with gallons of beer,” reports The Independent.

“Of course, there is another side to Indian food, and in recent years a small but determined group of cooks have sought to break through the stereotype.

“Monisha Bharadwaj is one of Britain’s top Indian cooks and an award-winning writer. Her latest book, Healthy Indian in Minutes, is mouth-watering collection of dishes… ‘The majority of British takeaways do not offer the best example of good Indian cooking,’ Bharadwaj says. ‘But you have to think about what they are. When they first opened, curry houses were catering to people who were used to eating heavy food with all its gravy, cream and stodginess. Takeaways offered something similar but with added spice.’

“But Bharadwaj says there is a growing demand for something different. I meet her in Hounslow, where she moved from her native Mumbai 22 years ago. As well as writing she now runs a cookery school in her kitchen. ‘More and more people want to cook home-cooked Indian food that’s fresh and healthy,’ she says. ‘They know that it is something different but they don’t know what it is because you can’t get it in restaurants.’

“Bharadwaj’s courses are proving a hit with everyone from housewives and husbands short of inspiration to top chefs looking to expand their repertoires.

“Bharadwaj is particular in the kitchen but that’s just how she learned to cook. Indian home cooking is governed by rules, some of them common sense but others more complex and founded on the ancient Indian science of Ayurveda. First recorded more than 5,000 years ago, the world’s oldest known system of medicine casts the kitchen as an apothecary in which herbs have healing powers.” More here…

Amazon website has this to say about Bharadwaj’s book: “People often see Indian food as greasy, fatty and labour-intensive, but everyday Indian home cooking is neither unhealthy nor difficult to prepare. Monisha Bharadwaj will prove that it is in fact a highly nutritious, gentle cuisine that has always included natural and whole foods such as whole wheat flour, raw cane sugar, lots of vegetables, beans, lentils and any number of healing spices.

“Indian eating is based on the ancient science of Ayurveda, a system of holistic living that is the oldest form of medicine known to man. Broken down into straightforward chapters – curries, dry dishes, light one-pot meals, salads and raitas, chutneys and relishes, drinks and sweets – ‘Healthy Indian in Minutes’ will give readers the tips and strategies they need to cook healthy home-style food in a matter of minutes.” More here…

Critics of the health care reform plan often refer to it derisively as “ObamaCare.” On the policy merits, this is highly questionable: the White House has taken a hands-off approach toward the legislation that recently passed in the House and the Senate version that Harry Reid unveiled on Wednesday. But when it comes to politics, “ObamaCare” could hardly be more apt: lawmakers’ support for or opposition to reform generally has less to do with the views of their constituents and more to do with the issue of presidential popularity.

I think I’ll watch Glee tonight and wait for Fox or the right wing blogs to review the plan. Then I’ll assume that the actual facts are the opposite.

From what I have heard so far (via progressive lawmakers like Tom Harkin and Chuck Schumer on Olbermann and Maddow earlier tonight) is that it’s really strong. It has a public option (opt-out, but that’s a lot better than opt-in or a trigger), and the price tag is $849 billion. Here’s more initial coverage from CNN:

Senate Majority Leader Harry Reid unveiled a sweeping health care bill Wednesday that would expand health insurance coverage to 30 million more Americans at an estimated cost of $849 billion over 10 years.Reid and other Senate Democrats cited an analysis by the nonpartisan Congressional Budget Office for the coverage and cost figures.

In addition, they said at a news conference, the budget office estimated that the proposal would reduce the federal deficit by $127 billion over the next 10 years and by more than $600 billion in the following decade.

The CBO figures were preliminary, the Senate Democratic leadership said in a media briefing. The CBO was expected to provide its final analysis later Wednesday or on Thursday, according to the briefing.

And the Stupak Amendment is gone! Apparently, Harry Reid has kept some restrictive language in the bill to keep anti-choice Democrats aboard, but it’s more along the lines of the language that was already in the House and Senate committee versions:

The original committee versions of the House and Senate bills already included limits on federal funding for abortion services but they did not go far enough to satisfy anti-abortion-rights Democrats like Stupak and Nelson.

Finding a middle ground will be a challenge, said Nelson. “The problem is, any kind of compromise leaves it somewhat short to one or both parties,” he said.An existing law, known as the Hyde amendment, already prohibits federal money from paying for abortions except in cases or rape or incest or when the woman’s life is endangered. Anti-abortion-rights lawmakers, however, argued that the House bill and the measures approved by two Senate committees would have circumvented that law.

Sen. John Kerry (D-Mass.), who supports abortion rights, said Reid’s new provisions would preserve the Hyde amendment while enabling people to buy insurance plans with abortion coverage on the exchange.

“We’re basically going to keep current law, which is what we ought to do,” Kerry said after the Democratic caucus meeting.

I will have more coverage and reaction on the bill as it comes in.

Last year, the voters gave him the largest popular vote margin won by a presidential candidate in 20 years. They gave Democrats their largest Senate majority since 1976 and their largest House majority since 1992.

Obama didn’t just offer bromides about hope and change. He made quite specific pledges. You’d think that the newly empowered Democrats would want to deliver quickly.

But what do real Americans see? On health care, they read about this or that Democratic senator prepared to bring action to a screeching halt out of displeasure with some aspect of the proposal. They first hear that a bill will pass by Thanksgiving, and then learn it might not get a final vote until after the New Year.

Is it any wonder that Congress has miserable approval ratings? Is it surprising that independents, who want their government to solve a few problems, are becoming impatient with the current majority?

Democrats in the Senate — the House is not the problem — need to have a long chat with themselves and decide whether they want to engage in an act of collective suicide.

But it’s also time to start paying attention to how Republicans, with Machiavellian brilliance, have hit upon what might be called the Beltway-at-Rush-Hour Strategy, aimed at snarling legislative traffic to a standstill so Democrats have no hope of reaching the next exit.

We know what happens when drivers just sit there when they’re supposed to be moving. They get grumpy, irascible and start turning on each other, which is exactly what Democrats are doing now.

Republicans know one other thing: Practically nobody is noticing their delay-to-kill strategy. Who wants to discuss legislative procedure when there’s so much fun and profit in psychoanalyzing Sarah Palin?

Yet there was a small break in the Curtain of Obstruction this week when Republican senators unashamedly ate every word they had spoken when George W. Bush was in power about the horrors of filibustering nominees for federal judgeships.

On Tuesday, a majority of Republicans tried to block a vote on the appointment of David F. Hamilton, a rather moderate jurist, to a federal appeals court.

Sen. Jeff Sessions of Alabama explained the GOP’s about-face by saying: “I think the rules have changed.”

That was actually a helpful comment, because the Republicans have changed the rules on Senate action up and down the line. Hamilton’s case is just the one instance that finally got a little play.

Thankfully, this filibuster failed because some Republicans were embarrassed by it. But Republican delaying tactics have made Obama far too wary about judicial nominations for fear of controversy. He is well behind his predecessor in filling vacancies, a shameful capitulation to obstruction. There’s also the fact that the nomination of Christopher Schroeder as head of the Justice Department’s Office of Legal Policy, which helps to vet judges, is snarled — guess where? — in the Senate.

Republicans are using the filibuster to stall action even on bills that most of them support. Remember: The rule is to keep Democrats from ever reaching the exit.

As of last Monday, the Senate majority had filed 58 cloture motions requiring 32 recorded votes. One of the more outrageous cases involved an extension in unemployment benefits, a no-brainer in light of the dismal economy. The bill ultimately cleared the Senate earlier this month by 98-0 — yes, that is a zero.

The vote came only after the Republicans launched three filibusters against the bill and also tried to lard it with unrelated amendments, delaying passage by nearly a month. And you wonder why it’s so hard to pass health care?

Defenders of the Senate always say the Founders envisioned it as a deliberative body that would cool the passions of the House. But Sessions unintentionally blew the whistle on how what’s happening now has nothing to do with the Founders’ design.

The rules have changed. The extra-constitutional filibuster is being used by the minority, with extraordinary success, to make the majority look foolish, ineffectual and incompetent. By using Republican obstructionism as a vehicle for forcing through their own narrow agendas, supposedly moderate Democratic senators will only make themselves complicit in this humiliation.

This column is copyrighted and licensed to appear on TMV in full. (c) 2009, Washington Post Writers Group

John Darkow, Columbia Daily Tribune, Missouri

This cartoon is copyrighted and licensed to run on TMV. Unauthorized reproduction prohibited. All rights reserved.

More, the effect of the amendment on the private market over time is likely to extend to the “rider” coverage that amendment supporters point to as an alternative for women shut out of the exchanges, and even to employer-provided insurance coverage:

… the study finds that the supposed fallback option for impacted women–a “rider” policy that provides supplemental coverage for abortions only–may not even be allowed under the terms of the law. “In our view, the terms and impact of the Amendment will work to defeat the development of a supplemental coverage market for medically indicated abortions. In any supplemental coverage arrangement, it is essential that the supplemental coverage be administered in conjunction with basic coverage. This intertwined administration approach is barred under Stupak/Pitts because of the prohibition against financial comingling.”

The authors also note that though the direct impact of the Stupak amendment on women who receive insurance from their employers will be initially minimal, the provision’s tentacles could nonetheless reach into the employer-provided insurance market, too, “further driv[ing] the industry to shift away from current abortion coverage norms and toward product designs that meet exchange and Hyde Amendment requirements.”

A “dog warning card” arrived with my mail today. Thanks to a New Jersey branch of the National Association of Letter Carriers, you can see the form online. The form provides invaluable advice, such as “Do not deliver mail if you feel endangered by an animal.”

For a better understanding of the threats faced by America’s letter carriers, I recommend the following passage from The Postal Employee’s Guide to Safety (August 2006 edition), Section IX D:

Animals and Insects
1. General Rules
You are not required to deliver mail when an animal threatens you. Use extra care in making deliveries when dogs or other animals are loose on your route…

Neither antagonize nor attempt to pet dogs. If a dog rushes toward you or takes you by surprise, do not run. Retreat very slowly, facing the dog. Keep your mail satchel between you and the dog as a first line of defense. Be careful not to stumble over objects as
you retreat.

Use dog repellent spray only if you are attacked. Spray it directly at the dog’s eyes, nose, and mouth. Do not use dog repellent indiscriminately or when there is danger of spraying children or adults.

When delivering mail through a door slot, keep your fingers out of the slot; an animal may be on the other side.

Yikes.

Cross-posted at Conventional Folly